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Onychomycosis is a highly prevalent disease worldwide. Accurate diagnosis is therefore required for the ongoing treatment and management of onychomycosis and to avoid misdiagnosis and treatment delay, which can be both lengthy and costly. There is no standard test for its diagnosis. Histomycology is rapid and easy to achieve. It increases the sensitivity in diagnosing onychomycosis above that achieved by standard examinations (culture and KOH direct exam). The location of the fungus also can be determined with precision. Invading fungi thus can be distinguished from colonizing or contaminating agents. Information concerning the viability of the fungi and accurate identification of the specific pathogen are not available through PAS histology alone. In addition, histomycology can also be used as a simple test to evaluate the effectiveness of the prescribed mycological treatment. It is the most sensitive method for detecting residual infection after therapy with oral antifungal medication. A combination of histomycology and culture is recommended to obtain an accurate diagnosis of onychomycosis.

Background: Blue nevus of the nail apparatus is a rare entity and only isolated cases are reported in the literature. Objective: The aim of this study was to better characterize blue nevus at the nail unit. Methods: Retrospective analysis of all nail unit blue nevi from the Nail Group of the French Society of Dermatology was compared to the literature. Results: Eleven cases were retrieved from 2002 to 2019 with an average age of 45 years. The majority were women (9/11) and acquired (10/11). Hands were more frequently involved (9/11) with a predilection for the thumb and 2 cases were located on the hallux. Nail unit blue nevus mostly presented as a well-delimited blue spot of the lunula (9/11) and histologically was of the common type (10/11). There was no malignancy. Conclusion: Nail unit blue nevus is a rare asymptomatic benign entity, mostly acquired on the thumb or the hallux of women. The most frequent presentation is a painless blue spot on the lunula. Congenital blue nevi seem to only affect the paronychium. Main differential diagnosis is melanoma and histopathological examination is mandatory., SCOPUS: ar.j, info:eu-repo/semantics/published

Herpes zoster is the clinical consequence of a late reactivation of the varicella zoster virus. It infects mainly the elderly, pediatric cases are uncommon, usually observed in immunocompromised children. We report an unusual clinical presentation of disseminated cutaneous herpes zoster in immunocompetent infant without history of chickenpox but with positive history of maternal varicella during pregnancy. A 22-month-old male infant was addressed to our department because of a history of crops of vesicular eruption on the thoracic area. This infant did not have a history of postnatal varicella, and his mother had acquired varicella infection during the 8th month of pregnancy. Physical examination showed many crops of vesicular lesions grouped on the left scapular area with some disseminated vesicular lesions present on the trunk and the four extremities. Intravenous acyclovir was administrated with total recovery 10 days later. Disseminated cutaneous varicella zoster virus in infancy is exceptional; few cases were reported in the literature. The dissemination is rare in healthy patients; it is more common in immunocompromised patients and likely to be complicated with visceral or neurologic involvement, but in healthy patients, the course is usually benign and not associated with high morbidity as in our case.

BACKGROUND Nail unit melanoma (NUM) is a rare melanoma variant, usually associated with a poor prognosis because of a delayed diagnosis. Few data are available concerning the management and long-term outcome of in situ NUM. OBJECTIVE To use a large cohort to provide comprehensive patient data and long-term follow-up information. This will serve to investigate distinctive epidemiological, clinical and histological features of in situ NUM. To report treatment modalities, assess conservative surgery and evaluate its long-term safety. METHODS Patients with confirmed diagnosis of in situ NUM were retrospectively reviewed. Demographics, clinical presentation, therapeutic data and follow-up were analysed. RESULTS Sixty-three cases of in situ NUM were identified as follows: 44 were women (70%), with a mean age of 51 years. The mean duration of symptoms prior to consultation was 4.3 years [range 3 months-28 years]. Clinically, with 58 cases, i.e. (92%) longitudinal melanonychia was the most common clinical presentation. The thumb was the most affected digit, being afflicted in 28 cases: 44%. Medical history found a widening and/or recent darkening of the melanonychia in 46 cases (82%). The treatment consisted of, respectively, 56 En bloc excisions of the nail apparatus 89% of the patients we studied, and seven amputations of the distal phalanx. During the follow-up period (mean: 10 years), two patients presented in situ recurrences. CONCLUSION The recognition of a NUM at an in situ stage allows early treatment and curing of this tumour. At this early stage, a 'functional surgery' is a rational approach with an excellent oncologic safety.

