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The occurrence or the worsening of cutaneous T-cell lymphoma (CTCL) during or after a treatment with dupilumab has recently been reported in a limited number of patients including a small series of 7 patients, of whom 4 had been previously diagnosed with atopic dermatitis (AD).1 We hereby describe a previously unreported observation of systemic CD30+ lymphoproliferation occurring during treatment with dupilumab, adding to the literature of new-onset cutaneous lymphomas associated with dupilumab therapy.

Acute attacks could occur during the convalescent phase of COVID-19 illness, more commonly in patients with a history of frequent attacks. However it is unclear whether the acute attacks during the convalescent phase are specifically triggered by COVID-19 or not.

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Background The number of patients with a history of melanoma who are waiting a solid organ transplantation (SOT) is increasing. Few recommendations exist on the timing to transplantation after melanoma diagnosis. The aim of this study was to assess the melanoma recurrence-free survival after pretransplant melanoma (PTM). Methods We conducted a multicenter ambispective observational study. Organ transplant recipients (OTR) with a history of PTM and complete AJCC staging were included. Results Thirty-seven patients (predominantly men with a renal allograft) were included. Five melanomas were in situ, 21 stage IA, 4 stage IB, 5 stage II and 2 stage IIIB. The median post-transplantation follow-up time was 4 years. 62% of patients were followed more than 2 years. Recurrence-free survival since melanoma reached 89.9%, but varied significantly according to AJCC staging (p=0.0129). Three patients presented a recurrence. Conclusion Despite the rather limited sample size and a wide range of follow-up, our findings concerning the recurrence-free survival appear reassuring for in situ and stage IA PTM; accordingly we suggest that a waiting time to transplantation is not mandatory in patients with in situ or stage IA PTM, especially whenever SOT I s urgently needed. Caution is however needed for patients with higher stage.

International audience; Acquired angioedema with C1-inhibitor deficiency is a rare and peculiar entity belonging to the spectrum of bradykinin angioedemas. It usually occurs in subjects over 60 years old, and is mostly associated with a B-cell lymphoid hemopathy or a monoclonal gammopathy.The diagnosis relies on at least one angioedema episode, lasting more than 24 h, and on the decrease of functional C1-inhibitor. Low C1q is observed in 90% of patients, and an anti C1-inhibitor antibody is found in 50% of patients.The treatment of severe attacks relies on icatibant or C1-inhibitor perfusions. Long term prophylaxis in patients with frequent attacks requires treatment of the associated hemopathy if so. In case of idiopathic angioedema, tranexamic acid and danazol may be used, provided that there is-no thrombophilia; as well as rituximab as second-line treatment. Inhibitors of kallikrein still need to be evaluated in this therapeutic indication.; Les angiœdèmes par déficit acquis en C1-inhibiteur représentent une entité rare au sein des angiœdèmes bradykiniques. Ils diffèrent des formes héréditaires essentiellement par le terrain, car ils surviennent chez des sujets âgés de 60 ans en moyenne, et sont, le plus souvent, associés à une hémopathie lymphoïde B de bas grade ou à une gammapathie monoclonale.Leur diagnostic repose sur la survenue d'au moins un épisode d'angiœdème durant plus de 24 heures et sur la diminution de C1-inhibiteur fonctionnel. Une baisse du C1q est présente dans 90 % des cas et un anticorps anti C1-inhibiteur chez 50 % des patients.Le traitement des crises sévères repose sur l'icatibant ou l'administration de C1-inhibiteur. Le traitement préventif, indiqué en cas de crises fréquentes, nécessite le traitement de l'hémopathie identifiée. En l'absence de pathologie associée, l'acide tranexamique ou le danazol sont des options à envisager en l'absence de facteur de risque de thrombose, et le rituximab peut être proposé en cas d'échec. La place des inhibiteurs de la kallicréine sera à définir dans cette indication.

