The viral etiology of an influenza-like illness during the 2009 pandemic.

Many viruses are known to cause influenza-like illness (ILI); however, in nearly 50% of patients, the etiologic agent remains unknown. The distribution of viruses in patients with ILI was investigated during the 2009 A/H1N1 influenza pandemic (A/H1N1p). From June 2009 to January 2010, 660 patients with suspected influenza were questioned and examined, and nasal swabs were collected. All patient samples were tested for influenza virus, and 286 negative nasal swabs were tested further for 18 other respiratory viruses using real-time RT-PCR. Two waves of ILI were observed in the epidemic curve (weeks 35-42 and 42-49). At least eight viruses co-circulated during this period: human rhinovirus (HRV) (58), parainfluenza 1-4 viruses (PIV) (9), human Coronavirus (hCoV) OC43 (9), enterovirus (5), adenovirus (AdV) (4), and human metapneumovirus (hMPV) (2); however, 204 samples remained negative for all viruses tested. ILI symptoms, according to the Centers for Disease Control and Prevention criteria for ILI definition, were reported in 75% of cases. These patients had positive swabs for A/H1N1p, HRV, hCoV-OC43, PIV, AdV, and hMPV without significant difference with non-ILI patients. This study found that many respiratory viruses circulated during this period and that the A/H1N1p did not impact on the kinetics of other respiratory viruses. The proportion of non-documented cases remains high. ILI could not distinguish A/H1N1p infection from that due to other respiratory viruses. However, in multivariate anlaysis, cough, chills, hyperemia, and dyspnea were associated significantly with influenza virus versus other respiratory viruses.

Evaluation of the Xpert Flu test and comparison with in-house real-time RT-PCR assays for detection of influenza virus from 2008 to 2011 in Marseille, France.

Rapid documentation of respiratory specimens can have an impact on the management of patients and their relatives in terms of preventive and curative measures. We compared the results of the Xpert(®) Flu assay (Cepheid) with three real-time RT-PCR assays using 127 nasopharyngeal samples, of which 75 were positive for influenza A (with 52 identified as A/H1N1-2009) and 52 were positive for influenza B. The Xpert(®) Flu assay presented a quasi-absence of non-interpretable tests, and showed sensitivity and specificity of 100% and 100% for Flu A, 98.4% and 100% for A/H1N1-2009, and 80.7% and 100% for Flu B.

Comparative effect of tacrolimus and betamethasone valerate on the passive sustainable hydration of the stratum corneum in atopic dermatitis.

BACKGROUND: There is ample evidence that the skin barrier function is altered in atopic dermatitis. Little information is available about the effect of topical corticosteroids and calcineurin inhibitors on this function. PURPOSE: To assess the water content and its rate of accumulation in the stratum corneum of atopic patients using an indirect electrometric method while on tacrolimus or betamethasone valerate treatment. METHOD: Twenty-one patients with moderate atopic dermatitis affecting both forearms completed this double-blind randomized study. One forearm was treated twice daily for 3 weeks with 0.1% tacrolimus ointment. The other forearm was similarly treated with 0.12% betamethasone valerate ointment. Electrometric measurements were made under continuous occlusion secured by a Nova Dermal Phase Meter sensor probe. Assessments were performed at inclusion, after the 3-week treatment and after a further 3-week follow-up out of treatment. RESULTS: During treatment, both compounds yielded a similar improvement in skin barrier function. Indeed, under probe occlusion, the rate of water accumulation was significantly decreased. This improvement was sustained after stopping the tacrolimus treatment. By contrast, the benefit was in part lost at the site that had been treated by betamethasone valerate. CONCLUSION: The difference in the effect of the 2 compounds may be due to the negative influence of betamethasone valerate on the epidermal metabolism leading to progressive atrophy of the tissue. The better preservation of the skin barrier function after stopping tacrolimus treatment may help retarding relapses of atopic dermatitis.

[Cutaneous vasculitis with necrotic ulcers in rheumatoid arthritis: treatment with anti-TNFalpha]. / Vasculite avec ulcérations cutanées au cours de la polyarthrite rhumatoïde: traitement par anti TNFalpha.

INTRODUCTION: Anti-TNFalpha has occasionally been used in the treatment of recalcitrant forms of systemic vasculitis such as Behçet's disease, Wegener's granulomatosis and Churg-Strauss syndrome. We report on the outcome of treatment in rheumatoid arthritis patients with cutaneous vasculitis lesions on anti-TNFalpha. OBSERVATIONS: Two patients with rheumatoid arthritis present for several years had necrotic ulcers of the lower limbs due to cutaneous vasculitis. After the failure of various immunosuppressive drugs (cyclophosphamide, azathioprine, methotrexate), the two patients were treated with anti-TNFalpha: infliximab in the first case and adalimumab in the second. Cutaneous ulcers healed within two to four months of the start of anti-TNFalpha treatment. Despite ongoing anti-TNFalpha treatment, these cutaneous ulcers relapsed four to six months after complete healing. CONCLUSION: Initially spectacular healing of cutaneous vasculitis ulcers under anti-TNF alpha treatment followed by relapse after several months of treatment is suggestive of an escape mechanism.

[How I treat...diaper dermatitis]. / Comment je traite...une dermite des langes.

