Inflammatory Tinea Capitis Mimicking Dissecting Cellulitis in a Healthy Woman.

Introduction: Inflammatory tinea capitis (TC) is uncommon in adults. Case Presentation: A 29-year-old healthy woman presented with a 2-year history of scalp alopecia with purulent discharge. Clinical, trichoscopic, and histological features and the negativity of a first fungal sampling were consistent with the diagnosis of dissecting cellulitis of the scalp. A second mycological examination guided by trichoscopy was carried out, showing tinea endothrix. Fungal culture isolated trichophyton violaceum. The patient was treated with terbinafine with complete healing. Conclusion: The diagnosis of adult TC is challenging, mainly the inflammatory form. An exhaustive trichoscopic examination of all alopecic plaques may help make a rapid diagnosis and provide a guide to the mycological examination.

Assessing the validity and interpretability of the Simplified Psoriasis Index in Tunisian patients.

INTRODUCTION: Multiple scores have been developed to assess the severity of psoriasis, but these scores have many limitations. The Simplified Psoriasis Index (SPI) is a summary score with separate components for current severity (SPI-s), psychosocial impact (SPI-p), and past history and interventions (SPI-i). It is available in two similar versions: proSPI and saSPI. AIM: To assess the validity of the SPI by studying its correlation to the benchmark scores in Tunisian patients. METHODS: It was a prospective bicentric study including 80 patients with plaque psoriasis. RESULTS: The median PASI was 7.6 and the median DLQI was 9. The median proSPI-s was 6 and the median saSPI-s was 8. The median SPI-p was 7. The median SPI-i was 2. There was a strong correlation between the proSPI-s and PASI (r=0.87) and between the proSPI-s and saSPI-s (r=0.82). There was a medium correlation between saSPI-s and PASI (r=0.70) and between SPI-p and DLQI (r=0.67). The threshold value for proSPI-s and saSPI-s was 7.25. The threshold value for SPI-p was 6.5. CONCLUSION: The SPI aims to provide a concise but global measure of the severity and impact of psoriasis on quality of life. The use of SPI has several advantages: the simplicity of use, the additional weight given to critical locations of psoriasis, the possibility for the patient to self-assess his own disease, and the possibility of evaluating all the dimensions of psoriasis at the same time.

[Tinea capitis: epidemiological study in Tunis from 2012 to 2020]. / Les teignes du cuir chevelu: étude épidémiologique dans la région de Tunis de 2012 à 2020.

Tinea capitis (TC) is the most common superficial mycosis seen in children before puberty. The distribution of these dermatophytes changes over time and varies from country to country. The purpose of this study was to investigate the epidemiological and mycological characteristics of TC in Tunis. We conducted a retrospective study, involving 474 patients referred for mycological analysis of the scalp between January 2012 and December 2020. For each patient, a Clinical Information Sheet was completed, and a mycological sample was taken. The identification of isolated dermatophytes was based on macroscopic and microscopic colony criteria. Molecular real-time Polymerase Chain Reaction (PCR) detection of 4 isolates was performed using the DermaGenius®2.0 kit. We collected 210 positive samples, reflecting a prevalence of 44.3% (n=210). Male patients were more frequently affected by TC (81%, n=170). The average age of patients was 6,2±3,4 years. Ring-shaped large patches were predominant (88%, n=184). Direct examination had a sensitivity of 87% (n=182). Microsporic ectothrix parasitism was detected in (79%, n=166) of cases and trichophytic endothrix in (7%, n=14) of cases. Culture was positive in (98%, n=207) of cases and five dermatophyte species were isolated: Microsporum canis (87%, n=182), Trichophyton violaceum (9%, n=19), Trichophyton mentagrophytes var mentagrophytes (3%, n=6), Microsporum gypsum (0.5%, n=1) and Trichophyton verrucosum (0.5%, n=1). This study reveals the occurrence of zoophilic dermatophytes, in particular M. canis. Mycological examination is essential to confirm the diagnosis, conduct epidemiological surveillance of dermatophytes in the districts and for therapeutic management.

Extraocular sebaceous carcinoma in a renal transplant patient: A case report.

The high risk of skin cancer after organ transplantation is a major clinical challenge. We describe a case of a patient presenting with sebaceous carcinoma (SC) after a kidney transplant. Although it is exceedingly rare, SC should always be considered in the presence of any skin lesion occurring after a transplant.

Confluent and reticulated papillomatosis of Gougerot-Carteaud in a North African patient.

Confluent and reticulated papillomatosis (CRP) is an underdiagnosed skin condition of uncertain etiology. The antibacterial and most importantly the anti-inflammatory mechanisms of some antibiotics seem to explain the effectiveness of these medications. Other measures such as reducing weight and treating an underlying endocrine disorder may be helpful.

New-onset guttate psoriasis secondary to COVID-19.

SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is associated with flares of psoriasis in patients with well-documented disease. Both viral infection and medications used for treatment, like hydroxychloroquine, were incriminated. Herein, we report the case of a 25-year-old male patient who presented a first-onset guttate psoriasis following a COVID-19 infection. We have not found previous descriptions of de novo guttate psoriasis post-COVID-19.

New onset of sinoatrial block in a young patient treated with systemic meglumine antimoniate.

The sinoatrial block is a new side effect of meglumine antimoniate. Prompt interruption of the drug results in the normalization of electrographic changes and prevents sudden cardiac arrest.

Factors associated with acute and recurrent erysipelas in a young population: a retrospective of 147 cases.

