[A new treatment for androgenetic alopecia : platelet-rich plasma injections]. / Un nouveau traitement de l'alopécie androgéno-génétique : les injections dans le cuir chevelu de plasma riche en plaquettes (PRP) autologue.

Androgenic alopecia is a genetically determined and leads to a progressive hair loss of the vertex, affecting both men and women. It is related to an important psychological and social distress. Medical therapies include topical minoxidil, oral 5?-reductase inhibitors and oestroprogestative drugs with anti-androgen effects for women. The surgical option is autograft hair transplantation. Recently, phototherapy with low-level energy lasers became available. All these treatments may present adverse effects and their effectiveness is questionable. Subcutaneous injections of autologous platelet-rich plasma into the scalp represent an interesting alternative treatment for androgenetic alopecia, as monotherapy or as an adjuvant treatment. The methodology, the possible mechanisms of action and some initial clinical results of this treatment are presented.

L'alopécie androgéno-génétique se manifeste par une perte progressive des cheveux du sommet du cuir chevelu, touchant aussi bien l'homme que la femme. Ses impacts sociaux et psychologiques négatifs sont souvent très importants. Elle peut se traiter par des médicaments (minoxidil topique, inhibiteurs de la 5?-réductase per os, oestroprogestatifs à visée anti-androgénique chez la femme), par des techniques chirurgicales d'autogreffes capillaires, ou encore, par photothérapie avec des lasers de basse énergie. Tous ces traitements ne sont pas dénués d'effets indésirables et leur efficacité n'est pas constante. Les injections sous-cutanées de plasma riche en plaquettes autologue dans le cuir chevelu peuvent constituer un traitement efficace de l'alopécie androgéno-génétique, en monothérapie ou comme adjuvant. Les modalités techniques, les modes d'action potentiels et les principaux résultats cliniques obtenus à ce jour sont présentés.

[Mitral prolapse and sudden death. A case report]. / Prolapsus mitral et mort subite : à propos d'un cas.

The association between the mitral valve prolapse and the sudden Cardiac Death remains controversial, the high prevalence of this valvulopathy contrasting with the low incidence of sudden death in this population. We report the case of a 54-year-old woman admitted for a sudden cardiac death, revealing a bi-prolapse with low-grade leakage, leading to the implantation of a subcutaneous automatic defibrillator. Combined echocardiography and cardiac MRI can identify the mitral annular disjunction, the rolling motion of the posterior face of the mitral annulus towards the myocardium, and the myocardial fibrosis of the inferolateral wall induced by streching forces of the sub valvular apparatus, that may lead to ventricular arrhythmias. More than the conventional clinical parameters (young woman, ventricular premature beats with a right bundle branch block morphology, mitral bi-prolapse), mitral annular disjunction and myocardial fibrosis are to be considered as powerful markers of the rhythmic risk of mitral prolapse and must be systematically sought and integrated into the prognostic evaluation of these patients. In the absence of randomised trials, therapeutic management is difficult especially in primary prevention, and needs Heart Team advice.

[Pathergic postsurgical-induced Pyoderma gangrenosum]. / Le cas clinique du mois. Pyoderma gangrenosum pathergique post-chirurgical.

Pyoderma gangrenosum (PG) is a rare pustular and ulcerative inflammatory disease belonging to the group of neutrophilic dermatoses. It is frequently associated with systemic immune diseases. In this context the PG can be exceptionally triggered by tissue trauma such as surgery (pathergy). We report the case of a patient with stabilized rheumatoid arthritis who developed aggressive and disseminated PG at all surgical wounds following an abdominal dermolipectomy associated with breast pexy. Systemic corticosteroid methylprednisolone allowed a rapid control of skin ulcerations. In the aftermath of an intervention, PG is often confused with a bacterial skin-necrotizing panniculitis. The recognition of the inflammatory nature of cutaneous symptoms is crucial to quickly start an immunosuppressive treatment and limit scarring sequelae. Our case also illustrates the need to consider any history of dysimmune inflammatory or oncohematological disease as a risk factor before surgery, even if the latter are stabilized.

