Esophageal cancer (EC) is the third most common digestive cancer in France with an incidence of 5450 new cases in 2018. All stages combined the prognosis remains poor with 5-year survival rates around 14%. In non-metastatic patients, the benefits of adding perioperative chemotherapy (CT) or neoadjuvant chemoradiotherapy (NACRT) to surgery have been demonstrated and are currently recommended. Immune checkpoint inhibitors (ICI) have showed promising results. The aim of the study was to provide real-world treatment outcomes before arrival of ICI in the therapeutic arsenal.

Esophageal cancer is the seventh most common cancer and sixth leading cause of cancer death, worldwide, with approximately 600,000 new cases and over 540,000 deaths in 2020. Squamous-cell carcinoma accounts for approximately 60% of cases in Europe. The study aim was to describe real-world treatment and outcomes of French patients presenting with UnResectable Advanced, or Metastatic Esophageal Squamous-Cell Carcinoma (URAM-ESCC) from 2014 to 2019 before approval of immune-checkpoint inhibitors (ICI).

Background. - The French are frequently regarded as grouchy. In a recent study, we observed a high proportion of patients initially consulting for psoriasis because they were dissatisfied with their previous therapy. We analyzed the characteristics of these patients. Patients and methods. - This was a cross-sectional multicenter study in 40 centers belonging to the ResoPso (psoriasis treatment network) multicenter study group, with consecutive inclusions over a period of 11months in 2014. All adults (age>18 years) consulting for the first time for psoriasis at a center were included in the study. Results. - Among patients, 1205 were included, of whom 249 (20.3%) were consulting because of their dissatisfaction with treatment. In the univariate analysis, these patients were younger (P=0.02) and presented psoriasis that had begun earlier in life (P<0.0001). It consisted mostly of generalized plaque psoriasis (P=0.047) and more severe forms of psoriasis (PASI and/or DLQI score>10, P<0.02). There were fewer cases of psoriatic arthritis (P=0.01). The "dissatisfied" patients reported significantly more frequent use of topical treatments (P<0.0001) and alternative medicines (P=0.02), and more infrequent use of biologics (P=0.006) as well as longer treatment periods (P=0.0005). They consulted at hospitals (P=0.01) and had previously seen more GPs and dermatologists (P=0.0008). There was no impact of gender on the dissatisfaction profile by either comorbidities (metabolic, blood pressure, alcohol and tobacco consumption, and depression), or socio-economic data. In the multivariate analysis, DLQI>10 (P=0.01; 95% CI: 1.01-1.07) and longer duration of care (P=0.004; 95% CI: 1.23-2.99) were associated with dissatisfaction. Conclusions. - Twenty percent of our psoriatic patients seem dissatisfied with their treatment. It is difficult to draw a specific demographic and socioeconomic profile of dissatisfied patients. Only disease severity and possibly inadequate treatment at the initial consultation are associated with patient dissatisfaction. Explanations related to the individual patients and doctors may be proposed. Finally, while the French may be considered grouchy, the frequency of patient dissatisfaction seen in our study does not appear to be any greater than that observed in other countries. Copyright (C) 2017 Elsevier Masson SAS. All rights reserved.

