[How I treat...diaper dermatitis]. / Comment je traite...une dermite des langes.

Diaper dermatitis is the most frequent skin disorder of the newborn. Several clinical types are distinguished. The most frequent type results from increased fragility of the newborn buttock skin when covered by diapers. According to the mechanisms involved and the severity of the dermatitis, one can distinguish the intertrigo of the chubby baby, and the so-called "W", "Y" and "red panties" types of diaper dermatitis. When the effects of occlusion are not controlled by adequate absorption by the diapers maceration of the stratum corneum occurs. As a result, degradation of the skin barrier function takes place. In addition, the value of the coefficient of friction of the skin increases with epidermal weakening to rubbing. In addition, fecal enzymes alter urines and skin. Judicious hygiene measures and a correct choice of care and diapers are mandatory. Cutaneous colonisation by microorganisms, in particular the yeasts Candida spp, is the main complication. Adequate preventive and curative measures can combat diaper dermatitis with confidence. A miconazole paste allows to improve the tribological properties of the interface between diapers and the skin. It also corrects the degradation of the skin barrier function, reduces inflammation and abates the impact of Candida spp. in the pathogenesis of the skin disorder.

[Physiological responses to sun exposure]. / Réponses physiologiques à l'exposition solaire.

The physiological responses to ultraviolet light exposure can be immediate, early or delayed. Typical examples include actinic erythema, suntan, the telogen actinic effluvium, ephelids, lentigines, some melanocytic naevi, and actinic wrinkles.

[Laser and pulsed light treatments]. / Traitements par lasers et lumiere pulsée.

Numerous types of lasers can exert different and specific effects in the skin. Devices delivering high intensity of pulsed light can exert similar effect.

[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.

[The skin, cold and winter sports]. / La peau, le froid et les sports d'hiver.

Winter sports are responsible for various dermatoses which could be often avoided by simple preventive procedures. Both the severity and duration of cold exposure combined with wind speed, altitude and environmental hygrometric value govern the potential types of cold injuries.

[Overview of tropical endoparasitic diseases with cutaneous manifestations]. / Survol des endoparasitoses tropicales à expression cutanée.

Among the diverse endoparasitic disorders some are primary cutaneous disorders and others exhibit signs on the skin in association with predominant internal manifestations. A variety of protozoans and helminths are responsible for these disorders.

[Leprosy and its cutaneous and neurologic manifestations]. / La lèpre et ses atteintes cutanées et neurologiques.

Leprosy is one of the most ancient diseases recognized in the history of man. It has been progressively eradicated from many countries. However, the disease remains a major problem of public health in a dozen of countries where it still represents an archetype of the tropical infectious pathology.

[Cutaneous melanomas, a spectrum of emerging cancers in women of Wallonia. Outlook by the Mosan Study Group of Pigmented Neoplasms]. / Les mélanomes cutanés, un spectre de cancers émergents chez la femme en région Wallonne. Un regard porté par le Groupe Mosan d'Etude des Tumeurs Pigmentaires.

The Mosan Study Group of Pigmented Neoplasms was founded about 15 years ago. It has collected more than 20,000 cutaneous malignancies including melanomas and basal and squamous cell carcinomas. The incidence of these cancers is on the rise in Wallonia. In particular, malignant melanomas represent a spectrum of emerging cancers characterized by a proteiform biological outcome. They mostly affect young women. The major risk factor appears to be iterative and unwise ultraviolet exposures. The prevention of melanomas is basically founded on such a dogma and accordingly relies on sunscreens. However, controversies about their beneficial effects are rife and fueled by axiomas and contradictory sophisms. At the exception of surgery, the therapeutic options for the diverse types of melanomas do not yet fulfill the scope of evidence-based medicine.

[Cutaneous-lymph node Kikuchi-Fujimoto disease]. / Maladie de Kikuchi-Fujimoto cutanéo-ganglionnaire.

