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J-C Guillaume

Publications and source records attributed to J-C Guillaume.

16 recordsLinked to original sources
PubMed2007

Multiple large solar lentigos on the upper back as clinical markers of past severe sunburn: a case-control study.

BACKGROUND: Multiple solar lentigos commonly seen on the upper back and shoulders of adults are classically considered as a sign of photodamage, although epidemiological studies are scarce. AIM: To assess whether these lesions are clinical markers of past severe sunburn. METHODS: A case-control study in two outpatient dermatology clinics in French university hospitals. Past episodes of moderate and severe sunburn were compared between 145 adult patients with multiple solar lentigos on the upper back and 145 matched controls. RESULTS: In multivariate analysis adjusted for potential confounders, recalled episodes of sunburn during childhood, adolescence and adulthood were independently associated with the presence of multiple solar lentigos (adjusted odds ratios, 95% confidence intervals: 2.3 (1.1-5.2) and 28.1 (10.4-75.6) for moderate and severe sunburn, respectively). CONCLUSION: Multiple solar lentigos on the upper back and shoulders of adults are potential clinical markers of past severe sunburn which may thus be used to identify a population at higher risk of developing cutaneous malignant melanoma.

Adolescent↗
PubMed2005

[Bullous pemphigoid in young patients: a retrospective study of 74 cases].

INTRODUCTION: Bullous pemphigoid usually affects elderly people. Only a few isolated cases among people younger than 65 years have been reported. OBJECTIVES: Describe the clinical and biological characteristics of patients younger than 60 years suffering from bullous pemphigoid, compare them with the usual characteristics known among elderly people and search for potential pathological associations. PATIENTS AND METHODS: Retrospective, national, multicenter study. Clinical, biological and histological characteristics were recorded with a standardised questionnaire as well as treatments and associated pathologies. RESULTS: Seventy-four cases of bullous pemphigoid diagnosed between June 1970 and March 2002 were analyzed. Mean age at the beginning of the disease was 46 +/- 11.6 years. Further explorations by indirect immunofluorescence of separated skin and/or immuno-electron microscopy and/or immunoblotting were performed for 42 patients (56.8 p. 100). Clinical characteristics among this restricted population were comparable to those found among the 32 other cases. Compared to usual data on bullous pemphigoid in elderly people, we observed a greater proportion of extensive form of disease (75 p. 100), a more frequent head and neck involvement (39.2 p. 100) and an overexpression of anti-BP180 autoantibodies (48 p. 100). Neoplasm was notified for 7 patients (9.5 p. 100), 18 (24.3 p. 100) suffered from a pathology of the basement membrane zone (6 psoriasis, 6 atopic dermatitis and 6 lichen) and 13 from neurological disease, among which 4 were bedridden. Fourty-six patients (62.2 p. 100) received drugs for the long term (mean 2.12 +/- 2.43), 4 patients were treated by PUVAtherapy and 2 by radiotherapy. DISCUSSION: Our results suggest that bullous pemphigoid among young people is more severe and more active than the usual form in the elderly. This particular form could be the result of a higher expression of anti-BP180 autoantibodies, which are considered as a marker of poor prognosis in this disease. We also found a high frequency of pathological associations and physical treatment, all responsible for damage to the basement membrane zone, which can involve auto-immunization against hemidesmosome components.

Adult↗
PubMed2005

[Assessment of a general practitioner training campaign for early detection of cutaneous melanoma in the Haut-Rhin department of France].

