ABSTRACT
Background: The efficacy of ketoconazole and fluconazole in pityriasis versicolor had been proved
Aim: To compare the efficacy and the safety of two doses of fluconazole given 1 week apart alone or associated to ketoconazole shampoo
Methods: Our study included all patients with pityriasis versicolor who attended in dermatology department of Habib Thameur Hospital, Tunis [over a 21-month period]. During the considered period, patients were randomly assigned in two study groups: G1 receiving fluconazole two doses 300mg given 1 week apart with G2 taken an association of fluconazole [two doses 300mg given 1 week apart] and ketoconazole shampoo the first day
Results: Seventy one patients were enrolled in our study: 35 in the fluconazole group and 36 in the fluconazole associated to ketoconazole shampoo comparator group. The mean age was 29.1 years [16-70 years]. Concerning the clinical form, 27% had macular lesions, 24% had plaques and 49% had mixed form. Lesions werehyperchromic52%; hypochromic 15% and erythematous 6%. As for main location, 67% had lesions on the neck; 66% on the trunk, 60% on the shoulders. At the end of the study, there was no significant difference in clinical presentation and in improvement rate of pityriasis versicolor between fluconazole and association of fluconazole and ketoconazole shampoo [[p=0.13 at day 14, p=0.57 at day 28 and p=0.2 at day56]
Conclusion: In this study, we have shown that the improvement rate of PV treated with two doses of 300 mg of fluconazole with one week interval was similar to those of an association of one application of ketoconazole shampoo and the same dose of fluconazole
ABSTRACT
Erythrasma is a chronic bacterial infection due to Corynebacterium minutissimum, affecting the interspaces of the toes, the axillary folds and the groin. Its impact is underestimated as it is often misdiagnosed ad wrongly taken as a dermatophytic infection. Through a hospital series, we report the epidemiologic and clinical features of erythrasma, as well as the therapeutic ways. A retrospective study over a 20 year period and including the patients diagnosed as having erythrasma after a Wood's light examination. There were 16 patients [6 males and 10 females] with an average age of 44.6 years-old. The majority of our patients consulted on hot season. Clinical examination showed macular plaques with clear limits, erythematous in 6 cases and yellowish in the remaining cases. The lesions were located at the axillary folds in 13 cases; the groin in 2 cases and at all folds in one case. Treatment with erythromycin [topical or general administration] was the most prescribed. Outcome was generally favourable, but recurrences have been noticed. Erythrasma is a frequent misdiagnosed infection and often confused with a mycosis [especially in the interspaces of the toes]; knowing that antimycotic agents are efficient in erythrasma. This is probably the reason of the small number of patients in our series
ABSTRACT
Dermatofibrosarcoma protuberans is the most common mesenchymatous skin tumor. It is often diagnosed late because of its slow development and the lack of symptoms. To elucidate the epidemio-clinical characteristics of dermatofibrosarcoma in our study. We report a retrospective study of 18 cases of DFS between 1989 and 2009. Mean age at diagnosis was 45.2 years. The average delay before consultation was 45.7 months. Three patients reported a history of trauma. The tumor was mainly located on the trunk or the back. The diagnosis of dermatofibrosarcoma protuberans was histologically confirmed in all cases. Immunohistochemical study was achieved in 6 cases and showed positive staining for CD34. The treatment consisted of surgical excision in all patients. Dermatofibrosarcoma protuberans is a low-malignancy potential skin tumor. Treatment of choice is surgery. The main risk is tumor relapse
ABSTRACT
Bowen's disease [BD] is a form of in situ SCC, characterized by chronic and progressive course, with low potential for invasive malignancy. To assess epidemiology and clinical features of BD in a Tunisian cohort. A retrospective study of 9 cases of BD managed in a Tunisian dermatology department. There were 7 males [77.8%] and 2 females [22.2%]. The mean age of patients was about 68.8 years [46-89]. Lesions were solitary in 7 cases and occurred in various sites: face [1 patient], trunk [2 patients], limbs [6 patients]. The mean diameter of the tumour was about 3.4 cm. Lesions presented clinically as an enlarging well demarcated erythematous plaque with irregular borders and crusted or scaling surface. Histological examination showed in all cases abnormal keratinocytes with disordered maturation and loss of polarity replacing the epidermis in its whole thickness. The main treatment was surgery [N=5]. Only one patient had radiotherapy [case 1]. Outcome was mentioned in 2 patients who remained free from recurrence respectively after a follow-up of 1 and 12 years. Our series outlines epidemiological and clinical features of BD in Tunisia through a small but representative sample. As in the literature, this condition prevailed mainly over 60 years. In our study, BD occurred predominantly in men and affected nonexposed sites in 8 cases. This profile is uncommon in a sunny country in Tunisia, in the absence of other aetiological agents
