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Netherton syndrome (NS) is a rare disease caused by SPINK5 mutations associated with ichthyosis (erythroderma and desquamation), alopecia and atopic manifestations. There are no effective treatments. Topical corticosteroids may be used for a limited period in the event of eczema. Herein we report on a patient with fatal complications related to misuse of topical corticosteroids.A 38-year-old woman with NS had been using betamethasone for about ten years for severe pruritus. Consumption was estimated at 7.2kg per year. On examination, she had osteoporosis, Cushing's syndrome, corticotropic insufficiency and inframammary, axillary, and intergluteal superinfected intertrigo. During hospitalization for necrotic leg wounds on severe skin atrophy, she sustained a fracture on falling down. The course was marked by the onset of septic shock of unknown etiology, complicated by acute adrenal insufficiency leading to fatal multi-organ failure.Many iatrogenic cases related to topical corticosteroids in children have been reported in the literature, including one case of fatal outcome (CMV infection) in an infant. Such iatrogenic cases are rarer in adults and we observed no fatal cases. In NS, the adverse effects of topical corticosteroids are amplified due to the major defect in the skin barrier which enhances the systemic passage of these drugs. In the absence of any effective therapeutic alternative, weaning patients off topical corticosteroids is usually difficult.This case illustrates the severity of iatrogenic effects secondary to misuse of topical corticosteroids in NS as well as the need to find effective new treatments for this syndrome.

The frequency of scabies is increasing in France. Crusted (or Norwegian) scabies is a very contagious form of scabies because of the huge number of mites in the skin. It is observed in patients suffering from immunodepression, motor or sensory deficiency, or mental retardation. The clinical presentation, except for the classic manifestation of scabies, is characterized by crusted lesions. Treatment is not easy and requires hospitalization. Topical corticosteroids are frequently used for children's dermatological diseases. Their long-term and inappropriate application in an infested scabies child can induce crusted scabies. We report on a case of an 8-year-old boy who developed crusted scabies induced by topical corticosteroid application. We discuss the therapeutic aspects of this severe form of scabies.

We report 3 cases of disseminated cysticercosis (DC) in adult male subjects in Togo. All had consulted in dermatology for asymptomatic subcutaneous nodules. The diagnosis was confirmed by histology of a resected nodule. Computed tomography allowed us to bring out the widespread dissemination of cysticerci. The skin, brain, muscle, eye, thyroid, and pleura were the affected organs. Treatment was based on albendazole and betamethasone, with adverse side effects in 2 of our 3 patients. Our 3 observations seem to be the first of their kind in Togo. The mechanism of contamination in these disseminated forms is not yet elucidated, however ingesting a gravid proglottis could be the basis of the widespread dissemination of cysticerci in the body. No consensus has yet been established in the treatment of DC and the management should follow the guideline for treatment of neurocysticercosis and ocular cysticercosis.

To report the anatomic and functional outcomes of Descemet's stripping automated endothelial keratoplasty (DSAEK) in 32 eyes after failed penetrating keratoplasty (PK).This retrospective, single-center observational study was performed on 32 eyes of 26 patients with failed PK grafts who underwent DSAEK between June 2009 and June 2013 at Clermont-Ferrand University Medical Center. Primary outcomes measured were: graft survival rates, functional improvement (visual acuity), and complications.Mean follow-up was 16.45 months [6-36]. Graft survival at 12 months was 76.1 % [68.1-82.3]. PK grafts cleared in 75 % of cases. Eight primary DSAEKs detached and/or decentered early (prior to day 8, average 6.22 days): 3 underwent repeat DSAEK with a new graft, and 3 underwent conversion to PK. Results were available for 26 patients at 6 months. Mean preoperative best-corrected visual acuity (BCVA) in logMAR increased from 1.48 (counting fingers at 2 meters) to 0.996 logMAR (1/10) at 6 months. BCVA improved in 17 patients (68 %). BCVA improved an average of 5.2 lines (P=0.0006). Eight patients had a large number of comorbid conditions that limited final visual acuity.Anatomic outcomes are similar to other studies. Final average BCVA was limited by severe comorbid conditions and performance of DSAEK solely for comfort. Many surgical strategies have been described to decrease graft dislocation and primary graft failure. Adapting graft trephine diameter to the host cornea as measured by AS-OCT, using a nomogram based on posterior corneal curvature obtained on AS-OCT, may be an interesting approach.DSAEK allows for quick visual recovery by preserving the anterior corneal curvature. It is an essential option for restoring corneal clarity in PK failure due to endothelial decompensation. A longer follow-up would allow a comparison of graft survival for the two techniques in this context.

