[Generalized pustular psoriasis activated by Klebsiella pneumoniae septicaemia]

Generalized pustular psoriasis is a severe form of psoriasis. The pustular dermatosis complicates a known psoriasis frequently after a medicinal taking or infection. It exceptionally inaugurates the psoriatic disease. We report a case of generalized pustular psoriasis triggered by Klebsiella pneumoniae septicaemia and discuss the characteristics of this association. A 43-year-old man, was hospitalized for a profuse pustular eruption evolving for one week with altered general state, fever and liquid diarrhea. The patient ate a tuna sandwich 48 hours prior to the onset of symptoms. The biology showed a hyperleucocytosis, elevated C Reactive Protein and hepatic cytolysis. The skin histology demonstrated a pustular psoriasis. Three blood samples, a coproculture and a catheter culture showed Klebsiella pneumoniae. The patient was treated with antibiotics. The pustular psoriasis was treated by acitretin. The evolution was gradually favourable. Generalized pustular psoriasis is a rare and severe affection. Its prognosis is mainly conditioned by infectious complications

[Psoriasis indicative of HIV infection progress to aids]

Psoriasis is a chronic inflammatory dermatosis which can appear before HIV infection in a patient with personal or family histories of psoriasis or which can be triggered by the HIV infection in a previously unaffected subject. The psoriasis with HIV is often more severe and refractory to classic psoriasis treatments. We report a case of psoriasis that revealed an HIV infection at the AIDS stage, and shall discuss the clinical and therapeutic characteristics of this association. A 40-year-old female has presented with a non pruriginous erythemato-squamous face and scalp eruption with palomplantar keratoderma and onychodystrophy of all toe nails evolving for one ear. On physical examination, an oral candidosis and chronic diarrhea were also noted. The diagnosis of common psoriasis was evoked and the investigations had revealed a lymphopenia at 610/mm[3]. The HIV serology was positive with CD4 at 31/mm[3] and viral load at 31,000 copies/ ml. A chest radiography had shown an apical left opacity due to pulmonary tuberculosis. In few days, the psoriasis extended to the whole integument. The patient was treated by antiretroviral therapy, antituberculosis drugs and local corticosteroids and ointments for her psoriasis. The evolution was quickly favourable. The recent psoriasis developed in an unaffected subject or the exacerbation of a former psoriasis can be associated with immune-suppression. HIV serology is required in such cases

[Familial psoriasis: descriptive report of 9 families]

Psoriasis is a chronic inflammatory skin disease. The familial nature of psoriasis has long been recognized. Our study was to describe the epidemiological, clinical and genetic features of familial psoriasis. Through a prospective study we investigated during a study period of 1 year [2006-2007] 9 Tunisian unrelated multiplex families. Patients with psoriasis and their available family members were examined by the same dermatologist. Thirty nine individual presented psoriasis [25 men and 4 women], with a mean age at onset about 19.8 years. With the systematic exam of member's family we discover 11 cases of unknown psoriasis. The common form of psoriasis was the preponderant one [37 cases]. The nails, the scalp, the mucous membranes were involved respectively in 21, 12 and 13 cases. The psoriasis was severe in 11 cases. Through this study we find similar epidemiological and clinical features of those reported previously. The intra and inter-familial variability was evident in our patients

[Erythema nodosum: profile in a Tunisian teaching hospital]

Background: Erythema nodosum [EN] is the most frequent acute nodular hypodermatitis. Etiologies of EN are varied although a similar clinical presentation

The aim of our study is to establish epidemio-clinical characteristics of EN in 103 patients

Methods: [62 in care [January 1980-december 2005] were seen on the dermatology unit of the Rabta hospital. We have only included patients that had done: blood count, chest X-Ray, ASLO, tuberculin intradermoreaction, transaminase, inflammation marker

Results: We had 86 women and 17 men with a mean age of 36,5 years. Lesions were located in lower limbs in 88 cases. The man etiologies were: post streptococcal infections [42 cases], tuberculosis [8 cases], Crohn disease [8 cases], Behcet disease [7 cases] and sarcoidosis [5 cases]. EN was idiopathic in 23 patients. The most common provoking agent of EN varies from a country to another and even in the same country from a study to another. In Tunisia, post streptococcal infection and Behcet disease still frequent etiologies for EN, sarcoidosis and inflammatory colites are more and more found unlike tuberculosis which is less incriminated than before. In case of EN it is reasonable to begin etiological enquiry by common causes

[Dermatofibrosarcoma protuberans about 18 cases]

Dermatofibrosarcoma protuberans [DFSP] is a rare mesenchyma skin tumor. It is characterized by a slow growth with a high rate of recurrence but limited potential for metastasis. We report the result of a retrospective study of 18 cases of DFSP collected over 16 years in the dermatology department of La Rabta Hospital. The mean age was 32 years with a sex ratio of 1.57. The site of predilection was the trunk [77.5%]. Histological features were typical in all cases with positivity for CD34 in 14 cases. Treatment was surgical in 13 cases. DFSP is a tumor of intermediate malignancy, which can have aggressive course. This tumor is best treated with surgery in which large excision are necessary to reduce the risk of recurrence

De l'usage des bolus de corticoides dans le pemphigus a propos de 4 cas

The authors report in this work the results of a therapeutic essay by corticosteroids pulse-therapy in four patients suffering from severe and/or cortico-resistant form of pemphigus. They compare their results with similar essays in litterature

Essai therapeutique du Ketoconazole per os dans le traitement du pityriasis versicolor

A therapeutic trial of ketoconazole with a dose 200mg daily for 10 days has been realized in 17 patients presenting an extensive and recurrent pityriasis versicolor. A mycological control has been done before treatment, at 10,20 and 30 day after treatment. The mycologic cure was observed in 94% of patients at the 20th day and in all patients at the 30th day. The clinical cure at the 30th day was observed in only 41% in all patients presenting a pigmented pityriasis versicolor in the beginning of the study. The difference between clinical and mycologic results is classic and the main cure criterion is the mycological one. The protocol conducted in our study is effective with an excellent clinical and biological tolerance. Ketoconazole is then a very intersting therapeutic in extensive and recurrent pityriasis versicolor