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Tedbirt B, Maho-Vaillant M, Houivet E, Mignard C, Golinski ML, Calbo S, Prost-Squarcioni C, Labeille B, Picard-Dahan C, Chaby G, Richard MA, Tancrede-Bohin E, Duvert-Lehembre S, Delaporte E, Bernard P, Caux F, Alexandre M, Musette P, Ingen-Housz-Oro S, Vabres P, Quereux G, Dupuy A, Debarbieux S, Avenel-Audran M, D’Incan M, Bédane C, Bénéton N, Jullien D, Dupin N, Misery L, Machet L, Beylot-Barry M, Dereure O, Sassolas B, Benichou J, Joly P, Hébert V. Sustained Remission Without Corticosteroids Among Patients With Pemphigus Who Had Rituximab as First-Line Therapy: Follow-Up of the Ritux 3 Trial. JAMA Dermatol 2024; 160:290-296. [PMID: 38265821 PMCID: PMC10809134 DOI: 10.1001/jamadermatol.2023.5679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/03/2023] [Indexed: 01/25/2024]
Abstract
Importance The Ritux 3 trial demonstrated the short-term efficacy and safety of first-line treatment with rituximab compared with a standard corticosteroid regimen in pemphigus. No data on the long-term follow-up of patients who received rituximab as first line are available. Objective To assess the long-term efficacy and safety of the Ritux 3 treatment regimen. Design, Setting, and Participants This 7-year follow-up study of the Ritux 3 trial included patients with pemphigus from 25 dermatology departments in France from January 1, 2010, to December 31, 2015. Exposure Patients were initially randomized in the rituximab plus prednisone group or prednisone-alone group. Main outcomes and measures The primary outcome was the 5- and 7-year disease-free survival (DFS) without corticosteroids, assessed by Kaplan-Meier curves. Secondary outcomes were occurrence of relapse, occurrence of severe adverse events (SAEs), and evolution of antidesmoglein (Dsg) antibody enzyme-linked immunosorbent assay values to predict long-term relapse. Results Of the 90 patients in the Ritux 3 trial, 83 were evaluated at the end of follow-up study visit (44 in the rituximab plus prednisone group; 39 in the prednisone-alone group) with a median (IQR) follow-up of 87.3 (79.1-97.5) months. Forty-three patients (93%) from the rituximab plus prednisone and 17 patients (39%) from the prednisone-alone group had achieved complete remission without corticosteroids at any time during the follow-up. Patients from the rituximab group had much longer 5- and 7-year DFS without corticosteroids than patients from the prednisone-alone group (76.7% and 72.1% vs 35.3% and 35.3%, respectively; P < .001), and had about half the relapses (42.2% vs 83.7%; P < .001). Patients who received rituximab as second-line treatment had shorter DFS than patients treated as first line (P = .007). Fewer SAEs were reported in the rituximab plus prednisone group compared with the prednisone-alone group, 31 vs 58 respectively, corresponding to 0.67 and 1.32 SAEs per patient, respectively (P = .003). The combination of anti-Dsg1 values of 20 or more IU/mL and/or anti-Dsg3 values of 48 or more IU/mL yielded 0.83 positive predictive value and 0.94 negative predictive value to predict long-term relapse. Conclusions and Relevance In this secondary analysis of the Ritux 3 trail, first-line treatment of patients with pemphigus with the Ritux 3 regimen was associated with long-term sustained complete remission without corticosteroid therapy without any additional maintenance infusion of rituximab.
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Affiliation(s)
- Billal Tedbirt
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Maud Maho-Vaillant
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Estelle Houivet
- Department of Biostatistics and Clinical Research, CHU Rouen, Rouen, France
| | - Claire Mignard
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Marie-Laure Golinski
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Sébastien Calbo
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Catherine Prost-Squarcioni
- Department of Dermatology, Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France
| | - Bruno Labeille
- Department of Dermatology, University of Saint-Étienne, Saint-Étienne, France
| | | | - Guillaume Chaby
- Department of Dermatology, University of Amiens, Amiens, France
| | - Marie-Aleth Richard
- CEReSS-EA 3279, Research Centre in Health Services and Quality of Life Aix Marseille University, Dermatology Department, Universitaire Hospital Timone, Assistance Publique Hôpitaux de Marseille, APHM, 13385, Marseille, France
| | | | | | | | | | - Frédéric Caux
- Department of Dermatology, Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France
| | - Marina Alexandre
- Department of Dermatology, Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France
| | - Philippe Musette
- Department of Dermatology, Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Univ Paris Est Créteil EpiDermE, Créteil, France
| | - Pierre Vabres
- Department of Dermatology, Dijon University Hospital, Dijon, France
| | - Gaëlle Quereux
- Department of Dermatology, University of Nantes, Nantes, France
| | - Alain Dupuy
- Department of Dermatology, University of Rennes, Rennes, France
| | - Sébastien Debarbieux
- Department of Dermatology, Centre Hospitalier Lyon Sud, Pierre Bénite, Lyon, France
| | | | - Michel D’Incan
- Department of Dermatology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Nathalie Bénéton
- Department of Dermatology, Le Mans General Hospital, Le Mans, France
| | - Denis Jullien
- Department of Dermatology, Edouard Herriot Hospital, Lyon Claude Bernard University, Lyon, France
| | - Nicolas Dupin
- Department of Dermatology, APHP and University of Paris cité, Paris, France
| | - Laurent Misery
- Department of Dermatology, Brest University Hospital, Brest, France
| | - Laurent Machet
- Department of Dermatology, Tours University Hospital, Tours, France
| | | | - Olivier Dereure
- Department of Dermatology, University of Montpellier, Montpellier, France
| | - Bruno Sassolas
- Department of Internal Medicine, Brest University Hospital, Brest, France
| | - Jacques Benichou
- Department of Biostatistics and Clinical Research, CHU Rouen and Inserm U1018, Université Paris-Saclay and Université de Rouen, Rouen, France
| | - Pascal Joly
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Vivien Hébert
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
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Mignard C, Maho-Vaillant M, Golinski ML, Balayé P, Prost-Squarcioni C, Houivet E, Calbo SB, Labeille B, Picard-Dahan C, Konstantinou MP, Chaby G, Richard MA, Bouaziz JD, Duvert-Lehembre S, Delaporte E, Bernard P, Caux F, Alexandre M, Ingen-Housz-Oro S, Vabres P, Quereux G, Dupuy A, Debarbieux S, Avenel-Audran M, D'Incan M, Bédane C, Bénéton N, Jullien D, Dupin N, Misery L, Machet L, Beylot-Barry M, Dereure O, Sassolas B, Benichou J, Joly P, Hébert V. Factors Associated With Short-term Relapse in Patients With Pemphigus Who Receive Rituximab as First-line Therapy: A Post Hoc Analysis of a Randomized Clinical Trial. JAMA Dermatol 2020; 156:545-552. [PMID: 32186656 DOI: 10.1001/jamadermatol.2020.0290] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Importance Rituximab and short-term corticosteroid therapy are the criterion standard treatments for patients with newly diagnosed moderate to severe pemphigus. Objective To examine factors associated with short-term relapse in patients with pemphigus treated with rituximab. Design, Setting, and Participants This post hoc analysis of a randomized clinical trial (Comparison Between Rituximab Treatment and Oral Corticosteroid Treatment in Patients With Pemphigus [RITUX 3]) conducted from January 1, 2010, to December 31, 2015, included patients from 20 dermatology departments of tertiary care centers in France from the RITUX 3 trial and 3 newly diagnosed patients treated according to the trial protocol. Data analysis was performed from February 1 to June 30, 2019. Exposure Patients randomly assigned to the rituximab group in the RITUX 3 trial and the 3 additional patients were treated with 1000 mg of intravenous rituximab on days 0 and 14 and 500 mg at months 12 and 18 combined with a short-term prednisone regimen. Main Outcomes and Measures Baseline (pretreatment) clinical and biological characteristics (Pemphigus Disease Area Index [PDAI] score, ranging from 0-250 points, with higher values indicating more severe disease) and changes in anti-desmoglein (DSG) 1 and anti-DSG3 values as measured by enzyme-linked immunosorbent assay during the 3 months after rituximab treatment were compared between patients with disease relapse and those who maintained clinical remission during the first 12 months after treatment. The positive and negative predictive values of these factors were calculated. Results Among 47 patients (mean [SD] age, 54.3 [17.0] years; 17 [36%] male and 30 [64%] female) included in the study, the mean (SD) baseline PDAI score for patients with relapsing disease was higher than that of the patients with nonrelapsing disease (54 [33] vs 28 [24]; P = .03). At month 3, 7 of 11 patients with relapsing disease (64%) vs 7 of 36 patients with nonrelapsing disease (19%) had persistent anti-DSG1 antibody values of 20 IU/mL or higher and/or anti-DSG3 antibody values of 130 IU/mL or higher (P = .01). A PDAI score of 45 or higher defining severe pemphigus and/or persistent anti-DSG1 antibody values of 20 IU/mL or higher and/or anti-DSG3 antibody values of 130 IU/mL or higher at month 3 provided a positive predictive value of 50% (95% CI, 27%-73%) and a negative predictive value of 94% (95% CI, 73%-100%) for the occurrence of relapse after rituximab. Conclusions and Relevance The findings suggest that initial PDAI score and changes in anti-DSG antibody values after the initial cycle of rituximab might help differentiate a subgroup of patients with high risk of relapse who might benefit from maintenance rituximab infusion at month 6 from a subgroup of patients with low risk of relapse who do not need early maintenance therapy. Trial Registration NCT00784589.
