Recurrent arginine substitutions in the ACTG2 gene are the primary driver of disease burden and severity in visceral myopathy

Visceral myopathy with abnormal intestinal and bladder peristalsis includes a clinical spectrum with megacystis-microcolon intestinal hypoperistalsis syndrome and chronic intestinal pseudo-obstruction. The vast majority of cases are caused by dominant variants in ACTG2; however, the overall genetic architecture of visceral myopathy has not been well-characterized. We ascertained 53 families, with visceral myopathy based on megacystis, functional bladder/gastrointestinal obstruction, or microcolon. A combination of targeted ACTG2 sequencing and exome sequencing was used. We report a molecular diagnostic rate of 64% (34/53), of which 97% (33/34) is attributed to ACTG2. Strikingly, missense mutations in five conserved arginine residues involving CpG dinucleotides accounted for 49% (26/53) of disease in the cohort. As a group, the ACTG2-negative cases had a more favorable clinical outcome and more restricted disease. Within the ACTG2-positive group, poor outcomes (characterized by total parenteral nutrition dependence, death, or transplantation) were invariably due to one of the arginine missense alleles. Analysis of specific residues suggests a severity spectrum of p.Arg178>p.Arg257>p.Arg40 along with other less-frequently reported sites p.Arg63 and p.Arg211. These results provide genotype-phenotype correlation for ACTG2-related disease and demonstrate the importance of arginine missense changes in visceral myopathy.

[Anatomo-clinical features of an erysipeloid form of cutaneous leismaniasis in Tunisia]

The erysipeloid form of cutaneous leishmaniasis is considered as an unusual and rare clinical presentation in Tunisia. Our prospective study on 4 observations, aimed at examining the clinical, histological and progressive features of the "erysipeloid" form of cutaneous leishmaniasis. Our patients were 3 females and one male more than 62 years old. Their cutaneous leishmaniasis was clinically characterised by an infiltrated and extensive plaque which was localised on the face covering the nose and cheeks looking like erysipelas. The treatment was intramuscular meglumine antimoniate (Glucantime) in three cases and metronidazole in one case. A regression without scar was noticed in all the cases. On the histological examination, we observed an intense epidermic and constant hyperplasia with presence of amastigotes in 3 cases. Our study shows the lesional polymorphism of the old word cutaneous leishmaniasis in our region. The "erysipeloid" form of cutaneous leishmaniasis is a rare clinical presentation which generally affects women. If the clinical aspect is very meaningful, the histological aspect is meaningful but not specific.

[Sporotrichoid cutaneous leishmaniasis in Tunisia: a clinical and histological study]

BACKGROUND

The sporotrichoid variety of cutaneous leishmaniasis is defined by the presence of dermal and hypodermal nodules along the lymphatic stream, and remote from the primary inoculation lesions. This clinical form is usually considered rare. The aim of our study was to investigate the epidemiological, clinical, histological and evolutionary particularities of sporotrichoid cutaneous leishmaniasis in the south of Tunisia.

PATIENTS AND METHODS

During a systematic study of all cases of cutaneous leishmaniasis from the south of Tunisia diagnosed in our hospital in 2002, sporotrichoid forms were diagnosed on the basis of clinical criteria. In all cases of sporotrichoid cutaneous leishmaniasis, the principal clinical characters were systematically specified. Cutaneous biopsies of subcutaneous nodules were performed in six cases.

RESULTS

Of 102 patients with cutaneous leishmaniasis, 19 presented sporotrichoid cutaneous leishmaniasis, that is, a frequency of 19%. Between two and 20 painless subcutaneous nodules were arranged in linear strings on the upper leg in 79% of cases. Time to appearance varied between 12 days and one year after the primary lesions. Fourteen appeared without any preliminary treatment for cutaneous leishmaniasis and five appeared after Glucantime infiltration in the primary lesions. Biopsies of the nodules showed an inflammatory infiltrate composed of lymphocytes and histiocytes. This infiltrate was particularly dense and rich in plasmocytes at the level of the deep dermis. The biopsies were deep enough to involve the hypoderm in one case and the same type of infiltrate was noted at the level of interlobular septa. A small number amastigotes was seen in one deep biopsy sample. Outcome was favourable in all cases under treatment.

