Journal of the European Academy of Dermatology and VenereologyVolume 33, Issue 12 p. e476-e478 Letter to the Editor Factors that may influence the choice for initiating apremilast or methotrexate treatment for psoriasis in real-world clinical setting A.-C. Fougerousse, Corresponding Author A.-C. Fougerousse ac.fougerousse@gmail.com orcid.org/0000-0002-2850-867X Dermatology Department, Hôpital d'Instruction des Armées Bégin, Saint Mandé, FranceCorrespondence: A.-C. Fougerousse. E-mail: ac.fougerousse@gmail.comSearch for more papers by this authorF. Maccari, F. Maccari Private Office, La Varenne Saint Hilaire, FranceSearch for more papers by this authorA. Beauchet, A. Beauchet Department of Public Health, Centre Hospitalier Universitaire Ambroise Paré, APHP & UVSQ, Université Paris-Saclay, Boulogne-Billancourt, FranceSearch for more papers by this authorJ. Parier, J. Parier Private Office, La Varenne Saint Hilaire, FranceSearch for more papers by this authorC. Boulard, C. Boulard Dermatology Department, Hôpital du Havre, Montivilliers, FranceSearch for more papers by this authorP.-A. Becherel, P.-A. Becherel Dermatology Department, Hôpital Privé d'Antony, Antony, FranceSearch for more papers by this authorN. Quiles-Tsimaratos, N. Quiles-Tsimaratos Dermatology Department, Hôpital Saint-Joseph, Marseille, FranceSearch for more papers by this authorT. Le Guyadec, T. Le Guyadec Dermatology Department, Hôpital d'Instruction des Armées Percy, Clamart, FranceSearch for more papers by this authorD. Thomas-Beaulieu, D. Thomas-Beaulieu Dermatology Department, Centre Hospitalier Intercommunal Poissy-Saint Germain en Laye, Poissy, FranceSearch for more papers by this authorB. Halioua, B. Halioua orcid.org/0000-0002-0823-6750 Private Office, Paris, FranceSearch for more papers by this authorE. Begon, E. Begon orcid.org/0000-0001-6112-0549 Dermatology Department, Hôpital René Dubos, Pontoise, FranceSearch for more papers by this authorM. Bastien, M. Bastien Private Office, Joinville-le-Pont, FranceSearch for more papers by this authorJ.-L. Perrot, J.-L. Perrot Dermatology Department, Centre Hospitalier Universitaire, Saint Etienne, FranceSearch for more papers by this authorV. Pallure, V. Pallure Dermatology Department, Centre Hospitalier, Perpignan, FranceSearch for more papers by this authorP. Bilan, P. Bilan Dermatology Department, Centre Hospitalier Robert Ballanger, Aulnay-sous-Bois, FranceSearch for more papers by this authorM. Steff, M. Steff Dermatology Department, Centre Hospitalier Robert Ballanger, Aulnay-sous-Bois, FranceSearch for more papers by this authorP. Pfister, P. Pfister Private Office, Paris, FranceSearch for more papers by this authorA. Vermersch-Langlin, A. Vermersch-Langlin Dermatology Department, Centre Hospitalier, Valenciennes, FranceSearch for more papers by this authorT. Boyé, T. Boyé Dermatology Department, Hôpital d'Instruction des Armées Sainte Anne, Toulon, FranceSearch for more papers by this authorL. Mery-Bossard, L. Mery-Bossard Dermatology Department, Centre Hospitalier François Quesnay, Mantes la Jolie, FranceSearch for more papers by this authorH. Maillard, H. Maillard Dermatology Department, Centre Hospitalier, Le Mans, FranceSearch for more papers by this authorM. Kemula, M. Kemula Private Office, Paris, FranceSearch for more papers by this authorC. Girard, C. Girard Dermatology Department, Centre Hospitalier Universitaire Sainte Eloi, Montpellier, FranceSearch for more papers by this authorC. Poiraud, C. Poiraud Dermatology Department, Centre Hospitalier, La Roche sur Yon, FranceSearch for more papers by this authorJ.-B. Monfort, J.-B. Monfort Dermatology Department, Centre Hospitalier Universitaire Tenon, Paris, FranceSearch for more papers by this authorI. Kupfer-Bessaguet, I. Kupfer-Bessaguet Dermatology Department, Centre Hospitalier, Niort, FranceSearch for more papers by this authorM. Perrussel, M. Perrussel Private Office, Auray, FranceSearch for more papers by this authorD. Lons-Danic, D. Lons-Danic Dermatology Department, Hôpital Saint Joseph, Paris, FranceSearch for more papers by this authorN. Sultan, N. Sultan Dermatology Department, Centre Hospitalier Gabriel Martin, Saint-Paul, FranceSearch for more papers by this authorE. Lorier, E. Lorier Private Office, Paris, FranceSearch for more papers by this authorM. Zeitoun, M. Zeitoun Private Office, Antony, FranceSearch for more papers by this authorL. Wagner, L. Wagner Private Office, Paris, FranceSearch for more papers by this authorG. Gabison, G. Gabison Private Office, Saint Maurice, FranceSearch for more papers by this authorE. Mahé, E. Mahé orcid.org/0000-0001-5780-1827 Dermatology Department, Hôpital Victor Dupouy, Argenteuil, FranceSearch for more papers by this authorfor the GEM Resopso, the GEM ResopsoSearch for more papers by this author A.-C. Fougerousse, Corresponding Author A.-C. Fougerousse ac.fougerousse@gmail.com orcid.org/0000-0002-2850-867X Dermatology Department, Hôpital d'Instruction des Armées Bégin, Saint Mandé, FranceCorrespondence: A.-C. Fougerousse. E-mail: ac.fougerousse@gmail.comSearch for more papers by this authorF. Maccari, F. Maccari Private Office, La Varenne Saint Hilaire, FranceSearch for more papers by this authorA. Beauchet, A. Beauchet Department of Public Health, Centre Hospitalier Universitaire Ambroise Paré, APHP & UVSQ, Université Paris-Saclay, Boulogne-Billancourt, FranceSearch for more papers by this authorJ. Parier, J. Parier Private Office, La Varenne Saint Hilaire, FranceSearch for more papers by this authorC. Boulard, C. Boulard Dermatology Department, Hôpital du Havre, Montivilliers, FranceSearch for more papers by this authorP.-A. Becherel, P.-A. Becherel Dermatology Department, Hôpital Privé d'Antony, Antony, FranceSearch for more papers by this authorN. Quiles-Tsimaratos, N. Quiles-Tsimaratos Dermatology Department, Hôpital Saint-Joseph, Marseille, FranceSearch for more papers by this authorT. Le Guyadec, T. Le Guyadec Dermatology Department, Hôpital d'Instruction des Armées Percy, Clamart, FranceSearch for more papers by this authorD. Thomas-Beaulieu, D. Thomas-Beaulieu Dermatology Department, Centre Hospitalier Intercommunal Poissy-Saint Germain en Laye, Poissy, FranceSearch for more papers by this authorB. Halioua, B. Halioua orcid.org/0000-0002-0823-6750 Private Office, Paris, FranceSearch for more papers by this authorE. Begon, E. Begon orcid.org/0000-0001-6112-0549 Dermatology Department, Hôpital René Dubos, Pontoise, FranceSearch for more papers by this authorM. Bastien, M. Bastien Private Office, Joinville-le-Pont, FranceSearch for more papers by this authorJ.-L. Perrot, J.-L. Perrot Dermatology Department, Centre Hospitalier Universitaire, Saint Etienne, FranceSearch for more papers by this authorV. Pallure, V. Pallure Dermatology Department, Centre Hospitalier, Perpignan, FranceSearch for more papers by this authorP. Bilan, P. Bilan Dermatology Department, Centre Hospitalier Robert Ballanger, Aulnay-sous-Bois, FranceSearch for more papers by this authorM. Steff, M. Steff Dermatology Department, Centre Hospitalier Robert Ballanger, Aulnay-sous-Bois, FranceSearch for more papers by this authorP. Pfister, P. Pfister Private Office, Paris, FranceSearch for more papers by this authorA. Vermersch-Langlin, A. Vermersch-Langlin Dermatology Department, Centre Hospitalier, Valenciennes, FranceSearch for more papers by this authorT. Boyé, T. Boyé Dermatology Department, Hôpital d'Instruction des Armées Sainte Anne, Toulon, FranceSearch for more papers by this authorL. Mery-Bossard, L. Mery-Bossard Dermatology Department, Centre Hospitalier François Quesnay, Mantes la Jolie, FranceSearch for more papers by this authorH. Maillard, H. Maillard Dermatology Department, Centre Hospitalier, Le Mans, FranceSearch for more papers by this authorM. Kemula, M. Kemula Private Office, Paris, FranceSearch for more papers by this authorC. Girard, C. Girard Dermatology Department, Centre Hospitalier Universitaire Sainte Eloi, Montpellier, FranceSearch for more papers by this authorC. Poiraud, C. Poiraud Dermatology Department, Centre Hospitalier, La Roche sur Yon, FranceSearch for more papers by this authorJ.-B. Monfort, J.-B. Monfort Dermatology Department, Centre Hospitalier Universitaire Tenon, Paris, FranceSearch for more papers by this authorI. Kupfer-Bessaguet, I. Kupfer-Bessaguet Dermatology Department, Centre Hospitalier, Niort, FranceSearch for more papers by this authorM. Perrussel, M. Perrussel Private Office, Auray, FranceSearch for more papers by this authorD. Lons-Danic, D. Lons-Danic Dermatology Department, Hôpital Saint Joseph, Paris, FranceSearch for more papers by this authorN. Sultan, N. Sultan Dermatology Department, Centre Hospitalier Gabriel Martin, Saint-Paul, FranceSearch for more papers by this authorE. Lorier, E. Lorier Private Office, Paris, FranceSearch for more papers by this authorM. Zeitoun, M. Zeitoun Private Office, Antony, FranceSearch for more papers by this authorL. Wagner, L. Wagner Private Office, Paris, FranceSearch for more papers by this authorG. Gabison, G. Gabison Private Office, Saint Maurice, FranceSearch for more papers by this authorE. Mahé, E. Mahé orcid.org/0000-0001-5780-1827 Dermatology Department, Hôpital Victor Dupouy, Argenteuil, FranceSearch for more papers by this authorfor the GEM Resopso, the GEM ResopsoSearch for more papers by this author First published: 16 July 2019 https://doi.org/10.1111/jdv.15804Read 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 onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume33, Issue12December 2019Pages e476-e478 RelatedInformation

