S Ingen-Housz-Oro

Hôpital Henri Mondor (Hôpitaux Universitaires Henri Mondor), Créteil, Île-de-France, France

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Publications (125)191.55 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Ear, nose, and throat (ENT) lesions are frequently involved in Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN), although a detailed description is lacking in the literature. To describe ENT lesions at the acute stage and follow-up in a large series of patients with SJS/TEN and identify factors associated with the severe ENT form. Retrospective study of 49 patients with SJS/TEN hospitalized in a referral care center from 2005 to 2010. Patients who underwent a full ENT workup including examination and a nasal fiberoptic endoscopy by an otorhinolaryngologist in the acute phase and during follow-up at 2 and 12 months were included in the study. Recorded variables included maximal body surface area (BSA) detachment, SCORTEN (Score of Toxic Epidermal Necrosis [a severity of illness score]), sites and type of ENT mucosal lesions, intensive care unit transfer, pulmonary infection, and mortality. "Severe ENT form" was defined by the occurrence of laryngeal lesions with the risk of airways obstruction. Clinical characteristics associated with severe ENT form were analyzed in univariate and multivariable analysis. Of the 49 patients who underwent a full ENT workup (female to male ratio, 1.1:1), ENT symptoms (eg, odynophagia, dysphagia, dysphonia, dyspnea, earache, nasal obstruction) occurred in 48 (98%). Dyspnea or dysphonia were significantly associated with severe ENT form (21% [P = .03] and 50% [P < .001], respectively). Topographic frequencies of lesions were as followed: lips and oral cavity (n = 46 [93%]) and pharynx and vestibule of the nose (n = 26 [53%]). Fourteen patients (29%) had severe ENT form. Findings for other recorded variables for those with vs without ENT examination are as follows: maximal BSA detachment (20% [0%-95%] vs 5.5% [0%-95%]; P = .004), SCORTEN (1 [0-5] vs 1 [0-5]; P = .54), intensive care unit transfer (10 [20%] vs 9 [19%]; P = .80), pulmonary infection (9 [18%] vs 6 [13%]; P = .10), and mortality (3 [6%] vs 5 [10%]; P = .70). In multivariable analysis, pulmonary infection was significantly associated with severe ENT form (odds ratio, 5.9 [95% CI, 1.1-32.8] [P = .04]). After remission of SJS/TEN, a complete ENT mucosal healing occurred in 36 patients (74%) at 2 months and in nearly all patients (n = 48 [98%]) at 1 year of follow-up. Severe ENT form is associated with pulmonary infection and is easily detected by nasal fiberoptic endoscopy. ENT evaluation should be suggested when dysphonia or dyspnea is observed at the acute stage of SJS/TEN.
    JAMA Dermatology 02/2015; DOI:10.1001/jamadermatol.2014.4844 · 4.30 Impact Factor
  • S. Hüe, S. Ingen-Housz-Oro, L. Fardet
    Annales de Dermatologie et de Vénéréologie 01/2015; 142(2). · 0.67 Impact Factor
  • S Hüe, S Ingen-Housz-Oro, L Fardet
    Annales de Dermatologie et de Vénéréologie 01/2015; · 0.67 Impact Factor
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    ABSTRACT: Importance The main component of the first-line treatment of pemphigus vulgaris is high doses of systemic corticosteroids, but adverse effects of these drugs are frequent and sometimes severe. Rituximab has shown effectiveness as a corticosteroid-sparing agent or in case of relapse. To our knowledge, the effectiveness of rituximab as a first-line treatment without systemic corticosteroids has not been evaluated.Observations Five women in their 50s, 60s, or 70s with pemphigus vulgaris (Pemphigus Disease Area Index score, 15-84 at diagnosis) and contraindications to systemic corticosteroid treatment received rituximab with high-potency topical corticosteroids as first-line treatment. All patients experienced a favorable response, with a mean time to healing of skin and mucosal lesions of 15 weeks. Two patients, with 42- and 48-month follow-up evaluations, did not experience relapse. Three patients developed 2 to 4 relapses, with effective retreatment achieved using rituximab and topical corticosteroids. No severe adverse effects were observed.Conclusions and Relevance Considering the high rate of severe adverse effects induced by prolonged administration of high doses of systemic corticosteroids, new therapeutic options are warranted in the treatment of pemphigus vulgaris. The combination of rituximab and topical corticosteroids could be considered in mild to severe cutaneous disease. Larger long-term studies are needed to evaluate the optimal treatment strategies according to the severity of the disease and the benefit-risk ratio of rituximab.
