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Modelling epidemics via classical population-based models suffers from shortcomings that so-called individual-based models are able to overcome, as they are able to take heterogeneity features into account, such as super-spreaders, and describe the dynamics involved in small clusters. In return, such models often involve large graphs which are expensive to simulate and difficult to optimize, both in theory and in practice. By combining the reinforcement learning philosophy with reduced models, we propose a numerical approach to determine optimal health policies for a stochastic epidemiological graph-model taking into account super-spreaders. More precisely, we introduce a deterministic reduced population-based model involving a neural network, and use it to derive optimal health policies through an optimal control approach. It is meant to faithfully mimic the local dynamics of the original, more complex, graph-model. Roughly speaking, this is achieved by sequentially training the network until an optimal control strategy for the corresponding reduced model manages to equally well contain the epidemic when simulated on the graph-model. After describing the practical implementation of this approach, we will discuss the range of applicability of the reduced model and to what extent the estimated control strategies could provide useful qualitative information to health authorities., Comment: 37 pages, 21 figures, to be published in the journal "Optimal Control Applications and Methods" (Special Issue: Optimal control in therapeutics and epidemiology)

BACKGROUND: Adapalene is a new chemical entity which binds with high affinity to specific nuclear retinoic acid receptors and exhibits tretinoin-like activities in the terminal differentiation process. OBJECTIVE: The purpose of the trial was to compare adapalene 0.1% gel (Differin Gel, Galderma Laboratories) with tretinoin 0.025% gel (Retin A Gel, Cilag Laboratories) in the treatment of acne patients, methods: A multicentre, investigator-masked, parallel-group study included 268 male and female patients with mild to moderate facial acne vulgaris. Treatments were applied once daily for 12 consecutive weeks. RESULTS A total of 134 patients (74 males and 60 females, mean age 19.7 years) received adapalene gel and 134 patients (69 males and 65 females, mean age 19.2 years) tretinoin gel. Among these patients, 259 were evaluable for efficacy and safety and 236 completed the study. The inflammatory, noninflammatory and total lesion counts, and the global facial acne grade were not significantly different betwee...

A multicentre randomized double-blind study of 143 patients was conducted to compare terbinafine (250 mg/day) and micronized griseofulvin (1 g/day) in the treatment of dermatophyte onychomycosis. The duration of treatment was up to 12 months, but the treatment could be interrupted in the event of complete cure, i.e. clinical disappearance of the pathological zone of the nail combined with mycological cure. The percentage of nails cured was significantly higher in the terbinafine than in the griseofulvin group (77.1% versus 45.7%, P=0.0001). Clinical and biological tolerability were good in both groups. Only 7.4% of patients treated with terbinafine showed one or more adverse events, but 31.5% with griseofulvin (P

Background: Adapalene is a new chemical entity that exhibits tretinoin-like activities in the terminal differentiation process. Objective: We evaluated a dose range effect of two concentrations of adapalene gel as acne treatment and compared adapalene 0.1% gel with tretinoin 0.025% gel in the treatment of acne patients in two large multicenter studies. Methods: Multicenter, investigator-masked, parallel group studies including 89 acne patients in the dose range study and 591 patients in the concurrent controlled studies were conducted. Results: Adapalene gel 0.1% was significantly more effective in treating acne lesions than 0.03% adapalene gel. Adapalene gel 0.1% was significantly more effective than 0.025% or tretinoin gel in one study and of the same effectiveness in the other study. Adapalene gel was always better tolerated than tretinoin gel. Conclusion: Adapalene 0.1% gel is a safe and effective treatment of acne vulgaris. (J Am Acad Dermatol 1997;36:S126-34.)

