Biomedical subjects
Publications and source records attributed to L Vaillant.
Langerhans' histiocytosis is a proliferation of atypical Langerhans cells which may affect several different organs. Two women had lesions of the vulva which led to the diagnosis. Vulvular involvement is the most frequent in gynaecological localization of Langerhans' histiocytosis. Pathological and immunohistochemical tests confirm the diagnosis.
We made a prospective study of 60 pregnant women from February 1992 to July 1992. Women with pathologic pregnancies were excluded. Fifty-one women had pigmentary changes; the most frequent was linea nigra in 45. Melasma was observed in 3 women only, and the other local melanosis were rare. Vascular changes appeared in 50 women and vascular spiders in 32. Only one vascular spider was seen on a leg; all the others were on the upper part of the body. Eighteen women had a palmar erythema. New striae distensae appeared in 37 women, the more often on the abdomen. Among the other non classified skin changes, acne appeared in 14 women, oedemas of the legs in 22, oedemas of the eyelids in 3 and molluscum fibrosum gravidarum in 4. We emphasize that skin changes are a frequent and polymorphous feature in pregnancy.
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BACKGROUND AND DESIGN: For a period of 1 year, all pregnant women presenting with itching were investigated by clinical, histologic, immunopathologic, and laboratory studies. Fifty-one of 3192 pregnant women were studied. RESULTS: We identified (1) two typical cases of herpes gestationis, with an approximate incidence of one in 1700 pregnancies; (2) 22 cases of pruritus gravidarum, including five cases with a polymorphous skin eruption, with an incidence of one in 145 pregnancies; (3) 25 cases of polymorphic eruption of pregnancy, including diseases without maternal or fetal side effects and without criteria defining herpes gestationis or pruritus gravidarum, with an incidence of one in 130 pregnancies; and (4) two cases of intercurrent disease (one scabies and one exfoliative dermatitis). CONCLUSION: Our study is a prospective homogeneous account of pruritic dermatosis of pregnancy. Our results show that the incidence of herpes gestationis is higher than is usually reported in the literature and that pruritus gravidarum must be considered in the presence of itching occurring during pregnancy, with or without skin eruption.
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Alternaria is a very common fungus. Its pathogenic role in human pathology is mainly expressed by asthma. Cutaneous infection is rare and only about 70 cases have been described. Because of its wide distribution in the environment, cutaneous biopsy is necessary to ensure the diagnosis. We report two cases of dermal alternariosis occurring in the course of pemphigus treated with immunosuppressive therapy. Histological examination revealed a hyperplasic epidermis. The upper dermis showed a mixed inflammatory infiltrate with neutrophils, histiocytes and giant cells. Round intracytoplasmic inclusions staining faintly with PAS wer seen in giant cells. Long intercellular filaments were present in the infiltrate. This histopathological aspect is not specific, and cultures of both cutaneous biopsies were necessary. The association of dermal alternariosis and pemphigus is explained both by the immunosuppressive therapy for pemphigus and by the cutaneous fragility induced by the acantholytic disease permitting direct inoculation of Alternaria.
BACKGROUND AND DESIGN: Diagnosis of autoimmune pemphigus is based on the immunodetection of IgG deposits in the epidermal intercellular spaces. Desmoglein is a desmosomal component that has been assumed to be the antigen of pemphigus foliaceus. We investigated the use of one monoclonal antibody (32-2B) to desmoglein 1 on paraffin sections. Twenty-nine pemphigus samples were studied (22 pemphigus vulgaris, seven pemphigus foliaceus). RESULTS: In 29 patients suffering from autoimmune pemphigus, the staining for desmoglein was represented by coarse granules along the cytoplasmic borders of epithelial cells in lesional and perilesional skin and in mucous membranes. This peculiar staining is different from the fine dots along the cytoplasmic membrane observed in normal skin. This abnormal staining seems to be specific for pemphigus. Hereditary acantholytic diseases and other diseases such as bullous pemphigoid, intraepidermal IgA dermatosis, eczema, herpes, and transient acantholytic dermatosis show a similar pattern to normal skin. CONCLUSION: The use of 32-2B on biopsy specimens in cases of autoimmune pemphigus demonstrated a specific staining pattern. It could be used on paraffin sections as a diagnostic test of autoimmune pemphigus. It can even be done retrospectively.
