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Liposarcoma is the most common malignant deep soft-tissue tumor in adults. however, primitive cutaneous liposarcoma is very rare. We report the observation of a patient who presents a liposarcoma of the thumb.

Methods Miss H.B, 30 years old, with a history of a psoriasis in the father. The patient was followed up for two years for a histologically confirmed sebopsoriasis. She received various therapies, initially put on moisturizers and Imidazoles but with no improvement, then on dermocorticoids and vitamin D derivatives. Treatment with UVB phototherapy could not be achieved, given the professional constraints of the patient. She was put on Methotrexate at 12.5 mg/week dose for six months without improvement. Treatment based on 5mg Isotretinoin, three times per week, was recommended allowing the complete whitening of lesions two months after the start of treatment with the benefit of one year hindsight. Results The sebopsoriasis alters significantly the quality of life of patients. The treatment is mainly based on local treatments but those are often ineffective. Phototherapy or other systemic therapies are also used with varying results. These centro-facial effects during psoriasis respond well to small doses of isotretinoin at the rate of 5 mg three times per week or every day, which is well illustrated through this observation. Conclusion Our case shows a remarkable efficiency with a good tolerance of isotretinoin in sebopsoriasis treatment. This promising result should prompt us to use more this retinoid in the treatment of this particular form of psoriasis. Disclosure of interest None declared.

Oral manifestations of the sarcoidosis are rare. We report a case of a systematic sarcoidosis revealed by a nodule of the palate.

Kaposi's sarcoma is an angiogenic tumour associated with HHV8 infection. There are several clinical forms, including those related to acquired immunosuppression. We report a case of nodular lesions in Kaposi's disease that appeared during treatment of bullous pemphigoid with topical corticosteroids.A 74-year-old female patient presented bullous pemphigoid lesions on all four limbs that were treated with clobetasol cream, a topical corticosteroid. After 2 months of treatment, the patient noted the appearance of several asymptomatic purple, erythematous, papulonodular lesions of elastic consistency on her right thigh and both legs. The histological examination revealed Kaposi's disease with positive immunolabelling for HHV8 in the tumour cells. HIV serology was negative. The lesions disappeared 4 months after cessation of corticosteroid therapy and the patient was still in remission one year later.Authentic "Mediterranean" cutaneous Kaposi's disease was apparently revealed in this patient during treatment with extremely potent topical corticosteroids, before regressing completely on discontinuation of the medication. We discuss the various mechanisms that could have contributed to this side-effect of dermal corticosteroids, whose sustained application over a wide area caused HHV8 antigen reactivation.

Pemphigus vulgaris is a bullous auto-immune disease affecting the skin and mucosa. It is characterised by acantholysis that results in the formation of intraepithelial bullous lesions. Herein we report a case distinguished by its unusual clinical presentation.A 45-year-old man, a chronic smoker, consulted for hyperkeratotic lesions of the toes on the right foot present for 5 months. Examination revealed a violet colour of the toes associated with localised yellowish keratoderma on the sole of the foot and impaired toe nails, as well as impairment on the nails of the first, third and fourth fingers on the right hand. In addition, two hyperkeratotic plaques with crusts were noted on the patient's forehead. Histological examination of a biopsy sample taken from the nail bed of the fourth toe on the right foot showed suprabasal acantholysis with a characteristic tombstone appearance. Direct immunofluorescence confirmed the diagnosis of pemphigus. Oral corticosteroid therapy was initiated consisting of prednisone 1.5mg/kg per day. Improvement of the nail lesions and subsidence of the lesions on the patient's forehead occurred after three months of treatment.During the course of pemphigus, the nail findings most commonly reported in the literature are paronychia, onychomadesis and onycholysis. However, these signs are generally seen in patients with known pemphigus vulgaris and only rarely indicate bullous disease. The case we report illustrates a special situation in which pemphigus vulgaris was revealed by unusual skin and nail lesions.