INTRODUCTION: The subacute necrotizing histiocytic lymphadenitis was reported for the first time in 1972 in Japan by Kikuchi and by Fujimoto and his colleagues. This idiopathic disease can affect the skin. We report a case of Kikuchi-Fujimoto disease with skin and lymph node involvement. OBSERVATION: The Yemani man developed cervical lymphadenitis and arciform papulo-nodular lesions of the face. The histologic examination revealed a necrotizing lymphadenitis with blast cells but devoid of neutrophils. The cutaneous involvement corresponded to an angiocentric infiltration by mononuclear cells among which plasmacytoid cells and caryorrhexis were recognized. A spontaneous resolution of the disease occurred spontaneously within three months. COMMENTARY: The clinical and histologic aspects of the present case resemble in part the presentation of lupus erythematosus. However, some distinctive features suggest Kikuchi-Fujimoto disease cannot be termed a classical type of lupus erythematosus.

Patterns of the immunohistochemical expression of melanoma-associated antigens and density of CD45R0+ activated T lymphocytes and L1-protein positive macrophages in primary cutaneous melanomas.

There is ample evidence for spontaneous antimelanoma immune reactivity mediated by melanocyte-differentiation-antigens (MDAs). Our aim was to determine whether MDA immunoreactivity is associated with increased tumour-infiltrating lymphocytes (TIL) and macrophages (TIM). A retrospective study was conducted in 30 medium and high grade primary cutaneous melanomas (PCM) as identified by CART-analysis. All of the cases had developed clinical evidence for metastasis within 3 years following surgical excision of the PCM. We used immunohistochemistry and computerized image analysis to quantify MDAs positive cells (Melan A/MART-1, gp100/Pmel 17/HMB45, tyrosinase), CD45R0-positive TIL and LI-protein-positive TIM. A stochastic relationship was present between the MDA immuno-reactivities and the densities in TIL and TIM. An inverse relationship was yielded between TIL and TIM. No specific pattern of PCM immunoreactivity for MDAs, TIL and TIM was found to predict metastases.

Digital image analysis of the effect of topically applied linoleic acid on acne microcomedones.

A major pathogenic factor of acne is the disturbed keratinization of the follicular infundibulum. It has been hypothesized that a relative decrease in linoleic acid in the sebum could be responsible, in part, for this. The aim of the present study was objectively to evaluate the effects of topically applied linoleic acid on the size of microcomedones in patients with mild acne. The design was a double-blind placebo-controlled randomized cross-over study. Evaluations were performed by digital image analysis of cyanoacrylate follicular biopsies. There was a significant effect of topically applied linoleic acid on the size of follicular casts and microcomedones, an almost 25% reduction in their overall size being achieved over a 1-month treatment period. In contrast, no change was found at placebo-treated sites. It is concluded that topical linoleic acid might play a role as a comedolytic agent in acne-prone patients.

Gravitational syndrome and tensile properties of skin in the elderly.

BACKGROUND: To evaluate the influence of gravitational edema due to chronic venous insufficiency upon the tensile properties of skin. METHOD: A total of 30 women aged 66-75 years participated in the study. Evaluations were made twice in the same subjects following the use or nonuse of daytime elastic compression. Mechanical properties of the skin were measured in the midportion of the legs using a computerized suction device. RESULTS: The consistency of skin which shows abnormal rheological characteristics at the site of gravitational edema was significantly modified by compression therapy. Both skin extensibility and hysteresis were increased after wearing tight stockings although the biologic elasticity remained unchanged. CONCLUSION: Noninvasive measurements of the tensile properties of the skin represent an objective assessment of the severity of leg edema and of its correction by compression therapy.

Sodium hypochlorite, bleaching agents, and the stratum corneum.

