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Biomedical subjects

L Vaillant

Publications and source records attributed to L Vaillant.

At least 55 records · Page 3Linked to original sources
PubMed2001

Acute generalized exanthematous pustulosis (AGEP)--a clinical reaction pattern.

BACKGROUND: A wide range of diseases or reactions can cause pustular eruptions of the skin. In this spectrum there seems to be a subgroup with characteristic clinical features and a typical course which is mostly caused by drugs for which the term acute generalized exanthematous pustulosis (AGEP) has been established. OBJECTIVE: To describe the clinical features of AGEP. METHODS: The authors' experience from a multinational epidemiological study on severe cutaneous adverse reactions and a comprehensive review of the literature were used to provide an overview of the disease and it's possible causes. An algorithm for validating cases which was established for this study is also presented. RESULTS: AGEP typically presents with at least dozens of non follicular sterile pustules occurring on a diffuse, edematous erythema predominantly in the folds and/or on the face. Fever and elevated blood neutrophils are common. Histopathology typically shows spongiform subcorneal and/or intraepidermal pustules, a marked edema of the papillary dermis, and eventually vasculitis, eosinophils and/or focal necrosis of keratinocytes. Onset is acute, most often following drug intake, but viral infections can also trigger the disease. Pustules resolve spontaneously in less than 15 days. CONCLUSION: The diagnosis AGEP should be considered in cases of acute pustular rashes and detection of the causative drug should be strived for. Knowledge of the clinical features and usual course of this disease can often prevent unnecessary therapeutical measures.

Acute Disease↗
PubMed2001

[Diagnostic criteria for erysipelas].

Diagnosis of erysipelas is based upon the association of an acute inflammatory plaque with fever, lymphagiitis, adenopathy and hyperleukocytosis. These associated symptoms are variable (20-70 p. 100 of cases). Bacteriology is not helpful for the diagnosis of erysipelas because of a low sensitivity (hemoculture 5 p. 100, standard examinations 5-41 p. 100), or delayed positivity (serology). Moreover cutaneous bacteriology is difficult to assess when other bacteria than streptococci are isolated. Erysipelas have to be distinguished from non-necrotizing cellulitis by peculiar clinical features (such as erysipeloid, facial staphylococcal infection, Pasteurella, Haemophilus influenzae) and from necrotizing fasciitis. Some non-infectious diseases may mimic erysipelas such as venous thrombosis, familial Mediterranean fever, prosthesis intolerance, and compartment syndrome. Because the diagnostic value of clinical symptoms is not known and no diagnostic gold standard has been established, it is impossible to be sure that non-streptococcal erysipelas (especially staphylococcal) really exists. Thus, the first line treatment for all erysipelas must be an antistreptococcal antibiotic. Before prescribing a treatment, hemoculture and blood cell count could be useful. If antistreptococcal antibiotherapy is inefficient, all the differential diagnoses must be reviewed.

Diagnosis, Differential↗
PubMed2001

[Paraneoplastic pemphigus: a pustular form during chronic lymphoid leukemia].

BACKGROUND: Paraneoplastic pemphigus is an autoimmune disease of the skin and mucosa described in 1990. The condition is generally associated with lymphoma or chronic lymphoid leukemia. Lesions are often misleading, masquerading as polymorphous erythema or lichen. We report a case of paraneoplastic pemphigus with pustulous skin lesions. CASE REPORT: A 52-year-old man developed over a few weeks time erosive lesions of the oral cavity and lips associated with papulous skin lesions. Secondarily, large-sized pustules, sometimes a hypopion, were observed associated with bullae. The diagnosis of paraneoplastic pemphigus was confirmed by direct immunofluorescence that evidenced IgG deposits within the keratinocytes and along the basal membrane and by indirect immunofluorescence on rat bladder that evidenced circulating antibodies. This paraneoplastic pemphigus was the inaugural sign of chronic lymphoid leukemia. DISCUSSION: Skin lesions described in paraneoplastic pemphigus include: erosion, vesicles, bullae, and psoriasiform, lichen-like, plate-like or vegetative formations. To our knowledge, this is the first report of a pustulous form; clinically similar to Hallopeau pustulous pemphigus.

