Search

Dystrophic epidermolysis bullosa (DEB) is a rare genodermatosis characterized by extensive fragility of the skin, which forms blisters and scars following a minimal friction or mechanical trauma.1 It is inherited as either autosomal recessive (RDEB) or dominant (DDEB) manner. DDEB is characterized by a wide range of clinical heterogeneity. Indeed, the blistering tendency can be relatively mild and limited to areas of considerable trauma, as in the DDEB-pretibial (DDEB-pt), or be more generalized, as in the DDEB-generalized (DDEBgen). 2 A peculiar form of DDEB-gen presents with albopapuloid lesions. DDEB is usually caused by missense mutations in the COL7A1 gene.

Malassezia folliculitis commonly affects the adolescents and the young adults. We describe an unusual case of Malassezia folliculitis which is particular in age of patient and scare evolution of lesions. The patient was a three-month-old immuno-competent boy. On clinical examination, 1- to 2-mm superficial follicular pustules were observed on his face, neck and upper trunk. Direct microscopy of pustule scrapings and hair follicles showed numerous Malassezia yeast cells. Based on the clinical and mycological data, the diagnosis of Malassezia folliculitis was made. The possible predisposing factors in our patient were heat and sweating, caused by the excessive heat of the summer season in Tunisia. Treatment with topical ketoconazole promoted cure with depressed varioliform scars.

Resume Chez l’enfant, la sarcoidose est rare et peut revetir des aspects trompeurs. Les auteurs rapportent l’observation d’un enfant âge de 13 ans explore pour une fievre prolongee, un syndrome inflammatoire et des lesions cutanees. L’echographie abdominale a montre une hepatomegalie, des adenopathies mesenteriques et un nodule splenique. Le scanner thoracique a visualise des adenopathies hilaires bilaterales. La biopsie d’une adenopathie inguinale a conclu a une tuberculose caseofolliculaire. L’echec du traitement antituberculeux, la fievre elevee, la negativite de l’intradermoreaction a la tuberculine et les resultats de la biopsie cutanee ont fait suspecter le diagnostic de sarcoidose. Celui-ci a ete conforte par les resultats du lavage broncho-alveolaire, le taux eleve de l’enzyme de conversion de l’angiotensine et le controle de l’examen anatomopathologique. L’evolution sous corticotherapie a forte dose a ete favorable. La sarcoidose, meme si elle est rare chez l’enfant, doit etre evoquee devant une fievre prolongee et un syndrome inflammatoire important.

Papillary haemangiomas were recently defined as morphologically distinct and benign cutaneous haemangiomas showing a predominantly intravascular capillary proliferation within dilated thin-walled dermal blood vessels. We describe the case of a 45-year-old woman who presented with multiple eruptive red-bluish raised papules and nodules distributed over the skin of the chin that were related to a papillary haemangioma.

Pemphigus is a severe and life-threatening autoimmune bullous dermatosis.We have analysed parameters that may influence prognosis of pemphigus (P).It was a retrospective study (2002-2010), with pemphigus considered as severe if body surface involvement ≥ 30%. Disease control and relapse-free survival (Kaplan-Meier) were analysed and compared according to several parameters (P0.05).47 cases of pemphigus were collected, mean age 51 years ± 16.8 (F/H = 3.27). There were 30 pemphigus profundus and 17 superficial pemphigus. The median remission period was of 9 months (1.2 months-5 years). The mean healing time was of 40 days (6 days-4 months), which did not depend on type of P, its severity or infectious complications, whereas it was shorter in aged patient (≥ 65 years) compared to non aged ones (P = 0.018). 36.2% of patients had relapsed. Relapses were significantly more frequently observed only in the presence of mucosal involvement at presentation (P = 0.015). The median overall 1st relapse-free survival was of 2.33 years. Only mucosal involvement at presentation was associated with a shorter median 1st relapse-free survival time (1.28 years vs. 3 years) (P = 0.0017). Mortality rate was of 10.6% (n = 5); in four patients the death was directly related to pemphigus and occurred rapidly after the onset of lesions.Our study illustrates the poor prognosis of pemphigus by a long duration to disease control, a high initial dose of oral steroid, a high rate of relapse and a short remission period. Only mucosal involvement at presentation was identified as a poor prognostic factor.

Pyoderma gangrenosum (PG) is an uncommon extensive cutaneous ulceration belonging to the neutrophilic disease spectrum. It is associated to a systemic disease in almost 50% of cases. The diagnosis primarily relies on clinico-pathological features and the treatment is empirical. We report a retrospective series of 6 observations of PG (4 women and 2 men, median age = 43 years) enrolled over 15 years. The diagnosis was established based on the presence of 2 major criteria and 2 minor criteria of the disease. In 3 patients, PG was associated to an already known ulcerative colitis. The treatment consisted in general corticotherapy.

