Benefits of Avène thermal hydrotherapy in chronic skin diseases and dermatological conditions: an overview.

The beneficial effects of Avène Thermal Spring Water (TSW), a low mineral content spring water, on chronic skin diseases have been recognized for more than two centuries. This article provides a brief overview of efficacy and tolerance data for Avène TSW from clinical studies conducted at the Avène Hydrotherapy Center in patients with chronic inflammatory skin diseases or temporary skin injuries. Avène TSW hydrotherapy is effective as adjuvant management for chronic skin diseases and dermatological conditions, relieving subjective and physical symptoms with excellent tolerance.

Dermatology today and tomorrow: from symptom control to targeted therapy.

For many decades and until recently, medical approach to dermatologic diseases has been based on the physician's ability to recognize and treat symptoms. Nowadays, advances in the understanding of the biology of diseases and in technologies for intervening against them have allowed physicians to diagnose and treat underlying disease processes rather than simply addressing the symptoms. This means that rather than addressing 'the disease in humans', physicians can now address the particular pathologic (biologic, molecular) disturbance as it presents in the individual patient, i.e., physicians now can practice something much closer to 'personalized medicine', leading to greater benefits for the patients and the health of society in general. The deeper understanding of ultraviolet radiation, the importance of photoprotection and increased knowledge about signalling pathways of melanoma and carcinoma have led to more complete care for the dermatologic patient. The current popularity for excessive exposure to the sun, without adequate application of the appropriate photoprotection remedies, is the origin of melanoma, but also for the weakening of the structure and functions of the skin. Indeed, fragility of the skin can affect humans around the world. In the senior population, this skin fragility is accompanied by pruritus, whereas atopic dermatitis is an inflammatory disease with highest prevalence in children and adolescents. Acne, the number one reason for dermatologic consultations worldwide, increases its prevalence in adolescents and in females. Senescent alopecia affects humans after menopause and andropause. The articles in this publication present an overview of the current advanced understanding of the diagnosis and therapeutic approaches in 6 fields of dermatology - dermatopaediatry and gerontodermatology, oncodermatology, hair loss, atopic dermatitis, photoprotection and acne - and thereby serve as a useful compendium of updated information and references for all healthcare professionals who see patients with presentations of the symptoms of these diseases.

[Skin hydration and hydrating products]. / Hydratation cutanée et produits hydratants.

One of the skin's principal functions is to protect the body against its environment by maintaining an effective epidermal barrier, not only against external factors, but also to prevent water loss from the body. Indeed, water homeostasis is vital for the normal physiological functioning of skin. Hydration levels affect not only visible microscopic parameters such as the suppleness and softness of skin, but also molecular parameters, enzyme activities and cellular signalling within the epidermis. The body is continually losing some of its water, but this phenomenon is limited and the optimal hydration gradient in skin is ensured via a set of sophisticated regulatory processes that rely on the functional and dynamic properties of the uppermost level of the skin consisting of the stratum corneum. The present article brings together data recently acquired in the fields of skin hydration and the characterisation of dehydrated or dry skin, whether through study of the regulatory processes involved or as a result of changes in the techniques used for in situ measurement, and thus in optimisation of management.

A self-assembling peptide matrix used to control stiffness and binding site density supports the formation of microvascular networks in three dimensions.

A three-dimensional (3-D) cell culture system that allows control of both substrate stiffness and integrin binding density was created and characterized. This system consisted of two self-assembling peptide (SAP) sequences that were mixed in different ratios to achieve the desired gel stiffness and adhesiveness. The specific peptides used were KFE ((acetyl)-FKFEFKFE-CONH2), which has previously been reported not to support cell adhesion or MVN formation, and KFE-RGD ((acetyl)-GRGDSP-GG-FKFEFKFE-CONH2), which is a similar sequence that incorporates the RGD integrin binding site. Storage modulus for these gels ranged from ∼60 to 6000Pa, depending on their composition and concentration. Atomic force microscopy revealed ECM-like fiber microarchitecture of gels consisting of both pure KFE and pure KFE-RGD as well as mixtures of the two peptides. This system was used to study the contributions of both matrix stiffness and adhesiveness on microvascular network (MVN) formation of endothelial cells and the morphology of human mesenchymal stem cells (hMSC). When endothelial cells were encapsulated within 3-D gel matrices without binding sites, little cell elongation and no network formation occurred, regardless of the stiffness. In contrast, matrices containing the RGD binding site facilitated robust MVN formation, and the extent of this MVN formation was inversely proportional to matrix stiffness. Compared with a matrix of the same stiffness with no binding sites, a matrix containing RGD-functionalized peptides resulted in a ∼2.5-fold increase in the average length of network structure, which was used as a quantitative measure of MVN formation. Matrices with hMSC facilitated an increased number and length of cellular projections at higher stiffness when RGD was present, but induced a round morphology at every stiffness when RGD was absent. Taken together, these results demonstrate the ability to control both substrate stiffness and binding site density within 3-D cell-populated gels and reveal an important role for both stiffness and adhesion on cellular behavior that is cell-type specific.

