Les effets cutanés indésirables des antagonistes du TNF alpha

in Revue Médicale de Liège (2012)

The TNF alpha antagonists, including adalimumab, etanercept and infliximab, represent a class of anti-inflammatory and immunosuppressive drugs. Although cutaneous adverse effects are uncomon, they are ... [more ▼]

The TNF alpha antagonists, including adalimumab, etanercept and infliximab, represent a class of anti-inflammatory and immunosuppressive drugs. Although cutaneous adverse effects are uncomon, they are varied. There is no particular risk profile to develop cutaneous adverse effects. The principal acute side effects are injection site reactions and pruritus. The major long term cutaneous side effects are infectious and inflammatory conditions. Neoplastic skin diseases are exceptional. the association with other immunosuppressive agents can increase the risk of developing cutaneous adverse effects. Some adverse effects, such as lupus erythematosus, require immediate withdrawal of the biological treatment, while in other cases temporary withdrawal is sufficient. The majority of the other cutaneous adverse effects can be dealt without interrupting biologic treatment. Preclinical and clinical investigations revealed that the new biologics, aiming IL12/23, IL23 and IL17, present a similar profile of cutaneous adverse effects, although inflammatory skin reactions may be less often encountered compared to TNF alpha antagonists. [less ▲]

Alitrétinoïne : une nouvelle arme dans l'eczéma chronique des mains

in Skin Inc (2011)

L'eczéma chronique des mains représente une difficulté thérapeutique majeure en dermatologie, et en particulier, quand l'exploration allergologique ne permet pas d'identifier l'agent responsable de l ... [more ▼]

L'eczéma chronique des mains représente une difficulté thérapeutique majeure en dermatologie, et en particulier, quand l'exploration allergologique ne permet pas d'identifier l'agent responsable de l'affection ou que l'éviction de celui-ci est difficile à obtenir pour raisons professionnelles. La première approche thérapeutique consiste en l'application de dermocorticoïdes. Cependant, leur utilisation chronique n'est pas recommandée en raison de leurs effets secondaires tels que l'atrophie cutanée. L'application topique des inhibiteurs de la calcineurine, comme le tacrolimus ou le pimecrolimus peut être envisagée comme traitement complémentaire. La photothérapie par UVB ou par PUVA est un traitement de deuxième ligne. Le méthotrexate et la ciclosporine sont des médicaments à réserver aux cas graves et multirésistants. L'alitrétinoïne, rétinoïde endogène et agoniste des récepteurs aux rétinoïdes, est une nouvelle thérapeutique contre l'eczéma chronique des mains qui ne répond plus aux dermocorticoïdes et est réfractaire aux autres options thérapeutiques. Plusieurs études randomisées, multicentriques et contrôlées contre placebo ont montré l'efficacité et l'innocuité de l'alitrétinoïne dans l'eczéma chronique des mains résistant aux traitements classiques. [less ▲]

A propos de la réticence à l’immunothérapie spécifique chez les personnes allergiques : les nouvelles données de la littérature

in Revue Médicale de Liège (2010)

The increasing number of allergic subjects and the alteration of their quality of life are major concerns of public health. Symptomatic treatments of allergic diseases are not always able to improve the ... [more ▼]

The increasing number of allergic subjects and the alteration of their quality of life are major concerns of public health. Symptomatic treatments of allergic diseases are not always able to improve the patient’s complaints. Allergic exploration aims to identify IgE-dependant mechanisms and subsequently to prove the responsibility of the detected allergen in the allergic disease. The efficacy of the specific immunotherapy (SIT ) using allergens in either subcutaneous or sublingual forms has been proven in rhinitis, conjunctivitis, asthma and IgE-induced reactions to hymenoptera venom. The lack of training in allergology is an important reticence of general practitioners and specialists to prescribe SIT . Furthermore, the duration of the treatment and its important cost in Belgium (where, only venom SIT is reimbursed by the Social Security) interfere significantly with the compliance of the patients. [less ▲]

Les allergies aux plantes d'intérieur

in Revue Médicale de Liège (2009)

