[Immunogenetics of psoriasis: update]

Psoriasis is a chronic inflammatory skin disease often benign, affecting 2-3% of the total world population. Psoriasis is a multifactorial disease. To present recent advances in the immunologic mechanisms and susceptibility genes involved in the pathogenesis of psoriasis. We presented a literature review of recent genetic and immunological basis of psoriasis to better understand the pathomecanisms of this disease and discuss the contribution of the Tunisian work in this area. Recent works focalized mainly in immunology and genetics. Current progresses in molecular biology have allowed to better characterize the immunogenetic abnormalities in psoriasis. Psoriasis is a multifactorial disease model in which environmental factors [psychological, climate, traumatic, infectious, and viral] seem to be triggering factors when associated with a particular immunogenetics predisposition

[Management of severe psoriasis: about 50 cases]

Background: With its varied clinical presentation, psoriasis is actually considered as a public health care problem. Severe psoriasis remains difficult to treat

Methods: Our study was retrospective involving 50 patient with severe psoriasis treated in the dermatology unit of military hospital of Tunis from January 1990 to December 2003

Aim of our study was to evaluate actual different therapeutic attitudes and new treatments in case of severe psoriasis

Results: During the 14 years studied the frequency of severe psoriasis was about 19,5%. Extended psoriasis was noticed on 64% of the patients. Arthropatic psoriasis was found on only 6% of the patients. Erythrodermic psoriasis, pustular psoriasis and palmoplantar psoriatic keratoderma were equally noticed in 10% of the patients. PUVA-therapy was firstly prescribed on 96,6% of the patient with extended psoriasis, bettering was noticed on 71% of all them during the 3 first cures. From the 20 patients that have received acitretin, 65% have noticed improvement. Methotrexate and RE-PUVA was secondarily used [only for the cases of psoriasic arthritis amd methotrexate] on respectively 18% and 10% of the patients. All our patients reported worsening on them quality of life

Conclusion: Cyclosporin is more and more used initially in cases of rebellious psoriasis. Actually therapeutic hope leans on biological therapies

[Fluconazole and treatment of onychomycosis. About 86 cases]

Systemic treatment of onychomycosis is based these last years on the new drug utilization aiming to decrease the length of the treatment and secondary effects particularly with fluconazole. The aim of our study is to determine the efficiency and the tolerance of the fluconazole [Funzol [registered sign]] managed to the dose of 150 mg per week in the treatment of ony-chomycosis. It is a multicentric and prospective study done to different department of dermatology in Tunisia. Are included adult patients with clinical and mycologic documented ony-chomycosis. They are treated during 12 to 24 weeks for the fingernail and 24 to 36 weeks for the toenail. The assessment of the efficiency and the tolerance of the drug was clinic and biologic. During this survey, 86 patients are included, 55 female and 31 male with mean age of 43,5 years. Onychomycosis seat to hands in 30 cases [34, 8%] with a pre-dominance of Candida species [73%], to toes in 68 cases [79%] witch due in 85% of cases to dermatophytic agent [85%]. At 6 months, clinical cure rate is observed in 51% of cases. After 9 months, at the end of therapy, 84% of patients were judged clinical successes and culture was negative in 82% of cases. Some minimal secondary effects are signalled in 11% of cases to 6 weeks and 10% to 12 weeks not justifying the stop of the treatment. So this study confirms the efficiency and the good tolerance of fluconazole in the treat-ment of onychomycosis

Efficacite et tolerance du fluconzole dans le traitement des dermatomycoses

The aim of the study was to evaluate the efficacy and the safety of fluconazole [Diflucan[']], 150mg/ week, for the treatment of Dermatomycosis. This study was a multicenter open study, and three departments of dermatology were involved. One hundred eight patients with Tinea cruris, Tinea corpons or Tinea pedis were recruited. The efficacy evaluation was based on a clinical and mycological assessment. The clinical success rate was 96.6% Mycological eradication was observed in 90.9% of cases and 80.2% at culture Two to three capsules of Difflucan'] were adminstered to 68.2% patients with Tinea cruris or Tinea corporis. Difflucan'] was well tolerated. Eight adverse events were notified during the study all of these events were moderate and didn't require any patients withdrawal