Anti-Inflammatory Agents↗
PubMed2000

[Mechanisms of cutaneous drug reactions].

Two main mechanisms, pharmacologic and immunoallergic, are responsible for cutaneous reactions to drugs. Pharmacologic mechanisms can be predictable (overdosage, cumulative or delayed toxicity, adverse effects) or unpredictable (idiosyncratic, intolerance, or anaphylactic reaction). Immunoallergic mechanisms can be mediated by IgE (some types of urticaria and anaphylactic shock), due to circulating immune complexes (leukocytoclastic vasculitis, serum sickness-type reactions) or mediated by lymphocytes (exanthema, Lyell's syndrome, fixed pigmented erythema, photosensitization). The diagnostic work-up varies according to the causative mechanism. When the reaction is predictable, the responsible drug can be identified according to the data in the present bibliography. When the reaction is immunologic, only the chronologic sequence of events can identify the responsible drug. The risk of recurrence with an identical or related molecule also varies according to the causative mechanism. For urticaria, diagnosis and the risk of recurrence differ according to whether the cause is allergic (mediated by IgE or urticarial vasculitis) or is pharmacologic (urticaria due to aspirin or to conversion enzyme inhibitors).

Drug Eruptions↗
PubMed2000

Transformation of mycosis fungoides: clinicopathological and prognostic features of 45 cases. French Study Group of Cutaneious Lymphomas.

The course of mycosis fungoides (MF) is indolent except when transformation to a large T-cell lymphoma occurs. The diagnosis of transformed MF (T-MF) relies on the presence of more than 25% of large cells on biopsy of an MF lesion. We analyzed 45 patients with T-MF recorded by the French Study Group on Cutaneous Lymphomas to better determine clinicopathological features of MF transformation and to analyze their impact on prognosis. Median time from diagnosis of MF to transformation was 6.5 years. Extracutaneous progression was present in 20 patients. Mean survival from transformation to death was 22 months. In univariate analysis, only an extracutaneous progression was associated with a worse prognosis (5-year actuarial survival: 7.8% versus 32%). Neither sex, age, clinical and skin disease stage at transformation, transformation speed, nor percentage of large cells or CD30 expression (14 of 45) had a prognostic value. When performing multivariate analysis, age (at least 60 years), and extracutaneous spreading were found to be associated with a poor prognosis. There was no difference between survival curves of patients with T-MF and with pleomorphic large T-cell CD30- lymphomas. The main diagnostic pitfall was "histiocytic-rich" MF, requiring CD68 staining for the diagnosis of T-MF. Out of 45 patients, 6 presented an histologic transformation before clinical progression, suggesting that an early histopathological diagnosis may be performed by histological follow-up. The prognostic value of such early histopathological diagnosis must be confirmed by prospective studies.

Adult↗
PubMed2000

Epidemiologic determinants of skin photoaging: baseline data of the SU.VI.MAX. cohort.

BACKGROUND: Although skin disorders associated with long-term sun exposure account for high morbidity, only few data on sun-related preclinical skin changes are available in the general population. OBJECTIVE: In the present study we determined reference values for markers of photoaging in French adults, and we evaluated the relationship between photoaging, phototype, and both behavioral and environmental factors. METHODS: The SU.VI.MAX trial is a multicenter, national intervention trial on 12,735 adults living in France. A transverse analysis was performed on the inclusion data of the sample of volunteers between 45 and 60 years of age who underwent skin evaluation in 1995: 3057 women and 3606 men. Skin was evaluated by means of the Larnier skin photoaging photographic scale and a sun reactive skin type classification derived from those proposed by Fitzpatrick in 1976 and Césarini in 1977. RESULTS: The prevalence of skin photoaging, assessed as a dichotomous variable (from moderate/severe to very severe), was comparable in men and women in same age groups: in women, age group 45-49 years = 22%, 50-54 years = 36%, and 55-60 years = 42%; in men, age group 45-49 years = 17%, 50-54 years = 38%, and 55-60 years = 45%. After adjusting for body mass index, exposure to tobacco, and sunlight exposure, the only variables found to be related to skin photoaging in women were age (55-60 years age group: adjusted odds ratio [AOR] = 6.0, 95% confidence interval [CI] = 4.4-8.2), phototype IIIa, IIIb, and IV (AOR = 0.2, 95% CI = 0.1-0.4; AOR = 0.3, 95% CI = 0.2-0.6; and AOR = 0.4, 95% CI = 0.3-0.8; respectively), menopausal status (AOR = 1.4, 95% CI = 1.1-1.9), and geographic location (Southern France: AOR = 0. 7, 95% CI = 0.6-0.9), with a more pronounced effect in lighter phototypes I-II and a protective impact related to southern locations. No relationship was found between the use of oral contraceptives and skin photoaging. The age effect was also found in men (55-60 years age group: AOR = 10.4, 95% CI = 8.3-13.1) and geographic location (Southern France: AOR = 0.8, 95% CI = 0.6-0.9), with a most pronounced effect in darker phototypes (phototypes > IV: AOR = 2.8, 95% CI = 1.4-5.6). CONCLUSION: Our results suggest that the prevalence of skin photoaging in the adult French population is determined by age, sex, geographic location, and phototype. The continuation of this longitudinal study will allow for the investigation of the relationship between skin photoaging and the risk of the development of skin diseases.

