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Competing Interests: There are no conflicts of interest.

Competing Interests: There are no conflicts of interest.

Pigmented nevi, still called melanocytic nevi or more improperly "naevus naevocellulaires" are benign melanocytic tumors characterized by a proliferation of melanocytes near the dermoepidermal junction. They are grouped in clusters or in theca cells that differentiate them from normal melanocytes. They occur at birth in approximately 1% of newborns with no sex predominance. Their occurrence is mostly sporadic, although rare family forms have also been reported. They can be separated in an arbitrary manner according to their diameter on the day of the birth: small congenital nevi <1.5cm, medium-sized 1.5 to 20cm and large-sized >20cm. Umbilical nevi are rare. We here report an interesting case of atypical and rare congenital nevus. The study involved a young girl presenting with pigmented umbilical nodule occurred at birth which had recently become problematic. We suspected a nevus, a melanoma or an endometriosis on the basis of the clinical appearance of this nodule. Resection was performed. The diagnosis of benign melanocytic tumor was confirmed., (© Fatima-Zahra Agharbi et al.)

Aphthae are single or multiple small painful ulcers, preceded by a burning sensation, with a yellow background surrounded by a non-indurated red border, healing usually in 8-10 days. They usually affect the buccal mucosa, but sometimes they are bipolar (orogenital) with possible variants: deep aphthae >1cm, herpetiform aphthae measuring 1-3mm, giants aphthae, miliary aphthae. Benign idiopathic aphtosis is frequent, reactivated by contact with some food (citrus fruit, tomato, walnuts, gruyère). Some drugs can cause aphthoid ulcerations: nonsteroidal anti-inflammatory drugs, nicorandil, alendronate sodium, betablockers, opiate analgesics, savarine, sirolimus, anti-EGFR. Complex aphtosis (at least 3 recurrent episodes of ulcers) can lead to enterocolopathy or celiac disease, sometimes revealing martial or vitamin deficiency (folates, vitamin B12). Bipolar aphtosis is strongly suggestive of Behçet's disease. We report the case of a 40-year old man presenting for increase in left thigh volume. Ultrasound showed aneurysm of the femoral artery. Clinical examination objectified giant aphthous ulcer in the tongue. Patient interview revealed recurrent genital and buccal aphthae and ophthalmologic examination showed posterior uveitis. The diagnosis of Behçet's disease was retained and emergency bolus dose of corticosteroids with immunosuppressants (cyclophosphamide) was started., (© Fatima-Zahra Agharbi et al.)

Keratosis pilaris is characterized by small bumps around hair follicles. Keratosis pilaris simplex results in gray and keratotic papules mainly on the arms, thighs and buttocks. It mainly affects women. Keratosis pilaris rubra often results in keratosis pilaris atrophicans. Common variants of keratosis pilaris include: ulerythema ophryogenes, atrophoderma vermiculata, Siemens alopecia. Keratosis pilaris is a genetic disorder and can occur in association with other hereditary diseases such as Noonan syndrome or vitamin disorders. Treatment is mainly based on emollients and keratolytics, but they have only a suspensive effect. We report the case of a 30 year old woman with a personal and family history of atopy, presenting with diffuse keratotic papules on the trunk. The remainder of the physical examination revealed no genetic abnormality. Treatment was based on emollients and keratolytics with slight improvement., (© Fatima-Zahra Agharbi et al.)

In infants less than 2 years of age, acute hemorrhagic edema of infancy (AHEI) is characterized by the rapid onset of purpuric annular lesions associated with initially local edemas of the extremities. In most cases, this disorder is benign, without visceral involvement and diagnosis is based on clinical examination. There are no specific laboratory data and the histological analysis of these lesions (which is unnecessary in the majority of cases) is usually unspecific (the patient sometimes has an unspecified leucocytoclasic vasculitis). This condition is of uncertain nosologic status, mimiking rheumatoid purpura. Sometimes the patient had had rhino-pharyngeal episode in previous days, suggesting a viral cause. There is a clear discrepancy between the good general condition and the profuse and spectacular appearance of the lesions. Children's monitoring in the first days must be rigorous but complications are exceptional (acute intussusception'). Patient's outcome is marked by spontaneous regression within 12 days. Treatment is based on careful monitoring of the child's general status. Fever, purpuric lesions extension and, especially, signs of alteration of the general state may suggest the diagnosis of purpura fulminans. Another differential diagnosis is acute hemorrhagic or ecchymotic urticaria. We report the case of a 3-month old infant with diffuse pseudo-roundel like lesions in a context of apyrexy and preservation of the general state. Patient's outcome was favorable, without receiving any treatment. This confirm the diagnosis of AHEI., (© Fatima-Zahra Agharbi et al.)

