[Erythrasma: study of 16 cases]

Erythrasma is a chronic bacterial infection due to Corynebacterium minutissimum, affecting the interspaces of the toes, the axillary folds and the groin. Its impact is underestimated as it is often misdiagnosed ad wrongly taken as a dermatophytic infection. Through a hospital series, we report the epidemiologic and clinical features of erythrasma, as well as the therapeutic ways. A retrospective study over a 20 year period and including the patients diagnosed as having erythrasma after a Wood's light examination. There were 16 patients [6 males and 10 females] with an average age of 44.6 years-old. The majority of our patients consulted on hot season. Clinical examination showed macular plaques with clear limits, erythematous in 6 cases and yellowish in the remaining cases. The lesions were located at the axillary folds in 13 cases; the groin in 2 cases and at all folds in one case. Treatment with erythromycin [topical or general administration] was the most prescribed. Outcome was generally favourable, but recurrences have been noticed. Erythrasma is a frequent misdiagnosed infection and often confused with a mycosis [especially in the interspaces of the toes]; knowing that antimycotic agents are efficient in erythrasma. This is probably the reason of the small number of patients in our series

[Dermatofibrosarcoma protuberans: a study of 18 cases]

Dermatofibrosarcoma protuberans is the most common mesenchymatous skin tumor. It is often diagnosed late because of its slow development and the lack of symptoms. To elucidate the epidemio-clinical characteristics of dermatofibrosarcoma in our study. We report a retrospective study of 18 cases of DFS between 1989 and 2009. Mean age at diagnosis was 45.2 years. The average delay before consultation was 45.7 months. Three patients reported a history of trauma. The tumor was mainly located on the trunk or the back. The diagnosis of dermatofibrosarcoma protuberans was histologically confirmed in all cases. Immunohistochemical study was achieved in 6 cases and showed positive staining for CD34. The treatment consisted of surgical excision in all patients. Dermatofibrosarcoma protuberans is a low-malignancy potential skin tumor. Treatment of choice is surgery. The main risk is tumor relapse

[Hyalinosis cutis et mucosae: 5 cases from Tabarka [Tunisia]]

Hyalinosis cutis et mucosae [HCM], is a rare autosomal recessive genodermatosis. Cutaneous features are characteristic and allow to suspect diagnosis. To report a series of HCM. A retrospective study of all cases of HCM, diagnosed in a dermatology department over a period of 25 years [1983-2007]. Over the considered period, 5 new cases of HCM were diagnosed. Patients were aged between 14 and 41 years. They were 3 females and 2 males. All patients were native of Tabarka [northwestern Tunisia]. The age of the onset of the disease varied from neonatal period to 5 years. Hoarseness was the first clinical manifestation in all cases. Skin lesions developed between the ages of 3 and 8 years. Vesiculobullous lesions were observed in 2 patients. Moniliform blepharosis was seen in all patients. Warty and hyperkeratotic papules were observed in 3 patients. Diffuse thickening of the skin was seen in 3 patients. Lesions were primarily distributed on the face. All patients presented diffuse scars. Linear palmoplantar keratoderma was seen in one patient. Asymptomatic endocranial calcifications were noted in 4 patients. A pituitary adenoma was noted in one patient. Histopathological examination of a skin lesion revealed a typical pattern of HCM. Two patients were treated with systemic retinoids without improvement. We reported five new cases of HCM. All patients were native from Tabarka. We report also one case of linear palmar keratoderma associated with HCM. This association was not reported in the literature. Finally, the association HCM-pituitary adenoma, seen in one patient, may be fortuitous

[Cutaneous schwannoma: study of 26 cases]

Schwannoma is generally a benign tumour developing from Schwann cells. To study epidemiological, clinical and pathological features of scwannoma. Retrospective study about 26 cases of cutaneous schwannoma collected in our department over 24 years. Our patients were 12 females and 14 males. Mean age was 30 years. Clinically, schwannoma was a subcutaneous tumour which was painful in 11 cases. Individual tumours were located on the limbs [10 cases], on the head [9 cases] and the trunk [5 cases]. Multiple tumours were seen in two patients. Histopathological examination confirmed the diagnosis of schwannoma in all cases. Treatment was complete surgical excision in all cases. Cutaneous location of schwannoma is not rare. Usually, and contrarily to our series, there is no sex predominance. Clinically, schwannoma is located on the limbs and head. The diagnosis is confirmed by histopathological examination. Malignant epitheloid schwannoma diagnosed in one of our patients is a rare tumour. Schwannomas usually grow slowly and are poorly invasive. Malignant degeneration is exceptional. Treatment is complete surgical excision

[Acanthosis nigricans: epidemiologic study of 69 cases]

