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Background Drug reactions with eosinophilia and systemic symptoms (DRESSs) and acute generalized exanthematous pustulosis (AGEP) are potentially severe cutaneous adverse drug reactions. Objective To describe the clinical findings and sensitization profiles of DRESS and AGEP patients who had been administered iodinated contrast media (ICM). Methods All adult patients in the dermatologist's French Investigators for Skin Adverse Reactions to Drugs (FISARD) network diagnosed with a DRESS or AGEP highly suspected to have been caused by an ICM were included retrospectively. Results Thirteen DRESS patients and 19 AGEP patients who had been administered ICM were included, and the median delay in DRESS and AGEP occurrence after ICM administration was short, 4 and 1 days, respectively. Five AGEP patients had systemic involvement. A high cosensitization rate (46%) was observed among the DRESS patients, mainly with beta-lactam antibiotics. Overall, 77% of our patients were sensitized to several ICM. Patch tests identified the suspected ICM for 21 cases (72%). The retrospective nature, the limited number of subjects, the absence of a control group of healthy individuals, and the lack of detailed information on previous exposure to sensitizing drugs are limitations of this study. Conclusions We report a large series of DRESSs and AGEPs related to ICM administration. Skin tests appear useful for diagnosis and potentially to identify alternative ICM.

Introduction Le role des medicaments dans la survenue d’eruptions eczematiformes du sujet âge (EESA) a ete suggere dans une etude cas-temoin francaise montrant une frequence de prise des inhibiteurs calciques de 26 % chez les patients ayant une EESA (OR de 2,5 par rapport aux temoins sans eczema). Ces resultats ont ensuite ete confirmes par une etude retrospective americaine. Des cas isoles d’EESA ont depuis ete rapportes avec le clopidogrel, les IEC, les ARAII et les diuretiques. Notre etude initiale ayant ete realisee il y a 15 ans, nous en avons realise une nouvelle pour reevaluer l’association entre les prises medicamenteuses et les EESA. Materiel et methodes Cette etude retrospective a ete conduite dans 16 centres du GREAT, FISARD ou DAG de 2018 a 2020. Nous avons compare la frequence des 10 classes medicamenteuses les plus prescrites entre la population etudiee (patients de plus de 65 ans developpant un eczema chronique sans cause identifiee) et la population generale de reference du meme âge dont les donnees ont ete obtenues grâce a l’Echantillon Generaliste des Beneficiaires (EGB) issu de la base informatique de la Securite Sociale, apres standardisation indirecte sur le sexe et l’âge. Tous les patients inclus avaient des lesions eczematiformes etendues (plus de 20 % de la surface corporelle), depuis plus de 3 mois. Une biopsie cutanee evocatrice d’eczema devait avoir ete realisee ainsi qu’une immunofluorescence directe negative ou des anticorps BPAG 1 et 2 negatifs afin d’eliminer une pemphigoide au stade pre-bulleux. Les patients n’avaient pas d’antecedent de dermatite atopique dans l’enfance. Resultats Cent quatre vingt cinq patients (120 H et 65 F) d’âge moyen 79,5 ± 7,5 ans ont ete inclus. L’hypertension arterielle representait la comorbidite la plus frequente (69,7 % des patients). Les patients prenaient en moyenne 5,0 ± 3,2 medicaments. Les medicaments les plus frequemment prescrits etaient les inhibiteurs calciques (39,5 %), les statines (36,8 %), les antiagregants plaquettaires (31,9 %), les betabloquants (30,8 %), les ARA2 (29,2 %), les diuretiques thiazidiques (23,8 %), les IEC (22,7 %), les IPP (21,6 %), les diuretiques de l’anse (17,8 %) et les benzodiazepines (15,1 %). Un ou plusieurs medicaments etaient arretes chez 60 (32,4 %) patients. Parmi eux, 31 (51,7 %) ne presentaient plus de lesion a 6 mois. L’analyse comparative par rapport a l’EGB est en cours. Discussion Les caracteristiques des patients concordent avec celles observees dans notre etude precedente, en particulier la predominance masculine et la polymedication. La frequence de prise des inhibiteurs calciques (39,5 %) est encore plus elevee (× 1,5) que dans notre etude initiale confirmant le tres fort risque lie a cette classe medicamenteuse. La comparaison avec les donnees de l’EGB (analyse en cours avec resultats prevus prochainement) permettra peut-etre de mettre en evidence une association avec d’autres classes medicamenteuses.