International audience; Hemophagocytic lymphohistiocytosis (HLH) has been only rarely reported in patients with BRAF-mutated advanced melanoma treated with targeted therapies and never with first-line dabrafenib/trametinib combination thus far. Two patients treated with first-line dabrafenib and trametinib combination therapy for metastatic melanoma presented with sudden occurrence of fever, cytopenia, rhabdomyolysis, hepatic cytolysis, hypertriglyceridemia and very high ferritin levels after few weeks of treatment, associated with concomitant epstein-barr virus (EBV) reactivation in one patient. In both cases, drug-induced HLH was primarily considered owing to a high H-score and the absence of other etiology. Patients rapidly improved after treatment discontinuation associated with oral steroids in one patient and did not relapse after subsequent treatment resumption with a concurrent anti-BRAF/anti-MEK combination. In metastatic melanoma HLH may occur either spontaneously in the absence of any treatment as a paraneoplastic condition, related to an intercurrent infection or drug-induced mainly with various immunotherapy or with dabrafenib and trametinib following immunotherapy. However, such observations are scarce and these are the first cases of HLH occurring during first-line treatment with dabrafenib and trametinib in advanced melanoma to our knowledge. Pathomechanisms remain to be elucidated since triggering factors may encompass the treatment itself but also other significant actors including viral reactivation along with the underlying disease. The liability of treatment should be considered in cases of HLH occurring in patients with advanced melanoma successfully treated with a combined targeted therapy. A rechallenge with a concurrent anti-BRAF/anti-MEK can be proposed in this setting.

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Optimal doses of total skin electron beam therapy for mycosis fungoides remain to be established. Clinical efficiency and adverse effects of middle-dose (25 Gy) vs. low-dose (10-12 Gy) total skin electron beam therapy were retrospectively compared in a series of 14 and 12 mycosis fungoides, respectively. Overall skin response rate was 96.2% (92.9% middle-dose and 100% low-dose; not significant (NS)). Overall complete and partial skin response rates were 57.7% (42.9% middle-dose and 75% low-dose; NS) and 38.5% (50% middle-dose and 25% low-dose; NS), respectively. All responding patients relapsed after an overall median time of 5 months (7 months middle-dose vs. 4 months low-dose; p = 0.164, NS). Tolerance was equally fair in both groups, with only grade 1 and 2 adverse events observed in 100% vs. 66.7% of patients in middle-dose and low-dose groups (NS). Although no significant difference was observed, middle-dose protocol may be recommended owing to a longer relapse-free survival for a similar tolerance.

Background Essure is an effective method for hysteroscopic sterilization. Reports of adverse effects, the underlying mechanisms of which are unknown, have increased in recent years. Objective The aim of the study was to determine whether there is a relationship between adverse events attributed to Essure and nickel sensitization. Methods Patients presenting alleged adverse reactions to Essure were referred for nickel patch testing before removal. Data regarding medical history of nickel sensitization and symptoms attributed to Essure were collected. Dimethylglyoxime spot tests were performed on the explanted Essure. There was a follow-up at 3 months to evaluate whether there is improvement of the symptoms after Essure removal. Conclusions Nickel sensitization via the classic delayed hypersensitivity pathway did not seem to be responsible for adverse events attributed to Essure. Among systemic symptoms reported, extracutaneous symptoms had the highest prevalence. Systemic contact dermatitis to nickel could not be ruled out in one case.

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Treatment of benign familial pemphigus or Hailey-Hailey disease (HHD), a rare inherited condition associated with a significant impairment of quality of life, is often challenging and disappointing with frequent relapses and infectious complications. Topical photodynamic therapy (PDT) may offer new perspectives in this difficult setting.Eight patients with long-lasting HHD lesions refractory to multiple treatments were treated on at least one involved site with PDT using methyl-amino levulinate with a standardized protocol of three sessions of irradiation separated by 3-week intervals.A complete or partial clearing was achieved in all treated areas, and the result was satisfactorily maintained in all cases after a follow-up period ranging from 3 to 36 months. Results were of higher quality in non-inguinal areas. Tolerance was overall acceptable with local pain during and shortly after irradiation being the main limiting factor.Our series, although limited in size, emphasizes the interest of PDT in this difficult condition even though results may be incomplete. Treatment-related pain can be adequately managed by prior analgesics, cooling with sprayed water and local tumescent anesthesia. Overall, PDT appears as a relevant option in refractory HHD management with a favorable benefit/risk ratio.

