Rym Benmously Mlika

Pyoderma gangrenosum: a report of 21 cases.

Background Pyoderma gangrenosum (PG) is an uncommon, destructive, cutaneous ulceration, belonging to the neutrophilic disease spectrum. It is associated with systemic disease in 50% of cases.

Tongue hyperpigmentation during PEG-interferon-alfa/ribavirin therapy in a non-Caucasian patient with chronic hepatitis C: a case report and review of the literature

Morphol 2002; 10: 7–14. 3 Wu YH, Chen HC, Hsiao PF, et al. Hydroa vacciniforme-like Epstein-Barr virus-associated monoclonal T-lymphoproliferative disorder in a child. Int J Dermatol 2007; 46: 1081–1086. 4 Quintanilla-Martinez L, Kimura H, Jaffe ES. EBV-positive T-cell lymphoproliferative disorders of childhood. In: Swerdlow SH, Campo E, Harris NL, et al., eds. WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues. Lyon: IARC Press, 2008: 278–280. 5 Oono T, Arata J, Masuda T, Ohtsuki Y. Coexistence of hydroa vacciniforme and malignant lymphoma. Arch Dermatol 1986; 122: 1306–1309. 6 Feng S, Jin P, Zeng X. Hydroa vacciniforme-like primary cutaneous CD8-positive T-cell lymphoma. Eur J Dermatol 2008; 18: 364–365. 7 Doeden K, Hernan MK, Perez E, et al. Hydroa-like lymphoma with CD56 expression. J Cutan Pathol 2008; 35: 488–494. 8 Xu Z, Lian S. Epstein-Barr virus-associated hydroa vacciniforme-like cutaneous lymphoma in seven Chinese children. Pediatr Dermatol 2010; 27: 463–469. 9 Cohen JI, Kimura H, Nakamura S, et al. Epstein-Barr virus-associated lymphoproliferative disease in nonimmunocompromised hosts: a status report and summary of an international meeting, 8–9 September 2008. Ann Oncol 2009; 20: 1472–1482. 10 Lyssel J, Wiegleb Edstrom D, Linde A, et al. Antiviral therapy in children with hydroa vacciniforme. Acta Derm Venereol 2009; 89: 393–397.

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.

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

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.