Mycosis fungoides (MF) is the most frequent form of cutaneous lymphomas. MF is known as the great mimicker. The tumour d'emblee form is an exceptional presentation, for which there is no precise treatment guidance. A 45-year old man presented with tumoral MF on the dorsal side of his right hand with an extension to the forefinger. After the histological, immunohistological and the TCR monoclonality proof of MF, different topical and systemic treatments have been administered. As none of these treatments provided satisfying clinical responses, a surgical excision was finally proposed, with a very good clinical outcome and no recurrence observed after 2 months. Although exceptional in the event of an MF in general, localized tumoral forms of MF could readily benefit from a surgical excision.

Köbner's phenomenon and its related phenomena are dermatological curiosities that are still partially misunderstood. The Köbner phenomenon is by far the best known and the most studied. It is characterized as the appearance of an inflammatory or infectious dermatosis in an area of healthy skin after skin trauma. The dermatoses most frequently concerned are psoriasis, lichen planus and vitiligo. The inverse Köbner phenomenon and the Renbök phenomenon are two very similar phenomena. The first represents the disappearance of a skin lesion after skin trauma. The second is characterized by a skin trauma that is more specifically induced by another dermatosis. Finally, the Wolf's isotopic phenomenon corresponds to the appearance of a new dermatosis on an area of the skin that was previously the site of another healed dermatosis.

Recently, brentuximab vedotin (BV) (Adcetris®) obtained the reimbursement in Belgium for the treatment of the primary cutaneous NKT-cell lymphomas mycosis fungoides (MF), large cell anaplastic lymphoma and lymphomatoid papulosis type A. BV is a monoclonal antibody directed against the CD30 expressed on tumoral T cells. The inhibition of this pathway releases the process of apoptosis leading to the cell death of the tumoral cells. BV is reimbursed after the use of another systemic treatment without success and if the number of CD30 positive atypical T-cells is larger than 10 %. BV is administered intravenously every 3 weeks with a dosing of 1,8 mg/kg with a maximum of 16 courses. The response rates exceed 75 %. In some instances, interesting treatment responses have been observed with BV in CD30 negative patients. The principal adverse effects are neutropenia and peripheral neuropathy. Two patients are presented with longstanding multi-resistant MF that were successfully treated with BV.

The management of melanoma is a typical example of a pluridisciplinary approach, in order to provide the patient with a rapid and adequate treatment plan after the initial diagnosis. Both in the domains of dermatology, pathology and oncology, enormous progress has been made. Recent advances permit a rapid access to diagnostic techniques using teledermoscopy, an improved diagnostic accuracy using dermoscopy, pre-interventional high-frequency ultrasound and optical coherence tomography, a determination of risk factors using immunohistochemistry and genetic analyses on the pathology samples. Furthermore, the development of immunotherapies, in particular the anti-PD1 antibodies, and the directed therapies, therapies permitting an increased number of patients to experience an increased survival with an acceptable tolerance profile in the event of metastatic lesions. This article describes the patient's care pathway, from the initial diagnosis, staging, to an eventual treatment and follow-up.

A 16-year-old boy was referred with a 12-year history of progressive atrophic indurated plaques over his right inner thigh and extending to involve the lower leg, flanks and more recently the upper back, associated with pain (Fig. 1). Based on the clinical appearances the main initial diagnostic consideration was morphoea. Thermography showed a small mildly hyperthermic area on the medial right thigh, but otherwise did not indicate warmth at any of the affected sites. Magnetic resonance imaging of both legs showed no signs of active oedema to suggest inflammation.

Psoriasis is a chronic inflammatory skin disease affecting around 2-3 % of the population. The disease spectrum evolves from to the knees and elbows limited disease to erythrodermic psoriasis. The impact on the quality of life, the pruritus, the pain from palmo-plantar disease, arthropathic psoriasis and the comorbidities are the major complaints of the patients. The treatment relies on topical treatments with dermocorticosteroids with or without vitamin D derivatives, UVA or UVB phototherapy, conventional treatments including methotrexate, ciclosporin and acitretin, and, since around 15 years, biological treatments. The biological treatments for moderate to severe psoriasis progressed in a spectacular way with an improvement of clinical results and an amelioration of the safety profile at every step. This article discusses these developments from the TNF? antagonists, including etanercept, adalimumab and infliximab to the newly arrivals, the anti-IL17 and anti-IL23 antagonists, the anti-PDE-4 antagonists and the JAK inhibitors.

The spectrum of the mucocutaneous adverse effects of directed oncologic therapies, such as anti-EGFR, anti-VEGF, anti-TK and anti-BRAF, presents similarities but also differences compared to that of the classic chemotherapeutics. This article reviews the dermatological toxicities of the targeted therapies, with 11 clinical cases, including mucositis and oral toxicities, the acne-like eruptions, nail changes and complications, the «hand/foot» syndrome, radiosensitization, alopecias, xerosis and skin fissures. After a brief clinical case presentation and theoretical issues, the clinical management is discussed in detail.