Les molluscums contagiosums (MC) sont souvent profus et chroniques chez l'enfant immunodéprimé. Leur traitement est difficile. Le cidofovir est un analogue nucléosidique de la déoxycitidine utilisé par voie intraveineuse pour le traitement des rétinites à cytomégalovirus de l'adulte infectées par le virus d'immunodéficience humaine (VIH). Nous rapportons les cas de 4 enfants, âgés de 5 à 8 ans, ayant développé de multiples MC au cours d'une poly-chimiothérapie pour une hémopathie lymphoïde, traités par du cidofovir en préparation magistrale à 1 %. Le début de réponse au traitement a été de 2 à 4 mois. La guérison a été complète chez 3 enfants en 7 à 9 mois, et partielle chez un. Aucun effet indésirable n'a été observé. Les MC constituent une difficulté thérapeutique chez l'enfant immunodéprimé, les traitements usuels étant peu adaptés. L'efficacité du cidofovir par voie locale est établie dans le traitement de nombreuses dermatoses à virus à acide désoxyribonucléique (ADN), et rapportée depuis peu pour les MC de l'adulte immunodéprimé. Son utilisation chez l'enfant est peu documentée. Alors que l'administration de cidofovir par voie parentérale entraîne des effets indésirables systémiques potentiellement graves, son utilisation par voie locale à forte concentration n'a été qu'exceptionnellement compliquée d'une atteinte systémique. Le cidofovir en préparation magistrale constitue une alternative efficace et bien tolérée pour le traitement des MC multiples de l'enfant immunodéprimé.Molluscum contagiosum (MC) is common and often numerous and recalcitrant in immunocompromised children. The response to available treatments is frequently unsatisfactory. Cidofovir is a nucleoside analog of the deoxycytidine antiviral drug approved for the intravenous treatment of cytomegalovirus retinitis in AIDS patients. We report four cases of children, 5–8 years old, who developed extensive MC in the context of chemotherapy for acute lymphoid leukemia and who were treated with a cream containing cidofovir 1%. In all patients, the lesions began to regress within 2 to 4 months. For three patients, complete regression was observed in 7 to 9 months, and the children remained clear of recurrence. For one patient, partial regression was obtained after 17 months of treatment. No side effects have been observed. Treatment of MC in immunocompromised children is difficult because the usual treatments are inappropriate. Successful use of either topically or intralesionally administered cidofovir in several virally induced cutaneous diseases has been demonstrated and recently documented in the treatment of MC in immunocompromised adults. Conversely, its use in children is not documented. Although intravenous use of cidofovir may lead to severe adverse effects, one single case of a systemic side effect has been reported after topical use at a greater concentration, but no changes in laboratory data were observed. Topical cidofovir offers an effective and well-tolerated therapeutic alternative option for the treatment of MC in immunosuppressed children.

Background Oral 8-methoxypsoralenUV-A (PUVA) and narrowband UV-B (NB-UVB or UVB TL-01) are effective and widely used treatments for chronic plaque psoriasis. Although the role of PUVA therapy in skin carcinogenesis in humans with psoriasis has been clearly demonstrated, there is still controversy regarding the risk of skin cancer with NB-UVB. Furthermore, there is no clear evidence about the maximum cumulative number of sessions not to be exceeded in a lifetime.Objectives To assess the respective cutaneous carcinogenic risks of PUVA or NB-UVB in psoriasis; to estimate the respective dose-relationship between skin cancers and PUVA or NB-UVB; to estimate a maximum number of sessions for PUVA or NB-UVB not to be exceeded in a lifetime.Methods A systematic literature search was carried out in Medline, Embase and Cochrane Library databases from 1980 to December 2010 in English and French, with the keywords 'Psoriasis' AND 'UVB therapy' AND 'UVA therapy' AND 'cancer' AND 'skin' OR 'neoplasm' OR 'cutaneous carcinoma' OR 'melanoma'.Results Of 243 identified references, 49 published studies were included. Most of them (45/49) concerned PUVA therapy, with 41 assessing the risk of non-melanoma skin cancers (NMSC) following PUVA. All publications referring to the US prospective PUVA follow-up study revealed an increased risk of NMSC with the following characteristics: risk most pronounced for squamous cell carcinomas developing even with low exposures and increasing linearly with the number of sessions, tumors occurring also on non-exposed skin including invasive penile tumors, risk persisting after cessation of treatment. An increased risk of basal cell carcinomas was observed in patients receiving more than hundred PUVA sessions.The four prospective European studies selected in our review and most of the pre-1990 European and US retrospective studies failed to find a link between exposure to PUVA and skin cancer. Only the most recent cohorts, including three large long-term retrospective European studies comparing records with their respective national cancer registries reported on an independent increased risk of NMSC with PUVA, The risk was lower as compared to the US prospective PUVA follow-up study.Six studies assessed the risk of melanoma following PUVA therapy: two of the three US publications coming from the same PUVA prospective follow-up study revealed an increased risk with more than doubled incidence of both invasive and in situ melanoma among patients exposed to at least 200 PUVA treatments compared with patients exposed to lower doses, whereas the three retrospectives European studies, comparing the incidence of melanoma in PUVA users with national cancer registers, did not find any increased risk of melanoma.No increased risk of skin cancer was evidenced in the four studies specifically assessing the potential carcinogenic risk of NB-UVBConclusion There is an increased risk of skin cancer following PUVA, shown by both US and European studies. The greater risk measured by the US studies may be at least partly explained by high UVA dose exposure and the lighter phototypes of the treated patients. The lack of prospective studies in psoriasis patients treated with NB-UVB constitutes a barrier to the robust assessment of carcinogenic risk of this phototherapy technique.

