RESUMELe psoriasis est une maladie inflammatoire chronique pouvant être associée à de nombreuses comorbidités.Le développement des agents biologiques a révolutionné la prise en charge des patients psoriasiques.Ces biothérapies sont devenues indispensables dans l'arsenal thérapeutique du psoriasis modéré à sévère.Elles sont cependant associées à des contreindications et certains effets secondaires qui nécessitent une bonne connaissance des molécules et une habitude de prescription.

Journal of the European Academy of Dermatology and VenereologyVolume 22, Issue 4 p. 514-515 Is sentinel lymph node biopsy useful in regressive and/or ulcerated thin cutaneous melanomas? A Hutin, A Hutin Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorM Heenen, M Heenen Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorP Vereecken, P Vereecken Department of Dermatology, Erasme Hospital, Brussels, Belgium, CHU-Brugmann, Brussels, Belgium, and Bordet, Brussels, BelgiumSearch for more papers by this authorJ Van Geertruyden, J Van Geertruyden Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorO De Lathouwer, O De Lathouwer Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorE Steels, E Steels Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorL Gordower, L Gordower Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorM Trakatelli, M Trakatelli Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorM Laporte, M Laporte Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this author A Hutin, A Hutin Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorM Heenen, M Heenen Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorP Vereecken, P Vereecken Department of Dermatology, Erasme Hospital, Brussels, Belgium, CHU-Brugmann, Brussels, Belgium, and Bordet, Brussels, BelgiumSearch for more papers by this authorJ Van Geertruyden, J Van Geertruyden Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorO De Lathouwer, O De Lathouwer Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorE Steels, E Steels Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorL Gordower, L Gordower Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorM Trakatelli, M Trakatelli Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this authorM Laporte, M Laporte Department of Dermatology, Erasme Hospital, Brussels, Belgium,Search for more papers by this author First published: 19 July 2007 https://doi.org/10.1111/j.1468-3083.2007.02376.xCitations: 2 *Corresponding author, tel. +32 (0)2 5554612; fax +32 (0)2 5554164; E-mail: [email protected] DOI: 10.1111/j.1468-3083.2007.02376.x 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 onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Lens MB, Dawes M, Newton-Bishop JA, Goodacre T. Tumour thickness as a predictor of occult lymph node metastases in patients with stage I and II melanoma undergoing sentinel lymph node biopsy. Br J Surg 2002; 89: 1223–1227. 2 Kesmodel SB, Karakousis GC, Botbyl JD et al . Mitotic rate as a predictor of sentinel lymph node positivity in patients with thin melanomas. Ann Surg Oncol 2005; 12: 449–458. 3 Nguyen CL, McClay F, Cole DJ et al . Melanoma thickness and histology predict sentinel lymph node status. Am J Surg 2001; 181: 8–11. 4 Guitart J, Lowe L, Piepkorn M et al . Histological characteristics of metastasizing thin melanomas. Arch Dermatol 2002; 138: 603–608. 5 Cook MG, Spatz A, Bröcker EB, Ruiter DJ. Identification of histological features associated with metastatic potential in thin (< 1.0 mm) cutaneous melanoma with metastases. A study on behalf of the EORTC Melanoma Group. J Pathol 2002; 197: 188–193. 6 Vereecken P, Laporte M, Petein M, Steels E, Heenen M. Evaluation of extensive initial staging procedure in intermediate/high risk melanoma patients. J Eur Acad Dermatol Venereol 2005; 19: 66–73. 7 King R, Googe PB, Mihm MC. Thin melanomas. Clin Lab Med 2000; 20: 713–729. 8 Ranieri JM, Wagner JD, Wenck S, Johnson CS, Coleman JJ 3rd. The prognostic importance of sentinel lymph node biopsy in thin melanoma. Ann Surg Oncol 2006; 13: 927–932. Citing Literature Volume22, Issue4April 2008Pages 514-515 ReferencesRelatedInformation

Melioidosis is a tropical disease caused by infection with the bacterium Burkholderia pseudomallei. Most cases present as an acute febrile illness with severe pneumonia and sepsis. Sub-acute and late onset disease can also occur Melioidosis has been diagnosed among travellers who contracted the disease while staying in endemic areas during the rainy season. We report a case of travel-associated B. pseudomallei cutaneous infection in a febrile 90-year-old woman with diabetes mellitus, with early stage manifestations of an isolated inoculation lesion. A 32 weeks' treatment with oral amoxicillin-clavulanate and doxycycline combination regimen led to resolution of the lesion and lack of relapse over fifteen months of follow-up. Melioidosis should be considered in the differential diagnosis of unusual subacute cutaneous lesions in a febrile patients returning from endemic areas, as successful management largely depends on early diagnosis and specific long-term suppressive antimicrobial therapy at an early stage of the course of the disease.

