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A 10-year-old male presented with complaints of yellowish papules on his neck. At the age of five years, he had abdominal pain and haemorrhagic diarrhoea with high levels of anti-transglutaminase and anti-endomysium antibodies, and negative hypercoagulable workup. The endoscopic examination of an intestinal biopsy showed subtotal villous atrophy, crypt hyperplasia, and lymphocyte infiltration of crypts, which confirmed the diagnosis of coeliac disease. The patient's mother noticed the appearance [...]

Fixed drug eruption (FDE) is one of the most typical cutaneous drug adverse reactions. This localized drug-induced reaction is characterized by its relapse at the same sites. Few large series of FDE are reported. The aim of this study was to retrospectively collect and analyse well informed cases observed in a hospital setting. This study involved 17 academic clinical centers. A French nation-wide retrospective multicentric study was carried out on a 3-year-period from 2005 to 2007 by collecting data in seventeen departments of dermatology in France. Diagnosis of FDE was based essentially on clinical findings, at times confirmed by pathological data and patch-testing. Records were reviewed for demographics, causative drugs, localization, severity, and patch-tests, when available. Fifty nine cases were analysed. Patients were 59-years-old on average, with a female predilection. The most common drug was paracetamol, followed by the non-steroidal anti inflammatory drugs. The time between drug intake and skin symptoms was, on average, two days. Beside these classical characteristics, some original findings were found including, a frequent non pigmentation course and a sex-dependent pattern of distribution. Women often had lesions on the hands and feet, and men on the genitalia. Given the fact that skin pigmentation is an inconstant feature of FDE, its French name (erytheme pigmente fixe) should be reconsidered. The sex-dependent distribution could help our understanding of the pathophysiology of fixed drug eruption.

Amoxicillin is known to induce exanthema in patients with EBV-induced infectious mononucleosis. It is widely recognized that the reactivation of herpesviruses, including HHV-6 (Human Herpesvirus 6) and EBV (Epstein Barr virus) is associated with DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms). We report 7 cases of amoxicillin-induced flare in patients with DRESS induced by other drugs and investigate whether amoxicillin may have a direct effect on HHV-6 replication in vitro. 7 cases of DRESS with amoxicillin-induced flare were retrospectively analysed. The influence of amoxicillin on HHV-6 HST strain replication was studied in vitro in a human T lymphoblastoid MT4 cell line. The viral replication was quantified by immunofluorescence assay and by real-time polymerase chain reaction (PCR). Comparisons were performed using the Student's t test. Amoxicillin-induced flare was observed in 7 patients with DRESS induced by other drugs. In two cases HHV-6 reactivation was studied and was demonstrated by PCR. Amoxicillin neither modified cell viability nor cell proliferation for the range of tested concentrations. Amoxicillin increased the replication of HHV-6 at 25 microg*mL-1 and 50 microg*mL-1. Amoxicillin may induce a flare of DRESS, possibly by acting directly on herpesvirus replication.

Cyclohexylthiophtalimide (CTP) is currently the most widely used vulcanization retarder in the rubber industry. Little is known about sensitization to CTP, although positive tests to it do occur in patients exposed to rubber objects. A retrospective study of 350 patients who were patch tested with the standard rubber chemical series was conducted in two departments of dermatology, one in Nancy, France, and one in Leuven, Belgium. Sixteen (4.6%) out of the 350 patients had clear and 6 (1.7%) had doubtful positive reactions to CTP. Cross-sensitivity with other molecules could not be determined. The source of sensitization in most cases seems to have been protective rubber gloves at work. In the other cases, sensitization was suspected to have been caused by rubber shoes, elastic bands in underwear, or other rubber objects. The determination of the relevance of positive tests remains difficult, especially since little is known about the components of rubber products.

A retrospective histological and immunohistochemical study was performed on 66 basal cell carcinomas (BCC). To determine the differentiation stages of epithelial cells in these BCC, three monoclonal antibodies directed against cytokeratins K1, K2, K9 and K10-11 (EE21-06), to cytokeratins K1 to K19 (F12-19), and to corneodesmosin (G36-19) were used in indirect immunofluorescence on paraffin-embedded sections. Three histological groups of BCC with specific cytokeratin immunohistochemical features were distinguished: (1) superficial BCC were unlabelled, (2) nodular and variant (keratotic, adenoid) BCC showed an homogeneous labelling, and (3) infiltrative aggressive-type BCC showed a heterogeneous cell to cell labelling. Some nodular BCC cells presented characteristics of granular keratinocytes, i.e. they were labelled by the anticorneodesmosin antibody. All the clinically recurrent tumors were found to be of the infiltrative aggressive-type. If these aggressive forms of BCC were not identified by specific marker, their topographic patterns of labeling with antibodies directed to cytokeratins allowed them to be distinguished. We suggest that an immunohistochemical analysis with antibodies specific for different stages of keratinocyte differentiation is an efficient complement to histological diagnosis of BCC.

Pemphigus is an autoimmune bullous skin disorder. Several cases have been reported to originate in traumatized areas or on a scar, suggesting Koebner's phenomenon. Pemphigus can either remain localized or subsequently extend. This paper reports on a 60-year-old man in whom pemphigus vulgaris began on a 40-year-old surgical scar. The pemphigus initially remained localized to the scar and subsequently extended after two months. The time to onset of this bullous disease on the scar was especially long, compared to that which has been previously reported in the literature. A few cases have been reported where pemphigus developed a few months to a few years after surgery. A time to onset exceeding 3 years is extremely rare.