Le Pyoderma gangrenosum (PG) est une pathologie inflammatoire pustuleuse et ulcérative rare appartenant au groupe des dermatoses neutrophiliques. Elle est fréquemment associée à une maladie systémique dysimmunitaire. Dans ce contexte, le PG peut être exceptionnellement déclenché par un traumatisme tissulaire tel qu'une intervention chirurgicale (pathergie). Nous rapportons le cas d'une patiente atteinte de polyarthrite rhumatoïde peu active, mais ayant développé un PG agressif et disséminé au niveau de toutes les plaies opératoires à la suite d'une dermolipectomie abdominale associée à une pexie mammaire. Une corticothérapie systémique à base de méthylprednisolone a permis un contrôle rapide des ulcérations cutanées. En post-opératoire, le PG est très souvent confondu avec une dermo-hypodermite bactérienne nécrosante. La reconnaissance du caractère inflammatoire de la symptomatologie cutanée est cruciale afin d'entamer rapidement un traitement immunosupresseur et de limiter les séquelles cicatricielles. Notre cas clinique illustre aussi la nécessité de prendre en compte les antécédents de pathologies dysimmunitaires inflammatoires ou onco-hématologiques comme facteurs de risque avant toute intervention chirurgicale, même si ces dernières sont stabilisées et peu actives.

A preliminary spatial assessment of risk: Marine birds and chronic oil pollution on Canada's Pacific coast.

Chronic oil pollution poses substantial risks to marine birds and other marine wildlife worldwide. On Canada's Pacific coast, the negative ecological consequences to marine birds and marine ecosystems in general remain poorly understood. Using information relating to oil spill probability of occurrence, areas of overall importance to marine birds, and the at-sea distribution and density of 12 marine bird species and seven bird groups, including multiple Species at Risk, we undertook a spatial assessment of risk. Our results identify two main areas important to marine birds potentially at higher risk of exposure to oil. For individual bird species or species groups, those predicted to have elevated bird densities near the mainland and the northeast coast of Vancouver Island were identified as being at higher potential risk of exposure. Our results, however, should be considered preliminary. As with other anthropogenic stressors, in order to better understand and subsequently mitigate the consequences of chronic oil pollution on marine birds, improved information relating to marine birds and the occurrence of oil spills on Canada's Pacific coast is needed.

[How I explore . HLA class II by ultrastructure in toxic epidermal necrolysis]. / Comment j'explore les HLA de classe II par ultrastructure dans la nécrolyse épidermique toxique.

Toxic epidermal necrolysis (TEN, Lyell syndrome) is a severe paroxystic drug reaction whose inductive mechanisms remain poorly understood. The HLA glycoproteins are possibly involved in the disease process. Such investigations rely on biomolecular methods, and suggest specific interactions between some drugs or their metabolites and some HLA groups according to ethnicity of the TEN patients. Electron microscopy following the immunogold method for revealing HLA-DR did not disclose any evidence for distinguishing distinct patterns on Langerhans cell membrane between the initial and the resolution phases of TEN.

La nécrolyse épidermique toxique (NET, syndrome de Lyell) est une toxidermie paroxystique grave dont les mécanismes inducteurs restent mal élucidés. Les glycoprotéines HLA ont été potentiellement impliquées dans ce processus. Leur étude a bénéficié des méthodes biomoléculaires qui suggèrent des interactions spécifiques entre certains médicaments ou leurs métabolites et certains HLA en fonction du groupe ethnique du patient atteint de NET. La microscopie électronique, par la méthode «immunogold¼ afin d'évaluer les HLA-DR, n'a pas révélé de différences notoires dans leur distribution sur la paroi de cellules de Langerhans entre la phase initiale et celle de résolution de 5 cas de NET.

Recent advances in toxicological testing of the stratum corneum.

