Search

Background: Silver‐containing dressings are considered to be safe even though there have been some reports of complications, including argyria and various organ system dysfunctions. Despite the widespread use of silver dressings, little research has been done regarding the absorption and toxicity of silver. Objective: We aimed to study the systemic absorption of silver in patients with chronic inflammatory wounds and to determine associated factors of systemic silver absorption and evaluated its association with silver toxicity. Patients and method: Prospective, longitudinal, observational, multicentre, open‐label pilot study. Patients from the Dermatology Departments of Lorraine (France) with the following inclusion criteria: (i) a chronic wound of more than 6 weeks and (ii) an ulcer needing silver‐containing dressing were included. Before and after 28 days of treatment, clinical characteristics of the wound were recorded; hemogram, hepatic and renal functions, albumin sera and serum silver level were measured. Results: Half of the cases displayed raised levels of silver after 1 month of treatment. Predictive factors for systemic silver absorption were wound area, anaemia and malnutrition with anaemia and malnutrition confirmed on multivariate analysis. Wound vascularization may also play a role, as a higher absorption was observed in cases of wound granulation without arterial components. No toxicity was detected. This work has also emphasized the slow elimination of silver from the body. Conclusion: Both long‐term application and iterative treatments with silver dressings should be discouraged, especially in the elderly, who often suffer from malnutrition and anaemia to avoid potential cumulative toxicity. [ABSTRACT FROM AUTHOR]

Background Psoriasiform lesions associated with anti-tumour necrosis factor ( TNF) therapy are frequent in patients with inflammatory bowel disease ( IBD). While methotrexate is the most frequently used systemic treatment for psoriasis, its efficacy for psoriasiform lesions related to anti- TNF therapy remains unknown. Aims To assess the efficacy of methotrexate for psoriasiform lesions associated with anti- TNF therapy refractory to topical therapy in IBD patients. Methods The charts of eight patients from the Nancy IBD cohort who developed psoriasiform lesions on anti- TNF therapy were reviewed. Clinical response was defined as a decrease of more than 50% in the lesions covering surface. All patients were followed up by the same experienced dermatologist. Results Eight women (seven Crohn's disease) were followed up for a median duration of 29 months (range, 20-45). Of the eight patients receiving methotrexate, three were primary responders without discontinuation of anti- TNF agents. Only one patient had a sustained response at final follow-up and was able to continue both methotrexate and anti- TNF therapy. Of the two other primary responders, one patient had to discontinue anti- TNF because of severe psoriasiform lesions, whereas the other one continued anti- TNF therapy despite persistent skin lesions at final follow-up. Among the five primary nonresponders, four patients had to stop anti- TNF treatment due to disabling skin lesions. Conclusion Methotrexate does not appear effective in treating psoriasiform lesions associated with anti- TNF therapy refractory to topical therapy in IBD. [ABSTRACT FROM AUTHOR]

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

Cutaneous adverse drug reactions (CADR) during chemotherapy are not rare, but difficult to manage. Case 1, a 49-year-old man was treated with 5-fluorouracil, irinotecan, and oxaliplatin for a pancreatic tumour. He developed a generalized urticaria during his seventh course of chemotherapy. 2 months later, skin tests determined a granisetron allergy with an ondansetron cross-reaction. Substituting the anti-emetic allowed continuation of the chemotherapy. Case 2, a 44-year-old woman, having recurring breast cancer that was treated with doxorubicin, and docetaxel developed a maculo-papular rash (MPR) the day after the first chemotherapy treatment. 2 weeks later, skin tests determined a corticosteroid class A allergy. Using a class C corticosteroid, no other reaction occurred. Case 3, a 44-year-old woman, having breast cancer treated with 5-fluorouracil, cyclophosphamide, and epirubicin developed an MPR after the second chemotherapy treatment. 12 days later, skin tests showed a granisetron allergy. Using alizapride, chemotherapy was continued with no further reaction. CADR necessitate a thorough investigation, modified according to the patient’s chemotherapy treatment chronology and precautions while testing the molecules. Tests are rarely carried out, however, these tests allow for continuation of effective chemotherapy once the responsible agent has been determined. The 3 cases reported underline the role of complementary treatment and the necessity to test those molecules. [ABSTRACT FROM AUTHOR]

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

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

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