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Actinic cheilitis is a premalignant condition that can progress to squamous cell carcinoma with a higher propensity for metastasis than cutaneous squamous cell carcinoma. Optimal treatment for actinic cheilitis has not been established, and evidence-based estimates of clinical cure in the dermatology literature are limited. Here, we review and synthesize outcome data published for patients with actinic cheilitis after treatment with various modalities. A systematic review was conducted in MEDLINE, Embase and the Cochrane library for English, French and German-language studies and references of included articles from inception to 20 January 2020. Studies were included if they reported on at least six patients with biopsy-proven actinic cheilitis. After quality appraisal, results of studies with the strongest methodology criteria were synthesized. 18 studies of 411 patients (published 1985 to 2016) were included. The majority of the studies were case series. Carbon dioxide laser ablation and vermilionectomy were associated with the most favourable outcomes with fewest recurrences. Chemical peel and photodynamic therapy were associated with higher recurrence. Adverse effects generally resolved in the weeks following treatment and cosmetic outcomes were favourable overall. In conclusion, there is a lack of high-quality comparative studies evaluating different treatment options for actinic cheilitis. The included publications used various outcome measures; however, the majority reported on the recently defined core outcome sets. These results suggest that both carbon dioxide laser ablation and vermilionectomy are effective treatments for actinic cheilitis. Prospective head-to-head studies are needed to compare these treatment modalities and to assess patient preferences.

Un des enjeux majeurs de ce XXIesiècle est la lutte contre le vieillissement, défini comme un ensemble de mécanismes physiologiques altérant les capacités physiques et intellectuelles de l’organisme. Le vieillissement de la peau n’est qu’un trait visible de ce processus. Il est associé à des défauts de cicatrisation majeurs liés à l’altération des propriétés biomécaniques des cellules cutanées, essentiellement des fibroblastes dermiques. Le système immunitaire, autre composante clé du maintien de l’homéostasie cutanée et du bon déroulement de la cicatrisation des plaies, subit aussi les effets du temps : l’immunosénescence cutanée consécutive limiterait la réponse anti-infectieuse et vaccinale, tout en favorisant un environnement pro-tumoral. Les principales atteintes cutanées dues au vieillissement, que celui-ci soit intrinsèque ou extrinsèque, seront détaillées avant d’énumérer les stratégies anti-âges efficaces pour lutter contre les stigmates dermiques et épidermiques liées à l’âge.

Cutaneous T-cell lymphomas (CTCL) are a heterogenous group of rare diseases. Many studies have reported on local epidemiology or geographic clustering, however we lack information from a global perspective. A systematic review and meta-analysis was conducted in Medline and the Cochrane Library based on a previously registered protocol and according to the preferred reporting of items for systematic reviews and meta-analyses (PRISMA). We selected publications that enrolled at least 100 patients with primary cutaneous lymphomas according to the current classifications. The relative frequencies (proportions) of subtypes were compared between studies and geographic regions in a meta-analysis. In total, 26 studies met our inclusion criteria, reporting on altogether 16,953 patients. Within primary cutaneous lymphomas, CTCL appeared to be 15% more frequent in Asian populations. Mycosis fungoides (MF) accounted for 62% of CTCL, with an important heterogeneity in frequencies between studies and continents. The proportion of S&eacute, zary syndrome (SS) was 3%, stable worldwide. Rare CTCL, such as NK/T-cell lymphoma or subcutaneous panniculitis-like lymphoma, were more frequent in Asian studies. This global meta-analysis of CTCL confirmed the predominance of CTCL among primary cutaneous lymphomas (83% on average) in the three analyzed continents, most of which were MF cases. It revealed the same proportions of SS across continents, and the heterogeneity of MF frequencies, suggesting the possible role of environmental factors in the pathophysiology of the latter. Registration number: CRD42020148295 (PROSPERO).