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A previously healthy 70-year-old woman presented with a 5-month history of an asymptomatic keratotic, papulonodular plaque on her right forearm. The lesion started as a follicular papule followed by progressive peripheral proliferation. No record of trauma, contact with any chemicals, use of immunosuppressive drugs, or history of neoplasm was noted. Clinical examination showed an arciform plaque of 10×5 cm, with infiltrated raised borders and central atrophy (Figure 1). Drops of yellowish material exuded from the coalescent nodules constituting an elevated and indurate border. Results from physical and laboratory examinations revealed no internal organ malignancy. The remainder of the physical examination (x-ray of the forearm and serologies for HIV, hepatitis, and syphilis) was normal.

Cutaneous peripheral T-cell lymphomas not otherwise specified (CPTL-NOS) are rare neoplasms accounting for just 2% of cutaneous peripheral T-cell lymphomas (CPTL). Only very few case series have been reported. They represent a phenotypically and prognostically heterogenous group of CPTL that do not fit into any of CPTL well-defined subtypes. The authors report a case of a 64-year-old man with simultaneous plaque-like lesions and disseminated nodules growing rapidly on the face, trunk, and extremities over a 6-month period. There was no a history of preceding patches, erythematous plaques, rash, or pruritic lesions. These lesions were extending over 80% of the skin surface. Histopathologic analysis revealed dense diffuse infiltrates composed of mostly medium-sized to large lymphoid cells throughout the entire dermis without epidermotropism. Neoplastic cells were atypical with markedly pleomorphic nuclei. Immunohistochemistry showed that the tumor cells were positive for CD3, CD4, and CD5 with a loss of CD7. They were negative for CD20, CD8, CD56, CXCL13, PD1, TIA-1, granzyme-B, perforin, CD25, and CD30. The proliferative fraction was low, with MIB-1 labeling less than 10% of cells. The authors diagnosed the patient with primary CPTL-NOS. Despite the rarity of these tumors, clinicians as well as dermatopathologists and pathologists should be familiar with these rare CPTL especially because most of these lymphomas have an aggressive behavior and exhibit an unfavorable prognosis.

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.

Mal de Meleda (MdM, MIM: 248300) is a rare autosomal recessive skin disorder characterized by diffuse palmoplantar keratoderma and transgressive keratosis with onset in early infancy. The gene responsible for MdM, ARS, encodes for Secreted Lys6/Plaur domain-containing protein 1 which is essential for epidermal homeostasis. Tight junctions have been proposed to have two mutually exclusive functions: a fence function which prevents the mixing of membrane proteins between the apical and basolateral membranes; and a gate function which controls the paracellular passage of ions and solutes between cells. In this study we report immunohistochemical investigations of tight junction proteins claudin-1 and occludin in MdM Tunisian families. Nine skin biopsies from patients with MdM were analyzed. The control group was formed by skin biopsies belonging to healthy individuals. Immunohistochemical study was performed on fixed sections from biopsies of four microns with the following polyclonal antibodies: anti-claudin-1 and anti-occludin. In control skin, claudin-1 exhibited membrane expression throughout the epidermis with increasing and upward intensity, whereas occludin was detected in the cell membrane of keratinocytes of the stratum granulosum. In MdM skin, claudin-1 was expressed throughout the thickness of the spinous layers with membrane staining, and occludin had cytoplasmic staining in the granular layer. The immunohistochemical expression of TJ proteins in MdM patients harbors premature expression of occludin and decreased expression of claudin-1, highlighting further evidence for disorders in epidermal homeostasis.

