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Merkel cell carcinoma is a neuroendocrine tumor of the skin, originating from neuroendocrine cells. A case report of Merkel cell carcinoma, discovered in a 77-Year-old woman, was diagnosed and confirmed on a biopsy. Diagnostic and therapeutic orientations of this unusual but malignant tumor are described.

Background: Folliculitis decalvans consists of recurrent patchy painful folliculitis of the scalp causing scarring alopecia. The physiopathology of this condition is still unclear, but is likely a manifestation of chronic neutrophilic bacterial folliculitis. Numerous topical and systemic treatments (corticosteroids, antistaphylococcal antibiotics) have been used with variable results. Based on the dapsone antimicrobial activity and its anti-inflammatory action especially directed to the neutrophil metabolism, we treated two patients with severe folliculitis decalvans with this drug., Case Reports: The patients were treated with dapsone at a daily dose of 75 and 100 mg, respectively for 4 to 6 months. After 1 and 2 months, pustular folliculitis progressively cleared, leaving a residual non inflammatory cicatricial alopecia. When maintaining a dapsone dosage at 25 mg/day no relapse occurred during 3 years and 1 year, respectively. No important adverse effect to dapsone was evidenced. After dapsone withdrawal, a moderate relapse of the disease with pruritus and folliculitis occurred after a few weeks in both cases. The disease relapse rapidly cleared after dapsone reintroduction at a daily dose of 25 mg., Comments: Dapsone at moderate dosage was well tolerated and rapidly effective in treating the two cases of folliculitis decalvans. A long term and low dose (25 mg daily) maintenance treatment avoided disease relapses.

Onychomycosis exhibits considerable diversity when the disease is scrutinized using traditional, fluorescence or confocal microscopy. Histomycology is a non-invasive assessment performed on nail clippings. The location of and the density in fungal cells is variable. In some instances, these aspects remain clinically unsuspected. In vivo confocal microscopy can provide the same information. Computerized image analysis of histological sections is the most powerful means for quantifying the fungal load. Immunohistochemistry provides information about the identity of the fungus or the association of different fungi present in the nail plate. Mixed infections may be unifocal or located at different levels in the nail apparatus. The viability of fungi as assessed by vital stains can be visualized under the microscope and quantified by flow cytometry. The different aspects of nail histomycology are complementary and shed some light on sometimes unsuspected aspects of onychomycoses.

Introduction: We report a case of severe pustular vasculitis most probably due to losartan (Cozaar) which is an antihypertensive drug inhibiting the receptors for angiotensin II., Case Report: A 64-year-old woman, suffering from hypertension, developed a widespread and rapidly evolving bullous and pustular eruption without any other clinical sign. Leucocytoclastic vasculitis and junctional blisters were present with deposits of both IgA and IgG at these sites. Withdrawal of losartan, which was the only drug taken by the patient, and tapered corticotherapy cleared the lesions. The rash left a prominent mottled hyperpigmentation. It did not recur during the following months despite the presence of antineutrophil cytoplasmic antibodies., Discussion: So far only a few cutaneous side effects have been reported following losartan intake. This drug was the likely culprit in the present case. Vasculitis was extremely severe and polymorphous.

Background: Cutaneous sensorial perception is complex and proves to be difficult to quantify. Skin sensitivity to mechanical distension is largely unexplored. We have developed an original method aimed at quantifiying these physiological parameters., Volunteers and Methods: The study was performed on 24 adult volunteers aged 20 to 50 years. A Cutometer SEM 474 equipped with 2 and 4 mm diameter probes was used to exert a progressive or a steep suction on the cheeks. The intensities of both the suction and the skin deformation observed at the earliest moment the traction was perceived by the volunteers were recorded., Results: The liminar sensorial detection under progressive suction force was 1.5 times lower when using the 4 mm probe than the 2 mm probe. Suction necessary for liminar sensation was 7 times lower under steep suction than in response to the progressive mode. The skin deformation corresponding to the liminar sensorial perception was almost constant (C=0.5 p. 100) for each subject. By contrast, a large inter individual heterogeneity unrelated to age was present., Comments: Sensitivity of facial skin to stretching can be explored using a precise suction method. Perception is more related to the rate of traction than to the surface area submitted to suction. Cutaneous deformation, nearly constant for each individual, appears to be the main parameter. Steep and progressive suctions appear to stimulate distinct types of mechanoreceptors. The presently described method can be applied in cosmetology and in functional investigation of various diseases such as diabetes, acromegaly and atopic dermatitis among others.