L’arthrose et l’arthrite rhumatoïde sont deux pathologies articulaires caractérisées par la dégradation du cartilage articulaire, subséquente à la production de divers médiateurs inflammatoires. Le traitement de ces pathologies se limite généralement à soulager le patient des épisodes douloureux et inflammatoires et à améliorer sa qualité de vie. Dans le cas de l’arthrose, peu de traitements permettent d’enrayer significativement l’évolution de la dégradation du cartilage et donc de la maladie. Par contre, l’arthrite rhumatoïde peut être efficacement ralentie grâce à l’administration de certaines molécules. Néanmoins, ces traitements n’ont généralement montré qu’une efficacité à court-terme, requérant une administration fréquente. L’objectif de ce travail repose donc sur l’élaboration de nouvelles options thérapeutiques permettant de réduire la fréquence d’administration ainsi que les effets indésirables des traitements actuels. La délivrance de molécules en intra-articulaire associée à une libération prolongée offre l’avantage d’exposer les sites directement impliqués dans l’évolution de la maladie à une ou plusieurs molécules efficaces contre l’inflammation et la douleur, et aidant à la régénération du cartilage, durant plusieurs semaines, voire des mois.Des microparticules de PLGA chargées en clonidine ou en bétaméthasone ont donc été optimisées afin d’obtenir des efficacités d’encapsulation appréciables (clonidine HCl :EE ≈ 20% ;dipropionate de bétaméthasone :EE ≈ 70%), une taille adaptée à l’administration intra-articulaire (12 – 38 µm) et une libération de la molécule s’échelonnant sur 5 à 8 semaines. La libération prolongée de la clonidine implique des mécanismes de diffusion de la molécule ainsi que de dégradation/érosion du polymère. Au vu de l’absence de réaction inflammatoire, les microparticules développées sont correctement tolérées par les chondrocytes, synoviocytes, PBMC et neutrophiles, principales cellules impliquées dans les mécanismes inflammatoires de l’arthrose et de l’arthrite rhumatoïde. L’évaluation de l’efficacité anti-inflammatoire des microparticules vides et chargées en clonidine ou en bétaméthasone via l’étude de l’expression et de la sécrétion de différents médiateurs de l’inflammation a permis d’aboutir à plusieurs conclusions :(i) les microparticules vides sont associées à un effet anti-inflammatoire, (ii) les microparticules chargées en clonidine n’ont pas montré d’activité anti-inflammatoire propre pouvant être attribuée à la clonidine, et (iii) les microparticules de bétaméthasone ont confirmé l’effet anti-inflammatoire de la bétaméthasone. Enfin, l’étude de la toxicité des principes actifs et microparticules vides ou chargées a montré une toxicité significative de la clonidine sur les synoviocytes. Néanmoins, l’encapsulation des principes actifs dans les microparticules de PLGA a permis d’éliminer cette toxicité, protégeant donc efficacement les cellules articulaires.Les microparticules développées permettent alors d’envisager l’encapsulation d’autres molécules anti-inflammatoires ou une combinaison de molécules ayant des effets complémentaires (anti-inflammatoire et antidouleur). L’utilisation de la clonidine dans ces indications devra être réévaluée en étudiant de façon approfondie son efficacité dans la douleur. / Both osteoarthritis and rheumatoid arthritis are articular diseases characterized by the degeneration of the joint cartilage, resulting from the production of various inflammatory mediators. The current treatment of these diseases is restricted to alleviate the painful and inflammatory episodes of the patients and to improve its quality of life. In osteoarthritic patients, few treatments allow to significantly stop the evolution of the degradation of the cartilage and, consequently, the disease. In rheumatoid arthritis, the evolution can be slowed down following the administration of some drugs. Nevertheless, these treatments are often associated to a short-term efficacy. The objective of this work is to develop new therapeutic options that allow to reduce the frequency of administration and the side effects of the current treatments. The intraarticular delivery combined to controlled-release presents the advantage to expose the sites directly involved in the evolution of the disease to one or more molecules effective to relieve the pain, inflammation and to help the regeneration of the cartilage.Clonidine or betamethasone-loaded PLGA microparticles were optimized to reach suitable encapsulation efficiencies (clonidine HCl: EE ≈ 20%; betamethasone dipropionate: EE ≈ 70%), an appropriate size for an intraarticular delivery (12 – 38 µm) and a controlled-release of the molecule over 5 to 8 weeks. The release of clonidine implies mechanisms of diffusion and degradation/erosion of the polymer. Given the absence of an inflammatory reaction, the developed microparticles were properly tolerated by the chondrocytes, synoviocytes, PMBC and neutrophils, which are the main cells involved in the inflammatory reaction of osteoarthritis and rheumatoid arthritis. The assessment of the anti-inflammatory efficacy of the drug-free and drug-loaded microparticles through the evaluation of the expression and the secretion of various inflammatory mediators allowed to draw several conclusions: (i) drug-free microparticles were associated to an anti-inflammatory effect, (ii) clonidine-loaded microparticles did not show any anti-inflammatory activity that could be attributed to clonidine, and (iii) betamethasone- loaded microparticles confirmed the anti-inflammatory effect of betamethasone. Finally, the evaluation of the toxicity of the drugs and microparticles showed a significant toxicity of clonidine against synoviocytes. Nevertheless, the encapsulation of the drugs in PLGA microparticles induced the suppression of this toxicity, protecting in this way the articular cells. Entrapping other anti-inflammatory molecules or a combination of molecules with complementary effects (anti-inflammatory and anti-nociceptive drugs) in the PLGA microparticles developed has to be considered. Moreover, the use of clonidine in these indications has to be reassessed by a thorough study of its anti-nociceptive potential., Doctorat en Sciences biomédicales et pharmaceutiques, info:eu-repo/semantics/nonPublished

Prenatal corticosteroids administration is one of the major advances in obstetrics and neonatology for the prevention of preterm-birth related complications. However, concerns have been raised about its safety regarding neonatal growth and children development. Therefore, some obstetricians have restricted the use of corticosteroids to precisely defined indications. It remains some uncertainty regarding the choice of antenatal corticosteroids, the interval between injections, the timing of effectiveness and the maximum number of courses per pregnancy that is acceptable without causing complications among children. Thus, we performed a current literature review in 2013 regarding short- and long-term efficacy and safety in order to give clear recommendations to practitioners.

