INTRODUCTION:UVA phototherapy, acitretin and oral corticosteroids are currently the front-line treatment of disseminated cutaneous lichen planus. We studied the efficacy of narrow band UVB therapy in this indication.PATIENTS AND METHODS:We retrospectively studied the dossiers of patients suffering from disseminated cutaneous lichen planus, treated with narrow band phototherapy in the Phototherapy Unit of the University hospital in Montpellier, from May to November of the year 2001. Disseminated lichen planus was defined as lichen involving at least 20p. 100 of the skin surface. Twenty patients were included. UVB were applied thrice weekly using a Philips TL01 cubicle (311-313 nm). The protocol was that used for the treatment of psoriasis. We defined 4 types of response: complete response (disappearance of more than 90p. 100 of the lesions), partial response (disappearance of at least 50p. 100) poor response (improvement in 20 to 50p. 100) and failure (less than 20p. 100 reduction in the lesions). Assessment of relapses in the long term was made using a telephone survey among the patients treated or their physicians.RESULTS:Complete response was obtained in 11 out of the 20 patients (55p. 100) and partial response in 4 (20p. 100), corresponding to 75p. 100 of the responders. Response was obtained with a median delay of 3 months, ranging from 2 to 6 months, following a median of 30 sessions (12 to 50) and accumulated dose of UVB of 36 +/- 4.8 joules/cm2. The phototype, gender, age and duration of evolution before treatment did not influence the response. The relapse rate was and estimated 18p. 100 (2/11) 42 months after treatment had been stopped.DISCUSSION:In our opinion, these results underline the efficacy of narrow band UVB in the treatment of disseminated cutaneous lichen planus. They confirm those of earlier studies and are superimposable with those of oral UVA phototherapy.

Introduction. UVA phototherapy, acitretin and oral corticosteroids are currently the front-line treatment of disseminated cutaneous lichen planus. We studied the efficacy of narrowband UVB therapy in this indication.Patients and methods. We retrospectively studied the dossiers of patients suffering from disseminated cutaneous lichen planus, treated with narrowband phototherapy in the Phototherapy Unit of the University hospital in Montpellier, from May to November of the year 2001. Disseminated lichen planus was defined as lichen involving at least 20P. loo of the skin surface. Twenty patients were included. UVB were applied thrice weekly using a Philips TL01 cubicle (311-313 nm). The protocol was that used for the treatment of psoriasis. We defined 4 types of response: complete response (disappearance of more than 90p. 100 of the lesions), partial response (disappearance of at least 50P. 100) poor response (improvement in 20 to 50P. 100) and failure (less than 20P. 100 reduction in the lesions). Assessment of relapses in the long term was made using a telephone survey among the patients treated or their physicians.Results. Complete response was obtained in 11 out of the 20 patients (55P. 100) and partial response in 4 (20P. 100), corresponding to 75P. 100 of the responders. Response was obtained with a median delay of 3 months, ranging from 2 to 6 months, following a median of 30 sessions (12 to 50) and acumulated dose of UVB of 36 +/- 4.8 joules/cm(2). The phototype, gender, age and duration of evolution before treatment did not influence the response. The relapse rate was and estimated 18p. 100 (2/11) 42 months after treatment had been stopped.Discussion. In our opinion, these results underline the efficacy of narrowband UVB in the treatment of disseminated cutaneous lichen planus. They confirm those of earlier studies and are superimposable with those of oral UVA phototherapy.

Sixteen psoriatic patients and 11 control subjects were investigated by immunofluorescence for skin immunoglobulins (IG) and complement (c) deposits and for keratinocyte membrane markers with anti β2 microglobulin (β 2m) antibodies (Ab), ConA, and pemphigus Ab. IG and/or c deposits were almost constant in involved epidermis. Three patterns were associated: (1) parakeratotic nuclear (dots-dashes), (2) stratum corneum (SC) intercellular (lamellar pattern), (3) vascular (granular or linear deposits in papillary dermal vessels). In uninvolved epidermis nuclear or vascular deposits could occasionnally be present but intercellular pattern was never found in SC. Control specimens were always negative.

Les concepts de continuité et de globalité des soins sont reconnus aujourd’hui par tous comme inhérents à la médecine moderne. Un groupe de travail s’est réuni pour proposer des modèles de coordination des soins de support pour toutes les maladies graves dans les différents établissements de soins privés et publics. Les « soins de support » sont : « l’ensemble des soins et soutiens nécessaire aux personnes malades, parallèlement aux traitements spécifiques, lorsqu’il y en a, tout au long des maladies graves ». Cette définition est inspirée de la définition du « supportive care » donnée en 1990 par la MASCC - Multinational Association for Supportive Care in Cancer : « The total medical, nursing and psychosocial help which the patients need besides the specific treatment ». Elle intègre autant le champ de la guérison avec éventuelles séquelles que celui des soins palliatifs dont la définition est précisée (phases palliatives initiale et terminale).