Sarcoidosis is a multisystem granulomatous disease of unknown aetiology. Tongue involvement is extremely rare. Herein we report a new case.A 65-year-old woman presented with a 6-month history of painless multiple nodules on the tongue. The patient also complained of xerostomia. Besides nodules on the tongue, physical examination revealed erythematous nodules on the dorsum of the hands and feet. A diagnosis of sarcoidosis with tongue, cutaneous and salivary gland involvement was made on the basis of these findings and further investigations performed. The patient's condition showed improvement with partial regression of tongue lesions after oral steroid therapy.Tongue involvement in sarcoidosis is exceedingly rare. It may be isolated or part of a generalized multisystem sarcoidosis. Nodules, indurations and swelling are the most common clinical manifestations. Management of tongue sarcoidosis is not consensual. Oral corticosteroids appear to be the most effective therapy.Sarcoidosis of the tongue should be considered when chronic unexplained nodules are noted. Diagnosis can easily be confirmed by a histological examination of mucosal biopsy.

To prevent the occurrence of corticosteroid's side effects, adjuvant measures are prescribed in a very different way depending on the practitioner's experience. The aim of this study was to assess the physicians' practices regarding the prescription of long-term corticosteroid therapy.In May 2010, we realized a cross-sectional study among physicians in Ibn Sina University Hospital in Rabat. With a data collection form, we assessed the principal indications for prescribing steroids and the frequency of prescription of measures sometimes associated with systemic corticosteroid.Fifty-nine out of eighty physicians completed the data collection form (response rate: 69.4%). Calcium-vitamin D supplementation was recommended by most of the physicians. Half of them were prescribing biphosphonate therapy. Most of them propose a low-sodium, a low-fat and a low-carbohydrate dietary regimen. Regular physical exercise was recommended by 35% of physicians. Gastric protection was indicating by 54.4% of practicians and potassium supplementation by 42.1% of them. Finally, the recommendation for influenza vaccination, hydrocortisone prescription and Synacthen(®) test, varied between physicians.The prescription of adjuvant measures with a long-term corticosteroid therapy was very heterogeneous. There is no consensus regarding most of the measures.

Seborrhoeic keratoses (SK) are benign tumours preferentially located on the head and trunk. We report a case of giant SK at an unusual site.An 85-year-old man consulted for pigmented genital lesions present for 10 years. Clinical examination revealed small pigmented formations evoking SK and other pigmented, confluent and hyperkeratotic bordering plaques with a circinate contour. The latter lesions were biopsied, and histological findings were characteristic of SK and showed epidermal acanthosis associated with orthokeratotic invagination of the mucosa, resulting in the formation of characteristic wells. Treatment by electrocoagulation curettage was undertaken.SK are benign tumours that occur primarily in patients aged over 50 years. They are preferentially located in the trunk, head and neck. A genital site of SK is very unusual, with no more than 10 published cases. The cause of genital SK is as yet unknown, but data in the literature point to a possible role of chronic friction and HPV.

Kaposi's disease (KD) is a multifocal disease affecting the skin and viscera. KD can occur in an endemic setting: it may be associated with human immunodeficiency virus (HIV) or it may occur as a complication of immunosuppression, particularly of iatrogenic origin in transplant patients. The purpose of this study is to describe the epidemiological, clinical and therapeutic profile and the course of iatrogenic KD in Morocco in a setting not involving organ transplantation.A retrospective study conducted at the dermatology department of the Ibn Sina hospital centre in Rabat, Morocco, covering a 21-year period and including 14 patients presenting histologically confirmed iatrogenic KD.Eight men and six women were included with a mean age of 56 years. All patients received corticosteroids, in combination with cyclophosphamide in three cases and with azathioprine in one case. The mean time to onset of lesions after the start of treatment was 16.5 months. The presentation in all cases was cutaneous. Impaired mucosal membrane was seen in 35.7% of patients, with visceral involvement being seen in only one patient. HIV serology tests were negative in all patients but HHV8 serology tests were positive in 78.5% of patients. Treatment consisted primarily of reduction or withdrawal of the immunosuppressant. The outcome was favourable in the majority of cases.In Morocco, KD is a rare but not exceptional complication of immunosuppressant therapy, particularly corticosteroids. The disease presented as a skin disorder in all of our patients, thus emphasising the value of regular follow-up and routine dermatological examination of patients on immunosuppressant therapy, and suggesting the value of screening for HHV8 infection before initiating such therapy.