La dermatite atopique (DA) est une dermatose inflammatoire chronique fréquente évoluant par poussées. Chez l'enfant, sa prévalence est de 10 à 25 %. En France, selon l'étude Objectifs Peau [SFD 2017] 2,5 millions de français de 15 ans et plus seraient atteints d'une DA [4,65 %]. Chez l'adulte, l'aspect clinique peut être trompeur avec des présentations variables telles que forme nummulaire, prurigo, forme tête et cou, dyshidrose. La fréquence de ces formes cliniques est mal connue. Il s'agit d'une étude en vie réelle, dont l'objectif est de décrire la répartition des formes phénotypiques de DA de l'adulte. Les patients étaient inclus consécutivement à l'issue d'une consultation par un dermatologue. Les données démographiques et cliniques étaient recueillies par l'investigateur. Nous présentons les résultats préliminaires à mi-parcours des inclusions. 30 dermatologues (hospitaliers et libéraux) français avaient inclus 506 patients [soit 50 % de l'objectif]. Un total de 465 patients ont été analysés (table 1). Le sex-ratio est légèrement en faveur des femmes [51,8 %]. Une évolution biphasique (début dans l'enfance puis rémission complète puis réapparition à l'âge adulte) était rapportée chez 32,6 % des femmes et 30 % des hommes. L'absence de forme clinique particulière était rapportée par le dermatologue pour 40 % des individus [42,8 % chez les hommes vs 41,5 chez les femmes, p < 0,001]. La forme clinique "tête et cou" (exclusivement ou presque exclusivement), était la forme la plus fréquemment rapportée (24 %) puis "eczéma chronique des mains" (19,3 %), eczéma nummulaire (9,1 %), érythrodermie (6,8 %), prurigo (4,3 %), dyshidrose (3,7 %) et eczéma craquelé. Enfin 40 % des sujets avaient une forme de DA "classique". La hiérarchie des proportions des différentes formes cliniques était la même dans les 2 sexes même si les prévalences montraient des différences de distribution. Les premiers résultats de l'étude DAPHNE illustrent l'hétérogénéité clinique de la DA de l'adulte. En effet seuls 40 % des sujets sont atteints d'une DA "classique" sans forme clinique particulière identifiée. Soixante pour cent des sujets sont porteurs d'une forme particulière : forme tête et cou et eczéma des mains majoritaires. Contrairement aux données précédentes de la littérature mettant en évidence une évolution biphasique chez 12 % des malades, nous rapportons cette évolution chez 30 % des sujets. Les formes d'apparition tardive semblent moins fréquentes que dans la littérature (20 à 30 % versus 20 à 40 %). Ces premiers éléments sont à confirmer sur un plus grand nombre de patients. Il s'agit de la première étude en vie réelle de la répartition des phénotypes de la dermatite atopique de l'adulte en France.