Pellagra is a rare condition that has been known for many years to be related to niacin deficiency. Clinically known as the 4 "D" symptoms for dermatitis, diarrhea, dementia, and even death, skin changes remain one of the most important features of this pathology, leading frequently to the diagnosis. Pellagra is mostly seen in poor populations with a deficient diet; still, it is sporadically observed in developed countries, usually in association with digestive disorders. We report a new case of pellagra in a 29-year-old woman in whom the diagnosis of megaduodenum was made. Megaduodenum is a rare condition that can be idiopathic or secondary to visceral myopathy or neuropathy. Parenteral supplementation with niacin has resulted in a quick response of dermatological and psychiatric symptoms. To our knowledge, no case of pellagra due to megaduodenum has been reported in literature.

Background: Endogenous ochronosis (EO) is an autosomal recessive inherited disorder where there is incomplete oxidation of tyrosine and phenylalanine due to a lack of the enzyme homogentisic acid oxidase. Objective: We report a singular observation of EO with a fatal outcome. Case Report: We report the case of a 46-year-old man born to consanguineous parents with a medical history of recurrent renal colic and chronic nonspecific arthropathy. On clinical examination, slate blue pigmentation was seen on the cheeks, forehead, and nose, as well as blue-gray patches on all fingernails and bluish discoloration of the gums. Familial investigation revealed that his sister had similar pigmentation on the ears, hands, and fingernails. Histologic examination of a biopsy specimen from a pigmented lesion showed a dermal deposit of an acellular, eosinophilic material without cell reaction. Based on the clinical and histopathologic data, combined with the family medical history, our patient was considered to have EO with mucocutaneous, articular, and renal involvement. Unfortunately, the diagnosis was late because our patient died a few months later of terminal renal failure. Conclusion: Skin signs are the hallmarks of EO and must alert the clinician to look for involvement of vital organs. Renseignements de base: L'ochronose endogène (OE) est une affection héréditaire récessive autosomique où il se produit une oxydation incomplète de la tyrosine et de la phénylalanine en raison d'un manque d'oxydase de l'acide homogentisique. Objectif: Nous présentons une observation singulière d'OE dont l'issue a été fatale. Rapport de cas: Nous exposons le cas d'un homme de 46 ans né de parents consanguins ayant des antécédents médicaux de coliques néphrétiques récurrentes et une arthropathie chronique non spécifique. À l'examen clinique, nous avons observé une pigmentation bleu ardoise au niveau des joues, du front, et du nez, ainsi que des plaques bleu gris sur tous les ongles de doigts et une décoloration bleuâtre des gencives. Une étude des antécédents familiaux a révélé que sa sœur présentait une pigmentation semblable au niveau des oreilles, des mains, et des ongles de doigts. L'examen histologique de l'échantillon de la biopsie pratiquée sur une lésion pigmentée a montré un dépôt cutané de matériel éosinophile acellulaire sans réaction cellulaire. Selon les données cliniques et histopathologiques, combinées aux antécédents médicaux familiaux, notre patient présentait une OE avec une atteinte rénale, articulaire, et muco-cutanée. Malheureusement, le diagnostic a été tardif puisque notre patient est décédé quelques mois plus tard d'insuffisance rénale terminale. Conclusion: Les signes cutanés constituent les caractéristiques de l'OE et ceux-ci doivent alerter le clinicien de manière à ce qu'il cherche la contribution des organes vitaux.

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.

Background Lichen planus limited to the nail is uncommon, and information about its long-term prognosis is lacking. Objectives We attempted to review the epidemiological, clinical and histological features, the response to treatment and the follow-up of a large series of patients with nail lichen planus (NLP). Methods We searched for the records of all patients with a clinical and histopathological diagnosis of isolated NLP apart from January 1997 to December 2008. The patients presented during this period and followed until December 2009 in the consultation for nail disorder were reviewed in detail. Results Data on 67 patients were collected, with an average age of 47 years (6–78 years). A male preponderance was observed (64%). The mean duration of the disease was about 38 months. Fingernails were the site of involvement in 94% of cases. Matrix involvement was observed in 91% of cases. A total of 120 specimen’s biopsy were taken and was contributory in 90% of cases. Two specimens biopsy were practiced in 70.15% of patients. Systemic corticosteroids were used in 46 patients, and associated in 20 cases to intralesional corticosteroids. Conclusions Our findings indicate that if NLP is correctly diagnosed and appropriately treated. Nail biopsy is proven to be a relatively simple, safe and useful procedure with a minimal scarring risk. Long-term observation indicates that the prognosis of NLP is poor with high rate of relapses, with permanent damage to the nail unit.

