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Stomatodynia is an oral dysesthesia with a psychosomatic component. Twelve consecutive patients with stomatodynia were offered hypnosis sessions. Measures of anxiety, depression, and pain were admi...

Background: Hereditary angioedema (HAE) is characterized by unpredictable and potentially life-threatening attacks of cutaneous and submucosal swelling. Over the past decade, new agents, based on a better understanding of the underlying biologic mechanisms of HAE, have changed the face of long-term prophylaxis (LTP). Objective: The objective was to describe current practices and unmet needs with regard to LTP for HAE in expert centers in France. Methods: The study was conducted in France in 2020. Based on their experience with patients with HAE who had visited their center at least once in the past 3 years, physicians from 25 centers who are expert in the management of HAE were requested to fill in a questionnaire that encapsulated their active patient list, criteria for prescribing LTP, and medications used. They were asked about potential unmet needs with currently available therapies. They were asked to express their expectations with regard to the future of HAE management. Results: Analysis was restricted to 20 centers that had an active patient file and agreed to participate. There were 714 patients with C1 inhibitor (C1-INH) deficiency, of whom 423 (59.2%) were treated with LTP. Altered quality of life triggered the decision to start LTP, as did the frequency and severity of attacks. Ongoing LTP included androgens (28.4%), progestins (25.8%), lanadelumab (25.3%), tranexamic acid (14.2%), intravenous C1-INHs (5.6%), and recombinant C1-INH (0.7%). Twenty-nine percent of the patents with LTP were considered to still have unmet needs. Physicians' concerns varied among therapies: poor tolerability for androgens and progestins, a lack of efficacy for tranexamic acid and progestins, dosage form, and high costs for C1-INHs and lanadelumab. Physicians' expectations encompassed more-efficacious and better-tolerated medications, easier treatment administration for the sake of improved quality of life of patients, and less-expensive therapies. Conclusion: Despite the recent enrichment of the therapeutic armamentarium for LTP, physicians still expressed unmet needs with currently available therapies.

To determine whether a single session of botulinum toxin type A (BTA) injections into both hands more effectively decreases the frequency of systemic sclerosis-associated Raynaud's phenomenon (SSc-RP) episodes than placebo.This multicenter, randomized, double-blind, placebo-controlled, parallel-group phase III trial in patients with SSc-RP assessed the effect of 50-unit BTA or placebo injections into the palms of both hands around each neurovascular bundle during 1 session in winter. The primary end point was the between-group difference in the median change in the number of RP episodes from baseline (day 0) to 4 weeks postinjection. Values between the groups were compared with the Wilcoxon rank-sum test.The intent-to-treat analysis included 46 BTA-treated patients and 44 placebo recipients. At 4 weeks after assigned treatment injections, the median number of daily RP episodes decreased comparably in the BTA and placebo groups (median change -1 episode/day [interquartile range (IQR) -1.5, 0 episodes/day] and -1 episode/day [IQR -2.5, 0 episodes/day], respectively) (P = 0.77 versus placebo). Moreover, change in Raynaud's Condition Score, quality of life assessed by Health Assessment Questionnaire disability index, and hand function assessed by shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Cochin Hand Function Scale from baseline to follow-up weeks 4, 12, and 24 did not differ significantly between groups. The BTA group experienced transient hand muscle weakness significantly more frequently (P = 0.003).Neither the primary nor secondary end points were reached, and our results do not support any beneficial effect of palmar BTA injections to treat SSc-RP.

Background: First-degree relatives (FDRs, defined as parents, children, and siblings) of melanoma patients are at a two-to-fivefold increased risk of developing melanoma themselves. FDRs are advised to perform self-skin examination (SSE) and annual medical total cutaneous examination (TCE) performed either by a dermatologist or a general practitioner, and to change their sun-related behavior. This advice is given orally to melanoma patients who are asked to relay the information to their FDRs. Objective: Our aim was to determine the impact of providing a tip sheet to melanoma patients intended to their first-degree relatives (FDRs) on early detection and sun-related behaviors in this group at increased risk of melanoma. Methods: A superiority, cluster-randomized trial was conducted at nine hospital centers. In the intervention group, dermatologists were asked to deliver to melanoma patients (index cases) the tip sheet and oral advice intended to their FDRs. The control group were asked to deliver the usual oral advice alone. The primary outcome was early detection of melanoma in FDRs with a medical TCE performed within one year after the first visit of the index case. Secondary outcomes were SSE and sun-related behaviors in FDRs. Results: A total of 48 index cases and 114 FDRS in the control group, 60 index cases and 166 FDRS in the intervention group were recruited. In the intervention group, 36.1% of FDRs performed a medical TCE as compared to 39.5% of FDRs in the control group (OR 0.9 [95% CI 0.5 to 1.5], p = 0.63). We did not find a between-group difference in SSE and sun-related behaviors. Conclusion: A tip sheet added to the usual oral advice did not increase medical TCE among FDRs of melanoma patients. Overall, the rate of TCE among FDRs was low. Research on other strategies is needed to increase melanoma detection in this population.

Despite the poor prognosis associated with melanoma brain metastases (BM), data concerning these patients and their inclusion in clinical trials remains scarce. We report here the efficacy results of a subgroup analysis in patients with BRAFV600-mutant melanoma and BM treated with BRAF and MEK inhibitors dabrafenib (D) and trametinib (T).This phase IIIb single-arm, open-label, multicenter, French study included patients with unresectable stage IIIc or IV BRAFV600-mutant melanoma with or without BM. The present analysis focuses on patients with BM. Response rates were determined clinically and/or radiologically as per standard clinical practice. Progression-free survival (PFS) was estimated using the Kaplan Meier analysis and modelled with multivariate Cox regression model. Risk subgroups were identified using an exponential regression tree analysis. Significance was set at plt; 0.05.Between March 2015 and November 2016, 856 patients were included and 275 (32%) patients had BM. Median PFS was 5.68 months (95% confidence interval [CI], 5.29-6.87). Significant independent factors associated with shorter PFS were ECOG ≥1, elevated serum lactate dehydrogenase (LDH), ≥3 metastatic sites, and non-naïve status. The binary-split classification and regression tree modelling identified baseline LDH and ECOG status as major prognostic factors.This is to date the largest, close to real-world, study in advanced BRAFV600-mutant melanoma patients with BM treated with D+T. ECOGgt;1, ≥3 metastatic sites and elevated LDH were associated with shorter PFS, a finding previously demonstrated only in patients without BM. Further studies are warranted to determine the optimal treatment sequence in this population.

