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Backgound: Over the last thirty years, the scientific community has become increasingly interested in the intestinal flora, whether commensal or pathogenic, and its impact on other organs. In dermatology, the correlation between intestinal microbial agents and cutaneous lesions is well established. Giardia duodenalis, an intestinal parasite, has been particularly widely studied. The aim of this work is to provide a review of studies demonstrating the involvement of G. duodenalis in various forms of dermatosis., Patients and Methods: The data were obtained by an English-language literature search of Medline, PubMed and Google Scholar for the period 1975-2015. Among the thirty case reports since 1976, we selected the twenty most objective and clinically relevant., Results and Discussion: This review demonstrates that intestinal giardiasis may be an etiological factor, either alone or in combination with other agents, of various dermatoses through inflammatory and allergic mechanisms or intestinal hyperpermeability. The mucocutaneous lesions are varied: urticaria, angioedema, atopic dermatitis, erythema nodosum, Wells syndrome, among others. The role and origin of the infection are often unknown, and it is thus difficult to determine the interval between parasite infestation and the onset of skin lesions. Consequently, a fecal examination to identify G. duodenalis should be considered in chronic urticaria or angioedema, and where atopic dermatitis occurs in adulthood without any specific etiology. Therapeutic test should be done in every suspicion., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Background: Systemic mastocytosis is characterised by abnormal proliferation of mast cells in various organs. We report an original case of systemic mastocytosis revealed by vulvar oedema., Patients and Methods: A 24-year-old patient was examined in the dermatology department for vulvar oedema appearing during sexual intercourse. She presented vasomotor dysfunction of the lower limbs, urticaria on the trunk on exertion, diarrhoea and bone pains. Laboratory tests showed serum tryptase of 29.7μg and plasma histamine at twice the normal value. Myelogram results showed infiltration by dysmorphic mast cells. Screening for c-kit D816V mutation was positive. Duodenal biopsies revealed mast-cell clusters with aggregation involving over 15 mast cells. CD2 staining was inconclusive and CD25 staining could not be done. Trabecular osteopenia was found, and we thus made a diagnosis of indolent systemic mastocytosis (ISM variant Ia) as per the WHO 2008 criteria. Symptomatic treatment was initiated (antiH1, H2, antileukotrienes) and clinical and laboratory follow-up was instituted., Discussion: The cutaneous signs leading to diagnosis in this patient of systemic mastocytosis involving several organs were seemingly minimal signs associated with mastocyte degranulation. This is the third recorded case of mastocytosis revealed by vulvar oedema and the first case revealing systemic involvement. The two previously reported cases of vulvar oedema revealed cutaneous mastocytosis alone. Mastocytosis, whether systemic or cutaneous, must be included among the differential diagnoses considered in the presence of vulvar oedema., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Background: Advances in neonatology have markedly improved prognosis for premature babies in recent years. However, they have also entailed the need for recourse to considerable intensive care involving potentially iatrogenic diagnostic and therapeutic acts. Among the resulting iatrogenic events, cutaneous lesions are the most frequent but have been the subject of very few studies. Our own study thus aimed to assess the rate of iatrogenic cutaneous events in premature infants born at less than 33 weeks of amenorrhea and hospitalised at Besançon university hospital and to identify the factors associated with the occurrence of these events., Patients and Methods: This was a prospective study carried out in the department of paediatric intensive care and neonatology at Besançon university hospital between May 2011 and April 2012. All babies born before 33 weeks of amenorrhea hospitalised over this period were included. An iatrogenic event was defined as "an adverse event related to a medical procedure". Iatrogenic cutaneous events were reported to the dermatologist by medical and paramedical staff., Results: One hundred and thirthteen newborn babies were included during the study period. Twenty-six iatrogenic cutaneous events were recorded in 19 infants, representing 16.8% of the population involved: nine were associated with ventilation techniques, six with the use of intravenous catheters, five with electrodes, two involved pressure sores, two were linked to the birth, one to disinfectants and one to dressings. The main risk factor was low birth weight (P=0.016). High prematurity and the duration of ventilation increased the risk, although not significantly. The death rate was higher in children with iatrogenic events but the difference was not significant. The duration of hospitalisation was unaffected by the presence or absence of an iatrogenic event., Conclusion: The frequency of iatrogenic cutaneous events is high in hospital departments in charge of very premature infants. Awareness by the medical and paramedical staff of the frequency of such iatrogenic events should improve the quality of care., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Background: Polyglandular auto-immune syndrome type 1 (PAS-1) or auto-immune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare autosomal recessive disorder linked to auto-immune regulator (AIRE) gene mutations. Herein, we report the case of a 3-year-old boy with APECED emphasizing the wide phenotypic variability and the extent of skin lesions., Patients and Methods: A 3-year-old boy with a history of auto-immune hepatitis was referred for a generalized pruriginous urticaria-like eruption present for one month. He was born to non-consanguineous parents. Cutaneous examination revealed twenty-nail dystrophy, which had been present since the age of 2 years. Both direct microscopy and culture of nail samples were negative for Candida albicans. Esophagogastroduodenoscopy revealed esophageal candidiasis. A diagnosis of APECED was suspected and subsequently confirmed by molecular analysis of the AIRE gene, which showed two mutations. No other auto-immune endocrinopathies were found., Discussion: Our case report illustrates the phenotypic variability of APECED with the absence of typical manifestations such as Addison's disease and hypoparathyroidism. APECED should thus be systematically suspected in young children presenting with cutaneous lesions associated with mucocutaneous candidiasis or auto-immune disease, even in the absence of known endocrinopathies., Conclusion: Dermatologists should be aware of this association since early diagnosis of APECED is critical in preventing life-threatening endocrinological crises., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Patients and Methods: A 34-year-old woman with an extensive surgical history developed two spontaneous carotido-cavernous fistula bilaterally. Skin examination revealed an acrogeric form of vascular Ehlers-Danlos syndrome and this diagnosis was confirmed by genetic analysis., Discussion: Vascular Ehlers-Danlos syndrome is a rare autosomal dominant genetic disease that may be suspected on the grounds of clinical symptoms. Severe complications can occur in early life and are associated with a high mortality rate. The prognosis of vascular Ehlers-Danlos syndrome has been radically changed by the use of beta-blockers., Conclusion: The originality of our observation lies in the long time to onset of the initial complications in the absence of any problems during the numerous operations undergone by the patient, as well as the two childbirths., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Aim: The aim of this study was to determine levels of bacterial contamination of the environment during chronic wound dressing changes., Methods: Sampling of chronic wounds and of the environment (air and surfaces) was performed during changing of chronic wound dressing. A series of samples was defined as the entire sample for a given day for a given patient. Five sequential samples of air and six samples of surfaces were taken for each series. Staphylococcus aureus, Pseudomonas aeruginosa and enterobacteria were specifically cultured., Results: Thirty series of samples were taken for 26 different patients. Twenty-seven out of these 30 series were colonized with one or two of the target species. For 13 series of the latter samples (13/27, 48.1%), bacteria isolated from the wound were recovered in the environment, namely S. aureus and P. aeruginosa. The six enterobacteria isolated from wounds were not retrieved in the environment. Air samples were more often positive than surfaces samples., Conclusion: We demonstrated frequent contamination of the hospital environment with bacteria colonizing wounds during dressing changes. This indicates that wearing of masks and hand disinfection after contact with the environment constitute key measures in the control of bacterial cross-transmission., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Background: Morbihan's disease (MD), also known as 'persistent facial oedema' or 'rosaceous lymphoedema', is an uncommon facial condition that is difficult to treat. Its cause remains unclear., Aim: We report three new cases of solid persistent facial oedema, which, after treatment with furosemide, showed dramatic improvement., Patients and Methods: Three men (respectively aged 38, 66 and 76 years) presented Morbihan's disease progressing respectively for 2, 5 and 8 years. These patients presented with facial oedema, mainly affecting the eyelids. The diagnosis of MD was based on clinical and laboratory criteria (after exclusion of other aetiologies such as sarcoidosis, lupus erythematosus, facial demodicidosis and rosacea). After several unsuccessful treatments (tetracyclines, synthetic antimalarials, danazol, systemic steroids and isotretinoin), the patients received diuretics: furosemide (60 mg/d) in two cases and spironolactone 75 mg twice daily for the third patient. The patients were evaluated after 1 month, then every 3 months., Results: Regression of oedema was complete or almost complete with follow-up of between 1 and 16 years. No adverse effects were reported., Discussion: Treatment of Morbihan's disease remains difficult and empirical. Diuretics may be of value since they help significantly reduce swelling even if they do not definitely cure patients., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Background: The aim of our paper is to examine changes in the use of human amniotic membrane for venous leg ulcers through clinical studies and to present different models of tissue engineering employing human amniotic membrane for the purpose of future therapeutic use in wound healing., Materials and Methods: This review is based on information obtained from a PubMed search using the following keywords "Amnion"[Mesh] AND "Leg Ulcer"[Mesh]; "Amnion"[Mesh] AND "Dermatology"[Mesh]. The selected articles are in English or French and deal with the sole use of human amniotic membrane in venous leg ulcers alone., Results: Human amniotic membrane has a positive impact on chronic venous leg ulcers by promoting granulation tissue formation, reducing fibrosis and inducing re-epithelialisation. Nevertheless, further randomized clinical studies are needed. At the same time, tissue engineering models using human amniotic membrane may help to reduce wound healing time, thereby creating renewed interest in the use of human amniotic membrane., Conclusion: Considering its properties and the clinical studies analysed, human amniotic membrane could be useful in venous leg ulcer care., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Introduction: autoimmune polyendocrinopathy with candidiasis and ectodermal dystrophy (APECED) is a rare autosomal recessive disorder caused by mutations in the autoimmune regulator gene (AIRE). We report the case of a young girl with APECED., Case Report: an 18 year-old girl born to consanguineous parents consulted for diffuse alopecia. Dermatological examination showed nail and dental enamel dystrophy and angular cheilitis. She had a history of mineralocorticoid deficiency (Addison's disease), hypoparathyroidism, hypogonadism and Biermer's disease, and she had also had chronic mucocutaneous candidiasis since childhood. She was presenting APECED with autoimmune endocrine failure, chronic mucocutaneous candidiasis and abnormalities of ectoderm-derived tissue. Analysis of mutation in the AIRE gene showed the c.769C>T homozygous mutation in exon 6., Discussion: APECED, a rare autosomal recessive disorder, is a potentially life-threatening autoimmune disease. Chronic mucocutaneous candidiasis is a common and early feature in children. Dermatologists are likely to be the first physicians to diagnose this syndrome., (2010. Published by Elsevier Masson SAS.)

