[Treatment of keloid with phenol: a new therapy]. / La phénolisation: un nouveau traitement des chéloïdes.

PURPOSE: Evaluation of a new treatment for keloid scars using a 40% phenol solution in accordance with a predefined protocol. PATIENTS AND METHODS: A retrospective study was made of the files of 25 patients treated with phenol from June 2010 to March 2012. RESULTS: The keloids were located predominantly on the trunk (48%) and upper extremities (34%). The total number of keloids was 52, with a median size of 11.16 cm(2). Phenol was the sole and first-line treatment in 40% of cases. Patient adherence to the protocol of phenol was noted in 81% of cases. The mean number of phenol sessions was 14.2. Seventy-two percent of patients were satisfied with the treatment. Mean regression in keloid size of 75.5% was noted. A change in local keloid pigmentation was observed in 75% of patients. Local adverse reactions (itching, infection, ulceration) were seen in 6 patients (28.6%). No cases of systemic signs of phenol were observed. After mean follow-up of 12.8 months, no recurrence of keloids was noted. CONCLUSION: Use of phenols in the topical treatment of keloids appears valuable since it is easy to apply and provides good results with few side effects.

[Dermatomycosis due to Trichophyton verrucosum in Sfax-Tunisia]. / Les dermatomycoses àTrichophyton verrucosum à Sfax-Tunisie.

UNLABELLED: Trichophyton verrucosum is a zoophilic dermatophyte. It can be responsible of various clinical aspects especially inflammatory lesions of skin and scalp. The aim of this study was to determine the clinical and epidemiological characteristics of dermatophytosis due to T. verrucosum. PATIENTS AND METHODS: It is a retrospective study realized on 35,918 patients suspected to have superficial mycoses in a 13-year-period (from 1998 to 2010). RESULTS: T. verrucosum was isolated in 178 patients corresponding to 1.2% of all dermatophytosis. Ochraceum variety was the most frequent (60%), followed by album variety (40%). Frequency of isolated T. verrucosum increased passing from one case in 1998 to 37 cases in 2010. The mean age was 22.7 years (range: 1.5-71 years). A percentage of 74.2 of our patients were male and 61% were from urban regions. A percentage of 32.5 could link their clinical lesions to contact with an animal (mainly cattle and sheep). Other family members were infected by tinea in 7.3% of cases. Tinea corporis was the most frequent (62.2%), followed by tinea capitis (31.6%). Ten cases of sycosis, one case of tinea pedis and one case of pubic tinea were diagnosed. Lesions of skin were erythemato-squamous (82.5%) and pustulo-inflammatory (17.5%), affecting mainly upper limb (58.3%) and face (25.8%). For tinea capitis, lesions were squamous (30.8%) and pustulo-inflammatory (41%). Eleven cases of kerion celsi were diagnosed (28.2%). Patients were affected in one site (79.7%), two sites (16.9%) and three or more (3.4%). CONCLUSION: Dermatophytosis due to T. verrucosum is in recrudescence in our region. This finding may be explained by changing behaviors and activities of the population with a low socioeconomic level who kept a larger number of domestic animals at homes.

First case of Trichophyton soudanense isolated in Tunisia.

This is a first case of Trichophyton soudanense isolated from Ivoiran student in Tunisia. A 24-year-old man was addressed for extensive erythematous, scaling lesions. Examination disclosed tinea capitis, tinea corporis, tinea pedis, and onychomycosis of toenails and fingernails. Isolates were identified as Trichophyton soudanense on the basis of macroscopy and microscopy colony characteristics. The patient was treated with fluconazole, topical econazole, and ciclopiroxolamine varnish. Although T. soudanense was identified since the late 1950s outside the African continent especially in the North America, Brazil, Australia, and many European countries, this is the first case reported in Tunisia. Accessibility to our universities for African students makes possible the emergence of this dermatophyte.

[Atypical cutaneous Fusarium infection in an immunocompetent patient]. / Fusariose cutanée atypique chez un sujet immunocompétent.

