[Scalp metastasis from small cell carcinoma of the rectum: an unusual case]

Cutaneous metastasis of rectal carcinoma is a rare event. It occurs in 4%of all patients with rectal cancer. Skin metastasis of rectal cancer are usually detected near the initial tumor. especially in the periumbilical region; but they rarely occur in the scalp. To report a new case of scalp metastases from rectal tumor. Our patient was a 63-year old male with a history small cell carcinoma of the rectum who subsequently developed s single nodule of the scalp of 4cm. Histopathological analysis revealed a small cell carcinoma infiltrating the dermis am subcutaneous tissue. The patient underwent palliative chemotherapy but his disease continued to progress. In contrast to the prior cases of scalp metastases reported in the literature, ours is the first documentation of such occurrence from rectal small cell carcinoma. The early diagnosis of skin metastases in these patients is very important because it can alter treatment

[Epidemiologic, clinic and allergologic profile of atopic dermatitis in south Tunisia]

Atopic dermatitis [AD] is the collection of the cutaneous inflammatory manifestations which are chronic or repetitive associated with the other atopic diseases. The prevalence of the AD varies from one country to another. The aims of this work is to study the allergolicol, clinical and epidemiological profile of the AD in the south of Tunisia. our study is prospective about 100 cases reported in a period of 18 months. The diagnostis was carried on the criteria of Hanifin and Radjka. For every patient we studied the biographical data and the clinical manifestations of AD. Allergoloigical explorations [pricks-tests] were carried out. the overage of the patients was 104 months with extremes of 5 moths and 43 years. 65% of our patients were men. At the beginning the average was 61 months with extremes of 2 months and 37 years. 55 patients had antecedents of family allergy and 34 had antecedents of personal allergy. The former preceded the AD in. 28 cases. We didn't note any significant relation between the existence of familial allergy and the severity of the AD. In the statement, the principal factor was the contact with the house dust [33 cases], the duration of maternal breastfeeding [average 13.7 months] didn't influence neither the SCORAD, nor the beginning age of the AD. The date of beginning of food diversity [overage 6.16 months] didn't significantly influence the severity of the illness. The clinical aspect was a sharp eczema in 71% of the cases according. To the SCORAD score. The AD was judged to be weak in 5 cases, moderate in 68 cases and severe in 27 cases. The number of rise per year varied from one rise [75 cases], to more then 6 rises per year [6 cases]. The evolution was chronic in 6 cases. The pricks test showed to be positive for the accariens in the group of aeroallergen in 9 cases among the 35 cases tested, and positive for the whole egg in the group of trophallergen in 5 cases among the 13 cases tested

Epidemic clinical profil of skin cancer in southern Tunisia

Skin cancer [SK] frequency is increasing all over the world. We report a clinical and epidemiological study of SK in the south of Tunisia through a 1476 cases series. On the basis of a retrospective study, we report the clinical and epidemiological data collected from files of patients with skin cancers seen during a 24-year-period [1979-2002]. Our series was composed of 1476 patients, with an incidence of 61.5 cases/year. The mean age was 55 years. Epithelial skin carcinomas were the most common [1288 cases, 87.3%]. Basal cell carcinomas were found in 890 patients [69%] and squamous cell carcinomas in 398 [31%]. The mean age was 60 years. The phototype III was the most common [52.8%] among these patients. Skin melanomas were found in 71 cases [4.8%]. The mean age was 54 years with a female predominance [60.6%]. Kaposi sarcoma was found in 4.5% of patients. The mean age was 64.3% and a male predominance was found [80% of cases]. Two patients with Kaposi sarcoma [3.3%] were HIV positive. Dermatofibrosarcoma protuberans was reported in 2% of patients and skin lymphoma in 1.7%.The mean age is relatively low in our series. The increase in the incidence of skin cancers is probably related to the climatic conditions, the ageing of the population and to the changes in the social, economic and cultural aspects in the country. The male predominance is changing toward an equal distribution between both sexes probably in relation to the present similarity in the life style and work conditions

Sexual disturbances secondary definitive colostomy

Sexual disturbances after colostomy are various. However, they probably remain underestimated in societies where sexuality is still a taboo issue. The aim of this prospective study was to evaluate the possible sexual behaviour and the post operative sexual disturbances in patients whome underwent colostomy. The group was devided in 10 male and 11 female patients. Seventeen patients [81%] were married, 3 widowed and 1 unmaried. Sexual disturbances were found in 47% of patients. There was a lack of interest in sexual relations in 2 women, a resolved premature ejaculation in one case, post operative dysparenia in 2 female patients, a retrograde ejaculation in a 60-year-old man, impotence in a 46 years old patient, and a premature ejaculation in a 36-year-old man. The frequency of sexual disturbances [47%] in our series was close to that reported in the literature [50%]. The sexual disorders are more common in male patients, the most frequent being ejaculatory dysfunction. In women, dyspareunia is the most common disorder. The particular case of colostomy in homosexuals remains a current issue