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Background Primary cutaneous lymphomas (PCLs) are a heterogeneous group of T-cell (CTCL) and B-cell (CBCL) malignancies. Little is known about their epidemiology at initial presentation in Europe and about potential changes over time. Objectives The aim of this retrospective study was to analyse the frequency of PCLs in the French Cutaneous Lymphoma Registry (GFELC) and to describe the demography of patients. Methods Patients with a centrally validated diagnosis of primary PCL, diagnosed between 2005 and 2019, were included. Results The calculated incidence was unprecedently high at 1·06 per 100 000 person-years. The number of included patients increased yearly. Most PCL subtypes were more frequent in male patients, diagnosed at a median age of 60 years. The relative frequency of rare CTCL remained stable, the proportion of classical mycosis fungoides (MF) decreased, and the frequency of its variants (e.g. folliculotropic MF) increased. Similar patterns were observed for CBCL; for example, the proportion of marginal-zone CBCL increased over time. Conclusions Changes in PCL frequencies may be explained by the emergence of new diagnostic criteria and better description of the entities in the most recent PCL classification. Moreover, we propose that an algorithm should be developed to confirm the diagnosis of PCL by central validation of the cases.

Primary cutaneous lymphomas are a group of T- (CTCL) and B-cell (CBCL) malignancies. These diseases have different clinical presentations and prognosis. Our knowledge on their epidemiology is limited. Aim of this review was to summarize recent findings on the incidence of CTCL and CBCL, how they change over time, and to describe possible causes and consequences. We found that although there are important differences in the epidemiology of cutaneous lymphomas in different countries, the relative frequency of certain, especially rare lymphomas remains stable. Several studies described growing incidences of both CTCL and CBCL. The emergence of new diagnostic criteria, a more precise definition of the entities and new biomarkers enable a better classification of cases.

Introduction Le diagnostic precoce de lymphome T cutane n’est pas toujours aise et repose sur un faisceau d’arguments cliniques, biologiques, histologiques et moleculaires. Le sequencage haut debit du TCR-beta permet par la reconnaissance de sequences CDR3 specifiques l’identification et la quantification de chaque clone T present dans un echantillon donne. Il existe encore peu d’etudes a ce sujet avec des resultats discordants et aucun critere diagnostic valide. Notre etude avait comme but de determiner pour cette technique des seuils optimaux pour les valeurs suivantes : frequence du clone T majoritaire dans la peau rapportee a l’echantillon total (TCF) et ratio entre la frequence du premier et du deuxieme clone T (RPF), avec comme objectif de developper de nouveaux algorithmes pour le diagnostic de lymphome T cutane. Materiel et methodes Nous avons analyse retrospectivement les donnees obtenues par le sequencage haut debit du TCR-beta dans des echantillons de biopsies cutanees realisees chez 144 patients entre 2013 et 2020. Le diagnostic de lymphome T cutane etait base sur des criteres internationaux valides. Nous avons inclus 101 echantillons de patients ayant un diagnostic de lymphome T confirme dont 47 MF stade I-IIA, 1 stade IIB, 4 stade III, 35 syndromes de Sezary, 8 lymphomes T agressifs (PTCL NOS ou CD8+) et 6 lymphoproliferations CD30+ (3 papuloses lymphomatoides et 3 lymphomes anaplasiques a grandes cellules). En complement 43 echantillons provenant de patients avec des pathologies inflammatoires etaient inclus. Les performances de la technique ont ete etudiees a l’aide de courbes ROC. Resultats Les meilleures performances diagnostiques etaient obtenues pour le TCF avec une AUC de 0,957 versus 0,929 pour le RPF. Les valeurs de TCF et RPF pour chaque categorie ont ete modelisees. Avec des seuils de TCF de 5 % et 25 %,la specificite pour le diagnostic etait de 95 % et 100 %, et la sensibilite de 89 % et 50 %. Il existait une correlation significative entre le TCF et l’importance de l’atteinte sanguine chez les patients SS (cellules TCD4 + CD26−, r = 0,59, p = 0,0008 ; T CD4 + CD7−, r = 0,45, p = 0,01 ; T CD4 + CD158k+, r = 0,4, p = 0,03) Discussion Le TCF obtenu par HTS-TRB est un critere robuste pour le diagnostic de lymphome T cutane et particulierement pour celui de MF, avec une sp de 95 % et une se de 89 % pour un seuil de 5 %. Une telle specificite permettrait un diagnostic precoce de lymphome T cutane dans des cas difficiles. Ces resultats sont meilleurs que ceux obtenus a l’aide de la PCR classique sur gel du TCR gamma qui sont entaches de nombreux faux negatifs et faux positifs. Des etudes multicentriques prospectives seraient necessaires pour la definition de criteres valides internationaux pour l’usage de cette technique dans le diagnostic de lymphome T cutane.