We present a case of atopic nipple eczema leading to reactive hyperprolactinemia, by mechanical nipple stimulation. This reactive hyperprolactinemia caused an aggravation of the eczema because of the resulting galactorrhea, by local irritation and inflammation, and was complicated by a galactocele. This benign tumour was a source of concern for the patient and required several diagnostic radiographic examinations.

Resume Introduction La toxicomanie est a l’origine de plaies chroniques (PC) responsables de complications severes. Peu d’etudes sur ce sujet sont disponibles. Notre objectif etait de determiner les caracteristiques epidemiologiques, cliniques, etiologiques et evolutives de ces PC. Patients et methodes Il s’agissait d’une etude retrospective et prospective, multicentrique incluant tous les toxicomanes porteurs de PC. Resultats Nous avons inclus 58 patients (17 en prospectif) dont 84,5 % d’hommes, d’âge median 43 ans, porteurs de PC multiples a la suite d’une toxicomanie intraveineuse (78,2 %), inhalee (41,1 %) ou nasale (20 %). La toxicomanie aux opiaces (68,4 %), a la cocaine (47,4 %) ou au cannabis (40,4 %) etait sevree ou substituee dans 79,3 % des cas. Les PC etaient fibrineuses (53,6 %) et necrotiques (42,9 %), recidivantes (54,2 %), evoluant depuis plus d’1 an (61,5 %). La toxicomanie intraveineuse etait associee a des ulceres de grande taille, fibrineux, sur une insuffisance veino-lymphatique clinique dans 74 % des cas. Seules 23 % de ces plaies etaient localisees aux membres superieurs. Les ulceres necrotiques associes a une arteriopathie clinique etaient associes a la voie inhalee. Les abces (50 %) et erysipeles (29,3 %) etaient les complications cutanees les plus frequentes. A 3 mois, 50 % des PC etaient ameliorees et 29,2 % des patients etaient perdus de vue. Discussion Les PC chez les toxicomanes surviennent preferentiellement chez l’homme jeune avec antecedent de toxicomanie intraveineuse. Majoritairement aux jambes et associees a une insuffisance veino-lymphatique, elles engendrent un risque majeur d’infection cutanee augmentant la morbi-mortalite chez ces patients au suivi difficile.

Background Topical calcineurin inhibitors are used off label in the treatment of vitiligo, and there is a lack of placebo-controlled, blinded studies to support their use. Objective This study aimed to compare the efficacy of tacrolimus 0.1% ointment with that of the vehicle for repigmentation in adult patients with facial vitiligo. Design This study was a 24-week multicenter randomized parallel double-blind study with a 24-week post-treatment follow-up extension. Population Participants included were adult patients with recent facial vitiligo target lesions ( Intervention Patients received either tacrolimus 0.1% ointment or vehicle twice daily. Main Outcomes and Measures The primary outcome was a therapeutic success, defined as a change ≥75% in the repigmentation of the target lesion between baseline and week 24, measured by ImageJ software. Secondary outcome measures were a variation of the physicians’ global assessment scores and patients’ satisfaction scores, safety data, and the rate of relapse at week 48. Results A total of 42 patients were included. Therapeutic success was achieved in 65% of tacrolimus-treated patients versus 0% of vehicle-treated patients at week 24 (P Conclusions and Relevance Twice-daily tacrolimus 0.1% ointment showed superior efficacy to that of the vehicle through the 24 weeks of intervention and 24 weeks of follow-up in adult patients with facial vitiligo. Trial Registration This study was registered at ClinicalTrials.gov (identifier: NCT02466997 ).

Stomatodynia is an oral dysesthesia with a psychosomatic component. Twelve consecutive patients with stomatodynia were offered hypnosis sessions. Measures of anxiety, depression, and pain were administered before the first and after the last hypnosis session. Pain severity was assessed with a Numeric Rating Scale (NRS). Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS). The data were collected retrospectively from medical records on the 12 patients. The difference between NRS pain ratings and HADS scores before and after hypnosis was significant (

Wide local excision constitutes the standard of care for Merkel cell carcinoma, but the optimal margin width remains controversial.To assess whether narrow margins (0.5-1 cm) were associated with outcome.Patients were recruited from a retrospective French multicentric cohort and included if they had had excision of primary tumor with minimum lateral margins of 0.5 cm. Factors associated with mortality and recurrence were assessed by multivariate regression.Among the 214 patients included, 58 (27.1%) had undergone excision with narrow margins (0.5-1 cm) versus 156 (72.9%) with wide margins (1 cm). During a median follow-up of 50.7 months, cancer-specific survival did not differ between groups (5-year specific survival rate 76.8% [95% confidence interval 61.7%-91.9%] and 76.2% [95% confidence interval 68.8%-83.6%], respectively). Overall survival, any recurrence-free survival, and local recurrence-free survival did not significantly differ between groups. Cancer-specific mortality was associated with age, male sex, American Joint Committee on Cancer stage III, and presence of positive margins.Retrospective design, heterogenous baseline characteristics between groups.Excision with narrow margins was not associated with outcome in this cohort, in which most patients had clear margins and postoperative radiation therapy. Residual tumor, mostly found on deep surgical margins, was independently associated with prognosis.

