Penile shaft involvement in pityriasis versicolor.

The Malassezia yeasts are among the normal human cutaneous flora in adults. They are also reported as part of the microflora of male genital region, mostly in uncircumcised males. The prevalence of Malassezia yeast colonization on the glans penis of circumcised males is discussed in multiple studies. We report the case of a male patient with extensive pityriasis versicolor that does not involve the preputial space.

[Porokeratosis. A study about 6 cases]. / Porokeratoses: etude de 6 cas.

BACKGROUND: Porokeratoses (PK) represent a less common group of dermatoses that are acquired or hereditary, of unknown pathogenesis, characterized by 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). AIM: In this retrospective study, we analysed the observations of PK collected in the Dermatology Department of La Rabta Hospital over a 16-year period. METHODS: Six cases of PK were collected: 4 females and 2 males, with no medical history with a mean-age of 42.7. RESULTS: 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.

Erysipelas of the left upper limb occurring after elbow dislocation.

BACKGROUND: Erysipelas is an acute infection occurring chiefly in the lower limbs, rarely in the upper limbs. OBSERVATION: A 45-year-old patient suffering from Charcot-Marie-Tooth disease with neuropathy of the limbs, presented with fever and a 24-hour history of a well-circumscribed inflammatory and infiltrated plaque of the left arm. Erysipelas was diagnosed and intravenous penicillin was administered leading to regression of the inflammatory signs, however edema persisted in the inner part of the left elbow. An x-ray showed left elbow dislocation. The patient revealed trauma of the left upper limb 5 weeks before. DISCUSSION: The occurrence of erysipelas is usually associated with lymphatic edema or venous incontinence. Lymphatic lesions due to radiotherapy or surgery may afflict draining vessels leading to venous and lymphatic stasis and then infection occurs. We find no reported cases of erysipelas following elbow dislocation but we postulate its pathogenesis to be similar.

[Cryosurgery for nose basal cell carcinoma. Series of 17 tumors]. / Place de la cryochirurgie dans le traitement des carcinomes basocellulaires du nez. A propos d'une série de 17 tumeurs.

UNLABELLED: Basal cell carcinoma (BCC) is the most common malignant tumour of the skin frequently located on the head and chiefly on the nose. Cryosurgery is one of the methods to treat BCC. OBJECT: To determine the efficacy of cryosurgery of 17 BCC of the nose in terms of recurrence rates and cosmetic results. RESULTS: 15 patients were included with a median age of 73 years and a photo type III or IV in 86% of cases. Mean size of tumours was 12 mm. Lesions were chiefly located on the alae nasi (70.5%). Complications were few and minor. After an average follow-up of 13.5 months, recurrence rate was about 5.8% (one case). Cosmetic results were good or excellent in 14 cases/17; only one patient had developed a notch of the nose. CONCLUSION: Cryosurgery is a rapid, of a low cost technique and chiefly with good oncological and cosmetic results.

[Pseudoxanthoma elasticum: a report of 11 cases]. / Pseudoxanthome elastique: a propos de 11 observations.

INTRODUCTION: Pseudoxanthoma elasticum (PXE) is an inherited disorder of elastic tissue with many systemic manifestations PATIENTS AND METHODS: We performed a retrospective study from all the patients diagnosed with PXE at the department of dermatology of La Rabta hospital of Tunis, between 1986 and 2003. RESULTS: During the observation period, we identified 11 patients with PXE, 5 males and 6 females with a mean age of 28 years (10-47 years). Family history was found in 5 patients. Exhibit yellowish, pigskin, and popular lesions on the sides of the neck were observed in all cases. Systematic ophthalmologic examination revealed angioïd streaks in 4 patients. No abnormalities were found in cardiovascular and metabolic explorations. DISCUSSION: Diagnosis of PXE is based on clinical, histological and genetic criteria. Ocular and cardiovascular damage make all the gravity of the disease, from where interest of an ophthalmologic and cardiovascular examination systematic.

