S. Boulinguez

Role of drug exposure in aphthous ulcers: a case–control study

Background Drug‐induced aphthous ulcers have been the subject of several isolated and heterogeneous case reports for the last three decades.

Photosensitivity with Sulfasalazopyridine Hypersensitivity Syndrome

Five weeks after the start of treatment with an association of sulfasalazopyridine and piroxicam, a 30-year-old woman presented with an eczematous eruption in light-exposed areas, hepatomegaly and fever (38°C). Laboratory studies showed leukocytosis, eosinophilia and hepatic cytolysis. Treatment consisted of withdrawing the two drugs and topical steroids. The clinical signs regressed in 6 days. An increase in eosinophilia and hepatic cytolysis was observed until the tenth day, after which the trend reversed. Laboratory parameters were normal on the twentieth day. One month later, photopatch testing was performed. A patch test with sulfanilamide irradiated with UVA was positive. Clinical and laboratory findings were highly suggestive of drug hypersensitivity syndrome. The positive result from the UVA photopatch test with sulfanilamide suggests that sulfasalazopyridine was involved in the occurrence of hypersensitivity syndrome in our patient. We conclude that photodistributed eruptions can be observed in drug hypersensitivity syndrome with photosensitizing drugs.

Chronic Pemphigoid gestationis: Comparative Clinical and Immunopathological Study of 10 Patients

Background: Pemphigoid gestationis (PG) is a rare autoimmune bullous disorder occurring during the last trimester of pregnancy and usually regressive within 3 months after delivery. Prolonged forms of the disease lasting more than 6 months after delivery have been reported as chronic PG. Objective: The aim of the present study was to compare the clinical and immunopathological findings between 4 patients presenting a normal regression of the disease after delivery and 6 patients with a chronic course. Methods: All patients were evaluated and studied by clinical patterns (age, mucosal and cutaneous involvement, obstetrical history, duration of the blistering disease and response to treatment), by direct and indirect immunofluorescence and Western blot. Eight patients were studied by immunoelectron microscopy (IEM) and 3 patients had an indirect IEM. Results: Patients with chronic PG were older, had multigravidity, a history of PG during previous pregnancies, widespread cutaneous eruption and mucosal involvement. Subclass analysis of circulating autoantibodies showed an IgG1 anti-BP180 response in all patients except 1 with disease of 7 years’ duration. Direct IEM was positive in 6/8 patients showing a labeling of the lamina lucida, and indirect IEM using colloidal gold probes confirmed the localization of the target antigens to the proximal part of the anchoring filaments in the lamina lucida. Conclusion: This study suggests that, even in chronic long-lasting PG, IgG1 remains the predominant subtype of IgG. Therefore no biological and predictable marker of chronicity can be ascertained from this series.

Acquired ichthyosis with pravastatin

1 Mashiah J, Brenner S. The acceptable addiction. Rapid response. e-published Feb 2003, Brit Med J, E journal. 2 Galindo PA, Borja J, Mur P, Feo F, Gomez E, Garcia R. Anaphylaxis to paracetamol. Allergol Immunopathol 1998; 26: 199–200. 3 Mahboob A, Haroon T. Drugs causing fixed eruptions: a study of 450 cases. Int J Dermatol 1998; 37: 833–839. 4 Wohl Y, Goldberg I, Sharazi I, Brenner S. A case of paracetamol induced acute generalized exanthematous pustulosis in a pregnant woman localized in the neck region. Skinmed 2004; 3: 47–49. 5 Halevy S, Cohen AD, Grossman N. Clinical implications of in vitro drug-induced interferon gamma release from peripheral blood lymphocytes in cutaneous adverse drug reactions. J Am Acad Dermatol 2005; 52: 254–261.

Botriomycomes révélant une fistule et un foyer infectieux profond : cinq cas

Resume Introduction Le botriomycome, survenant apres un traumatisme minime ou une piqure septique, est une tumeur inflammatoire benigne vasculaire situee habituellement sur la peau ou sur les muqueuses. Nous rapportons cinq observations inhabituelles de botriomycome revelant des orifices de trajets fistuleux vers un materiel etranger infecte (pacemaker, materiel d’arthrodese) ou satellites d’un foyer infectieux profond avec fistule. Methodes Il s’agissait d’un travail retrospectif, ayant inclus cinq hommes, âges en moyenne de 72,2 ans sur une periode de 22 ans (entre 1981 et 2003). Tous les malades avaient une iconographie et un diagnostic clinique de botriomycome, confirme histologiquement, associe a un ecoulement purulent chez quatre malades. Les delais diagnostiques, la notion de traumatisme, la recidive apres exerese, la mise en evidence de germe, la mise en route d’une antibiotherapie, la topographie du botriomycome ont ete analyses. Resultats Tous les malades avaient un botriomycome associe a une fistule avec un ecoulement purulent ayant permis de reveler un foyer infectieux profond osseux pour quatre d’entre eux et d’un pacemaker pour l’un d’eux. Ils ont tous gueri apres ablation des materiels d’osteosynthese ou du pacemaker associe a une double antibiotherapie. Conclusion Nous rapportons la premiere serie de botriomycome avec trajet fistuleux et permettant de decouvrir un foyer infectieux sous-jacent. Il s’agit d’une entite connue mais peu rapportee.