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An aqueous antiseptic containing "chlorhexidine digluconate/benzalkonium chloride/benzyl alcohol" (CBB) is widely used in France. The only previous documented study dealing with allergic contact dermatitis (ACD) to this antiseptic is one small case series in children. The French Vigilance Network for Dermatology and Allergy (REVIDAL-GERDA) has collected many cases in the last few years.To evaluate the clinical and sensitization profiles of patients diagnosed with ACD to CBB.We performed a retrospective study of patients with contact dermatitis to CBB and positive tests to CBB and/or at least one of its components. All patients had to be tested with all components of CBB.A total of 102 patients (71 adults and 31 children) were included. The lesions were extensive in 63% of patients and 55% had delayed time to diagnosis. CBB patch tests were positive in 93.8% of cases. The allergen was identified in 97% of patients, mainly benzyl alcohol in adults (81.7%) and chlorhexidine digluconate in children (54.8%). About 32.4% of the patients were sensitized to several components.CBB is a cause of ACD at all ages. The components of the antiseptic should be tested. The sensitization profile seems to be different between adults and children.

In the absence of formal marketing authorisation, the manufacturers of cosmetic products are responsible for their compliance with the cosmetic regulations. To present the key features of a structured, reactive, and rigorous global cosmetovigilance system through practical examples. During clinical development, adverse reactions are collected formally and analysed by cosmetovigilance experts. After commercialisation, information on reported adverse reactions is sought directly from the consumers. The results of allergological investigations are systematically requested. Pre- and post-marketing cases are analysed along with other sources of information (e.g. monitoring of the literature) to detect safety signals per product and per ingredient. A cosmetovigilance index (CVI) is calculated for each formula, based on the number of cases, causality level and number of commercialised units. Updated periodically, it is used to detect signals and select the best tolerated formulas to help formulating new products. Examples of safety issues raised during development or after commercialisation, and corresponding corrective actions, are presented. These actions include (but are not limited to) a safety watch to closely monitor adverse reactions, the modification of the formula or a change in the packaging. Cosmetovigilance data also impact future product development, as illustrated by the work done on sunscreens. Through the rigorous collection and analysis of adverse reactions during development and after commercialisation, the safety of dermo-cosmetic products can be improved by taking the appropriate corrective actions, monitoring their effectiveness and optimising future product development by focusing on the best tolerated formulas.

It is important to assess the burden of chronic urticaria (CU) with real-life studies. The AWARE study was performed in 36 countries over two years in CU patients resistant to H1-antihistamines.To correlate patient-reported outcomes and available therapeutic options in CU patients.The AWARE study was a prospective, non-interventional, international study that included adult patients who have had H1-antihistamine-resistant CU for at least two months. The primary endpoints were the evolution of disease activity (UAS7), urticaria control (UCT), dermatological quality of life (DLQI) and treatment satisfaction (visual analogic scale) during a two-year follow-up. The data from French centres are reported.Ninety-two patients were included (mean age: 47.8 years; women: 70.7%; mean disease duration: 6.5 years; angioedema: 34.1%). The percentage of patients with CU treatment increased from 56.5% at inclusion to 86.0% after two years (for patients with non-sedative H1-antihistamines from 52.2% to 74.4%, and omalizumab from 2.2% to 25.6%). During the follow-up, the percentage of patients with UAS7 score6 increased from 12.5% to 60.9%, and patients with well-controlled CU (UCT score12) increased from 11.1% to 62.2%. The negative impact on quality of life (DLQI10) decreased from 34.1% to 10.5%. The mean score of patient satisfaction for treatment increased from 4.6 to 7.6.The management of CU patients resistant to H1-antihistamines was not optimal at inclusion with uncontrolled disease, impaired quality of life and insufficient treatment. After a two-year follow-up, disease symptoms and quality of life improved, but the therapeutic management could be further optimized.

The repeated open application test (ROAT) is an adjuvant investigation measure to patch testing in the diagnosis of allergic contact dermatitis. ESCD recommends a 15 days duration but its overall duration varies according to publications and patients hardly adhere to prolonged ROAT duration beyond 1 week.The Dermatology and Allergy Group of the French Society of Dermatology performed a prospective study with the aim of determining the best duration for the ROAT.A total of 328 ROAT results were collected for topical products, including cosmetics (60%) and topical medications (31.1%). Fifty-nine (18%) ROATs were positive, and 16 (5%) were doubtful. All the positive ROATs occurred within 10 days, with a median time to positivity of 3 days.According to our results, a minimum duration of 10 days is necessary to achieve a positive ROAT to a topical product.

Background The European hidradenitis suppurativa (HS) guidelines recommend a multidisciplinary approach for patients with HS and management of comorbidities. Objective We aimed to describe the organization of a multidisciplinary HS program and characterize the patient population. Methods We conducted a retrospective study of patients with HS undergoing prospectively defined multidisciplinary work-up including examinations by a dermatologist, plastic surgeon, smoking specialist, and nutritionist in our outpatient unit between October 2015 and January 2017. Results The study included 49 patients with a sex ratio of 1:1. A total of 73.4% of patients were smokers, 20.4% were overweight, 48.9% were obese, and 30.6% had symptoms of depression. The mean Sartorius score was 30.4 (±17.6). The outcome of plastic surgery consultation was as follows: 16 patients had operations, 5 were excluded based on medical history, 9 refused surgery, and 16 remained undecided. The refusal rates for consulting with the smoking cessation and nutrition specialists were 55.8% and 69.5%, respectively. Twelve patients received antibiotics, 9 received biologics, 9 underwent medico-surgical treatment, 9 underwent surgery, and 10 were lost to follow-up. The mean visual analogue scale score for satisfaction was 8.3 (±1.6; n = 28). Conclusion An integrated multidisciplinary care model for HS is associated with high patient satisfaction. Adherence to the proposed comorbidity management was higher in female patients and related to empathetic interactions with physicians.

