Search

Competing Interests: Les auteurs déclarent n’avoir aucun lien d’intérêts.

Background: Atopic dermatitis (AD) is a chronic relapsing eczematous skin disease. It represents one of the symptoms of atopic diathesis. DA affects usually infants and children. aim : The aim of our study is to draw up the epidemiological, clinical features, treatment and outcome of severe childhood AD through a hospital series. methods: A retrospective study of 24 cases of severe childhood AD hospitalized in the Dermatology Department of La Rabta hospital of Tunis was conducted during a 28 year-period (1981 - 2009). results: The hospital incidence of severe childhood AD was 0,085‰. Patient's mean age at the beginning was 14 months. The sex ratio H/F was 1.66. Cutaneous manifestations occurred preferentially in face (75%). Generalized eczema was observed in 37.5% of cases. Pruritus and xerosis were constant. The mean duration of hospitalization was 11 days. Topical corticosteroids was the most effective method of treating severe DA, associated with antiseptic solutions emollient and antihistaminic drugs. Infectious complications were noted in 50% of cases. Ocular complications were observed in 16.7% of cases. Recurrences were reported in 9 cases. Conclusion :AD is an inflammatory, chronically relapsing, and pruritic skin disorder developing in a xerotic skin. Severe AD in childhood is rare in Tunisia. It requires a good understanding of therapeutic modalities by the patient and his family. It is a cause of important morbidity and it may have a bad impact on quality of life.

Background: Depilatory radiotherapy was used in the sixties as a treatment for ringworm in Tunisia. Subsequently some of these patients developed radio-induced carcinomas of the scalp., Aim: To present the epidemiological, clinical, pathological,therapeutic features and out come of radio-induced cutaneous carcinomas., Methods: We conducted a retrospective study performed in the dermatology department of the La Rabta hospital of Tunis over a 6- year-period recording all histologically confirmed carcinomas in patients irradiated in childhood for tinea capitis., Results: Thirty one patients were included with 49 tumors: 47 basal cell carcinomas and 2 squamous cell carcinomas. The average latent period between the irradiation and the appearance of the carcinomas was of 35.7 years. The average age was 53 years. A male predominance was noted, with a sex ratioM/F of 6.75. Clinically, basal cell carcinomas were nodular in all cases. Surgery was indicated in 90% of cases. Cryosurgery and radiotherapy were used respectively in 1 and 2 patients., Conclusion: Our study shows that radio-induced cutaneous carcinomas are widely dominated by basal cell carcinoma. They arise, approximately, ten years earlier than carcinoma in patients with no history of scalp irradiation. However X-ray exposure does not seem to influence clinical or histological presentation, therapeutic modalities nor prognosis of these tumors. The prognosis of radioinduced cutaneous carcinomas was globally similar to that of other cutaneous carcinomas with same histological type and equivalent degree of invasion.

Background: Squamous cell carcinoma (SCC) is one of the most common malignant tumors of the lips (90%). The prognosis of these SCC seems to be poor thus here periorificial localization., Aim: To present the epidemiological, clinical, pathological, therapeutic features and out come of SCC of the lips., Methods: we conducted a retrospective study performed in the dermatology department of the La Rabta hospital of Tunis over a 11-year-period [2000-2010] recording patients with histologically confirmed SCC of lips., Results: Thirty patients were included (26 men and 4 women) with an average age of 63 years. The most frequent risk factors were smoking and chronic sunlight exposure. The occurrence of the labial SCC on a precursor lesion was noted in 11 cases. It occurred more frequently on the lower lip (80%). Tumor was ulcero-vegetant in 21 patients. Twenty patients had a commune SCC, 19 of them were well-differentiated. Surgery was indicated in 18 cases and 10 patients were treated by exclusive radiotherapy. Lymph nodes metastases were noted in 2 cases. No visceral metastasis was observed. During the period of follow-up (20.12 months), two patients died., Conclusion: The diagnosis of SCC of the lips is late and the treatment often mutilating. The improvement of the prognosis depends not only on the early diagnosis and the treatment of the precursors, but also on the photo protection and alcohol and smoking eviction.

