Publications by authors named "Claire Bernier"

22 Publications

  • Page 1 of 1

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Series of 49 French Pediatric Cases.

J Allergy Clin Immunol Pract 2021 Jul 29. Epub 2021 Jul 29.

Service de Dermatologie, Hôtel Dieu, Centre Hospitalier Universitaire de Nantes, Nantes, France. Electronic address:

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare and potentially fatal adverse reaction. It can be difficult to diagnose, even more so among children, because symptoms may mimic other commonly encountered pediatric conditions.

Objective: To describe clinical and laboratory features of DRESS syndrome in the pediatric population (age ≤18 years) and establish causative agents and treatment modalities.

Methods: This was a multicenter retrospective study of probable and definite DRESS cases (Registry of Sever Cutaneous Adverse Reaction score ≥ 4) in children hospitalized in 15 French university hospitals between 2000 and 2020.

Results: We included 49 cases. All children had fever and rash, 69.4% had lymphadenopathy, and 65.3% had facial edema. The most common organ affected was the liver (83.7%). Treatment consisted of topical corticosteroid in only 30.6% and systemic corticosteroid in 55.1%; 12.2% received intravenous immunoglobulin. Among probable and likely culprit drugs, 65% were antibiotics and 27.5% were antiepileptics, median time to DRESS symptom onset after initiation of 15 days (13 days with antibiotics and 21 days with antiepileptics). Twenty-seven children had allergy assessment for causative agents, 65.4% of whom had positive tests.

Conclusions: Culprit drugs are frequently antibiotics and antiepileptic drugs, and onset is often less than 2 weeks after treatment starts, especially with antibiotics. Treatment with topical corticosteroids appears to be sufficient in the least severe cases. Treatment by systemic corticosteroid therapy remains the reference treatment in case of severe organ damage.
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http://dx.doi.org/10.1016/j.jaip.2021.07.025DOI Listing
July 2021

DRESS and AGEP Reactions to Iodinated Contrast Media: A French Case Series.

J Allergy Clin Immunol Pract 2021 Aug 20;9(8):3041-3050. Epub 2021 Mar 20.

Service de Dermatologie, Hôpital Henri Mondor, APHP, Créteil, France.

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.
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http://dx.doi.org/10.1016/j.jaip.2021.02.060DOI Listing
August 2021

Rheumatic involvement and bone scan features in Schnitzler syndrome: initial and follow-up data from a single-center cohort of 25 patients.

Arthritis Res Ther 2020 11 18;22(1):272. Epub 2020 Nov 18.

Department of Internal Medicine Interne, CHU Nantes, Nantes, France.

Objective: To report on the characteristics and long-term course of rheumatic manifestations in Schnitzler syndrome (SchS).

Methods: A retrospective cohort study of patients with SchS followed between 2000 and 2020. Inclusion criteria included a diagnosis of SchS (Strasbourg criteria). All available bone scans were reviewed and scored according to the intensity and number of pathological sites. The scintigraphic score was compared with the clinical activity score, CRP level, and treatments.

Results: Twenty-five patients were included. Median age at diagnosis was 68 years. Eighty patients (72%) had SchS-related rheumatic pain. Most patients had a long-standing isolated rash before constitutional and/or rheumatic symptoms appeared. The monoclonal component level was usually very low (IgMκ in 22/25). Rheumatic pain predominated around the knees. Bone scans revealed abnormal tracer uptake in 15/18 (85%). The scintigraphic score correlated with clinical activity (r = 0.4, p < 0.02) and CRP level (r = 0.47, p < 0.01). The scintigraphic score was lower in patients receiving corticosteroids or IL1Ra (interleukin 1 receptor antagonist) than in untreated patients (median scores:2, 0, and 13, respectively; p < 0.05). Two patients developed Waldenström macroglobulinemia. Of the 22 surviving patients, median age at follow-up was 76 years. IL1Ra was used in 13 patients, with dramatic efficacy on both symptoms and bone scan features.

