Publications by authors named "Fabien Pelletier"

28 Publications

  • Page 1 of 1

COVID-19 as a trigger of acute attacks in people with hereditary angioedema.

Clin Exp Allergy 2021 Mar 26. Epub 2021 Mar 26.

Department of Internal Medicine, Grenoble University Hospital, Grenoble, France.

Acute attacks could occur during the convalescent phase of COVID-19 illness, more commonly in patients with a history of frequent attacks. However it is unclear whether the acute attacks during the convalescent phase are specifically triggered by COVID-19 or not.
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http://dx.doi.org/10.1111/cea.13870DOI Listing
March 2021

A survey of psoriasis patients on biologics during COVID-19: a high-epidemic area experience - Franche Comté, France.

Eur J Dermatol 2021 02;31(1):101-103

Dpt of Dermatology, University Hospital, Besançon, France, Inserm 1098 RIGHT, University of Franche Comté, Besançon, France.

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http://dx.doi.org/10.1684/ejd.2020.3960DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120764PMC
February 2021

Allergic contact dermatitis from carbomers: two case report.

Contact Dermatitis 2020 Oct 22;83(4):326-328. Epub 2020 Jun 22.

Department of Dermatology, Allergology Unit, University Hospital of Besançon, Besançon, France.

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http://dx.doi.org/10.1111/cod.13616DOI Listing
October 2020

A case of immediate hypersensitivity reaction after an oral administration of patent blue dye.

Contact Dermatitis 2020 Feb 20;82(2):116-118. Epub 2019 Oct 20.

Department of Dermatology and EA3181, University Hospital and University of Franche Comté, Besançon, France.

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http://dx.doi.org/10.1111/cod.13402DOI Listing
February 2020

A challenging diagnosis of exercise-related transient abdominal pain.

J Sports Med Phys Fitness 2019 Nov 15;59(11):1934-1936. Epub 2019 Jul 15.

Department of Dermatology and Allergy, Besançon University Hospital, Besançon, France.

A 17-year-old woman, high-performance triathlete, presented transient abdominal pain, face angioedema and sometimes syncope during exercise. Exercise-induced anaphylaxis was suspected at first. Allergic explorations with skin prick tests were negative but wheat flour specific IgE and recombinant rTri a14 (LTP) were weakly positive. However, wheat eviction did not improve the symptoms and stress test after wheat oral challenge did not show any signs of anaphylaxis. An abdominal ultrasound revealed peak expiratory velocities with a stenosis evaluated at 70 to 80 percent with turbulences in the celiac artery, confirmed by computed tomography angiogram. The diagnosis of exercise-induced median arcuate ligament syndrome (MALS) was retained and we discuss here the challenging diagnosis mimicking exercise-induced anaphylaxis.
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http://dx.doi.org/10.23736/S0022-4707.19.09176-XDOI Listing
November 2019

Vitiligo Repigmentation with Melanoma Progression During Pembrolizumab Treatment.

Acta Derm Venereol 2019 09;99(10):913-914

Department of Dermatology, University of Bourgogne-Franche Comté, FR-25000 Besançon, France.

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http://dx.doi.org/10.2340/00015555-3199DOI Listing
September 2019

Postoperative purpuric contact dermatitis: Think about antiseptics.

Contact Dermatitis 2019 Sep 21;81(3):215-216. Epub 2019 May 21.

Department of Dermatology, Saint Eloi Hospital, University Hospital Centre of Montpellier, Montpellier, France.

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http://dx.doi.org/10.1111/cod.13277DOI Listing
September 2019

Comment on "Trends in phototherapy utilization among Medicare beneficiaries in the United States, 2000 to 2015".

J Am Acad Dermatol 2018 Nov 21. Epub 2018 Nov 21.

The Dermatology Department, University Hospital, Besançon, France.

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http://dx.doi.org/10.1016/j.jaad.2018.10.071DOI Listing
November 2018

Diagnostic biologique des angioedèmes bradykiniques : les recommandations du CREAK.

Presse Med 2019 Jan 8;48(1 Pt 1):55-62. Epub 2018 Nov 8.

Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; Service d'immunologie, CHUGA, 38043 Grenoble, France.