BACKGROUND Methylisothiazolinone (MI) is a preservative that is responsible for an epidemic of allergic contact dermatitis (ACD). Few studies have been published on the prognosis of patients with MI-induced ACD. OBJECTIVES To evaluate relapses of MI-induced ACD and difficulties in avoiding MI in patients who had received avoidance advice. METHODS A retrospective study of patients with MI-induced ACD diagnosed in two specialized dermato-allergology units between 2010 and 2015 was performed. The median follow-up was 3 years. RESULTS Relapses were observed in 64% of 139 included patients, and were severe in 18%. Rinse-off cosmetics were responsible for the largest proportion of relapses (27%). The median time to relapse was 5 months. Sixty-nine per cent of relapses were on the hands, and 29% were on the face. Risk factors for relapsing were hand eczema and a personal history of atopy. The main difficulties encountered in the avoidance strategy were hidden sources of MI, the lack of labelling on industrial products, the complexity of cosmetic labelling, and remembering the name of the allergen. CONCLUSION MI-induced ACD has a poor prognosis. Its high rate of relapse is mainly attributable to the difficulties of avoidance. Management needs to be improved. Specialized follow-up in the year following diagnosis is essential to educate patients.

Introduction Le dupilumab, anticorps monoclonal anti-IL-4/IL-13Rɑ, a montre son efficacite dans le traitement de la dermatite atopique (DA) moderee a severe mais le rapport benefice risque en vie reelle est encore peu documente. Notre objectif etait d’etudier la frequence des arrets de traitement, les motifs d’arret et les strategies therapeutiques apres arret du dupilumab chez les adultes atteints de DA en vie reelle. Materiel et methodes Etude nationale multicentrique retrospective incluant les patients adultes ayant une DA moderee a severe pour lesquels le traitement par dupilumab etait interrompu (defini par arret ≥ 1 mois) entre mars 2017 et septembre 2020. Resultats Un total de 968 patients etaient traites par dupilumab dans 16 centres francais dans la periode de l’etude. Parmi eux, le dupilumab etait interrompu chez 150 patients (15,5 %) apres une duree mediane de traitement de 5 mois [IQR = 3–10]. Les motifs d’arret principaux etaient un/des effet(s) secondaire(s) chez 61 patients (40,7 %), une inefficacite chez 22 patients (14,7 %), une inefficacite couplee a des effets secondaires chez 23 patients (15,3 %), un projet de grossesse chez 12 patients (8 %) ou une remission complete (RC) chez 6 patients (4 %) apres une duree mediane de 16 mois. Les effets secondaires a l’origine de l’arret etaient des evenements ophtalmologiques (59 %), des aggravations cervico-faciales (19,7 %) ou diffuses (16,4 %) de la DA. Les patients avec comorbidites atopiques (principalement conjonctivite allergique) arretaient le dupilumab davantage pour effets secondaires que pour inefficacite (p = 0,007). Le phenotype de la DA (classique/cervicofaciale/prurigo/erythrodermie) n’etait pas predictif du motif d’arret. Les strategies therapeutiques apres arret du dupilumab etaient: autre traitement systemique (41 %), traitements locaux seuls (31 %) ou reprise du dupilumab (21,7 %) apres un delai moyen d’arret de 20 semaines. Discussion Les arrets du dupilumab pour effets secondaires sont rares dans les essais cliniques (seulement 1,8 % d’arret dans l’essai clinique de phase III CHRONOS apres 52 semaines de suivi). En revanche, une precedente etude francaise en vie reelle realisee en 2018 chez 241 patients avait rapporte une frequence d’arret du traitement de 17,4 %, comparable a notre etude, et une frequence d’arret pour effets secondaires de 11,3 % apres 1 an d’utilisation (11,5 % dans notre etude a 3 ans). Ces resultats soulignent l’importance des etudes en vie reelle dans l’evaluation du rapport benefice/risque des traitements. Trois ans apres le debut de l’utilisation du dupilumab en vie reelle dans la DA, notre etude montre une frequence d’arrets pour effets secondaires de 11,5 %, majoritairement ophtalmologiques, similaire aux etudes en vie reelle precedentes. L’arret pour remission complete est actuellement une modalite rare (seulement 4 % des motifs d’arret) chez l’adulte.

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 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.

SummaryBackground Airborne allergic contact dermatitis caused by paints containing isothiazolinones has been recognized as a health hazard. Objectives To collect epidemiological, clinical and patch test data on airborne allergic contact dermatitis caused by isothiazolinone-containing paints in France and Belgium. Methods A descriptive, retrospective study was initiated by the Dermatology and Allergy Group of the French Society of Dermatology, including methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI)- and/or MI-sensitized patients who developed airborne allergic contact dermatitis following exposure to isothiazolinone-containing paint. Results Forty-four cases were identified, with mostly non-occupational exposure (79.5%). Of the patients, 22.5% of also had mucosal symptoms. In several cases, the dermatitis required systemic corticosteroids (27.3%), hospitalization (9.1%), and/or sick leave (20.5%). A median delay of 5.5 weeks was necessary to enable patients to enter a freshly painted room without a flare-up of their dermatitis. Approximately one-fifth of the patients knew that they were allergic to MI and/or MCI/MI before the exposure to paints occurred. Conclusion Our series confirms that airborne allergic contact dermatitis caused by paints containing isothiazolinones is not rare, and may be severe and long-lasting. Better regulation of isothiazolinone concentrations in paints, and their adequate labelling, is urgently needed.

