Childhood cutaneous tuberculosis: a 20-year retrospective study in Tunis.

Despite prevention programs, tuberculosis is still endemic in developing countries. We assessed the epidemiologic and clinical profiles of childhood cutaneous tuberculosis in our dermatology department from 1981 to 2000 and compared it to previous Tunisian reports and to the relevant literature. This is a retrospective study over a 20-year period (1981-2000) in a large teaching hospital of the capital. Patients included were below age 15 years. Diagnosis was based upon clinical examination, tuberculin reaction, histopathology and response to antitubercular therapy. There were 26 patients with cutaneous tuberculosis, 0.1 percent of the total number of dermatology outpatients for that time period. Of these 26, seven (27 %) were immunocompetent. There were four boys and three girls and the mean age was 9.5 years. Three patients had lupus vulgaris, three had scrofuloderma, and one child had orificial tuberculosis. Six out of seven children were BCG vaccinated. There was no family history of tuberculosis. The Mantoux reaction was positive in six children. There was no systemic organ involvement in all cases. All patients were treated successfully with triple or quadruple anti-tubercular drugs for 4-11 months. Compared to a previous Tunisian report conducted over an 8-year period in the seventies, the incidence of childhood cutaneous tuberculosis has decreased. In that report, scrofuloderma was the most frequent form. Currently the incidence of lupus vulgaris has reached that of scrofuloderma, demonstrating the increase of the clinical pattern associated with strong immunity. All children had localized disease and responded to antimycobcterial chemotherapy.

[Cutaneous tuberculosis. A review of 38 cases]. / La tuberculose cutanée. A propos de 38 cas.

INTRODUCTION: Cutaneous tuberculosis (CT) represents only 2% of extra-pulmonary locations. This form should be studied because it may indicate visceral forms of tuberculosis. MATERIAL AND PROCEDURES: Retrospective study of patients affected by CT, conducted in the dermatology department of Charles Nicolle Hospital from 1991 to 2002. Tuberculids have been excluded. RESULTS: We have studied 38 cases of CT subdivided on 8 lupus tuberculosis, fourteen scrofuloderma, two warty tuberculosis, one association between lupus tuberculosis and scrofuloderma, twelve BCG specific reactions and one unclassifiable form. The average age of our patients was 43 years. The sex ratio (H/F) was 1,91. Concomitant visceral tuberculosis was discovered in 9 patients. All cases were confirmed by anatomopathologic examination and half of them had a caseous necrosis. CONCLUSIONS: The incidence of cutaneous tuberculosis seems to be increasing in our country: from 3 per 1000 new consultants in our dermatology department between 1970 and 1977 to 0.44 per 1000 new consultants from 1991 to 2002. Our study points out a male predominance in cutaneous tuberculosis. Clinical forms are still dominated by scrofuloderma which is a multibacillary form.

[Genital lichen sclerosus]. / Lichen sclereux genital.

Lichen sclerosus 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 seventeenth. 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 sclerosus were examined at the dermatology department of Habib Thameur hospital. Thirty-four patients suffered from lichen sclerosus. 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 sclerosus was about 20% (7/34). An epidermoid carcinoma occurred in three patients. The frequency of lichen sclerosus 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 sclerosus was found in our study. This may be related to an inadequate follow up added to an insufficient treatment adherence.