Hymenal polyps in two infants.

Pathological conditions of the hymen are rare in everyday medical practice. Hymenal polyps are polypoid formations originating from the hymenal rim and are benign and disappear spontaneously within a few weeks of onset. We report two cases of hymenal polyps in two infants.

Diffuse dermal angiomatosis of the breast with adjacent fat necrosis: a case report and review of the literature.

Diffuse dermal angiomatosis (DDA) is a type of reactive skin angioproliferation. Clinically, this rare disorder presents as red-violet purpuric papules and/or plaques (some with a greater tendency towards necrosis and ulceration), which can be localized in any body area, but is most often seen in the upper and lower extremities. Localization in the breast commonly presents with severe intractable breast pain and characteristic reticular violaceous erythematous plaques with central ulcerations. Histological examination is fundamental for the diagnosis and is characterized by varied patterns of lobular or diffuse hyperplasia of endothelial cells at the extravascular level. The condition is associated with various underlying conditions, many of which result in local tissue ischemia. In this report, we present a patient with DDA with an underlying mass lesion of the breast, which proved to be an adjacent fat necrosis. Various treatments have proven beneficial, including revascularization, oral corticosteroids, smoking cessation, and isotretinoin. In this case, our patient benefited from secondary excision of the affected area.

[Cutaneous adverse drug reaction: prospective study of 118 cases]. / Profil des toxidermies médicamenteuses: étude prospective de 118 cas.

BACKGROUND: Few prospective studies are available on the incidence and analysis of the characteristics of adverse cutaneous drug reactions. AIM: To describe the adverse cutaneous reactions, their epidemiologic characteristics as well as the different causative drugs through a prospective hospital study. METHODS: A 12-month prospective study was managed in our department of dermatology of the teaching hospital Hedi Chaker of Sfax. Requested information included patient characteristics (associated disorders), drug intake (list and chronology of the drug intake during the 3 weeks preceding the adverse reaction) and characteristics of the skin reaction (type, course). The diagnosis was based on a beam of clinical and anamnestic arguments. The drug imputability was evaluated according to the Begaud's French method. RESULTS: One hundred eighteen cases were collected. A prevalence of 1.08/100 among patients consulting in dermatology department was estimated. The macular and papular exanthema represented the most frequent clinical aspects (42 cases) followed by acute urticaria (23 cases), photosensitivity (19 cases) and fixed drug eruption (15 cases). Principal imputable drugs were antibiotics, mainly penicillins followed by analgesics and non-steroidal anti-inflammatory. CONCLUSION: Although it was monocentric, this study revealed a high frequency of drug-induced dermatitis with different clinical presentation. The high incidence of drug-induced dermatitis induced by antibiotics, analgesics and anti-inflammatory is due to their widespread use, often in self-medication.

An unusual pigmented skin lesion on the nipple-areola area.

Considering the rarity and underdiagnoses of this disorder, a pigmented and hyperkeratotic skin lesion located on the trunk, resembling to acanthosis nigricans should always be investigated for terra firma-forme dermatosis (TFFD) and thus alcohol must be applied. TFFD should be known among dermatologists and can be easily diagnosed and treated with isopropyl alcohol.

Unusual malar rash with ulceration: What can we expect?

Considering the clinical polymorphism of the disease, longstanding skin lesions located on the face, resembling erysipelas in an endemic area should always be investigated for CL and thus, atypical presentations should be kept in mind.

Lichenoid lesions around the anus: An unusual site of Hailey-Hailey disease.

The anal region is an unusual site of Hailey-Hailey disease. It manifests with lichenoid lesions with crusted erosions around the anus. It should be differentiated from condylomata acuminata, extramammary Paget disease, and bowenoid papulosis.

A rare case of melanoma erysipeloides.

Malignant melanoma presenting as an inflammatory skin metastasis has been described but is an exceedingly rare phenomenon. We report a case of inflammatory metastasis of cutaneous melanoma (CM).

Erysipeloid cutaneous leishmaniasis: a study of 40 cases of an unusual variant.

