Childhood dermatomycoses study in Sfax Hospital, Tunisia.

Mycoses are frequent affections in childhood. Fungal type varies according to the age and the affected organ. The aim of this study was to determine the aetiological agents of childhood dermatomycoses and to draw attention to the diversity of their clinical manifestations. Retrospective study dealing with children's cases with age <16-year old and having dermatomycosis diagnosed between 1991 and 2005 at the Parasitology and Mycology Laboratory of Sfax University Hospital. A total of 4559 children suspected to have superficial mycoses were examined. Dermatomycosis diagnosis was confirmed in 49.3% of cases. Dermatophytes were the most prevalent fungal agents and accounted for 1865 cases (80.6%) dominated by Trichophyton violaceum (54.1%) and Microsporum canis (24.5%). Tinea capitis (69.4%) was the most common type of infection, followed by tinea corporis (20%). Superficial yeast infections (442 cases) were dominated by Malassezia infections (71%). Candida infections were mainly due to Candida albicans (58%). The clinical features of paediatric dermatomycoses vary with the age of the children: tinea capitis and tinea corporis were more frequent before 13 years of age. After this age, tinea versicolor and onychomycoses became more common.

[Childhood actinic lichen planus (6 cases)]. / Lichen plan actinique de l'enfant (à propos de 6 cas).

INTRODUCTION: Actinic lichen planus (ALP) is a chronic and benign disease that affects young people of the Middle East and Maghreb countries. PURPOSE: To analyse clinical features and prognosis of ALP in children. PATIENTS AND METHODS: A retrospective, descriptive study of cases observed in the department of dermatology of Sfax hospital over a period of 11 years (1995-2005). RESULTS: Our patients were 5 boys and 1 girl. Mean age at diagnosis was 11 years. Onset was during the summer in 5 cases. The face was involved in 5 cases and the upper limb in 3 cases. The annular form was found in 5 cases, the pigmented melasma-like form in 1. Cheilitis was associated in 3 cases. Treatment consisted in photoprotection in all the patients. Antimalaria drugs were used in 4 patients and topical steroids in 2. Evolution was favourable in 5 cases. Disease relapsed in one child after treatment interruption. CONCLUSION: ALP can be seen during childhood. Ultraviolet rays are involved in pathogenesis. The annular form is predominant. Treatment is based on sun protection associated with antimalarials or topical steroids.

[Discoid lupus erythematosus with eyelid involvement. A series of nine patients]. / Lupus érythémateux discoïde et paupière. Une série de 9 patients.

INTRODUCTION: Discoid lupus erythematosus (DLE) is a chronic autoimmune skin disease that usually affects the sun-exposed skin. Palpebral involvement occurs uncommonly. MATERIAL AND METHOD: The goal of our study was to present the clinical and therapeutic features of a series of nine patients with discoid lupus erythematosus with eyelid involvement. RESULTS: Lesions of discoid lupus were more frequent in the lower eyelids (seven cases). The palpebral location was the only manifestation of the disease in a 34-year-old woman. In the other cases, cutaneous lesions of typical discoid lupus were noted. Seven patients responded to therapy with antimalarial drugs associated with local corticosteroids and photoprotection. DISCUSSION: Eyelid lesions of discoid lupus erythematosus are rare. Involvement of the lower eyelids is more common. It is important to diagnose discoid lupus of the eyelids because misdiagnosis (isolated form) can delay treatment and cause deformities. The treatment is systemic antimalarial drugs, which have an excellent clinical response.

[Clinical polymorphism of cutaneous leishmaniasis in centre and south of Tunisia]. / Polymorphisme clinique de la leishmaniose cutanée du centre et sud tunisien.

The cutaneous leishmaniasis (CL) is an affection which is quite well known in Tunisia. The zoonotic cutaneous leishmaniasis caused by Leishmania major by far the more frequent, is endemo-epidemic in the centre and south of the country. It is characterized by clinical polymorphism. The aim of our study is to precise the different clinical aspects of the CL in our region through a prospective study of 102 cases. The average age was 37.8 years old (from 4 to 78 years old) with a slight female predominance. All of our cases lived or stayed in an endemic zone. Various clinical forms were noted in our series. The ulcerated and crusted form was predominant: 54,9% of the cases, the lupoid form was noted in 15.7% of the cases and the sporotrichoid form was observed in 18.6% of the cases. Other rare forms were noted (papular erysipeloid, verrucous, vegetant, erythematous, ulcerated, necrotic and linear) were noted in 25.5% of the cases. Our series is characterized by the multiplicity of clinical forms. Besides, the classical form (ulcerated and crusted form), other clinical form can be individualised: lupoid, loco regional spreading (sporotrichoid form, satellite papules). Some atypical forms can be found which are due to variation of host immune responses and to the strain of the parasites involved.