INTRODUCTION: Dermatologists frequently provide training for general practitioners, but such training is not systematic and evaluation is rare. MATERIALS AND METHODS: A training campaign for general practitioners and occupational physicians in melanoma screening was carried out in the Haut-Rhin Department of France in 2004. The 630 general practitioners and 120 occupational physicians in this geographic department received repeated mail together with materials (posters and booklets) for their waiting rooms, and they were invited to attend medical training sessions. The sessions consisted of 10 photographs for initial evaluation, provision of epidemiological information, training in identification of subjects at risk and diagnosis of pigmented lesions, with a further 10 photographs for evaluation at the end. The 20 evaluation photographs were randomly selected for each session from 40 photographs comprising 18 cases of melanomas, 14 of nevi, 4 of basal cell carcinomas and 4 of seborrheic keratoses. At the end of each session, the physicians returned 2 anonymous questionnaires containing their overall assessment of the campaign (Q1) and their answers concerning the 20 evaluation photographs (proposed diagnosis and management strategy) (Q2). The questionnaires were then analyzed. The 40 evaluation photographs were also tested on 47 dermatologists. RESULTS: Three hundred and fifty physicians - 278/630 general practitioners (44%) and 72/120 occupational physicians (60%) - attended 18 medical training sessions. Response levels for questionnaires Q1 and Q2 were 88% and 90% respectively. Almost all of the physicians involved considered the campaign to be warranted. At the end of the training sessions, 96% felt they were better equipped to identify subjects at risk for melanoma and 53% (58% of general practitioners and 39% of occupational physicians, p=0.03) felt they had greatly improved their ability to diagnose pigmented lesions. The median number of correct replies concerning the evaluation photographs increased from 6/10 to 7/10 between the initial evaluation photographs and the final evaluation photographs (p<0.0001), with no difference being seen between the general practitioners and occupational physicians. The median number of correct replies from the 47 dermatologists was 35/40 (8.75/10). The most striking improvement noted during the campaign concerned the ability to identify melanomas. The figure rose from an initial 59% at the start of the session (initial evaluation photographs) (versus 86% for the dermatologists) to 84% by the end of the session (final evaluation photographs) (p<0.0001). The management strategy proposed for photographs of melanoma (irrespective of the proposed diagnosis) was judged "appropriate" in 86% of cases at the start of the session versus 94% at the end of the session (p<0.001). Seborrheic keratosis was correctly identified in 43% of cases by the general practitioners/occupational physicians versus 75% by the dermatologists, and was confused with melanoma in 22% of cases by the general practitioners/occupational physicians versus 5% by the dermatologists. No improvement was seen during the training session in terms of the ability of the general practitioners/occupational physicians to correctly identify seborrheic keratosis. The majority of participants indicated their willingness to participate in the screening program and asked to receive information on melanoma on a regular basis. DISCUSSION: This initial study shows the immediate impact of medical training sessions on general practitioners/occupational physicians to be important in terms of sensitization and moderate but significant in terms of improved diagnosis of pigmented lesions. The longer term impact, as well as the impact of the campaign on physicians not taking part in the medical training sessions, remains unknown. This study militates in favor of the involvement of general practitioners and occupational physicians in mass screening for melanoma in collaboration with dermatologists. The 2004 campaign in the Haut-Rhin Department also included information for the general public. The primary evaluation criterion of the campaign will be change in incidence of thick melanomas recorded by the departmental cancer registry.

Education, Medical, Continuing↗
PubMed2005

[Chromium-induced vasculitis-like purpuric allergic contact dermatitis].

INTRODUCTION: Purpuric allergic contact dermatitis is a rare and poorly understood condition. CASE REPORT: A 27-year-old male patient with a personal history of atopic dermatitis since childhood consulted for chronic papular-purpuric rash present for 7 years. Moderate pruritus was seen. Profuse lesions were observed on the palms and soles and on the upper and lower limbs, with sparing of the trunk. These lesions consisted of purpuric papules, in some cases with crusts, forming large plaques. The clinical picture was initially suggestive of vasculitis, but this diagnosis was ruled out by histological examination and laboratory tests. Skin patch tests were evocative of chromium-induced contact dermatitis. Retrospective directed history-taking confirmed the relevance of the latter test since it revealed regular wearing of leather clothing. Lasting cure was achieved following eradication of the allergen. DISCUSSION: Reports of contact purpuric dermatitis are rare. This condition has been described principally for allergens consisting of rubber or dyes used in clothing. Our case was notable on account of the severity of the lesions, mimicking vasculitis, as well as the novelty of the incriminated allergen, chromium, found in leather garments. It underlines the value of routine skin patch tests in the event of chronic non-specific dermatitis. To our knowledge, this is the first reported case of chromium-induced purpuric allergic contact dermatitis.

Adult↗
PubMed2005

[Hypersensitivity to fluindione (Previscan). Positive skin patch tests].