The aim of this study was to compare oxiconazole, 1 p. 100 cream, with ketoconazole, 2 p. 100 cream, applied once-daily, in the treatment of tinea cruris.A prospective, randomized, double-blind trial was performed in 8 dermatology departments on two parallel groups in patients having this type of mycosis confirmed by mycological examination.The efficacy was analyzed in 66 out of the 79 patients included in the study (36 patients treated with oxiconazole, 30 with ketoconazole). At Day 14, a first assessment was made and 77.1 p. 100 of the patients treated with oxiconazole had been cured; this result was significantly better (p0.05) than that obtained with ketoconazole (51.7 p. 100 of cured patients). At Day 21, after a further week of treatment, both treatments were efficient with statistically non-different results between the two groups: 97.2 p. 100 of the patients treated with oxiconazole, versus 86.7 p. 100 with ketoconazole. Thus, a greater rapidity of action of oxiconazole was observed. No correlation was detected between the ratio of cured patients and the duration of the mycosis. The safety was assessed in 74 patients. No adverse effects were reported for the patients treated with oxiconazole, whereas 9 patients treated with ketoconazole experienced contact sensitization reactions and irritant skin reactions due to the application of the product. The difference between the two groups of treatment was statistically greatly significant (p0.001). Furthermore, acceptance of the drug on the part of the patient was better (p0.05) with oxiconazole.After 3 weeks of topical treatment oxiconazole has revealed itself to be as efficient as ketoconazole, but it seems more rapidly efficient and better tolerated than ketoconazole.

Birdshot chorioretinopathy, also known as vitiliginous chorioretinitis, is a rare and serious retinochoroidopathy. We describe a case in a patient with long-standing typical psoriasis. To our knowledge this association has not been previously reported in the dermatologic literature. Both psoriasis and chorioretinitis appeared to respond to aromatic retinoids. The incidence of birdshot chorioretinopathy in patients with psoriasis should be assessed.

The physical properties of the skin were measured by using noninvasive methods on 72 people displaying various levels of solar elastosis on the neck. The physical parameters measured were the skin extensibility, the elastic recovery, the skin colour, the skin thickness and the electrical conductance. The correlation between the above parameters, the clinical grades of elastosis and the chronological age of each subject were studied using two different statistical approaches. They both showed that elastotic skin is less elastic, dryer, darker, more erythematous and less yellowish than the nonexposed skin. The similarities and differences between the properties of elastotic skin and purely chronologically aged skin are discussed.

Genetically, Klinefelter's syndrome is characterized by a super-numerary chromosome X in male subjects presenting with clinical and biochemical hypoandrogenism and relative hyperoestrogenism. The association of Klinefelter's syndrome with chronic leg ulcer has given rise to numerous publications. The cause of the trophic disorders is unclear. We report two cases of this syndrome associated with chronic leg ulcers and anomalies of haemostasis. One of these two patients had platelet hyperaggregability followed by disorders of fibrinolysis, while the other had disorders of fibrinolysis. We reviewed the literature concerning the various aetiopathogenic hypotheses put forward to explain the cause of these leg ulcers, as well as their interactions and relationship with the hormonal anomalies. The position occupied by disorders of haemostasis is particularly developed.

Metabolism of the essential fatty acids (AGE) in an organism leads to synthesis of eicosanoids, which have various biological properties. Linoleic acid plays an important part in maintenance of epidermal integrity by intervening in the cohesion of the stratum corneum and in prevention of transepidermal water loss. Metabolites of arachidonic acid (mostly those obtained by the lipoxygenase pathway) are important agents in causing many inflammatory skin reactions concurrent with development of skin diseases such as psoriasis and atopic dermatitis. Pharmacological and dietetic control of the metabolism of arachidonic acid is a new and interesting therapeutic concept in the care of skin diseases. Also, fish oil, which is rich in linoleic acid and poor in arachidonic acid, seems to be useful in basal treatment of psoriasis. The value of evening primrose oil, which is rich in gamma-linoleic acid, in the treatment of atopic dermatitis is discussed.

A 37 year-old man developed, over 20 years, multiple clustered dermatofibromas on the left thigh. Three similar cases have been described previously and the benign course of this lesion has been referred to. Analysis of collagen amino acids revealed a sharp increase of hydroxylysine on the fibrous central zone, suggesting an abnormal accumulation of type IV collagen.

