[Prevalence of asymptomatic sexually transmitted infections among high-risk patients attending a free anonymous HIV-screening center]. / Prévalence des infections sexuellement transmissibles asymptomatiques chez des sujets à haut risque consultant dans un centre de dépistage anonyme et gratuit du SIDA.

INTRODUCTION: The aim of this study was to assess the prevalence of sexually transmitted infections among patients attending an anonymous HIV Screening Center. PATIENTS AND METHODS: This prospective study was performed in the HIV Screening Center of University hospital in Reims (France) from May 1997 to December 1997. The inclusion criteria were the asymptomatic clinical presentation and the presence of risk factors for sexually transmitted infections referring to WHO criteria. The methods included clinical examination after application of acetic acid and urethral and endocervical swabs to identify:Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Gardnerella vaginalis, Trichomonas vaginalis in specific culture. Treponema pallidum and HIV-1 infection were both detected by Enzym Linked Immuno Sorbent Assay (ELISA). RESULTS: One hundred and one patients (62 men and 39 women) were included in the study. Their mean age was 27 +/- 4 Years. Risk factors for sexually transmitted infections were: multiple sexual partners 81 p. 100; homo or bisexuality 16 p. 100; intravenous drug use 3 p. 100. The sexually transmitted infections were: HIV-1 infection 1 p. 100;Ureaplasma urealyticum 25 p. 100; genital warts 5 p. 100;Chlamydia trachomatis 3 p. 100; Gardnerella vaginalis 3 p. 100; Mycoplasma hominis 2 p. 100; Treponema pallidum 0 p. 100; Neisseria gonorrhoeae 0 p. 100; Trichomonas vaginalis 0 p. 100. The prevalence of sexually transmitted infections was significantly higher among women (p<0.05). DISCUSSION: Classical sexually transmitted infections and HIV infection were rarely detected in this study; but prevalence of other sexually transmitted infections (genital warts, Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum) was high. Ureaplasma urealyticum is considered as a possible pathogenic agent in pregnant women (preterm delivery, decrease of birth weight, chorioamniotitis). These results suggest that other than sexually transmitted infections in high risk patients attending a HIV Screening Center other sexually transmitted infections should also be systematically screened for.

[Cryosurgery of basal cell carcinoma: a study of 358 patients]. / Cryochirurgie des carcinomes basocellulaires: étude de 358 malades.

INTRODUCTION: Cryosurgery is a well-established therapeutic modality for basal cell carcinoma. We report herein an important series of basal cell carcinoma treated by cryosurgery, with a five year cure rate evaluation. PATIENTS AND METHOD: Retrospective study with 395 basal cell carcinomas (over 358 patients - sex ratio H/F: 0.85) treated by cryosurgery between 1981 and 1992. For each patient the data were: age, sex, size of the lesion, location, clinical sub-type, tissue-temperature monitoring, recurrence date and esthetic outcome. RESULT: The lesions were located on the face (93 p. 100) and back (7 p. 100). Mean size was 17 mm. Clinical sub-types were known for 178 lesions; 11 p. 100 of BCC were morpheaform. Tissue-temperature monitoring was performed for 55 p. 100 of cases. 111 tumors were observed for more than 5 years. The 5-year actuarial failure rate was 9 p. 100. The 5-year cure rate was not significantly altered by sex, size of lesions, location and clinical sub-type. No frequent recurrences were observed when tissue-temperature monitoring had not been performed. Complications were rare and esthetic outcome was good. DISCUSSION: The 5-year actuarial recurrence rate with cryosurgery is similar to conventional surgery. It is not essential to control tissue-temperature for preventing recurrences. Cryosurgery is a reliable treatment and outcome depends on surgeon experience. Quickness and low cost of this procedure argue for choosing cryosurgery when treating elderly patients.

[Cutaneous granulomatous lesions disclosing ataxia-telangiectasia]. / Lésions granulomateuses cutanées révélatrices d'une ataxie-télangiectasie.

