An Atypical Presentation of Cutaneous Leishmaniasis.

Cutaneous leishmaniasis is a parasitic infection characterized by a high clinical polymorphism. Unusual clinical aspects have been reported in immunodeficient patients or associated with particular parasite species. This is the case report of a 36-year-old man with a history of type 1 diabetes who presented with a verrous plaque on the dorsal aspect of the fourth finger of the left hand, which appeared six months after traveling to southern Morocco. It was a papulo-nodular verrucous lesion, and was nonpruritic and nonpainful, with a keratotic surface, which had been progressively increasing in volume. A skin biopsy was performed, which showed evidence of leishmaniasis bodies after specific staining (May-Grünwald Giemsa stain). The patient was treated for eight weeks with weekly intralesional injections of meglumine antimoniate (Glucantime) and touch-ups with trichloroacetic acid (TCA) 20%. The evolution was marked by a clear regression of the lesion after four months. Herein, we describe a particular clinical aspect of cutaneous leishmaniasis: the verrucous form. This is a rare presentation that suggests the role of factors related to parasite species and/or diabetes. The combination of TCA with meglumine antimonate is a promising treatment option.

Eosinophilic Annular Erythema: A New Entity of Eosinophilic Dermatosis.

Eosinophilic annular erythema (EAE) is a rare dermatosis. Its relationship with Wells syndrome (WS) is debated. We report a case treated with hydroxychloroquine.  A 31-year-old patient presented with a mildly pruritic rash that had been evolving by flares for two weeks. Clinical examination revealed inflammatory erythematous-annular plaques on the trunk and limbs. The blood count was normal. Skin histology showed an eosinophilic-rich inflammatory infiltrate. After local steroid treatment, the patient was treated with oral steroids with a momentary improvement. The course with new relapses is treated by synthetic antimalarial drugs with the complete disappearance of the lesions at a six-month follow-up. Although some authors consider EAE to be a variant of WS, we believe that there are subtle differences that differentiate them despite their clinical similarity.

Associated Pyoderma Gangrenosum, Erythema Elevatum Diutinum, and Chronic Recurrent Annular Dermatosis: The Neutrophilic Disease Spectrum.

Neutrophilic dermatoses (ND) refer to a group of skin diseases characterized histologically by a cutaneous infiltrate of mature polymorphonuclear cells without an identifiable cause. Previously described as autonomous, these clinically distinct entities are included in the spectrum of neutrophilic disease due to the existence of overlapping forms, as described in our observation. Erythema elevatum diutinum (EED) is a rare dermatosis characterized by reddish-violaceous to browning papulonodular and plaques and belongs to the spectrum of cutaneous leukocytoclastic vasculitis. Chronic recurrent annular neutrophilic dermatosis (CRAND) is an exceptional neutrophilic dermatosis characterized by chronic annular lesions and the absence of generalized signs or hematological abnormalities. Histological features are similar to those seen in Sweet's syndrome. A 55-year-old woman with a history of pyoderma gangrenosum (PG) presented successively with two rare forms of ND, namely, EED and CRAND. There were no clinical or paraclinical arguments for any underlying systemic disease. Treatment with azathioprine 100 mg/day and topical steroids led to a total regression of lesions after a nine-month follow-up. Our observation is important because it reports two rare entities, CRAND and EED. Their occurrence in a single patient with a history of PG illustrates the concept of "neutrophilic disease" reported in the 1990s.

Trichoblastoma Arising From the Nevus Sebaceus of Jadassohn.

Trichoblastoma is a rare benign skin adnexal tumour, belonging to the category of trichogenic tumours. The clinical and histological findings may often be confused with basal cell carcinoma, a malignant epidermal skin tumour. We report here a case of a 70-year-old man presented with a dome-shaped, dark-pigmented nodule within a yellowish hairless plaque on the scalp. The plaque had existed since childhood. However, the central pigmented nodule began appearing three months ago and enlarging gradually. The patient had no medical history. Furthermore the physical examination revealed a translucent, verrucous, and yellowish plaque, with central and pigmented nodule measuring 0.7 × 0.5 cm. Also basal cell carcinoma and trichoblastoma's diagnosis were discussed. The patient was subsequently referred to the plastic surgery department, where he underwent a total excision. The histological examination was in favour of trichoblastoma arising from the nevus sebaceus. After 24 months of checking, no recurrence was observed. Trichoblastoma is a benign adnexal tumour. Its progression to malignant trichoblastoma (or trichoblastic carcinoma) is possible, but remains exceptional. Therefore, complete excision should be proposed to the patient at the time of diagnosis.

Acquired Reactive Perforating Collagenosis: A Case Report.

Reactive perforating collagenosis (RPC) is a rare form of dermatosis. It forms with perforating folliculitis, Kyrle's disease, and serpiginous perforating elastosis, which is a group of perforating dermatosis. RPC can be hereditary with autosomal dominant transmission or it can be acquired, which is usually observed in diabetics with chronic renal failure. Here we report a new observation in a 72-year-old woman treated by phototherapy with a favorable outcome.