The treatment of locally advanced or metastatic cutaneous squamous cell carcinoma (cSCC) essentially relies on surgery and eventually radiotherapy of the treated site and afferent lymph nodes. Unfortunately, some cases are no candidates for surgery or radiotherapy and a systemic treatment may be indicated. Chemotherapies are only partially efficacious and associated with potential toxicities. A recent study evaluating the efficacy and tolerance of cemiplimab, a PD1 antagonist for locally advanced and metastatic cSCC demonstrated an objective response rate of 49 % and 47 % for locally advanced and metastatic cSCC, while maintaining a response of at least 6 months of 63 % and 60 %, respectively. We present a clinical case of a patient with a locally advanced cSCC of the forehead with bone resorption and cervical lymphadenopathies. After failure of multiple surgical interventions and radiotherapies, he responded partially to cemiplimab immunotherapy with a good safety profile.

Hidradenitis suppurativa (HS), also known as Verneuil's disease and acne inversa, is a chronic inflammatory skin disease characterized by a dysfunction of the pilosebaceous structures resulting in occlusion and inflammation. The disease usually starts after puberty, on average between twenty and thirty years, with subcutaneous painful inflammatory nodules, abscess collections, fistulization and scars mainly in the axillary, inguinal, sub-mammary, perineal and perianal regions. It is a multifactorial disease with the most commonly cited risk factors or aggravating factors being smoking, obesity, and HS family history. The first line of treatment relies on antibiotics, including tetracyclins, clindamycin and rifampycin. In case of non-response, TNF? antagonists, more specifically adalimumab, may be considered.

Les moisissures et/ou les levures peuvent jouer un rôle important dans l’induction des poussées et de la persistance de la DA et de l’AR. Nous avons voulu déterminer les taux de sensibilisation aux moisissures et aux levures chez les patients atteints d’AR par rapport à ceux atteints de DA, qui ont consulté notre service, durant une année. Des prick-tests ont été effectués chez 267 patients (172 femmes et 95 hommes, âge médian 38 ans, de 25–50 ans). Les patients ont été classés en 4 groupes : dermatite atopique de la tête et du cou (DA) (n = 64), eczéma du tronc (eczéma) (n = 52), allergies respiratoires (AR) (n = 64 : rhinite, conjonctivite, asthme) et groupe témoin (n = 87 : dermatite séborrhéique, sébopsoriasis, urticaire, allergie alimentaire et sujets sains). Les extraits aqueux commerciaux standardisés suivants ont été utilisés dans des conditions standardisées : Alternaria, Penicillium, Aspergillus, Cladosporium, Candida albicans, Malassezia et Saccharomyces cerevisiae. Le taux de sensibilisation aux moisissures était significativement plus élevé dans la DA et l’AR. Il était presque équivalent dans l’eczéma et dans le groupe témoin. Le taux de sensibilisation à l’Alternaria et au Penicillium était significativement plus élevé dans la DA (25 %) que dans l’AR (15 %). Celui à l’Aspergillus et au Cladosporium était similaire dans la DA et l’AR. Dans la DA, le taux de sensibilisation aux levures était significativement plus élevé. Il était similaire dans l’eczéma, l’AR et le groupe témoin. Celui à Malassezia était significativement plus élevé dans la DA que dans le groupe témoin. Les taux de sensibilisation aux moisissures étaient élevés dans la DA et l’AR. La sensibilisation maximale était observée à l’Alternaria et au Penicillium dans la DA. Les mêmes moisissures étaient souvent isolées dans l’échantillon d’air ambiant prélevé au domicile du patient en cas de test cutané positif. Dans la DA, les taux de sensibilisation aux levures surtout au Malassezia étaient les plus élevés. Les taux élevés de sensibilisation à ces allergènes dans la DA et l’AR confirment l’intérêt de leur recherche pour adapter les mesures d’éviction et les orientations thérapeutiques.

Background: Mycosis fungoides (MF) is the most frequent type of primary cutaneous NK and T-cell lymphoma (pCNKTCL). MF-required immunosuppressive therapies and MF-related immunosuppressive characteristics render patients with MF more prone to infections. Aim: To describe the clinical features of cutaneous infections observed in MF patients. Materials and Methods: A series of 56 MF patients were followed prospectively over three years and screened for cutaneous infections. Type of study: Prospective observational study. Results: Four herpes simplex virus type-1 (HSV-I), 2 staphylococcal (S. aureus) impetiginizations and 2 Malassezia infections were detected in single isolated plaque/patch stage MF as well as 1 varicella zoster virus (VZV) infection (herpes zoster (HZ)) and 2 cases of cellulitis in 10 patients. All patients presented advanced MF. All the diagnoses were delayed due to atypical clinical presentations. Conclusions: Patients with advanced MF should be particularly monitored for skin infections, especially by HSV and S. aureus. Unexplained exacerbation or the sudden appearance of oozing or ulcerations in MF lesions should initiate a search for viral or bacterial agents. Cellulitis and HZ can be more severe and prolonged in MF patients.