The syndrome of the tourniquet or "strangler hair" is the consequence of the strangulation of an appendage or body end by a constrictor link. Toes and fingers are the most affected extremities but also the genitals whether it is the penis, small or large lips or clitoris. Most of the links are hair, more rarely textile fibers (cotton, wool). The speed of diagnosis is important in order to proceed to the removal of the link as soon as possible and avoid seeing the process evolve towards necrosis or inflammation. Spontaneous or surgical amputation of the ischemic extremity. The difficulty lies in the fact that inflammatory edema following progressive constriction is a slow process that can last for weeks. The edema participates in the burying of the link making it accessible to the eye, delaying its ablation by increasing the risk of bone damage, necrosis and partial or total amputation. At the beginning of the process, incessant crying can summarize the symptomatology present by the infant. Different methods have been described to remove the link: mechanical or surgical removal. We report the case of an infant who presented edema and painful erythema of abrupt installation of the third left toe outside a traumatic context. The radiograph did not objectify a fracture or other abnormality and the exploration found constriction by the mother's hair. The evolution was favorable after ablation of the hairs and application of the healing creams., (© Fatima-Zahra Agharbi et al.)

The whole of the lesions associated with Crohn's disease affecting the anal canal, the skin of the perineum, the bottom-rectum and the recto vaginal septum are referred to as anoperineal lesions of Crohn's disease. The main types of primary lesions include ulcerations, suppurations and stenoses. Crohn's disease-like anoperineal lesions are often suspected in patients with severe inflammatory process, peri-anal skin thickening, œdematous marisques, multiple lesions and lesions extending above pectineal line. Fistulas usually originate from an ulceration or a scar rather than the crypts of the anal canal. Elementary lesions of Crohn's disease are rarely isolated and they are, in most cases, combined lesions. The presence of a stenosis of the anal canal or of the rectum is very often associated with an inflammatory and suppurative process. Anal ulcerations are complicated with suppuration in half of the cases. We report the case of 45-year old woman treated for autoimmune thyroiditis and vitiligo who presented with knife-cut painful perineal ulcerations. The patient reported episodes of diarrhea during interview. Histological examination of skin lesions showed epitheliogigantocellular granuloma without caseous necrosis and digestive exploration suggested Crohn's disease which was confirmed with histology., (© Fatima-Zahra Agharbi et al.)

Chancroid (also known as soft chancre and ulcus molle) is a sexually transmitted disease (STD) due to the Ducrey's bacillus (or Haemophilus ducreyi) characterized by chancre at the site of ulcerated inoculation associated with lymphadenopathy. The disease manifests as a small pinkish papule at the site of penetration of the bacterium. After an incubation period ranging from 24 hours to 15 days (on average 5 days). The lesion rapidly evolves into a more or less extended pinkish, painful, deep ulcer with very inflamed and sharp edges and a ragged appearance. The lymphadenopathies usually occur 2-3 weeks after the contact. They are often unilateral and can evolve into ulcers with pus discharge at the level of the skin. Some complications can occur: penile gangrene, extended gangrene of the skin, local superinfection, association with other sexually transmitted diseases. Bacterium can be identified by microscopic examination of a smear of the chancre-like ulcer, more rarely by fine-needle puncture biopsy of a lymphadenopathy. Giemsa or Pappenheim coloration allows identification of the germ. Treatment is based on azithromycin (1g per os in a single dose) or ceftriaxone (250mg administered intramuscularly in a single dose). We report the case of a 30-year old man with well-defined deep scrotum ulcer with necrotic center which occurred 1 week after unprotected sexual intercourse. Haemophilus ducrey has been detected by culture and the patient underwent Azithromycin therapy with good outcome., (© Fatima-Zahra Agharbi et al.)

In infants less than 2 years of age, acute hemorrhagic edema of infancy (AHEI) is characterized by the rapid onset of annular purpuric lesions associated with initially localized edemas affecting the extremities. This disorder is usually benign, without visceral involvement. Diagnosis is based on clinical examination, no specific laboratory findings exist and the histological examination of the lesions (which is unnecessary in the majority of cases) is most often nonspecific (sometimes patients have nonspecific leukocytoclastic vasculitis). Nosological status of AHEI remains unclear, but some reports suggest it is a clinical manifestation of rheumatoid purpura. Rhinopharyngeal episodes in the days before its onset have sometimes been reported, suggesting a viral cause. There is a net mismatch between patient's good general condition and the remarkable dissemination of the lesions. Infants monitoring must be rigorous in the first days, even though complications are exceptional (acute intussusception). Patients recover spontaneously within 12 days. Therapeutic management is based on accurate monitoring of the infant's general status. Fever, the extension of the purpuric lesions and, in particular, signs of impaired general condition may suggest the diagnosis of purpura fulminans. Another differential diagnosis is acute hemorrhagic or ecchymotic urticaria. We here report the case of a 3-month old infant with diffuse pseudoannular lesions within a context of apyrexy and preservation of patient's general condition. Patient's outcome was favorable without any treatment, confirming the diagnosis of AHEI., (© Fatima-Zahra Agharbi et al.)