    JAMA Dermatology 10/2014; 151(2). DOI:10.1001/jamadermatol.2014.2421 · 4.30 Impact Factor
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    ABSTRACT: Background: The value of anti-desmoglein 1 and 3 (Dsg1, Dsg3) enzyme-linked immunosorbent assay (ELISA) is controversial in the follow-up of pemphigus. Objective: To evaluate anti-desmoglein ELISA (Dsg ELISA) in the follow-up of pemphigus and compare ELISA with direct and indirect immunofluorescence in complete remission (CR). Methods: We performed a retrospective monocenter study of patients with pemphigus and consecutive sera samples collected at baseline (M0), 12 months (M12) and 24 or 36 months after M0 (M24/36). Tests were compared in CR and in active disease. Direct immunofluorescence and circulating autoantibodies were compared for patients with stable CR. Results: We included 36 patients. At M12, ELISA values did not differ between CR and active disease. At M24/36, Dsg3 but not Dsg1 ELISA values were lower in CR (p = 0.07). For 5/8 patients with stable CR, direct immunofluorescence and ELISA findings remained positive. Conclusion: In routine practice, Dsg ELISA seems to be of little interest for immunological follow-up of pemphigus. © 2014 S. Karger AG, Basel.
    Dermatology 09/2014; DOI:10.1159/000365079 · 1.69 Impact Factor
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    ABSTRACT: We read with interest the letter by Fortuna et al.(1) about our paper "Linear IgA bullous dermatosis (LABD): comparison between the drug-induced and spontaneous forms".(2) In our study, we compared the clinical and histological aspects of drug-induced and "idiopathic" (in fact a better wording than "spontaneous" as previously used) forms of LABD. Drug-induced LABD was defined by two available imputability scores: the French method (modified Begaud score(3) ), based on intrinsic and extrinsic criteria, mostly used by French pharmacovigilance and in our routine practice, and the Naranjo score(4) , more often used in the international literature and based on intrinsic criteria only. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 06/2014; 171(6). DOI:10.1111/bjd.13174 · 4.10 Impact Factor
  • S Ingen-Housz-Oro, A Amiot, N Ortonne, S Hüe
    Annales de Dermatologie et de Vénéréologie 05/2014; 141(5):387-91. · 0.67 Impact Factor
  • S. Ingen-Housz-Oro, A. Amiot, N. Ortonne, S. Hüe
    Annales de Dermatologie et de Vénéréologie 05/2014; DOI:10.1016/j.annder.2014.03.013 · 0.67 Impact Factor
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    ABSTRACT: Background: Administrative bodies for compensating medical accidents were created in France in 2002. Objectives: To evaluate the knowledge patients with severe cutaneous adverse reactions (SCARs) have of procedures and to compare the rate of compensation for SCARs for France and for our referral center. Methods: A questionnaire was sent to 247 patients of our SCARs referral center and 225 patients with Stevens-Johnson syndrome and toxic epidermal necrolysis from the patient association AMALYSTE. We calculated the rate of compensation for France and our center. Results: Among the 123 respondents (26%), 28 (23%) knew the compensation procedure; 13 (11%) had received compensation. The Commission of Conciliation and Compensation had received 63 applications for SCARs since 2002 and proposed compensation for 56%. The estimated rate of compensation for France was 2.6% and 2.5% for our referral center (p = 0.9). Conclusions: The procedure of compensation for SCARs is misunderstood. Better information should be disseminated for patients with threshold disability conditions. © 2014 S. Karger AG, Basel.
    Dermatology 03/2014; 228(4). DOI:10.1159/000358295 · 1.69 Impact Factor
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    ABSTRACT: IMPORTANCE Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT), occurs in elderly patients and has been considered as a lymphoma with a poor prognosis, with estimated 5-year specific survival rates of approximately 50%. The hypothesis of an improvement in prognosis over time has not been studied. OBJECTIVES To evaluate this hypothesis in a large series of patients and investigate factors associated with prognosis as well as improvement in the prognosis. DESIGN, SETTING, AND PARTICIPANTS A retrospective multicenter study was conducted including dermatology departments belonging to the French Study Group on Cutaneous Lymphoma. Participants were 115 patients with PCDLBCL-LT diagnosed between 1988 and 2003 (period 1) or between 2004 and 2010 (period 2). MAIN OUTCOMES AND MEASURES Age, sex, period of diagnosis, number of skin lesions, tumor stage, tumor location (leg vs nonleg), lactate dehydrogenase level, type of therapy (with or without a combination of rituximab and polychemotherapy [PCT]), and outcome were recorded. Baseline characteristics and outcome were compared according to period of diagnosis and type of therapy. Prognosis factors were identified by univariate and multivariate survival analyses. RESULTS The mean age of the patients was 76.9 years, and 47% of the patients were older than 80 years. The 3- and 5-year specific survival rates improved between period 1 and period 2, from 55% to 74% and from 46% to 66%, respectively (P = .01). Patients had similar baseline characteristics during both periods, but rituximab-PCT regimens were administered to 88.5% of the patients in period 2 vs 16.7% in period 1 (P < .001). The 3- and 5-year specific survival rates were 80% and 74%, respectively, in patients who received a rituximab-PCT regimen compared with 48% and 38% in those who received less-intensive therapies. No significant difference was observed between both groups in age and baseline prognostic factors. In multivariate analysis, treatment without rituximab-PCT was the only adverse prognostic factor (odds ratio, 4.6 [95% CI, 2.4-9.1]; P < .001), whereas the number of skin lesions (P = .06) and location on the leg (P = .07) had only borderline significance. CONCLUSIONS AND RELEVANCE A major improvement in the survival of patients with PCDLBCL-LT has occurred over time in France, mainly as a result of the use of intensive rituximab-PCT regimens in most patients, including very elderly ones. Until further prospective clinical trials are conducted, such regimens should be considered as the standard of care in these patients.