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Affiliation(s)
- Claire Mignard
- Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Rouen University Hospital, Normandie University, INSERM U1234, Rouen, France
| | - Maud Maho-Vaillant
- Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Rouen University Hospital, Normandie University, INSERM U1234, Rouen, France
| | - Marie-Laure Golinski
- Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Rouen University Hospital, Normandie University, INSERM U1234, Rouen, France
| | - Pierre Balayé
- Department of Biostatistics and Clinical Research, Rouen University Hospital, Rouen, France
| | - Catherine Prost-Squarcioni
- Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Department of Dermatology, University of Paris 13, Bobigny, France
| | - Estelle Houivet
- Department of Biostatistics and Clinical Research, Rouen University Hospital, Rouen, France
| | - Sé Bastien Calbo
- Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Rouen University Hospital, Normandie University, INSERM U1234, Rouen, France
| | - Bruno Labeille
- Department of Dermatology, University of Saint Etienne, Saint Etienne, France
| | | | | | - Guillaume Chaby
- Department of Dermatology, University of Amiens, Amiens, France
| | - Marie-Aleth Richard
- Assistance Publique des Hôpitaux de Marseille, Department of Dermatology, Aix Marseille University, UMR 911, INSERM CRO2, Marseille, France
| | - Jean-David Bouaziz
- Department of Dermatology, St Louis Hospital, Paris 7 Sorbonne Paris Cité University, Paris, France
| | | | | | | | - Frédéric Caux
- Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Department of Dermatology, University of Paris 13, Bobigny, France
| | - Marina Alexandre
- Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Department of Dermatology, University of Paris 13, Bobigny, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
| | - Pierre Vabres
- Department of Dermatology, Dijon University Hospital, Dijon, France
| | - Gaëlle Quereux
- Department of Dermatology, University of Nantes, Nantes, France
| | - Alain Dupuy
- Department of Dermatology, University of Rennes, Rennes, France
| | - Sébastien Debarbieux
- Department of Dermatology, Centre Hospitalier Lyon Sud, Pierre Bénite, Lyon, France
| | | | - Michel D'Incan
- Department of Dermatology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Nathalie Bénéton
- Department of Dermatology, Le Mans General Hospital, Le Mans, France
| | - Denis Jullien
- Department of Dermatology, Edouard Herriot Hospital, Lyon Claude Bernard University, Lyon, France
| | - Nicolas Dupin
- Department of Dermatology, University of Paris V, Paris, France
| | - Laurent Misery
- Department of Dermatology, Brest University Hospital, Brest, France
| | - Laurent Machet
- Department of Dermatology, Tours University Hospital, Tours, France
| | | | - Olivier Dereure
- Department of Dermatology, University of Montpellier, Montpellier, France
| | - Bruno Sassolas
- Department of Internal Medicine, Brest University Hospital, Brest, France
| | - Jacques Benichou
- Department of Biostatistics and Clinical Research, Rouen University Hospital, Rouen, France
| | - Pascal Joly
- Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Rouen University Hospital, Normandie University, INSERM U1234, Rouen, France
| | - Vivien Hébert
- Centre de référence des maladies bulleuses auto-immunes, Department of Dermatology, Rouen University Hospital, Normandie University, INSERM U1234, Rouen, France
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Cinotti E, Belgrano V, Labeille B, Grivet D, Douchet C, Chauleur C, Cambazard F, Thomas A, Prade V, Tognetti L, Cartocci A, Rubegni P, Perrot JL. In vivo and ex vivo confocal microscopy for the evaluation of surgical margins of melanoma. J Biophotonics 2020; 13:e202000179. [PMID: 32706484 DOI: 10.1002/jbio.202000179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/30/2020] [Accepted: 07/16/2020] [Indexed: 06/11/2023]
Abstract
We report the first series of melanomas (MMs) where the surgical margins were evaluated both by ex vivo confocal microscopy (EVCM) and in vivo reflectance confocal microscopy (RCM). We evaluated the surgical margins of 42 cutaneous MMs of lentigo maligna/lentigo maligna melanoma type and 2 mucosal MMs with EVCM. Cutaneous MMs also underwent RCM mapping. Imaging results were compared with histopathology. The rate of correct identification of the tumor margins (invaded or not invaded) was 97.6% for RCM (evaluations of cutaneous MMs) and 95.5% for EVCM (evaluations of both cutaneous and mucosal MMs). Our study showed that the MM extension is visible under EVCM and that the combination of in vivo RCM and EVCM can be a new strategy for the evaluation of surgical margins of MMs.
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Affiliation(s)
- Elisa Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Valerio Belgrano
- Department of Surgical Sciences and Integrated Diagnostics, San Martino University General Hospital, Genoa, Italy
| | - Bruno Labeille
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Damien Grivet
- Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Catherine Douchet
- Department of Pathology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Celine Chauleur
- Department of Gynecology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Frédéric Cambazard
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Alix Thomas
- Department of Maxillofacial and Plastic Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Virginie Prade
- Department of Maxillofacial and Plastic Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Linda Tognetti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | | | - Pietro Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Jean Luc Perrot
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
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Cinotti E, Bovi C, Tonini G, Labeille B, Heusèle C, Nizard C, Schnebert S, Aubailly S, Barthélémy JC, Cambazard F, Cevenini G, Tognetti L, Cartocci A, Rubegni P, Perrot JL. Structural skin changes in elderly people investigated by reflectance confocal microscopy. J Eur Acad Dermatol Venereol 2020; 34:2652-2658. [PMID: 32294278 DOI: 10.1111/jdv.16466] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 03/17/2020] [Accepted: 03/25/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Reflectance confocal microscopy (RCM) is particularly suitable for the study of skin ageing because it provides nearly histological information in vivo and non-invasively. However, there are no studies that evaluated RCM skin features of a large population older than 70 years. OBJECTIVES The aim of our investigation was to study age-related skin changes in an elderly population by RCM and to evaluate their topographical and gender differences. METHODS We obtained RCM images of photoprotected (volar arm) and chronic (face) and intermittently photoexposed (dorsal forearm) body sites of 209 volunteers (105 women and 104 men, mean age: 77.5, range 74-81 years). 15 previously reported and new RCM parameters related to skin ageing were assessed. RESULTS Photoexposed sites had thicker suprapapillary epidermis, more linear, distant and thin furrows, higher presence of mottled pigmentation, polycyclic papillae and coarse and huddled collagen and lower presence of dermal papillae than the photoprotected site. Irregular honeycomb pattern was not higher in photoexposed sites, indicating that it is probably more dependent on intrinsic ageing. Two ageing scores defined for facial skin ageing (epidermal disarray score and epidermal hyperplasia score) were found useful for the identification of photoageing. Gender differences only concerned some RCM parameters (i.e. thickness of different layers of the epidermis, furrows and collagen score) and some body sites, in line with the fact that women and men of our cohort had no major differences in clinically visible skin ageing. CONCLUSIONS Our study confirmed that RCM is a powerful non-invasive technique to microscopically quantify ageing signs and our observations contribute to highlight the differences between intrinsic and extrinsic ageing.
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Affiliation(s)
- E Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - C Bovi
- Dermatology Unit, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - G Tonini
- Dermatology Unit, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - B Labeille
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - C Heusèle
- LVMH Research, Saint-Jean-de-Braye, France
| | - C Nizard
- LVMH Research, Saint-Jean-de-Braye, France
| | | | - S Aubailly
- LVMH Research, Saint-Jean-de-Braye, France
| | - J C Barthélémy
- Clinical and Exercise Physiology Laboratory, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - F Cambazard
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - G Cevenini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - L Tognetti
- Dermatology Unit, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - A Cartocci
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - P Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - J L Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
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Schadendorf D, Hauschild A, Fosko S, Zloty D, Labeille B, Grob J, Puig S, Makrutzki M, Gilberg F, Hong A, Dréno B, Rogers G, Kunstfeld R. Quality‐of‐life analysis with intermittent vismodegib regimens in patients with multiple basal cell carcinomas: patient‐reported outcomes from the MIKIE study. J Eur Acad Dermatol Venereol 2020; 34:e526-e529. [DOI: 10.1111/jdv.16446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - A. Hauschild
- University Hospital Schleswig‐Holstein Kiel Germany
| | - S. Fosko
- Saint Louis University Medical School St. Louis MO USA
| | - D. Zloty
- University of British Columbia Vancouver BC Canada
| | - B. Labeille
- University Hospital of Saint‐Etienne Saint‐Priest‐en‐Jarez France
| | - J.‐J. Grob
- Aix‐Marseille University Marseille France
- Timone Hospital Marseille France
| | - S. Puig
- Hospital Clinic de Barcelona University of BarcelonaIDIBAPS (Institut d’Investigacions Biomediques August Pi i Sunyer) Barcelona Spain
- Centro de Investigación Biomedica en Red de Enfermedades Raras (CIBER ER) Barcelona Spain
| | | | - F. Gilberg
- F. Hoffmann‐La Roche Ltd Basel Switzerland
| | - A. Hong
- Genentech, Inc. South San Francisco CA USA
| | | | - G. Rogers
- Tufts University School of Medicine Boston MA USA
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Chen D, Odueyungbo A, Csinady E, Gearhart L, Lehane P, Cheu M, Maho‐Vaillant M, Prost‐Squarcioni C, Hebert V, Houivet E, Calbo S, Caillot F, Golinski M, Labeille B, Picard‐Dahan C, Paul C, Richard M, Bouaziz J, Duvert‐Lehembre S, Bernard P, Caux F, Alexandre M, Ingen‐Housz‐Oro S, Vabres P, Delaporte E, Quereux G, Dupuy A, Debarbieux S, Avenel‐Audran M, D'Incan M, Bedane C, Bénéton N, Jullien D, Dupin N, Misery L, Machet L, Beylot‐Barry M, Dereure O, Sassolas B, Benichou J, Musette P, Joly P. Rituximab is an effective treatment in patients with pemphigus vulgaris and demonstrates a steroid-sparing effect. Br J Dermatol 2020; 182:1111-1119. [PMID: 31487383 PMCID: PMC7317434 DOI: 10.1111/bjd.18482] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Corticosteroids (CS) with or without adjuvant immunosuppressant agents are standard treatment for pemphigus vulgaris (PV). The efficacy of adjuvant therapies in minimizing steroid-related adverse events (AEs) is unproven. OBJECTIVES To utilize data collected in a French investigator-initiated, phase III, open-label, randomized controlled trial to demonstrate the efficacy and safety of rituximab and seek approval for its use in PV. METHODS This was an independently conducted post hoc analysis of the moderate-to-severe PV subset enrolled in the Ritux 3 study. Patients were randomized to rituximab plus 0·5 or 1·0 mg kg-1 per day prednisone tapered over 3 or 6 months, or 1·0 or 1·5 mg kg-1 per day prednisone alone tapered over 12 or 18 months, respectively (according to disease severity). The primary end point was complete remission at month 24 without CS (CRoff) for ≥ 2 months, and 24-month efficacy and safety results were also reported. RESULTS At month 24, 34 of 38 patients (90%) on rituximab plus prednisone achieved CRoff ≥ 2 months vs. 10 of 36 patients (28%) on prednisone alone. Median total cumulative prednisone dose was 5800 mg in the rituximab plus prednisone arm vs. 20 520 mg for prednisone alone. Eight of 36 patients (22%) who received prednisone alone withdrew from treatment owing to AEs; one rituximab-plus-prednisone patient withdrew due to pregnancy. Overall, 24 of 36 patients (67%) on prednisone alone experienced a grade 3/4 CS-related AE vs. 13 of 38 patients (34%) on rituximab plus prednisone. CONCLUSIONS In patients with moderate-to-severe PV, rituximab plus short-term prednisone was more effective than prednisone alone. Patients treated with rituximab had less CS exposure and were less likely to experience severe or life-threatening CS-related AEs. What's already known about this topic? Pemphigus vulgaris (PV) is the most common type of pemphigus. Corticosteroids, a standard first-line treatment for PV, have significant side-effects. Although their effects are unproven, adjuvant corticosteroid-sparing agents are routinely used to minimize steroid exposure and corticosteroid-related side-effects. There is evidence that the anti-CD20 antibody rituximab is effective in the treatment of patients with severe recalcitrant pemphigus and in patients with newly diagnosed pemphigus. What does this study add? This study provides a more detailed analysis of patients with PV enrolled in an investigator-initiated trial. Rituximab plus prednisone had a steroid-sparing effect and more patients achieved complete remission off prednisone. Fewer patients experienced grade 3 or grade 4 steroid-related adverse events than those on prednisone alone. This collaboration between academia and industry, utilizing independent post hoc analyses, led to regulatory authority approvals of rituximab in moderate-to-severe PV.