Female↗
PubMed2000

Inherited palmoplantar keratoderma and sensorineural deafness associated with A7445G point mutation in the mitochondrial genome.

We report a French pedigree with members having an inherited combination of non-epidermolytic palmoplantar keratoderma (NEPPK) and sensorineural deafness. The penetrance of both features was incomplete. Additional ectodermal defects were absent. The expression of numerous epidermal proteins (keratins, fillagrin, cornified envelope proteins, intercellular junction proteins including connexin 26, and loricrin) defined with immunolabelling was normal in the proband. The combination was shown to be associated with the A7445G point mutation in the mitochondrial genome (mtDNA). This mutation is responsible for a subtype of NEPPK which is so far the only mtDNA mutation-associated keratoderma.

Adolescent↗
PubMed2000

[Comparative diffusion of fusidic acid, oxacillin, and pristinamycin in dermal interstitial fluid after repeated oral administration].

OBJECTIVE: The aim of this study was to use the suction bullae technique to compare skin diffusion of 3 antibiotics commonly used for skin infections (fusidic acid, oxacillin, pristinamycin) and to estimate their potential activity at the site of skin infections. SUBJECTS AND METHODS: This comparative open study was conducted in 12 healthy volunteers using a repeated latin square experimental scheme. Antibiotic concentrations in serum and suction bullae fluid were measured by high performance liquid chromatography after 5.5 days of repeated oral administration of fusidic acid (1 g/d), oxacillin (2 g/d), and pristinamycin (2 g/d). RESULTS: Mean antibiotic concentrations in serum and interstitial fluid (suction bullae fluid) were highest for fusidic acid with a Cmax at 91.3 +/- 23.0 mg/l and 45.5 +/- 18.0 mg/l respectively (interstitial fluid/serum ratio=49 +/- 10 p. 100). For oxacillin, Cmax was 8.3 +/- 3.6 mg/l and 0.98 +/- 0.49 mg/l (ratio 13 +/- 5 p. 100). Pristinamycin concentrations were low with a Cmax at 0.51 +/- 0.40 and 0.26 +/- 0.15 mg/l (ratio 73 +/- 57 p. 100). Comparing the area under the interstitial fluid and the serum concentration-time curves showed that the best diffusion was obtained with pristinamycin (114 +/- 61 p. 100), followed by fusidic acid (57 +/- 13 p. 100) and oxacillin (48 +/- 25 p. 100). DISCUSSION: These data were used to calculate indicators of potential efficacy in the interstitial dermal fluid: inhibitor quotient (Cmax/MIC) and AUIC (ASC/MIC), indicator of the time antibiotic concentrations are maintained above the minimal inhibitor concentration (MIC). This showed that fusidic acid was potentially more active against all staphylococci. For streptococci, the observed interstitial concentrations of pristinamycin and of fusidic acid should theoretically inhibit streptococci A growth, but oxacillin was the most adapted antibiotic.

Administration, Oral↗