[Pityriasis rubra pilaris diagnostic and therapeutic difficulties about 9 cases]

The pityriasis rubra pilaris is a quite rare erythematosquarnous dermatosis characterized by a follicular hyperkeratosis with perifollicular erythema Nine cases have been collected at the department of dermatology of Ibn Rochd University Hospital in Casablanca over 17 years. The classic type I of the adult has been the most frequent, the classic juvenile form has been noticed in one case. This study emphasizes the diagnostic and therapeutic difficulties of this dermatosis

[Prevalence of syphilis and HIV infection in female prisoners in Morocco]

We studied the prevalence of syphilis and HIV infection in 217 female prisoners at Oukacha prison, Casablanca and associated risk factors. The mean age was 32.0 years and mean length of imprisonment 22.8 months. As regards risk factors, 9% of the women said they used condoms, homosexuality was not admitted, 1.8% were intravenous drug users and the average number of sexual partners was 5.17. Fifty-one women [23%] were positive for syphilis and 4 [2%] were HIV-positive. Multivariate analysis found that being married was protective [OR = 0.75, 95% CI: 0.57-0.97], while high number of partners was a positive risk factor [OR = 2, 95% CI: 1.2-3.51]

[Soft tissue alveolar sarcoma: Study of two cases with bones envolvement]

We report two cases of alveolar soft part sarcoma associated with bone involvement. The first case concerned a 61-year old female patient with a left sus-clavicular mass and the second a 67-year old male patient with a tumor of the left hand. The bone involvement, observed on skeletal radiography, was histologically confirmed. Surgery was the treatment in both cases, followed by radiotherapy in one case. Alveolar soft part sarcoma is a rare soft tissue malignant tumor with a local slowly growing and pejorative prognosis. If metastasis of lung, brain and bone are often present at diagnosis, the local bone involvement is not well documented

[Cauda equina syndrome secondary to disc herniation. [Report of 24 cases]]

Cauda equina syndrome is secondary to lumbo sacral nerve roots compression, it is a rare complication of a lumbar disc herniation. Earlier surgical treatment has to be performed for a best improvement. We report 24 cases of cauda equina syndrome secondary to a disc herniation. 58% of our patients were males and the mean age was 47.7 years. Clinical examination found genito sphincteriens disturbances [80%], strenght deficits [62.5%], and sensitif troubles [84%]. CT scan and MRI confirmed the cauda equina compression by a disc herniation, wich were more frequent at L4L5 level [83%]. Surgical treatment was performed in all our cases: laminectomy and discectomy. Clinical out come was satisfactory in 83.5% of cases

Solar risk and sun protection in adolecents

Several studies proved that sunrays intense exposure, since childhood, is a primordial environment factor which increases risk of melanoma. The aim of this study is to evaluate the knowledge of a group of students concerning the consequences of sun exposure, and to insist on the importance of information and prevention. Method: a survey was conducted on a sample of 1000 students in several schools of Casablanca. A questionnaire with 21 items with open answers was auto-filled by all the participants. there were 66,6% girls and 33,4% boys, with a mean age of 13 year-old. 38% of girls and 24% of boys were frequently exposed to the sunrays. The time of exposure was between midday and 4pm. 16% of the students knew that it is the maximal luminal intensity and requires maximal sun protection. The frequency of sunburns was high [43% of girls / 34% of boys]. Most of them exposed themselves regularly at the highest risk hours. The use of external solar photo protector was less frequent when practicing sport [16% of girls and 7% of boys]. During sport, 13% of the students knew the need to renew the application every two hours or after the bath. 54% of girls and 45% of boys knew that the clothes are the best protection.This study shows that the risk of sun exposure is badly known within teenagers and it exists a misreading of the benefit of sunscreen and of the role of clothes. Information, education of children and their families and the awareness of doctors about the solar risk are the best way to eliminate the high increase of the bad effects of the sun [melanoma, hyperpigmentation]

Biologic diagnosis of syphilis

The biologic diagnosis of syphilis is based particularly on the syphilitic serology, as the emphasis of the Treponema pallidum by direct examination is difficult. The serological techniques used are various and contain: TPHA, VDRL, FTAABS. Positive TPHA in the blood indicates the diagnosis of treponematosis, but there is no any serology able to distinguish the syphilis from the other non venereal treponematosis. A positive VDRL may be noticed in non syphilitic cases [false positive serology]. So, it is necessary to ask for two tests [TPHA: treponemic, VDRL: non treponemic]. A correct interpretation of the syphilitic serology permits knowing the various stages of the disease and to follow its evoluation. The decrease of the VDRL quantitive titre is the main criteria of the serologic supervision after treatment. Some difficulties of interpretation are met with cases of neurosyphilis and congenital syphilis. The advent of the new techniques as the ELISA and the PCR make their diagnosis easier but they are still expenxive and difficult to realise