Cutaneous Fluorescence Diagnosis (FD) is a new promising dermatological procedure which is based on the combination of a local application of a photosensitizer such as 5-aminolevulinic acid (ALA) or its methyl ester (MAL) and the use of a light source (red light) adapted to the absorption spectrum of these molecules. The targeted photosensitization of skin cancers, particularily superficial and extensive lesions including superficial basal cell carcinoma and Bowen's disease, by ALA or MAL induced porphyrins leads to a selective red fluorescence which can be demonstrated by Wood's lamp. This technique may be useful either to define better the choice of margins or to detect earlier and or multifocal recurrences.

Journal Article Long‐term benefit of combined radiofrequency ablation and surgery in a patient with AJCC stage IV metastatic melanoma Get access E. Steels, E. Steels Department of Dermatology Search for other works by this author on: Oxford Academic Google Scholar V. Donckier, V. Donckier Medicosurgical Department of Gastroenterology Search for other works by this author on: Oxford Academic Google Scholar P. Flamen, P. Flamen Nuclear Medicine Search for other works by this author on: Oxford Academic Google Scholar D. Blocklet, D. Blocklet Department of Nuclear Medicine, Erasme Hospital, Universite Libre de Bruxelles, Brussels, Belgium Search for other works by this author on: Oxford Academic Google Scholar F. Sales, F. Sales Surgery Search for other works by this author on: Oxford Academic Google Scholar P. Vereecken P. Vereecken Department of Dermatology††Medical Oncology, Jules Bordet Institute, Brussels, BelgiumDepartment of Dermatology, CHU Brugmann, Brussels, Belgium E‐mail: vereecken.pierre@belgacom.net Search for other works by this author on: Oxford Academic Google Scholar Clinical and Experimental Dermatology, Volume 32, Issue 1, 1 January 2007, Pages 100–101, https://doi.org/10.1111/j.1365-2230.2006.02230.x Published: 01 January 2007 Article history Accepted: 07 June 2006 Published: 01 January 2007

Hutin, A.; Heenen, M.; Vereecken, P.; Van Geertruyden, J.; De Lathouwer, O.; Steels, E.; Gordower, L.; Trakatelli, M.; Laporte, M. Author Information

Hydroxyurea is an antitumour agent used most commonly to treat myeloproliferative disorders. We present a clinical observation illustrating different cutaneous side effects susceptible to occur during a long-term treatment by hydroxyurea : leg ulceration, oral ulcer and spinocellular carcinoma. This clinical observation is completed by a review of the literature published on the cutaneous side effects of hydroxyurea treatment.

Urinary Incontinence (UI) affects over 13 million people in the United States. Individuals with UI and overactive bladder (OB) who have consumed UroLogic™, a dietary supplement containing Crateva nurvala bark extract and standardized Equisetum arvense report a reduction in frequency, nocturia, leakage and urgency symptoms associated with UI/OB. In vitro assays have found Urologic exhibits antioxidant activity in the following assays: peroxyl oxygen radical absorbance capacity (ORAC) assay, hydroxyl radical scavenging activity (HORAC) assay, peroxynitrite radical scavenging assay (NORAC). Significant inhibition was found in formation of reactive oxygen species (ROS) in fresh human neutrophil cells. Bacterial reverse mutagenicity assay found that Urologic™ is non-mutagenic in all six strains. To determine if Urologic is a potential inducer of human cytochrome P450 (CYP1A2 and CYP3A4) an assay using immortalized human hepatocytes (Fa2N-4 cells) found a lack of interference of P450 cytochromes as preliminary evidence of its safety when taken with other medications. A 12-week open-label study in 8 women demonstrated a reduction in the frequency of daytime microturition (51%), episodes of nocturia (70%), associated with a 68.4% improvement in quality of life on the Incontinence Impact Questionnaire (IIQ) and Urogenital Distress Inventory (UDI). Preliminary evidence suggests that Urologic™ may be a safe treatment option to reduce symptoms associated with UI /OB. Funding Source: Biologic Health Solutions Pty Ltd., Brisbane, Australia