Collagen metabolism was studied in fibroblasts grown from a skin biopsy specimen of a patient who presented the striking clinical features of Ehlers-Danlos syndrome and, in particular, hyperextensibility of the skin, hypermobility of the joints, and kyphoscoliosis. A reduction in lysine hydroxylation, characteristic of Ehlers-Danlos Type VI, was observed after labelling of the collagen with 14C-proline and 3H-lysine. Other modifications in the collagen metabolism of fibroblast cultures were noted, including an increase in collagen and total protein synthesis, and an increase in both the Type I and Type III collagen. The percentage of Type III collagen was, however, lower than in the control fibroblasts. The results point out the complexity of collagen disturbances in Ehlers-Danlos Type VI.

The purpose of this double-blind study was to compare the therapeutic effects of a low initial dosage of acitretin, increased at 2-week intervals (group 1:10, 30, 50 mg/day) with a high initial dosage decreased at similar intervals (group 3: 50, 30, 10 mg/day) and with a constant dosage (group 2: 30 mg/day) in 66 patients (47 men and 19 women) with severe psoriasis. At the end of the double-blind phase the mean percent improvement calculated by the Psoriasis Area and Severity Index score, was as follows: 62.7% in group 1, 55.9% in group 2 and 67.1% in group 3.The double-blind phase of 6 weeks was followed by an open phase of 6 weeks, during which the patients were treated either with 10, 30 or 50 mg/day, according to the therapeutic response. At the end of treatment (12 weeks), a mean improvement of more than 80% was obtained in all three groups. Hypervitaminosis A signs and symptoms were observed in all patients. The frequency and severity of these adverse reactions were shown to be dose-dependent. This study shows that a low dose progressively increased is advisable because of similar activity and better acceptability.

Erosive lichen planus developed in a 12-year-old adolescent also presenting polycythemia vera (Vaquez’ disease). Though a casual association cannot be exluded, the rarity of the two diseases in children suggests a pathogenetic link, possibly involving an abnormal hematologic stem cell line.

The aim of the study was to investigate the concentrations of Ro 10–1670 (acitretin) and its isomeric metabolite Ro 13–7652 (cis-acitretin) after multiple oral dosing of acitretin. We used a highly sensitive HPLC method for simultaneous determination of the 2 retinoids with a quantification limit of 2 ng/ml in plasma and 10 ng/g in total skin (epidermis and dermis). In hairless rats receiving orally 8 mg/kg acitretin once daily during 8 days, blood and skin samples were taken at different time points between 5 and 96 h after the last dose. After 96 h, appreciable concentrations of Ro 10–1670, but not Ro 13–7652 could be measured in the skin, whereas both isomers were below the quantification limit in plasma. In psoriatic patients treated with a once daily dose of 30 mg acitretin, blood samples and biopsies were taken after 1 month of treatment (i.e. under steady state conditions). 24 h after the last drug intake, skin concentrations of acitretin were approximately 10 times higher than those observed in plasma. Ro 10–1670 concentrations in the skin were approximately 3–5 times higher than for Ro 13–7652 and concentrations of both isomers were higher in lesional compared to uninvolved skin.

Resume L'amelioration clinique dans l'acne de la face s'accompagne de modifications notables de la flore superficielle : chute du taux de St. epidermidis , augmentation du taux d'autres especes (microcoques et corynebacteries). Par ailleurs, les souches de St. epidermidis isolees au niveau des lesions et des fosses nasales se revelent identiques dans 6 cas sur 8.

Resume La pathogenie des urticaires chroniques (U.C.) est un probleme complexe en raison de la possibilite d'intrications physiopathologiques, dont certaines sont encore hypothetiques. Pour essayer d'eclaircir le ou les mecanismes pathogeniques de l'U.C., sont etudies successivement a la lumiere des travaux recents : — les facteurs de provocation et de maintien de l'augmentation de la permeabilite vasculaire qui est le substratum de l'affection ; — le mode d'action de ces differents facteurs vaso-actifs ; — la part de l'intervention des rencontres pathologiques faites dans un bon nombre d'observations d'U.C., y compris celles qui paraissent neuro-psychogenes. Au total, il convient de dire modestement que l'origine de nombreux cas d'U.C. demeure encore mysterieuse.