Henna, or Lawsonia inermis, has been used since antiquity by women in the Orient for dyeing the hair, hands, and feet. Contact dermatitis to pure henna is very rare, most often caused by additives such as perfume oils or paraphenylenediamine (PPD). We report the case of a girl who presented contact dermatitis to henna associated with eczema to draw attention to the dangers related to its use.A 12-year-old girl developed erythematovesicular and edematous lesions with very itchy burning, suggestive of contact dermatitis, 48 hours after application of black henna. Lesions were located at the tattooing site exactly following the original design. The patient also had eczema lesions on the left cheek after contact with the tattooed hand. The lesions were improved by treatment with level II corticosteroids.Today, henna has become very popular in Western countries. PPD is added to reduce the fixation time or to obtain a darker color. It can cause severe systemic reactions. The most common allergic reaction is contact dermatitis. Treatment is based on topical steroids. Better legislation on temporary tattooing practices and control preparations as well as regular annual information aimed at the general public are essential.This observation raises awareness of the importance of information on the serious risks of a labile tattoo, most particularly for the young.

There have been a very small number of reported cases of radiotherapy-induced autoimmune bullous disease. We describe a case of generalised autoimmune sub-epidermal bullous pemphigoid (BP) induced by radiotherapy in a female patient presenting squamous cell carcinoma of the vulva.In June 2008, a 48-year-old woman underwent vulvectomy with lymph node curettage for squamous cell carcinoma of the vulva. Following surgery, adjuvant radiotherapy was indicated. At the 16th session (dose of 32 Gy), erythema occurred on the irradiation field. At the 23rd session (46 Gy), the patient presented bullous lesions that became generalised after four days with involvement of the oral mucosa. Skin biopsy revealed sub-epidermal bullae and direct immunofluorescence showed continuous linear deposits of IgG and of C3 along the dermal-epidermal junction. Indirect immunofluorescence revealed the presence of antibodies directed against the basement membrane. A favourable outcome was achieved under systemic corticosteroids. No immunotransfer analysis of serum or any other immunological investigations were performed.The clinical and histological features of this autoimmune bullous disease were evocative of BP, despite the absence of any formal proof. Radio-induced BP is extremely rare, with only 28 cases being described to date in the literature. The trigger mechanism is poorly understood; radiotherapy appears to cause changes in the antigenic properties of proteins in the dermal-epidermal junction resulting in production of autoantibodies. The radio-induced nature of BP does not affect therapeutic response. The case we report is novel in terms of both generalisation of the eruption and mucosal involvement.

A 64-year-old male with no underlying disease presented with the development of multiple skin nodules, loss of sensation in the extremities, hoarseness, macroglossia, and pain in the oral cavity. Direct laryngoscopy showed nodules involving the oral cavity, oropharynx, supraglottic region, and vocal cords. Biopsy from skin nodules showed amyloid deposits staining with Congo red. Immunohistochemical staining was used for AA protein and was positive. Biopsy from the oral floor was also positive for amyloid. Oto-Rhino-Laryngology (ORL) involvement has been reported in approximately 40 percent of AL amyloidosis patients, but does not appear to be frequent in AA amyloidosis. Cutaneous manifestations in AA amyloidosis are rare, although cases with lesions presenting as purpura are reported occasionally; we are not aware of other cases of ORL nodular involvement in systemic AA.

