[Presenting skin disorders in black Afro-Caribbean patients: a multicentre study conducted in the Paris region]. / Motifs de consultation en dermatologie des sujets de peau noire d'origine africaine et antillaise: enquête multicentrique en région parisienne.

BACKGROUND: There have been few studies in France concerning the specific features of dermatological practice regarding dark skin (Fitzpatrick's phototype V and VI) or the special requirements of black African and Afro-Caribbean patients. AIM: To determine the principal reasons for dermatological consultation among black patients of African or Afro-Caribbean descent in the Paris region. METHODS: This was a prospective clinical study conducted between 15 February and 15 May 2004. The diagnoses of cutaneous conditions leading to dermatological consultation for all black patients of phototype V to VI were recorded by 10 dermatologists practicing in 14 centres within the Paris region. LIMITS: The method used did not allow any conclusions to be drawn regarding the incidence of the presenting conditions among the global population nor did it allow comparison between populations of different phototypes. The absence of any preset list of diagnoses or of precise inclusion criteria regarding evaluation of skin colour left individual investigators with a broad margin of interpretation. RESULTS: In 836 adults and 228 children (half of whom were from Africa and half from the West Indies), diagnoses were as follows: acne in 29.2% of adults and 13.2% in children, and eczema in 6.8% of adults and 27.2% of children. Among dermatoses more specific to black subjects, scalp conditions were frequently seen in both adults (alopecia 7% of diagnoses) and children (tinea capitis 9.6% and alopecia 3.6% of diagnoses). In at least 25% of cases, consultation was associated with dyschromia. Clinical signs suggesting the use of skin lightening products were seen in 95 patients. CONCLUSION: In France, as in other industrialized countries, black patients consult dermatologists essentially for common benign dermatoses also seen amongst white people. Nevertheless, it is important to emphasise the presence of skin problems specific to black patients such as dyschromia and pigmentary disorders, hair and scalp dermatoses, and side effects associated with the use of skin lightening products.

[Nocardia farcinica infection. Cutaneous form in an immunodepressed patient]. / Infection à Nocardia farcinica. Forme cutanée pure chez une malade immunodéprimée.

Nocardiosis is a rare localized or systemic infection caused by bacteria of the Actinomycetaceae family. Nocardia farcinica, recently identified as a distinct species from Nocardia asteroides, characteristically causes severe systemic infections and is particularly resistant to antibiotics. We report a case of nocardiosis observed in a patient receiving general corticosteroid therapy for bullous pemphigoid and who developed a sub-cutaneous abscess of the breast. N. farcinica was identified on puncture specimens and found to be resistant to beta-lactams, aminosides, cyclines, chloramphenicol, fosfomycin and pefloxacin. No dissemination beyond the skin was observed. The abscess was drained and cleaned surgically and cicatrization was uneventful. Six weeks later the patient was again hospitalized for an inflammatory abscess of the left buttocks which was drained surgically. N. farcinica was again identified and a complete work-up eliminated dissemination. Cotrimoxazole was given as a long-term therapy (480 mg trimethoprim, 2.4g sulfamethoxazole) for 6 months and was well tolerated. No recurrence was observed.

Granulomatous cheilitis in two children with sarcoidosis.

Sarcoidosis is rare in children, who usually have only asymptomatic pulmonary involvement. We report granulomatous cheilitis in two children with sarcoidosis. Both children had systemic sarcoidosis with lymph node and pulmonary involvement.

[The association of neuro-endocrine carcinoma of the skin and Bowen's disease. Review of the literature apropos of 4 cases]. / Association d'un carcinome neuro-endocrine cutané et d'une maladie de Bowen. Revue de la littérature à propos de quatre cas.

Four cases of neuroendocrine carcinoma following Bowen's disease are presented. An immunohistochemical study was performed. The four patients, 3 men and a woman, ranging from seventy to eighty-seven years of age, developed a nodular tumor on a preexisting cutaneous lesion. In one of those cases the diagnosis of Bowen's disease was confirmed histologically before the apparition of the nodular tumor. The tumors were localized on the scalp, thorax, dorsum of the hand, and the scrotum. The four tumors were immunohistologically typical of neuro-endocrine carcinoma: there was a positivity for neurofilaments, cytokeratins and neurone-specific enolase. The clinico-pathological characteristics of those 4 neuro-endocrine carcinomas associated with a Bowen's disease, when compared with the 15 similar described in the literature, are identical to the isolated neuroendocrine carcinoma, from a clinical, morphological and evolutional point of view. The majority are seen in patients older than 60 years old and one third of the cases described survived at least 5 years. The coexistence of Bowen's disease and neuroendocrine carcinoma, the association of neuroendocrine and epidermoid cells in other cutaneous tumors, reactivate the controversy concerning the histogenesis of the so-called Merkel cell carcinoma. In fact, the histogenesis of the tumor is still not fully understood.

[Tinea capitis presenting as staphylococcal pyodermatitis of the scalp]. / Teignes se présentant comme des pyodermites staphylococciques du cuir chevelu.

Two severe cases of pyoderma (staphylococcus aureus) of the scalp, resistant to appropriate antibiotic treatment, proved to be due to exotic dermatophytes (Trichophyton soudanense and Trichophyton violaceum) in two North African children living in France. Both cases exemplify the growing number of Tinea capitis due to anthropophilic species imported from Africa by immigrated populations, their sometimes atypical clinical presentation and their familial epidemiology. Fungal cultures and identification procedures are essential for the diagnosis and epidemiological investigation of such cases.

[Papular mucinosis. Associated dermatologic and dysimmune aspects]. / Mucinose papuleuse. Aspects dermatologiques et dysimmunitaires associés.

Papular mucinosis (PM) is an overload disease mostly made of proteoglycans, essentially cutaneous and accompanied with a monoclonal gammapathy. In addition to the cutaneous lesions, vascular and neurological manifestations may be responsible for severe complications. The gammapathy, most often benign, does not seem always correlated with the skin involvement. We report the case of a patient with mucinosis associated with a rheumatoid polyarthritis, then with a systemic necrotizing angiitis. A review of the literature has enabled us to notice the frequency with which PM is accompanied with dysimmune diseases, especially lupus.

[Thymoma associated with myasthenia, erythroblastopenia, myositis and giant cell myocarditis. One case (author's transl)]. / Thymome, myasthénie, érythroblastopénie, myosite et myocardite á cellules géantes. Une observation.

The authors report on a 76-year-old woman presenting with malignant thymoma associated with myasthenia, erythroblastopenia, myositis and giant cell myocarditis. Blood examination showed antinuclear antibodies, anti-platelet antibodies and LE cells. Only one similar case and 22 cases of thymoma associated with giant cell myocarditis have been published. It seems probable that thymomas plays a part in the pathogenesis of giant cell myocarditis.