[DRESS syndrome to sulfasalzine]. / Syndrome dress a la sulfasalazine.

We report a case of drug hypersensibility syndrome (DRESS syndrome) developed one month after initiation of a treatment by sulfasalazine. Due to the severity of the cytolytic hepatic damages as observed in this case, we emphasize the importance of suggesting this diagnosis in any patient developing a cutaneous rash and an alteration of the general health status after initiation of a new treatment. The hematologic alterations which represent a key feature for the diagnosis may rash. develop only a few days after the cutaneous rash.

[How I treat ... lentigo maligna by topical imiquimod]. / Comment je traite ... un lentigo malin par l'imiquimod topique (Aldara).

Lentigo maligna is a special form of in situ cutaneous melanoma that develops on the face of sun worshipers. The topic immunostimulator imiquimod can destroy the neoplasm before it expresses its invasive potential. A strict clinical follow-up of the treated zone must be observed at least 5 years to detect any early sign of recurrence.

[How I explore ... pruritus resulting from a tropical vacation]. / Comment j'explore ... un prurit souvenir de vacances sous les tropiques.

Any journey or stay in a tropical country can lead to a variety of diseases with exotic background. One of the symptoms is represented by localized or generalized pruritus. It is associated or not associated with primary cutaneous lesions.

[Cutaneous stigmata of diabetes mellitus]. / Stigmates cutanés du diabète.

A number of relationships exist between diabetes mellitus and a series of cuteanous disorders. Skin lesions may reveal diabetes in a more or less specific way. They may also represent complications supervening in an already treated diabetic patient. Some of these dermatoses (acanthosis nigricans, purpuric and pigmented capillaritis) are markers of macrovascular complications. The same disorders and some others (xerosis, Dupuytren's disease) are more frequently associated with microangiopathy in Type II diabetes. Other skin diseases (alopecia areata, vitiligo) are markers of auto-immunity in Type I diabetes.

Photodynamic therapy and imiquimod immunotherapy for basal cell carcinomas.

Photodynamic therapy (PDT) and topical imiquimod immunotherapy (TII) are two recently introduced treatment modalities for certain types of basal cell carcinomas (BCC). We present a review of the relevant literature and report our own findings regarding the efficacy and tolerance of PDT and TII in the treatment of BCCs. According to published studies, the cure rates range from 75-95% for PDT and 42-100% for TII, depending on treatment modalities and BCC type. In our observations, 13 patients with nodular or superficial BCCs were treated by PDT using two courses of 3-hour topical application of methyl aminolevulinate, followed by 8 minutes illumination (lambda = 634 nm, e = 37J/cm2). Biopsies were taken before and one month after PDT. Side effects including pain and crusting were assessed. Eight patients with superficial BCC were treated by TII using 3 monthly courses each consisting of 3 weekly applications for 3 weeks followed by one week out of treatment. Biopsies were taken before and after 3 months of TII. Adverse reactions including erythema, oozing, ulceration, and crusting were recorded. Clinico-histological cure was obtained in 12/13 PDT cases as assessed after 1 month, and in 6/8 TII cases after 3 months. Minimal pain during illumination and crust formation were observed in 7/13 and 3/13 PDT cases, respectively. Variable erythema, oozing, ulceration, and crusting were observed in all TII-treated lesions. It is concluded that PDT represents an active and well tolerated alternative treatment for both nodular and superficial BCCs. TII also shows activity, although the tolerance may be poor and cure needs a longer time to be obtained. The final cosmetic appearance was fine following both PDT and TII procedures. Both PDT and TII may leave intact neoplastic aggregates inside the skin. They cannot be clinically perceived, leading to unexpected recurrences. It is stressed that the currently available efficacy information about PDT and TII deals with short term follow-up periods. A 5-year follow-up must be awaited before drawing firm conclusions.

Hyperkeratotic nail discoid lupus erythematosus evolving towards systemic lupus erythematosus: therapeutic difficulties.

Nail changes occur in about 25% of systemic lupus erythematosus (SLE) cases. Onycholysis has been reported as the most frequent abnormality in SLE. Nailbed hyperkeratosis may be observed in both SLE and discoid lupus erythematosus (DLE). Involvement of the nail apparatus in DLE is extremely uncommon and never restricted to it. We report on a patient in whom the clinical features on the proximal nailfold were similar to those observed on the skin of a patient with typical DLE. This has, to the best of our knowledge, not yet been reported. The patient also exhibited a very distinctive prominent subungual hyperkeratosis. Interestingly, the patient developed biological alterations suggesting a systematization of the disease. Only a combination of systemic corticoids, retinoids and antimalarials was able to achieve nail improvement and this partial resistance to therapy may be explained by the very unusual subungual hyperkeratosis.

[How I treat ... the athlete's foot and its non-mycotic cutaneous pathology]. / Comment je traite ... le pied du sportif et sa pathologie cutanée non mycosique.

Skin and nails of the foot of sport practitioners of various disciplines are subjected to the effects of benign but invalidating pathologies. Microtraumatisms are frequently involved. Beside dermatomycoses and onychomycoses, a dozen of typical disorders are identified.

[Between dermatoses and enteropathies]. / Entre dermatoses et entéropathies.

A series of gastro-intestinal diseases exhibits some connection with various cutaneous lesions. Some skin manifestations are clinically or histologically evocative, while others lack specificity. These manifestations can occur in overt digestive disease or be the clue for a silent one. A careful skin examination can thus reveal some inflammatory or neoplastic diseases of the gastro-intestinal tract, a malabsorption syndrome or food intolerance.

[DHEA and rejuvenating intracrinology? Between reason and magic]. / DHEA et intracrinologie de jouvence pour la peau? Entre raison et magie.

