Publications by authors named "Jean Revuz"

42 Publications

Proposed Definitions of Typical Lesions in Hidradenitis Suppurativa.

Dermatology 2020 9;236(5):431-438. Epub 2020 Jun 9.

Private practice, Paris, France.

Background: Although not rare, hidradenitis suppurativa (HS) is often under-recognized by physicians. The diagnosis of HS is clinical via the recognition of lesions typical of the disease, but universally accepted definitions of these latter are currently lacking, which means that certain severity scores employed for HS classification/management are used differently by different physicians. Our aim was to develop a set of descriptive definitions and associated images of HS lesions, in order to enable doctors to better recognize and evaluate the disease.

Methods: MEDLINE-available literature and dermatological textbooks on HS morphology were retrieved (January 1996 to February 2016). A preliminary set of definitions of HS typical lesions was created, including 10 terms. Each term was associated with a pathophysiological classification and an image. This preliminary set was shown during the 5th Conference of the European HS Foundation (EHSF). The physicians attending the event were invited to vote on each term and make comments via a voting sheet.

Results: A total of 81 physicians answered the questionnaire. Their agreement/disagreement rates and comments were used to obtain a revised set of definitions and images. Pathophysiological classifications were dropped.

Conclusion: A user-friendly set of definitions/images of HS typical lesions was proposed and will need to be validated by further studies. This set could ultimately serve as a tool to better recognize, score, and assess treatment efficacy.
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http://dx.doi.org/10.1159/000507348DOI Listing
July 2021

New Evidence Supporting Cyclosporine Efficacy in Epidermal Necrolysis.

J Invest Dermatol 2017 10;137(10):2047-2049

Paris, France (retired).

Sixty years after its original description by Sir Alan Lyell, epidermal necrolysis (from Stevens-Johnson syndrome to toxic epidermal necrolysis) seems finally amenable to a specific treatment in addition to essential symptomatic measures in specialized settings. A recently published systematic review and an article by Gonzales-Herrada et al. strongly suggest that cyclosporine is effective in reducing the risk of death.
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http://dx.doi.org/10.1016/j.jid.2017.07.828DOI Listing
October 2017

Phenotypic Characterization of Patients with Hidradenitis Suppurativa.

Dermatology 2016 30;232(4):521. Epub 2016 Aug 30.

Clinique Dermatologique, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.

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http://dx.doi.org/10.1159/000448246DOI Listing
July 2017

Hidradenitis Suppurativa: Terminology.

Authors:
Jean Revuz

Dermatology 2016 29;232(3):381. Epub 2016 Apr 29.

Private practice, Paris, France.

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http://dx.doi.org/10.1159/000445739DOI Listing
April 2017

Diagnosing Hidradenitis Suppurativa.

Dermatol Clin 2016 Jan;34(1):1-5

Department of Dermatology, Roskilde Hospital, Health Sciences Faculty, University of Copenhagen, Køgevej 7-13, Roskilde DK-4000, Denmark. Electronic address:

Three diagnostic criteria must be met for hidradenitis suppurativa: typical lesions, occurrence in one or more of the predilection areas, and that it is chronic and/or recurrent. Several outcome measures are used, including patient-reported pain and itch scales, Dermatology Life Quality Index, and Skindex. Hidradenitis suppurativa is associated with significant comorbidities that must be addressed in the evaluation of the patients.
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http://dx.doi.org/10.1016/j.det.2015.08.009DOI Listing
January 2016

A randomized, investigator-masked, double-blind, placebo-controlled trial on thalidomide in severe cutaneous sarcoidosis.

Chest 2014 Oct;146(4):1046-1054

The Department of Dermatology, CHU Rennes; Université de Rennes 1, Inserm CIC 1414, Rennes; Pharmacoepidemiology Unit, Inserm CIC 1414, Rennes. Electronic address:

Background: Thalidomide use in cutaneous sarcoidosis is based on data from small case series or case reports. The objective of this study was to evaluate the efficacy and safety of thalidomide in severe cutaneous sarcoidosis.

