[Alcohol and the skin]. / L'alcool et la peau.

Cutaneous manifestations related to alcohol intake and abuse are various. Most frequently, there are vascular lesions and cutaneous alterations secondary to hepatic dysfunction. Alcohol consumption represents also a risk factor for many cutaneous diseases, such as psoriasis, where its prevalence is high. Other cutaneous complications associated with alcohol are also discussed.

Les manifestations cutanées en relation avec la consommation et l'abus d'alcool sont multiples. Il s'agit essentiellement de manifestations vasculaires et de signes cutanés en relation avec l'atteinte hépatique. La consommation d'alcool constitue, par ailleurs, un facteur aggravant de plusieurs maladies cutanées. C'est notamment le cas pour le psoriasis, dont la prévalence est plus élevée. D'autres répercussions cutanées, en relation avec la prise d'alcool, sont également discutées.

Bateman purpura (dermatoporosis): a localized scurvy treated by topical vitamin C - double-blind randomized placebo-controlled clinical trial.

BACKGROUND: Bateman purpura is characterized by diffuse senile skin atrophy, senile purpura and spontaneous stellar pseudocicatrices. Cutaneous changes in the course of ageing have been related to lower levels of ascorbic acid into the dermis of elderly people. OBJECTIVE: In this study, we postulate that senile purpura could be linked to dermal vitamin C deficiency and could be corrected by topical administration of this vitamin. METHODS: A 12-weeks, hemi-member (forearm or leg), randomized double-blind comparative study was conducted in 18 patients with Bateman purpura aged over than 60 years. At each visit, clinical assessment and biometrological measurements were performed. Clinical examination and scoring by experts showed a significant improvement on the vitamin C-treated side compared with the control, with reduction of haemorrhage areas, increase of dermal thickness. RESULTS: Twice-daily application of 5% topical vitamin C led to a clinically apparent improvement of the skin symptoms and allows beneficial effects on skin elasticity and thickness. Bateman purpura, a classical sign of photoaging whose origin has not clearly been recognized could be improved by vitamin C applied on to the skin. CONCLUSION: These results confirm the hypothesis of the underlying role of vitamin C deficiency in the determinism of Bateman purpura.

[The major SCAR syndromes]. / Les syndromes SCAR majeurs.

Some drug eruptions are frequent and follow an indolent course, while others prove to be life-threatening. By contrast, SCAR syndromes are serious skin drug reactions that are rare but their vital prognosis is affected. The three distinct entities of importance are the former Lyell's syndrome, now identified as SJS-TEN syndrome (Stevens-Johnson syndrome/toxic epidermal necrolysis), the DRESS syndrome (drug reaction with eosinophilia and systemic symptoms), and the AGEP syndrome (acute generalized exanthematous pustulosis).

Certaines toxidermies sont fréquentes et ont un décours indolent, alors que d'autres grèvent de manière sévère le pronostic vital. En revanche, les syndromes SCAR sont des toxidermies médicamenteuses graves qui sont rares, mais dont le pronostic vital est réservé. Ils concernent trois entités distinctes qui sont l'ancien syndrome de Lyell, actuellement identifié comme SJS-NET (syndrome de Stevens-Johnson/nécrolyse épidermique toxique), le syndrome DRESS (drug reaction with eosinophilia and systemic symptoms) et le syndrome AGEP (acute generalized exanthematous pustulosis).

[The Mosan Study Group of Pigmented Tumours facing toward the oligometastatic cutaneous melanoma]. / Le Groupe Mosan d'étude des Tumeurs Pigmentaires face au mélanome cutané oligométastatique.

The oligometastatic melanoma is a peculiar stage of cancer progression which is initially restricted to the initial body area. In most instances, only a small number of metastases are simultaneously present. The oligometastatic stage is synchronous when metastases are disclosed at the time of initial diagnosis of the primary cancer. Metastases are metachronous when they are detected after the initial treatment of the primary neoplasm. A variant of the disease is called the smouldering disease when cutaneous metastases grow or regress in unison. The smouldering disease is granted to a condition when some metastases keep grooving when other metastases regress.

Le mélanome oligométastatique est un mode particulier de progression cancéreuse qui se cantonne initialement au territoire de drainage lymphatique du site du cancer primitif. Dans la majorité des cas, un très petit nombre de métastases seraient présentes simultanément. Le stade oligométastatique est synchrone lorsque les métastases sont découvertes au moment du diagnostic initial du cancer primitif. Les métastases sont dites métachrones lorsqu'elles surviennent après traitement initial. Une variante de ce processus, décrite sous le nom de maladie couveuse ou «smouldering disease¼, concerne des lésions métastatiques cutanées qui grandissent et régressent de concert sur ce même territoire.