In order to study the elimination of Ro 10-1670 (acitretin) and Ro 13-7652, its 13-cis-isomeric metabolite after chronic administration, determination of the residual plasma concentrations of these two compounds were assayed in 9 patients in a range of 22–30 days following cessation of a 2- to 7.5-month course with daily oral doses of 10–50 mg of acitretin. A highly sensitive HPLC method was used (2 ng/ml). Residual plasma concentrations of Ro 10-1670 were below the quantification limit in all cases. Residual plasma concentrations of Ro 13-7652 were below the quantification limit in 7 cases and respectively of 3 and 4 ng/ml in the other 2 cases. These data appear to confirm the absence of storage of acitretin even after an extended course of therapy.

Cutaneous form of periarteritis nodosa. Four personal cases are added to 70 cases of the previous literature. The clinical and biological picture of the cutaneous form of P.A.N. are different from the systemic one by the lack of visceral involvement and a noteworthy good long-term prognosis. Venous (superficial thrombophlebitis) and distal arterial involvement in some cases, raise doubts about diagnosis and classification. The solution is in an accurate definition of the diagnostic clues and specially of the histopathological ones.

We have treated patients suffering from psoriasis and other dermatoses — such as keratotic and micaceous balanitis and porokeratosis of Mibelli — with an aromatic retinoid, Ro 10-9359 (Tigason).

Pulva 47 Neomycine was tested in 30 patients suffering from a leg ulcer, 11 of those were surinfected. Half the ulcers dated back over 6 months. The would preparation included a careful cleaning with a permanganate or dakin's solution. In most of the cases, the product was applied on a once a day basis during an average period of 30 days. In 12 patients, the severity of the infection needed an additional antibiotherapy administered orally. The results were expressed in relation to the activity on the infection and wound healing. In 28 patients, the signs of infection disappeared completely. The wound healing effect was very satisfying in 22 patients (19 of them had varicose or post-phlebitis ulcers). The value of the results is independent on the date of onset and on the area of the lesions. The tolerance was good; only 4 patients suffered from itching after the application of the compound. It is mainly through his wound healing effect that Pulvo 47 Neomycine represents a progress compared to other similar specialties.

A typical case of Montgomery xanthomatosis is reported by the authors. Out of this case and of a hundred other ones gathered from the literature, they outline the main features of the disease. It is revealed as being stereotyped and particularly the prognosis is usually good. Whether the ultra structural study may show Langerhans corpuscules or not, it brings us a material to the discussing of border-line cases (xanthomatosis with diabetes insipidus, Hand-Schüller-Christian disease with cutaneous lesions similar to Montgomery's.

Cysts and congenital lateral cervical fistulas are related to the persistance of the normally transitory branchial pouches and their embryologico-anatomic arrangement. Due to this fact they have a preferential topography. An atypical fistula of the second branchial cleft is reported. It is a congenital supra-hyoidian lateral cervical fistula with an intra-parotid route which terminates in the tonsils. The extreme variability of the external orifice, the pathogenic nature of the internal orifice and of the fistular route, as well as the initial discovery of the facial nerve and tonsillectomy in lateral fistulas of the neck are, by the same occasion, brought to mind.