Bradykinin mediated angioedema (BK-AE) can be associated either with C1Inhibitor deficiency (hereditary and acquired forms), either with normal C1Inh (hereditary form and drug induced AE as angiotensin converting enzyme inhibitors…). In case of high clinical suspicion of BK-AE, C1Inh exploration must be done at first: C1Inh function and antigenemy as well as C4 concentration. C1Inh deficiency is significant if the tests are below 50 % of the normal values and controlled a second time. In case of C1Inh deficiency, you have to identify hereditary from acquired forms. C1q and anti-C1Inh antibody tests are useful for acquired BK-AE. SERPING1 gene screening must be done if a hereditary angioedema is suspected, even if there is no family context (de novo mutation 15 %). If a hereditary BK-AE with normal C1Inh is suspected, F12 and PLG gene screening is suitable.
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http://dx.doi.org/10.1016/j.lpm.2018.06.015DOI Listing
January 2019

Efficacy and survival of biologic agents in psoriasis: a practical real-life 12-year experience in a French dermatology department.

J Dermatolog Treat 2019 Sep 8;30(6):540-544. Epub 2019 Apr 8.

a Department of Dermatology, University Hospital and EA3181, University of Franche Comté , Besançon , France.

Drug survival in a real-life setting is critical to long-term use of biologics for psoriasis. : We describe our 12-year experience with biologics in psoriasis patients. All patients treated with biologics including infliximab, adalimumab (ADA), etanercept (ETA), and ustekinumab (UST) for psoriasis vulgaris between January 2005 and December 2016 were retrospectively analyzed. In total, 545 treatment series were administered to 269 patients, including 211 treatment series with ADA, 135 with ETA, 77 with infliximab, and 122 with UST. ADA and ETA were initiated most often as first-line therapy; 65.3% of treatment sequences were discontinued. UST had the highest drug survival. The major reason for treatment termination was a loss of efficacy (44.9%). Definitive discontinuation increased with the number of biologic therapy sequences. Subjects were not randomized to the different treatments. In a long-term real-life setting, drug survival of UST is better than that of TNF-a inhibitors for both biologic-naive and biologic-experienced patients with psoriasis.
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http://dx.doi.org/10.1080/09546634.2018.1480746DOI Listing
September 2019

Occupational contact dermatitis caused by polyurethane foam: 6 cases.

Contact Dermatitis 2018 Jul 10;79(1):52-54. Epub 2018 Apr 10.

Department of Dermatology, University Hospital of Besançon, Besancon, France.

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http://dx.doi.org/10.1111/cod.12989DOI Listing
July 2018

Pregnancy After Tubal Sterilization in a Woman Treated with Biologics for Severe Psoriasis.

Dermatol Ther (Heidelb) 2018 Jun 9;8(2):323-326. Epub 2018 Mar 9.

Service de Dermatologie, Centre Hospitalier Universitaire, Université de Franche Comté, Unité de recherche EA 3181, Besançon, France.

Little is known about whether immunosuppressed patients mount the immunological response necessary to ensure tubal occlusion. Theoretical concern for non-occlusion has limited the use of hysteroscopic sterilization in patients on immunosuppressive therapies. The effects of tumor necrosis factor-alpha (TNF-α) blockers and interleukin (IL)-17 inhibitors on contraception and pregnancy for patients with psoriasis are poorly documented. We report a case of pregnancy that ended in miscarriage in a patient treated first with TNF-α and then with IL-17 inhibitors for severe psoriasis after tubal sterilization with micro-inserts. Our observation suggests that the efficacy of tubal sterilization by micro-inserts may be impaired by these two biologics and that the risk of miscarriage may be increased in women with psoriasis treated with secukinumab.
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http://dx.doi.org/10.1007/s13555-018-0232-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6002320PMC
June 2018

Increased levels of circulating platelet-derived microparticles are associated with metastatic cutaneous melanoma.

Exp Dermatol 2017 10 9;26(10):961-963. Epub 2017 May 9.

INSERM UMR 1098, University of Bourgogne Franche Comté, Besançon, France.