    03/2014; 150(5). DOI:10.1001/jamadermatol.2013.7452
  • C Guillaud, S Hüe, S Ingen-Housz-Oro
    Annales de Dermatologie et de Vénéréologie 12/2013; 140(12):821-6. DOI:10.1016/j.annder.2013.08.001 · 0.67 Impact Factor
  • Saskia Ingen-Housz-Oro, Nicolas Ortonne, Olivier Chosidow
    12/2013; 149(12):1440. DOI:10.1001/jamadermatol.2013.7329
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    ABSTRACT: Drug-induced adverse reactions represent major health problems, with the skin being one of the most common targets. Approximately 2% of all drug-induced skin reactions are considered serious. Stevens–Johnson syndrome/toxic epidermal necrolysis corresponds to rare and acute life-threatening mucocutaneous reactions characterized by extensive necrosis and epidermal detachment. This review focuses on the management of these severe cutaneous reactions in the French Referral Center for Toxic Bullous Diseases. Early referral to a specialized unit, early diagnosis of severe cutaneous adverse reactions, prompt withdrawal of the culprit drug, improved symptomatic management, and specific dermatological care have contributed to better survival in the past 10 years and also has limited sequelae.
    Dermatologica Sinica 12/2013; 31(4):191–195. DOI:10.1016/j.dsi.2013.09.008 · 0.57 Impact Factor
  • Annales de Dermatologie et de Vénéréologie 12/2013; 140(12):S361–S362. DOI:10.1016/j.annder.2013.09.008 · 0.67 Impact Factor
  • S Ingen-Housz-Oro, N Ortonne, O Chosidow
    Journal of the European Academy of Dermatology and Venereology 11/2013; 28(7). DOI:10.1111/jdv.12313 · 3.11 Impact Factor
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    ABSTRACT: The treatment of advanced-stage primary cutaneous T-cell lymphomas remains challenging. Especially, large-cell transformation of mycosis fungoides is associated with a median overall survival of 2 years for all stages taken together. Little is known regarding allogeneic hematopoietic stem cell transplantation in this context. We performed a multicentre retrospective analysis of 37 cases of advanced-stage primary cutaneous T-cell lymphomas treated with allogeneic stem cell transplantation, including 20 (54%) transformed mycosis fungoides. Twenty-four patients (65%) had stage IV disease (for mycosis fungoides and Sezary syndrome) or disseminated nodal or visceral involvement (for non epidermotropic primary cutaneous T-cell lymphomas). After a median follow-up of 29 months, 19 patients experienced a relapse, leading to a 2-year cumulative incidence of relapse of 56% (95% CI, 0.38-0.74). Estimated 2-year overall survival was 57% (95% CI, 0.41-0.77) and progression-free survival 31% (95% CI, 0.19-0.53). Six of 19 patients with a post-transplant relapse achieved a subsequent complete remission after salvage therapy, with a median duration of 41 months. A weak residual tumor burden before transplantation was associated with increased progression-free survival (HR=0.3, 95%CI, 0.1-0.8, p=0.01). The use of antithymocyte globulin significantly reduced progression-free survival (HR=2.9, 95%CI, 1.3-6.2, p=0.01) but also transplant-related mortality (HR=10-7, 95%CI, 4.10-8-2.10-7, p<0.001) in univariate analysis. In multivariate analysis, the use of antithymocyte globulin was the only factor significantly associated with decreased progression-free survival (p=0.04). Allogeneic stem cell transplantation should be considered in advanced-stage primary cutaneous T-cell lymphomas, including transformed mycosis fungoides.