Our objective was to study the prognostic value of stoutness in non-metastatic breast cancer, from a population of French women.We constituted a large observational cohort of patients followed since a first unilateral breast cancer without distant dissemination. Stoutness was assessed using the body mass index (BMI, in kg/m(2)) at the time of diagnosis. Patients were classified into the four main categories of BMI, defined according to the World Health Organization recommendations. The risk of prognosis events was analyzed according to the BMI categories. To this end, survival analyses were achieved.The patients having a BMI value of at least 25 kg/m(2) presented significantly higher risks of death and metastasis recurrences when they were compared to the patients having a normal value of BMI. The multivariate analyses found a modest increase of risk, about 10 to 20%, depending on the degree of fatness. It reached about 20 to 50% according to the univariate analyses. The obese patients (BMIor= 30 kg/m(2)) had an increase of 50% of the risk of second primary cancers, comparatively to the patients having a normal value of BMI. Regarding contralateral, nodal and local recurrences, the survival analyses did not achieve any significant relationship with stoutness.A poorer prognosis is observed when breast cancer patients have a value of BMI that matches at least with overweight. Contrary to the results of few recent surveys, underweight patients do not present a poorer prognosis than normal weight patients. Excess of weight represents a modifiable factor in order to improve female breast cancer prognosis.

Baker-Rosenbach's erysipeloid is a skin infection caused by Erysipelothrix rhusiopathiae. It occurs essentially in humans exposed to animals colonized with this germ such as swine. The typical skin lesion, an erythematous macule generally localized to inoculation site, frequently in the extremities, quickly resolves spontaneously. The lips are an atypical site of this infection. We describe a case of chronic granulomatosis cheilitis in a farmer caused by E. rhusiopathiae.A 40-year-old farmer, a wild-boar hunter and chronic smoker with no history of tuberculosis, injury or insect bites, presented at our dermatology unit with ulcerative macrocheilitis of the lower lip ongoing for 1 year. Its surface was purulent. A biopsy specimen showed non-caseating epithelioid granulomas. Laboratory and radiological screening for tuberculosis, sarcoidosis and Crohn's disease, and parasitological examination for Leishmaniasis proved negative. Bacteriological examination identified E. rhusiopathiae and labial Baker-Rosenbach's erysipeloid was diagnosed. The lesion healed after 15 days of treatment with parenteral penicillin G (12m IU/d), totally disappearing after 3 months.Swine erysipelas usually occurs in man as Baker-Rosenbach's erysipeloid. This localized form of infection with E. rhusiopathiae is the most frequent and the lesion typically observed is a violaceous plaque, less inflammatory with induration; spontaneous regression occurs after a mean 3 months. To our knowledge, this case is the first report of ulceration associated with macrocheilitis. Histologically, the granuloma directed our investigation towards the principal aetiologies of granulomatosis cheilitis, such as tuberculosis considering the epidemiological context, sarcoidosis or Crohn's disease. The diagnosis of erysipeloid was supported by epidemiological evidence (occupational exposure), isolation of the germ at the lesion and its regression on treatment with penicillin G.Diagnosis of E. rhusiopathiae infection was confirmed by bacteriology. However, the hypothesis concerning the pathogenesis of its chronic course in our patient remains a subject of discussion.

We undertook a monocentric retrospective analysis of childhood leishmaniasis in order to describe the epidemio-clinical profile, therapeutic characteristics and clinical outcomes of affected patients.The files of all children treated for cutaneous leishmaniasis (CL) in the Dermatology Department of Ibn Sina University Hospital over an 11-year period were reviewed.A total of thirteen children were included. The mean age was 10.2 years and the sex ratio (F/M) was 5.5. All patients lived or had stayed in an endemic area. The average delay of diagnosis was 11.8 months. The most frequent clinical finding consisted of ulcers (61.5%), usually located on the face (69.2%). The clinical diagnosis was confirmed by parasitologic smear in 76.9 percent of cases. The treatment used was intralesional meglumine antimoniate in twelve cases. The outcome was favorable in all cases.Our series is characterized by a female predominance and the patients presented with a single lesion. The lesions were frequently located on the face and a favorable outcome was obtained after treatment with intralesional meglumine antimoniate.

Generalized pustular psoriasis of the von Zumbusch type is a severe form of psoriasis characterized by disseminated pustular skin lesions with high fever and hyperleukocytosis. We report a 32-year-old woman who presented a generalized pustular psoriasis with extra-cutaneous manifestations of the disease that included pulmonary involvement, aseptic arthritis, jaundice, and liver abnormalities. The extra-cutaneous manifestations of generalized pustular psoriasis should be known to physicians caring for patients with psoriasis in order to avoid diagnostic delay.