Conclusions: Rheumatic manifestations are very prevalent in SchS. However, bone pain can be misleading and contribute to misdiagnosis. Bone scan abnormalities are very prevalent and correlate with disease activity and treatments. IL1-Ra has a dramatic and durable efficacy but may not be required in every patient early on.
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http://dx.doi.org/10.1186/s13075-020-02318-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677784PMC
November 2020

Drug reaction with eosinophilia and systemic symptoms may occur within 2 weeks of drug exposure: A retrospective study.

J Am Acad Dermatol 2020 Mar 25;82(3):606-611. Epub 2019 Sep 25.

Service de Dermatologie, Hôpital Saint André, Bordeaux, France.

Background: Diagnosing drug reaction with eosinophilia and systemic symptoms (DRESS) is challenging. Some clinicians reject this diagnosis when the delay of onset is less than 15 days after drug intake.

Objectives: To assess the delay of DRESS occurrence and culprit drugs.

Methods: All patients hospitalized in 3 dermatology departments with a first occurrence of DRESS for which a drug was highly suspected were included in this retrospective study. Based on the delay in DRESS occurrence, cases were classified into 2 groups: a rapid-onset group (≤15 days after exposure) and a delayed-onset group (>15 days).

Results: A total of 41 patients with DRESS were included: 14 in the rapid-onset and 27 in delayed-onset groups. In the rapid-onset group, antibiotics (n = 6/14) and iodinated contrast media (n = 5/5) were the predominant culprits. Carbamazepine (n = 4/4), lamotrigine (n = 6/6), allopurinol (n = 8/8), and sulfasalazine (n = 2/2) were exclusively found in the delayed-onset group.

Limitations: The retrospective nature, limited number of participants, and lack of detailed information on previous exposure to sensitizing drugs in some instances.

Conclusions: DRESS is frequently related to drugs introduced 15 or fewer days before the occurrence of cutaneous adverse reactions. The time of onset of DRESS may differ depending on the medications involved.
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http://dx.doi.org/10.1016/j.jaad.2019.09.036DOI Listing
March 2020

Higher Frequency of Dipeptidyl Peptidase-4 Inhibitor Intake in Bullous Pemphigoid Patients than in the French General Population.

J Invest Dermatol 2019 04 10;139(4):835-841. Epub 2018 Dec 10.

Department of Dermatology, Poissy-Saint Germain Hospital, Saint-Germain-en-Laye, France.

Dipeptidyl peptidase-4 inhibitors have been suspected to induce bullous pemphigoid (BP). The objective of this study was to compare the observed frequency of gliptin intake in a large sample of 1,787 BP patients diagnosed between 2012 and 2015 in France, with the expected frequency after indirect age standardization on 225,412 individuals extracted from the database of the National Healthcare Insurance Agency. The secondary objective was to assess the clinical characteristics and the course of gliptin-associated BP, depending on whether gliptin was continued or stopped. The observed frequencies of intake of the whole gliptin class and that of vildagliptin in the BP population were higher than those in the general population after age standardization (whole gliptin class: 6.0%; 95% confidence interval = 4.9-7.1% vs. 3.6%, observed-to-expected drug intake ratio = 1.7; 95% confidence interval = 1.4-2.0; P < 0.0001; vildagliptin = 3.3%; 95% confidence interval = 2.5-4.1% vs. 0.7%, ratio = 4.4; 95% confidence interval = 3.5-5.7; P < 0.0001). The association of any gliptin+metformin was also higher than in the general population, ratio = 1.8 (95% confidence interval = 1.3-2.4; P < 0.0001). Gliptin-associated BP had no specific clinical characteristics. Gliptin was stopped in 48 (45.3%) cases. Median duration to achieve disease control, rate, and delay of relapse were not different whether gliptin was stopped or continued. This study strongly supports the association between gliptin intake, particularly vildagliptin, and the onset of BP.
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http://dx.doi.org/10.1016/j.jid.2018.10.045DOI Listing
April 2019

Drug reaction with eosinophilia and systemic symptoms syndrome induced by combination of vemurafenib and cobimetinib in melanoma: A series of 11 cases.