CONCLUSION

Sporotrichoid cutaneous leishmaniasis appears to be common in the south of Tunisia, were cutaneous leishmaniasis is dominant because of Leishmania major. It is not associated with a poor prognosis.

[Clinical polymorphism of cutaneous leishmaniasis in centre and south of Tunisia]

The cutaneous leishmaniasis (CL) is an affection which is quite well known in Tunisia. The zoonotic cutaneous leishmaniasis caused by Leishmania major by far the more frequent, is endemo-epidemic in the centre and south of the country. It is characterized by clinical polymorphism. The aim of our study is to precise the different clinical aspects of the CL in our region through a prospective study of 102 cases. The average age was 37.8 years old (from 4 to 78 years old) with a slight female predominance. All of our cases lived or stayed in an endemic zone. Various clinical forms were noted in our series. The ulcerated and crusted form was predominant: 54,9% of the cases, the lupoid form was noted in 15.7% of the cases and the sporotrichoid form was observed in 18.6% of the cases. Other rare forms were noted (papular erysipeloid, verrucous, vegetant, erythematous, ulcerated, necrotic and linear) were noted in 25.5% of the cases. Our series is characterized by the multiplicity of clinical forms. Besides, the classical form (ulcerated and crusted form), other clinical form can be individualised: lupoid, loco regional spreading (sporotrichoid form, satellite papules). Some atypical forms can be found which are due to variation of host immune responses and to the strain of the parasites involved.

Lupus érythémateux subaigu de l'enfant: à propos d'un cas

Subacute cutaneous lupus erythematosus is extremely rare in childhood. We report the case of a 7 year-old girl who presented annular erythematous infiltrated lesions on sun exposed areas since the age of 2 months. Histopathologic examination showed orthohyperkeratosis, epidermal atrophy, widespread hydropic degeneration of epidermal basal cell layer, and a dermal lymphohistiocytic infiltrate. The lupus band test was negative. The immunological investigations (antinuclear antibodies) were negative. Treatment with antimalarials, topical steroids and sun protection allowed clearance of the cutaneous lesions. Lesions relapsed after antimalarials discontinuation and sun exposure. Four years later, at the age of 11, the antinuclear antibodies became positive. The diagnosis of subacute cutaneous lupus erythematosus is based on the clinical aspect of lesions, topography, histological finding, evolution and immunological profile of the patient.

[Tricho-epithelioma multiplex: two cases reports]

Tricho-epitheliomas are benign tumors of the pilosebaccous apparatus. Multiple tricho-epithelioma form is particular. We report 2 new cases. 1) R.A., a 41 year-man with a 2 years history of histologically confirmed multiple tricho-epitheliomas. New lesions appeared during a 9 years-follow-up. Treatment was local excision of tumors. 2) M.B., a 41 year-man, have a 8 years history of 3 to 30 mm papulonodular lesions with telangiectasia, located on the face and associated to multiple milia, comedones and alopecia areata plaques. Histological study confirmed the diagnosis of multiple tricho-epitheliomas. Multiple tricho-epitheliomas is a genodermatosis it is often associated to other benign cutaneous tumors, mainly cylindromas and spiradenomas. It occurs in the 1st and 2nd decade. The lesions are symmetrically located on the face. Histological examination confirm the diagnosis. After repeated episodes, the lesions stabilize. Malignant changes are rare. Treatment is supported by aesthetic considerations. Various therapeutic means are available. Our reported cases are particular by the occurrence at relatively advanced age, the localization and the large size of some lesions. The associated alopecia areata in the 2nd patient could be fortuitous.

