Publications by authors named "Revuz J"

518 Publications

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

[Antibiotic treatment of hidradenitis suppurativa].

Authors:
J Revuz

Ann Dermatol Venereol 2012 Aug-Sep;139(8-9):532-41. Epub 2012 Jun 22.

Bacterial infection plays an important role in hidradenitis suppurativa (HS). This infection has a number of unique features: chronicity, absence of lymph node involvement, and absence in most cases of acute super-infection by Staphylococcus aureus and/or streptococci. Treatment is based mainly on antibiotics. Various bacteria are involved; they are often part of the resident flora and may combine in polymicrobial infections, and they consist mainly of two families: coagulase-negative staphylococci (CNS) and anaerobes. Numerous antibiotics are active against CNS: betalactamins, lincosamides, macrolides, rifampicin, tetracyclines and fluoroquinolones. Antibiotics active against anaerobes include metronidazole, betalactamins, lincosamides and one fluoroquinolone (moxifloxacine). Antibiotics are given per os and in combination. Treatment is usually long-term, with a frequent need for maintenance therapy. It has to be tailored to various clinical situations: intermittent development, in which "abortive" emergency treatment is used; major or major continuous forms, where combined antibiotics are used, most frequently rifampicin and clindamycin. The global treatment strategy involves a surgical approach, which can be aided but not replaced by antibiotics. While the risks of long-term antibiotic use are reduced in this specific population of "healthy" young adults, they are not absent.
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http://dx.doi.org/10.1016/j.annder.2012.05.016DOI Listing
January 2013

Cervicofacial actinomycosis.

G Ital Dermatol Venereol 2012 Jun;147(3):325-6

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June 2012

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

[Ethics and medical techniques: a transcultural approach].

Authors:
J Revuz

Ann Dermatol Venereol 2011 Nov 5;138(11):723-4. Epub 2011 Oct 5.

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http://dx.doi.org/10.1016/j.annder.2011.09.002DOI Listing
November 2011

[Retrospective studies and therapeutic research].

Authors:
J Revuz

Ann Dermatol Venereol 2011 Oct 15;138(10):643-4. Epub 2011 Aug 15.

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http://dx.doi.org/10.1016/j.annder.2011.07.005DOI Listing
October 2011

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

[Algorithm for treatment of juvenile facial acne].

Ann Dermatol Venereol 2011 Jan 30;138(1):23-9. Epub 2010 Aug 30.

Hôpital européen Georges-Pompidou, 20 rue Leblanc, Paris cedex, France.

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http://dx.doi.org/10.1016/j.annder.2010.06.033DOI Listing
January 2011

[Acne and diet].

Authors:
J Revuz

Ann Dermatol Venereol 2010 Nov;137 Suppl 2:S60-1

11 Chaussée de la Muette, 75016 Paris, France.

The classical opinion of dermatologists on the absence of a dietary effect on acne is challenged by the discovery of so-called primary populations with no acne and by the demonstration of a possible role played by dairy products in the diet of adolescents. The role played by IGF1 as the effector of these dietary effects has a number of elements of proof. From a practical point of view, however, it is too early to provide particular advice to patients other than eating a balanced diet.
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http://dx.doi.org/10.1016/S0151-9638(10)70027-2DOI Listing
November 2010

[Adult acne in women].

Authors:
J Revuz

Ann Dermatol Venereol 2010 Nov;137 Suppl 2:S57-9

11 Chaussée de la Muette, 75016 Paris, France.

Acne, a disease of adolescence, is actually quite frequent in the adult and may be on the rise. It is particularly observed in women, but this may result from consultation bias. Stress and hormone disorders are blamed with no tangible evidence. The clinical aspect in females is quite specific: inflammatory acne in the lower facial region. This acne is highly chronic and recurrent, requiring adaptation of contraception and often isotretinoin.
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http://dx.doi.org/10.1016/S0151-9638(10)70026-0DOI Listing
November 2010

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

Open trial of ciclosporin treatment for Stevens-Johnson syndrome and toxic epidermal necrolysis.

Br J Dermatol 2010 Oct;163(4):847-53

Department of Dermatology, Reference Centre for Toxic and Autoimmune Blistering Diseases, Universite´ Paris XII, F-94010 Cre´teil, France.

Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)are acute mucocutaneous reactions associated with poor prognosis. The treatment is mainly symptomatic, based on supportive care. Until now, several curative treatments have been proposed without evidence of effectiveness.Objectives To evaluate the effect of ciclosporin on SJS and TEN after a short series had suggested a benefit.Methods We conducted an open, phase II trial to determine the safety and possible benefit of ciclosporin. Among the 45 consecutive patients admitted for SJS /TEN from March 2005 to September 2007, 29 fulfilled inclusion criteria. Ciclosporin was administered orally (3 mg kg)1 daily for 10 days) and tapered over a month. Clinical and biological evaluations were performed sequentially. Predicted death rate was estimated with a validated prognostic score (SCORTEN).Results Twenty-nine patients were included at a mean +/- SD of 2.8 +/- 1.8 days after onset. The final diagnosis was SJS (n = 10), SJS ⁄TEN overlap (n = 12) and TEN(n = 7). One month of treatment was completed in 26. Ciclosporin was stopped after more than 10 days in three cases for side-effects including posterior leucoencephalopathy (n = 1), neutropenia (n = 1) and nosocomial pneumopathy(n = 1). Ciclosporin dosage was tapered earlier than scheduled in two cases for alteration in renal function. The prognostic score predicted 2.75 deaths; none occurred (P = 0.1). Mean epidermal detachment remained stable in 18 of 29 cases (62%). The mean ± SD hospital stay was 16.2 +/- 9.1 days.Conclusions Both the death rate and the progression of detachment seemed lower than expected, suggesting a possible usefulness of ciclosporin in SJS and TEN that needs to be confirmed.
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http://dx.doi.org/10.1111/j.1365-2133.2010.09863.xDOI Listing
October 2010

[Erythema elevatum diutinum associated with pyoderma gangrenosum in an HIV-positive patient].

Ann Dermatol Venereol 2010 May;137(5):386-90

Département de pathologie, groupe hospitalier Henri-Mondor-Albert-Chenevier, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.

Background: Erythema elevatum diutinum (EED) is a very rare form of chronic dermatosis clinically characterised by reddish-violet papular nodules extending to the surfaces of the limbs and extremities. Histologically, there are classically two phases of progression initially involving associated neutrophilic dermatosis and leucocytoclastic vasculitis, which is later followed by fibrosis of characteristic appearance. We report the association of EED and pyoderma gangrenosum in a patient infected with HIV.

Patients And Methods: A 53-year-old male seen since 1989 for HIV infection had been presenting firm bilateral and symmetrical nodules on the feet for 6 months. Histological analysis of one of these nodules resulted in diagnosis of chronic erythema elevatum diutinum and treatment with dapsone was initiated. Three months later, despite regression of the EED lesions under dapsone, two large pustules appeared on the outer aspect of the right leg; they were confluent and progressed towards a superficial ulcer with rounded edges with a clinical appearance evocative of pyoderma gangrenosum (PG). Histopathological analysis demonstrated a massive dermal infiltrate beneath the ulcer comprising neutrophils with evidence of leucocytoclasia, all of which militated in favour of the diagnosis of pyoderma gangrenosum.

Discussion: We report for the first time the association of two forms of neutrophilic dermatosis, EED and PG, in an HIV-positive patient. This case report and certain data in the literature suggest that the various forms of neutrophilic dermatosis tend to result in a range of lesions rather than in clearly distinct entities.
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http://dx.doi.org/10.1016/j.annder.2010.03.025DOI Listing
May 2010

Development and evaluation of a Global Acne Severity Scale (GEA Scale) suitable for France and Europe.

J Eur Acad Dermatol Venereol 2011 Jan;25(1):43-8

Department of Cancero-Dermatology, Hôtel Dieu, Nantes Cedex, France.

Background And Objective: Many acne grading methods exist; however, there is no agreed-upon standard. Our objective was to create and validate a reproducible acne assessment scale for rating the severity of juvenile facial acne suitable for use in France and Europe.

Methods: The scale we created described the different types of acne lesions in a manner similar to global assessment scales used in clinical trials. The scale was then validated by seven expert dermatologists in the field of acne [the Global Evaluation Acne (GEA) group] first on 34 photographic cases of Caucasian acne patients and second by clinical examination of 22 acne patients.

Results: There was good agreement in Investigators' assessments of acne both on photographs and patients (R = 0.8057; P < 0.0001, and R = 0.8437; P = 0.0015).