International audience

Introduction Le dupilumab est autorise dans le traitement de la dermatite atopique (DA) moderee a severe. Decrits au cours des etudes cliniques et confirmes en vie-reelle, des effets indesirables oculaires (EIO) ont ete rapportes chez les patients traites pour une DA. Bien que frequents, la caracterisation de ces EIO restent limitee en raison souvent du faible nombre de patients decrits/ou de l’absence d’examen ophtalmologique systematique. Notre etude a pour objectif de combiner une approche dermatologique et ophtalmologique afin de preciser l’incidence, les caracteristiques cliniques et les facteurs de risque de l’atteinte oculaire. Materiel et methodes Etude prospective, multicentrique, en vie reelle chez des patients adultes atteints de DA traites par dupilumab. Les caracteristiques demographiques et cliniques des patients atteints de DA etaient decrites. Une evaluation ophtalmologique initiale et a 4 mois (M4) etait systematique chez tous les patients inclus. Resultats Un total de 181 patients ont ete inclus. L’âge median etait de 36 ans, le SCORAD moyen a j0 etait de 46 et 43 % des patients avaient des antecedents de troubles ophtalmologiques atopiques. L’incidence des conjonctivites a M4 etait de 19 % (35 patients). Parmi eux, 20 patients ont developpe une conjonctivite de novo et 15 patients ont aggrave une conjonctivite deja presente. En analyse bivariee, a l’inclusion, un âge plus eleve (p = 0,028) la severite de la DA estimee par le SCORAD (p = 0,08) et une atteinte erythrodermique (p = 0,009) etaient associes au developpement d’une conjonctivite a M4. On notait une tendance a l’association entre une atteinte cervico-faciale objectivee a M4 et la survenue d’une conjonctivite (p = 0,07). Les antecedents personnels ou familiaux de comorbidites atopiques, les antecedents de conjonctivites a j0 ou un taux eleve d’IgE n’etaient pas associes a une conjonctivite. Discussion Nos resultats sur l’incidence sont concordants avec les donnees actuelles de la litterature. Concernant les facteurs de risque, les phenotypes cliniques des patients semblent particulierement interessants pour cibler les patients a risques d’EIO. Alors que la severite initiale avait deja ete mise en evidence dans deux etudes anterieures, l’erythrodermie initiale et l’atteinte « tete et cou » en cours de traitement sont evoques comme facteurs de risques pour la premiere fois. D’autres facteurs cliniques ne sont pas confirmes par notre etude. En conclusion, il s’agit de la plus large cohorte de patients traites par dupilumab pour une DA evalues systematiquement et prospectivement jusqu’a M4. La connaissance de l’incidence reelle des EIO et de leurs facteurs de risque permettra d’ameliorer la prise en charge des patients eligibles a ce traitement.

Introduction Le dupilumab est utilise dans la dermatite atopique (DA) moderee a severe de l’adulte depuis 2017. Il y a peu de donnees concernant l’efficacite au-dela d’un an de traitement. L’objectif de notre etude etait d’analyser l’efficacite de ce traitement au-dela d’un an, en vie reelle. Materiel et methodes Il s’agissait d’une etude observationnelle retrospective monocentrique. Les patients atteints de DA et traites par dupilumab entre fevrier 2017 et mai 2021 etaient inclus. Le score SCORAD (SCOring Atopic Dermatitis), les echelles visuelles analogiques (EVA) du prurit et de la perte de sommeil, l’IGA (Investigator Global Assessment) et le DLQI (Dermatology Life Quality Index) etaient recueillis a l’initiation du traitement (A0) et au moins une fois par an. Resultats Un total de 146 patients etaient inclus (86 hommes, 60 femmes), d’âge median 41 ans. Les scores moyens initiaux etaient de 47,6 pour le SCORAD, 6,2 pour l’EVA prurit, 4,7 pour l’EVA perte de sommeil, 3 pour l’IGA et 13,8 pour le DLQI. Le pourcentage de patient avec un IGA a 0 ou 1 etait de 8,9 %. La duree mediane de suivi etait de 18 mois. Les resultats sont presentes sous forme de tableau ci joint. Sur l’ensemble de notre cohorte (n = 146), 20 patients (13 %) arretaient le traitement, dont 9 pour cause d’effets indesirables (troubles oculaires pour la plupart, hepatopathie pour un patient, colite pour un patient, eruption cutanee paradoxale pour une patiente), et 5 pour inefficacite. Discussion Il existe de nombreuses etudes a court terme en vie reelle concernant l’efficacite et la securite du dupilumab dans la DA moderee a severe de l’adulte. Une cohorte hollandaise de 221 patients montrait une diminution moyenne du score EASI (Eczema Area and Severity Index) de 70 % a 16 semaines, et 76 % a 52 semaines. Huit pour cent des patients avaient du interrompre le traitement. Une meta-analyse incluant 32 etudes, (3303 patients) montrait une diminution moyenne du score EASI a 16 semaines de 69 %. Notre cohorte comportait un suivi plus long en faveur d’un maintien d’efficacite a long terme. Les arrets de traitement etaient peu nombreux plus souvent expliques par la survenue d’effets indesirables que par une perte d’efficacite.