INTRODUCTION: Fluindione (Previscan) is an oral anticoagulant belonging to the vitamin K antagonist class and is very widely used in France. While bleeding is a common complication, severe immunoallergic reactions are less frequent. The authors report a case of drug-induced hypersensitivity syndrome. CASE REPORT: A 75 year-old woman was hospitalized for diffuse erythematous papular rash associated with facial oedema. These symptoms appeared 3 weeks after the beginning of treatment with fluindione, allopurinol and perindopril. Laboratory tests showed hyperleukocytosis, mixed hepatitis and moderate renal failure, with the entire picture being evocative of drug-induced hypersensitivity reaction. The eruption was associated with eosinophilia, hepatic cytolysis with cholestasis, and acute renale failure. While allopurinol and perindopril were stopped definitively, fluindione was only suspended temporarily following overdosage. On reintroduction, rapid recurrence of clinical and biologic signs was observed with increased severity. The skin rash resolved completely on withdrawal of the drug. Patch tests performed later were positive for fluindione and negative for allopurinol and perindopril. DISCUSSION: These manifestations were consistent with the diagnosis of drug-induced hypersensitivity syndrome due to fluindione. Very few cases have been described with fluindione despite widespread prescription of the treatment is in France. While there may be no skin involvement, immunoallergic signs such as fever, hepatitis and acute tubular interstitial nephritis have been described with fluindione and these may be related to this syndrome (DRESS - Drug Reaction with Eosinophilia and Systemic Symptoms). Skin patch testing, which is easily performed, can be extremely helpful in determining a causal relationship with medication.

Administration, Oral↗
PubMed2004

[Characteristics and evolution of consultants, their risk factors and their behavior at the free anonymous HIV screening center of Colmar (France)].

INTRODUCTION: Data collected in free anonymous HIV screening centers (Centre d'Information et de Dépistage Anonyme et Gratuit du VIH, CIdAG) are numerous but poorly exploited. The characteristics of the consultants, their risk factors and their behavior were rarely analyzed previously. MATERIAL AND METHODS: Data of 3995 patients attending the CIdAG of Colmar between January 93 and February 99 were prospectively analyzed. Two 18-month periods at the beginning and end of the study were compared. RESULTS: The activity of the center was stable. Nine HIV infections were detected (2 p. 1000 consulting). The male/female ratio was 1.2 and the mean age was 26 years. The proportion of very young patients (<20 years) was 30 p. 100 and increased significantly between the two periods. Six per cent of the consultants were male homo/bisexuals and 2 p. 100 used intravenous drugs. A regular use of condoms when having occasional sexual relations was reported by 40 p. 100 of consultants before 20 years of age, but this proportion decreased regularly as the age increased. It was minimal among intravenous drug users (19 p. 100), and greater among male homo/bisexuals (46 p. 100) than among male heterosexuals (37 p. 100) and women (33 p. 100). This proportion increased significantly during the study period in heterosexual men and women but not in male homo/bisexuals. The number of sexual partners did not vary but the knowledge of the partners'status for HIV infection and drug addiction progressed significantly. Some subjects who attended the centre several times were identified anonymously. They differed from the other consultants by an older age (mean: 31), a higher proportion of male homo/bisexuals (14 p. 100) and a less regular use of condom (26 p. 100). COMMENTS: In some French anonymous HIV screening centers, information and prevention currently appears to prevail over detecting new HIV infections. Modifying at-risk behaviour is difficult. Current messages for prevention must be improved.

Adult↗
PubMed2004

[Relationship between clinical findings of patients with bullous pemphigoid and antigens recognized by their circulating antibasement membrane zone antibodies].

INTRODUCTION: Clinical features and extent of bullous pemphigoid lesions differed widely among patients. The pathogenic role of anti-BPAG2 antibodies has been recently demonstrated. The aim of this study was to analyze the relationship between clinical features of bullous pemphigoid patients and the antigens recognized by their serum. PATIENTS AND METHODS: One hundred and twelve bullous pemphigoid patients were included in this prospective multicenter study. Inclusion criteria were the following: 1) diagnosis of bullous pemphigoid established on the presence of 3 of the 4 clinical features of bullous pemphigoid, histological picture of bullous pemphigoid and positive direct immunofluorescence; 2) serum available for immunoblotting studies. The clinical and biological findings were prospectively recorded on standard forms. Sera were collected and analyzed using indirect immunofluorescence and immunoblotting on human epidermal extracts. RESULTS: Analysis of patient's clinical features depending on the antigens recognized by their serum showed that patients whose serum contained anti-BPAG1 antibodies had more frequently pruritus, blisters on the lower limbs and a positive indirect immunofluorescence. Patients whose serum contained anti-BPAG2 antibodies had blisters more frequently localized on the head, and a more frequently negative indirect immunofluorescence. Patients whose serum was negative by immunoblotting had less frequently urticarial and/or eczematous lesions, bullae less frequently localized on the lower part of the trunk, abdomen and lower limbs, lower eosinophilia and a more frequently negative indirect immunofluorescence. CONCLUSION: Patients with circulating anti-BPAG1 antibodies exhibited the most typical, clinical and biological features of bullous pemphigoid.