α-Hydroxy acid (AHA) formulations are commonly used for skin chemical peelings. The primary target is the stratum corneum (SC). The aim of this study was to assess the effects of various glycolic acid concentrations and commercial phenolic acid formulations on the SC. Quantitative colorimetry of a corneoxenometry bioassay was used. The test procedure involved glycolic acid concentrations ranging from 3% to 70% in alcoholic solution. Exposure times were set for 1 min and 3 min. The bioassay showed consistent reactivity with a dose-effect relationship when using the selected low exposure times. In a similar procedure the aggressiveness of commercially available phenolic acid formulations was identified not using hazardous in vivo testing. Corneoxenometry appears useful for in vitro testing of AHA peeling agents during short exposure times.

Skin viscoelasticity during hormone replacement therapy for climacteric ageing.

BACKGROUND: Climacteric ageing refers to the period of women's life centred by the perimenopause. This step of life is responsible for initiating skin atrophic withering and slackness responsible for changes in the viscoelasticity of the dermal connective tissue. Some women benefit from hormone replacement therapy (HRT) for controlling some unpleasant internal climacteric changes (osteoporosis, vasomotor instability, …). OBJECTIVE: To investigate some corrective effects of HRT on the functional damages in the dermal tensile strength. PATIENTS AND METHODS: This study was performed on 200 healthy Caucasian women. In vivo skin viscoelasticity was assessed using the suction method. RESULTS: Skin distensibility and hysteresis appeared increased at menopause with or without HRT. By contrast, the biological elasticity significantly decreased out of HRT. CONCLUSION: Some drugs and cosmetics might attempt at improving such viscoelastic attributes of the skin at menopause.

Toxic Epidermal Necrolysis and Graft-versus-Host Reaction: Revisiting a Puzzling Similarity.

Drug-induced toxic epidermal necrolysis (TEN) and acute cutaneous graft-versus-host reaction (GVHR) under immunopreventive therapy share some histopathological resemblance. So far, there are no serum biomarkers and no immunohistochemical criteria distinguishing with confidence and specificity the skin lesions of TEN and GVHR. Both diseases present as an inflammatory cell-poor necrotic reaction of the epidermis. This report compares three sets of 15 immunostaining patterns found in TEN, GVHR, and partial thickness thermal burns (PTTB), respectively. Three series of 17 skin biopsies were scrutinized. Irrespective of the distinct causal pathobiology of TEN and GVHR, similar secondary effector cells were recruited in lesional skin. Burns were less enriched in cells of the monocyte-macrophage disease. These cells likely exert deleterious effects in TEN and GVHR and cannot be simply regarded as passive bystanders. These life-threatening conditions are probably nursed, at least in part, by macrophages.

Temporal variation in site fidelity: scale-dependent effects of forage abundance and predation risk in a non-migratory large herbivore.

Large herbivores are typically confronted by considerable spatial and temporal variation in forage abundance and predation risk. Although animals can employ a range of behaviours to balance these limiting factors, scale-dependent movement patterns are expected to be an effective strategy to reduce predation risk and optimise foraging opportunities. We tested this prediction by quantifying site fidelity of global positioning system-collared, non-migratory female elk (Cervus canadensis manitobensis) across multiple nested temporal scales using a long-established elk-wolf (Canis lupus) system in Manitoba, Canada. Using a hierarchical analytical approach, we determined the combined effect of forage abundance and predation risk on variation in site fidelity within four seasons across four nested temporal scales: monthly, biweekly, weekly, daily. Site fidelity of female elk was positively related to forage-rich habitat across all seasons and most temporal scales. At the biweekly, weekly and daily scales, elk became increasingly attached to low forage habitat when risk was high (e.g. when wolves were close or pack sizes were large), which supports the notion that predator-avoidance movements lead to a trade-off between energetic requirements and safety. Unexpectedly, predation risk at the monthly scale increased fidelity, which may indicate that elk use multiple behavioural responses (e.g. movement, vigilance, and aggregation) simultaneously to dilute predation risk, especially at longer temporal scales. Our study clearly shows that forage abundance and predation risk are important scale-dependent determinants of variation in site fidelity of non-migratory female elk and that their combined effect is most apparent at short temporal scales. Insight into the scale-dependent behavioural responses of ungulate populations to limiting factors such as predation risk and forage variability is essential to infer the fitness costs incurred.

