Ines Zaraa

Inflammatory Tinea capitis: a 12‐year study and a review of the literature

Inflammatory Tinea capitis (TC) is a rare form of TC. The aim of this study was to review epidemiological, clinical and mycological profile of inflammatory TC. We present a retrospective study (1999–2010), enrolled all the cases of inflammatory TC observed at a referral hospital in the northern Tunisia. One hundred and twenty‐one patients with inflammatory TC, 83 male patients (68.6%) and 38 female patients (31.4%) were enrolled. The mean age was about 8 years. A majority of TC (71.9%) were in patients lesser than 10 years of age. Positive family history and contact with animals were noted in seven and 35 cases respectively. Direct examination was positive in 110 cases (59 ectothrix, 51 endothrix) and positive cultures were obtained in 105 patients (49 Trichophyton violaceum, 31 Microsporum canis, 13 Trichophyton interdigitale complex, 12 Trichophyton verrucosum). Systemic treatment was carried out in 115 patients with griseofulvin, in one with terbinafine. A complete recovery was noted in 88 cases; and persistent alopecia in 28 cases. The inflammatory TC is rare, but more common in rural families. The disease mostly affected male genders (68.6%) and T. violaceum remains the common pathogen of inflammatory TC in northern Tunisia.

Lichen planus pemphigoides: four new cases and a review of the literature

Lichen planus pemphigoides (LPP) is a rare autoimmune blistering disease. It appears to be combination of lichen planus and bullous pemphigoid. We describe four new cases of LPP and discuss the epidemiological, clinical, pathological, and therapeutic features of this singular association through a review of the 74 published cases within the English literature. We report four cases of LPP (three women aged respectively 47, 51, and 53 years old, and a 53‐year‐old man). All patients presented with bullae on lichenoid and normal skin, predominately on the extremities. The diagnosis was confirmed by immunohistological findings. Our patients were treated with oral corticosteroids with a good response. Our review of the literature of 78 cases of LPP (65 adults and 13 children) showed that it involved adults (mean age: 54 years), with a slight female preponderance. A mean lag time between LP and the development of LPP was 8.3 months. LPP is characterized by developing blisters on lichenoid lesions and on uninvolved skin with more acral distribution of bullous lesions. Involvement of palms and soles was more frequent in children. The diagnosis is based on pathological and immunological confrontation. LPP is usually idiopathic, but some cases were reported in association with various drugs. There have also been reports of association with internal malignancy. Most cases of LPP are successfully treated with systemic corticosteroids. In most cases, the prognosis was good.

Spectrum of autoimmune blistering dermatoses in Tunisia: an 11-year study and a review of the literature

Background  Autoimmune bullous dermatoses (ABD) are a rare but significant group of cutaneous disorders posing great diagnostic and therapeutic challenges to the treating dermatologist. Few surveys have been carried out to describe the whole spectrum of ABD in a region.

Association analysis of LCE3C–LCE3B deletion in Tunisian psoriatic population

An association between a common deletion comprising the late cornified envelope LCE3B and LCE3C genes (LCE3C_LCE3B-del) and psoriasis has been reported in Caucasian and Asian populations. To investigate whether this deletion plays a role in the genetic of psoriasis in Tunisian population, we determined the LCE3C_LCE3B-del genotype in 180 Ps patients and 208 healthy controls from different regions of Tunisia. The LCE3B and LCE3C gene variant was determined in the patients through PCR amplification and the SPSS software package. The frequency of the LCE3C_LCE3B-del was similar between patients and healthy controls. Subanalyses by family history revealed that the frequency of LCE3C_LCE3B-del was significantly higher in patients with a positive family history than in control individuals, as well as in individuals with a positive family history versus those without in the case cohort. However, no significant difference was observed between psoriatic patients with no family history and controls. We also evaluated the relationship between LCE3C_LCE3B-del and PSORS1. No significant epistatic effect was observed suggesting that there was no significant epistasis of the two loci in the Tunisian population. Our findings indicate that the LCE3C_LCE3B-del might play a role in familial psoriasis in the Tunisian population.

Systemic lupus erythematosus induced by interferon β1 therapy in a patient with multiple sclerosis

Drug‐induced lupus erythematosus is defined as a lupus‐like syndrome temporally related to a drug exposure. We report a 34‐year‐old woman with multiple sclerosis who developed, while being treated with interferon β‐1a, myalgia and associated with wrist synovitis. Clinical and immunologic investigations were in favor of systemic lupus erythematosus. Interferon therapy was maintained. Under corticosteroids and antipaludeen treatment, the patient did not develop any other lupic manifestations.