Background Tattooing is a widespread phenomenon, with an estimated prevalence of 10-30% in Western populations. For psoriasis patients, current recommendations are to avoid having a tattoo if the disease is active and they are receiving immunosuppressive treatments. Although scientific data supporting these recommendations are lacking, dermatologists are often reluctant to advocate tattooing in psoriasis patients. Objective We aimed to evaluate the frequency of tattoo complications in patients with psoriasis and determine whether the occurrence of complications was associated with psoriasis status and treatments received at the time of tattooing. Methods We performed a multicentre cross-sectional study. Adults with psoriasis were consecutively included and classified as tattooed or non-tattooed. Prevalence of complications associated with tattoos was then evaluated according to psoriasis onset and treatments. The study was divided into three parts, in which data were collected through a series of questionnaires filled in by the dermatologist. Complications included pruritus, oedema, allergic reaction/eczema, infection/superinfection, granuloma, lichenification, photosensitivity, Koebner phenomenon and psoriasis flare after tattooing. Diagnosis of complications was made retrospectively. Results We included 2053 psoriatic patients, 20.2% had 894 tattoos. Amongst non-tattooed patients, 15.4% had wished to be tattooed, with psoriasis being stated as a reason for not having a tattoo by 44.0% and 5.7% indicating that they planned to have a tattoo in the future. Local complications, such as oedema, pruritus, allergy and Koebner phenomenon, were reported in tattoos in 6.6%, most frequently in patients with psoriasis requiring treatment at the time of tattooing (P < 0.0001). No severe complications were reported. Conclusions The rate of tattoo complications in psoriasis patients was low. Although the risk of complications was highest amongst patients with psoriasis requiring treatment at the time of tattooing, all the complications observed were benign. These results can be helpful for practitioners to give objective information to patients.