Acanthosis nigricans is a well-defined skin disorder with a distinctive appearance and an elective topography to the flexural areas that facilitate its diagnosis. In Tunisia, apart from isolated reports of malignant AN, few epidemiologic data are available. In order to describe the characteristics of this affection, we conducted a retrospective study in the area of Tunis over a 12-year period. Retrospective study of all the cases of AN seen in the dermatology department of Habib Thameur teaching hospital between 1991 and 2003, including the cases coming from the north and of the centre of Tunisia. Sixty-nine cases were recorded with a sex-ratio H/F of 0.17. The average age was 24.1 years [extremes of 3 and 66 years] and 57.9% of the patients were aged between 9 and 22 years. The neck [98.6%] and the axillae [75.4%] represented the most common localizations. All the patients presented a benign AN, comprising 51 cases of pseudo-AN, 11 cases of AN associated with endocrine diseases, 5 cases of familial AN and 2 cases of AN associated with an auto-immune disease. Local treatments associated an hypocaloric diet [AN with obesity] were recommended with a light improvement after 3 months an average follow-up. The frequency of the AN is probably underestimated because of the usually asymptomatic character of this affection. AN constitutes a double cutaneous marker, being able to reveal either an hyperinsulinemia constituting a cardiovascular risk factor or an ignored subjacent neoplasm engaging the vital prognosis

[Cutaneous sarcoidosis through a hospital series of 28 cases]

Sarcoidosis is a systemic disease, of unknown etiology, characterized by noncaseating epithelioid granulomas. It may affect many organs mainly lungs, lymph nodes and skin. The aim of our study is to evaluate retrospectively the epidemiological, clinical features and therapeutic particularities of cutaneous sarocidosis through a hospital series conducted in the dermatology department of Habib Thameur hospital. We have included 28 patients [23 females and 5 males] with a mean age of 45.5 years. The most frequent skin lesions were: papular sarcoidosis in 6 cases, nodular sarcoidosis in 8 cases and plaques in 6 cases. The other clinical types observed were: lupus pernio [2 cases], subcutaneous nodules [2 cases] and scar sarcoidosis [2 cases]. Three patients presented erythema nodosum. Tuberculin skin test was negative in 77% of cases. Lymph nodes were palpable in 4 patients. Investigative exams revealed intrathoracic involvement in 8 cases and anterior uveitis sequels in 2 cases. Cutaneous manifestations were treated by chloroquin in 13 cases, allopurinol in 3 cases and intralesional betamethasone injections in 1 case. Five patients, with systemic involvement, underwent a therapy with oral corticosteroids, Sarcoidosis is a rare affection in Tunisia that affects mainly females. Cutaneous manifestations incite physicians to carry out complete investigations and to uphold a regular follow-up in order to detect systemic involvement

[Epdemioclinical aspects of dermatomyositis in the region of Tunis]

Dermatomyositis [DM] is a rare but serious disease. The aim was to evaluate the epidemiology, presenting clinical manifestations, therapeutic features and outcome of patients with DM. From January 1986 to December 2003, we collected retrospectively cases of DM identified at the dermatology department of Habib Thameur hospital. We included only patients with definitive diagnosis of DM. We included 13 patients, mean aged 32.85 years: 9 adults and 4 children. We identified 9 cases of adult DM among them 2 cases of which were of paraneoplastic DM and 4 cases of juvenile DM among them 1 case of amyopathic DM and 1 case of DM associated with connective tissue disease. The evolution of DM followed the course of the neoplasm for the 2 patients with paraneoplastic DM. All patients received corticotherapy initially. Patients were folio wed-up for an average of 3 years [2 months to 10 years]. We found no serious repercussions on the growth of children with juvenile DM. DM is rare in Tunisia. In our study, its frequency is about 0.72 patients per year. Age of onset of DM is markedly smaller than the one reported in the relevant literature. Our 2 cases of DM associated with cancer are considered like really paraneoplastic. Juvenile DM seems to have a relatively good prognosis

[Sneddon wilkinson's subcorneal pustular dermatosis: an atypical case]

Sneddon-Wilkinson disease [SW] is chronic and benign disease belonging to the heterogeneous spectrum of neutrophilic diseases. It is characterised by flask, superficial, aseptic pustules, mainly involving the trunk axilla and inguinal folds, favourably responsive to sulfones. We report an original case with an atypical clinical presentation and course. A 25-year old women presented with an erythematous pustular eruption appeared one week ago. Similar flares were reported since 3 years. No drug intake history nor recent infection were reported. Physical examination showed superficial pustules mainly located on the face and limbs, lying on an erythematous skin and sometimes grouped in larges plaques with a serpiginous disposition having a characteristic aspect of hypopion pustule. A specimen taken from the pustules did not show bacterial or fungal infection. Histological examination of a biopsy specimen showed subcorneal pustules with a dermal peri-capillar neutrophilic infiltrate. Direct immunofluoresence was negative. No associated diseases were found. The patient was resistant to a 1 month treatment with dapsone [100mg/day]. Improvement was obtained with acitretin [25mg/day] within 3 months. Our case has some specificities: cephalic involvement, resistance to dapsone and favourable outcome to a low dose of acitretin

[Study of the cutaneous drugs reactions in a teaching hospital in Tunis]