Multivariate control charts are commonly used for monitoring processes, the quality of which is determined by two or more correlated output variables. The aim of this paper is to point out the effectiveness of multicriterion control charts for supervising the variability of the outcome of an electrostatic separation process. The experiments were carried out on samples of chopped electric cable wastes, similar to those currently processed by the recycling industry. The two output variables considered in this paper were the masses of product recovered in the middling and conductive compartments of the collector. When the separation process was in control, the two variables were correlated, and T 2-type control charts could be established. Two out-of-control situations were simulated. The multivariable control charts monitoring the process location and spread were able to detect these situations, although each output variable taken independently remained within the control limits.

Fixed drug eruption is a characteristic cutaneous adverse reaction that recurs at fixed localisations. It is due to medical drugs. However, food may sometimes be responsible for a similar eruption, known as "fixed food eruption". We report a case of fixed food eruption due to liquorice.A 22-year-old woman presented with liquorice-induced fixed drug reaction. Topical challenges remained negative both at previously affected sites and in unaffected skin. Therapeutic re-exposure to liquorice confirmed the diagnosis.To our knowledge, we report the first case of food drug reaction caused by liquorice.

Maffucci syndrome is a rare disorder characterized by multiple enchondromas associated with soft tissue haemangioma. We report a case of Maffucci syndrome associated with epidermal verrucous nevus.A 33-year-old woman, with no previous history of note, had presented multiple episodes of vascular tumefaction of the toes and verrucous lesions of the right lower limb since childhood. Clinical examination revealed multiple pain-free and round haemangiomas on the toes; some were hard and evocative of chondromas while others were soft and suggested angiomas. In addition, there was an epidermal verrucous nevus of the right lower limb. Skeletal examination revealed multiple phalangeal enchondromas. A diagnosis of Maffucci syndrome associated with epidermal verrucous nevus was made.Maffucci syndrome is a rare form of sporadic dysplasia characterized by superficial haemangiomas and cartilaginous tumours (enchondromas), with just over one hundred published cases to date. Localization in the bones of the hands is seen in 89% of cases, in contrast with our observation. While epidermal verrucous nevus may be associated with neurological or osseous anomalies, to our knowledge, association of epidermal verrucous nevus with Maffucci syndrome has not previously been described; the present association could of course be fortuitous.

Pseudoxanthoma elasticum (PXE) is a hereditary disease that presents clinically as cutaneous, ocular and cardiovascular problems. The associated clinical signs are due to calcification of elastic fibres and blood vessels. The case we describe below involves a 24 year-old woman hospitalised for pseudoxanthoma elasticum and also diagnosed with asymptomatic renal nephrocalcinosis.A diagnosis of pseudoxanthoma elasticum was suspected in this patient based upon yellowish papules on the head and neckline together with angioid streaks. This diagnosis was confirmed by histological examination of the skin biopsy sample. Levels of calcium and phosphorus in blood and urine were normal, as were the cardiovascular test results. Abdominal ultrasound revealed bilateral nephrocalcinosis.This case is original in terms of the association of pseudoxanthoma elasticum with nephrocalcinosis. There are in fact increasing reports of diffuse visceral calcifications in pseudoxanthoma elasticum and the literature contains reports of association with mammary and testicular calcifications. To our knowledge, associated nephrocalcinosis has only been described in two subjects in a series of 11 PXE patients. The question is whether this association was entirely fortuitous or if it in fact constitutes a rare manifestation of the disease.

