B. Fazaa

Collision of primary malignant neoplasms on the skin: the connection between malignant melanoma and basal cell carcinoma.

Several studies have reported the association of cutaneous malignant melanomas (MM) with carcinomas. Collision malignancies cases from our files were retrieved. Among a series of 78,000 primary cutaneous cancers, 11 were collision tumors of MM with basal cell carcinoma and 106 were basosquamous carcinomas while no association was found between MM and squamous cell carcinomas. It is concluded that coexisting and confluent malignancies of the skin might not always be a random event.

Epidemiological and Etiological Study of Foot Mycosis in Tunisia

BACKGROUND Tinea pedis and onychomycosis are among the commonest fungal diseases in the world. Recently, there has been an increase in the numbers of fungal agents implicated in these conditions. OBJECTIVE To analyze the epidemiology of fungal foot diseases and to identify associated etiological factors in outpatients attending the Department of Dermatology of Charles Nicolle Hospital in Tunis, Tunisia. PATIENTS AND METHODS One hundred and forty eight patients were assessed for the presence of fungal foot diseases during the period between January and April 2009. The mean age was 41.5 years (range: 2-87 years) and sex ratio was 0.8. A complete dermatological examination was performed on all subjects, and specimens of the feet were taken from patients presenting signs of tinea pedis or onychomycosis for microscopy and fungal culture. RESULTS Fungal foot infection was suspected in 71 subjects, and the diagnosis was confirmed in 67 cases (45.3%) by positive microscopy or culture. Older age and family history of mycosis were predisposing factors for foot fungal infection. The condition was caused by dermatophytes in 57.1% of cases and Candida species in 35.7%. Trichophyton rubrum and Candida parapsilosis were the predominant dermatophyte and yeast species, respectively.

Low-Dose X-Ray Depilatory Treatment Induces Trichoblastic Tumors of the Scalp

Background: Depilatory radiotherapy for ringworm was largely used before antifungals were available. Patients who underwent this treatment are at high risk of developing scalp tumors or other cancers. The aim of this study was to characterize scalp tumors occurring after X-ray therapy for ringworm. Methods: We included cases of postradiotherapy scalp tumors recorded at the Dermatology Department of the Charles Nicolle Hospital, Tunis between 1988 and 2001. We recorded clinical descriptions and all cases were resubmitted to microscopic analysis. Results: Sixty-one tumors occurred in 33 men and 12 women with a mean age of 49.8 years. Radiodermatitis was present in 21% of patients. Tumors were basal cell carcinomas in 47 cases, trichoblastomas in 10 cases and trichoblastic carcinomas in 4 cases. Twelve patients had 2–5 tumors, with combinations of tumor types in 3 of them. Mean delay of onset of tumors after radiotherapy was 39.4 years in basal cell carcinoma cases, 38.3 years in trichoblastoma cases and 35.6 years in trichoblastic carcinoma cases. Conclusions: This series shows that although basal cell carcinoma is the most frequent tumor in this situation, trichoblastomas are common. We describe, for the first time, radio-induced trichoblastic carcinomas. Trichoblastic tumors have not yet been described in this context because this concept is relatively recent.

Dyskeratosis follicularis disease: case reports and review of the literature

Background  Dyskeratosis follicularis (Dariers disease) is rare autosomal dominant disease characterized by the loss of adhesion between epidermal cells and by abnormal keratinization.

Dissecting cellulitis of the scalp: response to isotretinoin

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The course and prognosis of pemphigus in 47 Tunisian patients.

Background  Pemphigus is a severe and life‐threatening autoimmune bullous dermatosis.

A Multicenter, Randomized, Open-Label, Controlled Study Comparing the Efficacy, Safety and Cost-Effectiveness of a Sequential Therapy with RV4104A Ointment, Ciclopiroxolamine Cream and Ciclopirox Film-Forming Solution with Amorolfine Nail Lacquer Alone in Dermatophytic Onychomycosis

Background: The efficacy of topical antifungals is controversial. Objective: To compare the efficacy and safety of a sequential (SEQ) treatment with chemical nail avulsion and topical antifungals to amorolfine nail lacquer in dermatophytic onychomycosis. Methods: This was a randomized, parallel-group, controlled study comparing a 36-week SEQ treatment with chemical nail avulsion with RV4104A ointment (class I medical device containing 40% urea) followed by ciclopirox cream for 8 weeks and ciclopirox nail lacquer for 25 weeks (SEQ group) to amorolfine nail lacquer for 36 weeks (AMO group). Patients had to have a big toenail onychomycosis, sparing the matrix. The primary efficacy criterion was complete cure at week 48. A cost-effectiveness analysis was performed. Results: A total of 142 patients were randomized. The complete cure rate at week 48 was significantly higher in the SEQ group than in the AMO group (36.6 vs. 12.7%, p = 0.001). Clinical cure at week 48 was observed in 53.5% of patients in the SEQ group versus 17% in the AMO group (p < 0.01). The cost of cure per patient was 50% lower with SEQ treatment (EUR 33) compared with amorolfine (EUR 76). Conclusion: A treatment of onychomycosis comprising chemical avulsion of the pathological nail, ciclopirox cream and nail lacquer is significantly more effective than amorolfine nail lacquer.