J Am Acad Dermatol 2019 Feb 4;80(2):558-562. Epub 2018 Aug 4.

Service de Dermatologie, Centre Hospitalier Universitaire de Nantes, Nantes, France; Immuno-Dermatology Laboratory, Nantes University Hospital, Nantes, France; Nantes University, Nantes, France.

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http://dx.doi.org/10.1016/j.jaad.2018.07.029DOI Listing
February 2019

Is a specific eyelid patch test series useful? Results of a French prospective study.

Contact Dermatitis 2018 Sep 8;79(3):157-161. Epub 2018 Jun 8.

Department of Dermatology, CHU Montpellier, Montpellier, France.

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.
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http://dx.doi.org/10.1111/cod.13040DOI Listing
September 2018

Hand dermatitis: hand hygiene consequences among healthcare workers.

Contact Dermatitis 2017 Nov;77(5):330-331

Dermatology Department, Nantes University Hospital, 44000 Nantes, France.

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http://dx.doi.org/10.1111/cod.12825DOI Listing
November 2017

Methotrexate Versus Cyclosporine in Adults with Moderate-to-Severe Atopic Dermatitis: A Phase III Randomized Noninferiority Trial.

J Allergy Clin Immunol Pract 2018 Mar - Apr;6(2):562-569.e3. Epub 2017 Sep 28.

Department of Allergology and Immunology, Clinical Research Unit, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, Université Lyon 1, France; Université Lyon 1, Centre International de Recherche en Infectiologie, Inserm U1111, Lyon, France.

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 < .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.
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http://dx.doi.org/10.1016/j.jaip.2017.07.007DOI Listing
November 2019

Airborne allergic contact dermatitis caused by isothiazolinones in water-based paints: a retrospective study of 44 cases.

Contact Dermatitis 2017 Sep 27;77(3):163-170. Epub 2017 Apr 27.

Dermatology and Allergology Department, Tenon Hospital (AP-HP), Sorbonne Universities, UPMC University Paris 06, 75020, Paris, France.

Background: 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.
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http://dx.doi.org/10.1111/cod.12795DOI Listing
September 2017

Prevalence of Mycoplasma genitalium Infection and Relationship with Symptoms Among Adults Attending a Sexual Health Centre.

Acta Derm Venereol 2017 04;97(4):543-545

Centre for Prevention of Infectious and Transmissible Diseases, Nantes University Hospital, 44093 cedex1 Nantes, France.

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http://dx.doi.org/10.2340/00015555-2585DOI Listing
April 2017

Development of monoclonal gammopathy under biotherapy in psoriasis: a French multicenter retrospective study.

Eur J Dermatol 2016 Jan-Feb;26(1):75-81

Dermatology department, Hôpitaux de brabois, Bâtiment des spécialités médicales Philippe Canton, Rue du Morvan, 54511 Vandoeuvre les Nancy, France.

Background: Biotherapies or targeted therapies are fairly new treatments indicated for moderate to severe psoriasis. The side effects appear to be mainly infectious or cancerous. The role of biotherapies in the development of a pre-cancerous condition, monoclonal gammopathy of undetermined significance (MGUS), has recently been debated in the literature.

Objectives: To evaluate the incidence of MGUS in psoriasis patients treated with biotherapy.

Materials And Methods: This study was a French multicenter retrospective study carried out through the French multicenter study group RESOPSO. Data on the results of serum protein electrophoreses performed before and within at least six months after the start of the biotherapy were collected. Demographic data, medical history, and psoriasis treatment history were specified.

Results: Four hundred and forty three patients were eligible for inclusion. Of these, three presented with monoclonal gammopathy for which the assessment was in favor of MGUS. The average treatment period was 19.7 months. Six patients presented with MGUS prior to the treatment. These patients' immunoglobulin levels remained stable, with an average remission of 24 months. Only psoriatic rheumatism appeared to be statistically linked to MGUS.

Conclusion: The incidence and frequency of MGUS in psoriasis patients treated with biotherapy do not appear to increase relative to the general population.
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http://dx.doi.org/10.1684/ejd.2015.2700DOI Listing
December 2016

Long-term effectiveness and safety of interleukin-1 receptor antagonist (anakinra) in Schnitzler's syndrome: a French multicenter study.

