[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

[Epidemiologic profile of skin diseases in Tunisian children]

Skin diseases are fairly common in children and can be related to a heavy morbidity. However, very little data about the epidemiology of pediatric skin diseases are available in the literature. retrospective study about 2007 children seen at the dermatological outpatient's department of children's hospital of Tunis between January 1997 and December 2004. The children's sex, age and diagnosis were noted. the median age was 5 years 2 months +/- 4.5 years [range 3 days, 18 years]. Infants and preschool children represented 67.3per cent of the study population. There was 1023 boys and 984 girls [sex-ratio: 1.03]. There were 2100 skin diseases in the 2007 children. Skin infections constituted the largest group [35.3 per cent] followed by allergic skin diseases [26.3 per cent]. Among skin infections, viral infections were most prevalent [31.2 per cent], followed by fungal infections [28.2 per cent], bacterial infections [21.1 per cent] and parasitic infections [19.4 per cent]. Atopic dermatitis was the most prevalent allergic disease. It was also the most prevalent dermatosis in the infant group. The number of children with atopic dermatitis decreased with age, suggesting that this condition tends to clear with age. epidemiologic data are useful in monitoring changes in diseases trends in children and planning healthcare programs for them

[Familial exudative vitreo-retinopathy in a Tunisian family]

Familial exudative vitreoretinopathy [FEVR] is a hereditary ocular disorder with retinal and vitreous abnormality similar to those seen in retinopathy of prematurity. It manifests with a premature arrest of peripheral retinal capillaries. We report an observation of aTunisian family whose 5 members presented clinical signs of FEVR. We report a case of a Tunisian family whose mother and 4 children had fundus ocular abnormalities calling up for FEVR. Clinical manifestations were various with retinal detachment, temporal vasculature traction, macular ectopia and macular edema. FEVR diagnostic was made based on these clinical presentations and after eliminating premature retinopathy. FEVR is one of the causes of retinal detachment in children with retinopathy of prematurity. when FEVR is suspected, families members must be examinated in order to confirm the diagnostic, to detect signs of this disease and to prevent its complications in these cases

[Systemic juvenile scleroderma: about 6 cases]

Introduction: The systemic juvenile scleroderma [SJS] is a rare acquired auto-immune disease. The aim of our study was to analyse the epidemiologic, clinical, therapeutic and prognostic features

Patients and Methods: through a retrospective study, 6 patients were observed with SJS. We adopted the Barnett's classification. Results: The six patients were females, with a mean age of began on 9 +/- 3 years. Five patients were classified type II of Barnett and for 1 patient the classification was difficult. Raynaud's phenomen was observed in 4 cases. The cutaneous sclerosis was noted in the all cases. Five children presented oesophageal damage. Lung involvement was noted in 3 cases. No cardiac dysfunction was found at the clinical exam. Mild renal involvement was noted in 1 case. SJS was associated to systemic lupus in 2 cases and to dermatomyositis in 1 case

Discussion: Systemic juvenile scleroderma is rare. The cardiac involvement is a major concern in children; it appears to be a more common cause of death in SJS. The therapeutic problems were similar to those in adults

[Impetigo in childhood: study of 93 cases]

Impetigo is a superficial non follicular pyoderma due mainly to staphylococcus aureus and/or to streptococcus pyogenes. It occurs chiefly in childhood. We achieved a retrospective study dealing with 93 cases of impetigo occurring in childhood. The aim of this study was to evaluate the epidemiological and clinical features of this condition and its management. In our series, the mean age was 4.5 years with no sex predominance. Thirteen patients [14 per cent] had chronic diseases. Atopic dermatitis was seen in only 6.5 per cent of our patients. Impetigo occurred mainly in summer and autumn. The lesions were mostly erosions covered with yellowish crusts. Rarely, it was matter of vesicles and blisters. These lesions were mainly localized on the face. Treatment was based on antiseptic agents in all patients, associated to topical or systemic antibiotics

Fixed drug eruption: about 13 cases

To discuss, through a retrospective study, the epidemiological and clinical aspects and the causative agents of fixed drug eruption. Thirteen cases were collected retrospectively during 11 years. There were 10 females and 3 males with a mean age of 44 years. The lesions correspond to erythematous plaques which fade to leave slate-brown macules in all cases. The most frequent localizations were limbs [12 cases], trunk [6 cases], face [3 cases] and external genitals [3 cases]. Sulfonamides were the most frequent responsible drugs in our series [7 cases]. Fixed drug eruption is characterized by one or more erythematous plaques which recur in the same places after challenge. Sulfonamides are actually the most frequent causative drugs in the different series

[Dacryocystorhinostomy in children]

To evaluate the efficiceny and safety of dacryocystorhinostomy in children. We report a retrospective study about 20 patients aged under 16 years old who underwent dacrycystorhnistomy. Patients were aged from 4 to 16 years. Dacryocystorhninostomy was indicated for congenital nasolacrimal duct obstruction in all cases. Only 7 patients [35%] have previously one [or two] nasolacrimal probing. Dacryocystorhinostomy was associated with nasolacrimal intubation in 13 cases [65%]. Preoperative haemorrhage occurred in 1 patient [5%]. Post operative complications occurred in 2 patients [10%], one had infection of the wound and another patient had externalization of the nasolacrimal intubation. Success rate of surgery was 95%. Dacryocystorhinostomy is effective in the treatment of congenital nasolacrimal duct obstruction that persist or in cases of failure of probing

[Optic disc drusen in alagille syndrome]

Alagille syndrome [AS] is one of the six forms of familial intrahepatic cholestasis, [AS] signs were neonatal jaundice and paucity of intrahepatic bile ducts. The ophthalmic features distinguish AS from the other forms of familial intrahepatic cholestasis. Posterior embrytoxon is the most common ophthalmic sign associated with this syndrome. We report a case of five months old boy that was suspected to have AS based on the association of jaundice, facial and skeletal abnormalities. Ocular examination revealed slightly elevated optic disc with irregular borders in both eyes. There was evidence of optic disc drusen in ocular B scan ultrasound in both eyes. Ocular ultrasound is a useful tool in the diagnosis of AS particularly in the cases which embrytoxon is absent or difficult to detect [young children]

[Are spring water thermal cures helpful for the treatment of atopic dermatitis?]

The prevalence of atopic dermatitis [AD] is usually high in western countries, varying from 18% to 20% that s why AD is considered as a public health problem. Although the prevalence of AD in Tunisia is not as high as in European countries, recent studies suggest an increasing of this frequency. Spring water thermal cures are considered as a helpful adjuvant measure in the treatment of AD. We present the clinic and therapeutic features of atopic dermatitis and discuss the indication of spring water thermal cures

[Tuberous xanthoma associated to plan xanthoma during a dyslipidemea - about 14 cases]

Xanthoma are benign cutaneous tumors. They can be isolated or associated to hyperlipidaemia. We report the observation of a 15-year-old patient, born from un inbred marriage, which presents a tuberous xanthoma of the right elbow associated to plan xanthoma which revealed a type IIa hyperlipoproteinemia. We shall call back the various aspects of xanthoma, as well as the clinical and biological particularities of the type IIa hypertipoproteinemia

[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