[Gingival metastasis in breast phyllodes tumor]

BACKGROUND

The metastasis of oral cavity is rare. We report a gingival metastasis in the course of low grade phyllode sarcoma of the breast which is usually little metastatic.

CASE-REPORT

A 44 year old woman was operated two years ago for a phyllod sarcoma of the breast histologically confirmed. She presented for a mandibular exophytic tumour associated with haemorrhagic, necrotic, ulcerated and bulking gingivitis surrounding at the level of the maxillary and mandibular gingiva. The examination revealed multiple nodular lesions of the trunk and the scalp. The histological examination confirmed the diagnosis of cutaneous and gingival metastasis of the phyllod sarcoma of the breast. The evolution was rapidly fatal.

DISCUSSION

The gingival metastasis are rare tumours with a bad prognostic. Their diagnosis is based on clinical and histological arguments and must be made different from chronic gingivitis which can be associated.

[Profile of basal cell carcinomas of the scalp after radiotherapy for tinea capitis (about 63 cases)]

The induction of basal cell carcinoma (BCC) of the scalp by X-ray therapy for tinea capitis is well known. The aim of the study was to specify the epidemiological, clinical and histological characteristics of this disease. In a retrospective study, we collected data from the files of 63 patients, with a history of radiotherapy for tinea capitis, followed between January 1995 and December 2004. Fifty one men and 12 women with a total of 108 BCC of the scalp are reported (1.76 lesion per patient and 1.13 cm on average of diameter). The mean age at the occurrence of the BCC was 45.5 years. Thirty seven percent of BCC occurred on the occipital area; 28.7% were in the parietal site. The most frequent clinical aspect was the nodular BCC (51%) and the cicatricial BCC (35%). Histological study showed a nodular aspect in 74 % and pigmentation in 62% of cases. It is concluded that BCC of the scalp following X-ray therapy for tinea capitis have some clinical and histological particularities. It represents the most frequent tumour developing on irradiated scalp.

[Biermer disease disclosed by mucous ulcerations]

Pernicious anemia rarely induces mucous membranes lesions, wich, exceptionally reveal the disease. We report a case of a 64-year-old man who presented a clinical history of recurrent painful ulcerations of the buccal, genital and ocular muosa. He also had peripheral sensory nerve impairement of the legs. The diagnosis of pernicious anemia was made after a 19 year course. Cobalamin supplementation induced an improvement of the mucous membrane lesions and of the anemia, but recurence occurred each time the treatment was stopped. Our observation is particular by the multiple mucous membrane involvement revealing pernicious anemia and by the ocular lesions which had never been previously reported.

[Necrobiosis lipoidica - 3 case reports]

Necrobiosis lipoidica is a rare degenerative disease mostly seen on the legs. The association to diabetes mellitus is usual. We report three patients with necrobiosis lipoidica located on the extremities, 2 of them were already treated for diabetes. Necrobiosis lipoidica has distinctive clinical and histological appearances. The lesions appear as well circumscribed, erythematous plaques, with a depressed centre. Some of these lesions may progress to ulcers. The legs are commonly involved. Angiopathy leading to thrombosis of the cutaneous vessels has been implicated in its pathogeny. There is no specific therapy for this disease Topical and/or intralesional corticosteroids are the most widely used treatment.

Hyperplasie géante des glandes sébacées de la vulve

BACKGROUND

Sebaceous gland hyperplasia is an epithelial tumour with sebaceous differentiation. Genital involvement is rare. In this paper, we report a new case of sebaceous gland hyperplasia of the vulva.

CASE REPORT

A 27 year-old woman presented multiple polypoid lesions of the lower third of left labium majus. The lesions were soft to the touch, measured 5 cm in length and were painless. The cutaneous biopsy confirmed the diagnosis of sebaceous gland hyperplasia of the vulva. Surgical excision was performed in two separate procedures and was successful.