Introduction Topical steroids are used for more than 50 years to treat mild-to-moderate plaque psoriasis. The purpose of this systematic review was to evaluate the efficacy but also the optimal modalities of administration of topical corticosteroids in psoriasis i.e. influence of steroid potency on clinical response, putative impact of topical formulation, occlusion procedure, rate of application to control the initial response and the potential interest of a maintenance treatment to prolong psoriasis clearance.Material and methods A systematic search was performed between 1980 and January 2011 in Medline, Embase and Cochrane databases (English and French language, adults), using the keywords 'psoriasis'/exp/mj AND 'corticosteroid'/exp/mj. To analyse response across studies, three levels of response were categorized depending on the data available in studies: percentage of patients who achieved more than 50%, 75% or 90% improvement of initial psoriasis severity.Results From an initial selection of 1269 references, 1166 references were excluded on reading the title or the abstract and 32 on reading the article and 71 were finally retained and analysed. Fifty randomized controlled trials (RCT) assessing topical steroids in the initial treatment of mild-to-severe psoriasis body plaque psoriasis were retained: 40 were parallel-group studies and 10 were within-patient studies. Treatment duration was mostly 4 weeks. Sample size varied from 30 to 1 603 patients. Outcome measures to assess efficacy were highly variable. A total of 30-90% patients across parallel group studies experienced more than 50% of initial mild-to-severe psoriasis improvement while from 7% to 85% experienced more than 75% improvement and from 5% to 85% experienced at least 90% of improvement. The success rate in the within-patient studies varied from 10% to 70%. Eighteen RCT were performed in scalp psoriasis: 16 were parallel-group and two were within-patient studies, with a treatment follow-up time from 2 weeks to 6 months, enrolling 42-1417 patients. A total from 40% to 75% patients across studies experienced more than 75% of initial scalp psoriasis improvement and from 43% to 90% experienced more than 90% initial psoriasis improvement.Only three RCT studies evaluated topical steroids as a maintenance treatment for body psoriasis and one for scalp lesions. Despite heterogeneity in treatment schedule, topical steroid intermittent maintenance treatment was shown to prolong remission.The literature analysis did not provide with high evidence-based quality data on the role of formulation, topical steroid potency, number of applications per day to obtain the highest rate of success excepting occlusion dressing which provided with additional benefit.Conclusion The clinical development of topical steroids in psoriasis did not follow state of the art modern methodology. Treatment success appears to be highly variable across studies. Maintenance intermittent treatment appears to be useful to prolong remission.Recommendations concerning topical steroids treatment modalities in plaque psoriasis should be mostly based on expert opinion.

Background Treatment adherence has been recognized as an important issue in the management of chronic diseases such as psoriasis.Objective The aim of this work was to analyse data about topical treatment adherence in psoriasis.Methods Systematic literature review (62 references) between 1980 and 2011 (database: PubMed, Embase and Cochrane; Mesh keywords: Patient Compliance [Mesh] OR Medication Adherence [Mesh] AND Psoriasis [Mesh]; limits: date of publication >1980, humans subjects, written in French or English, aged 19 years). Two parameters were evaluated: (i) the ratio of number of product applications performed vs. number of applications expected according to physician recommendations, (ii) the ratio of amount of product used vs. amount of product prescribed.Results A total of 22 studies were selected. Nine studies reported on the frequency of topical treatment application in a real world setting. Five studies showed a frequency of applications varying between 50% and 60% of those expected. Because of the high variability in medication adherence assessment methods, the data could not be combined. Twelve articles reported on the frequency of topical treatment application in randomized controlled trials with adherence varying between 55% and 100%. Concerning the amount of product use, four studies showed patients applied between 35% and 72% of the recommended dose during a treatment period of 14 days to 8 weeks. The most frequently mentioned reasons for non-adherence to topical treatment were low efficacy, time consumption and poor cosmetic characteristics of topical agents. Patients experiencing adherence issues were significant younger, were men, had younger age at onset of psoriasis and had a higher self-assessed severity. To improve adherence, the following strategies were suggested: to give patients information about psoriasis, to recognize social impact, to give written instructions for use such as a care plan, to explain side effects of topical therapies, to choose treatment and its cosmetic properties in agreement with the patient.Conclusions Literature data about topical treatment adherence are heterogeneous and scarce. They confirm the limited topical treatment adherence in psoriasis in real life, much lower than what is reported in randomized controlled trials. Therapeutic education and clear instructions on the use of topical agents are necessary to improve adherence. Studies are needed to identify predictors of limited adherence and to identify interventions improving adherence to topical medications in psoriasis.