Background: Despite increasing availability of therapeutic agents, Sezary syndrome (SS) remains associated with a generally poor prognosis. Typically, patients endure multi-line treatment, frequently with disappointingly short durations of clinical benefit. Time to next treatment (TTNT) measures the interval from the date of commencement of one therapy to the date of initiation of the next line of therapy, and provides a simple and reliable surrogate for duration of clinical benefit outside of clinical trials [ 1 ]. In this multi-centre collaborative study, we review the clinical outcomes of patients with SS/ mycosis fungoides (MF) with B1-2 blood involvement, and compare the treatment efficacy of the currently available systemic therapies using TTNT. Methods: In this retrospective analysis, eligible patients were identified from University Hospital Birmingham, Birmingham, Peter MacCallum Cancer Centre, Melbourne, and Hopital Saint Louis, Paris. Strict eligibility required biopsy-proven MF/SS, with B1-2 blood involvement, newly diagnosed during 1/1/2012 to 31/12/2020. Studied treatment groups include monotherapy and combination therapies of interferon, methotrexate, ECP, HDAC inhibitors, retinoids, monoclonal antibodies, biologicals, chemotherapy, allogeneic stem cell transplant, and best supportive care. The primary endpoint was TTNT, with the aim to compare the efficacy of these systemic therapies. Results: 178 patients were eligible. 77 (43%) were female, median age was 66 (17–94) years. At diagnosis, 35 (20%) patients had Stage IIIB, 131 (74%) Stage IVA and 12 (7%) Stage IVB MF/SS. Large cell transformation was present in 35 (20%) patients at time of diagnosis. A total of 802 treatment lines were delivered, of which 711 were systemic therapies and were included for analysis. Of the 178 patients, 168 received systemic therapy first-line: the most commonly delivered first-line systemic treatments were ECP-containing regimens in 42 (25%) patients (ECP-monotherapy, 17, ECP-based combination therapy, 25), retinoid monotherapy in 34 (19%), interferon monotherapy in 25 (14%) and methotrexate monotherapy in 25 (14%) patients. TTNT and overall survival data will be presented. Conclusions: As a surrogate for duration of clinical benefit, TTNT is a useful endpoint to retrospectively compare the treatment efficacy of currently available systemic therapies for SS/MF with B1-2 blood involvement. Long-term disease control with durable clinical benefit remains the ultimate goal for patients with SS/MF with blood involvement.

Introduction: Cancer-associated fibroblasts (CAFs), a component of tumor microenvironment, play a key role in oncogenesis and promote growth, invasion, metastasis and chemo-resistance of tumor cells. Our previous RNAseq results brought evidence of the contribution of dermal fibroblasts obtained from cutaneous T-cell lymphoma (CTCL) lesions to support tumor growth. Here, we further go on by analyzing the alteration of protein production by dermal fibroblasts obtained from CTCL lesions versus control fibroblasts. Materials and methods: Secretome and proteome was performed on fibroblast primary cultures skin biopsies of 6 cutaneous T-cell lymphoma (CTCL[GD1]) versus fibroblasts from healthy mammary skin controls (age-paired). The fibroblasts of the two groups were studied at the 3rd passage, after stimulation or not with 5 ng/ml TGF-β for 24 h. The supernatants and lysates collected underwent enzymatic digestion with trypsin before peptide analysis by HLPC/Mass spectrometry Results: The comparison of the secretomes from the CTCL groups (± TGF-s) and the control donors showed a global significant differential expression (fold >2, p-value 2, p-value Conclusion: The present data demonstrate the potent proteomic alteration of CTCL-associated dermal fibroblasts, confirming the involvement of mesenchymal cells on the behavior of CTCL.