INTRODUCTION:Early diagnosis and treatment of metastases have been shown to improve overall survival of melanoma patients. The purpose of this study was to evaluate the impact of extensive initial staging, including positron emission tomography (PET) scan on the management of melanoma patients. PATIENTS AND METHODS:Forty-three patients with intermediate/poor prognosis primary melanoma benefited from complementary excision and sentinel lymph node biopsy (SLB) after clinical and paraclinical staging (computed tomography, nuclear magnetic resonance and whole body fluorodeoxyglucose PET scan). RESULTS:No systemic metastases were demonstrated, while the SLB procedure emphasized the presence of regional lymph node metastases in 10 patients as suggested by the PET scan in four patients (sensitivity of the PET scan 40%). These 10 patients with early diagnosed lymph node involvement benefited from early surgery and were included in adjuvant treatment protocols. A secondary primary cancer was fortuitously diagnosed and treated early in two patients. CONCLUSIONS:The development of new adjuvant therapies and therapeutic procedures (specific and non-specific immunotherapy, gamma-knife radiosurgery, etc.) now raises the relevance of extensive staging in intermediate/poor prognosis melanoma patients. We confirm in our series that PET scan is not useful to detect micrometastasis and cannot replace SLB in initial regional staging. However, we show in our study that 12 of 43 patients were treated early or were included early in treatment protocols thanks to the extensive staging procedure. Nevertheless, it seems important to evaluate through larger prospective trials the real impact of these early diagnoses and new treatments on overall survival before defining new diagnostic and therapeutic guidelines.

PURPOSE:Graft-versus-host disease (GVHD) is one of the major complications of allogeneic bone marrow transplantation. Twenty-two patients, who had an allogeneic bone marrow transplantion at the Institute J. Bordet, developed a GVHD proven by a biopsy.RESULTS:Twenty-two cases of GVHD were registered; 17 of these patients suffered from the acute form of the disease. All the patients presented the characteristic skin lesions, usually associated with other organ involvement. Most of the cases suffered from relapse after a time-limited response or from resistance to therapy, despite an effective treatment. Uncontrolled GVHD led to the death of two patients.CONCLUSION:GVHD is a frequent pathology that significantly contributes to the morbidity and mortality associated with bone marrow transplantation, despite appropriate management. Recognition of clinical and histopathological features of GVHD is important for dermatologists involved in the care of bone marrow transplant patients. Actually, bone marrow transplantation is now easily and more frequently performed than in the past.

The role of the anti-apoptotic protein Bcl-2 in lung cancer remains controversial. In order to clarify its impact on survival in small and non-small cell lung cancer (NSCLC), we performed a systematic review of the literature. Trials were selected for further analysis if they provided an independent assessment of Bcl-2 in lung cancer and reported analysis of survival data according to Bcl-2 status. To make it possible to aggregate survival results of the published studies, their methodology was assessed using a quality scale designed by the European Lung Cancer Working Party (including study design, laboratory methods and analysis). Of 28 studies, 11 identified Bcl-2 expression as a favourable prognostic factor and three linked it with poor prognosis; 14 trials were not significant. No differences in scoring measurement were detected between the studies, except that significantly higher scores were found in the trials with the largest sample sizes. Assessments of methodology and of laboratory technique were made independently of the conclusion of the trials. A total of 25 trials, comprising 3370 patients, provided sufficient information for the meta-analysis. The studies were categorised according to histology, disease stage and laboratory technique. The combined hazard ratio (HR) suggested that a positive Bcl-2 status has a favourable impact on survival: 0.70 (95% confidence interval 0.57-0.86) in seven studies on stages I-II NSCLC; 0.50 (0.39-0.65) in eight studies on surgically resected NSCLC; 0.91 (0.76-1.10) in six studies on any stage NSCLC; 0.57 (0.41-0.78) in five studies on squamous cell cancer; 0.75 (0.61-0.93) and 0.71 (0.61-0.83) respectively for five studies detecting Bcl-2 by immunohistochemistry with Ab clone 100 and for 13 studies assessing Bcl-2 with Ab clone 124; 0.92 (0.73-1.16) for four studies on small cell lung cancer; 1.26 (0.58-2.72) for three studies on neuroendocrine tumours. In NSCLC, Bcl-2 expression was associated with a better prognosis. The data on Bcl-2 expression in small cell lung cancer were insufficient to assess its prognostic value.

