[CO2 fractional resurfacing: side effects and immediate complications]. / Lasers CO2 fractionnés: suites normales et complications post-interventionnelles.

BACKGROUND: Fractional resurfacing is a new concept in laser treatment designed to divide radiation into multiple evenly spaced microspots. The aim of our study was to analyze side effects and complications following fractional CO2 laser therapy. PATIENTS AND METHODS: This retrospective study involved the analysis of records of patients treated with ablative fractional CO2 laser. Pain, type and duration of usual side effects, and immediate complications were analysed. RESULTS: Forty-six treatments were studied. The average duration of erythema was 5.2 (±2) days while that of scabs was 4.1 (±1.9) days. Average pain was 3.3/10 (±2.5) for nine patients premedicated with Emla® and 4.1/10 (±2) for the other 14 non-premedicated patients. Complications were reported for 21.7% of the 46 treatments, as follows: 10.6% facial herpes, some of which occurred despite antiviral prophylaxis (valacyclovir 500 mg/day p.o.), 8.7% inflammatory reactions, including severe facial swelling, and 2.2% acne. All complications resolved quickly. DISCUSSION: Our study specifically examined the safety of CO2 fractional lasers and showed an acceptable per interventional pain and simple follow-ups. The frequency of complications was high compared to that described with the Fraxel®, but no severe complications were reported. Given the extent of herpes complications, our study encourages the prescription of valacyclovir prophylaxis 500 mg twice a day for all patients. Patients should also be informed of the high risk of severe inflammatory reaction.

[Hypercarotenaemia in an infant]. / Hypercaroténémie chez un nourrisson.

BACKGROUND: Hypercarotenaemia is the consequence of high serum carotenoid levels, which are deposited in the stratum corneum and give a yellowish coloration to the skin. It can be distinguished from jaundice by the absence of colouring of the conjunctivae as well as orange discolouration of the palms and soles. CASE REPORT: We report a rare case of hypercarotenaemia in a child that began at the age of three months. Clinical signs and symptoms included yellowish discolouration of the skin, orange palms and soles, xerosis and pruritus. Hypercarotenaemia was confirmed by high levels of serum carotenoids. Serum vitamin A was normal. Dietary and drug-induced causes of hypercarotenaemia were excluded in this case, as well as other classical metabolic causes (renal insufficiency, malabsorption syndrome, diabetes, hypothyroidism). The child was placed on a low-carotenoids diet for six months, resulting in decreased serum carotenoid levels and regression of cutaneous signs and symptoms, especially pruritus. DISCUSSION: Although pruritus has never been reported in isolated hypercarotenaemia it is a classical sign of hypervitaminosis A. The mechanism of pruritus is not understood in this instance since vitamin A levels were normal. This case report is also unusual in that no classical cause of hypercarotenaemia was found, as a result of which we concluded on a likely defect in beta-carotene 15, 15'oxygenase, an enzyme involved in vitamin A production.

Contribution of skin biometrology to the diagnosis of the Ehlers-Danlos syndrome in a prospective series of 41 patients.

BACKGROUND/PURPOSE: The diagnosis of the Ehlers-Danlos syndrome (EDS) is primarily clinical. Clinical signs result from modifications of the rheological properties of the skin: thickness, extensibility and hydration. Our main objective was to demonstrate what skin biometry can contribute to the diagnosis and evaluation of the different types of EDS. METHODS: Forty-one patients clinically diagnosed with EDS were paired by age and sex to 41 healthy subjects with no known dermatologic disease, in particular connective tissue diseases. We measured skin thickness, extensibility, hydration and sebum secretion by skin ultrasonography, use of a Cutometer, a Corneometer and a Sebumeter. RESULTS: The skin is thinner in all three disease types (classical, hypermobility and vascular). It is more extensible only in the classical type, and more hydrated and fatty in the hypermobility type. CONCLUSION: Non-invasive measurement of skin thickness and elasticity are quantitative parameters that can be used to better diagnose EDS. Moreover, the sebaceous rate can help to diagnose the hypermobility type whereas the immediate retraction distinguishes the classical form from vascular and hypermobile types.

[Techniques and applications of noninvasive high-resolution ultrasound imaging]. / Techniques et applications de l'échographie haute résolution non invasive.

Today manufacturers propose echographic systems with a resolution ranging from 100 microm down to 30 microm. This requires ultrasonic frequencies ranging from 20 to 60 MHz. However, when associated with an increase in the attenuation of the wave in the media this limits the applications to superficial exploration. High frequencies also bring special technological limitations mainly in the fields of transducers, electronics, and acoustic coupling. Although high-resolution echography has long remained marginal and been used for the exploration of the skin or the anterior chamber of the eye, new powerful and easy-to-use devices have recently appeared on the market. With these new products, new applications have also appeared such as the exploration of the oral cavity or small laboratory animals (mice).

[Ehlers Danlos type IV syndrome presenting with simultaneous dissection of both internal carotid and both vertebral arteries]. / Dissections simultanées des deux artères carotides internes et des deux artères vertébrales révélatrices d'un Syndrome d'Ehlers-Danlos type IV.

INTRODUCTION: Dissection of cervical arteries is a frequent cause of stroke in young subjects. CASE REPORT: We report the case of a 34-year-old patient who experienced simultaneous dissection of both internal carotid arteries and both vertebral arteries leading to repeated motor deficit of the right half-body associated with persistent otalgia. Search for an etiology led to the diagnosis of Ehlers-Danlos syndrome type IV. CONCLUSION: Search for the cause of cervical artery dissection must consider connective tIssue disease, particularly vascular forms of Ehler-Danlos syndrome. Diagnostic, therapeutic as well as prognostic aspects are discussed.

[Cutaneous immature hemangioma and hepatic angioma: there is no frequent association]. / Angiomes immatures cutanés et angiomes hépatiques: il n'y a pas d'association fréquente.

INTRODUCTION: The aim of this work was to determine the usefulness of systematic liver sonography in patients with immature cutaneous hemangiomas. PATIENTS AND METHODS: Children with immature cutaneous hemangiomas who met inclusion criteria underwent liver sonography. RESULTS: No case of hepatic angioma was observed. CONCLUSIONS: Liver sonography is not necessary as a routine test in children with several immature angiomas. This examination could be proposed in situations other than those evaluated in this work including miliary angiomas, unusual immature angiomas, hepatomegaly, unexplained heart failure.

[Menkes syndrome. An unusual pigmentation anomaly in a mother and three sisters]. / Maladie de Menkès. Anomalie particulière de la pigmentation chez la mère et trois soeurs.

Menkès syndrome is a sex-linked recessive disease. The authors previously reported a case in a boy whose neurologic condition deteriorated gradually until death occurred at the age of seven and a half months. Diagnosis was confirmed by the finding of very low plasma levels of copper and ceruloplasmin. Evaluation of family members disclosed hypopigmentation of one half of the abdomen in three sisters and in the carrier mother. This hypopigmentation may be ascribed to decreased melanocyte copper-dependant tyrosinase activity. Among cells in the body, this anomaly may be present or absent according to whether or not the abnormal X chromosome is inactivated.