Introduction Le RCP des biotherapies (BT) et de l’apremilast (APR) ne mentionne aucune contre-indication en cas d’antecedents de cancer solide. Cependant les recommandations francaises proposent de discuter au cas par cas avec l’oncologue l’initiation de BT/APR dans ces circonstances. Materiel et methodes Etude retrospective multicentrique au sein du GEM Resopso decrivant la tolerance BT/APR chez les patients psoriasiques aux antecedents de cancer solide. Criteres d’inclusion : patient ayant debute BT/APR apres le diagnostic de cancer. Criteres d’exclusion : carcinomes basocellulaires, carcinomes epidermoides cutanes(CEC) du groupe 1. Resultats Un total de 92 patients etaient inclus, 49 femmes, âge moyen 61,8 ans, rhumatisme psoriasique 21,7 %. Avant le diagnostic de cancer, 20 patients avaient deja recu une BT ; 87 patients avaient eu un cancer solide et 5 deux cancers. Il s’agissait de cancer du sein n = 30, melanome n = 13, prostate n = 10, colorectal n = 8, col uterin n = 6, ORL n = 6, urothelial n = 5, CEC du groupe 2 n = 5, rein n = 4, poumon n = 3, testicule n = 2, sarcome n = 2, thyroide n = 1, thymome malin n = 1, carcinome hepatocellulaire n = 1. Au diagnostic du cancer, 20 patients etaient sous BT. Le delai moyen entre le diagnostic de cancer et le debut de BT/APR etait de 82,6mois [0,7–347]. Le cancer etait en remission n = 83 (duree > 5 ans n = 40), stable n = 5, en progression n = 4. Le traitement du cancer etait en cours pour 9 patients au debut de BT/APR ; 92 patients recevaient 139 lignes de BT/APR : APR n = 52, anti-TNF n = 30, anti-IL17 n = 21,ustekinumab (UST) n = 18, anti-IL23p19 n = 18. Parmi ceux sous BT au diagnostic du cancer,18 beneficiaient d’un autre traitement apres le cancer (APR n = 11,UST n = 2, anti-IL17 n = 1, anti-IL23p19 n = 2,anti-TNF n = 2), 1 reprenait UST, chez 1 patient UST n’etait jamais interrompu. La duree moyenne de traitement par BT/APR etait de 27,3mois [1–126].Quatre patients ont eu une progression de leur cancer (cancer de vessie depuis 3 mois sous guselkumab, adenocarcinome rectal metastatique depuis 1 mois sous APR, 2 carcinomes canalaires infiltrants du sein sous hormonotherapie depuis 11 et 40 mois sous APR), 5 sont restes stables et 4 ont presente un nouveau cancer (CEC n = 4, carcinome epidermoide rectal metastatique n = 1) ; 5 patients sont decedes : progression du cancer n = 1, progression d’un cancer survenu sous BT n = 1, infection COVID 19 n = 1, autre n = 2. Discussion Il s’agit a notre connaissance de la plus grande serie de patients aux antecedents de cancer solide traites par BT/APR pour un psoriasis, avec 4,3 % de progression de cancer sous BT/APT. Une meta-analyse n’a pas trouve de surrisque de recurrence de cancer sous anti-TNF versus immunomodulateur et absence de traitement chez des patients traites pour des pathologies inflammatoires chroniques avec antecedent de cancer. Ces donnees doivent etre confirmees sur d’autres cohortes.

International audience; Background: BRAF and MEK inhibitors combination, including dabrafenib (D) and trametinib (T) have transformed the treatment of BRAF V600-mutant advanced melanoma patients, including patients with brain metastasis (BM). In a large phase IIIb, single-arm, open-label, multicenter French study, we assessed safety, response to treatment, progression-free survival (PFS) and factors associated with progression, and stratified the population into risk groups. Methods: Patients with unresectable, advanced, BRAF V600-mutant melanoma were included, including those with the presence of BM, Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≤2, elevated lactate dehydrogenase (LDH) or previous melanoma treatments. Responses were determined locally, without central review. PFS was estimated using the Kaplan–Meier analysis and modelled with multivariate Cox model. Risk subgroups were identified using a regression tree analysis. Results: Between March 2015 and November 2016, 856 patients received at least one D + T dose. Overall, 92% had stage IV melanoma, 38% ECOG PS ≥1, 32% BM and 37.5% elevated LDH. Median PFS was 8.02 months (95% confidence interval [CI] 7.33–8.77). Significant factors associated with lower PFS were ECOG PS ≥1, elevated LDH, ≥3 metastatic sites and presence of BM. Patients with

Introduction Les patients ayant une maladie bulleuse auto-immune (MBAI) etant a risque d’infection (âge, traitement corticoide et/ou immunosuppresseur), nous avons evalue le risque de la COVID-19 et de ses formes severes chez les patients ayant une MBAI. Materiel et methodes Cette etude retrospective multicentrique (49 services de dermatologie) a inclus tous les cas connus de COVID survenus entre janvier et juin 2020 en France metropolitaine. Les cas ont ete classes en certains (PCR + ), probables (PCR− ou non faite, TDM pulmonaire evocateur) ou possibles (PCR et TDM negatifs ou non faits mais signes cliniques et/ou cas contacts). L’incidence cumulee des cas de COVID a ete calculee a partir des cas certains et hospitalises de patients MBAI suivis dans chaque service, puis comparee a celle dans la population generale sur la meme periode (donnees Sante Publique France) apres standardisation indirecte sur l’âge et la region. L’incidence et le pronostic ont ete analyses pour l’ensemble des MBAI et pour le sous-groupe ayant recu du rituximab (RTX) dans les 9 derniers mois. Resultats Incidence : 59 cas de COVID-19 ont ete recenses (âge : 73,1 ± 16,2 ans) parmi 5180 patients suivis pour une MBAI : 29 (49 %) correspondaient a des cas certains, 8 (14 %) probables et 22 (37 %) possibles. Les MBAI etaient une PB (n = 21, 36 %), une P muqueuse (PM) (PC/EBA, n = 19, 32 %), un pemphigus (n = 18, 31 %) et 1 P gestationnelle (n = 1, 2 %). Le ratio d’incidence standardise (RIS) etait de 0,42 [IC95 % : 0,20–0,80] p = 0,005 pour les PB, 1,02 [0,37–2,26], p = 0,91 pour les pemphigus et de 1,18 [0,55–2,23], p = 0,62 pour les PM. Parmi les 516 patients ayant recu du RTX, on comptait 22 cas possibles probables ou certains d’infection COVID correspondant a un RI = 5,37 [3,15–8,96], parmi lesquels 13 cas probables ou certains (RI = 4,90 [2,43–9,40]) par rapport aux patients n’ayant pas recu de RTX, et un RI de formes certaines et hospitalisees de 3,62 [1,29–8,85]. Pronostic 30 cas (51 %) ont ete hospitalises pour COVID et 15 (25 %) sont decedes (RR = 1,63 [0,83–2,55] p = 0,13 par rapport a la population generale ajustee a l’âge et a la region. Un patient MBAI avait 3,4 [2,2–5,1] fois plus de risque de deceder sur la periode epidemique s’il contractait la COVID que s’il ne la contractait pas. L’âge moyen des patients ayant une forme severe (hospitalisation ou deces) de COVID etait plus eleve que celui de ceux ayant une forme non severe (77,9 ± 11,2 vs 65,0 ± 19,3, p = 0,006). Les RR de forme severe des PM/pemphigus avec COVID probable ou certaine traites par RTX (âge moyen 68,8 ± 14,9) etaient respectivement de 0,77 [0,45–1,33] p = 0,33 et de 0,51 [0,08–2,56] p = 0,40 par rapport aux PM/pemphigus avec COVID non traites par RTX (âge moyen 76,7 ± 9,1). Discussion La COVID entraine une forte surmortalite chez les patients MBAI. L’incidence semble particulierement elevee parmi les patients ayant recu du RTX, sans que l’on puisse conclure a une plus grande severite de la COVID-19 chez ces patients.

