[Helioderma, heliophiles and heliophobes]. / Héliodermie, héliophiles et héliophobes.

The cumulative effect of lifelong sun exposures induces skin alterations which are coined helioderma. The manifestations of helioderma vary according to the body site. This is particularly the case for the prominent differences in the expression of solar elastosis. This condition is commonly more severe on the face and nape of the neck than on the forearms and back of the hands. The age, phototype and behaviour regarding sun exposure are cofactors responsible for the severity of solar elastosis.

[Skin cancer and sunlight]. / Photocancérogenèse cutanée.

Most of the cutaneous carcinomas and melanomas are photo-induced cancers. By contrast, some cutaneous lymphomas are inhibited by light exposure. The annual incidence of photo-induced cancers is steadily on the rise.

[How I treat ...scalp psoriasis]. / Comment je traite...un psoriasis du cuir chevelu.

Scalp involvement by psoriasis requires a ted treatment suited to the particularities of the anatomical site In course of time, the improvement of therapeutic agents and the galenic refinement have enhanced both the efficacy and cosmetic acceptability of the scalp care. The main therapeutic classes encompass keratolytics, dermocorticosteroids and vitamine D3 analogues. The patient compliance is reported to be best for the liquid or foam formulations.

Effect of haemodialysis on acoustic shear wave propagation in the skin.

BACKGROUND: Diverse skin alterations may develop in patients under chronic haemodialysis. Among them, signs of premature photo-ageing have been described. AIM: To assess alterations in the physical properties of skin consistent with ageing effects and with cutaneous fluid exchanges during haemodialysis sessions. METHODS: In the first part of the study, 45 haemodialysed patients were compared to 45 age-, sex- and body-mass-index-matched healthy subjects. In the second part of the study, skin of 30 haemodialysed patients was assessed immediately before and after a haemodialysis session. The speed of ultrasound shear wave propagation was measured in each subject. Series of 16 multidirectional resonance running time measurements (RRTM) were performed on the forehead and/or the volar forearm. They were averaged for each subject. The corresponding intra-individual coefficients of variation were calculated as an estimate of the skin mechanical anisotropy. RESULTS: In both haemodialysed patients and their matched controls, RRTM values were significantly higher on the forearms than on the forehead. By contrast, no significant difference was found in RRTM values that could be ascribed to chronic haemodialysis. However, RRTM values were significantly increased as an immediate and probably transient effect of haemodialysis sessions. In healthy subjects, ageing was associated with increased RRTM values. CONCLUSION: Chronic haemodialysis does not appear to influence significantly the functional expression of the dermal ageing process. Subtle fluid movements occurring in the skin during haemodialysis sessions can be assessed by measuring non-invasively the speed of ultrasound shear wave propagation in the skin.

[Dying for a tan versus osteomalacia. The solar protection dilemma between charybdis and scylla]. / Allons-nous mourir bronzés ou ostéomalaciques? Le dilemme de la protection solaire entre Charybde et Scylla.

Sun is at the origin of life. It can also be responsible for death. In the past decades cutaneous melanoma killed more and more young adults. Currently, the disease still progresses in the population, but survival increases hopefully. Sun is pointed out as the main culprit. Hence, protection against harmful effects of ultraviolets is mandatory. However, preventive measures to be taken generate heated scientific argument. Sunlight exposure particularly in moderation is indeed necessary for health through vitamin D3 synthesis and psychological effects on wellbeing. Vitamin D3 provides numerous biological effects, particularly on bone calcification and also by inhibiting proliferation and migration of malignant cells including melanoma cells. Hence, we are facing the dilemma between too much and too little ultraviolet light exposure. Anyway, one cannot advocate that people lie in the sun until they burn or until they turn a rich brown complexion.

Regional variability in mottled subclinical melanoderma in the elderly.

The density in melanin chromatophores becomes heterogeneous in the epidermis during the early events of photoaging. Little is known about the regional variability in the resulting mottled skin appearance on the sun-exposed parts of the body in the elderly. The relationship between these features and the dermal atrophy related to aging is also an area ripe for study. The aim of the present study was to objectively assess and compare such aspects of photoaging in older subjects. A computer-assisted video camera equipped with an internal ultraviolet-emitting unit (Visioscan) was used in combination with image analysis to quantify the infraclinical mottling of the skin on the forehead, neck and dorsal forearm. A Densi Score device served to assess the dermal atrophy by rating the skin folding capacity. A mottled subclinical melanoderma was disclosed on the three evaluation sites in all subjects irrespective of their phototypes. Three main patterns were identified corresponding to regular perifollicular dots, streaky macules along shallow wrinkles and unevenly shaped macules in the interfollicular area. The extent in melanoderma was larger on the forehead than on the neck and forearm. The age after 60 years did not influence the severity of mottled melanoderma, but clearly altered the skin folding capacity. The greatest inter-individual differences in mottled melanoderma were found in phototype II subjects. In conclusion, infraclinical mottled melanoderma is present in all individuals after 60 years of age. This type of epidermal photoaging does not appear to be influenced in older ages. By contrast, skin laxity due to dermal aging continues to progress beyond the age of 60 years.