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Les anticorps monoclonaux thérapeutiques en dermatologie ont d’abord été utilisés pour la prise en charge du psoriasis, puis, plus récemment, de l’urticaire chronique spontanée et de la dermatite atopique. Trois exemples seront abordés dans cette revue: le dupilumab, l’omalizumab et le lanadélumab. Leur mode d’action spécifique résulte d’une meilleure compréhension des mécanismes inflammatoires de ces maladies chroniques qui partageaient autrefois des traitements topiques ou systémiques plus ou moins ciblés. Leur utilisation onéreuse doit cependant être raisonnée par la mise en perspective de l’épidémiologie, de l’évaluation précise de la sévérité, de l’optimisation des traitements de première ligne, et de la balance bénéfices/risques.

International audience; The efficacy and safety of dupilumab, a humanized monoclonal antibody targeting the α subunit of the interleukin (IL)-4 and IL-13 receptors, has been assessed in adults with moderate-to-severe atopic dermatitis (AD).1,2 Injection site reactions, nasopharyngitis, conjunctivitis, and transient increases in eosinophil counts from baseline were higher in the dupilumab groups than in the placebo groups in pivotal studies.1,2 A recent study by Zhu et al3 reported new regional dermatoses in 17 patients with AD treated with dupilumab, with facial area involvement in 14 cases, whereas Blauvelt et al4 reported an equal improvement of AD with dupilumab on different anatomic regions in a post hoc analysis of data extracted from 4 phase 3 clinical trials.

International audience; BackgroundDupilumab is the first biologic available to treat atopic dermatitis (AD). Its effectiveness and safety were demonstrated in clinical trials.ObjectiveWe sought to assess the effectiveness and safety of dupilumab in adults with AD in a real-life French multicenter retrospective cohort.MethodsWe included patients treated during March 2017-April 2018. Efficacy outcomes, including Scoring Atopic Dermatitis (SCORAD) and Eczema Area and Severity Index (EASI) scores, were collected at baseline and 3 months when available. Adverse events (AEs) were recorded at follow-up.ResultsWe included 241 patients. The median ± interquartile range (IQR) follow-up time was 3.8 ± 3.7 months. A ≥75% improvement in SCORAD was achieved in 27 of 163 (16.6%) patients, and a ≥75% improvement in EASI was achieved in 40 of 82 (48.8%) patients. The median SCORAD and EASI scores at 3 months were significantly lower than those at baseline (SCORAD ± IQR, 25 ± 21 vs 56 ± 27.4, P < 10−9 and EASI ± IQR, 4.1 ± 6.8 vs 17.9 ± 15.4, P < 10−9, respectively). Conjunctivitis was reported in 84 of 241 (38.2%) patients. The proportion with eosinophilia (>500 cells/mm3) during follow-up (57%) was higher than that at baseline (33.7%) (n = 172, P < 10−6). Dupilumab was stopped in 42 cases; 27 patients stopped because of AEs.LimitationsNo control group, missing data.ConclusionThis real-life study demonstrated a similar dupilumab effectiveness as that seen in clinical trials, but it also revealed a higher frequency of conjunctivitis and eosinophilia.

International audience; Le risque de cancers cutanés induits par des médicaments photosensibilisants est connu. Le rôle de l’hydrochlorothiazide a été soulevé par plusieurs études épidémiologiques récentes. Une revue systématique des études cas-témoins ou de cohortes prospectives montre qu’il existe un surrisque de carcinomes épidermoïdes dans la majorité des études même si certains facteurs de confusion comme le tabac n’ont pas été pris en compte. Les données sont plus contradictoires pour les carcinomes basocellulaires et les mélanomes. Ces résultats ne remettent pas en cause le rapport bénéfice/risque de cette molécule, mais peuvent inciter à des mesures de prévention renforcées chez les malades pour lesquels une prescription d’hydrochlorothiazide est proposée : identifier les patients à risque de carcinomes cutanés, éviter si possible de prescrire cette molécule chez les patients immunodéprimés ou ayant un carcinome, effectuer un examen cutané régulier chez les malades recevant ce traitement au long cours.

