M. Mseddi

Annular Atrophic Lichen planus

Annular lesions occur in 10% of lichen planus (LP) cases. Usually they coexist with typical LP lesions. However, purely annular atrophic LP (AALP) is possibly a very rare form of LP. A 60-year-old woman with a 5-year history of diabetes, a high blood pressure and bilateral cataract had had, for 1 year, an annular pigmented plaque, measuring 5 cm in diameter, well delineated, with a squamous papular border and an atrophic centre. The lesion was located in the epigastric area (fig. 1). The clinical aspect at the onset was an itchy papular lesion, which increased in size, with a centrifugal extension and a secondary central atrophy. No other abnormalities were noticed. Screening for fungal infection was negative. Two skin biopsies were taken. Histopathologic examination of the centre of the lesion showed a thin epidermis with flattened rete ridges (fig. 2). The papillar dermis was thick and fibrous with numerous dilated capillaries and numerous melanophages. The histopathologic examination of the border showed a typical LP picture (fig. 3). On orcein staining, elastic fibres were absent in the superficial dermis in the two biopsies. Topical steroids led to a clinical improvement of skin atrophy with persistent pigmented maculae.

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.Introduction Le lupus erythemateux discoide est une dermatose auto-immune touchant habituellement le visage et le cuir chevelu, la localisation palpebrale etant rare. Materiels et methodes Le but de ce travail etait d’illustrer les caracteristiques cliniques et therapeutiques de l’atteinte palpebrale du lupus discoide a travers une serie de 9 patients avec des localisations palpebrales de lupus discoide. Resultats Les lesions palpebrales etaient plus frequentes au niveau de la paupiere inferieure (7 cas). Chez une patiente âgee de 34 ans, l’atteinte palpebrale superieure etait l’unique manifestation de la maladie lupique. Dans les autres cas, la blepharite etait associee a des lesions typiques de lupus discoide a distance. Les antipaludeens de synthese indiques dans 7 cas ont ete efficaces associes a une corticotherapie locale et une photo protection. Discussion Les localisations palpebrales du lupus discoide sont rares. Ces lesions palpebrales sont plus frequentes au niveau de la paupiere inferieure. Il est important de diagnostiquer un lupus discoide au niveau d’une paupiere, une erreur diagnostique (formes isolees) etant cause d’un retard de traitement et de sequelles fonctionnelles parfois importantes. Les antipaludeens de synthese sont remarquablement efficaces.

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.

Manifestations ophtalmologiques de la hyalinose cutanéo-muqueuse

Resume Introduction La hyalinose cutaneo-muqueuse (HCM) ou lipoproteinose d’Urbach-Wiethe est une affection rare a transmission autosomique recessive. Elle est caracterisee par un depot d’une substance hyaline au niveau de la peau et des muqueuses. Les manifestations ophtalmologiques sont frequentes pouvant conditionner le pronostic visuel. Observation Il s’agit d’une patiente âgee de 28 ans qui a eu des lesions vesiculo-bulleuses de la face evoluant vers des cicatrices varioliformes associees a un raucite de la voix. Elle avait une atteinte oculaire unilaterale gauche sous forme d’un depot hyalin limbique, irien et trabeculaire qui s’est complique d’une uveite, d’une cataracte et d’un glaucome ayant entraine la perte fonctionnelle de l’œil. L’etude histologique d’une biopsie cutanee concluait a une hyalinose cutaneo-muqueuse. Discussion L’atteinte palpebrale au cours de la hyalinose cutaneo-muqueuse est classique particulierement la blepharose moniliforme qui est pathognomonique. Ce cas se caracterisait par une atteinte intra-oculaire rare a type d’uveite. Par ailleurs, on peut trouver des depots corneo-conjonctivaux, trabeculaires ou au niveau de la membrane de Bruch. L’examen histologique des biopsies cutanee et/ou conjonctivale confirme le diagnostic. Les moyens therapeutiques sont assez limites.

Acute generalized exanthematous pustulosis induced by piroxicam: a case report.