The process of angiogenesis is an important factor in tumour development. One of the principal factors implicated in this process is vascular endothelial growth factor (VEGF) which induces, among other things, an increase in vascular permeability. We have undertaken a systematic review of the English and French literature in order to clarify its effect on the survival of patients with small cell (SCLC) and non-small cell (NSCLC) lung cancer. To be eligible studies had to deal with the the evaluation of VEGF or its receptors in lung cancer and describe the relationship of their expression to survival. The survival figures were subject to meta-analysis after a methodological evaluation by means of a specific numerical scale evaluating the design of the study, the methodology (including laboratory techniques), and the analysis of results. Among the 20 studies selected 15 identified VEGF expression, using univariate analysis, as a statistically significant indicator of poor prognosis. 17 reported sufficient data to allow aggregation of the survival figures, of which 15 were devoted to NSCLC (1,549 patients). The median overall methodological score was 48.3% (range 21.8-72.4%), without significant difference (p=0.63) between studies eligible or non-eligible for meta-analysis. The meta-analysis, using the authors' threshold of positivity for VEGF, showed that VEGF is an unfavourable prognostic factor in NSCLC (HR=1.48; 95% confidence interval 1.27-1.72). The data were insufficient to determine the prognostic value of VEGF in SCLC and that of its two receptors Flt-1 and KDR, with 1, 2 and 1 published studies respectively. In conclusion the expression of VEGF in MSCLC is a factor indicating a poor prognosis.

The effectiveness of granulocyte and granulocyte-macrophage colony-stimulating factor (G-CSF and GM-CSF) in the treatment of febrile neutropenic cancer patients remains controversial. To assess their role in this condition, we conducted a systematic review of randomised trials published as full papers. A methodological evaluation using a specifically designed quality scale was performed before meta-analysis. Eleven trials were eligible, 8 of which were meta-analysable. The median quality score for the 11 pooled trials was 58.3% (range: 33.3%–68.8%). No significant quality difference was observed between positive (colony-stimulating factor more effective) and negative trials (P=0.36). No quality difference was observed between the 8 meta-analysable studies and the 3 others, with respective median scores of 59.3% and 50%. No advantage was detected for the use of CSF in terms of mortality from febrile neutropenia, with a relative risk of 0.71 (95% CI 0.44–1.15). The relative risk was 0.66 (95% CI 0.39–1.13) in the G-CSF subgroup and 0.97 (95% CI 0.34–2.79) in the GM-CSF subgroup. Aggregation of the results on infection-related mortality, length of stay in hospital, fever and of neutropenia duration, antibiotic therapy adaptation and duration, superinfection rate and toxicity was not possible owing to the lack of adequate data in the publications. On the basis of this review, we cannot recommend the routine use of G-CSF or GM-CSF in established febrile neutropenia.

The prognostic value of epidermal growth factor receptor (EGF-R) for survival of patients with lung cancer remains controversial. The authors performed a systematic review of the literature in order to clarify its impact. Published studies were identified using an electronic search in order to aggregate the available survival results, after a methodological assessment using a scale specifically designed by the European Lung Cancer Working Party (ELCWP). To be eligible, a study had to have dealt with EGF-R assessment in lung cancer patients on the primary site and to have analysed survival according to EGF-R expression. Among the 16 eligible studies, 14 assessed any nonsmall-cell lung cancer (NSCLC) subtype, one adenocarcinoma only and one squamous-cell carcinoma only. The overall median quality score was 56.3%, with no significant difference either between studies assessable or not assessable for meta-analysis or between studies with significant and nonsignificant results. One individual trial reported a survival benefit for patients with EGF-R expression, three a survival disadvantage and 12 no statistically significant difference. Eleven studies (2,185 patients) provided sufficient data to allow a meta-analysis of the survival results. EGF-R expression positivity was determined according to the cut-off as determined by the authors. The meta-analysis showed that EGF-R expression was not a statistically significant prognostic factor for survival in NSCLC. In the subgroup of studies using immunohistochemistry, statistical tests reached a significant level against EGF-R. Epidermal growth factor receptor might be a poor prognostic factor for survival in nonsmall-cell lung cancer. The amplitude of the impact is small, however, and may be subject to publication bias.