Chancroid (also known as soft chancre and ulcus molle) is a sexually transmitted disease (STD) due to the Ducrey's bacillus (or Haemophilus ducreyi) characterized by chancre at the site of ulcerated inoculation associated with lymphadenopathy. The disease manifests as a small pinkish papule at the site of penetration of the bacterium. After an incubation period ranging from 24 hours to 15 days (on average 5 days). The lesion rapidly evolves into a more or less extended pinkish, painful, deep ulcer with very inflamed and sharp edges and a ragged appearance. The lymphadenopathies usually occur 2-3 weeks after the contact. They are often unilateral and can evolve into ulcers with pus discharge at the level of the skin. Some complications can occur: penile gangrene, extended gangrene of the skin, local superinfection, association with other sexually transmitted diseases. Bacterium can be identified by microscopic examination of a smear of the chancre-like ulcer, more rarely by fine-needle puncture biopsy of a lymphadenopathy. Giemsa or Pappenheim coloration allows identification of the germ. Treatment is based on azithromycin (1 g per os in a single dose) or ceftriaxone (250 mg administered intramuscularly in a single dose). We report the case of a 30-year old man with well-defined deep scrotum ulcer with necrotic center which occurred 1 week after unprotected sexual intercourse. Haemophilus ducrey has been detected by culture and the patient underwent Azithromycin therapy with good outcome., (© Fatima-Zahra Agharbi et al.)

Palpebral hidrocystomas are benign tumors also known as cystic apocrine adenoma, cyst of sweat gland, apocrine retention cyst or cyst of Moll. They originate from eccrine or apocrine sweat glands and often occur on the face and the eyelids. Other atypical locations such as the chest, the shoulders and the foreskin have been reported. Hidrocystoma is a small translucent, shiny cyst. It appears as single or multiple cystic lesion. Their histogenesis is uncertain. Indeed, apocrine hidrocystoma could arise from the residuals of the primitive apocrine glands or of the gland of Moll. The eccrine hidrocystoma could arise from the eccrine glands or the excretory duct of the glands of Moll. Their clinical differentiation is little obvious and diagnosis is based on histological examination. They are characterized by two clinical presentations: isolated hidrocystomas and the associated types. Isolated hidrocystoma is the most common type: hidrocystoma appears as single or multiple cystic lesions and it is not associated with extraocular signs. Apocrine hidrocystomas are solitary in 93% of cases while eccrine hidrocystomas appear most often as multiple lesions. The associated types are more rare and have been only described for the multiple hidrocystomas. If in the majority of cases a treatment based on argon laser is sufficient, more voluminous hidrocystomas require surgical resection. We here report the case of a young patient presenting with translucent nodule in the external canthus of the left eye. Hidrocystoma, molluscum pendulum and syringoma were the suspected diagnoses. Surgical resection was performed as well as histologic examination which confirmed the diagnosis of hidrocystoma.

Limb lymphedemas are due to a malfunction of the lymphatic system responsible for lymph stasis in the interstitial tissue and secondarily to an increase in the volume of the affected limb. They are divided into primary lymphedema (PL) and secondary lymphedema (SL). SLs develop most frequently in lower limbs after breast cancer treatment while lymphedemas are either secondary (iatrogenic or infectious) or primitive, most often sporadic, sometimes familial or they can be part of syndromes resulting in malformations and/or more complex genetics in upper limbs. The diagnosis of lymphedema is essentially based on clinical examination. Erysipelas are the main complication of lymphedema. Other abnormalities are often visible: yellowish skin and nails, lymphangiectasias, keratotic papules with papillomatosis, lichenified plaques. The main differential diagnosis in patients with limb lymphedema is lipoedema, defined as body fat distribution from the hips up to the ankles and affecting almost exclusively obese women. We report the case of a 30 year old man with left lower limb lymphedema occurred at puberty complicated by verrucous papillomatosis. It is a late-revelation congenital lymphedema.

Epidermodysplasia verruciformis, also known as Lewandowsky-Lutz syndrome or tree man disease is a rare genetic skin disorder. It is characterized by abnormal susceptibility of the skin coating to human papillomaviruses (HPVs). It commonly affects people between the ages of 4 and 8, most often before the age of 20 years but it may exceptionally occur later. It is characterized by the appearance of scaly macules and sometimes exuberant pseudotumoral papules, mainly on hands and feet. HPV 5 and HPV-8 have been characterized in these lesions, viruses that are found in about 80% of the normal population. Other HPV types can sometimes be identified. Felix Lewandowskyand-Wilhelm Lutz provided the first clinical description of this disorder. The most frequently observed skin lesion is a macular rash similar to that of pityriasis versicolor associated with verrucous scaly papules. The risk of malignant transformation to squamous cell carcinoma is high. Several treatments have been tried (retinoids, interferon, cimetidine) with little or non-repeatable success. Sun protection, assiduous clinical monitoring and early excision of any lesion undergoing malignang transformation are essential. We report the case of a 30 year old man presenting with multiple verrucous lesions on limbs and trunk occurred at the age of 4 years associated with pityriasis versicolor-like lesions. Clinical examination didn't show suspicious lesions and retinoid therapy was started.