[Perioperative nutrition - a nationwide web-based survey of German surgery departments]. / Perioperative Ernährung aus Sicht von Chirurgen - Eine deutschlandweite Online-Umfragen.

BACKGROUND: Insufficient nutrition in surgical patients increases perioperative morbidity, mortality, length of stay and therapy costs. Therefore, guidelines declare the integration of nutrition into the overall management as one of the key aspects of perioperative care. This study was conducted to evaluate the current clinical practice of clinical nutrition in surgical departments in Germany. METHODS: In 2009 German Surgical Society (DGCH) members in leading positions were surveyed with a standardised online questionnaire concerning their perioperative nutritional routines in elective surgery. RESULTS: From the addressed physicians n = 156 (6.24 %) answered. Of those, 86.9 % consider the nutritional status of their patients. Only 6 % use standardised nutritional screening tools. Short preoperative fasting for solid and liquid food is practiced by 65 % and 40 %, respectively. After the operation, 65 % allow intake of clear fluids on the day of surgery and 78 % initiate solid food on the day of surgery or the first postoperative day. Oral nutritional supplements are given only "sometimes" or "rarely" by 53.9 % of the respondents. CONCLUSION: The low response rate may imply the dilemma that the evidence-based benefit of perioperative nutrition does not meet sufficient interest. Even in case of a positive selection of "pro-nutrition respondents", standardised preoperative malnutrition screening is also rare. Aspects such as shorter perioperative fasting are already practiced more progressively. However, still greater efforts are needed to promote guideline-based clinical nutrition in surgical care in Germany.

[How I treat ... some skin conditions by cooling]. / Comment je traite ... certaines pathologies cutanées par le froid.

Cold application to the skin is commonly used in dermatology. The modalities of application are diversified and condition the temperature reached in the skin and the therapeutic result. Hense, the term cryotherapy without further precision remains little informative. The sensibility to cold of the diverse types of cutaneous cells is heterogeneous, as well as that of healthy and neoplastic tissues.

[Actinic keratosis in tune with field photocarcinogenesis. A revisited concept]. / La kératose actinique au diapason de la photocarcinogenèse en champs. Un concept revisité.

Actinic keratosis should no more be considered as a single neoplasm calling for an individual treatment. The concept of actinic photocarcinogenesis presently turns upside down the perception of skin cancers induced by nonionizing electromagnetic radiations. Currently, the clinician should cope with the whole skin area that has been damaged by chronic exposures to the visible and the invisible spectrum of the light. The therapeutic archetypes are 5-fluorouracile 5% and imiquimod 5% carefully applied to the skin area.

[Primary and secondary prevention of skin cancers]. / Prévention primo-secondaire des cancers cutanés.

The occurrence of the vast majority of skin cancers depends on the environment, in particular on exposure to ultraviolet light radiations. Several modalities of primary and secondary prevention are possible. The first modality relies on proper covering or remaining hidden under shadow. Textiles exhibit some photoprotective function the efficacy of which depends on their nature and diverse modulating factors. Sun protection cream, some food habits, the intake of non steroidal anti-inflammatory drugs, and that of specific food complements are supposed to be beneficial at various levels.

[How I explore...a skin tumor in a transplant patient]. / Comment j'explore...une tumeur cutanée chez un transplanté.

