BACKGROUND:The occurrence and clinical characteristics of cutaneous squamous cell carcinoma (cSCC) associated with cosmetic skin bleaching have been well documented in the literature. However, the histopathological characteristics have not yet been reported. This study aimed to describe the histological abnormalities observed in cases of cSCC associated with cosmetic skin bleaching and to explore the potential contributing factors. METHODS:We re-analysed archived paraffin-embedded tissue blocks from all cases of cSCC diagnosed in different pathology laboratories in Dakar between November 2006 and October 2021. RESULTS:We collected 19 cases of cSCC, all occurring in women, with a mean age of 58 years. On average, the women had been practising cosmetic skin bleaching for 20 years. Most of them (14 cases) used bleaching products containing a mixture of hydroquinone and clobetasol propionate. All carcinomas were well-differentiated, and 17 cases (89.5%) were invasive. Histological abnormalities associated with the cSCC included intense fibrosis with a lymphoplasmacytic infiltrate in all cases, telangiectasias in 18 cases (94.7%), exogenous ochronosis deposits in 9 cases (47.4%), and solar elastosis in one case. In addition, koilocytes, histological markers of human papillomavirus (HPV) infection, were identified in 10 cases (52.6%). CONCLUSION:cSCC associated with cosmetic skin bleaching exhibit a distinctive histopathological pattern with frequent koilocytosis (52.6%). These findings support a multifactorial pathogenesis in which HPV may act as a cofactor. Future studies using PCR and in situ hybridisation are needed to clarify this potential association.
INTRODUCTION:Genital herpes, caused by Herpes simplex virus (HSV), is a sexually transmitted infection that is the leading cause of genital ulcers in many countries around the world. Although many treatments exist for this condition, their prioritization is often unclear. This study aimed to develop French national recommendations for the treatment of genital herpes in both immunocompetent and immunocompromised (ID) adults, pregnant women (PW), and adolescents. METHODS:These guidelines were developed by a multidisciplinary working group (WG) following the methodology of the Haute Autorité de Santé. No conflicts of interest were declared. A systematic review (SR) of the literature was conducted using PubMed and Embase, covering publications up to June 1, 2024. The protocol was published in PROSPERO (CRD42023399760) after drafting and submission to a multidisciplinary panel of reviewers. Risks of bias were assessed using various tools. RESULTS:A total of 127 sources were analysed, including randomised controlled trials (RCTs), SRs, and guidelines. Recommendations were formulated for oral, parenteral, and topical treatments. Key management strategies for primary infection and recurrence were summarised in a clinical algorithm. The methodological quality of the included evidence varied, and many studies were dated. Data gaps were identified for specific populations, particularly PW and ID. CONCLUSION:These new French guidelines provide updated, evidence-based recommendations derived from a systematic review for the management of genital herpes across diverse populations and clinical scenarios.
BACKGROUND:The lichen planus spectrum includes cutaneous, scalp, pigmentary, and nail phenotypes. Topical Janus kinase inhibitors offer targeted treatment with limited systemic exposure. OBJECTIVE:To map and critically appraise clinical, safety, and molecular evidence for topical Janus kinase inhibitors across lichen planus phenotypes. METHODS:We performed a PRISMA-guided systematic review (PROSPERO CRD420251155683) searching MEDLINE, Embase, Scopus, trial registries, and other sources to 1 November 2025. Human studies of topical JAK inhibitors for cutaneous lichen planus (LP), lichen planopilaris, frontal fibrosing alopecia (FFA), lichen planus pigmentosus (LPPig), or nail lichen planus were included. Risk of bias was assessed, certainty of evidence was graded, and findings were synthesized narratively. RESULTS:Thirteen studies (n = 118 patients) and one registry trial were included. In FFA, a phase 2 double-blind, vehicle-controlled trial of delgocitinib 2% cream in 30 patients met its molecular primary endpoint and showed greater clinical improvements than vehicle over 12 weeks. Two cohorts reported improvement with topical tofacitinib 2% and topical ruxolitinib 1.5% in scarring alopecia. In cutaneous LP (n = 12), an open-label study showed improvement in lesion severity and symptoms with topical ruxolitinib. Evidence for LPPig and nail LP was limited to case reports. Topical JAK inhibitors were well tolerated with infrequent local irritation and no serious adverse events. CONCLUSIONS:Topical Janus kinase inhibitors appear promising, well tolerated, and potentially steroid-sparing, particularly in lichen planopilaris and FFA. However, the evidence remains limited, and well-designed vehicle-controlled trials are needed before routine use can be justified.
