Florence Le Duff

Importance Hailey-Hailey disease (HHD) is a rare, autosomal-dominant acantholytic dermatosis characterized clinically by development of recurrent blisters and erosions in friction areas. Despite progression in our understanding of the molecular genetics of HHD, therapy remains suboptimal and there is no known cure. Objective To determine whether the novel phosphodiesterase-4 inhibitor apremilast is effective in the treatment of HHD. Design, Setting, and Participants Clinical case series of 4 patients with severe, treatment-resistant HHD at an outpatient clinic in the Department of Dermatology of Nice University Hospital, Nice, France. The patients were treated with apremilast; after the initial titration, the dose was 30 mg, twice daily. Main Outcomes and Measures Objective clinical response was assessed by the treating dermatologist using the physician global assessment score; recorded adverse effects were monitored throughout the treatment at intervals of 2 to 3 months. Results Three women and 1 man, with a mean age of 56 years, were treated and followed up for 6 to 10 months. Family history of the disease was noted in 3 (75%) of the cases. The lesions affected the axillary regions (75%), submammary regions (75%), inguinal regions (100%), and back and neck areas (50%). An improvement in the symptoms was reported by all of the patients after a treatment period of 1 month. After 6 months, the improvement of HHD lesions was reported as moderate to almost cleared among the patients. However, 2 patients developed some flares after 6 to 10 months of treatment and stopped apremilast therapy. One of the patients developed uncontrolled diffuse lesions and apremilast was reintroduced, resulting in partial control of her disease. Conclusions and Relevance Apremilast appears to offer a low-risk therapeutic alternative or adjunct in resistant and severe forms of HHD. A prospective controlled trial with long-term follow-up is required to confirm these preliminary observations.

Background: Based on the presumed role of hair in pilonidal cyst (PNC) pathogenesis, laser epilation has been used to decrease recurrences. However, most of the data rely on case reports and uncontrolled series, and the rare controlled studies reported conflicting results. The objective of this study was to investigate the efficacy of laser hair removal (LHR) to decrease the recurrence rate after surgery of PNC vs. surgery alone.Methods: We conducted a retrospective monocentric case–control study in the departments of Pediatric Surgery and Laser Center of Dermatology of the University Hospital of Nice in France from January 2010 to June 2017. We included all patients with PNC who had surgery during the period, and we compared patients who had LHR after surgery to those having surgery alone. The main outcome was the prevalence and number of recurrences of PNC in each group.Results: Twelve patients – eight treated with alexandrite laser and four patients with Nd : YAG – were included in the cases group; 29 patients treated with surgery alone were included in the control group. The mean and the median number of laser sessions were 4.2 and 5, respectively (extremes 1–10). The postsurgical recurrence rate without LHR was 51.7%, and their number varied from 1 to 3. A significant decrease in the recurrence rate was observed after LHR (8.3%) compared to control group (P < 0.001). The median duration before recurrence was 14 months for surgery alone. The median follow‐up was 18 months (1–30 months) for LHR group and 30 months (6–72 months) for surgery alone group. Two patients had abnormal healing or persistent sinus after surgery alone compared to none in the group who undergone laser procedure after surgery.Conclusions: Laser hair removal decreases the risk of delayed healing and of recurrences of PNL after surgical procedure.