We investigated the plasma levels of PMPs in patients with 45 stage III and 45 stage IV melanoma. PMPs were characterised by flow cytometry and their thrombogenic activity. We also investigated the link between PMPs circulating levels and tumor burden. The circulating levels of PMPs were significantly higher in stage IV (8500 μL ) than in patients with stage III (2041 μL ) melanoma (P=.0001). We calculated a highly specific (93.3%) and predictive (91.7%) cut-off value (5311 μL ) allowing the distinction between high-risk stage III and metastatic stage IV melanoma. The thrombogenic activity of PMPs was significantly higher in patients with stage IV melanoma (clotting time: 40.7 second vs 65 second, P=.0001). There was no significant association between the radiological tumoral syndrome and the plasma level of PMPs. Our data suggest the role of PMPs in metastatic progression of melanoma.
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http://dx.doi.org/10.1111/exd.13339DOI Listing
October 2017

Diagnosis and treatment of upper airway oedema caused by acute angio-oedema in the emergency department: a French consensus statement.

Eur J Emerg Med 2017 Oct;24(5):318-325

aDepartment of Anaesthesiology and Intensive care, Edouard Herriot University Hospital bDepartment of Clinical Research and Innovation, Hospices Civils de Lyon, Lyon cEmergency Department, Louis Mourier University Hospital, Paris 7 University dDepartment of Internal Medicine, Saint Antoine University Hospital, Paris 6 University, Assistance Publique-Hôpitaux de Paris, Paris eDepartment of Internal Medicine, Grenoble University Hospital, Grenoble-Alpes University, Grenoble fDepartment of Dermatology, Gabriel-Montpied University Hospital, Clermont-Ferrand gDepartment of Internal Medicine, Niort Hospital, Niort hDepartment of Internal Medicine, Archet 1 University Hospital, Nice Sophia-Antipolis University, Nice iDepartment of Medicine, Saint Louis University Hospital, Saint Pierre, Réunion jDepartment of Internal Medicine, Caen University Hospital, Caen kDepartment of Dermatology and Allergology, Grenoble University Hospital, Grenoble lDepartment of Internal Medicine, Timone University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille mDepartment of Dermatology, Saint Eloi University Hospital, Montpellier nDepartment of Dermatology, Besançon University Hospital, Franche-Comté University, INSERM UMR 1098, Besançon oDepartment of Internal Medicine Toulouse University Hospital, Toulouse University, Toulouse pDepartment of Internal Medicine, Lille University Hospital, Lille University, INSERM U995 Lille, Lille, France.

Angio-oedema is a transitory, localized, noninflammatory oedema of subcutaneous tissue or mucous. When the oedema affects the mouth, lips, tongue or larynx, it can result in fatal asphyxiation in the absence of specific treatment. Oedema secondary to plasma extravasation is usually mediated by either histamine or bradykinin. As laboratory tests are not available in an emergency setting, the implicated mediator cannot be readily determined. The challenge for the emergency physician is to determine the aetiological type, evaluate severity and initiate adapted treatment by means of a structured approach. A team of experts from the French Reference Centre for Angio-oedema reached a consensus for recommendations for the diagnostic and therapeutic strategy to be adopted by emergency departments faced with angio-oedema of the upper airways in adults. The experts defined 11 important questions. Responses were rated using a two-round Delphi methodology. The 11 recommendations were related to triage on admission, a step-by-step diagnostic protocol, definition of attack severity, discouragement of instrumental examination, prioritization of treatment for severe attacks according to clinical signs and anticipation of access to specific treatments by the hospital. Angio-oedema of the upper airways can be fatal and requires anticipation by the emergency department. A search for the aetiology, an evaluation of clinical symptoms and the availability of the treatments are challenges justifying these recommendations.
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http://dx.doi.org/10.1097/MEJ.0000000000000446DOI Listing
October 2017

"Puffy hand syndrome".

Joint Bone Spine 2017 Jan 3;84(1):83-85. Epub 2016 Jun 3.

Department of Rheumatology, CHRU Besançon, boulevard Fleming, 25030 Besançon, France. Electronic address:

Intravenous drug addiction is responsible for many complications, especially cutaneous and infectious. There is a syndrome, rarely observed in rheumatology, resulting in "puffy hands": the puffy hand syndrome. We report two cases of this condition from our rheumatologic consultation. Our two patients had intravenous drug addiction. They presented with an edema of the hands, bilateral, painless, no pitting, occurring in one of our patient during heroin intoxication, and in the other 2 years after stopping injections. In our two patients, additional investigations (biological, radiological, ultrasound) were unremarkable, which helped us, in the context, to put the diagnosis of puffy hand syndrome. The pathophysiology, still unclear, is based in part on a lymphatic toxicity of drugs and their excipients. There is no etiological treatment but elastic compression by night has improved edema of the hands in one of our patients.
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http://dx.doi.org/10.1016/j.jbspin.2016.05.001DOI Listing
January 2017

Anaphylactic reaction to povidone in a skin antiseptic.

