Bullous fixed drug eruption: A potential diagnostic pitfall: a study of 18 cases.

BACKGROUND: Bullous fixed drug eruption (BFDE) is a rare and particular adverse drug reaction characterized by localized or generalized blisters and erosions, which can be confused with Stevens-Johnson syndrome, toxic epidermal necrolysis, major erythema multiforme and autoimmune bullous dermatosis. OBJECTIVE: The aim of our study was to assess the epidemiological, clinical and therapeutic features and outcome of BFDE. METHODS: A retrospective and descriptive study collecting all observations of BFDE was conducted in the dermatology department of Habib Thameur Hospital in Tunisia, over an 18-year period (2000-2017). The diagnosis of BFDE was confirmed by histopathological examination and all the patients underwent pharmacovigilance investigation. RESULTS: Totally, 18 cases were enrolled in our study with BFDE. The mean age was 57.9 years with a sex ratio M/F of 1. BFDE was localized in 8 cases and generalized in 10 cases. It was the first episode of BFDE in 11 patients and a recurrence in 7 patients. Drugs involved in the genesis of BFDE in our study were mainly non-steroidal anti-inflammatory drugs in 10 patients and antibiotics in 5 cases. Drug patch tests were performed in four patients on the residual plaques of FDE (fixed drug eruption) and were positive to the suspected drug. A favorable outcome was observed in all our patients under treatment and after suspected drug withdrawal. CONCLUSION: BFDE is a rare adverse drug reaction and could be severe especially when it presents as a generalized eruption. Drugs involved are mainly non-steroidal anti-inflammatory drugs followed by antibiotics.

[Pruritus in the elderly: an epidemic-clinical study (about 208 cases)]. / Prurit chez le sujet âgé: etude de 208 cas.

BACKGROUND: Pruritus is an unpleasant cutaneous feeling causing the desire to scratch. Few epidemiologic studies were interested in this symptom which relates to the old subject particularly. AIM: To study the epidemiological and clinical features as well as the treatment of pruritus in this age bracket. METHODS: A retrospective study over 10 years and 5 months at the dermatology department of Habib Thameur hospital concerned 208 patients, 65 years old and more presenting a pruritus without specific dermatological lesion. RESULTS: The frequency of pruritus in the old subject was 5.14 per 1000 new consultants. Pruritus had revealed an ignored affection in 36.36% of the cases: an iron deficiency in 10 cases, a type 2 diabetes in 6 cases, a hypereosinophilia over 1000 elements/mm3 in 4 cases, a chronic renal failure in 2 cases, a hepatic cytolysis in 2 cases, a cholestasis in one case, a polycythemia vera in one case and hepatitis B one a case. Skin lubricants and antihistamines associated to topical corticosteroids in 25 cases and UVB therapy in a case were prescribed. These treatments brought an attenuation of pruritus in 62% of the cases. CONCLUSION: Iron deficiency anemia was the principal cause of pruritus in our series, followed by the type 2 diabetes. Our results contrast with the data of the literature considering that the traditional prevalence of the hepatic cholestasis was not noted and that diabetes is not regarded as inductive factor of pruritus.

[Acanthosis nigricans: epidemiologic study of 69 cases]. / Acanthosis nigricans: étude épidémiologique de 69 cas.

BACKGROUND: Acanthosis nigricans is a well-defined skin disorder with a distinctive appearance and an elective topography to the flexural areas that facilitate its diagnosis. In Tunisia, apart from isolated reports of malignant AN, few epidemiologic data are available. AIM: In order to describe the characteristics of this affection, we conducted a retrospective study in the area of Tunis over a 12-year period. METHODS: Retrospective study of all the cases of AN seen in the dermatology department of Habib Thameur teaching hospital between 1991 and 2003, including the cases coming from the north and of the centre of Tunisia. RESULTS: Sixty-nine cases were recorded with a sex-ratio H/F of 0.17. The average age was 24.1 years (extremes of 3 and 66 years) and 57.9% of the patients were aged between 9 and 22 years. The neck (98.6%) and the axillae (75.4%) represented the most common localizations. All the patients presented a benign AN, comprising 51 cases of pseudo-AN, 11 cases of AN associated with endocrine diseases, 5 cases of familial AN and 2 cases of AN associated with an auto-immune disease. Local treatments associated an hypocaloric diet (AN with obesity) were recommended with a light improvement after 3 months an average follow-up. CONCLUSION: The frequency of the AN is probably underestimated because of the usually asymptomatic character of this affection. AN constitutes a double cutaneous marker, being able to reveal either an hyperinsulinemia constituting a cardiovascular risk factor or an ignored subjacent neoplasm engaging the vital prognosis.

[Study of the cutaneous drugs reactions in a teaching hospital in Tunis]. / Etude des réactions cutanées aux médicaments dans un centre hospitalo-universitaire à Tunis.

BACKGROUND: Cutaneous adverse drug reactions correspond to adverse effects with cutaneous expression resulting from the systemic penetration of a drug in the body. The aim of this study is to evaluate the various clinical pictures of RCM, their epidemiologic characteristics as well as the different causative drugs, through a retrospective hospital series. METHODS: It is about a retrospective study about all the patients consulting and/or hospitalized for suspicion of an adverse cutaneous drug reaction led to the service of dermatology of the teaching hospital Habib Thameur of Tunis over a 3-year period (from January 2002 to December 2004). The diagnosis was based on a beam of clinical and anamnestic arguments. Only the patients having a positive pharmacovigilance investigation were retained. RESULTS: 28 patients were retained for this study. The macular and papular exanthema represented the most frequent clinical aspects followed by acute urticaria and fixed drug eruption. The antibiotics represented the most causative drugs followed by analgesics and non steroidal anti-inflammatory. CONCLUSION: We record a lower frequency of cutaneous adverse drug reactions in comparison with the literature. We also find a high frequency of severe forms and stress on the difficulties encountered in the identification of the causativele drugs. Though, a close cooperation between the various hospital structures and pharmacovigilance centers is mandatory.

[Squamous cell carcinoma and discoid lupus erythematosus. Report of 2 cases]. / Lupus discoïde et carcinome épidermoïde. A propos de deux cas.

Some cases of skin cancer developping from chronic discoid lupus erythematosus were publied among the world. We make know our experience about two cases suffering with a chronic discoid lupus erythematosus from 16 and 11 years and developped a squamous cell carcinoma from the elbow and the lower lip.