International audience; BACKGROUND: Hereditary angioedema is a life-threatening illness caused by mutations in the gene encoding C1 inhibitor (also called C1 esterase inhibitor) that lead to overactivation of the kallikrein-bradykinin cascade. BCX7353 is a potent oral small-molecule inhibitor of plasma kallikrein with a pharmacokinetic and pharmacodynamic profile that may help prevent angioedema attacks.METHODS: In this international, three-part, dose-ranging, placebo-controlled trial, we evaluated four doses of BCX7353 (62.5 mg, 125 mg, 250 mg, and 350 mg once daily) for the prevention of angioedema attacks over a 28-day period. Patients with type I or II hereditary angioedema with a history of at least two angioedema attacks per month were randomly assigned to BCX7353 or placebo. The primary efficacy end point was the number of confirmed angioedema attacks. Key secondary end points included angioedema attacks according to anatomical location and quality of life.RESULTS: A total of 77 patients underwent randomization, 75 received BCX7353 or placebo, and 72 completed the trial. The rate of confirmed angioedema attacks was significantly lower among patients who received BCX7353 at daily doses of 125 mg or more than among those who received placebo, with a 73.8% difference at 125 mg (P

The mortality rate for malignant melanoma is higher in elderly patients aged 75 years or more, with over 25% of melanomas being diagnosed in this population. This poorer prognosis might perhaps be improved by emerging targeted therapies and immunotherapy, although these agents must be prescribed with care in this rather fragile population. The purpose of our review of the literature concerning phase-2 and -3 published trials of these innovative molecules was to examine their optimal use in elderly patients presenting metastatic malignant melanoma. Most of the trials examined included elderly patients and some were analyzed by age sub-groups. In conclusion, elderly patients with ECOG 0/1 status can be given ipilimumab or vemurafenib as first-line therapy depending on tumoral BRaf mutation status. The benefit of combined targeted therapies does not seem to apply consistently in elderly patients and their use must be discussed. Further specific data must be collected in elderly patients concerning anti-PD1 molecules. For more fragile patients, risk scales or scores should enable more accurate use of innovative therapies in metastatic melanoma. Moreover, physicians must be aware of the common drug interactions with targeted therapies, since elderly patients are often taking several concomitant drugs.

BACKGROUND: Identification of myositis-specific autoantibodies (MSAs) for dermatomyositis (DM) could allow the characterization of an antibody-associated clinical phenotype. OBJECTIVE: We sought to define the clinical phenotype of DM and the risk of cancer, interstitial lung disease (ILD) and calcinosis based on MSA. METHODS: A 3.5-year multicentre prospective study of adult DM patients was conducted to determine the clinical phenotype associated with MSAs and the presence of cancer, ILD and calcinosis. RESULTS: MSAs were detected in 47.1% of 117 included patients. Patients with antimelanoma differentiation-associated protein-5 antibodies (13.7%) had significantly more palmar violaceous macules/papules [odds ratio (OR) 9.9], mechanic's hands (OR 8), cutaneous necrosis (OR 3.2), articular involvement (OR 15.2) and a higher risk of ILD (OR 25.3). Patients with antitranscriptional intermediary factor-1 antibodies (11.1%), antinuclear matrix protein-2 antibodies (6.8%) and antiaminoacyl-transfer RNA synthetase (5.1%) had, respectively, significantly more poikiloderma (OR 5.9), calcinosis (OR 9.8) and articular involvement (OR 15.2). Cutaneous necrosis was the only clinical manifestation significantly associated with cancer (OR 3.1). CONCLUSION: Recognition of the adult DM phenotype associated with MSAs would allow more accurate appraisal of the risk of cancer, ILD and calcinosis.