Background Topical steroids have been used for more than 50 years in mild-to-moderate plaque psoriasis and carry a theoretical risk of adverse events.Objectives The aim of this systematic literature review was to evaluate the risk of hypothalamo-pituitary-adrenal (HPA) axis suppression and the risk of skin atrophy with topical steroids in the treatment of plaque psoriasis.Methods A systematic search between 1980 and January 2011 in Medline, Embase and Cochrane databases (English, French language, adults), using the keywords 'psoriasis'/exp/mj AND 'corticosteroid'/exp/mj,Results Altogether 1269 references were found. Of these 1124 articles were excluded by reading the abstract and 123 by reading the article. A total of 22 randomized trials were selected.Effects on HPA axis: Thirteen studies, with a sample size varying from 7 to 341 patients, were selected. The effect on HPA axis was evaluated by the morning cortisol level (11 studies), the 24 h urine steroid levels (five studies) and/or by the Synacthen(R) test (three studies). Reduction of morning cortisol was observed in 0-25% of patients in 10 short-term studies (two in scalp psoriasis, eight in body psoriasis) and in 48% of patients in the remaining short-term study (body psoriasis). Only four of these studies with three on body psoriasis evaluated the effect of long-term treatment defined as 6-month treatment duration or longer and did not identify HPA axis suppression by cortisol level measurement. The Synacthen(R) test, considered as the gold standard to assess HPA axis, was always normal. There was no evidence of clinically significant HPA axis suppression due to absorption of topical steroids even when treating the scalp or in patients with extensive disease.Risk of skin atrophy: Thirteen studies with topical steroid evaluating treatment durations from 4 weeks to 1 year were analysed. The frequency of skin atrophy assessed clinically, varied from 0% to 5% of patients.Conclusions The literature analysis on topical steroids in psoriasis is reassuring although the quality of safety studies is limited with a majority of short-term studies. Although short-term biological effects of topical steroids on the HPA axis were observed in several clinical studies, they were not associated with clinical signs. Adequately designed long-term studies would be necessary to better determine the risk of skin atrophy using modern methods of evaluation such as dermoscopy and echography.

BACKGROUND:Oral 8-methoxypsoralen-UV-A (PUVA) and Narrowband UV-B (NB-UVB or UVB TL-01) are well established treatments for chronic plaque psoriasis but there is limited evidence regarding their respective efficacy. OBJECTIVES:To prepare for evidence-based recommendations concerning the practical use of oral 8-methoxypsoralen-UV-A and Narrowband UV-B in psoriasis, a systematic review to assess respective response rates, remission duration and predictive factors of efficacy was performed. METHODS:A systematic search was carried out in PubMed, Cochrane and Embase databases, using the key words 'Psoriasis', 'UVB therapy', 'UVA therapy' for the period from 1980 to December 2010. RESULTS:The initial literature search identified 773 articles. The final selection included 29 randomized controlled trials: 18 were about the efficacy of PUVA, eight about the efficacy of NB-UVB and three directly compared PUVA vs. NB-UVB. The response rate defined by 75% or more improvement in PASI was 80% with PUVA vs. 70% with NB-UVB. The meta-analysis of the three comparative studies found a higher probability of remission at 6 months with PUVA than with NB-UVB [OR = 2.73 (95% CI 1.19-6.27), P = 0.02]. The choice of initial dose, according to skin type, the minimal erythemal dose or minimal phototoxic dose, incremental regimen and periodicity of the sessions did not appear to be predictive factors of efficacy for PUVA or NB-UVB. Despite methodological limitations in trials, the number of sessions needed for psoriasis clearance appeared to be lower with PUVA than with NB-UVB (approx. 17 vs. 25, respectively). CONCLUSION:PUVA and NB-UVB are both effective therapies in treatment of psoriasis. Our results suggest that compared with NB-UVB, PUVA tends to clear psoriasis more reliably, with fewer sessions, and provides with longer lasting clearance. However, the long-term safety of PUVA, especially its cutaneous carcinogenic risk, and the easier administration procedure often lead dermatologists to prefer NB-UVB as first line phototherapy treatment in plaque type psoriasis.