Introduction Le port de gants est source de dermites de contact irritatives ou allergiques le plus souvent dues aux accelerateurs de vulcanisation. De nouvelles sensibilisations aux gants en caoutchouc synthetique ou en vinyle ont ete rapportees. Une batterie Europeenne caoutchouc (BEC) et des patch tests avec les gants personnels sont conseilles depuis 2016 pour le diagnostic d’allergie aux gants. Depuis, une seule etude systematique a ete realisee chez les porteurs de gants. Nos objectifs etaient d’evaluer le profil clinique des patients atteints d’ECM et porteurs de gants, et l’interet des tests avec les gants personnels, la BEC et des allergenes de gants vinyle. Materiel et methodes (ou observation(s) si cas clinique(s)) Le groupe DAG de la Societe francaise de dermatologie a inclus dans une etude multicentrique tous les patients atteints d’ECM et porteurs de gants en milieu professionnel ou non, ayant beneficie, selon les regles de bonnes pratiques du groupe, d’un questionnaire enquete de pratiques dans l’ECM, d’un recueil standardise d’observation, de patch tests avec la BSE, la BEC et ses ajouts, les allergenes commercialises de gants vinyle et de tests avec des gants personnels (patch tests et tests semi-ouverts 5 × 5 cm SO). Resultats (si adapte) On avait 283 patients, d’âge moyen 38,6 ans, dont 75 % de femmes, 56 % d’atopiques, avec une duree moyenne de l’ECM 53,6 mois, et un eczema fissuraire ou vesiculeux dans plus de 50 % des cas. 43 % exercaient dans le milieu de la sante et 26 % portaient les gants plus de 2 h/jour. 62 % portaient plusieurs types de gants (latex 58 %, vinyle 47 %, nitrile 47 %, textile enduit 15 %, neoprene 7 %). Le lavage des mains etait frequent (64,8 %) ; 80 % utilisaient un savon doux et un emollient. L’ECM etait rythme par le travail dans 62,6 % des cas. Au total, 32 % des patients avaient des tests positifs a des gants personnels ou des allergenes de gants. Les allergenes principaux etaient : thiurams 13 %, (dont 20 % non depistes par la BSE), carbamates 3,2 %, benzothiazoles 3,2 %, 1,3-diphenylguanidine 5,3 % ; 48,7 % des sensibilisations n’etaient detectees que par la BEC. Sur les 55 gants positifs, 10,9 % etaient des gants vinyle et sur les 35 patients ayant eu patch tests et tests SO, 22,8 % avaient uniquement des tests SO positifs. 25 % etaient sensibilises a d’autres allergenes. 52 % de patients allergiques aux gants etaient revus avec 87 % d’evolution tres favorable apres eviction. Discussion Notre etude montre l’interet de tester la batterie europeenne caoutchouc et les gants apportes. Le taux eleve d’allergie aux gants s’explique par un biais de recrutement hospitalier. Le taux de sensibilisation aux thiurams, carbamates et benzothiazoles est similaire aux donnees de la litterature. Nous confirmons l’importance de la sensibilisation a la diphenylguanidine. Les tests semi-ouverts avec les gants sont apparus utiles. Nous soulignons une proportion significative (10,9 %) de tests positifs aux gants vinyle avec une faible pertinence des allergenes commercialises dans ces cas.

BACKGROUND Photoaggravated allergic contact dermatitis caused by methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) and MI has been reported. OBJECTIVES To describe the clinical characteristics and results of (photo)patch tests and photo-tests of 10 patients in Belgium and France suffering from photoaggravated contact dermatitis caused by MI. PATIENTS AND METHODS Five men and five women, with a median age of 49.5 years, were investigated between January 2012 and February 2017 because of suspected photoaggravated contact dermatitis. Patch tests, photopatch tests and/or photo-tests were performed. RESULTS Seven patients had positive patch test reactions to both MCI/MI and MI, whereas 3 patients had positive patch test reactions only to MI. In most cases, MI was the (strong) primary sensitizer. Photopatch tests with MCI/MI and/or MI gave stronger reactions than patch tests with these derivatives, indicating photoaggravation. Sensitization probably took place from cosmetics and work-related biocides, whereas elicitation of dermatitis was remarkably often related to airborne exposure to MI present in paints or industrial biocides. Four patients suffered from transient photosensitivity. CONCLUSION Photoaggravated allergic contact dermatitis and transient photosensitivity caused by MI is a peculiar clinical presentation of allergic contact dermatitis caused by this preservative, and should be considered in daily clinical practice.

The AWARE study is an ongoing international study of patients with chronic urticaria refractory to H1-antihistamines. The aim of this study is to evaluate the burden of disease and the use of healthcare resources in real-life conditions.To analyse the baseline data of French patients included in the AWARE study.AWARE is a prospective, non-interventional, international study that includes adult patients who have had chronic urticaria, refractory to at least one H1-antihistamine, for at least two months.Ninety-four patients (mean age: 47.9 years; 71.3% women) with chronic urticaria (50.0% spontaneous only, 9.6% inducible only, and 40.4% both) were included in French centres. The median duration from diagnosis was three years and angioedema was present in 31.5% of patients for the past six months. In 63.8% of cases, the patients received at least one treatment for urticaria (H1-antihistamine for 66.0%). Chronic urticaria was poorly controlled (UCT score12) in 88.9% of patients and quality of life was severely impaired (mean DLQI score: 8.6). The use of healthcare resources was significant with frequent visits to general practitioners (80.8% of patients; mean: 8.1 visits). However, more than half of patients had not previously consulted a dermatologist.These baseline data of French patients in the AWARE study show that patients suffering from chronic urticaria, refractory to H1-antihistamines for a median of three years, are insufficiently treated and that their quality of life is impaired. Despite the significant use of healthcare resources, access to specialised consultations remains insufficient.

Data on the clinical burden of chronic spontaneous urticaria (CSU) and economic consequences are lacking in France. To characterize the clinical and economic burden of CSU in symptomatic patients despite treatment by analysing data of French patients from the ASSURE-CSU study. ASSURE-CSU was an international observational study that included CSU patients with symptoms that lasted for 12 months or more despite treatment. Disease characteristics and healthcare resource use were obtained from medical records. Data on disease history, health-related quality of life (HR-QoL), and work productivity were collected from a patient survey. A total of 101 patients were analysed (76.2% female; mean age: 48.9 years) with moderate to severe disease (UAS7 score ≥16) in 43.4% and angioedema in 72.3%. The mean (S.D.) total scores of Chronic Urticaria Quality of Life (CU-Q

Background Eyelids are frequent sites of contact dermatitis. No prospective study focused on eyelid allergic contact dermatitis (EACD) has yet been published, and this topic has never been studied in French patients. Objectives To prospectively evaluate the usefulness of an eyelid series in French patients patch tested because of EACD, and to describe these patients. Methods We prospectively analysed standardized data for all patients referred to our departments between September 2014 and August 2016 for patch testing for suspected EACD as the main reason. All patients were patch tested with an eyelid series, the European baseline series (EBS), the French additional series, and their personal products. Patch testing with additional series and repeated open application tests (ROATs) or open tests were performed if necessary. A standardized assessment of the relevance was used, and the analysis of the results was focused on patients having positive test results with a current certain relevance. Results Two-hundred and sixty-four patients (238 women and 26 men) were included. Three-hundred and twenty-two tests gave positive results in 167 patients, 84 of whom had currently relevant reactions: 56 had currently relevant positive test reactions to the EBS, 16 had currently relevant positive test reactions to their personal products, 8 had currently relevant positive test reactions to the French additional series, and 4 had currently relevant positive test reactions to the eyelid series. Sixty-seven per cent of all relevant cases were related to cosmetic products. The most frequent allergens with current relevance were methylisothiazolinone (10.2%), fragrance mix I (3%), nickel (2.7%), hydroxyperoxides of linalool (2.7%) and limonene (2.3%), and Myroxylon pereirae (2.3%). Current atopic dermatitis was found in 9.5% of patients. The duration of dermatitis was shorter (23.2 vs 34.2 months; P = .035) in patients with currently relevant test reactions. The percentage of currently relevant tests remained the same when atopic patients or dermatitis localized only on the eyelids were taken into account. Conclusion In French patients, testing for EACD with the extended baseline series and personal products, also including ROATs and use tests, appears to be adequate, considering the currently relevant positive test reactions. The regular addition of an eyelid series does not seem to be necessary.

