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Biomedical subjects

J P Lacour

Publications and source records attributed to J P Lacour.

At least 19 recordsLinked to original sources
PubMed2005

[The management of atopic dermatitis in children by dermatologists, paediatricians, general practitioners and allergologists: a national survey on practice patterns].

A national survey on practice habits was conducted from June to August 2004 within the framework of the consensus conference on the management of atopic dermatitis (AD) in children. The telephone survey involved a sample population of 100 dermatologists, 100 paediatricians, 100 general practitioners and 100 allergologists. The survey demonstrated the interest that those interviewed had with regard to AD and the frequency of the disease in daily practice. The severe forms are usually seen by the allergologists and dermatologists, but paediatricians also see a lot of mild or moderate AD in infants under the age of 2. The modalities of its management vary depending on the specialization, notably with regard to topical treatment. Hygiene and environment counselling provided by the practitioners is fairly homogenous. These results will help to assess the future modifications in practising habits, following the diffusion of the guidelines from the consensus conference.

Allergy and Immunology↗
PubMed2004

Eruptive lingual papillitis with household transmission: a prospective clinical study.

BACKGROUND: Eruptive lingual papillitis with household transmission (ELP) is an acute stomatitis of unknown cause occurring in children, with possible spread to one or several members of the family. OBJECTIVES: To verify clinical features and search for clinical characteristics of ELP. METHODS: A prospective case series, including an analysis of epidemiological and clinical factors, was conducted within private paediatric practices in collaboration with a dermatology department at the University Hospital of Nice, France. RESULTS: Thirty-eight children (21 girls and 17 boys) with clinical criteria of ELP referred from 1 February 2000 to 31 January 2002 were included in the study. Mean age at diagnosis was 3 years and 6 months. Thirty-three children attended day nursery or school. The seasonal distribution of observed cases showed a peak of incidence in spring. The eruption started abruptly. Fever was found in 15 (39%) cases. Difficulties in feeding were observed in all cases; intense salivation in 23 (61%) cases. The glossitis was characterized by inflammatory hypertrophy of the fungiform papillae on the tip and dorsolateral part of the tongue. Enlarged submaxillary or cervical lymph nodes were noted in 16 (42%) cases. Angular cheilitis was observed in four (11%) children. Spontaneous regression of the stomatitis occurred between the second and 15 days of clinical evolution. Mean duration was 7.3 days. Transmission to one or several members of the family was noted in 20 (53%) cases. Recurrence of symptoms was observed in five (13%) children. CONCLUSIONS: This study confirms some clinical characteristics of ELP: localized lesions of the fungiform papillae on the tip and dorsolateral part of the tongue, high frequency of intrafamilial transmission, and possibility of recurrence. This study also showed unsuspected clinical data such as possible occurrence of fever and angular cheilitis. ELP resembles an entity termed 'transient lingual papillitis' or commonly 'lie bumps'. The origin of this eruption remains unknown, but the transmission data could suggest a possible infectious origin.

Age of Onset↗
PubMed2003

[Concurrent mycetoma and chromomycosis: case report from Senegal].

A 68-year-old cattle farmer from northern Senegal sought medical attention for tumefaction that had been progressing on the right foot and leg for 20 years. Physical examination of the right extremity revealed very firm tumefaction involving the foot and whole leg associated with numerous nodules. Bone radiographs and CT-scan of the foot and leg disclosed extensive osteolytic involvement. A specimen of squamous tissue from the top of nodules showed the presence of fumagoid cells characteristic of chromomycosis. Histologic examination after skin biopsy demonstrated fungal myocetoma. Due to the extent of involvement surgical and antifungal treatment was proposed but the patient refused to undergo surgery. Only one previous case of concurrent chromomycosis and mycetoma has been described. However the previous case involved actinomycetoma. The rarity of this combination of diseases despite their common contamination mode is due to different geographical distribution with mycetoma being found in the Sahelian region and chromomycosis in the humid equatorial region.

Aged↗
PubMed2002

[Neurofibromatosis 1: recommendations for management].

