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L Dubertret

Publications and source records attributed to L Dubertret.

At least 37 records · Page 2Linked to original sources
PubMed2003

Intra-individual comparison of the cutaneous safety and efficacy of calcitriol 3 microg g(-1) ointment and calcipotriol 50 microg g(-1) ointment on chronic plaque psoriasis localized in facial, hairline, retroauricular or flexural areas.

BACKGROUND: Psoriasis involving sensitive skin areas remains difficult to treat because of the side-effects of topical corticosteroids and the irritancy potential of vitamin D3 derivatives. Several clinical trials have demonstrated that calcitriol, the naturally occurring and hormonally active form of vitamin D3, is effective and safe at the dose of 3 microg g(-1) for the treatment of psoriasis affecting the trunk and limbs. METHODS: We compared the safety and efficacy of calcitriol 3 microg g(-1) ointment and calcipotriol 50 microg g(-1) ointment in a multicentre, randomized, investigator-blinded, left-right comparison in mild to moderate chronic plaque psoriasis affecting sensitive areas, defined as being the face, hairline, retroauricular and flexural areas. One pair of symmetrical and bilateral target lesions was selected from each area and assessed for perilesional erythema, oedema, and stinging/burning. Global assessment of local tolerability and global improvement were rated by the investigator, and the subjects were asked to evaluate the tolerability and efficacy of each product and to express their global preference. RESULTS: In the 75 subjects, calcitriol and calcipotriol both led to clearing of at least one target lesion in 21 (28%) of the subjects each. Perilesional erythema (P < 0.001), perilesional oedema (P < 0.02) and stinging/burning (P < 0.001) were all significantly less severe with calcitriol than with calcipotriol. The subjects' evaluation of local tolerability was significantly (P < 0.0001) in favour of calcitriol. Ten treatment-related dermatological events occurred in eight subjects, including one subject who experienced skin discomfort on both sides. All other events occurred only on the calcipotriol-treated side (irritant dermatitis, six subjects; contact dermatitis, one subject). Global assessment of improvement from baseline by the investigators was significantly greater for the calcitriol-treated lesions (P < 0.02). The subjects' global preference was significantly in favour of calcitriol (P < 0.02). CONCLUSIONS: In the present study, calcitriol ointment was found to be better tolerated and would appear to be more effective than calcipotriol ointment in the treatment of psoriasis in sensitive areas.

Adolescent↗
PubMed2003

Calcitriol shows greater persistence of treatment effect than betamethasone dipropionate in topical psoriasis therapy.

OBJECTIVE: To establish the efficacy and duration of remission post-treatment of calcitriol 3 micro g/g ointment in comparison with betamethasone dipropionate 0.05% ointment. METHODS: A randomized, multicentre trial was conducted in 258 adult patients with chronic plaque psoriasis. Calcitriol 3 microg/g ointment or betamethasone dipropionate 0.05% ointment was applied twice daily for 6 weeks or until complete clearance of lesions. Patients whose psoriasis cleared or were significantly improved and did not require treatment continuation at treatment endpoint were contacted over the following 8 weeks to determine whether relapse had occurred. RESULTS: Both treatments were efficacious; improvement in psoriasis or clearance of lesions (residual erythema was allowed) was recorded for 79% and 82% of patients receiving calcitriol or betamethasone dipropionate, respectively. Global improvement and global severity scores at treatment endpoint showed statistically significant differences in favour of betamethasone dipropionate (p<0.05); however, the absolute reduction in mean PASI (psoriasis area and severity index) was comparable between the groups. A statistically significantly (p<0.01) higher proportion of responders remained in remission (no worsening of the disease warranting new treatment) following calcitriol therapy (48%) than betamethasone therapy (25%). This is of potential importance to patients, physicians and healthcare suppliers. CONCLUSION: Twice-daily applications of either calcitriol 3 microg/g ointment or betamethasone dipropionate 0.05% ointment can be used to good effect in the treatment of chronic plaque psoriasis. However, the beneficial effect is likely to persist for longer following calcitriol treatment.