Lupus erythematosus with revealing dermatitis in children: a 26 cases report

The infant lupus erythematosus is rare before the age of 15 years and exceptional during the first 2 years of life. Through a retrospective study of 26 child lupus erythematosus collected in Casablanca Ibn Rochd Dermatology Unit from January 1970 to December 2002, we tried to study anamnestic, clinical, paraclinical, therapeutic and evolutive characteristics of this disease in our context. The children were 7 day-old to 15 year-old with a mean age of 12 years and a clear female predominance [76.9%]. The cutaneous manifestations were the first symptom in all cases. The extracutaneous manifestations were detected in 10 cases [38.46%]. The anatomic clinical forms were: chronic lupus erythematosus in 13 cases, systemic lupus erythematosus in 9 cases, subacute lupus erythematosus in 2 cases, deep lupus erythematosus in one case, neonatal lupus erythematosus in one case. Treatment of the systemic lupus was corticotherapy in 10 cases. In pure dermatologic forms, dermocorticoids were given to 10 children and synthesis antimalarial to 3 children. The remission was obtained in 15 cases [57.69%] and 3 had relapses. Our study showed the predominance of the child lupus erythematosus in girls, the diversity of the clinical forms in this age with predominance of the chronic lupus erythematosus

Juvenile dermatomyositis: a 8 cases report

Juvenile dermatomyositis is a multisystemic rheumatic disorder characterized by non infectious inflammation of skin and striated muscle. The aim of this retrospective study is to stress the diagnostic and therapeutic difficulties of dermatomyositis in children. From January 1990 to December 2002, 8 cases of childhood dermatomyositis were collected in the Dermatology Department of Casablanca University Hospital. The mean age of our patient was 10 year-old [3 to 14 year-old]. They were 6 girls and 2 boys. The evolution mean duration was 17 months. Cutaneous and muscular signs were found in all cases. Raynaud's phenomenon was present in 2 cases. Two children had bad general status and 1 child had a dysphagia. An inflammatory syndrome was present in all cases. Muscle enzymes were increased in 6 patients [75%]. Muscular biopsy has confirmed the diagnosis in 5 cases [62%]. High dose corticosteroid therapy was used in all cases, associated to immunosuppressive therapy in 1 case. The evolution was good in 2 cases. Three children had a relapse with cutaneous calcinosis in 2 cases. Three patients were lost from follow-up. Juvenile dermatomyositis is a severe disease. Corticosteroids, associated to immunosuppressors or immunoglobulins have decreased mortality. The prognosis depends on an early diagnosis and treatment

Physiologic skin changes of pregnancy

We made a prospective study of 146 pregnant women from February 1998 to April 1998. 95% of women had pigmentary changes; the most frequent site was presented by abdomen and breast. Melasma was seen in 53% of cases. New striae distensae appeared in 102 pregnant women [69%]. The more often on the abdomen. Vascular changes appeared in 42 women: varix [11 cases], varicosity [14 cases], and vascular spides [9 cases]. Eight women. Among the other skin changes observed in this serie: oedema of the legs [21%] gingivorrhagia [19%], acne [14%] and molluscum fibrosum gravidarum [4.8%]. Our study demonstrate the high frequency and polymophous of skin changes during pregnancy

[Vulvar pathology]

We evaluated the main causes of vulvar dermatoses; in 785 patients with a vulvar diseases who visited Ibn Rochd Hospital Centre, Casablanca between January 1991 and December 2002. The average age was 31 years [range 2 months to 81 years]; 362 patients [41.52%] had vulvar pruritus, 273 patients [34.77%] had warts and 157 [20%] had one or more vulva ulcers. The most common infectious pathology was papillomavirus infection, found in 273 cases [34.77%], followed by vulvovaginal candidiases in 102 cases [12.99%], syphilitic chancre in 18 cases [2.29%] and herpes genitalis in 17 cases [2.16%]. The most common non-infectious pathology was vulvar dermatosis: 259 cases [32.99%]; idiopathic pruritus vulvae: 61 cases [7.7%]; and tumour-related conditions: 45 cases [5.6%]. The frequency of infectious conditions was over 50% and these were generally sexually transmitted infections