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

[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

[Experience of a multidisciplinary comittee in the management of superficial venous malformations: 99 cases]

Vascular malformations are heterogenous angiodysplasias. The aim of this work is to study the epidemiological and clinical features of venous malformations [VM] as well as their multidisciplinary management. It is a retrospective study of patients having simple VM, seen at the multidisciplinary consultation of angiodysplasias of our hospital, over a 10 year period. This study included 99 patients having VM. A female predominance was noticed. Average age was 18.5 years. VM had mainly cephalic location. All VM were treated with percutaneous sclerotherapy. Aesthetic results were excellent in the cases of small VM size. VM are most frequent in cephalic region and cause aesthetic and functional handicaps. Percutaneous sclerotherapy is the treatment of choice for such a venous malformations, especially for small VM. VM are anomalies which can have serious complications. Their management has to be multidisciplinary in order to better precise the diagnosis and to take the adequate therapeutic decision

[Systemic corticosteroids and their place in the management of haemorrhagic erysipelas]

Haemorrhagic erysipelas is a recently described clinical condition. Our aim is to study the clinical and evolutive particularities of haemorrhagic erysipelas treated with adjuvant corticotherapy. It's a retrospective study of 6 cases of erysipelas of the lower limbs with serious local signs [purpura, bullae, petechia]. Surgical examination as well as evaluation of muscular enzymes blood level were achieved in all cases. Adequate antibiotherapy and rapidly degressive systemic corticosteroids [0.5mg/Kg daily] were prescribed. Fever, pain and cutaneous signs regressed rapidly. Haemorrhagic erysipelas is different from common erysipelas by the presence of serious local signs [bullae, purpura], by its bad response to adequate antibiotics and by its response to systemic steroids

[Arteriovenous malformations: study about 54 patients]

Background: Arteriovenous malformation [AVM] are vascular anomalies that may threaten functional and vital prognosis

The aim of this study was to assess the management of Arteriovenous malformation

Methods: it is retrospective study about 54 patients, having AVM, collected over a 7-year period

Results: Sex ratio M/F was 1.25; average age at the diagnosis was 25.4 years. Puberty, pregnancy and trauma, were the most important favoring factors for the development of AVM. Location was the head in 75% of the cases. Doppler ultrasound was the most indicated examination to confirm the diagnosis

In over than 70% of our patients, therapeutic abstention and follow-up were indicated. In the other cases, embolixation, with or without surgery was the treatment. A patient died of massive haemorrhage

Treatment is necessary in complicated AVM. Follow-up [if abstention or after treatment] is mainly based on clinical and Doppler data

Conclusions: AVM are anomalies that may be serious and their management must be multidisciplinary to allow better therapeutic indications

[Porokeratosis. A study about 6 cases]

Porokeratoses [PK] represent a less common group of dermatoses that are acquired or hereditary, of unknown pathogenesis, characterized b keratinization disorder. Different clinical forms have been identified and the most frequent are the Mibelli's porokeratosis [MP] and the Disseminated Superficial Actinic Prokeratosis [DSAP]. In this retrospective study, we analysed the observations of PK collected in the Dermatology Department of La Rabta Hospital over a 16-year period. Six cases of PK were collected: 4 females and 2 males, with no medical history with a mean-age of 42.7. Only a female patient had [PK] familial history. All our patients had typical clinical aspects with lesions in annular plaques, of atrophic center, surrounded by keratotic border. The histological aspect was consistent with PK, showing the typical cornoid slide. In our series, there are 3 cases of [MP] and 3 cases of [DSAP]. PK lesions usually appear during the childhood and the third and fourth decades for the DSAP. In MP, there is one or some large, unilateral, annular plaques. DSAP is characterized by numerous small annular lesions of the photo-exposed regions Their prognosis is on the whole, favourable but remains conditioned by malignant transformation. Treatment is difficult aiming at reducing that risk of degeneration