A. Phan

Claude Bernard University Lyon 1, Villeurbanne, Rhône-Alpes, France

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Publications (49)92.12 Total impact

  • Journal of the European Academy of Dermatology and Venereology 08/2015; DOI:10.1111/jdv.13236 · 3.11 Impact Factor
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    ABSTRACT: The parallel ridge pattern (PRP) is considered as the dermoscopic hallmark of acral melanoma (AM). However, it was recently shown that approximately one third of AM do not display dermoscopically a PRP, rendering their detection more troublesome. To investigate the diagnostic accuracy of dermoscopic criteria for the diagnosis of AM. Dermoscopic images of consecutive cases of histopathologically diagnosed AMs and acral nevi with histopathologic diagnosis or with at least 1 year of follow up were evaluated by 3 independent investigators for the presence of pre-defined criteria. Crude odds ratios, adjusted odds ratios and corresponding 95% confidence intervals were calculated by univariate and multivariate logistic regression, respectively. ROC curves were used to choose among competing classification schemes. A total of 603 lesions (472 nevi and 131 AMs) were included in the study. A scoring system (named BRAAFF) composed of 6 variables was associated with optimal area under curve and sensitivity for the diagnosis of AM. This method included 4 positive (blotches irregular, ridge pattern, asymmetry of structures and asymmetry of colours) and 2 negative predictors (furrow pattern and fibrillar pattern). The BRAAFF checklist significantly improves the diagnostic accuracy of dermoscopy for the diagnosis of AM. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 07/2015; DOI:10.1111/bjd.14045 · 4.10 Impact Factor
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    ABSTRACT: PRKDC encodes for DNA-dependent protein kinase catalytic subunit (DNA-PKcs), a kinase that forms part of a complex (DNA-dependent protein kinase [DNA-PK]) crucial for DNA double-strand break repair and V(D)J recombination. In mice DNA-PK also interacts with the transcription factor autoimmune regulator (AIRE) to promote central T-cell tolerance. We sought to understand the causes of an inflammatory disease with granuloma and autoimmunity associated with decreasing T- and B-cell counts over time that had been diagnosed in 2 unrelated patients. Genetic, molecular, and functional analyses were performed to characterize an inflammatory disease evocative of a combined immunodeficiency. We identified PRKDC mutations in both patients. These patients exhibited a defect in DNA double-strand break repair and V(D)J recombination. Whole-blood mRNA analysis revealed a strong interferon signature. On activation, memory T cells displayed a skewed cytokine response typical of TH2 and TH1 but not TH17. Moreover, mutated DNA-PKcs did not promote AIRE-dependent transcription of peripheral tissue antigens in vitro. The latter defect correlated in vivo with production of anti-calcium-sensing receptor autoantibodies, which are typically found in AIRE-deficient patients. In addition, 9 months after bone marrow transplantation, patient 1 had Hashimoto thyroiditis, suggesting that organ-specific autoimmunity might be linked to nonhematopoietic cells, such as AIRE-expressing thymic epithelial cells. Deficiency of DNA-PKcs, a key AIRE partner, can present as an inflammatory disease with organ-specific autoimmunity, suggesting a role for DNA-PKcs in regulating autoimmune responses and maintaining AIRE-dependent tolerance in human subjects. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
    The Journal of allergy and clinical immunology 04/2015; 27(6). DOI:10.1016/j.jaci.2015.01.040 · 11.25 Impact Factor
  • Annales de Dermatologie et de Vénéréologie 12/2014; 141(12):S308-S309. DOI:10.1016/j.annder.2014.09.181 · 0.67 Impact Factor
  • Annales de Dermatologie et de Vénéréologie 12/2014; 141(12):S295-S296. DOI:10.1016/j.annder.2014.09.156 · 0.67 Impact Factor
  • Annales de Dermatologie et de Vénéréologie 11/2014; 141(12). DOI:10.1016/j.annder.2014.09.067 · 0.67 Impact Factor
  • Annales de Dermatologie et de Vénéréologie 11/2014; 141(12). DOI:10.1016/j.annder.2014.09.042 · 0.67 Impact Factor