[Erythema nodosum : a panniculitis of diverse origins]. / L'érythème noueux, une hypodermite aux origines diverses.

Erythema nodosum is an acute nodular panniculitis, mainly affecting young women. Diverse etiologies are evoked, but the most frequent are sarcoidosis (Löfgren syndrome), streptococcal infections, yersiniosis and inflammatory enteropathies. Antalgic drugs and rest are usually adequate in this condition, which is spontaneously of favourable evolution. Treatment of the cause is open to discussion, considering their lack of effect on the evolution of erythema nodosum.

L'érythème noueux est une hypodermite nodulaire aiguë atteignant principalement la femme jeune. Ses racines biologiques sont diverses, mais le tableau étiologique est dominé par la sarcoïdose (syndrome de Löfgren), des infections streptococciques, la yersiniose digestive et des entéropathies inflammatoires. Antalgiques et repos au lit sont habituellement suffisants pour contrôler cette affection d'évolution spontanément favorable. Le traitement de la cause est à discuter en fonction de chaque cas, en sachant qu'il sera sans effet sur l'évolution de l'érythème noueux.

[Skin carcinogenesis in renal transplant recipients]. / La cancérogenèse dans la peau de patients transplantés rénaux.

Organ transplants are bound to the induction and upkeep of immunosuppression. The immunomodulatory regimen modalities have changed over time with an improvement of the overage graft survival. The effects are also present on the skin and its cancerogenesis which is particularly activated for the squamous cell carcinoma. A review of the recent medical literature reveals the importance of searching squamous cell carcinomas, actinic keratoses, seborrheic keratoses and keratocanthomas before and after organ transplants. The severity of the carcinomas is due to their multiplicity and to the progressive occurrence of more aggressive lesions. Prevention relies on a strict adherence to sun protection after transplantation and on refined immunosuppressive strategies.

Toute greffe d'organe s'accompagne de l'induction et de l'entretien d'un état d'immunosuppression. Les modalités des traitements immunosuppresseurs ont évolué au cours du temps avec une amélioration de la survie des greffons. Les effets se marquent aussi au niveau de la peau et de sa cancérogenèse qui est particulièrement active pour le carcinome spinocellulaire. Un survol de la littérature médicale récente semble indiquer l'importance de répertorier les carcinomes spinocellulaires, les kératoses actiniques, les kératoses séborrhéiques et les kératoacanthomes avant et dans le suivi d'une greffe. La gravité des carcinomes tient à leur multiplicité et à la survenue progressive de lésions biologiquement plus agressives. La prévention des lésions repose sur une protection solaire stricte dès la transplantation et sur l'adoption de stratégies immunosuppressives adaptées.

[How I treat... minor superficial wounds]. / COMMENT JE TRAITE ... des plaies mineures superficielles.

Superficial minor wounds represent frequent events in daily practice. Their evolution is often favourable and without any mishap. However, they possibly evolve to some serious episodes. Normal healing develops in three successive phases. They correspond to the inflammatory, proliferative and remodeling phases, respectively. Their treatments are distinct. The major active agents are cleaning products, antiseptics, corticosteroids and silicone gels. By contrast products claiming some healing properties are disappointing in most cases, and in some instances, they are of no use.

[Dermatomycoses due to dermatophytes]. / DERMATOMYCOSES À DERMATOPHYTES.

Dermatophytoses are frequent skin diseases. They are caused by anthropophilic, zoophilic or geophilic agents from the Trichophyton, Microsporum and Epidermophyton genus. The clinical aspects distinguish diverse tinea on the scalp, distinct tinea of glabrous skin corresponding to lesions on the body, face, large folds as well as on palms and soles. Nails are also affected by dermatophytes. According to the involved area, the antifungal treatments are adapted to the nature and location of the fungus.

[INABILITY TO TOLERATE COSMETICS]. / INTOLÉRANCE AUX COSMÉTIQUES.

Inability to tolerate cosmetics can result from distinct mechanisms which appear as the so-called sensitive skin corresponding to one aspect of invisible dermatosis, or which corresponds to manifestations of a contact allergic or irritation dermatitis.