Methods: This study consisted of a randomized, double-bind, parallel, placebo-controlled, investigator-masked, multicenter trial lasting 3 months and an open-label study from month 3 to month 6. Adults with a clinical and histologic diagnosis of cutaneous sarcoidosis were included in nine hospital centers in France. Patients were randomized 1:1 to oral thalidomide (100 mg once daily) or to a matching oral placebo for 3 months. In the course of an open-label follow-up from month 3 to month 6, all patients received thalidomide, 100 mg to 200 mg daily. The proportions of patients with a partial or complete cutaneous response at month 3, based on at least a 50% improvement in three target lesions scored for area and infiltration, were compared across randomization groups.

Results: The intent-to-treat population included 39 patients. None of them had a complete cutaneous response. Four out of 20 patients in the thalidomide group (20%) vs four out of 19 patients in the placebo group (21%) had a partial cutaneous response at month 3 (difference in proportion of -1% [95% CI, -26% to +24%] for thalidomide vs placebo, P = 1.0). Eight patients with side effects were recorded in the thalidomide group vs three in the placebo group. We observed a large number of adverse event-related discontinuations in patients taking thalidomide in the first 3 months (four patients with thalidomide, zero with placebo) and in the 3 following months (five patients).

Conclusions: At a dose of 100 mg daily for 3 months, our results do not encourage thalidomide use in cutaneous sarcoidosis.

Trial Registry: ClinicalTrials.gov; No.: NCT0030552; URL: www.clinicaltrials.gov.
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http://dx.doi.org/10.1378/chest.14-0015DOI Listing
October 2014

Identification of three hidradenitis suppurativa phenotypes: latent class analysis of a cross-sectional study.

J Invest Dermatol 2013 Jun 13;133(6):1506-11. Epub 2012 Dec 13.

LIC EA 4393-Laboratoire d'Investigation Clinique, Faculté de Médecine, Université Paris-Est Créteil, Créteil, France.

To identify the underlying subtypes of hidradenitis suppurativa (HS), we performed latent class analysis on prospective clinical data of 618 consecutive patients seen between 2002 and 2010. The median patient age was 31 years (Q1=26; Q3=38), median age at HS onset was 20 years (16-25), and median Sartorius score was 18 (11-19); 34.4% of patients were of Hurley stage II or III. A three-class model showed the best fit. Latent class 1 (LC1) patients (48%) had a high probability of breast and armpit lesions (0.74) and hypertrophic scars (0.41). LC2 patients (26%) had a high probability not only of breast and armpit lesions (0.96) but also of lesions in the ears, chest, back, or legs (0.55); follicular lesions (pilonidal sinus: 0.48; comedones: 0.74); severe acne (0.47); and a family history of HS (0.44). Compared with LC1 patients, LC2 patients were more often male (odds ratio, 4.6; 95% confidence interval, 3-7; P<0.001) and current smokers (2.2; 1.3-3.9; P=0.005), and had greater disease severity (odds ratio, 1.6; 1.3-1.9; P<0.001). LC3 was characterized by gluteal involvement (0.54), papules, and folliculitis (0.71). LC3 patients were less often obese (0.6; 0.3-0.95; P=0.03) and had less severe disease (0.9; 0.7-1.1; P<0.001). These three phenotypes ("axillary-mammary", "follicular", and "gluteal") may help stratify patients for clinical trials.
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http://dx.doi.org/10.1038/jid.2012.472DOI Listing
June 2013

Prognostic value of histologic features of toxic epidermal necrolysis.

J Am Acad Dermatol 2013 Feb 16;68(2):e29-35. Epub 2011 Nov 16.

Department of Dermatology, Assistance Publique - Hôpitaux de Paris, Hôpital Henri-Mondor, Université Paris Est, LIC EA4393, F-94010, Créteil, France.

Background: The prognosis of toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), and SJS/TEN overlap syndrome has been assessed using a disease-specific severity score (SCORTEN) based on clinical and laboratory data. Histologic data may improve outcome prediction.

Objective: We sought to evaluate whether dermal mononuclear infiltration and epidermal necrosis predict survival of patients with TEN, SJS, or SJS/TEN.

Methods: We conducted a retrospective review of clinical records and skin biopsy specimens read without knowledge of clinical data.