Background Aged residents of institutional long-term care facilities are at high risk for developing skin and tissue diseases. Besides various common skin problems, dry skin (xerosis cutis) is one of the most frequent skin conditions in this setting. Objectives To investigate the effectiveness of two structured skin care regimens in comparison to routine skin care on xerosis cutis in nursing home residents. Design A multi-center, pragmatic, randomized, controlled, investigator blinded study with three parallel groups. Settings The study was conducted in a random sample of ten out of 291 institutional long-term care facilities of the federal state of Berlin, Germany. Participants Long-term care residents being 65+ years affected by dry skin were included. Methods The residents were allocated into one of three study groups. Two interventional groups used standardized skin care regimens, consisting of a body wash and twice daily applications of leave-on products for eight weeks. The third control group performed skin care as usual. All participating residents were examined at baseline and after 4 and 8 weeks. Xerosis cutis was measured with the Overall Dry Skin score. Instrumental skin barrier measurements were performed at baseline and after 8 weeks. Diaries were used to document washing and skin care frequencies. Results In total, 133 residents were included and allocated to one of the three groups. Mean age was 83.8 (SD 8.3) years, 65.4% were female and most residents had care levels I (42.9%) or II (42.9%) according to the German Social Code Book XI. Mean Barthel score was 46.8 (SD 24.2) and mean Braden score was 17.6 (SD 3.7). Leg skin areas were drier compared to arms and trunk areas. At the end of the study the Overall Dry Skin scores in the intervention groups were lower compared to the control group. There were statistically significant improvements of skin dryness in both intervention groups compared to the control group over time. Conclusions The results of this pragmatic trial indicate that structured skin care regimens are effective in reducing skin dryness in aged nursing home residents within eight weeks. Trial registration The study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526.

Background Dry skin (xerosis cutis) is increasingly recognized as a relevant health problem in daily life and in health and nursing care. The use of bath additives such as oils is common to reduce dry skin, but empirical evidence supporting this practice is limited. Objectives The aim of this study was to investigate the effectiveness of using a bath oil additive in improving skin barrier function and ameliorating dry skin in comparison to non-oil containing skin cleansers for bathing or showering. Design Single centre randomized observer blind pragmatic parallel group trial. Settings Outpatient/community care. Participants Volunteers showing clinically mild to moderate dry skin recruited from the city of Berlin. Methods Healthy children and adults were randomly assigned to use either a commercially available bath oil or to continue using their regular non-oil containing skin cleansers every other day over a study period of 28days. Skin barrier parameters and the severity of dry skin were assessed at baseline and at two follow-up visits at the study centre. Transepidermal water loss was the primary outcome. Results All sixty participants randomized completed the trial. Median age was 32.5 (IQR 8.3 to 69) years. At the end of study the mean transepidermal water loss in the intervention group was statistically significant lower compared to the control group (mean difference −1.9 (95% CI −3.1 to −0.8) g/m 2 /h). Stratum corneum hydration was statistically significantly higher in the intervention group at the end of the study. Skin surface pH and roughness were comparable in both groups and remained unchanged, while both groups showed a trend to improvement in dry skin symptoms Conclusions This pragmatic trial provides empirical evidence that the regular use of the investigated bath oil is effective in improving the skin barrier function in children and adults with mild dry skin when used in routine skin care and supports its use as a basic element for the management of a broad spectrum of dry skin conditions. Trial registration ClinicalTrials.gov Identifier NCT02557698.

Introduction Les lymphomes cutanes primitifs sont un groupe heterogene de lymphomes T cutanes (LTC) et de lymphomes B cutanes (LBC). Nous avons peu dinformations sur les caracteristiques des patients atteints de ces maladies et leurs stades initiaux. Malgre plusieurs publications nationales europeennes il existe peu de donnees sur ĺevolution de leur epidemiologie au cours du temps. Le but de cette etude etait de comparer ĺepidemiologie, les caracteristiques et la demographie des patients atteints dun lymphome cutane primitif au cours des quinze dernieres annees et dinvestiguer d’eventuels changements. Materiel et methodes Nous avons inclus les patients ayant eu un diagnostic de lymphome cutane primitif selon les criteres de ĺEORTC-OMS entre 2005 et 2019. Les patients ont ete tries en 3 groupes definis par leur periode d’inclusion (2005–2009, 2010–2014 et 2015–2019) pour les comparer. Resultats Le nombre total de patients inclus a augmente annuellement. Ĺincidence calculee des lymphomes cutanes primitifs etait de 1,06/100 000 habitants en France, ce qui est plus eleve que ce qui a ete decrit dans la litterature. La majorite des lymphomes cutanes etaient plus frequents chez les hommes a un âge moyen de 60 ans. La frequence relative des LTC etait stable, la proportion du mycosis fongoide classique avait diminue et la proportion des autres variants etait croissante (par exemple le mycosis fongoide folliculotrope). Des tendances similaires ont ete observees pour les lymphomes B cutanes, la frequence relative des lymphomes B de la zone marginale etait croissante. Discussion Les changements de frequence des lymphomes cutanes peuvent etre expliques par ĺemergence de nouveaux criteres diagnostiques et des definitions plus precises de ces maladies dans la nouvelle classification. Cest la premiere etude a demontrer des changements de ĺepidemiologie des lymphomes cutanes primitifs au cours du temps.