Atopic dermatitis (AD) is a multifactorial disease that may have a psychosomatic component. In this study, the authors aimed to measure the effect of hypnosis on AD in a clinical setting. Patients with AD who never had systemic treatment were offered hypnosis sessions. Twenty-seven patients with AD and a mean age of 34.5 years participated in a mean of six hypnosis sessions (range 2 to 16). AD severity can be assessed with the Eczema Area and Severity Index (EASI). EASI score was calculated during the first and last hypnosis sessions for 21 patients. Eczema improved or resolved in 26 of the 27 patients. Mean EASI score for the 21 patients evaluated was 12 at the first session and 2.8 at the last session. Hypnosis may be useful in AD and may overcome the need for systemic treatments for some patients.

ObjectiveTo evaluate the efficacy, safety and acceptability of an innovative two-component versus a well-established four-component compression systems in the management of venous leg ulcer.MethodMulticentre randomized controlled trial in patients with active venous leg ulcer. Patients were followed-up monthly for a maximum of 16 weeks. The primary endpoint was the complete healing rate at 16 weeks.ResultsNinety-two patients were randomized to either the two-component BIFLEX® Kit group ( n = 49) or the four-component PROFORE® group ( n = 43). In the full analysis set ( n = 88), a complete healing rate of 48.9% and 24.4% was reported in BIFLEX® Kit versus PROFORE® groups, respectively (i.e. a superiority of 24.5%, p = 0.02). Acceptability of BIFLEX® Kit was higher from both the patients’ and physicians’ perspectives.ConclusionThe BIFLEX® Kit represents a valid alternative therapy in the management of venous leg ulcer according to its clinical efficacy, safety and acceptability with potential positive impacts on healthcare costs.

Mycosis fungoides (MF) is a low-grade cutaneous lymphoma accounting for more than half of primary cutaneous T-cell lymphomas (CTCLs). Due to the rarity of CTCL, randomized studies are lacking, and treatment is based mainly on the recent published European Organisation for Research and Treatment of Cancer guidelines. Basically, early-stage MF is treated with skin-directed treatments, whereas advanced-stage MF requires more aggressive therapies. Among the skin-directed therapies, nitrogen mustard has been used for more than 50 years. A gel formulation was developed recently, showing a slight decrease in efficacy, counterbalanced by better tolerance (essentially due to a decrease in delayed hypersensitivity reactions). This review aims to summarize the current management of MF and the role of chlormethine gel in the treatment of the disease.

Le pyoderma gangrenosum est une cause rare d’ulcere pour lequel le diagnostic est essentiellement clinique. Il est important de savoir le reconnaitre pour mettre en place un traitement adapte, qui est souvent systemique. Il peut reveler une maladie sous-jacente comme les pathologies inflammatoires du tube digestif ou une hemopathie. Des syndromes sont aussi decrits, en lien avec des mutations genetiques.

Lower-limb ulcers in systemic sclerosis patients are rarely reported. The aim of this study was to describe the main causes and outcomes of lower-limb ulcers in systemic sclerosis patients and to assess factors associated with ischaemic causes (arterial disease and/or microvascular impairment). A retrospective, multicentre, case-control study was conducted in 2013 and 2014, including 45 systemic sclerosis patients presenting lower-limb ulcers between 2008 and 2013. The estimated prevalence of lower-limb ulcers among systemic sclerosis patients was 12.8%. Ulcers were related to venous insufficiency in 22 cases (49%), ischaemic causes in 21 (47%) and other causes in 2 (4%). Complete healing was observed in 60% of cases in a mean time of 10.3 months; 59% relapsed during a mean follow-up of 22 months. Ischaemic lower-limb ulcer outcomes were poor, with a 28.6% amputation rate. Logistic-regression multivariate analyses between ischaemic lower-limb ulcer cases and matched systemic sclerosis-controls identified past or concomitant digital ulcer and cutaneous sclerosis of the feet as independent risk factors associated with ischaemic lower-limb ulcers.

Treating pain is a priority for caregivers and patients. With in-home care, nurses care for patients who are sometimes in pain and for whom they implement treatments prescribed by the doctor. A nurse and a doctor describe here the complementary contribution of hypnosis in the treatment of pain, including in in-home nursing practice.