INTRODUCTION:Anogenital warts (AGW) are benign epithelial skin lesions caused mainly by the human papillomavirus (HPV, types 6 and 11) but are sometimes associated with other oncogenic HPV types. They have a high rate of post-treatment recurrence. There are many guidelines, but they do not prioritise treatments. Therapeutics are classified as either self-administered or clinician applied. The aim of this study was to propose recommendations for the management of AGW. METHOD:These recommendations were based on a systematic review of the literature by a working group (WG) with no links of interest. The databases used were PubMed and Embase up to 1st June 2024. The risks of bias of the included studies were analysed using the PRISMA, ROBIS, AMSTAR 2, AGREE II, RIGHT and ROB grids. They were assessed by an expert review group using the GRaAL method of the French Health Authority (FHA). RESULTS:A total of 204 studies were selected from 1446 (including randomised clinical trials (RCTs), systematic reviews (SR), non-randomised clinical trials involving more than 30 patients, meta-analyses (MA), and guidelines) by the working group (WG). The methodological quality of the studies varied widely. An algorithm proposing a hierarchy of treatments was developed for the general population, pregnant women, children, immunocompromised patients and for specific sites (urethral, vaginal and anal). Combination therapy has been widely adopted. CONCLUSION:Despite a lack of data on specific populations and variability in the quality of the studies analysed, these recommendations provide a hierarchy of treatments for AGW based on a systematic review of the literature.
Extramammary Paget's disease (EMPD) is a rare malignant adenocarcinoma with a poor prognosis when invasive or metastatic, and no standardized care when inoperable. One-third of EMPDs overexpress HER2/ERBB2 (human epidermal growth factor receptor 2), highlighting the potential efficacy of HER2 inhibitors in EMPD. Including an institutional case, we reviewed 70 previously published cases treated with at least one HER2 inhibitor for a metastatic or locally advanced EMPD (representing a total of 92 therapeutic lines), retrieved from PubMed and Scopus, to assess their efficacy, tolerability, and prescribing procedures. Monoclonal antibodies, tyrosine kinase inhibitors, and antibody-drug conjugates have been reported, with trastuzumab being the most used. In our study, HER2 inhibitors demonstrated a median progression free survival (PFS) of 12.5 months when used as first-line therapy (12 months when used as monotherapy, and 13.3 months when combined with another systemic treatment - mostly chemotherapeutic agents). The search for HER2 overexpression (through immunohistochemistry and fluorescence in situ hybridization/FISH) may be proposed in all cases of advanced EMPD, ideally in both the primary and metastatic sites, with testing for ERBB2 mutations, particularly in cases without HER2 overexpression. For patients in good general condition, a combination of a HER2 inhibitor and chemotherapy may be proposed, but good responses have also been observed with HER2 inhibitors as monotherapy, which shows excellent tolerability. Numerous types of HER2 inhibitors are now available, using different mechanisms of action, and may be effective even after progression on a first-line HER2 inhibitor.
BACKGROUND:Visible skin diseases affecting the face and hands-crucial for non-verbal communication and social interaction-can deeply impact psychological well-being. Beyond physical symptoms, their visibility often affects self-esteem and social functioning, contributing to high rates of depression and anxiety. While facial dermatoses have been extensively studied, few investigations have explored the psychological impact of visible localization in other dermatoses. OBJECTIVE:To estimate the prevalence of depression and anxiety in patients with visible skin diseases, identify associated factors, and better understand their psychological impact. METHODS:Following PRISMA guidelines, a systematic search of Medline and Embase was conducted to identify studies assessing depression and/or anxiety in visible skin diseases. A random-effects meta-analysis using Freeman-Tukey transformation estimated pooled prevalences. A qualitative synthesis explored associated factors, quality of life, and suicidal ideation. RESULTS:Of 6689 articles screened, 41 were included (12,372 patients), mainly with vitiligo, acne, alopecia areata, and rosacea. Thirty-eight studies assessed depression, 32 assessed anxiety, primarily using the Hospital Anxiety and Depression Scale (HADS). Pooled prevalence was 38.0% [95% confidence interval (CI): 31.1-45.2] for depression and 43.6% [36.3-51.1] for anxiety, with high heterogeneity (I2 > 97%). Most comparative studies found higher rates versus controls. Associations with disease severity or demographic factors were inconsistent. Over half of the studies reported moderate to severe impairment in quality of life, correlated with anxiety and depressive symptoms. Suicidal ideation ranged from 5.8 to 23.3%. CONCLUSION:Visible skin diseases are associated with high rates of depression and anxiety, supporting integrated dermatological and psychiatric care. Future research should clarify causal mechanisms and promote psychodermatology centers to improve outcomes for these vulnerable patients.