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International audience; The aim of this 10-year monocentric prospective study was to determine a cut-off value of Fas/CD95 expression by peripheral blood CD4+ T lymphocytes in discriminating patients with mycosis fungoides from controls with cutaneous benign lymphocytic conditions. CD95 expression in peripheral blood CD4+ T lymphocytes was measured using flow cytometry in 330 patients referred for diagnosis: 104 with mycosis fungoides and 226 with eczema, psoriasis, drug reaction, etc. The sensitivity and specificity of different thresholds of CD95 expression were calculated regarding the final diagnosis of patients with mycosis fungoides or controls. CD95 expression higher than 30% reached a specificity of 91% in ruling out a diagnosis of mycosis fungoides, although overall CD95 expression was not significantly different from that of controls (p = 0.309) and sensitivity was very low (5%). Thus, peripheral CD95 expression higher than 30% could be used among the exclusion criteria in a multicomponent score for mycosis fungoides diagnosis.

Summary Hereditary angioedema (HAE) is a rare disease associated with either a quantitative or qualitative deficiency in C1-inhibitor (C1-INH) or normal C1-INH. HAE with normal C1-INH is associated in 20% of cases with mutations in the gene for factor XII (FXII) or FXII-HAE. A recent review described 41 families, including 14 German and 15 Spanish families. We have constructed a register of French patients and their characteristics. A national survey was launched through the French National Center of Reference for Angioedema (CREAK) to study the clinical, biological and therapeutic characteristics of patients with HAE linked to a mutation of FXII gene. Fifty-seven patients were identified from 24 different families. In most cases they were young women (mean age at diagnosis: 31 years, mean age at first symptom: 21 years, female/male ratio: 76%). Twenty-one per cent of the patients experienced angioedema attacks only during pregnancy or when on oestrogen contraception. Sixty-three per cent had attacks at all times, but they were more severe during these same periods. Male carriers of the mutation were more frequently asymptomatic than females (P = 0·003). C1-INH concentrate and icatibant were both effective for treating attacks. The prophylactic use of tranexamic acid led to a 64% decrease in the number of attacks. This is one of the largest series reported of HAE patients with FXII mutation. The therapeutic management appeared to be identical to that of HAE with C1-INH deficiency.

The diagnosis of actinic keratosis is generally established by clinical examination. However, actinic keratosis can progress into an invasive squamous cell carcinoma, therefore biopsy and histological examination may be needed. The risk of progression into an invasive carcinoma is not well established; it varies in the literature between 0.025% and 20% for a given lesion. Some clinical aspects suggest transformation into an invasive carcinoma; they include inflammation, induration, size > 1 cm, rapid enlargement of the lesion, bleeding or ulceration, and should prompt the clinician to perform a skin biopsy. In case of resistance after a well-driven treatment, a biopsy may be necessary. Finally, in cases of atypical clinical aspect, a biopsy may be useful in order to obtain a correct diagnosis.

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Summary Background The interest of long-term superpotent topical steroids (STS) in bullous pemphigoid (BP) has been supported by randomized controlled trials. However, inadequate compliance, poor cutaneous tolerance and nursing difficulties are potential drawbacks. Open-label studies on limited series of patients suggested that low-dose methotrexate (MTX) may be useful, permitting long-term maintenance of a clinical remission obtained by initial, short-term STS. Objectives Open, clinical records-based retrospective analysis of a multicentre series of patients receiving a combined regimen of initial, short-term STS and MTX followed by long-term MTX alone. The primary objective was evaluation of the clinical efficiency of this strategy based on initial clinical remission and subsequent clinical maintenance. The secondary objective was evaluation of the tolerance (type and rating of adverse events) of this combined regimen. Methods Seventy patients with BP (mean age 82·7 years) were included. Treatment consisted of an initial combination of STS and MTX for a mean duration of 12·3 weeks followed by long-term MTX alone for a mean duration of 8·48 months with a mean and median MTX dosage of 10 mg per week. Results One hundred per cent of the patients showed an initial, complete clinical remission after a mean time interval of 21·9 days. The overall rate of long-term disease control was 76%, whereas 24% of patients experienced at least one relapse during subsequent treatment with MTX alone. Drug-related adverse effects were mainly haematological and gastrointestinal and resulted in treatment discontinuation in 11 patients (16%). Six patients (9%) died during the follow-up period with one death (1%) most likely to be related to treatment. Conclusions Long-term low-dose MTX combined with short-term STS may result in protracted control of BP in carefully selected patients. These results should prompt randomized controlled trials comparing this treatment with the more usual regimen of long-term STS alone.