Results: We identified 108 patients (SJS, n = 42; SJS/TEN, n = 36; TEN, n = 30). Overall mortality was 21.3%. Dermal infiltration and epidermal necrosis were not associated with time from disease onset to biopsy. Extensive dermal infiltrates were seen in 19 (18.5%) patients and full-thickness epidermal necrosis in 56 (52%) patients. Dermal infiltrate severity was not associated with day-1 (D1) SCORTEN or hospital death. Epidermal necrosis severity showed trends toward associations with D1 SCORTEN (P = .11) and hospital death (P = .06). In univariate analyses, full-thickness epidermal necrosis was significantly associated with hospital death (32.1% vs 11.4%, P = .017) and worse D1 SCORTEN values (1.98 ± 1.29 vs 1.55 ± 1.21; P = .04). In the bivariate analysis, however, D1 SCORTEN remained significantly associated with hospital death (odds ratio = 3.07, 95% confidence interval 1.83-5.16) but the association with full-thickness epidermal necrosis was no longer significant (odds ratio = 2.02, 95% confidence interval 0.65-7.12).

Limitations: Retrospective study design and indirect assessment of progression are limitations.

Conclusion: Full-thickness epidermal necrosis was associated with mortality but did not independently predict hospital death after adjustment based on the SCORTEN value. Dermal infiltrate severity was not associated with hospital death.
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http://dx.doi.org/10.1016/j.jaad.2011.10.007DOI Listing
February 2013

Acne as seen by adolescents: results of questionnaire study in 852 French individuals.

Acta Derm Venereol 2011 Sep;91(5):531-6

Hôpital Européen Georges Pompidou, Paris, France.

Acne can have an important psychological impact. We surveyed 852 adolescents aged 12-25 years about their knowledge of acne and its treatment in a non-medical context. The study involved a questionnaire administered to callers to a youth telephone helpline in France. Callers were categorized into those who currently had acne, those who had had acne previously, and those who had never had acne. Most respondents (66.2%) had experienced acne symptoms, which were mild in 50.2% of cases and severe in 16% of cases. Often, acne had been long-lasting (>12 months in 49.6% of cases). Many thought that gender, excess weight, eating dairy products, and physical activity did not influence acne, and that frequent washing could improve acne. Eating chocolate and snacks, smoking cigarettes, sweating, not washing, touching/squeezing spots, eating fatty foods, using make-up, pollution, and menstruation were thought to worsen acne. The majority (80.8%) did not believe acne to be a disease, but rather a normal phase of adolescence, yet 69.3% agreed it should be treated. There was a preference for topical vs. systemic treatment. Many (38.6%) of the respondents with acne had not consulted a physician. Almost two-thirds of respondents wanted more information about acne. Providing more information about acne might increase the likelihood of them consulting a physician and getting better treatment for the condition.
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http://dx.doi.org/10.2340/00015555-1125DOI Listing
September 2011

Hidradenitis suppurativa.

Authors:
Jean Revuz

Presse Med 2010 Dec 20;39(12):1254-64. Epub 2010 Oct 20.

Hidradenitis suppurativa, or Verneuil's disease, is somewhat common, especially in women, but it often unrecognized. Clinical manifestations include painful nodules, abscesses, sinus tracts, and ropelike hypertrophic scars in the apocrine gland-bearing areas. It is a chronic disease. Smoking and overweight are risk factors, but the cause is unknown: it is a disease of the follicular apparatus, neither infectious nor hormonal. Severe dramatic forms are rare. Quality of life is severely affected even in the mild forms. Treatment is both medical and surgical: wide-spectrum antibiotics and excisions tailored to the extent of involvement. Anti-TNFα drugs are effective, but their risk-benefit ratio is still in question. Laser treatment is under study.
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http://dx.doi.org/10.1016/j.lpm.2010.08.003DOI Listing
December 2010

Back and face involvement in hidradenitis suppurativa.

Dermatology 2010 5;221(2):137-41. Epub 2010 Jul 5.

Departement of Dermatology, Groupe Henri-Mondor, Albert-Chenevier, AP-HP, Paris, France.

Background: Hidradenitis suppurativa (HS) may be associated with face and back lesions which are considered as acne.

Objective: To describe the skin lesions of a group of patients with HS.

Methods: Twelve patients were selected from a series of 648 patients on the basis of their specific skin lesions.

Results: The patients (mostly male) had typical hidradenitis. On their face or back they had one or several of the following skin lesions which are not seen in acne: hypertrophic rope-like bridged scars, raised plaques with multiple carbuncle-like openings or with ulcerations, 'worm-eaten scars' and coalescent nodules with round ulcerations. All patients had deep round scars. Several had a pilonidal cyst or large epidermal cysts. Isotretinoin had been used by 7 patients with no effect.