Cerebral venous thrombosis (CVT) is a rare origin of stroke, the clinical presentation and etiologies vary. The prognosis is shown to be better compared to arterial thrombosis. Magnetic Resonance Imaging (MRI) and MR Venograpgy (MRV) are currently important tools for the diagnostic. We studied 30 cases of CVT diagnosed in the department of neurology of the University Hospital of Fez (Morocco). Patients diagnosed with CVT signs between January 2003 and October 2007 were included in the study. Cerebral CT-scan was performed in 27 cases (90%) while the MRI examination was done in 18 patients (67%); and most patients (90%) received anticoagulant therapy. The mean age of our patients was of 29 years (age range between 18 days and 65 years). A female predominance was observed (70%). The clinical presentation of patients was dominated by: headache in 24 cases (80%), motor and sensory disability in 15 cases (50%), seizures in 10 cases (33%) , consciousness disorder in 10 cases (33%). CVT was associated to post-partum in 10 cases (33%), infectious origin in 8 cases (26%), Behcet disease in 2 cases (7%), pulmonary carcinoma in 1 case, thrombocytemia in 1 case and idiopathic in 7 cases (23%). The evolution was good in 20 cases (67%), minor squelaes were observed in 6 patients (20%), while major squelaes was observed in 2 cases. Two cases of death were registered. The CVT is a pathology of good prognosis once the diagnosis is promptly established and early heparin treatment initiated.

It has been reported that D-penicillamine causes pemphigus that is typically superficial. Immunostaining with monoclonal anti-32-2B antibody targeting desmoglein 1 and 3 can help differentiate between drug-induced and classical auto-immune pemphigus. Absence of specific staining militates in favour of drug-induced pemphigus whilst positive staining suggests an auto-immune aetiology that is ongoing despite discontinuation of drug therapy.A 59-year-old male patient was referred for management of superficial pemphigus 1 year after starting D-penicillamine treatment for scleroderma. The diagnosis of pemphigus was confirmed histologically (intra-epidermal cleavage, acantholysis and perikeratinocytes, deposition of IgG and complement C3). Immunochemical staining with anti-32-2B antibody was initially normal, in keeping with drug-induced pemphigus. Despite discontinuation of D-penicillamine, pemphigus recurred in 2008. A further skin biopsy was undertaken and anti-32-2B staining was abnormal, which is consistent with auto-immune pemphigus.Numerous cases of drug-induced pemphigus have been described in the literature. In approximately half of all cases, the pemphigus recedes after cessation of the causative drug. However, there have been no previous reports that changes over time in the immunostaining with anti-32-2B antibodies can mirror a change in form of pemphigus from a drug-induced type to an idiopathic type as well as the associated clinical feature of persistence after drug withdrawal.Normal staining with anti-32-2B antibody is associated with a favourable prognosis as regards resolution of drug-induced pemphigus. When, as in this case, status changes to abnormal staining, there is a risk that the pemphigus may become chronic despite discontinuation of therapy.

Sinus histiocytosis with massive lymphadenopathy is a rare disease. Its location is ubiquitous, but the most frequent is cervical lymph nodes.We report 2 cases of sinus histiocytosis with massive lymphadenopathy. The patients were respectively 9 and 30 years of age. They both presented with bilateral cervical polylymphadenopathy with a cervical compression syndrome in the first patient. The diagnosis was made histologically by demonstrating histiocyte emperipolesis, in the first case, and by immuno-histochemistry in the second. The treatment was corticosteroids, resulting in an almost total involution.Sinus histiocytosis with massive lymphadenopathy is a clinical and a specific pathology, but its etiopathogenesis remains to be elucidated. The cervical localization is common. The definitive diagnosis is histological. There is currently no codified treatment. The outcome is usually favorable, apart from mechanical and systemic complications that are important prognostic factors.

The case of a 85 years old woman is reported. She suffered from a partially reversible episodic memory dysfunction after i.m. injections of bethamethasone for acute lumbalgia. Cognitive impairments observed in Cushing's disease are reviewed as well as the deleterious effects of glucocorticoid treatments on episodic memory. They could be prevented by memantine.