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Mignard C, Maho-Vaillant M, Prost-Squarcioni C, Calbo S, Golinski ML, Labeille B, Picard-Dahan C, Konstantinou M, Richard MA, Bouaziz J, Duvert-Lehembre S, Bernard P, Caux F, Alexandre M, Oro S, Vabres P, Quereux G, Dupuy A, Debarbieux S, Martin L, D’Incan M, Bedane C, Bénéton N, Jullien D, Dupin N, Misery L, Machet L, Beylot-Barry M, Dereure O, Sassolas B, Hébert V, Joly P. Facteurs pronostiques de rechute à long terme chez les patients atteints de pemphigus traités par rituximab en première ligne. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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8
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Tognetti L, Cinotti E, Fiorani D, Couzan C, Cavarretta C, Chazelle M, Labeille B, Pianigiani E, Cevenini G, Perrot JL, Rubegni P. Long‐term therapy of multiple basal cell carcinomas: Clinicodermoscopic score for monitoring of intermittent vismodegib treatment. Dermatol Ther 2019; 32:e13097. [DOI: 10.1111/dth.13097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/09/2019] [Accepted: 09/23/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Linda Tognetti
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro‐SciencesUniversity of Siena Siena Italy
| | - Elisa Cinotti
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro‐SciencesUniversity of Siena Siena Italy
| | - Diletta Fiorani
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro‐SciencesUniversity of Siena Siena Italy
| | - Caroline Couzan
- Dermatology ServiceUniversity Hospital of Saint‐Etienne France
| | - Camilla Cavarretta
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro‐SciencesUniversity of Siena Siena Italy
| | - Marie Chazelle
- Dermatology ServiceUniversity Hospital of Saint‐Etienne France
| | - Bruno Labeille
- Dermatology ServiceUniversity Hospital of Saint‐Etienne France
| | - Elisa Pianigiani
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro‐SciencesUniversity of Siena Siena Italy
| | | | - Jean L. Perrot
- Dermatology ServiceUniversity Hospital of Saint‐Etienne France
| | - Pietro Rubegni
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro‐SciencesUniversity of Siena Siena Italy
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9
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Cinotti E, Ekinde S, Labeille B, Raberin H, Tognetti L, Rubegni P, Perrot J. Image Gallery: Pigmented hyphae can be identified
in vivo
by high and super‐high magnification dermoscopy. Br J Dermatol 2019; 181:e4. [DOI: 10.1111/bjd.17828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- E. Cinotti
- Department of Medical Surgical and Neurological Science, Dermatology Section University of Siena S. Maria alle Scotte Hospital SienaItaly
| | - S. Ekinde
- Department of Medical Surgical and Neurological Science, Dermatology Section University of Siena S. Maria alle Scotte Hospital SienaItaly
| | - B. Labeille
- Department of Dermatology University Hospital of Saint‐Etienne 42055 Saint‐Etienne Cedex 2France
| | - H. Raberin
- Parasitology and Mycology Laboratory University Hospital of Saint‐Etienne 42055 Saint‐Etienne Cedex 2 France
| | - L. Tognetti
- Department of Medical Surgical and Neurological Science, Dermatology Section University of Siena S. Maria alle Scotte Hospital SienaItaly
| | - P. Rubegni
- Department of Medical Surgical and Neurological Science, Dermatology Section University of Siena S. Maria alle Scotte Hospital SienaItaly
| | - J.L. Perrot
- Department of Dermatology University Hospital of Saint‐Etienne 42055 Saint‐Etienne Cedex 2France
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10
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Cinotti E, Fiorani D, Labeille B, Gonzalez S, Debarbieux S, Agozzino M, Ardigò M, Lacarrubba F, Farnetani F, Carrera C, Cevenini G, Le Duff F, Tognetti L, Pellacani G, Rubegni P, Perrot JL. The integration of dermoscopy and reflectance confocal microscopy improves the diagnosis of lentigo maligna. J Eur Acad Dermatol Venereol 2019; 33:e372-e374. [PMID: 31074539 DOI: 10.1111/jdv.15669] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- E Cinotti
- Dermatology Section, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - D Fiorani
- Dermatology Section, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - B Labeille
- Department of Dermatology, University Hospital of St-Etienne, Saint-Etienne, France
| | - S Gonzalez
- Medicine and Medical Specialities Department, Alcalá University, Madrid, Spain
| | - S Debarbieux
- Departments of Dermatology, Centre Hospitalier Lyon Sud, Pierre Benite, France
| | - M Agozzino
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - M Ardigò
- Clinical Dermatology, San Gallicano Dermatological Institute, Rome, Italy
| | - F Lacarrubba
- Dermatology Clinic, University of Catania, Catania, Italy
| | - F Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - C Carrera
- Melanoma Unit, Department of Dermatology, Hospital Clínic de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona University, Barcelona, Spain
| | - G Cevenini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - F Le Duff
- Department of Dermatology, Clinical Research Center, Hopital Archet 2, Nice, France
| | - L Tognetti
- Dermatology Section, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - P Rubegni
- Dermatology Section, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - J L Perrot
- Department of Dermatology, University Hospital of St-Etienne, Saint-Etienne, France
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11
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Cinotti E, La Rocca A, Labeille B, Grivet D, Lambert V, Kaspi M, Nami N, Cambazard F, Fimiani M, Thuret G, Gain P, Tognetti L, Rubegni P, Perrot J. Dermoscopy for the diagnosis of eyelid margin tumours. Br J Dermatol 2019; 181:397-398. [DOI: 10.1111/bjd.17743] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- E. Cinotti
- Department of Medical Surgical and Neurological Science, Dermatology Section University of Siena Santa Maria alle Scotte Hospital SienaItaly
| | - A. La Rocca
- Department of Medical Surgical and Neurological Science, Dermatology Section University of Siena Santa Maria alle Scotte Hospital SienaItaly
| | - B. Labeille
- Department of Dermatology University Hospital of Saint‐Etienne 42055 Saint‐Etienne cedex 2France
| | - D. Grivet
- Department of Ophthalmology; University Hospital of Saint‐Etienne 42055 Saint‐Etienne cedex 2France
- Laboratory of Biology, Engineering and Corneal Graft Imaging Jean Monnet University 42000 Saint‐EtienneFrance
| | - V. Lambert
- Department of Ophthalmology; University Hospital of Saint‐Etienne 42055 Saint‐Etienne cedex 2France
- Laboratory of Biology, Engineering and Corneal Graft Imaging Jean Monnet University 42000 Saint‐EtienneFrance
| | - M. Kaspi
- Department of Ophthalmology; University Hospital of Saint‐Etienne 42055 Saint‐Etienne cedex 2France
- Laboratory of Biology, Engineering and Corneal Graft Imaging Jean Monnet University 42000 Saint‐EtienneFrance
| | - N. Nami
- Department of Medical Surgical and Neurological Science, Dermatology Section University of Siena Santa Maria alle Scotte Hospital SienaItaly
| | - F. Cambazard
- Department of Dermatology University Hospital of Saint‐Etienne 42055 Saint‐Etienne cedex 2France
| | - M. Fimiani
- Department of Medical Surgical and Neurological Science, Dermatology Section University of Siena Santa Maria alle Scotte Hospital SienaItaly
| | - G. Thuret
- Department of Ophthalmology; University Hospital of Saint‐Etienne 42055 Saint‐Etienne cedex 2France
- Laboratory of Biology, Engineering and Corneal Graft Imaging Jean Monnet University 42000 Saint‐EtienneFrance
- French University Institute Boulevard Saint‐Michel 75005 Paris France
| | - P. Gain
- Department of Ophthalmology; University Hospital of Saint‐Etienne 42055 Saint‐Etienne cedex 2France
- Laboratory of Biology, Engineering and Corneal Graft Imaging Jean Monnet University 42000 Saint‐EtienneFrance
| | - L. Tognetti
- Department of Medical Surgical and Neurological Science, Dermatology Section University of Siena Santa Maria alle Scotte Hospital SienaItaly
| | - P. Rubegni
- Department of Medical Surgical and Neurological Science, Dermatology Section University of Siena Santa Maria alle Scotte Hospital SienaItaly
| | - J.L. Perrot
- Department of Dermatology University Hospital of Saint‐Etienne 42055 Saint‐Etienne cedex 2France
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12
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Lamberti A, Cinotti E, Habougit C, Labeille B, Rubegni P, Perrot JL. Ex vivo confocal microscopy for dermatofibrosarcoma protuberans. Skin Res Technol 2019; 25:589-591. [PMID: 30861221 DOI: 10.1111/srt.12690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 02/14/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Arianna Lamberti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Elisa Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Cyril Habougit
- Department of Pathology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Bruno Labeille
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Pietro Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Jean-Luc Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
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13
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Hébert V, Boulard C, Houivet E, Duvert Lehembre S, Borradori L, Della Torre R, Feliciani C, Fania L, Zambruno G, Camaioni DB, Didona B, Marinovic B, Schmidt E, Schumacher N, Hünefeld C, Schanz S, Kern JS, Hofmann S, Bouyeure AC, Picard-Dahan C, Prost-Squarcioni C, Caux F, Alexandre M, Ingen-Housz-Oro S, Bagot M, Tancrede-Bohin E, Bouaziz JD, Franck N, Vabres P, Labeille B, Richard MA, Delaporte E, Dupuy A, D’Incan M, Quereux G, Skowro F, Paul C, Livideanu CB, Beylot-Barry M, Doutre MS, Avenel-Audran M, Bedane C, Bernard P, Machet L, Maillard H, Jullien D, Debarbieux S, Sassolas B, Misery L, Abasq C, Dereure O, Lagoutte P, Ferranti V, Werth VP, Murrell DF, Hertl M, Benichou J, Joly P. Large International Validation of ABSIS and PDAI Pemphigus Severity Scores. J Invest Dermatol 2019; 139:31-37. [DOI: 10.1016/j.jid.2018.04.042] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/20/2018] [Accepted: 04/25/2018] [Indexed: 11/29/2022]
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14
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Plaquevent M, Tétart F, Fardet L, Ingen-Housz-Oro S, Valeyrie-Allanore L, Bernard P, Hebert V, Roussel A, Avenel-Audran M, Chaby G, D'Incan M, Ferrier-Le-Bouedec MC, Duvert-Lehembre S, Picard-Dahan C, Jeudy G, Collet E, Labeille B, Morice C, Richard MA, Bourgault-Villada I, Litrowski N, Bara C, Mahe E, Prost-Squarcioni C, Alexandre M, Quereux G, Bernier C, Soria A, Thomas-Beaulieu D, Pauwels C, Dereure O, Benichou J, Joly P. Higher Frequency of Dipeptidyl Peptidase-4 Inhibitor Intake in Bullous Pemphigoid Patients than in the French General Population. J Invest Dermatol 2018; 139:835-841. [PMID: 30543900 DOI: 10.1016/j.jid.2018.10.045] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 10/17/2018] [Accepted: 10/29/2018] [Indexed: 12/13/2022]
Abstract
Dipeptidyl peptidase-4 inhibitors have been suspected to induce bullous pemphigoid (BP). The objective of this study was to compare the observed frequency of gliptin intake in a large sample of 1,787 BP patients diagnosed between 2012 and 2015 in France, with the expected frequency after indirect age standardization on 225,412 individuals extracted from the database of the National Healthcare Insurance Agency. The secondary objective was to assess the clinical characteristics and the course of gliptin-associated BP, depending on whether gliptin was continued or stopped. The observed frequencies of intake of the whole gliptin class and that of vildagliptin in the BP population were higher than those in the general population after age standardization (whole gliptin class: 6.0%; 95% confidence interval = 4.9-7.1% vs. 3.6%, observed-to-expected drug intake ratio = 1.7; 95% confidence interval = 1.4-2.0; P < 0.0001; vildagliptin = 3.3%; 95% confidence interval = 2.5-4.1% vs. 0.7%, ratio = 4.4; 95% confidence interval = 3.5-5.7; P < 0.0001). The association of any gliptin+metformin was also higher than in the general population, ratio = 1.8 (95% confidence interval = 1.3-2.4; P < 0.0001). Gliptin-associated BP had no specific clinical characteristics. Gliptin was stopped in 48 (45.3%) cases. Median duration to achieve disease control, rate, and delay of relapse were not different whether gliptin was stopped or continued. This study strongly supports the association between gliptin intake, particularly vildagliptin, and the onset of BP.