DISCUSSION

This case was unusual in terms of the site, the clinical appearance and the weeping seen due to the high concentration of hyperplasic sebaceous glands.

Erysipelas after breast cancer treatment (26 cases)

Erysipelas is a bacterial hypodermal cellulitis usually associated with Streptococcal infection. Erysipelas of the upper limbs in women treated for breast cancer is relatively rare. We undertook a 10-year retrospective study identifying 26 cases of erysipelas of the upper limb following treatment for breast cancer; we describe the clinical, therapeutic, and evolutionary aspects. The age of our patients ranged from 37 to 80 years with a mean age of 53. All patients had a breast surgery and lymphadenectomy. Fifteen patients had chemotherapy and 23 had radiotherapy. The erysipelas appeared with an average of 5.23 years after cancer treatment (3 months to 15 years) and was recurrent in nine cases. Lymphedema occurred in eighteen patients. The first signs were fever and shivering in 25 patients. The clinical aspect was an inflammatory plaque. The physical findings of erysipelas included a raised edge (6 cases), blisters (1 case), purpura (1 case), and cellulitis (1 case). The portal of entry was not found in eleven patients. The upper limb was affected in all cases. Involvement of the axillary folds or the chest was observed in eight cases. Treatment with penicillin was undertaken for all patients; the length of treatment varied from 11 to 26 days. Lympadenectomy and radiotherapy in breast cancer may lead to lymphedema, which can be evident or sometimes discrete. Those patients who developed erysipelas in our series usually fared well with treatment, but many had recurrences attributed to persistent lymphedema. It was also of note that for many patients in this series, the portal of entry was not identified.

[The cutaneous leishmaniasis of the face in Gafsa area, Tunisia]

The cutaneous leishmaniasis is a frequent affection in Tunisia. In the Gafsa region it is a endemoepidemic infection. Our prospective study was carried out on 225 cases of cutaneous leishmaniasis of the face collected over two years in the outpatients' department of dermatology at Gafsa hospital. The aim of our study was to know more about the evolutive epidemio-clinical particularities of the cutaneous leishmaniasis of the face. The relative frequency of the cutaneous leishmaniasis of the face for the new patients reached 5%. An equal distribution between the two sexes was noted. The average age of our patients was 24 years old and 6 months old with extremes ranging from 3 months to 77 years. The nodular and ulcerated forms were the most frequent (35.3%), followed by impetiginoid forms (23%), then the lupoid forms (15%). The papular form was quite frequent (13%). Impetiginoid lesions occurred frequently in the child. Lupoid lesions appeared particularly on the nose. The complicated forms: the cutaneuos necrosis or erysipelas of the face appeared after intralesional injections of meglumine antimoniate (Glucantime). The intramuscular meglumine antimoniate was used in 172 patients, among them 47 needed two treatments or more because of a particular resistance of the lesions of the face. The pimple of Gafsa, term initially used for ulcerated skin nodules, was actually characterised by a lesional polymorphism. The prognosis was good however the risk of in aesthetic scar of the face was important.

Identification of Malassezia species from Tunisian patients with pityriasis versicolor and normal subjects

BACKGROUND

The genus Malassezia (Pityrosporum), recognized as a member of microbiological flora of the skin in humans and warm-blooded animals, has been recently revised to include 10 Malassezia species. The aim of the study was the isolation, identification and analysis of Malassezia species distribution in skin of healthy volunteers and lesions of pityriasis versicolor (PV).

MATERIAL AND METHODS

Specimens were taken from 100 patients with PV and 30 healthy volunteers. Cultures were made in modified Dixon agar medium and the isolates were identified by morphological and physiological methods: macroscopy, microscopy, catalase, beta-glucosidase and lipid assimilation tests.