The online version of this article ( https://doi.org/10.1007/s00428-018-2342-0) contains supplementary material, which is available to authorized users.; International audience; Merkel cell carcinoma (MCC) is an aggressive neuroendocrine carcinoma of the skin. The main etiological agent is Merkel cell polyomavirus (MCPyV), detected in 80% of cases. About 5% of cases, called combined MCC, feature an admixture of neuroendocrine and non-neuroendocrine tumor cells. Reports of the presence or absence of MCPyV in combined MCC are conflicting, most favoring the absence, which suggests that combined MCC might have independent etiological factors and pathogenesis. These discrepancies might occur with the use of different virus identification assays, with different sensitivities. In this study, we aimed to determine the viral status of combined MCC by a multimodal approach. We histologically reviewed 128 cases of MCC and sub-classified them as "combined" or "conventional." Both groups were compared by clinical data (age, sex, site, American Joint Committee on Cancer [AJCC] stage, immunosuppression, risk of recurrence, and death during follow-up) and immunochemical features (cytokeratin 20 and 7, thyroid transcription factor 1 [TTF1], p53, large T antigen [CM2B4], CD8 infiltrates). After a first calibration step with 12 conventional MCCs and 12 cutaneous squamous cell carcinomas as controls, all eight cases of combined MCC were investigated for MCPyV viral status by combining two independent molecular procedures. Furthermore, on multiplex genotyping assay, the samples were examined for the presence of other polyoma- and papillomaviruses. Combined MCC differed from conventional MCC in earlier AJCC stage, increased risk of recurrence and death, decreased CD8 infiltrates, more frequent TTF1 positivity (5/8), abnormal p53 expression (8/8), and frequent lack of large T antigen expression (7/8). With the molecular procedure, half of the combined MCC cases were positive for MCPyV in the neuroendocrine component. Beta papillomaviruses were detected in 5/8 combined MCC cases and 9/12 conventional MCC cases. In conclusion, the detection of MCPyV DNA in half of the combined MCC cases suggests similar routes of carcinogenesis for combined and conventional MCC.

Introduction Les carcinomes epidermoides cutanes avances (acSCC), des tumeurs dont la prise en charge curative par chirurgie ou radiotherapie n’est plus possible, touchent le plus frequemment des sujets âges, fragiles et polypathologiques peu representes dans les essais cliniques. L’immunotherapie a recemment ete recommandee dans cette indication. Materiel et methodes Objectif - Evaluer l’efficacite et la tolerance des anti-PD-1 dans la prise en charge des acSCC de la personne âgee et etudier cette population d’un point de vue oncogeriatrique. Methodes - Une etude retrospective multicentrique francaise incluant des patients de > 70 ans traites par cemiplimab, nivolumab ou pembrolizumab pour un acSCC avec possibilite de radiotherapie concomitante. Le critere de jugement principal etait le taux de reponse (ORR). Les criteres de jugements secondaires incluaient la duree avant reponse, la duree de la reponse, la survie globale (OS), la survie sans progression (PFS) et la tolerance. Resultats A la date de point (15/05/2020), 63 patients etaient inclus. L’ORR etait de 57,1% (IC95 % : 44,0–69,5), le temps median avant reponse de 3 mois et la duree moyenne de reponse de 5,5 mois. L’OS median n’etait pas atteint (IC95 % : 12,5 mois-non atteint), la PFS mediane etait de 8 mois (IC95 % : 5-non atteint) ; 87,3 % des patients presentaient des effets secondaires tous grades confondus et 47,6 % de grade 3–5 avec 5 deces possiblement imputables au traitement. Figure - effet du cemiplimab associe a une radiotherapie concomitante chez un patient de 73 ans presentant un carcinome epidermoide cutane du cuir chevelu metastatique : photo a baseline apres un traitement par carboplatine + 5-FU + cetuximab (gauche) ; apres 14 seances de radiotherapie pour un total de 30 Gy et 1 mois de cemiplimab (milieu) ; apres 3 mois de cemiplimab (droite). Discussion Conclusion–Les anti-PD-1 representent un traitement prometteur des acSCC mais sont greves d’une tolerance variable chez les patients âges. Un suivi oncogeriatrique specialise semble opportun, de meme que discuter de l’adjonction d’une radiotherapie concomitante.

Introduction Dans ce contexte actuel de penurie medicale et notamment de dermatologues en France, la tele-expertise trouve un interet croissant dans la pratique quotidienne des differents acteurs de sante. C’est le cas particulierement en Sarthe (72) ou le nombre de medecins est en declin permanent. En 2020, le departement comptait 12 dermatologues, soit 2,1 pour 100 000 habitants contre 4,3 pour 100 000 dans les Pays de la Loire et 5,8 en France. Le delai moyen d’obtention d’une consultation est de plus de 7 mois en Sarthe contre 95 jours en moyenne sur le reste du territoire Francais. Cette situation s’est d’autant plus aggravee avec la limitation de l’acces aux soins engendree par l’epidemie de COVID-19. Materiel et methodes Nous avons recueilli de maniere retrospective les donnees des demandes de tele-expertise adressees au Centre Hospitalier du Mans entre 6 mai 2019 et le 9 avril 2021. Les demandes etaient adressees par les medecins generalistes du departement a travers une plateforme departementale sous-traitee par l’Agence regionale de sante (covotem). Resultats Six cent quarante trois demandes ont ete enregistrees au cours de cette periode, portant sur 90 diagnostics differents. Le delai moyen de reponse etait de 1,98 jours pour un delai moyen demande de 9,29 jours. Cent cinquante trois demandes concernaient des suspicions de tumeurs dont 17 et 79 pour suspicion de melanome et de carcinome respectivement, 130 demandes de pathologies tumorales benignes, 183 demandes de pathologies inflammatoires, 95 demandes de plaies. Cent vingt et un patients, soit 18 % des demandes, ont ete convoques en consultation au centre hospitalier dans un delai moyen de 29 jours. Nous avons constate une augmentation progressive du nombre de demande au cours du temps. Des images dermoscopiques etaient realisees chez 11 patients. Elles etaient de bonne qualite et contributives dans la totalite des cas. Discussion La mise en place de la tele-expertise au Centre Hospitalier du Mans a permis d’introduire des elements de reponse a la problematique de manque de dermatologues en Sarthe. Les reponses rapides ont permis de reduire les deplacements de populations, souvent fragiles et âgees, dans ce contexte pandemique. De plus, les delais de consultations obtenus pour ces patients a travers la tele-expertise etaient bien moindres qu’habituellement (29 jours en moyenne contre plus de 7 mois habituellement). Il nous est egalement apparu que la pandemie a permis d’accelerer la mise en place de cet outil avec une augmentation des demandes rythmees par les dates charnieres de l’epidemie: en effet la CPAM a permis d’elargir le champ de prise en charge. Le Segur de la sante vise a rendre accessible la tele-expertise a toute la population.