Twenty experts, members of a French medical network devoted to neurofibromatosis 1 have elaborated recommendations for the management of the disease. Bibliography was obtained through a Medline of articles from 1966 to 1999 for the terms neurofibromatosis, NF1, neurofibroma and from textbooks. A consensual document was written taking into account extracted data. An annual careful clinical examination is recommended except in cases with complications. Screening investigations are not recommended due to the rarity of complications, generally symptomatic and easily detected during the clinical follow-up. The only controversial exception might be magnetic resonance imaging for early detection of optic pathway gliomas in young children. A co-ordinated follow-up in specialised multidisciplinary centres, providing patients with a rational management, is recommended.

Adolescent↗
PubMed2002

Carcinogenesis of basal cell carcinomas: genetics and molecular mechanisms.

Basal cell carcinoma (BCC) of the skin is the most common type of cancer in humans. Like squamous cell carcinomas, they are also believed to be ultraviolet (UV)-induced, but several data suggest that some differences might exist in the mechanisms of their UV induction. The originating cells may arise from interfollicular basal cells, hair follicles or sebaceous glands, thus from a deeper zone than the SCC ones, which probably means exposure to different doses or wavelengths of UV. The p53 gene and the patched gene (PTCH) are major targets of UV for BCC induction. Mutations in p53 are present in about 56% of human BCC, even small early lesions. The "UV signature" is observed in 65% of them. Mutations in the PTCH play also a major role in BCC development, being responsible for hereditary BCCs in Gorlin's syndrome, sporadic BCC, and BCCs isolated from xeroderma pigmentosum, although with a lower incidence of "UV signature". Smoothened-activating mutations and PTCH2 mutations are also involved in BCC formation. Transgenic mice overexpressing Smoothened or Sonic hedgehog in the skin spontaneously produce skin lesions resembling human BCCs, but contrary to findings in the hairless albino mouse and with SCC, no data on experimental UV induction of BCCs are available.

Animals↗
PubMed2002

[Cutaneous Waldenström's macroglobulinemia].

BACKGROUND: We report the case of a patient in whom the first manifestation of Waldenström' s macroglobulinemia was specific skin lesions, treated with chlorambucil chemotherapy. CASE REPORT: A 76-years old woman was referred to us because of chronic red nodular lesions on her face. A biopsy specimen showed a dense lymphocytic dermal infiltrate and immunohistochemistry identified a monoclonal B lymphoid population with an IgM-kappa phenotype. The patient's disease was diagnosed as Waldenström's macroglobulinemia with cutaneous localization, on the basis of a high level of circulating macroglobulinemia and a lymphoplasmocytic infiltrate in the bone marrow expressing the same monoclonal IgM-kappa as in blood and skin. Treatment with radiotherapy (12 Grays) was unsuccessful. Chlorambucil (16 mg per day, 7 days per month) was then introduced with rapid disappearance of the skin lesions. Neutropenia led to withdrawal of this treatment after 4 courses. The skin lesions relapsed 18 months later and were cured with chlorambucil at a lower dose. DISCUSSION: Specific skin infiltrates have been rarely described during Waldenström's macroglobulinemia. Review of the literature showed eight cases of such lesions treated by chemotherapy with only two successes with oral cyclophosphamide and polychemotherapy (cyclophosphamide, vincristine and CCNU). Chlorambucil was used unsuccessfully three times. We hypothesize that primary resistance to alkylating-agent and the small number of cases of cutaneous Waldenström's macroglobulinemia may explain the poor response to systemic chemotherapy previously reported.

Aged↗
PubMed2002

[Noninvoluting congenital hemangioma: 2 cases].

INTRODUCTION: Hemangiomas (or immature hemangiomas) are characterized by a stereotyped 3-phase evolution: proliferation, stabilization and regression. The rare congenital hemangiomas are present at birth and regress spontaneously more rapidly. However, certain congenital hemangiomas, described recently as "noninvoluting congenital hemangiomas", evolve differently and do not regress. We report two cases. OBSERVATIONS: Two adolescents aged 16 and 17 were born with a congenital hemangioma. Its evolution during childhood was marked by the progressive collapse of the lesion and lightening of the skin. After stabilizing, a round, centrally involuted lesion persisted with numerous telangiectasia on the surface and peripheral varicosities. The lesion was hot but no pulsation or murmur were observed. Doppler sonography revealed a rapid flowing lesion, limited to the cutaneous areas. Magnetic resonance imaging, conducted in one case, showed a hypersignal area limited to the skin. DISCUSSION: Noninvoluting congenital hemangiomas can be differentiated from classical congenital hemangiomas by their partial regression, stereotyped clinical aspect and a certain activity after stabilization. All the clinical, histological and imaging data support a vascular malformation with proliferative component, rather than a true hemangioma. Whenever possible, treatment is surgical. Knowledge of the existence of this type of angioma is important, and the dermatologist should be careful when reassuring parents of children presenting with congenital hemangioma.