BACKGROUND: Erysipeloid cutaneous leishmaniasis (ECL) is known as the chronic form of cutaneous leishmaniasis (CL). However, keeping its clinical presentation in view, there is a need to revisit this form of the disease. AIMS: To describe ECL in view of clinical features and treatment modalities. METHODS: We include a case series seen in Sfax (Southern Tunisia) from January 2017 to January 2021. All patients clinically suggestive and laboratory confirmed with a diagnosis of CL were registered. Patients of all age groups and of either gender having cutaneous lesions resembling erysipela on the face were included in the study. Different demographic features of the patients and clinical aspects were identified. Descriptive statistics were used for analysis. RESULTS: Of 1300 registered patients with CL, 40 (3%) were diagnosed as ECL. Ages ranged from 15 to 65 years, and duration of lesions varied from 15 to 180 days. All patients had lesions over the face. Clinically, a painful infiltrated inflammatory placard of the central facial area with a butterfly shape was observed in 14 cases, as well as zones of the cheekbone (11 cases), cheekbone and nose (5 cases), cheekbone and eyelid (8 cases), and cheekbone with ear (2 cases). Several therapeutic methods were prescribed with a sufficient result with no recurrence. CONCLUSION: ECL is a rare presentation that typically occurs on the face, looking like erysipelas, in patients who are native from an endemic region of CL.

Hydroxychloroquine-induced acute generalized exanthematous pustulosis: a series of seven patients and review of the literature.

BACKGROUND: Hydroxychloroquine (HCQ)-induced acute generalized exanthematous pustulosis (AGEP) is poorly described in the literature. The aim of our study was to characterize the clinical, laboratory, allergological, and genetic features of HCQ-induced AGEP. METHODS: We conducted a retrospective study of patients with HCQ-induced AGEP diagnosed between 2011 and 2019. We performed molecular analysis to identify variations in the IL36RN gene. We also reviewed similar cases reported between 1991 and March 2020. RESULTS: Seven female patients were included. The mean age was 47 years old, and the average time from HCQ start to onset of symptoms was 40 days. All patients received topical steroids with a full resolution of the rash within an average of 39 days after HCQ withdrawal. Patch tests were performed for three patients with positive results in one case. Genetic analyses were performed for three patients, and no mutation in the IL36RN gene was identified. CONCLUSION: The latent period and the duration for resolution of HCQ-induced AGEP may be longer than with other drugs due to the metabolic characteristics of HCQ. Mutations in the IL36RN gene were not identified in our patients.

Effect of date seed oil on p53 expression in normal human skin.

A critical step to escape from the carcinogenic potential of UV radiation is mediated by the protein p53. P53 activates growth arrest, allowing for DNA repair, which removes damaged cells. The concept of photoprotection involves blocking apoptosis and the prevention of oxidative damage to cellular DNA. Date seed oil (DSO) extract has been reported to be beneficial in the reduction of chemically induced oxidative stress in normal human skin. In this study, we investigated the DNA-protective qualities of DSO as measured by p53 expression in human skin biopsies, one day after exposure to ultraviolet B (UVB) radiation. P53 expression was analyzed using immunohistochemistry. The results showed an increase in p53 expression in the basal cell compartment of UVB-exposed skin as compared to the non-UVB-exposed skin. However, DSO has significant photoprotective effects by inhibition of damage caused by UVB irradiation: a significantly lower fraction of cells was p53 positive as compared to the non-DSO-treated skin. We conclude that p53 expression is a sensitive parameter for the detection of UVB-induced damage in the skin and suggest that DSO could provide an efficient complement to photoprotective measures and may contribute to reduce the DNA damage.

Date seed oil inhibits hydrogen peroxide-induced oxidative stress in normal human epidermal melanocytes.

