[Periungual lipoma: An unusual site]. / Lipome péri-unguéal : une localisation inhabituelle.

BACKGROUND: Lipomas are common benign mesenchymal tumors composed of mature fat cells that may or may not be surrounded by a thin fibrous capsule. Lipomas involving the fingers are extremely rare but must be taken into account in the differential diagnosis of benign soft tissue masses of unusual localization. We describe a case of digital periungual lipoma. PATIENTS AND METHODS: A 65-year-old Moroccan woman presented with a tumefaction of the right index finger reminiscent of a lipoma. There was no history of nail trauma, other lipomas on the body, or a family history of lipomatosis. She did not complain of any pain, but she had a slight limitation on the movement of the affected finger. Surgical excision was performed. Histological examination confirmed the diagnosis of lipoma. There was no recurrence after one year of follow-up. DISCUSSION: Lipomas of the fingers are extremely rare. To our knowledge, 6 cases of subungual localization and 4 cases in the lateral edge of the nail have been described in the literature. We report another case of unusual posterior periungual localization. In our case, the suspected diagnoses were either neurofibroma, superficial acral fibromyxoma, or giant cell tumor of the synovial sheaths of the tendons. Radiological examinations may be performed to aid diagnosis. Although finger lipomas are rare entities, they must be considered in the differential diagnosis of benign soft tissue masses of the finger.

Dermoscopy of Pigmented Actinic Keratosis of the Face: A Study of 232 Cases / Dermatoscopia en la queratosis actínica pigmentada del rostro: estudio de 232 casos

The diagnosis of pigmented actinic keratosis (PAK) is often challenging because of overlapping features with lentigo maligna. Objective: To investigate dermoscopic patterns of PAK according to their different evolutionary stages, and to correlate the pattern with clinical characteristics of the patients. Methods: Descriptive and analytical study of 232 PAK. Dermoscopic patterns were divided into two categories: the follicule surroundings’ abnormalities (FSA) and follicular keratosis’ abnormalities (FKA). Results: FSA and FKA dermoscopic patterns were related to male gender, except for star-like appearance, double white clods and dermoscopic horn (p≤0.04). Rhomboidal, annular granular pattern, gray halo, white circle and double clods were dermoscopic pattern significantly related to xeroderma pigmentosum's type of skin. Based on the evolutionary stages of PAK, the jelly sign was significantly related to thin patches of PAK. Central crusts and scales were related to thick plaques and the star-like appearance to hypertrophic PAK. The presence of 2 or more dermoscopic signs in both FSA and FKA was noticed in 99.1% of lesions. Conclusions: The dermoscopic diagnosis of PAK vary according to the evolutionary stages of the disease, this will increase the diagnosis accuracy, with therapeutic implications. El diagnóstico de la queratosis actínica pigmentada (QAP) es a menudo difícil, debido a sus características, que se solapan con las propias del lentigo maligno (AU)

Objetivo: Investigar los patrones dermatoscópicos de la QAP con arreglo a sus distintos estadios evolutivos, y correlacionar dicho patrón con las características clínicas de los pacientes. Métodos: Estudio descriptivo y analítico de 232 QAP. Se dividieron los patrones dermatoscópicos en 2 categorías; alteraciones perifoliculares (APF) y la queratosis folicular (QF). Resultados: Se relacionaron los patrones dermatoscópicos de APF y QF con el sexo masculino, exceptuando las características de aspecto estrellado, double white clods y cuerno dermatoscópico (p≤0,04). Las características romboidal, anular-granular, de halo gris, círculo blanco y double clots constituyeron los patrones dermatoscópicos significativos relacionados con el tipo de piel del xeroderma pigmentoso. Sobre la base de los estadios evolutivos de la QAP, el signo de la jalea guardó relación significativa con los parches finos cutáneos de la QAP. Las costras y escamas centrales se relacionaron con las placas densas, y el aspecto estrellado de la QAP hipertrófica. La presencia de 2 o más signos dermatoscópicos, tanto en APF como en QF, se apreció en el 99,1% de las lesiones. Conclusiones: El diagnóstico dermatoscópico de QAP varía con arreglo a los estadios evolutivos de la enfermedad, incrementándose la precisión diagnóstica, con implicaciones terapéuticas (AU)

Dermoscopy of Pigmented Actinic Keratosis of the Face: A Study of 232 Cases.