HLA A, B, DR and DQ alleles study in Tunisian patients with atopic dermatitis

Background: Atopic dermatitis [AD] is a chronic inflammatory skin disease resulting from the interaction between envirommental and genetic factors. Many genes are involved in the etiopathology of AD, such as HLA genes

Objectives: Study the association between HLA-A, B, DR and DQ genes and the AD

Methods: HLA A and B genotyping were practised for 53 atopic dermatitis patients and 76 healthy controls using the microlymphotoxicity complement dependent technique, while HLA DR and DQ genetyping were practised for only 20 patients with AD and the controls by PCR-SSP method

Results: allelic frequency of HLA A32 was significantly increased in healthy individuals compared to patients affected with AD [p=0.02, RR=0.24]. HLA-B, DR and DQ showed no differences in distribution between patients and controls

Conclusion: Our study suggested that HLA-A32 could be a protective marker against atopic dermatitis for Tunisian patients, in contrast to HLA-B, DR and DQ alleles which seemed to have no importance in AD pathogenis

[Mal de meleda. About 16 cases]

Mal de Meleda is a recessive transgressive palmoplantar keratoderma. We report the epidemiological, clinical and progressiveness aspects of the disease in 16 patients of a large consanguineous Tunisian family, the age ranged from 3 to 90 years. Nine were male and 7 female patients. Onset in early infancy was characterized by erythema of the palms and sole, followed by a diffuse yellowish hyperkeratosis. Thickness of the dorsal aspect of the fingers started in childhood. Extension of hyperkeratosis to the dorsa of the hand were reported only in adults and usually precede the involvement of the feet Palmoplanatar hyperhidrosis with fetid odor between the toes was frequently seen as well as conical distal phalanges. In some adults, keratoderma gave contracture of the fingers leading to limitation of movementsMal de Meleda must be differentiated from other recessive plamoplantar keratodermas such as Papillon le fever syndrome and male de Naxos the remaining inherited pal moplantar keratodermas being autosomal dominant. Mal de meleda is rare disease but is still relatively frequent in some Tunisian regions, due to the high rare of consanguinity Mal de Meleda remains an afflicting and disabling disease

Beneficial effects of Antimalarials in the Treatment of Generalized Granuloma Annular in children

Granuloma annulare is a polymorphic granulomatous disease of the skin. It has a chronic course and affects mainly children and young adults. We report two cases of generalized granuloma annulare in children successfully treated with antimalarials.Two children, 6 and 12 years of age, without clinical history, presented with multiple granuloma annulare lesions which did not respond to potent topical steroids. Blood glucose level was normal. These lesions responded to small doses of antimalarials. No side effects were noticed.Compared with other drugs, with potential important side effects for children. Small doses of antimalarials might be beneficial in the treatment of generalized granuloma annulare

[Fluconazole and treatment of onychomycosis. About 86 cases]

Systemic treatment of onychomycosis is based these last years on the new drug utilization aiming to decrease the length of the treatment and secondary effects particularly with fluconazole. The aim of our study is to determine the efficiency and the tolerance of the fluconazole [Funzol [registered sign]] managed to the dose of 150 mg per week in the treatment of ony-chomycosis. It is a multicentric and prospective study done to different department of dermatology in Tunisia. Are included adult patients with clinical and mycologic documented ony-chomycosis. They are treated during 12 to 24 weeks for the fingernail and 24 to 36 weeks for the toenail. The assessment of the efficiency and the tolerance of the drug was clinic and biologic. During this survey, 86 patients are included, 55 female and 31 male with mean age of 43,5 years. Onychomycosis seat to hands in 30 cases [34, 8%] with a pre-dominance of Candida species [73%], to toes in 68 cases [79%] witch due in 85% of cases to dermatophytic agent [85%]. At 6 months, clinical cure rate is observed in 51% of cases. After 9 months, at the end of therapy, 84% of patients were judged clinical successes and culture was negative in 82% of cases. Some minimal secondary effects are signalled in 11% of cases to 6 weeks and 10% to 12 weeks not justifying the stop of the treatment. So this study confirms the efficiency and the good tolerance of fluconazole in the treat-ment of onychomycosis

[Kaposi's sarcoma, a series of 65 cases]

Kaposi sarcoma [SK] is characterized by proliferation of vascular and spindle-shaped cells with variable clinical presentations. The association with AIDS modifies the profile of this disease. The pathophysiology seems to be based on the major role HHV-8 The goal of this work was to specify the profile of this disease in our region through a retrospective study of 65 cases of SK over a 23-year period [1981-2003]. In our series, the classic form prevailed 163 cases [96.9%]]. One patient had a secondary form due to steroid therapy and another patient had a KS associated with AIDS. A male prevalence was noticed [M/F: 2.8]. Cutaneous lesions were dominated by papulo-nodular lesions [90.9%] of the lower limbs [92.3% of the cases]. Mucous lesions were present in 15.4% of the cases. Therapeutic abstention was decided in 38.4%.Surgical excision was indicated in 35.4% of cases, radiotherapy in 4.6% of the cases and chemotherapy in 23% of the cases. The classic form of KS is the most frequent in our area; the other forms remaining rare