Adolescent↗
PubMed2002

[Juvenile dermatomyositis in the Nice area: a retrospective study 1991-2001].

INTRODUCTION: Juvenile dermatomyositis is a rare disease. We conducted a retrospective chart review on patients with juvenile dermatomyositis diagnosed in the Nice area from 1991 to 2001. Our purpose was to review diagnosis criteria and treatment strategies. PATIENTS AND METHODS: The cases of juvenile dermatomyositis were identified by phone investigation of physicians of the departments of paediatrics, dermatology, rheumatology and internal medicine. RESULTS: Seven cases of juvenile dermatomyositis (sex ratio M/W: 0.75, medium age: 7.7 years) were identified. Myalgia and/or weakness were the main reasons for initial consultation. Cutaneous lesions were present in all patients on initial presentation. Muscular enzymes were abnormal in 4 cases out of 7. Muscular biopsy was conducted in 6 patients. In one case, MRI revealed an inflammatory involvement although no clinical or biological sign existed. Systemic corticosteroids was the initial treatment, associated with monthly intravenous immunoglobulins in 5 cases, allowing initial control of the disease in all cases. The other therapies were: methotrexate (3 cases), ciclosporin A (1 case), and chloroquine (2 cases). The evolution was monocyclic in three cases, polycyclic in four cases. With a median follow-up of two years, all the patients are alive: five under treatment, three still in first flare. COMMENT: The diagnosis strategy seems relevant because at least 3 criteria of Peter and Bohan were found in 6/7 patients. Muscular biopsy appears fundamental in the diagnosis strategy. MRI was useful when it was conducted but its use has to be assessed. Therapies were those of previous published studies, except for the use of intravenous immunoglobulins as first-line treatment, associated with corticosteroids. This strategy may be justified for corticosteroid-sparing purposes. CONCLUSION: Working on a real, well-codified strategy of diagnosis and treatment would enhance the uniform management of these patients.

Adolescent↗
PubMed2001

Interstitial granulomatous drug reaction with a histological pattern of interstitial granulomatous dermatitis.

The interstitial granulomatous drug reaction (IGDR) is a novel drug-associated entity, characterized by violaceous plaques with a predilection for skin fold areas. Light microscopically, it resembles the incipient diffuse interstitial phase of granuloma annulare. Differentiating light microscopic features include the absence of complete collagen necrobiosis, the presence of interface dermatitis, and variable lymphoid atypia. The lack of vasculitis rules out the extravascular necrotizing granuloma (Winkelmann granuloma) associated with systemic disease. The differential diagnosis with interstitial granulomatous dermatitis with arthritis as defined by Ackerman et al. has not been studied until now. Our aim was to determine the histologic criteria allowing us to differentiate IGDR without interface dermatitis and lymphoid atypia from interstitial granulomatous dermatitis. We report three patients with IGDR triggered, in two cases by respectively angiotensin convertin enzyme (ACE) inhibitors and furosemide, and in one case by the association of an ACE inhibitor, furosemide, and fluindione. Histologic examination showed a histological pattern of interstitial granulomatous dermatitis. We found a dense, diffuse histiocytic infiltrate distributed interstitially and in palisaded array within the reticular dermis. Eosinophils and some neutrophils were scattered throughout the infiltrate. In some tiny foci, enveloped by histiocytes, thick collagen bundles associated with basophilic nuclear debris or "flame figures" were seen. Vasculitis, interface dermatitis, or lymphoid atypia were absent. Our study allowed us to expand the histological spectrum of IGDR including a histological pattern similar to interstitial granulomatous dermatitis. The lack of degenerated collagen could be a subtle clue in favor of interstitial granulomatous dermatitis triggered by a drug.

Aged↗