Houda Hammami

Radiotherapy‐induced pemphigus vulgaris with autoantibodies targeting a 110 kDa epidermal antigen

Background  Pemphigus is an autoimmune intraepidermal blistering disease mediated by autoantibodies targeting desmosomes. It can be induced by many triggers, such as ionizing radiation.

Should we continue to indicate meglumine antimoniate as first-line treatment for cutaneous leishmaniasis in Tunisia.

Meglumine antimoniate compounds have been the mainstay of treatment for cutaneous leishmaniasis (CL) for decades. We propose to evaluate the place of these drugs in this indication in Tunisia. We retrospectively reviewed medical records of 67 patients treated for (CL) using meglumine antimoniate at a dose of 20 mg/kg/day for 15 day from 1998 to 2010. Clinical and laboratory data, tolerance, and outcome were precised. Side effects were recorded in 17 among 67 patients (25%). The average age was 44.4 years (2–86 years). Antimony intolerance events occurred in 11 patients, stibio‐intoxication events in nine cases, and the both type of antimony adverse effects were observed in three patients. Fever was the most frequent complication of antimony intolerance (five cases), followed by cough (three cases), rash (two cases), injection site erythema (two cases), musculoskeletal pain (one case), asthenia (one case), and vomiting (one case). Signs of stibio‐intoxication were asymptomatic elevation of amylase level (four cases), hepatic cytolysis (three cases), hematologic toxicity (three cases), and acute toxic kidney failure (one case). Meglumine antimoniate was stopped in 13 cases. Systemic administration of pentavalent antimonials in the treatment of CL has been associated with severe adverse effects. CL observed in Tunisia is a self‐healing dermatosis that never induces sequela; therefore, other therapies such as topical treatment or cryotherapy should be considered.

Insect bite-like reaction associated with the relapse of non-Hodgkin B cell-lymphoma

Auteur(s) : Rym Benmously1, Houda Hammami1, Mondher Rouatbi1, Achraf Debbiche2, Adnane Souissi2, Incaf Mokhtar1, Sammy Fenniche1 1Dermatology Department, Habib Thameur Hospital, 8, Ali Ben Ayed Sreet Montfleury-1008 Tunis-Tunisia 2Histopathology Department, Habib Thameur Hospital, Tunis An exaggerated reaction to an insect bite is a non specific phenomenon described mostly with chronic lymphocytic leukemia [1]. This dermatosis has been described in about 40 patients affected by lymphoproliferative [...]

Lupoid leishmaniasis of the nose responding well to cryotherapy

A 23-year-old girl from Tunisia presented to our dermatology department in May 2007 with a 9-month history of a slowly enlarging, asymptomatic nodule of the nose. Her medical history was unremarkable. Clinical examination showed a 2-cm diameter, well-demarcated, granulomatous nodular lesion of the tip of the nose (FIG. 1A). The lesion was painless and had an erythematous, large, raised border with numerous papules and a mild scaling (FIG. 1B).There was no cervical lymphadenopathy, and no evidence of organomegaly. The hematologic and biochemical studies were all within normal limits. A direct smear from the exudate of fluid obtained by needle aspiration of the lupoid lesion was stained with Giemsa for leishmania parasite. A biopsy was performed, and a part of the tissue was used for culture. The smear showed leishmania bodies, and the culture was negative. The histopathological examination showed hyperkeratosis, parakeratosis, and acanthosis within the epidermis. The dermis was filled with aggregates of large, pink histiocytes and mixed chronic inflammatory cells. The histiocytes contained dot-like organisms typical of CL (FIG. 1C). The patient was admitted for a daily intramuscular injection of meglumine antimoniate (60 mg/kg), but no improvement was obtained 2 weeks later. Then, she received ketoconazole 200 mg daily for 1 month. The patient was controlled 4 months later, and the lesion still showed no evidence of healing. She was admitted again for a second 15-day course of intramuscular injection of meglumine antimoniate (60 mg/kg). After 2 months, only a mild improvement was noted. The present authors attempted to identify the parasite agent of this resistant case of CL by polymerase chain reaction (PCR) method. Unfortunately, the result of PCR yielded negative. The cutaneous lesion was disfiguring and had a psychosocial impact on our patient. So, the present authors decided to try cryotherapy. A handheld unit for spraying (Cry-ac, Brymill, CA) with a 1-mm nozzle was used to spray liquid nitrogen on the lesion. The spraying was performed at a 2-cm distance between the nozzle and the lesion for 10–15 seconds until the freezing reached up to a few millimeters within the healthy skin surrounding the lesion. Applications were repeated until the entire lesion was included. Cryotherapy was performed every 2 weeks.The lesion healed completely after six sessions with very good cosmetic result (FIG. 2). The patient was followed-up for 1 year and showed no signs of recurrence. LL, also known as chronic or relapsing leishmaniasis, is usually resistant to conventional therapies. Diagnosis of LL may be difficult if no parasites are detected. In fact, leishmaniasis amastigotes are frequently absent on microscopy, and culture for leishmaniasis is frequently negative. PCR method had a sensitivity of about 45.5% in LL. There is no standardized treatment for this condition. Treatment options include local injection of amphotericin B (1); combination of systemic meglumine antimoniate and allopurinol (2); triple therapy with paramomycin, cryotherapy, and intralesional meglumine antimoniate (3); combination therapy of topical trichloroacetic acid (TCA) and systemic meglumine antimoniate (4); and carbon dioxide laser (5). These wide ranges of therapies may be expensive, toxic, and not so effective in the treatment of LL. Our patient, who responded