Background The additional benefit of 18FDG-Positron Emission Tomography-Computed Tomography (FDG PET-CT) compared with conventional imaging is still a controversial issue in MCC. Objectives This study was designed to evaluate the ability of FDG PET-CT to detect secondary lesions clinically inconspicuous and not shown by conventional imaging. Methods Clinical records of 15 MCC patients were retrospectively reviewed to investigate the specific interest of FDG PET-CT compared with X-computed tomography (CT). The main endpoint was the ability of FDG PET-CT to detect secondary lesions and the possible resulting changes in disease staging and management compared with pre-FDG PET-CT data including clinical examination, sentinel lymph node biopsy (SLNB), and diagnostic CT. Results FDG PET-CT was relevant with a single false negative result and led to significant changes in disease staging and management in 46% of patients compared with clinical examination alone. However, additional secondary lesions not detected by CT were evidenced during follow-up in a single patient with an already known metastatic disease, data which did not result in any change in staging and treatment. Sensitivity, specificity, positive predictive value and negative predictive value were respectively 0.66, 1, 1 and 0.8 for SLNB, 0.89, 1, 1 and 0.93 for CT and 0.89, 1, 1 and 0.93 for FDG PET-CT. No additional neoplasm was detected by FDG PET-CT. Conclusion Although FDG PET-CT is of questionable value in MCC management when used in parallel with CT, it may be considered as a valuable option as a single whole-body survey procedure.

International audience; Cold contact urticaria (CCU) is a physical urticaria, also called inducible urticaria, which is triggered by exposure of the skin to cold air, surfaces or fluids. Clinical manifestations of CCU range from mild, localized whealing to life-threatening anaphylactic shock. CCU is mostly idiopathic (primary), but in rare cases it is secondary to infectious disease, with or without cryoproteins. We report here, for the first time, 4 cases of CCU that developed following vaccination, which suggests a link between these events.

International audience; There is no consensus on a diagnostic strategy for osteomyelitis underlying pressure ulcers. We conducted a prospective study to assess the accuracy of multiple bone biopsies and imaging to diagnose pelvic osteomyelitis. Patients with clinically suspected osteomyelitis beneath pelvic pressure ulcers were enrolled. Bone magnetic resonance imaging (MRI) and surgical bone biopsies (three or more for microbiology and one for histology per ulcer) were performed. Bacterial osteomyelitis diagnosis relied upon the association of positive histology and microbiology (at least one positive culture for non-commensal microorganisms or three or more for commensal microorganisms of the skin). From 2011 to 2014, 34 patients with 44 pressure ulcers were included. Bacterial osteomyelitis was diagnosed for 28 (82.3%) patients and 35 (79.5%) ulcers according to the composite criterion. Discrepancy was observed between histology and microbiology for 5 (11.4%) ulcers. Most common isolates were Staphylococcus aureus (77.1%), Peptostreptococcus (48.6%) and Bacteroides (40%), cultured in three or more samples in 42.9% of ulcers for S. aureus and ≥20% for anaerobes. Only 2.8% of ulcers had three or more positive specimens with coagulase-negative staphylococci, group B Streptococcus, and nil with enterococci and Pseudomonas aeruginosa. Staphylococcus aureus, Proteus and group milleri Streptococcus were recovered from one sample in 22.8%, 11.4% and 11.4% of ulcers, respectively. Agreement was poor between biopsies and MRI (κ 0.2). Sensitivity of MRI was 94.3% and specificity was 22.2%. The diagnosis of pelvic osteomyelitis relies on multiple surgical bone biopsies with microbiological and histological analyses. At least three bone samples allows the detection of pathogens and exclusion of contaminants. MRI is not routinely useful for diagnosis.