Autoimmun Rev 2014 Oct 23;13(10):1035-41. Epub 2014 Aug 23.

CHU de Nantes, Service de Médecine Interne, F 44093 Nantes, France; Faculté de Médecine, Université de Nantes, F44093 Nantes, France.

The aim of this study is to assess the long-term effectiveness and safety of IL1Ra in Schnitzler syndrome (SchS). Between 2010 and 2012, we performed a nationwide survey among French internal medicine departments to identify SchS patients. We retrospectively analyzed the long-term efficacy and safety of IL1Ra and the outcome of patients that did not receive this treatment. Forty-two patients were included in the study, 29 of whom received IL1Ra. The mean age at disease onset was 59.9years. Disease manifestations included urticaria (100%), fever (76%), bone/joint pain (86%), bone lesions (76%), anemia (67%), and weight loss (60%). The monoclonal gammopathy was overwhelmingly IgM kappa (83%). The mean follow-up was 9.5years (range: 1.6-35). Two patients developed Waldenström's macroglobulinemia and one developed AA amyloidosis. All of the 29 patients who received IL1Ra responded dramatically. After a median follow-up of 36months (range: 2-79), the effectiveness remained unchanged. All patients remained on anti-IL-1 therapy. Twenty-four patients (83%) went into complete remission and five (17%) into partial remission. Three patients experienced grade 3-4 neutropenia. Six patients developed severe infections. No lymphoproliferative diseases occurred while on IL1Ra. When last seen, all patients without anakinra had an active disease with variable impact on their quality of life. Their median corticosteroids dosage was 6mg/d (range: 5-25). IL1Ra is effective in SchS, with a sharp corticosteroid-sparing effect. Treatment failures should lead to reconsider the diagnosis. Long-term follow-up revealed no loss of effectiveness and a favorable tolerance profile. The long-term effects on the risk of hemopathy remain unknown.
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http://dx.doi.org/10.1016/j.autrev.2014.08.031DOI Listing
October 2014

Different patterns of skin manifestations associated with parvovirus B19 primary infection in adults.

J Am Acad Dermatol 2014 Jul 14;71(1):62-9. Epub 2014 Apr 14.

Service de Dermatologie, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris (APHP), et Université René Descartes, Paris, France. Electronic address:

Background: Skin involvement is reported during primary parvovirus B19 infection in adults.

Objectives: We sought to describe the cutaneous presentations associated with parvovirus B19 primary infection in adults.

Methods: We conducted a descriptive, retrospective, multicenter study. The patients included (>18 years old) had well-established primary infections with parvovirus B19.

Results: Twenty-nine patients were identified between 1992 and 2013 (17 women, 12 men). The elementary dermatologic lesions were mostly erythematous (86%) and often purpuric (69%). Pruritus was reported in 48% of cases. The rash predominated on the legs (93%), trunk (55%), and arms (45%), with a lower frequency of facial involvement (20%). Four different but sometimes overlapping patterns were identified (45%): exanthema, which was reticulated and annular in some cases (80%); the gloves-and-socks pattern (24%); the periflexural pattern (28%); and palpable purpura (24%).

Limitations: The limitations of this study were its retrospective design and possible recruitment bias in tertiary care centers.

Conclusion: Our findings suggest that primary parvovirus B19 infection is associated with polymorphous skin manifestations with 4 predominant, sometimes overlapping, patterns. The acral or periflexural distribution of the rash and the presence of purpuric or annular/reticulate lesions are highly suggestive of parvovirus B19 infection.
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http://dx.doi.org/10.1016/j.jaad.2014.02.044DOI Listing
July 2014

Use of interferon gamma release assays in clinical practice: review of QuantiFERON-TB prescription in a French university hospital.

Scand J Infect Dis 2014 May 19;46(5):392-6. Epub 2014 Mar 19.

From the Department of Infectious Diseases, CHU Nantes , Nantes , France.