Contact Dermatitis 2016 Jan;74(1):55-6

Allergology Unit, Department of Dermatology, University Hospital, 25030, Besançon, France.

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http://dx.doi.org/10.1111/cod.12473DOI Listing
January 2016

Effects of anti-TNF-α agents on circulating endothelial-derived and platelet-derived microparticles in psoriasis.

Exp Dermatol 2014 Dec;23(12):924-5

University of Franche-Comté, INSERM UMR1098, Besançon, France; Dermatology Department, Besançon Hospital, Besançon, France; Hematology or Immunology Laboratory, EFS- Bourgogne Franche-Comté, UMR1098, Biomonitoring, Besançon, France.

Psoriasis involves TNF-α secretion leading to release of microparticles into the bloodstream. We investigated the effect of TNF blockers on microparticles levels before and after treatment in patients (twenty treated by anti-TNF-α agents and 6 by methotrexate) with severe psoriasis. Plasmatic microparticles were labelled using fluorescent monoclonal antibodies and were analysed using cytometry. Three months later, 70% of patients treated with anti-TNF-α agents achieved a reduction in PASI score of at least 75%. The clinical improvement in patients treated with anti-TNF-α agents was associated with a significant reduction of the mean number of platelet microparticles (2837/μl vs 1849/μl, P = 0.02) and of endothelial microparticles (64/μl vs 22/μl, P = 0.001). Microparticles are significantly decreased in psoriatic patients successfully treated by anti-TNF-α. Microparticles levels as circulating endothelial cells represent signs of endothelial dysfunction and are elevated in psoriasis. Then, TNF blockade may be effective to reduce cardiovascular risk through the reduction of circulating microparticles.
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http://dx.doi.org/10.1111/exd.12551DOI Listing
December 2014

Increased levels of circulating microparticles are associated with increased procoagulant activity in patients with cutaneous malignant melanoma.

J Invest Dermatol 2014 Jan 28;134(1):176-182. Epub 2013 Jun 28.

Service de Dermatologie, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France; Université de Franche Comté, EA3181, SFR FED4234, Besançon, France.

Microparticles (MPs) are known to be increased in various malignancies and are involved in tumor invasion, angiogenesis, coagulation, and metastasis. We investigated the plasma levels of annexin-V MPs (AV(+)MPs), platelet-derived MPs (PMPs), and endothelial-derived MPs (EMPs) in patients with melanoma (n=129) and in healthy controls (n=49). A functional coagulation test STA Procoag-PPL measuring the clotting time was performed on samples containing MPs to evaluate their procoagulant potential. The plasma levels of PMPs, EMPs, and AV(+)MPs were significantly higher, and the clotting time-PPL was significantly lower in melanoma patients than in healthy controls. The plasma levels of PMPs, EMPs, and AV(+)MPs were higher in stage IV than in the other stages of melanoma, but with no significant difference. In addition, we observed an inverse correlation between PMPs, AV(+)MPs, and clotting times. Our data suggest that MPs are involved in the progression of melanoma and may be associated to melanoma-associated thrombogenesis.
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http://dx.doi.org/10.1038/jid.2013.288DOI Listing
January 2014

Sentinel lymph node biopsy in melanoma: our 8-year clinical experience in a single French institute (2002-2009).

BMC Dermatol 2012 Dec 10;12:21. Epub 2012 Dec 10.

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

Background: Since the introduction of sentinel lymph node biopsy (SLNB), its use as a standard of care for patients with clinically node-negative cutaneous melanoma remains controversial. We wished to evaluate our experience of SLNB for melanoma.

Methods: A single center observational cohort of 203 melanoma patients with a primary cutaneous melanoma (tumour thickness > 1 mm) and without clinical evidence of metastasis was investigated from 2002 to 2009. Head and neck melanoma were excluded. SLN was identified following preoperative lymphoscintigraphy and intraoperative gamma probe interrogation.