We report the case of a 56-year old male patient with pulmonary, abdominal and pelvic metastases from a dermatofibrosarcoma (DFS) which had developed 23 years previously in the right scapulo-humeral region and had recurred twice after the first excision, in 1983. Surgery was only performed once. The most remarkable feature of the disease was the progressive transformation, with each recurrence, of a typical DFS into a poorly differentiated and highly malignant tumour, about as active as a fibrosarcoma. A review of the literature yielded 31 cases of histologically proven metastatic DFS. Although the actual incidence of metastases is difficult to determine with accuracy, their frequency may be estimated at 3 p. 100 (most probably a maximum figure). The disease spreads mostly through the blood, but also sometimes through the blood and lymph. However, since lymphatic involvement is rare the usefulness of lymph node excision is extremely doubtful. Pulmonary lesions are the most frequent ones, but various other organs may be affected, although this seldom applies to the liver. Following a first excision, metastases occur within 6 years on average (range: 1 to 33 years). This mean delay is superior to the mean follow-up period for most of the important series without metastases. The histopathological picture is usually one of typical DFS but in some cases, including ours, it is much less typical and may even be frankly malignant. A few reports mention the presence of histiocytic infiltrates associated with the fibroblasts. The prognosis in patients with metastases is particularly poor: in most of the cases reported the patient died within the year following the discovery of metastatic lesions. The very high progressivity of the secondary lesions contrasts with the slow course of the primary tumour. None of the treatments tried (surgery, radiotherapy, chemotherapy) has resulted in a significant prolongation of life. No correlation can be established between the occurrence of metastases and the following parameters taken together: patient's age and sex, tim elapsed between the appearance of the tumour and the date of exicision, and histological features of the initial tumour. The development and number of recurrences seems to be the most significant predictive factor as regards the risk of metastasis. The noxious role of incomplete and/or repeated surgery creating vascular breaks, disrupting the defense barriers and encouraging malignancy in some cases has been mentioned by most authors; it emphasizes the value of the widest possible initial surgery.(ABSTRACT TRUNCATED AT 400 WORDS)

In order to study the elimination of Ro 10-1670 (acitretin) and Ro 13-7652, its 13-cis-isomeric metabolite after chronic administration, determination of the residual plasma concentrations of these two compounds were assayed in 9 patients in a range of 22-30 days following cessation of a 2- to 7.5-month course with daily oral doses of 10-50 mg of acitretin. A highly sensitive HPLC method was used (2 ng/ml). Residual plasma concentrations of Ro 10-1670 were below the quantification limit in all cases. Residual plasma concentrations of Ro 13-7652 were below the quantification limit in 7 cases and respectively of 3 and 4 ng/ml in the other 2 cases. These data appear to confirm the absence of storage of acitretin even after an extended course of therapy.

Acitretin (RO 10-1670) the main metabolite of ethylester etretinate is used in the treatment of hyperkeratoses. Since it is teratogenic it is always used in association with oral contraceptives in women of childbearing age. This study was done in order to determine whether or not acitretin interacts with and reduces the efficacy of oral contraceptives. 10 patients were given acitretin (25-40 mg/day) for at least 2 cycles in combination with 1 of 3 contraceptive regimens. 3 patients were given a normal dose combined oral contraceptive (levonorgestrel .50 mg-ethinyl estradiol .05 mg); 6 patients were given low-dose combined oral contraceptives (either levonorgestrel .15/.20 mg-ethinyl estradiol .03/.04 mg or levonorgestrel .15 mg-ethinyl estradiol .03 mg); and 1 patient was given a very low dose progestin (levonorgestrel .03 mg). By the end of the study a total of 52 cycles had been controlled for plasma progesterone levels. Only in the patient taking the very low-dose progestin (levonorgestrel .03 mg) was there a significant increase in progesterone level. It is concluded that acitretin does not interfere with antiovulatory activity of combined oral contraceptives.

