[Polymorphic lucite: about a case]. / La lucite polymorphe: à propos d'un cas.

Polymorphic lucite (PL) is a frequent photodermatosis, but its pathophysiologic mechanism is still poorly elucidated. We report the case of a 54-year old male teacher, with no previous medical-surgical history, presenting with recurrent papular and very pruritic rash lasting for 12 years. Clinical examination showed papular-vesicular excoriated lesions on the face, the neck and the scalp. Eczematiform lesions occurred on the back of the hands. The remainder of the integument as well as the mucous membranes were spared. The suspected diagnoses were lupus, drug-induced photosensitization or contact photosensitivity and polymorphic lucite (PL). During the interview, the patient reported that this eruption had recurred in the same period every year, namely at the beginning of spring and lasted until the end of summer. Photobiological evaluations were not performed. Antinuclear antibody test was negative, and histological examination was non-specific showing dermal dense lymphocytic infiltrate. The diagnosis of LP was suspected and the patient underwent synthetic antimalarial drug-based therapy associated with external photoprotection.

[Sebaceous hamartoma on the face: about a case]. / Hamartome sébacé de la face: à propos d'un cas.

Sebaceous naevus (sebaceous hamartoma) is a congenital lesion mainly localized to the scalp, whose clinical and histologic diagnosis is generally easy. In the vast majority of cases, it is diagnosed at birth, but it can sometimes go unnoticed and give the impression to occur later. This lesion may be complicated by benign tumors or more rare malignancies. We report the case of a 45-year old patient, who had been followed-up for Biermer's anemia (treated with monthly HYDROXOCOBALAMINE injection) and ophiasic alopecia for 15 years, presenting with a 10-year history of bilateral and symmetric pigmented plaques gradually increasing in size. Clinical examination showed temporal and subauricular plaques, with brownish verrucous appearance and smooth surface (A, B). Histological examination objectified acanthosis, papillomatosis and voluminous sebaceous glands located abnormally high within the dermis, suggesting sebaceous hamartoma. CO2 laser treatment was proposed to the patient.

[Acquired facial angiokeratoma]. / Angiokératome acquis de la face.

Angiokeratomas are vascular dilations (telangiectasic papules) with keratotic surface caused by capillary dilation in the dermal papilla due to venous hyperpression, vascular malformation or a capillary fragility. They most commonly are benign and just unsightly and they may sometimes reveal a dreaded overload disease known as Fabry Disease. Here we report the case of a 56-year old patient, with no notable medical history, presenting with nontraumatic, nonpruritic, bleeding on contact, grouped cluster erythematous papules without extracutaneous manifestations on the left malar region, that had occurred 4 months before. Diascopy revealed partially emptied papules with keratotic surface. Kaposi syndrome, melanoma, carcinoma or angiokeratoma were suspected. Histological examination revealed angiokeratoma. Treatment based on electrocoagulation was proposed to the patient.

[Tuberous sclerosis complex: the role of patient's history and clinical examination]. / Sclérose tubéreuse de Bourneville: importance de l'anamnèse et de la clinique.

Tuberous sclerosis complex (TSC) is a neurocutaneous multisystemic syndrome most commonly affecting the skin, the brain, the kidneys, the lungs and the eyes. The diagnosis is based on clinical characteristics; 90% of patients have skin lesions and seizures are the initial symptom in 80% of patients. Patients with STB often show a high incidence of neuropsychiatric symptoms, including mental retardation, autism and learning difficulties. Epilepsy and brain and renal tumors are treated with aggressive therapeutic and surgical approaches. We report the case of a 13-year old girl, presenting with a 1-year history of acne resistant to therapy. Clinical examination showed symmetric grouped red papules with smooth surface on the central face and the chin (A). The objective clinical examination also showed frontal fibrous plaques (A), achromic macules on the upper limbs and grayish tumors in the periungual folds of the toes (B). During a new interview, patient's mother reported that these lesions had their onset when the patient was 5 years old, manifesting as seizures at the age of 2 years and disappearing at the age of 6 years, with good psychomotor development. The girl had a history of consanguinity but she had no other family history. Based on these major criteria, the diagnosis of Tuberous sclerosis complex was made. The patient underwent MRI of the brain showing intensely enhanced multiple bilateral subependymal and intraventricular nodules as well as signal abnormalities in the subcortical white matter at the level of the frontal, parietal and temporal area and linear abnormalities in the subcortical white matter. Thoracoabdominopelvic CT scan showed liver and renal lesions suggesting angiomyolipomas. Ophthalmologic examination, electrocardiogram and cardiac ultrasound were normal. Vascular laser treatment of angiofibromas, annual clinical monitoring and paraclinical monitoring every 3 years were proposed to the patient.

[Terebrant basal cell carcinoma]. / Carcinome basocellulaire térébrant.

Basal cell carcinoma (BCC) is the most frequent skin cancer. It never affects the mucosa. It is characterized by a local malignancy with an extremely rare risk of developing distant metastasis and the lowest mortality. However in the absence of diagnosis and early surgery, BCC can be locally invasive and result in severe tissue destruction. It can ulcerate and its growth can be extensive and destructive: terebrant tumors affecting the structures of the muscles and the bone. We here report the case of a 80-year old woman living in an isolated rural areas, presenting with ulcerated exudative and smelly burgeoning lesion in the pretragal and the parotid regions. Locoregional examination was unremarkable and histology showed infiltrative BCC. Staging evaluation objectified no bone invasion. The patient was referred to the Division of Plastic Surgery for carcinologic treatment.