The administration of antioxidants has been shown to enhance repair and healing processes in cutaneous tissue. Date seed oil (DSO) extract, which might be a potential source of natural antioxidants such as phenols and tocopherols, has been reported to be beneficial in the reduction of chemically induced oxidative stress in normal human skin. In this study, we investigated the protective effects of DSO against hydrogen peroxide (H(2)O(2))-induced oxidative stress in terms of lipid peroxidation, depletion of such endogenous antioxidant defense enzymes as superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) using normal human epidermal melanocytes (NHEM). The results showed that DSO, endowed with a radical scavenging ability, decreased oxidative injury by inhibition of damage caused by H(2)O(2). Treatment of NHEM with DSO inhibited H(2)O(2)-induced lipid peroxidation. In addition, the extract inhibited H(2)O(2)-induced depletion of antioxidant defense components, such as SOD, CAT, and GPx. Our findings demonstrate that DSO is an efficient extract able to prevent melanocytes oxidative damage induced by H(2)O(2) exposure. Thus it may be a potential promising candidate, as a chemopreventive agent, in the development of melanocyte-related pathologies like vitiligo and melanoma.

Effects of date seed oil on normal human skin in vitro.

Oxidative stress has been implicated in various skin diseases through the generation of reactive oxygen species and the depletion of endogenous antioxidant systems. The administration of antioxidants or free radical scavengers is reportedly helpful, notably in order to enhance the healing process. We investigated the protective effect of one new natural product:"date seed oil: DSO" against hydrogen peroxide (H(2)O(2))-induced oxidative stress, in terms of lipid peroxidation, depletion of endogenous antioxidant defense enzymes such as glutathione peroxidase (GPx), superoxide dismutase (SOD) and catalase (CAT), one day after a 2 h exposure to H(2)O(2), using human skin organ culture as an in vitro model. In the investigated model system, DSO has significant protective effect, by inhibition of damage caused by H(2)O(2), endowing a radical scavenging ability. Treatment of skin with DSO inhibited H(2)O(2)-induced lipid peroxidation. In addition, this oil inhibited H(2)O(2)-induced depletion of antioxidant defense components, such as superoxide dismutase and catalase. We conclude that DSO could be useful in the attenuation of H(2)O(2)-induced oxidative stress-mediated skin diseases in human skin, possibly due to antioxidant properties.

Date seed oil limit oxidative injuries induced by hydrogen peroxide in human skin organ culture.

The skin is chronically exposed to pro-oxidant agents, leading to the generation of reactive oxygen species (ROS). To protect the skin against an over-load of oxidant species, we studied the chemoprotective effect of one new natural product: "date seed oil: DSO". This oil may serve as a potential source of natural antioxidants such as phenols and tocopherols. Here, the antioxidative potential of DSO was compared that of to extra virgin olive oil. Adult human skin was maintained in organ culture in the presence of the DSO and extra virgin olive oil before the addition of hydrogen peroxide (H2O2), in order to prevent the tissue from its oxidizing effects. Skin specimens were collected for histology and for melanin studies. In the investigated model system, DSO protects skin against oxidative injuries. It has a significant chemoprotective effect, by inhibition of damage caused by H_{2}O_{2} compared with specimens without such addition endowing with a radical scavenging ability. The various components from DSO were much more potent antioxidant and more free radical scavengers of the H2O2 than those of olive oil. Our study shows that topical DSO treatment of the skin stimulates events in the epidermis leading to repair skin damage possibly due to antioxidant synergisms.

Acquired lymphangioma circumscriptum of the vulva.

Lymphangiomas are rare benign proliferations of the lymphatic system. Acquired lymphangioma circumscriptum of the vulva is induced by impaired lymph flow. We describe a new case of lymphangioma circumscriptum resulting from tuberculosis involving a lymph node. A 45-year-old female presented with swelling of the vulva for the past 8 years. She had a history of multiple left inguinal swellings successfully treated with four antituberculosis drugs. Her vulval swelling did not respond and was diagnosed as acquired lymphangioma circumscriptum. She becomes the fifth reported case of acquired lymphangioma circumscriptum of the vulva with tubercular lymphadenitis. The single antituberculosis treatment is insufficient to control lymphangioma. Ablative methods seem encouraging.

[Sweet syndrome: retrospective study of 54 cases]. / Syndrome de Sweet: étude rétrospective de 54 cas.