Photoaggravated allergic contact dermatitis caused by methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) and MI has been reported.To describe the clinical characteristics and results of (photo)patch tests and photo-tests of 10 patients in Belgium and France suffering from photoaggravated contact dermatitis caused by MI.Five men and five women, with a median age of 49.5 years, were investigated between January 2012 and February 2017 because of suspected photoaggravated contact dermatitis. Patch tests, photopatch tests and/or photo-tests were performed.Seven patients had positive patch test reactions to both MCI/MI and MI, whereas 3 patients had positive patch test reactions only to MI. In most cases, MI was the (strong) primary sensitizer. Photopatch tests with MCI/MI and/or MI gave stronger reactions than patch tests with these derivatives, indicating photoaggravation. Sensitization probably took place from cosmetics and work-related biocides, whereas elicitation of dermatitis was remarkably often related to airborne exposure to MI present in paints or industrial biocides. Four patients suffered from transient photosensitivity.Photoaggravated allergic contact dermatitis and transient photosensitivity caused by MI is a peculiar clinical presentation of allergic contact dermatitis caused by this preservative, and should be considered in daily clinical practice.

International audience; Photodynamic therapy (PDT) is used for the treatment ofnon-melanoma skin cancers. A photosensitizer [amino-laevulinic acid (ALA) or methyl aminolaevulinate (MAL)]is applied to the skin and activated by light to producecytotoxic oxygen species. Keratosis–ichthyosis–deafness(KID) syndrome is a form of ichthyosis caused by muta-tions in theGJB2gene. Patients present with vascular-izing keratitis, hearing loss, and increased susceptibilityto some cancers. We report systemic allergic contact der-matitis caused by MAL in a patient with KID syndrome.

Background The preservative methylisothiazolinone (MI) is used in combination with methylchloroisothiazolinone (MCI), but the MCI/MI mixture has been identified as highly allergenic. MI is considered to be less allergenic, and since the mid-2000s has been widely used alone, but is now clearly identified as a contact allergen. The French Vigilance Network for Dermatology and Allergy of the Study and Research Group on Contact Dermatitis (REVIDAL-GERDA) added MI to its baseline patch testing series in 2010. Objective To evaluate the change in the proportion of MI-positive tests in France between 2010 and 2012. Patients/materials/methods We conducted a nationwide, multicentre, retrospective study of all MI-tested patients between 2010 and 2012. Results Sixteen centres participated in the study (7874 patients were tested). Patch tests were performed mainly at a concentration of MI 200 ppm aq. We observed a significant increase in the proportion of MI-positive tests in 2012 and 2011 as compared with 2010 (5.6%, 3.3%, and 1.5%, respectively; p Conclusions We report a significant increase in the number of MI-positive tests. MI is confirmed to be a rapidly emerging allergen, as also observed in other European countries.

Introduction En l’absence d’etudes en vie reelle, le fardeau de l’urticaire chronique (UC) reste meconnu. L’etude AWARE conduite dans 36 pays a recueilli pendant 2 ans des donnees cliniques de « vraie vie » chez des patients souffrant d’UC. Son objectif principal etait de correler les resultats rapportes par le patient « patient reported outcomes » avec les options therapeutiques proposees. Les donnees des centres francais sont presentees dans cette analyse. Materiel et methodes L’etude AWARE est une etude prospective, non interventionnelle, internationale qui a inclus des patients adultes atteints d’UC depuis au moins 2 mois et resistante aux antihistaminiques anti-H1. Les principaux parametres evalues etaient l’evolution des scores moyens d’activite de la maladie (UAS7), de controle de l’urticaire (UCT), de qualite de vie (DLQI) et de satisfaction au traitement (EVA) au cours du suivi. Resultats Quatre-vingt-douze patients ont ete inclus (âge moyen, 47,8 ans ; femmes, 70,7 %), seuls 43 patients (46,7 %) etaient presents a la derniere visite, en raison de la nature observationnelle de l’etude ; 7 patients ont eu une remission spontanee de la maladie avant la fin de l’etude (selon le jugement de l’investigateur). L’anciennete moyenne de la maladie etait de 6,5 ans. Le pourcentage de patients qui ne recevaient aucun traitement etait de 43,5 % avant l’inclusion et diminuait a 14 % a la fin des 2 ans de suivi. L’utilisation des antihistaminiques de seconde generation augmentait de 52,2 % a 74,4 % a la fin de l’etude (dont respectivement 10,9 % et 20,9 % a dose optimisee). L’omalizumab etait prescrit chez 2,2 % des patients en debut d’etude contre 25,6 % a la fin du suivi. Le pourcentage de patients avec un score UAS7 12) augmentait de 11,1 % a 62,2 %. Un angiœdeme au cours des 6 derniers mois etait present chez 34,1 % des patients, ce chiffre diminuait a 7 % au bout des 2 ans de suivi. L’impact sur la qualite de vie (QdV) etait important a extremement important pour 34,1 % des patients a l’inclusion, et 10,5 % des patients a 2 ans (score DLQI > 10). Le score moyen de satisfaction du patient (EVA) vis-a-vis de son traitement augmentait en moyenne de 4,6 ± 3,0 a 7,6 ± 3,0. Discussion Cette etude observationnelle confirme le retentissement de l’UC resistante aux antihistaminiques anti-H1 sur la QdV des patients. La prise en charge des patients a l’inclusion n’etait pas optimale avec une maladie non controlee, une QdV alteree et un nombre important de patients (43,5 %) ne recevant aucun traitement. Au cours du suivi de 2 ans, les resultats rapportes par le patient se sont ameliores notamment la satisfaction vis-a-vis de son traitement. Conclusion La prise en charge therapeutique des patients souffrant d’UC resistante aux antihistaminiques peut etre optimisee dans le but d’attenuer les symptomes de la maladie et d’ameliorer la QdV des patients.