BACKGROUND: erysipelas is a common infection of the superficial layer of the skin, predominantly caused by groups A ß-hemolytic streptococci. It is an acute infection of the skin and frequently affects the legs. It is common in the elderly and favoured by the associated comorbidities. Its occurrence in young healthy people is rare. AIM: The present study aimed to elucidate factors associated with acute and recurrent erysipelas in a young population. METHODS: We retrospectively analyzed 147 cases of erysipelas admitted to the dermatology department of the Military Hospital of Tunis, Tunisia, over 18 years, identifying factors associated with recurrence. All patients were aged less than 35 years. RESULTS: During the study period, 147 patients were registered with the diagnosis of erysipelas. There were 125 military soldiers and 22 non-military patients. The prevalence of erysipelas was 2.23%. The median age was 25 years. Almost 86.2% of patients were male. The main favorable factors were: obesity (9%), alcoholism (8%), chronic venous insufficiency (6.5%), chronic lymphedema (3%), leg fracture (2%), and diabetes mellitus (1%). The lesions were mostly located in the lower limbs in 94.9%. According to our multivariate analysis, there was an association between recurrence and diabetes mellitus (p=0.02), female sex (p=0.004), onychomycosis (p=0.004), and plantar dyshidrotic eczema (p<0.005). CONCLUSION: Identifying factors associated with recurrent erysipelas in a young population remains essential for proposing primary and secondary prevention measures.

Verrucous Carcinoma of the Nail Bed: A New Case.

Verrucous carcinoma (VC) of the nail bed is a rare variant of squamous cell carcinoma that is often misdiagnosed as a benign condition. The clinical presentation of this tumor is very similar to that of warts or onychomycosis hence the delayed appropriate treatment. Its association with human papillomavirus (HPV) infection has rarely been reported. The treatment of VC of the nail unit depends on the extent of the lesion and the presence or the absence of bone. We here report an unusual case of VC of the nail bed of the left big toe in a man associated with HPV53 infection that had been mistaken for a wart for 1 year. The condition was treated by ray amputation.

Nail Involvement in Psoriatic Patients and Association with Onychomycosis: Results from a Cross-Sectional Study Performed in a Military Hospital in Tunisia.

Nail psoriasis has variable prevalence and heterogeneous aspects. Many of them could mimic onychomycosis (OM). It has been suggested that patients with nail psoriasis are at high risk of OM. The aim of our study was to determine the epidemiological and clinical characteristics of nail psoriasis and to estimate the frequency and the factors associated with OM in psoriatic patients. The studied group included 163 patients with psoriasis aged 18 years or older. Epidemiological and clinical data, as well as the severity of skin and nails disease by evaluating the Psoriasis Area Severity Index (PASI) and Nail Area Psoriasis Severity Index (NAPSI) scores were specified. Mycological testing was performed for patients with nail alterations. Nail involvement was found in 71.2% of patients. The most common nail alterations were subungual hyperkeratosis and onycholysis. The mean NAPSI score was 11.6. Mycological testing was performed in 104 patients with onychodystrophy. OM was diagnosed in 53% of the cases. Dermatophytes were the most isolated pathogens. OM was associated with male gender, but not with age, NAPSI, or PASI score. Psoriasis is one of the dermatoses that most commonly affect the nail. Available data about the association between nail psoriasis and OM are controversial. However, mycological testing should be routinely performed on psoriatic nails.

Magnetic Resonance Imaging in the Diagnosis of Onychomatricoma: A Case Report.

Onychomatricoma (OM) is a rare benign tumour of the nail matrix characterized by specific clinical and histologic features. The main clinical signs are thickening of the nail plate, xanthonychia, overcurvature of the nail plate, and multiple splinter haemorrhages. The diagnosis is based on clinical, radiological and histopathological findings. Histologically, the tumour is characterized by filiform epithelial projections. The objective of this study is to present the first reported Tunisian case of OM, focusing on the contribution of magnetic resonance imaging to the diagnosis of OM. A review on the subject is also presented.

Perforating necrobiosis lipoidica in a girl with type 1 diabetes mellitus: a new case reported.

Necrobiosis lipoidica is an idiopathic dermatological condition that is strongly associated with diabetes mellitus. It is more commonly seen in women than men. The average age of onset is 30-40 years. Necrobiosis Lipoidica diabeticorum is an extremely rare finding in childhood diabetes. We describe the case of a 13-year-old girl who has had type 1 diabetes mellitus since she was 8 years old. The patient presented with 2 well-defined, persistent plaques with a depressed central area and elevated purple peripheral ring, one on the right thigh and the other over the lateral left leg. Histopathologic evaluation of the patient's biopsy confirmed the diagnosis of necrobiosis lipoidica with transfollicular elimination. Our patient is the second pediatric case described with perforating necrobiosis lipoidica. We review the literature and discuss clinical features, several complications, and the most recent treatment options for necrobiosis lipoidica in diabetic children.

Giant condyloma (Buschke-Löwenstein tumor). A case report.

Buschke-Löwenstein tumor (BLT), or giant condyloma acuminatum, is a rare sexually transmitted disease. The virus responsible for condyloma is human papillomavirus, usually serotype 6 or 11. A BLT is always preceded by condyloma acuminatum and may occur at any age after puberty. It is characterized by invasive growth and recurrence after treatment, and malignant transformation is possible. We report the case of a 44-year-old male patient with a 2-year history of a penoscrotal Buschke-Löwenstein tumor.