Results: The SLN identification rate was 97%. The SLN was tumor positive in 44 patients (22%). Positive SLN was significantly associated with primary tumor thickness and microscopic ulceration. The median follow-up was 39.5 (5-97) months. Disease progression was significantly more frequent in SLN positive patients (32% vs 13%, p = 0.002). Five-year DFS and OS of the entire cohort were 79.6% and 84.6%, respectively, with a statistical significant difference between SLN positive (58.7% and 69.7%) and SLN negative (85% and 90.3%) patients (p = 0.0006 and p = 0.0096 respectively). Postoperative complications after SLNB were observed in 12% of patients.

Conclusion: Our data confirm previous studies and support the clinical usefulness of SLNB as a reliable and accurate staging method in patients with cutaneous melanoma. However, the benefit of additional CLND in patients with positive SLN remains to be demonstrated.
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http://dx.doi.org/10.1186/1471-5945-12-21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538072PMC
December 2012

Rare skin cancer: a population-based cancer registry descriptive study of 151 consecutive cases diagnosed between 1980 and 2004.

Acta Oncol 2009 ;48(4):605-9

Centre Hospitalier Universitaire de Besançon, France

Background: There are few epidemiological data available on rare skin cancer, including Merkel cell carcinoma, Paget's disease, adnexal carcinoma, and sarcoma. We conducted this study to investigate the epidemiology of rare skin cancer diagnosed in the department of Doubs from 1980 to 2004.

Methods: Data were collected from a population-based cancer registry from 1980 to 2004. Diagnosis was based on the 3(rd) edition of the International Classification of Diseases for Oncology. The incidence rates were standardized on world population.

Results: One hundred and fifty one patients were investigated (88 women and 63 men). Median age for the diagnosed disease was 63 years. The standardized incidence rate was 0.82/100 000 person-year (95% CI = 0.68-0.96) and increased from 0.25 in 1980-1984 to 1.50 in 2000-2004. Fifty nine cases (39%) were sarcomas, 35 (23%) adnexal carcinomas, 27 (18%) Merkel cell carcinoma and 27 (18%) Paget's disease. The standardized incidence rates were 0.37/100 000 (0.27-0.47) for sarcomas, 0.16 (0.10-0.22) for adnexal tumors, 0.13 (0.08-0.18) for Merkel cell carcinoma, and 0.15 (0.09-0.21) for Paget's disease.

Conclusions: Our results based on a population-based cancer registry showed an increase of the standardized incidence rate for all types of rare skin tumors. These results may be useful when considering the growing interest in rare diseases in identifying risk factors and planning scientific research programmes.
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http://dx.doi.org/10.1080/02841860802680435DOI Listing
May 2009

Primary cutaneous lymphomas: a population-based descriptive study of 71 consecutive cases diagnosed between 1980 and 2003.

Leuk Lymphoma 2008 Aug;49(8):1537-44

Service de Dermatologie, CHU de Besançon, France.

Although primary cutaneous lymphomas (PCL) are the second most common group of extra-nodal non-Hodgkin lymphomas, few epidemiological data are available in the literature, and most of them are provided by large databases from population-based cancer registries in the US or patients attending a single institution. We conducted this study to investigate the epidemiological and clinical features of PCL diagnosed in the department of Doubs from 1980 to 2003. Data were collected from the Doubs cancer registry from 1980 to 2003. Seventy-one patients with PCL were investigated. 82% were cutaneous T-cell lymphoma (CTCL) and 18% were cutaneous B-cell lymphoma (CBCL). Among CTCL, mycosis fungoides (MF) represented 58% and Sezary syndrome 10%. The standardised incidence rate of PCL was 0.42 for 100 000 person-years and significantly increased from 0.21 in 1980-1984 to 0.70 in 2000-2003 (p <0.05). The incidence rate of CTCL was 0.34 for 100 000 person-year and significantly increased from 0.2 to 0.57 (p <0.05). For MF and CBCL, the incidence rates were 0.20 and 0.08, respectively and did not vary significantly from 1980-1984 to 2000-2003. Five-year survival was 64.5% for PCL patients similar to MF patients. Our results provide updated data on the incidence of PCL in France.
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http://dx.doi.org/10.1080/10428190802136368DOI Listing
August 2008

Pulmonary and cutaneous sarcoidosis associated with interferon therapy for melanoma.

Cutis 2007 Nov;80(5):441-5

Department of Dermatology, Centre Hospitalier Universitaire de Besançon, l'Université de Franche-Comté, France.