La comparaison des taux de sensibilisation IgE-dépendante aux moisissures, aux dermatophytes et aux levures dans les maladies allergiques générales et les dermatoses inflammatoires

in Revue Française d'Allergologie et d'Immunologie Clinique (2006), 46

We aimed to determine IgE-dependant skin sensitization rates to moulds, dermatophytes and yeasts in patients with typical allergic diseases in comparison to those with inflammatory dermatitis seen over ... [more ▼]

We aimed to determine IgE-dependant skin sensitization rates to moulds, dermatophytes and yeasts in patients with typical allergic diseases in comparison to those with inflammatory dermatitis seen over the course of one year. Skin prick tests were done in 267 patients (172 women and 95 men; median age 38 years, range 25–50 years). We allocated them into 8 groups: 64 with head and neck atopic dermatitis; 11 with seborrheic dermatitis; 52 with eczema and not atopic dermatitis other than on the head and neck; 64 with rhinitis, conjunctivitis and asthma; 28 with urticaria; 10 with food allergy; and 12 healthy controls. Skin tests were done with the following aqueous standardized commercial extracts: Alternaria, Penicillium, Aspergillus, Cladosporium, Mucor, Trichophyton, Epidermophyton, Candida albicans, Malassezia and Saccharomyces cerevisiæ. Globally, positive skin test reactions occurred most frequently with the yeast extracts, less to the dermatophytes and even less to the moulds. The results were homogenous among members of each group. The relevance of our tests was reinforced by the fact that the moulds that gave positive skin tests most frequently were those most often isolated in the Belgian environment. In patients with atopic dermatitis of the head and neck, positive tests were most frequent with four moulds and three yeasts; compared to this group, positive tests were less frequent in patients with atopic dermatitis localized to other sites. In inflammatory dermatitis of the head and neck, the study of immediate hypersensitivity to yeasts seems to be important. [less ▲]

Étude comparative des « prick » et « patch » tests aux moisissures, aux dermatophytes et aux levures dans la dermatite atopique de la tête et du cou, la dermatite séborrhéique et le sébopsoriasis

in Revue Française d'Allergologie et d'Immunologie Clinique (2005), 45

Aim of the study. – The capacity of fungi to induce eczema in head and neck dermatitis has already been studied. Malassezia has often been implicated in two other dermatitis of the cephalic region ... [more ▼]

Aim of the study. – The capacity of fungi to induce eczema in head and neck dermatitis has already been studied. Malassezia has often been implicated in two other dermatitis of the cephalic region (seborrhoeic dermatitis and sebopsoriasis).We have explored the cellular and IgE dependant reactions to different groups of fungi in these three dermatitis using “patch” and “prick” tests. Tested allergens were: Alternaria, Penicillium, Aspergillus, Cladosporium, Trichophyton, Epidermophyton, Candida albicans, Malassezia, Saccharomyces cerevisiae. Material and methods. – Seventy persons including 42 females (60%) and 28 males (40%) aged 40 years old in average were distributed in four groups: Head and neck dermatitis (24 patients), seborrheic dermatitis of the face (21 patients) and sebopsoriasis of the face (10 patients) compared to 15 controls without these dermatoses. Results and conclusions. – Globally, in “prick” and “patch” tests, yeasts had the highest number of positivity comparing to the two other groups. Malassezia was the leader in “prick tests”. In “patch tests”, the global results showed a positivity rate, which was clearly lower than those in “prick tests”. Detailed analysis of the results revealed that in the head and neck dermatitis the highest number of positive “patch tests” for all of these allergens is found. For the three other groups, no significant difference for these two techniques for any of these allergens has been detected. [less ▲]

Une bouche en or

in Revue Française d'Allergologie et d'Immunologie Clinique (2004), 44

Contact dermatitis to gold has rarely been reported. This precious metal is generally considered as inert, insoluble and resistant to corrosion. Nevertheless, gold salts have a strong potential for ... [more ▼]

