Dermatologic manifestations in inflammatory bowel disease in Tunisia

Cutaneous manifestations are the most common extra intestinal manifestations associated with inflammatory bowel disease [IBD]. To assess the epidemio-clinical profile of skin manifestations in IBD. A prospective and descriptive study was conducted. We have examined skin, mucosa, hair and nails, of all patients with an IBD during one year. One hundred-ninety-five patients were included. Crohn's disease [CD] was noted in 154 cases [79.8%], ulcerous rectocolitis [UC] in 39 cases [21.2%] and inclassable IBD in 2 cases. Cutaneous manifestations were found in 91% of Crohn's patients and in 92% of UC patients. Granulomatous perianal skin lesions were the main cutaneous manifestations of CD [53%]. The most common affected sites were ano-perineal fistulae, perianal and perineal fissures and oedematous and infiltrated perianal and genital plaques. Reactive lesions [Erythema nodosum, Pyoderma gangrenosum, Aphthous stomatitis] were noted in 14 cases. Skin manifestations due to malabsorption were also frequently observed [101 cases: 51.7%].Other dermatoses implicating various mechanisms such as psoriasis, alopecia areata, vitiligo, rosacea, lichen planus, were also noted. Adverse skin manifestations due to treatment [folliculitis, acne, macula-papular rash and DRESS syndrome] were present in 16 cases. Our series is characterized by a high frequency of cutaneous manifestations associated to IBD. A better recognition of these skin manifestations by the physician may improve their management

[Erythrodermic psoriasis: epidemiological clinical and therapeutic features about 60 cases]

The erythrodermic psoriasis [EP] is a rare but severe form of psoriasis that may be potentially life-threatening. To study the characteristics of this severe form of psoriasis. We present a retrospective study, including all cases of EP followed in the dermatology department of the La Rabta hospital of Tunis over a 31-year-period from January, 1980 to June, 2010. Sixty patients were included, concerning 46 men and 14 women, with an average age of 53.7. A history of psoriasis was reported in 78% of the cases. A triggering factor was found in 53% of the cases. Systemic treatments were required in 55% of cases. An improvement was noted in 69.4% of the cases. A recurrence of the EP was observed in 15% of the cases. Three cases of sepicemia and one of stroke were noted. Erythrodermic psoriasis is the most common etiology of erythroderma. It represents more than half of severe psoriasis. As shown in our study it affects mainly adults' males. It complicates usually a common psoriasis. Septic and thromboembolic complications ones justify a close follow up

[Acute generalized exanthematous pustulosis. study of 22 cases]

Acute generalized exanthematous pustulosis [AGEP] is an uncommon but severe dermatosis, characterized by acute occurrence of fever, and erythemato-oedematous rash, covered by sterile nonfollicular pustules. Most cases of AGEP have been described in association with the intake of drugs. To determine clinical and prognostic features of AGEP in our patients. All cases of AGEP diagnosed between 1992 and 2007 according to EuroSCAR criteria have been collected. Twenty two patients [16 female, 6 male] with a mean age of 40.9 years [19-81] were included in the study. Clinical features showed in all cases an acute eruption with oedematous erythema, rapidly covered by nonfollicular pustules. The rash was mainly localized on big folds, trunk and/or limbs in 14 cases and generalized in 8 cases. A biological cytolysis was noted in 5 cases and a functional acute renal failure was objected in 2 cases. Etiological work up has found an association with the intake of drugs in 14 cases, a toxic cause [mercury] in 1 case and a B19 parvovirus infection in one case. The mean delay between drug intake and beginning of the eruption was 5 days [24 hours- 15 days]. Pharmacovigilance enquiry has concluded to a probable or plausible causality in all our cases. Clinical features improved with drug or toxic withdrawal with a mean delay of 7 days [4 -12 days]. A relapse of AGEP was observed in 2 cases after accidental introduction of the drug. AGEP is a cutaneous side effect not to ignore, because of its severe prognosis in case of systemic involvement and the possibility of relapses in case of retake of the causal drug

[Epidemiological and clinical features of juvenile vitiligo: about 106 cases]

Vitiligo is acquired circumscribed leukoerma. Half of all cases begin before the age of 20 years. Our study was to specify the epidemiological and clinical features of juvenile vitiligo [JV]. Through a retrospective study we collected all cases of vitiligo aged less than 16 years, followed during 9 years, between 1997 and 2005 in the Dermatology department of the la Rabta hospital. For every patient, we have focused the epidemiologic, clinical and therapeutic data. One hundred and six cases of JV were enrolled. The mean age was 10 years, with sex ratio [M/F] about 0.49. The mean duration of disease was about 1.5 years. A positive family history of vitiligo and autoimmune disease was noted respectively in 13.2%et 1.9%of our patients. Vulgaris presentation was observed in 53.77%of cases. More patients in our study were treated with topical steroid. There was a paucity of published data regarding JV, they reported some characteristics [female preponderance, higher incidence of family history of vitiligo, autoinimune and/or endocrine disease, increased segmental presentation]. Despite these features, it is premature to conclude that JV is a distinct subset of vitiligo

[Lyell's syndrome: a report of 16 cases]

Lyell's syndrome [SL] or toxic epidermal necrolysis is a rare mucocutaneous eruption, which is characterised by an acute necrosis of the totality of the epidermis +1-the mucosal epithelium. This is a serious affection considering the severity of systemic manifestations, the unprcdictable evolution, and the absence of specific therapy. To assess epidemiological and clinical features of this condition in our departments. This was a retrospective study concerning the cases of Lyell's syndrome carried in the dermatology and the intensive care department of Parhat Hached hospital over a 26 year period. Results: We listed 12 women and 4 with a mean age of 48,9 years. Epidermal detachmcnt varied between 26 and 80%of the body surface and mucus were involved in 87, 5%of cases. Systemic manifestatinns wcre noted in 11 patients. A drug etiology was found in 875%of cases, half of which was due to antibiotics. Our results are similar to those in the literature. Our study illustrates the severity of this toxiderma with a high mortality rate [43, 75%of cases], conformable with what was predicted by the severity-of-illness score "SCORTEN". Infectious complications wore the principal cause of death

[Norwegian scabies, a rare diagnosis in Tunisia]

Norwegian scabies is a particular form of scabies, rarely reported in Tunisia. It habitually occurs in immunocompromised hosts, with prolounged immunosuppressive therapy, congenital immune disease, HIV-1 infection or neoplasm. We report an observation of norwegian scabies, occuring in a woman with prolounged systemic corticosteroid therapy

Observation: a 65-year old woman, with a long history of obstructive bronchoneumopathy and bronchiectasis, treated with systemic corticosteroids for 5 years, was referred with a mild pruriginous and scaly erythroderma. This dermatosis developed within 5 months, with fever and impairing of heal-th. Skin parasitological exams showed a massive infestation by sarcoptes. Histologic findings revealed multiple sarcoptes scabiei and eggs in the stratum corneum. The patient was treated with benzyl benzoate during 48 hours. She died rapid-ly with acute respiratory distress

Discussion: basing on this observation of norwegian scabies occuring in an old immunocompromised woman, we put the accent on this particular form of scabies, often misappreciated, and incite to practice skin and nail parasitological exams in case of mild pruriginous, chronic scaly erythroderma, developing in immunocompromised patients