Interferon alfa is widely used as adjuvant therapy for melanoma. Numerous side effects have been attributed to interferon alfa. Interferon alfa-induced sarcoidosis is an uncommon event. We report the third case of pulmonary and cutaneous sarcoidosis in the course of interferon alfa treatment for melanoma. Most cases of sarcoidosis have been reported during treatment of chronic hepatitis C. The prognosis is good with discontinuation of treatment. Other than interferon therapy, sarcoidosis or granulomatosis reactions rarely have been reported in malignant melanoma. We discuss and review the literature on the physiopathology of sarcoidosis brought on by interferon therapy.
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November 2007

Gluten intolerance and skin diseases.

Eur J Dermatol 2006 Jan-Feb;16(1):4-11

Department of Dermatology, University of Franche-Comté, CHU Saint Jacques, 25030 Besançon, France.

Gluten sensitivity with or without coeliac disease (CD) symptoms and intestinal pathology has been suggested as a potentially treatable cause of various diseases. CD is a chronic disease which improves on withdrawal of wheat gliadins and barley, rye and oat prolamins from the diet. There have been numerous reports linking CD with several skin conditions. A body of evidence shows that dermatitis herpetiformis is actually a cutaneous manifestation of CD. Autoimmune diseases, allergic diseases, psoriasis and miscellaneous diseases have also been described with gluten intolerance. Dermatologists should be familiar with the appraisal of gluten sensitive enteropathy and should be able to search for an underlying gluten intolerance (GI). Serological screening by means of antigliadin, antiendomysial and transglutaminase antibodies should be performed. HLA typing is often useful in association with serologic tests. Intestinal biopsy is usually needed to establish the diagnosis of CD or GI. Thus, gluten intolerance gives rise to a variety of dermatological manifestations which may benefit from a gluten-free diet.
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May 2006

Minocycline-induced cutaneous polyarteritis nodosa with antineutrophil cytoplasmic antibodies.

Eur J Dermatol 2003 Jul-Aug;13(4):396-8

Department of Dermatology, University Hospital, 2 Place Saint-Jacques, 25030 Besançon, France.

Minocycline is an antibiotic widely used in the treatment of acne. Among the induced auto-immune disorders, cutaneous polyarteritis nodosa (PAN) is very rare. A new case is reported below. A 23-year-old female patient treated with minocycline for acne for 24 months developed sub-cutaneous nodules, livedo reticularis and pigmented lesions of the lower limbs. Antineutrophil cytoplasmic antibodies (ANCA) were positive at 1/320. Skin biopsy showed vasculitis of a medium-sized artery. The role of minocycline was suspected using the imputability criteria. The diagnosis of minocycline-induced cutaneous PAN with ANCA was sustained. After withdrawal of the treatment, the nodular lesions decreased spontaneously, whereas livedo disappeared and inflammatory parameters were normalized after oral corticosteroid therapy. Minocycline is a tetracycline which is efficient for treating acne. Auto-immune disorders are frequently observed. Among them, it is very rare to observe cutaneous PAN associated with positive ANCA. The pathophysiological mechanisms are discussed.
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December 2003

Lipschütz genital ulceration: a rare manifestation of paratyphoid fever.

Eur J Dermatol 2003 May-Jun;13(3):297-8

Service de Dermatologie 1, Hôpital Saint-Jacques, 2, place Saint-Jacques, 25030 Besançon cedex, France.

In 1913, a distinctive clinical entity of acute genital ulcer occurring in an adolescent girl with a non-venereal infectious aetiology was described by Lipschütz. Since the initial description, several aetiologies have been discussed, and among them, paratyphoid fever is very uncommon. After her return from a trip, a 25-year-old girl developed high fever and diarrhoea. Examination of the vulva revealed a genital ulcer. The rest of the general examination was normal. Blood cultures identified Salmonella paratyphi A, and a diagnosis of Lipschütz's ulcer associated with paratyphoid fever was made. Bacteriaemia was then treated with antibiotics and the vulvar ulceration rapidly disappeared. Lipschütz described a distinctive clinical entity of acute genital ulcers occurring in adolescents. To our knowledge, we report herein the second case associated with proved paratyphoid fever. The authors thus recommend that typhoid or paratyphoid fever should be included in the differential diagnosis of genital ulcerations.
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September 2003