[Generalized pustular psoriasis activated by Klebsiella pneumoniae septicaemia]

Generalized pustular psoriasis is a severe form of psoriasis. The pustular dermatosis complicates a known psoriasis frequently after a medicinal taking or infection. It exceptionally inaugurates the psoriatic disease. We report a case of generalized pustular psoriasis triggered by Klebsiella pneumoniae septicaemia and discuss the characteristics of this association. A 43-year-old man, was hospitalized for a profuse pustular eruption evolving for one week with altered general state, fever and liquid diarrhea. The patient ate a tuna sandwich 48 hours prior to the onset of symptoms. The biology showed a hyperleucocytosis, elevated C Reactive Protein and hepatic cytolysis. The skin histology demonstrated a pustular psoriasis. Three blood samples, a coproculture and a catheter culture showed Klebsiella pneumoniae. The patient was treated with antibiotics. The pustular psoriasis was treated by acitretin. The evolution was gradually favourable. Generalized pustular psoriasis is a rare and severe affection. Its prognosis is mainly conditioned by infectious complications

[Psoriasis indicative of HIV infection progress to aids]

Psoriasis is a chronic inflammatory dermatosis which can appear before HIV infection in a patient with personal or family histories of psoriasis or which can be triggered by the HIV infection in a previously unaffected subject. The psoriasis with HIV is often more severe and refractory to classic psoriasis treatments. We report a case of psoriasis that revealed an HIV infection at the AIDS stage, and shall discuss the clinical and therapeutic characteristics of this association. A 40-year-old female has presented with a non pruriginous erythemato-squamous face and scalp eruption with palomplantar keratoderma and onychodystrophy of all toe nails evolving for one ear. On physical examination, an oral candidosis and chronic diarrhea were also noted. The diagnosis of common psoriasis was evoked and the investigations had revealed a lymphopenia at 610/mm[3]. The HIV serology was positive with CD4 at 31/mm[3] and viral load at 31,000 copies/ ml. A chest radiography had shown an apical left opacity due to pulmonary tuberculosis. In few days, the psoriasis extended to the whole integument. The patient was treated by antiretroviral therapy, antituberculosis drugs and local corticosteroids and ointments for her psoriasis. The evolution was quickly favourable. The recent psoriasis developed in an unaffected subject or the exacerbation of a former psoriasis can be associated with immune-suppression. HIV serology is required in such cases

[Familial psoriasis: descriptive report of 9 families]

Psoriasis is a chronic inflammatory skin disease. The familial nature of psoriasis has long been recognized. Our study was to describe the epidemiological, clinical and genetic features of familial psoriasis. Through a prospective study we investigated during a study period of 1 year [2006-2007] 9 Tunisian unrelated multiplex families. Patients with psoriasis and their available family members were examined by the same dermatologist. Thirty nine individual presented psoriasis [25 men and 4 women], with a mean age at onset about 19.8 years. With the systematic exam of member's family we discover 11 cases of unknown psoriasis. The common form of psoriasis was the preponderant one [37 cases]. The nails, the scalp, the mucous membranes were involved respectively in 21, 12 and 13 cases. The psoriasis was severe in 11 cases. Through this study we find similar epidemiological and clinical features of those reported previously. The intra and inter-familial variability was evident in our patients

[Staphylococcus aureus skin infections: a hospital study]

Staphylococcus skin infections [SSI] are common. The emergence methicillin-resistant Staphylococcus aureus [MRSM is a growing concern. our study was to describe the epidemiological, clinical and bacteriological features of SSI in a hospital department. This was a prospective study performed in the Dermatology and Bacteriology department of the La Rabta Hospital during a period of three months [February-April 2008, Were included all cases presenting with a primary SSI. For each patient wee collected epidemiological, clinical, bacteriological and therapeutic features. Twenty-five patients were included in the study concerning 15 men and 10 women, with a mean age of 47 years. Clinical exam revealed a unique lesion in 52%of cases. The abscess was the predominant clinical form [40%]. The bacteriological study isolated a Staphylococcus aureus in the lesion in 40%of cases and in the other sites of staphylococcus portage in 24%of cases. 32%of patients had MRSA. Dermatologists are increasingly faced with cutaneous infections caused by MRSA. Bacterial samples should be taken routinely and probabilistic antibiotic therapy for MRSA instituted in severe infections

[ epidemio clinical of lichen sclerosus about 31 cases]

Lichen sclerosus is a chronic inflammatory mucocutaneous disease. Through a retrospective study of all patients with Lichen sclerosus followed between 1997 and 2005 at the dermatology department of La Rabta hospital, we outline the epidemio-clinical aspects of this entity. There were 29 female and two male. Two patients were child. The mean age at the occurrence of adult lichen sclerosus was 51, 5 years. The site of the lesions was perineum and genital in 26 cases [one male and 25 female]. Extragenital involvement was present in 10 patients. All patients underwent topical corticosteroid therapy. Architectural changes of vulva were noted in 7 cases. An epidermoid carcinoma occurred in five patients. The male Lichen sclerosus seem to be rare in our study. It is probably explained by the protective role of the circumcision which is practised in all male children in our country. In our study, the risk of malignant transformation of genital Lichen sclerosus is estimated at 19, 2%. It is lightly more than mentioned in the literature. This may be related to the cofactor role of l-IPV and to an insufficient treatment adherence

[Systemic juvenile scleroderma: about 6 cases]

Introduction: The systemic juvenile scleroderma [SJS] is a rare acquired auto-immune disease. The aim of our study was to analyse the epidemiologic, clinical, therapeutic and prognostic features

Patients and Methods: through a retrospective study, 6 patients were observed with SJS. We adopted the Barnett's classification. Results: The six patients were females, with a mean age of began on 9 +/- 3 years. Five patients were classified type II of Barnett and for 1 patient the classification was difficult. Raynaud's phenomen was observed in 4 cases. The cutaneous sclerosis was noted in the all cases. Five children presented oesophageal damage. Lung involvement was noted in 3 cases. No cardiac dysfunction was found at the clinical exam. Mild renal involvement was noted in 1 case. SJS was associated to systemic lupus in 2 cases and to dermatomyositis in 1 case

Discussion: Systemic juvenile scleroderma is rare. The cardiac involvement is a major concern in children; it appears to be a more common cause of death in SJS. The therapeutic problems were similar to those in adults

[Dermatofibrosarcoma protuberans about 18 cases]

Dermatofibrosarcoma protuberans [DFSP] is a rare mesenchyma skin tumor. It is characterized by a slow growth with a high rate of recurrence but limited potential for metastasis. We report the result of a retrospective study of 18 cases of DFSP collected over 16 years in the dermatology department of La Rabta Hospital. The mean age was 32 years with a sex ratio of 1.57. The site of predilection was the trunk [77.5%]. Histological features were typical in all cases with positivity for CD34 in 14 cases. Treatment was surgical in 13 cases. DFSP is a tumor of intermediate malignancy, which can have aggressive course. This tumor is best treated with surgery in which large excision are necessary to reduce the risk of recurrence