Background: Psoriasis is a chronic inflammatory skin disease often benign, affecting 2-3% of the total world population. Psoriasis is a multifactorial disease., Aim: To present recent advances in the immunologic mechanisms and susceptibility genes involved in the pathogenesis of psoriasis., Methods: We presented a literature review of recent genetic and immunological basis of psoriasis to better understand the pathomecanisms of this disease and discuss the contribution of the Tunisian work in this area., Results: Recent works focalized mainly in immunology and genetics. Current progresses in molecular biology have allowed to better characterize the immunogenetic abnormalities in psoriasis., Conclusion: Psoriasis is a multifactorial disease model in which environmental factors (psychological, climate, traumatic, infectious, and viral) seem to be triggering factors when associated with a particular immunogenetics predisposition.

Background: Kaposi's sarcoma (KS) is a mutifocal angiogenic process characterized by cellular and vascular proliferation., Aim: To identify the epidemio-clinical, histological and therapeutic features of KS., Methods: Retrospective study of 75 cases of KS at the dermatology department of Rabta hospital in Tunis during a period of 25 years (1982-2007)., Results: Three epidemio-clinical forms of KS were observed in our study: the classic KS (70 cases), the AIDS-related KS (4 cases) and the iatrogenic KS (1 case). The mean age of our patients at diagnosis was 69.16 years with a sex ratio of 2.33. Elective site of cutaneous lesions in the classic KS was the limbs (87.1%). The cephalic part was concerned in 17.1% of cases. Mucosal involvement was found in 28.5% of patients. Extra dermatological localizations of KS were observed in 32.9%., Conclusion: Our study identified some epidemio-clinical features of the classic KS especially the high frequency of mucosal and cephalic involvement as well as extra dermatological localizations. Thus further exploration is required even without alarm signs.

Background: the erythrodermic psoriasis (EP) is a rare but severe form of psoriasis that may be potentially life-threatening., Aim: To study the characteristics of this severe form of psoriasis., Methods: We present a retrospective study, including all cases of EP followed in the dermatology department of the La Rabta hospital of Tunis over a 31-year-period from January, 1980 to June, 2010., Results: sixty patients were included, concerning 46 men and 14 women, with an average age of 53.7. A history of psoriasis was reported in 78 % of the cases. A triggering factor was found in 53 % of the cases. Systemic treatments were required in 55 % of cases. An improvement was noted in 69.4 % of the cases. A recurrence of the EP was observed in 15% of the cases. Three cases of sepicemia and one of stroke were noted., Conclusion: Erythrodermic psoriasis is the most common etiology of erythroderma. It represents more than half of severe psoriasis. As shown in our study it affects mainly adults' males. It complicates usually a common psoriasis. Septic and thromboembolic complications ones justify a close follow up.

Background: Acute generalized exanthematous pustulosis (AGEP) is an uncommon but severe dermatosis, characterized by acute occurrence of fever, and erythemato-oedematous rash, covered by sterile nonfollicular pustules. Most cases of AGEP have been described in association with the intake of drugs., Aim: To determine clinical and prognostic features of AGEP in our patients., Methods: All cases of AGEP diagnosed between 1992 and 2007 according to EuroSCAR criteria have been collected., Results: Twenty two patients (16 female, 6 male) with a mean age of 40.9 years (19-81) were included in the study. Clinical features showed in all cases an acute eruption with oedematous erythema, rapidly covered by nonfollicular pustules. The rash was mainly localized on big folds, trunk and/or limbs in 14 cases and generalized in 8 cases. A biological cytolysis was noted in 5 cases and a functional acute renal failure was objected in 2 cases. Etiological work up has found an association with the intake of drugs in 14 cases, a toxic cause (mercury) in 1 case and a B19 parvovirus infection in one case. The mean delay between drug intake and beginning of the eruption was 5 days (24 hours- 15 days). Pharmacovigilance enquiry has concluded to a probable or plausible causality in all our cases. Clinical features improved with drug or toxic withdrawal with a mean delay of 7 days (4 -12 days). A relapse of AGEP was observed in 2 cases after accidental introduction of the drug., Conclusion: AGEP is a cutaneous side effect not to ignore, because of its severe prognosis in case of systemic involvement and the possibility of relapses in case of retake of the causal drug.