Background: The course of biological therapy (BT) in clinical practice may differ markedly from treatment schedules in clinical trials. Treatment modifications and patient characteristics can affect treatment safety and efficacy. In addition, long-term results concerning the use of BT in clinical practice are lacking., Objectives: To report our experience of BT in terms of short- and long-term efficacy and safety., Patients and Methods: The retrospectively analysed cohort consisted of psoriasis patients receiving BT between 2004 and 2008. Patients in clinical trials were excluded. Mean body surface area (BSA) and Dermatology Life Quality Index were recorded., Results: Fifty-eight patients undergoing 86 courses of BT were enrolled. Thirty-three patients were treated with efalizumab, 21 with infliximab and 32 with etanercept. During the study period, 40% of patients were switched to another BT. The number of patients attaining BSA-75 at 3and 6months respectively was 38% and 75% for efalizumab, 62% and 61% for infliximab, and 36% and 61% for etanercept. After 24months of follow-up, only 33% of patients (34% of patients with efalizumab, 52% with infliximab and 22% with etanercept) were still following their initial BT, with treatment being discontinued in 52% of patients due to adverse events or treatment failure., Discussion: Our study confirms the efficacy and feasibility of BT in clinical practice. However, the high frequency of BT discontinuation for adverse events or non-response led to sequential therapy using different biological treatments.