Background: Mycosis fungoides (MF) is the most frequent type of primary cutaneous natural killer and T-cell lymphoma. MF-required immunosuppressive therapies and MF-related immunosuppressive characteristics render patients with MF more prone to infections. Aim: To describe the clinical features of cutaneous infections observed in MF patients. Materials and Methods: A series of 56 MF patients were followed prospectively over 3 years and screened for cutaneous infections. Type of Study: Prospective observational study. Results: Four herpes simplex virus type-I (HSV-I), 2 staphylococcal (S. aureus) impetiginizations and 2 Malassezia infections were detected in single isolated plaque/patch stage MF as well as 1 varicella zoster virus infection (herpes zoster, HZ) and 2 cases of cellulitis in 10 patients. All patients presented advanced MF. All the diagnoses were delayed due to atypical clinical presentations. Conclusions: Patients with advanced MF should be particularly monitored for skin infections, especially by HSV and S. aureus. Unexplained exacerbation or the sudden appearance of oozing or ulcerations in MF lesions should initiate a search for viral or bacterial agents. Cellulitis and HZ can be severer and prolonged in MF patients.

There are no demographic data published on those with viral infections of the pubis (VIPs). We conducted a two-year prospective study to collect demographic information on patients with VIPs. Data were gathered on age, sex, diagnosis, low (≤10) or high (>10) lesion number, symptoms, how the patient discovered the lesions, localization, lesions beyond the pubis, risk factors, shaving habits, human papillomavirus (HPV) vaccination status and treatment. In a total of 61 patients, molluscum contagiosum (MC) was identified in 71%, condylomata acuminata (CA) in 11%, concomitant MC and CA infections in 11% and herpes simplex virus (HSV) infection in 4.8%. Shaving represented a risk factor for a high lesion number, but not for the extension beyond the pubis. MC, CA and HSV infections affecting the pubis are uncommon and often asymptomatic. As they may represent a hidden source of infection we recommend thorough inspection of the pubis during routine skin examination.

The TNFalpha antagonists, including adalimumab, etanercept and infliximab, represent a class of anti-inflammatory and immunosuppressive drugs. Although cutaneous adverse effects are uncommon, they are varied. There is no particular risk profile to develop cutaneous adverse effects. The principal acute side effects are injection site reactions and pruritus. The major long term cutaneous side effects are infectious and inflammatory conditions. Neoplastic skin diseases are exceptional. The association with other immunosuppressive agents can increase the risk of developing cutaneous adverse effects. Some adverse effects, such as lupus erythematosus, require immediate withdrawal of the biological treatment, while in other cases temporary withdrawal is sufficient. The majority of the other cutaneous adverse effects can be dealt without interrupting biologic treatment. Preclinical and clinical investigations revealed that the new biologics, aiming IL12/23, IL23 and IL17, present a similar profile of cutaneous adverse effects, although inflammatory skin reactions may be less often encountered compared to TNFalpha antagonists.

In Tanzania, the impact, on clinical outcomes and treatment-seeking behaviour, of a rural, nurse-led clinic that provides free, antivenom-based treatment of snakebite envenomation was recently assessed. Data on all 85 patients who, between April 2007 and the end of 2009, received treatment for snakebite envenomation at the Snake Park clinic in Meserani, Tanzania, were collected prospectively. Although only four cases of snakebite envenomation were treated in the last 9 months of 2007, 34 such cases were treated in 2008 and 47 in 2009. The 85 snakebite cases had a mean age of 23 years and a male:female ratio of 1.4. Most of the bites occurred in the evening or at night and most also occurred during the rainy season. In some cases, the seeking of treatment from traditional healers delayed treatment at the clinic. After being bitten, the snakebite cases travelled a mean of 82 km (range=2-550 km) to reach the clinic. Thirty-two (37%) of the cases were each unable to identify the snake that had bit them. Of the bites in which the snake was identified, the puff adder (Bitis arietans) caused more (24) than any other snake. Forty-two of the snakebite cases received antivenom. Only one patient (1%), a 12-year-old girl, was believed to have died as the result of a snakebite but another six (7%) each required a skin graft or the amputation of a limb or digit. Establishment of the Snake Park clinic appears to have improved access to snakebite treatment, with cases of snakebite travelling long distances to reach the clinic (because of the lack of any other source of antivenom in Tanzania). Although the clinic is nurse-led, treatment outcomes among the snakebite victims who attend the clinic appear to be good.