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Affiliation(s)
- Marthe Plaquevent
- Department of Dermatology, Rouen University Hospital and Institut National de la Santé et de la Recherche Médicale U1234, Centre de Référence des Maladies Bulleuses Autoimmunes, Normandie University, Rouen, France.
| | - Florence Tétart
- Department of Dermatology, Rouen University Hospital and Institut National de la Santé et de la Recherche Médicale U1234, Centre de Référence des Maladies Bulleuses Autoimmunes, Normandie University, Rouen, France
| | - Laurence Fardet
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
| | - Laurence Valeyrie-Allanore
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
| | | | - Vivien Hebert
- Department of Dermatology, Rouen University Hospital and Institut National de la Santé et de la Recherche Médicale U1234, Centre de Référence des Maladies Bulleuses Autoimmunes, Normandie University, Rouen, France
| | - Aude Roussel
- Department of Dermatology, Orleans Hospital, Orléans, France
| | | | - Guillaume Chaby
- Department of Dermatology, University of Amiens, Amiens, France
| | - Michel D'Incan
- Department of Dermatology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | | | - Geraldine Jeudy
- Department of Dermatology Dijon University Hospital, Dijon, France
| | - Evelyne Collet
- Department of Dermatology Dijon University Hospital, Dijon, France
| | - Bruno Labeille
- Department of Dermatology, University of Saint Etienne, Saint Etienne, France
| | - Cécile Morice
- Department of Dermatology, University of Caen, Caen, France
| | - Marie-Aleth Richard
- Department of Dermatology, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Unité Mixte de Recherche 911, Institut National de la Santé et de la Recherche Médicale CRO2, Marseille, France
| | | | - Noémie Litrowski
- Department of Dermatology, Jacques Monod Hospital, Montivilliers, France
| | - Corina Bara
- Department of Dermatology, Le Mans General Hospital, Le Mans, France
| | - Emmanuel Mahe
- Department of Dermatology, Argenteuil Hospital, Argenteuil, France
| | | | - Marina Alexandre
- Department of Dermatology, University of Paris XIII, Bobigny, France
| | - Gaelle Quereux
- Department of Dermatology, University of Nantes, Nantes, France
| | - Claire Bernier
- Department of Dermatology, University of Nantes, Nantes, France
| | - Angèle Soria
- Department of Dermatology and Allergology, Tenon Hospital, Paris, France
| | | | - Christine Pauwels
- Department of Dermatology, Poissy-Saint Germain Hospital, Saint-Germain-en-Laye, France
| | - Olivier Dereure
- Department of Dermatology, University of Montpellier, Montpellier, France
| | - Jacques Benichou
- Department of Biostatistics, Rouen University Hospital and Institut National de la Santé et de la Recherche Médicale U1219, Normandie University, Rouen, France
| | - Pascal Joly
- Department of Dermatology, Rouen University Hospital and Institut National de la Santé et de la Recherche Médicale U1234, Centre de Référence des Maladies Bulleuses Autoimmunes, Normandie University, Rouen, France
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15
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Perrillat-Collomb N, Grivet D, Habougit C, Labeille B, Perrot JL. Apport de la microscopie confocale in vivo (MCIV) par rapport à l’examen à la lampe à fente dans le diagnostic des lésions mélaniques caronculaires. Ann Dermatol Venereol 2018. [DOI: 10.1016/j.annder.2018.09.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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16
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Theillac C, Cinotti E, Malvehy J, Ronger Savle S, Balme B, Robinson P, Perrot JL, Douchet C, Biron Schneider AC, Alos L, Garcia A, Barreiro A, Labeille B, Duru G, Dalle S, Thomas L, Debarbieux S. Evaluation of large clinically atypical vulvar pigmentation with RCM: atypical melanosis or early melanoma? J Eur Acad Dermatol Venereol 2018; 33:84-92. [PMID: 29920797 DOI: 10.1111/jdv.15141] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/22/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vulvar melanosis can occasionally be clinically challenging by mimicking an early melanoma. OBJECTIVE To report our experience of initial evaluation and follow-up in this peculiar subset of vulvar melanosis using reflectance confocal microscopy (RCM). METHODS We retrospectively evaluated 18 consecutive cases referred for atypical vulvar pigmentation or for which melanoma was considered and that underwent both RCM examination and histopathological assessment. In 13 cases with available dermoscopic pictures, RCM classification was compared to dermoscopic diagnosis, and in all cases, the density of melanocytes was evaluated on biopsies using MelanA immunostaining. RESULTS Among the 18 atypical pigmented lesions, 17 vulvar melanosis and one melanoma were histologically determined. RCM concluded a benign vulvar melanosis in 10 of 17 cases, whereas dermoscopy did so in three of 12 cases. RCM identified the only early malignant lentiginous melanoma. In several cases of vulvar melanosis, RCM could identify foci of melanocytic hyperplasia in an otherwise benign pattern. CONCLUSIONS In this clinically and dermoscopically challenging subset of vulvar pigmentations, RCM appears relevant for initial extensive evaluation, especially to target initial biopsy sampling, and to perform non-invasive monitoring of foci of melanocytic hyperplasia.
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Affiliation(s)
- C Theillac
- Dermatology Department, Centre Hospitalier de Lyon Sud, Hospices civils de Lyon, Université Claude Bernard Lyon 1, Pierre Bénite, France
| | - E Cinotti
- Dermatology Department, University Hospital of Saint-Etienne, Saint-Etienne, France.,Pour le Groupe Imagerie Cutanée Non Invasive de la Société Française de Dermatologie, Paris, France
| | - J Malvehy
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - S Ronger Savle
- Dermatology Department, Centre Hospitalier de Lyon Sud, Hospices civils de Lyon, Université Claude Bernard Lyon 1, Pierre Bénite, France
| | - B Balme
- Pathology Department, Centre Hospitalier de Lyon Sud, Lyon, France
| | - P Robinson
- DRCI, Hospices Civils de Lyon, Lyon, France
| | - J L Perrot
- Dermatology Department, University Hospital of Saint-Etienne, Saint-Etienne, France.,Pour le Groupe Imagerie Cutanée Non Invasive de la Société Française de Dermatologie, Paris, France
| | - C Douchet
- Pathology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - A C Biron Schneider
- Dermatology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - L Alos
- Pathology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A Garcia
- Pathology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A Barreiro
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - B Labeille
- Dermatology Department, University Hospital of Saint-Etienne, Saint-Etienne, France.,Pour le Groupe Imagerie Cutanée Non Invasive de la Société Française de Dermatologie, Paris, France
| | - G Duru
- Department of Biostatistics, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - S Dalle
- Dermatology Department, Centre Hospitalier de Lyon Sud, Hospices civils de Lyon, Université Claude Bernard Lyon 1, Pierre Bénite, France
| | - L Thomas
- Dermatology Department, Centre Hospitalier de Lyon Sud, Hospices civils de Lyon, Université Claude Bernard Lyon 1, Pierre Bénite, France
| | - S Debarbieux
- Dermatology Department, Centre Hospitalier de Lyon Sud, Hospices civils de Lyon, Université Claude Bernard Lyon 1, Pierre Bénite, France.,Pour le Groupe Imagerie Cutanée Non Invasive de la Société Française de Dermatologie, Paris, France
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17
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Cinotti E, Veronesi G, Labeille B, Cambazard F, Piraccini B, Dika E, Perrot J, Rubegni P. Imaging technique for the diagnosis of onychomatricoma. J Eur Acad Dermatol Venereol 2018; 32:1874-1878. [DOI: 10.1111/jdv.15108] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- E. Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section S. Maria alle Scotte Hospital University of Siena Siena Italy
| | - G. Veronesi
- Dermatology Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna Italy
| | - B. Labeille
- Department of Dermatology University Hospital of St‐Etienne Saint‐Etienne France
| | - F. Cambazard
- Department of Dermatology University Hospital of St‐Etienne Saint‐Etienne France
| | - B.M. Piraccini
- Dermatology Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna Italy
| | - E. Dika
- Dermatology Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna Italy
| | - J.L. Perrot
- Department of Dermatology University Hospital of St‐Etienne Saint‐Etienne France
| | - P. Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology Section S. Maria alle Scotte Hospital University of Siena Siena Italy
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18
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Cinotti E, Perrot JL, Labeille B, Cambazard F, Rubegni P. Ex vivo confocal microscopy: an emerging technique in dermatology. Dermatol Pract Concept 2018; 8:109-119. [PMID: 29785327 PMCID: PMC5955077 DOI: 10.5826/dpc.0802a08] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 01/18/2018] [Indexed: 12/13/2022] Open
Abstract
This review aims to give an overview of the current available applications of ex vivo confocal microscopy (EVCM) in dermatology. EVCM is a relatively new imaging technique that allows microscopic examination of freshly excised unfixed tissue. It enables a rapid examination of the skin sample directly in the surgery room and thus represents an alternative to the intraoperative micrographic control of the surgical margins of cutaneous tumors by standard microscopic examination on cryopreserved sections during Mohs surgery. Although this technique has mainly been developed for the margin’s control of basal cell carcinoma, many other skin tumors have been studied, including melanoma. Use of EVCM is continuing to evolve, and many possible applications are under investigation, such as the study of nails and hair diseases and the diagnosis of skin infections.