We report here the first case of a misleading association of Clostridium difficile infection (CDI) with ipilimumab-related immune diarrhea in a patient with unresectable stage III melanoma.After an unsuccessful first-line chemotherapy with dacarbazine (1000 mg/m2 every three weeks) for a subcutaneous and nodal relapse of a stage IIb melanoma of the right lower limb (Breslow index 3.75 mm, Clark level IV), treated by surgical excision 11 months previously and incomplete adjuvant treatment with alpha [...]

Background A major etiologic hypothesis in primary cutaneous T-cell lymphomas is a defective lymphocyte apoptosis after antigenic activation, which could be induced by various infectious agents. Objective To investigate the presence of the possibly lymphotropic and folliculotropic Merkel cell polyomavirus (MCPyV) DNA and proteins in folliculotropic mycosis fungoides (fMF). Study design Fresh-frozen and fixed skin biopsies were collected in lesional and non-lesional skin from 24 fMF patients, in lesional skin from 22 patients with various T-cell mediated skin benign infiltrates (TSBI) and in normal-appearing skin from 22 healthy individuals (HI). Detection and quantification of MCPyV DNA were carried out using real-time PCR; MCPyV genome integration status was presumed through a previously described differential real-time PCR (MCPyV ΔC-TAg) targeting a constantly conserved sequence versus an integration-induced deleted sequence. The MCPyV proteins expression was assessed by immunohistochemistry using antibodies targeting a tumoral antigen or a capsid protein. Results Although MCPyV DNA was similarly detected in lesional versus non-lesional fMF samples (50% each), in 36.4% HI and 40.9% TSBI; viral load was significantly higher in fMF lesional samples versus HI and TSBI. The integration of the viral genome appeared unlikely. The MCPyV proteins expression was exclusively observed inside skin appendages in 18.2% of the fMF lesional skin samples. Conclusion MCPyV genome detection rate was similar in all skin samples, but MCPyV viral load was significantly higher in fMF lesions versus TSBI and HI, although the viral genome was probably not integrated. Episomal MCPyV DNA may be expressed in skin appendages in fMF.

Keywords: allergic contact dermatitis; anti-ageing cream; cosmetics; facial dermatitis; Magnolia officinalis bark extract

Background: Solar urticaria is a rare, disabling, chronic disease. Few large series are available. Objective: To report the epidemiological, clinical, phototesting, treatment and patient outcome data of a large series. Methods: Data from 61 patients’ files were retrospectively retrieved in a tertiary referral centre. Results: 43 women and 18 men were included (mean age at first symptoms: 34 y). 3 patients had a medical history of chronic urticaria and 29% of atopy. Urticaria occurred before the 15 th minute of sun-exposure in 95% of the patients and resolved spontaneously after its interruption within 1h in 76.4%. Determination of the action spectra revealed UVA sensitization in 91.8% of the patients, alone (49.2%) or with UVB (24.6%) or visible light (14.75%). 61.7% of the patients received antihistamines, 75% noted a significant improvement. 36.2% benefited from UVA phototherapy and were satisfied. 3 patients reported complete remission after 4 to 11 years. Conclusions: Our study is the second largest in the literature. Main discrepancies with previous series concern the absence of associated photodermatoses and the predominance of UVA sensitization over visible light, which could be explained by suboptimal phototesting in the most ancient cases. Interpretation of our results is restricted because data were missing in 10 to 25% of the patients’ files. The response to treatment was evaluated upon the dermatologist's observation, which highlights the need of validated tools to evaluate patients’ disability and response to treatment.

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Drug-induced acne is a specific subset of acne that usually has some specific features, namely a monomorphic pattern, an unusual location of the lesions beyond the seborrheic areas, an unusual age of onset, a resistance to conventional acne therapy and, of course, the notion of a recent drug introduction. Many drugs can be responsible for such a clinical pattern. Corticosteroids, neuropsychotherapeutic drugs, antituberculosis drugs, and immunomodulating molecules are the more classical drugs associated with induced acne. Recently, new drugs, mainly targeted therapy in the field of oncology, such as epidermal growth factor receptor inhibitors, have been associated with an increased frequency of this adverse effect. Disruption of the culprit drug is rarely mandatory in cases of drug-induced acne. Close cooperation between the dermatologist and medical staff in charge of the patient is an important challenge to achieve optimal management of the initial disease.