[Eccrine poroma of the scalp: A study of three cases]. / Porome eccrine du cuir chevelu. A propos de trois observations.

The eccrine poroma is a rare benign sudoral tumour, which creates a fleshy formation. The diagnosis is made according to the anatomopathological study. The usual site is the sol, but in rare cases, other sites have also been reported. The authors report three cases of eccrine poroma localised in the scalp with literature review.

[Nasosinusal sarcoidosis: 2 cases. A report of 2 cases]. / Sarcoidose naso-sinusienne. A propos de deux cas.

INTRODUCTION: Nasosinusal sarcoidosis is a rare non caseating granulomatous disease. It may be inaugural, isolated or associated with multisystemic sarcoidosis. MATERIAL AND METHODS: [corrected] We report two cases of nasosinusal sarcoidosis associated to multisystemic sarcoidosis. Both patients were females aged over 43 years. In one case, the primary symptom was a nasal obstruction. Tomodensitometric and guided biopsy findings provided the main diagnostic criteria. Anti-malaric treatment was prescibed in both cases. Stabilisation of the lesions was noted. DISCUSSION: we tried to reveal through this study the diagnostic an therapeutic difficulties of nasosinusal sarcoidosis.

Discoid lupus erythematosus in an infant.

Discoid lupus erythematosus (DLE) is rare in childhood. We report the case of a 15-month-old female infant who presented with erythematous telangectatic lesions and photosensitivity involving the sun-exposed areas. Histological examination confirmed the diagnosis of DLE. Direct immunofluorescence (DIF) on lesional skin showed granular IgM deposits along basement membrane zone. Laboratory tests were normal. External photo-protection and topical corticosteroids lead to complete healing. Summer recurrences that responded to topical corticosteroids were noted but there was no progression to systemic lupus erythematosus. Several authors note the absence of female predominance in children with DLE; prevalence of photosensitivity is controversial. Histological confirmation of DLE is easy and important for diagnosis. DIF is not specific but can be helpful in establishing the diagnosis of DLE. Laboratory tests rarely show low titers of antinuclear antibodies. Treatment is based on sun avoidance and photoprotection. Topical corticosteroids are indicated for active lesions. For resistant cases antimalarials are the treatment of choice. Progression to SLE is probably more frequent in children than in adults.

[Erythema elevatum diutinum. A clinicopathologic study of 5 cases]. / Erythema elevatum diutinum: etude anatomo-clinique de 5 cas.

Erythema elevatum diutinum is a rare condition of unknown etiology listed with cutaneous vasculitis or neutrophilic diseases. Medical records and histopathologic slides of 5 patients with erythema elevatum diutinum were studied to better understand the disease. Lesions were clinically characteristic. All biopsy specimens showed leucocytoclastic vasculitis. The most significant finding is the association of erythema elevatum diutinum whith seronegative rheumatoid arthritis.

[Granuloma annulare: apropos of 18 cases]. / Le granulome annulaire: à propos de 18 observations.

Granuloma annulare is a benign skin disorder which cause is unknown. The aim of this work is to report the results of a retrospective study dealing with 18 cases of granuloma annulare carried in the dermatology department of la Rabta hospital over a nine year period. We describe 3 clinical forms: localized granuloma annulare: 9 cases, generalized granuloma anulare: 7 cases and deep granuloma annulare: 2 cases. Diabetes mellitus was associated to granuloma annulare in 6 patients, from which 3 presented with multiple lesions. Corticosteroids were used topically in 11 cases. The outcome was marked by a partial resolution in 15 cases. In our study. We didn't found any malignancy with our granuloma annulare patients.

Dystrophic epidermolysis bullosa phenotypes in a large consanguineous Tunisian family.