Administration, Cutaneous↗
PubMed2003

[Intravenous pulse methylprednisolone therapy for severe alopecia areata: an open study of 66 patients].

INTRODUCTION: Treatment of alopecia areata is a difficult challenge. Some European publications have shown encouraging results with high dose pulse corticosteroid therapy in extensive plurifocal alopecia areata. We undertook a prospective open study between January 2000 and December 2001 using repeated pulse each month, with the aim of identifying the effects of this repetition and underlining the best indications. PATIENTS AND METHODS: Sixty-six patients aged 9 to 60 years old presenting an extensive alopecia areata exceeding 30% of the scalp surface (n=47), alopecia totalis (n=8), alopecia universalis (n=8), ophiasic alopecia (n=3), for less than 12 months entered this study. The administered treatment was methylprednisolone 500 mg/d during 3 days or 5 mg/kg twice per day during 3 days in children. These pulses were repeated after 4 and 8 weeks, then a second series was carried out or not according to cases. The main evaluation criterion was the percentage of new terminal hair appearing on the bald areas, appreciated by clinical and photographic evaluation at 3 and 6 months. RESULTS: Ophiasic alopecia areata did not respond to treatment. A quarter of patients presenting universal alopecia had a good response (higher than 80 p. 100) followed by a relapse in half the cases. Half of the patients presenting alopecia totalis had a good response, which was maintained three times out of four. Multifocal alopecia areata seems the best indication since the patients under study presented a good response in 63.8 p. 100 of cases (78 p. 100 when it was a first episode and 90.5 p. 100 if the treatment had been started in less than 3 months before). The repetition of the pulses did not appear to increase the number of responders. CONCLUSION: This study provides the best indication of pulse methylprednisolone therapy: first recent episode of extensive plurifocal alopecia areata. These results are less convincing in long term history or other forms of alopecia areata.

Adolescent↗
PubMed2003

[Acute generalized exanthematous pustulosis induced by drugs with low-digestive absorption: acarbose and nystatin].

INTRODUCTION: Acarbose and nystatin are usually well-tolerated drugs because of their minimal intestinal absorption. We report herein two cases of acute generalized exanthematous pustulosis induced by these two molecules. CASES REPORT: A 43 year-old man with a history of insulin-deficient diabetes was admitted to our department for a febrile generalized cutaneous pustular erythema, that had appeared 48 hours after acarbose (Glucor) introduction. Acarbose was discontinued and the eruption resolved in one week. A 29 year-old man developed a flexural erythema twenty four hours after nystatin (Mycostatin) treatment, progressing towards a febrile pustular erythroderma, with elevated neutrophilic and eosinophilic counts. The lesions regressed rapidly with topical steroid treatment. The patch tests performed a few months later with Mycostatin and nystatin were positive. DISCUSSION: The clinical presentation of these two patients was typical of acute generalized exanthematous pustulosis, according to the EuroSCAR group criteria and acarbose and nystatin were the most likely factors that caused the disease according to the French unexpected or toxic drug reaction assessment. The minimal intestinal absorption of these two molecules explains their usual good tolerance. However, some cases of toxiderma have already been reported. There is the first described case of acute generalized exanthematous pustulosis with acarbose. Our two observations underline the possibility of severe toxiderma induced by low-absorbed and low-blood concentration molecules and focus on the need to take them in account in the toxiderma anamnesis.

Acarbose↗
PubMed2003

[Dapsone-induced sensory peripheral neuropathy].

