[Chronic lupus erythematosus: 104 Tunisian cases]

Chronic lupus erythematosus is a cutaneous form of lupus eryhematosus, usually involving photoexposed areas. The aim of our study is to evaluate the epidemio-clinical trends, therapeutic features and outcome of patients with chronic lupus erythematosus, through a Tunisian hospital series. We have tried to compare our results with those of other African and western series. It is a retrospective study, concerning all patients with chronic lupus erythematosus, attending the Dermatology department of Charles Nicolle Hospital over an 11 years period. The patients' age, sex, clinical features, explorations results, treatment and evolution were recorded. A total of 104 patients were included. Chronic lupus erythematosus represented 0,1% of all the dermatitis seen over 11 years. Chronic lupus erythematosus affects young women with a ratio F/M of 1,97 and an average age of 42 years. The discoid form was the most frequent clinical shape, observed in 73% of cases [76 patients]. The face was the most frequent localization of the lesions [91%]. Five patients [4.8%] presented a generalized chronic lupus erythematosus. The direct immunofluorescence in stick skin was positive in 54% of cases. Treatment included sun avoidance and oral antimalarials drugs in the majority of cases [95%]. The progression from chronic lupus erythematosus to systemic lupus erythemetosus was observed in two cases [2%]. Chronic lupus erythematosus is a relatively are disorder in Tunisia, compared to other African countries, where prevalence is 7 to 10 times more frequent. As shown in our study, the most common clinical feature is the discoid form. The diagnosis can be confirmed by histopathological and direct immunofluorescence examination. Progression of chronic lupus erythematosus to systemic lupus erythematosus is possible, as observed in tow of our patients. Thus, patients with chronic lupus erythematosus should be continually followed up

[Side effects of meglumine antimoniate in cutaneous leishmaniasis: 15 cases]

Leishmaniasis is wide spread parasitic disease considered to be endemic in 88 countries in both old and new world. The standard treatment remains Meglumine antimoniate. We study the side effects of systemic meglumine antimoniate in cutaneous leishmaniasis. We conduct a retrospective study covering 3-year period [2002- 2005]. All medical reports of cutaneous leishmaniasis treated by systemic Meglumine antimoniate are reviewed. The study comprise 63 patients all treated by systemic meglumine antimoniate at the dose of 60mg/kg/day for 10-15 days. Side effects were noted in 15 cases [12 females and 3 males] .The subject's age range from 11 to 78 years. Stibio-intolerance [fever, rash, arthralgia, abdominal pain] was observed in 12 cases and stibio-toxicity in 3 cases: precordialgies 1 case, hyperamylasemia and increase liver enzyme: 1 case, pancytopenia, renal and hepatic failure leading to death: 1 case, skin eruption: 7 cases, pruritis and erythema in the site of injection: 5 cases, urticaria: 1 case. Meglumine antimoniate was stopped in 13 cases Meglumine antimoniate is the generally recommended treatment of cutaneous leishmaniasis. In spite of the rarity of Glucantime's side effects, we recommend a careful survey especially in older patients

[Bullosis diabeticorum: ten cases report]

Bullosis diabeticorum is a rare characteristic complication of diabetes mellitus; it affects 0.5%of diabetics. Bullosis diabeticorum is a manifestation of complicate and longstanding diabetes mellitus. Of our study was to describe particularities of diabetes in patients suffering of this disease. We have led a retrospective study covering a 5 year-period [January 2001-December 2007] in the dermatology department of the Charles Nicolle's hospital in Tunisia. We selected for this study all cases of bullosis diabeticorum. During the studied period, 10 cases have been collected. They were in all cases about complicate and long-standing diabetes. Bullosis diabeticorum has a favourable outcome in all cases with symptomatic treatment. The different cases of bullosis diabeticorum reported in our series were associated to complicate diabetes mellitus what lets suggest that vascular deteriorations led to cutaneous fragility responsible for the skin cleavage

[Orf of the hand]

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

[Hypohidrotic ectodermal dysplasia: ten cases]

Ectodermal dysplasias are rare hereditary diseases characterised by congenital absence of ectodermally derived structures and classified according to four symptoms: trichodysplasia, hypodontia, onychodysplasia and hypohidrosis. The objective of our study is to precise the epidemioclinical characteristics, the diagnostic tools, the evolution and the treatments of this rare disease through a 10-case series of hypohidrotic ectodermal dysplasia [HED]. The present report is a retrospective study of all cases of an/hypohidrotic ectodermal dysplasia collected from 1977 to 2006. We have specified age, sex, parental consanguinity, similar familial cases, clinical and histological features, dental, oto-rhino-laryngologic, ophthalmologic and respiratory examinations. Ten cases of HED were collected [average age: 14 years, sex ratio 9/1]. The mean duration diagnostic period was of 14 years. Parental consanguinity was registered in 3 cases but only one patient had similar familial cases. All patients had facial dysmorphy, hypotrichosis and hypo/anodontia [respectively 8/10 and 2/10]. All patients had clinically and histologically documented hypoplastic [6/10] or aplastic sweat glands [4/10]. Extra-cutaneons manifestations were noted in 8 patients [recurrent rhinitis 6/10, recurrent pneomopathies 3/10, xerophtalmy 3/10]. Our series deals with 10 cases of HED, consisting in Chris-Siemens Taos-nine syndrome. It highlights the delayed diagnosis of Ibis disease [mean: 14 years] with a diagnosis made at an adult age in four patients. Our study confirm the X-linked heredity [9/10] with a possible autosomal transmission [one female-case]. HED is rarely life-threatening, but early diagnosis allows a better quality of life to patients and genetic counselling to parents. Our series illustrates the rarity of RED which is also probably due to its underestimation by clinicians