Les traitements systémiques sont utilisés depuis de nombreuses années dans le psoriasis en plaques. L’aprémilast (APR) a une AMM proche de celle du méthotrexate (MTX). L’objectif de cette étude était d’évaluer le profil des patients à l’introduction de ces traitements, en vie courante. Il s’agissait d’une étude non interventionnelle, rétrospective, multicentrique réalisée entre le 22 janvier et le 9 avril 2018. Étaient inclus les patients ≥ 18 ans atteints de psoriasis chez qui avait été débuté du MTX ou de l’APR entre le 3 octobre 2016 (date de l’AMM de l’APR) et le 19 janvier 2018 (début de l’étude). Les données colligées comprenaient le lieu de prescription (ville/hôpital), le type de traitement (MTX/APR), l’âge, le sexe, les caractéristiques du psoriasis (âge de début, type, sévérité (PGA), rhumatisme psoriasique, traitements antérieurs), l’indice de masse corporelle, la présence d’un diabète, d’une dyslipidémie, d’une hypertension artérielle (HTA), le tabagisme, un antécédent de pathologie cardiovasculaire, de cancer, une dépression, une infection chronique, la préférence du patient pour le traitement. Cinq cent soixante-quinze patients étaient inclus (Tableau 1). En analyse univariée, l’APR était utilisé chez des patients plus âgés (p < 0,0001) et avec un âge de début du psoriasis plus tardif (p = 0,02). Le sexe, le type de psoriasis, sa sévérité et l’existence d’un rhumatisme psoriasique ainsi que le lieu de prescription n’avaient pas d’influence sur le choix du traitement. L’APR était initié chez des patients ayant plus fréquemment reçu de la photothérapie (p = 0,01), de l’acitrétine (p < 0,0001), du MTX (p < 0,0001), de l’étanercept (p = 0,01), de l’adalimumab (p = 0,01) et de l’ustékinumab (p = 0,001). Le MTX était choisi chez des patients n’ayant reçu aucun traitement systémique lors des 6 derniers mois (p < 0,0001). L’APR était préféré chez les patients atteints de dyslipidémie (p = 0,0007), d’HTA (p = 0,006), de dépression (p = 0,02), avec antécédent de pathologie cardiovasculaire (p = 0,02), ou de cancer (p = 0,0002). Le tabagisme, l’existence d’un surpoids ou d’une obésité n’influaient pas sur le choix du traitement. L’APR était plus fréquemment prescrit du fait du choix du patient (p = 0,004). En analyse multivariée (variables retenues avec p < 0,01), seuls l’âge plus élevé (p < 0,0001 ; OR [IC 95 %] : 1,04 [1,02–1,05]), l’antécédent de cancer (p = 0,01 ;OR [IC95 %] : 2,34 [1,20–4,74]), et l’utilisation d’un traitement systémique dans les 6 mois précédant la prescription (p < 0,0001 ; OR [IC 95 %] : 3,0 [1,96–4,66]) étaient associés à la prescription d’APR. Dans cette étude, l’APR a majoritairement été initié après échec à au moins un traitement systémique et ce conformément à l’avis de commission de transparence. Il a été privilégié chez les patients avec antécédent de cancer, chez qui une biothérapie était contre indiquée et chez les patients plus âgés, souvent considérés comme plus fragiles.

