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This report describes a case of facial hyperpigmentation in a patient with Crohn's disease receiving adalimumab, a tumor necrosis factor (TNF)-alpha inhibitor. The onset of hyperpigmentation coincided with adalimumab administration, and its discontinuation resulted in significant improvement. Histopathological findings suggest a postinflammatory process at the dermo-epidermal junction. However, the precise mechanism remains unclear. [ABSTRACT FROM AUTHOR]

Hearing impairment (HI) is a prevalent neurosensory condition globally, impacting 5% of the population, with over 50% of congenital cases attributed to genetic etiologies. In Tunisia, HI underdiagnosis prevails, primarily due to limited access to comprehensive clinical tools, particularly for syndromic deafness (SD), characterized by clinical and genetic heterogeneity. This study aimed to uncover the SD spectrum through a 14-year investigation of a Tunisian cohort encompassing over 700 patients from four referral centers (2007-2021). Employing Sanger sequencing, Targeted Panel Gene Sequencing, and Whole Exome Sequencing, genetic analysis in 30 SD patients identified diagnoses such as Usher syndrome, Waardenburg syndrome, cranio-facial-hand-deafness syndrome, and H syndrome. This latter is a rare genodermatosis characterized by HI, hyperpigmentation, hypertrichosis, and systemic manifestations. A meta-analysis integrating our findings with existing data revealed that nearly 50% of Tunisian SD cases corresponded to rare inherited metabolic disorders. Distinguishing between non-syndromic and syndromic HI poses a challenge, where the age of onset and progression of features significantly impact accurate diagnoses. Despite advancements in local genetic characterization capabilities, certain ultra-rare forms of SD remain underdiagnosed. This research contributes critical insights to inform molecular diagnosis approaches for SD in Tunisia and the broader North-African region, thereby facilitating informed decision-making in clinical practice. [ABSTRACT FROM AUTHOR]

Methotrexate-induced cutaneous ulceration is a rare but potentially serious drug adverse reaction. This adverse reaction of methotrexate therapy has been initially described in psoriasis patients and is unusual in patients with cutaneous T-cell lymphoma. In 1978, Mc Donald et al reported the first three cases of cutaneous ulcerations in patients treated for a mycosis fungoides with intravenous infusions of methotrexate [1]. Since then, few cases of methotrexate-induced skin ulcers in patients with mycosis fungoides have been published [2-5]. We report an additional patient with erythrodermic mycosis fungoides who developed cutaneous ulcerations as a sole manifestation of methotrexate toxicity.

Background: Ingrown toenail is a common problem causing significant morbidity. Various procedures used for treating this painful condition were discussed in the literature.Objetctive: Through a prospective study we aimed to evaluate in a long-term follow-up the efficacy of partial nail plate avulsion combined with phenolic chemical matricectomy for the treatment of Ingrown toenails.Methods: We recruited outpatient from January 2006 to December 2009; all treated by phenol matricectomy and assured a regular follow up.Results: Consecutive 146 patients with a total of 171 Ingrown toenails were enrolled. There was no significant morbidity and the procedure was tolerated well by all patients. The short-term results were excellent. No severe complications occurred during the 21-month follow-up period. The overall recurrence was 2.7 %.Conclusion: Phenol cauterization compared with other surgical ablation techniques may be the treatment of choice of Ingrown toenails. It’s an effective technique for the treatment of Ingrown toenails accompanied by less morbidity and lower recurrence rates.

This article discusses the use of trichoscopy as a tool for diagnosing and monitoring scalp discoid lupus erythematosus (SDLE). The study analyzed the trichoscopic features of 63 plaques in 31 patients with SDLE. The findings revealed several trichoscopic features associated with disease activity, such as erythema, large yellow dots, comedones, and broken hairs. Additionally, the study found that certain trichoscopic features were more common in early-stage SDLE lesions, while others were more prevalent in advanced lesions. The authors suggest that further research is needed to evaluate the reliability of trichoscopy in detecting early and active forms of SDLE. [Extracted from the article]

Lesion features in cutaneous leishmaniasis (CL) depend on the infecting Leishmania species as well as on host immune reponse. In this study, we evaluated the histological and immunological differences between two forms of CL described in Tunisia: zoonotic cutaneous leishmaniasis (ZCL) caused by L. major and sporadic cutaneous leishmaniasis (SCL) caused by L. infantum. Histological analysis showed a mild to moderate infiltrate within ZCL lesions. In contrast, massive infiltration of the dermis was observed within SCL lesions. Contrary to ZCL, infiltrates within SCL lesions were organized and showed granuloma composed of macrophages and lymphocytes. In addition, immunohistochemical analysis showed a predominance of CD4+ T cells within both CL forms. Furthermore, expression of interferon-γ, interleukin (IL)-10, IL-8, IL-13 and monocyte chemotactic protein (MCP)-1 was evaluated using real-time quantitative polymerase chain reaction (RT-qPCR). MCP-1 and IL-10 were expressed at comparable levels in ZCL and SCL lesions. Interestingly, IL-8 mRNA levels were significantly higher in ZCL lesions compared to SCL lesions, but interferon-γ was significantly higher in SCL lesions than in ZCL lesions.

Hereditary vitamin D-resistant rickets associated with alopecia and epidermal cysts Hereditary vitamin D-resistant rickets (HVDRR) is a rare autosomal recessive disorder. It is associated in 75% of cases with partial or total alopecia which may precede the onset of symptoms of rickets.[2] Hair is present at birth, and alopecia develops in the first months of life. [Extracted from the article]