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    ABSTRACT: Background Obesity is more frequent in adults with psoriasis than in the general population. Little data is available in children but this association seems to exist also in children.Objective To evaluate whether obesity was more frequent in French children (2y<age<18y) with psoriasis of any clinical type, and severity of psoriasis.Methods Multicentre case-control study performed in 23 French dermatology centres. Comorbidities in children and parents were routinely collected. Controls were children without chronic or genetic inflammatory disease matched for age, sex, and dermatology centre. We used three weight cut-offs to compare the two groups: overweight, overweight with abdominal obesity, and overweight with obesity according to French Health Authority guidelines.ResultsA total of 261 children with psoriasis and controls were included. Mean age was 9.8 years, M/F: 126/135, 42.5% of children had plaque psoriasis, 32.2% had severe psoriasis. If we compare all the frequencies of overweight children there was no difference between the two groups (20·7%in psoriasis group, vs. 17·1% in control group, p=0·18). Overweight with abdominal obesity including obesity (18·4% vs. 10·4%; p=0·009), and obesity alone (10·0% vs. 3·1%; p=0·001) were more common in psoriasis. This was not seen in patients with severe psoriasis or those with plaque psoriasis The only determinants for overweight or obesity in the psoriasis group were female sex, or to have a parent with overweight (also found in controls).Conclusion This study shows that overweight with abdominal obesity and obesity are more frequent in children with psoriasis than in controls. Risk factors are to be a female and to have a parent with overweight, similar to that seen iin French general population. Severity and clinical type of psoriasis are not associated with overweight and obesity.This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 11/2014; 172(6). DOI:10.1111/bjd.13507 · 4.10 Impact Factor
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    ABSTRACT: Background Pigmented purpuric dermatosis (or Schamberg's disease) is characterized by chronic macular purpura and capillaritis. It is more common in young adult males and adolescents and is generally localized on the lower limbs. In this article, we report on five young children with generalized Schamberg's disease. Patients and methods Five children (aged 13 months to 5 years) were included in this retrospective study. Time to consultation delay ranged from 15 days to 1 year. Results All patients presented asymptomatic generalized macular purpura. Skin biopsies were performed in 4 cases and were characteristic. The results of coagulation tests and complete blood counts were within the normal range in all patients. The clinical course was chronic, with periods of improvement and worsening. No treatment was prescribed. Discussion Schamberg's disease is uncommon in childhood. Our observations suggest that this diagnosis is not exceptional. Clinical appearance, setting and normal blood count values are sufficient to enable a diagnosis to be made. The clinical course is generally chronic, and as yet no treatments have demonstrated efficacy.
    Annales de Dermatologie et de Vénéréologie 05/2014; 141. DOI:10.1016/j.annder.2014.01.018 · 0.67 Impact Factor
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    ABSTRACT: Hand, Foot, and Mouth disease (HFMD) is classically defined as a childhood fever accompanied by a rash with vesicles or erosions of the oral mucosa, hands, feet and sometimes the buttocks. Severe neurological complications are associated with enterovirus 71 outbreaks in Asia. Recently, it has been suggested that HFMD is related to coxsackie virus A6 (CV-A6) when there is an atypical skin rash. To determine the dermatological pattern of HFMD and to identify the virus serotypes associated with a specific dermatological pattern. A prospective, cross-sectional study was conducted in seven pediatric dermatology units in France from March 2010 to February 2012. All children with clinically suspected diagnosis of HFMD were included. Clinical data were collected and swabs from the nasopharynx and vesicles were taken for RT-PCR and genotyping. Only children with confirmed HFMD - defined by clinical diagnosis of HFMD and positive enterovirus PCR results - were included for analysis. One hundred and four (104) children consulted for suspected HFMD, including 89 (mean age 25.7 months; sex ratio M/F 1.54) with confirmed HFMD. Seventy-eight (87.6%) had skin lesions on sites other than hand feet and mouth (HFM). Thirty-seven (41.5%) had five or more anatomical sites involved (HFM, buttocks, legs, arms, and trunk) considered as widespread exanthema. Widespread vesicular exanthema was observed with both CV-A6 and CV-A16. Peri-oral rash was associated with CV-A6 (p<0.001). HFMD has a clinical spectrum ranging from classical to generalized vesicular exanthema. Generalized and atypical exanthema were observed with both CV-A6 and CV-A16 infections. CV-A6 is associated with peri-oral rash.
    The Pediatric Infectious Disease Journal 01/2014; 33(4). DOI:10.1097/INF.0000000000000120 · 3.14 Impact Factor
  • Annales de Dermatologie et de Vénéréologie 12/2013; 140(12):S432-S433. DOI:10.1016/j.annder.2013.09.152 · 0.67 Impact Factor