[How to investigate....A darkened skin lesion during pregnancy. A difficult task for the clinician]. / Comment j'explore ... une tache noire au cours de la grossesse. Une tâche parfois difficile pour le clinicien.

Cancers rarely coexist with pregnancy. Cutaneous melanoma, however, is one of the most frequently encountered neoplasms during pregnancy. Gestation may also be a period during which the aspect of some melanocytic naevi can change eventhough the tumor remains benign. Distinction between a benign and a malignant lesion may then be a dilemma. Clinical morphometry, dermoscopy, skin surface biopsy, conventional histology and immunohistochemistry are valuable means that can be used to secure maximum diagnostic confidence.

Factor XIII a-positive dermal dendrocytes and shear wave propagation in human skin.

BACKGROUND: The in vivo interdependence between the phenotypic characteristics of dermal cells and the strain imposed on the tissue has not been studied thoroughly in humans. In particular the mechanical force modulation of Factor XIII a expression in dermal dendrocytes (DD) remains unknown. MATERIALS AND METHODS: The present study compares the numerical density of Factor XIII a-positive DD and the in vivo shear wave velocity in the skin. The investigation was performed in 20 men of normal weight and 20 obese men before and after entering a slimming process. RESULTS: Excess cutaneous fat places the skin under increased intrinsic tension. The resonance running time measurement (RRTM) and the DD density were significantly reduced in overweight individuals. After a short-term but intense slimming process, the same individuals showed a trend to normalization of these two parameters without, however, reaching significance. Pooling all data yielded a significant logarithmic correlation between RRTM values and densities in Factor XIII a-positive DD. CONCLUSION: Factor XIII a expression in human DD may be partially regulated by the intrinsic resting tensions in the skin.

[Prevention of skin cancers with sunscreening agents]. / Prévention des cancers cutanés par les crèmes de protection solaire.

How do sunscreens protect against skin cancers? The answer to this question is a matter of controversy among scientist for several years. The doubt persists because the wise use of such products is only one of the factors involved in sun behavior together with avoiding excessive sunlight exposure and wearing protective clothes.

[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.

[Pharma clinics. Medication of the month. Imiquimod (Aldara): an immunomodulator for the skin]. / Pharma clinics. Le médicament du mois. L'imiquimod (Aldara): un immunomodulateur pour la peau.

Imiquimod is the first drug of a new therapeutic class encompassing cutaneous immune response modifiers. This molecule induces the synthesis and release of macrophage-related cytokines. It boosts some local immune responses. These properties are used to treat cutaneous viral condylomas. Other prospective therapeutic goals are presently scrutinized.

[Tanning benches to accusation benches]. / Les bancs solaires au banc des accusés.

Sunbeds used in sun parlours do not garantee a controlled innocuity. By contrast, health hazards are obvious in many instances. Forceful tanning is a transitory aspect behind which the spectrum of many skin changes includes accelerated photoageing, irreversible pigmentary and keratotic changes, and cutaneous malignancies including malignant melanoma. In the absence of protection, the eye is also affected. Even if tanning salon exposure increases the risk for skin cancer by a small amount, it represents a significant potential public health hazard given the number of people attending salons. Digital dermoscopy and ultraviolet light videoscopy are new methods allowing to predict the cutaneous ransom to be paid by the sunbed worshippers.

Nudging hair shedding by antidandruff shampoos. A comparison of 1% ketoconazole, 1% piroctone olamine and 1% zinc pyrithione formulations.