Les complications rhumatologiques de la lèpre ne sont pas rares. Lorsqu'elles inaugurent le tableau clinique, elles peuvent poser des problèmes diagnostiques avec d'autres affections rhumatismales en particulier la polyarthrite rhumatoïde. Nous rapportons l'observation d'un homme de 24 ans qui a présenté depuis l'âge de 19 ans des poussées de rhumatisme inflammatoire accompagnées de fièvre. Au début, l'examen clinique et les explorations radiologiques n'ont pas montré d'anomalies. L'évolution après quelques années a été marquée par l'apparition d'une amyotrophie sévère des muscles des mains avec une anesthésie en gants et en chaussettes, des cicatrices de brûlures au niveau des doigts et des maux perforants plantaires. L'EMG a objectivé une neuropathie sensitivomotrice à prédominance démyélinisante. L'analyse biologique a montré un syndrome inflammatoire alors que le bilan immunologique a été négatif. La biopsie nerveuse a mis en évidence un infiltrat inflammatoire endoneural intense fait de cellule mononucléée évoquant une lèpre. L'enquête familiale a montré que la tante du malade est atteinte de la lèpre. Le malade a été mis sous traitement spécifique, ce qui a entraîné une amélioration sur le plan rhumatologique et du syndrome inflammatoire biologique mais aucune amélioration neurologique n'a été constatée.

Objective The objective of this systematic review was to prepare for evidence-based recommendations on the use of vitamin D analogues, and their combination with topical steroids in psoriasis.Methods Literature systematic review performed in May 2011. The Cochrane, PubMed and Embase databases were systematically searched with different combinations: including Psoriasis AND calcipotriol expanded to all vitamin D analogues. To assess efficacy across studies, we used two predefined criteria to account for the numerous endpoints found in the literature, 'Treatment success' corresponding to 90% improvement in severity and 'Satisfactory response' corresponding to 75% improvement. We conducted a meta-analysis comparing the efficacy of vitamin D analogues plus topical steroids (VDS) vs. vitamin D analogues alone (VD). To determine the relative cost-efficacy of the topical drugs available on the market, cost/efficacy ratios were calculated for each product according to the approved therapeutic regimen.Results 51 articles were selected. The application duration varied between three to 52 weeks across studies. VD as monotherapy had a satisfactory response rate between 22% to 96% and a treatment success rate ranging from 4% to 40%. VDS had a satisfactory response rate between 35% to 86% and a treatment success rate ranging from 27% to 53%. A meta-analysis found a probability of success twice higher with VDS than with VD in adult plaque psoriasis. The cost/efficacy ratio was evaluated as 1.2-1.8 times higher for VDS than for VD.Conclusion VDS is twice more effective than VD and displays a better cost per success. Additional studies are needed to clarify maintenance treatment, impact on quality of life, treatment of non-plaque psoriasis. It will be important to harmonize outcome measures in future studies with topical agents in psoriasis to better appraise their efficacy.