Conclusion: The GEA Scale is a global scale validated both on photographs and acne patients which can be used either in clinical research or by the dermatologist in his office.
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http://dx.doi.org/10.1111/j.1468-3083.2010.03685.xDOI Listing
January 2011

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

[Severe tularaemia mimicking glandular tuberculosis during adalimumab therapy].

Ann Dermatol Venereol 2009 Oct 20;136(10):718-22. Epub 2009 May 20.

Service de dermatologie, hôpital Henri-Mondor, AP-HP, université Paris-XII, 94010 Créteil cedex, France.

Background: Tularaemia is an anthropozoonosis, transmitted by small mammals (hares) and arthropods (ticks, horseflies). The causative agent is Francisella tularensis, a facultatively intracellular Gram-negative bacillus. We report a case of tularaemia in its ulceroglandular form occurring during methotrexate and adalimumab treatment (Humira) for rheumatoid arthritis.

Patients And Methods: A 58-year-old man with a history of primary tuberculosis receiving adalimumab in combination with methotrexate for rheumatoid arthritis for almost 1 year consulted for a febrile inflammatory plaque on the left leg with a small central necrotic area. An enlarged left inguinal lymph node was present. Doxycycline has previously been prescribed for a tick bite. The lymphadenopathy gradually became enlarged resulting in skin fistulisation. After surgical excision, histopathology revealed epithelioid granulomas accompanied by giant cells and central necrosis. Mycobacterial cultures were negative. Positive tularaemia serology at significant titres suggested a diagnosis of tularaemia, with probable transmission via a tick bite. The diagnosis was confirmed by F. tularensis DNA amplification using PCR on a lymph node biopsy. Doxycycline was continued for a further 6 weeks. One year later, no relapse had occurred.

Discussion: A febrile adenopathy presenting the histological features of necrotic granulomas in a patient receiving anti-TNF alpha treatment initially suggested reactivation of tuberculosis. However, the history of tick bite and failure to isolate mycobacteria from different tissue specimens prompted screening for a tick-borne disease, finally leading to a diagnosis of tularaemia. We discuss the possible relationship between immunosuppression and the clinical course of this rare infection.
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http://dx.doi.org/10.1016/j.annder.2009.01.015DOI Listing
October 2009

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

Hidradenitis suppurativa.

Authors:
J Revuz

J Eur Acad Dermatol Venereol 2009 Sep;23(9):985-98

Hidradenitis suppurativa is a chronic disease characterized by recurrent, painful, deep-seated, rounded nodules and abscesses of apocrine gland-bearing skin. Subsequent suppuration, sinus tracts and hypertrophic scarring are its main features. Onset is usually after puberty, although it is most common during the third decade and may persist in old age. The disease tends to be chronic and may develop to subcutaneous extension leading to indurations, sinus, and fistula having a profound impact on the quality of life. The prevalence is 1% in several studies. Axillary and inguinal involvement is more common in females; peri-anal and buttocks localizations are prevalent in males. The exact aetiology remains unknown. The primary event is a follicular occlusion with secondary inflammation, infection and destruction of the pilo-sebaceo-apocrine apparatus and extension to the adjacent sub-cutaneous tissue. Infection is common. Smoking may be a triggering factor. Obesity aggravates the discomfort. Differential diagnostic includes Crohn's disease, nodular acne and furonculosis. The main complications are arthropathy, carcinoma. Treatment depends upon the stage of the disease. Early nodular lesions may be treated by antibiotics for acute stage; long-term antibiotics, zinc salts may be useful as maintenance treatment; anti-TNF drugs have been used in severe cases; systemic steroids, estrogens, anti-androgens, retinoids have been used as options with limited success. Surgical treatment includes incision with or without drainage for limited abscesses; limited excisions are used for locally recurring draining sinuses. Total wide excision and healing with secondary intention or flaps and grafts is the only curative procedure in case of advanced disease.
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http://dx.doi.org/10.1111/j.1468-3083.2009.03356.xDOI Listing
September 2009

Combination therapy with clindamycin and rifampicin for hidradenitis suppurativa: a series of 116 consecutive patients.

Dermatology 2009 8;219(2):148-54. Epub 2009 Jul 8.

Service de Dermatologie, Groupe Henri-Mondor Albert-Chenevier, AP-HP, Créteil, France.

Background: Antibiotics are frequently used to treat hidradenitis suppurativa (HS); however, few data on their efficacy are available.

