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Background Polymorphisms of genes controlling cytokine production have not been studied in the genetic susceptibility to cutaneous adverse drug reactions ( CADR). Objectives The objective was to determine whether polymorphisms in nine cytokine genes were associated to the occurrence of drug reaction with eosinophilia and systemic symptoms ( DRESS) compared to drug-induced maculopapular eruption or urticaria and to controls without drug intolerance. Methods Results from 118 patients with a well-defined CADR were compared to 236 controls without drug intolerance living in the same area of France. We assessed nine polymorphisms: interleukin ( IL)1-alpha-889C>T (rs 1800587), IL1-beta-511C>T (rs 16944), IL1- RN intron-2- VNTR (rs2234663), IL2-330T>G (rs 2069762), IL4-33C>T (rs 2070874), IL5-745C>T (rs 2069812), IL10-592C>A (rs 1800872), IL16-295T>C (rs 4778889) and tumour necrosis factor-alpha-308G>A (rs 1800629). Results Three polymorphisms exhibited a significant association with CADR ( P < 0.05). The combination of the IL1- RN-A2 and IL1-beta-511C alleles was statistically different between cases and controls ( P = 0.007) and the A2C haplotype was associated with susceptibility to CADR, particularly in drug reaction with eosinophilia and systemic symptoms ( DRESS) patients (odds ratio = 3.22; 95% confidence interval = 1.23-8.41; P = 0.016). The frequency of the IL10-592A allele was higher in DRESS patients than in controls (dominant model CC vs. CA + AA: P = 0.035). These abnormalities were not evident in maculopapular eruptions or urticaria. Conclusions This is the first study showing that IL1-cluster polymorphisms and haplotypes and the IL10-592A allele (a low IL10 producer) are associated with DRESS. These gene variants may decrease drug tolerance and promote herpes virus reactivation. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about a patient who had developed a generalized eczema while taking desloratadine.

Several complications have been described, including intravascular injection of hyaluronic acid (HA).[1] Current management of intravascular HA injection is based on early injection of hyaluronidase[2] which should be performed as soon as possible and mandatorily within 72 h of the procedure. A 54-year-old woman, who had received a well-tolerated HA injection 3 years earlier, underwent bilateral HA injections into the nasolabial folds at a private dermatologist's office. Intra-arterial facial injection of hyaluronic acid complicated by Nicolau's dermatitis: Treatment with iloprost. [Extracted from the article]

Colchicine appeared to be more effective in cases of significant neutrophilic infiltrate: 42.85% effectiveness in NU group (clinical remission in 12 patients) versus 6.25% in CSU group. Neutrophilic urticaria was defined by an inflammatory dermal infiltrate composed of at least 60% PNN, without leukocytoclasia/vasculitis, averaging 50% and 70% reported in the literature,4,5 which is more reliable than a number of PNN per field of observation. Neutrophilic Urticaria or Urticaria With Predominantly Neutrophilic Inflammatory Infiltrate: Study of Its Clinical and Histopathologic Characteristics and Its Possible Association With Rheumatic Disease. [Extracted from the article]

Mineral oils and waxes are mixtures of predominantly saturated hydrocarbons consisting of straight‐chain, branched and ring structures with carbon chain lengths greater than C14. They have been used for many decades in skin and lip care cosmetic products due to their excellent skin tolerance as well as their high protecting and cleansing performance and broad viscosity options. In contrast to vegetable oils, mineral oils are non‐allergenic since they are highly stable and not susceptible to oxidation or rancidity. They have a long history of safe use which is confirmed by clinical and epidemiological data. In Europe, mineral oils are only permitted in cosmetics if compliant with purity specifications on polycyclic aromatic hydrocarbons and safety requirements laid down in the European pharmacopoeia and the EU cosmetics regulation EC/1223/2009. The high quality of these mineral oils is assured by robust quality assurance and a refining/purification process designed to exclude substances with carcinogenic potential and to minimize the presence of mineral oil aromatic hydrocarbons. Given their highly lipophilic properties, mineral oils do not penetrate human skin and, thus, are not systemically bioavailable in the body. Moreover, no significant changes in the skin and no effects on any internal organ system have been reported and attributed to the topical application of refined mineral oils. Regarding potential oral exposure from cosmetic lip care products, Cosmetics Europe, the European trade association for the cosmetics and personal care industry, has advised cosmetic manufacturers to only use mineral oil fractions for which recognized food acceptable daily intake (ADI) values apply. The estimated dose of mineral oils ingested via lip care products contributes to <10% of the ADI value and should therefore be considered of no toxicological concern. [ABSTRACT FROM AUTHOR]

A response by J.P. Arnault, N. Petitpain, F. Granel-Brocard, J.F. Curry, A. Barbaud and Jean-Luc Schmutz to a letter to the editor regarding their study on acitretin as the causal agent of sixth nerve palsy is presented

Background: There are few population‐based studies assessing the prevalence of skin diseases. Objectives: To estimate the prevalence of five chronic skin inflammatory diseases, i.e. atopic dermatitis (AD), psoriasis, alopecia areata (AA), vitiligo and hidradenitis suppurativa (HS) in France, using validated self‐diagnostic questionnaires. Methods: Population‐based study using a representative sample of the French general population aged more than 15 years and sampling with replacement design. All participants were asked (ii) to fill in a specific questionnaire including socio‐demographic characteristics, (ii) to declare if they have been diagnosed with one or more skin problem or skin diseases during their life, and (iii) to fill in five validated self‐reported questionnaires for AD, psoriasis, AA, vitiligo and HS. Results: A total of 20.012 adult participants responded to the questionnaire of whom 9760 were men (48.8%) and 10.252 (51.2%) were women. We identified a prevalence of 4.65% for AD (931 individuals), 4.42% for psoriasis (885 individuals), 1.04% for AA (210 individuals), 0.46% for vitiligo (93 individuals) and 0.15% for HS (29 individuals), respectively. Limitations: Questionnaire‐based study and possible disease misclassifications. Conclusion: This is the largest population‐based study aiming to estimate the prevalence of five chronic skin inflammatory diseases. [ABSTRACT FROM AUTHOR]