Background The postadolescent form of acne papulopustulosa, also referred to as ‘acne tarda’ can have substantial negative impact on Quality of Life, especially in adult female patients. Objective Although the Dermatology Life Quality Index (DLQI) is widely used, empirical evidence about its performance in adult female acne patients is lacking. Methods In this prospective cohort study, we have investigated the sensitivity to change of the DLQI in 53 female adult acne patients with mild to moderate facial acne treated with azelaic acid (AzA) 15% gel twice daily over 24 weeks. Results Mean Investigator Static Global Assessment (ISGA) score was 2.3 (SD 0.5) at baseline and ranged from 0.9 (SD 0.3) to 2.1 (SD 0.4) at the end of the study in the ‘Highly Improved’ and ‘Unchanged’ responder groups respectively. The mean baseline DLQI score was 5.1 (SD 4.2). The Effect Size in the responder group ‘Highly Improved’ was 0.66; in group ‘Improved’ 0.62 and 0.23 in group ‘Unchanged’. At the end of study, the mean DLQI score ranged from 1.1 (SD 1.5) in the ‘Highly Improved’ group to 3.7 (SD 6.0) in the ‘Unchanged’ group. Conclusion The results support the sensitivity to change of the DLQI in this population.

Introduction Les lymphomes cutanes primitifs sont un groupe heterogene de maladies rares. Plusieurs publications ont demontre des motifs epidemiologiques locaux, mais pour l’instant, il n’y avait pas encore de comparaison systematique globale publiee. Le but de cette etude etait de comparer les frequences relatives des lymphomes cutanes entre les differents pays du monde et d’analyser d’eventuels regroupements regionaux. Materiel et methodes Nous avons conduit une revue systematique de la litterature sur Medline (Pubmed) et dans la librairie Cochrane pour les publications incluant au moins 100 cas de lymphomes cutanes primitifs et au moins 3 diagnostics differents selon les classifications internationales reconnues. Les proportions relatives de chaque sous-type de lymphome cutane ont ete calculees et comparees dans une meta-analyse. Cette etude a ete realisee en accord avec son protocole enregistre et publie et avec les principes PRISMA. Resultats Apres une selection en double-aveugle, nous avons identifie 26 etudes rapportant 16 953 patients correspondant a nos criteres d’inclusion et exclusion. La frequence des lymphomes cutanes T etait 15 % plus elevee dans les populations asiatiques. La frequence moyenne du mycosis fongoide etait de 62 % avec une heterogeneite importante entre les etudes. Par contre, la frequence du syndrome de Sezary etait stable a 3 % independamment du pays. Certains lymphomes cutanes T rares, comme par exemple le lymphome T a type de panniculite ou le lymphome NK/T de type nasal, etaient plus frequents dans les etudes asiatiques. Discussion Cette meta-analyse globale des lymphomes cutanes a montre que les lymphomes cutanes T sont les lymphomes cutanes primitifs les plus frequents (83 % en moyenne) avec une predominance du mycosis fongoide. Cependant, la frequence relative du syndrome de Sezary etait plutot stable a environ 3 % ce qui pourrait indiquer qu’une instabilite genetique innee joue un role important dans la physiopathologie de cette maladie.