The presence of iron overload in porphyria cutanea tarda (PCT) is well-known, although the overload is not always concentrated in the liver as was originally thought. The origin of this overload is not known with certainty in all cases and is probably explained by various, most often genetic, mechanisms. From this perspective, the implication of protein activity-modifying mutations or polymorphisms in key genes involved in iron metabolism regulation has already been well documented, with deleterious HFE mutations being the most frequently identified changes, occurring in up to one-third of patients (1). Conversely, other genes involved in the regulation of iron metabolism (haemojuvelin, hepcidin, type 2 transferrin receptor) have also been analysed in previous reports with negative results. Ferroportin is another important player in iron metabolism. We report here the search for functionally relevant changes in the ferroportin-encoding SLC40A1 gene in a series of patients with PCT, the first analysis of its kind. Thirty-seven consecutive patients diagnosed with PCT based on the usual clinical and biochemical criteria (25 men and 12 women, age range 34–71 years, including 5 patients with familial-type disease), all originating from southern France, were studied. After receiving written consent, genomic DNA was extract ed from peripheral blood mononuclear cells and subjected to SLC40A1 analysis using stringent amplification con ditions. Then, its eight exons and flanking areas were directly sequenced. The HFE gene was also analysed for functionally significant mutations (homozygous or heterozygous C282Y mutations and the homozygous H63D mutation). (The heterozygous H63D mutation was not studied since its possible effect on iron metabolism remain doubtful and it is frequently encountered in the Mediterranean basin.) Analysis of the HFE and SLC40A1 genes was performed in all 37 patients. In the case of SCL40A1, a number of known polymorphisms with no influence on the primary structure of the encoded protein were identified. A previously unreported complex genomic

Cutaneous malignant melanoma (CMM) is the most serious type of skin cancer because of its tendency to metastasize. The prognosis and therapeutic management of patients are primarily based on clinical criteria (number of cancerous lymph nodes and/or the presence of distant metastases) and histopathological criteria (tumor depth, presence of ulceration and mitotic index). Although these factors are informative in advanced stages of the disease, they are less important in the early stages. In recent years, a number of attempts have been made to identify new serological prognostic biomarkers, especially for early forms of CMM. The recent development of proteomic techniques may offer new perspectives in this field. This article details the considerations of each of the proteomic techniques used today and describes the results of the most recent clinical studies conducted to identify new potential prognostic serum biomarkers for CMM. However, independent and large validation studies are needed before such markers can be used in everyday clinical practice.

ejd.2013.2184 Auteur(s) : Aurelie Du-Thanh1 a-du_thanh@chu-montpellier.fr, Celine Girard1, Georges-Philippe Pageaux2, Bernard Guillot1, Olivier Dereure1 1 Department of Dermatology and INSERM U1058, Hopital Saint-Eloi, 80 avenue Augustin Fliche, 34295 Montpellier cedex 5, France 2 Department of Hepato-gastro-enterology University Montpellier 1, Montpellier, France Recently developed, targeted, anti-neoplastic treatments display a still growing spectrum of cutaneous side effects. Sorafenib is [...]

ejd.2013.2128 Auteur(s) : Aurelie Du-Thanh1 a-du_thanh@chu-montpellier.fr, Eric Frouin2, Marie-Dominique Vignon-Pennamen3, Anca Debu1, Bernard Guillot1, Olivier Dereure1 1 Department of Dermatology, 2 Department of Pathology, CHU Saint-Eloi 80 avenue Augustin Fliche 34295 Montpellier cedex 5 France 3 Department of Pathology, Saint-Louis University Hospital, APHP, Paris, France As oral mucosal porokeratosis has rarely been reported, this unusual diagnosis can easily be overlooked. We present the [...]