Introduction Le melanome de Dubreuilh in situ ou lentigo malin (LM), proliferation melanocytaire des zones photo-exposees peut evoluer vers un melanome invasif. La chirurgie est recommandee en 1re intention. Cependant, le principal defi en cas de lesion de grande taille est l’etendue de l’exerese (marges 10 mm theoriquement recommandees en chirurgie classique) qui est parfois soit refusee par les patients soit non realisable. Plusieurs etudes ont montre que l’imiquimod (IMQ) induisait une regression du LM en augmentant la production locale d’IFN-γ et la fonction effectrice des cellules T. L’objectif principal de cette etude est d’investiguer l’effet de l’IMQ vs placebo en situation neoadjuvante pour reduire la taille du LM et optimiser l’exerese des la 1re chirurgie. Materiel et methodes Etude prospective, randomisee, ouverte, multicentrique, de phase III ( NCT01720407 ) dont l’objectif principal etait de demontrer qu’en situation neoadjuvante, l’IMQ pouvait reduire la taille d’excision du LM avec une marge de tissu sain de 5 mm. Les principaux criteres d’inclusion etaient : âge > 18 ans. LM de la tete confirme histologiquement et non traite auparavant. Lesion ≥ a 1 cm2 et ≤ a 20 cm2. Les deux bras de traitement etaient l’IMQ ou le placebo suivis d’une chirurgie. L’IMQ ou le placebo etaient appliques une fois par jour, 5 jours/semaine pendant 4 semaines, suivis d’une chirurgie avec une marge de 5 mm realisee 4 semaines apres la derniere application du traitement. Pour la taille de l’echantillon, 268 patients etaient attendus pour une difference de 15 % entre les deux bras avec un risque alpha de 5 % et un risque beta de 20 %. Resultats L’essai a porte sur 273 patients (sexe- ratio H/F = 0,78), d’un âge moyen de 71 ± 10,2 ans. L’analyse statistique, en ITT modifiee, a ete effectuee sur 122 patients dans le bras IMQ et 116 patients dans le bras placebo. Pour le critere d’evaluation principal, la premiere exerese extralesionnelle a ete realisee chez 112 (91,8 %) patients dans le bras IMQ et chez 98 (84,5 %) patients du groupe placebo (non significatif p = 0,1067). Cependant, l’IMQ a permis une reduction tres significative de la surface du LM (4,2 cm2 ± 4,6 a 2,3 cm2 ± 3,3) par rapport a ceux traitees par placebo (4,0 cm2 ± 3,5 a 4,0 cm2 ± 3,3 ; p Discussion Cette etude prospective randomisee montre que l’IMQ reduit la surface des LM (−50 %) apres un mois de traitement. La reduction de la surface des LM avec l’imiquimod n’est pas associee a un risque plus eleve d’exerese intralesionnelle (marge de 5 mm), avec un resultat esthetique significatif (moins de surface excisee).

International audience; No abstract available

Changes in the duration of efficacy of botulinum toxin A injections for primary axillary hyperhidrosis have not been studied in depth. The aim of this study was to assess such changes. In a retrospective cohort of 220 patients, seen over a 17-year period, duration of efficacy was recorded, including duration of efficacy of first and last injections. Of 220 patients, 117 fulfilled the study criteria (79 females and 38 males, age 17–79 years, mean age 38.3 years). Patients received 3–24 injections (mean 5.5). The duration of efficacy of the first injections was 3 weeks to 30 months (median 6 months), and the duration of efficacy of the final injections was 3 weeks to 66 months (median 8 months) (p 10 years, the mean number of treatments was 8.25/patient; in 18 of these patients the duration of efficacy increased by > 50%. In conclusion, repeated botulinum toxin A injections lead to an increase in duration of efficacy without secondary decrease.

Treating pain is a priority for caregivers and patients. With in-home care, nurses care for patients who are sometimes in pain and for whom they implement treatments prescribed by the doctor. A nurse and a doctor describe here the complementary contribution of hypnosis in the treatment of pain, including in in-home nursing practice.

Mycosis fungoides (MF) is a low-grade cutaneous lymphoma accounting for more than half of primary cutaneous T-cell lymphomas (CTCLs). Due to the rarity of CTCL, randomized studies are lacking, and treatment is based mainly on the recent published European Organisation for Research and Treatment of Cancer guidelines. Basically, early-stage MF is treated with skin-directed treatments, whereas advanced-stage MF requires more aggressive therapies. Among the skin-directed therapies, nitrogen mustard has been used for more than 50 years. A gel formulation was developed recently, showing a slight decrease in efficacy, counterbalanced by better tolerance (essentially due to a decrease in delayed hypersensitivity reactions). This review aims to summarize the current management of MF and the role of chlormethine gel in the treatment of the disease., Video abstract

Les greffes cutanees sont une technique utile dans la prise en charge des ulceres pour stimuler l’epidermisation et apporter un benefice antalgique. Cet article decrit les techniques de greffes en pastilles qui peuvent se realiser au lit du patient et les greffes en filet pratiquables sous anesthesie locale. La combinaison d’une compression et d’une detersion hydrochirurgicale permet de faciliter la prise de greffe des ulceres veineux. Des techniques innovantes comme les kits Cellutome® et Xpansion® permettent l’acces beaucoup aise aux techniques de greffes pour des plaies de petite et moyenne tailles.