Acute generalized exanthematous pustulosis (AGEP) is a severe adverse cutaneous reaction characterized by an acute episode of sterile pustules over erythematous-edematous skin. The main triggering drugs are antibiotics, mainly beta-lactam and macrolides. Non-steroid anti-inflammatory drugs may rarely be responsible. We describe a case of a woman with AGEP, who presented with generalized pustulosis lesions after the use of piroxicam for renal colic. The diagnosis was confirmed by the clinical and histological correlations and the dermatosis resolved after withdrawal of the drug.

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.

Mémoire originalLa phénolisation : un nouveau traitement des chéloïdesTreatment of keloid with phenol: A new therapy

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.

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.

Atteinte oculaire au cours du pseudoxanthome élastique

Resume Introduction Le pseudoxanthome elastique (PXE) est une affection hereditaire caracterisee par une atteinte cutanee, oculaire et cardiovasculaire. Nous avons analyse les atteintes oculaires des cas de PXE observes dans notre hopital. Methodes Onze patients atteints de PXE ont eu un examen ophtalmologique a la recherche de manifestations oculaires. Resultats Tous les patients avaient des manifestations oculaires. Il s’agissait de stries angioides chez 7 patients (63%). Quatre patients avaient un aspect en peau d’orange du fond d’œil. Deux patients avaient une atteinte maculaire et un patient avait des drusen du nerf optique. Conclusion L’examen ophtalmologique doit etre systematique et regulier pour mettre en evidence ces manifestations et diagnostiquer les complications rapidement.

Lymphome B cutané au cours d’une sclérodermie systémique

BackgroundSystemic sclerosis seems to be a predisposing factor malignant neoplasm, particularly lung and breast carcinomas. The occurrence of malignant lymphoma in this disease is rare. We report a case showing the recurrence of cutaneous B-cell lymphoma during a systemic sclerosis.Case reportA 56 year-old woman presented with a systemic sclerosis with Raynaud’s phenomenon, sclerodactyly, pulmonary and esophageal involvements. The antinuclear antibodies were positive with a titer of 1/320 and the antiScl70 antibodies were also positive. Ten years after the onset of her disease, the patient developed a cutaneous B-cell lymphoma of the left supra orbital region. Regression of the cutaneous lesion was obtained after chemotherapy followed by local radiation therapy. However, six years later, she developed a recurrence of the cutaneous B-cell lymphoma in both cheeks.DiscussionThe association of systemic sclerosis and malignant lymphoma is rare. In this rheumatic disease, there is a predominance of B-cell malignant lymphoma. The lack of course correlation in the many cases described suggests the occasional nature of this association. However, the improvement of the scleroderma and the lymphoma, reported by some authors, suggests a close link between the two diseases. Autologous stem cell transplantation and rituximab may be proposed in the treatment of recurrent malignant lymphoma associated with systemic sclerosis.RésuméIntroductionLa sclérodermie systémique semble prédisposer à la survenue des néoplasies. Il s’agit essentiellement de carcinomes bronchiques et de carcinomes mammaires. La survenue du lymphome malin au cours de cette connectivite reste rare. Nous rapportons un cas de sclérodermie systémique qui se complique d’un lymphome B cutané à grandes cellules.ObservationUne femme âgée de 56 ans, qui présente une sclérodermie systémique avec un phénomène de Raynaud, une sclérodactylie, une atteinte pulmonaire et oesophagienne. Dix ans après le début de sa maladie, la patiente a présenté un lymphome B cutané à grandes cellules au niveau de la région sus-orbitaire gauche. Elle a bénéficié d’une chimiothérapie, suivie d’une radiothérapie locale avec une régression de la lésion cutanée. L’évolution ultérieure était marquée par la récidive du lymphome B cutané au niveau des deux joues après cinq ans et demi.DiscussionL’association d’une sclérodermie systémique et d’un lymphome malin est rare. Les lymphomesmalins non hodgkiniens de phénotype B prédominent au cours de cette connectivite. L’absence de corrélation évolutive des deux pathologies dans la plupart des cas rapportés peut être en faveur du caractè re fortuit de cette association. Néanmoins, une étroite relation entre les deux affections a été suggérée devant leur évolution parfois parallèle après chimiothérapie. L’autogreffe de la moelle et le rituximab peuvent constituer des alternatives thérapeutiques intéressantes en cas de récidive d’un lymphome malin au cours d’une sclérodermie systémique.