Simultaneous cutaneous infection due to Paecilomyces lilacinus and Alternaria in a heart transplant patient.

Paecilomyces lilacinus is an emerging pathogen in immunocompromised patients. We report here a case of cutaneous hyphomycosis in a 63-year-old heart transplant recipient caused by the simultaneous presence of 2 molds: Paecilomyces lilacinus and Alternaria alternata. The infection was successfully treated with local voriconazole followed by oral terbinafine.

Sensitive skin in Europe.

INTRODUCTION: Sensitive skin appears as a very frequent condition, but there is no comparative data between countries. OBJECTIVES: To perform an epidemiological approach to skin sensitivity in different European countries. METHODS: An opinion poll was conducted in eight European countries: Belgium, France, Germany, Greece, Italy, Portugal, Spain and Switzerland. This sample (4506 persons) was drawn from a representative sample of each population aged 15 years or older. RESULTS: Sensitive or very sensitive skin was declared by 38.4% and slightly or not sensitive skin by 61.6%. Women declared more sensitive skin than men. A dermatological disease was declared by 31.2% of people with very sensitive skin, 17.6% of those with sensitive skin, 8.7% of those with slightly sensitive skin and 3.7% of those who do not have sensitive skin. A history of childhood atopic dermatitis was more frequent in patients with sensitive or very sensitive skin. The interviewees who declared that they had dry or oily skin also reported significantly more frequently sensitive or very sensitive skin than those with normal skin. Sensitive and very sensitive skins were clearly more frequent in Italy and France. DISCUSSION: This study is the first study that compares skin sensitivity in European countries. Prevalence is high, but significant differences are noted between these countries. Dermatological antecedents (or treatments?) could be involved in the occurrence of skin sensitivity.

[Tolerance of the association sucralfate / Cu-Zn salts in radiation dermatitis]. / Tolérance de l'association de sucralfate / sels de Cu-Zn dans les radiodermites.

The aim of this study was to evaluate the tolerance of topical application of the combination sucralfate / copper zinc salts in radiation dermatitis in women suffering from breast cancer and treated by radiotherapy. 47 patients (average age : 57,5 years) that have to be treated by radiation therapy on non lesional areas, were included into this open multicentric study. They had to apply Cicalfate cream twice a day, from the fi rst radiation therapy session and during 10 weeks. Patients were treated by photon- or electrontherapy (72 % et 28 %, respectively; cumulated total dose : 58,6Gy). Tolerance was considered to be excellent. The radiation dermatitis (score NCIC > or = 2) was noted at the 3rd week of radiotherapy only in 5 % of the subjects and in 53 % of the subjects, the last week of treatment. Pruritus was significantly increased at D21. Pain and discomfort were increased at D28, but remained low intensity. The soothing effect of the combination of sucralfate/ copper zinc salts were considered satisfying or very satisfying by investigators and patients during the study, varying from 94 to 100 % of satisfaction. The impact of radiation therapy on the patients'quality of life, assessed by DLQI, evaluated at the end of the study was not statistically different from the score calculated at D7 (DLQI=0,8 et D7 versus DLQI=1 at D70). Thus, topical application of the combination sucralfate / copper zinc salts can be used in the indication radiation dermatitis.

[Medical corrective make-up in post- chemotherapy]. / Maquillage correcteur médical en post chimiothérapie.

INTRODUCTION: Medical corrective make up can be applied to hide the adverse effects of cancer treatments. The aim of this study was to evaluate the tolerance and the satisfaction of patients needing medical make up to hide the cutaneous side effects induced by chimiotherapy and to improve self-esteem. METHODS: 90 cancer patients were included in this multicentric study. They were being treated by chimiotherapy and had eyebrow alopecia, complexion changes, irregular lip contour or lip dryness. They were made up by socio-esthecians. Photos were taken before and after applications of make up. The patients had to fill in a self-questionnaire at home. The duration of the study varied from 1 to 4 weeks. RESULTS: Included patients were 52 years old. Tolerance was considered to be satisfactory or very satisfactory by 95,4% and 98,9% of the patients for eyebrow pencil corrector and the dual lip and contour corrector, respectively. Questions on quality of live and self-esteem revealed that the medical corrective make up improved the quality of life in general for 81,2% of the patients. This product range enhanced the self-esteem of 76,8% of the patients. Cosmetic agreement was highly satisfactory. CONCLUSION: In this study in which patients were suffering from cancer and treated by chimiotherapy, we showed that medical corrective make up can improve the quality of life with a very good tolerance.