[Subacute cutaneous lupus erythematosus in childhood: a case report]. / Lupus érythémateux subaigu de l'enfant: à propos d'un cas.

Subacute cutaneous lupus erythematosus is extremely rare in childhood. We report the case of a 7 year-old girl who presented annular erythematous infiltrated lesions on sun exposed areas since the age of 2 months. Histopathologic examination showed orthohyperkeratosis, epidermal atrophy, widespread hydropic degeneration of epidermal basal cell layer, and a dermal lymphohistiocytic infiltrate. The lupus band test was negative. The immunological investigations (antinuclear antibodies) were negative. Treatment with antimalarials, topical steroids and sun protection allowed clearance of the cutaneous lesions. Lesions relapsed after antimalarials discontinuation and sun exposure. Four years later, at the age of 11, the antinuclear antibodies became positive. The diagnosis of subacute cutaneous lupus erythematosus is based on the clinical aspect of lesions, topography, histological finding, evolution and immunological profile of the patient.

[Biermer disease disclosed by mucous ulcerations]. / Le cas clinique du mois. Ulcérations muqueuses révélatrices d'une anémie de Biermer.

Pernicious anemia rarely induces mucous membranes lesions, wich, exceptionally reveal the disease. We report a case of a 64-year-old man who presented a clinical history of recurrent painful ulcerations of the buccal, genital and ocular muosa. He also had peripheral sensory nerve impairement of the legs. The diagnosis of pernicious anemia was made after a 19 year course. Cobalamin supplementation induced an improvement of the mucous membrane lesions and of the anemia, but recurence occurred each time the treatment was stopped. Our observation is particular by the multiple mucous membrane involvement revealing pernicious anemia and by the ocular lesions which had never been previously reported.

[Necrobiosis lipoidica - 3 case reports]. / La nécrobiose lipoïdique: à propos de trois observations.

Necrobiosis lipoidica is a rare degenerative disease mostly seen on the legs. The association to diabetes mellitus is usual. We report three patients with necrobiosis lipoidica located on the extremities, 2 of them were already treated for diabetes. Necrobiosis lipoidica has distinctive clinical and histological appearances. The lesions appear as well circumscribed, erythematous plaques, with a depressed centre. Some of these lesions may progress to ulcers. The legs are commonly involved. Angiopathy leading to thrombosis of the cutaneous vessels has been implicated in its pathogeny. There is no specific therapy for this disease Topical and/or intralesional corticosteroids are the most widely used treatment.

[Profile of basal cell carcinomas of the scalp after radiotherapy for tinea capitis (about 63 cases)]. / Profil des carcinomes basocellulaires du cuir chevelu secondaires a une radiothérapie pour teigne (a propos de 63 cas).

The induction of basal cell carcinoma (BCC) of the scalp by X-ray therapy for tinea capitis is well known. The aim of the study was to specify the epidemiological, clinical and histological characteristics of this disease. In a retrospective study, we collected data from the files of 63 patients, with a history of radiotherapy for tinea capitis, followed between January 1995 and December 2004. Fifty one men and 12 women with a total of 108 BCC of the scalp are reported (1.76 lesion per patient and 1.13 cm on average of diameter). The mean age at the occurrence of the BCC was 45.5 years. Thirty seven percent of BCC occurred on the occipital area; 28.7% were in the parietal site. The most frequent clinical aspect was the nodular BCC (51%) and the cicatricial BCC (35%). Histological study showed a nodular aspect in 74 % and pigmentation in 62% of cases. It is concluded that BCC of the scalp following X-ray therapy for tinea capitis have some clinical and histological particularities. It represents the most frequent tumour developing on irradiated scalp.

[Tricho-epithelioma multiplex: two cases reports]. / Les tricho-epithéliomes multiples: a propos de deux observations.