Auto-reactive cytotoxic T lymphocytes play a key role in the progressive loss or destruction of melanocytes in vitiligo but the mechanism underlying the loss of self-tolerance is unknown. A deregulation of regulatory T-cell biology has recently been suggested. The analysis of the suppressive effects of peripheral T regulatory cells in vitiligo patients revealed a functional defect in seven of 15 cases. This defect was strongly correlated with disease activity. The evaluation of the percentage of peripheral regulatory T lymphocytes did not reveal any intrinsic quantitative defect. Yet, a decrease in the percentage of such cells was noted in patients with progressive forms, suggesting a recruitment of regulatory T cells from the peripheral blood to the site of injury. This was further corroborated by the significant increase of Forkhead box P3 expression in the vitiliginous skin of patients. Our data support the involvement of a functional defect of peripheral regulatory T cells in the pathogenesis of vitiligo and open new possibilities to advance therapeutic approaches.

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. Objective To determine the clinicoepidemiological features of various ABD. Methods We retrospectively recruited all ABD cases seen during an 11-year period (1997–2007). Results One hundred and seventy-four patients were involved (16.3 cases/year). Pemphigus was observed to be the most common ABD (53%), with the majority being pemphigus vulgaris (61%) vs. 36% of pemphigus foliaceus (Tunisian pemphigus). Discussion Most epidemiological surveys have focused on a single or just one group of ABD. In our series, pemphigus foliaceus was relatively more prevalent than in occidental data. The frequencies of subepidermal immunobullous dermatoses in our study were in agreement with those in the literature.

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. Materials and methods We retrospectively analyzed 100 cases of ACDR from 1981 to 2007, collected in the Department of Dermatology of the La Rabta Hospital in Tunis, which is located in the north of Tunisia. Severity was defined on three criteria: hospitalization; visceral involvement; and severity markers. Results Characteristics of the 54 included cases were: women (70%); mean age: 44.8 years; responsible drugs: anticonvulsants (28%), antibiotics (28%), and nonsteroidal anti-inflammatory drugs (15%). The most common dermatoses were maculopapular rash (50%). We observed fever (76%), lymphadenopathy (31.5%), eosinophilia (35%), and visceral involvement (50%). Twelve patients died directly related to the ACDR. Conclusion This study underlines the polymorphous clinical presentation of ACDR and the importance of researching some severity markers, which have important practical implications.

Erythema nodosum (EN) in association with kerion celsi is a rare condition in children, with only 11 cases having been reported in the English literature. We describe a new case in a 7-year-old boy in whom the disorder had begun 2 months before. He had many inflamed, boggy, suppurative nodules over the left occipitoparietal area of the scalp and, 2 weeks later, developed multiple painful, erythematous subcutaneous nodules of the shins, thighs, and upper limbs. EN was confirmed by histologic examination. Our review of the literature of all cases of EN during kerion showed that it usually occurs at or slightly after the height of infection or after drug introduction. Trichophyton mentagrophytes was involved in the majority of cases, and improvement of EN usually occurs with griseofulvin.

A 64-year-old man was noted to have a single pigmented lesion in the nostril of his nose. Clinical examination revealed a 5 mm nodular growth and brown lesion. With a presumed clinical diagnosis of malignant skin tumor, a biopsy was performed. The histological examination revealed the unexpected diagnosis of pigmented inverted follicular keratosis. The inverted follicular keratosis is an uncommon benign lesion that is usually diagnosed histologically rather than clinically. It commonly simulates other proliferative skin lesions.