Background: Chronic urticaria (CU) is a common condition. Usually benign, it can be debilitating. The main step was to identify the potential causes of CU to institute the strategy for management of patients., Aim: To present the epidemiological, clinical and therapeutic features of CU., Methods: 233 cases of CU were enrolled through a retrospective study conducted in the dermatology department of La Rabta hospital during 10 years (1997-2006)., Results: The mean age of our patients was about 36 years with a sex ratio of 2.28. The mean duration of the CU before the consultation was 21 months. Inducing Factors were reported in 109 cases, dominated by physical factors (73 cases). Severe symptoms as facial edema were observed in 44 cases. The CU was considered as idiopathic in 179 cases (77%). An etiology was found in 54 cases, dominated by physical origin, noted in 25 cases. All patients were treated by antihistaminic. Systemic corticosteroids were associated in 41 patients. Partial improvement was the mainly outcome (166 cases)., Conclusion: CU is a frequent disease which the diagnosis is based on clinical exam. The causes of CU were numerous and sometimes intricate, that gives the etiologic courses difficult and usually disappointing.

Pemphigus is a severe autoimmune blistering disorder, in which immunoglobulin G autoantibodies are directed against desmosomal glycoproteins. The antibodies against desmogleine1 are prevalent in normal subjects living in Tunisia, that suggests the role of environment in the pathogenesis of this endemic type of pemphigus and the need for additional factors to switch from a subclinical form to a clinical form of the disease. The aim of this study was to investigate explanatory environmental factors. We tested the hypothesis that normal subjects whom presented staphylococcal infections have antibodies against desmoglein. We recruited 29 patients with staphylococcal infections from the dermatology department of the university hospital of Tunis. 29 controls healthy subjects are used to compare the prevalence of anti-desmoglein1 and 3 between these two groups. We used a specific and sensitive enzyme linked immunosorbent assay to detect autoantibodies against Dsg1. (10.3% versus 7% in healthy Tunisian blood donors: p < 0.05). Conversely, we observed a significant association with antibodies against Dsg3 (20.78% versus 3% in healthy Tunisian blood donors: p < 0.05). Subclasses analysis of anti-desmoglein antibodies showed that they were almost exclusively the IgG 1, 2 and 3 subclasses in positive normal sera. The antibodies against desmogleins binding activity of these positive sera were confirmed by indirect immunofluorescence analysis and by immunobloting using human epidermal extract. In conclusion, we detected autoantibodies in the sera of patients with staphylococcal infections and found elevated levels of autoantibodies against Dsg 3.

Background: Participation in athletic activities is associated with a variety of skin problems. We aimed to precise the most important sports related dermatoses in athletes., Methods: We conducted transversal study on 30 athletes of 2 teams: one of soccer and the other of basketball players. For each athlete dermatological exam was practiced., Results: 18 soccer players and 12 basketball players were enrolled; the mean age was about 25.3 years [18-35 years]. The results suggest that athletic activity seems to be a predisposing factor for cutaneous infections (87%) especially fungal infections (90%). Traumatic lesions were also frequent in our athletes (20/30), dominated by calluses and nail disorders (80%)., Conclusion: Sports-related dermatoses include infections, traumatic entities, allergic contact dermatitis, environmental encounters, exacerbation of preexisting dermatoses, thus regular dermatological screening of athletes is critical for rapid identification and treatment of dermatoses distrusting sport performance.

Background: Porokeratoses (PK) represent a less common group of dermatoses that are acquired or hereditary, of unknown pathogenesis, characterized by keratinization disorder. Different clinical forms have been identified and the most frequent are the Mibelli's porokeratosis (MP) and the Disseminated Superficial Actinic Prokeratosis (DSAP)., Aim: In this retrospective study, we analysed the observations of PK collected in the Dermatology Department of La Rabta Hospital over a 16-year period., Methods: Six cases of PK were collected: 4 females and 2 males, with no medical history with a mean-age of 42.7., Results: Only a female patient had (PK) familial history. All our patients had typical clinical aspects with lesions in annular plaques, of atrophic center, surrounded by keratotic border. The histological aspect was consistent with PK, showing the typical cornoid slide. In our series, there are 3 cases of (MP) and 3 cases of (DSAP). PK lesions usually appear during the childhood and the third and fourth decades for the DSAP. In MP, there is one or some large, unilateral, annular plaques. DSAP is characterized by numerous small annular lesions of the photo-exposed regions. Their prognosis is on the whole, favourable but remains conditioned by malignant transformation. Treatment is difficult aiming at reducing that risk of degeneration.