The concept of continuous and global care is acknowledged today by all as inherent to modern medicine. A working group gathered to propose models for the coordination of supportive care for all severe illnesses in the various private and public health care centres. The supportive care are defined as: "all care and supports necessary for ill people, at the same time as specific treatments, along all severe illnesses". This definition is inspired by that of "supportive care" given in 1990 by the MASCC (Multinational Association for Supportive Care in Cancer): "The total medical, nursing and psychosocial help which the patients need besides the specific treatment". It integrates as much the field of cure with possible after-effects as that of palliative care, the definition of which is clarified (initial and terminal palliative phases). Such a coordination is justified by the pluridisciplinarity and hyperspecialisation of the professionals, by a poor communication between the teams, by the administrative difficulties encountered by the teams participating in the supportive care. The working group insists on the fact that the supportive care is not a new speciality. He proposes the creation of units. departments or pole of responsibility of supportive care with a "basic coordination" involving the activities of chronic pain, palliative care, psycho-oncology, and social care. This coordination can be extended, according to the "history" and missions of health care centres. Service done with the implementation of a "unique counter" for the patients and the teams is an important point. The structure has to comply with the terms and conditions of contract (Consultation, Unit or Centre of chronic pain, structures of palliative care, of psycho-oncology, of nutrition, of social care). A common technical organization is one of the interests. The structure has to set up strong links with the private practitioners, the networks, the home medical care (HAD) and the nurses services at home (SSIAD), when they exist, to guarantee the continuity of the supportive care under all its aspects and in order to take into account the preferences of the patients. According to Hospital 2007 propositions, the extended, flexible and general purpose Group of Sanitary Cooperation (GCS) meets the necessities inherent to the structures of supportive care within the territories of health because it can be established between one or several health care centres and the private health professionals, thus favouring the cooperation between public and private health care centres. PSPH and general medicine.

espanolUn grupo de trabajo de expertos de la Asociacion Europea de Cuidados Paliativos ha revisado y actualizado sus directrices sobre el uso de morfina en el tratamiento del dolor oncologico. Las recomendaciones revisadas que presentamos aqui proporcionan directrices sobre el uso de la morfina y de opiaceos alternativos que son analgesicos potentes y que se han introducido en muchas partes del mundo en los ultimos anos. Asimismo, se sugieren estrategias practicas para hacer frente a situaciones dificiles y se exponen opiniones basadas en el consenso en aquellos casos en los que no existen evidencias. Se indica tambien la solidez de las evidencias sobre las que se basa cada recomendacion. EnglishAn expert working group of the European Association for Palliative Care has revised and updated its guidelines on the use of morphine in the management of cancer pain. The revised recommendations presented here give guidance on the use of morphine and the altemative strong opioid analgesics which have been introduced in many parts of the world in recent years. Practical strategies for dealing with difficult situations are described presenting a consensus view where supporting evidence is lacking. The strength of the evidence on which each recommendation is based is indicated.

BACKGROUND:Ultraviolet (UV) B-induced effects on the skin immune system have been extensively investigated, but little is known regarding the immunological changes induced by UVA exposure of human skin. Recent data assessing the protection afforded by sunscreens against photoimmunosuppression stress the need for broad-spectrum sunscreens with an adequate UVA protection.OBJECTIVES:The purpose of this study was first to determine the changes observed in epidermal Langerhans cells (ELC) density and epidermal antigen-presenting cell (APC) activity after exposure of human skin to UVAI (340-400 nm) radiation, and secondly to assess the immune protection afforded in vivo by a sunscreen formulation containing a long wavelength UVA filter with a low UVA protection factor (UVA-PF = 3).METHODS:Epidermal cell (EC) suspensions were prepared from skin biopsies 3 days after exposure to a single dose of UVAI (either 30 or 60 J cm(-2)).RESULTS:Flow-cytometric analysis of EC suspensions revealed that exposure to 60 J cm(-2) UVAI resulted in a decreased number of ELC without infiltration of CD36+ DR+ CD1a- antigen-presenting macrophages into the epidermis, and a significant reduction of HLA-DR expression on viable ELC. In vivo exposure to both 30 and 60 J cm(-2) resulted in a decreased allogeneic CD4+ T-cell proliferation induced by UVAI-irradiated ECs. The sunscreen application partially prevented (57 +/- 9%) the decrease in epidermal allogeneic APC activity induced by 60 J cm(-2) UVAI.CONCLUSIONS:In vivo UVAI exposure of human skin results in a decreased number of ELC and in a downregulation of epidermal APC activity. This last effect is partially prevented by prior application of a sunscreen with a low UVAI-PF value. These results indicate that increasing the absorption of UV filters for long UVA wavelengths may lead to an improved immune protection.

