Oxybutynin as a treatment for generalized hyperhidrosis: a randomized, placebo-controlled trial.

BACKGROUND: Hyperhidrosis is a disorder that can impair quality of life. Localized treatments may be cumbersome and ineffective, and no systemic treatments have proven to be significantly beneficial. OBJECTIVES: To evaluate the effectiveness and tolerance of low-dose oxybutynin for hyperhidrosis. METHODS: We conducted a prospective, randomized, placebo-controlled trial. From June 2013 to January 2014, 62 patients with localized or generalized hyperhidrosis were enrolled. Oxybutynin was started at a dose of 2·5 mg per day and increased gradually to 7·5 mg per day. The primary outcome was defined as improvement of at least one point on the Hyperhidrosis Disease Severity Scale (HDSS). Dermatology Life Quality Index (DLQI) and tolerance were also reported. RESULTS: Most patients (83%) in our study had generalized hyperhidrosis. Oxybutynin was superior to placebo in improving the HDSS: 60% of patients treated with oxybutynin, compared with 27% of patients treated with placebo, improved at least one point on the HDSS (P = 0·009). The mean improvement in quality of life measured by DLQI was significantly better in the oxybutynin arm (6·9) than in the placebo arm (2·3). The most frequent side-effect was dry mouth, which was observed in 43% of the patients in the oxybutynin arm, compared with 11% in the placebo arm. CONCLUSIONS: Treatment with low-dose oxybutynin is effective in reducing symptoms of hyperhidrosis in generalized or localized forms. Side-effects were frequent but minor and mainly involved dry mouth.

[Neutrophilic eccrine hidradenitis in a healthy patient]. / Hidradénite eccrine neutrophilique chez un sujet sain.

BACKGROUND: Neutrophilic eccrine hidradenitis occurs mostly in patients receiving chemotherapy for acute myeloblastic leukemia, rarely in healthy patients. Histopathologic pattern is characteristic and includes selective necrosis of the eccrine glands with a local neutrophilic infiltrate. CASE REPORT: We report the case of a 41 year-old woman with no medical past-history who developed during 2 years successive papulous skin eruptions. The latter always resolved spontaneously. Skin biopsy led to the diagnosis showing typical features of neutrophilic eccrine hidradenitis. DISCUSSION: Our case is original because the neutrophilic eccrine hidradenitis had occurred in a healthy woman. Neither malignant hematologic disease nor visceral cancer was disclosed in this patient in the following 31 months.

Evaluation of vaseline oil applied prior to UVB TL01 phototherapy in the treatment of psoriasis.

BACKGROUND: Use of emollient prior to phototherapy could enhance UV transmission through psoriasis plaques on the condition that the emollient is not photoprotective. Emollient pretreatment with narrow-band phototherapy (313 nm) has not been studied extensively. We conducted a study to assess if vaseline oil prior to UVB TL01, in chronic psoriasis plaques could accelerate psoriasis clearance. METHODS: Fifteen patients with chronic psoriasis plaques were enrolled in a prospective, single-blind, controlled study. For each patient, one to three symmetrical pairs of plaque were selected and scored initially and after every six exposures. RESULTS: On the vaseline oil pretreated side, significantly more plaques were cleared, especially in severe psoriasis. Scaling and infiltration were significantly improved. Application of vaseline oil was more interesting in thick and scaly psoriasis probably because the oil penetrates the intercellular space allowing an optical matching effect which increases the UV transmission. CONCLUSION: We strongly recommend vaseline oil pretreatment with UVB TL01 phototherapy in psoriasis, especially in severe psoriasis.

[Fluvastatin-induced dermatomyositis]. / Dermatomyosite induite par la fluvastatine.

BACKGROUND: Dermatomyositis is a rare inflammatory dermatosis for which an iatrogenic origin has been described in very few cases. We report a case of dermatomyositis occurring after fluvastatin intake. CASE REPORT: A 76-year-old male patient sought medical attention for a photodistributed rash and considerable muscular weakness present for one month. Two months earlier, fluvastatin had been introduced following the discovery of dyslipidemia. Serum creatine phosphokinase levels were elevated. Histological examination of a muscle biopsy was consistent with a diagnosis of dermatomyositis. Investigation for neoplasia and associated autoimmune disease proved negative. All clinical and laboratory abnormalities diminished spontaneously without recourse to corticosteroids within one month of the final intake of fluvastatin. After a follow-up period of three years, no recurrence was observed and no signs of neoplasia or connectivitis were found. DISCUSSION: Iatrogenic dermatomyositis has only been reported in rare cases. Certain drugs have been incriminated, notably D-penicillamine. Six cases of drug-induced dermatomyositis have been described with statins: simvastatin, atorvastatin, pravastatin and lovastatin. Of these cases, only one resolved spontaneously after withdrawal of the drug alone without use of corticosteroids. Our case concerns intake of fluvastatin, an HMG-CoA reductase inhibitor with rare though well-known muscular side effects: elevated serum CPK, myalgia and rhabdomyolysis. Six cases of polymyositis have also been reported. Ours is the first case of dermatomyositis described with this category of statins. It is also the second reported case showing improvement after withdrawal of the lipid-lowering agent and without corticosteroids. Thus in cases of dermatomyositis, this iatrogenic picture should be sought routinely.

