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Introduction Les dermites des mains (DM) chez les soignants sont frequentes en pratique courante. Ainsi, deux enquetes realisees successivement en 2015 sur l’ensemble du personnel soignant, puis en 2017 sur les soignants de reanimation ont montre le role aggravant du lavage de mains > 10/jour et du port de gants prolonge sur les DM et leurs repercussions sur les habitudes d’hygiene (sous-utilisation des produits hydroalcooliques [PHA]). L’objectif de notre etude etait d’evaluer les modifications des pratiques suite a la mise en place des consignes strictes « 5 gestes barriere » contre la CoViD-19, leurs repercussions sur l’induction de DM et leur impact sur les mesures d’hygiene. Materiel et methodes Etude transversale, prospective, descriptive, a destination de tout le personnel du CHU de Nantes. Donnees saisies en ligne par le personnel et analysees sous Sphinx®, puis comparees aux enquetes precedentes. Resultats Trois cent soixante-neuf professionnels ont repondu a l’enquete (dont 329 soignants). Parmi eux, 77,6 % se lavaient les mains > 10 fois par jour, 77 % utilisaient les PHA > 20/jour (contre respectivement 48,1 % et 50,4 % avant). Les DMs etaient tres significativement augmentees : 79 % dans les unites CoViD-19 + Rea + Urgences pendant l’epidemie versus 60 % anterieurement (23 % sans lesion avant mars 2020) ; 86 % dans les autres services versus 54 % avant (36 % sans lesion avant mars 2020). Les symptomes rapportes etaient : 96,8 % secheresse, 63,9 % rougeur, 50 % demangeaisons, 48,4 % crevasses, 27,4 % douleurs. On observait une utilisation plus importante de cremes hydratantes (85,9 % pendant l’epidemie versus 70,2 % avant) associee a une utilisation moindre des dermocorticoides. Durant l’epidemie, les modifications des habitudes d’hygiene des mains en cas de lesions etaient moins frequentes que lors des etudes precedentes. Discussion Malgre un biais de selection (les repondants a cette enquete sont probablement des professionnels particulierement concernes par les problemes de DM), cette etude est la premiere a s’interesser aux mains des soignants durant la pandemie de SARS-CoV-2. On observe une augmentation tres significative du nombre quotidien de lavages de mains et d’utilisation des PHA avec pour consequence une augmentation des lesions des mains. La communication sur les facteurs de risque de DM a permis aux soignants de maintenir les mesures d’hygiene recommandees malgre les lesions cutanees ainsi que la mise a disposition de cremes hydratantes. Conclusion L’epidemie de SARS-CoV-2 a eu des consequences majeures sur l’augmentation du nombre de DM du personnel hospitalier. Une education des soignants, la mise a disposition de produits lavant doux et de cremes emollientes, ainsi que l’acces rapide a une consultation dediee sont fondamentaux.

Melanoma is a malignancy in which the immune system plays a central role, thus explaining the effectiveness of therapeutic vaccination and cellular immunotherapy with tumor-infiltrating lymphocytes. The identification of specific melanoma antigens was an important step in the development of these new approaches. These treatments are capable of yielding tumor responses that last several years, but the response rate is currently inadequate. The crucial role of the tumor microenvironment has recently been shown: melanoma cells render their immediate environment immunotolerant, undermining the effectiveness of stimulated cytotoxic T lymphocytes. The mechanisms responsible for this state of immune tolerance are a major focus of research. Current therapeutic strategies are based on early adjuvant approaches, destruction of regulatory T cells by lymphodepletion prior to immunotherapy, selection of the melanoma antigens inducing the best cytotoxic T cell responses, and combining cellular therapy with monoclonal antibodies that block molecules inhibiting T lymphocyte activation. Immune therapy for melanoma is thus moving towards adjuvant strategies for early-stage disease and combined treatments for metastatic melanoma. It is also important to identify markers that can be used to predict which patients will respond to a given treatment.

The epidermal growth factor receptors (EGFR)-inhibitors are frequently responsible for cutaneous adverse drug reactions that may alter the patients' quality of life and hamper the continuation of treatment. We present here the experience of a group of French multidisciplinary experts - the PROCUR group (PRise en charge de la tOxicité CUtanée des anti-EGFR) - created in order to establish a therapeutic algorithm. It was built in three steps under the responsibility of a steering committee: (1) a systematic literature review was performed by a group of three dermatologists and one oncologist; (2) regional meetings evaluated practical aspect of the treatments in France; (3) a final meeting confrontating the practices in France and the evidence-based medicine including the steering committee, the bibliographic group, and oncologists, radiotherapists, dermatologists and hepato-gastroenterologists involved in regional scientific committees, resulted in a therapeutic algorithm, resulting in the collegial writing of this algorithm. This multidisciplinary study should facilitate the standardised, optimised management of skin toxicity associated with EGFR-inhibitors.

This article describes current concepts and future challenges in non specific immunotherapy, vaccination, and antigen-specific adoptive immunotherapy of melanoma. If these treatments are to realize their full potential, it will be essential to understand how the tumor induces immune tolerance.