Resume Introduction La grossesse est une periode de modifications hormonales, immunologiques, metaboliques et vasculaires. Certaines sont considerees comme etant physiologiques, alors que d’autres correspondent a de reelles maladies specifiques ou non de la grossesse. Le but de notre travail etait de definir les caracteristiques epidemiocliniques des modifications physiologiques dermatologiques observees au cours de la grossesse. Methodes Nous presentons une etude transversale colligeant cent parturientes suivies a la maternite du CHU de La Rabta (Tunisie). Un examen cutaneo-muqueux systematique realise par un dermatologue a ete pratique a la recherche de modifications physiologiques. Resultats L’âge moyen des 100 gestantes etait de 29 ans [20–46 ans]. Les modifications pigmentaires etaient les plus frequentes (93 %) dominees par la pigmentation areolaire (77 %). Les modifications des annexes etaient notees dans 75 % des cas. Les modifications vasculaires etaient retrouvees chez 77 % des femmes, essentiellement a type de gingivite hyperplasique (46 %). Les autres modifications etaient moins frequentes (vergetures 45 %, modification des naevi 35 %, molluscum gravidarum 10 %). Discussion Les modifications physiologiques cutanees au cours de la grossesse sont nombreuses. Notre etude confirme la frequence et le polymorphisme de ces modifications. Elles sont de loin dominees par les modifications pigmentaires.

A three-month-old male infant presented with generalized blisters that were first noted when he was two months old. A portion of blisters formed spontaneously and a portion formed when the patient was scratched or rubbed. The lesions were first observed on the hands and feet and spread to the scalp, face and trunk. The infant was otherwise healthy. The mother reported that there was no history of local or systemic symptoms, including flushing, pruritus, shortness of breath, hypotension and diarrhea. Furthermore, the family history was negative for any dermatologic, gastrointestinal or hematologic diseases. Cutaneous examination revealed multiple tense vesicles, bullae, and erosions on the face, scalp, trunk and extremities (Fig. 1). All of the patient’s skin was erythematous and thickened. It had a leathery appearance and a doughy texture, and the skin markings were exaggerated. The patient was positive for Darier’s sign. There was no evidence of organomegaly or lymphadenopathy. Bacterial blister culture results were negative. Direct immunofluorescence was also negative. Histological examination of a biopsy specimen taken from a tense blister revealed sub-epidermal bullae with a dense infiltration of mast cells and a number of eosinophils in the upper dermis (Figs. 2 and 3).

Background Pemphigus vegetans (P Veg) is a rare clinical form of pemphigus. Studies on P Veg are rare in the literature and none has so far evaluated the prognostic parameters. Objective In this retrospective study of P Veg, we aimed to analyse epidemiological, clinical, immunopathological and therapeutic data. Study of prognostic factors with accuracy of patient survival was also carried out. Methods This is a retrospective study (1981–2009) including 17 cases of P Veg. Statistical analysis was performed with chi-square and Fisher tests looking for a possible relationship between clinical data and prognostic factors. Follow-up time and disease-free survival time were estimated using Kaplan–Meier methods. Clinical data were evaluated in univariate analysis looking for a significant association with survival. Equality of survival distribution was studied using log rank test. Results The hospital prevalence of P Veg was 0.084‰ with a frequency of 9.1% among pemphigus. The mean age at onset was 47.6 years, with a sex-ratio (F/M) about 4.66. Neumann P Veg was the predominant clinical form (11/17). Clinically, the lesions were multifocal (16/17), prevailed on folds and mucous membranes. Under corticosteroids the mean period for healing was 24 ± 9 days. During the follow-up time, three patients died and 11 patients relapsed. Median of overall relapse-free survival was 13 ± 1.7 months. No significant association between clinical data and prognostic factors was found. Limitations This study was a retrospective chart analysis and the number of patients was small. Conclusion The P Veg seems to be more frequent in Tunisia with high rate of mortality.

Methotrexate-induced cutaneous ulceration is a rare but potentially serious drug adverse reaction. This adverse reaction of methotrexate therapy has been initially described in psoriasis patients and is unusual in patients with cutaneous T-cell lymphoma. In 1978, Mc Donald et al reported the first three cases of cutaneous ulcerations in patients treated for a mycosis fungoides with intravenous infusions of methotrexate [1]. Since then, few cases of methotrexate-induced skin ulcers in patients with mycosis fungoides have been published [2-5]. We report an additional patient with erythrodermic mycosis fungoides who developed cutaneous ulcerations as a sole manifestation of methotrexate toxicity.

