Talel Badri

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.

DRESS Syndrome Following Levofloxacin Exposure With Positive Patch-test

Drug rash with eosinophilia and systemic symptoms (DRESS syndrome) in a severe cutaneous drug reaction, which can be life threatening. Levofloxacin has not been reported in literature as a causative drug. We are presenting an exceptional case of levofloxacin-induced DRESS without eosinophilia and with positive patch-tests to levofloxacin.

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.

Frontotemporal hairline recession in a postmenopausal woman

A 69-year-old postmenopausal woman consulted for frontal hair loss for two years. She had started menopause at the age of 50 years old and had been taking bisphosphonates for her osteoporosis for two years. Her clinical history, including gynecological data, was otherwise negative. Anamnestic data ruled out the possibility of traction alopecia. Dermatological examination revealed a Fitzpatrick skin type III. She had a linear frontotemporal recession with perifollicular erythema, lonely hairs on the frontal region, and scarring alopecia ( Fig-ure 1). The patient had a total loss of eyebrows but she did not have body hair loss. There were no other skin or mucosal abnormalities. Thyroid hormone function was also normal. Dermoscopy with a non-contact polarizing FotoFinder der-matoscope x20 (FotoFinder Systems, Inc, Bad Birnbach, Germany) revealed perifollicular erythema and very mild perifollicular scaling in addition to hair shaft dystrophy and broken hair. Furthermore, dermoscopy noted the presence of white dots coexisting with irregular white and pink areas devoid of hair follicular openings ( Figure 2 ). No prior topical treatment was used before our consultation. A 4 mm scalp punch biopsy from the frontal hairline was performed. His-

A case of linear atrophoderma of Moulin successfully treated with methotrexate

Linear atrophoderma of Moulin is an acquired rare and self‐limited skin condition. It is characterized by atrophic bandlike skin lesions that often show hyperpigmentation and always follow the lines of Blaschko. Usually it begins in childhood or adolescence and there is no evidence of any long term progression. We describe a case of a 21‐year‐old woman with clinical and histological features of linear atrophoderma of Moulin. The patient was successfully treated with methotrexate 20 mg/week during 6 months with an improvement of skin pigmentation and atrophy. Approximately, 30 cases of linear atrophoderma of Moulin were described in the literature. There is not a proven effective treatment of this dermatosis. High dose penicillin, topical corticosteroids, heparin, and oral potassium aminobenzoate have been used but found to be uneffective. To our knowledge, this is the first case of extensive linear atrophoderma of Moulin treated with methotrexate.

Unilateral upper limb skin sarcoid reaction after homolateral mastectomy for breast cancer

in patients with familial benign chronic pemphigus (Hailey–Hailey disease). J Am Acad Dermatol 1989; 21: 506–510. 3 Remitz A, Lauerma AI, Stubb S, et al. Darier’s disease, familial benign chronic pemphigus (Hailey–Hailey disease) and contact hypersensitivity. J Am Acad Dermatol 1990; 22: 134. 4 Pónyai G, Kárpáti S, Ablonczy E, et al. Benign familial chronic pemphigus (Hailey–Hailey) provoked by contact sensitivity in two patients. Contact Derm 1999; 40: 168– 169. 5 Walker SL, Beck MH. Undiagnosed Hailey–Hailey disease causing painful erosive changes during patch testing. Br J Dermatol 2005; 153: 253–254.

Localized genital porokeratosis in a female patient with multiple myeloma

© 2008 The Authors JEADV 2009, 23, 570–620 Journal compilation

Lichen nitidus génital

icropapules, légèrement bombées, de couleur de la peau ormale, brillantes, de 1 à 2 mm de diamètre et siégeant sur e fourreau de la verge, le gland et les bourses (Fig. 1). Le este du tégument était indemne. Les muqueuses et les phaères étaient sains. L’examen histologique d’une lésion du ourreau montrait une atrophie épidermique associée à un nfiltrat dense, micronodulaire, bien limité, comportant des ymphocytes, des plasmocytes, des histiocytes et des celules géantes (Fig. 2). Le diagnostic de lichen nitidus (LN) tait retenu. La biologie était normale. Un antihistaminique nti-H1 per os était prescrit après avoir rassuré le patient sur a bénignité de l’affection. Aucun traitement local n’était réconisé.

Iatrogenic pyoderma gangrenosum following iodine-containing contrast media

© 2008 The Authors JEADV 2009, 23, 702–738 Journal compilation

Carcinomes basocellulaires multiples après radiothérapie pour cancer du cavum

INTRODUCTION Basal cell carcinoma (BCC) is a cutaneous, generally primary malignancy, most common among the elderly. We report the case of a patient presenting numerous BCCs several years after radiation therapy for nasopharyngeal cancer and discuss the risk factors for this tumor and the role played by radiation in its genesis. CASE A 30-year-old woman presented with pigmented facial lesions that had been developing over the past year. Eleven years earlier, she had had an undifferentiated nasopharyngeal carcinoma (T3N2M0), which was treated by neoadjuvant chemotherapy and then external radiation therapy. Initial cutaneous examination noted two lesions that were identified as BCC after biopsy. The tumors were excised surgically. Neither clinical nor radiological check up showed signs of basal cell nevus syndrome. DISCUSSION BCC is the most frequent malignant tumor. It is observed mainly among those aged 45-60 years. Disorders that might promote or complicate BCC should be systematically sought in young patients, especially basal cell nevus syndrome. While our patient may have had this syndrome, we found none of the other clinical or radiographic elements often observed with it. The occurrence of BCC within the irradiation area, the multiplicity of lesions, and the sufficient latency period are consistent with radiation-induced tumors. We found no reports in the literature of BCC following radiation treatment for nasopharyngeal cancer, but the occurrence of these tumors in our patient suggests the need for close supervision in such cases.Resume Introduction Le carcinome basocellulaire (CBC) est une neoplasie cutanee, le plus souvent primitive, du sujet âge. L’observation d’une patiente ayant de multiples CBC apparus apres une radiotherapie pour un cancer du cavum conduit a discuter les facteurs de risque de survenue de cette tumeur et le role tres vraisemblable de la radiotherapie dans sa genese. Observation Une patiente âgee de 30 ans a consulte pour des lesions pigmentees du visage evoluant depuis un an. Onze ans auparavant, elle a eu un cancer du cavum type UCNT (Undifferentiated carcinoma of nasopharyngeal type), classe T3N2M0, traite par chimiotherapie neoadjuvante suivie d’une radiotherapie externe. L’examen cutane initial a montre 2 lesions dont la biopsie a conclu a des CBC. Une exerese chirurgicale des lesions tumorales a ete realisee. Une naevomatose basocellulaire a ete recherchee mais le bilan clinique et radiologique a la recherche de lesions evocatrices etait normal. Discussion Le CBC est la plus frequente des tumeurs malignes. Certaines affections pouvant favoriser ou se compliquer de CBC doivent etre systematiquement cherchees chez le sujet jeune, dont la naevomatose basocellulaire. Chez notre patiente, il n’y avait pas assez d’elements cliniques ou radiographiques pour retenir cette maladie. La survenue des CBC dans l’aire d’irradiation, la multiplicite des lesions et le temps de latence compatible sont des arguments qui nous ont fait retenir l’hypothese de CBC radio-induits. Nous n’avons pas trouve dans la litterature de cas de CBC survenant apres radiotherapie pour cancer du cavum mais la survenue de telles tumeurs dans notre observation incite a une surveillance rapprochee chez de tels patients.