INTRODUCTION: Fusarium are filamentous saprophytic brown fungi found in soil, on plants and outdoors. Invasive, necrotic fusarial skin infections are rare and are found in immunodepressed subjects. We report a case in a woman with no discernible immune deficiency. PATIENTS AND METHODS: A 24-year-old woman in good general health, pregnant at 34 weeks amenorrhoea, consulted for ulcerating, budding lesions with a necrotic centre over her entire body, but mainly localised on the cheeks and four limbs. The diagnosis of fusariosis due to Fusarium oxysporum was made on the basis of direct examination and repeated skin biopsy culture. All investigations were normal, and in particular, the patient had no detectable immune deficiency. Treatment was extremely difficult. The patient received amphotericin B, then voriconazole and terbinafine, ketoconazole and finally liposomal amphotericin. DISCUSSION: In immunocompetent subjects, fusarial species generally colonise the corneal layers of the skin. Our case was special in terms of the clinical aspect of the pseudotumoural lesions with a necrotic centre in an immunocompetent woman and in terms of the difficulty in treating her.

[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.

[Impetigo herpetiformis (two cases)]. / L'impétigo herpétiforme (deux cas).

UNLABELLED: The hepetiformis impetigo is a pustulosis dermatosis. It is rare and specific to pregnancy. It can menace the prognostic of the mother and the child. This entity is actually considered as a pustulor psoriasis. We report two cases. CASES REPORTS: Two patients, respectively, aged 24 and 21, presented erythematous, pustular and extensive plaques for which the diagnosis of hepetiformis impetigo was clinically and histologically posed. For the first patient, the lesions appeared in the two pregnancies and were more severe and foetal repercussions (oligoamnios and hypotrophy) during the second pregnancy. For the second patient, the pregnancy was complicated with premature interruption of the membrane, giving birth to a deed fetus and causing an aggravation of the cutaneous lesions. The treatment was oral steroid followed by acitretin for the first patient, however, for the second patient; the treatment was by local steroid associated with UVB during the pregnancy. Then, acitrétine was used and was efficient. CONCLUSION: Our two cases show the importance of gynaecological control in order to avoid complications which can be sometimes fatal. They also show the importance of local steroid associated with UVB which constitute another therapeutic alternative in the treatment of hepetiformis impetigo.

[Disseminated cutaneous leishmaniasis secondary to lymphoedema: two cases]. / Leishmaniose cutanée disséminée sur lymphoedème: deux cas.

BACKGROUND: Dissemination of cutaneous leishmaniasis may take various forms: satellite papules, sporotrichoid nodules and widespread papulonodular lesions (disseminated cutaneous leishmaniasis). We describe a particular clinical form of dissemination in two patients with erysipelas secondary to lymphoedema. PATIENTS AND METHODS: Case 1. A 75-year-old man with diabetes consulted for erysipelas of the leg secondary to lymphoedema. The site of entry was an infected cutaneous leishmaniasis lesion. The initial outcome was favourable under intravenous penicillin G treatment. Twelve days later, some fifty papulonodular lesions appeared and were strictly limited to the erythematous erysipelas plaque. PCR screening of papulonodular lesion smears for Leishman bodies was positive. Histological examination of skin biopsy samples showed lobular panniculitis. Case 2. A 64-year-old woman with diabetes presented erysipelas in the right upper limb secondary to lymphoedema scattered with multiple erythematous, infiltrated, papular lesions in a setting of cutaneous leishmaniasis lesions. PCR analysis of smears taken from the secondary nodular lesions demonstrated the presence of leishmaniasis, while histological analysis of biopsy samples revealed panniculitis. DISCUSSION: Disseminated cutaneous leishmaniasis is characterized by the appearance of multiple (>10) pleomorphic lesions on two or more noncontiguous areas of the body. Our two patients presented certain features of disseminated cutaneous leishmaniasis. However, they were unusual in terms of the strict localisation of nodular lesions to the erysipelas plaque. This particular aspect suggests haemolymphatic dissemination of the protozoan infection from the initial lesion as a result of local factors.

[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.

[Gingival metastasis in breast phyllodes tumor]. / Métastase gingivale d'un sarcome phyllode du sein.

BACKGROUND: The metastasis of oral cavity is rare. We report a gingival metastasis in the course of low grade phyllode sarcoma of the breast which is usually little metastatic. CASE-REPORT: A 44 year old woman was operated two years ago for a phyllod sarcoma of the breast histologically confirmed. She presented for a mandibular exophytic tumour associated with haemorrhagic, necrotic, ulcerated and bulking gingivitis surrounding at the level of the maxillary and mandibular gingiva. The examination revealed multiple nodular lesions of the trunk and the scalp. The histological examination confirmed the diagnosis of cutaneous and gingival metastasis of the phyllod sarcoma of the breast. The evolution was rapidly fatal. DISCUSSION: The gingival metastasis are rare tumours with a bad prognostic. Their diagnosis is based on clinical and histological arguments and must be made different from chronic gingivitis which can be associated.