Background: In recent years, the clinical use of interferon gamma release assays (IGRAs) has increased exponentially, while their indications remain controversial given difficulties in interpretation. Four indications were recommended by the French National Authority for Health (HAS) in 2006. We evaluated the utilization of the QuantiFERON-TB Gold In-Tube (QFT-IT) test over a 1-y period in a French university hospital and the impact of IGRA results in particular.

Methods: The QFT-IT tests requested in 2009 were analysed retrospectively, excluding those from the Occupational Health Department, the Regional Tuberculosis Centre, and rheumatology consultations for which the indications were clearly defined.

Results: Three hundred and sixty QFT-IT tests were analysed. The interpretation was frequently problematic given the inclusion of a significant proportion of patients over 80 y of age (11%), immunocompromised patients (43%), and patients with a known history of tuberculosis (6%). The indications failed to comply with HAS recommendations in 42% of cases (151/360), i.e. 14% of all QFT-IT tests in 2009. Thirty-seven percent of request forms were related to suspected pulmonary tuberculosis. In the case of a positive QFT-IT test, the clinical decision-making was changed in 58% of cases when the indications met the HAS recommendations, compared with only 16% if they did not (p < 0.005).

Conclusion: When the indications do not meet the health authority recommendations, the diagnostic value of the IGRA remains limited.
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http://dx.doi.org/10.3109/00365548.2014.887221DOI Listing
May 2014

[Atopic dermatitis of the child].

Rev Prat 2013 Nov;63(9):1271-81

Ecole de l'atopie, service de dermatologie, CHU de Nantes, 44093 Nantes Cedex 1, Paris.

Atopic dermatitis is a chronic inflammatory skin disease characterized by episodes of acute eczema alternating with periods of remission. It is a common disease, Its prevalence is estimated to be between 10 and 15 %. The affected areas change depending on the age of the child. Treatment consists of topical corticosteroids for which safety for the prescribed doses is now established. We distinguish the initial treatment and maintenance treatment. Investigation for a food allergy or contact allergy is reported as a second-line after failure of local treatment or in the presence of other suggestive symptoms.
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November 2013

Therapeutic patient education in children with atopic dermatitis: position paper on objectives and recommendations.

Pediatr Dermatol 2013 Mar-Apr;30(2):199-206

Department of Dermatology, Nantes University Hospital, Nantes, France.

Poor adherence is frequent in patients with atopic dermatitis (AD), leading to therapeutic failure. Therapeutic patient education (TPE) helps patients with chronic disease to acquire or maintain the skills they need to manage their chronic disease. After a review of the literature, a group of multispecialty physicians, nurses, psychologists, and patients worked together during two international workshops to develop common recommendations for TPE in AD. These recommendations were structured as answers to nine frequently asked questions about TPE in AD: What is TPE and what are its underlying principles? Why use TPE in the management of AD? Who should benefit from TPE in AD? How can TPE be organized for AD? What is the assessment process for TPE in AD? What is the evidence of the benefit of TPE in AD? Who are the people involved in TPE? How should TPE be funded in dermatology? What are the limits of the TPE process?
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http://dx.doi.org/10.1111/pde.12045DOI Listing
September 2013

Therapeutic patient education in atopic dermatitis: worldwide experiences.

Pediatr Dermatol 2013 May-Jun;30(3):329-34. Epub 2013 Feb 14.

Department of Dermatology, Nantes University Hospital, Nantes, France.

