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Biomedical subjects

G Guillet

Publications and source records attributed to G Guillet.

At least 19 recordsLinked to original sources
PubMed2006

[Improvement of Darier's disease on treatment with topical 5-fluorouracil].

BACKGROUND: Darier's disease is an inherited genodermatosis with autosomal dominant transmission characterized by hyperkeratotic papules of seborrheic regions in the axillae, groin or submammary skin in women. Current therapeutic alternatives are poor, encouraging recourse to alternatives treatments such as topical 5-fluorouracil (Efudix) used until now for pre-epitheliomatous keratosis. CASE REPORT: A 55-year-old man presenting severe Darier's disease refractory to therapy for more than twenty years was treated with topical 5-fluorouracil. The cream was applied at a concentration of 1% every second day for five months, alternating with clobetasol ointment in order to improve tolerability. After one month of treatment, clinical signs of hyperkeratosis had virtually disappeared from the patient's face and neck. This dramatic improvement persisted for 2 months after the end of the treatment with 5-fluorouracil. No local or systemic side-effects have been observed to date. DISCUSSION: Darier's disease is caused by mutations of the ATP2A2 gene, which codes for the SERCA2 endoplasmic reticulum calcium pump. This pump is rendered non-functional through decreased ATP and calcium affinity and blockade of phosphorylation-dephosphorylation. We propose a new hypothesis according to which the action of 5-fluorouracil results from restoration of normal intracytoplasmic calcium concentrations, leading to renewed keratinization. Thanks to its mode of activation, this prodrug can compensate for failure of the ATP phosphorylation-dephosphorylation mechanisms necessary for calcium pump activity by releasing phosphoric acids. Thus, topical 5-fluorouracil appears to constitute an effective alternative therapy. Long-term studies in a larger population are needed to clarify the optimal dosage and identify potential side effects.

Administration, Topical↗
PubMed2006

[Erythema multiforme majus and Chlamydia pneumoniae infection].

BACKGROUND: Erythema multiforme majus of infectious origin is an acute eruptive syndrome seen more commonly in young subjects and characterised by an appearance of round target lesions. In most cases, it is associated with infection involving Herpes simplex virus or Mycoplasma pneumoniae. We report an original case of erythema multiforme majus subsequent to infection with Chlamydia pneumoniae. CASE REPORT: An 18 year-old man was hospitalised for management of generalised skin rash comprising lesions in rings, associated with bullous and post-bullous lesions, chiefly in the oral (preventing eating) and genital areas in a setting of febrile cough. Various bacterial agents (Mycoplasma pneumoniae, Chlamydia pneumoniae) and viral agents were suspected, but serological testing for Chlamydia pneumoniae alone was positive with IgM of 128 IU and IgG of 64 IU. The outcome was favourable within several days following administration of symptomatic treatment (rehydration, mouthwashes, etc.) and aetiological treatment (acyclovir: 30 mg/kg/d, ofloxacine: 400 mg/d). At D15, serologic tests for Mycoplasma pneumoniae continued to be negative. Anti-Chlamydia pneumoniae IgM and IgG were 256 IU. At D30, IgM was 128 IU while IgG remained at 256 IU. DISCUSSION: The existence of a systematic skin rash comprising typical target lesions and mucosal lesions in the oral and genital areas suggested to us a diagnosis of erythema multiforme majus. Screening for the agents generally responsible was negative and drug-induced rash was ruled out. Serological tests for Chlamydia pneumoniae were positive at various times, resulting in diagnosis of erythema multiforme majus secondary to infection with Chlamydia pneumoniae. Following demonstration of the presence of Chlamydia pneumoniae using reliable methods and the elimination of other causes of erythema multiforme majus, dermatologists should opt for this aetiology in order to optimise treatment.

Acyclovir↗
PubMed2006

A retrospective review of 20 hypertensive leg ulcers treated with mesh skin grafts.

BACKGROUND: Few articles have been published about hypertensive leg ulcers and their surgical treatment. Since mid of the year 2000, it has been our policy to treat all hypertensive leg ulcers very early with mesh split-thickness skin grafts. The present series consists of 15 patients whose hypertensive leg ulcers, including five bilateral cases, were treated with 20 mesh grafts from 2000 to 2002. SUBJECTS AND METHODS: All patients, nine women and six men, had a long history of hypertension. The same surgical procedure was applied to all 15 patients: a complete mechanical debridement of all necrotic tissues, immediately followed by mesh skin grafting. RESULTS: Patients were discharged from the hospital after an average post-operative period of 16 days. Upon leaving the hospital, the patients had lesions completely healed in 14 of 20 cases. The graft take had been complete after an average period of 14 days. In six cases, one or two very small patches of skin graft had necrosed and complete healing required an additional period of 1 to 3 months. In all 20 cases, pain had disappeared within 1 week from surgery. DISCUSSION: All patients were on opioid therapy before surgery. With medical treatment only, hypertensive leg ulcers used to heal after a mean period of 15 months. After surgery, the average healing period was 2 weeks and opioids were stopped within 1 month after surgery. CONCLUSION: The review of the present series shows that early mesh grafting of hypertensive leg ulcers is beneficial, because healing is very quick and the pain will disappear quasi-instantly.

Aged↗
PubMed2005

[Mycosis fungoides presenting as annular erythema].