Aged↗
PubMed2003

[Acral purpura and hyperhomocysteinemia].

INTRODUCTION: Increased level of homocysteine has been shown to be associated with atherosclerotic disease and venous thrombosis. There are only exceptional reports of cutaneous disease due hyperhomocysteinemia. CASE REPORT: A 71-year-old man presented with an acral purpura mainly located under the nail plates and resulting in onycholysis. Histologic examination of a skin biopsy specimen showed thromboses of dermal vessels without vasculitis. Laboratory tests revealed highly elevated homocysteinemia due to a mutation in the methylene-tetra-hydrofolate-reductase gene. No other cause of purpura or thrombophilia was found. When oral folic acid was given, both homocysteinemia and cutaneous lesions were controlled. However, a biological and clinical recurrence occurred when therapy was discontinued. DISCUSSION: Hyperhomocysteinemia has probably a causal role in this original case of acral purpura. Since treatment is effective, the detection of hyperhomocysteinemia should be proposed in patients with cutaneous lesions secondary to distal vascular thromboses.

Aged↗
PubMedDate not supplied

[Knowledge and prevention of tick-bite borreliosis: survey of the population in Alsace, an endemic area].

INTRODUCTION: European borreliosis, known to the general public as 'Lyme disease' in analogy with the American form, which it differs from in many points, is endemic in the area of Alsace and is a public health problem. The level of knowledge and prevention of the population with regard to the disease has never been assessed in France. MATERIAL AND METHODS: A survey was conducted in all the national health examination centers in Alsace using a self-applied questionnaire. The data collected concerned the socio-demographical characteristics, knowledge on the disease, history of tick bites, fear the disease creates, frequency of visits to the forest, prevention habits when visiting the forest and the attitude adopted in the case of a tick bite. RESULTS: Out of the 600 persons included, 99 (16.5 p.cent) had been bitten by ticks once or more over the past year. The existence of Lyme's disease was known to 74 p.cent of the consultants, 63 p.cent claimed they were worried by the disease and 43 p.cent knew that the first manifestation is redness spreading over the skin. Twenty-seven percent wore trousers and long sleeves when visiting the forest and 19 p.cent inspected their body carefully on their return. The persons least well informed were also those who did little to protect themselves against tick bites. They often were under 30 years old, lived in urban settings and had few diplomas. Those who had frequent spare time in forest and those who had a history of tick bites were the best informed and protected themselves better. The fear of the disease was associated with better knowledge and more appropriate behaviour. DISCUSSION: This study shows that a large percent of the population in Alsace is exposed to tick bites. Tick bite borreliosis is relatively well known, but protection remains insufficient. Better knowledge of the disease is related to better prevention. Information and teaching campaigns for the general public could specifically target the young people, urban dwellers and those with few diplomas. Specific messages of prevention could be delivered to the most exposed at-risk subjects (i.e. those bitten by ticks or having leisure in forest) at the places of their leisure or medical consultations.

Adult↗
PubMedDate not supplied

[Malignant dermohypodermic melanoma of the soft tissues].

INTRODUCTION: Melanoma of the soft tissue is a rare tumor that develops in most cases in the deep structures, only rarely involving the skin surface. We report an exceptional case of melanoma of the superficial soft tissue, exclusively involving the skin surface. OBSERVATION: A 35-year-old man presented with a superficial, pink, soft, mobile, lesion on the thigh. The histological examination revealed a tumoral proliferation of the reticular dermis and hypodermis, composed of pale giant cells grouped in nests or in lobules separated by connective ducts. Immunostaining was positive for HMB45, protein S-100, vimentine and NKIC3. It was negative for EMA, CD34, smooth muscle actin, cytokeratine and desmine. The search for a metastatic localization was negative. Extensive exeresis was performed. Three years later, the patient was still in complete remission. The macroscopic, histological and immunohistochemical examinations concluded in the diagnosis of a strictly dermohypodermic melanoma of the soft tissues. DISCUSSION: Our case report of a melanoma of the soft tissues is original because of the superficial localization of the tumor that, to our knowledge, has never been reported. It underlines the interest of performing systematic biopsies of any fast growing cutaneous lesion of recent discovery.

Adult↗