Conclusion: Some HS patients have specific lesions of the face and back which are not acne and have to be treated differently.
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http://dx.doi.org/10.1159/000315508DOI Listing
December 2010

Use of thalidomide for severe recurrent aphthous stomatitis: a multicenter cohort analysis.

Medicine (Baltimore) 2010 May;89(3):176-182

From Department of Dermatology (MH, SB), CHU Hôtel-Dieu, Nantes; Department of Dermatology (OC), Hôpital Henri-Mondor, AP-HP, Créteil, and Université Paris 6-Pierre-et-Marie-Curie, Paris; Department of Clinical Research and Public Health (SBG), Hôpital Henri-Mondor, AP-HP, Université Paris 12, LIC EA 4393, Créteil; and 11 Chaussée de la Muette, Paris (JR);France.

Severe recurrent aphthous stomatitis (SRAS) is a rare, disabling disorder of unknown etiology. Thalidomide is an effective second-line therapy for SRAS, but is suppressive rather than curative, and adverse events limit its use. Few reports describe the efficacy, tolerance, and safety of thalidomide, and how it is actually used as long-term (maintenance) therapy for SRAS. Therefore, we conducted this study to describe thalidomide use in the real-life management of a cohort of patients with SRAS. This multicenter retrospective cohort study covered a period of 5 years and 5 months (January 2003-May 2008). Patients who had started thalidomide monotherapy for SRAS during the 2003-2006 period were eligible. Data were collected from patients' medical charts and supplemented by patients' responses during a targeted telephone interview. Ninety-two patients followed at 14 centers were included: 76 had oral or bipolar aphthosis, and 16 had Behçet disease. Thalidomide was rapidly effective: 85% (78/92) entered complete remission (CR) within a median of 14 days. Response time was independent of the initial thalidomide dose (r = 0.04). Thalidomide was continued for > or =3 months (maintenance therapy) by 77/92 (84%) of the patients on 1 of 2 maintenance regimens: continuous therapy with regular intake (60/77) or intermittent therapy in response to attacks (17/77). Although intermittent therapy was less restrictive than continuous therapy, medical supervision under the former was less rigorous. The median maintenance dose was 100 mg/week, and did not reflect the initial dose (r = 0.18). The intermittent-treatment group's median dose was significantly lower and its median duration of thalidomide intake significantly longer than for patients on continuous therapy (19 vs. 150 mg/wk; p < 0.0001, and 32 vs. 19 mo; p = 0.002, respectively). Adverse events were reported by 84% (77/92) of patients. They were mostly mild (78% of patients), but sometimes severe (21%). Nevertheless, after 40 months of follow-up, 60% of patients were still receiving continuous or intermittent maintenance therapy with favorable efficacy/tolerance ratios. Despite its retrospective nature, this detailed study provides novel information on the different ways thalidomide is used as SRAS maintenance therapy in a large and unselected cohort of patients. Low-dose maintenance regimens appear to be widely used, effective, and relatively well tolerated. These observations suggest the value of undertaking a randomized trial to assess various maintenance regimens.
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http://dx.doi.org/10.1097/MD.0b013e3181dfca14DOI Listing
May 2010

Efalizumab-induced bullous pemphigoid.

J Am Acad Dermatol 2010 Jan;62(1):161-162

Department of Dermatology, Hôpital Henri Mondor, Université Paris, Créteil, France.

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http://dx.doi.org/10.1016/j.jaad.2009.02.031DOI Listing
January 2010

Factors influencing the clinical evaluation of facial acne.

Acta Derm Venereol 2009 ;89(4):369-71

Clinic of Dermatology, Edouard-Herriot Hospital FR-69003 Lyon, France.

Existing scoring systems for facial acne focus on the lesions themselves, but clinical decisions are based on a general assessment of severity, including the time since onset, the site(s) of involvement, the patient's history, and the response to prior treatments. The aim of this study was to investigate the influence of some of these factors on the global assessment of acne severity. Involvement of the trunk, prior systemic treatment and a positive family history of acne increased the severity score. Inclusion of these factors could help to compose more homogeneous groups for clinical trials.
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http://dx.doi.org/10.2340/00015555-0657DOI Listing
September 2009

Clinical characteristics of a series of 302 French patients with hidradenitis suppurativa, with an analysis of factors associated with disease severity.