Resume Introduction De nombreux cas de drug reaction with eosinophilia and systemic symptoms (DRESS) a la minocycline ont deja ete decrits, mais ce syndrome a rarement ete attribue a la doxycycline. Observation Une femme de 59 ans, d’origine africaine, etait rapatriee d’un voyage au Ghana pour une hyperthermie associee a un exantheme maculopapuleux infiltre avec œdeme du visage, sans atteinte muqueuse et avec une polyadenopathie. On notait une hypereosinophilie, une cytolyse hepatique et un syndrome mononucleosique. L’histologie cutanee etait aspecifique. La patiente avait debute une chimioprophylaxie antipalustre par doxycycline trois semaines avant les premiers symptomes. Les tests epicutanes a la doxycycline pratiques trois mois plus tard etaient negatifs. Le diagnostic de DRESS sous doxycycline etait retenu. Le phenotype HLA de cette patiente etait A 3,30 et B 39,42. Discussion L’imputabilite intrinseque de la doxycycline dans l’eruption observee ici est vraisemblable (I3). La sensibilite et la specificite des tests epicutanes a la doxycycline ne sont pas connues dans l’exploration du DRESS, et leur negativite ne permet pas d’eliminer le diagnostic. Plusieurs cas de DRESS a la doxycycline sont maintenant decrits, pouvant s’expliquer par sa plus grande prescription (chimioprophylaxie antipalustre, acne). Les populations d’ethnie africaine et certains phenotypes HLA ont un risque accru d’hypersensibilite medicamenteuse. Conclusion Il s’agit a notre connaissance du troisieme cas decrit de DRESS a la doxycycline. L’exploration allergologique par tests epicutanes et la caracterisation du phenotype HLA font l’originalite de cette observation.

Atopic dermatitis (AD) is a common inflammatory skindisease with a prevalence of 6–9% in the Frenchpaediatric population (1). Treatment of AD is primarilybased on basic skin care and long-term topical treatmentswith emollients and topical corticosteroids (2, 3). Epider-mal barrier dysfunction is an extremely important com-ponent of AD pathophysiology. Both genetic andacquired impairments are implicated in skin barrierdysfunction in AD. The permanent skin barrier defectin AD is associated with a greater permeability to foreignantigens (4). This may be associated with a greater risk ofsensitization to topical agents including topical treatmentin patients with AD. It has been shown that long-termexposure to allergens may be a risk factor of allergiccontact dermatitis (ACD) in AD (5). In order to minimizethe risk of irritation and sensitization, attention shouldfocus on everything that comes into contact with the skin,especially the topical formulations used to treat AD (6).Studies investigating the frequency of positive patch teststo common antigens in children with AD have shown aprevalence of about 40% (7). Epidemiological studies didnot find a higher risk of contact sensitization in ADpatients as compared to the general population (8–10). Ina prospective study including 137 children with AD (7),positive patch tests were observed in about 43% ofchildren. The most frequent allergens from the Europeanstandard series were metals, especially nickel (19.3%),fragrance (4.4%), balsam of Peru (2.6%), lanolin (4.4%),neomycin (2.6%). Emollients tested positively in 2.6% ofpatients. This study showed that emollients, an essentialpart of AD treatment, were the sixth most frequentcontact sensitizer in children with AD.Few data are available on the prevalence of allergiccontact dermatitis to topical treatment in children withAD (7, 8, 11–14).The aim of our study was to assess the frequency ofcutaneous sensitization to topical AD treatments, in agroup of 641 children with atopic dermatitis and todetermine the risk factors associated with skin sensitiza-tion to topical AD treatment.Background: There is little information regarding the risk of sensitizationassociated with topical atopic dermatitis (AD) treatment.Objectives: To assess the frequency of sensitization to topical treatment of AD inchildren and to determine risk factors associated with skin sensitization.Methods: Six hundred and forty-one children with AD were systematically patchtested with seven agents of common topical treatment: chlorhexidine, hexami-dine, budesonide, tixocortol pivalate, bufexamac, sodium fusidate and with thecurrent emollient used by the child. The following variables were recorded: age,sex, age at onset of AD, associated asthma, severity of AD, and history ofprevious exposure to topical agents used in the treatment of AD. Skin prick teststo inhalant and food allergens were used to explore the IgE-mediated sensiti-zation.Results: Forty-one positive patch tests were found in 40 patients (6.2%).Allergens were emollients (47.5%), chlorhexidine (42.5%), hexamidine (7.5%),tixocortol pivalate and bufexamac (2.5% each). Risk factors associated withsensitization to AD treatment were AD severity [OR: 3.3; 95% confidenceinterval (CI):1.5–7.1 for moderate to severe AD], AD onset before the age of6 months (OR: 2.7; 95% CI: 1.2–6.1), and IgE-mediated sensitization (OR: 2.5;95% CI: 1.1–5.9).Conclusions: Topical treatment of AD is associated with cutaneous sensitization.Antiseptics and emollients represent the most frequent sensitizers and may beincluded in the standard series in AD children when contact dermatitis issuspected. Risk factors associated with sensitization to AD topical treatmentsare AD severity, early AD onset and IgE-mediated sensitization.C. Mailhol