The various forms of ophthalmic pharmaceutical presentation of steroids is proliferating on the market: solutions, gels, and suspensions. Suspensions are characterized by particles in solution and require agitation before instillation. This trial studied the impact of agitation on the corticoid concentration of eye drop solutions, gels, and suspensions.Corticosteroid levels in a drop of a dexamethasone solution or suspension or betamethasone suspension or gel were compared using liquid chromatography. These levels were measured after shaking for 5, 10, 30s, and 1 min using a vortex or without shaking.The results of this study show that, whatever shaking time was used, the suspension form seems less suited to instillation of corticosteroids. The suspension did not deliver consistent levels of corticosteroids (mean between 23 and 99%) compared to solutions and gels, which released about 100% of the corticosteroid content in each drop.Physicians, ophthalmologists, and pharmacists should remind the patient of the proper use of these suspensions before instillation. In cases of treatment failure, it is necessary to check the instillation method before questioning patient compliance.

Because they might not be efficient in reducing neonatal morbidities associated with preterm birth after 7 days of exposure, antenatal corticosteroids have been systematically repeated every week or every 2 weeks in the late 90's. Evaluation of these strategies by randomized trials demonstrated, for the neonates exposed to multiple courses, short-term neonatal benefits, mainly pulmonary, but also alterations of fetal growth and potential impairments in neurodevelopmental outcomes, without benefits at 2 years of age. This is the reason why systematic repetitive doses of antenatal corticosteroids have been stopped and has emerged the concept of rescue course in which betamethasone is given only when delivery has again become likely. It can be concluded from the only two randomized trials having evaluated this strategy that antenatal corticosteroids rescue courses might be beneficial in reducing acute pulmonary morbidity, without noticeable effects on fetal growth. Scientific data suggesting the efficacy and innocuousness of antenatal corticosteroids rescue courses in the early neonatal period are now available, however, they should be further confirmed by new randomized trials and follow up studies before this strategy can be recommended for a daily clinical practice.

In the last few years, several studies related to the benefit/risk balance of postnatal corticosteroids administered to premature neonates for prevention or treatment of bronchopulmonary dysplasia (BPD) have been published. These data encourage caution, given the risk of long-term adverse neurodevelopmental outcomes. In the meantime, the clinical profile of BPD has been altered based on the progress made in the pre- and postnatal care of premature infants. In 2006, a survey conducted in France in neonatal centers showed that corticosteroids were still frequently used (57% of the centers) following various protocols in very preterm-born infants for respiratory impairment. To promote safer practices and rational use of corticosteroids in the prevention and treatment of BPD in preterm-born neonates, we reviewed the available data in order to establish recommendations. Systemic administration of corticosteroids for prevention or treatment of BPD: (i) should not be used during the first 4 days of life; (ii) is not indicated in the first 3 weeks of life nor (iii) in extubated infants (nasal ventilation or oxygen therapy). The systemic administration of steroids can only be considered after the first 3 weeks of life in very preterm-born ventilator-dependent infants to facilitate extubation (or prevent reintubation related to the severity of BPD). Postnatal dexamethasone administration studied in several randomized clinical trials was shown to have an unfavorable benefit/risk profile, mainly because of the long-term adverse neurocognitive outcomes. Very few studies have been conducted with betamethasone in the postnatal period. According to sparse data, this drug might be as efficacious as dexamethasone, but its long-term risk profile is unknown. It should be noted that following prenatal administration, the benefit/risk profile of betamethasone is better than that of dexamethasone, especially with regard to neurocognitive development. Intravenous hydrocortisone administered at an early stage for the prevention of BPD is being evaluated and should not be administered in this indication, except within clinical trials approved by the ethics committee. No other corticosteroids have been evaluated in the postnatal period in respiratory indications. In conclusion, in the situations described above for which systemic corticosteroids could be justified, the use of betamethasone (or hydrocortisone) appears to be better. As usual, the lowest possible dose of corticosteroids should be administered for the shortest possible duration. The betamethasone-equivalent dose of 0.125 mg/kg/day for 3 days is deemed adequate. If inhaled, corticosteroid therapy may facilitate extubation. Neither its efficacy in respiratory diseases nor its long-term risk profile has been so far established.

Children and adults may experience neuropsychiatric disorders during glucocorticoid treatment, most of which are reversible upon drug withdrawal. Whereas the occurrence of these disorders is well documented in teenagers, only a few cases have been reported in children under 3 years of age. We report on severe neuropsychiatric disorders that occurred in a 27-month-old child during glucocorticoid treatment for asthma that did not regress when treatment was stopped. The psychiatric symptoms suggested autism and were associated with deterioration of the child-mother relationship. This led the medical staff to initiate a dual therapy (conducted by a psychiatrist and a speech therapist) focused on the restoration of the maternal bond. A dramatic improvement in both the child's and the mother's behavior was observed within a few months. Severe psychiatric disorders induced by glucocorticoids can occur in young children and be worsened by environmental factors. The quality of the child-parent relationship should be kept in mind during the management of drug-induced psychiatric disorders.