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Affiliation(s)
- Elisa Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Jean Luc Perrot
- Department of Dermatology, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Bruno Labeille
- Department of Dermatology, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Frédéric Cambazard
- Department of Dermatology, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Pietro Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
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19
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Couty E, Tognetti L, Labeille B, Douchet C, Habougit C, Couzan C, Biron-Schneider AC, Cambazard F, Prade V, Rubegni P, Cinotti E, Perrot JL. In vivo reflectance confocal microscopy combined with the 'spaghetti technique' for the identification of surgical margins of lentigo maligna: experience in 70 patients. J Eur Acad Dermatol Venereol 2018; 32:e366-e368. [PMID: 29573292 DOI: 10.1111/jdv.14947] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E Couty
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - L Tognetti
- Department of Dermatology - Division of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - B Labeille
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - C Douchet
- Department of Pathology, University Hospital of Saint Etienne, Saint-Etienne, France
| | - C Habougit
- Department of Pathology, University Hospital of Saint Etienne, Saint-Etienne, France
| | - C Couzan
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - A C Biron-Schneider
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - F Cambazard
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - V Prade
- Department of Maxillofacial and Plastic Surgery, University Hospital of Saint Etienne, Saint-Etienne, France
| | - P Rubegni
- Department of Dermatology - Division of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - E Cinotti
- Department of Dermatology - Division of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - J L Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
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20
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Mandel V, Cinotti E, Benati E, Labeille B, Ciardo S, Vaschieri C, Cambazard F, Perrot J, Pellacani G. Reflectance confocal microscopy and optical coherence tomography for the diagnosis of bullous pemphigoid and pemphigus and surrounding subclinical lesions. J Eur Acad Dermatol Venereol 2018; 32:1562-1569. [DOI: 10.1111/jdv.14795] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 12/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- V.D. Mandel
- Dermatology Unit; Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - E. Cinotti
- Department of Dermatology; University Hospital of Saint-Étienne; Saint-Étienne France
| | - E. Benati
- Dermatology Unit; Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - B. Labeille
- Department of Dermatology; University Hospital of Saint-Étienne; Saint-Étienne France
| | - S. Ciardo
- Dermatology Unit; Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - C. Vaschieri
- Dermatology Unit; Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - F. Cambazard
- Department of Dermatology; University Hospital of Saint-Étienne; Saint-Étienne France
| | - J.L. Perrot
- Department of Dermatology; University Hospital of Saint-Étienne; Saint-Étienne France
| | - G. Pellacani
- Dermatology Unit; Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine; University of Modena and Reggio Emilia; Modena Italy
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21
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Cinotti E, Labeille B, Debarbieux S, Carrera C, Lacarrubba F, Witkowski A, Moscarella E, Arzberger E, Kittler H, Bahadoran P, Gonzalez S, Guitera P, Agozzino M, Farnetani F, Hofmann-Wellenhof R, Ardigò M, Rubegni P, Tognetti L, Łudzik J, Zalaudek I, Argenziano G, Longo C, Ribero S, Malvehy J, Pellacani G, Cambazard F, Perrot J. Dermoscopy vs. reflectance confocal microscopy for the diagnosis of lentigo maligna. J Eur Acad Dermatol Venereol 2018; 32:1284-1291. [DOI: 10.1111/jdv.14791] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/19/2017] [Indexed: 11/30/2022]
Affiliation(s)
- E. Cinotti
- Department of Dermatology; University Hospital of St-Etienne; Saint-Etienne France
- Department of Medical; Surgical and Neurological Science; Dermatology Section; University of Siena; S. Maria alle Scotte Hospital; Siena Italy
| | - B. Labeille
- Department of Dermatology; University Hospital of St-Etienne; Saint-Etienne France
| | - S. Debarbieux
- Departments of Dermatology; Centre Hospitalier Lyon Sud; Pierre Benite France
| | - C. Carrera
- Melanoma Unit; Department of Dermatology; Hospital Clínic de Barcelona; IDIBAPS; Barcelona University; Barcelona Spain
| | - F. Lacarrubba
- Dermatology Clinic; University of Catania; Catania Italy
| | - A.M. Witkowski
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - E. Moscarella
- Dermatology Unit; Second University of Naples; Nuovo Policlinico; Naples Italy
| | - E. Arzberger
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - H. Kittler
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - P. Bahadoran
- Department of Dermatology; Clinical Research Center; Hopital Archet 2; Nice France
| | - S. Gonzalez
- Medicine and Medical Specialities Department; Madrid and Dermatology Department; Alcalá University; Memorial Sloan-Kettering Cancer Center; New York NY USA
| | - P. Guitera
- Department of Dermatology; The University of Sydney; Sydney Melanoma Diagnostic Centre and Melanoma Institute Australia; Sydney NSW Australia
| | - M. Agozzino
- Dermatology Unit; Second University of Naples; Nuovo Policlinico; Naples Italy
| | - F. Farnetani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - R. Hofmann-Wellenhof
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - M. Ardigò
- Clinical Dermatology; San Gallicano Dermatological Institute; Rome Italy
| | - P. Rubegni
- Department of Medical; Surgical and Neurological Science; Dermatology Section; University of Siena; S. Maria alle Scotte Hospital; Siena Italy
| | - L. Tognetti
- Department of Medical; Surgical and Neurological Science; Dermatology Section; University of Siena; S. Maria alle Scotte Hospital; Siena Italy
- Department of Medical Biotechnologies; University of Siena; Siena Italy
| | - J. Łudzik
- Department of Bioinformatics and Telemedicine; Jagiellonian University Medical College; Krakow Poland
| | - I. Zalaudek
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - G. Argenziano
- Dermatology Unit; Second University of Naples; Nuovo Policlinico; Naples Italy
| | - C. Longo
- Dermatology and Skin Cancer Unit; Arcispedale Santa Maria Nuova-IRCCS; Reggio Emilia Italy
| | - S. Ribero
- Department of Medical Sciences; University of Turin; Turin Italy
| | - J. Malvehy
- Melanoma Unit; Department of Dermatology; Hospital Clínic de Barcelona; IDIBAPS; Barcelona University; Barcelona Spain
| | - G. Pellacani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - F. Cambazard
- Department of Dermatology; University Hospital of St-Etienne; Saint-Etienne France
| | - J.L. Perrot
- Department of Dermatology; University Hospital of St-Etienne; Saint-Etienne France
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22
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Bordeianu C, Parat A, Piant S, Walter A, Zbaraszczuk-Affolter C, Meyer F, Begin-Colin S, Boutry S, Muller RN, Jouberton E, Chezal JM, Labeille B, Cinotti E, Perrot JL, Miot-Noirault E, Laurent S, Felder-Flesch D. Evaluation of the Active Targeting of Melanin Granules after Intravenous Injection of Dendronized Nanoparticles. Mol Pharm 2018; 15:536-547. [PMID: 29298480 DOI: 10.1021/acs.molpharmaceut.7b00904] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The biodistribution of dendronized iron oxides, NPs10@D1_DOTAGA and melanin-targeting NPs10@D1_ICF_DOTAGA, was studied in vivo using magnetic resonance imaging (MRI) and planar scintigraphy through [177Lu]Lu-radiolabeling. MRI experiments showed high contrast power of both dendronized nanoparticles (DPs) and hepatobiliary and urinary excretions. Little tumor uptake could be highlighted after intravenous injection probably as a consequence of the negatively charged DOTAGA-derivatized shell, which reduces the diffusion across the cells' membrane. Planar scintigraphy images demonstrated a moderate specific tumor uptake of melanoma-targeted [177Lu]Lu-NPs10@D1_ICF_DOTAGA at 2 h post-intravenous injection (pi), and the highest tumor uptake of the control probe [177Lu]Lu-NPs10@D1_DOTAGA at 30 min pi, probably due to the enhanced permeability and retention effect. In addition, ex vivo confocal microscopy studies showed a high specific targeting of human melanoma samples impregnated with NPs10@D1_ICF_Alexa647_ DOTAGA.
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Affiliation(s)
- C Bordeianu
- Université de Strasbourg , CNRS, Institut de Physique et Chimie des Matériaux de Strasbourg, UMR 7504, F-67000 Strasbourg, France.,Fondation IcFRC/Université de Strasbourg , 8 allée Gaspard Monge BP 70028, F-67083 Strasbourg Cedex, France
| | - A Parat
- Université de Strasbourg , CNRS, Institut de Physique et Chimie des Matériaux de Strasbourg, UMR 7504, F-67000 Strasbourg, France.,Fondation IcFRC/Université de Strasbourg , 8 allée Gaspard Monge BP 70028, F-67083 Strasbourg Cedex, France
| | - S Piant
- Université de Strasbourg , CNRS, Institut de Physique et Chimie des Matériaux de Strasbourg, UMR 7504, F-67000 Strasbourg, France.,Fondation IcFRC/Université de Strasbourg , 8 allée Gaspard Monge BP 70028, F-67083 Strasbourg Cedex, France
| | - A Walter
- Université de Strasbourg , CNRS, Institut de Physique et Chimie des Matériaux de Strasbourg, UMR 7504, F-67000 Strasbourg, France.,Fondation IcFRC/Université de Strasbourg , 8 allée Gaspard Monge BP 70028, F-67083 Strasbourg Cedex, France
| | - C Zbaraszczuk-Affolter
- Université de Strasbourg , INSERM, UMR 1121 Biomatériaux et Bioingénierie, 11 rue Humann F-67000 Strasbourg, France
| | - F Meyer
- Université de Strasbourg , INSERM, UMR 1121 Biomatériaux et Bioingénierie, 11 rue Humann F-67000 Strasbourg, France
| | - S Begin-Colin
- Université de Strasbourg , CNRS, Institut de Physique et Chimie des Matériaux de Strasbourg, UMR 7504, F-67000 Strasbourg, France.,Fondation IcFRC/Université de Strasbourg , 8 allée Gaspard Monge BP 70028, F-67083 Strasbourg Cedex, France
| | - S Boutry
- University of Mons , General, Organic and Biomedical Chemistry NMR and Molecular Imaging Laboratory, Avenue Maistriau 19, 7000 Mons, Belgium.,CMMI - Center for Microscopy and Molecular Imaging, MRI & Optical Imaging , Rue Adrienne Bolland 8, 6041 Gosselies, Belgium
| | - R N Muller
- University of Mons , General, Organic and Biomedical Chemistry NMR and Molecular Imaging Laboratory, Avenue Maistriau 19, 7000 Mons, Belgium.,CMMI - Center for Microscopy and Molecular Imaging, MRI & Optical Imaging , Rue Adrienne Bolland 8, 6041 Gosselies, Belgium
| | - E Jouberton
- Clermont Université, Université d'Auvergne , Laboratoire d'Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, F-63000 Clermont-Ferrand, France.,INSERM, U1240 , F-63005 Clermont-Ferrand, France
| | - J-M Chezal
- Clermont Université, Université d'Auvergne , Laboratoire d'Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, F-63000 Clermont-Ferrand, France.,INSERM, U1240 , F-63005 Clermont-Ferrand, France
| | - B Labeille
- CHU , Département de Dermatologie, F-42000 St. Etienne, France
| | - E Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena , S. Maria alle Scotte Hospital, F-53100 Siena, Italy
| | - J-L Perrot
- CHU , Département de Dermatologie, F-42000 St. Etienne, France
| | - E Miot-Noirault
- Clermont Université, Université d'Auvergne , Laboratoire d'Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, F-63000 Clermont-Ferrand, France.,INSERM, U1240 , F-63005 Clermont-Ferrand, France
| | - S Laurent
- University of Mons , General, Organic and Biomedical Chemistry NMR and Molecular Imaging Laboratory, Avenue Maistriau 19, 7000 Mons, Belgium.,CMMI - Center for Microscopy and Molecular Imaging, MRI & Optical Imaging , Rue Adrienne Bolland 8, 6041 Gosselies, Belgium
| | - D Felder-Flesch
- Université de Strasbourg , CNRS, Institut de Physique et Chimie des Matériaux de Strasbourg, UMR 7504, F-67000 Strasbourg, France.,Fondation IcFRC/Université de Strasbourg , 8 allée Gaspard Monge BP 70028, F-67083 Strasbourg Cedex, France
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Grechenig C, Cinotti E, Labeille B, Langmann G, Perrot JL, Schatz O, Tarmann L, Wedrich A, Wackernagel W, Zalaudek I, Haybaeck J, Schwab C. Examination of the melanocytes of the Nevus of Ota with in vivo reflectance confocal microscopy: 15 cases. J Eur Acad Dermatol Venereol 2018; 32:e241-e242. [PMID: 29314292 DOI: 10.1111/jdv.14783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C Grechenig
- Department of Ophthalmology, Medical University of Graz, Graz, Styria, Austria
| | - E Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - B Labeille
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - G Langmann
- Department of Ophthalmology, Medical University of Graz, Graz, Styria, Austria
| | - J L Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - O Schatz
- Department of Ophthalmology, Medical University of Graz, Graz, Styria, Austria
| | - L Tarmann
- Department of Ophthalmology, Medical University of Graz, Graz, Styria, Austria
| | - A Wedrich
- Department of Ophthalmology, Medical University of Graz, Graz, Styria, Austria
| | - W Wackernagel
- Department of Ophthalmology, Medical University of Graz, Graz, Styria, Austria
| | - I Zalaudek
- Department of Dermatology, Hospital Maggiore, University of Triest, Triest, Italy
| | - J Haybaeck
- Institute of Pathology, Medical University of Graz, Graz, Styria, Austria.,Department of Pathology, Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - C Schwab