[Adverse effects of intralesional Glucantime in the treatment of cutaneous leishmaniosis]. / Les effets indésirables du Glucantime en intralésionnel dans le traitement de la leishmaniose cutanée.

OBJECTIVE: The treatment of cutaneous leishmaniasis used in Tunisia is Glucantime. The aim of this retrospective study was to determine the adverse effects of intralesional Glucantime and to calculate the risk/benefit rate of this treatment. RESULTS: Adverse effects were observed in 14 cases (5%). For facial lesions, we observed facial staphylococci in 2 cases, stibio-intolerance in 1 case, and a palpebral subcutaneous nodule in 1 case. In limb lesions the complications were: sporotrichoid nodules in 5 cases, vagal malaise (1 case), pyodermitis (1 case), erysipelas (1 case), necrosis (1 case), and urticaria (1 case). COMMENTARY: The adverse effects of intralesional Glucantime are mostly infections, mainly observed in cephalic localization, and stibio-intolerance. For this reason, intralesional injection of Glucantime must be avoided in the cephalic region.

[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.

Twenty-nine cases of lupus vulgaris.

UNLABELLED: Cutaneous tuberculosis (TB) is a rare presentation of extrapulmonary TB. Lupus vulgaris (LV) is a common presentation of cutaneous TB. OBJECTIVE: We aimed to describe the epidemiological, clinical, paraclinical, therapeutic, and outcome features of LV in the region of Sfax, Tunisia. PATIENTS AND METHODS: We conducted a retrospective and descriptive study of LV case patients observed at the dermatology department of the Hédi Chaker Hospital (Sfax) over a 34-year period. RESULTS: A total of 88 cutaneous TB case patients were identified during the study period, including 29 patients presenting with LV. All patients had clinical features of the most common presentation of LV. The results of skin biopsies indicated tuberculoid granulomas without caseous necrosis. Patients received TB treatment. LV progressed to squamous cell carcinoma in one patient. CONCLUSION: In Tunisia, endemic country for TB, LV should be considered in patients presenting with an old skin lesion.

[Penile sporotrichoid cutaneous leishmaniasis]. / Leishmaniose sporotrichoïde de la verge.

The localisation of the cutaneous leishmaniasis of L. major at the penis level is rare, we report here a new observation. Mr K. R aged of 41, without known pathological background presented for 20 days a nodular lesion of the anterior face of the neck, 2 juxtaposed ulcerated nodular lesions of the left wrist. He presented also subcutaneous nodules ranged linearly and extended to the root of the penis. Theses lesions were covered by an erythematous or ulcerated skin. The smear made from the genital lesions of the penis confirmed the diagnosis of a cutaneous leishmaniasis. The evolution was favourable after a 21 days treatment by doxycyclin after an interval of one week. Our observation was specific by the localisation of the cutaneous leishmaniasis and by the clinical form. This shows that in our region cutaneous leishmaniasis is characterised by different clinical symptoms.

[Glucantime injection: benefit versus toxicity]. / Glucantime par voie parentérale: bénéfice versus toxicité

UNLABELLED: Glucantime is the most common stibied derivative used to treat cutaneous leishmaniasis (CL) in Tunisia; however adverse effects have been reported. OBJECTIVES: This retrospective study deals with the various adverse of intramuscular glucantime used for CL. RESULTS: Nineteen patients (21%) receiving intramuscular Glucantime developed adverse effects. 8 male and 11 female patients, mean age 45, ranging from 8 to 84 years were affected. adverse effects were: fever (3), arthralgia and myalgia (4), nausea and vomiting (2), erythema nodosum (1), acute renal failure (3 including 1 lethal case), hepatic cytolysis (1), skin rash (4), and inflammation of the injection site (1). CONCLUSION: Adverse effects of intramuscular Glucantime were relatively frequent in our series. Arthralgia, myalgia, and skin rash were not severe and disappeared when the treatment was stopped. Stibiointoxication cases, mainly acute renal failure, were serious.