In 1999, 80% of French neonatal centers used corticosteroids, mainly betamethasone (BMT), to prevent or treat bronchopulmonary dysplasia (BPD) [Lee SK, McMillan DD, Ohlson A, et al. Variations in practice and outcomes in the canadian NICU Network 1996-1997. Pediatrics 2000;106:1070-9]. As many data suggested a low risk-benefit ratio, an updated assessment of this use was necessary [Desnoulez L, Empana J, Anceschi M, et al. Prise en charge de l'immaturité pulmonaire en néonatologie : enquête sur les pratiques européennes. Arch Pediatr 2005;12:4-9; Halliday HL, Ehrenkranz RA, Doyle LW. Early postnatal (less than 96h) corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev 2003:CD001146; Yeh TF, Lin YJ, Lin HC, et al. Outcomes at school age after postnatal dexamethasone therapy for lung disease of prematurity. N Engl J Med 2004;350:1304-13; Lin YJ, LKin CH, Wu JM, et al. The effects of early postnatal dexamethasone therapy on pulmonary outcome in premature infants with respiratory distress syndrome: a 2-year follow-up study. Acta Paediatr 2005;94:310-16].Questionnaires addressing the use of and indications for corticosteroids were sent to all French neonatal centers.The study was conducted over 5 months (July to November 2006). Of 202 questionnaires sent out, 186 (92%) were completed. Of these 186 centers, 147 (79%) had a standard protocol for corticosteroid use, covering systemic and inhaled steroids (76 units), only systemic steroid therapy (30 units) and only inhaled steroids (41 units). Systemic corticosteroids were used in 106 centers for hemodynamic purposes in 42 cases (40%), prevention of BPD in 1 case (1%), early treatment of BPD (day 4 to day 21) in 23 cases (22%) and late treatment of BPD (after day 21) in 74 cases (70%). Hemisuccinate hydrocortisone (HSHC) was the only corticoid used for hemodynamic failure. The steroid used for early treatment of BPD was BMT (21 out of 23). The duration of treatment was less than 4 days in 10 centers (43%). The steroid most often used for late treatment was BMT (67 out of 74). The duration of treatment was less than 4 days in 29 centers, between 4 and 8 days in 22 centers, and longer than 8 days in 26 centers. Among 117 centers administering corticosteroids by inhalation, 74% used budesonide. Use of corticosteroids was higher in teaching hospitals (86%) than in others (49%), likely due to the immaturity of the neonates hospitalized in these centers.We showed a still frequent use of corticosteroids in preterm infants in France but only after the fourth day of life to treat BPD and not as a prevention therapy. We also found a marginal use of DXM in accordance with both short-term and long-term adverse side effects, suggesting an unbalanced risk-benefit ratio even though it has a beneficial effect on respiratory status. Our findings indicate the need for national recommendations and trials to assess oral BMT treatment in premature neonates with BPD.

In black population, the skin-bleaching with cutaneous topical corticosteroids on a large body area is a widespread practice and is associated with numerous cutaneous complications. We report a 25-year-old Congolese woman who was admitted for weakness, arthralgias and abdominal pain. The association of a relative hyperpigmentation of the small joints of hands and feet with clinical features of hypercorticism led to suspect a chronic use of cutaneous topical steroids for skin-bleaching. On biological tests, plasma cortisol and corticotropin levels were undetectable and the short corticotropin (ACTH) stimulation test was negative, leading to the diagnosis of adrenal insufficiency complicating the chronic use of topical steroids. Clinical symptoms resolved with hydrocortisone therapy. One year later, the patient admitted a five-year continuous use of cutaneous topical steroids (betamethasone, 0.05%). Skin-bleaching through chronic use of cutaneous topical steroids, is a common practice in black women, and should be suspected in the presence of adrenal insufficiency with or without clinical features of hypercorticism, and conversely, skin-bleaching users should be tested for hypothalamo-pituitary-adrenal function.

The aim of this study was to evaluate the efficacy of treatment of generalized cutaneous lichen planus using dipropionate and betamethasone disodium phosphate.A prospective study was conducted among patients presenting generalized cutaneous lichen planus consulting a dermatology service of Lomé teaching hospital in Togo (September 2003 to August 2005). Each patient included in our study reveived three injections of dipropionate and betamethasone disodium phosphate every 2 weeks. Evaluation was done at 6 weeks, 3 months and 6 months.73 cases of generalized cutaneous lichen planus were included in our study. The sex-ratio (H/F) was 0.7. The average age of patients was 29.5 +/- 11.9 years. At six weeks: complete remission was 83.6% (61 cases) and partial remission was 8.2% with a failure rate of 8.2%. At 3 months, persistent complete remission was 58.9% vs. 23.3% relapse. At 6 months, relapse was 31.5%. No major side-effects were reported among our patients during the study period.The study results suggest that dipropionate and betamethasone disodium phosphate may constitute an alternative therapeutic approach in generalized cutaneous lichen planus. However these results require confirmation by a randomized trial over a longer period.

Actinic lichen planus (ALP) is a chronic and benign disease that affects young people of the Middle East and Maghreb countries.To analyse clinical features and prognosis of ALP in children.A retrospective, descriptive study of cases observed in the department of dermatology of Sfax hospital over a period of 11 years (1995-2005).Our patients were 5 boys and 1 girl. Mean age at diagnosis was 11 years. Onset was during the summer in 5 cases. The face was involved in 5 cases and the upper limb in 3 cases. The annular form was found in 5 cases, the pigmented melasma-like form in 1. Cheilitis was associated in 3 cases. Treatment consisted in photoprotection in all the patients. Antimalaria drugs were used in 4 patients and topical steroids in 2. Evolution was favourable in 5 cases. Disease relapsed in one child after treatment interruption.ALP can be seen during childhood. Ultraviolet rays are involved in pathogenesis. The annular form is predominant. Treatment is based on sun protection associated with antimalarials or topical steroids.

