Comparative clinical trial: fluconazole alone or associated with topical ketoconazole in the treatment of pityriasis versicolor

Background: The efficacy of ketoconazole and fluconazole in pityriasis versicolor had been proved

Aim: To compare the efficacy and the safety of two doses of fluconazole given 1 week apart alone or associated to ketoconazole shampoo

Methods: Our study included all patients with pityriasis versicolor who attended in dermatology department of Habib Thameur Hospital, Tunis [over a 21-month period]. During the considered period, patients were randomly assigned in two study groups: G1 receiving fluconazole two doses 300mg given 1 week apart with G2 taken an association of fluconazole [two doses 300mg given 1 week apart] and ketoconazole shampoo the first day

Results: Seventy one patients were enrolled in our study: 35 in the fluconazole group and 36 in the fluconazole associated to ketoconazole shampoo comparator group. The mean age was 29.1 years [16-70 years]. Concerning the clinical form, 27% had macular lesions, 24% had plaques and 49% had mixed form. Lesions werehyperchromic52%; hypochromic 15% and erythematous 6%. As for main location, 67% had lesions on the neck; 66% on the trunk, 60% on the shoulders. At the end of the study, there was no significant difference in clinical presentation and in improvement rate of pityriasis versicolor between fluconazole and association of fluconazole and ketoconazole shampoo [[p=0.13 at day 14, p=0.57 at day 28 and p=0.2 at day56]

Conclusion: In this study, we have shown that the improvement rate of PV treated with two doses of 300 mg of fluconazole with one week interval was similar to those of an association of one application of ketoconazole shampoo and the same dose of fluconazole

[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

Bowen's disease: epidemioclinical study of 9 tunisian cases

Bowen's disease [BD] is a form of in situ SCC, characterized by chronic and progressive course, with low potential for invasive malignancy. To assess epidemiology and clinical features of BD in a Tunisian cohort. A retrospective study of 9 cases of BD managed in a Tunisian dermatology department. There were 7 males [77.8%] and 2 females [22.2%]. The mean age of patients was about 68.8 years [46-89]. Lesions were solitary in 7 cases and occurred in various sites: face [1 patient], trunk [2 patients], limbs [6 patients]. The mean diameter of the tumour was about 3.4 cm. Lesions presented clinically as an enlarging well demarcated erythematous plaque with irregular borders and crusted or scaling surface. Histological examination showed in all cases abnormal keratinocytes with disordered maturation and loss of polarity replacing the epidermis in its whole thickness. The main treatment was surgery [N=5]. Only one patient had radiotherapy [case 1]. Outcome was mentioned in 2 patients who remained free from recurrence respectively after a follow-up of 1 and 12 years. Our series outlines epidemiological and clinical features of BD in Tunisia through a small but representative sample. As in the literature, this condition prevailed mainly over 60 years. In our study, BD occurred predominantly in men and affected nonexposed sites in 8 cases. This profile is uncommon in a sunny country in Tunisia, in the absence of other aetiological agents

[Pruritus in the elderly: an epidemic-clinical study [about 208 cases]]

Pruritus is an unpleasant cutaneous feeling causing the desire to scratch. Few epidemiologic studies were interested in this symptom which relates to the old subject particularly. To study the epidemiological and clinical features as well as the treatment of pruritus in this age bracket. A retrospective study over 10 years and 5 months at the dermatology department of Habib Thameur hospital concerned 208 patients, 65 years old and more presenting a pruritus without specific dermatological lesion. The frequency of pruritus in the old subject was 5.14 per 1000 new consultants. Pruritus had revealed an ignored affection in 36.36% of the cases: an iron deficiency in 10 cases, a type 2 diabetes in 6 cases, a hypereosinophilia over 1000 elements/mm3 in 4 cases, a chronic renal failure in 2 cases, a hepatic cytolysis in 2 cases, a cholestasis in one case, a polycythemia vera in one case and hepatitis B one a case. Skin lubricants and antihistamines associated to topical corticosteroids in 25 cases and UVB therapy in a case were prescribed. These treatments brought an attenuation of pruritus in 62% of the cases. Iron deficiency anemia was the principal cause of pruritus in our series, followed by the type 2 diabetes. Our results contrast with the data of the literature considering that the traditional prevalence of the hepatic cholestasis was not noted and that diabetes is not regarded as inductive factor of pruritus

[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

[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

Sweets syndrome: about of 8 cases

Sweet's syndrome is a dermatosis classically determined by painful erythematous plaques or nodules associated with fever, neutrophilia and dense neutrophilic dermal infiltrate. In most cases, Sweet's syndrome may occur in the absence of other diseases. However, it can be associated with an inflammatory disease and essentially with malignant conditions in 20% of cases requiring a careful investigation. We report herein, the epidemiological, clinical, therapeutic and evolutive features of a hospital serie. We retrospectively reviewed all the files of patients conforming with the diagnosis of SS, seen at the dermatology departement of Habib Thameur hospital during a 7-year period [from 1997 to 2003]. All patients fulfilled at least two major criteria and two minor criteria of Su et Liu's diagnostic criteria modified by Von Den Driesch. 8 cases of .Sweet's syndrome were diagnosed. All patients were females. The mean age was 51.62 years. The lesions occurred on the upper limbs in 7/8 cases. SS was isolated in 6 cases and para-inflammatory in one case corresponding to an associated Sjogren's syndrome. Besides the st and ard therapy using oral corticosteroids [3 patients], non steroidal inflammatory agents has been efficient in 4 cases. In our serie, we report an exclusive female involvement and a lower frequency of associated diseases compared with the relevant literature. Association of SS and Sjogren's syndrome is exceptional. To our knowledge, only 6 cases have already been reported

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

[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