Nevus lipomatosus cutaneous superficialis (NLCS) is a rare hamartomatous skin lesion histologically characterised by the presence of mature fat tissue within the dermis. Clinically, two types of NLCS can be distinguished: a multiple type of Hoffmann-Zurhelle and a solitary type. We report a retrospective study of 13 cases of NLCS seen in the Anatomopathological department of La Rabta hospital of Tunis during a period of 12 years (1992-2004). Two clinical forms were distinguished: the solitary form (11 cases) consisting of a unique papulo-nodular lesion and the multiple form (2 cases). Histologically, the tumor consisted in all cases on mature fat tissue.

Unlabelled: Basal cell carcinoma (BCC) is the most common malignant tumour of the skin frequently located on the head and chiefly on the nose. Cryosurgery is one of the methods to treat BCC., Object: To determine the efficacy of cryosurgery of 17 BCC of the nose in terms of recurrence rates and cosmetic results., Results: 15 patients were included with a median age of 73 years and a photo type III or IV in 86% of cases. Mean size of tumours was 12 mm. Lesions were chiefly located on the alae nasi (70.5%). Complications were few and minor. After an average follow-up of 13.5 months, recurrence rate was about 5.8% (one case). Cosmetic results were good or excellent in 14 cases/17; only one patient had developed a notch of the nose., Conclusion: Cryosurgery is a rapid, of a low cost technique and chiefly with good oncological and cosmetic results.

Introduction: Pseudoxanthoma elasticum (PXE) is an inherited disorder of elastic tissue with many systemic manifestations, Patients and Methods: We performed a retrospective study from all the patients diagnosed with PXE at the department of dermatology of La Rabta hospital of Tunis, between 1986 and 2003., Results: During the observation period, we identified 11 patients with PXE, 5 males and 6 females with a mean age of 28 years (10-47 years). Family history was found in 5 patients. Exhibit yellowish, pigskin, and popular lesions on the sides of the neck were observed in all cases. Systematic ophthalmologic examination revealed angioïd streaks in 4 patients. No abnormalities were found in cardiovascular and metabolic explorations., Discussion: Diagnosis of PXE is based on clinical, histological and genetic criteria. Ocular and cardiovascular damage make all the gravity of the disease, from where interest of an ophthalmologic and cardiovascular examination systematic.

Introduction: Nasosinusal sarcoidosis is a rare non caseating granulomatous disease. It may be inaugural, isolated or associated with multisystemic sarcoidosis., Material and Methods: [corrected] We report two cases of nasosinusal sarcoidosis associated to multisystemic sarcoidosis. Both patients were females aged over 43 years. In one case, the primary symptom was a nasal obstruction. Tomodensitometric and guided biopsy findings provided the main diagnostic criteria. Anti-malaric treatment was prescibed in both cases. Stabilisation of the lesions was noted., Discussion: we tried to reveal through this study the diagnostic an therapeutic difficulties of nasosinusal sarcoidosis.

The paraneoplastic acanthosis nigricans occurs in association with visceral neoplasms. We report a case of acanthosis nigricans that seat at a dorsal face of the second, third and fourth right toe of a 63 year-old patient. The exploration has been put in evidence a carcinoma of the right lung. The acanthosis nigricans has been nearly disappeared after resection of the pulmonary lobe. The relapses of the acanthosis nigricans in a same sit after five years has been reveal a carcinoma of the bladder. The resection of the bladder tumour has been followed by disappearance of the acanthosis nigricans.

Some cases of skin cancer developping from chronic discoid lupus erythematosus were publied among the world. We make know our experience about two cases suffering with a chronic discoid lupus erythematosus from 16 and 11 years and developped a squamous cell carcinoma from the elbow and the lower lip.

Granuloma annulare is a benign skin disorder which cause is unknown. The aim of this work is to report the results of a retrospective study dealing with 18 cases of granuloma annulare carried in the dermatology department of la Rabta hospital over a nine year period. We describe 3 clinical forms: localized granuloma annulare: 9 cases, generalized granuloma anulare: 7 cases and deep granuloma annulare: 2 cases. Diabetes mellitus was associated to granuloma annulare in 6 patients, from which 3 presented with multiple lesions. Corticosteroids were used topically in 11 cases. The outcome was marked by a partial resolution in 15 cases. In our study. We didn't found any malignancy with our granuloma annulare patients.