Contact dermatitis to gold has rarely been reported. This precious metal is generally considered as inert, insoluble and resistant to corrosion. Nevertheless, gold salts have a strong potential for sensitization. This condition can occur after contact with gold jewellery and dental alloys, after systemic therapy with gold salts and after occupational contact. The lesions may be expressed as contact dermatitis on the face, ear, neck and/or fingers, and as lichen planus and/or lichenoid stomatitis. The dermatitis is usually not very irritating and the lesions are rarely persistent. Diagnosis is based on the clinical history and examination, on the nature of the exposure sources, and on the results of patch tests with gold sodium thiosulfate (GSTS) at 0.5% in petrolatum. The patch test is read on days 2 and 3 and again after 1 and 3 weeks. Allergen avoidance can be expensive and tiresome, and improvement is not guaranteed.We report the case of a female patient who came to us complaining of burning in her mouth. She had polymetallism and lichenoid lesions facing gold tooth crowns. Patch tests were positive to GSTS at 72 h and at 1 week. Replacement of the gold crowns led to total disappearance of her symptoms within 1 year. Local factors, including humidity, temperature, acid pH, abrasion and contact with substance such as amino acids, bring about the liberation of the sensitizing metallic salts, which may be enhanced by galvanic corrosion secondary to the polymetallism. [less ▲]

Urticaire de contact suite à l’application d’un fond de teint contenant de l’huile de sésame

in Revue Française d'Allergologie et d'Immunologie Clinique (2003), 43

A number of cosmetic products containing sesame oil are used for daily cutaneous care. The risk of secondary induction of eczema or even anaphylactic shock after topical use of products containing ... [more ▼]

A number of cosmetic products containing sesame oil are used for daily cutaneous care. The risk of secondary induction of eczema or even anaphylactic shock after topical use of products containing vegetable oils is still unknown. We describe the case of 36-years-old atopic, sesame sensitized women who presented with contact urticaria after application of a foundation cream containing sesame oil. Immediate prick and patch tests with sesame oil, sesame grains, the foundation cream and its components confirmed this sensitization. We discuss the innocuousness of vegetable and animal products present in foods and in cosmetics and problems that may occur when they are used by patients during an inflammatory phase of atopic dermatitis and by patients with specific sensitization to these allergens. [less ▲]

Urticaires

in Medi-Sphere (1999), 94

Les urticaires sont des affections cutanées papuleuses et prurigineises, dont le diagnostic positif est généralement facile. Par contre, elles posent de nombreux problèmes étiologiquesn ... [more ▼]

Les urticaires sont des affections cutanées papuleuses et prurigineises, dont le diagnostic positif est généralement facile. Par contre, elles posent de nombreux problèmes étiologiquesn physiopathologiques et thérapeutiques. Classiquement, on distingue les urticaires aiguës, spontanément résolutives, et les urticaires chroniques, qui évoluent sur une période beaucoup plus longue (entre 6 semaines et 6 mois). Quoiqu'il en soit, leur physiopathologie est identique. L'urticaire est une pathologie fréquente car elle fait partie des 20 dermatoses les plus courantes et qu'environ un individu sur quatre a présenté dans sa vie une poussée d'urticaire. En dehors de l'inconfort qu'elle procure au patient, elle risque d'engager ke pronostic vital en raison de la survenue potentielle d'un oedème de Quincke, voire d'un choc anaphylactique ou anaphylactoïde. [less ▲]

Congenital psoriasis following the lines of Blaschko.

in Pediatric Dermatology (1996), 13(3), 219-221

Congenital psoriasis without an underlying nevus following the lines of Blaschko is described in a 6-year-old girl. In addition to this special type of psoriasis, she suffered from atopic dermatitis. The ... [more ▼]

Congenital psoriasis without an underlying nevus following the lines of Blaschko is described in a 6-year-old girl. In addition to this special type of psoriasis, she suffered from atopic dermatitis. The lesions were aggravated by sun exposure and phototherapy treatments, as well as by upper airways infections, without any clear explanation of these trigger factors. We propose to call this form of psoriasis congenital blaschkoid psoriasis. [less ▲]