J Am Acad Dermatol 2009 Jul 29;61(1):51-7. Epub 2009 Apr 29.

Laboratoire d'Investigation Clinique EA4393, Université Paris 12, Créteil, France.

Background: Factors associated with the severity of hidradenitis suppurativa (HS) are not known.

Objective: We sought to identify factors associated with the severity of HS.

Methodology: The severity of disease in a series of 302 consecutive patients with HS was assessed using the Sartorius score.

Results: Atypical locations were more common in men than in women (47.1% vs 14.8%; P < .001). Men also had more severe disease (median Sartorius score: 20.5 vs 16.5; P = .02). Increased body mass index (P < .001), atypical locations (P = .002), a personal history of severe acne (P = .04), and absence of a family history of HS (P = .06) were associated with an increased Sartorius score. The Sartorius score was highly correlated with the intensity and duration of pain and suppuration (all P values < .001).

Limitations: The referral center base of the study may have biased recruitment.

Conclusion: Our data showed a significant association between the severity of HS and several clinical and behavioral factors. Prospective studies are needed to confirm the prognostic role of these factors.
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http://dx.doi.org/10.1016/j.jaad.2009.02.013DOI Listing
July 2009

Lymph nodes in hidradenitis suppurativa.

Dermatology 2009 10;219(1):22-4. Epub 2009 Apr 10.

Radiology Department, Hospital del Profesor and Clínica Servet, Santiago de Chile, Chile.

Background: Hidradenitis suppurativa (HS) is an inflammatory disease, and yet palpable lymph nodes are rarely found. This may be due to lack of lymph node swelling or to the inability to palpate lymph node regions due to overlying disease. Ultrasound was used to identify and measure regional lymph nodes in HS patients.

Methods: High-resolution ultrasound scanning was carried out with compact linear 15-7 MHz and linear 12-5 MHz probes in both axillae and inguinal regions following informed consent.

Results: A total of 198 lymph nodes were identified in 6 HS patients in Hurley stage II and 4 in stage III, and 101 from regional control scans in healthy controls. All the lymph nodes in both HS patients and controls showed a normal oval shape, with a hypoechoic rim and a hyperechoic center, and all were located in the deep subcutaneous tissue. The overall mean lymph node number per region was not significantly different. The overall mean lymph node diameter was not significantly different, but in patients with Hurley stage III disease it was significantly increased (1.3 +/- 0.4 cm, p = 0.03).

Conclusion: Lymph node involvement only occurs with late-stage HS and may therefore reflect secondary infection rather than primary etiological involvement.
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http://dx.doi.org/10.1159/000213064DOI Listing
October 2009

Creation of a tool to assess adherence to treatments for acne.

Dermatology 2009 22;218(1):26-32. Epub 2008 Oct 22.

Cabinet privé, Paris, France.

Background: Acne is a disorder in which adherence has a major impact on treatment outcome.

Objective: To create an easy-to-use tool to assess treatment adherence, based on a questionnaire that can be used on a daily basis by dermatologists.

Methods: First, we evaluated adherence by comparing responses to a self-administered questionnaire with the dermatologist's prescription. Second, concordance was assessed between adherence and each question of a dermatologist-directed questionnaire (DDQ) administered during the consultation. Third, DDQ questions were combined to construct a mini-questionnaire, and these combinations were tested to maximize specificity.

Results: The study included 246 patients, who were prescribed topical treatment alone, combined treatment (excluding oral isotretinoin) or oral isotretinoin alone. The mini-questionnaires for oral and topical treatments had 89% specificity for detecting poor adherence. An inappropriate answer to one question classified the patient as a probable poor compliance.

Conclusions: Our mini-questionnaires provide dermatologists with specific tools to rapidly identify poor compliance.
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http://dx.doi.org/10.1159/000165628DOI Listing
March 2009

Prevalence and factors associated with hidradenitis suppurativa: results from two case-control studies.

J Am Acad Dermatol 2008 Oct;59(4):596-601

AP-HP, Groupe Henri-Mondor Albert-Chenevier, Service de Dermatologie, Creteil, France, Universite Paris 12, Faculte de Medecine, Creteil, France.