L'immunothérapie (IT) par anti PD-1 conduit à des rémissions complètes (RC) chez 10–15 % des patients (pts) en 1re ligne pour un mélanome (MM) évolué. Ces RC semblent se maintenir après l'arrêt de l'IT (Keynote 001 et 006). Les caractéristiques de ces patients en RC n'ont pas encore été décrites. Notre objectif est de rapporter les caractéristiques cliniques et biologiques des patients en RC sous anti PD-1. Il s'agit d'une étude rétrospective dans 3 centres, incluant les patients traités par anti PD-1 pour un MM stade III inopérable ou IV, en RC et ayant interrompu l'IT. La RC était définie par les critères RECIST ou par une réponse métabolique complète au TEP scanner. Le suivi clinique et radiologique était trimestriel. Vingt patients, d'âge moyen 64 ans (35–83 ans), présentant un MM cutané (n = 17), oculaire (n = 1), muqueux (n = 1) ou de primitif inconnu (n = 1) étaient recensés. Cinq patients étaient porteurs d'une mutation de BRAF. Les métastases survenaient en moyenne 47 mois (M) (1–204 M) après le diagnostic. À l'initiation de l'IT (pembrolizumab : n = 13 ; nivolumab : n = 7), les 20 patients avaient des localisations viscérales (6 M1a, 2M1b et 12 M1c dont 3 avec des métastases cérébrales). Le nombre de sites atteints était alors de 1 (n = 7), 2 (n = 7), 3 (n = 2) et > 3 (n = 4). Douze patients avaient déjà reçu 1 (n = 2) ou plusieurs (n = 10) lignes de traitement ; 8 patients étaient naïfs de traitement. Trois ont bénéficié de radiochirurgie cérébrale. Tous avaient un performans status (PS) à 0 ou 1. Les LDH étaient normales chez 17 patients (94 % ; 2 NC). Des effets indésirables (EI) de grade 1–2 cutanés (n = 9) et/ou endocriniens (n = 6 dysthyroïdies) survenaient chez 65 % des patients. Aucun EI sévère n'était rapporté. Le délai moyen d'obtention de la RC était de 9,5 M (4–16 M). La durée moyenne de l'IT était de 13 M (4–25 M) et l'IT était arrêtée en moyenne 6 M (1–17 M) après l'obtention de la RC. Le délai moyen de suivi après arrêt de l'IT est de 7 M (1–13 M) et seulement 2 patients ont rechuté. Il s'agit de la 1re série homogène de patients en RC de MM sous anti PD-1. Ils ont un PS 0–1, < 3 sites métastatiques (70 %), des LDH normales et un statut BRAF WT (75 %). Ces caractéristiques pronostiques sont à rapprocher de la cohorte d'Heidelberger comparant les répondeurs (R) et non R à l'IT et à l'étude de Long et al. sur les facteurs prédictifs de réponse à la thérapie ciblée. Enfin nous démontrons que l'IT peut conduire à des RC qui se maintiennent après son arrêt chez des patients ayant des métastases cérébrales. Les patients en RC de MM après IT avaient le plus souvent une maladie associée à des facteurs de bon pronostic à l'initiation de l'IT. Le maintien des RC doit être confirmé par un suivi prolongé. Il pourrait remettre en cause l'attitude actuelle de poursuivre au long cours l'IT avec un impact sur la qualité de vie des patients mais aussi le coût en santé publique. La durée optimale de l'IT après obtention d'une RC est à préciser.

Background. - Certain anticancer drugs are known to induce leg ulcers, mainly chemotherapy agents such as hydroxyurea. We report 2 cases of leg ulcers in cancer patients treated with the tyrosine kinase inhibitors, sunitinib and nilotinib, and we discuss the role of these treatments in the pathogenesis of leg ulcers.Patients and methods. - Case 1. A 62-year-old patient on sunitinib for intrahepatic cholangiocarcinoma developed a lesion on her right foot. The vascular evaluation was negative. After progressive worsening, sunitinib was stopped and healing was observed within a few months. Case 2. A 83-year-old patient had been treated for chronic myeloid leukemia since 2005. Nilotinib was introduced in 2009. Peripheral arterial revascularization was required in May 2013. A few months later, worsening was noted with the onset of ulceration and necrosis of the third toe. Further revascularisation surgery was performed, and nilotinib was suspended and antiplatelets introduced. Healing occurred a few months later.Discussion. - Many skin reactions have been described in patients on nilotinib and sunitinib, but few publications report the development of de novo ulcers in patients without risk factors. The pathophysiology of the development of ulcers in patients receiving tyrosine kinase inhibitors is not clear, and probably involves several mechanisms of action. The increasing use of this type of treatment could lead to an upsurge in the incidence of vascular complications.Conclusion. - We report two cases of leg ulcers developing in patients on tyrosine kinase inhibitors and raise the question of causal implication of these treatments in the pathogenesis of ulcers. (C) 2016 Elsevier Masson SAS. All rights reserved.

Certain anticancer drugs are known to induce leg ulcers, mainly chemotherapy agents such as hydroxyurea. We report 2 cases of leg ulcers in cancer patients treated with the tyrosine kinase inhibitors, sunitinib and nilotinib, and we discuss the role of these treatments in the pathogenesis of leg ulcers.Case 1. A 62-year-old patient on sunitinib for intrahepatic cholangiocarcinoma developed a lesion on her right foot. The vascular evaluation was negative. After progressive worsening, sunitinib was stopped and healing was observed within a few months. Case 2. A 83-year-old patient had been treated for chronic myeloid leukemia since 2005. Nilotinib was introduced in 2009. Peripheral arterial revascularization was required in May 2013. A few months later, worsening was noted with the onset of ulceration and necrosis of the third toe. Further revascularisation surgery was performed, and nilotinib was suspended and antiplatelets introduced. Healing occurred a few months later.Many skin reactions have been described in patients on nilotinib and sunitinib, but few publications report the development of de novo ulcers in patients without risk factors. The pathophysiology of the development of ulcers in patients receiving tyrosine kinase inhibitors is not clear, and probably involves several mechanisms of action. The increasing use of this type of treatment could lead to an upsurge in the incidence of vascular complications.We report two cases of leg ulcers developing in patients on tyrosine kinase inhibitors and raise the question of causal implication of these treatments in the pathogenesis of ulcers.

