Bureau-Barriere disease

Introduction. - The acrodystrophic neuropathy described by Bureau a,ld Barr iere in the 1950s is a rare trophic complication of chronic, analgesic neur opathy due to alcohol abuse, which is at the origin of perforating ulcers o f the foot, vasomotor disorders with dysautonomia, and lends to mutilating arthropathy of the lower limb. This neuroacropathy also termed vagabonds' o r vagrants' disease, usually occurs in subjects with a debilitated conditio n, chronic alcoholism, and unfavourable socioeconomic conditions. Exegesis. - We report four cases of Bureau-Barriere disease which occurred irt merle subjects who were on average 55 years of age. The clinical presen tation was close to that reported in the literature. Indeed, all four patie nts were alcoholic, nondiabetic and lived under conditions of precarious hy giene. Therapeutic management of the patients was difficult due to bad comp liance with the treatment and persistence of alcohol abuse. Immobilization of the foot is considered to be the primary treatment. Local care including baths and bandages with hydrocolloids must be continued during several mon ths, and associated with antibiotic therapy, administered by infusion when necessary. The outcome is often chronic, with poor prognosis. Given the lim ited therapeutic possibilities, acrodystrophic neuropathy is an invalidatin g disease with high morbidity. Conclusion. - Bureau-Barriere disease is a rare, serious invalidating disea se. The clinical symptomatology is usually Dosed on the diagnostic triad: a nalgesia of the Soot, perforating ulcers of the foot, and deforming and mut ilating arthropathy of the lower, limb. Treatment is often hampered due to poor compliance with local care and persistence of alcohol abuse. (C) 1999 Editions scientifiques ct medicale Elsevier SAS.