Nevus comedonicus is a rare disease and diagnosis is made chiefly on clinical grounds. It may occur in isolation, or in rare cases, it may be combined with other congenital malformations to constitute nevus comedonicus syndrome. We report a case of this disease herein.A young woman aged 20 years presented with cribriform plaques since birth resulting from the juxtaposition of depressed pigmented scars and comedonic lesions. These lesions were found on the entire face, the left hemithorax and the left upper limb, with well delineated distribution stopping at the median line. The patient's history revealed congenital cataract of the left eye operated at the age of 10 years. Clinical diagnosis of nevus comedonicus was confirmed by histological examination of the skin. Laboratory screening for other associated malformations revealed no abnormalities. Oral retinoids were proposed but the patient refused all treatments.Nevus comedonicus is one of the rarest forms of cutaneous nevus. This case is original as regards the extent and topography of the nevus covering the left side of the patient's body and its association with congenital cataract potentially indicating nevus comedonicus syndrome. This syndrome is extremely rare and belongs to a large group of epidermal nevus syndromes characterised by association of nevus and extracutaneous malformations, particularly ocular, skeletal and neurological.

Verrucous carcinoma of the oral cavity is a clinical variant of squamous cell carcinoma. Infection with human papillomavirus (HPV) seems to be a significant risk factor in carcinogenesis, as illustrated in our case report.A 72 year-old woman with a history of actinic cheilitis consulted for a bulky tumour of the lips and palate. Clinical examination revealed a highly infiltrated labial tumour vegetating and budding, with a thick edge. A bulky tumour and firm masses were seen on the hard and soft palates. Biopsy samples from both sites indicated well-differentiated veruccous epidermoid carcinoma with chorionic infiltration. The immunohistochemical study showed intestinal tumour containing HPV-16 virus. The central facial scan showed involvement of the nasal fossae, soft palate and lips with lysis of the upper maxilla arcade and the osseous palate. The patient died a few days before the start of preoperative chemotherapy following severe deterioration of her general state.Verrucous carcinoma is an authentic well-differentiated low-grade cancer. It appears as a wart-like exophytic lesion and progresses over several years. Diagnosis is based on histological examination. Management and treatment are not codified but surgery remains the treatment of choice and relapse is common in the case of locoregional involvement.

Purpose of study Pemphigus is a group of autoimmune bullous dermatosis diseases characterized by autoantibodies against keratinocyte adhesion molecule. A significant association with HLA class II genes, particularly DR4 and DR14 has been described in many ethnic groups and countries. We have investigated, for the first time in Morocco the relationship between different pemphigus subtypes and HLA genes. Patients and methods Fifty-two unrelated patients were compared to 178 healthy controls matched by age, sex and ethnic origin. HLA typing was performed by standard complement dependent microlymphocytotoxic method for class I and by sequence-specific primer amplification method for class II. Results No significant association was observed with any of the HLA-A or -B antigens. Generic typing showed a significant increase of DRB1*04 ( p = 0.002), DRB1*14 ( p = 0.003) and DQB1*03 ( p = 0.02) allele frequencies and significant decrease of DRB1*15 ( p DQB1*06 ( p = 0.01) allele frequencies. HLA-DRB1*15 – DQB1*06 haplotype seems to confer a protective effect in our population while DRB1*04–DQB1*03 and DRB1*14–DQB1*05 haplotypes induced susceptibility to the disease. Conclusion Taken together, our results confirmed the genetic predisposition to pemphigus. However, genetic factors are not sufficient to explain the high prevalence of pemphigus observed in the Moroccan population since alleles of susceptibility were similar to those commonly described in other populations throughout the world.

Pyoderma gangrenosum is a form of neutrophilic dermatosis often associated with inflammatory disease or blood dyscrasias. We report a case of pyoderma gangrenosum revealing Takayasu's arteritis.A 26 year-old woman was followed since 2002 for pyoderma gangrenosum occurring during pregnancy and regressing under general corticosteroids. In January 2004, immediately after childbirth, she presented an extensive ulcerated lesion on the right forearm. Histological examination of a biopsy sample from this solution pointed towards pyoderma gangrenosum. Somatic examination showed reduced peripheral pulse on the right side, asymmetric blood pressure between the two arms and vascular murmur in the carotid, femoral and renal arteries. Based on laboratory and x-ray examinations, Takayasu's arteritis was diagnosed and chronic viral hepatitis B detected. Resumption of treatment with prednisone (1 mg/kg/d) resulted in resolution of the wounds within 1 month.Although pyoderma gangrenosum is a classic complication in Takayasu's arteritis in Japan, this combination is rare in Europe, North America and North Africa. This case was singular in terms of the occurrence of pyoderma gangrenosum with each pregnancy. However, a number of epidemiological and clinical features were consistent with those reported in the literature, namely presentation predominantly in female patients, young age and involvement of the limbs. In 60% of cases, pyoderma gangrenosum precedes Takayasu's arteritis. The recommended mode of treatment comprises oral corticosteroids as first-line therapy followed by cyclosporine as second-line treatment.

