V. Doffoel-Hantz

Incidence and Mortality of Bullous Pemphigoid in France

A major increase in the incidence of BP has been recently reported in the United Kingdom. In addition, there are some controversies about the over-mortality of BP patients. The primary objective was to reevaluate the incidence of BP in France as compared with that we estimated 15 years ago. The secondary objective was to assess mortality of BP patients. BP incidence was retrospectively estimated from all BP cases diagnosed between January 2000 and December 2005 in three French regions with a total population of 3.858 million inhabitants. BP mortality was assessed from a prospective cohort accrued during the same time period. A total of 502 incident BP patients (mean age: 82.6±8.8 years) were identified. Overall estimated incidence was 21.7 cases per million persons per year (95%CI:19.8-23.7 cases per million persons per year), which is about 3-fold higher than the incidence that we estimated 15 years ago. In the population aged 70 years or above, BP incidence was 162 cases per million per year (95%CI:147-177 cases per million per year). The overall 1-year survival rate was 62% (95% CI: 56-67%). The risk of death for BP patients was more than six times greater than that for the general population (SMR:6.60; 95%CI:5.47-7.90). The incidence of BP in France has increased 3-fold in the last 15 years. BP is associated with high mortality.

Predictive Clinical Features of Eczema Craquelé Associated with Internal Malignancy

Objective: To describe a series of hospitalized patients with eczema craquelé (EC) and the possible correlations between clinical features of EC and cancer in an open prospective observational study. Patients and Interventions: The study population comprised 68 consecutive patients included between January 1, 1999 and December 31, 2000 who were followed up through December 2004. All patients who had localized or generalized EC were included. Patients underwent complete clinical examinations, routine laboratory tests, chest x-rays, abdominal ultrasound, and cutaneous biopsies performed on EC. Main Outcome Measures and Results: Rates of EC associated with cancer, clinical features of eczema, rate of recalcitrant eczema, relationship to other clinical prognostic factors, and paraneoplastic evolution were evaluated. Cancer was diagnosed in 32 patients (47%). We observed a significant difference in the presenting clinical signs of EC between patients with malignant tumors and patients without cancer. In patients with malignancies, EC was widespread on the trunk and we noted deep red and inflammatory fissures. In all cases, EC led to the discovery of malignancy or recurrence of cancer. Conclusion: Widespread EC, topical corticosteroid resistance, and deep red and inflammatory fissures were significantly correlated with neoplasia.

Traitement de la maladie de Paget extramammaire par photothérapie dynamique topique

BACKGROUND The usual treatment for extramammary Pagets disease (EMPD) is surgery, but this approach may have grave functional and physical consequences, as well as high recurrence rates. Topical photodynamic therapy (PDT) offers an optional approach for EMPD; it has a high complete response rate and there is no dose restriction. The aim of this study was to evaluate the efficacy and safety of PDT in the treatment of EMPD. PATIENTS AND METHODS This series of patients was seen at a single centre between 1 December 2005 and 31 December 2010. All patients with histologically confirmed EMPD were included. Patients received two courses of PDT 21 days apart: 3 hours after topical application of methyl aminolevulinic acid emulsion, they underwent illumination with red light (570-670 nm) at a dose of 37 J/cm(2) for 10 minutes. In the event of relapse, a further cycle was given at week 6. RESULTS Eight patients (seven female, one male) of a mean age of 69 years were included. After two series of two illuminations, seven patients were in complete clinical remission at 3 months and one patient was in partial remission. Five patients were still in complete clinical remission at 6 months. All patients had relapsed after a mean 8.4 months (4-14 months). The limiting factor appears to be pain occurring during illumination. Patients reported satisfaction with the disappearance of symptoms and a notable improvement in quality of life. DISCUSSION The complete clinical response rate to PDT at month 6, after two series of two illuminations, was equivalent to that for surgery. Although the recurrence rate was high, this treatment may be repeated without functional or physical consequences. PDT resulted in disappearance of pain and improved quality of life.

Early neurosyphilis with etanercept treatment.

ejd.2013.2181 Auteur(s) : Safae Assikar, Valerie Doffoel-Hantz, Agnes Sparsa, Jean-Marie Bonnetblanc jean-marie.bonnetblanc@wanadoo.fr Service de Dermatologie, CHRU Dupuytren, 2 avenue Martin Luther King, 87042 Limoges cedex, France Tumour necrosis factor α (TNF-α) is active in host defense against bacterial infections. TNF antagonists are used in different diseases but they increase the risk of serious infections and malignancies [1]. Since 2000, the incidence of syphilis has increased in developed [...]

Affections cardiaques et pulmonaires

Pli diagonal du lobule de l’oreille Le pli diagonal du lobule de l’oreille, ou signe de Frank, est un pli cutane situe sur le trajet reliant le tragus au lobule posterieur de l’oreille et s’etendant sur au moins un tiers de la distance (fig. 83.1). Il barre ainsi diagonalement le lobe de l’oreille. L’examen histologiquemet en evidence une rupture et une desorganisation des fibres elastiques et un epaississement de l’intima des arterioles. Il pourrait etre le temoin d’un vieillissement precoce du tissu conjonctif cutane et coronarien.