Search

Objective: In venous leg ulcer (VLU), the impaired healing has been shown to be associated with excessive levels of protease activities such as matrix metalloproteinases (MMPs) and elastases found in exudates. The present study focused on exudates absorption and proteases trapping capacity of a new generation of polyacrylate superabsorbent, Tegaderm superabsorber (TS), compared with a traditional dressing such as Zetuvit. Method: We studied the proteases implicated in VLU (MMP-1, MMP-2, MMP-9 and PMN elastase). Absorption was tested using an artificial exudate like fluid, over 30 minutes. The protein trapping ability was obtained using ELISA assays (enzyme-linked immunosorbent assay) to determine the amount retained by the dressings from spiked fluid samples. Results: TS had a higher exudate absorption capacity (72.8±1.7%) compared with the standard dressing (36.5±1.6%), and was also able to trap and retain proteases while the standard dressing released them. The difference was shown to be much larger for MMP-2 and PMN elastase. Conclusion: In our knowledge, this is the first comparative in vitro study evaluating absorption capacity as well as protease trapping capacity of a polyacrylate dressing for the four most implicated proteases in VLU. TS could be an appropriate alternative to improve the management of VLU by trapping MMPs and PMN elastse with a particularly high affinity for MMP-2 and PMN elastase.

Objective: To describe an in vitro fibrin clot model that could reliably assess the fibrinolytic activity of enzymatic debriding agents for wound care application. Method: A model of a fibrin clot was reconstructed in vitro by mixture of human fibrinogen and a-thrombin supplemented with factor XIII. These clots were then treated with enzymatic ointments. Fibrinolytic activity was investigated by measuring D-dimer levels, using an automated immunoturbidimetric Liatest D-dimer assay. Results: Collagenase and papain-urea ointments demonstrated fibrinolytic activity which was macroscopically visible. Their effect was identical on the in vitro reconstructed fibrin clot and ex vivo collected wound fibrin clot; collagenase and papain-urea both induced a complete degradation and dissolution of both fibrin clots after 24 hours of treatment. This was associated with an increase in D-dimer concentration. Conclusion: This reconstructed fibrin clot in vitro model has the potential to predict the efficacy of fibrinolytic agents and therefore appears to be a suitable model for in vitro assays. Declaration of interest: This study was supported by a grant from URGO Laboratory.

Currently, numerous patients who receive targeted chemotherapy for cancer suffer from disabling skin reactions due to cutaneous toxicity, which is a significant problem for an increasing number of patients and their treating physicians. In addition, using inappropriate personal hygiene products often worsens these otherwise manageable side-effects. Cosmetic products for personal hygiene and lesion camouflage are part of a patients' well-being and an increasing number of physicians feel that they do not have adequate information to provide effective advice on concomitant cosmetic therapy. Although ample information is available in the literature on pharmaceutical treatment for cutaneous side-effects of chemotherapy, little is available for the concomitant use of dermatological skin-care products with medical treatments. The objective of this consensus study is to provide an algorithm for the appropriate use of dermatological cosmetics in the management of cutaneous toxicities associated with targeted chemotherapy such as epidermal growth factor receptor inhibitors and other monoclonal antibodies. These guidelines were developed by a French and German expert group of dermatologists and an oncologist for oncologists and primary care physicians who manage oncology patients. The information in this report is based on published data and the expert group's opinion. Due to the current lack of clinical evidence, only a review of published recommendations including suggestions for concomitant cosmetic use was conducted.

Resume Introduction La place de la maladie du Morbihan dans la nosographie est incertaine. Tantot denommee « œdeme facial persistant solide », tantot « rosacee lymphœdemateuse », elle pourrait correspondre a une forme clinicopathologique particuliere de lymphœdeme ou de rosacee. Elle est peu frequente et pose un veritable probleme de prise en charge chronique au long cours. Nous rapportons, pour la premiere fois dans la litterature francaise, un effet favorable du traitement par diuretiques dans trois cas de maladie du Morbihan. Observations Trois hommes âges de 38, 66 et 76 ans, suivis pour une maladie du Morbihan invalidante evoluant respectivement depuis deux, cinq et huit ans, presentaient un œdeme de la face predominant sur les paupieres. Le diagnostic etait retenu selon des criteres cliniques et paracliniques, apres exclusion d’un certain nombre d’affections (lupus cutane chronique, sarcoidose, causes infectieuses, notamment demodecie faciale, et enfin rosacee granulomateuse). Apres plusieurs echecs therapeutiques (cyclines, antipaludeens de synthese, danazol, corticoides et isotretinoine), ces patients ont recu un traitement par diuretiques : furosemide a la dose de 60 mg/j chez deux d’entre eux et spironolactone chez le troisieme, a raison de 75 mg deux fois par jour. Resultats Nous avons constate une regression quasi-totale, voire totale, de l’œdeme avec un recul allant d’un a 16 ans. Aucun effet secondaire n’a ete rapporte. Discussion La prise en charge de la maladie du Morbihan reste difficile et surtout empirique. Le traitement par diuretique est une alternative therapeutique interessante dans les formes severes de cette affection.