Introduction L’urticaire chronique spontanee (UCS) est une urticaire (papules et/ou angiœdemes) evoluant depuis plus de 6 semaines sans cause connue. ASSURE-CSU est la 1 re etude internationale (6 pays Europeens et Canada) non-interventionnelle dont l’objectif est de decrire l’impact humain et economique de l’UCS en cas de non-reponse aux antihistaminiques anti-H1 (AH1). Nous rapportons les resultats de la France. Materiel et methodes Les patients devaient etre symptomatiques a l’inclusion depuis plus de 12 mois et avoir recu au moins une fois des AH1 sans succes. Des donnees etaient extraites retrospectivement des dossiers medicaux. L’intensite et l’impact sur la qualite de vie de l’UCS ont ete evalues en prospective a l’aide d’outils valides : score d’activite de l’urticaire sur 7 jours (UAS7), index dermatologique de qualite de vie (DLQI) et questionnaire de qualite de vie de l’urticaire chronique (CU-Q2oL). La dimension economique de l’UCS a ete evaluee par les couts de sante directs et indirects. Resultats Quatre-vingt-dix-huit patients ont ete inclus dont 91 ont rempli les carnets patients et la qualite de vie evaluee pour 96 patients. 75,5 % etaient des femmes et la moyenne d’âge a l’inclusion etait de 48,7 ans. La duree moyenne entre le diagnostic et l’inclusion etait de 64,1 ( σ = 81,9) mois. Les resultats des scores montrent en moyenne : UAS7 a 16,7 ( σ = 10,1), DLQI a 10,0 ( σ = 6,7) et CU-Q2oL a 38,6 ( σ = 21,9). D’apres les dossiers medicaux et au cours des 12 mois precedant l’etude, 68,4 % des patients (67/98) ont consulte 2,6 fois en moyenne pour l’UCS et 15,3 % (15/98) ont necessite une admission aux urgences. Le total des couts de sante directs annuels a ete estime en moyenne a 2443,6 euros ( σ = 7344,7) par patient. Parmi les 59,3 % de patients ayant une activite professionnelle, l’absenteisme moyen a ete estime a 6,8 % ( σ = 23,7 %) du temps de travail et le presenteisme a 22,0 % ( σ = 23,6 %), sur les 7 derniers jours. Les couts indirects sont calcules a partir de la perte de productivite au travail, estimee a 22,0 % sur les 7 derniers jours : ils representent en moyenne 446,10 euros par patient et par mois. Discussion La litterature rapporte des donnees qualitatives sur le retentissement individuel et parfois le cout economique de l’UCS, mais l’analyse est souvent limitee (Brzoza, 2011 ; O’Donnell, 2014 ; Dias, 2011). Les resultats d’ASSURE-CSU en France montrent que l’epidemiologie de l’UCS est comparable a celle observee dans les autres pays. L’UCS touche majoritairement des femmes, avec un retentissement significatif sur la qualite de vie. Les resultats francais permettent egalement pour la 1 re fois d’identifier l’impact global de l’UCS dans notre pays. L’impact societal et individuel de l’UCS en France semble comparable a d’autres pathologies telles que le psoriasis et la dermatite atopique (Grob, 2005). Conclusion L’UCS a un impact majeur sur la qualite de vie des malades et est responsable de couts de sante directs et indirects importants.

Introduction Le fardeau de l’urticaire chronique (UC) et l’impact de la prise en charge therapeutique sur la qualite de vie (QdV) sont peu decrits. Nous rapportons les resultats de l’analyse intermediaire (donnees initiales) pour les centres francais de l’etude AWARE. Methodes Etude internationale observationnelle prospective, aupres de dermatologues hospitaliers, liberaux ou mixtes. Les patients inclus devaient avoir une UC depuis au moins 2 mois et etre resistants a un traitement antihistaminique (AH1). Les donnees suivantes ont ete recueillies : echelle visuelle analogique (EVA de 0 a 10) de satisfaction au traitement, indice dermatologique de qualite de vie (DLQI, 0 a 30), indice d’impact sur la productivite au travail (WPAI, 0 a 100), test de controle de l’urticaire (UCT, 0 a 16, la valeur maximale correspondant a un controle total de l’UC). Resultats L’etude a recrute 94 patients (71 % de femmes, âge moyen 48 ans) en France dans 25 centres. Les taux d’UC spontanee, inductible ou d’association des 2 etaient respectivement 50 %, 10 % et 40 %. Au cours de l’evolution de la maladie, 81 % des patients avaient consulte un medecin generaliste pour UC (8,1 consultations en moyenne), 25 % avaient suivi une consultation specialisee et 25 % avait ete admis aux urgences. Les traitements au cours des 12 derniers mois (44 % des patients) incluaient en majorite les AH1 (40 %), prednisolone (10 %), omalizumab (1 %). La plupart (89 %) des patients avaient un score UCT Discussion Le controle insuffisant de l’UC (89 %), le faible recours aux consultations specialisees (25 %) et l’absence frequente de traitement (56 %), temoignent de l’errance des patients. La principale limitation de ces donnees est leur caractere retrospectif, reposant, en partie, sur la memoire des patients. Conclusion Les resultats initiaux des patients francais de l’etude AWARE montrent une alteration de la QdV et une insatisfaction au traitement de l’UC. Les resultats finaux devraient aider a mieux comprendre et ameliorer la prise en charge therapeutique.

International audience; Background: There is considerable debate about the prevalence and relevance of food allergy (FA) in atopic dermatitis (AD). The aim of this study was to investigate the prevalence of and risk factors for FA in a cohort of children with AD attending a multidisciplinary paediatric allergy clinic. Methods: The analysis was performed on 386 children (50.8% boys, median age 4 years) consecutively evaluated for AD. A diagnosis of FA was established on positive skin tests and/or a specific IgE value or a positive oral food challenge. Results: Point prevalence of FA was 17.8%. Egg, peanuts, milk, tree nut and mustard accounted for 93% of cases. 37.7% of children had ≥2 positive food reactions. Risk factors associated with FA were young age (OR=7.9 when ≤2 years compared with ≥5 years), moderate to severe AD (OR=7.8 for severe and 2.4 for moderate AD) and onset of AD before 3 months of age (OR=5.7). Conclusion: Point prevalence of FA in children with AD is lower than initially reported in patients recruited in a paediatric allergology setting. Children≤2 years of age with early-onset or severe AD are at higher risk of FA and may be candidates for FA evaluation.

Blepharopigmentation has been introduced during the last decade as a technique for creating a permanent line along the eyelid margin, thus simulating a cosmetic eyeliner. Complications related to this procedure are mostly reported in the opthalmologic literature describing infectious, allergic, or technical problems. We report a case of a woman who underwent blepharopigmentation with aluminum-silicate and in whom a delayed hypersensitivity granulomatous reaction developed. (J Am Acad Dermatol 2000;42:888-91.)