Introduction: Skin whitening (SW) is very common in dark-skinned populations and the practice is often named after a popular local brand of product and such is the case in Mayotte where this practice is called "pandalao"., Patients and Methods: We carried out a descriptive epidemiological study in a sample of black Mahoran women aged 15 and over. The survey comprised a questionnaire completed by 163 women between 12 November 2007 and 24 January 2008. The aim of our study was to investigate the practice of SW in Mayotte and to determine its prevalence., Results: Hundred percent of the subjects were aware of SW and 95% knew people practicing this procedure. The prevalence of users of whitening products was 33%, although 74% of these subjects did not use such products on a regular basis and 89% of the women limited application to exposed areas (visible to others). Sixty-three percent simultaneously applied Diproson (betamethasone dipropionate) and Pandalao, the main component of which is salicylic acid. Fifty-four percent of users had presented one or more adverse effects after application of these products and 28% had stopped this practice due to such adverse effects (chiefly acne and dyschromia)., Discussion: Although illegal, the trade in skin whitening products continues to grow because it is profitable and takes full advantage of the success of ethnic cosmetics. In Mayotte, as in metropolitan France and Africa, the existence of SW is acknowledged but is still taboo. However, a number of specific characteristics are seen in Mayotte: SW is rarely performed on the whole body, salicylic acid is added to a topical corticosteroid, and the traditional Mahoran mask, the "mzindzano", is still worn for photoprotection.