INTRODUCTION: Idiopathic cutaneous granulomatous lesions are exceptionally described in the course of congenital immunodeficiency, including ataxia-telangiectasia. CASE REPORT: We describe a new case of a 28-month girl who presented granulomatous skin lesions revealing a previously unknown ataxia-telangiectasia in the absence of typical neurologic signs, telangiectasia and infectious complications. The clinical aspect showed infiltrated erythemato-squamous plaques and nodules predominating on the face and limbs. These lesions increased in number without remission. Histological examination revealed a nodular, lymphohistiocytic infiltration with granulomatous tendency in the deep dermis and the hypodermis. Before the onset of skin treatment, the child developed an Epstein-Barr-virus related lymphoproliferation. Immunoglobulins and oral corticosteroids associated with chemotherapy permitted the regression of the granulomatous lesions but not of the fatal spread of the lymphoproliferative syndrome. DISCUSSION: These rare cutaneous manifestations are important to know because they can be the initial sign of an immunodeficiency. Clinical and histological aspects are characteristic. They are eventually associated with visceral granulomatous lesions. Physiopathology remains hypothetical. An abnormal immune response to an undetermined antigenic stimulation could be suspected in this particular context. The question of a correlation between these lesions and a proliferative syndrome remains open.

EMLA cream as a topical anesthetic for the repeated mechanical debridement of venous leg ulcers: a double-blind, placebo-controlled study.

BACKGROUND: A granulating surface is important for skin grafting and healing of leg ulcers. Mechanical debridement to remove necrotic tissue often must be stopped before completion because of pain. OBJECTIVE: Our purpose was to assess the effect of EMLA cream on the number of debridements required to obtain a clean ulcer and on pain during debridement and to determine its safety after repeated doses. METHODS: In this randomized double-blind, placebo-controlled study, 69 patients with venous leg ulcers received cream before debridement until a clean ulcer was obtained (or a maximum of 15 debridements). RESULTS: EMLA decreased the median number of debridements required for a clean ulcer (EMLA 11.5, placebo >15; P = .019) and decreased pain by 50% (P = .003). Plasma levels of lidocaine, prilocaine, and their main metabolites were low without any apparent accumulation. CONCLUSION: EMLA produces effective pain relief for the debridement of leg ulcers and shortens the time to a clean ulcer.

Recurrent painful hand crisis in a four-year-old girl, revealing an erythropoietic protoporphyria.

We report the case of a 4-year-old girl, who had been suffering for 2 years from a recurrent, painful crisis affecting both hands, following sun exposure. There were no obvious cutaneous lesions, which initially caused us to consider a diagnosis of a psychiatric disorder. However, the diagnosis of erythropoietic protoporphyria was then established by the demonstration of elevated levels of free protoporphyrin in erythrocytes. The present case illustrates the effectiveness of beta-carotene associated with canthaxanthin in erythropoietic protoporphyria.

Porphyria cutanea tarda associated with human immunodeficiency virus infection.

Since 1987, about 60 cases of porphyria cutanea tarda (PCT) associated with human immunodeficiency virus (HIV) have been reported. The respective roles of HIV and toxic hepatic factor in PCT remain unclear. We report 10 new cases and analyse the following toxic hepatic factors: hepatitis C and B, alcoholism, drugs. The route of HIV transmission to these 10 men were: IV drugs abuse (3), homo/bisexuality (4), heterosexuality (1), and unknown (2). When PCT was diagnosed, their average age was 38 years (29-54) and the HIV-infection had been established for 4.8 years (0.33-9). Seven men had HIV-related symptoms and a CD4+ lymphocyte count below 200/mm3. Cutaneous signs and urinary porphyrin count were characteristic. Alcohol abuse was present in 8/10 patients. AST, ALT and/or gamma GT were high in 9/10 patients; 5/10 patients had HCV antibodies (4 were HCV-PCR positive). HBs antigenemia was negative among the 5/8 patients with HBV antibodies; 10/10 patients took prescribed hepatotoxic drugs. Our series confirms the presence of toxic hepatic factors in PCT of HIV-positive patients. Hepatitis C, alcoholism and hepatotoxic drug consumption seem to be triggers for the appearance of PCT in HIV-positive patients.