- Department of Ophthalmology, Medical University of Graz, Graz, Styria, Austria
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24
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Perrot JL, Zuckervar P, Salavert M, Parier J, Michel JL, Barrachin JP, Guillem P, Cinotti E, Labeille B. Descriptif des sites atteints par la maladie de Verneuil à propos de 882 sujets : étude multicentrique française ville-hôpital EpiVer. Ann Dermatol Venereol 2017. [DOI: 10.1016/j.annder.2017.09.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Jalenques I, Rondepierre F, Massoubre C, Labeille B, Perrot JL, Mulliez A, D'Incan M. Treatment of Psychiatric Disorders and Skin-Restricted Lupus Remission: A Longitudinal Study. JAMA Dermatol 2017; 153:1331-1332. [PMID: 28979971 DOI: 10.1001/jamadermatol.2017.3590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Isabelle Jalenques
- Service de Psychiatrie de l'Adulte A et Psychologie médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Fabien Rondepierre
- Service de Psychiatrie de l'Adulte A et Psychologie médicale, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Catherine Massoubre
- Service de Psychiatrie, CHU St-Etienne, University Jean Monnet, St-Etienne, France
| | - Bruno Labeille
- Service de dermatologie, CHU Hopital Nord, Saint-Etienne, France
| | - Jean-Luc Perrot
- Service de dermatologie, CHU Hopital Nord, Saint-Etienne, France
| | - Aurélien Mulliez
- Direction de la Recherche Clinique et de l'Innovation, CHU Clermont Ferrand, Clermont-Ferrand, France
| | - Michel D'Incan
- Service de Dermatologie, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
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Plaquevent M, Tetart F, Fardet L, Oro S, Bernard P, Roussel A, Avenel-Audran M, Chaby G, D’incan M, Souteyrand P, Duvert-Lehembre S, Picard-Dahan C, Jeudy G, Labeille B, Morice C, Richard MA, Bourgault Villada I, Litrowski N, Bara C, Mahe E, Prost C, Alexandre M, Quereux G, Soria A, Thomas-Beaulieu D, Pauwels C, Joly P. Pemphigoïdes bulleuses associées aux gliptines : mythe ou réalité ? Ann Dermatol Venereol 2017. [DOI: 10.1016/j.annder.2017.09.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Couty E, Labeille B, Cambazard F, Cinotti E, Biron A, Douchet C, Couzan C, Perrot J. Utilisation du microscope confocal dans la chirurgie de MOHS des lentigos malins. Ann Dermatol Venereol 2017. [DOI: 10.1016/j.annder.2017.09.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Allal S, Guillem P, Fougerousse A, Beneton N, Maccari F, Labeille B, Tisseran E, Vuering F, Vergote-Pelamourgues S, Cinotti E, Perrot JL. Données démographiques et biométriques de 882 sujets atteints de maladie de Verneuil : EpiVer étude multicentrique française ville-hôpital. Ann Dermatol Venereol 2017. [DOI: 10.1016/j.annder.2017.09.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Couzan C, Cinotti E, Labeille B, Vercherin P, Rubegni P, Cambazard F, Perrot JL. Reflectance confocal microscopy identification of subclinical basal cell carcinomas during and after vismodegib treatment. J Eur Acad Dermatol Venereol 2017; 32:763-767. [PMID: 29055164 DOI: 10.1111/jdv.14650] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/09/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Recently, it has been shown that reflectance confocal microscopy (RCM) could identify subclinical basal cell carcinoma (BCC) during vismodegib treatment of locally advanced BCC. OBJECTIVES To evaluate specificity and sensitivity of clinical, dermoscopic and RCM examination for BCC in patients with multiple BCCs treated by vismodegib. METHODS Ninety four BCCs had 710 clinical, dermoscopic and RCM examinations during 72 weeks of vismodegib treatment. Thirty-eight were biopsied at the end of the treatment. Sensitivity and specificity for these 38 lesions were calculated. BCC diagnoses of clinical, dermoscopic and RCM examination on all the 710 investigations were compared using chi-square test. RESULTS Reflectance confocal microscopy was extremely more sensitive than dermoscopy and clinical examination and slightly less specific (sensitivity of 95%, 35% and 33% and specificity of 81%, 88% and 86% for RCM, dermoscopy and clinical examination, respectively) for the identification of residual BCC in the 38 biopsied cases. Considering all the 710 observations, RCM correctly diagnosed more BCCs than dermoscopy and clinical examination. CONCLUSION Reflectance confocal microscopy is a non-invasive technique that can detect subclinical residual BCC during and after vismodegib treatment helping the clinician to identify incomplete tumour regression.
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Affiliation(s)
- C Couzan
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - E Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - B Labeille
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - P Vercherin
- Service de Santé Publique et de l'Information Médicale, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - P Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - F Cambazard
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - J L Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
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30
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Cinotti E, Perrot JL, Labeille B, Mora Gues A, Chol C, Leclerq A, Jaffelin C, Biron AC, Barthélémy JC, Cambazard F. Prevalence of actinic keratosis in a French cohort of elderly people: the PROOF study. Ital J Dermatol Venerol 2017; 152:537-540. [DOI: 10.23736/s0392-0488.16.05353-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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31
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Jalenques I, Rondepierre F, Massoubre C, Bonnefond S, Schwan R, Labeille B, Perrot JL, Collange M, Mulliez A, D'Incan M. High Prevalence of Personality Disorders in Skin-restricted Lupus Patients. Acta Derm Venereol 2017; 97:941-946. [PMID: 28448094 DOI: 10.2340/00015555-2691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Psychiatric and personality disorders have been extensively documented in patients with systemic lupus erythematosus (SLE). However, the prevalence of personality disorders in skin-restricted lupus (SRL) patients remains unknown. The aim of this study was to assess the prevalence of personality disorders in SRL outpatients and to examine the associated factors. We evaluated 60 SRL outpatients and 118 controls matched for sex, age and education level. On the basis of the Personality Diagnostic Questionnaire 4+, 38% of patients vs 20% of controls fulfilled the criteria for at least one personality disorder (OR 2.2 [95% CI 1.01-4.6], p = 0.048). Only one patient with a personality disorder had specialised mental health care. Late lupus onset and more frequent past treatments by thalidomide were associated factors. This study evidences a high prevalence of personality disorders in SRL patients and shows that most SRL patients with personality disorder do not receive specialised mental health care.
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Affiliation(s)
- Isabelle Jalenques
- Service de Psychiatrie de l'Adulte A et Psychologie médicale, Pôle de Psychiatrie, CHU Clermont-Ferrand; Université d'Auvergne, FR-63003 Clermont-Ferrand, France
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Cinotti E, Singer A, Labeille B, Grivet D, Rubegni P, Douchet C, Cambazard F, Thuret G, Gain P, Perrot JL. Handheld In Vivo Reflectance Confocal Microscopy for the Diagnosis of Eyelid Margin and Conjunctival Tumors. JAMA Ophthalmol 2017; 135:845-851. [PMID: 28654937 DOI: 10.1001/jamaophthalmol.2017.2019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Importance The clinical diagnosis of conjunctival and eyelid margin tumors is challenging, and new noninvasive imaging techniques could be valuable in this field. Objective To assess the diagnostic accuracy of handheld in vivo reflectance confocal microscopy (IVCM) for the diagnosis of eyelid margin and conjunctival tumors. Design A prospective observational study was conducted at University Hospital of Saint-Etienne from January 2, 2011, to December 31, 2016 (inclusion of patients until December 31, 2015, and follow-up until December 31, 2016). A total of 278 consecutive patients with eyelid margin or conjunctival lesions were included. Conjunctival lesions were diagnosed with a conventional clinical examination using a slitlamp and by handheld IVCM. Final diagnoses were established by histopathologic examination for 155 neoformations suspicious for being malignant through clinical and/or IVCM examination that were excised and on follow-up of 12 months or longer for the remaining 140 lesions. Main Outcomes and Measures Sensitivity, specificity, and positive and negative predictive values for malignant tumors of the conjunctiva and eyelid margin were calculated using clinical examination with slitlamp and handheld IVCM. Results In the 278 patients (136 [48.9%] females; mean [SD] age, 59 [21] years), a total of 166 eyelid margin and 129 conjunctival lesions were included in the analysis. Of the 155 excised neoformations with a histopathologic diagnosis, IVCM showed higher sensitivity compared with clinical examination conducted with the slitlamp for malignant tumors of the eyelid margin (98% vs 92%) and conjunctiva (100% vs 88%). The specificity for malignant eyelid margin tumors was higher for IVCM than for slitlamp examination (74% vs 46%), but slightly less for malignant conjunctival tumors (78% vs 88%). Analysis of all neoformations (155 excised and 140 in follow-up) confirmed these differences in the diagnostic accuracy of the clinical examination and IVCM. The presence of hyperreflective Langerhans cells mimicking malignant melanocytes was the main cause for misdiagnosis of malignant conjunctival tumors with IVCM. Conclusions and Relevance Handheld IVCM could be a useful tool for the identification of malignant conjunctival tumors. Further studies are required to confirm the usefulness of this device and identify possible features that can differentiate Langerhans cells from malignant melanocytes to prevent the misdiagnosis of melanoma using IVCM.
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Affiliation(s)
- Elisa Cinotti
- Department of Medical, Surgical, and Neurological Science, Dermatology Section, University of Siena, S Maria alle Scotte Hospital, Siena, Italy
| | - Aurélie Singer
- Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Bruno Labeille
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Damien Grivet
- Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne, France.,Biology, Engineering and Imaging of Corneal Graft Laboratory, EA2521, Jean Monnet University, Saint-Etienne, France
| | - Pietro Rubegni
- Department of Medical, Surgical, and Neurological Science, Dermatology Section, University of Siena, S Maria alle Scotte Hospital, Siena, Italy
| | - Catherine Douchet
- Department of Pathology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Frédéric Cambazard
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Gilles Thuret
- Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne, France.,Biology, Engineering and Imaging of Corneal Graft Laboratory, EA2521, Jean Monnet University, Saint-Etienne, France.,French University Institute, Paris, France
| | - Philippe Gain
- Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne, France.,Biology, Engineering and Imaging of Corneal Graft Laboratory, EA2521, Jean Monnet University, Saint-Etienne, France
| | - Jean Luc Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
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Cinotti E, Labeille B, Cambazard F, Dupuis F, Rubegni P, Perrot J. Noninvasive skin imaging for the diagnosis of myiasis. J Eur Acad Dermatol Venereol 2017; 31:e365-e366. [DOI: 10.1111/jdv.14170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E. Cinotti
- Department of Medical, Surgical and Neurological Science; Dermatology Section; University of Siena, S. Maria alle Scotte Hospital; Siena Italy
| | - B. Labeille
- Department of Dermatology; University Hospital of St-Etienne; St-Etienne France
| | - F. Cambazard
- Department of Dermatology; University Hospital of St-Etienne; St-Etienne France
| | - F. Dupuis
- Faculté des Sciences et Techniques; Université Jean Monnet; St-Etienne France
| | - P. Rubegni
- Department of Medical, Surgical and Neurological Science; Dermatology Section; University of Siena, S. Maria alle Scotte Hospital; Siena Italy
| | - J.L. Perrot
- Department of Dermatology; University Hospital of St-Etienne; St-Etienne France
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Perrot JL, Labeille B, Richard Coulet E, Cochin S, Biron Schneider AC, Rubegni P, Cambazard F, Cinotti E. [Contribution of reflectance confocal microscopy in the diagnosis of uterine cervix melanoma: First case report]. Ann Dermatol Venereol 2017; 144:567-569. [PMID: 28668262 DOI: 10.1016/j.annder.2017.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/31/2017] [Indexed: 11/27/2022]
Affiliation(s)
- J L Perrot
- Service de dermatologie, hôpital universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - B Labeille
- Service de dermatologie, hôpital universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - E Richard Coulet
- SIPATH-anatomie et cytopathologie pathologique, 73, rue Général-Giraud, 42300 Roanne, France
| | - S Cochin
- Clinique du Renaison, 75, rue Général-Giraud, 42300 Roanne, France
| | - A-C Biron Schneider
- Service de dermatologie, hôpital universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - P Rubegni
- Service de dermatologie, hôpital universitaire S. Maria alle Scotte, 16, viale Bracci, 53100 Siena, Italie
| | - F Cambazard
- Service de dermatologie, hôpital universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - E Cinotti
- Service de dermatologie, hôpital universitaire S. Maria alle Scotte, 16, viale Bracci, 53100 Siena, Italie.