[Clinical and psychological correlation in acne: use of the ECLA and CADI scales]. / Corrélation clinique et psychologique dans l'acné: utilisation des grilles ECLA et CADI.

BACKGROUND: The psychological consequences of acne are frequently unrelated to the severity of the actual lesions. Thus, a number of scales have been designed and validated to allow quantitation of the severity of acne, such as the ECLA scale (Echelle de Cotation des Lésions d'Acné or Acne Lesion Score Scale) while others are designed to evaluate quality of life, such as the CADI (Cardiff Acne Disability Index) questionnaire recently validated in the French language. The purpose of this study was to use both of these scales in individual applications in order to determine whether or not any correlation exists between the two specific tools and to determine the two groups of patients affected by acne. METHODS: One hundred and twenty-eight acne patients (21+/-6.8 years) seen by seven dermatologists were included in this study. The severity of their acne was evaluated using the ECLA scale; the seven participating dermatologists were trained in the use of this scoring system. In addition, patients completed the CADI quality-of-life questionnaire after their consultation. Each factor on the ECLA was compared with each item in the CADI questionnaire by means of analysis of variance. RESULTS: There was no correlation between overall scores on the ECLA and CADI scales (r(2)=0.0242). However, a positive correlation was observed between overall CADI score and factors F1 and F3 in the ECLA scale (p=0.0085 and p=0.0373 respectively). In contrast, the global score on the ECLA scale was significantly correlated with item 5 of the CADI questionnaire, namely patients' perception of their acne (p=0.0035). CONCLUSION: Acne, even in mild forms, has a detrimental psychological effect on patients. The ECLA score coupled with the CADI assessment system appear to be two useful and complementary scores for use in complete acne patient management.

Sensitive skin: psychological effects and seasonal changes.

INTRODUCTION: Sensitive skin is a frequent disorder, but its effects and its variability are unknown. OBJECTIVES: To investigate the effects of sensitive skin first on quality of life and the psyche, and secondly, on seasonal changes. METHODS: The French Opinion Poll Institute (IPSOS) conducted two opinion polls in March and July 2004. Samples included, respectively, 1006 and 1001 individuals, from a representative national sample of the French population aged 15 years or older. The polling subjects were interviewed by phone and selected by the quota method (gender, age, occupation of household head, type of geographical area and region). Questions about their perception of their sensitive skin and about potential aggravating factors were asked. Quality of life was assessed using the SF-12 questionnaire and depressive symptoms using the Hospital Anxiety and Depression (HAD) rating scale. RESULTS: The characteristics of the two samples were strictly similar. Persons with sensitive skin and very sensitive skin were more numerous in summer than in winter. In both surveys, the degree of sensitivity was significantly higher in the female population. Quality of life was worse in people with sensitive or very sensitive skin, above all in its psychological component - the more sensitive the skin, the more the quality of life deteriorated. There was no significant relationship between depressive symptoms and skin sensitivity in the 'very sensitive' or 'sensitive' groups. CONCLUSION: Our study was the first to show seasonal changes in skin reactivity and to study the psychological impacts of sensitive skin.

ECCA grading scale: an original validated acne scar grading scale for clinical practice in dermatology.

INTRODUCTION: The ECCA grading scale (échelle d'évaluation clinique des cicatrices d'acné) is a tool designed to help dermatologists to assess the severity of acne scars and to standardize the discussions about the treatments of scars. METHODS: We developed an acne scar clinical grading scale called ECCA, which consists of 6 items designed to assess easily and quickly the severity of acne scars by a global score. The interobserver reliability of the ECCA grading was statistically validated. RESULTS: The statistical analysis showed the interinvestigator reliability of the ECCA grading scale among 7 dermatologists who used it on the same group of 10 acne patients. CONCLUSION: ECCA is a new tool which will now be available for dermatologists to use in their everyday practice and for clinical trials evaluating the efficacy of treatments on acne scars.

Comparative study of the anti-aging effect of retinaldehyde alone or associated with pretocopheryl in a surviving human skin model submitted to ultraviolet A and B irradiation.

In the past few years, the cellular effects of ultraviolet (UV) irradiation induced on skin have become increasingly recognized. Indeed, it is now well known that UV irradiation induces structural and cellular changes in all the compartments of skin tissue. Our aim was to study the anti-aging efficacy of a cosmetic cream containing 0.05% retinaldehyde associated with an antioxidant such as pretocopheryl in comparison with a cream containing only 0.05% retinaldehyde. For this purpose, an ex vivo technique using human skin was used to approximate in vivo metabolic conditions. In this model, human skin was maintained alive by organ culture for 14 days and skin aging was simulated with UV irradiation. Creams were applied to the surface of the epidermis and were compared with nontreated skin. After 14 days, free radical modulation was analyzed by hydroperoxide dosage. Epidermal (laminin) and dermal changes (elastic fibers and collagen) were studied by a histological method. Moreover, to examine collagen synthesis, tritiated proline was added to the culture medium and its incorporation in the newly synthesized collagen was evaluated by Webster's method. The formula containing 0.05% retinaldehyde and pretocopheryl significantly decreased UV-generated free radicals. Repair of laminin, elastic fiber and collagen network was significant and the results were better than those obtained with retinaldehyde alone. An increase of collagen synthesis was also shown with the two creams.