Tricho-epitheliomas are benign tumors of the pilosebaccous apparatus. Multiple tricho-epithelioma form is particular. We report 2 new cases. 1) R.A., a 41 year-man with a 2 years history of histologically confirmed multiple tricho-epitheliomas. New lesions appeared during a 9 years-follow-up. Treatment was local excision of tumors. 2) M.B., a 41 year-man, have a 8 years history of 3 to 30 mm papulonodular lesions with telangiectasia, located on the face and associated to multiple milia, comedones and alopecia areata plaques. Histological study confirmed the diagnosis of multiple tricho-epitheliomas. Multiple tricho-epitheliomas is a genodermatosis it is often associated to other benign cutaneous tumors, mainly cylindromas and spiradenomas. It occurs in the 1st and 2nd decade. The lesions are symmetrically located on the face. Histological examination confirm the diagnosis. After repeated episodes, the lesions stabilize. Malignant changes are rare. Treatment is supported by aesthetic considerations. Various therapeutic means are available. Our reported cases are particular by the occurrence at relatively advanced age, the localization and the large size of some lesions. The associated alopecia areata in the 2nd patient could be fortuitous.

[Radiotherapy-induced pemphigus: a case report]. / Pemphigus induit par radiothérapie: à propos d'un cas.

A 61-year-old male patient suffering from squamous cell carcinoma of the lower lip developed pemphigus vulgaris two months after exposure to radiotherapy. Skin lesions were initially localised to the face and neck and later extended over other skin areas. The eruption are improved with glucosteroid therapy, which were stopped after six months. Pemphigus induced by radiotherapy is rare, latency before the onset of the vesiculobullous eruption is variable. Clinical, histological and immunological characteristics are similar to those of other types of pemphigus.

Erysipelas after breast cancer treatment (26 cases).

Erysipelas is a bacterial hypodermal cellulitis usually associated with Streptococcal infection. Erysipelas of the upper limbs in women treated for breast cancer is relatively rare. We undertook a 10-year retrospective study identifying 26 cases of erysipelas of the upper limb following treatment for breast cancer; we describe the clinical, therapeutic, and evolutionary aspects. The age of our patients ranged from 37 to 80 years with a mean age of 53. All patients had a breast surgery and lymphadenectomy. Fifteen patients had chemotherapy and 23 had radiotherapy. The erysipelas appeared with an average of 5.23 years after cancer treatment (3 months to 15 years) and was recurrent in nine cases. Lymphedema occurred in eighteen patients. The first signs were fever and shivering in 25 patients. The clinical aspect was an inflammatory plaque. The physical findings of erysipelas included a raised edge (6 cases), blisters (1 case), purpura (1 case), and cellulitis (1 case). The portal of entry was not found in eleven patients. The upper limb was affected in all cases. Involvement of the axillary folds or the chest was observed in eight cases. Treatment with penicillin was undertaken for all patients; the length of treatment varied from 11 to 26 days. Lympadenectomy and radiotherapy in breast cancer may lead to lymphedema, which can be evident or sometimes discrete. Those patients who developed erysipelas in our series usually fared well with treatment, but many had recurrences attributed to persistent lymphedema. It was also of note that for many patients in this series, the portal of entry was not identified.

[Squamous cell carcinoma complicating an hereditary epidermolysis bullosa]. / Carcinome spinocellulaire compliquant une épidermolyse bulleuse héréditaire.

The dystrophic form of hereditary epidermolysis bullosa is associated with an increased frequency of squamous cell carcinoma. We report a new case. An 18-year-old patient, carrying a Hallopeau Siemens hereditary epidermolysis bullosa, presented a subcutaneous nodular lesion, for 1 year that ulcerated and budded with inguinal lymphadenopathy. The histological study led to the conclusion of a well differentiated squamous cell carcinoma. The patient was treated surgically. Tumor and metastatic lymph nodes were excised. A radiotherapy was decided but the postoperative course was fatal due to an infection and to a deterioration of her general condition. Squamous cell carcinoma frequently occurs on the cicatricial lesion of hereditary epidermolysis bullosa and usually affects males with recessive hereditary epidermolysis bullosa. Metastases are frequent, precocious and multiple. The treatment may be surgical. The particularities of our observation are the young age of patient and the localization.

[Basal cell carcinoma of the scalp after radiation therapy for tinea capitis: 33 patients]. / Carcinomes basocellulaires du cuir chevelu secondaires à une radiothérapie pour teigne: une série de 33 malades.

Occurrence of basal cell carcinoma (BCC) following radiotherapy for tinea capitis is well known. The aim of this study was to specify the clinical and histological features of these BCC seen in 33 patients (1995-2000). Twenty seven men and six women were diagnosed with BCC. The age of onset varied between 32 an 62 years. Radiotherapy was received between 5 and 17 years of age. The interval between irradiation and the onset of carcinoma varied between 21 and 51 years. Total number of lesions was 55. Forty percent of BCC occurred on the occipital area, the number varied from 1 to 5 and the size from 2 to 45 mm. Clinically, the nodular type was found in 51% of cases. Pigment was present in 64% of cases. Histological study showed a nodular aspect in 76% and pigmentation in 63% of cases. Nodular and pigmented type were the predominant BCC occurring after radiotherapy for tinea capitis in our series. In the literature, BCC are the most frequent carcinomas occurring after radiotherapy (70-100%). Pigmentation was not described in other series. The nodular histological form was the most frequent.

