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E Grosshans

Publications and source records attributed to E Grosshans.

At least 91 records · Page 5Linked to original sources
PubMed1999

[Cutaneous lymphoma manifesting as pigmented, purpuric capillaries].

INTRODUCTION: A few cases of patients with both purpuric pigmented dermatitis and cutaneous lymphoma have been reported. The aim of this study was to evaluate the prognosis of purpuric pigmented dermatitis. MATERIAL AND METHODS: This is a monocentric retrospective study at the dermatology department of the university hospital of Strasbourg. The records of all patients hospitalized for purpuric pigmented dermatitis between 1967 and 1997 have been reviewed. RESULTS: Eight women and 9 men aged between 17 and 84 years were hospitalized for purpuric pigmented dermatitis during the reference period. Except for one patient, all had had a cutaneous biopsy showing the typical features of purpuric pigmented dermatitis. On the basis of clinical signs and course, one patient was thought to have contact dermatitis and three patients were thought to have a purpuric pigmented dermatitis-like drug eruption (meprobannate, pefloxacine and lorazepam or aspirin). The mean follow-up was one year. During follow-up, two patients developed cutaneous T-cell lymphoma after two and four years respectively and one patient developed Hodgkin's disease with skin and lymph node involvement. Another patient who suffered from purpuric pigmented dermatitis for four years had a monoclonal T cell population within the dermal infiltrate. Two patients died of their lymphoma. DISCUSSION: This study shows that purpuric pigmented dermatitis can be associated to or evolve into lymphoproliferative disease. This course should be suspected when purpuric pigmented dermatitis is extensive, long-lasting (> 1 year), has a reticular arrangement and negative patch-testing. In this situation, a long-term follow-up and treatments indicated in the early patch stage of mycosis fungoides (PUVA therapy, chlormethine) seem adequate.

Adolescent↗
PubMed1999

Eccrine porocarcinoma, tricholemmal carcinoma and multiple squamous cell carcinomas in a single patient.

A 75-year old woman without remarkable medical history presented with a large eccrine porocarcinoma of the trabelucar type located on her leg. This tumor was associated with two invasive squamous cell carcinomas of the legs, two Bowen's diseases of her thigh and arm and multiple actinic keratoses of the face. Despite major surgery, local recurrence of the porocarcinoma was observed 6 months later. During the 3-year follow-up after a second surgical intervention, this lesion did not reccur, but the patient developed a rapidly enlarging ulcerated tumor of the forehead which proved to be tricholemmal carcinoma. Although no carcinogenetic factor or familial history of multiple neoplasms could be evidenced, the occurrence of multiple tumors of various histogenesis over a 1 year period of time is unlikely to be fortuitous. Such an association of rare adnexal neoplasms has not yet been described.

Acrospiroma↗
PubMed1999

[Neuroendocrine carcinoma: first case observed in Dakar].

Neuro endocrine carcinoma is an unusual malignant tumor occurring in white elderly persons. It's most common location is the skin of head and neck. We report the first case of of Merkel cell carcinoma from Dakar. It was a woman of 21 years with history of three nodular lesion on the left foot which occurred 8 month before her arrival in our department. Inguinal and poplital lymph nodes were enlarged. Histopathology and immunocytochemistry confirmed the diagnosis of Merkel cell carcinoma. Our case is remarkable by the young age of our patient, her black race, the relative importance of the size and the localization of the tumor and the early occurrence of lymph node and pulmonary metastases.

Adult↗
PubMed1998

Nail changes in patients infected with human immunodeficiency virus. A prospective controlled study.

OBJECTIVES: To study the frequency of nail changes in a population of human immunodeficiency virus (HIV)-infected patients and to evaluate the specificity of these findings by comparison with HIV-negative control subjects. DESIGN: Prospective controlled study. Nail changes were recorded by a standardized clinical examination (curvature, nail plate, color, onychomycosis). In case of clinical diagnosis of onychomycosis, mycological culture was performed. SETTING: Primary care university hospital. PATIENTS: A total of 155 HIV-1-positive patients and 103 healthy HIV-negative control subjects of comparable age and sex ratio. INTERVENTION: None. MAIN OUTCOME MEASURE: Clinical examination findings. RESULTS: Nail symptoms were present in 67.7% of HIV-positive patients vs 34.0% of controls (P << .001). The following symptoms were significantly more frequent in the HIV group: clubbing (5.8%) (P < .05), transverse lines (7.1%) (P < .01), onychoschizia (7.1%) (P < .05), leukonychia (14.3%) (P < .001), and longitudinal melanonychia (14.8%) (P < .01). The main finding was onychomycosis in 30.3% of patients vs 12.6% of controls (P < .001). Trichophyton rubrum was present in 48% of onychomycoses and unusual Candida species were also recorded. Multiple fungi were frequently cultured in a single patient. The mean CD4+ cell count was lower in patients with onychomycosis and the frequency of onychomycosis increased in advanced stages of HIV disease. Acquired total leukonychia of the 20 nails was present in 4% of patients. CONCLUSION: Nail symptoms are much more frequent in patients with HIV than in healthy controls, and some of them could be linked to the level of immunosuppression.

