P. Bayle

Aggravation d'un lupus érythémateux subaigu sous infliximab

Resume Introduction L’infliximab (Remicade®) est un medicament, ayant une action anti-TNF alpha, indique dans le traitement de fond des rhumatismes inflammatoires, notamment de la polyarthrite rhumatoide. Observation Nous rapportons le cas d’une femme de 56 ans ayant eu une aggravation d’un lupus erythemateux subaigu, SSA positif, lors de la mise en route d’un traitement de fond par infliximab pour une polyarthrite rhumatoide. Discussion Une revue de la litterature a permis de colliger 30 cas de lupus induits et de lister les modifications auto-immunes induites par les anti-TNF alpha. Ce premier cas de lupus erythemateux subaigu, preexistant a l’introduction d’un tel traitement et aggrave par celui-ci, souligne le risque de developper une poussee severe d’une maladie auto-immune lors d’un traitement par anti-TNF alpha. Il fait discuter la contre-indication relative des anti-TNF alpha chez les malades atteints de lupus erythemateux.

Hidradenitis suppurativa is acne inversa

Hidradenitis suppurativa is acne inversa Dear Sir, We have examined the analysis proposed by Klaus Sellheyer and Dieter Krahl. 1 This work is of particular interest to us because hidradenitis suppurativa is a fairly common and very disabling affection for which treatments are still mostly ineffective. Etiological circumstances remain unknown even though responsibility for the pathological process appears to be situated in the excretory canal of the apocrine gland, with no participation of sebaceous nor eccrine glands and no keratinization anomaly. The apocrine gland appears to be unaltered at the onset as demonstrated by the authors of this article. However, why mention acne since the sebaceous gland is not concerned any more than the eccrine gland; furthermore, if it is not acne, why use the term inverse? To speak of inverse acne solely on the argument of inversed topography could lead to the belief that there are common points between hidradenitis suppurativa and acne, whereas everything seems to oppose them: • Heredity: the affection is transmitted on a dominant mode with variable expressivity; moreover, often associated with Dowling Degos disease, which follows the same dominant hereditary transmission. • Trigger factor responsible for the expression of this affection is tabagism, which is found in 75–85% of cases. Passive tabagism has not been mentioned, but in a family where several members appear to be or might be carriers of the defect, non-affected subjects were nonsmokers. • Onset circumstances: puberty, when the apocrine glands appear; prepubescent observations are so exceptional that they are published and no association with hyperandrogenism is found. • Clinical aspects: lesions are often preceded by acute hidradenitis and share no characteristics with acne – papules are exceptional and comedos are not a characteristic element of hidradenitis suppurativa; fibrous retractions of the armpit or inguinal areas with unknown cause, the constitution of fistula, are never observed in acne. Lastly, acne tends to improve even spontaneously after puberty. • Complications: organization of fistula and retractile fibrosis, which justify surgery; infectious complications with superficial superinfection; presence of germs at the end of the fistula resistant to antibiotics is frequent and justifies recourse to antibiotherapy over several months at a sufficient dose; rifampicine and clindamycine. • Treatments: hidradenitis suppurativa does not respond to any of the treatments for acne – cyclines, retinoids, cyproterone acetate; certain studies to be confirmed show that finasteride might be effective (5 α reductase type II inhibitor). For all these reasons, it does not seem reasonable to us to imply that hidradenitis suppurativa, which according to the most recent studies can be classified among the autoinflammatory diseases, might share certain traits with acne. Thus the term ‘Acne Inversa’ does not appear to be acceptable and could lead to errors.

Urticarial manifestations due to Raphanus niger

Discussion The reaction to Bactroban® ointment previously reported was due to allergy to polyethylene glycol in the ointment base. In contrast, this patient was allergic to calcium mupirocin free base itself. It is most likely that his sensitivity to Bactroban® occurred through its application to his leg ulcers, a situation notorious for the induction of allergic contact hypersensitivities. Increased systemic absorption of mupirocin may thus have occurred, as well as of its principle metabolite monic acid, detected in the urine in those with skin conditions and amounting to 0.4--0.6% of the applied dose (6). It is necessary to consider the possibility of sensitivity to mupirocin, especially when applied to broken skin over protracted periods. Contact Dermatitis 1995: 32: 241

In reference to "Itching stretch marks and bullous lesions in a pregnant woman" by Uwe Wollina, Karl-Werner Degen, Helga Konrad, and Jacqueline Schönlebe.

References 1 Mitarnun W, Suwiwat S, Pradutkanchana J, et al. Epstein– Barr virus-associated peripheral T-cell and NK-cell proliferative disease/ lymphoma: clinicopathologic, serologic, and molecular analysis. Am J Hematol 2002; 70: 31–38. 2 Liebowitz D. Epstein–Barr virus and a cellular signaling pathway in lymphomas from immunosuppressed patients. N Engl J Med 1998; 338: 1413–1421. 3 Mori A, Takao S, Pradutkanchana J, et al. High tumor necrosis factor-alpha levels in the patients with Epstein–Barr virus-associated peripheral T-cell proliferative disease/ lymphoma. Leuk Res 2003; 27: 493–498. 4 van Doorn R, Van Haselen CW, van Voorst Vader PC, et al. Mycosis fungoides: disease evolution and prognosis of 309 Dutch patients. Arch Dermatol 2000; 136: 504–510. 5 Monopoli A, Annessi G, Lombardo GA, et al. Purely follicular mycosis fungoides without mucinosis: report of two cases with review of the literature. J Am Acad Dermatol 2003; 48: 448–452.

Nodules sur sclérodermie en plaque ou morphée

Resume Introduction Les sclerodermies en plaques ou morphees apparaissent habituellement comme des lesions planes ou deprimees. Observations Nous rapportons 3 cas de morphee d’aspect atypique bigarre, alternant des zones pigmentees et depigmentees, avec la presence de nodules ou de bandes sclereuses, survenues chez des hommes adultes. Commentaires La survenue d’elements nodulaires sur des sclerodermies systemiques ou localisees, bien que rare, a ete rapportee dans la litterature des 1884 par Addisson. Ces nodules apparaissent habituellement au cours de l’evolution. Ces sclerodermies sont alors qualifiees de cheloidiennes ou nodulaires. Nous rapportons 3 cas de nodules sur sclerodermies en plaque apparus des l’apparition de la dermatose et ou les sclerodermies avaient un aspect similaire pigmente irregulier inhabituel.