Background: Conflicting opinions have been reported regarding the epidemiology of hidradenitis suppurativa.

Objective: We sought to evaluate the prevalence of hidradenitis suppurativa and to identify associated factors.

Methodology: Prevalence was evaluated using a representative sample of the French population (n=10,000). Associated risk factors were assessed using two case-control studies, one population-based with 67 self-reported patients and 200 control subjects, and the other clinic-based with 302 medically assessed patients and 906 control subjects.

Results: The prevalence was 1% of the French population. Multivariate analyses showed a strong association with current smoking in self-reported (odds ratio=4.16, 95% confidence interval [2.99-8.69]) and in medically assessed (odds ratio=12.55 [8.58-18.38]) populations. Association with body mass index was significant in medically assessed patients (odds ratio=1.12 [1.08-1.15]) for each increase of 1 U of BMI.

Limitations: A causal relationship could not be established with such a cross-sectional study.

Conclusion: Hidradenitis suppurativa is a common disease, frequently associated with smoking and being overweight.
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http://dx.doi.org/10.1016/j.jaad.2008.06.020DOI Listing
October 2008

Minocycline-induced DRESS: evidence for accumulation of the culprit drug.

Dermatology 2008 9;216(3):200-4. Epub 2008 Jan 9.

Department of Dermatology, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.

Background: Minocycline-induced drug rash with eosinophilia and systemic symptoms (DRESS) may have a prolonged course, especially in African and African-American patients.

Objectives: To determine if a prolonged course of minocycline-induced DRESS was associated with an accumulation of the culprit drug.

Patients And Methods: We determined plasma and skin levels of minocycline in patients with minocycline-induced DRESS. We investigated the genetic polymorphisms of enzymes potentially involved in the detoxification of the drug, glutathione S-transferases and UDP-glucuronosyltransferases.

Results And Conclusions: We demonstrated the persistence of minocycline in the plasma and/or in the skin of 7 out of 9 patients with skin phototypes V-VI. As pigmented skin contains more melanin, this could promote the formation of a melanin-minocycline complex, which could explain the severe and prolonged DRESS which may occur in this subgroup of patients.
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http://dx.doi.org/10.1159/000112926DOI Listing
April 2008

Neurofibromatosis 1: analysis of the demand for prenatal diagnosis in a French cohort of 361 patients.

Am J Med Genet A 2008 Jan;146A(2):159-65

Department of Dermatology, AP-HP Henri Mondor, Université Paris 12, Créteil, France.

The severity of neurofibromatosis 1 and its variable expressivity make prenatal diagnosis appealing. We conducted our research to assess patient characteristics associated with the desire for prenatal diagnosis. Between 1995 and 2004, 361 neurofibromatosis 1 adult patients were interviewed about their desire for prenatal diagnosis. Answers were classified in three groups: (1) 'no;' (2) 'uncertain;' (3) 'yes.' Socio-demographical and clinical data were analyzed by logistic multinomial regression for their association with the desire for prenatal diagnosis. Male-to-female sex ratio was 0.93. Mean age at study +/- SD was 33.5 +/- 10. Seven four patients (20.5%) would consider prenatal diagnosis; 240 (66.5%) did not; and 47 (13.0%) were uncertain. In multivariate analysis, compared to the 'no' group, a longer follow-up (OR = 1.25 [1.11-1.41]), a younger age at study time (OR = 1.25 [1.11-1.41]), not having child (OR = 2.46 [1.03-5.97]) and a higher educational level (OR = 5.07 [1.05-24.47]) were independently associated with the 'yes' group. Compared to the 'no' group individuals who were in the 'uncertain' groups were younger (0.95 [0.90-0.99]), less often married (0.11 [0.01-0.89]) and had a longer follow-up (1.26 [1.09-1.46]). There is a significant demand for prenatal diagnosis among neurofibromatosis 1 French patients. This demand is associated with individuals who are younger, have no child, have a longer follow up, and higher level of education.
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http://dx.doi.org/10.1002/ajmg.a.32066DOI Listing
January 2008

Living with acne. A study of adolescents' personal experiences.

Dermatology 2007 ;215(4):308-14

Background: Acne can have important psychological repercussions.

Objectives: We studied adolescents' perceptions of acne, in a nonmedical context.