Objective: To evaluate the efficacy of a combination of systemic clindamycin (300 mg twice daily) and rifampicin (600 mg daily) in the treatment of patients with severe HS.

Methods: Patients (n = 116) who received this combination were studied retrospectively. The main outcome measure was the severity of the disease, assessed by the Sartorius score, before and after 10 weeks of treatment.

Results: The Sartorius score dramatically improved at the end of treatment (median = 29, interquartile range = 14.5, vs. median = 14.5, interquartile range = 11; p < 0.001), as did other parameters of severity as well as the quality of life score. Eight patients (6.9%) stopped the treatment because of side effects.

Conclusion: The combination of clindamycin and rifampicin is effective in the treatment of severe HS.
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http://dx.doi.org/10.1159/000228334DOI Listing
December 2009

Inter-observer agreement on acne severity based on facial photographs.

J Eur Acad Dermatol Venereol 2010 Feb 27;24(2):196-8. Epub 2009 May 27.

Clinique de Dermatologie, Hôpital Edouard Herriot, Lyon Cedex, France.

Background: The three-grade acne classification (mild, moderate, severe) is widely used to define the licensed indications of acne treatments, and for therapeutic decision-making in clinical practice, but its reproducibility has never been assessed.

Methods: Ten photographs of facial acne were scored independently by eight experts using the three-grade acne classification. We conducted a descriptive analysis of the results, based on graphical representation of the scores for each photograph.

Results: Inter-observer agreement on acne severity based on the three-grade acne classification was very poor.

Conclusion: The classical three-grade acne classification is poorly reproducible. A new rating tool accompanied by a clinical description of each severity level would be extremely useful.
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http://dx.doi.org/10.1111/j.1468-3083.2009.03278.xDOI Listing
February 2010

[Long live parabens].

Authors:
J Revuz

Ann Dermatol Venereol 2009 May 18;136(5):403-4. Epub 2009 Apr 18.

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http://dx.doi.org/10.1016/j.annder.2009.03.017DOI Listing
May 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

[Cosmetics and health. New frontiers, new confusion].

Authors:
J Revuz

Ann Dermatol Venereol 2009 Jan 23;136(1):5-7. Epub 2008 Jul 23.

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http://dx.doi.org/10.1016/j.annder.2008.03.027DOI Listing
January 2009

[Wells' cellulitis and bacterial necrotizing cellulitis induced by anakinra].

Ann Dermatol Venereol 2008 Dec 3;135(12):839-42. Epub 2008 Aug 3.

Service de dermatologie, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.

Background: Anakinra is a recombinant form of the naturally occurring human interleukin-1 receptor antagonist. It is used in the treatment of rheumatoid arthritis. The most frequent side effects are injection site reactions, which seem to have a toxic mechanism.

Patients And Methods: We report two unusual cases of injection site reactions with anakinra: a woman presented Wells' cellulitis of the thigh and a man developed serious bacterial cellulitis distinguished by deep necrosis at the site of the latest anakinra subcutaneous injection.

Discussion: The cases are examples of serious side effects that can occur during treatment with anakinra and underline the need for careful use of this new biological agent.
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http://dx.doi.org/10.1016/j.annder.2008.02.026DOI Listing
December 2008

Absence of efficacy of oral isotretinoin in hidradenitis suppurativa: a retrospective study based on patients' outcome assessment.

Dermatology 2009 5;218(2):134-5. Epub 2008 Dec 5.

Service de Dermatologie, Groupe Hospitalier Henri Mondor et Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris 12, Créteil, France.

Background: In analogy to acne, oral isotretinoin has been considered in the treatment of hidradenitis suppurativa (HS).

Objectives: To assess the efficacy of oral isotretinoin according to patients.

Methods: From 1999 to 2006, 358 consecutive HS patients were interviewed and examined. A standardized record of the data was performed for each patient during the first consultation. Patients were questioned regarding the effect of previous treatment with oral isotretinoin: patients had to grade the effect as either 'improved', 'no effect' or 'worse'.

Results: Fourteen patients (16.1%) declared an improvement, 67 patients (77%) no effect and 6 patients (6.9%) worsening of HS.

Conclusion: According to our patients, oral isotretinoin is not effective in the treatment of HS.
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http://dx.doi.org/10.1159/000182261DOI Listing
June 2009
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