Palmoplantar filiform hyperkeratosis with Darier's disease. Association or coincidence?

Palmoplantar orthokeratotic filiform hyperkeratosis is characterized by multiple, spiny, keratotic projections. We report a new case, occurring in an 85-year-old woman, associated with typical Darier's disease involving her chest and groin, that may be not fortuitous. Three previous reports point out its possible association with underlying diseases, such as malignancy or Darier's disease.

Measurement of cutaneous erythema by means of photodensitometry: application to cutaneous photosensitivity.

We have developed a photodensitometry method to evaluate the intensity of cutaneous erythema objectively. The method measures the optical density of photographic slides of cutaneous erythema. It combines techniques used commonly but separately by investigators: diffuse transmittance spectroscopy (which is a variant of diffuse reflectance spectroscopy) and photography. We have used this method to study photosensitivity in 22 volunteers who received increasing doses of ultraviolet radiation to the back. Our work confirms the usefulness of an important parameter in photobiology: the regression slope of the curve representing the erythema index, a function of the logarithm of the dose applied.

[Lichenoid contact dermatitis from the ink of a red pen]. / Dermite de contact lichénoïde à l'encre rouge d'un stylo.

INTRODUCTION: Numerous cutaneous inflammatory reactions have been reported in literature, after using red dyes; most of them are lichenoid reactions and occur after tattooing. Few reports have mentioned inflammatory complications after using red ink. CASE REPORT: A 21-year-old woman was examined for papular erythematous, pruritic lesions on the back of her left hand. They developed within the area of a red inked pen writing, a few days before. There was an isomorphic reaction on the cheek which was in contact with the hand during sleep. Diagnosis of lichen reaction to red ink was made, and histologically confirmed on the hand. DISCUSSION: We report the first case to our knowledge of lichen reaction to red inked pen, which can be compared to hypersensitivity reactions to red pigment reported in literature. A Koebner phenomenon by friction, usual with lichen, is possible, but doesn't explain the reaction on the cheek. A contact dermatitis to red pigment of ink can also be suggested, although mostly eczema-like reactions have so far been reported; it seems moreover that lichenoid reactions reported only occur after intradermal injection of pigment during tattooing. This contact mechanism would nevertheless explain both localizations of lichen reaction in our patient.

[Multiple isolated cutaneous myxomas]. / Myxomes cutanés multiples isolés.

INTRODUCTION: Cutaneous myxomas are rare. They are more often single; when they are multiple, they may be one of the component of the Carney's syndrome. CASE REPORT: We report a case of multiple and isolated cutaneous myxomas arising at 19 year-old. Diagnosis was confirmed by histologic studies. Examination failed to reveal other cutaneous or visceral features. DISCUSSION: The multiplicity of cutaneous myxomas is an essential element for diagnosis of Carney's syndrome; other components and notably atrial myxomas can appeared over time. Normal visceral explorations don't eliminated the diagnosis, and follow-up including screening echocardiography must be ensured before concluding, as in our case, as multiple and isolated cutaneous myxomas.

[Chronic depigmentation due to positive patch tests for methacryate derivatives]. / Dépigmentation durable secondaire à des tests positifs aux dérivés des méthacrylates.

INTRODUCTION: Many chemical products are known to induce depigmentation. This phenomenon was never reported with methacrylates which are components of acrylic resine. CASE REPORT: A female patient with artificial nails developed contact dermatitis. Localized depigmentation at the site of positive patch tests to methacrylates derivatives was observed. DISCUSSION: The chemical substance could have a direct influence either by its toxic effect or by the induced inflammatory reaction.

A comparative study of cryogenic lesions in organ-cultured human skin and in reconstituted human skin equivalent.