RESULTS

Malassezia globosa was the predominant species in lesional skin of PV (65%). It was isolated alone in 47% of cases and associated in 18% with M. furfur (13%) or M. sympodialis (5%). In healthy skin M. globosa was found alone in 7.77% and associated in 15.54%, respectively, with M. furfur (4.44%), M. sympodialis (4.44%), M. restricta (3.33%) and M. slooffiae (1.11%).

CONCLUSION

From these findings it was suggested that M. globosa presents the main species implicated in the pathogenicity of PV and M. furfur as the second agent of importance.

Pemphigus induit par radiothérapie : à propos d'un cas

A 61-year-old male patient suffering from squamous cell carcinoma of the lower lip developed pemphigus vulgaris two months after exposure to radiotherapy. Skin lesions were initially localised to the face and neck and later extended over other skin areas. The eruption are improved with glucosteroid therapy, which were stopped after six months. Pemphigus induced by radiotherapy is rare, latency before the onset of the vesiculobullous eruption is variable. Clinical, histological and immunological characteristics are similar to those of other types of pemphigus.

Glucantime® par voie parentérale : bénéfice versus toxicité

Glucantime is the most common stibied derivative used to treat cutaneous leishmaniasis (CL) in Tunisia; however adverse effects have been reported.

OBJECTIVES

This retrospective study deals with the various adverse of intramuscular glucantime used for CL.

RESULTS

Nineteen patients (21%) receiving intramuscular Glucantime developed adverse effects. 8 male and 11 female patients, mean age 45, ranging from 8 to 84 years were affected. adverse effects were: fever (3), arthralgia and myalgia (4), nausea and vomiting (2), erythema nodosum (1), acute renal failure (3 including 1 lethal case), hepatic cytolysis (1), skin rash (4), and inflammation of the injection site (1).

CONCLUSION

Adverse effects of intramuscular Glucantime were relatively frequent in our series. Arthralgia, myalgia, and skin rash were not severe and disappeared when the treatment was stopped. Stibiointoxication cases, mainly acute renal failure, were serious.

Carcinomes basocellulaires du cuir chevelu secondaires à une radiothérapie pour teigne : une série de 33 malades

Occurrence of basal cell carcinoma (BCC) following radiotherapy for tinea capitis is well known. The aim of this study was to specify the clinical and histological features of these BCC seen in 33 patients (1995-2000). Twenty seven men and six women were diagnosed with BCC. The age of onset varied between 32 an 62 years. Radiotherapy was received between 5 and 17 years of age. The interval between irradiation and the onset of carcinoma varied between 21 and 51 years. Total number of lesions was 55. Forty percent of BCC occurred on the occipital area, the number varied from 1 to 5 and the size from 2 to 45 mm. Clinically, the nodular type was found in 51% of cases. Pigment was present in 64% of cases. Histological study showed a nodular aspect in 76% and pigmentation in 63% of cases. Nodular and pigmented type were the predominant BCC occurring after radiotherapy for tinea capitis in our series. In the literature, BCC are the most frequent carcinomas occurring after radiotherapy (70-100%). Pigmentation was not described in other series. The nodular histological form was the most frequent.

Carcinome spinocellulaire compliquant une épidermolyse bulleuse héréditaire

The dystrophic form of hereditary epidermolysis bullosa is associated with an increased frequency of squamous cell carcinoma. We report a new case. An 18-year-old patient, carrying a Hallopeau Siemens hereditary epidermolysis bullosa, presented a subcutaneous nodular lesion, for 1 year that ulcerated and budded with inguinal lymphadenopathy. The histological study led to the conclusion of a well differentiated squamous cell carcinoma. The patient was treated surgically. Tumor and metastatic lymph nodes were excised. A radiotherapy was decided but the postoperative course was fatal due to an infection and to a deterioration of her general condition. Squamous cell carcinoma frequently occurs on the cicatricial lesion of hereditary epidermolysis bullosa and usually affects males with recessive hereditary epidermolysis bullosa. Metastases are frequent, precocious and multiple. The treatment may be surgical. The particularities of our observation are the young age of patient and the localization.