Hair shedding and hair thinning have been reported to be affected by dandruff and seborrhoeic dermatitis. The present study was conducted in 150 men presenting with telogen effluvium related to androgenic alopecia associated with dandruff. They were randomly allocated to three groups receiving each one of the three shampoos in the market containing either 1% ketoconazole (KTZ), 1% piroctone olamine (PTO) or 1% zinc pyrithione (ZPT). Shampoos had to be used 2-3 times a week for 6 months. Hair shedding during shampoo was evaluated semiquantitatively. Hair density on the vertex was evaluated on photographs using a Dermaphot. Trichograms were used for determining the anagen hair percentage and the mean proximal hair shaft diameter using computerized image analysis. The sebum excretion rate (SER, mug cm(-2) h(-1)) was also measured using a Sebumeter. The three treatments cleared pruritus and dandruff rapidly. At end point, hair density was unchanged, although hair shedding was decreased (KTZ: -17.3%, PTO: -16.5%, ZPT: -10.1%) and the anagen hair percentage was increased (KTZ: 4.9%, PTO: 7.9%, ZPT: 6.8%). The effect on the mean hair shaft diameter was contrasted between the three groups of volunteers (KTZ: 5.4%, PTO: 7.7%, ZPT: -2.2%). In conclusion, telogen effluvium was controlled by KTZ, PTO and ZPT shampoos at 1% concentration. In addition, KTZ and PTO increased the mean hair shaft thickness while discretely decreasing the sebum output at the skin surface.

Dual presentation of extranodal marginal B-cell lymphoma involving the skin, viscera and bones.

A 65-year-old man presented with an erythematous indurated plaque on the scalp and forehead. A low-grade marginal-zone B-cell lymphoma with small cells and kappa-chain monoclonality was diagnosed. Radiotherapy was initiated. He soon developed abdominal pain and hematemesis. A high-grade marginal-zone B-cell lymphoma with large cells and lambda-chain predominance was disclosed infiltrating the stomach and lungs. Bone localizations were also found. There was no evidence for lymph node and bone marrow involvement. The distinct cytological and immunophenotypic presentations in the skin and viscera are a puzzling finding.

Varicella-zoster virus vasculitis: a case of recurrent varicella without epidermal involvement.

New types of diseases due to the varicella-zoster virus (VZV) are increasingly recognized. A case of cutaneous VZV vasculitis without epidermal involvement is presented. The patient received chemotherapy for a large B cell lymphoma. He presented a few painless papules on one hand and in the axilla. A lymphocytic vasculitis was evidenced. Immunohistochemistry revealed the presence of VZV in endothelial cells and dermal dendrocytes. Nerves and keratinocytes were free of the virus infection. Such a presentation probably represents a mild form of recurrent varicella with prominent but limited vascular involvement.

[Cutaneous melanomas, a spectrum of emerging cancers in women of Wallonia. Outlook by the Mosan Study Group of Pigmented Neoplasms]. / Les mélanomes cutanés, un spectre de cancers émergents chez la femme en région Wallonne. Un regard porté par le Groupe Mosan d'Etude des Tumeurs Pigmentaires.

The Mosan Study Group of Pigmented Neoplasms was founded about 15 years ago. It has collected more than 20,000 cutaneous malignancies including melanomas and basal and squamous cell carcinomas. The incidence of these cancers is on the rise in Wallonia. In particular, malignant melanomas represent a spectrum of emerging cancers characterized by a proteiform biological outcome. They mostly affect young women. The major risk factor appears to be iterative and unwise ultraviolet exposures. The prevention of melanomas is basically founded on such a dogma and accordingly relies on sunscreens. However, controversies about their beneficial effects are rife and fueled by axiomas and contradictory sophisms. At the exception of surgery, the therapeutic options for the diverse types of melanomas do not yet fulfill the scope of evidence-based medicine.

[Airborne dermatoses]. / Dermatoses aéroportées.

Airborne dermatoses are due to various gas and particles in suspension in air. They have irritative, toxic or allergic origins. They may be associated with ocular and respiratory complaints. Such diseases are likely underestimated in both their prevalence and practical considerations dealing with their prevention.

Cutaneous cancers in the Mosan region and Ardennes of Belgium.

BACKGROUND: The ratios of basal cell carcinomas (BBC) to squamous cell carcinomas (SCC) and to malignant melanomas (MM) have changed over time in the white population throughout the world. OBJECTIVE: To evaluate the incidence of skin cancers in the Mosan region and the Belgian Ardennes over the past 6 years. RESULTS: In contrast with epidemiological data reported by the Belgian National Cancer Registry, cutaneous cancers are the commonest malignancies occurring in humans. At the present time, the ratio BCC:SCC roughly equals 4 to 1. When combined, the incidence of BCC and SCC is about 10 times greater than that of MM. CONCLUSION: The rate of detection of skin cancers does not always correlate with the rate of notification of a national registry.