[Treatment of scabies and Ascabiol(®) supply disruption: what about the pediatric population?]. / Traitement de la gale et rupture d'Ascabiol(®) : quid de la population pédiatrique ? Gale chez l'enfant et rupture d'Ascabiol(®)

Scabies is a disease in steady increase in Île-de-France region. Standard treatment, Ascabiol(®) (benzyl benzoate/sulfiram), is back-order for several months and its return remains uncertain. Facing this drug shortage, French Drug Agency (ANSM) has imported a drug from Germany, Antiscabiosum 10 % (benzyl benzoate), to treat patients having contraindications for other scabicides available in France (ivermectin, esdepallethrine). However, infants less than 1 year (<15 kg) and asthmatics infants have no alternative treatment. A multidisciplinary workgroup explored the various existing therapeutic alternatives in France and worldwide. From ANSM's recommendations and group's experience, a decision algorithm was proposed for treating patients. However, pediatric context implied the use of off-label drugs. Proposed treatments widely known by practitioners, prescriptions-types, dose, modalities of use and dispensation, and flyers to patients were realized to optimize treatment efficacy.

[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.

[Dermatosis and depressive symptoms]. / Symptomatologie dépressive et dermatoses.

BACKGROUND: Dermatological diseases modify and impair patients' self-image and can result in considerable psychological suffering. The purpose of this study was to determine the prevalence of depressive symptoms in patients consulting for dermatological diseases. PATIENTS AND METHODS: A prospective study was carried out on 5 successive days at the dermatology department of the Saint-Louis Hospital in Paris. A questionnaire designed to assess depressive symptoms, the CES-D, was given to all patients consulting throughout the study period. This self-assessment scale for depression was devised by the National Institute of Mental Health and has been validated over more than 20 years by means of hundreds of large-scale epidemiological studies in both general and selected patient populations. RESULTS: On completion of the 5-day study, 879 questionnaires had been collected. The sex-ratio was 53.4% women to 46.6% men. The prevalence of depressive symptoms as evaluated by the questionnaire was 23.6% for a total of 774 evaluable dossiers. Patients consulting without an appointment (n = 172) represented 22% of study subjects versus 78% attending a scheduled visit (n = 602). Depressive symptoms were found in 31.4% of patients consulting without an appointment versus 21.4% of patients with an appointment (p<0.01). Male patients consulting without an appointment constituted the most fragile group, with depressive symptoms being seen in 38.8% of this population. DISCUSSION: The prevalence of depressive symptoms among patients seen at a hospital dermatology department was 23.6% in this study. This figure was significantly higher among patients consulting without an appointment, and among men in particular. It was equal to or higher than that seen among patients considered as having more incapacitating or painful conditions as assessed using the same questionnaire. The incidence of concomitant depression should prompt dermatologists to investigate for its existence and to take appropriate therapeutic measures in order to reduce the mental suffering of their patients.

High seroprevalence to Bartonella quintana in homeless patients with cutaneous parasitic infestations in downtown Paris.

Bartonella quintana infections have recently been reported in homeless patients. We prospectively studied the prevalence of and the factors associated with a positive serology to B quintana in the homeless population of downtown Paris. The following data were recorded: ongoing cutaneous parasitic infestation, years of homelessness, living status, previous episodes of body pediculosis and scabies, alcoholism, intravenous drug use, known immunodepression (including undernutrition and known HIV infection), and contacts with animals. B quintana serology was performed in 57 patients and in 53 age- and sex-frequency-matched downtown Paris volunteer blood donors. Thirty-one patients (54%; 95% confidence interval [CI], 41%-68%) had a positive B quintana serology as compared with 2% in the control group (P <.0001); 8 of 57 patients (14%; 95% CI: 6%-26%) had a serologic profile of an evolving infection. Age and years of homelessness were independently associated with a positive B quintana serology with adjusted relative risks (RRs) of 2.9 (95% CI, 1.4-5.9) for age 40 years and older and 1.7 (95% CI, 1.1-2.7) for years of homelessness 3 or more. Our results suggest a high prevalence of past and recent infections with B quintana in the downtown Paris homeless population with cutaneous parasitic infestations.

[Alpha interferon-induced eczema in atopic patients infected by hepatitis C virus: 4 case reports]. / Eczéma induit par l'interféron alpha chez les malades atopiques infectés par le virus de l'hépatite C: 4 observations.

OBJECTIVES: We report four cases of eczema induced by alpha interferon in atopic patients treated for chronic hepatitis C. CASE REPORTS: Eczema developed in 4 patients with certain (3 cases) or possible (1 case) atopy treated by subcutaneous injections of alpha interferon for hepatitis C virus infections. Delay to onset was 3 weeks to 6 months. Interferon was highly likely the causal agent: lesions started at site of interferon injection, followed the rhythm of interferon injections (three cases), disappeared at interferon withdrawal. In two patients, the lesions diffused to other sites. Both Introna and Roféron were used. Three patients also took ribavirine. The possible role of a contact factor (antiseptic.) was ruled out. Skin tests (patch tests, prick tests, intradermal reactions) were negative for interferon alpha and for a standard battery. DISCUSSION: The role of interferon in the induction of skin diseases or its influence on the course of certain dermatoses is well known. In atopic patients, interferon might induce eczema via an immunomodulator rather than an allergic mechanism since skin tests (performed in one patient) were negative. This observation is similar to that in psoriasis induced by interferon in predisposed subjects who develop skin lesions at injection sites which sometimes diffuse to distant localizations. The role of other factors (hepatitis C virus infection, ribavirine) remains unknown; they might participate in this mechanism by aggravating skin dryness.