In clinical evaluation, digital photography is a valuable low-cost and easy to use tool to illustrate assessments; hence the temptation to use it for analysis purposes, particularly in the assessment of facial wrinkles (forehead wrinkles, crow's feet). We review different methods to quantify the volume from 2D images, most of them directly adapted from algorithms initially developed in 3D profilometry. The 3D representation of these photographs is also detailed using several examples. Finally, the limits and drawbacks of this 3D "pseudo quantification" are listed and compared with those usually found in classic profilometry.

The remarkable development of digital photography has been possible thanks to joint advances in computer science and photography processing and retouching software. The scientific use of photography is now possible as long as its intrinsic limits are comprehended, particularly in the very specific time-limited structure of clinical trials. We list the two main limits inherent to this method: geometrical calibration and colorimetric calibration. These limitations are illustrated by numerous images used in our practice in Besançon during the last decade.

Botulinum toxin could represent nowadays a new treatment modality especially for cutaneous conditions in course of which conventional treatments remain unsuccessful. Besides palmar and plantar hyperhidrosis, botulinum toxin has demonstrated efficacy in different conditions associated with hyperhidrosis, such as dyshidrosis, multiple eccrine hidrocystomas, hidradenitis suppurativa, Frey syndrome, but also in different conditions worsened by hyperhidrosis such as Hailey-Hailey disease, Darier disease, inversed psoriasis, aquagenic palmoplantar keratoderma, pachyonychia congenital. Moreover, different cutaneous conditions associated with sensitive disorders and/or neurological involvements could benefit from botulinum toxin, for example anal fissures, leg ulcers, lichen simplex, notalgia paresthetica, vestibulitis. Endly, a case of cutis laxa was described where the patient was improved by cutaneous injections of botulinum toxin.

Background: Infantile myofibromatosis (IM) is the most common fibrous disorder of infancy and childhood. It is characterized by congenital tumours of the skin, striated muscle, bones and viscera. Most cases are sporadic and few familial cases have been reported., Patients and Methods: We describe a 5-month-old girl presenting with two congenital nodules. The diagnosis of infantile myofibromatosis was based on clinical and histopathological examination. Surgical excision was performed and there was no relapse at six years. The patient's brother presented multiple nodules and toe necrosis at birth due to infantile myofibromatosis. Two months later, the congenital nodules increased in size and new nodules developed. Surgical excision was performed. At 11 months of age, the boy presented with cranial relapse and bone resorption at P3 of the third right toe. The clinical and radiological investigations were normal., Discussion: Three clinical forms of IM have been described: solitary cutaneous nodules, multiple cutaneous nodules and generalized MI with visceral involvement. The prognosis is good except in generalized MI. All familial cases of MI may be interpreted as autosomal dominant or alternatively there may be genetic heterogeneity. Strict follow-up is recommended to identify potentially life-threatening complications. Spontaneous regression usually occurs but in some cases the treatment of choice is surgical removal.

