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M-A Richard

Publications and source records attributed to M-A Richard.

10 recordsLinked to original sources
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

[Treatment of cutaneous metastases of a squamous cell carcinoma of the leg with topical miltefosine].

INTRODUCTION: Miltefosine (Hexadecylphosphocholine) is a chemotherapy, which when applied locally, has demonstrated efficacy in the treatment of cutaneous metastases of breast cancer. CASE REPORT: A 79 year-old woman developed recurrent in transit cutaneous metastases of a squamous cell carcinoma on her left leg. All lesions completely resolved after topical applications of miltefosine. Tolerance was excellent and the patient remained disease-free 24 months after the end of the treatment. DISCUSSION: Miltefosine, which might prove to be a simple and effective alternative for the usually heavy treatments proposed, warrants further assessment in this context.

Administration, Topical↗
PubMed2005

[Anti-H1 in dermatological practice].

INTRODUCTION: Histamine is an inflammation mediator that is fundamental for the development of some allergic reactions and is also implied in several common dermatological affections. Anti-H1s are molecules capable of couteracting the effect of histamine on its specific receptors. There are two types: first generation anti-H1 and second generation anti-H1. OBJECTIVE: To assess the efficacy of anti-H1 in the treatment of skin diseases. PATIENTS AND METHODS: A reference search was made using the Pubmed data bank. Critical analysis was made of the articles selected based on their evidence. RESULTS AND CONCLUSION: Demonstration of the efficacy of anti-H1 was only confirmed in a few dermatitis. Urticaria is the indication of choice. The symptomatic use of anti-H1 may be justified within the context of other dermatitis. The second rather than the first generation molecules should be preferred because of the lesser side effects and improved pharmacokinetic profile.

Dermatitis↗
PubMed2004

[Treatment of pemphigus with intravenous immunoglobulin].

INTRODUCTION: The interest of intravenous immunoglobulins (Igi.v.) in the treatment of pemphigus is discussed. Pemphigus is not a recognized indication for this treatment by the CEDIT (French Committee for the assessment and diffusion of technological innovations). The aim of this study was to assess the efficacy of Igi.v. in the treatment of severe corticosteroid-dependent or resistant pemphigus. MATERIAL AND METHODS: A retrospective study using a standardized questionnaire was conducted in the various departments of dermatology among the "Groupe Bulles" of the French Society of Dermatology. The study collected the following information from 12 patients suffering from pemphigus and treated with Igi.v.: 1) general demographical data; 2) characteristics of the pemphigus; 3) different treatments applied, and 4) efficacy and side effects of treatments. RESULTS: Among the 12 patients studied at the end of treatment with Igi.v., 8 were in complete remission (1 fleetingly for 2 months and 1 preceding initiation of Igi.v.), and 2 were improved (1 temporarily for 4 months). A reduction in corticosteroid therapy was possible in 75 p. 100 of cases (9 patients). During treatment with Igi.v., immunosuppressors were combined with oral corticosteroids in 3 cases. It was possible to reduce their dose 1 one case and to stop them in another case. No major side effect related to treatment with Igi.v. was observed. Six months and one year after the treatment, complete remission rates were respectively 6/10 and 5/8. One patient relapsed more than one year after the end of Igi.v. treatment. CONCLUSIONS: Although very expensive, treatment with Igi.v. appears of interest in the treatment of severe corticosteroid-dependent or resistant pemphigus. Moreover tolerance is excellent. The results of our study warrant confirmation in a prospective study.

Adrenal Cortex Hormones↗
PubMed2003

[Cutaneous metastasis of pleural mesothelioma: two cases].