Introduction: The treatment of the severe forms of photodermatoses often requires potent systemic immunosuppressive drugs. We report two patients suffering from severe photodermatitis successfully treated with oral cyclosporine., Cases Report: A 58-year-old man developed severe pruritic eczematous reactions for several years on light-exposed and light-protected skin following each sun exposure. A 66-year-old man showed similar lesions restricted to the head and neck. The clinical presentation and evolution as well as histologic, immunohistologic, allergologic and photobiologic assessments suggested the diagnosis of actinic reticuloid and persistent light reactivity, respectively. The lesions of both patients did not respond to a high dose regimen of systemic corticosteroids (methylprednisolone 1 mg/kg/day) for several weeks. The severity of cutaneous lesions and pruritus required another potent immunosuppressive treatment. Oral cyclosporine at the maximum daily dose of 4 mg/kg was given for three months. A rapid improvement of the pruritus and skin lesions occurred in the two patients, without significant side-effect. The first patient experienced recurrent lesions after termination of cyclosporine treatment during summer time. The other patient did not develop new skin eruption for 3 years after stopping the initial treatment with cyclosporine., Discussion: Low-dose oral cyclosporine is a quick-acting and well tolerated symptomatic treatment of severe photodermatoses resistant to other systemic immunosuppressive drugs. However, therapeutic results do not consistently exhibit long-standing remanent effect.

Introduction: The subacute necrotizing histiocytic lymphadenitis was reported for the first time in 1972 in Japan by Kikuchi and by Fujimoto and his colleagues. This idiopathic disease can affect the skin. We report a case of Kikuchi-Fujimoto disease with skin and lymph node involvement., Observation: The Yemani man developed cervical lymphadenitis and arciform papulo-nodular lesions of the face. The histologic examination revealed a necrotizing lymphadenitis with blast cells but devoid of neutrophils. The cutaneous involvement corresponded to an angiocentric infiltration by mononuclear cells among which plasmacytoid cells and caryorrhexis were recognized. A spontaneous resolution of the disease occurred spontaneously within three months., Commentary: The clinical and histologic aspects of the present case resemble in part the presentation of lupus erythematosus. However, some distinctive features suggest Kikuchi-Fujimoto disease cannot be termed a classical type of lupus erythematosus.

Introduction: Cutaneous manifestations of myelodysplastic syndromes are rare and polymorphous. They can be the direct expression of the hematological disease or represent signs of a vasculitis or a neutrophilic syndrome. Myelodysplastic syndromes progress sometimes toward an acute leukemia., Observation: A 53-year-old woman suffering from myelodysplastic syndrome presented for several months a cutaneous vasculitis without any histological specificity. In time, such presentation was complicated by the simultaneous occurrence of a cutaneous Langerhans cell histiocytosis and an acute monoblastic leukemia type LMA 4. The disease was rapidly fatal., Discussion: The complication of a myelodysplastic syndrome by concurrent Langerhans cell histiocytosis and acute monoblastic leukemia suggests a pathogenic relationship between these two latter disorders.

We report a case of lethal varicella developed in an immunocompromised man in his seventies. A study by immunohistochemistry and in situ hybridization was conducted revealing the presence of the glycoprotein gpI specific for VZV and its corresponding nucleic acids found in multiple foci of most tissues and organs, except in the brain and paravertebral sympathetic ganglia.