[Photodistribution of varicella in an adult]. / Photodistribution d'une varicelle chez un adulte.

INTRODUCTION: Exacerbation of viral exanthema has been described after different types of aggression such as sun exposure. Photoaggravation of varicella is unusual. CASE REPORT: We report the case of a 25 year-old woman who presented with varicella mainly distributed on the neckline and the top of the back. During the viral incubation she had been sunburnt in these areas. DISCUSSION: The clinical lesions and the evolution of a photoaggravated varicella differs from those of classical varicella. The vesicles are selectively distributed on areas previously sunburned or suntanned. The more tanned or more erythematous the area is, the greater the number of lesions. They are often at the same stage of development and the course can be shortened with only one or two progressive phases. Inflammatory modifications secondary to ultraviolet exposure induces in photoexposed areas an increase in vascular flow and also an increase in capillary permeability, which can promote diapedesis of the lymphocytes or the transit of viral particles. Therefore, sun exposure during the incubation of the virus can enhance the deposit of viral pArticles in the cutaneous areas submitted actinic stress. The amount of virus in sun exposed areas is greater than in the non-exposed ones.

Is Vacuum Assisted Closure a valid technique for debriding chronic leg ulcers?

OBJECTIVE: Between May 2001 and October 2002 a prospective controlled open non-comparative study was performed to assess the effectiveness of topical negative pressure in the fibrinous debridement of chronic leg ulcers. METHOD: Fifteen leg ulcers that had not responded to several other treatment modalities were treated with the Vacuum Assisted Closure system (KCI) for six days. RESULTS: The median percentage reduction in fibrinous tissue was 28% on day three and 40% on day six. Between days one and three the percentage change was > or = 50% in four patients and > or = 25% in six patients. Between days three and six percentages of fibrin in the wound were lower in all patients, except for two who had higher percentages and two who had the same percentage. CONCLUSION: VAC therapy was rapidly efficacious, promoting angiogenesis and the formation of healthy tissue.

[Atrophic involution of juvenile xanthogranulomas]. / Involution atrophique de xanthogranulomes juvéniles.

INTRODUCTION: We report an unusual atrophic involution of juvenile xanthogranulomas. CASE REPORT: A newborn boy presented with 5 papular, nodular and necrotic lesions located on the upper part of the body. The diameter of the lesions ranged between 1 and 3 cm. Light microscopy showed an infiltrate with foamy and Touton cells. Langerhans' cell histiocytosis was eliminated because none of these cells showed reactivity for S100 protein and CD1a. At the age of 8 years, all the lesions had spontaneously regressed leaving unusual atrophic scars that had the same size as the active lesions. DISCUSSION: We compared the clinical, histological and evolution data of our patient with 251 published cases. The most significant clinical feature of juvenile xanthogranuloma is the spontaneous involution without any trace. However, hyperpigmentation, anetoderma or atrophy may occur. Atrophy is not frequent and can result from 2 mechanisms. Inflammation of the hypodermic tissue, which becomes atrophic and atrophy that may also result from collagen remodeling anomalies during the scarring process.

[An association of paraneoplastic syndromes in a patient]. / Association de syndromes paranéoplasiques chez un malade.

BACKGROUND: Erythema gyratum repens is a rare cutaneous marker for internal malignancy and the association with other paraneoplastic syndromes is not unusual. CASE REPORT: We report the case of a 54 year-old man with a three-month history of erythroderma which evolved into erythema gyratum repens; a bronchial carcinoma was discovered. Erythema gyratum repens was associated with acquired ichthyosis, hyperkeratosis of the ears and eosinophilia. Improvement of the paraneoplastic dermatosis was achieved by treatment of the underlying carcinoma with chemotherapy, surgery and radiation. However, the lesions relapsed when metastases appeared. Another regimen of chemotherapy improved the carcinoma and the dermatosis. DISCUSSION: The parallel course of the carcinoma and the cutaneous eruption strongly supports the diagnosis of a cutaneous paraneoplastic syndrome. Three months prior to erythema gyratum repens, the patient developed a scaling erythroderma. This unusual early manifestation is misleading. Our case highlights the possible association of different paraneoplastic syndromes: initially scaling erythroderma, followed by erythema gyratum repens associated with acquired ichthyosis, hyperkeratosis of the ears and eosinophilia.