Introduction Le microenvironnement tissulaire joue un role cle dans l’oncogenese et favorise la croissance, l’invasion, les metastases et la resistance a la chimio-prevention des cellules tumorales. Notre objectif est de determiner quelle est la contribution du microenvironnement cutane mesenchymateux dans les lesions tumorales des lymphomes T cutanes (LTC) en caracterisant plus particulierement le profil d’expression genique des fibroblastes dermiques obtenus a partir de lesions cutanees. Materiel et methodes Un sequencage d’ARN (RNA-seq) a ete effectue sur des cultures primaires de fibroblastes cultives a partir de biopsies cutanees de 8 mycosis fongoides (MF), 6 syndrome de Sezary (SS) et 15 fibroblastes normaux (FN) provenant de plasties mammaires (âge apparie). Le RNA-seq a ete realise en utilisant les reactifs Illumina TruSeq V3. La quantification du niveau d’expression et l’identification des genes exprimes differentiellement (differential gene expression : DEG) dans les LTC par rapport aux temoins a ete realisee par DESeq2 (valeur de p ajustee padj Resultats 1044 DEG ont ete identifies entre les fibroblastes associes aux LTC et les FN, avec 542 genes sous-exprimes et 502 surexprimes (1345 genes dans les fibroblastes MF vs FN), 457 genes pour les SS et seulement 45 genes entre SS vs MF. L’analyse GSEA de tous les fibroblastes associes aux CTCL a identifie l’enrichissement de 3 voies principales de signalisation : “IFNa reponse”, “IFNγ reponse”,“cibles MYC”. L’analyse du facteur de transcription IPA® a mis en evidence 25 reseaux moleculaires et plusieurs ensembles de genes associes, dont « Inhibition des Metalloproteases » ou « Signalisation d’extravasation des leucocytes ». Les principaux genes d’interet ont ete valides en qRT-PCR. Discussion Les presentes donnees demontrent l’alteration de l’expression des genes dans les fibroblastes dermiques associes aux LTC, suggerant l’implication des cellules mesenchymateuses sur l’evolution des LTC.

is missing (Short communication).

The report concerns a 61-year-old woman suffering from a chronic pain syndrome of peripheral arterial vascular disease. Despite level III-WHO medication she was not able to walk a distance of more than 100 m without pain. The patient received sonographically guided procaine injections into both femoral arteries. Directly after the injection the patient was free of pain for 4 weeks and for 6 months after a repeat injection.Wir berichten über eine 61-jährige Patientin, die unter einem Schmerzsyndrom bei pAVK leidet. Eine Gehstrecke von maximal 100 m war nur unter starken Schmerzen trotz WHO-Stufe-III-Medikation möglich. Die Patientin erhielt sonografisch gesteuerte intraarterielle Procaininjektionen in beide Femoralarterien. Nach der Injektion war die Patientin schmerzfrei für 4 Wochen und nach wiederholter Injektion 6 Monate.

In Germany herbal medicines are traditionally frequently used. They represent an important therapeutic option, especially in self-medication.Current systematic review articles and meta-analyses were evaluated and summarized with respect to the evidence of phytotherapeutic drugs for selected psychiatric indications.Apart from the use of St. John's wort for depression, no other herb has so far shown convincing evidence.Due to the promising effects and the low side effect potential within the existing studies, further randomized controlled trials (e. g. for Passiflora incarnata, Rhodiola rosea and Lavendula officinalis) are definitely indicated.

Background Associations between daily amounts of drinking water and skin hydration and skin physiology receive increasingly attention in the daily life and in clinical practice. However, there is a lack of evidence of dermatological benefits from drinking increased amounts of water. Materials and methods Pubmed and Web of Science were searched without any restrictions of publication dates. References of included papers and related reviews were checked. Eligibility criteria were primary intervention and observational studies investigating the effects of fluid intake on skin properties in English, German, Spanish or Portuguese language, including subjects being healthy and 18+ years. Results Searches resulted in 216 records, 23 articles were read in full text, and six were included. The mean age of the samples ranged from 24 to 56 years. Overall the evidence is weak in terms of quantity and methodological quality. Disregarding the methodological limitations a slight increase in stratum corneum and "deep" skin hydration was observed after additional water intake, particularly in individuals with lower prior water consumption. Reductions of clinical signs of dryness and roughness were observed. The extensibility and elasticity of the skin increased slightly. Unclear associations were shown between water intake and transepidermal water loss, sebum content, and skin surface pH. Conclusions Additional dietary water intake may increase stratum corneum hydration. The underlying biological mechanism for this possible relationship is unknown. Whether this association also exists in aged subjects is unclear. Research is needed to answer the question whether increased fluid intake decreases signs of dry skin.

The report concerns a 61-year-old woman suffering from a chronic pain syndrome of peripheral arterial vascular disease. Despite level III-WHO medication she was not able to walk a distance of more than 100 m without pain. The patient received sonographically guided procaine injections into both femoral arteries. Directly after the injection the patient was free of pain for 4 weeks and for 6 months after a repeat injection.