Introduction: The microbiological identification of onychomycosis may be uncertain as some fungi growing in culture from this material are not necessarily pathogen and invasive. Conversely, the negativity of a culture is not rare even when fungi are seen by microscopy., Materials and Methods: We compared the information brought by standard histological examination, immunohistochemistry and in vivo confocal microscopy., Results: The histological examination of nails is of importance in this pathology. We present a laboratory technique that proves to be easy and rapid. We report diagnostic criteria allowing the distinction between dermatophytes, yeasts and non-dermatophyte molds. The standard microscopic examination may further be improved by immunohistochemistry using some antibodies to fungi. In vivo confocal microscopy is a technique for the future. The dermatologist will be able to see fungi in the nail at the clinical examination, without any sampling or peculiar preparation., Conclusion: The histological examination is a routine technique useful for defining the nature and localization of fungi in the nail plate. Immunohistochemistry applied to onychomycosis is an experimental approach bringing prominent informations about the identification of fungi. In vivo confocal microscopy is a door opened to the future.

We observed an adult female patient presenting an autosomal recessive ectodermal dysplasia difficult to classify among the various reported forms of this disease. She had the major signs of the hidrotic type of the disease (palmo-plantar hyperkeratosis, nail and hair dystrophies, and typical sweat glands) and anodontia as reported in the hypohidrotic form of the syndrome. We evaluated the function of the sweat glands and found them hyporeactive to a heat stimulus. Most of the epithelial alterations have improved under therapy by acitretin.

We present a morphometric method aimed at evaluating the growth of pigmented naevi. The index of clinical atypia includes evaluation of area and corrugation of the lesions. The index of evolutivity compares the indices of clinical atypia at intervals of 100 days. The indices differ with the pathologies and also with each naevus in each group. Arranging the clinical atypia and evolutivity indices in decreasing values enabled us to distinguish between naevi under the influence of human growth hormone (hormonal influence), naevi intensively and recently sun-irradiated (UV influence) and unstimulated naevi of normal subjects.

We report an ultrastructural study of azidothymidine-induced melanoderma. The hyperpigmentation is linked to the presence of numerous single melanosomes and polymelanosomes in keratinocytes at all levels of the epidermis, and in dermal Factor XIIIa-positive dendrocytes. Such observation suggests an increased melanogenesis in melanocytes associated to a defect in the degradation of melanosomes normally occurring during epidermal maturation.

We have looked for the presence of Borrelias by immunohistochemistry in cutaneous biopsies taken from patients with positive Borrelia serology. We used the monoclonal antibody "P41 Borrelia burgdorferi flagellin". We found Borrelias in the dermis of Pick-Herxheimer disease (3/3), erythema chronicum migrans (6/9), lymphocytoma (1/3), and morpheas (2/5). They were also seen in the vascular wall of hypodermal arterioles in a case of cutaneous periarteritis nodosa (1/2). Treponema pallidum was not revealed by the antibody.

We have developed a new monoclonal antibody EB-A1 that recognizes Aspergillus sp. by immunoassay and in formalin fixed tissues. The sensitivity of this antibody is excellent and its specificity appears correct as many human tissues and several fungi other than Aspergillus sp. are not revealed.

Objective assessment of seborrhea of the scalp has seldom been reported in the literature. We have used a variant of the method described by Saint-Léger and Lévêque to measure the sebum excretion rate in normal scalp, male pattern alopecia, pityriasis amiantacea, pityriasis capitis and alopecia areata. The sebum excretion rate was significantly increased in male pattern alopecia, significantly decreased in pityriasis amiantacea and showed a trend towards reduction in alopecia areata. Pityriasis capitis was not associated with changes in the excretion of sebum.

Sensitivity and specificity of TPHA, TPI, RPCF, Kline's and Kolmer's tests are compared in a retrospective study carried out on 2,500 sera. The interest of these tests differs as far as diagnosis and survey of syphilis are concerned and the association of TPHA with a quantitative test as Kline's test appears optimal. TPHA is highly sensitive and specific. Its positivity, which usually remains after treatment, is particularly valuable in the diagnosis of cases of late syphilis. Its association with a quantitative test brings a better evaluation of the evolutivity of the disease.

We have measured and compared the mechanical properties of the skin, muscles and of a cushion designed to prevent bedsores. The mechanical properties of the tested material are intermediate to those of skin and muscles. They permit an even and optimal distribution of the pressures on the skin.