Unilateral erythema nodosum and homolateral cutaneous leishmaniasis

OBJECTIVE The authors wanted to report an uncommon etiology of erythema nodosum. CASE REPORT A 45-year-old woman presented with numerous encrusted nodular lesions on the left leg and arm. Leishmania was identified after a parasitological examination. Subcutaneous erythematous nodules developed later on the same leg. Erythema nodosum was diagnosed with a biopsy of the nodules. The patient was treated with systemic meglumine 60 mg/kg per day for 13 days. All lesions improved under treatment. DISCUSSION This was the first reported case of unilateral erythema nodosum with cutaneous leishmaniasis. Clinical and laboratory exams were in the range of normal and led the authors to exclude common causes of erythema nodosum. Subcutaneous nodules occurred before the beginning of treatment with meglumine. Thus, drug allergy (previously reported) was excluded as an etiology of EN.

Significant alleviation of Darier's disease with fractional CO2 laser.

Abstract Dariers disease (DD) is a dominantly inherited genodermatosis with highly variable expression. It is characterized by symmetrical hyperkeratotic papules affecting seborrheic areas and extremities. The existence of unsightly lesions could lead to discomfort and social handicap. Conventional treatment consists of topical and systemic steroids and/or retinoids alleviating DD. Ablative lasers also have been used to treat these conditions with variable results and side effects. To the best of our knowledge, fractional CO2 laser has never been used to treat DD. We present a case of a 36-year-old woman with verrucous and hyperkeratotic plaques of the forehead significantly improved after two sessions of fractional CO2 laser treatment. Neither scars nor pigmentary disorders were noted.

Long-pulsed Nd:YAG laser in the treatment of facial hypertrichosis during topical minoxidil therapy.

Abstract Hypertrichosis is a well-recognized adverse effect of therapy with either oral or topical minoxidil. We report a case of fronto-temporal hypertrichosis occurring in an 8-year-old girl treated for patchy alopecia areata of the frontal area of the scalp with 2% minoxidil solution. After failure of 5-months minoxidil-discontinuation, hair removal with Nd:YAG laser (1064 nm line) (Smartepil II, Deka) was tested leading to complete resolution within 2 sessions.

Subungueal haemorrhages following docetaxel (taxotere) treatment.

INTRODUCTION Docetaxel belongs to the taxane group of chemotherapeutic agents used in the management of various malignant diseases. Nail changes as a complication of such treatment are observed in about 44%. Subungual haemorrhages (SH), are very rare following docetaxel therapy and only a few cases have been previously reported. OBSERVATION An 80-year-old man suffering from prostate adenocarcinoma was treated with a 3-weekly cure of docetaxel started 3 months earlier. Nail changes occurred after the 5th cycle of docetaxel. Clinical examination revealed orange discoloration of the nail plates, subungueal haemorrhages (SH) and onycholysis involving nails of all the digits and toenails of both hands and feet. These features were highly suggestive of nail toxicity following docetaxel therapy. DISCUSSION Nail changes secondary to Taxane chemotherapy includes nail bed dyschromia, onycholysis, red or orange Beaus lines and subungueal hyperkeratosis. SH, as reported in this case, is related to the cumulative dose of docetaxel and should not be attributed to other systemic diseases. Clinicians should recognize this complication to avoid abusive treatment or investigations and inform the patients about the possibility of nail changes secondary to taxane drugs.

My Daughter Has Thin and Short Hair

A 16-year-old female presented to our dermatology department for a history of congenital hypotrichosis. She was born from a consanguineous marriage. Her sister and brother also suffered from sparse and fragile hair. Dermatologic examination revealed diffuse hypotrichosis with sparse, short, and broken hair on her entire scalp (Fig. 1). Her hypotrichosis was more pronounced on her occipital scalp. She also had small keratotic papules on her occipital region. Her eyebrows and eyelashes were not affected. There were no tooth nor nail abnormalities. There was no evidence of mental retardation, epilepsy, or systemic diseases.

H syndrome: Clinical, histological and genetic investigation in Tunisian patients

H syndrome is a rare autosomal recessive disorder with characteristic dermatological findings consisting of hyperpigmentation and hypertrichosis patches mainly located on the inner thighs and multisystemic involvement including hepatosplenomegaly, hearing loss, heart abnormalities and hypogonadism. The aim of this study was to conduct a clinical and genetic investigation in five unrelated Tunisian patients with suspected H syndrome. Hence, genetic analysis of the SLC29A3 gene was performed for four patients with a clinical diagnosis of H syndrome. We identified a novel frame‐shift mutation in the SLC29A3 gene in a female patient with a severe clinical presentation. Furthermore, we report two mutations previously described, the p.R363Q mutation in a male patient and the p.P324L mutation in two patients of different age and sex. This paper extends the mutation spectrum of H syndrome by reporting a novel frame‐shift mutation, the p.S15Pfs*86 in exon 2 of SLC29A3 gene and emphasizes the relevance of genetic testing for its considerable implications in early diagnosis and clinical management.