Medical literature is rich with new and relevant information, resulting from basic or applied research. Some strong arguments are presented in this document. Firstly, the discovery and role of a virus, the polyomavirus, in the development of Merkel tumours. It is a small virus with double bit DNA strand, coding for a oncoprotein. If the polyomavirus plays a causal role in the tumorigenesis, it acts by various mechanisms. The micro-RNAs represent an abundant class of small RNA not coding for proteins, but which control the gene expression coding for proteins on a post-transcriptional level. The first obvious sign of the role of the micro-RNAs in the inflammatory dermatoses appeared recently, in particular when these micro-RNAs associated with psoriasis and atopic dermatitis were identified through a broad genomic analysis of the expression of these micro-RNAs. A new giant virus strain sheltering another unknown tiny virus to date has just been discovered. This virus infinitely small called Sputnik enables to deteriorate a much larger virus baptized Mama, at the point of preventing it to manufacture normal viral particles and also preventing it from reproducing. This discovery raises a crucial question: Is Sputnik a new system of transfer of genes of a species of one virus to another? A group of blood cells expressing E-cadherin, the dot cells, found in the fetal blood of the dermis, contributes to tissue repair through the mechanisms of cellular differentiation and their action allows healing without scar. CD4+ T helper lymphocytes producing interleukin 17 (IL17) play a pathogenic part in atopic dermatitis. The genes of the beta defensins could be involved in the genetic susceptibility of the psoriatic disease. The autoimmune origin of the alopecia areata is supported by a great number of observations, the role of neuropeptides in the initiation of the autoimmunity during alopecia areata has just been demonstrated. The dendritic cells are cells presenting antigens which play a crucial role in the adaptive immunological response. It was shown that activation of the proliferation of the lymphocytes T after the migration of dendritic cells on the level of the lymphatic ganglion depended not on Langerhans cell, but of the dendritic cell. A new way appears to control the autoimmunity in the psoriasis and involves the plasmacytoid dendritic cells which are sensitized with the DNA itself when it is coupled with an antibacterial peptide. Mast cells express cathelicidin, which acts like an antibiotic with broad spectrum and influences the defence system of the epitheliums. We have perhaps found a new therapeutic target for rosacea by disclosing high rates of cathelicidin and a series of associated proteases in skin lesions. The sebocytes express antibacterial functional peptides deriving from cathelicidin which can have a bactericidal effect against P. Acnes. A vast genomic study in the androgenetic alopecia highlighted the existence of new loci localized on the 20p11 chromosome, associated with the risk of androgenetic alopecia. New alleles to determine the color of hair and the cutaneous pigmentation were identified. Two loci (IRF 4 and SLC24A4) are highly associated with the color of hair, like three other areas. The blue color of the eyes could be due to a change of an element located in gene HERC2 preventing of the expression of OCA2. Thus, many fields of dermatology were the object of research which opens new prospects for diagnosis and treatment.

Background: Phenylbutazone frequently induces a range of potentially dangerous adverse reactions. We report a case of Sweet's syndrome with sialadenitis induced by phenylbutazone., Case-Report: A 54-year-old woman presented lumbar pains treated with phenylbutazone for three days. Six days later, she exhibited inflammation of the submaxillary and parotid salivary glands, followed by an erythematous, oedematous, pustular and febrile eruption, with failure of antibiotic therapy. Laboratory data showed leukocytosis and neutrophilia, anaemia, an elevated platelet count and liver dysfunction. The infectious and autoimmune tests were negative. The skin biopsy confirmed Sweet's syndrome. Clinical and biological abnormalities resolved on administration of systemic steroids., Discussion: Phenylbutazone-induced sialadenitis is rare and presents unrecognized adverse effects that may be associated with a systemic reaction. In the present case report, Sweet's syndrome met the criteria for drug-induced Sweet's syndrome. There appears to have been a systemic reaction caused by a hypersensitivity mechanism, in the same way as sialadenitis.

Background: Chromomycosis is a widespread subcutaneous fungal infection seen essentially in tropical and subtropical regions and transmitted via skin injury caused by the prickles of plants or infected wood splinters. It is prevalent throughout the West Indies including Guadeloupe, where its incidence is not well known., Patients and Methods: This retrospective and descriptive study concerns five histologically established cases of chromomycosis in Guadeloupe between 1995 and 2005. The five patients were diagnosed and treated at Pointe-à-Pitre University Teaching Hospital., Results: The study concerned four male patients and one female patient with an average age of 78 years; four were from the Basse-Terre district and one was from the Grande-Terre district. The most frequent clinical aspect was nodular or verrucous. The most common initial topography was the upper limbs. Fonsecaea pedrosoi was the only species identified. Diagnosis was confirmed by histopathology, which in all cases revealed sclerotic cells. Three patients underwent surgical treatment and two received medical treatment; only two patients were cured by 2005., Discussion: Our study confirms the presence of a source of chromomycosis in Guadeloupe, where Fonsecaea pedrosoi is clearly the best adapted species. It also highlights the difficulties of therapeutic care in tropical areas.