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Cinotti E, Chevallier J, Labeille B, Cambazard F, Thomas L, Balme B, Leccia MT, D'Incan M, Vercherin P, Douchet C, Rubegni P, Perrot JL. Mucosal melanoma: clinical, histological and c-kit gene mutational profile of 86 French cases. J Eur Acad Dermatol Venereol 2017; 31:1834-1840. [PMID: 28543798 DOI: 10.1111/jdv.14353] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/24/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Mucosal melanomas are rare and highly aggressive tumours. Few studies evaluated mucosal melanomas of locations other than the head and neck region, and other than those of the Asian population. OBJECTIVES The objective of this study was to analyse the clinical and histological features, as well as the mutational status of c-kit and b-raf gene of mucosal melanoma in any localization in a French series. METHODS We investigated clinical (sex, age, performance status, survival, treatment of the patients and lack of pigmentation of the tumours) and histopathological features (ulceration, Breslow's index, mitotic rate), as well as the mutational status of c-kit and b-raf of 86 mucosal melanomas diagnosed in 15 years in four French University Hospitals. RESULTS Most melanomas affected women (72%) and the genital region (46.5%). A fifth of melanomas were amelanotic. 81% of melanomas had a Breslow's index ≥1, whereas all glans melanomas, and most vulvar melanomas had a Breslow index ≤1 mm. Overall survival was 54% at 3 years; 11.6% of the 43 tested mucosal melanomas were c-kit-mutated while the 15 tested genital melanomas were not. The c-kit gene mutation did not influence the overall survival. Age ≥ 50, amelanotic type and performance status ≥1 were not poor prognostic factors in our series. CONCLUSION This study confirmed that mucosal melanomas are rare and could be difficult to diagnose being often amelanotic and in hidden sites. Most melanomas were thick at the diagnosis, but glans and vulvar melanomas were thinner probably because of their greater visibility. The frequency of the c-kit mutation varied depending on the initial tumour site. In our series, the prognosis was poor, independently from c-kit mutations and the patient's general health and age. The presence of metastasis at diagnosis was associated with a worse prognosis indicating the importance of an early diagnosis.
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Affiliation(s)
- E Cinotti
- Department of Dermatology, University Hospital of Saint Etienne, Saint Etienne, France.,Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - J Chevallier
- Department of Dermatology, University Hospital of Saint Etienne, Saint Etienne, France
| | - B Labeille
- Department of Dermatology, University Hospital of Saint Etienne, Saint Etienne, France
| | - F Cambazard
- Department of Dermatology, University Hospital of Saint Etienne, Saint Etienne, France
| | - L Thomas
- Dermatology Department, University Hospital of Lyon Sud, Pierre Bénite, France
| | - B Balme
- Dermatopathology Department, University Hospital of Lyon Sud, Pierre Bénite, France
| | - M T Leccia
- Department of Dermatology, University Hospital of Grenoble, Grenoble, France
| | - M D'Incan
- Dermatology Department, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - P Vercherin
- Department of Public Health and Medical Information, University Hospital of Saint Etienne, Saint Etienne, France
| | - C Douchet
- Department of Pathology, University Hospital of Saint Etienne, Saint Etienne, France
| | - P Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - J L Perrot
- Department of Dermatology, University Hospital of Saint Etienne, Saint Etienne, France
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Joly P, Maho-Vaillant M, Prost-Squarcioni C, Hebert V, Houivet E, Calbo S, Caillot F, Golinski ML, Labeille B, Picard-Dahan C, Paul C, Richard MA, Bouaziz JD, Duvert-Lehembre S, Bernard P, Caux F, Alexandre M, Ingen-Housz-Oro S, Vabres P, Delaporte E, Quereux G, Dupuy A, Debarbieux S, Avenel-Audran M, D'Incan M, Bedane C, Bénéton N, Jullien D, Dupin N, Misery L, Machet L, Beylot-Barry M, Dereure O, Sassolas B, Vermeulin T, Benichou J, Musette P. First-line rituximab combined with short-term prednisone versus prednisone alone for the treatment of pemphigus (Ritux 3): a prospective, multicentre, parallel-group, open-label randomised trial. Lancet 2017; 389:2031-2040. [PMID: 28342637 DOI: 10.1016/s0140-6736(17)30070-3] [Citation(s) in RCA: 347] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/07/2016] [Accepted: 11/16/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND High doses of corticosteroids are considered the standard treatment for pemphigus. Because long-term corticosteroid treatment can cause severe and even life-threatening side-effects in patients with this disease, we assessed whether first-line use of rituximab as adjuvant therapy could improve the proportion of patients achieving complete remission off-therapy, compared with corticosteroid treatment alone, while decreasing treatment side-effects of corticosteroids. METHODS We did a prospective, multicentre, parallel-group, open-label, randomised trial in 25 dermatology hospital departments in France (Ritux 3). Eligible participants were patients with newly diagnosed pemphigus aged 18-80 years being treated for the first time (not at the time of a relapse). We randomly assigned participants (1:1) to receive either oral prednisone alone, 1·0 or 1·5 mg/kg per day tapered over 12 or 18 months (prednisone alone group), or 1000 mg of intravenous rituximab on days 0 and 14, and 500 mg at months 12 and 18, combined with a short-term prednisone regimen, 0·5 or 1·0 mg/kg per day tapered over 3 or 6 months (rituximab plus short-term prednisone group). Follow-up was for 3 years (study visits were scheduled weekly during the first month of the study, then monthly until month 24, then an additional visit at month 36). Treatment was assigned through central computer-generated randomisation, with stratification according to disease-severity (severe or moderate, based on Harman's criteria). The primary endpoint was the proportion of patients who achieved complete remission off-therapy at month 24 (intention-to-treat analysis). This study is registered with ClinicalTrials.gov, number NCT00784589. FINDINGS Between May 10, 2010, and Dec 7, 2012, we enrolled 91 patients and randomly assigned 90 to treatment (90 were analysed; 1 patient withdrew consent before the random assignment). At month 24, 41 (89%) of 46 patients assigned to rituximab plus short-term prednisone were in complete remission off-therapy versus 15 (34%) of 44 assigned to prednisone alone (absolute difference 55 percentage points, 95% CI 38·4-71·7; p<0·0001. This difference corresponded to a relative risk of success of 2·61 (95% CI 1·71-3·99, p<0·0001), corresponding to 1·82 patients (95% CI 1·39-2·60) who would need to be treated with rituximab plus prednisone (rather than prednisone alone) for one additional success. No patient died during the study. More severe adverse events of grade 3-4 were reported in the prednisone-alone group (53 events in 29 patients; mean 1·20 [SD 1·25]) than in the rituximab plus prednisone group (27 events in 16 patients; mean 0·59 [1·15]; p=0·0021). The most common of these events in both groups were diabetes and endocrine disorder (11 [21%] with prednisone alone vs six [22%] with rituximab plus prednisone), myopathy (ten [19%] vs three [11%]), and bone disorders (five [9%] vs five [19%]). INTERPRETATION Data from our trial suggest that first-line use of rituximab plus short-term prednisone for patients with pemphigus is more effective than using prednisone alone, with fewer adverse events. FUNDING French Ministry of Health, French Society of Dermatology, Roche.
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Affiliation(s)
- Pascal Joly
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France.
| | - Maud Maho-Vaillant
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
| | | | - Vivien Hebert
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
| | - Estelle Houivet
- Department of Biostatistics, Rouen University Hospital and INSERM U1219, Normandie University, Rouen, France
| | - Sébastien Calbo
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
| | - Frédérique Caillot
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
| | - Marie Laure Golinski
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
| | - Bruno Labeille
- Department of Dermatology, University of Saint Etienne, Saint Etienne, France
| | | | - Carle Paul
- Department of Dermatology, University of Toulouse, Toulouse, France
| | - Marie-Aleth Richard
- Department of Dermatology, Assistance Publique des Hopitaux de Marseille, Aix Marseille University, UMR 911, INSERM CRO2, Marseille, France
| | - Jean David Bouaziz
- Department of Dermatology of St Louis Hospital, Paris 7 Sorbonne Paris Cité University, Paris, France
| | - Sophie Duvert-Lehembre
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
| | | | - Frederic Caux
- Department of Dermatology, University of Paris XIII, Bobigny, France
| | - Marina Alexandre
- Department of Dermatology, University of Paris XIII, Bobigny, France
| | | | - Pierre Vabres
- Department of Dermatology Dijon University Hospital, Dijon, France
| | | | - Gaelle Quereux
- Department of Dermatology, University of Nantes, Nantes, France
| | - Alain Dupuy
- Department of Dermatology, University of Rennes, Rennes, France
| | - Sebastien Debarbieux
- Department of Dermatology, Centre Hospitalier Lyon Sud; Pierre Bénite, Lyon, France
| | | | - Michel D'Incan
- Department of Dermatology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Nathalie Bénéton
- Department of Dermatology, Le Mans General Hospital, Le Mans, France
| | - Denis Jullien
- Department of Dermatology, Edouard Herriot Hospital, Lyon Claude Bernard University, Lyon, France
| | - Nicolas Dupin
- Department of Dermatology, University of Paris V, Paris, France
| | - Laurent Misery
- Department of Dermatology, Brest University Hospital, Brest, France
| | - Laurent Machet
- Department of Dermatology, Tours University Hospital, Tours, France
| | | | - Olivier Dereure
- Department of Dermatology, University of Montpellier, Montpellier, France
| | - Bruno Sassolas
- Department of Internal Medicine, Brest University Hospital, Brest, France
| | - Thomas Vermeulin
- Department of Medical Information and Informatics, Rouen University Hospital, Rouen, France
| | - Jacques Benichou
- Department of Biostatistics, Rouen University Hospital and INSERM U1219, Normandie University, Rouen, France
| | - Philippe Musette
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
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Ronin C, Grivet D, Kaspi M, Dumollard JM, Douchet C, Thuret G, Gain P, Labeille B, Cinotti E, Perrot JL. Apport de la microscopie confocale par réflectance dans le diagnostic du mélanome conjonctival. Ann Dermatol Venereol 2017; 144:227-229. [DOI: 10.1016/j.annder.2016.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/04/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
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Dréno B, Kunstfeld R, Hauschild A, Fosko S, Zloty D, Labeille B, Grob JJ, Puig S, Gilberg F, Bergström D, Page DR, Rogers G, Schadendorf D. Two intermittent vismodegib dosing regimens in patients with multiple basal-cell carcinomas (MIKIE): a randomised, regimen-controlled, double-blind, phase 2 trial. Lancet Oncol 2017; 18:404-412. [PMID: 28188086 DOI: 10.1016/s1470-2045(17)30072-4] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/07/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Vismodegib, a first-in-class Hedgehog-pathway inhibitor, is approved for use in adults with advanced basal-cell carcinoma. Patients with multiple basal-cell carcinomas, including those with basal-cell nevus (Gorlin) syndrome, need extended treatment. We assessed the safety and activity of two long-term intermittent vismodegib dosing regimens in patients with multiple basal-cell carcinomas. METHODS In this randomised, regimen-controlled, double-blind, phase 2 trial, we enrolled adult patients with multiple basal-cell carcinomas, including those with basal-cell nevus syndrome, who had one or more histopathologically confirmed and at least six clinically evident basal-cell carcinomas. From a centralised randomisation schedule accessed via an interactive voice or web-based response system, patients were randomly assigned (1:1) to treatment group A (150 mg oral vismodegib per day for 12 weeks, then three rounds of 8 weeks of placebo daily followed by 12 weeks of 150 mg vismodegib daily) or treatment group B (150 mg oral vismodegib per day for 24 weeks, then three rounds of 8 weeks of placebo daily followed by 8 weeks of 150 mg vismodegib daily). Treatment assignment was stratified by diagnosis of basal-cell nevus syndrome, geographical region, and immunosuppression status. The primary endpoint was percentage reduction from baseline in the number of clinically evident basal-cell carcinomas at week 73. The primary analysis was by intention to treat. The safety population included all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, number NCT01815840, and the study is ongoing. FINDINGS Between April 30, 2013, and April 9, 2014, 229 patients were randomly assigned treatment, 116 in treatment group A and 113 in treatment group B. The mean number of basal-cell carcinoma lesions at week 73 was reduced from baseline by 62·7% (95% CI 53·0-72·3) in treatment group A and 54·0% (43·6-64·4) in treatment group B. 216 (95%) of 227 patients included in the safety analysis had at least one treatment-emergent adverse event deemed to be related to study treatment (107 [94%] of 114 in treatment group A and 109 [97%] of 113 in treatment group B). The most common grade 3 or worse treatment-related adverse events were muscle spasms (four [4%] patients in treatment group A vs 12 [11%] in treatment group B), increased blood creatine phosphokinase (one [1%] vs four [4%]), and hypophosphataemia (zero vs three [3%]). Serious treatment-emergent events were noted in 22 (19%) patients in treatment group A and 19 (17%) patients in treatment group B. Four (2%) patients died from adverse events; one (pulmonary embolism in treatment group A) was possibly related to treatment. INTERPRETATION Both intermittent dosing schedules of vismodegib seemed to show good activity in long-term regimens in patients with multiple basal-cell carcinomas. Further study is warranted. FUNDING F Hoffmann-La Roche.
