Acute generalized exanthematous pustulosis induced by lansoprazole.
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Biomedical subjects
Publications and source records attributed to G Lorette.
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Each kind of superficial vascular malformation (or "angioma") has been included in a widespread classification that has been elaborated by means of a multidisciplinary approach. At present, therapeutic management of these vascular malformations often needs one or several procedures of interventional radiology. The purpose of this paper in to illustrate embolization techniques in each indication and to describe advantages and drawbacks of these different techniques.
INTRODUCTION: Mycobacterium chelonae is an ubiquitous mycobacterium which is exceptionally pathogenic. It can cause localized skin infections which are difficult to treat because of multiple drug-resistance. CASE REPORT: A 87-year-old woman with bullous pemphigoid was treated with long-term prednisone and developed a skin infection due to M. Chelonae. Treatment with clarithromycin was successful, but relapse occurred 6 months after withdrawal of the antibiotic. DISCUSSION: Clarithromycin is effective in single drug regimen for M. Chelonae infection, but the duration of treatment should be long when immunosuppression cannot be avoided.
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BACKGROUND AND DESIGN: The skin properties of 98 postmenopausal women with hormone replacement therapy (oestradiol gel or patches) or without hormone replacement therapy were studied using non-invasive techniques: skin thickness with skin echography, skin hydration with a dryness score and measurement of capacitance, skin surface lipids with a Sebumeter and microtopography with image analysis of cutaneous replicas. RESULTS: In this open study we demonstrated an increase in skin thickness and sebum in the treated group in comparison to the untreated group (7-15% according to area for skin thickness, 35% for sebum). Hydration and microtopography were not different in the two groups. CONCLUSIONS: Postmenopausal women who were receiving hormonal substitution have a greater thickness and casual level than untreated women. We therefore suggest that hormonal aging exists and that cutaneous atrophy can be prevented with hormone replacement therapy.
Alternaria is a very common and saprophytic fungus. Cutaneous infection is rare and about 71 cases have been described, mainly in Europe in immunocompromised hosts. We report a case of dermal alternariosis occurring in a woman treated with corticosteroids for dermatomyositis. The cutaneous lesion consisted of an erythematous and scaly plaque on the leg measuring 2 x 2 cm. Cutaneous biopsy showed hyphae and round inclusions stained with PAS and Gomori-Grocott within a polymorphous granuloma. Cultures of cutaneous biopsies grew Alternaria sp. HIV1 and HIV2 serology was negative. The patient was treated by local excision and corticosteroids were decreased. One-year follow-up showed no recurrence. Cutaneous alternariosis is an opportunistic infection. the disease has been described mainly in patients treated with systemic corticosteroids (39 cases out of the 71 reported cases) or local corticosteroids (3/71) and in patients suffering from Cushing's syndrome (7/71) but rarely in HIV-infected patients (3/71). Cutaneous fragility induced by hypercorticism is an important cofactor permitting direct inoculation from the environment.
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INTRODUCTION: Dapsone is a drug widely prescribed in dermatology. It can lead to undesirable side effects including hematologic disorders. CASE REPORT: A patient with dermatitis herpetiformis was treated with dapsone. Agranulocytosis developed 6 weeks later and was revealed by fever and pneumonia which resolved under antibiotics. The agranulocytosis regressed without specific treatment after drug withdrawal. Blood counts returned to normal 2 weeks later. DISCUSSION: Dapsone-induced agranulocytosis is in common (1/10,000 to 1/20,000). The drug is widely prescribed, particularly for leprosy. Nevertheless, when dapsone is prescribed for dermatitis herpetiformis, the risk of agranulocytosis increases 25-fold reaching 1/400. The indication for dapsone must always made carefully, with surveillance of the blood counts every 15 days during the first 3 months of treatment for dermatitis herpetiformis.
INTRODUCTION: Elastosis perforans serpiginosa frequently occurs in trisomy 21. Usually no cause is found. We report a case in which vitamin deficiency may have contributed to the development of skin lesions. CASE REPORT: A 11-year-old girl with trisomy 21 developed papulokeratosic eruptions with a linear serpiginous distribution, predominantly involving the lower limbs. On ultrastructure examination, numerous elastic fibers penetrated the epiderma and the baseline membrane had disappeared. The patient also had a totally patent atrioventricular canal with hypoplasia of the left ventricle and cardiac liver. Serum vitamin A level was low (0.56 mumol/l, normal > 1.55). Acitretine was prescribed at the dose of 0.5 mg/kg/day but had to be stopped 2 months later due to elevated liver enzyme levels despite a clear clinical improvement. DISCUSSION: This association between elastosis perforans serpiginosa and vitamin A deficiency, observed here in a child with trisomy 21, has never been reported by others. Vitamin A deficiency might aggravate the skin lesions. In our case, there was probably a relationship between the vitamin A deficiency and the cardiogenic liver disease. The keratoregulatory effect of vitamin A on elastic tissue is less well known. Treatment with retinoids provided clinical improvement but had to be stopped due to hepatotoxicity. Parenteral vitamin A would be an interesting alternative but the risk of side effects would theoretically be greater than with oral retinoids.
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.
INTRODUCTION: Lipomatosis of the tongue is rarely observed. CASE REPORT: An 85-year-old man with chronic alcoholism presented several symmetrical lipomas of the tongue with no other clinical manifestations. There was no capsule at the histology examination. DISCUSSION: The multiple and symmetrical nature of the lesion without a capsule led to the diagnosis of benign symmetrical lipomatosis of the tongue, the fourth case reported in the literature.
We report a case of acute intoxication due to a massive overdose of isotretinoin. A 29-year-old male patient ingested 900 mg of isotretinoin corresponding to 12.5 mg (kg/day) or 30 times the prescribed dosage and 1 day later the patient experienced mild headache. Forty-eight hours later, cheilitis, diffuse cutaneous xerosis and desquamation of the forehead and of the external auditory meatus occurred; cutaneous xerosis and cheilitis resolved spontaneously, We determined the serum level of isotretinoin and of 4-oxo-isotretinoin, its natural metabolite in sera taken 4, 5, 6 and 11 days following ingestion. The side-effects were mild and represented only exacerbations of some common isotretinoin side-effects. To date, three other cases of isotretinoin overdosage have been reported. There was a low toxicity of isotretinoin overdose.
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BACKGROUND: Although cutaneous photosensitivity is one of the major criteria used for the diagnosis of systemic lupus erythematosus, this criterion is not precise. OBJECTIVE: To evaluate the interest of photobiological exploration in patients with cutaneous lupus erythematosus, and to compare the results to clinical photosensitivity. METHODS: Nineteen patients consecutively seen in one year, have been tested using a standardized method. RESULTS: Clinical photosensitivity was present in 16 cases. The clinical presentation of cutaneous disease was classified in 3 groups: acute, subacute, and chronic. One patient with no history of photosensitivity had positive photobiological tests, and five patients had negative tests though they experienced clinical photosensitivity. Positive phototests with UVA and UVB were present in 6/8 subacute lupus cases, 3/6 acute lupus cases, 3/5 chronic lupus cases. Histological aspect of cutaneous biopsies from phototest was not characteristic of lupus. Minimal erythematous doses was comparable in lupus group and in controls. No correlation between positivity of phototests and the presence of systemic involvement or anti-Ro/SSA antibodies was established. CONCLUSION: Phototesting is useful to assess photosensitivity in lupus patients.