Erythroderma is a severe syndrome and prognostic studies are rare in the literature.Through a retrospective study of erythroderma in adults, we have analysed epidemiological and clinical data and precised the relevant aetiologies and survival in our patients.This study was performed at the Department of Dermatology of Charles Nicolle Hospital of Tunis (1995-2007) including 82 cases of acquired erythroderma (16 years). We have recorded epidemio-clinical, biological and histological data, treatment and outcome. Clinical-histological correlation was analysed [kappa coefficient (kappa)]. Follow-up time and disease-free survival time were calculated as were Kaplan-Meier estimates of overall survival and relapse-free survival for some aetiologies.Erythroderma represented 0.44 per thousand of all dermatoses with an age of 55.13 +/- 18.16 and no sex predilection. Psoriasis was the predominant aetiology (32.9%) with a median duration of 6.75 years and previous one or more episodes of erythroderma. Psoriasis was significantly associated with pruritus (P = 0.0001), pachyonychia (P = 0.00001), palmoplantar keratoderma (P = 0.0001) and hypereosinophilia (P = 0.008). The latter is then not specific for drug induced erythroderma (P = 0.004). Carbamazepine (27.8%) and penicillin (22.2%) were the most implicated drugs. Positive Clinical-histological correlation was found in 77% of cases (kappa = 0.753). Relapse was seen in all aetiologies, but drug reactions and had occurred in the first 3 years in 90% of them. Mortality rate was 11.3 per 1000 patients-years.Our study illustrates the severity of erythroderma. It alters heavily the quality of life of patients which is initially altered by the pre-existent dermatosis. It may be life threatening as mortality rate is high.

Three clinical forms of cutaneous leishmaniasis can be found in Tunisia, i.e. the sporadic form due to Leishmania infantum in the North, the zoonotic epidemic form due to Leishmania major in the center and Southwest, and the chronic cutaneous form due to Leishmania tropica in the South. Unlike cutaneous forms, mucosal involvement is uncommon. The purpose of this report is to describe another case of mucosal leishmaniasis due to contiguity with a skin lesion in a 54-years-old woman. The patient responded well to treatment with meglumine antimoniate.

Langerhans cell histiocytosis, previously known as histiocytosis X, is a disease whose clinical presentation varies. Although it is uncommon, Langerhans cell histiocytosis may involve the perianal region. We report the case of a 2-year-old boy who presented with perianal ulcerated vegetative lesions and seborrheic dermatitis of the scalp. Biopsy of the lesions showed Langerhans cell histiocytosis. This patient did not have any other organ involvement, which is rare. The outcome was favourable with vinblastine and corticoids.

Blepharochalasis is characterized by recurrent painless oedema of the eyelids leading to alteration of periorbital skin with a nearly complete loss of elastic fibers. It usually affects the upper eyelids bilaterally. An 11-year-old girl suffered from recurrent erythematous swelling episodes during 3 months. The manifestations were confined to the periorbital region. She gradually noticed a bilateral loss of elasticity of the skin of the upper eyelid. The skin showed some folding and laxity. A mild aponeurotic ptosis was present. A skin biopsy showed the absence of elastic fibres. Blepharochalasis is a disease of young people. It has been divided in two hypertrophic and atrophic types. The condition typically follows recurrent painless episodes of oedema infiltrating both upper eyelids. The eyelid oedema usually resolves after several days and recures several times a year.

Granuloma annulare (GA) is a palisading granulomatous skin disease. It is a relatively common dermatosis typically characterized by an annular arrangement of erythematous or flesh-coloured papules. The aim of this study was to assess the epidemiological and clinical pattern of GA and its management.A retrospective study dealing with 35 cases of GA collected during an 11-year period from 1995 to 2005 was carried out at the Dermatology Department of Charles Nicolle's Hospital of Tunis.There were 24 females and 11 males including 13 children. Four clinical patterns were observed: localized GA with annular shaped lesions in 22 cases (62.8%), subcutaneous GA in 9 cases (25.7%) with 4 children, combination of localized and subcutaneous patterns in one child (2.8%), generalized GA in one adult-patient (2.8%) and combination of generalized and subcutaneous patterns in 2 cases (5.7%). Associated diabetes mellitus was seen in 9 adults (25%) and thyroid diseases in 2 other adults (5.7%). Topical steroids were proposed in 9 cases with partial resolution in 6 of them. Four patients were treated by hydroxychloroquine with an improvement in 3 of them. Two patients (generalized GA with subcutaneous form and subcutaneous GA) were treated by dapsone with partial clearing.In these series, GA has the same epidemiological and clinical pattern as other series of the literature. Subcutaneous form had a pseudo-rheumatoid presentation in adults and an exclusive involvement of children when it is localized on the scalp. Associated systemic diseases, especially diabetes mellitus, are frequent in the series here observed.