Primary mucinous carcinoma of the skin is a rare sweat-gland neoplasm with a high recurrence rate. We report a new case of a primary recurrent mucinous carcinoma of the face in a 59-year-old man. Histopathologic examination of the neoplasm showed epithelial islands floating in mucoid material compartmentalized by fibrous septa. Cytokeratin 7, protein S100, estrogen and progesterone receptors were detected at immunohistochemical study, while cytokeratin 20 and actin were undetectable. Histologically, mucinous carcinoma of the skin can be mistaken for a metastasis from extracutaneous sites, particularly the breast or the gastrointestinal tract. Mucinous carcinoma of the skin has a relatively good prognosis with rare distant metastases, but high recurrence rate.

Introduction L’onychomatricome est une tumeur fibro-epitheliale rare de la matrice ungueale. Elle se caracterise par un epaississement, une hypercourbure longitudinale et transversale de la tablette et une xanthonychie. Le but de notre travail etait d’en etudier les caracteristiques epidemiologiques, anatomocliniques et therapeutiques a travers la plus grande serie de la litterature, colligeant 72 nouveaux cas. Patients et methodes Nous presentons une etude retrospective, de 72 cas d’onychomatricome vus en consultation de pathologie ungueale et operes de 1997 a 2016 par le meme dermatologue ayant une expertise en pathologie ungueale, avec une confirmation histologique. Nous avons systematiquement recueilli les caracteristiques epidemiologiques, cliniques, histologiques et therapeutiques des patients. Resultats Il s’agissait de 72 patients d’âge moyen de 53 ans et une predominance feminine (61,5 %). La duree d’evolution etait en moyenne de 8 ans. Des tumeurs multiples (6 ongles) etaient notees chez une patiente. La tumeur siegeait plus souvent aux doigts (76,5 %), avec une atteinte preferentielle du majeur (50 % des onychomatricomes des mains). Cliniquement, l’aspect etait caracteristique chez 84 % des patients. L’onychomatricome etait de grande taille (geant) ou pigmente dans respectivement 8 % et 20 % des cas. Une clinique atypique etait notee dans 16 % des cas ; c’est l’aspect peroperatoire et l’histologie qui permettaient alors de confirmer le diagnostic. Une imagerie en resonance magnetique (IRM) de haute resolution a ete pratiquee dans 28 % des cas. Tous les patients ont ete traites chirurgicalement. Une onychodystrophie postoperatoire etait notee chez 47 % des patients ; elle etait severe dans 10 % des cas. Discussion L’onychomatricome est une tumeur indolente de la matrice ungueale. Elle est souvent meconnue, alors que les signes cliniques sont souvent typiques (84 %). Nous rapportons ici la plus grande serie de la litterature. L’onychomatricome touche l’adulte, siege surtout aux doigts. La lesion est habituellement unique mais nous rapportons 6 tumeurs chez une patiente. Contrairement aux donnees de la litterature, nous retrouvons une plus grande frequence des presentations cliniques atypiques et des formes geantes et pigmentees pouvant poser un probleme de diagnostic differentiel avec le melanome ou la maladie de Bowen. L’aspect peroperatoire de tumeur matricielle emettant des digitations qui penetrent dans les tubulures longitudinales de la tablette permet de poser le diagnostic. Le traitement est chirurgical. Les recidives sont exceptionnelles, mais une onychodystrophie secondaire peut etre observee. Conclusion L’onychomatricome est une tumeur benigne de la matrice ungueale. L’aspect clinique de la tablette apres avulsion permet de retenir le diagnostic.

A 30-year old man with no trauma history presented to our department of dermatology with a 2-year history of abdominal painful masses. The spontaneous pain and tenderness in the abdominal region gradually worsened. Physical examination revealed 3 firm, irregular subcutaneous nodules measuring 1 x 0.5 cm, which were movable and unattached to the overlying skin. One of the nodules was ulcerated (Figure 1). Histopathologic examination showed spindle-shaped fibroblast cells intermingled with gangliocyte-like giant cells in the hypodermis with an infiltrate made of lymphocytes and histiocytes (Figure 2 and Figure 3). The immunohistochemical staining showed the negativity of the fusiform cells and the gangliocyte-like cells to anti-S100 protein and to anti-smooth muscle actin.