Nevus lipomatosus cutaneous superficialis: Report of eight cases.

IntroductionNevus lipomatosus cutaneous superficialis (NLCS) is a rare benign hamartomatous skin tumor characterized by dermal deposition of mature adipose tissue. It’s classified in two types: the classical form with multiple soft, pedunculated, cerebriform papules and nodules that coalesce into plaques, and the solitary form that consists of a solitary papule or nodule. In this study, eight cases of NLCS are reported.MethodsThe study was a retrospective case series including all patients with histopathologically documented NLCS who attended the Dermatology Department of Charles Nicolle hospital between January 1997 and December 2010. The objective of our study was to determine the epidemioclinical characteristics, the histopathologic features, and the treatment of this hamartoma. Patients included three males and five females aged between 7 and 41 years.ResultsIn four cases hamartoma was present since childhood, and in the other four cases it appeared in the third and fourth decades. Classical form was noted in seven cases and the solitary form in one case. Lesions involved limbs in four patients and trunk in four patients. Seven patients underwent surgical excision, and for one case no treatment was proposed.ConclusionThe multiple or classical form is largely predominant in our study. Habitually, NLCS has an asymptomatic course. Treatment is usually not necessary unless for cosmetic reasons; surgical excision is curative and recurrence after is rare.

Acquired erythroderma in adults: a clinical and prognostic study

Background  Erythroderma is a severe syndrome and prognostic studies are rare in the literature.

Pathologie cutanée chez le sujet âgé : Étude multicentrique tunisienne

Resume Introduction Avec le vieillissement progressif des populations, les problemes de sante geriatrique sont devenus l’une des preoccupations majeures des autorites sanitaires. Les donnees concernant les affections dermatologiques chez le sujet âge sont cependant rares. Le but de ce travail etait de degager le profil de la pathologie cutanee motivant une consultation du sujet âge en dermatologie (secteurs public et prive) dans la region de Tunis. Malades et methodes Il s’agissait d’une etude prospective, multicentrique et descriptive portant sur tous les nouveaux diagnostics d’affections cutanees colliges durant une annee (juin 1999-juillet 2000), en consultation de dermatologie, chez les patients âges de plus de 65 ans. Cette etude a concerne l’activite de 11 dermatologistes exercant a Tunis, dans differentes structures publiques et privees, qui ont collige de maniere exhaustive tous les nouveaux diagnostics d’affections cutanees vues a leur consultation. Resultats 1 518 malades ont ete examines avec un total de 1 550 nouveaux diagnostics. L’âge moyen etait de 72, 6 ans avec un sex-ratio homme/femme = 1,41. Les mycoses representaient le principal motif de consultation (16,9 p. 100), suivies par les tumeurs 12,8 p. 100 (benignes 63,3 p. 100), l’eczema (11,9 p. 100), les troubles de la keratinisation (8,7 p. 100), les dermatoses bacteriennes (8,7 p. 100), les dermatoses virales (6,8 p. 100) et le prurit (6,4 p. 100). Les mycoses etaient essentiellement representees par les intertrigos interorteils et les onychomycoses. Les carcinomes basocellulaires et les kystes epidermoides representaient respectivement les tumeurs malignes et benignes les plus frequentes. Discussion Cette etude montre la frequence des mycoses, des tumeurs benignes et de l’eczema chez les sujets âges. Ceci rejoint les resultats d’autres etudes qui rapportent cependant une predominance de l’eczema. La frequence elevee des mycoses dans notre etude peut s’expliquer par les conditions climatiques (chaleur, humidite). Le prurit semble un motif de consultation frequent chez le sujet âge. Les affections cutanees constituent une cause importante de morbidite chez le sujet âge.INTRODUCTION With progressive aging of populations, geriatric health care has become a major international issue for health authorities. However, little data is available about geriatric skin diseases. The aim of this study is to determine the pattern of skin disorders among elderly patients seen in private and public skin outpatient clinics in Tunis. PATIENTS AND METHODS We performed a prospective, multicentre and descriptive study of all new skin diseases diagnosed in dermatological outpatients aged over 65 years. This study lasted one year (June 1999 to July 2000) and evaluated the activity of eleven Tunisian dermatologists in private or public practice, who collated all cases of skin diseases diagnosed in their practices. RESULTS A total of 1518 patients with 1550 new diagnoses were examined. Mean age was 72.6 years with a sex M/F -ratio of 1.41. Fungal infections were the most common conditions (16.9%), followed by tumors 12.8% (benign 63.3%), eczema (11.9%), keratinization anomalies (8.7%), bacterial infections (8.7%), viral infections (6.8%) and pruritus (6.4%). Fungal infections were mainly represented by toe-web intertrigo and onychomycosis. Basal cell carcinoma and epidermoid cysts were the most common malignant and benign tumors respectively. DISCUSSION This study reflects the frequency of mycoses, benign tumors and eczema in elderly patients. This is consistent with the results of other studies of the literature showing eczema as the predominant skin disease. The high prevalence of mycosis in our study may be explained by climatic conditions (heat, moisture). Pruritus seems to be frequent in geriatric patients. Skin disorders are an important source of morbidity in elderly patients.