INTRODUCTION: Cutaneous manifestations of pleural mesothelioma are rare, polymorphic, and occur at various stages of the disease. CASE REPORTS: Case 1. A 60 year-old man, 6 months after the initial diagnosis of a pleural mesothelioma, developed a right latero-thoracic subcutaneous nodule. The lesion resulted from an inoculation of tumoral cells to the wall at the time of the initial thoracoscopy. No specific treatment was proposed. Case 2. A 62 year-old man, with a history of pleural mesothelioma developed an inflammatory layer of the left chest wall. The lesion, laid out like an hemi-belt, was centred by the thoracotomy scar and was associated with retraction phenomena of the thoracic wall. The lesion corresponded to a direct extension of the mesothelioma to the wall. At the same time, the pleural disease was progressing. The patient died a few weeks later. COMMENTS: Cutaneous manifestations usually occur when the diagnosis of primitive pleural cancer has been already established. Distant cutaneous metastases are exceptional and involve with predilection the cephalic extremity. The majority of cutaneous lesions are distributed near the tumoral site and represent either a direct extension of the tumor to the thoracic wall, or a malignant seeding by diffusion of the pleural fluid at the time of the diagnostic and therapeutic procedures.

Cicatrix↗
PubMedDate not supplied

[Granulomatous hypodermitis revealing a cutaneous mucormycosis in an immunodepressed patient].

INTRODUCTION: Mucormycosis is an exceptional opportunist fungal infection, despite the ubiquitous nature of its pathogenic agents. It is sometimes revealed by primary cutaneous involvement and its prognosis is bad in the case of visceral dissemination. Our observation illustrates the need for early diagnosis and treatment of this infection. OBSERVATION: An immunodepressed, 45 year-old woman, had developed necrotic hypodermitis lesions on the lower limbs. The skin biopsy led to the diagnosis of mucormycosis. Despite treatment with liposomal amphotericin, the fungal infection worsened, spread to the organs (lungs and brain) and the patient died. DISCUSSION: This case report underlines the potential severity of mucormycosis, which is presently emerging in the onco-hematological field. The infection is sometimes revealed by inaugural ulcerated and/or necrotic cutaneous lesions. Its diagnosis must be evoked early so that salvage medical-surgical treatment can be initiated.

Brain Diseases↗
PubMedDate not supplied

[Treatment of Hailey-Hailey disease with carbon dioxide laser vaporization].

INTRODUCTION: Only ablative methods lead to long term remission of areas affected by Hailey-Hailey disease: excision/skin graft, cryosurgery, dermabrasion... The method using the CO2 laser is a recent addition in the management of this dermatitis. We report our experience with this technique in 4 patients. PATIENTS AND METHODS: Carbon dioxide laser vaporization was proposed to 4 patients exhibiting Hailey-Hailey disease resistant to classical treatments. A test under local anesthesia was performed beforehand in all the patients. A 60 year-old man had an immediate reaction and refused to continue treatment. In the other 3 cases, the result of the test at 6 months was considered satisfactory. These patients were treated under general anesthesia in a single area of 50 to 70 cm2, and a half-body for comparison. The CO2 laser was used in pulse mode, with successive irradiations, until a homogenous, whitish-yellow aspect with first retraction was obtained. RESULTS: Although the healing delays were long (a mean of 1 month) and required major analgesics over the first few days, the cosmetic results were satisfactory and no abnormal scarring was observed. After a median follow-up of 27 months, no relapse of the disease other than punctiform elements was noted. All the patients wanted treatment of the other remaining affected areas be continued. In 2 patients, CO2 laser vaporization permitted treatment of areas not easily accessible to other ablative methods (around the mouth, the anus and the vulva) with anatomy and normal function spared. DISCUSSION: These results are globally good. Although the time to healing was long, the cosmetic and functional results were always satisfactory, without abnormal scarring. Moreover, in 2 of the patients, CO2 laser was able to treat areas inaccessible to other methods. The reason for the efficacy of ablative methods is debated. Re-epidermization with keratinocytes of appendices and not expressing the molecular defect, and the constitution of dermal cicatricial tissue, are two currently proposed hypotheses.

Adult↗
PubMedDate not supplied

[Facial rash].

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Adult↗