Sophie Blaise

L’onychomatricome, une lésion rare de l’ongle

Resume L’onychomatricome est une lesion fibro-epitheliale rare de la matrice ungueale avec des caracteres cliniques et histologiques tres particuliers. Cliniquement, il s’agit d’un epaississement longitudinal jaunâtre d’une partie de l’ongle avec hypercourbure transversale et hemorragies filiformes. L’avulsion de la tablette met en evidence une tumeur matricielle multilobee dont les digitations penetrent dans la tablette qui apparait creusee de multiples cavites. Histologiquement, la lesion est caracterisee par une epaisse zone keratogene formant une tablette epaissie. La portion proximale de la lesion s’invagine en profondeur dans un stroma organise en deux couches. La portion distale est faite de multiples digitations epithelio-conjonctives qui s’etendent dans la tablette. Le diagnostic peut etre difficile si l’aspect clinique est atypique ou si la piece d’exerese est incomplete ou mal orientee. Le traitement recommande est l’exerese chirurgicale.

Photodynamic Therapy Can Improve Warts’ Discomfort in Renal Transplant Patients Prospective Multicenter Study

Many studies have been conducted showing that aminolevulinic acid (ALA)‐photodynamic therapy (PDT) can be an alternative treatment for recalcitrant warts. Recently, we performed a study evaluating methyl‐aminolevulinic acid (MAL)‐PDT for the treatment of hand warts in a population of renal transplant patients. Two symmetrical targets were selected on each hand and randomly assigned to chemical keratolytic treatment followed by three cycles of ALA‐PDT (75 J cm−² red light). Patients were evaluated after 3 months and a second run of PDT was performed if the total area and number of warts decreased less than 50%, with evaluation every 3 months for 1 year. Twenty patients were included and 16 were evaluable (9 M, 7 F). After 6 months the reduction of warts’ area was 48.4% on the treated side versus 18.4% in the control area (P = 0.021). The decrease in the total number of warts was 41%versus 19.4% (P = NS). The global tolerance of the treatment was good with acceptable pain during irradiation. These results suggest that ALA‐PDT is a safe and efficient treatment for transplanted patient warts. The improvement between treated and control zone is 20% due to the decrease in untreated warts’ area and number.