Summary Introduction Several studies have shown a high prevalence of cardiovascular and metabolic comorbidities in psoriasis. Our study aimed to evaluate the association of psoriasis with key comorbidities such as smoking, obesity, hypertension, dyslipidaemia and diabetes comparatively with French national data. Material and methods This multicentre noninterventional observational study of adults with psoriasis was conducted in 29 dermatology centres in France. A total of 2210 patients were included. The prevalence of comorbidities in psoriatic patients was compared to data from the French national databanks “ObEpi 2012” (obesity, hypertension, dyslipidaemia and diabetes) and “Barometre Sante 2010” (smoking). Results We reported a higher prevalence of all metabolic comorbidities and high blood pressure in psoriatic patients. Smoking: 32.5% were active smokers; the age of onset and the prevalence of familial psoriasis were significantly lower in the smoking group but the severity of psoriasis was significantly higher. The frequency of smoking was higher than in the general population, particularly among young female patients. Obesity: 24% of patients with psoriasis were obese. Multivariate analysis showed obesity to be significantly associated with other comorbidities, severity of psoriasis and psoriatic arthritis. The incidence of obesity was higher than in general population, occurring chiefly in subjects aged over 45 years. Hypertension: 26% of patients with psoriasis had hypertension. The age of onset of psoriasis and the prevalence of psoriatic arthritis were significantly higher in the hypertension group, although there was less familial psoriasis. The incidence of hypertension was higher than in general population. Dyslipidaemia: 27.5% of patients with psoriasis had dyslipidaemia. The age of onset in the dyslipidaemia group was higher although there was less familial psoriasis. The incidence of dyslipidaemia was higher than in general population. Diabetes: 11.0% of patients with psoriasis had diabetes. The age of onset of psoriasis was significantly higher in the diabetes group although there was less familial psoriasis. The incidence of diabetes was higher than in general population particularly after the age of 35 years. Conclusion These results confirmed that psoriasis is associated with significant metabolic comorbidities and hypertension compared to the general population in France, with certain epidemiological differences for each.

Introduction La cladribine est un cytoreducteur utilise dans les mastocytoses (M) de l’adulte echappant au traitement symptomatique. Certaines M avec atteinte cutanee entrainent un handicap par alteration de la qualite de vie (QdV) justifiant ce traitement, mais l’evaluation de la QdV apres cladribine n’est pas rapportee. Nous avons traite par cladribine des adultes M avec atteinte cutanee et evalue la reponse cutanee et la QdV au decours. Materiel et methodes De 2015 a 2019, les adultes M confirmes selon les criteres OMS et traites par cladribine, ont ete inclus et traites par 3 ou 4 cures de 5 jours de cladribine SC (0,14 mg/kg). Une evaluation photographique comparative de reponse cutanee en analysant le % de surface cutanee atteinte (SC), l’erytheme cutane et la pigmentation (en utilisant 2 panels grades predefinis) etait pratiquee par un dermatologue en aveugle du patient. Le DLQI, le score specifique des mastocytoses MC-QoL etaient releves par un autre dermatologue comme les parametres clinicobiologiques. Eval1 etait faite apres la derniere cure et Eval2 entre 6–18 mois apres Eval1. Une analyse statistique comparative et appariee avant/apres cladribine etait realisee. Resultats Seize patients (13 zF) avec M d’âge median de 47 ans ont ete inclus. Les patients avaient tous initialement un prurit, des flushs (81 %), une atteinte de type maculopapuleuse (mediane 50 % de SC) et un signe de Darier constant. Les scores DLQI et MC-QoL etaient eleves respectivement en valeur mediane a 11/30 et 52/108. A l’evaluation 1, 6 mois en mediane apres initiation du traitement, les parametres cliniques etaient significativement ameliores (prurit, flushs, et signes extra-cutanes d’activation mastocytaires ; p Discussion Cette etude retrospective confirme l’efficacite de la cladribine anterieurement publiee sur les manifestations cutanees de la M, tout en montrant l’amelioration de la QdV dermatologique et globale specifique. Le profil de toxicite et le benefice attendu avec la cladribine sont en faveur de son utilisation dans les formes de M avec handicap modere a severe avec atteinte cutanee. L’utilisation de scores de handicap pour selectionner les patients est a prendre en consideration pour guider les options therapeutiques et le suivi des patients traites par cladribine.

Introduction Il est conseille aux apparentes au 1er degre (AP1D) des patients ayant eu un melanome (MM) d’adopter des mesures de photoprotection et de detection precoce (auto-examen et consultation d’un dermatologue). Ces conseils sont donnes oralement aux patients qui sont invites a relayer l’information a leurs AP1D. Nous avions evalue l’utilite d’une fiche ecrite remise aux patients contenant des conseils de photoprotection et de detection precoce pour eux-memes et leurs AP1D. La remise de cette fiche en 2005 a tous les patients en plus des conseils oraux, fut associee a une meilleure adhesion au depistage familial du MM (de 62 % en 1998 a 83,5 % en 2005 puis 56 % en 2012 quand la fiche n’etait plus remise qu’a 16 % des patients, p = 0,002). Cependant en 2012, l’adhesion au depistage familial etait plus elevee dans le sous-groupe qui avait recu la fiche, 88 % vs 51 % pour ceux qui ne l’avaient pas recue, p Materiel et methodes C’est un essai de superiorite, multicentrique, randomise en clusters. L’unite de randomisation est le centre hospitalier. Ainsi, au sein d’un meme centre, tous les cas index recoivent la meme information sur la detection precoce (orale et ecrite ou orale seule). Les criteres d’inclusion pour les patients (sujets index) etaient : exerese dans les 3 mois precedents d’un MM cutane stade I ou II dans un des centres participant a l’etude, et d’avoir au moins un AP1D. Les criteres d’inclusion pour les AP1D etaient d’etre apparente a un cas index (pere et mere, freres et sœurs, enfants), et d’accepter le recueil et l’utilisation de leurs donnees. Le critere de jugement principal est la realisation d’un examen medical de detection precoce d’un MM entre la premiere visite du cas-index (environ 1 an avant) et le jour de l’appel telephonique. Resultats Un total de 48 patients et 114 AP1D dans le bras controle, 60 patients et 166 AP1D dans le bras intervention ont ete inclus. L’examen medical de detection a ete fait par 39,5 % [30,5 ; 49,1] des AP1D du groupe controle, et 36,1 % [28,8 ; 44,0] des AP1D du groupe intervention, (OR 0,88 [0,53 ;1,47] p = 0,63), aboutissant a l’exerese d’1 MM dans le groupe controle et de 3 dans le groupe intervention (p = 0,85). Discussion L’objectif principal n’est pas atteint : la remise ecrite de la fiche conseil n’ameliore pas l’adhesion des AP1D au depistage par comparaison au conseil oral usuel delivre dans le cadre de cette etude. Sa generalisation au plan national n’est donc pas indiquee.