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    ABSTRACT: The specific anatomy of the glabrous skin, characterized by marked orthokeratosis and the presence of furrows and ridges, results in peculiar dermoscopic patterns of acral melanocytic lesions. Most frequently, acral nevi are typified by a parallel furrow pattern and acral melanoma (AM) by a parallel ridge pattern (PRP). Although the dermoscopic patterns of AM have been extensively investigated, little attention has been paid to site-related differences between palmar and plantar AM. The current study aimed to compare patients' characteristics, melanoma thickness, and the morphologic variability of AM depending on the localization on palms or soles. Patients demographics and dermoscopic images of 118 AM, including 99 (83.9%) plantar and 19 (16.1%) palmar lesions (mean thickness, 2.1 mm), were extracted from the databases of seven pigmented skin lesion clinics and were evaluated for the presence of predefined criteria. Palmar melanomas were remarkably more frequent in women (male-to-female ratio, 1/3.8) and thinner than plantar melanomas (1.3 vs. 2.2 mm). Dermoscopically, no significant differences were found between plantar and palmar melanomas, with PRP scored in 64.6 and 68.4% of plantar and palmar lesions, respectively. Non-site-specific melanoma criteria were detected in 83.9% of lesions and, among melanomas not exhibiting a PRP, 95.1% showed at least one non-site-specific melanoma criterion. In conclusion, plantar and palmar AMs show sex-related and thickness-related differences, but do not differ with respect to their dermoscopic features. For cases lacking the PRP, non-site-specific melanoma criteria may be considered as helpful additional clues for the correct diagnosis.
    Melanoma research 11/2013; DOI:10.1097/CMR.0000000000000037 · 2.10 Impact Factor
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    ABSTRACT: Although dermoscopy reflects the anatomy, skin anatomy is different on facial and acral skin as well as in the nail unit. Malignant patterns on acral sites include the parallel ridge pattern and irregular diffuse pigmentation, whose presence should lead to a biopsy. Malignant patterns on the face include features of follicular invasion (signet-ring images, annular granular images, and rhomboidal structures) and atypical vessels. Malignant patterns on the nail unit include the micro-Hutchinson sign and irregular longitudinal lines.
    Dermatologic clinics 10/2013; 31(4):615-24. DOI:10.1016/j.det.2013.06.006 · 1.43 Impact Factor
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    ABSTRACT: BACKGROUND:: Staphylococcal scalded skin syndrome and toxic shock syndrome are associated with exfoliatins and superantigens, respectively; and are easy to distinguish in their usual presentation. However, there is confusion about the mild forms of these two staphylococcal diseases. These mild forms are both designated as "staphylococcal scarlet fever" despite differences in their pathophysiology and clinical presentation.Our study aimed to distinguish between the clinical characteristics of the rash associated with exfoliatins and the rash associated with superantigens. METHODS:: Patients were selected from the French National Reference Center for Staphylococci. We retrospectively compared the clinical characteristics of patients with a generalized rash during S. aureus infection. Patients that met the criteria of staphylococcal scalded skin syndrome or toxic shock syndrome were excluded. The patients were classified into two groups, depending on the presence of a gene coding for exfoliatin or for superantigenic toxin. RESULTS:: We included 13 cases with exfoliatin and 9 with superantigens. The patients of the exfoliatin group were more likely to have facial involvement, fold involvement and a superficial focus of infection. In the second group, S. aureus was isolated from a deeper focus in 8/9 patients. CONCLUSION:: Mild forms of S. aureus toxin-mediated infection affect the paediatric population. Examination made it possible to distinguish an exanthema associated with an exfoliatin from one associated with a superantigen. This early clinical distinction results in differences in management.
    The Pediatric Infectious Disease Journal 02/2013; 32(7). DOI:10.1097/INF.0b013e31828e89f5 · 3.14 Impact Factor
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    ABSTRACT: We report a case of an immunocompetent child who developed parvovirus B19 infection complicated by auto-inflammatory disease with myocarditis, tamponade and macrophage activation syndrome. He recovered with immunotherapy including prednisone, immunoglobulins, cyclosporin and anakinra (anti-IL1). The report shows that parvovirus can provoke severe systemic inflammation with acute heart injury and that anti-IL1 might be considered in such parvovirus-related inflammation.
    The Pediatric Infectious Disease Journal 02/2013; 32(7). DOI:10.1097/INF.0b013e31828df4d1 · 3.14 Impact Factor
  • S. Dalle · A. Phan · L. Depaepe · B. Balme · L. Thomas