Acrodermatitis enteropathica is a rare autosomal recessive disorder, caused by impaired absorption of zinc from the gastrointestinal tract. Symptoms of acrodermatitis enteropathica occur within the first few months after birth and tend to appear shortly after discontinuation of breast-feeding. We report a breast-fed infant with acrodermatitis enteropathica.A full term, 4-month-old girl, consulted in dermatologic department for persistent and refractory anogenital lesions since the age of 1 month, with progressive erythematous, vesiculous and squamous lesions, sometimes erosive in a peri orificial and acral pattern. She was calm and healthy baby. She was breast feeding. The diagnosis of acrodermatitis enteropathica was confirmed by decreased plasma zinc level (14 microg/100 ml). Breast milk zinc levels was low (46 microg/100 ml), as plasma zinc level of the mother (94 microg/100 ml). A genetic study showed that she was homozygous for the mutation, whereas her brother and parents were heterozygous. She was given zinc sulphate, and her condition has improved significantly.Acrodermatitis enteropathica is characterized by a characteristic clinical feature and the diagnosis is confirmed by decreased plasma zinc level. Acrodermatitis enteropathica in exclusively breast fed infant is rare, it was essentially reported in premature babies. Our case report is particular because it's concerning a full-term breast-fed infant, with zinc deficiency in breast milk and mother's decreased plasma zinc level.

Chronic septic granulomatosis is a disease characterized by an impaired bactericidal potential of the neutrophilic polynuclear. The cutaneous manifestations rarely reveal the disease, but are of considerable interest in the diagnosis, notably during the late onset forms. We report such a case.A 15 year-old girl, born of consanguine parents, had a history of visceral leishmaniasis and hepatic hydatidosis. For the past 3 years she had developed dermatitis lesion on the face and skin folds, chronic folliculitis and suppurating axillary and inguinal lymphoadenitis. The absence of a reduction in tetrazolium nitro blue led to the diagnosis of chronic septic granulomatosis. Prophylactic treatment stabilized the cutaneous lesions.Chronic septic granulomatosis regroups various severe and recurrent manifestations. Its transmission is usually X-linked recessive or, on rare occasions, autosomal recessive. The clinical manifestations leading to the diagnosis are often of very early onset. They are principally pneumonia due to apergillus fumigatus and lymphoadenitis. Cutaneous involvement, although less common, must not be neglected because it can lead to the diagnosis of late onset forms, as in our patient.

Three epidemic-clinical forms of leishmaniasis are found in Tunisia: the sporadic cutaneous form due to L. Infantumin in the North, the zoonotic cutaneous form due to L. Major in the Center and South-West, and the chronic cutaneous form due to L. Tropica in the South. We report 5 cases of mucosal leishmaniasis diagnosed in a Dermatology unit in Tunis.Four women and one man, from the North-west of Tunisia, with a mean age of 42.4 years (range: 8-75 years) presented with leishmaniasis. The lesions were localized on the mucosa of the lips in 4 patients and on the endonasal mucosa with infiltration and nasal obstruction in a 75 year-old female patient. Diagnosis of leishmaniasis was established on direct examination in 4 cases and histological examination in 3 cases and by culture in NNN milieu for one patient exhibiting a MON5 L. Major leishmaniasis. All the patients responded well to treatment with intramuscular meglumine antimoniate (Glucantime). In our 5 patients, the mucosal involvement was not as mutilating, nor resistant to treatment, as that described for the cutaneous-mucosal forms in the New World.Mucocutaneous leishmaniasis, endemic in Central and South America, are due to L. Braziliensis. They provoke mutilating and disfiguring lesions, resistant to treatment. In Tunisia, the forms of the disease observed are dermotropic, usually responsible for cutaneous leishmaniasis. However, mucosal involvement is not uncommon and is characterized by the absence of mutilating lesions and the excellent response to treatment.