The diagnosis of pigmented actinic keratosis (PAK) is often challenging because of overlapping features with lentigo maligna. OBJECTIVE: To investigate dermoscopic patterns of PAK according to their different evolutionary stages, and to correlate the pattern with clinical characteristics of the patients. METHODS: Descriptive and analytical study of 232 PAK. Dermoscopic patterns were divided into two categories: the follicule surroundings' abnormalities (FSA) and follicular keratosis' abnormalities (FKA). RESULTS: FSA and FKA dermoscopic patterns were related to male gender, except for star-like appearance, double white clods and dermoscopic horn (p≤0.04). Rhomboidal, annular granular pattern, gray halo, white circle and double clods were dermoscopic pattern significantly related to xeroderma pigmentosum's type of skin. Based on the evolutionary stages of PAK, the jelly sign was significantly related to thin patches of PAK. Central crusts and scales were related to thick plaques and the star-like appearance to hypertrophic PAK. The presence of 2 or more dermoscopic signs in both FSA and FKA was noticed in 99.1% of lesions. CONCLUSIONS: The dermoscopic diagnosis of PAK vary according to the evolutionary stages of the disease, this will increase the diagnosis accuracy, with therapeutic implications.

Defining the mimics and clinico-histological diagnosis criteria for mycosis fungoides to minimize misdiagnosis.

BACKGROUND: Mycosis fungoides (MF) is a significant diagnostic challenge; it has various differential diagnosis especially at an early stage. Our aim was to describe mimics of MF clinically and histologically, and to define significant diagnostic criteria of the disease. METHODS: This was a retro-prospective cohort of 370 patients in whom the diagnosis of MF was suspected clinically. RESULTS: MF was histologically confirmed in 15.4% of cases and rejected in 84.5%. Other identified histologically diagnosis were eczema, psoriasis; nonspecific dermatitis, lichen, lupus; pseudolymphoma, parapsoriasis and toxidermia. 4 patients with palmoplantar MF were wrongly treated as eczema, and 10 patients with psoriasiform MF were initially treated as psoriasis. We also described the clinical, histological and immunohistochemistry diagnostic criteria for distinguishing MF from benign dermatosis. CONCLUSIONS: Misdiagnosis of MF was a real problem for this study, because it shared common clinical and histological characteristics with other inflammatory diseases like eczema and psoriasis. Therefore, defining significant clinico-histological diagnosis criteria of MF would be of great help and would increase the accuracy of the diagnosis.

[Frontal fibrosing alopecia: A prospective study of 20 cases]. / Alopécie frontale fibrosante : étude prospective de 20 cas.

BACKGROUND: Frontal fibrosing alopecia (FFA) is a variant of lichen planopilaris predominantly affecting postmenopausal women. We report a series of 20 cases of FFA and describe the epidemiological, clinical, dermoscopic features and progress under treatment. PATIENTS AND METHODS: This was a prospective study conducted over a period of 16 months in patients seen at the dermatology department of the Hassan II University in Fez, Morocco. RESULTS: Mean patient age was 46 years. Patients were premenopausal in 65% of cases. Dermoscopic examination revealed specific signs of the disease. Skin biopsy guided by dermoscopy confirmed the diagnosis of lichen planus pilaris in its FFA variant in all cases. Immune dysfunctions and other disorders were noted in half of the cases. Various treatments had been initiated, including topical corticosteroids, tacrolimus ointment, minoxidil 2%, hydroxychloroquine, and oral finasteride. The results were satisfactory with a decline within one year. CONCLUSION: FFA is increasingly widely described in premenopausal women. Dermoscopy may be used to facilitate diagnosis, guide biopsy, evaluate treatment efficacy and establish a prognosis.

Cutaneous tuberculosis revealing multifocal tuberculosis in immunocompetent patients.