In clinical evaluation, digital photography is a valuable low-cost and easy to use tool to illustrate assessments; hence the temptation to use it for analysis purposes, particularly in the assessment of facial wrinkles (forehead wrinkles, crow's feet). We review different methods to quantify the volume from 2D images, most of them directly adapted from algorithms initially developed in 3D profilometry. The 3D representation of these photographs is also detailed using several examples. Finally, the limits and drawbacks of this 3D "pseudo quantification" are listed and compared with those usually found in classic profilometry.

Resume Introduction La prise de phenylbutazone expose a des effets indesirables frequents, tres varies et parfois graves. Nous rapportons pour la premiere fois une observation de syndrome de Sweet associe a une sialadenite, induite par la prise de phenylbutazone. Observation Une femme de 54 ans traitee pour des lombalgies, neuf jours auparavant par de la phenylbutazone durant trois jours, voyait apparaitre une parotidite et une sous-maxillite bilaterale, puis une eruption febrile erythemateuse, œdemateuse et pustuleuse, resistant aux antibiotiques. Les examens biologiques montraient un syndrome inflammatoire majeur avec hyperleucocytose a polynucleaires neutrophiles, thrombocytose, anemie et cytolyse hepatique. Le bilan infectieux et auto-immun etait negatif. L’examen histologique d’une biopsie cutanee confirmait le diagnostic de syndrome de Sweet. Une corticotherapie generale entrainait la disparition de la symptomatologie clinique et biologique. Discussion Une sialadenite induite par la phenylbutazone est un effet secondaire rare et meconnu, qui peut s’accompagner d’une reaction systemique. Dans notre observation, le syndrome de Sweet correspond aux criteres bien definis de syndrome de Sweet medicamenteux. Il correspond vraisemblablement a une reaction systemique par hypersensibilite medicamenteuse, au meme titre que la sialadenite.

Objective: We compared the effects on cultured human fibroblasts of a new non-adhesive wound dressing, Urgotul, with five other wound dressings. Urgotul is a hydrocolloid dressing; the comparator dressings included impregnated gauze and modern wound dressings. Method: Cultures in monolayer were used to study the morphology and growth of fibroblasts. The Bell model of cultured dermis equivalents was used to investigate myofibroblast differentiation. These cultures were labelled a-SM actin and F-actin. Results: Two of the tested dressings induced cytotoxic effects. They were found to inhibit cell growth (greater than 60%) and to disturb cell shape and cytoskeletal differentiation. Urgotul and the remaining three dressings showed no effect on proliferation. However, some of them modified fibroblast morphology and affected F-actin distribution. Conclusion: Depending on their nature and components, wound dressings may respect or affect fibroblast behaviour in vitro (proliferation, morphology and a-SM actin and F-actin distribution). The significance of these in vitro observed findings require further investigations. Declaration of interest: This study was supported by Urgo Laboratories.