[How I treat... psoriasis using step procedures]. / COMMENT JE TRAITE ... un psoriasis par paliers progressifs.

Psoriasis is a multifactorial disease characterized by a cutaneous involvement possibly associated with various comorbidities. The disease associates some qualitative abnormal epidermal proliferation and immune alterations expressed by the presence of a dermal inflammatory infiltrate with neutrophil exocytosis. The hereditary aspect is well-documented and various susceptibility loci have been described on several chromosomes. The treatment relies on an eventual identifiable cause, and on the severity of the cutaneous involvement, as well as the presence of various comorbidities. The disease associates some qualitative abnormal epidermal proliferation, and an inflammatory cell infiltrate with neutrophil exocytosis. The treatment relies on a possible identifiable cause, and on the severity of the cutaneous involvement, as well as on a set of various comorbidities. Since some decades, psoriasis treatment follows a progressive step procedure. Liminar procedures rely on emollient applications. The next topical treatments concern dermocorticoids, vitamine D derivatives, calcineurin inhibitors and tars. The next step turns to photo(chemo)therapy using PUVA or UVB. In a further step, systemic treatments following oral intake include metharexate and ciclosporin. In severe cases resistant to treatments, biotherapies represent a hope for improving or even clearing the lesions. The stream of the current treatments has considerably reformed the psoriatic management over the long age.

[HOW I EXPLORE... SKIN COMPLEXION BY ANALYTICAL APPROACH]. / COMMENT J'EXPLORE ... la carnation de la peau par une approche analytique.

Skin colour is important for interindividual relationships considerations, as well as for the assessment of some physiopathological aspects. Its subjective assessments varies among observers and according to light. By contrast, an objective approach, both qualitative and quantitative by analytical measurements, has been available for some years. Its application in routine clinical settings is possible. The aspects are dependent on the incident light wavelengths. Accordingly, a series of skin diseases, but also ictera, uremia, anemia and hemochromatosis are possibly assessed in the field of internal medecine according to variations of skin colors.

[How I treat dandruff using a shampoo with a sulfate-free tensio-active]. / Comment je traite un état pelliculaire par un shampoing à base lavante «sulfate-free¼.

A new formulation of an anti-dandruff shampoo containing a surfactant devoid of a sulfate-type anionic part has been assessed in vivo in 41 subjects. Introducing a welltried agent, the 0.5 % piroctone olamine confers to this shampoo a high anti-dandruff efficacy, a reduction in the density in Malassezia spp, as well as a good remanence after shampoo. In addition, piroctone olamine appears to influence the sebum rheology by reducing the hair greasing.

Une nouvelle formulation d'un shampoing antipelliculaire, basée sur l'utilisation de tensio-actifs sans groupe anionique de type sulfate («sulfate free¼) a été évaluée in vivo sur 41 sujets. L'introduction d'un agent éprouvé, la piroctone olamine à 0,5 %, confère à ce shampoing une efficacité antipelliculaire élevée, une réduction de la densité de Malassezia spp, ainsi qu'une bonne rémanence de l'effet après shampoing. La piroctone olamine semble, de plus, modifier la rhéologie du sébum en ralentissant le phénomène de regraissage des cheveux.

[Toxic epidermal necrolysis (Lyell syndrome), a lifethreatening emergency of introgenic origin]. / La nécrolyse épidermique toxique (syndrome de Lyell). Une urgence dramatique d'origine médicamenteuse.

Cutaneous drug eruptions are frequently encoun¬tered. Their putative diagnosis is based on a set of imputability arguments. The histopathological aspect is often suggestive of the dermatosis nature, and varies according to the type of drug reaction. Some drug eruptions follow a benign course, but others including the toxic epidermal necrolysis are severe and life-threatening. It corresponds to a dermatological emer¬gency to be managed in a specialized burn unit.

Les toxidermies sont des réactions médicamenteuses cutanées indésirables. Elles représentent des pathologies fré¬quentes dont le diagnostic de présomption est fondé sur un faisceau d'arguments structurés. L'aspect histopathologique est souvent évocateur, et il est diversifié en fonction de la nature de la toxidermie. Certaines toxidermies ont un décours indolent et d'autres, comme la nécrolyse épidermique toxique, grèvent de manière sévère le pronostic vital. Il s'agit d'une urgence dermatologique à prendre en charge dans une unité de soins spécialisée pour les grands brûlés.