Diaper dermatitis is the most frequent skin disorder of the newborn. Several clinical types are distinguished. The most frequent type results from increased fragility of the newborn buttock skin when covered by diapers. According to the mechanisms involved and the severity of the dermatitis, one can distinguish the intertrigo of the chubby baby, and the so-called "W", "Y" and "red panties" types of diaper dermatitis. When the effects of occlusion are not controlled by adequate absorption by the diapers maceration of the stratum corneum occurs. As a result, degradation of the skin barrier function takes place. In addition, the value of the coefficient of friction of the skin increases with epidermal weakening to rubbing. In addition, fecal enzymes alter urines and skin. Judicious hygiene measures and a correct choice of care and diapers are mandatory. Cutaneous colonisation by microorganisms, in particular the yeasts Candida spp, is the main complication. Adequate preventive and curative measures can combat diaper dermatitis with confidence. A miconazole paste allows to improve the tribological properties of the interface between diapers and the skin. It also corrects the degradation of the skin barrier function, reduces inflammation and abates the impact of Candida spp. in the pathogenesis of the skin disorder.

[Pimecrolimus (Elidel) for a variety of skin diseases]. / Le pimecrolimus (Elidel) hors des sentiers battus.

Pimecrolimus is an immune downregulator that belongs to the class of calcineurin inhibitors. Its efficacy is recognized for the topical treatment of the mild to moderate types of atopic dermatitis. In addition, the drug shows activity in a series of other dermatitides. We report a review of the international literature about this topic.

[The skin and menopause]. / La peau et le temps de la ménopause.

The estrogen deficit occurring at menopause manifests itself under various modalities in the diverse organs and their functions. Skin does not escape this global involutive process. In addition to the effects of chronological ageing, sunlight exposure and other environmental and endogenous stimuli, the climacteric appears to exert some dramatic consequences on skin biology and aspect. The epidermis, its adnexae and the dermis are altered by this process. The epidermis may become xerotic and exhibits altered functions. The dermis thins out and its elasticity decreases in concert with the decline in bone mass. The skin microcirculation is impaired. These aspects are some of the better-worked out skin climacteric changes of which in turn seem to be stabilized or in part reversible with hormone replacement therapy (HRT).

[Cutaneous signs of endocrinopathies]. / Manifestations cutanées des pathologies endocriniennes.

Some cutaneous lesions accompany or reveal endocrine disorders. Identifying the endocrinopathy is very important because it sometimes allows corrective rather than symptomatic treatment. The most frequenly involved diseases include thyrotoxicosis, hypothyroidism, the auto-immune disorders of thyroid, Cushing syndrome, Addison disease, acromegaly, androgen-dependent disorders, hypopituitarism, hypoparathyroidism, pseudohypoparathyroidism and diabetes mellitus.

A novel method of comparing the healing properties of two hydrogels in chronic leg ulcers.

Skin ulcers on the legs have a chronic, relapsing course and are often a significant management challenge. Novel methods of measuring and comparing the effects of different treatments can be of assistance in addressing this situation. A clinical pilot study using original methods was undertaken to compare the healing properties of the alginate gel Flaminal (test) and the hydrocolloid gel Intrasite (control) on chronic leg ulcers. The study was performed over a period of 28 days with two parallel groups of 10 patients. Both the surface (acetate tracing and planimetry) and the volume (Jeltrate mould impression and weighting) of each wound were measured at baseline and after 7, 14 and 28 days of treatment. On both parameters results were superior with the test product compared to the control, with volume reduction being the first parameter to change. Between groups, difference in wound volume reduction was detected as early as day 7 whereas difference in surface reduction was clearly apparent only at day 28. Correlation between wound surface and volume reductions was also better in the test group (r = 0.843 vs. 0.421) than in the control. In conclusion, this pilot study suggests that combining wound surface and volume evaluations allows a more precise analysis of the healing process in venous leg ulcers and that this method is able to detect very early differences in treatments even with limited sample size.

Whitening effect of a dermocosmetic formulation: a randomized double-blind controlled study on melasma.

Melasma is an endocrine-mediated facial hypermelanosis with epidermal and occasionally dermal components. We tested in a randomized double-blind design the effect of a whitening formulation (Thiospot intensive) on this skin disorder. The product containing ethyl linoleate, thioctic acid, octadecenedioic acid, lactic acid and ethylhexyl methoxycinnamate was applied twice daily for 3 months by 20 young women. Another control group of seven women received a non-skin lightening formulation. Clinical assessments were made at 1-month intervals. In addition, objective measurements of the hypermelanosis were performed using narrow-band reflectance spectrophotometry, image analysis of video-recorded ultraviolet light reflection (ULEV method) and photodensitometry of the corneomelametry test. A significant lightening effect was evidenced beginning the second month of treatment with the whitening formulation. No significant effect was observed with the control product.

The riddle of genuine skin microrelief and wrinkles.

Wrinkles result from distinct structural changes occurring in specific parts of the dermis and subcutaneous tissue. There is a need for evidenced-based cosmetology identifying and quantifying the different aspects of wrinkling. Histology allows to detect specific changes associated with particular types of wrinkles. Four main types of wrinkles can thus be recognized, including the atrophic crinkling rhytids, the permanent elastotic creases, the dynamic expression lines, and the gravitational folds. Each type usually develops on specific skin regions exhibiting distinct microanatomical characteristics. Whereas skin microrelief, expression lines and skin folds appear clearly marked at the histological level, only little dermal changes are identified under other reducible or permanent wrinkles compared with the skin immediately adjacent to them. Distinguishing different types of wrinkles brings more precision to the clinical practice. This is of importance because the different types of wrinkles respond differently to cosmetic, dermatological and surgical treatments.

[Linear dermatosis]. / Les dermatoses linéaires.

Some typical distributions of skin lesions represent a helpful sign for the differential diagnosis in dermatology. Indeed, some dermatoses, affecting the skin, nails or mucosae, display an annular or linear disposition. The linear pattern can be explained by several factors. The dermatosis can follow either a nerve traject, vascular or lymphatic vessels, or embryological lines. Exogenous factors, including traumatisms or automutilations, can also contribute to this particular distribution. In this review, the principal linear dermatoses are discussed together with their pathogenesis.