Adult↗
PubMed1998

The significance of the 'dust-like particles' pattern of immunofluorescence. A study of 66 cases.

Subacute cutaneous lupus erythematosus (SCLE) is a marker of a unique subset of lupus erythematosus patients. A 'dust-like particles' direct immunofluorescence (DIF) staining pattern, which consists of fine granular particles of immunoglobulin(s) scattered through the epidermis and the cellular infiltrates of the dermis, was reported to be specific for SCLE. In this study, we assessed the real specificity of this staining pattern, which had not yet been evaluated. We systematically searched for the dust-like particles staining pattern among the 4374 skin biopsy specimens submitted for direct cutaneous immunofluorescence during a 7-year period (1989-96). The corresponding patient records were reviewed. Dust-like particles were observed in 66 samples originating from 60 patients. Only 53% of the patients had SCLE. The remaining patients had systemic lupus erythematosus with visceral involvement (17%), discoid lupus erythematosus (3%), mixed connective tissue disease (2%). Sjögren syndrome (2%) and other diseases. Eighty-five per cent of the patients had connective tissue disease. Seventy-seven per cent of the patients were positive for antinuclear antibodies, but only 36% were positive for anti-Ro (SSA) antibodies. This study shows that the dust-like particles staining pattern is not specific for SCLE, but is highly suggestive of connective tissue disease. The nature of the antigen responsible for the immunoglobulin deposition and the prognostic significance of this DIF pattern remain to be established.

Antibodies↗
PubMed1998

Evaluation of clinical efficacy and safety of adapalene 0.1% gel versus tretinoin 0.025% gel in the treatment of acne vulgaris, with particular reference to the onset of action and impact on quality of life.

A randomized, multicentre, investigator-masked study was conducted in 105 patients with mild to moderate acne vulgaris to compare the efficacy and safety of adapalene 0.1% gel with tretinoin 0.025% gel after three months of treatment, with particular emphasis on reduction in inflammatory lesion counts after one week of treatment and impact on quality of life. In terms of efficacy, adapalene gel was found to be superior to tretinoin gel after one week of treatment, with respect to reduction in inflammatory lesion counts (32% vs. 17%, respectively; P = 0.001), total lesion counts (28% vs. 22%, respectively; P = 0.042) and global severity grade (28% vs. 16%, respectively; P = 0.001). No significant difference between the two treatments was found after 12 weeks of treatment for any of these variables. Evaluation of facial skin tolerance parameters showed significant differences between the two treatments in favour of adapalene for dryness, erythema, immediate and persistent burning and pruritus for at least one time point. One patient in the adapalene group and three patients in the tretinoin group experienced medical events which lead to discontinuation of treatment (skin irritation; NS). Quality of life scores improved more rapidly in the adapalene group than in the tretinoin group, with significant differences (P < 0.05) appearing at week 1 for questions related to problems with partners, close friends or relatives and to skin symptoms. There was also a significantly greater improvement in social and leisure activity in the adapalene group at week 12. Adapalene 0.1% gel reduced inflammatory and total lesion counts more rapidly than tretinoin 0.025% gel, and was also better tolerated. These differences appear to result in an earlier and greater quality of life improvement for the patients receiving adapalene.

Acne Vulgaris↗
PubMed1998

Erythema nodosum and associated diseases. A study of 129 cases.

BACKGROUND: Erythema nodosum (EN) is associated with many infectious diseases. The purpose of this study was to evaluate the relative prevalence of associated diseases in a large series of EN, and to review the previously described causes of EN. MATERIALS AND METHODS: A total of 157 inpatients with a diagnosis of EN made in Strasbourg, France between 1960 and 1995 were studied retrospectively, but only 129 patients with confirmed EN were evaluated. A biopsy was taken in 30 patients with atypical clinical symptoms. Chest radiography, blood cell count, throat swab, and anti-streptolysin dosage were performed systematically. Viral investigations and serodiagnoses for various bacterial infections were carried out in approximately half of the patients. All investigations were analyzed retrospectively and compared with the world literature. RESULTS: The female: male ratio was 5 : 1 and the mean age was 31 years. We found 28% confirmed streptococcal infections, 11% sarcoidosis, 1.5% enteropathies, 1.5% Chlamydia infections, 0.8% Mycoplasma infections, 0.8% Yersinia infections, 0.8% hepatitis B, and 0.8% tuberculosis (one case). The causative factor could not be determined in 55% of patients. CONCLUSIONS: Our data confirm the predominance of streptococcal infections and sarcoidosis among patients with EN. Tuberculosis has virtually disappeared, since the last case was observed in 1962. Various viral or bacterial diseases are rarely associated with EN, but all patients were not thoroughly investigated. A large and prospective study should be performed in order to determine the true prevalence of associated diseases in EN. In the absence of specific symptoms, exhaustive investigations are not cost-effective.

Adolescent↗
PubMed1998

Systematic cutaneous examination in hepatitis C virus infected patients.