INTRODUCTION: Peripheral neuropathy is a rare complication of dapsone therapy. CASE-REPORT: A 74 year-old woman was treated with dapsone, 50 mg per day, for a linear IgA dermatosis. One month later, the disease was controlled but the patient complained of a sensory peripheral neuropathy, which was documented on electromyographic studies. Dapsone was stopped and symptoms resolved within 24 hours. Three months after the beginning of linear IgA dermatosis, a colic adenocarcinoma was revealed by an acute occlusive syndrome. After surgical resection of the tumor, remission of linear IgA dermatosis was obtained with salazopyrine. DISCUSSION: This is a rare side effect of dapsone therapy. Twenty-one cases have been previously reported. In most cases, there was a pure motor or mixed neuropathy. Dapsone therapy was then stopped or decreased. Recovery usually occurs within one year after dapsone therapy is discontinued.

Aged↗
PubMed2003

[Amyloidosis complicating psoriatic arthritis].

BACKGROUND: Secondary AA amyloidosis is a classical complication of rheumatismal or chronic infectious diseases. Psoriasis is a rare cause of secondary amyloidosis with only around thirty cases reported in the literature. CASE REPORT: A 62 year-old man exhibited cutaneous lesions of psoriasis for six years complicated by articular involvement over the past year. The occurrence of an isolated proteinuria revealed renal and hepatic AA amyloidosis. Treatment with methotrexate (Méthrotrexate), enalapril (Renitec) and colchicine (Colchicine) was initiated and led to a stabilization of the proteinuria for two years. DISCUSSION: In psoriatic patients, secondary amyloidosis mainly complicates the arthritic diseases of prolonged progression. Our case report is original in the rapid onset of amyloidosis after the first articular signs. The clinical manifestations of secondary amyloidosis are related to renal or gastrointestinal involvement. Prognosis is usually poor. Treatment of secondary amyloidosis is difficult and relies on systemic treatment. Colchicine may be helpful.

Amyloidosis↗
PubMed2002

A randomized controlled evaluator-blinded trial of intravenous immunoglobulin in adults with severe atopic dermatitis.

BACKGROUND: There is a need for alternative therapy in severe adult atopic dermatitis (AD). Intravenous immunoglobulin (IVIG) treatment has been shown to be beneficial in a few open observations, but evidence of effectiveness is still lacking. OBJECTIVE: To investigate whether treatment with IVIG is effective in adults with severe AD. METHODS: In a randomized evaluator-blinded trial, 10 patients with severe AD were randomized to immediate or delayed (by 1 month) treatment with IVIG 2 g kg-1. Patients received an 8-h infusion of 1 g kg-1 daily for two consecutive days. They were assessed clinically at days 15, 30, 60 and 90. The primary efficacy criterion was measurement of the severity scoring of AD (SCORAD) index at day 30. RESULTS: The SCORAD values were not significantly different between the two groups at day 30. Similarly, global evaluation of disease severity by patients did not show any clinically significant change at day 30. In the cohort of 10 patients, the mean percentage decrease in SCORAD as compared with baseline was, respectively, 15%[95% confidence interval (CI) 6-24%] and 22% (95% CI 5-39%) at 30 and 60 days after IVIG infusion. CONCLUSIONS: IVIG treatment was not associated with clinically significant improvement of AD signs and symptoms in this randomized study. Although this study may have been too small to detect a beneficial effect in a small subset of patients, the results do not support the common use of IVIG in refractory AD.

Adult↗
PubMed2002

[Cutaneous B-cell lymphoma treatment with rituximab: two cases].

INTRODUCTION: Anti-CD20 monoclonal antibodies have been successfully used in patients affected with B-cell lymphomas - mostly of the centrofollicular variety - showing relapse after treatment with antineoplastic chemotherapy. We report herein two patients with cutaneous B-cell lymphomas showing complete remission after treatment with rituximab. CASE REPORTS: A 70 year-old man with a cutaneous large cell lymphoma of the legs relapsing despite chemotherapy, and a 38 year-old woman with a cutaneous and lymph node centrofollicular lymphoma were treated with rituximab 375 mg/m(2) weekly for 4 weeks, leading to complete remission, persisting 15 months after the end of treatment in one case, while remission lasted 10 months in the first case. In this latter case, relapsing lesions responded following treatment with a rituximab/cytotoxic polychemotherapy combination. DISCUSSION: Rituximab is a monoclonal chimeric antibody targeting CD20, a surface antigen which is expressed by cells belonging to the B-lymphocytic lineage and by most B cell malignancies. Sixteen other patients with cutaneous B-cell lymphomas treated with rituximab have been previously reported in the literature, with a complete remission rate of 25 p. 100 and a partial remission rate of 56 p. 100. The presently reported cases support the use of rituximab in cases of cutaneous B-cell lymphoma showing resistance or relapse after antineoplastic chemotherapy, either alone or in combination with cytotoxic drugs.