Paclitaxel (Taxol) is a drug derived from the bark of the Pacific yew tree and is widely used in cancer treatment, especially for breast, ovarian, and lung cancers. It has not previously been reported to induce lupus.We report the case of a woman with ovarian cancer who developed paclitaxel-induced lupus on two occasions. Both times, the paclitaxel dramatically improved the ovarian cancer.The diagnosis of lupus was confirmed by the initial skin appearance, elevated levels of antinuclear antibodies, recurrence on reintroduction, and biopsy results. To our knowledge, it is the first case reported of paclitaxel-induced lupus.

Diabetic pregnancy is a precarious situation, both for mother and fetus, because it increases the risk of prematurity and respiratory distress. We report 3 cases of severe acute complications following antenatal betamethasone treatment in mothers presenting with severe diabetes. Corticosteroids are strongly recommended to prevent prematurity complications in newborns. We highlight the high risk profile of theses pregnancies, the effect of this treatment on the mother and the child, and question the real benefit of corticotherapy for these fragile newborns. The metabolic and blood pressure balance is dangerously disturbed in such pregnancies by this treatment. This brings the question of how justified are corticosteroids in such cases?

Beneficial effects of antenatal corticotherapy on neonates are now well established. However, after the first conference of consensus, three controversial issues were left unresolved = use of dexamethasone or betamethasone, ideal number of curses to be given, and appropriateness of corticotherapy in case of prmature of the membranes. A literature review suggests that betamethasone is preferred to dexamethasone, that prscription of a single course is more advisable than multiple courses, and that antenatal corticotherapy is finally not contraindication in case of premature rupture of membranes.

The combination of calcipotriol and betamethasone dipropionate in a single topical formulation is a recent advance in treatment of plaque type psoriasis. Studies rooted on evidence-based medicine have been recently published. We report a synthesis and a critical analysis, critical analysis of these investigations, and translate their data with a view to apply them in daily practice.

The topical treatment of psoriasis benefits from the alternate use of dermocorticosteroids and vitamin D3 analogues. A new galenic formulation allows to combine them in a single application. Dovobet (LEO Pharma) ointment is the association of calcipotriol 50 microg/g with betamethasone dipoprionate 0.5 mg/g. This formulation boosts the therapeutic activity of calcipotriol. It also decreases the irritative inflammatory reaction due to calcipotriol without increasing the atrophogenic risk of the dermocorticoid.

Central serous chorioretinopathy has three patterns: the first or typical form with one or several points of diffusion; the second, diffuse retinal pigment epitheliopathy; and the third, the bullous form of serous chorioretinopathy. The authors present a case of a 55-year-old male presenting with diffuse retinal pigment epitheliopathy and topical treatment of psoriasis, with a 9-year history of corticoid ointment use, associated with cyclosporine over the last year. The topical treatment was discontinued and the patient recovered his vision, with a final visual acuity of 5/10 in the right eye and 4/10 in the left eye.

The Baboon syndrome is a form of systemic contact dermatitis. We report the case of a patient who presented a Baboon syndrom following oral medication with betamethasone.A 58 year-old man had consulted for eczema involving the groin, the buttocks and the axillae. It was clinically a baboon syndrome related to oral betamethasone (Celestene) treatment, ingested 48 hours earlier. The exploration with a patch-test confirmed the sensitization to betamethasone. This exploration also showed a sensitization to all four classes of corticosteroids. Prolonged withdrawal of all corticosteroids led to the clear improvement of his eczema.The baboon syndrome of this patient was the symptom of a systemic eczema due to betamethasone. The patient was sensitized by the percutaneous route. The application of many topical corticosteroids had provoked this polysensitization. It was impossible to consider a safe corticosteroid for this patient.

A favorable benefit-to-risk ratio is well established for a single dose of antenatal corticosteroids in women at risk of preterm delivery. The efficacy is real with an important decrease of mortality and morbidity. No adverse effects were described after one course. Possible beneficial effects of repeated courses include lower rates of RDS and a decrease in oxygen use, whereas an increasing body of evidence raises the concern of multiple short and long term adverse consequences, principally neurological. It seems rational to prescribe one course of corticosteroids. The indication for a second course should be discussed but multiples courses of this treatment should not be prescribed. We prefer betamethasone over dexamethasone because of the better side profile. Further work is needed to understand the long-term effects of this treatment.

Scalp involvement by psoriasis requires a ted treatment suited to the particularities of the anatomical site In course of time, the improvement of therapeutic agents and the galenic refinement have enhanced both the efficacy and cosmetic acceptability of the scalp care. The main therapeutic classes encompass keratolytics, dermocorticosteroids and vitamine D3 analogues. The patient compliance is reported to be best for the liquid or foam formulations.