BACKGROUND: Dystrophic epidermolysis bullosa (DEB) is a clinically heterogeneous blistering disorder of the skin and mucous membranes. DEB is caused by mutations in the COL7A1 gene encoding type VII collagen, the major component of anchoring fibrils. On the basis of the mode of inheritance and the clinical manifestations, DEB is classified into two major subtypes: one dominant (DDEB) and one recessive (RDEB). OBJECTIVE: We report, here, clinical, histological and genetic investigation of a large Tunisian family presenting with a wide range of clinical manifestations of DEB and a pedigree suggestive for a pseudodominant pattern of inheritance of a recessive mutation. METHODS: Indirect immunofluorescence (IF) with the antibody LH7:2 against collagen VII and electron microscopy (EM) analyses were performed. The members of the family were genotyped with five markers flanking COL7A1, and screening for the deleterious mutation by DHPLC and direct sequencing. RESULTS: The family presented four pretibial DEB patients and one generalized RDEB. Molecular investigation showed that all family members, unaffected and affected by the pretibial form, were heterozygous for the c.7178delT mutation, except for the member with the generalized form who was homozygous. IF showed that heterozygous individuals, independently of their clinical status, have a slightly reduced staining, and the homozygous individual with generalized DEB has markedly reduced staining at the dermal-epidermal junction. CONCLUSION: These results are suggestive for an autosomal semidominant model of inheritance with incomplete penetrance and variable expression for the identified mutation. No genotype phenotype correlation was observed suggesting the existence of other genetic determinants influencing dermo-epidermal junction cohesion.

Haplotypic classification of dystrophic epidermolysis bullosa in Tunisian consanguineous families: implication for diagnosis.

Dystrophic epidermolysis bullosa (DEB) is a rare genodermatosis caused by mutations in the type VII collagen gene COL7A1. Clinical diagnosis of DEB should be confirmed by histopathological and electron microscopy analysis, which is not always accessible. We report here a genetic investigation of DEB consanguineous families in Tunisia. A total of 23 EB families were genotyped with 5 microsatellite markers overlapping the COL7A1 gene. Among these families, 19 presented with the dystrophic form of EB, 9 were diagnosed by histopathological examination, 2 had the simplex form, 1 had a junctional EB, and 1 was affected by an unclassified form of EB. The informativeness of the markers was studied and allowed us to select three markers for genetic testing of DEB in Tunisian families at risk. Haplotype analysis and homozygosity by descent suggest that all families classified clinically as having DEB and the patient who presented with an unclassified form of EB are likely linked to the COL7A1 gene, and showed evidence for exclusion for the simplex and junctional cases. For COL7A1 linked families, two main haplotypes were shared by eight families. For all the other cases, haplotypic heterogeneity was observed, thus suggesting a mutational heterogeneity among Tunisian DEB families. The genetic results matched with the ultrastructural analysis in all the DEB families and with the clinical examination in 94.7% of all studied DEB families. This study is to our knowledge the first genetic investigation of DEB in the Maghrebian population. We propose a selection of informative markers and show the importance of haplotype analysis as a relatively easy and cost and time effective method for carrier screening and prenatal diagnosis of DEB in consanguineous families at risk.

Childhood discoid lupus erythematosus: a Tunisian retrospective study of 16 cases.

Discoid lupus erythematosus (DLE) is uncommon in children. The clinical features of childhood DLE are similar to those of adult DLE in presentation and chronic course. However, children have a particularly high level of transition to systemic disease. We undertook a retrospective study of 16 children with DLE ranging in age from 2 to 15 years, seen over a 9-year period. Six were less than 10 years old at the onset of the disease. The sex ratio was equal. The frequency of childhood DLE was about 7% of the total number of DLE patients seen in our department. Photosensitivity was defined as a clinical history of induction or exacerbation of discoid lesions following sun exposure, and was present in 81% of patients. There was no progression to systemic lupus erythematosus (SLE); an average follow-up time was 10.5 months (2-30 months). We would like to emphasize the increased frequency of childhood DLE in our country and the importance of photosensitivity. However, follow-up data regarding transition to SLE is lacking, therefore we are unable to offer a prognosis to our patients.