Adult↗
PubMed2002

[Psoriasis].

Explore the source record for details and available documents.

Diagnosis, Differential↗
PubMed2001

The use of tetracyclines for the treatment of sarcoidosis.

BACKGROUND: To evaluate the safety and efficacy of minocycline in the treatment of sarcoidosis, a nonrandomized, open study was performed in patients with cutaneous sarcoidosis. OBSERVATIONS: Twelve patients with cutaneous sarcoidosis were treated with minocycline, 200 mg/d, for a median duration of 12 months. Three patients had extracutaneous lesions at the time of the study. The median follow-up was 26 months. A clinical response was observed in 10 patients, consisting of complete responses in 8 patients and partial responses in 2 patients. A progression of skin lesions was observed in 1 patient, and lesions remained stable in another patient. Adverse effects were minimal, except in 1 patient, who developed hypersensitivity syndrome. A slight hyperpigmentation occurred in 2 patients at the site of previous lesions, which completely disappeared after minocycline use was discontinued. A relapse of skin symptoms occurred after minocycline withdrawal in 3 patients, who further received doxycycline, 200 mg/d, allowing a complete remission of lesions. CONCLUSIONS: These results support that minocycline and doxycycline may be beneficial for the treatment of cutaneous sarcoidosis. Randomized controlled studies are warranted for the evaluation of the true efficacy of tetracyclines in these patients.

Adolescent↗
PubMed2001

HLA-G and NK receptor are expressed in psoriatic skin: a possible pathway for regulating infiltrating T cells?

Recent data have suggested that in psoriasis, the T-infiltrating cells could be submitted to regulatory pathways, possibly through natural killer receptors. HLA-G binds to different natural killer receptors and is able to inhibit T-cell functions. Because this molecule is induced by interferon-gamma, a major cytokine in psoriasis, we asked whether HLA-G and its receptor might be expressed in this disease. Specific RNAs for HLA-G1 and HLA-G5 were consistently found in lesional skin specimens, soluble HLA-G5 transcripts being found only in psoriasis. HLA-G protein was found in all psoriatic sections, but never in normal skin controls. Double labeling demonstrated that HLA-G-positive cells were CD68(+), CD11c(+) macrophages. The NKR ILT2 was also present in psoriatic skin, the T CD4(+)-infiltrating cells expressing indeed ILT2. The demonstration of HLA-G and ILT2 expression in psoriatic skin suggests that this pathway may act as an inhibitory feed back aimed to down-regulate the deleterious effects of T-cell infiltrate in this disease.

Alternative Splicing↗
PubMed2001

UV-A-induced AP-1 activation requires the Raf/ERK pathway in human NCTC 2544 keratinocytes.

UV-A irradiation causes a dose-dependent activation of ERK in human NCTC 2544 keratinocytes. The specific inhibition of either ERK activity or Raf kinase activity impedes the activation of AP-1 DNA binding induced by UV-A. In addition, UV-A raises AP-1 promoter transcriptional activity, which is downregulated in NCTC 2544 cells expressing an inactive mutant of Raf-1. We found that singlet oxygen might be one of the mediators in both UV-A-induced AP-1 DNA binding and transcriptional activity. These results strongly suggest that UV-A-induced AP-1 activity requires the Raf-ERK pathway and imply a singlet oxygen effector.

Cell Line↗