The presence of tyrosinase mRNA in the peripheral blood cells of melanoma patients has been recently studied as a possible marker of haematogenous dissemination. However, considerable variations in the rates of detection have been noted. We determined the presence of tyrosinase mRNA-positive circulating cells using reverse transcriptase-polymerase chain reaction (RT-PCR) in 35 patients with stage I melanoma, two patients with stage II melanoma and two patients with stage III melanoma. Among the patients with stage 1, 13 were tested before and after surgery (< 1 h). Twenty healthy subjects served as negative controls. Out of the melanoma patients, the tyrosinase gene was expressed in three of the 52 samples tested. Tyrosinase mRNA was present in the circulating cells of only one patient with stage I melanoma after intra-congenital naevi resection. However, two other stage I patients developed rapidly lethal metastasis within the following 6 months, despite the lack of detectable tyrosinase mRNA. None of stage II patients were positive for the tyrosinase transcripts, while both patients with stage III melanoma showed enzyme expression. Our results confirm those of previous studies, showing that a small proportion of stage I melanoma patients have tyrosinase-positive circulating cells. Moreover, the lack of tyrosinase mRNA detection in the blood does not necessarily exclude metastatic progression. Therefore, this study indicates that the detection of tyrosinase mRNA-positive circulating cells by RT-PCR is not a predictive biomarker of a metastasis risk in patients with stage I melanoma.

Background: HIV-infected patients, like renal transplant recipients, are at increased risk of developing skin cancer in photoexposed areas. Previous studies demonstrated that prolonged ultraviolet (UV)-induced erythema and a decreased and delayed tanning could be correlated with an increased risk of skin cancers. Objective: As HIV-infected patients are at an increased risk of developing skin cancers, we aimed to assess the cutaneous response to UV irradiation in these patients. Methods: Twelve HIV-infected patients and 12 healthy volunteers were included in a prospective case-control study. No patient or volunteer had a history of skin cancer or photodermatosis. The minimal erythemal dose (MED) was determined using a solar simulator UV source, and, then, each subject underwent an exposure of 6 MED. The erythemal and pigmentation responses were studied using a visual scale and a tristimulus colorimeter over a 4-week period. Results: We failed to demonstrate any significant differences between HIV-infected patients and controls for erythema and delayed pigmentation. No difference was found for MED between the two groups although most HIV-infected patients received potentially photosensitive drugs. Conclusions: Our results suggest that, as a group, the HIV-infected patients without a history of photosensitivity or skin cancer did not demonstrate a greater susceptibility to intense UV irradiation in terms of erythema and pigmentation induced by intense UV exposition.

Background: Retinaldehyde, the natural precursor of retinoic acid, should exert similar effects on photoaged skin. Objective: To establish the efficacy and safety of topical retinaldehyde on photoaged skin. Methods: Open and controlled clinical studies using image analysis of silicone skin replicas. Results: Retinaldehyde proved efficient and safe. Conclusion: Retinaldehyde is efficient and well tolerated for the improvement of the signs of photoaging.

Summary Background Provoked vestibulodynia is difficult to treat. The beneficial effects of botulinum toxin A are being considered because of the muscular anomalies observed in this pathology. Objective To evaluate the efficacy of botulinum toxin A in the treatment of provoked vestibulodynia. Methods Patients aged between 18 and 60 years presenting with provoked vestibulodynia (according to the 2003 International Society for the Study of Vulvar Disease classification) received 50 U of botulinum toxin A bilaterally in the bulbospongiosus muscle under electromyographic monitoring. Pain was evaluated by a visual analogue scale (VAS), quality of life was evaluated by the Dermatology Life Quality Index and sexual function by the Female Sexual Function Index. Results Twenty patients received the injections. Sixteen patients presented with a muscular hyperactivity on electromyography. After 3 months, 80% of the patients improved in terms of pain. Mean ± SD VAS values significantly decreased from 8·37 ± 1·22 (range 4·5–10) to 2·57 ± 2·67 (0–9; P

International audience

Objective: The tissue contraction phenomenon associated with wound healing is of prime importance for wound closure. Contractile properties of human fibroblasts from chronic venous leg ulcers were compared with those of normal fibroblasts using in vitro models. Method: Biopsies were taken from the uninvolved skin of the thigh, the epithelialised ulcer edge and the non-epithelialised ulcer centre in four patients (average age: 78 years). Fibroblasts were obtained by an explant technique and expanded in vitro in Dulbecco’s Modified Eagle’s Medium supplemented with 10% foetal calf serum and used for the assays at their fourth passage. Intracellular alpha-smooth muscle actin expression (αSM-actin) was studied by immunofluorescence labelling of cells cultured in monolayer. Contractile properties were evaluated using three-dimensional collagen lattices. Results: Fibroblasts from the ulcer centre were the richest cells in actin filaments. Both populations of venous ulcer fibroblasts contracted more rapidly and to a greater extent than normal fibroblasts. The peak contractile forces developed by fibroblasts from the ulcer centre and the ulcer edge were 30% and 18% greater than normal fibroblasts respectively. Conclusion: Some functions of fibroblasts, in particular the generation of contractile forces and the formation of cytoplasmic actin filaments, seem not to be affected in chronic venous ulcers. Declaration of interest: This study was supported by the Fondation Coloplast pour la Qualite de la Vie of France.