Cryosurgery is a technique that is widely used in the treatment of cutaneous tumors. However, there are still features of healing in cryosurgery wounds that are incompletely understood and necessitate further study. In the present paper, we describe two in vitro models that were developed to study the initial stages of development of the cryolesion: reconstituted human skin and organ-cultured human skin. Cryolesions were generated in both models by applying a 2-mm-diameter cryoprobe at -196 degrees C for 35 s. Histological features were analyzed at days 0, 3, 5, and 14 following cryotreatment and showed epidermal detachment and keratinocyte necrosis very close to the findings reported in vivo. Results were similar in the two models. Gross alteration of the dermal architecture was noticed beneath the cryolesion, particularly in the reconstituted skin model. Cell proliferation was investigated at days 0, 3, and 5 by [3H]thymidine incorporation and Ki-67 antigen immunolabeling. In the case of organ-cultured skin, a significant increase in keratinocyte and fibroblast proliferation was observed at day 3, compared to the controls. At day 5, a return to the basic level was noticed. This was not observed in the reconstituted skin model at either day 3 or day 5. These data led us to propose that organ-cultured skin may be a useful model for evaluating the response of human skin to freezing; reconstituted skin was not adequate for this purpose.

Antagonistic effects of interferon-gamma and interleukin-4 on fibroblast cultures.

A major characteristic of scleroderma (SSc) fibroblasts is an increased biosynthesis of extracellular matrix macromolecules that could be linked to impaired regulation by cytokines. We investigated the effects of two cytokines from T lymphocytes, interleukin-4 (IL-4) and interferon-gamma (IFN-gamma), on normal and scleroderma fibroblast cultures. In both types of fibroblasts, IL-4 strongly stimulated collagen synthesis, whereas IFN-gamma was a potent inhibitor. The effects of these cytokines were localized at the pre-translational level, and both mRNA steady-state level and protein synthesis were equally affected. SSc fibroblasts responded to IL-4 and IFN-gamma as well as normal fibroblasts. When fibroblasts were incubated with combinations of both cytokines, IFN-gamma completely suppressed the stimulation of collagen gene expression induced by IL-4. Northern blot and western blot analyses demonstrated that IFN-gamma induced a rapid and strong decrease in the expression of the IL-4 receptor-alpha by fibroblasts. This effect might explain the antagonistic effects of IFN-gamma on the IL-4-dependent enhancement of collagen synthesis. Thus, our data suggest that the alteration of collagen production in scleroderma fibroblasts does not depend on an altered sensitivity of these cells to stimulatory or inhibitory cytokines but is more likely the consequence of an imbalance in the local production of autocrine or paracrine regulatory factors.

[Palmoplantar filiform parakeratotic hyperkeratosis and digestive adenocarcinoma]. / Hyperkératose palmo-plantaire filiforme parakératosique et adénocarcinome digestif.

INTRODUCTION: There are very few observations of filiform palmo-plantar hyperkeratosis reported. Nevertheless it's worth knowing this entity for his potential association with a visceral neoplasia. CASE REPORT: We report the first case of filiform palmo-plantar hyperkeratosis associated with a digestive adenocarcinoma and a polycystic kidney disease. DISCUSSION: After a review of palmar and plantar filiform hyperkeratosis in the literature, we will discuss the possible association with neoplasia or other pathologies. This pathology requires a strict clinical and paraclinical follow-up.

Influence des ions sur le pouvoir hydratant de l'ure e: e tude sur peau de porc ex vivo.

This study deals with the influence of ions (NaCl and MgSO4) in a W/O emulsion containing 10% urea. Moisturization kinetics are assessed by corneometry on pig skin ex vivo. The formula's influence on urea penetration is measured by infrared spectrometry with an ATR device and the stripping method. Corneometry and spectroscopy were chosen to record simultaneously the hydratation levels and urea localization into superficial cell layers. Urea crystallization after evaporation of emulsions and aqueous solutions is described. Results show that urea does not hydrate nor penetrate when applied to the skin through an aqueous gel. In a W/O emulsion, sodium chloride increases the ability of urea to moisturize without improving penetration. In vitro urea crystallization is disturbed by sodium chloride or magnesium sulphate for solutions and emulsions. This stabilization by ions is correlated with good moisturization values. The stabilization of urea in the solute state provided by ions increases its water epidermal binding capacity without enhancing penetration.