Background: Diagnosis of naevus lesions may be complex where they contain little or no pigmentation. Naevus spilus (or naevus on naevus) is, generally, readily identified by the difference in pigmentation between overlying and underlying naevi and healthy skin. Malignant transformation of naevus spilus is rare. We report two cases of melanoma in which surgical procedures revealed underlying melanocyte lesions, diagnosed at histology but undetectable on clinical examination., Patients and Methods: Two patients were operated for melanoma in which surgery, at a site remote from the melanoma, suggested incomplete relapse despite the fact that previous clinical examination had indicated healthy skin. A diagnosis was made of melanoma in invisible naevus spilus., Discussion: Diagnosis of melanoma in invisible naevus spilus may be suspected where several naevi are found together in a specific area. The main problem is the therapeutic stance to be adopted since complete excision of the underlying naevi is difficult in practice. Wood's light examination may be helpful.

Background: Tacrolimus applied locally is a non-steroid anti-inflammatory drug with proven efficacy in atopic dermatitis. Skin infections can occur, especially viral infections., Case-Report: A 35-year-old male patient had been treated for extensive atopic dermatitis for several months with tacrolimus (Protopic). After six months of treatment, he presented a large eruption of molluscum contagiosum, in particular on the zones that had received a substantial amount of tacrolimus. The treatment was discontinued and application of a preparation containing cidofovir led to the patient's quick complete recovery, without recurrence in the ensuing months., Discussion: Viral skin infections, in particular poxvirus infections, are prompted by topical immunosuppressant treatments such as tacrolimus, usually in dose-dependent fashion. Paradoxically, they provide protection against bacterial infections by restoring the integrity of the cutaneous barrier. Application of cidofovir successfully treated a severe form of molluscum contagiosum rapidly without any noticeable adverse effects. This confirms several observations about the efficacy and the good safety of this drug in the treatment of infections by DNA viruses. It provides an additional therapeutic prospect for immunodepressed patients who often present extensive and resistant forms of infections that are usually common.

Introduction: Hemangiomas are the most common benign tumors in childhood. In rare cases, they can be associated with dysmorphic malformations. The acronym, the PHACE (S) syndrome, was recently described by Frieden et al. in 1996 as a large facial or cervical Hemangioma, associated with one or more of the following systemic abnormalities including:Posterior fossa malformation, Arterial abnormalities, Coarctation of the aorta and/or cardiac defects, Eye abnormalities and Sternal clefts., Case Report: A 2 year-old girl presented with a large left hemifacial hemangioma. The rest of the clinical examination was normal. Initially, simple clinical surveillance was scheduled. The outcome was good with almost complete regression of the hemangioma by the age of 8. However, there were remains to the left of the upper lip and plastic surgery was scheduled. Pre-operative conventional arteriography revealed the complete, asymptomatic, absence of the ipsilateral internal carotid artery. Cerebral MRI and cardiac ultrasonography were normal. In the absence of somatic manifestations, regular clinical surveillance was decided on., Discussion: Large facial or cervical hemagiomas can be associated with one or more systemic abnormalities described by the PHACE (S) acronym. Its prevalence is unknown, but is shows marked female preponderance. Among the systemic abnormalities, neurological and cardiac malformations predominate. Hence the PHACE (S) syndrome must be recognized. Moreover, in patients presenting with large facial or cervical hemangioma, the following examinations should be performed: neurological examination and cerebral MRI to rule out abnormality of the posterior fossa, completed by a sequence of angio-MRI in the search for cerebral artery malformations; cardiovascular exploration, completed by echocardiography in the case of doubt and examination of the eyes and sternum. Lastly, the enhanced risk of laryngeal sub-glottis hemangioma should be kept in mind.

Introduction: Leucinosis (maple syrup urine disease) is a metabolic disorder caused by an enzymatic deficiency involved in the degradative pathways of the three branched-chain amino acids. We report an observation of acrodermatitis enteropathica-like syndrome induced by essential amino acid deficiency in a child with leucinosis., Case Report: A child with leucinosis was referred to our hospital for exfoliative dermatitis of the perioral and anogenital regions associated with diarrhea and pancytopenia. The diagnosis of iatrogenic acrodermatitis enteropathica-like syndrome was confirmed after screening showing isoleucine deficiency. Rapid response was observed after adequate isoleucine supplementation., Discussion: The acrodermatitis enteropathica-like eruption in our patient was due to an iatrogenic amino acid nutritional imbalance. Our observation underlines the risk of using a branched-chain amino acid-free formula without adequate supplementation of deficient amino acids. In addition, dietary insufficiency of isoleucine, associated with the treatment of organic aciduria should be added to the causes of acrodermatitis enteropathica-like syndrome.