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    ABSTRACT: Los nevos pigmentarios, también denominados nevos melanocíticos, son tumores melanocíticos benignos que se caracterizan por una proliferación de melanocitos en las cercanías de la unión dermoepidérmica, con un reagrupamiento en cúmulos o tecas que permite distinguirlos de los melanocitos normales. Aparte de los nevos adquiridos comunes, algunos nevos adquiridos son notables por sus características clínicas y/o sus variantes evolutivas. Los problemas principales que plantean los nevos pigmentarios son el diagnóstico diferencial con el melanoma y, en algunos casos, el riesgo evolutivo de transformación maligna. La dermatoscopia permite mejorar los resultados diagnósticos en manos de un operador experimentado y, en consecuencia, proponer una clasificación de los nevos centrada en la observación clínica. Los nevos congénitos plantean problemas específicos y se deben tratar por separado.
    12/2012; 46(4):1–16. DOI:10.1016/S1761-2896(12)62720-4
  • Annales de Dermatologie et de Vénéréologie 12/2012; 139(12):B160. DOI:10.1016/j.annder.2012.10.246 · 0.67 Impact Factor
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    ABSTRACT: Merkel cell carcinoma (MCC) is an aggressive cutaneous tumor whose clinical presentation, usually a pink nodule, is not specific. We aimed in this study to determine the dermoscopic criteria encountered in MCC. From our image database we selected the patients diagnosed with MCC and scored the dermoscopic criteria shown by these tumors. Ten patients coming from three different academic hospitals were studied. Vascular structures were the more relevant dermoscopic features. In 8 out of 10 (80%) patients a polymorphic vascular pattern was seen, composed of milky-red clods/areas in association with one or more additional vascular structures. Although an overlap existed between the dermoscopic features observed in MCC and amelanotic melanoma, the presence of a polymorphous vascular pattern may constitute an additional clinical clue to accurately diagnose this rare tumor.
    Dermatology 04/2012; 224(2):140-4. DOI:10.1159/000337411 · 1.69 Impact Factor
  • Annales de Dermatologie et de Vénéréologie 12/2011; 138(12):A57–A58. DOI:10.1016/j.annder.2011.09.040 · 0.67 Impact Factor
  • N Sureda · A Phan · N Poulalhon · B Balme · S Dalle · L Thomas
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    ABSTRACT: Subungual melanoma (SUM) is a rare entity, comprising approximately 0·7-3·5% of all melanoma subtypes. SUM histopathologically belongs to the acral lentiginous pathological subtype of malignant melanoma. Its diagnosis is helped by dermoscopy but pathological examination of doubtful cases is required. Classical management of SUM is based on radical surgery, namely distal phalanx amputation. Conservative treatment with nonamputative wide excision of the nail unit followed by a skin graft has been insufficiently reported in the medical literature even though it is performed in many centres. To report a series of patients with in situ or minimally invasive SUM treated by conservative surgery, to investigate the postoperative evolution and to evaluate the outcome with a review of the literature. We performed a retrospective extraction study from our melanoma register of all patients with in situ and minimally invasive SUM treated with conservative surgery in the University Hospital Department of Dermatology, Lyon, France from 2004 to 2009. The patient demographics, disease presentation, delay to diagnosis, histopathology and postoperative evolution were reviewed. Seven cases of SUM treated as such were identified in our melanoma database. All cases had a clinical presentation of melanonychia striata. The mean delay to diagnosis was 2years. Surgical excision of the entire nail unit with a 5-10mm safety margin without bone resection followed by full-thickness skin graft taken from the arm was performed in all cases. No recurrence was observed with a mean follow-up of 45months. Functional results were found satisfactory by all patients and their referring physicians. Sixty-two other cases have been found in the literature and are also discussed. Conservative surgical management in patients with in situ or minimally invasive SUM is a procedure with good cosmetic and functional outcome and, in our cases as well as in the literature, the prognosis is not changed.
    British Journal of Dermatology 08/2011; 165(4):852-8. DOI:10.1111/j.1365-2133.2011.10477.x · 4.10 Impact Factor

Publication Stats

312 Citations
92.12 Total Impact Points

Institutions

  • 2006–2015
    • Claude Bernard University Lyon 1
      • Service de dermatologie
      Villeurbanne, Rhône-Alpes, France
  • 2013–2014
    • CHU de Lyon - Hôpital Femme-Mère-Enfant
      Lyons, Rhône-Alpes, France
    • Hôpital Louis Pradel
      Lyons, Rhône-Alpes, France
  • 2008–2013
    • University of Lyon
      Lyons, Rhône-Alpes, France
  • 2009–2012
    • Centre Hospitalier Lyon Sud
      Lyons, Rhône-Alpes, France
  • 2011
    • CHU de Lyon - Centre Hospitalier Lyon Sud
      Lyons, Rhône-Alpes, France
  • 2005–2011
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France