La hernia incisional es una patología muy común cuya incidencia se estima en torno al 15-20% de todas las laparotomías. La evisceración es otro problema importante, con una incidencia menor (2,5-3%) pero con graves consecuencias para el paciente. Por todo ello, la prevención de ambas complicaciones surge como un objetivo fundamental para el tratamiento correcto de los pacientes, por la mejora de la calidad de vida y por el ahorro de costes que supondría.Esta revisión narrativa pretende realizar una puesta al día en la prevención de la hernia incisional y la evisceración. Se analizan los criterios actuales para el cierre correcto de la pared abdominal, seguido de la posibilidad de añadir refuerzos protésicos en aquellos pacientes o casos que así lo requieran. Eventraciones especiales, como las originadas tras la inserción de trócares de laparoscopia o las secundarias a la realización de un estoma, se incluyen también en este trabajo.Incisional hernias are a very common problem, with an estimated incidence around 15-20% of all laparotomies. Evisceration is another important problem, with a lower rate (2.5-3%) but severe consequences for patients. Prevention of both complications is an essential objective of correct patient treatment due to the improved quality of life and cost savings.This narrative review intends to provide an update on incisional hernia and evisceration prevention. We analyze the current criteria for proper abdominal wall closure and the possibility to add prosthetic reinforcement in certain cases requiring it. Parastomal, trocar-site hernias and hernias developed after stoma closure are included in this review.

Les cancers peuvent se présenter d’emblée sous forme de plaies des membres inférieurs (MI) et avoir un aspect trompeur faisant suspecter un ulcère vasculaire. L’objectif de cette étude était d’évaluer la fréquence et les caractéristiques de ces plaies néoplasiques des MI adressées comme des « ulcères des membres inférieurs » sans que soit suspecté le diagnostic de cancer. Une étude rétrospective a été menée du 1er janvier 2011 au 28 février 2015 portant sur l’ensemble des patients hospitalisés codés tumeur maligne de la peau du MI (C43.7, C44.7, C49.7). Seuls les patients qui étaient adressés avec le diagnostic de d’ulcère vasculaire étaient inclus. La suspicion de néoplasie par le médecin adressant le patient et la transformation maligne d’un ulcère vasculaire déjà suivi étaient des critères d’exclusion. Des données épidémiologiques, cliniques, paracliniques et thérapeutiques étaient colligées. Sur 48 patients avec des lésions néoplasiques des MI, 14 avaient été adressés sans suspicion diagnostique. L’âge moyen était de 87,7 ans (78–93 ans), le sex-ratio de 4 hommes pour10 femmes. La durée moyenne d’évolution était de 3 ans (0,5–10 ans). Les médecins qui adressaient les patients étaient principalement des médecins généralistes (n = 9). Huit patients présentaient des troubles cognitifs. Des troubles vasculaires des MI étaient trouvés chez 7 patients. La taille moyenne des lésions était de 29,3 cm2 (1,5–144 cm2). Elles étaient localisées à la jambe dans 11 cas, aux pieds dans 2 cas, à la cuisse dans 1 cas. Les plaies étaient bourgeonnantes (n = 12), hémorragiques (n = 4), et indolores (n = 11). Il s’agissait de carcinomes basocellulaires (n = 6), de carcinomes épidermoïdes (n = 5), de mélanomes (n = 2) et d’un sarcome myéloïde (n = 1). Deux patients ont présenté des métastases à distance et 1 patient une extension locale. Onze patients ont pu être traités par chirurgie, 1 par radiothérapie et 1 par chimiothérapie. Deux patients sont décédés des conséquences de leur cancer. La fréquence des tumeurs primitives malignes des MI « mimant » une plaie banale n’est pas négligeable dans un service prenant en charge les plaies chroniques. Le terrain est trompeur car il s’agit en majorité de femmes âgées, ayant une localisation à la jambe et pouvant présenter des troubles vasculaires sous-jacents. Les caractères bourgeonnant et indolore des plaies semblent plus importants que le critère hémorragique pour orienter vers une étiologie cancéreuse. Les carcinomes sont les principaux cancers simulant une plaie banale. Le retard diagnostique n’est pas sans conséquence avec 2 décès et des chirurgies souvent larges en raison de la taille des plaies. Le retard au diagnostic de tumeurs primitives malignes des MI mimant un ulcère de jambe est important, incitant à accentuer la formation sur l’étiologie des plaies auprès des médecins et infirmières.