Severe adverse cutaneous drug eruptions: epidemiological and clinical features

Introduction  Adverse cutaneous drug reactions (ACDR) are common, and some can be lethal. The aim of our study was to discuss the epidemiological and clinical features of severe ACDR.

Simvastatin-induced dermatomyositis in a 50-year-old man.

Dermatomyositis (DM) is a rare inflammatory autoimmune disease for which an iatrogenic origin has been described in a few cases. The authors report a case of DM occurring after simvastatin intake. A 50-year-old male sought medical attention for a photodistributed rash and considerable muscular weakness present for 3 months. One year earlier, simvastatin had been introduced. Serum creatine kinase levels were elevated. Histological examination of a muscle biopsy was consistent with a diagnosis of DM. Investigation for neoplasia and associated autoimmune disease proved negative. All clinical and laboratory abnormalities diminished corticosteroid therapy (1 mg/kg/day). Case reports have suggested that lipid-lowering drugs, especially statins, could induce or reveal chronic muscle diseases. In statins myopathy, reduction of coenzyme Q has been discussed as a key mechanism. Our case of DM in a patient receiving simvastatin adds to the previous reported cases in the literature and highlights the potential role of statins as triggers of immune systemic diseases.

IgG/IgA pemphigus with IgG and IgA antidesmoglein 3 antibodies and IgA antidesmoglein 1 antibodies detected by enzyme-linked immunosorbent assay: a case report and review of the literature

IgA pemphigus represents a group of autoimmune blistering skin diseases characterized by intraepidermal neutrophilic pustules, intercellular IgA antibodies, or circulating IgA antibodies to keratinocyte surfaces. Currently, it is seen as a distinct subset of pemphigus with particular clinical and immunopathologic pictures. As it is a newly defined disorder, its frequency is unknown but surely rare. Even less reported is the pemphigus with deposits of both IgG and IgA on keratinocyte cell surfaces; a new entity described in the recent literature as IgG and IgA pemphigus. In this study, we report the first Tunisian case with IgG ⁄ IgA pemphigus and try to discuss the clinical and immunopathological features of this new type of pemphigus.

Childhood and adult cutaneous leishmaniasis in Tunisia.

Cutaneous leishmaniasis (CL) is an infection caused by various species of Leishmania protozoa, which are mainly transmitted by the bite of Phlebotomine sandflies. It occurs widely throughout Africa, Asia, South America, the Middle East, and the Mediterranean region. In Tunisia, three epidemic clinical forms of CL are recognized. The most frequent one is zoonotic cutaneous leishmaniasis caused by Leishmania major MON-25. It is spreading in the center and south of the country. The second form is the anthroponotic CL occurring in the south-east of Tunisia and caused by Leishmania killicki and the final type is sporadic cutaneous leishmaniasis (SCL) occurring in north of Tunisia caused by Leishmania infantum. The leishmaniases are one of the so-called neglected tropical diseases. Whilst not fatal, CL can lead to significant morbidity as well as social stigma. CL can arise at any age and it often causes cosmetic disfiguration. The aim of this study was to describe the epidemiological, clinical, and therapeutic features of CL in Tunisia and to compare the clinical features of childhood and adult CL.

Human herpesvirus-8 and hepatitis B and C virus infections in pemphigus.

we obtained clinical resolution. No recurrence was observed over the 11-month period. Pseudochromhidrosis is characterized by the secretion of colorless sweat, which becomes colored when it reaches the skin surface because of contact with dyes, exo-genous pigments, or products derived from chromogenic microorganisms (corynebacteria, Bacillus spp., Piedraia, Malassezia furfur). The differential diagnosis includes chromhidrosis, where it produces colored sweat from eccrine or apocrine sweat glands. The apocrine form is caused by the increased concentration or a change in the oxidation state of lipofuscin, the pigment normally present in the apocrine sweat. In the eccrine form, less commonly, sweat glands release sweat in the water-soluble pigments derived from the ingestion of drugs or dyes. Pseudochromhidrosis, eccrine chromhidrosis, and apocrine chromhidrosis differ not only in pathogenesis but also in terms of prognosis and treatment: in the first two forms, we can achieve complete healing by removing the cause of the pigmentation of the sweat; in the last one, we can act only with symptomatic drugs, such as pilocarpine, and reduce or inhibit sweating. Apocrine chromhidrosis is a chronic disease that occurs in puberty; when under hormonal stimulation the apocrine secretion activates and tends to resolve spontaneously in adulthood, when physiologically apocrine secretion is reduced. In our case, videodermoscopy was of great help, which allowed us to evaluate the distribution of pigment on the skin surface.