[Oropharyngeal candidiasis resistant to fluconazole in patients infected by HIV]. / Candidoses oropharyngées résistantes au fluconazole chez des malades infectés par le VIH.

PURPOSE: To study the susceptibility to fluconazole of Candida albicans strains in oral candidiasis of HIV positive patients. PATIENTS AND METHODS: Eleven HIV positive patients with confirmed oral candidiasis were included in a 4 to 10 months prospective study. In addition, 23 HIV positive patients were evaluated in a restrospective study (14 with oral candidiasis and 9 control subjects). The MICs to fluconazole of C. albicans were characterized by genotyping (electrophoretic karyotype). RESULTS: Thirty patients were evaluable. Oral candidiasis was found in 21 patients; 7/21 patients (33,3 p. 100) developed resistant C. albicans strain (MIC > 32 mg/ml) after a mean fluconazole cumulative dose of 18 g. In this study, the electrophoretic karyotype confirmed the persistence of the same C. albicans strain in each patient. In addition increased colonization by C. krusei or C. glabrata was found in 6/21 patients (28.5 p. 100). DISCUSSION: Our data demonstrate that prolonged treatment with fluconazole dose higher than 13 g induces the emergence of resistant C. albicans with persistence of the same C. albicans strain. Fluconazole has to be reserved to oral candidiasis after failure of a local treatment or to severe cases.

Fluconazole-resistant recurrent oral candidiasis in human immunodeficiency virus-positive patients: persistence of Candida albicans strains with the same genotype.

Thirty human immunodeficiency virus-positive patients carrying Candida albicans in their oropharynx were treated with fluconazole and were monitored for 90 to 570 days. Fluconazole-resistant C. albicans (MIC, > 32 micrograms/ml) appeared only in seven patients and only after 90 days of treatment corresponding to a total dose of more than 10 g. Resistance was not associated with resistance to other azole derivatives. Susceptible and resistant strains from each patient had the same genotype (as defined by electrophoretic karyotype and restriction fragment length polymorphism). Thus, the resistant strains were selected by the antimycotic treatment from the susceptible strain present in each case.

Zosteriform and epidermotropic metastasis. Report of two cases.

We report two cases of zosteriform metastasis to the skin. One patient had epidermotropic papulovesicular metastases from a presumed cutaneous adnexal neoplasm. The second patient had painful zoster-like papulovesicles from metastatic breast cancer. Previously reported dermatomal or zosteriform metastases are reviewed.

Cutaneous response to ultraviolet radiation-induced erythema in patients with type A dysplastic nevi.

The effects of an exposure to 6 times the minimal erythemal dose of ultraviolet radiation (UV) were studied using a visual scale and a tri-stimulus colorimeter in 12 sun-tolerant (skin types III and IV) patients with type A dysplastic nevus syndrome. In such individuals, the melanocytic system would be susceptible to neoplastic transformation induced by sunlight. The cutaneous response to a marked UVB erythema has been shown to identify the high-risk patients prone to light-induced skin cancer. This study indicates that the UVB cutaneous susceptibility of patients with type A dysplastic nevi is not significantly different from control subjects, in terms of erythemal and tanning response.

Transient acantholytic dermatosis in patients with cancer.

Nine patients with transient acantholytic dermatosis were seen at a hospital treating patients with cancer within less than two years. This common disorder seemed to be related to heat, fever, sweating, and bed rest, and it is important to differentiate it from a drug-induced rash.

[Bazin's hydroa vacciniforme. General review of 2 cases]. / L'hydroa vacciniforme de Bazin. Revue générale à propos de deux cas.

Hydroa vacciniform is a rare recurrent photosensitive skin condition in which deep-seated vesicles appear on sun-exposed areas and heal leaving a depressed scar. Two cases are reported, with particular emphasis on phototesting investigations. Results of blood and urine porphyrin studies were normal and no systemic abnormalities were noted. Phototesting may be viewed as an important diagnostic aid, since the induction of lesions, clinically identical to hydroa vacciniform can occur following sequential exposure to UV-A, as was the case in one of our patients.

[Mechanisms of psoralen photoreaction]. / Mécanismes de photoréaction des psoralènes.

The molecular aspects of the mode of action of psoralens is not clearly understood since two types of reactions may occur simultaneously and independently of each other, when the psoralen-treated skin is exposed to ultraviolet A radiation. Type 1 is an oxygen-independent reaction, leading directly to photoaddition of psoralen to pyrimidine bases of DNA, and type 2 is an indirect oxygen-dependent reaction involving the generation of reactive oxygen species. Thus, the psoralens can damage the cell membranes, the cytoplasmic constituents and the cell nuclei resulting in the observed phototoxic effects. The molecular mechanisms underlying the generation of free radicals and DNA damages are described, and are related to the two classes of psoralens.