[Dermatologic consultation in a precarious situation: a prospective medical and social study at the Hôpital Saint-Louis in Paris]. / Consultation dermatologique en situation de précarité: étude prospective médicale et sociale à l'Hôpital Saint-Louis à Paris.

INTRODUCTION: The aim of our study was to evaluate the outcomes and the cost of the dermatological consultation for poor and destitute patients, in Saint-Louis Hospital. PATIENTS AND METHODS: We carried out a prospective study from May to October 1996. One hundred and eighty-nine patients (237 consultations) who had no social welfare, were examined. RESULTS: They revealed that 82 p. 100 were male, 63.7 p. 100 were French, 13.9 p. 100 came from Maghreb, 9.7 p. 100 from Sub-Saharan Africa, 73 p. 100 were homeless and 25.7 p. 100 were alcoholic. The average age was around 37.6. The main medical disorders: scabies (56.5 p. 100), lice (22.4 p. 100) and cutaneous infections (7.2 p. 100) were related to the patients' living conditions and their social and economic situation. The other diseases observed were identical to the ones detected in regular health care centers. Complementary laboratories were necessary in 9.3 p. 100 consultations. Only 2 p. 100 of patients were admitted in Hospital. Local treatment was applied by nurses in 67 p. 100 of cases. Drugs were delivered free of charge by the Hospital's pharmacy in 64 p. 100 of cases. The cost of drugs was 83 FF per patient. The mean of duration of treatment was 10.5 days. DISCUSSION: Social workers are a key element in helping the patients to recover their social rights (49 p. 100 of patients have recovered social rights after 6 months). The frequency of skin diseases is higher in this population than in general population, especially in homeless persons. Access to health care is a problem of public health.

Chronic radiodermatitis following cardiac catheterisation: a report of two cases and a brief review of the literature.

Cardiac angiography produces one of the highest radiation exposures of any commonly used diagnostic x ray procedure. Recently, serious radiation induced skin injuries have been reported after repeated therapeutic interventional procedures using prolonged fluoroscopic imaging. Two male patients, aged 62 and 71 years, in whom chronic radiodermatitis developed one to two years after two consecutive cardiac catheterisation procedures are reported. Both patients had undergone lengthy procedures using prolonged fluoroscopic guidance in a limited number of projections. The resulting skin lesions were preceded, in one case, by an acute erythema and took the form of a delayed pigmented telangiectatic, indurated, or ulcerated plaque in the upper back or below the axilla whose site corresponded to the location of the x ray tube during cardiac catheterisation. Cutaneous side effects of radiation exposure result from direct damage to the irradiated tissue and have known thresholds. The diagnosis of radiation induced skin injury relies essentially on clinical and histopathological findings, location of skin lesions, and careful medical history. Interventional cardiologists should be aware of this complication, because chronic radiodermatitis may result in painful and resistant ulceration and eventually in squamous cell carcinoma.

Internal involvement in localized scleroderma.

We studied 76 consecutive patients with localized scleroderma (morphea with or without linear scleroderma) and analyzed the frequency, prognosis, and predictors of internal involvement in a subset of 53 patients systematically investigated for the presence of such involvement. Internal involvement was found by systematic examination in 16 patients. Only 2 of them, including 1 patient who developed systemic scleroderma, had symptomatic and severe visceral disease. The other 14 patients had asymptomatic and minor abnormalities consisting of abnormal lower sphincter pressure, and/or peristaltic failure in the esophagus and slightly impaired carbon monoxide diffusion in the lung. Frequent seroimmunologic abnormalities had no predictive value. Three parameters were found to be associated with internal involvement: male gender (p < 0.05), increasing number of plaque-like lesions (p = 0.02) and hypergamma-globulinemia at 1st examination (p < 0.005). Mild esophageal and pulmonary involvement are not rare in morphea but are usually silent. In our series, after a median follow-up of 48 months, such involvement did not impair the prognosis. The mildness of these visceral abnormalities suggests that they do not justify routine detection in asymptomatic patients. Morphea and systemic scleroderma behave as 2 different diseases.

[Comparative study of the development and prognosis of pemphigus vulgaris and seborrheic pemphigus]. / Etude comparative de l'évolution et du pronostic du pemphigus vulgaire et du pemphigus séborrhéique.

Traditionally, the prognosis of pemphigus erythematosus is thought to be more favourable than that of pemphigus vulgaris. A retrospective study of the records of 10 patients with pemphigus erythematosus and 13 patients with pemphigus vulgaris was set up to compare the courses of the two diseases. This comparison, carried out in populations with similar age, sex ratio, pretreatment duration of the disease and treatment received, showed that relapses were more frequent in the course of pemphigus erythematosus, whereas remissions, mean duration of the disease and iatrogenic complications were the same in both groups. This study, therefore, throws some doubts on the dogma of relative mildness of pemphigus erythematosus, which goes back to a period long before systemic corticosteroid therapy was known. Mortality studies performed since the event of this treatment have shown that the prognosis had improved and tended to be the same in both diseases. The other data concerning the course of treated pemphigus erythematosus are little known and were never compared with those concerning pemphigus vulgaris. Our study shows that treatments similar to those of pemphigus vulgaris are necessary to obtain remissions in pemphigus erythematosus and that these diseases share the same evolutive profile. However, the question of the best therapeutic strategy to be used has not yet been answered.