[Hereditary ichthyosis in Tunisia: epidemiological study of 60 cases]

Ichthyosis are a group of inherited keratinizing disorders. The cutaneous abnormalities may be isolated or associated with extra-cutaneous symptoms. To report the epidemiological and clinical profiles of patients with these genodermatoses from a hospital Tunisian study. A retrospective study of all cases of ichihyosis referred during a period of 5 years to the department of dermatology of Charles Nicole's hospital of Tunis. Sixty cases of hereditary ichihyosis were seen. The sex-ratio was of 0.5. Parental consanguinity was noted in 36 patients [60%]. Seventeen patients [25.7%] had a positive familial history of ichthyosis. The clinical form of ichthyosis was determined in 52 cases. The nonbullous ichthyosiform erythroderma was observed in 25 patients [41.6%]. Sixty patients presented an ichihyosis vulgaris [26.6%]. The other forms of ichthyosis were rarely observed: 4 cases of X-linked recessive ichthyosis, 2 cases of lamellar ichthyosis and 2 cases of bullous iclithyosiform erythroderma. Two patients were born with collodion-like membranes. Two cases presented a complex syndrome. The NBIE, commonly considered as a rare form of ichthyosis, was the most frequently form seen in our study [41.6%], probably because of the high frequency of consanguineous marriages in Tunisia. The IV represents the most frequent form reported in the litterature and was observed in 25% of our patients. The classification of some ichthyosis associated with other extra-cutaneous abnormalities [found in 2 of our patients] remains difficult

[Diabetic dermopathy: epidemioclinical characteristics]

Diabetic derruopathy is a common cutaneous marker of diabetes mellitus. Our purpose was to investigate the association of diabetic dermopathy and diabetic degenerative complications. We conducted a retrospective study in an outpatient diabetes clinic during a 6-month period. Diabetic were examined for the presence of diabetic denuopathy and diabetic degenerative complications. The data of 414 diabetic seen at National Institut of Nutrition were collected retrospectively. DO was present in 9 patients middle aged 46 years. Eight patients had type II diabetes, 5 of whom were insulindependant. The diabetic duration was over 10 years for 7 patients. Microangiopathy complications were present in 6 patients. DO may serve as a clinical sign of internal complications in diabetic patients

[Pemphigoid gestationis: a pregnancy- related pathology underestimated by obstetricians]

Pemphigoid gestations [herpes gestationis] is an autoimmune bullous dermotosis occurring during pregnancy or in the post-partum period. The interaction of this rare pathology with pregnancy is underestimated by obstetricians. Authors report one case of pemphigoid gestations diagnosed in a pregnant woman at term. After a literature review clinical aspects of this dermatosis and especially its interactions, with pregnancy are assessed

[Profile of bullous pemphigoid, 47 cases reported]

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 aquired autoimmune bullous skin diseases, differ pemphigus. The profile of bulbous pemphigoid in our series difere 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 an infantile form. Systemic corticosteroids were choice treatment for our patients

Evaluation of HPV oncogen risk in condyloma. A prospective study of 24 patients

Human papillomavirus [HPV] infection tend to be the most prevalent sexually transmitted disease [STD], and "high-risk" HPV types are correlated to intro-epithelial neoplasia, especially cervical cancer. - The aim of this study was to evaluate the frequency of "high-risk" HPV types in condylona. - Patients and methods: a non randomized prospective study was performed, including 24 patients with condyloma examined int the department of Dermatology of Charles Nicolle's hospital. Molecular hybridization method was realized 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 percent]

Degenerescence des cicatrices de brulure A propos d'une serie de 12 observations

The development of cancer in burn scars is rare, but not exceptional [2% of burn scars are developing cancers]. We report a study of 12 cases of cancers arising in burn scars, and we discuss the epidemiologic, clinic and prognosis characteristics of those cancers. We notice that squamous cell carcinoma are the most frequent cancers arising generally on burn scars of legs, and trunk. The improvement of prognosis depend not only on an earlier diagnosis and treatment, but also on a good management of burns when they occurred