Methods: Between November 2004 and January 2005, a questionnaire was presented to adolescents calling a youth helpline. It focused on perceptions of acne and, among callers with personal experience of acne, its severity and treatment. Callers were divided into those with acne, those having had acne and those never having had acne.

Results: The questionnaire was completed by 1,566 callers. It showed that 51% of respondents with acne did not seek medical help; acne has as big a psychological impact as some far severer diseases; many respondents with no history of acne said they were very worried that they would develop this skin disorder.

Conclusions: This study underlines the major psychological impact of acne. Young people need to be informed that acne can be treated.
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http://dx.doi.org/10.1159/000107624DOI Listing
October 2007

Cytokeratin expression in squamous cell carcinoma arising from hidradenitis suppurativa (acne inversa).

J Cutan Pathol 2007 Sep;34(9):675-8

Department of Dermatology, Mie University Graduate School of Medicine, Mie, Japan.

We have studied cytokeratin (CK) expression in two cases of well-differentiated and poorly differentiated squamous cell carcinoma (SCC) arising from hidradenitis suppurativa (HS) (acne inversa). In both cases, type A (infundibular-like keratinized) epithelia were observed. In type A epithelia, CK 1 and 10 expressions were decreased, and CK 14 and 17 were detectable in the whole layers. CK 7, 8, 15, 16 and 18 were not detected in type A epithelia. In tumor nests of well-differentiated SCC, CK 1 and 10 expressions were downregulated, and CK 14 expression was upregulated. In tumor nests of poorly differentiated SCC, CK 1 and 10 were not expressed, but simple epithelial keratins (CK 8, 18 and 19) were expressed. These changes of CK expression are related to malignant transformation from the sinus tract (type A epithelium) in HS to SCC.
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http://dx.doi.org/10.1111/j.1600-0560.2006.00680.xDOI Listing
September 2007

Quality of life impairment in hidradenitis suppurativa: a study of 61 cases.

J Am Acad Dermatol 2007 Apr 20;56(4):621-3. Epub 2006 Oct 20.

Department of Dermatology, Hôpital Henri-Mondor, AP-HP, Paris XII University, Créteil, France.

Objective: We sought to determine quality of life impairment in hidradenitis suppurativa.

Methods: Questionnaires were administered to 61 patients.

Results: Quality of life impact in hidradenitis was much greater than that of several other dermatologic conditions.

Limitation: This hospital-based population may not be representative.

Conclusion: Hidradenitis is one of the most distressing conditions observed in dermatology.
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http://dx.doi.org/10.1016/j.jaad.2006.08.061DOI Listing
April 2007

[Epidemiology of tinea capitis. Five-year retrospective study in three hospitals in the Val de Marne].

Presse Med 2006 Sep;35(9 Pt 1):1231-4

Laboratoire de Parasitologie, Service de dermatologie, CHU Henri Mondor, Paris.

Objective: Describe the epidemiology of Tinea capitis in three hospitals in the Val de Marne (suburban district southeast of Paris) and evaluate the usefulness of screening the families of index cases.

Methods: The study included 3 hospitals: Henri Mondor Hospital, Creteil Intermunicipal Hospital Center and Bicêtre Hospital. Index patients had a positive culture for dermatophytes during visits to the mycology-dermatology or pediatric clinics from January 1998 through December 2002. The diagnostic procedure was identical in all centers. In two centers, scalp samples were taken routinely from family members, even in the absence of clinical lesions. Species were identified according to the phenotypic features of the cultures. We recorded the age, sex, and geographic origin of each patient, when available.

Results: Samples were obtained from 487 outpatients (including family members): 383 were positive (356 children under 16 years, 27 adults). Of the children with positive cultures, 214 were boys (60%); of the adults, 18 (66%) were women. Distribution of geographic origin was: sub-Saharan Africa (71%), Europe (10%), Caribbean (5%) and North Africa (4,7%). Species identification confirmed the predominance of anthropophilic species, with 46% of the isolates Trichophyton soudanense and 33% Microsporum langeronii. T. violaceum was reported in 5.5% of cases and T. tonsurans in 2.8%. M. canis (9%), found in 34 Europeans, was the main zoophilic species. Family screening accounted for 263 of the 487 outpatients. Of 242 children from 86 families, 153 (63%) had positive cultures. Of the 21 parents, 5 had a positive culture. Globally, the family screening identified 158 cases in 263 tests (60%).