ABSTRACT
Schwannoma is generally a benign tumour developing from Schwann cells. To study epidemiological, clinical and pathological features of scwannoma. Retrospective study about 26 cases of cutaneous schwannoma collected in our department over 24 years. Our patients were 12 females and 14 males. Mean age was 30 years. Clinically, schwannoma was a subcutaneous tumour which was painful in 11 cases. Individual tumours were located on the limbs [10 cases], on the head [9 cases] and the trunk [5 cases]. Multiple tumours were seen in two patients. Histopathological examination confirmed the diagnosis of schwannoma in all cases. Treatment was complete surgical excision in all cases. Cutaneous location of schwannoma is not rare. Usually, and contrarily to our series, there is no sex predominance. Clinically, schwannoma is located on the limbs and head. The diagnosis is confirmed by histopathological examination. Malignant epitheloid schwannoma diagnosed in one of our patients is a rare tumour. Schwannomas usually grow slowly and are poorly invasive. Malignant degeneration is exceptional. Treatment is complete surgical excision
ABSTRACT
Rosacea is a common, chronic facial dermatosis of uncertain etiology, several well-defined types and variable progression. There is a paucity of epidemiologic studies from North African countries especially in Tunisia. To determine epidemiological, clinical, histological features, treatment and outcome of rosacea in a Tunisian study. A tretrospective study of all rosacea cases diagnosed in the outpatient Dermatology Department of Charles Nicolle hospital of Tunis was conducted between 1990, January and 2003, May. Our study included 244 patients. The diagnosis of rosacea was made on symptoms and clinical features in 185 cases and on histological findings in 59 patients. The hospital prevalence of rosacea was 0.2%. The sex ratio M/F was 0,4. Patient's Mean age was of 49 years. Triggered factors mentioned included most often: sun exposure [64%] and thermal stimuli [25%]. Mean duration between the onset of symptoms and the first consultation was about 20 months. The rosacea subtypes were: erythematotelangiectatic type [12%], papulopustular rosacea [69%], and rhinophyma [3.7%]. Granulomatous rasacea was diagnosed in 8 patients and steroid rosacea in 28 cases. Ocular rosacea was observed in 41 cases. Treatment modalities included: topical treatment [1.6%], systemic treatment [85%], systemic and topical treatment [5%] and surgical procedures [1.2%]. Rosacea seems to be a frequent dermatosis in Tunisia where most of the population is phenotype IV-V. It affects mostly middle-aged women. Most of our patients present with papulopustular rosacea [69%]. More epidemiological and clinical studies in North African countries should be conducted to emphasize these results
ABSTRACT
The orf is a z0000tic infection which can be transmitted to humans. The aim of our report is to describe this often misdiagnosed viral infection in a man with an orf of the hand appearing after the feast of the sacrifice. A 40-year-old man with no past medical history, presented with a nodular lesion on the fifth right finger evolving for 3 weeks which had appeared 2 weeks after the feast of the sacrifice. Histology showed a vacuolar degeneration of keratinocytes probably of viral origin. Both histological aspect and the contact with sheep, led to the diagnosis of hand orf. Three weeks later the lesion had spontaneously resolved. Orf is an infectious mucocutaneous disease due to a parapoxvirus. It is more frequent in professionally exposed persons [veterinary, butchers]. But, in our country, the frequency of the orf increases after the feast of the sacrifice and remains undiagnosed because patients do not consult. The diagnosis may be confirmed by electron microscopy, conventional histopathology or by isolation of the virus by PCR. Information on the benign character of the disease and reassurance of the infected patient are very important because lesion usually resolves spontaneously