Journal of the European Academy of Dermatology and VenereologyVolume 26, Issue s3 p. 32-35 LETTER Ocular damage in patients with psoriasis treated by Psoralen UV-A therapy or Narrow band UVB therapy: a systematic literature review E. Archier, E. Archier Aix-Marseille Univ, UMR 911, INSERM CRO2 and Dermatology Department, Timone Hospital, Marseille, FranceSearch for more papers by this authorS. Devaux, S. Devaux Dermatology Department, Paul Sabatier University, Toulouse, FranceSearch for more papers by this authorE. Castela, E. Castela Dermatology Department, Nice University, L'Archet II Hospital, Nice, FranceSearch for more papers by this authorA. Gallini, A. Gallini UMR 1027 INSERM, Paul Sabatier University, Toulouse, FranceSearch for more papers by this authorF. Aubin, F. Aubin Dermatology Department, Franche-Comté University, EA3181, IFR133, University Hospital, Besançon, FranceSearch for more papers by this authorM. Le Maître, M. Le Maître Dermatologist, Caen, FranceSearch for more papers by this authorS. Aractingi, S. Aractingi Dermatology Department, Tenon Hospital, APHP and Paris 6 University, Paris, FranceSearch for more papers by this authorH. Bachelez, H. Bachelez Dermatology Department, Saint-Louis Hospital, Paris, FranceSearch for more papers by this authorB. Cribier, B. Cribier Dermatology Department, University Hospital, Strasbourg, FranceSearch for more papers by this authorP. Joly, P. Joly Dermatology Department, Charles Nicolle Hospital, INSERM U 905, University of Rouen, FranceSearch for more papers by this authorD. Jullien, D. Jullien Dermatology Department, Edouard Herriot Hospital, Lyon, FranceSearch for more papers by this authorL. Misery, L. Misery Dermatology Department, University Hospital, Brest, FranceSearch for more papers by this authorC. Paul, C. Paul Dermatology Department, Paul Sabatier University, Toulouse, FranceSearch for more papers by this authorJ.P. Ortonne, J.P. Ortonne Dermatology Department, Nice University, L'Archet II Hospital, Nice, FranceSearch for more papers by this authorM.A. Richard, M.A. Richard Aix-Marseille Univ, UMR 911, INSERM CRO2 and Dermatology Department, Timone Hospital, Marseille, FranceSearch for more papers by this author E. Archier, E. Archier Aix-Marseille Univ, UMR 911, INSERM CRO2 and Dermatology Department, Timone Hospital, Marseille, FranceSearch for more papers by this authorS. Devaux, S. Devaux Dermatology Department, Paul Sabatier University, Toulouse, FranceSearch for more papers by this authorE. Castela, E. Castela Dermatology Department, Nice University, L'Archet II Hospital, Nice, FranceSearch for more papers by this authorA. Gallini, A. Gallini UMR 1027 INSERM, Paul Sabatier University, Toulouse, FranceSearch for more papers by this authorF. Aubin, F. Aubin Dermatology Department, Franche-Comté University, EA3181, IFR133, University Hospital, Besançon, FranceSearch for more papers by this authorM. Le Maître, M. Le Maître Dermatologist, Caen, FranceSearch for more papers by this authorS. Aractingi, S. Aractingi Dermatology Department, Tenon Hospital, APHP and Paris 6 University, Paris, FranceSearch for more papers by this authorH. Bachelez, H. Bachelez Dermatology Department, Saint-Louis Hospital, Paris, FranceSearch for more papers by this authorB. Cribier, B. Cribier Dermatology Department, University Hospital, Strasbourg, FranceSearch for more papers by this authorP. Joly, P. Joly Dermatology Department, Charles Nicolle Hospital, INSERM U 905, University of Rouen, FranceSearch for more papers by this authorD. Jullien, D. Jullien Dermatology Department, Edouard Herriot Hospital, Lyon, FranceSearch for more papers by this authorL. Misery, L. Misery Dermatology Department, University Hospital, Brest, FranceSearch for more papers by this authorC. Paul, C. Paul Dermatology Department, Paul Sabatier University, Toulouse, FranceSearch for more papers by this authorJ.P. Ortonne, J.P. Ortonne Dermatology Department, Nice University, L'Archet II Hospital, Nice, FranceSearch for more papers by this authorM.A. Richard, M.A. Richard Aix-Marseille Univ, UMR 911, INSERM CRO2 and Dermatology Department, Timone Hospital, Marseille, FranceSearch for more papers by this author First published: 18 