An expert working group of the European Association for Palliative Care has revised and updated its guidelines on the use of morphine in the management of cancer pain. The revised recommendations presented here give guidance on the use of morphine and the alternative strong opioid analgesics which have been introduced in many parts of the world in recent years. Practical strategies for dealing with difficult situations are described presenting a consensus view where supporting evidence is lacking. The strength of the evidence on which each recommendation is based is indicated. © 2001 Cancer Research Campaign

The increased incidence of skin cancers is due to modifications of our behavior toward solar exposure. Photocarcinogenesis represents the sum of complex and intricate events that lead to the occurrence of skin cancers.In epidermal cells UV light induces lesions of DNA that lead to modifications in oncogene and tumor suppressor gene expression. UV-induced immunosuppression is also important for tumoral promotion. UV exposure decreases the number of Langerhans cells in the epidermis and modifies their antigen-presenting cell capacity. Numerous experimental data obtained in animal models clearly indicate the existence of a relationship between UV-induced immune suppression and skin cancers. In humans, growing evidence suggests that skin cancers and photoimmunosuppression are linked.Better knowledge of mechanisms involved in UV-induced immune suppression is essential for developing new strategies aimed at photoprotection and cancer prevention.

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<0.001).

Background: Cutaneous exposure to UVB radiation impairs the induction of contact hypersensitivity (CHS). Variable results have been found among studies examining the use of sunscreens to prevent UV-induced immunosuppression. Objective: Our purpose was to determine whether solar-simulated exposure of human skin resulted in an impairment of CHS responses and whether the preapplication of an intermediate sun protection factor (SPF) sunscreen could prevent this locally UV-induced immunosuppression. Methods: Irritant and CHS responses to dinitrochlorobenzene (DNCB) were randomly assessed in 160 human volunteers with or without UV exposure and with or without prior application of an SPF 15 sunscreen with high UVA protection. DNCB sensitization was performed 3 days after acute UV irradiation corresponding to 3 minimal erythema doses. Results: After solar-simulated UV exposure, the percentage of positive responses to DNCB sensitization dropped from 95% to 50% ( p = 0.003). Prior application of the sunscreen formulation did not modify the percentage of positive responses (90%) and maintained the immunization rate at 85% among volunteers exposed to UV. Conclusion: A localized sunburn can impair the afferent arm of CHS reactions in humans. The use of intermediate SPF sunscreens with high UVA protection adequately protects from the suppression of CHS responses that occurs after acute solar-simulated UV exposure.

Grab, J J; Dreno, B; Delaunay, M; Chastang, C; Cupissol, D; Guillot, B; Souteyrand, P; Sassolas, B; Cesarini, J P; Lyonnet, S; Lok, C; Mansat, E; Lacour, J P; Thomas, L; Beylot, M; Truchetet, F; de la Salmonière, P; Chemaly, C; Lorette, G; Meynadier, J; Thyss, R; Avrii, M F; Prigent, F; Chevrant-Breton, J; Dalac, S; Fargeot, C; Amblard, P; Schaerrer, E; Thill, L; Massimini, G; Royer, P Author Information

Journal Article Adult cutaneous Langerhans cell histiocytosis: remission with thalidomide treatment Get access L. Meunier, L. Meunier Department of Dermatology, Hôpital St Charles, 300 rue Auguste Broussonnet, University of Montpellier, Montpellier, France Search for other works by this author on: Oxford Academic Google Scholar Y. Marck, Y. Marck Department of Dermatology, Hôpital St Charles, 300 rue Auguste Broussonnet, University of Montpellier, Montpellier, France Search for other works by this author on: Oxford Academic Google Scholar C. Ribeyre, C. Ribeyre Department of Dermatology, Hôpital St Charles, 300 rue Auguste Broussonnet, University of Montpellier, Montpellier, France Search for other works by this author on: Oxford Academic Google Scholar J. Meynadier J. Meynadier Department of Dermatology, Hôpital St Charles, 300 rue Auguste Broussonnet, University of Montpellier, Montpellier, France Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 132, Issue 1, 1 January 1995, Page 168, https://doi.org/10.1111/j.1365-2133.1995.tb08659.x Published: 01 January 1995

INTRODUCTION Nocardiasis is caused by a germ belonging to the Actinomycetales order. Skin disease usually occurs as a secondary localization of a pulmonary infection in an immunocompromised patient. Purely cutaneous lesions usually occur in immunocompetent subjects. CASE REPORT We observed primary cutaneous nocardiasis due to N. asteroides with a cold abscess in a patient with a pemphigoid given immunodepression treatment. DISCUSSION Primary cutaneous nocardiasis can occur by direct contamination of a skin wound. In our patient with a pemphigoid given immunodepression treatment, the erosion of a pemphigoid bulla and general corticosteroid treatment favoured the localized infection. Cure could not be obtained until after 7 months treatment. This long course can be explained by the need to continue high-dose general corticosteroids to control the pemphigoid.