Our aim was to examine the specific clinical and therapeutic characteristics of acne in women seen in our practice.This retrospective observational study included all women older than 25 years seen in our practice between 1 January 2001 and 31 December 2003.The mean age of the 79 women included in the study was 31.8 years; 67% reported a family history of acne; 79% reported at least one acne-promoting factor, 62% regular cosmetic use. Acne began at a mean age of 16.6 years, and only 13% had lesions before menarche. Before referral, they had received an average of 2.3+/-1.6 systemic treatments and 43% had already been treated by isotretinoin. Over an average follow-up period of 11 months, 83% of those for whom we prescribed isotretinoin had complete remissions, and 17% a partial response.Acne in women seems to be a persistent form of juvenile acne. Most of the cases we saw were inflammatory acne, with extrafacial lesions in one third of cases. The high frequency of familial history and severe seborrhea suggest a genetic factor. We also noticed the influence of the premenstrual period, stress, sun exposure and cosmetic use. Isotretinoin treatment produced the best therapeutic response.

Acne is a disease that develops in pilosebaceous follicles. Acne was long considered was an infectious disease related to Propionibac-terium acnes, but studies show that the production of inflammatory substances in situ was much more important to the action of this bacterium than was simple infection. It was once thought that only the androgens could stimulate the seba-ceous gland, but today we know that neuromediators can also stimulate sebum production. This finding provides physiological support to the clinical observation that stress can induce acne.

The treatment of acne is based on local and systemic treatments. It must be adapted to the type of acne and take some prognostic factors into account. Because of the possibility of drug resistance, systemic and local antibiotics should be used for only limited periods and preferably as part of combined treatments. Prescription of isotretinoin to women must follow strict rules. Some new-generation contraceptive pills are an interesting alternative for acne treatment in women. Zinc, which basically targets inflammatory acne, is a possible option for pregnant women and during the summer. Cosmetic care is also a fundamental part of acne treatment.

At the stage of primary tumour and lymph node extension, the treatment of melanoma is mainly surgical. Interferon alpha has obtained marketing authorisation to be used as adjuvant therapy at different doses in the treatment of these two stages of the disease and must therefore be discussed with the patient. At the metastatic stage, no real progress in chemotherapy has been noted for more than 20 years. Combined therapy with chemotherapy and cytokines (interferon alpha or interleukine 2) increases the percentage of response but without increasing the overall survival. THREE IMMUNOTHERAPY TECHNIQUES: Cellular immunotherapy represents the main hope of these future years in the treatment of melanoma, with the injection of in vitro expanded cytotoxic T cells, vaccination and dendritic cells. Although clinical results are starting to be published, cellular immunotherapy remains in the field of clinical research, within the framework of clinical trials.

A WORRYING INCIDENCE: In frequency, the melanoma, is placed just after breast, colic and pulmonary cancer with around 6 000 new cases per year in France. Moreover, it is the tumour that is increasing the most and its frequency has doubled over the past 10 years. It is presently estimated as 7 to 9/100 000 in France. THE IMPACT OF PREVENTIVE MEASURES: Primary and secondary prevention is therefore crucial, as is the identification of patients at risk. However, till now, the impact of educational and preventive campaigns with regard to sun exposure, which plays a major role in the development of a melanoma, are still insufficient

EARLY DIAGNOSIS FOR EFFICIENT MANAGEMENT: The melanoma is a cutaneous tumour of poor prognosis and its incidence is increasing. Some risk factors are now well established ( field, phototype, family history) and its early discovery is clinically possible since the lesions are visible to the eye. When diagnosed early, the prognosis is clearly improved. CLINICAL FORMS OF VARYING PROGNOSIS: Depending on the clinical, histopathological and progressive differences, it is possible to distinguish a Superficial Spreading Melanoma (60 to 70%), nodular melanoma (10 to 15%), Dubreuilh's melanoma (5 to 10%) and acrolentigenous melanoma (5%). Apart from these 4 major clinical forms, there is also the sub-ungual melanoma and the mucosal melanoma. Particular situations may also exist: the discovery of metastasis without identification of cutaneous tumour, a melanoma in a pregnant woman or a child, a familial melanoma or multiple melanomas. THE ELEMENTS OF DIAGNOSIS: The semiological analysis of an often-pigmented lesion of the skin, relying on the ABCDE rule and the notion of rapid progression, is the first stage in the diagnostic approach. It is completed, following complete exeresis, by anatomopathological exploration (Breslow's index, existence of ulceration, signs of regression, Clark's classification, histological type and mitotic activity). Two further elements should also be taken into account: the results of a dermatoscopy and the analysis of the sentinel nodes.

Herpes is a viral infection which increases, specifically genital herpes. The aim of this survey was to assess the perception of herpes in the general population and in patients with herpes in France using a self-administered questionnaire. A total of 10,000 persons answered the questionnaire among which 128 patients presented herpes. This study showed that only 5% of the French population knew that herpes was a viral infection, and 7% a sexually transmitted disease. Among patients with genital herpes only 34% indicated a sexual relationship and a mode of contamination. The interference with sexual and social life is important. Development of information and communication on herpes appears crucial.

The primary indication for systemic antibiotics is acute therapy for moderate-to-severe inflammatory acne. The preferred agents include tetracyclines and derivatives; macrolides, co-trimoxazole, and trimethoprim may represent acceptable alternatives. Antibiotics act mainly on inflammatory lesions (papules and pustules) and are only slightly comedolytic. Oral antibiotics reduce the number of Propionibacterium acnes. In addition, they have an anti-inflammatory activity. The side effects associated with oral antibiotics for acne depend on the drug; however, severe side effects are not common. Resistant strains of Propionibacterium acnes to antibiotics are increasing. Thus, general guidelines are useful when utilizing oral antibiotic therapy in acne.