[Pemphigoid gestationis: a study of 15 cases]. / Pemphigoïde gestationis: une étude de 15 cas.

INTRODUCTION: Pemphigoid gestationis is a rare subepidermal bullous dermatosis generally occurring during the 2(nd) or 3(rd) quarter of gestation or in the postpartum period in women who already have been pregnant. OBJECTIVE: The aim of this work is to draw a profile of the epidemiology, clinical aspects, treatment and evolution of the disease by studying hospital series. METHODS: In this retrospective study, 15 cases of pemphigoid gestationis confirmed by direct immunofluorescence, followed in the department of dermatology between 1983 and 1999, were included. RESULTS: The age of onset was 19 to 39 years (mean age: 30 years). In 73% of cases, pemphigoid gestationis occurred in women who had already been pregnant, and appeared during the last 3 months of gestation in 11 patients. In all cases, purities was the first symptom, followed by a erythematous maculopapular eruption. In the steady state of the disease, all patients had annular confluent erythematous papules with herpes, like vesicles predominant in the umbilicus. The diagnosis of pemphigoid gestationis was confirmed by direct immunofluorescence in all cases demonstrated linear staining of C3 at the basement membrane zone. Systemic corticosteroids (0.5-1mg/kg/day) were used in 54% of reported cases. Dapsone was efficient in 26% of patients. 20% of patients were treated with oral antihistamine and topical glucocorticoid. Recurrence occurred in postpartum in 53,3% of patients. Two patients had recurrence during the following pregnancies. CONCLUSION: PG remains a rare dermatitis of pregnancy. Our series is comparable to the literature: the late occurrence of PG during the course of pregnancy, the high frequency of multigravida women, the lack involvement in the newborn, however with some particularities: the frequent involvement of the face and the efficiency of dapsone.

[Pityriasis versicolor in children: a retrospective study of 164 cases]. / Pityriasis versicolor de l'enfant: étude rétrospective de 164 cas.

INTRODUCTION: Pityriasis versicolor is a superficial mycosis uncommonly reported in children. It occurs frequently in warm humid climates. Clinical diagnosis can be confirmed by mycology examination of a biopsy sample or a patch-test. The aim of our work was to assess the frequency of pityriasis versicolor in children in our region and ascertain the contribution of the cutaneous patch test and its diagnostic specificity. PATIENTS AND METHODS: A retrospective analysis was conducted in patients meeting the following inclusion criteria over a 5-year period: age < 14 years, clinical presentation compatible with pityriasis versicolor, a positive patch-test. Age, sex, clinical features and favoring factors were recorded for all patients. Patch tests were performed in a control group of age-matched children with eczema or vitiligo. RESULTS: Pityriasis versicolor was diagnosed in 1,379 cases during the study period including 164 children (11.8 p. 100). Age varied from 5 months to 14 years (mean 11 years), with a slight female predominance. Facial lesions were the most frequent (n = 78; 47.5 p. 100), preferentially on the forehead (n = 53; 68 p. 100). An achromic and hypochromic aspect predominated (n = 118; 72 p. 100). The adhesive tape tests were negative in all controls. DISCUSSION: Pityriasis versicolor is exceptional in children in our region. The adhesive tape test provides a specific diagnostic tool. Preferential facial localization and predominant achromic and hypochromic aspect are characteristic of childhood pityriasis versicolor in our region. These 2 features are also reported in the literature. Childhood cases suggests the pathogenic factors involved in pityriasis versicolor should be reconsidered. Pityriasis versicolor should be included in the differential diagnosis of childhood hypopigmentation of the face.

[Hemopigmented villonodular synovitis of the knee. Apropos of 2 cases]. / La synovite villonodulaire hémopigmentée du genou. A propos de deux cas.

We report two cases of hemopigmented villonodular synovitis in two girls aged 5 years 9 months and 13 years respectively. This condition is a clinicopathologic entity of unknown pathogenesis and is exceedingly rare in childhood. Patients of both sexes can be affected, with no particular predominance. The clinical picture in our two patients consisted only in chronic hemarthrosis of the knee with occasionally tumor-like features. Arthrographic changes were not specific. Diagnosis was established upon arthrography and results of pathologic studies of biopsy specimens. Therapy of this condition is surgical and recurrences are infrequent.