Topical retinoic acid has demonstrated its efficacy in acne. Glycolic acid has also keratolytic action and could be interesting to treat acne.To evaluate the efficacy and safety of topical glycolic acid (Glyco A 12%) and retinoin acid (Kefrane 0.05%) on facial acne lesions.It was a randomised double blind study of 40 patients, divided in 2 groups, 20 receiving GlycoA cream (Group A) and 20 receiving Kefrane cream (group B). Medical exam was realised by the same physician at day 0, 21 and 45. The improvement of acne as well as side effects were assessed by both the physician and the patients themselves.2 patients developed severe eczema of the face and were excluded (one from group A and one from group B). 22 patients followed totally the study. 90% of group A and 83.3% of group B patients improved significantly their lesions. A comparative tolerability was observed for both groups.Glyco A cream could be a good treatment for acne even in dark skin patients.

The prevalence of atopic dermatitis is usually high in western countries, varying from 18 p. 100 to 20 p. 100. Recent studies suggest an increasing of this frequency. The aim of our study is to determine the epidemiological and clinical characteristics of atopic dermatitis in Tunisia through the analysis of a retrospective cohort.We retrospectively studied all the medical reports of atopic dermatitis registrated in the department of dermatology during a 7 years period (1992-1998). We analysed epidemiological and clinical features of every medical report. We used diagnosis criteria of Hanifin and Rajka.Four hundred fifty-one cases of atopic dermatitis have been diagnosed (54 adults and 397 infants). Relative frequency of new cases of atopic dermatitis compared to new diagnosis was 0.37 p. 100 in 1992 and 0.72 p. 100 in 1998. Mean age was 3.2 years. A personal history of atopy was observed for 15.2 p. 100 of patients and a family history of atopy for 35.9 p. 100. A few numbers of complications were observed. Bacterial infections interested 15.3 p. 100 of cases. Hospitalisation was needed for 4 patients (0.88 p. 100). Class III and IV topical corticosteroids were usually used (84.8 p. 100). Potent corticosteroids (class I) were required for only 3.2 p. 100 of cases.We notice a low frequency of atopic dermatitis in this study and a predominance of mild forms of the disease. Other studies are needed to confirm these results and to determine the prevalence of atopic dermatitis in Tunisia.

Latex devices release allergenic proteins which are responsible for immune IgE mediated reactions. Casual surgical gloves are most often responsible for contact urticaria. Other allergic manifestations include conjunctivitis, rhinitis, asthmatiform dyspnoea and diverse gastro-intestinal troubles. Cardiovascular collapse and anaphylactic shock are possible. Physicians and the paramedical staff are particularly affected by the allergy to latex proteins. Multi-operated patients and those under prolonged health care using latex-made medical probes also present a high-risk group for this type of allergy.

We report forty-seven cases of bullous pemphigoid recorded in the dermatology department of Charles Nicolle hospital in Tunis during 16 years. In Tunisia, bullous pemphigoid is at the second rank of acquired autoimmune bullous skin diseases, after pemphigus. The profile of bullous pemphigoid in our series differ from that reported in the literature by the more young age (67.2 years) and the male predilection but don't present any clinical an epidemiological particularity. Three atypicals forms were observed: a vesicular form, a localized form and a infantile form. Systemic corticosteroids were choice treatment for our patients.

Human papillomavirus (HPV) infection tend to be the most prevalent sexually transmitted disease (STD), and "high-risk" HPV types are correlated to intra-epithelial neoplasia, especially cervical cancer. The aim of this study was to evaluate the frequency of "high risk" HPV types in condyloma.A non randomised prospective study was performed, including 24 patients with condyloma examined in the department of Dermatology of Charles Nicolle's hospital. Molecular hybridisation method was realised for all patients to identify HPV type.Mean age of the 24 patients was 37.8 years Ratio (male/female): 1.4 In 21 patients HPV DNA was detected 2 women had "high risk" HPV type (9.5%).

The incidence of condylomata acuminata is increasing in all countries. They are one of the most frequent sexually transmitted disease (STD). The authors reported the experience of the department of Dermatology of charles Nicolle's hospital between the year 1979 and 1998. This HPV infections were in the third position of the STD and occurred mainly in young males. The clinical lesions are genital condylomata. They were successfully treated with electrodessication or cryotherapy.

Stealthy arthropods perpetrate their insults to humans through three distinct mechanisms including bites, stings or simple contact with the skin. The present review is a summary of the bite effects of spiders and diptera.

The contact of some marine organisms with the skin may prove to be traumatic and sometimes very dangerous. Some coelenterates, fishes, urchins, sea snakes, cephalopods, molluscs and other sea organisms are responsible for dermatological lesions, associated or not with toxic or allergic reactions exhibiting systemic effects.