INTRODUCTION: Sweet syndrome is the most common neutrophilic dermatosis. We studied its natural history and epidemiologic, clinical, and therapeutic characteristics from a series of 54 cases. MATERIALS AND METHODS: This retrospective study examines 54 cases collected over a 10-year-period. Diagnosis was based on clinical and histological criteria. RESULTS: Patients' mean age was 47 years. The sex ratio was 8 women for every man. Disease developed most often in autumn and onset was sudden in all patients. Untypical aspects were found in 20 patients. Lesions were located mainly on the arms (43 cases) and legs (33 cases). No mucous membrane involvement was observed. Histological testing found leukocytoclastic vasculitis in 8 cases. Sweet syndrome was idiopathic for 38 patients. Lesions began at the site of previous trauma for 9 patients, occurred during pregnancy for 2, and were associated with cancer for 3. First-line treatment was colchicine for 23 patients and oral steroids for 12. Six patients had recurrences and 2 patients had relapses. COMMENTARY: This large series of patients with Sweet syndrome differs from other reports by the frequency of untypical aspects and post-traumatic forms, as well as the rarity of association with cancer. Histological findings of vasculitis do not rule out a diagnosis of Sweet syndrome.

[Clinical and histological study of lupoid cutaneous leishmaniasis (16 cases)]. / Etude anatomoclinique de la forme lupoïde de la leishmaniose cutanée (16 cas).

INTRODUCTION: Zoonotic cutaneous leishmaniasis (CL) is characterised by a major clinical polymorphism, especially the lupoid type. The aim of our study was to precise the anatomic and clinical particularities of this clinical form of CL. MATERIALS AND METHODS: The present work was a prospective 1-year study. In all patients, the epidemiologic and clinical characteristics were identified, together with those regarding disease progression. Standard cutaneous biopsies were carried out for all study patients. RESULTS: The lupoid form was observed in 15% of the patients. It was clinically characterised by a lupoid aspect with papular and squamous placard surrounded by a satellite papule, a short duration of disease progression (28 months in average) and a preferential localisation at the level of the face and the elbow, statistically proven. At the histological level, epidermic hyperplasia was found in 93.8% of the cases; an inflammatory polymorphic dermic infiltrate consisting of lymphocytes and plasmocytes was found in all patients; granulomas were noted in 50% of the cases, and isolated epitheloid cells were observed in the derm of 3 patients. Amastigotes were rarely observed. DISCUSSION: In our series, the lupoid form was characterised with a short and non chronic evolution and two preferential sites for the affection: the face and the elbow. At the histological level, the lupoid type of CL appeared characterized by a high frequency of granuloma, usually organized, and rare amastigotes. However, the histology of authentic lupoid forms can be non granolomatosic.

[Epidemio-clinical profile of skin cancer in southern Tunisia]. / Profil epidemio-clinique des cancers cutanes dans le sud Tunisien.

BACKGROUND: Skin cancer (SK) frequency is increasing all over the world. AIM: We report a clinical and epidemiological study of SK in the south of Tunisia through a 1476 cases series. METHOD: On the basis of a retrospective study, we report the clinical and epidemiological data collected from files of patients with skin cancers seen during a 24-year-period (1979-2002). RESULTS: Our series was composed of 1476 patients, with an incidence of 615 cases/year. The mean age was 55 years. Epithelial skin carcinomas were the most common (1288 cases, 87.3%). Basal cell carcinomas were found in 890 patients (69%) and squamous cell carcinomas in 398 (31%). The mean age was 60 years. The phototype III was the most common (52.8%) among these patients. Skin melanomas were found in 71 cases (4.8%). The mean age was 54 years with a female predominance (60.6 %). Kaposi sarcoma was found in 4.5% of patients. The mean age was 64.3% and a male predominance was found (80% of cases). Two patients with Kaposi sarcoma (33%) were HIV positive. Dermatofibrosarcoma protuberans was reported in 2% of patients and skin lymphoma in 1.7%. CONCLUSION: The mean age is relatively low in our series. The increase in the incidence of skin cancers is probably related to the climatic conditions, the ageing of the population and to the changes in the social, economic and cultural aspects in the country. The male predominance is changing toward an equal distribution between both sexes probably in relation to the present similarity in the life style and work conditions.