[Hydroxyurea induced-Leg ulcer in polycythemia vera]

Hydroxyurea [HU] is an antineoplastic drug commonly used to treat chronic myeloproliferative disorders. Dermatological side effects are frequent and usually benign. Leg ulceration following HU therapy is less common. To describe epidemioclinical and therapeutic features of leg ulcers induced by HU. A 70-year-old woman is treated with hydroxyurea for polycythemia vera. One year later; she presented with a malleolar painful ulcer, initially healed without discontinuation of the treatment, but has been recurred 2 months later, becoming multiple and bilateral. HU has been discontinued and ulcers were completely cured. Leg ulcers induced by hydroxyurea are rare. Pathogenesis of HU-induced ulcers remains unknown and is multi factorial. Discontinuation of treatment is still the option of choice for complete recovery

[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

[Experience of a multidisciplinary comittee in the management of superficial venous malformations: 99 cases]

Vascular malformations are heterogenous angiodysplasias. The aim of this work is to study the epidemiological and clinical features of venous malformations [VM] as well as their multidisciplinary management. It is a retrospective study of patients having simple VM, seen at the multidisciplinary consultation of angiodysplasias of our hospital, over a 10 year period. This study included 99 patients having VM. A female predominance was noticed. Average age was 18.5 years. VM had mainly cephalic location. All VM were treated with percutaneous sclerotherapy. Aesthetic results were excellent in the cases of small VM size. VM are most frequent in cephalic region and cause aesthetic and functional handicaps. Percutaneous sclerotherapy is the treatment of choice for such a venous malformations, especially for small VM. VM are anomalies which can have serious complications. Their management has to be multidisciplinary in order to better precise the diagnosis and to take the adequate therapeutic decision

[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

[What is new in the treatment of vitiligo]

Vitiligo is a frequent hypomelanosis that affects 1% of the world population, and 0,95% of the Tunisian population. The objective of our study is to describe through a recent review of the literature, the different therapeutic modalities, now used in vitiligo. We have used a clinical approach to guide therapeutic indications. We have performed a review of the articles, dealing with the treatment of vitiligo and published during the 10 previous years. We have used a Medline research with these key-words: "vitiligo and treatment". Randomized studies were privileged and 29 articles were analysed. We have initially presented all validated therapeutic means now used in vitiligo. We have then proposed, according to this recent review of the literature, clinical indications according to vitiligo type, extension of lesions and if vitiligo involves adults or children. We dispose of multiple chemical, physical and surgical treatments of vitiligo. Vitiligo with partial melanocyte defect can be treated especially by the different modalities of phototherapy [PUVA therapy, PUVASOL, UVB therapy TL01, Laser excimer]. Surgical treatments were also described, with there principal indications. Ethiopathgenic treatments [local steroids, Tacrolimus, Calcipotriol, Vitix] were especially indicated in vitiligo with complete epidermic and follicular achromy. Finally, different therapeutic associadons were reported in the litterature, showing synergic effect of some treatments. Phototherapy remains the best treatment of vitiligo type I. In vitiligo type II and III, ethiopathogenic treatments may be efficient, alone or associated with phototherapy

[Epidemiologic study of cutaneous cancers in aged persons]

The aging of the population in the developed world is an accepted fact. Consequently, the number of aged patients with cutaneous cancer will increase in coming years. The objective was to determine the nature of skin cancer occurring in elderly patients. We retrospectively assessed all patients of 65 years of age and over, with histologically documented skin cancer, in the department of Dermatology of Charles Nicolle hospital of Tunis between 2000 and 2005. We studied sex, age and the type of tumours. 246patients aged 65 years and over and presenting cutaneous cancers were collected. They represented 57.34% of all cutaneous cancers. The average age was 73 years with a majority [91.46%] between 70 and 85 years. Sex-ratio M/F was 1, 82. Basal cell carcinoma [BCC] represented 68.2% of all cutaneous cancers in aged persons and 53.84% of all BCC independently of age. Squamous cell carcinoma [SCC] represented 23.5% of all cutaneous cancers in aged persons and 67.44% of all SCC independently of age. Eight cases [3.25%] of melanomas in aged persons were collected, representing 61.53% of the 13 cases of melanoma during these 5 previous years, independently of age. More than half of the collected cutaneous cancers during these 5 previous years have occurred in aged persons with a majority between the ages of 70 and 85 years. This is explained by a higher life expectancy in Tunisia. Through this study we conclude that the geriatric patient is at a high risk of developing cutaneous neoplasms especially carcinomas

[Systemic corticosteroids and their place in the management of haemorrhagic erysipelas]

Haemorrhagic erysipelas is a recently described clinical condition. Our aim is to study the clinical and evolutive particularities of haemorrhagic erysipelas treated with adjuvant corticotherapy. It's a retrospective study of 6 cases of erysipelas of the lower limbs with serious local signs [purpura, bullae, petechia]. Surgical examination as well as evaluation of muscular enzymes blood level were achieved in all cases. Adequate antibiotherapy and rapidly degressive systemic corticosteroids [0.5mg/Kg daily] were prescribed. Fever, pain and cutaneous signs regressed rapidly. Haemorrhagic erysipelas is different from common erysipelas by the presence of serious local signs [bullae, purpura], by its bad response to adequate antibiotics and by its response to systemic steroids

[Embolization of head and neck hypervascular lesions. a retrospective study of 5 cases]

Embolisation of head and neck hypervascular tumours and arterioveinous malformations [AVMs] is now a well-established therapeutic procedure. The purpose of this study was to analyse the technique and to evaluate the safety and value of preoperative embolization of hypervascular lesions. We retrospectively reviewed the records of 5 patients, aged between 14 and 47 years, with hypervascular tumours and AVMs in the head and neck. Lesions were distributed as follow: nasal angiofibroma [n=1], nasal angioleiomyoma [n=1], nasopharyngeal angiofibroma [n=1], aneurysmal bone cyst in the posterior element of the second cervical vertebra [n=1] and AVM of the inferior lip [n=1]. Angiography and embolization were carried out at the same time. Complete exclusion of lesions was obtained without any complications. Complementary surgical resection was performed with not notable blood loss

Erysipele. Etude retrospective a propos de 647 patients

We conducted a retrospective at the department of dermatology of charles. Nicolle hospital of Tunis between January 1994 and December 2000 to determine the epidemiological, clinical profile and the evolution of erysipelas. A total of 647 patients were studied. The mean age was 44.73 years and sex ratio about 1.55. erysipelas predominately involved in the lower limbs [91.2%]. Antecedents of erysipelas were found in 26.12%. Portal of entry was found in 76.66% represented essentially by toe-web intertrigo. 26.6% of patients were hospitalized. Erysipelas can be controlled with antibiotics; treatment is essentially based on penicillin G 4 mega units intramuscularly every day [60.58%] for mean duration of 10.13 days. Satisfying results were observed in 87.78%. Erysipelas is common disease source of over morbidity. Many predisposing factors were incriminated, account for the frequency of recurrence, justifying implement of primary and secondary prevention

Psoriasis pustuleux juvenile. A propos de 15 cas

Psoriasis is a common, chronic and recurrent inflammatory disease of the skin. Children were affected in 30% of cases. Severe form can be observed: pustular psoriasis [pp], psoriatic arthropathy and erythrodermic psoriasis. There were 15 children with an age range of 1-15.5 years, [mean age 7.56 years]. Psoriasis constituted 5% of the total dermatological disorders in children. The severe forms of psoriasis were rare in children annular pp was the most common form of pp in children. Juvenile pp had generally better prognostic than in adults, but the evolution is characterized by recurrences