Multifocal tuberculosis (TB) is rare. It occurs especially in immunocompromised patients. Association with skin involvement is rarer, and few cases are reported in the literature. The present study reports 7 cases of multifocal TB with cutaneous localization in immunocompetent patients. Cutaneous forms of TB included in this series are: gummas, scrofuloderma, vasculitis TB and lupus TB. The patients had at least two extra skin locations, namely: osteoarticular, lung, pleural, scrotal, muscular, digestive, laryngeal, nodal and splenic locations. These patients had no context of immunosuppression which is uncommon, but should be kept in mind, especially in endemic countries.

[Acquired ichthyosis and haematological malignancies: five cases]. / Ichtyose acquise et hémopathie maligne : cinq observations.

BACKGROUND: Acquired ichthyosis is a rare condition that can reveal an unsuspected haematological malignancy, thus allowing early diagnosis and management. If ichthyosis regresses under treatment for the haematological disorder, its recurrence reflects a turning point in the course of the disease and implies worsening of the prognosis. PATIENTS AND METHODS: The patients were examined at a joint dermatology/haematology consultation. The diagnosis of ichthyosis was based on clinical examination alone with no patients undergoing skin biopsy. RESULTS: Our series included three men and two women aged 38 to 65 years consulting for a variety of reasons including asthenia, anaemia and adenopathy. Ichthyosis occurred 2 to 9 months after the initial symptoms of the blood disease. Lesions consisted of diffuse brown scales. The disease was associated with lymphadenopathy and biological inflammatory syndrome. Two patients were presenting non-Hodgkin lymphoma, one had Hodgkin's disease, one had chronic myeloid leukaemia in progression and one had an undifferentiated lymphomatous process. Treatment was based on chemotherapy and emollients. The ichthyosis progressed in step with the underlying malignancy in all cases, with regression being complete in three cases, partial in one case and absent in one case. DISCUSSION: In rare cases, acquired ichthyosis reveals systemic disease, and may be of infectious, endocrine or drug origin; it may also be idiopathic. However, it is most often a paraneoplastic syndrome with cutaneous expression encountered during haematological malignancies. Because of the variety of causative blood dyscrasias, ichthyosis cannot be used to guide their diagnosis, although it remains a reliable monitoring tool. CONCLUSION: Acquired ichthyosis should prompt the clinician to search for a neoplastic condition, primarily a haematological disorder, guided by other associated signs, given that in our study, skin lesions generally appear to precede signs of the blood disease.

[Syphilis: 57 observations in Fez, Morocco]. / Syphilis: 57 observations à Fès, Maroc.

A prospective study of syphilis cases over a period of 2 years (January 2008 to September 2009) was carried out in the Department of Dermatology of the Hassan II University Hospital Center in Fes, Morocco. A total of 57 cases were identified. The M/F sex ratio was 0.89. Mean patient age was 40.5 years (range, 22-80). Risk factors included unprotected sex in 96.5% of cases and multiple partners in 42.1%. Nine patients had a history of sexually transmitted infection. No patient had received blood transfusion. Clinical picture was late latent syphilis in 70.2% of cases (n = 41). Only one case was associated with human immunodeficiency virus. The mainstay treatment was intramuscular benzathine benzylpenicillin. Outcome was favorable in 48 cases.

[Cutaneous tuberculosis: a 36-case series from Morocco]. / Tuberculose cutanée: trente-six observations au Maroc.

Tuberculosis is still endemic in Morocco. Cutaneous tuberculosis is the fifth most common form after pleuropulmonary, glandular, digestive and urogenital tract tuberculosis. The purpose of this single-center prospective study is to describe all cases of cutaneous tuberculosis treated between May 2006 and June 2009. Diagnosis was suspected based on clinical, immunological and histological features. The main clinical presentations, i.e., scrofuloderma and gumma, were consistent with endemicity of tuberculosis in Morocco. Since definitive diagnosis by detection of the tubercle bacillus was rarely possible, therapy was usually undertaken presumptively based on clinical and laboratory findings and therapeutic response.