Slowing down ageing is a goal for a large part of the population. Some mercantile claims hold out bright prospects to DHEA. The effects of this hormone manifest themselves after intracrine conversion. In the skin, sebaceous glands enlarge and seborrhoea increases in post-menopausal women. No other effect is clinically discernable on the skin. At this level, DHEA does not show efficacy comparable to that of other anti-ageing compounds.

High-dose alizapride versus high-dose domperidone: a double-blind comparative study in the management of cis-platinum-induced emesis.

A double-blind, randomized crossover trial was carried out in 44 cancer patients receiving chemotherapy with cis-platinum to compare the anti-emetic effectiveness and tolerance of alizapride and domperidone given in high dosage. Patients received 5 administrations of either 4 mg alizapride/kg body weight or 0.6 mg domperidone/kg during a chemotherapy session and then the alternative anti-emetic during the next session. Treatment order was randomized. Patients were followed-up for 12 hours and details recorded of the total time during which there was some nausea, the duration of mild and severe nausea, and the number of episodes of mild and severe vomiting. A note was also made of the duration of mild and moderate sedation, and the incidence and severity of any other side-effects either probably or possibly related to anti-emetic medication. The investigator gave an overall assessment of the severity of nausea and vomiting experienced during each chemotherapy session and an opinion on the comparative effectiveness of the two anti-emetics. At the end of the two sessions, patients were asked to state a preference, if any, for one or other treatment and to select which they would like to have for their next chemotherapy session. The results showed that whilst both alizapride and domperidone appeared to be equally effective in limiting mild nausea, alizapride was significantly better in preventing severe nausea and episodes of vomiting. In those cases where a positive choice between treatments was made, alizapride was considered to be significantly better than domperidone by the investigator and more patients preferred alizapride and would select it for their next session.(ABSTRACT TRUNCATED AT 250 WORDS)

Tiapride versus placebo: a double-blind comparative study in the management of Huntington's chorea.

A double-blind, placebo-controlled, crossover trial was carried out in 29 patients with Huntington's chorea to evaluate the effectiveness and tolerance of high doses of tiapride in the management of neurological symptoms. Patients were allocated at random into 3 groups to receive 3 g tiapride daily for two periods of 3 weeks either preceded, interrupted or followed by a 3-week period on placebo. Patients were assessed on entry and at the end of each treatment period using a battery of tests designed to measure choreatic movements, motor skills, recognition and reaction times, and mental state. Twenty-three patients completed the trial; only 2 of the 6 drop-outs withdrew because of drug-related side-effects (sedation and extrapyramidal signs). The results showed that tiapride treatment significantly improved choreatic movements and motor skills and these findings were supported by the objective psychometric measurements. Overall evaluation of effectiveness by the physician and patients indicated the significant superiority of tiapride over placebo. Treatment was generally well tolerated and although there were significantly more reports of sedation and extrapyramidal signs whilst patients were receiving tiapride, these effects were rated as mild in most cases and did not interfere with treatment.

Veralipride versus conjugated oestrogens: a double-blind study in the management of menopausal hot flushes.

A double-blind, randomized study was carried out in 43 women, who had undergone spontaneous menopause at least 6 months earlier, to compare the effectiveness and tolerance of veralipride with that of a conjugated oestrogens preparation in the control of hot flushes. Twenty-one women received 100 mg veralipride per day and 22 were due to receive 1.25 mg per day of the hormone preparation over a period of 20 days but 3 women in the oestrogen group discontinued the trial without giving any reason. The number, duration and severity of hot flushes were assessed and scored at the start of the trial and during treatment. Statistical analysis of the results showed marked relief with both preparations but no significant difference between them in terms of effectiveness or tolerance. Veralipride, however, appeared to provide better control in patients who had complained of severe hot flushes initially.

Tiapride versus glafenine: a double-blind comparative study in the management of acute rheumatic pain.

A double-blind study was carried out in 42 patients suffering from acute rheumatic pain to compare the analgesic effectiveness and tolerance of tiapride with that of glafenine, a widely used analgesic in Europe. Patients were allocated at random to receive either 100 mg tiapride or 200 mg glafenine 3-times daily over a period of 14 days. Pain intensity was rated daily by the patients using a visual analogue scale and an overall assessment of response to treatment was made by both patients and physician at the end of the study. The results showed that, whilst both treatments resulted in a marked reduction in mean pain scores, pain disappeared completely in 16 (76%) of the 21 patients treated with tiapride compared with 9 (43%) of the 21 receiving glafenine. There was also a significant difference in favour of tiapride in the physician's overall assessment of response which was considered as excellent in 71% of the patients on tiapride compared with 31% receiving glafenine. Both treatments were well tolerated and few side-effects were reported. Drowsiness occurred in 6 patients on tiapride but this was only mild in 5 and moderate in the other patient.

Recurrent turret exostoses--case report.

Two turret exostoses in one hand were simultaneously excised--one with good results, one with recurrence of adhesions. Photographic documentation, starting with the original injury, shows that the periosteum was widely lacerated. Tenolysis with fat tissue graft interposition failed. A second tenolysis with interposition of Silastic membrane was successful.

Combined Coventry-Maquet tibial osteotomy: preliminary report of two cases.

When both the medial and patellofemoral compartments of the knee joint are involved with osteoarthritis, combining the Coventry high tibial osteotomy with the Maquet tibial tubercle advancement in one single operation has the following advantages: only one incision is necessary; no donor site is needed; and the sagittal alignment of the tibial shaft with the tibial plateau is preserved, which allows a better contact of the cut surfaces and better biomechanical stability. Modified techniques provide for medial displacement of the patellar ligament and may reduce the risk of ischemic necrosis.