Since 1967, about 40 cases of digital necrosis associated with neoplasia have been reported. We report a new case of digital necrosis associated with an ovarian carcinoma and with a lupus-like syndrome. Immunologic cross-reactivity to tumoral antigen could explain the lupus-like syndrome.

Ultraviolet (UV) radiation causes a variety of biologic effects on the skin, including erythema, pigmentation, immunomodulation, mutagenicity, carcinogenicity, and aging. UV-induced erythema is the most demonstrative effect and is associated with the other signs of inflammation, i.e. warmth, pain, and swelling. The subject of our topic will be focused on the time course of UV erythema.

Graft-versus-host disease (GVHD)* is a frequent complication of allogeneic bone marrow transplantation. The potentially beneficial effect of phototherapy for treatment of cutaneous manifestations of GVHD led us to investigate retrospectively the effect of this therapy in a larger series of patients. Eleven patients with cutaneous GVHD (acute GVHD in 4 patients, chronic lichenoid GVHD in 6 patients, and chronic sclerodermatous GVHD in 1 patient) resistant to standard immunosuppressive drugs were treated with phototherapy. Skin lesions showed a complete clearing in 75% of patients with acute GVHD, and a response rate of 70% was observed in patients with chronic GVHD. No effect of phototherapy was achieved in 3 patients. Our results suggest that phototherapy is a nonaggressive treatment that may benefit patients with cutaneous GVHD, who already take high doses of immunosuppressive drugs.

The concentration of 5-methoxypsoralen (5-MOP) in suction blister fluid (SBF) after oral intake was determined in relation to the peak blistering point. Interstitial fluid was obtained from nine healthy male volunteers by applying mild suction (300–350 mmHg) to the skin of the volar aspect of the forearm. Blisters were raised at three different times: 18 h prior to drug administration (group I); 2 h prior to drug administration (group II); and during drug ingestion (group III). SBF levels of 5-MOP were determined in each group of blisters 2 h after oral administration of 1.2 mg/kg micronized 5-MOP. The results showed a statistically significant difference in the concentrations of 5-MOP between each group of blisters. The highest concentration of 5-MOP in the SBF was found in group III and the lowest in group II blisters. These findings suggest that the point of peak blistering in relation to drug administration needs to be known in each pharmacological study using suction blisters.

1,25-Dihydroxyvitamin D3 [1,25(OH)2 D3] may be an immunomodulatory drug which could have a role in controlling collagen deposition, and inducing reversal of fibrosis in some tissues. These observations prompted a study of the possible use of this hormone for the treatment of scleroderma. A 35-year-old woman, who had been suffering from localized scleroderma for 2 years, was given oral 1,25(OH)2 D3 for 6 months. The effects of the treatment were evaluated using clinical and physical measurements (skin thickness, extensibility properties of the skin). The evolution of the patient's condition during the 6-month therapy suggests that 1,25(OH)2 D3 is beneficial in localized scleroderma. The mechanisms of action are discussed in relation to the literature, which suggests both immunoregulatory and inhibitory effects on fibroblast growth.

A new fiberized fluorescence imaging probe is presented. This device can potentially be used for a wide range of biological or medical applications. By exploiting the chromatic aberrations of gradient index lenses, the excitation blue or near-UV excitation light is focused on the sample surface, while the red fluorescence signal is efficiently launched back to collecting fibers. The excitation fiber is single mode at the working wavelength so that a resolution of 5 microm is obtained over a scanning area of several square millimeters. Experimental fluorescence images are presented. They concern either self-fabricated fluorescent microsamples or views of leaves that constitute an example of biological tissues analysis. The probe can also be adapted for spectroscopic investigations.

Resume Les auteurs rapportent l'observation d'une jeune femme noire, qui, 16 mois apres une suspicion de salpingite presenta une encephalite et un syndrome de Fitz-Hugh Curtis : le role de Chlamydia trachomatis semble pouvoir etre retenu dans ces deux affections sur la base d'elements cliniques, biologiques et evolutifs.