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Background: Drug addiction causes chronic wounds (CW) responsible for severe complications. Very few studies are available on this topic. The aim of our study was to describe the demographic, clinical and etiological characteristics as well as the course of CW in drug addicts., Patients and Methods: This was a retrospective and prospective multicenter study including all drug addicts with CW., Results: We included 58 patients (17 prospectively), 84.5% of whom were male, of median age 43 years, presenting multiple CW as a result of intravenous (78.2%), inhaled (41.1%) and/or snorted (20%) drug abuse. Addiction to opioids (68.4%), cocaine (47.4%) and/or cannabis (40.4%) was ended and/or treated through substitution in 79.3% of patients. CW were fibrinous and necrotic (42.9 to 53.6%), recurrent (54.2%), and in some cases had been present for more than 1 year (61.5%). Intravenous drug addiction was associated with large, fibrinous, ulcers in a setting of venous and lymphatic insufficiency (74%). Only 23% of these wounds involved the upper limbs. Necrotic ulcers associated with clinical arteriopathy were described mainly with inhaled addiction. Abscesses (50%) and erysipelas (29.3%) were the most common cutaneous complications. After 3 months, 50% of CW were improved and 29.2% of patients were lost to follow-up., Discussion: Drug abuse-related CW occurred preferentially in young men with history of intravenous abuse. For the most part, CW were seen on the legs and were associated with venous and lymphatic insufficiency, and the resulting major risk for cutaneous infection increased morbidity and mortality in this population in whom medical follow-up is inherently complicated., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

A 26-year-old nurse presented with a three-day history of sudden onset of pyrexia of 39 °C, malaise, and a patchy maculopapular rash, after returning from a monthlong work in Senegal. A tourniquet was applied to help locate the vein for diagnostic blood sampling. After the procedure, a petechial rash erupted with a demarcation line below the level of the tourniquet. A diagnostic test for dengue fever was performed and confirmed by the polymerase chain reaction (PCR) to be positive for serotype DEN-1. The tourniquet test is performed by inflating a blood pressure cuff tied on the upper arm to a point midway between systolic and diastolic blood pressure for five minutes. The test is considered positive when there are 20 or more petechiae per square inch (6.25 cm(2)) on the forearm, and is one of several clinical parameters considered by the World Health Organization to be important in the diagnosis of dengue fever.

The discovery of the major role of TNF alpha in the physiopathology of certain inflammatory diseases and notably in rheumatoid arthritis and Crohn's disease has led to the development of anti-TNF alpha drugs. These new therapeutic arms issued from bio-technology have rapidly demonstrated their efficacy in the treatment of these two diseases. The anti-TNF alpha arsenal is currently dominated by etanercept, a fusion protein composed of a soluble TNF alpha receptor, and infliximab, a chimeric monoclonal antibody. However, new molecules will soon enrich this arsenal. TNF alpha is a major cytokine of inflammatory diseases of the skin. Many dermatological diseases will probably benefit from these new treatments. Two studies have already demonstrated their interest in cutaneous and articular psoriasis. Encouraging sporadic results suggest other potential indications (Behcet's disease, bullous dermatitis, neutrophilic dermatitis, toxic epidermal necrolysis, systemic vascularitis,.). These promising new treatments, although expensive, and with yet unknown long term side effects, justify rigorous assessment of their efficacy and tolerance in each indication. Here again the dermatologist has a major role to play in post-marketing pharmacovigilance.

The authors study some cases of surgical revision in post traumatic or secondary rhinoplasty. Cartilaginous grafts with temporal superficialis fascia are recommended. The removal of ear cartilage is used by a posterior approach for the concha cartilage associated with a septum or an alar cartilage removal. They describe the Delta graft associating a concha cartilage supported by a prop (auricular or septal) to repair a loss of substance from the middle or lower third of the nasal pyramid.

The authors, reviewing their own experience of Blepharoplasty (92 cases) since ten years, discuss the principal approaches used depending on the age of the patient, the amount of adipose tissue, the lower lid tarsal and muscular laxity and the quality of the skin excess. On the lower eye lid they emphasize the interest of the transconjunctival approach in young an or coloured people and they undermine a cutaneo-muscular flap in the classical technique. On the upper eye lid, they combine the skin excision with an orbicular muscle strip and in old people with a suspension of the lateral canthus. A good choice between these different approaches avoid the rare complications (ectropion and scleral show) because blepharoplasty must be considered like a "variable geometry" operation.

The authors start by recalling the principal histomorphological and physiological characteristics of skin tissues subjected to expansion, in particular their hyper-vascularisation which allows the raising of vast flaps of excellent quality. After presenting the major principles, they then present their clinical experience in the context of reconstructive surgery of the scalp, particularly in the correction of Juri flap scars used in the treatment of baldness. Finally, they emphasise the great potential of this technique in the whole field of reconstructive surgery.

Fourteen cases of Ewing's inversed papilloma of the nose and sinuses were treated as primary lesions or after recurrence. Clinical and paraclinical, mainly radiologic, endoscopic, and biologic investigations are of fundamental importance and should be as extensive for primary as for recurrent lesions. Treatment is largely dependent on the results of these examinations, is essentially surgical, and should respond to two imperatives. First, it should lead to total excision under the best possible conditions, and second, it should involve a minimum of sequelae, particular esthetic complications. Techniques for excision through the natural pathways are described, followed by those using an external approach (canine fossa or para-lateronasal approaches), as well as their advantages and inconveniences. The preferred procedure is through an open, wide, para-lateronasal approach, enabling the most effective excision to be performed, this technique appearing to be essential for recurrent lesions.

Musculus depressor septi nasi is a muscle of facial expression, supplied by the facial nerve, it is more or less visible according to the individual. Easily exposed, using the intersepto-columellar incision, it is dissected from the skin surrounding it, then resected and in cases where the muscle is clearly defined, he can be brought up immediately. We consider resection of the musculus depressor septi nasi to be invaluable in rhinoplasty: -- firstly, to keep the tip of the nose well positioned during; -- secondly, to prevent certain "pseudo crow's-bill" deformities; -- finally, to give an impression of length to certain short upper (white ?) lips.