Conclusion: Tinea capitis in the Val de Marne is mainly due to anthropophilic species and involves children of African origin. The frequency of family contamination indicates that routine screening of family members of infected children is valuable.
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http://dx.doi.org/10.1016/s0755-4982(06)74794-7DOI Listing
September 2006

Performance of the SCORTEN during the first five days of hospitalization to predict the prognosis of epidermal necrolysis.

J Invest Dermatol 2006 Feb;126(2):272-6

Department of Dermatology, Henri-Mondor Hospital (AP-HP), University Paris XII, Créteil, France.

The SCORTEN, calculated within 24 hours of admission, is a severity-of-illness score validated for toxic epidermal necrolysis and Stevens-Johnson syndrome. Our purpose was to assess the performance of successive SCORTEN during the first 5 days of hospitalization and to determine the influence of admission delay. Charts of 144 patients aged 46.8 years (+/-19.7), admitted to our department (1993-2003) with Stevens-Johnson syndrome or toxic epidermal necrolysis, were reviewed. Successive SCORTEN were compared between deceased patients (n = 28, 19.4%) and survivors (n = 116). The performance of the score (calibration, discrimination) was assessed on days 1-5. All seven SCORTEN variables, on days 1-5, were associated with a higher mortality rate. The SCORTEN rose slightly during hospitalization, with a significant difference between days 1 and 4 (<0.05). Performance of the SCORTEN was good on each day, but slightly better on day 3. The areas under the receiver-operating characteristic curves were above 80%. The admission delay did not differ between deceased patients and survivors. Delay-adjusted SCORTEN was close to the crude SCORTEN. The SCORTEN performance during the first 5 days of hospitalization was excellent, and at its best on day 3. We recommend to compute again the SCORTEN on day 3. The admission delay did not influence prognosis or SCORTEN.
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http://dx.doi.org/10.1038/sj.jid.5700068DOI Listing
February 2006

Terbinafine-induced subacute cutaneous lupus erythematosus.

Dermatology 2006 ;212(1):59-65

Department of Dermatology 1, Saint Louis Hospital, Paris, France.

Background: Nearly 10% of lupus erythematosus (LE) are drug induced. More than 60 different drugs are involved in iatrogenic LE. We report herein 3 cases of terbinafine-induced LE.

Observations: Three patients receiving terbinafine for a suspected dermatophytic infection developed a subacute cutaneous LE, within 7 weeks following terbinafine introduction. The patients' medical history included sicca syndrome, lung carcinoma and Kikuchi disease, respectively. Clinical remission occurred within 15 weeks following terbinafine withdrawal.

Discussion: Sixteen cases of terbinafine-induced LE have been previously reported, including 13 women. The median age was 54 years. Prior autoimmunity was reported in 10 cases, including 5 pre-existing LE. The median delay between terbinafine introduction and LE onset was 5 weeks. The median time until clinical recovery following terbinafine withdrawal was 8 weeks.

Conclusion: Terbinafine should be prescribed only in patients with proven dermatophytosis. We recommend cautious monitoring in patients with pre-existing autoimmunity. The diagnosis of terbinafine-induced LE should lead to the immediate and definitive withdrawal of the drug.
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http://dx.doi.org/10.1159/000089024DOI Listing
January 2006

Severe sialadenitis: a new complication of drug reaction with eosinophilia and systemic symptoms.

J Am Acad Dermatol 2004 Nov;51(5):827-30

Departments of Dermatology, Hôpital Henri Mondor, Créteil, France.

Background: Drug cutaneous reaction and isolated cases of parotitis induced by terbinafine have been reported.

Observation: We report a case of drug reaction with eosinophilia and systemic symptoms induced by terbinafine associated with a severe sialadenitis and a complete sicca syndrome. Evolution was protracted with a slow recovery of the rash but sicca syndrome persisted with only a very mild improvement at 6 months.

Conclusion: Liver, kidneys, lungs, and heart are the organs the most frequently involved in drug reaction with eosinophilia and systemic symptoms. Salivary and lacrimal glands can also be severely involved in the course of drug reaction with eosinophilia and systemic symptoms.
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http://dx.doi.org/10.1016/j.jaad.2004.06.023DOI Listing
November 2004
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