Ecologically sound because they are synthesized from natural and renewable sources, the mild surfactants alkyl glucosides are being rediscovered by the cosmetic industry. They are currently found in rinse-off products such as shampoos, liquid cleansers, and shower gels, but also in leave-on products that include moisturizers, deodorants, and sunscreens. During the past 15 years, numerous cases of allergic contact dermatitis have been published, mostly to lauryl and decyl glucosides, and these compounds are considered emergent allergens. Interestingly, the sunscreen Tinosorb M contains decyl glucoside as a hidden allergen, and most cases of allergic contact dermatitis reported to this sunscreen ingredient are probably due to sensitization to decyl glucoside. This article will review the chemistry of alkyl glucosides, their sources of exposure, as well as their cutaneous adverse effects reported in the literature and encountered in various patch testing centers.

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; BACKGROUND: Methotrexate is currently used to treat atopic dermatitis but has never been assessed versus cyclosporine in adults. OBJECTIVE: This study evaluated the efficacy and safety of methotrexate versus cyclosporine in patients with moderate-to-severe atopic dermatitis. METHODS: Patients were randomized to receive either oral methotrexate (15 mg/wk) or cyclosporine (2.5 mg/kg/d) for 8~weeks. The primary end point was a patient achieving 50% improvement in the SCORing Atopic Dermatitis index (SCORAD 50) at week 8. When the primary end point was not achieved, methotrexate was increased to 25 mg and cyclosporine to 5 mg during the next 16 weeks. The secondary end points were a patient achieving a 50% reduction in the Eczema Area Severity Intensity index (EASI 50) and SCORAD 50 at each visit (ClinicalTrials.gov no. NCT00809172). RESULTS: A total of 97 patients received methotrexate 15 mg (n~= 50) or cyclosporine 2.5 mg (n~= 47). Regarding the primary end point at week 8, methotrexate was inferior to cyclosporine because the proportion of patients with SCORAD 50 was 8% (4 of 50) in the methotrexate arm versus 42% (18 of 43) in the cyclosporine arm. The difference in percentages for the 2 treatment groups (2-sided 90% CI) was~-34% (-48% to~-20%). At week 8, methotrexate and cyclosporine dosages were increased in 56% and 49% of the patients, respectively. Regarding EASI 50, the noninferiority end point was reached at week 20 in 92% (22 of 24) of patients in the methotrexate arm and 87% (26 of 30) of patients in the cyclosporine arm. The treatment-related adverse events were more frequent with cyclosporine (P \textless .0001). CONCLUSIONS: Methotrexate 15 mg/wk was inferior to cyclosporine 2.5 mg/kg/d at week 8. Increasing the doses of methotrexate to 25 mg/wk induced a significant improvement versus cyclosporine at week~20.

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.

Summary Background Induction of delayed hypersensitivity reactions by red tattoos has been occasionally reported. Little is known about the inks used. Azo pigments have been implicated in some instances, but there is only one reported case involving quinacridones. Objectives To describe the clinical and pathological features and outcome of skin reactions induced by red tattoo pigments. Patients, materials, and methods Six patients with a cutaneous reaction induced by a red tattoo pigment underwent biopsy and prick and patch testing with the inks supplied. Results We observed seven reactions in the 6 patients. Histology showed various patterns: three lichenoid, two eczematous, and two pseudolymphomatous. Five reactions occurred with azo pigments, and two with quinacridones, in both cases with Violet 19 and Red 122. Four inks were tested. Only one patch test gave a positive result at a late reading (day 7). Prick tests gave negative results. The reactions required various treatments, including laser treatment for 2 patients. Activation of the reaction in 1 case was transient. Conclusion Azo pigments and quinacridones both triggered reactions with similar clinical aspects but with varying histological findings. Patch and prick test results were disappointing with both. Reactions occurred following laser use in 1 case.

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.

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.

We read with interest the recentArchivesarticle by Lichtenstein et al 1 describing 4 patients with radiodermatitis induced by radiocardiographic procedures. In the past 3 years we have observed 6 patients who developed radiodermatitis following multiple cardiac catheterizations. The patients' characteristics are summarized in the Table . All our patients, like those described in the article by Lichtenstein et al, had undergone coronary angiography and percutaneous transluminal coronary angioplasty. Although it has not been possible to determine the radiation doses delivered, in all but 1 case (patient 3), 2 angioplasties and at least 1 coronary angiography were performed on each patient, suggesting that the radiation dose was high. Patient 6, for example, underwent 1 coronary angiographyand 2 successive angioplasties during a 3-week period because of a relapse of arterial stenosis. None of our patients, unlike those of Lichtenstein et al, mentioned any acute radiodermatitis immediately after