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Affiliation(s)
- Brigitte Dréno
- Service de Dermato-Cancérologie, Nantes University, Nantes, France.
| | - Rainer Kunstfeld
- University Dermatology Clinic, Medical University of Vienna, Vienna, Austria
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Scott Fosko
- Department of Dermatology, Saint Louis University Medical School, St Louis, MO, USA; Department of Dermatology, Mayo Clinic, Jacksonville, FL, USA
| | - David Zloty
- Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Bruno Labeille
- Dermatology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Jean-Jacques Grob
- Service de Dermatologie, Aix Marseille University and Timone Hospital, Marseille, France
| | - Susana Puig
- Department of Dermatology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain; Research, Oncology and Haematology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Frank Gilberg
- Biostatistics, F Hoffmann-La Roche, Basel, Switzerland
| | - Daniel Bergström
- Global Product Development, Medical Affairs, Oncology, F Hoffmann-La Roche, Basel, Switzerland
| | - Damian R Page
- Global Product Development, Medical Affairs, Oncology and Haematology, F Hoffmann-La Roche, Basel, Switzerland
| | - Gary Rogers
- Department of Surgery, Oncology Center, Tufts University School of Medicine, Boston, MA, USA
| | - Dirk Schadendorf
- Klinik für Dermatologie, Venereologie und Allergologie, Universitätsklinikum Essen, Essen, Germany
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Espinasse M, Cinotti E, Grivet D, Labeille B, Prade V, Douchet C, Cambazard F, Thuret G, Gain P, Perrot JL. ‘En face’ ex vivo
reflectance confocal microscopy to help the surgery of basal cell carcinoma of the eyelid. Clin Exp Ophthalmol 2017; 45:442-447. [DOI: 10.1111/ceo.12904] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/01/2016] [Accepted: 12/14/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Marine Espinasse
- Department of Ophthalmology; University Hospital of St-Etienne; Saint Etienne France
- Department of Biology, Engineering and Imaging of Corneal Graft Laboratory, Institute of Research in Sciences and Health Engineering, EA2512; Jean Monnet University; Saint-Etienne France
| | - Elisa Cinotti
- Department of Dermatology; University Hospital of St-Etienne; Saint Etienne France
| | - Damien Grivet
- Department of Ophthalmology; University Hospital of St-Etienne; Saint Etienne France
- Department of Biology, Engineering and Imaging of Corneal Graft Laboratory, Institute of Research in Sciences and Health Engineering, EA2512; Jean Monnet University; Saint-Etienne France
| | - Bruno Labeille
- Department of Dermatology; University Hospital of St-Etienne; Saint Etienne France
| | - Virginie Prade
- Department of Oral and Maxillofacial Surgery; University Hospital of St-Etienne; Saint Etienne France
| | - Catherine Douchet
- Department of Pathology; University Hospital of St-Etienne; Saint Etienne France
| | - Frédéric Cambazard
- Department of Dermatology; University Hospital of St-Etienne; Saint Etienne France
| | - Gilles Thuret
- Department of Ophthalmology; University Hospital of St-Etienne; Saint Etienne France
- Department of Biology, Engineering and Imaging of Corneal Graft Laboratory, Institute of Research in Sciences and Health Engineering, EA2512; Jean Monnet University; Saint-Etienne France
- University Institute of France; Paris France
| | - Philippe Gain
- Department of Ophthalmology; University Hospital of St-Etienne; Saint Etienne France
- Department of Biology, Engineering and Imaging of Corneal Graft Laboratory, Institute of Research in Sciences and Health Engineering, EA2512; Jean Monnet University; Saint-Etienne France
| | - Jean Luc Perrot
- Department of Dermatology; University Hospital of St-Etienne; Saint Etienne France
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Cinotti E, Labeille B, Cambazard F, Perrot JL. [Dermoscopy and reflectance confocal microscopy examination of pigmented fungiform papillae of the tongue]. Ann Dermatol Venereol 2016; 144:323-325. [PMID: 27939645 DOI: 10.1016/j.annder.2016.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/04/2016] [Accepted: 10/13/2016] [Indexed: 11/17/2022]
Affiliation(s)
- E Cinotti
- Service de dermatologie, hôpital universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
| | - B Labeille
- Service de dermatologie, hôpital universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - F Cambazard
- Service de dermatologie, hôpital universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - J L Perrot
- Service de dermatologie, hôpital universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
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Cinotti E, Perrot JL, Labeille B, Heusèle C, Nizard C, Schnebert S, Barthélémy JC, Cambazard F. Rapport entre le vieillissement cutané et la fonction du système nerveux autonome. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Labeille B, Fouilloux B, Perrot JL, Cinotti E, Douchet C, Cambazard F. Application de la microscopie confocale ex vivo aux tumeurs glomiques sous unguéales. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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43
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Singer A, Perrot JL, Kaspi M, Ronin C, Labeille B, Grivet D, Douchet C, Cambazard F, Espinasse M, Thuret G, Cinotti E. Apport de la microscopie confocale in vivo pour le diagnostic de tumeurs conjonctivales bulbaires à propos de 129 tumeurs. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mandel V, Ciardo S, Cinotti E, Labeille B, Benati E, Perrot JL, Pellacani G. Rôle de la microscopie confocale de réflectance et de tomographie par cohérence optique pour le diagnostic de la pemphigoïde bulleuse et du pemphigus. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Perrot JL, Labeille B, Biron Schneider A, Douchet C, Cambazard F, Cinotti E. Lentigo malin et examen par OCT HD à propos d’une série de 29 malades : premiers cas rapportés. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cinotti E, Perrot JL, Labeille B, Heusèle C, Nizard C, Schnebert S, Pichot V, Bernois A, Rabillon C, Barthélémy JC, Cambazard F. Is there a relation between autonomic nervous system activity and skin ageing? Evaluation of heart rate variability and skin ageing in 209 elderly subjects. Exp Dermatol 2016; 26:278-281. [PMID: 27572269 DOI: 10.1111/exd.13178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Elisa Cinotti
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jean Luc Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Bruno Labeille
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | | | | | | | - Vincent Pichot
- Clinical and Exercise Physiology Laboratory, University Hospital of Saint-Etienne, Saint-Etienne, France
| | | | | | - Jean-Claude Barthélémy
- Clinical and Exercise Physiology Laboratory, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Frédéric Cambazard
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
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47
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Cinotti E, Labeille B, Cambazard F, Flori P, Raberin H, Perrot JL. Unusual reflectance confocal microscopy findings during the examination of a perianal nevus: pinworms. J Eur Acad Dermatol Venereol 2016; 30:e86-e87. [PMID: 26374669 DOI: 10.1111/jdv.13333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E Cinotti
- Department of Dermatology, University Hospital of Saint-Etienne, 42055, Saint Etienne, France.
| | - B Labeille
- Department of Dermatology, University Hospital of Saint-Etienne, 42055, Saint Etienne, France
| | - F Cambazard
- Department of Dermatology, University Hospital of Saint-Etienne, 42055, Saint Etienne, France
| | - P Flori
- Department of Parasitology, University Hospital of Saint-Etienne, 42055, Saint Etienne, France
| | - H Raberin
- Department of Parasitology, University Hospital of Saint-Etienne, 42055, Saint Etienne, France
| | - J L Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, 42055, Saint Etienne, France
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Schadendorf D, Hauschild A, Fosko S, Zloty D, Labeille B, Grob J, Puig S, Makrutzki M, Templeton I, Rogers G, Dreno B, Kunstfeld R. Evaluation of the pharmacokinetic (PK) profile of vismodegib (VISMO) in patients (pts) with multiple basal cell carcinomas (BCCs) across two intermittent treatment regimens in the MIKIE study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw379.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Perrot JL, Julienne R, Kaspi M, Labeille B, Grivet D, Vercherin A, Cambazard F, Cinotti E. [The role of reflectance confocal microscopy in the diagnosis of ocular-cutaneous erucism or dermatitis and keratitis induced by pine processionary caterpillar hairs]. Ann Dermatol Venereol 2016; 143:860-862. [PMID: 27659386 DOI: 10.1016/j.annder.2016.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/23/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
Affiliation(s)
- J-L Perrot
- Service de dermatologie, hôpital universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - R Julienne
- Service d'ophtalmologie, hôpital universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - M Kaspi
- Service d'ophtalmologie, hôpital universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - B Labeille
- Service de dermatologie, hôpital universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - D Grivet
- Service d'ophtalmologie, hôpital universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - A Vercherin
- Service d'anatomopathologie, institut de pathologie du Forez, 11, rue de la République, 42001 Saint-Étienne, France
| | - F Cambazard
- Service de dermatologie, hôpital universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - E Cinotti
- Service de dermatologie, hôpital universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
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