Cutaneous adverse drug reactions correspond to adverse effects with cutaneous expression resulting from the systemic penetration of a drug in the body

The aim of this study is to evaluate the various clinical pictures of RCM, their epidemiologic characteristics as well as the different causative drugs, through a retrospective hospital series

Methods: It is about a retrospective study about all the patients consulting and/or hospitalized for suspicion of an adverse cutaneous drug reaction led to the service of dermatology of the teaching hospital Habib Thameur of Tunis over a 3-year period [from January 2002 to December 2004]. The diagnosis was based on a beam of clinical and anamnestic arguments. Only the patients having a positive pharmacovigilance investigation were retained

Results: 28 patients were retained for this study. The macular and popular exanthema represented the most frequent clinical aspects followed by acute urticarial and fixed drug eruption. The antibiotics represented the most causative drugs followed by analgesics and non steroidal anti-inflammatory

Conclusion: We record a lower frequency of cutaneous adverse drug reactions in comparison with the literature. We also find a high frequency of severe forms and stress on the difficulties encountered in the identification of the causativele drugs. Though, a close cooperation between the various hospital structures and pharmacovigilance centers is mandatory

Paraneoplastic digital necrosis: a case report

Digital necrosis is a frequent vascular disease. Its very often reflects arterial disorders of macro or mirocirculation. Paraneoplastic digital necrosis is rare, however.Report a new case of paraneoplastic digital necrosis. Our patient was a 62-year old diabetic female patient with a history of total thyroid ablation at 50 year old. She presented with bilateral digital necrosis of the second, third and fourth fingers. During her recovery, we have found a biological inflammatory syndrome and abdominal echography revealed a metastatic liver. Radiological investigations in search for the primitive tumour were negative. The patient was referred to a specialized center for a palliative chemotherapy. Etiologies of digital necrosis are various, mainly iatrogen, professional, toxic, atheroma or systemic disease. In case of no evident cause, explorations should be gone to detect underlying malignancies

[Urticarian vasculitis. a case report after sulfamethoxazole-trimethoprime ingestion]

Urticarian vasculitis [UV] is an anatomoclinical disorder characterized by the association of urticarian papules lasting for more than 24 hours with histological cutaneous vasculitis. Several etiologies are associated with the disease. We report the case of a 30-year-old woman with a-two-month history of urticarial purpuric and necrotic cutaneous lesions of the low limbs. These lesions occurred after oral sulfam‚thoxazole-trim‚thoprime ingestion, 2 weeks before the skin eruption. Histological examination revealed a leucocytoclasic vasculitis and direct immunofluorescence showed a perivascular IgG and C3 deposits. Immunological, allergological and radiological investigations were normal. The pharmacological enquiry confirmed the imputability of sulfam‚thoxazole-trim‚thoprime in the onset of skin eruption; Mild cutaneous improvement was observed after 3 months of treatment with prednisone 0,5 mg/Kg/day. Drug induced urticaria constitutes a rare etiology of UV. Sulfam‚thoxazole-trimethoprime imputability has not been reported before among the drug responsible for UV. Management of patients is difficult and improvement usually occurs after several months because of the resistance of the skin lesions

Lichen sclereux genital

Lichen sclerosis is a chronic inflammatory mucocutaneous, disease which origin remains unknown. Its prevalence ranges from one in 300 to one in 1000 of all patients referred to a dermatology clinic in the seventeeth. Through the analysis of a hospital survey, we outline the epidemio-clinical aspects of this dermatosis. Over a 19-year period [1984-2002], we have conducted a retrospective and monocentric study of all patients with genital lichen sclerosis were examined at the dermatology department of Habib Thameur hospital. Thirty-four patients suffered from lichen sclerosis. There were 33 female and only one male [sex-ratio: 0.03]. All patients underwent topical corticosteroid therapy [level I, II or IV]. The recovery rate of lichen sc1erosus was about 20% [7/34]. An epidermoid carcinoma occurred in three patients. The frequency of lichen sc1erosus in our study is estimated at 1,8 new cases per year. This frequency is probably under-estimated because of some patients' reluctance to seek help. A relatively low recovery rate of genital lichen sclerosis was found in our study. This may be related to an inadequate follow up added to an insufficient treatment adherence

[Chondroid syringoma]

This is a retrospective monocentric study of all the cases diagnosed at our department over a period of 10 years. The study included seven male patients. All patients presented with a single painless skin lesion of about 1,5 cm on the face, lasting for 14 months on average. In all cases, treatment was surgical and the outcome satisfactory. Chondroid syringoma is a benign sweat gland tumor. This lesion is electively located in the craniofacial area, made of a subcutaneous painless tumor measuring from 0.5 to 3 cm. Diagnosis can always be confirmed by histology which shows tubuloalveolar and gland like structures with two or more cuboidal cell lines in a fibroadipoid or chondroid stroma that is positively stained for Alcian blue. Mixed tumors have a slow course; their progress to malignancy is rare but possible. The best treatment remains surgical allowing a histological diagnosis with a control of the lesion edges