Une revue systematique de la litterature sur le role de la chimiotherapie par rapport aux traitements locaux - chirurgie et radiotherapie -dans les cancers bronchiques non a petites cellules a permis d'identifier 35 etudes randomisees. L'evaluation methodologique n'a pas mis en evidence de difference significative de scores de qualite entre les etudes positives ou negatives en termes d'effet sur la survie. L'agregation (meta-analyse) montre un effet significatif d'amelioration de la survie avec la chimiotherapie, que l'on prenne en consideration l'ensemble des indications, ou des sous-groupes particuliers comme la chimiotherapie adjuvante a la chirurgie, la chimiotherapie neo-adjuvante, la radio-chimiotherapie concomitante ou la chimiotherapie premiere avant radiotherapie thoracique.

The role of p53, as a prognostic factor for survival in lung cancer, is controversial and the purpose of the present systematic review of the literature is to determine this effect. Published studies were identified with the objective to aggregate the available survival results after a methodological assessment using a scale specifically designed by the European Lung Cancer Working Party (ELCWP). To be eligible, a study had to deal with p53 assessment in lung cancer (primary site) only, and to provide a survival comparison according to the p53 status. Among the 74 eligible papers, 30 identified p53 abnormalities as a univariate statistically significant poor prognostic factor and 56 provided sufficient data to allow survival results aggregation. There was no significant difference between the trials that either showed or did not show a prognostic effect of p53 according to the methodological score or to the laboratory technique used. The studies were categorized by histology, disease stage, treatment and laboratory technique. Combined hazard ratios suggested that an abnormal p53 status had an unfavourable impact on survival: in any stage nonsmall cell lung cancer (NSCLC) the mean (95% confidence interval) was 1.44 (1.20-1.72) (number of studies included in the subgroup was 11), 1.50 (1.32-1.70) in stages I-H NSCLC (n=19), 1.68 (1.23-2.29) in stages I-IIIB NSCLC (n=5), 1.68 (1.30-2.18) in stages III-IV NSCLC (n=9), 1.48 (1.29-1.70) in surgically resected NSCLC (n=20), 1.37 (1.02-1.85) in squamous cell carcinoma (n=9), 2.24 (1.70-2.95) in adenocarcinoma (n=9), 1.57 (1.28-1.91) for a positive immunohistochemistry with antibody 1801 (n=8), 1.25 (1.09-1.43) for a positive immunohistochemistry with antibody DO-7 (n=16), and 1.65 (1.35-2.00) for an abnormal molecular biology test (n=13). Data were insufficient to determine the prognostic value of p53 in small cell lung cancer. In each subgroup of nonsmall cell lung cancer, p53 abnormal status was shown to be associated with a poorer survival prognosis.

In order to clarify the role of mitomycin (MMC) in the treatment of NSCLC, we performed a systematic review of the literature and qualitatively assessed the selected studies using the ELCWP and Chalmers scales. 5 trials (202 patients) assessed the activity of MMC as single-agent chemotherapy in NSCLC. The overall response rate was 25% (95% Cl 19–31). In 10 randomized phase III trials (1769 patients), we studied the role of MMC in combination therapy. A meta-analysis, based on the available published data, failed to show any survival advantage of the MMC containing regimens (hazard ratio = 0.95; 95% Cl 0.83–1.10). Finally, 4 eligible trials (139 patients) assessed the activity of MMC regimens as salvage therapy, 3 in combination with vindesine and one with cisplatin and vinblastine. The overall response rate for the MMC-vindesine regimen was 10.5% (95% Cl 1.7–19.4). In conclusion, MMC is an active drug for NSCLC but does not improve survival when combined with other active drugs, particularly cisplatin. Its use for salvage therapy appears to be associated with marginal activity only. © 2001 Cancer Research Campaign http://www.bjcancer.com