[Erysipelas after osteoarticular prosthesis]. / Erysipèle après prothèses ostéoarticulaires.

OBJECTIVE: The occurrence of erysipelas after implantation of osteoarticular prosthesis is rarely reported in literature except when it may indicate infection of the implant. PATIENTS AND METHODS: We studied retrospectively 77 files of patients that had been hospitalized for erysipelas from January 1999 to December 2003. RESULTS: We included 3 patients (3.8%) 2 women and a man (average age: 61 years) with a history of osteoarticular prosthesis implantation on the same side as erysipelas. The period between implantation of the prosthesis and erysipelas varied from 6 months to 30 years. The 3rd patient also presented with chronic venous insufficiency and was treated for legs ulcers of venous origin. There were neither clinical nor radiological signs of prosthesis infection. The clinical schedule was typical. The initial outcome was favorable under intravenous penicillin G and local care. Antibiotic prophylaxis was recommended for all the patients, however, 2 patients relapsed.

[Pemphigoid gestationis: a study of 20 cases]. / Pemphigoïde gravidique: étude de 20 cas.

INTRODUCTION: Pemphigoid gestationis is a bullous autoimmune sub-epidermal dermatosis, occurring during pregnancy and/or postpartum. The objective of our study was to define the epidemio-clinical profile, the histopathological and immunopathological features, the treatment and the course of pemphigoid gestationis in Tunisian patients. PATIENTS AND METHODS: This was a retrospective study concerning the cases of pemphigoid gestationis recorded between 1989 and 2003 in the dermatology department in La Rabta Hospital in Tunis. The patients were included according to clinical, histopathological and immunopathological criteria. RESULTS: We retained 20 patients: 15 multiparae and 5 primiparae. The average age at onset was 29. The first clinical signs appeared in the 3rd trimester in 60 p. 100 of all cases. Clinically, the urticarial patches were noticed in 90 p. 100 of all cases and blisters in 65 p. 100 of the cases. The eruption was located mainly on the trunk and the limbs. The face was affected in 7 cases, the mucous membranes in 3 cases, the palms in 2 cases and the soles in 1 case. Cutaneous histologic examination revealed a sub-epidermal blister in 11 cases and a lymphohistiocyte infiltrate in all cases. Direct immunofluorescence showed a linear deposition of the third component of the complement along the basement membrane zone in all cases. Fetal prognosis was assessed in 13 cases: 1 fetal death, 1 still-born, 3 miscarriages, 1 anencephaly and 2 cases of transit bullous affection in the new-born. DISCUSSION: Our results are similar to those in the literature, but with some particular aspects: the late onset of the pemphigoid gestationis in the course of the 3rd trimester of pregnancy, the frequent involvement of the face and the mucous membranes and the absence of the two main fetal risks: prematurity and hypotrophy. Moreover, we underline the efficiency of topical class I corticosteroids in the treatment of pemphigoid gestationis.

Calcipotriol and PUVA as treatment for vitiligo.

We performed a prospective study to evaluate efficacy of the combination of calcipotriol and psoralen plus ultraviolet A (PUVA) in the treatment of vitiligo. Twenty-three patients with essentially bilateral symmetrical lesions of vitiligo were included. Calcipotriol (0.005 %) ointment was applied twice daily over the right side of the body, and the other side was not treated. PUVA was performed three times per week. All patients received at least forty five sessions of PUVA. Patients were evaluated clinically and photographed all fifteen weeks. At the fifteenth session, 69 percent of the patients had minimal to moderate improvement on the calcipotriol side compared to 52 percent on the PUVA-only side (p = 0.015). At the forty-fifth session, 52 percent showed marked improvement on the calcipotriol side compared to 30 percent on the PUVA-only side (p = 0.13), with more intense repigmentation on calcipotriol-treated areas. Treatment was well tolerated, and no adverse effect was noted. This combination was an effective treatment for vitiligo, especially in initiating repigmentation.

[Pyoderma gangrenosum. 15 cases]. / Pyoderma gangrenosum. A propos de 15 observations.

We report a retrospective study of 15 cases of pyoderma gangrenosum. The male/female ratio was 2, average age 40 years (range: 2-48 years). The typical ulcerous form was observed in 11 patients, whereas bullous pyodrma gangrenosum was noted in 2 patients and the granulomatous superficial form in 2 others. The leg was the most frequent localization. It was often associated with another skin localization. Two patients had neutrophilic pulmonary involvement which was concomitant to the skin ulcers. Association with internal disease was found in 8 patients. Histology showed vasculitis in 11 patients. In 9 of them, leukocytoclastic vasculitis was observed. Prednisone and clofazimine were the most frequently prescribed drugs. Th rate of recurrence of pyoderma gangrenosum was 46% independently of treatment. Occurrence of neutrophilic pneumopathy was rapidly fatal in two of our patients

[Type 1 neurofibromatosis in Tunisia: 66 cases]. / Neurofibromatose type 1 en Tunisie: 66 cas.

A multidisciplinary transversal descriptive study was conducted from June to October 1992 to determine the clinical manifestations and laboratory findings observed in 66 patients with type 1 neurofibromatosis. Diagnostic criteria were those of the National Institute of Health as recommended for subjects over 20 years of age. All patients over the age of 25 had café au lait spots, neurofibromas, lentigines and nodules. Occurrence of lesions of the central nervous system was significantly earlier than peripheral nervous manifestations. The optic glioma was the most frequent lesion of the central nervous system. Complications were observed during the first twenty years of the disease. Based on these findings, we propose a clinical and laboratory work-up designed as a function of age.