The purpose of this study was to evaluate the frequency of skin changes among 100 patients from the Hepatogastroenterology Department of the University Hospital, Strasbourg, France who were hepatitis C virus-positive (HCV) and HIV-negative. Their clinical data were compared to those of 50 HCV-, and HIV-negative patients from the same Department, who suffered from various liver diseases. Psoriasis, rosacea, seborrheic dermatitis, cherry angiomas, spider nevus and skin cancers were noted in similar proportions in the two groups. In 15% of HCV-positive patients vs. 4% of controls, chronic pruritus was noted (p < 0.05). In 9 HCV-positive patients, pruritus was not related to itching dermatosis, and only 2 of these patients had mild cholestasis. Four cases of lichen planus vs. 0 in the control group were recorded. The virological data of patients with pruritus or lichen planus were not different than those of the rest of the group. Our findings indicate that systematic skin check-up in HCV-positive patients is valuable.

Adult↗
PubMed1998

[Erythroderma with immunoglobulin deposits along the basal membrane. Pemphigoid erythroderma?].

INTRODUCTION: There are many clinical forms of bullous pemphigoid. Nodular, localised, vegetating, vesicular and dysidrosiform variants have been described. The appartenance to the spectrum of pemphigoid was confirmed by the demonstration of antibodies directed against the 230 and 180 kDa BP antigens. Three cases of erythrodermic pemphigoid were recently described. OBSERVATIONS: We describe two cases of patients suffering from erythroderma for several months associated with a linear deposit of immunoglobulins and complement along the basement membrane. In the first observation, the patient suffered from bullae of the legs before developing erythroderma. The positive direct immunofluorescence of the skin was associated with circulating anti basement membrane antibodies, making therefore the diagnosis of erythrodermic pemphigoid possible. In the second case, the patient never developed blisters. We also found a linear deposit along the basement membrane, localized on the dermic side of a skin treated by molar NaCl. No circulating antibodies were found by indirect immunofluorescence or by immunoblott. Direct immuno electron microscopy showed a deposit of immunoglobulins into the deep layers of the lamina lucida and into a part of the lamina densa. CONCLUSION: These two cases suggest that there are true erythrodermic pemphigoid without blisters. The value of the systematic direct immunofluorescence examination of the skin of erythroderma should be evaluated.

Aged↗
PubMed1998

[Melanoma in the Strasbourg University Hospital. A 30-year study].

INTRODUCTION: The incidence of melanoma has increased more than the incidence of any other cancer in the past twenty years. There is no cure for advanced-staged melanoma and it's early diagnosis has become a main issue of health policy. Therefore, precise epidemiological data are needed. These data depend on the geographical setting and very few data are available for France. We studied these data in Strasbourg. PATIENTS AND METHODS: All patients hospitalized for melanoma between 1960 and 1989 at the academic dermatology department, Strasbourg, were included in this retrospective, monocentric, study. The diagnosis of melanoma was confirmed in all cases by a dermatopathologist. Clinical, histopathologic and epidemiological data of the patients were recorded. RESULTS: Six hundred seventeen patients with a mean age of 52 years were included. The number of new patients hospitalized for melanoma grew steadily. The mean tumor thickness was 2.31 mm (+/- 1.59) and it remained unchanged between 1970 and 1989. The mean duration between the first clinical signs of melanoma and excision of the tumor was 22 months. Only 4 p. 100 of the melanomas were diagnosed by means of routine examination, and this concerned almost exclusively patients hospitalized after 1980. Eighty five p. 100 of the patients had localized melanoma (stage I) at time of diagnosis. Forty two p. 100 of the patients developed metastasis. The mean five year survival rate was 68 p. 100. CONCLUSION: The number of new patients hospitalized each year for melanoma grew steadily, but the mean tumor thickness remained unchanged. This indicates that the ratio "thick"/"thin" melanomas has remained unchanged between 1960 and 1989 and that the number of melanomas of any thickness has increased. Clinical data show an unawareness of the local population of the dangers of pigmented lesions during the reference period. This unawareness can be partially explained by the fact that no specific information campaign has ever taken place in this area. These data suggest that such a campaign should be recommended.

Adult↗
PubMed1998

[Orbital edema induced by psychotropic drugs?].

INTRODUCTION: Drugs known to be responsible for orbital edema are calcium channel blockers, rifampicin, atracurarium, methylprednisolone and mannitol. We describe three patients with orbital edema induced by psychotropic drugs administrated for a long period of time. OBSERVATIONS: These patients were aged 51 to 73 years, and had orbital edema predominant in the morning, but persisting during the day. All the other causes of orbital edema--including steatoblepharon--were ruled out by medical history and investigations. In one case the edema decreased after the interruption of nearly all psychotropic drugs. DISCUSSION: The exclusive orbital localization of the edema suggests a local or regional mechanism that could be an exacerbation of the physiological morning orbital edema induced by decreased lymphatic flow. This flow is usually enhanced by gravity and automatic palpebral blinking.

Aged↗