Effets indésirables cutanés des glucocorticoïdes

Glucocorticoids are largely used in therapy for many diseases with a noteworthy efficacy. However, the use of glucocorticoids by a systemic or local way (topical or inhaled) is associated with numerous cutaneous side effects. Long duration of treatment and high dosage are associated with more severe side effects. Complications are related to the pharmacological properties of the molecules, especially metabolic and immunosuppressive. Metabolic side effects are mainly skin atrophy: the skin is thin, with easy bleeding and superficial erosions. Other metabolic complications are striae, acne of papulo-pustular type, hypertrichosis, and delayed wound healing. Immunosuppressive side effects are mainly infections: mycoses (dermatophytosis), parasites (Norwegian scabies), bacterial or viral (especially with herpes virus) infections. Glucocorticoids promote opportunistic infections of the skin. Allergy to glucocorticoids is frequent but its diagnosis is uneasy. Clinical aspect is an eczematous eruption related to delayed hypersensitivity and etiological diagnosis is obtained by epicutaneous tests. A better knowledge of glucocorticoid-induced cutaneous side effects can allow to propose preventive measures and especially educational program for patients receiving long-term glucocorticoids for chronic diseases.     

Corrélation phénotype-génotype des mutations des récepteurs des gonadotrophines chez la femme

Different mutations have been described in LH and FSH genes as well as in their receptors. These mutations are either activating (gain of function), or inhibiting (loss of function). Activating mutations are expressed as a dominant trait, thus in the heterozygous state, whereas inhibiting mutations are only expressed when both alleles bear the mutation. Inactivating mutations of FSH receptor gene, in women, are associated with primary ovarian insufficiency. Inactivating mutations of LH receptor gene have also been described, most often in XX patients whose families also include cases of male pseudohermaphrodism. Clinically, these women suffer from primary amenorrhea but with normal development of breasts and the hair system. Infertility is constant. LH blood levels are increased, estradiol blood levels are those encountered at the beginning of the follicular phase (50-70 pg/ml). The discovery of these mutations allows a better understanding of some genotypes and is helpful in advancing our knowledge of these receptors.     

Prise en charge des lymphœdèmes des membres

Lymphedema results from impaired lymphatic transport with increased limb volume. Cellulitis is the main complication, but psychological or functional discomfort may occur throughout the course of lymphedema. Lymphedema management is based on complete decongestive physiotherapy (multilayer low stretch bandage, manual lymph drainage, skin care, exercises). First phase of treatment leads to a reduction of lymphedema volume. The second phase stabilizes the volume and is based on elastic compression. Resection surgery is a useful tool in external genitalia lymphedema.     

Traitement des calcinoses sous-cutanées des connectivites

Calcinosis cutis constitutes a heterogeneous group of chronic disorder. It can be associated with disturbance of calcium and/or phosphate metabolism (metastatic, tumor calcinosis, calciphylaxis) but may also develop without any metabolic disorder, in particular during the course of connective tissue diseases. Among these, the most common are dermatomyositis and the limited form of systemic sclerosis. The physiopathology of calcinosis cutis is poorly known. It can cause pain, chronic ulcerations, infections, which are sources of sometimes major disability. Treatment of calcinosis is challenging because no drug has been shown to be reliably effective in stopping the progression or decreasing dystrophic calcifications in controlled trials. Calcium blocker and colchicine are generally prescribed as the first line systemic therapy. In the localized forms of small lesions, surgical excision is often effective and sometimes preceded by local treatments (laser therapy, extracorporeal shock wave lithotripsy, topical sodium thiosulfate, etc.) or systemic treatment (minocycline, warfarine). When calcinosis is disseminated, it may require additional treatments (aluminium hydroxyde, bisphosphonates) possibly associated with surgery in case of large lesions. Time to response may be prolonged from weeks to months. The calcinosis cutis can lead to secondary infection, pain and functional disability that have to be prevented.     

Les recombinants des panallergènes polliniques : application à l’interprétation des polysensibilisations

Multiple pollen sensitization is frequently encountered in patients who present with seasonal allergic respiratory symptoms. This regularly leads the allergist to question the significance of skin and laboratory test results because such results make it difficult to differentiate between cross-reactions and co-sensitization. Assays for specific IgE with recombinant panallergens, such as those in the profilin or polcalcin families, the results of which are now available in clinical practice, may lead to a better interpretation of such cases.