Interactions between bleaching agents containing sodium hypochlorite (NaOCl) and human stratum corneum are complex and not fully understood. The same applies when NaOCl is used as a war gas decontaminant. In this study data yielded by in vivo testing and an ex vivo bioassay are compared. Fifteen volunteers received patch tests of a neat proprietary NaOCl bleaching agent for 15, 30, 45, 60, and 90 min. No clinical reaction was seen. Reflectance colorimetry, transepidermal water loss (TEWL), and capacitance were measured for 72 hr after patch removal. Squamometry was also performed using D-Squames and colorimetry of the samples. In addition, the ex vivo corneoxenometry bioassay was conducted on various dilutions of the bleach. Data reveal that conductance and squamometry were more sensitive than TEWL to disclose the action of bleach upon the stratum corneum. Corneoxenometry proved to be a good predictive ex vivo bioassay, indicating the same information as the in vivo tests. Both squamometry and corneoxenometry appear valuable and complementary in assessing infraclinical damages of human skin by a NaOCl bleaching agent.

Effect of organic solvents on normal human stratum corneum: evaluation by the corneoxenometry bioassay.

BACKGROUND: Organic solvents alter the stratum corneum structure and barrier function. OBJECTIVE: To measure the effect of various solvents upon human stratum corneum using the ex vivo corneoxenometry bioassay which is a variant of corneosurfametry. METHODS: Corneoxenometry entails collection of human stratum corneum by cyanoacrylate. The material is immersed in organic solvents for periods ranging from 1 to 120 min. After staining the samples with a toluidine blue-basic fuchsin solution, the color is measured using reflectance colorimetry. Solvent aggressivity to the stratum corneum correlates with the color darkening of the samples. RESULTS: The least aggressive solvent was hexane, followed by ethanol, methanol, hexane-ethanol, chloroform, chloroform-methanol and hexane-methanol. The influence of contact time between solvents and the stratum corneum showed a logarithmic pattern which varied according to the solvent. CONCLUSION: Data are in line with previous experiments conducted in vivo and in vitro, thus indicating the predictive value of corneoxenometry. Such a bioassay may avoid hazards of some in vivo human testings.

Tribological and mycological consequences of the use of a miconazole nitrate-containing paste for the prevention of diaper dermatitis: an open pilot study.

UNLABELLED: The diaper environment increases the coefficient of skin friction and compromises the function of the stratum corneum. In this study, the tribological and mycological benefit of the use of a miconazole nitrate-containing paste on diapered skin was evaluated. A total of 135 instrumental measurements of both erythema and stratum corneum alterations were made on alternate days for 3 weeks in 15 infants. Biometrological parameters were the chromacity a* of the skin and the squamometry index. Cultures testing for Candida albicans were also performed. In the days following the use of the paste, the chromacity a*, the squamometry index and the number of positive cultures of C. albicans were significantly reduced compared to the same evaluations made off treatment. CONCLUSION: Miconazole nitrate-containing paste reduces the tribological interference between cloth diapers and skin as well as providing the diapered skin with an improved microbial environment.

Mechanical properties of the diabetic waxy skin.

BACKGROUND: In some diabetic patients, the skin of the hands has a waxy appearance. OBJECTIVE: To study subclinical skin stiffening in diabetic patients using a noninvasive, in vivo suction device measuring skin extensibility and elasticity. Skin thickness was also measured by high-resolution ultrasonography. METHODS: Evaluations were made on the dorsum of the hands and on the volar aspect of the forearms. RESULTS: In type 1 diabetic patients, the extensibility of skin was decreased while values of thickness and elasticity were increased. These alterations were most prominent on the hands. Similar modifications, although less pronounced, were also found in type 2 diabetic subjects. CONCLUSION: The reported biomechanical changes indicate the presence of subclinical skin stiffening in many patients with diabetes mellitus. Such noninvasive biometrological evaluations could be used for monitoring, rating and correlating some diabetes-associated disorders.

Squamometry in rating the efficacy of topical corticosteroids in atopic dermatitis.

OBJECTIVE: Squamometry is a non-invasive test allowing a reproducible rating of cutaneous xerosis including atopic dermatitis lesions. The method was used to compare the efficacy of proprietary topical corticosteroids in alleviating signs of atopic xerosis. RESULTS: The steroid compounds and their vehicles improve the texture of the stratum corneum at different rates after treatment for 1 week. Some differences in efficacy may be explained by the nature of the vehicle, which enhances the basic pharmacological activity of the corticosteroid itself.