April 2012 https://doi.org/10.1111/j.1468-3083.2012.04521.xCitations: 11 E. Archier. E-mail: elodie.archier@live.fr Funding sources: Abbott France provided financial support for publication but took no further part in the project. The authors have no financial interest in the subject matter or materials discussed in the manuscript. Conflicts of interest: All the authors have been paid consultants of Abbott. In addition C. Paul has been investigator and consultant for Janssen-Cilag, Leo Pharma, Novartis and Pfizer. H. Bachelez has been paid for consulting activities for Centocor, Janssen-Cilag, Leo Pharma, Novartis, Pfizer, and Schering-Plough. B. Cribier has been paid for consulting activities for Pfizer, for redaction activities by Leo Pharma and Janssen Cilag. and speaker for Pfizer, Leo Pharma and Schering Plough. D Jullien has been consultant for Merck, Janssen-Cilag, Novartis, Pfizer, and Schering-Plough/MSD. JP Ortonne has been investigator, speaker and advisor for Schering-Plough/MSD, Abbott, Merck Serono, Centocor, Pfizer, Janssen Cilag, Pierre Fabre, Galderma, Leo Pharma, Meda L. Misery has been a paid consultant of Novartis, Janssen-Cilag, Leo Pharma, Pfizer and Pierre Fabre. MA Richard has been investigator and consultant for Janssen-Cilag, Novartis, Pfizer. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume26, Issues3Special Issue: Evidence-based Recommendations on Topical Treatment and Phototherapy of Psoriasis: Systematic Review and Expert Opinion of a Panel of DermatologistsMay 2012Pages 32-35 RelatedInformation

La dépigmentation volontaire est une pratique répandue dans la population à peau noire et les dermocorticoïdes sont largement utilisés sur une grande surface du corps avec des effets secondaires locaux fréquents. Nous rapportons l’observation d’une patiente de 25 ans, d’origine congolaise, hospitalisée pour altération de l’état général et un syndrome polyalgique articulaire et abdominal. L’usage de dermocorticoïdes pour dépigmentation volontaire était suspecté devant une hyperpigmentation relative de la face d’extension des petites articulations des mains et des pieds, associée à des signes cliniques d’hypercorticisme. Le bilan biologique trouvait un effondrement de la cortisolémie et de l’adreno-cortico-tropic hormone (ACTH) avec un test de stimulation immédiat par l’ACTH (Synacthène®) négatif, permettant de porter le diagnostic d’insuffisance surrénalienne haute compliquant l’usage prolongé de dermocorticoïdes. La mise sous hydrocortisone permettait la régression des symptômes. Un an plus tard, la patiente avouait l’usage continu depuis cinq ans de dermocorticoïdes (bétaméthasone, 0,05 %). La dépigmentation volontaire avec utilisation prolongée de dermocorticoïdes, fréquente chez les femmes à peau noire, doit être évoquée dans un contexte d’insuffisance surrénalienne avec ou sans signes d’hypercorticisme exogène et inversement, l’axe corticotrope doit être exploré chez toute patiente pratiquant la dépigmentation volontaire.In black population, the skin-bleaching with cutaneous topical corticosteroids on a large body area is a widespread practice and is associated with numerous cutaneous complications. We report a 25-year-old Congolese woman who was admitted for weakness, arthralgias and abdominal pain. The association of a relative hyperpigmentation of the small joints of hands and feet with clinical features of hypercorticism led to suspect a chronic use of cutaneous topical steroids for skin-bleaching. On biological tests, plasma cortisol and corticotropin levels were undetectable and the short corticotropin (ACTH) stimulation test was negative, leading to the diagnosis of adrenal insufficiency complicating the chronic use of topical steroids. Clinical symptoms resolved with hydrocortisone therapy. One year later, the patient admitted a five-year continuous use of cutaneous topical steroids (betamethasone, 0.05%). Skin-bleaching through chronic use of cutaneous topical steroids, is a common practice in black women, and should be suspected in the presence of adrenal insufficiency with or without clinical features of hypercorticism, and conversely, skin-bleaching users should be tested for hypothalamo–pituitary–adrenal function.