INTRODUCTION: Mycosis fungoides is a lymphoma, the classical clinical form of which involves erythematosquamous lesions. However, it can present various atypical aspects: hyper pigmentation or hypo pigmentation, suggestive of pyoderma gangrenosum or ichtyosis. We report a case of mycosis fungoides, unusual in its presentation in the form of centrifugal annular erythema. OBSERVATION: A 78 year-old man had developed a parapsoriasis in plaques for more than 20 years. In May 2002 he consulted because of the recent infiltration of one of the plaques, without concomitant pruritus. The clinical examination revealed 3 lesions of the popliteal groove of the right groin and the left cheek suggestive of centrifugal annular erythema. Histology, revealing Pautrier microabscesses, was compatible with the diagnosis of mycosis fungoides. Evolution was marked by the spontaneous regression of the plaque on the face and remission of the other two plaques after local treatment with chloromethin and topical corticosteroids. Nevertheless, new plaques appeared despite continued treatment, combined with PUVA therapy sessions. DISCUSSION: When searching the literature, we only found one other case of mycosis fungoides, the clinical aspect of which was a centrifugal annular erythema, but in which the histological examination confirmed the diagnosis of mycosis fungoides. Our case report is also unusual in the clinical regression of the lesion on the face, without treatment; this has only been reported in two cases. Mycosis fungoides can appear in various clinical forms. The centrifugal annular erythema form is rare, but this diagnosis should be evoked.

Adrenal Cortex Hormones↗
PubMed2005

[Vulvar contact dermatitis due to seminal allergy: 3 cases].

BACKGROUND: Contact sensitivity deserves to be assessed in acute vulvitis as well as chronic vulvar dermatitis with a specific orientation toward semen allergy whenever the pathology is post-coital. OBSERVATIONS: Three observations of semen allergy are reported. Two women presented with post-coital vulvitis due to delayed hypersensitivity to semen proteins without associated specific IgE. The type 2 allergy was confirmed by positive patch-tests and disappearance of symptoms when using condoms. Another woman presented with oedematous vulvitis associated with asthma and malaise per and post-sexual intercourse. Positive prick-tests with husband's semen and blood tests for specific IgE led to the diagnosis of type 1 hypersensitivity to semen, with disappearance of both vulvar and systemic symptoms with the use of condoms. DISCUSSION: Immediate or delayed type hypersensitivity may be discovered using prick and patch tests respectively. The observation of vulvitis or vulvar discomfort should promote such investigations, whenever a post-coital chronology is suggested. The good clinical pertinence of positive skin tests must be emphasized. Although type I hypersensitivity to semen is documented in the literature, with easy detection of specific IgE, delayed type 2 allergy presents as an as yet under-diagnosed etiology of post-coital vulvitis. Patch tests may help to confirm that contact dermatitis may be due to seminal proteins.

Acute Disease↗
PubMed2005

Allergic contact dermatitis from natural rubber latex in atopic dermatitis and the risk of later Type I allergy.

The aims of the study were to assess whether contact dermatitis in children could be due to a delayed hypersensitivity reaction to natural rubber latex (NRL) and to define risk factors for later occurrence of Type I hypersensitivity to this allergen. Among 1800 children investigated for contact dermatitis, 55 were referred on suspicion of rubber allergy and had patch tests to NRL, as well as prick tests and blood tests for specific immunoglobulin E (IgE). A 2-year follow-up was then carried out. Delayed hypersensitivity to NRL was confirmed in 32 children. Patch testing with NRL proved to be positive, and clinical improvement confirmed the diagnosis and relevance of patch tests. 30 of these 32 patients had associated atopic dermatitis (AD). Prick tests and blood tests for specific IgE to latex were negative at the time of diagnosis. A 2-year follow-up showed that 10 of 27 patients presenting initially with a positive patch test without associated Type I sensitization later developed immediate hypersensitivity. Children with AD are at high risk for allergy to NRL protein. Exclusion of this allergen should be strongly advised in atopics because of the dual risk of dermatitis and later evolution into severe Type I hypersensitivity.

Allergens↗
PubMed2004

Topical imiquimod treatment of lentigo maligna: clinical and histologic evaluation.

We have treated extensive lentigo maligna in two elderly patients with Imiquimod 5% (Aldara). It was applied 3 times weekly, for 3 to 5 months. Clinical and histological remission was observed over 13 months of follow-up care. Tolerance was good. We suggest that topical imiquimod could be an interesting therapeutic alternative.

Administration, Topical↗
PubMed2004

[Contact urticaria to natural rubber latex in childhood and associated atopic symptoms: a study of 27 patients aged under 15 years].

BACKGROUND: Although natural rubber latex hypersensitivity is considered as a major problem in adult, it may be still misdiagnosed in childhood. PATIENTS AND METHOD: We collected 27 observations of natural rubber latex contact urticaria in children under 15 Years of age, 21 of them aged under 8. RESULTS: All of them where atopic and 19 out of 27 presented with other association paroxystic signs of immediate hypersensitivity, that were lately related to latex allergy (i. e. asthma, rhinitis, conjunctivitis, fainting). Cross-allergy to food allergens was present in 33 p. 100. Average level of specific IgE to natural rubber latex was 21.7 kU/l. One to 4 Years follow up confirmed the benefit of latex eviction on urticaria as well as on associated symptoms. It led to the early detection of ficus allergy in 4 of them. DISCUSSION: This series confirms that atopy is at high risk for natural rubber latex allergy in children. These data suggest that atopic children are exposed too early to latex devices such as pacifiers, toodles of latex toys. Contact urticaria in children must be considered as a possible marker of other respiratory or general symptoms that may have been misconsidered under other etiologies.

Adolescent↗