    Haematologica 11/2013; DOI:10.3324/haematol.2013.098145 · 5.87 Impact Factor
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    ABSTRACT: Background: Consensus is lacking about investigations to be performed for viral eruptions. Aims: Audit of investigative practices for viral eruption. Methods: Retrospective study of patients hospitalized for viral eruption, divided into 2 groups: suspected viral infection (SV), with a clinical presentation suggesting a specific virus, and nonspecific suspected viral infection (NSV). Investigations of results and costs of virology tests. Results: We included 59 patients, 25 in the SV and 34 in the NSV group. Measles was suspected in 21/25 SV patients and confirmed in 20 (95%). The causal agent was confirmed in 6 NSV cases (17.6%), including 2 HIV infections. The median number of virology tests was 7 (1-14) and the median cost was EUR 144, with no significant differences between the 2 groups. Conclusion: Virology testing is useful when a putative virus is clinically suspected. HIV serology screening should be systematically performed. © 2013 S. Karger AG, Basel.
    Dermatology 08/2013; 227(1). DOI:10.1159/000352078 · 1.69 Impact Factor
  • S Ingen-Housz-Oro, S Hüe, S Grootenboer-Mignot, C André
    Annales de Dermatologie et de Vénéréologie 08/2013; 140(8-9):563-70. DOI:10.1016/j.annder.2013.04.082 · 0.67 Impact Factor
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    ABSTRACT: Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction characterized by rash with sterile pustules, high fever and elevated circulating neutrophil counts. To investigate the frequency and clinical features of AGEP systemic involvement. Methods This retrospective study included all patients hospitalized in our department between 2000 and 2010 with a discharge diagnosis of AGEP. Patients had to fulfill the following criteria: (i) a specific EuroSCAR score > 4 and (ii) biological and radiological work-up available. Among the 58 patients enrolled, 10 had at least one systemic involvement: hepatic function test results were abnormal for seven; six had renal insufficiency; two developed acute respiratory distress, with one patient's bronchoalveolar lavage fluid containing many neutrophils but no microorganisms; and one was agranulocytotic. Mean peripheral neutrophil counts and mean C-reactive protein levels were significantly elevated in patients with systemic involvement. Amoxicillin rechallenge and hospitalization duration were associated with systemic involvement. AGEP systemic involvement was observed in 17·2% of studied cases, including liver, kidney, bone-marrow and lung involvement. Outcomes were favorable after drug withdrawal, and symptomatic and topical steroid treatments. Agranulocytosis was linked to drug toxicity and renal insufficiency to inflammatory status. The neutrophil count-systemic involvement association could suggest a role of neutrophils in AGEP systemic involvement. Physicians should be aware of the possibility of systemic involvement in AGEP and should actively seek extracutaneous involvement. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 07/2013; 169(6). DOI:10.1111/bjd.12502 · 4.10 Impact Factor
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    ABSTRACT: Linear IgA bullous dermatosis (LABD) is a rare autoimmune blistering skin disorder characterized by linear deposits of immunoglobulin A (IgA) along the dermoepidermal junction visualized by direct immunofluorescence (DIF). It is usually spontaneous and drug-induced. To compare clinical and histological LABD forms. This retrospective monocenter cohort study concerned 28 patients diagnosed with LABD from 1 January 1995 to 31 December 2010. Imputability determined according to the French imputability method (modified Bégaud score) and Naranjo scores, enable constitution of drug-induced or spontaneous LABD groups, whose clinical and histological features were compared with blinded analysis of images and histological patterns. Sixteen patients had spontaneous LABD and 12 had drug-induced LABD. Nikolsky's sign and large erosions were significantly more frequent in drug-induced than spontaneous LABD (P=0·003 and P=0·03 respectively), with no between-group differences for erythematous plaques, target or target-like lesions, string of pearls, location, mucosal involvement or histological features. Drug-induced LABD was more severe than the spontaneous form, with lesions mimicking toxic epidermal necrolysis. Because LABD may be polymorphic and sometimes life-threatening, DIF assay is recommended for all patients with Nikolsky's sign and large erosions. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 07/2013; 169(5). DOI:10.1111/bjd.12488 · 4.10 Impact Factor

Publication Stats

444 Citations
191.55 Total Impact Points

Institutions

  • 2009–2015
    • Hôpital Henri Mondor (Hôpitaux Universitaires Henri Mondor)
      • Service de Dermatologie
      Créteil, Île-de-France, France
  • 2013–2014
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
    • Centre Hospitalier Universitaire Rouen
      Rouen, Upper Normandy, France
    • Centre Hospitalier Universitaire de Nancy
      Nancy, Lorraine, France
  • 2011
    • Université Paris-Est Créteil Val de Marne - Université Paris 12
      Créteil, Île-de-France, France
  • 2010
    • University of Paris-Est
      La Haye-Descartes, Centre, France
  • 2005–2009
    • Centre Hospitalier Victor Dupouy
      Argenteuil, Île-de-France, France
  • 2002
    • French Institute of Health and Medical Research
      • Unit of Immunology, Dermatology, Oncology
      Lutetia Parisorum, Île-de-France, France