Background. - Tuberculosis is the most common mycobacterial disease in the world. The cutaneous form is rare in low endemic countries. The occurrence of several cutaneous tuberculosis cases in our dermatology department during 2011-2012 led us to investigate whether there was a resurgence of cutaneous tuberculosis in France. The aim was to analyse changes in cutaneous tuberculosis and the related clinical, microbiological and therapeutic data.Patients and methods. - We conducted a retrospective study in our hospital between 2005 and 2012 by querying the PMSI database (code: A 18.4). Epidemiological, clinical, paraclinical and therapeutic data were collected. Erythema induratum was regarded as a variety of cutaneous tuberculosis.Results. - Thirteen patients presented cutaneous tuberculosis between 2005 and 2012. The most frequent clinical forms were erythema induratum of Bazin (n = 6) and scrofuloderma (n = 3). Microbiological evidence was provided in only 4 cases.Discussion. - Diagnosis is difficult due to the varied clinical forms and to the relatively high frequency of paucibacillary forms. Further, the set of additional examinations is non-specific. In some cases, it is only therapeutic tests that allow diagnosis to be made. The place of new diagnostic tools must be clarified and a universally acceptable definition of erythema induratum devised. (C) 2015 Elsevier Masson SAS. All rights reserved.

Tuberculosis is the most common mycobacterial disease in the world. The cutaneous form is rare in low endemic countries. The occurrence of several cutaneous tuberculosis cases in our dermatology department during 2011-2012 led us to investigate whether there was a resurgence of cutaneous tuberculosis in France. The aim was to analyse changes in cutaneous tuberculosis and the related clinical, microbiological and therapeutic data.We conducted a retrospective study in our hospital between 2005 and 2012 by querying the PMSI database (code: A 18.4). Epidemiological, clinical, paraclinical and therapeutic data were collected. Erythema induratum was regarded as a variety of cutaneous tuberculosis.Thirteen patients presented cutaneous tuberculosis between 2005 and 2012. The most frequent clinical forms were erythema induratum of Bazin (n=6) and scrofuloderma (n=3). Microbiological evidence was provided in only 4 cases.Diagnosis is difficult due to the varied clinical forms and to the relatively high frequency of paucibacillary forms. Further, the set of additional examinations is non-specific. In some cases, it is only therapeutic tests that allow diagnosis to be made. The place of new diagnostic tools must be clarified and a universally acceptable definition of erythema induratum devised.

INTRODUCTION:The etiologic treatment of venous ulcers is based on compression therapy in compliance with the new guidelines promulgated by the French National Authority for Health (HAS) in 2010. Prescriptions often originate from a request by the nurse delivering care in the patient's home. A recent French study demonstrated the positive impact of compression therapy on venous ulcer healing. The objective of this study was to evaluate medical practices in order to target corrective actions.MATERIALS AND METHODS:We conducted a single-center prospective observational study, using a standardized questionnaire from January to May 2014. Patients with venous ulcers who had an indication for compression therapy were included consecutively. The questionnaire collected demographic and clinical data and also recorded the results of complementary tests and the characteristics of the compression therapy.RESULTS:One hundred patients were included (61 women and 39 men). The average age was 76 years. Patients were recruited during consultations (n = 69), with a majority of patients living at home (n = 80) and receiving home care delivered by a nurse (n = 81). Thirteen patients were seen for the first time and 87 patients were receiving long-term care. The ulcers evolved for 5.7 years on average. Patients presented peri-lesional edema (n = 58), ankle ankylosis (n = 49), autonomous mobilization (n = 40) and walking problems (n = 60). Physical therapy was prescribed for 39 patients and was effectively carried out for 24. The two main causes were venous varices (n = 66) and post-phlebitis disease (n = 18). Compression therapy was prescribed for 97 patients and the products delivered by the pharmacy were consistent with the prescription for 74 patients. Compliance with compression therapy was faulty for 28 patients because of poor tolerance, misunderstanding, manipulation problems, or inappropriate footwear. At assessment, 66 patients were wearing the bands, but not always correctly (starting at the base of the toes [n = 61], heel included [n = 43], proper stretching [n = 43] up to below the knee [n = 57]). Proper footwear was noted in 70 patients.CONCLUSION:Data are scarce on compliance with compression banding. This study shows that further efforts are needed to ensure proper patient education and professional training for physicians and allied profession concerning the installation of compression therapy. Total compliance was observed in only 35% of patients. In addition, the products delivered by the pharmacy were not consistent with the prescription in 26% of cases. Many discrepancies were observed between what was prescribed and what the patients achieved. Patient adherence is a crucial issue for compression therapy.

BACKGROUND:Radiation-induced subcutaneous calcinosis is a rare and special form of potentially severe subcutaneous calcinosis of late onset. Herein, we report three cases of this disease, occurring in each instance more than 10 years after use of radiotherapy as an adjuvant treatment in breast cancer.PATIENTS AND METHODS:Our report concerns 3 women aged 69-88 years consulting for pre-sternal ulcers (n=2) and/or subcutaneous nodules (n=2). These lesions developed on areas irradiated between 10 and 38 years earlier for breast cancer. In all three cases, radiological explorations showed extensive subcutaneous calcification. In one case, calcification extended into the mediastinum. In each patient, a diagnosis of radiation-induced subcutaneous calcinosis was made and symptomatic treatment was given.DISCUSSION:Radiation-induced subcutaneous calcinosis is an irreversible and rare complication of high-dose radiation that usually occurs several years after radiotherapy. Its severity is related to potential ulcerations, pain and a risk for in-depth extension up to the mediastina. This complication remains unclear and treatment has not been codified. The only option seems to be "heavy" plastic surgery.