Therapeutic patient education (TPE) has proven effective in increasing treatment adherence and improving quality of life (QoL) for patients with numerous chronic diseases, especially atopic dermatitis (AD). This study was undertaken to identify worldwide TPE experiences in AD treatment. Experts from 23 hospitals, located in 11 countries, responded to a questionnaire on 10 major items. Patients in TPE programs were mainly children and adolescents with moderate to severe AD or markedly affected QoL. Individual and collective approaches were used. Depending on the center, the number of sessions varied from one to six (corresponding to 2 to 12 hours of education), and 20 to 200 patients were followed each year. Each center's education team comprised multidisciplinary professionals (e.g., doctors, nurses, psychologists). Evaluations were based on clinical assessment, QoL, a satisfaction index, or some combination of the three. When funding was obtained, it came from regional health authorities (France), insurance companies (Germany), donations (United States), or pharmaceutical firms (Japan, Italy). The role of patient associations was always highlighted, but their involvement in the TPE process varied from one country to another. Despite the nonexhaustive approach, our findings demonstrate the increasing interest in TPE for managing individuals with AD. In spite of the cultural and financial differences between countries, there is a consensus among experts to integrate education into the treatment of eczema.
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http://dx.doi.org/10.1111/pde.12024DOI Listing
January 2014

Octocrylene, an emerging photoallergen.

Arch Dermatol 2010 Jul;146(7):753-7

Service de Dermatologie, Centre Hospitalier Universitaire, Angers CEDEX 9, France.

Background: Octocrylene is a new emerging photoallergen. We report and discuss 50 cases of photoallergic contact dermatitis from octocrylene use and/or positive photopatch test reactions to this UV filter and draw attention to the unexpected association in adults with a history of photoallergic contact dermatitis from ketoprofen.

Observations: Patients were divided in 3 groups: group A comprised 11 children; group B, 28 adults with a history of photoallergy from sunscreen products; and group C, 14 adults systematically tested with octocrylene because of a history of photoallergy from ketoprofen. All patients but 3 in group C had positive test reactions to octocrylene. Ten of 11 children in group A and 9 of 28 adults in group B had positive patch test reactions to octocrylene. One child in group A, the other 19 adults in group B, and 11 of 14 adults in group C had positive photopatch test reactions to octocrylene. All adults in group C and 24 of 28 adults in group B had a history of photoallergy from ketoprofen and positive patch test or photopatch test reactions to other allergens that are often positive in patients with photoallergy from ketoprofen, especially fragrance components.

Conclusions: Octocrylene appears to be a strong allergen leading to contact dermatitis in children and mostly photoallergic contact dermatitis in adults with an often-associated history of photoallergy from ketoprofen. Patients with photoallergy from ketoprofen frequently have positive photopatch test reactions to octocrylene. These patients need to be informed of sunscreen products not containing octocrylene, benzophenone-3, or fragrances.
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http://dx.doi.org/10.1001/archdermatol.2010.132DOI Listing
July 2010

CD13 and TCR clone: markers of early mycosis fungoides.

Acta Derm Venereol 2007 ;87(2):155-9

Unit of Skin Oncology, Hôtel Dieu, Place Alexis Ricordeau, Nantes, France.

Making a differential diagnosis between early mycosis fungoides and parapsoriasis is often difficult at the clinical and histological level. The aim of this study was to explore markers that could help in this process. A total of 88 patients were included in 2 categories: large plaque parapsoriasis and digitiform parapsoriasis. A histological examination was performed for each patient, and expression of the antigen My7 (CD13), which is lacking in cutaneous T-lymphomas (but not in inflammatory lesions) and rearrangement of the T-cell receptor gene were analysed. A histological aspect of epidermotropic cutaneous T-cell lymphoma was observed in 23.5% of cases of large plaque parapsoriasis and 15% of cases of digitiform parapsoriasis. A disappearance of My7 antigen was noted in the 2 forms of parapsoriasis, more frequently when there was cutaneous T-cell lymphoma histology. A cutaneous clone was observed in 10.3% of cases of large plaque parapsoriasis, but not of digitiform parapsoriasis. For 3 patients, a cutaneous clone and a disappearance of My7 were associated with a non-specific histology. Considering these histological, immunological and molecular biological data, it appears that My7 antigen combined with T-cell clone may help the dermatologist to confirm the diagnosis of early mycosis fungoides. Moreover, further studies will determine whether CD13 is an early prognostic marker of evolution of a parapsoriasis to mycosis fungoides. Finally, these results demonstrate that digitiform parapsoriasis can be an early stage of MF.
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http://dx.doi.org/10.2340/00015555-0197DOI Listing
August 2007
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