[Contact allergy to antiseptics: 75 cases analyzed by the dermato-allergovigilance network (Revidal)]. / Allergie de contact aux antiseptiques: 75 cas analysés par le réseau Revidal de dermato-allergovigilance.

AIM: To determine the clinical features of contact dermatitis caused by antiseptics and to ascertain whether the substance responsible is the antiseptic itself or the excipients. PATIENTS AND METHODS: A multicenter, retrospective study based on analysis of all cases reported over a 2-year period to the Dermato-Allergology Vigilance network known as Revidal. Each dossier contained details of the clinical characteristics of lesions, the incriminated antiseptic, the mode of exposure and the results of patch tests done with the antiseptic in question. RESULTS: 75 patients (mean age: 44 years) were sensitized to chlorhexidine (14 cases), hexamidine (20 cases), povidone iodine (14 cases), mercuric antiseptics (3 cases), triclocarban (Septivon, 17 cases), hexamidine-chlorhexidine-chlorocresol (Cytéal, 4 cases), or chlorhexidine surfactant (Hibiscrub), cetrimide or chlorhexidine digluconate (Diaseptyl) (1 case each). Exposure was therapy-related (68 cases), work-related (6 cases; 5 in health workers and 1 in a cattle farmer due to povidone-iodine) or related to cosmetics (1 case, hexamidine). The clinical features consisted mainly of localized contact dermatitis, although generalized eczema occurred in 9 cases due to hexamidine contact. Sensitization was due to the antiseptic itself (53 cases) or to the excipients alone (22 cases), particularly in the 17 cases caused by Septivon. In 27/75 cases (35%), patients exhibited polysensitization to antiseptics belonging to different chemical classes or to other topical drugs. CONCLUSION: Sensitization to antiseptics is probably not rare, with various sources of exposure being present in everyday life. Patch tests are essential for diagnosis in order to distinguish between antiseptic-related and excipient-related sensitization and to screen for polysensitization to topical drugs.

[Contact dermatitis with Hirudo medicinalis]. / Eczéma de contact à Hirudo medicinalis.

BACKGROUND: Hirudine is the first natural anti-coagulant ever described. It is used for its anti-coagulant properties in plastic surgery or for the treatment of post-phlebitic diseases. Natural hirudine is extracted from the saliva of the Hirudo medicinalis leech, but it can also be found in crushed leech and included in a cream (Hirucrème). Side effects to hirudine are considered to be rare. CASE REPORT: We report a contact eczema caused by an extract from the medicinal Hirudo medicinalis leech. This was confirmed by the patch tests. However, we noticed a negativity of these tests with two analogs of the recombinant hirudine. DISCUSSION: Several cases of contact dermatitis with Hirucreme have been described. The analogs of recombinant hirudine, which share similar biological activity, have a very close molecular structure. They are indicated via the systemic route for thrombopenia related to heparin for the prevention of severe thromboses. The negative patch tests does not allow definite conclusion, but they prove that these molecules do not always lead to cross-allergies.

[Fixed pigmented erythema caused by levamisole administration]. / Erythème pigmenté fixe secondaire a l'administration de lévamisole.

INTRODUCTION: Description of a case of fixed drug eruption induced by levamisole. OBSERVATION: Fixed toxic erythema with pigmentation was observed in a patient taking levamisole as an adjuvant to 5 fluorouracil chemotherapy for cancer of the colon. The imputability of levamisole was highly likely. Epicutaneous skin tests were negative. DISCUSSION: Several types of skin eruptions have been described after intake of levamisole. It was highly likely that levamisole was implicated here and fixed pigmented erythema should be added to the list.

Erythema elevatum diutinum in a patient with relapsing polychondritis.

A 69-year-old man with a history of relapsing polychondritis developed a widespread cutaneous eruption that was clinically and histologically typical of erythema elevatum diutinum. This eruption was accompanied by a recurrence of arthralgias. The significance of this association between relapsing polychondritis and erythema elevatum diutinum, which has not been previously reported, is discussed.

[Xanthoma disseminatum (Montgomery's syndrome) (author's transl)]. / Xanthoma disseminatum (syndrome de Montgomery).

Montgomery's syndrome is distinguished by skin and mucous membrane xanthomatosis, predominant on folds, associated with diabetes insipidus and normal lipidic balance. From one typical case history occurring in a young gravida, the authors stresse upon: --Review of literature's cases. --Peculiar therapeutic problems during pregnancy. --Nosological discussion: the position of Montgomery's syndrome compared with histocytosis X and other nonnormolipidic xanthomatosis. This problem is all the more important as in this observation xanthomatosis was first with a normal lipidic measurement, lipidic disorders appearing only secondarily.

[Pyoderma gangrenosum: Clofazimine therapy]. / Pyoderma gangrenosum: thérapeutique par clofazimine.

Two patients with pyoderma gangrenosum have responded remarkably well to treatment with Clofazimine (Lamprène). The first patient, a 68-year old women suffered from pyoderma gangrenosum of the buttock and left leg and on the incision scar for cancer of the breast. Laboratory findings showed monoclonal dysglobulinemia (alpha 2-kappa 2). A daily dose of 300 mg of Clofazimine resulted in complete healing with ten days. The second patient was a 24-year old women suffering from ulcerative colitis and a rapidly progressing pyoderma gangrenosum of the left leg. The lesions was completely healed after two weeks of Clofazimine therapy. The dosage was 200 mg daily and was increased to 400 mg daily. Our cases showed decreased cellular immunity and their phagocytic activity was variable.