Resume Introduction L’acrodermatite enteropathique est une maladie rare autosomique recessive, liee a une anomalie de l’absorption intestinale du zinc. Elle se revele habituellement dans les premiers mois de la vie, lors du sevrage de l’allaitement maternel. Nous rapportons l’observation d’un nourrisson nourri exclusivement au sein, atteint d’une acrodermatite enteropathique. Observation Un nourrisson, de sexe feminin, âge de 4 mois etait ne a terme. Elle consultait dans le service de dermatologie pour une dermite du siege persistante depuis l’âge de 1 mois, resistant aux differents traitements symptomatiques. Des lesions erythemato-vesiculeuses et squameuses, parfois erosives, peri-orificielles avec extension au tronc et aux extremites, etaient progressivement apparues. Elle etait nourrie exclusivement au sein et avait un bon etat general. Le diagnostic d’acrodermatite enteropathique etait confirme par une zincemie effondree (14 μg/100 ml). La concentration du zinc dans le lait maternel etait abaissee (46 μg/100 ml), ainsi que la zincemie de la mere (94 μg/100 ml). Une etude genetique etait pratiquee chez tous les membres de la famille : seule l’enfant etait homozygote pour la mutation, tandis que son frere et ses parents etaient heterozygotes. Un traitement par le sulfate de zinc etait institue, et l’evolution etait favorable. Discussion L’acrodermatite enteropathique est caracterisee par un tableau clinique tres evocateur et le diagnostic est confirme par la mise en evidence d’un taux bas du zinc plasmatique. La survenue d’une acrodermatite enteropathique lors de l’allaitement maternel exclusif est rare, elle a ete rapportee essentiellement chez les prematures. Notre observation est particuliere par l’existence d’une acrodermatite entero-pathique chez un nourrisson ne a terme, nourri exclusivement au sein, avec un deficit en zinc du lait maternel et une zincemie abaissee chez la mere.

Author(s): Zaraa, Ines; Dorbani, Imen; Hawilo, Abdelmoati; Mokni, Mourad; Ben Osman, Abel | Abstract: Background: Ingrown toenail is a common problem causing significant morbidity. Various procedures used for treating this painful condition were discussed in the literature.Objetctive: Through a prospective study we aimed to evaluate in a long-term follow-up the efficacy of partial nail plate avulsion combined with phenolic chemical matricectomy for the treatment of Ingrown toenails.Methods: We recruited outpatient from January 2006 to December 2009; all treated by phenol matricectomy and assured a regular follow up.Results: Consecutive 146 patients with a total of 171 Ingrown toenails were enrolled. There was no significant morbidity and the procedure was tolerated well by all patients. The short-term results were excellent. No severe complications occurred during the 21-month follow-up period. The overall recurrence was 2.7 %.Conclusion: Phenol cauterization compared with other surgical ablation techniques may be the treatment of choice of Ingrown toenails. It’s an effective technique for the treatment of Ingrown toenails accompanied by less morbidity and lower recurrence rates.

Squamous cell carcinoma (SCC) is one of the most common malignant tumors of the lips (90%). The prognosis of these SCC seems to be poor thus here periorificial localization.To present the epidemiological, clinical, pathological, therapeutic features and out come of SCC of the lips.we conducted a retrospective study performed in the dermatology department of the La Rabta hospital of Tunis over a 11-year-period [2000-2010] recording patients with histologically confirmed SCC of lips.Thirty patients were included (26 men and 4 women) with an average age of 63 years. The most frequent risk factors were smoking and chronic sunlight exposure. The occurrence of the labial SCC on a precursor lesion was noted in 11 cases. It occurred more frequently on the lower lip (80%). Tumor was ulcero-vegetant in 21 patients. Twenty patients had a commune SCC, 19 of them were well-differentiated. Surgery was indicated in 18 cases and 10 patients were treated by exclusive radiotherapy. Lymph nodes metastases were noted in 2 cases. No visceral metastasis was observed. During the period of follow-up (20.12 months), two patients died.The diagnosis of SCC of the lips is late and the treatment often mutilating. The improvement of the prognosis depends not only on the early diagnosis and the treatment of the precursors, but also on the photo protection and alcohol and smoking eviction.

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.