Cutaneous tuberculosis in children from the northeastern region of Morocco.

INTRODUCTION: In Morocco, tuberculosis is an endemic disease. The aim of this study was to trace the epidemiological, paraclinical, therapeutic, and progressive characteristics of cutaneous tuberculosis (CT) in children. MATERIALS AND METHOD: This multicenter retrospective and prospective study concerned all pediatric patients followed for CT in our region. The diagnosis was based on comparing clinical, immunological, bacteriological, and histological data. RESULTS: We found 147 cases of CT, of which 16 cases (10%) were children. The average age was 10.5 years, with extremes ranging from 15 months to 16 years. The sex ratio was 0.75. Deterioration in general condition and weight loss were noted in three cases, and none of the patients was immunocompromised. The clinical forms were essentially scrofuloderma tuberculosis in nine cases (57%), gummas in five cases (35%), a single case each of verrucous tuberculosis and lupus vulgaris. The histological study of the lesions confirmed the diagnosis for all cases by showing a tuberculous granuloma. Multifocal forms were found in one case. Antibacillary treatment was recommended for 6 months in all patients except in the child with a multifocal form whose treatment was prolonged to 9 months. The progression was favorable with total healing in all cases except in a single case that retained sequelae such as bone deformities and scars in most cases. DISCUSSION: Cutaneous tuberculosis in children is dominated by scrofuloderma and gummy lesions in our region. Despite deterioration in the general condition and weight loss in three cases, none of these children was immunocompromised. Therapeutic management was then carried out based on several clinical and paraclinical arguments and the histological study. Even if the compulsory BCG vaccine in Morocco prevents serious forms, early diagnosis remains the only way to reduce the risk of complications. CONCLUSION: Cutaneous tuberculosis concerns our pediatric population, multibacillary forms of cutaneous localization is the most frequent one, although the BCG vaccine in Morocco is compulsory.

[Lichenoid drug eruption with antituberculosis drugs associated with an anonychia]. / Toxidermie lichénoïde aux antituberculeux associée à une anonychie.

INTRODUCTION: Lichenoid cutaneous reactions to antituberculosis drugs are rare. Herein we report a new case. PATIENTS AND METHODS: A 41-year-old patient was seen for a profuse and pruriginous rash occurring 2 weeks after administration of rifampicin and isoniazid for pulmonary tuberculosis. Dermatological examination revealed polymorphic erythemato-squamous plaques with lichenoid, psoriatic and eczematous features, associated with cheilitis, erosions on the cheeks and diffuse onychodystrophy. The skin biopsy confirmed a lichenoid reaction. The pharmacovigilance investigation incriminated isoniazid and rifampicin. The patient was treated with topical corticosteroids and UVB phototherapy. The outcome involved complete regression of the eruption but with secondary anonychia. DISCUSSION: Antituberculosis drugs including isoniazid and rifampicin are known to induce lichenoid reactions. It is difficult to distinguish the results from lichen planus. The clinical polymorphism of the rash as well as the patient's drug intake militate in favour of a diagnosis of lichenoid reaction. Widespread ungual involvement, which is extremely rare, warranted early management in order to avert irreversible anonychia.

Granulomatous rosacea: a case report.

BACKGROUND: Granulomatous rosacea is a rare chronic inflammatory skin disease with an unknown origin. The role of Demodex follicularum in its pathogenesis is currently proved. CASE PRESENTATION: We report a case of a 54-year-old Moroccan man with a 3-month history of erythematous, nonpruritic papules on the lateral side around the eyes. Dermoscopy and histology confirmed the diagnosis of granulomatous rosacea. CONCLUSIONS: We describe another clinical presentation of granulomatous rosacea with a clinical-dermoscopic-pathological correlation.

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.

[Surgical treatment of acral melanoma: a report of eight cases]. / Traitement chirurgical du mélanome acral: à propos de huit cas.

Acral melanoma represents 3 to 15% of all cutaneous melanoma. In Morocco, this location is predominant. Through our study, we intend to analyze the therapeutic aspects of acral melanoma, while focusing on the epidemiological, clinical, pathological and prognostic profile of acral melanoma cases listed in osteoarticular surgery department of the CHU Hassan II of Fez in the period from January 2009 to December 2012. The mean age of the patients was 63 years, with slight predominance of women. The most commonly involved location was plantar region (including the heel) and pigmented color was the most common. The concept of micro trauma was found in almost half of our patients. Plantar localization was the most commun lesion. Inguinal lymph nodes attended three patients and one patient had deep lymph nodes. Only one of them had a lymphadenectomy. Nodular melanoma os the most found histological type in our study with a Breslow thickness of 8.5mm on average, and Clark level IV is found in the majority of cases. Excision of the tumour was performed in all patients. It was estimated wide in all cases. Five patients received reparative surgery consisting of flap coverage. This study has proved a high incidence of poor prognostic factors clinically and histologically.

[Eosinophilic fasciitis, morphea and vitiligo in a single patient]. / Association fasciite avec éosinophilie, morphées et vitiligo.