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We describe a new case of signet ring cell peripheral T cell lymphoma in a 45-year-old man. This lymphoma had a very indolent course, since--without treatment--the clinical staging has shown no evidence of disease progression 11 years after initial symptoms. Immunophenotype indicated pan T antigens (Leu 4 CD3, Leu 1 CD5) and T suppressor cytotoxic antigen (IOT8 CD8) expression. Several T antigens (Leu 5b CD2, Leu 9 CD7, Leu 3a CD4) were not expressed. The proliferation index was less than 5% with Ki 67 monoclonal antibodies. The ultrastructural study showed characteristic cytoplasmic vacuoles containing microvesicles. Five cases of signet ring T cell lymphoma, which were very similar to our case, have been previously described. Their characteristics were primary cutaneous presentation, indolent course, good response to current therapies and a long survival period. The indolent course of these signet ring cell lymphomas may indicate that this type of lymphoma is a low grade malignant lymphoma and not only a morphological pattern.
Vertical cutaneous extensibility was studied before and after 1, 2, 5 and 10 min hydration by application of tap water. After hydration, we noted an increase in all rheological parameters linked to elasticity whereas viscosity and hysteresis parameters were unmodified. These modifications took place from the first minute and increased thereafter. Men and women showed identical values prior to hydration. After hydration, an extensibility gain was noted only in the women, men's extensibility being unmodified. Studying rheological behaviour as a function of age, we showed similar modifications in younger and older groups, the extensibility gain being greater in the older group. Prior to hydration, the stratum corneum was extremely rigid and extensibility was comparable between men and women. Hydration, softening the horny layer, allows a rapid extensibility gain proportional to the reduced thickness of the dermis, especially in women and older subjects.
Autoimmune bullous diseases have been reported associated with different causal factors: drugs, mechanical trauma and physical trauma, particularly ultraviolet light and radiotherapy. In these cases different hypotheses regarding the pathogenesis of blister formation can be supported. In this observation, we report a localized cicatricial pemphigoid with unusual clinical presentation. Moreover, it appeared 9 years after radiotherapy for breast carcinoma and it was preferentially localized on an upper limb lymphoedema. Because of the long time between the treatment of carcinoma with radiotherapy and the onset of pemphigoid, we assume that lymphoedema played a major etiological role in this particular cicatricial pemphigoid.
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BACKGROUND AND DESIGN: Bullous pemphigoid is usually treated with systemic corticosteroids. Side effects are common in elderly patients, justifying the search for adjuvant therapy. This randomized, multicentric unblind study was designed to assess the efficacy of azathioprine or plasma exchange when added to conventional doses of prednisolone. One hundred patients with active disease entered the study. They were randomly allocated to receive 28 days of treatment with oral prednisolone sodium metasulfobenzoate (1 mg/kg per day) either alone or in combination with oral azathioprine (100 to 150 mg/d) or four large-volume plasma exchanges. After 28 days, the prednisolone doses were progressively decreased according to the same strict regimen in the three groups (in combination with oral azathioprine in group 2). RESULTS: The clinical results were evaluable in 98 of the 100 patients included in the study. There was no appreciable difference in the percentages of complete remission of the disease in the three therapeutic groups at 28 days (71%, 80%, and 71%, respectively) or at 6 months (42%, 39%, and 29%, respectively). Severe complications were more often observed among patients receiving azathioprine. At 6 months, 14 of 98 patients had died, without any differences noted among the three study groups. CONCLUSIONS: We conclude that neither azathioprine nor plasma exchange is effective enough to be used routinely as an adjuvant to corticosteroids in the management of bullous pemphigoid.
High spatial resolution is required for echographic exploration of the skin, microvessels or small laboratory animals. With the scanner described here, high resolution is obtained by means of a strongly focused, wide-band 17 MHz center frequency transducer (-6 dB bandwidth: 22 MHz). The movement of this transducer above the skin provides a 6 mm wide and 5 mm deep echographic cross-section with an image rate of 15 images/s. The resolution is about 0.08 mm in axial and 0.2 to 0.3 mm in lateral directions. The device was tested on phantoms in water and in vivo on normal and pathological skin in the Department of Dermatology. With the easy-to-handle probe, explorations were made on psoriasis, basocellular carcinoma, malignant melanoma and sarcoidosis.