Introduction Les granulomes post-vaccinaux (GPV) se caracterisent par un placard persistant prurigineux infiltre ou nodulaire, erythemateux, pileux et mal delimite. L’augmentation de frequence de ces lesions interroge sur les facteurs de sensibilisation a l’aluminium chez le jeune enfant, et en particulier le role de la lidocaine en patch (Milpied et al. Contact Dermatitis, 2012). A l’aide d’une etude cas-temoins, notre objectif etait de rechercher un lien entre differentes sources de contact precoce avec l’aluminium et la survenue de GPV. Patients et methodes Les membres du groupe de recherche clinique de la SFDP et du groupe Revidal-GERDA ont ete sollicites pour inclure les cas de GPV au cours de la periode juillet 2013-mai 2014. Pour chaque patient inclus, 2 temoins apparies en âge et en sexe etaient recrutes. Un questionnaire standardise rempli par les parents informait sur les items suivants : nombre de doses vaccinales recues ; application de patch ou de creme a la lidocaine ; usage de topiques contenant de l’aluminium ; alimentation lors des premiers mois de vie (presence d’aluminium dans les laits artificiels). La recherche d’une sensibilisation a l’hydroxyde d’aluminium etait realisee par patch-tests. Resultats Soixante-quatre patients et 128 temoins ont ete inclus. Le sex-ratio H/F etait de 0,66 ; l’âge moyen de 4,5 ans (6 mois–14 ans). Dans 82 % des cas, le GPV siegeait a la face anterieure de cuisse. L’âge moyen d’apparition des nodules etait de 18 mois ; 39/44 avaient un patch-test positif pour l’aluminium. Il n’y avait pas de difference entre les 2 groupes vis-a-vis de l’exposition a la lidocaine locale ni a d’autres topiques contenant de l’aluminium (protecteurs solaires, deodorants, antiperspirants, pierre d’alun, talc). En revanche, les enfants du groupe temoin avaient plus frequemment recu un allaitement artificiel (32 %) et moins souvent un allaitement maternel (56 %) que les cas (respectivement 21 % et 66 %). Discussion Notre etude rapporte la plus grande serie multicentrique de GPV de l’enfant et confirme qu’une allergie de contact a l’hydroxyde d’aluminium y est associee dans pres de 9 cas sur 10. Contrairement aux hypotheses recemment emises, l’etude cas-temoins ne montre pas de lien entre l’application de lidocaine locale en patch (ou d’autres topiques liberateurs d’aluminium) et la survenue des GPV. L’utilisation plus frequente de lait artificiel des les premiers mois dans le groupe temoin suggere que l’exposition orale a l’aluminium favoriserait la tolerance. Un facteur limitant de notre etude est de ne pas avoir pu analyser precisement la voie d’administration des vaccins recus dans les 2 groupes (strictement intramusculaire, ou en partie sous-cutane). Compte tenu d’une meilleure diffusion hors du territoire cutane avec la voie intramusculaire, l’hypothese selon laquelle l’injection sous-cutanee, au moins partielle, favorise la survenue de GPV, demeure.

The preservative methylisothiazolinone (MI) is used in combination with methylchloroisothiazolinone (MCI), but the MCI/MI mixture has been identified as highly allergenic. MI is considered to be less allergenic, and since the mid-2000s has been widely used alone, but is now clearly identified as a contact allergen. The French Vigilance Network for Dermatology and Allergy of the Study and Research Group on Contact Dermatitis (REVIDAL-GERDA) added MI to its baseline patch testing series in 2010.To evaluate the change in the proportion of MI-positive tests in France between 2010 and 2012.We conducted a nationwide, multicentre, retrospective study of all MI-tested patients between 2010 and 2012.Sixteen centres participated in the study (7874 patients were tested). Patch tests were performed mainly at a concentration of MI 200 ppm aq. We observed a significant increase in the proportion of MI-positive tests in 2012 and 2011 as compared with 2010 (5.6%, 3.3%, and 1.5%, respectively; p 0.001).We report a significant increase in the number of MI-positive tests. MI is confirmed to be a rapidly emerging allergen, as also observed in other European countries.

Reading the labels of cosmetic products often proves difficult as mandatory labelling information is mixed with non-obligatory and sometimes misleading data, which is included on the labels according to the manufacturer's wishes. This article aims at clarifying the labelling information provided for by the new European Regulation on cosmetic products that will come into effect in 2013 and on the non-regulated but frequently seen information on the packaging of cosmetic products.

Introduction Le choc anaphylactique (CA) est une manifestation severe mettant le pronostic vital en jeu. Suivant l’enquete etiologique, on distingue le CA allergique, idiopathique ou mixte. Il n’y a pas de donnees concernant le CA dans une population de patients atteints de pathologie mastocytaire (PM). Le but de notre travail est d’evaluer la frequence du CA dans une cohorte des patients atteints d’une PM et de definir les facteurs de risque du CA idiopathique. Materiel et methodes Nous avons inclus tous les patients atteints de PM vus dans notre centre entre janvier 2010 et decembre 2014 et pour lesquels un bilan complet de mastocytose systemique (MS) conformement aux recommandations de l’OMS etait realise. Nous avons divise les patients dans 3 groupes concernant la PM : MS, mastocytose cutanee (MC) et syndrome d’activation mastocytaire (SAMA) et deux groupe concernant le CA : sans et avec CA idiopathique. Nous avons recueilli les donnees demographiques, cliniques (type de PM, presence ou non de CA et son type) et biologiques (taux de tryptase serique, statut mutationnel du KIT medullaire). Nous avons compare les caracteristiques entre les groupes. Les medianes etaient comparees par le test de Wilcoxon ou le test de Kruskal-Wallis et les proportions par le test exact de Fisher ou le test de Chi2. Resultats Parmi 116 patients inclus, 81 (70 %) presentaient une MS, 14 (12 %) une MC isolee et 21 un SAMA (18 %). Le CA etait present chez 26 patients (22,2 %), dont 16 cas (61,5 %) de CA idiopathique, 4 (15,4 %) mixte et 6 (23 %) allergique. La figure resume la repartition de CA dans chacun des trois groupes. Le taux median de tryptase serique etait de 18 μg/L (IQR : 6–39) chez les patients avec CA idiopathique et 22 μg/L (IQR : 7,8–41) chez les patients sans CA idiopathique. Le flush recidivant etait present chez 16 (80 %) patients avec CA idiopathique et chez 45 (51 %) sans CA idiopathique (p = 0,02). Au niveau medullaire, la mutation D816 V du KIT etait presente chez 8 patients (40 %) avec CA idiopathique et chez 67 (70 %) sans CA idiopathique (p = 0,01) Le tableau regroupe les facteurs de risque du CA idiopathique et l’analyse multivariee est en cours. Discussion Le CA est present chez plus de 20 % des patients atteints de PM. La presence de flush, phenomene vasomoteur, semble etre un facteur de risque de CA idiopathique. Conclusion Le dermatologue devrait etre prevenu du risque frequent de CA chez les patients atteints de PM, y compris dans les cas de MC isolee et de SAMA. Des etudes complementaires sur de plus grandes cohortes apparaissent importantes afin de confirmer les facteurs de risque de CA idiopathique chez les patients.