Background. - Acute ischemia of the upper limbs is rare in comparison with ischemia of the lower limbs. The origins of this condition are varied.Goals. - We retrospectively analyzed cases of acute finger ischemia (Raynaud's phenomena was excluded) in a dermatology department between 2008 and 2013 in order to evaluate the etiology and management of this phenomenon.Results. - Thirteen cases of finger ischemia were reported. The mean age was 54 years. Active smoking was noted in 11 cases. Ischemia was acute in 9 cases and subacute in 4 cases. The location was unilateral in 10 cases and bilateral in 2. Etiologies were: dysplasia of the palmar arch, antiphospholipid antibody syndrome, frostbite, distal arteritis linked to smoking, paraneoplastic arteritis, Buerger's disease, polyarteritis nodosa, stenosis of the subclavian artery, and 3 cases of embolic origin (ulnar, cardiac, and paraneoplastic aneurysm). In the acute phase, antiplate-lets were given in 6 cases, anticoagulants in 10 cases and ilomedin in 6 cases. Sympathectomy was performed in 1 case and amputation in 2 cases.Discussion. - This study illustrates the diversity of etiologies of finger ischemia. The etiological test battery should be broad and include immunological and thrombophilia tests, arterial and cardiac investigations, cervical radiography and CT scan (screening for cancer). Close collaboration between dermatologists, hematologists, vascular surgeons and radiologists is essential for the management of these patients. (c) 2015 Elsevier Masson SAS. All rights reserved.

La fréquence de la gale est en augmentation en France. La gale hyperkératosique (ou norvégienne) est une forme de gale très contagieuse en raison d’un nombre important de parasites présents dans la peau. Elle survient sur un terrain d’immunodépression, de déficit sensitif ou moteur ou de retard mental. Sa présentation clinique, en dehors des signes classiques de la gale, se caractérise par des lésions hyperkératosiques. Son traitement est difficile et nécessite une hospitalisation. Les dermocorticoïdes sont fréquemment utilisés en pathologie dermatologique de l’enfant. Nous rapportons le cas d’un garçon de 8ans présentant une gale hyperkératosique induite par l’application de dermocorticoïdes et discutons des aspects thérapeutiques de cette forme sévère de gale.

Radiation-induced subcutaneous calcinosis is a rare and special form of potentially severe subcutaneous calcinosis of late onset. Herein, we report three cases of this disease, occurring in each instance more than 10 years after use of radiotherapy as an adjuvant treatment in breast cancer.Our report concerns 3 women aged 69-88 years consulting for pre-sternal ulcers (n=2) and/or subcutaneous nodules (n=2). These lesions developed on areas irradiated between 10 and 38 years earlier for breast cancer. In all three cases, radiological explorations showed extensive subcutaneous calcification. In one case, calcification extended into the mediastinum. In each patient, a diagnosis of radiation-induced subcutaneous calcinosis was made and symptomatic treatment was given.Radiation-induced subcutaneous calcinosis is an irreversible and rare complication of high-dose radiation that usually occurs several years after radiotherapy. Its severity is related to potential ulcerations, pain and a risk for in-depth extension up to the mediastina. This complication remains unclear and treatment has not been codified. The only option seems to be "heavy" plastic surgery.

Background. Pruritus in children is a frequent reason for consultation, most often related to a common dermatosis. Where dermatological investigation fails to reveal a dermatological cause, a general cause may be suspected. We report three cases of pruritus revealing Hodgkin's lymphoma in children.Patients and methods. Case 1: a 14-year-old girl presented pruritus with diffuse scratching lesions present for 6 months, associated with right cervical lymph nodes occurring after the onset of pruritus. Tomodensitometry revealed involvement of the supra- and sub-diaphragmatic lymph nodes as well as pulmonary involvement. Lymph node biopsy confirmed nodular sclerosing Hodgkin's lymphoma. Case 2: a 14-year-old boy was hospitalized for suspected psychogenic pruritus. He presented intense itching, predominantly in the lower extremities and at night, occurring over the previous 6 months as well as night sweats. Examination showed that the patient had lost 5 kg in 1 month and had a low-grade fever of 38 degrees C; he presented linear striated scratching lesions on both legs. Cervical and inguinal lymphadenopathy was seen. The chest scan also revealed supra-diaphragmatic adenomegaties. The biopsy confirmed Hodgkin's lymphoma.Discussion. Systemic causes of pruritus in children are poorly described in the literature. In these two cases, pruritus allowed a diagnosis of Hodgkin's lymphoma to be made, emphasizing the important role of dermatologists in the early diagnosis of haematological malignancy. (C) 2014 Published by Elsevier Masson SAS.