Introduction: Verneuil's disease (hidradenitis suppurativa) is a chronic inflammatory, suppurating and fistulizing disease of apocrine sweat gland-bearing skin. The aim of this study was to describe the surgical treatment, conducted in 15 patients suffering from this disease., Patients and Methods: We retrospectively analyzed 15 observations (9 men, 6 women, mean age 38.6). The mean delay between beginning of the symptoms and diagnosis was 55.5 months. Surgery was conducted at the stage of abscesses, fistulization and keloids in all patients. The first surgical step was wide and deep excision of affected skin and subcutaneous fat. The second step was secondary intention healing, or ideal suture, Z plasty or dorsalis major flap., Results: Only four patients had complications: two axillary strictures, one anal margin stenosis and one hypertrophic scarring. Three relapses occurred, treated by excision under local anesthesia., Conclusion: Surgical treatment seems to be the only definitive treatment of Verneuil's disease.

Introduction: Hypercalcemia associated with subcutaneous fat necrosis of the newborn is a well known but rare event., Case Report: A newborn with a history of cesarean section, fetomaternal infection, neurological and respiratory distress was admitted with anorexia, adynamia, vomiting, polyuria and polydipsia at the age of 37 days. Physical examination showed red and violaceous infiltrated skin lesions. Skin biopsy revealed focal areas of fat necrosis with crystal-like structures. Calcium and 1,25 (OH(2) ) vitamin D serum levels were increased. Diagnostic of subcutaneous fat necrosis of the newborn with symptomatic hypercalcemia was made. Evolution was favorable after treatment including furosemide, prednisone and a diet low in calcium and vitamin D., Discussion: Hypercalcemia must be detected in infants with subcutaneous fat necrosis. This major complication may have fatal outcome. Treatment of hypercalcemia includes dietary changes associated with classic treatment of hypercalcemia. Routine evaluation of serum calcium level is essential.

Background: Acne is the most common symptom prompting patients to consult a dermatologist. No previous study has been conducted in France to determine the prevalence of acne and describe the main epidemiological features., Subjects and Methods: A cross sectional study was conducted in November 1996 and included 913 school children aged 11 to 18 years. This sample was statistically representative of the entire secondary school population in France during the 1996-1997 school year. The subjects were stratified by 5 criteria: age, sex, rural or urban residence, sun exposure, type of school., Results: Taking the clinical diagnosis made by the dermatologist investigator as the main criteria, the overall prevalence of acne was 72 p. 100. It was 76.1 p. 100 using the new ECLA grading system previously described. The prevalence of acne was sex and age dependent: highest scores were found for girls aged 14-16 years and for boys aged 16-17 years. Genetic factors were very important for the outcome of acne. Finally, 41 p. 100 of the acneic subjects were following a treatment, prescribed by a dermatologist in two-third of the cases., Discussion: These results are in agreement with those previously published in the literature although some differences were disclosed. It would appear important to distinguish between minimal acne with a few retentional pimples occuring during adolescence and severe acne (more than 20 pimples on the face) requiring early medical care to avoid scarring.

Background: Different acne gradings have been proposed: global grading, semi-global grading, quantitative grading and photographic grading. They are mainly used in clinical studies for the evaluation of acne treatment. However, it would be important for physicians to have an acne grade which would be useful for assessing acne lesions prior to treatment and following treatment efficacy., Methods: Six French dermatologists developed an acne grading scaled called "ECLA" which only takes 2 minutes to fill out and specifically designed for use by dermatologist practitioners. In addition, the intra- and inter-observer reliability of the grading scale was assessed., Results: This analysis demonstrated the excellent reliability of the ECLA grading scale both in terms of intra- and inter-observer variability except for the retentional factor. The cross physician reliability decreased with time specificity for the retention factor, indicating that previous training prior to a multicentric clinical study would be necessary., Conclusion: ECLA grading appears to be an interesting and useful tool in dermatology for the follow-up of acne patients.