Atopic Dermatitis (AD) is a chronic, relapsing inflammatory skin disease that carries a significant burden of disease and patient quality-of-life impairment. Several disorders known or supposed to be associated with AD were collected: atopic manifestations, cardiometabolic diseases, neuropsychiatric disorders, auto-immune or inflammatory diseases, addictions, neoplasia and patient-reported past skin infections. [Extracted from the article]

A letter to the editor is presented which discusses the case of a 23-year-old patient with chronic graft-versus-host disease in striae distensae.

Background The script concordance test (SCT) measures clinical data interpretation in the context of uncertainty. To our knowledge, its feasibility has not yet been demonstrated in dermatology. Objectives This study describes the feasibility, reliability and validity of the SCT for use in dermatology teaching to family medicine residents. Methods We designed an SCT for dermatology teaching, adapted to the level of family medicine students. The family medicine residents attending a dermatology lecture course and a reference panel of dermatologists underwent the test. Software available on the SCT-dedicated website was used to determine the scores. The Cronbach's α was calculated. The scores were described by means, standard deviation, and minimum and maximum scores. Mann-Whitney tests were used to compare resident and reference panel scores. Results The test contained 33 vignettes of four questions each. Cronbach's α was 0.80. Mean scores were 75.6 for the reference panel and 65.0 for the residents ( P = 0.0009). Conclusions This study confirmed the SCT's capacity to distinguish groups on the basis of experience. This study demonstrated the feasibility and reliability of the SCT in the field of dermatology. [ABSTRACT FROM AUTHOR]

Background Post-excisional brachytherapy with Iridium 192 is a treatment of keloids scars (KS). Its indications and its parameters are not subject to any consensus. Objective We wanted to assess the effectiveness and satisfaction of patients treated in our centre. Patients and Methods This was a retrospective study conducted from November 2006 to November 2007. Patients with clinically and histologically proven KS treated between 1990 and 2005, were convened in consultation between September and October 2007. Clinical data and parameters of the brachytherapy have been collected. Results Eighty-seven patients (138 KS) were treated. Eighty-two KS (46 patients) met the criteria for inclusion. Thirty-two patients (55 KS) have been seen in consultation. The average time between the onset of KS and treatment was 63.5 months. The brachytherapy has begun after a maximum of 7 hours posterior to surgery for all KS. The average dose was 17.9 Gy calculated at 5 mm. We observed 23.6% of recurrence after treatment. Seventy-nine per cent of itching and 87.5% of pain have totally disappeared. The phototypes 5 and 6 had an increased risk of reccurence. Discussion This is the most important series of KS treated with Post-excisional brachytherapy presented so far. The technique is efficient in preventing keloid reccurence and in treating the functional signs, but at the expense of an unaesthetic result, of wich patient must be warned about. A follow-up of at least two years after treatment is recommended. Conflicts of interest None declared [ABSTRACT FROM AUTHOR]

Background Molluscum contagiosum ( MC) is caused by a DNA virus of the poxvirus group. It is common in children, and is also found in sexually active adults and HIV-seropositive patients. Cellular immunity is essential to controlling MC virus infection. We report the first observation of a patient with stage IV Sezary syndrome, who presented multiple molluscum contagiosum, spread and surrounded by a pale halo. Case report A woman aged 70 presented with aggravation of Sezary syndrome diagnosed in 2009 and treated with topical corticosteroids. The examination showed a generalized pruritic exanthem and multiple flesh-coloured papules from 1 to 3 mm, spread over the entire skin surface and surrounded by a white halo. Histological examination of a lesion showed the presence of infected cells with intracytoplasmic inclusions infected in an acanthotic epidermis, surrounded by a melaninopenic hypomelanosis with a normal melanocyte density. There was no inflammatory character. The diagnosis of multiple molluscum contagiosum was given, the application of clobetasol propionate was suspended and treatment with chlorambucil 4 mg/day and prednisone 0.5 mg/kg/day was started. The evolution of the rash and pruritus was rapidly favourable. After 3 months, the rash and pruritus had regressed. There was no molluscum contagiosum or clear halo. Conclusion We report the original observation of a patient with stage IV Sezary syndrome, who presented multiple molluscum contagiosum, spread and surrounded by a pale halo, without inflammation, eczema or disappearance of melanocytes. This halo could be due to the secretion of a protein by molluscum contagiosum inhibiting inflammation around this MC. To our knowledge, this phenomenon reported in a patient with severe atopic dermatitis associated with Sezary syndrome has not previously been described. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 54-year-old Algerian woman was admitted for erythroderma, localized blisters and erosions. It discusses the patch test performed using components of essential oils, herbals and Nigella sativa oil (NSO) used by the patient. It also discusses results of the biopsy which showed subepidermal blister with eosinophils and linear deposition of C3 and IgG at the dermo-epidermal junction.

A letter to the editor related to vasodilatation by opening membrane-bound ATP-dependent potassium channels by nicorandil is presented.

A letter to the editor is presented which evaluates rosacea as a disorder that predominantly affect non- or ex-smokers.

A letter to the editor is presented in response to the article on acitretin and sixth nerve palsy that was published in the previous issue.

A letter to the editor is presented which discusses the effects of body piercing.