Introduction Le lymphome T cutane anaplasique a grandes cellules est un lymphome T cutane (LTC) de bon pronostic avec expression de CD30 par plus de 75 % des cellules. Les lymphomes T cutanes primitifs qui ne correspondent a aucune des categories definies par la classification Organisation mondiale de la sante/European Organization for Research and Treatment of Cancer (OMS/EORTC) sont classes comme lymphome T peripherique non classable (pcPTCL-NOS). Materiel et methodes Nous presentons deux cas cliniques avec un diagnostic initial de pcPTCL-NOS avec peu ou pas d’expression de CD30 initiale qui echappaient apres la premiere ligne de traitement et rechutaient sous forme de lymphomes cutanes CD30+ avec une atteinte systemique. Observations Cas 1 : un patient de 79 ans presentait une plaque ulceree du prepuce. L’histologie montrait une infiltration dense de lymphocytes atypiques de taille moyenne sans epidermotropisme. Les cellules tumorales exprimaient CD3, CD8, granzyme B et 10 % etaient CD30+, ce qui permettait de porter le diagnostic de pcPTCL-NOS. Le patient etait en reponse complete apres radiotherapie. Il rechutait 4 ans plus tard sous forme de lesions cutanees et systemiques. L’examen anatomopathologique montrait un aspect de lymphome anaplasique a grandes cellules, avec une infiltration lymphocytaire dense, dont 80 % des cellules etaient CD30+. Les traitements par doxorubicine liposomale pegylee et brentuximab vedotin permettaient d’obtenir une reponse complete, mais le patient rechutait a nouveau. Une analyse des recepteurs T des lymphocytes par hightroughput sequencing retrouvait un clone T identique au diagnostic initial et au moment de la rechute dans les biopsies cutanees. Cas 2 : un patient de 71 ans se presentait avec des symptomes B et des ulcerations du genou droit. La biopsie montrait une infiltration dermique par des lymphocytes de taille moyenne, CD3+ CD5-, CD7-, granzyme B+, CD4+/− et CD8+/−, sans expression de CD30. La tomographie a emission de positons–tomodensitometrie (TEP-TDM) etait strictement normale, le diagnostic de pcPTCL-NOS etait retenu. Quelques mois apres la polychimiotherapie, le patient rechutait avec une atteinte systemique et des ulcerations cutanees. La biopsie montrait un aspect de lymphome T anaplasique CD30+. Discussion L’heterogeneite de l’expression du CD30 chez un meme patient et dans la meme biopsie a deja ete rapportee. Ces observations demontrent la plasticite d’un meme clone T qui peut realiser des tableaux anatomocliniques differents ce qui peut avoir des consequences therapeutiques, en particulier concernant les possibilites de traitement par un anticorps anti-CD30. Conclusion Il est toujours utile de faire plusieurs biopsies initiales et au cours de l’evolution devant des lymphomes cutanes de classement et de traitement difficiles.

Clinical scales are widely used in anti-ageing research and practice. More than 100 skin ageing scales exist, which makes it difficult to choose outcome measures and to compare study results. The objectives were to assess and evaluate the quality of measurement properties of available clinical skin ageing scales. A systematic review was conducted. Electronic databases including Medline (1970 to June 2013) and EMBASE (1974 to June 2013) were searched via Ovid SP. To enhance the sensitivity forward searches were conducted in Scopus and Web of Science. We identified 111 scales in 52 included publications. Thirty studies had good methodology for at least one measurement property. Forty-two scales were evaluated for their test-retest or interrater reliability. Nineteen showed high reliability coefficients. A further 15 instruments were partly supported by content and/or structural and/or criterion validity and/or hypotheses-testing evidence. The majority of existing clinical skin ageing scales were developed for evaluating facial characteristics. Many scales quantify similar constructs. In contrast to the high number of available scales there is limited evidence supporting their measurement properties. Recommendations for the use of specific skin ageing scales for clinical studies must be made with caution because of the high number of studies with poor methodology. Development of new instruments should be justified, and existing ones investigated for scale behaviour using appropriate methods. Future research should aim to select and/or adapt existing scales to identify the 'best' to improve clinical research and practice.