Introduction Le tacrolimus pommade est largement utilise hors autorisation de mise sur le marche (AMM) dans le vitiligo, seul ou en combinaison avec la phototherapie. Une meta-analyse recente a suggere une meilleure efficacite des inhibiteurs de calcineurine topiques dans le vitiligo facial. Le rationnel physiopathologique de l’utilisation du tacrolimus dans le vitiligo repose sur sa capacite a interferer avec la perte melanocytaire d’origine auto-immune, et sur son effet modulateur de la fonction, la proliferation et la migration melanocytaire. Les principales limites des etudes evaluant le tacrolimus dans le vitiligo sont l’absence de suivi a long terme et l’absence d’etude multicentrique randomisee. Le but de cette etude etait de confirmer l’efficacite et la tolerance du tacrolimus pommade 0,1 % dans le vitiligo non- segmentaire du visage chez l’adulte, et permettre ainsi son usage dans le cadre d’une extension d’AMM. Materiel et methodes Etude multicentrique francaise, randomisee comparative en double-insu versus placebo, d’une duree de 24 semaines avec une periode de suivi post-traitement de 24 semaines. L’atteinte du visage devait etre recente ( Resultats 42 patients ont ete inclus. L’analyse en intention de traiter avec recherche du biais maximal, montrait un succes therapeutique chez 65 % des patients sous tacrolimus pommade contre 0 % dans le groupe placebo a 24 semaines (p Discussion Notre etude confirme pour la premiere fois l’interet du tacrolimus topique 0,1 % pour le vitiligo du visage chez l’adulte. Cependant, il existe un taux de rechute important a l’arret du tacrolimus, ce qui souligne l’interet d’un traitement preventif d’entretien.

Objective: To assess the efficacy, safety and acceptability of a new TLC-NOSF dressing with poly-absorbent fibres in the management of exuding leg ulcers, at the different stages of healing. Method: This work presents the results of two prospective, multicentric clinical studies: NEREIDES and CASSIOPEE. Patients with a non-infected, moderate-to-strongly exudating leg ulcer of venous or mixed origin, were treated with the dressing and an appropriate compression system for 12 weeks. The wounds included in NEREIDES had to be in debridement stage, and those in CASSIOPEE at granulation stage. In both studies, the primary outcome was the relative wound area reduction (RWAR) at week 12. Main secondary outcomes included healing rate, time-to-reach wound closure, adverse events and acceptability of the dressing by patients and health professionals. Results: There were 37 patients included in NEREIDES and 51 in CASSIOPEE. The two cohorts presented similar patient and wound characteristics, except from the percentage of sloughy tissue on wound bed at baseline (median: 75% NEREIDES and 30% CASSIOPEE). At week 12, the RWAR (60% NEREIDES and 81% CASSIOPEE), wound closure rates (18% NEREIDES and 20% CASSIOPEE) and mean times-to-reach wound closure (58±27 days NEREIDES and 55±23 days CASSIOPEE) supported the beneficial outcomes of the treatment in both cohorts. In patients with a wound duration ≤6 months, the wound area reduction reached 85% in NEREIDES and 81% in CASSIOPEE, highlighting the importance to initiate adequate treatment as soon as possible. The nature and frequency of the local adverse events were similar in both studies and consistent with the good safety profiles of the poly-absorbent fibres and of the TLC-NOSF dressings. The acceptability of the dressing (easy to apply, conformable and non-adherent to the wound bed at removal, with no pain or bleeding at removal) has been judged ‘very good’ or ‘good’ at each stage of the healing process, by both nursing staff and patients. Conclusion: These clinical results establish the new TLC-NOSF dressing with poly-absorbent fibres (UrgoStart Plus, Laboratoires Urgo) as an effective, safe and simple treatment for the local management of leg ulcers, at the different stages of healing and until wound closure.

International audience; Importance: Calcific uremic arteriolopathy (CUA), a rare, potentially fatal, disease with calcium deposits in skin, mostly affects patients with end-stage renal disease who are receiving dialysis. Chemical composition and structure of CUA calcifications have been poorly described.Objectives: To describe the localization and morphologic features and determine the precise chemical composition of CUA-related calcium deposits in skin, and identify any mortality-associated factors.Design, Setting, and Participants: A retrospective, multicenter cohort study was conducted at 7 French hospitals including consecutive adults diagnosed with CUA between January 1, 2006, and January 1, 2017, confirmed according to Hayashi clinical and histologic criteria. Patients with normal renal function were excluded. For comparison, 5 skin samples from patients with arteriolosclerosis and 5 others from the negative margins of skin-carcinoma resection specimens were also analyzed.Main Outcomes and Measures: Localization and morphologic features of the CUA-related cutaneous calcium deposits were assessed with optical microscopy and field-emission-scanning electron microscopy, and the chemical compositions of those deposits were evaluated with μ Fourier transform infrared spectroscopy, Raman spectroscopy, and energy dispersive radiographs.Results: Thirty-six patients (median [range] age, 64 [33-89] years; 26 [72%] female) were included, and 29 cutaneous biopsies were analyzed. Calcific uremic arteriolopathy and arteriolosclerosis skin calcifications were composed of pure calcium-phosphate apatite. Calcific uremic arteriolopathy vascular calcifications were always circumferential, found in small to medium-sized vessels, with interstitial deposits in 22 (76%) of the samples. A thrombosis, most often in noncalcified capillary lumens in the superficial dermis, was seen in 5 samples from patients with CUA. Except for calcium deposits, the vessel structure of patients with CUA appeared normal, unlike thickened arteriolosclerotic vessel walls. Twelve (33%) patients died of CUA.Conclusions and Relevance: Calcific uremic arteriolopathy-related skin calcifications were exclusively composed of pure calcium-phosphate apatite, localized circumferentially in small to medium-sized vessels and often associated with interstitial deposits, suggesting its pathogenesis differs from that of arteriolosclerosis. Although the chemical compositions of CUA and arteriolosclerosis calcifications were similar, the vessels' appearances and deposit localizations differed, suggesting different pathogenetic mechanisms.