Systemic corticosteroid therapy is the usual treatment for hemangioma with vascular risk. Tolerance to such treatment is usually good.A two Month-old girl presented with a hemangioma of the lower right eyelid that had developed since she was 15 days old. Treatment with betamethasone at the dose of 0.3 mg/kg/day was prescribed because of the risk of alteration in sight. The treatment was highly effective. The discovery of a systolic cardiac murmur motivated a cardiac sonography that showed signs of an obstructive hypertrophic myocardiopathy. The progressive reduction of the corticosteroids led to the regression of this disease.The onset of a cardiomyopathy during systemic corticosteroid therapy has only been reported exceptionally in the literature. There is little known of the risks. When in doubt, clinical and sonographic monitoring is probably necessary. In the case of the appearance of a cardiac murmur, the sonography is crucial.

We report the case of a 65-year-old patient suffering from a long-term ulcerative colitis treated with corticosteroid enema and presenting a bilateral posterior subcapsular cataract. As far as we know, this is the first case report of steroid-induced cataract after intrarectal corticosteroid use. Alternative hypotheses concerning the mechanism of cataract formation are suggested. This case report should warn ophthalmologists and gastroenterologists about the cataractogenic effects of corticosteroid enema to ensure that information is provided for patients suffering from ulcerative colitis.

Objectives To assess the benefits and risks of antenatal corticosteroid therapy for fetal maturation. Options To administer antenatal corticosteroids or not to women at risk of preterm birth. Outcomes Perinatal morbidity, including: respiratory distress syndrome, intraventricular hemorrhage, infection, adrenal suppression, somatic and brain growth; perinatal mortality; and maternal morbidity, including infection and adrenal suppression. Evidence MEDLINE and PubMed searches 1996 to August 2002 for English-language articles related to antenatal corticosteroid therapy for fetal maturation, the Cochrane Library, and national statements including that of the National Institutes of Health (NIH), the American College of Obstetricians and Gynecologists, and the Royal College of Obstetricians and Gynaecologists. Values The evidence obtained was reviewed and evaluated by the Maternal-Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and recommendations were made according to guidelines developed by the Canadian Task Force on the Periodic Health Exam. BENEFITS AND HARMS: A single course of corticosteroids reduces perinatal mortality, respiratory distress syndrome, and intraventricular hemorrhage. Information regarding repeat courses of corticosteroids is limited and conflicting, with many studies being retrospective and non-randomized. Some studies suggested a reduction in respiratory distress syndrome with repeat courses, but some found increased rates of neonatal and maternal infection; fetal, neonatal, and maternal adrenal suppression; decreased fetal or neonatal somatic and brain growth; and increased perinatal mortality. Recommendations The SOGC supports the recommendations of the NIH Consensus Development Panel: 1. All pregnant women between 24 and 34 weeks' gestation who are at risk of preterm delivery within 7 days should be considered candidates for antenatal treatment with a single course of corticosteroids. (I-A) 2. Treatment should consist of two 12 mg doses of betamethasone given IM 24 hours apart, or four 6 mg doses of dexamethasone given IM 12 hours apart (I-A). There is no proof of efficacy for any other regimen. 3. Because of insufficient scientific data from randomized clinical trials regarding efficacy and safety, repeat courses of corticosteroids should not be used routinely (II-2E) but be reserved for women participating in randomized controlled trials. Validation This Committee Opinion has been reviewed and approved by the Maternal-Fetal Medicine Committee of the SOGC and approved by SOGC Council.

The aim of the study was to determine the feasibility, the cost and the effects of antenatal maternal corticosteroid treatment on preventing respiratory distress syndrome in premature neonates of our population.Between January, 1, 1998 and June, 31, 1999, 118 pregnant women at 26-34 weeks' gestation and at a high risk of premature delivery, were prospectively randomized in 2 groups: group 1 received intramusculary 24 mg of betamethasone (12 mg every 24 hours), group 2 didn't receive antenatal corticosteroids. At birth, premature neonates were systematically examined by a neonatologist.131 premature neonates were born (63 from group 1, 68 from group 2). The incidence and the degree of severity of respiratory distress syndrome, appeared substancially reduced (4.8% vs 27.9%) by the use of antenatal corticosteroids. Moreover, neonatal mortality due to respiratory distress syndrome was statistically less in group 1 than in group 2 (22.9% vs 57%). There was no significant difference in the occurrence of maternal or neonatal corticosteroid complications such as infection between treated group and control subjects. We estimated a potential annual savings of 21 thousands tunisian dinars, when the cost implications for antenatal corticosteroid therapy were estimated to 2 thousands tunisian dinars.Maternal administration of corticosteroids before preterm delivery results in a decrease in the incidence and severity of respiratory distress syndrome and a decrease in neonatal mortality rate among premature neonates born to treated versus untreated mothers at 26-34 weeks' gestation; added to an annual savings estimated to 21 thousands tunisian dinars.

