[Evaluation of the prescription of long-term systemic steroid-therapy associated measures]. / Mesures adjuvantes à une corticothérapie systémique prolongée : que faut-il prescrire ?

INTRODUCTION: To prevent the occurrence of corticosteroid's side effects, adjuvant measures are prescribed in a very different way depending on the practitioner's experience. The aim of this study was to assess the physicians' practices regarding the prescription of long-term corticosteroid therapy. METHODS: In May 2010, we realized a cross-sectional study among physicians in Ibn Sina University Hospital in Rabat. With a data collection form, we assessed the principal indications for prescribing steroids and the frequency of prescription of measures sometimes associated with systemic corticosteroid. RESULTS: Fifty-nine out of eighty physicians completed the data collection form (response rate: 69.4%). Calcium-vitamin D supplementation was recommended by most of the physicians. Half of them were prescribing biphosphonate therapy. Most of them propose a low-sodium, a low-fat and a low-carbohydrate dietary regimen. Regular physical exercise was recommended by 35% of physicians. Gastric protection was indicating by 54.4% of practicians and potassium supplementation by 42.1% of them. Finally, the recommendation for influenza vaccination, hydrocortisone prescription and Synacthen(®) test, varied between physicians. CONCLUSION: The prescription of adjuvant measures with a long-term corticosteroid therapy was very heterogeneous. There is no consensus regarding most of the measures.

[Iatrogenic Kaposi's disease in Morocco in a non-transplant context]. / La maladie de Kaposi iatrogène au Maroc en dehors du contexte de la transplantation.

BACKGROUND: Kaposi's disease (KD) is a multifocal disease affecting the skin and viscera. KD can occur in an endemic setting: it may be associated with human immunodeficiency virus (HIV) or it may occur as a complication of immunosuppression, particularly of iatrogenic origin in transplant patients. The purpose of this study is to describe the epidemiological, clinical and therapeutic profile and the course of iatrogenic KD in Morocco in a setting not involving organ transplantation. PATIENTS AND METHODS: A retrospective study conducted at the dermatology department of the Ibn Sina hospital centre in Rabat, Morocco, covering a 21-year period and including 14 patients presenting histologically confirmed iatrogenic KD. RESULTS: Eight men and six women were included with a mean age of 56 years. All patients received corticosteroids, in combination with cyclophosphamide in three cases and with azathioprine in one case. The mean time to onset of lesions after the start of treatment was 16.5 months. The presentation in all cases was cutaneous. Impaired mucosal membrane was seen in 35.7% of patients, with visceral involvement being seen in only one patient. HIV serology tests were negative in all patients but HHV8 serology tests were positive in 78.5% of patients. Treatment consisted primarily of reduction or withdrawal of the immunosuppressant. The outcome was favourable in the majority of cases. CONCLUSION: In Morocco, KD is a rare but not exceptional complication of immunosuppressant therapy, particularly corticosteroids. The disease presented as a skin disorder in all of our patients, thus emphasising the value of regular follow-up and routine dermatological examination of patients on immunosuppressant therapy, and suggesting the value of screening for HHV8 infection before initiating such therapy.

Factors influencing the awareness of diabetic foot risks.

INTRODUCTION: The aim of the present study was to identify factors influencing diabetic patients' awareness of the risk of foot problems. METHODS: We performed a prospective study of diabetic patients hospitalized or seen in consultation. Various factors were analyzed in order to identify those related to the patients' level of awareness of risk factors in diabetic foot. RESULTS: Ninety-one patients were included (mean age: 48; male/female gender ratio: 0.63). Over 50% of the study population was not aware of the risks of diabetic foot. Educational level and socioeconomic status had an impact on awareness of good foot health and care. Poor knowledge of the degenerative complications of diabetes was associated with age, a low educational level and low socioeconomic status. DISCUSSION: Our results revealed low levels of patient awareness concerning the potential severity of diabetic foot and the means of preventing foot problems. The patients gave a range of explanations for this marked lack of awareness; including a lack of information and financial constraints. Hence, patient education is still a major aspect of prevention in diabetes. CONCLUSION: In diabetes, there is still a need for easily assimilated, locally provided patient education.

[Henna symbolic tattoo and real dermatitis]. / Du henné d'un tatouage symbolique à une vraie dermatose.

INTRODUCTION: Henna, or Lawsonia inermis, has been used since antiquity by women in the Orient for dyeing the hair, hands, and feet. Contact dermatitis to pure henna is very rare, most often caused by additives such as perfume oils or paraphenylenediamine (PPD). We report the case of a girl who presented contact dermatitis to henna associated with eczema to draw attention to the dangers related to its use. CASE REPORT: A 12-year-old girl developed erythematovesicular and edematous lesions with very itchy burning, suggestive of contact dermatitis, 48 hours after application of black henna. Lesions were located at the tattooing site exactly following the original design. The patient also had eczema lesions on the left cheek after contact with the tattooed hand. The lesions were improved by treatment with level II corticosteroids. DISCUSSION: Today, henna has become very popular in Western countries. PPD is added to reduce the fixation time or to obtain a darker color. It can cause severe systemic reactions. The most common allergic reaction is contact dermatitis. Treatment is based on topical steroids. Better legislation on temporary tattooing practices and control preparations as well as regular annual information aimed at the general public are essential. CONCLUSION: This observation raises awareness of the importance of information on the serious risks of a labile tattoo, most particularly for the young.

[Treatment of alopecia areata with prednisone in a once-monthly oral pulse]. / Traitement de la pelade par bolus oral mensuel de prednisone.

BACKGROUND: Various modalities have been used in the treatment of alopecia areata (AA), including pulsed oral corticosteroids. The aim of this study was to evaluate the efficacy and safety of pulsed oral prednisone in the management of AA. METHODS: This was a prospective study in patients with progressive AA affecting more than 40% of the scalp. All patients received 5mg/kg (300 mg) oral prednisone once a month for 3 to 6 months and were examined for adverse effects. Hair growth was classified as complete, cosmetically acceptable, incomplete or no growth. RESULTS: Thirty-four patients (18 men) with a mean age of 12+/-3 years were included. AA was ongoing for a mean 2 (1-17) years. Thirteen (38%) patients presented multifocal AA, six universalis (20%), six multifocal with ophiasic pattern (18%), six totalis (18%), and three ophiasic (6%). Six patients (18%) had no regrowth. At 3 months, incomplete or cosmetically acceptable response was noted in 28 patients (82%). At 6 months, 14 patients (41%) presented complete response, eight patients (23%) had a persistent incomplete response, and six patients (18%) had a persistent cosmetically acceptable response. Adverse effects were noted in five patients (15%). Variables predictive for no-growth response were nail involvement (P=0.001), associated dysimmunity (P=0.017), and universalis form (P=0.050). CONCLUSION: A once-monthly oral pulse of 300 mg prednisone appears effective and safe. It can be recommended as first-line treatment for widespread AA.