Immunosuppressive therapy associated with organ transplant leads to an increased risk to develop skin cancers. In such circumstances, squamous cell carcinomas and basal cell carcinomas represent the most frequent tumors. Other neoplasms include malignant melanoma, Merkel cell carcinoma and Kaposi disease. Histopathology is primordial in the establishment of the diagnosis. In addition, bioengineering devices and skin imaging methods are useful in establishing the risk of cancers and for detecting incipient tumoral lesions.

Spotlight on adapalene.

BACKGROUND: In the field of dermatology, topical retinoids represent a mainstay in acne treatment. Adapalene is a naphthoic acid derivative showing some pharmacological activities similar to the regular retinoids. The drug is used singly or in combination for treating acne and a few other miscellaneous skin disorders. OBJECTIVE: To critically review the pharmacokinetic, pharmacologic aspects and clinical benefits and adverse effects associated with topical adapalene. METHOD: A systematic literature review was conducted primarily based on PubMed citations. RESULTS/CONCLUSIONS: Adapalene shares some biological activities in common with retinoic acid. However, it exhibits distinct physicochemical and binding properties for selective retinoic acid receptors. In acne, adapalene is expected to reduce comedogenesis, expel mature comedones and exert some anti-inflammatory effects. The drug is effective as monotherapy in mild comedonal acne and in combination with benzoyl peroxide for mild-to-moderate inflammatory acne. The safety profile of adapalene is good. Indeed, only discrete to moderate adverse events including erytheme, xerosis, itching and stinging may develop during the early treatment phase. Clinical experience has established that adapalene represents a valuable addition to the other current treatments for acne.

[A range of targeted treatments using monoclonal antibodies in dermatology. Current and future practice]. / Panoplies des thérapies ciblées par anticorps monoclonaux en dermatologie. Actualité et prospectives.

Targeted therapies are focused on one or a few molecules particularly involved in specific diseases. Some inflammatory dermatoses and cutaneous neoplasia potentially benefit from these approaches. Nine monoclonal antibodies of interest in dermatology are presented according to the disorders where they have proven their efficacy. Biotherapies extend beyond monoclonal antibodies. A given effect, such as TNF-alpha antagonism, is indeed obtained by distinct drug classes. The interindividual differences in the therapeutic responses remain unpredictable, and there is no criteria of selection of patients who could benefit the most from these targeted medications.

[Cutaneous adverse effects predicting the efficacy of targeted antineoplastic therapies]. / Le paradoxe des effets cutanés indésirables, mais prédictifs de l'efficacité des thérapies ciblées anticancéreuses.

A series of medical disciplines benefit from the emergence of diverse targeted therapies using monoclonal antibodies. Skin is affected by adverse events of such therapies primarily targeting internal cancers. As a unique event in medicine, some of the skin adverse effects are predictive markers of the therapeutic antineoplastic activity. This fact concerns the paroxismal acneiform eruption and the inflammatory flare-up of actinic keratoses. Such a situation is linked to the fact that these specific "unwanted" effects are not really side effects but rather represent the direct pharmacological consequence of the activity directed to the EGF receptors which are particularly abundant in the follicular ostium and in precursor lesions to skin carcinomas.

[Case of the month. Acute generalized exanthematous pustulosis due to an iodinated contrast radiodiagnostic agent]. / Le cas clinique de mois. Pustulose exanthématique aiguë généralisée due a un agent de contraste iodé pour radiodiagnostic.

Iodinated contrast agents are frequently involved in delayed polymorphic adverse skin reactions. Acute generalized exanthematous pustulosis following administration of iodinated contrast agents is a rare but severe form of such reactions. The disease is characterized by the sudden occurrence of an erosive and pustular erythroderma with fever, leukocytosis and sometimes peripheral adenopathies and liver involvement. This condition is considered as an immunologic reaction, primarily involving T lymphocytes. The overall mortality reaches about 1%. Elucidating the differential diagnosis with other acute paroxysmal drug eruptions (toxic epidermal necrolysis, Steven-Johnson syndrome and drug hypersensitivity syndrome) is of paramount importance for establishing the adequate treatment of PEAG.