Fifteen randomized studies in Crowley's analysis compared a group of patients receiving, a single course of steroids versus placebo between 24 and 34 weeks of gestation. It clearly demonstrated the benefit of a single course of steroids in the prevention of the prematurity-related complications with a decrease in neonatal mortality, a decrease in the incidence of respiratory distress syndrome, a reduction in the incidence of intraventricular haemorrhage and a reduction in necrotizing enterocolitis (NP 1). Because only bethamethasone has proved its efficiency in the reduction of neonatal mortality (NP 2) and antenatal exposition to betamethasone is associated with a decrease in the risk of periventricular leukomalacia in children born prematurely (NP 3) it seems preferable to use betamethasone rather than dexamethasone. Antenatal administration of repeated courses compared with single course of steroids improves fetal lung function with a decrease of RDS notably if the children is born before 28 weeks of gestation (NP 2) but numerous animal studies reported adverse effects of repeated courses. Several studies in women having received of repeated courses steroids report a decrease in birth weight and head circumference at birth but with a 3 years follow up similar to that of children exposed to a single course (NP 3). In conclusion the benefit of a single course of steroids is indisputable for the prevention of the prematurity-related complications but there is today a strong concern about the benefit/risk ratio in relation to the prescription of repeated courses of steroids.

Unavailable, La glande surrénale est au centre des mécanismes qui régissent l'homéostasie des grandes fonctions des organismes vivants supérieurs. Afin d'assurer sa fonction, même au début du développement, elle possède la faculté de moduler son activité en réponse à des stimuli, physiologiques comme l'hypoxie ou pharmacologiques comme une exposition anténatale aux corticoïdes exogènes (recours thérapeutique largement répandu aujourd'hui pour accélérer la maturation pulmonaire foetale en cas de risque d'une naissance prématurée). Cependant, les voies neurogéniques de contrôle surrénalien ne deviennent matures que bien après la naissance dans de nombreuses espèces dont l'Homme. Le système ubiquitaire des récepteurs dopaminergiques constitue un des éléments intervenant très probablement dans les mécanismes non neurogéniques qui participent à la régulation de cette réponse surrénalienne, notamment pendant la période périnatale. Il jouerait ainsi un rôle dans l' adaptation néonatale. Le récepteur dopaminergique DI (R DA DI) est présent dans la glande surrénale, mais son expression a été peu étudiée. En raison d'analogies dans l'ontogenèse du tissu nerveux sympathico-adrénergique entre les espèces humaine et lapine, nous avons entrepris une étude expérimentale utilisant le lapin comme modèle animal. Une étude préliminaire s'est attachée à évaluer la modulation de l'expression de l'ARN messager (ARNm) des récepteurs dopaminergiques Dl et D2 dans le striatum au cours du développement après exposition anténatale à un corticoïde, la bétaméthasone. Ce système de neurotransmission très élaboré, et particulièrement bien étudié, constitue un système de référence. Ceci nous a permis de valider nos techniques moléculaires d'analyse de type Northern Blot. Les résultats montrent une sur-expression des ARNm des 2 récepteurs chez le foetus exposé, puis une sous-expression à 1 et 25 jours postnatals avec retour à la normale chez l'adulte. Le travail a été alors axé sur le R DA DI dans la glande surrénale. L'analyse par Northern Blot a montré que l'expression du récepteur dopamipergique Dl est présente dès le stade foetal et jusqu'à l'âge adulte, sans modulation âge-dépendante. Après traitement anténatal aux corticoïdes, il est constaté une sur-expression chez le foetus, qui se prolonge à 1 et 25 jours de vie pour disparaître chez l'adulte. L'étude a été complétée par l'analyse postnatale de la modulation d'expression de l'ARNm du R DA Dl après exposition à l'hypoxie (4 conditions expérimentales ont été appliquées: FiO2 15% pendant 6 ou 24 heures, et FiO2 8% 6 ou 24 heures). Quelle que soit la durée ou l'intensité de l'hypoxie, il est mis en évidence une diminution d'expression uniquement chez le nouveau-né de 1 jour. Il n'y a pas de modulation à 25 jours ou chez l'adulte, alors que le contrôle neurogénique s'est installé. Ce travail, qui a fait l'objet d'une convention de cotutelle France-Québec, prouve l'existence d'une expression de l'ARNm du R DA Dl dans la glande surrénale de lapin précocement au cours du développement. Il montre le caractère modulable de cette expression sous l'influence de stimuli physiologique ou pharmacologique. Enfin, il met l'accent sur les effets potentiels postnatals à moyen et long terme d'une thérapeutique administrée en anténatal. De même, il permet de souligner la différence de réponse selon l'âge postnatal auquel est appliqué un stimulus hypoxique.

Systemic corticosteroid is the main treatment of severe forms of pemphigoid gestationis. We report a case of generalised pemphigoid gestationis successfully treated with very potent topical corticosteroid.A 37-year-old woman developed during her third pregnancy with a new partner an urticated generalised eruption associated with bullous lesions. The diagnosis of pemphigoid gestationis was confirmed by direct immunofluorescence which detected a linear C3 deposition along the basement membrane zone and the positivity of Herpes Gestationis Factor (10 units). Local treatment with potent corticosteroid (betamethasone dipropionate 0.05 p. 100) failed and the patient was successfully treated by clobetasol propionate 0.05 p. 100 cream. The infant, in good health, was not delivered prematurely.Severe form of pemphigoid gestationis are currently treated with 0.5 to 1 mg/kg/day of systemic corticosteroids, with maternal and pediatric possible side effects. As in bullous pemphigoid, this observation underlines the efficiency and good tolerance of very potent corticosteroid in severe forms of pemphigoid gestationis.