[Cutaneo-systemic vasculitis in homozygote C4 deficiency].
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Biomedical subjects
Publications and source records attributed to O Chosidow.
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Anecdotal reports have suggested that reduced efficacy of pediculicides against Pediculus humanus capitis could be related to resistance to treatments. Ovicidal and pediculicidal activities of 0.5% malathion and 0.3% d-phenothrin lotions were tested in an experimental model of P humanus capitis grown on rabbits to ensure that the two treatments were pharmacologically equipotent. We then did a randomised controlled trial in which the lotions were administered to 193 P humanus capitis-infested schoolchildren (malathion, 95; d-phenothrin, 98). Success rate was defined as the absence of both live lice and viable nits. Before treatment, live lice were collected and subjected to a pediculicidal test. Pharmacological tests showed 100% killing of the rabbit-grown nits and lice after exposure to both pediculicides. On day 1 of the controlled trial, the success rate was 92% in the malathion group (95% CI, 0.86-0.97) and 40% in the d-phenothrin group (0.30-0.49) (p < 0.0001); on day 7, it was 95% in the malathion group (0.90-0.99) and 39% in the d-phenothrin group (0.29-0.48, p < 0.0001). Malathion was also significantly more active in the pediculicidal tests compared to d-phenothrin and control. These results suggest an acquired resistance to d-phenothrin in the schoolchildren tested, since all other conditions of the administration of insecticides were standardised.
BACKGROUND: Epidermolysis bullosa aquisista can leave several functional sequelae. The lesions sometimes resist treatment. CASE REPORT: We report a case of a 25-year-old young man presenting with a severe epidermolysis bullosa acquisita confirmed by the electronic immunomicroscopy. He had a major ocular involvement with symblepharon and cicatricial synechial lesions. He was almost blind because of corneal scars. All immunosuppressive treatments had failed: systemic corticoids, cyclosporin, azathioprine. The introduction of extracorporeal photochemotherapy resulted in the healing of the lesions, after a total of 32 procedures. All treatment are now stopped, and the lesions are purely cicatricial, without any relapse of the disease since 9 months. Corneal grafts are now under process, to try to recover a part of the lost visual acuity. DISCUSSION: This case demonstrates the efficacy of extracorporeal chemotherapy to be tried in case other treatments failed.
NEW AGENTS: Among new treatments used for infectious dermatology diseases, new agents for genital herpes, valaciclovir and famciclovir, have greatly simplified therapeutic schemes. Cidofovir has also been shown to be effective against aciclovir-resistant cutaneous and mucosal herpetic lesions and for the treatment of molluscum contagiosum. NEW ADMINISTRATION ROUTES: For genital papillomavirus infections, trials using systemic or intralesional administered interferon have not provided conclusive evidence but imiquimode appears to be quite promising. Itaconazole and fluconazole are effective for onchomycoses. NEW POSSIBILITIES: Ivermectine is effective against scabies, but must be reserved for particularly severe forms. Finally, the emergence of Neisseria gonorrhoeae strains resistant to fluoroquinolones is disquieting.
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