[How I explore scalp and hairin erythemato-squamous disorders]. / Comment j'explore le scalp et la chevelure au cours de dermatoses érythémato-squameuses.

In their early stages, some dermatoses of the scalp such as psoriasis seborrheic dermatitis, tinea capitis and discoid lupus erythematosus are often hardly noticeable to others. However, the eruptions are occasionally severe and extensive. Reaching an adequate diagnosis is of utmost impor¬tance for an adequate healthcare.

A leurs débuts, certaines dermatoses du cuir chevelu telles que le psoriasis, la dermite séborrhéique, une teigne ou le lupus érythémateux discoïde, sont souvent peu discernables par l'entourage. Cependant, ces éruptions sont occasionnelle¬ment sévères et extensives. Obtenir un diagnostic de certitude est un objectif majeur pour une prise en charge adéquate.

[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.

[New paradigms and metaphors in cutaneous melanoma treatment]. / Nouveaux paradigmes et métaphores du traitement du mélanome cutané.

In recent years, new drugs have been designed for treating advanced cutaneous malignant melanoma, in particular the metastases. They afford modest benefits despite the fact they are commonly heralded as breakthroughs in the lay press and by some medical opinion leaders. Unfortunately, the use of inflated descriptors of the drug efficacy leads to misunderstandings among the clinicians in charge of patients. Currently, vemurafenib, ipilimumab, pembrolizumab and nivolumab have demonstrated their relative activity in the control of advanced malignant melanoma. The results expected from surrogate markers of efficacy are magnified and idealized regarding the expectations from many patients. The recent therapeutic advance improves the median overall survival for a few months. Some combined treatments could possibly boost the current beneficial effects.

Au cours des récentes années, de nouveaux médicaments ont été offerts pour le traitement du mélanome cutané avancé et, en particulier, de ses métastases. Ils apportent des bénéfices qualifiés de modestes par certains malgré leur présentation en tant qu'innovations par divers médias et par quelques médecins et biologistes élevés au rang de leaders d'opinion. Malheureusement, l'emploi de descripteurs inflationnistes de l'efficacité des médicaments entraîne certaines incompréhensions parmi les cliniciens en charge de ces patients. A ce jour, le vémurafénib, l'ipilimumab, le pembrolizumab et le nivolumab ont démontré leurs activités relatives dans le contrôle du mélanome avancé. Le bénéfice escompté par certains marqueurs de substitution de l'efficacité est magnifié et idéalisé par rapport aux attentes de beaucoup de patients. Les avancées thérapeutiques récentes procurent un accroissement de quelques mois à la survie médiane. Des traitements combinés pourraient améliorer le bénéfice dès à présent atteint.

[GAZING INTO A CRYSTAL BALL AND DETECTING SUBJECTS AT RISK FOR DEVELOPING CUTANEOUS MELANOMA]. / REGARDER DANS UNE BOULE DE CRISTAL ET DÉPISTER DES SUJETS À RISQUE POUR LE MÉLANOME CUTANÉ.

Cutaneous melanoma is the deadliest skin cancer showing an increasingly growing incidence in white populations of Europe and United States. Intensive research in recent years has begun to unlock its molecular pathogenesis. Screening the neoplasm at an early stage remains primordial. Hence, targeting populations at risk is likely efficient. In such an attempt, the regular clinical examination benefits from a series of non invasive procedures such as skin surface biopsies, in vivo confocal microscopy, dermoscopy and specular fluorescent light reflectance.

[SPORADIC SKIN MELANOMA BEYOND ITS NORMATIVE CLASSIFICATION. PLEA CONSIDERING ITS EVOLUTIVE CHARACTERISTICS]. / LE MÉLANOME CUTANÉ SPORADIQUE AU-DELÀ DE SA CLASSIFICATION NORMATIVE. Plaidoyer prenant en compte son particularisme évolutif.

For aeons, cutaneous sporadic melanoma, exhibiting either a slow or rapid growth rate, is identified using a set of well defined histopathological criteria. Such diagnostic step is greatly appreciated, and it brings a rough estimate of the probable evolution of the cancer. Some additional assessments try to improve the progressive prognosis of cutaneous melanoma. In this scope, fractals and spectral analyses expect to better perceive the individual progressive characteristics of each tumor. The extent in the tumoral germinative compartment and the peritumoral microvascular network are explored and should in a near future make clear the progressive potential of cutaneous melanoma. The posible tumoral regression and the immune reaction should be better perceived.