The aim of the study was to investigate the concentrations of Ro 10-1670 (acitretin) and its isomeric metabolite Ro 13-7652 (cis-acitretin) after multiple oral dosing of acitretin. We used a highly sensitive HPLC method for simultaneous determination of the 2 retinoids with a quantification limit of 2 ng/ml in plasma and 10 ng/g in total skin (epidermis and dermis). In hairless rats receiving orally 8 mg/kg acitretin once daily during 8 days, blood and skin samples were taken at different time points between 5 and 96 h after the last dose. After 96 h, appreciable concentrations of Ro 10-1670, but not Ro 13-7652 could be measured in the skin, whereas both isomers were below the quantification limit in plasma. In psoriatic patients treated with a once daily dose of 30 mg acitretin, blood samples and biopsies were taken after 1 month of treatment (i.e. under steady state conditions). 24 h after the last drug intake, skin concentrations of acitretin were approximately 10 times higher than those observed in plasma. Ro 10-1670 concentrations in the skin were approximately 3-5 times higher than for Ro 13-7652 and concentrations of both isomers were higher in lesional compared to uninvolved skin.

Crosti's reticulosis is defined as a peculiar form of well-circumscribed, slow developing lymphomas in adults, with a malignant histological picture. Three cases with typical dorsal localisation according to Crosti's first description are reported and the cardinal features of this type of tumour are recalled. One observation includes an ultrastructural study which confirms the malignant nature of histiocytes in this disease. Localisation in back seems not to be exclusive and a study of 32 cases of the literature about other localised cutaneous reticulum cell lymphomas show them similar to Crosti's reticulosis-which authorizes their classification, as was proposed by Thiers in a single group of slow developing circumscribed reticuloses.

Xeroderma pigmentosum (XP) is a rare autosomal recessive disorder with defective DNA repair. These patients frequently develop skin or eye malignancies but the incidence of internal neoplasms is not precisely known. We report two first cousins with severe XP who developed in their midtwenties a rapidly fatal myelodysplastic syndrome. Such an association has, to our knowledge, never been previously reported

The incidence of cutaneous effects of oral contraceptives (OCs) is estimated at 2.7-5%. Secondary effects directly attributable to the hormonal action of OCs include melasma, acne and hyperseborrhea, alopecia, and cutaneous lesions of vascular origin. Melasma or chloasma accounts for about 2/3 of all cutaneous side effects of OCs. It appears from 1 month-3 years after the start of OC use, its frequency increasing with dose and duration of use. Pigmentation appears to accentuate the symptoms in brunettes rather than predisposing them to melasma. Exposure to the sun plays a certain role, but use of a low dose OC and effective sun protection are not enough to reverse the pigmentation. These melasmas regress more slowly than after pregnancy and many remain definitive. The influence of OCs on acne is variable, with some OCs provoking sebaceous hypersecretion and some improving acne enough to be used for treatment. For the therapeutic effect to be observed, the estrogen dose must be sufficient to offset the androgenic effect of the progestin. Combined pills containing the strong antiandrogen cyproterone acetate should control acne if other, less androgenic progestins fail. Alopecia is a very rare effect of OCs and its appearance may even reflect simple coincidence. Vascular complications of combined OCs are dependent on estrogens and may include such manifestations as telangiectasias, angiomas, and livedo reticularis. Some secondary cutaneous effects are probably not due to a hormonal influence. They are less well known than the direct hormonal effects, and publications concerning the often detail isolated observations that are difficult to interpret. Reactions of hypersensitivity or allergy to combined OCs may include urticaria and eczema. A history of OC use should be sought in all women presenting with erythema nodosum and the OCs should be discontinued. Pruritus and jaundice may be observed in 1 OC user in 100,000. They indicate a cholestatic hepatitis for which estrogens are responsible. Most patients developing the condition have already had pruritus or jaundice during pregnancy; such a history contraindicates OC use. Several dermatological and systemic disorders are aggravated by OC use. Hereditary angioedema, herpes gestationis, porphyries, and systemic lupus erythematosus are exacerbated by OC use. The role of OCs in malignant melanomas remains controversial.

A 46-year-old woman with widespread prurigo nodularis was treated with 300 mg clofazimine a day for six months. Ten months after stopping the drug she complained of weight loss and gastrointestinal side effects which were shortly improved by a gluten-free diet, but relapsed one year later. At laparotomy, all tissues were stained bright orange-yellow, and histological examination showed crystals deposited in the chorion of intestinal villi and in the mesenteric lymph nodes.