Introduction Le syndrome d’activation mastocytaire (SAMA) est une nouvelle entite clinique decrite en 2010. Il peut etre primaire et en relation avec une activation mastocytaire monoclonale, secondaire a une pathologie inflammatoire ou neoplasique ou peut etre idiopathique. Les caracteristiques clinico-biologiques et les criteres diagnostiques du SAMA sont en cours de definition. Objectif Description des caracteristiques clinico-biologiques et d’imagerie des patients avec SAMA suivis dans un centre de competence des mastocytoses. Materiel et methodes Nous avons inclus tous les patients adultes diagnostiques avec un SAMA entre janvier 2012 et decembre 2014. Le diagnostic de SAMA a ete porte selon les criteres de Valent et al. (2012) modifies. Nous avons recueilli les donnees demographiques et cliniques : type de SAMA, type de symptomes d’activation mastocytaire, le delai diagnostique. Les donnees suivantes ont ete egalement collectees : taux serique de la tryptase, statut mutationnel du gene KIT cutane et medullaire, expression de CD2/CD25 par les mastocytes medullaires, histologie cutanee et medullaire et osteodensitometrie. Resultats Nous avons inclus 21 patients atteints de SAMA avec un âge median de 49 ans (range : 19–75) et un sex-ratio H/F de 10/11. Sept patients (33,3 %) avaient un SAMA primaire, deux patients (9,5 %) avaient un SAMA secondaire (un cas satellite d’une myelodysplasie et un cas associe a un psoriasis) et 12 patients (57,1 %) repondaient aux criteres de SAMA idiopathique. Le retard diagnostique median etait de 4 ans (range : 0–30). Vingt patients (95,2 %) presentaient des symptomes d’activation mastocytaire a expression cutanee : 14 cas (66,6 %) d’urticaire superficielle, 8 cas (38,1 %) d’urticaire profonde, 16 cas (76,1 %) de flush et 13 cas (61,9 %) de prurit sine materia et/ou d’exantheme non specifique. Huit patients (38,0 %) de notre serie presentaient des chocs anaphylactiques. Le taux median de la tryptase serique etait de 4,3 μg/l (range : 2,6–20). La densite osseuse etait basse chez 8 patients (38,1 %) dont deux (9,5 %) presentaient des fractures multiples et elle etait augmentee chez deux patients (9,5 %). Sept patients (33,3 %) presentaient un nombre augmente de mastocytes normaux sur la biopsie de mœlle. Onze patients (52,3 %) presentaient un nombre augmente de mastocytes normaux dans la biopsie de la peau normale. Discussion A notre connaissance il s’agit de la premiere serie descriptive de SAMA. La peau est un organe cible du SAMA. Les manifestations cutanees du SAMA comportent : urticaire superficielle et profonde, flush, exantheme non specifique et prurit sine materia. Conclusion Le dermatologue joue un role important dans le diagnostic de cette entite qui peut etre associee a des manifestations systemiques graves comme l’anaphylaxie et l’osteoporose fracturaire.

Background: Previously, a quantitative risk assessment suggested there was no risk of induction of fragrance allergy from minor residues of fragrance chemicals on washed fabrics. Objective: To investigate whether there was any risk of the elicitation of contact allergy from fragrance chemical residues on fabric in individuals who were already sensitized. Methods: Thirty-six subjects with a positive patch test to isoeugenol (n = 19) or hydroxyisohexyl 3-cyclohexene carboxaldehyde (n = 17) were recruited. Dose-response and fabric patch tests were performed, respectively, with filter paper and a cotton sample loaded with fragrance in ethanol-diethylphthalate (DEP) and applied in a Finn Chamber (R) or a Hill Top Chamber (R). Results: Only two subjects reacted to an isoeugenol patch test concentration of 0.01% (>20x the estimated likely skin exposure level), none reacted to lower concentrations. Of 36 subjects, 18 reacted to the fabric patch treated with ethanol-DEP vehicle alone and 20 to the fragrance-chemical-treated fabric patch. These were only minor non-specific skin reactions. They were also quite evenly distributed between the two fragrance chemical allergic groups. Conclusions: On the basis of the examples studied, fragrance chemical residues present on fabric do not appear to present a risk of the elicitation of immediate or delayed allergic skin reactions on individuals already sensitized.

Although the benefits of emollient therapy are widely accepted in atopic dermatitis, there is a relative lack of clinical evidence supporting their efficacy in these conditions. The aim of this study was to evaluate the efficacy, the tolerance and the effects on children's quality of life of a new moisturizer milk (Exomega milk) in childhood atopic dermatitis.This controlled, randomized, multi-centric study had two parallel groups, involving children aged 6 months to 12 years, with mild and moderate atopic dermatitis (Scorad35). The treated group applied the moisturizer milk twice a day for 2 months, in association with a cleansing bar. The non-treated group had only the cleansing bar. The use of strong and moderate topical corticoids was allowed and quantified. The following parameters were evaluated: Scorad, tolerance and the children's quality of life index.A total of 76 children (mean age 4 years) were included: 37 in the treated group, 39 in the non-treated group. After 2 months, the decrease of the Scorad index in the treated group was not statistically significant (p = 0.051) but detailed evaluation showed a significant improvement of xerosis (p = 0.01) and pruritus (p = 0.01) in the treated group compared with the non-treated group. Clinical improvement in the treated group after 2 months of treatment was correlated to a significant improvement of the children's quality of life index (p = 0.0011). Tolerance was good to excellent in 97% of cases.The milk emollient studied was found to provide an interesting auxiliary treatment in childhood atopic dermatitis since it gave positive results, in particular on xerosis and pruritus, as well as an improvement of the quality of life of the children.