BACKGROUND: Fasciitis with eosinophilia (FE), or Shulman syndrome, is a rare disease of unknown origin for which the nosological profile has not been clearly defined. It is clinically characterised by oedema and induration of the limbs with hypereosinophilia. It may be associated with morphea, in which case it carries a poor prognosis, or other diseases, particularly autoimmune conditions. Herein, we report a case of fasciitis associated with eosinophilia, morphea and vitiligo. PATIENT AND METHODS: A 45-year-old male patient followed up for vitiligo for 20 years had been presenting swelling and induration of the skin on all 4 limbs for the previous 7 months associated with morphea on the trunk. Treatment consisting of systemic corticosteroids and methotrexate was initiated and displayed a certain degree of efficacy. DISCUSSION: The association of morphea/fasciitis with eosinophilia is a classical finding; the presence of vitiligo raises the question of possible association between these different disorders.

[Sporadic anterior cervical hypertrichosis]. / Hypertrichose cervicale antérieure sporadique.

BACKGROUND: Anterior cervical hypertrichosis is a rare and little-known form of congenital localized hypertrichosis. It is characterized by the presence of a tuft of terminal hairs in the anterior cervical region. We report four typical clinical observations of this condition. PATIENTS AND METHODS: Four patients aged from 5 to 21 years were seen for a tuft of terminal long hair on the neck, next to the cricoid cartilage, recorded at birth or during early childhood. There was no indication of previous trauma or topical drug application. No similar familial history was found. In one case, histological examination performed for suspicion of an "atypical" smooth muscle hamartoma contributed nothing of note. No neurological abnormalities were observed. In one case there was a history of chronic juvenile idiopathic arthritis and familial thyroid disease. Treatment with 5 sessions of laser hair removal was proposed in one case and the improvement was considered satisfactory by the patient. DISCUSSION: Anterior cervical hypertrichosis constitute a specific clinical picture of a benign nature, and is sometimes associated with neurological, orthopaedic or ocular abnormalities. Although rarely reported, its frequency is probably underestimated.

[Choriocarcinoma: a hidden face of pemphigoid gestationis]. / Le choriocarcinome: une face cachée de la pemphigoïde gestationnelle.

Gestationis pemphigoid is an autoimmune subepidermal blistering dermatosis occurring predominantly in pregnancy, more seldom in early puerperium, and exceptionally in post-abortion. The association of gestationis pemphigoid with choriocarcinoma is extremely rare. We report this association in a patient of 35 years in which the diagnosis of gestationis pemphigoid was made on clinical, histological and immunological criteria, and the one of choriocarcinoma was made on clinical, biological radiological and histological criteria. Through this article, we put the item on this association reported for the first time in post-abortion.

Tuberculous gummas with sporotrichoid pattern in a 57-year-old female: A case report and review of the literature.

Sporotrichoid tuberculosis is a rare form of cutaneous tuberculosis; it primarily affects children after a post-traumatic inoculation. The diagnosis is often difficult and based on a set of arguments; it should be considered in any sporotrichoid lesion, especially in tuberculosis endemic countries. The following describes a new case of Mycobacterium tuberculosis skin infection with an unusual sporotrichoid clinical appearance in a healthy woman, emphasizing the diagnostic difficulties with a review of literature.

[Primary familial erythromelalgia. A case report]. / Érythermalgie primitive familiale. À propos d'un cas.

Erythromelalgia is a rare disease whose etiology is poorly understood. It is characterized by paroxysmal attacks of erythema, pain, and warmth of the extremities and can be primary or secondary. We report a case of primary familial erythromelalgia and stress the difficulties in its therapeutic management. We provide a brief update on the pathophysiology and treatment of primary erythromelalgia.

[Prolonged corticosteroid-therapy and anxiety-depressive disorders, longitudinal study over 12 months]. / Corticothérapie prolongée et troubles anxieux et dépressifs. Étude longitudinale sur 12 mois.

UNLABELLED: To date, there is little data in the literature describing the anxiety and depressive disorders iatrogenic to corticosteroids. These disorders are common, underestimated, with potentially serious consequences that may jeopardize the patient's prognosis; their management is not consensual. OBJECTIVES: The objective of our work is to determine the prevalence of anxiety and depressive disorders induced by corticosteroids, assessing their accountability to the corticosteroids and studying their risk factors. METHODS: We conducted a prospective longitudinal study over 12months evaluating the prevalence of anxiety and depressive disorders in patients followed for chronic skin diseases treated with prolonged corticosteroid-therapy. Our patients were assessed using standardized instruments: the Mini International Neuropsychiatric Interview (MINI), the Hamilton Anxiety Scale (HAS) and the Beck Depression Inventory (BDI). RESULTS: Of 54 patients included, our study showed a high prevalence of anxiety and depressive disorders estimated at 27%. These disorders were divided into depressive disorder in 16% of cases, and anxiety disorder in 11% of cases. The early onset of these disorders was found during the first weeks of treatment. According to the Beck Depression Inventory (BDI), depression was moderate in 67% of cases; severe with suicide attempts in 22% of cases, and mild in 11% of cases. According to the Hamilton Anxiety Scale (HAS), anxiety was mild in 33% of cases and moderate in 67% of cases. The disorders observed were mainly distributed into: 33% deep pemphigus, 27% lupus, 13% bullous pemphigoid and 13% dermatomyositis. In this study the statistically significant risk factors are dose of corticosteroids and personal psychiatric history of the patient; in addition, there is a high prevalence of disorders in patients whose age exceeds 40 years, female gender, and patients treated for deep pemphigus. The evolution after pharmacological treatment and supportive psychotherapy was favorable in most patients. CONCLUSION: The psychiatric examination prior to prescription of long-term corticosteroid-therapy use should be standard practice to identify patients at risk, discuss the treatment modalities, and provide comprehensive care.