The authors reported a case which does not seem to be possibly related to any known clinical entity; an aspect of keratosis lichenoides striata is associated with an ichthyosiform condition of the trunk and a pseudo-ainhum; there is also a neurological syndrome similar to a multilocular sclerosis. This patient resembles the previous cases of the literature; however there is neither erythema nor any striation at the back of the knees. There is also a pseudo-ainhumm. Concerning this observation, a review of the literature on keratosis lichenoides striata is presented.

An ultrastructural study of Kaposi's disease showed often immature vascular proliferation bordered by large globular or fusiform endothelial cells. Other cell types participated in this proliferation: inflammatory cells, pericytes and fibroblasts. These various cell types are the site of active erythrophagocytosis. It is reasonable to accept that the disease is the result of reticulo-endothelial proliferation with multiple morphological types and predominant vascular differentiation.

Thalidomide (alpha-N-phtalimido-glutarimide) was withdrawn from sale in 1961 since it was held responsible for the birth of hundreds of phocomelus children. Despite this teratogenic potential, thalidomide remains a useful tool in the treatment of erythema nodosum leprosum, as well as in discoid lupus erythematosus when antimalarial drugs are ineffective or contraindicated. In addition, good results have been reported in several diseases such as actinic prurigo, polymorphous light eruption, Behçet syndrome, Weber-Christian disease, prurigo nodularis, pyoderma gangrenosum and ulcerative colitis. The mechanism of action is under debate but it is likely that thalidomide has immunomodulating properties by controlling T-suppressor lymphocytes, and anti-inflammatory effects, particularly an inhibition of neutrophil chemotaxis. Several attempts at synthesis of effective thalidomide derivatives devoid of teratogenic effects are ongoing.

An inflammatory nodule developed on the glans penis of a 79-year-old man. Histological examination confirmed the diagnosis of metastasis from a carcinoma of the prostate. This case is of interest in view of the rarity of this metastatic localization and the very unusual microscopic pattern of the primary cancer (epidermoid carcinoma).

The authors present a case of "verrucous carcinoma" of the eyelid. Such a location never seems to have been described in the literature. As the histological features of the tumor are highly differentiated the exact diagnosis can be ascertained, only upon examination of a large biopsy specimen or of the operative specimen. Clinical, histological and evolutional features are recalled. The therapeutic means of curing this locally malignant and potentially recurrent lesion are discussed. In most cases, recovery depends on early treatment, particularly on surgery.

The authors present an ultrastructural study of two cases of Stewart-Treves syndrome in elderly women. Under light microscopy, the dermal and hypodermal proliferations showed vascular features which were more clearly preceptible in the second case than in the first. Ultrastructural studies showed, in the first case, clefts containing erythrocytes and surrounded by neoplastic cells which were linked by zonulae adherentes. A rudimentary form of basal membrane was also noted, with an exterior lining of pericyte-like cells. In the second case, typical capillary vessels were bordered by endothelial cells containing a few pinocytotic vesicles and microfilaments, in contact by zonulae adherentes. The walls of these vessels consisted of a clearly defined membrane lined with pericytes, and constituting, in some areas, an anastomotic network due to the swelling of the endothelial cells. Ultrastructural study suggests an angiosarcomatous origin of these lesions. Finally, the article includes a review of the literature.

The case of a 30-year-old man with a 6-year history of eosinophilic pustular folliculitis (EPF) is reported. Isotretinoin (1 mg/kg/day) led to a dramatic improvement of all the lesions within 2 weeks. The withdrawal of the drug was followed by a recurrence after 10 days of the papulopustular f ollicular and pruritic lesions. Reintroduction of isotretinoin was successful. The benefits of isotretinoin in the treatment of EPF have to the best of our knowledge never been reported previously. The mechanisms underlying this efficacy may involve the inhibition of the eosinophilic chemotactic factors thought to be present in sebaceous lipids and in the stratum corneum of patients suffering from EPF.