Important changes related to declining level of several hormones occur during menopause: vasomotor instability, bone loss, anxiety, sexual dysfunction, skin aging... Our objective was a review of the literature concerning the histological and clinical changes seen in post menopausal skin, and also an analysis of the effect of hormonal replacement therapy in slowing down the aging process. Decline in progesterone increases the impact of androgen on the sebaceous glands and hair. Decreased estrogen slows down mitotic activity in the epidermal basal layer, reduces the synthesis of collagen and contributes to thickening of the dermo-epidermal junction. This hypoestrogenemia may be spontaneously attenuated by local synthesis of oestradiol in peripheral target tissues according to the intracrine process. This new hormonal pattern is associated with skin atrophy, hyperseborrhea, increased pilosity on the cheeks and upper lip, loss of scalp hair, increase in degeneration of elastic tissue, atrophy and dryness of the vaginal mucosa. Estrogen treatment in post menopausal women has been shown to increase collagen content, dermal thickness and elasticity. Biophysical properties are also significantly improved for the parameters reflecting hydration and sebum secretion. However, numerous side effects such as increased incidence of cancer and cardiovascular morbidity limit the use of this treatment. So non hormonal alternatives are proposed. Laser and lifting remain the most important options.

Bullous lupus is a rare manifestation of systemic lupus characterized by subepidermal blistering. We report a case of a-27-year-old woman with vesiculobullous lesions and class IV lupus nephritis. Bullous lupus is often associated with autoimmunity to type VII collagen.

Pseudoainhum is a rare disease characterised by gradual fibrous constriction of the fingers and/or toes eventually resulting in their amputation. In this article, we report the first case seen in Morocco, highly unusual in terms of its severity.A 46-year-old woman with no toxic habits was hospitalised for spontaneous amputation of the fingers and toes. This condition began when the patient was 12 years old with the appearance of a circular constriction band at the base of the fifth toe, eventually resulting in its loss. The patient gradually lost all her other toes and fingers except for the first joint of her left index finger. There was no family history of any similar condition. Clinical examination also revealed perforating plantar disease in two of the stumps and peripheral neuropathy in all four limbs, comprising predominantly axonal disease responsive to electromyogram. Amputation of the index finger was completed and histological examination of the removed section showed nothing unusual, with no signs of diabetes.The peculiarity of our case resides in the exceptional severity of these amputations and their association with isolated polyneuropathy. Pseudoainhum has been described chiefly in patients with congenital keratoderma, certain systemic diseases, diabetes and alcohol dependence. A number of etiopathogenic hypotheses have been suggested: traumatic, infectious, vascular, neurological and genetic processes.

Verneuil's disease is a chronic inflammatory, suppurating and fistulizing disease. It is often misdiagnosed and taken for another pathology. The aim of this study was to describe the epidemiological, clinical, and therapeutic features of 10 patients presenting with this disease, in our dermatology unit.We retrospectively analyzed 10 observations of Verneuil's disease from 1994 to 2005. We studied the clinical, epidemiological, and therapeutic characteristics.Nine male and one female patients were included. The mean age was 35 years. The mean delay between onset of symptoms and diagnosis was 6 years. All patients presented with a severe form of the disease. The localizations were the buttocks in 4 cases, the pubis in one case, and the axilla in another case. Four patients also presented with buttock and anoperineal lesions. The medical treatment was antiseptics, antibiotic therapy, or isotretinoin. All patients were treated surgically.A suppurated and fistulized nodule on an anoperineal or axillary location must suggest this disease. Our series is characterized by the prevalence of men and the frequency of severe forms.