[A case of vitiligo occurring after initiation of antiretroviral treatment and disappearing during this treatment: autoimmune IRIS syndrome?]. / Vitiligo régressif au début d'un traitement antirétroviral : syndrome de reconstitution immunitaire ?

BACKGROUND: Immune reconstitution inflammatory syndrome (IRIS) includes all signs occurring during the reconstitution of an extensive and insufficiently regulated immune response to an infective or a non-infective antigen and observed during the immune suppression phase in an individual. We report a case of vitiligo appearing after the initiation of antiretroviral treatment and with repigmentation during the course of the treatment. PATIENTS AND METHODS: A 30-year-old man, seropositive for HIV1-M, consulted for a diffuse eruption of hypopigmented and achromic macules. The lesions appeared 7 weeks after the start of antiretroviral therapy with zidovudine, lamivudine and efavirenz, starting on the forearm and spreading to the remainder of the skin. At control visits during the ensuing two months, gradual repigmentation of the achromic macules was noted. Plasma viral load, determined only during the treatment period, was less than 40 copies/ml (1.60(log)). DISCUSSION: This report concerns an original case of vitiligo occurring at the start of antiretroviral treatment in an HIV-positive patient, with spontaneous repigmentation during treatment. The chronology points to a hypothesis of immune reconstitution inflammatory syndrome (IRIS), despite the absence of any indication of the patient's viral load prior to therapy.

[Stevens-Johnson's syndrome following ingestion of gunpowder]. / Syndrome de Stevens-Johnson après ingestion de poudre à canon.

BACKGROUND: A cutaneous adverse drug reaction is a skin eruption secondary to the intake of a drug, be it prescribed by a medical practitioner or taken as auto-medication for a given ailment. In this document we present an original case of Stevens-Johnson's syndrome secondary to the ingestion of gunpowder. PATIENTS AND METHODS: A 22-year-old female student was hospitalised for diffuse and painful skin eruptions for the previous three days. She had complained six days earlier of an allergic reaction to pineapples, an allergy she had presented for quite a long time. In an attempt to remedy the situation, her mother made her drink a solution made of gunpowder bought at a market mixed with some water. On the third day of this "treatment", the patient noticed eruptions on her skin. These were initially maculopapular, later becoming erosive, and she had a mild fever. Later, a variety of eruptions appeared on the skin, from hyper-pigmented macular papules to blisters and erosive lesions with no Nicolsky sign. These lesions spared the palms of the hands and the soles of the feet. The mucosa of the conjunctivae, nose, buccal cavity, vulva, vagina and anus were severely affected. This clinical presentation was typical of Steven Johnson syndrome. The patient had stopped taking the "treatment" when she noticed the first lesions. On therapy, the outcome was favourable, except for severe complications such as synechiae with diffuse dyschromia. CONCLUSION: To the best of our knowledge this is the first time gunpowder has been incriminated in Stevens-Johnson's syndrome.

[Hair darkening close to a patch of frontal fibrosing alopecia]. / Repigmentation pilaire en bordure d'une alopécie frontale fibrosante.

BACKGROUND: Fibrosing frontal alopecia is scarring form alopecia and is most often seen in menopausal women. It is currently considered as an anatomoclinical form of lichen planopilaris of selective topography. We report a case of hair repigmentation during the course of post-menopausal frontal fibrosing alopecia. CASE REPORT: A 78-year-old woman developed alopecia of the scalp and eyebrows in 1997. Her eyebrows had been white for some ten years. In 1999, she noted repigmentation of a strip of hair at the edge of her scalp, but the rest of her hair remained white. The patient had not been taking any long-term drugs or any hair treatment. Histological examination of the regions of alopecia revealed lesions of lichenoid appearance at the junction with erosion by lymphocytes and keratinocytic necroses of the lower layers of the epidermis. Direct cutaneous immunofluorescence testing was negative. A diagnosis of post-menopausal fibrosing frontal alopecia was made on the basis of the clinical and laboratory evidence. DISCUSSION: 96 cases of post-menopausal fibrosing frontal alopecia have so far been reported in the literature, but to our knowledge, this is the first case combined with or inducing hair repigmentation. The other cases of repigmentation were eliminated by history-taking, and clinical or laboratory examinations. The mechanism of hair repigmentation in our patient could have been the result of a post-inflammatory process.

[Outbreak of cutaneous dermatophytosis in the Judo French Programme in Orleans: September 2004-June 2005]. / Epidémie de trichophyties cutanées chez les judokas du pôle France d'Orléans: septembre 2004-juin 2005.

BACKGROUND: High contact sports regularly allow transmission of infectious agents, including fungi such as dermatophytes. The occurrence of dermatophytosis outbreaks among wrestlers has been extensively described since the 90s. The emergence of such outbreaks among judokas was described for the first time in December 2004. We report here an outbreak which occurred in a high level judo team and is, to our knowledge, the largest ever published. PATIENTS AND METHODS: From October 2004 to June 2005, every judokas of the Pôle France Orléans who were suspect of dermatophytosis were addressed to one single dermatologist. Lesions were sampled for fungal culture and their anatomical cartography was extensively raised. Two protocols of treatment were defined. RESULTS: 97 medical appointments occurred over the period, leading to 74 clinically-defined episodes of dermatophytosis, distributed as 51 primo-contaminations and 23 re-contaminations (new episode in an individual who was considered cured). The distribution of the lesions on the body was: forearms > anterior trunk > neck and face > scalp. Among the 74 episodes, 53 could grow Trichophyton tonsurans. Infected athletes received oral and topical antifungal treatments. No adverse effects were noticed. DISCUSSION: This series among judokas is the largest ever published. It allowed the description of the specific clinical and anatomical presentation of tinea corporis gladiatorum, emphasising that contamination takes place through direct skin to skin contacts during practice. T. tonsurans is regularly the responsible fungus in recently published series. Caring for such an outbreak raises specific problems because of the numerous structures involved and of the nature of these structures and of the sportive goals they aim at. CONCLUSION: This outbreak is probably part of a wider one diffusing among high level judo teams. Stopping it requires the cooperation of several distinct actors, among which sports federations as well as sports-related physicians and dermatologists should play a major role.