[Purely cutaneous Rosai-Dorfman disease present for 19 years]. / Maladie de Rosai-Dorfman cutanée pure évoluant depuis 19 ans.

BACKGROUND: Rosai-Dorfman disease is a non-Langerhans histiocytosis chiefly affecting lymph nodes sites. In rare cases, it presents in the form of isolated skin lesions, without adenopathy, in which case it is a benign disease that regresses spontaneously within our number of months and years. PATIENTS AND METHODS: An 83 year-old man presented with multiple red-brown nodular lesions on the upper part of the body that had been progressing over a period of 19 years. Histological examination showed infiltrate characteristic of Rosai-Dorfman disease, with numerous dermal foci of histiocytes expressing protein S100 but not expressing CD1a on immunohistochemical analysis, as well as emperipolesis. The lymph nodes sites were unaffected, and the remainder of the clinical and laboratory examinations were normal, indicating a purely cutaneous form of the disease. Treatment with isotretinoin was ineffective and the lesions continued to spread gradually, being treated from time to time with CO2 laser or cryotherapy. DISCUSSION: Our case is atypical in terms of clinical presentation since it involved diffuse nodular lesions. The disease course was also unusual in that no spontaneous regression was observed even after 19 years.

[Incidence of drug-induced photosensitization during phototherapy]. / Incidence des accidents par photosensibilisation médicamenteuse au cours des photothérapies.

BACKGROUND: Exogenous photosensitization represents one of the adverse effects of phototherapy. However, the impact of potentially photosensitizing drugs on the incidence of photo-induced eruptions during phototherapy is unknown. AIM OF THE STUDY: To determine the incidence of drug photosensitization during phototherapy. PATIENTS AND METHODS: This was a retrospective study of all patients undergoing phototherapy between November 1999 and April 2004 in the Dermatology Department of Caen University Teaching Hospital. Details of all topical or systemic medications taken before or during phototherapy were recorded. Since methoxsalen induces photosensitization, sessions of phototherapy were stratified according to whether methoxsalen was given. Screening was performed for the following clinical signs of drug photosensitization: acute photo-induced, erythematous and/or vesicular eruption, associated with pruritus or burning. RESULTS: In the non-methoxsalen group, use of a potentially photosensitizing drug was found for 29/155 TL01 phototherapy sessions. Drug-induced photosensitization was suspected in 3/29 sessions (10.3%). In the methoxsalen group, a potentially photosensitizing drug was found in 21/118 sessions of PUVA-therapy. Drug-induced photosensitization was suspected in 4/21 sessions (19%). Risk of photo-induced eruption was not associated with photosensitizing drug therapy, TL01 phototherapy or PUVA-therapy. DISCUSSION: Drug photosensitization appears to be rare during phototherapy, regardless of photosensitizing drug intake. It is twice as frequent during PUVA-therapy as during TL01 phototherapy but this difference is not significant.

[CO2 laser therapy of verrucous epidermal nevus]. / Laser CO2 continu dans le traitement des hamartomes épidermiques verruqueux.

INTRODUCTION: Verrucous epidermal nevus are benign epidermal hyperplasias. Their treatments are disappointing because of recurrences and anaesthetic scars. The aim of this study was to evaluate the efficacy of continuous carbon dioxide laser in the treatment of verrucous epidermal nevus. MATERIAL AND METHODS: It was a retrospective study concerning all patients treated for epidermal verrucous nevus by carbon dioxide laser from 1991 to 2003. Several criteria were evaluated by the patients, a dermatologist and a staff (external observers). Aesthetic result, recurrences, pain due to treatment and global result were evaluated by the patients when they came back. RESULTS: Twenty-one patients (12 F and 9 M), medium age 20.4, were evaluated with a 40.4 months follow-up (7 to 165 months). The epidermal verrucous nevus was situated on the neck or on the head for 62% of them (n = 13). Among these 21 patients, 86% (n = 19) estimated their skin as "cured" or "nearly normal" or "much improved". The rate was the same for the dermatologist. As for the staff, thanks to photos, only 53% of results were satisfying. The recurrences were never complete, but moderate in 38% of patients. Five patients, medium age 12,5, had hypertrophic scars. Among them, three were only partially hypertrophic. DISCUSSION: A literature review has been made. Our satisfaction rates (nearly 90%) were slightly higher than other studies rates using carbon dioxide laser (74%) or other types of lasers (87%). The medium follow-up was longer than the one of other laser CO2 studies (26.7 months) or other lasers studies' (15.8 months). This study shows that continuous wave carbon dioxide laser is an easy and effective treatment of verrucous epidermal nevus. Aesthetic results are satisfying but moderate recurrences often occur. To prevent hypertrophic scars, we suggest to exclude teenagers.

[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.