[Sensitive skin in France: an epidemiological approach]. / Peaux sensibles en France: approche épidémiologique.

INTRODUCTION: Sensitive skin is a frequently evoked cosmetic disorder, but its prevalence in France is unknown. METHODS: Using a survey of a representative sample of the French population aged over 15 carried out by ISPSOS-Santé, we assessed the frequency of sensitive skin. We used the quota method (gender, age, occupation of the head of the family) and stratification by area and category of the agglomeration. RESULTS: One thousand and six persons were surveyed. The non-response rate was less than 1 p.cent. Fifty-two percent claimed they had sensitive or very sensitive skin. Women were predominantly concerned (59 vs. 44 p.cent, p<0.0001). There was no significant difference between the socio-professional categories. Twenty-eight p.cent of the population claiming their skin was very sensitive declared they had a concomitant dermatological disease, whereas 14 p.cent with sensitive skin, 7 p.cent with not very sensitive skin and 2 p.cent with normal skin declared likewise. Skin sensitivity was triggered by emotion, cold, heat or cosmetics. A quality-of-life assessment using the SF-12 scale showed significant alteration in the psychological dimension (but not physical) of the score for those with sensitive and very sensitive skin compared with the others, notably in the women (p<0.0001). DISCUSSION: This survey revealed a prevalence of sensitive skin in France equal to that found in England. It only measured the subjective feeling of sensitive skin experienced by those surveyed, since there was no clinical examination. The phenomenon appears frequent. Although women appeared to suffer more, a large proportion of men also suffered from sensitive skin.

Efficacy of sunscreens containing pre-tocopheryl in a surviving human skin model submitted to UVA and B radiation.

The aim of the present study was to evaluate by means of histological and biochemical tools the additive efficacy of pre-tocopheryl during photoprotection using a sunscreen containing mineral sunblock agents 50B-10A (TiO(2), ZnO) and pre-tocopheryl in comparison to a cream containing only mineral sunblock agents 50B-10A. For this purpose, an ex vivo technique and an acetone-impaired human skin model were used in order to approximate in vivo metabolic conditions. Creams were topically applied to the surface of the epidermis and submitted to UV radiations. Then, human skin explants were maintained alive in organ culture for 3 days. Free radical modulation was analysed by hydroperoxide assay. Epidermal (involucrin, cell proliferation, stratum corneum lipids) and dermal changes (elastic fibres and collagen) were studied. Analysis of ex vivo surviving skin samples impaired by UV irradiations and treated with the mineral sunscreen 50B-10A showed a significant decrease in hydroperoxide production and an improvement in the elastic fibre and collagen network in the dermis. Adding pre-tocopheryl to this formula induced an increase in involucrin and epidermal lipids such as squalenes and ceramides. Altogether, these results confirm the efficacy of the combination of a mineral sunscreen and pre-tocopheryl in photoprotection and free radical protection.

Topical retinaldehyde with glycolic acid: study of tolerance and acceptability in association with anti-acne treatments in 1,709 patients.

BACKGROUND: Retinaldehyde (RAL), a key metabolite between vitamin A and retinoic acid, acts by modulating differentiation and proliferation of keratinocytes, which is of interest in acne lesions, mainly retentional lesions. Glycolic acid increases the exfoliation of corneocytes explaining its mild activity on retentional lesions. Thus, RAL and glycolic acid combined in the same product (Diacneal) have complementary activities which can be of interest for acne patients. The aim of this study was to evaluate the tolerance of Diacneal used by 1,709 acne patients in combination with their usual acne products except retinoids. RESULTS: This study demonstrated a very good tolerance of Diacneal when used with other acne treatments for 90 days. Complaints about side-effects were rare. Moreover, the significant decrease in both inflammatory and retentional lesions between day 0 and day 90 indicates that Diacneal could amplify the efficiency of other anti-acne products used at the same time by the patients. The subjective evaluation of the preparation's efficacy by investigators and patients was strongly favourable. CONCLUSION: These data show that a combination of RAL 0.1% and glycolic acid 6% may be used in association with other topical anti-acne treatments (benzoyl peroxide and topical antibiotics) with an excellent tolerance.