Favus due to Trichophyton mentagrophytes var. quinckeanum

A case of inflammatory tinea capitis caused by Trichophyton mentagrophytes var. quinckeanum in a 3-year-old Tunisian girl is presented. The disease healed after treatment with griseofulvin for 6 weeks and topical application of econazole.

[Eosinophilic pustular folliculitis in infancy: an unusual case]

INTRODUCTION

Eosinophilic pustular folliculitis in children is a follicular inflammatory dermatosis, usually occurring early in life. The disease progresses in flares of prurigenous plaques studded with papules and sterile pustules of the scalp and other areas of the skin.

OBSERVATION

A 7 year-old boy presented with itching papular vesicular and pustular plaques on the scalp and the face. Pigmented plaques with pustular border, located on the trunk, were associated with pustular and erosive lesions of the side of the lower lip and in the nostrils. A specimen taken from the pustules did not show bacterial or fungal infection. Histologic examination of a biopsy specimen showed subcorneal pustules with eosinophilic and neutrophilic infiltrates of follicles. Clinical improvement was obtained only by the combination of steroids and dapsone, but recurrence followed withdrawal of treatment.

DISCUSSION

Eosinophilic pustular folliculitis in children is rare. Our case report combines features of the infancy form (lesions located on the scalp and face) and the adult form (location on the trunk and limbs with annular distribution), expressing the conceptual confusion that remains between both forms. The mucosal involvement seen in our patient has never been reported in the literature neither in the infancy nor in the adult form.

[Pseudoxanthoma elasticum: 11 cases]

INTRODUCTION

Pseudoxanthoma elasticum is a congenital dystrophy of the connective tissue. Its clinical expression is cutaneous, ocular and cardiovascular.

PATIENTS AND METHODS

The aim of our study was to specify the principle characteristics of this disease and to discuss the interest of various supplementary examinations in its diagnosis and control in a series of 11 patients.

RESULTS

The study included 9 women and 2 men (sex ratio: 4.5). The mean age the onset of the symptoms was of 18 years. In 4 cases there was a family history of the disease. All the patients exhibited yellowish, pigskin, and papular lesions on the sides of the neck. The systematic ophthalmologic examination revealed angioid streaks in 7 cases and a pigskin aspect in 4 cases. The systematic cardiovascular and metabolic explorations revealed no abnormalities specific to pseudoxanthoma elasticum. Two cases of asymptomatic nephrocalcinosis were observed.

DISCUSSION

In our patients, the disease was probably of autosomal recessive transmission. The predominance of women consulting for the disease would be explained by the esthetic damage. Diagnosis of pseudoxanthoma elasticum is based on clinical, histological and genetic criteria. Supplementary explorations are useful to confirm the diagnosis and also for the search to other, visceral, localizations. Such examinations vary depending on the teams, means and above all the evocative signs.

[Pemphigoid gestationis: a study of 15 cases]

INTRODUCTION

Pemphigoid gestationis is a rare subepidermal bullous dermatosis generally occurring during the 2(nd) or 3(rd) quarter of gestation or in the postpartum period in women who already have been pregnant.

OBJECTIVE

The aim of this work is to draw a profile of the epidemiology, clinical aspects, treatment and evolution of the disease by studying hospital series.

METHODS

In this retrospective study, 15 cases of pemphigoid gestationis confirmed by direct immunofluorescence, followed in the department of dermatology between 1983 and 1999, were included.

RESULTS

The age of onset was 19 to 39 years (mean age: 30 years). In 73% of cases, pemphigoid gestationis occurred in women who had already been pregnant, and appeared during the last 3 months of gestation in 11 patients. In all cases, purities was the first symptom, followed by a erythematous maculopapular eruption. In the steady state of the disease, all patients had annular confluent erythematous papules with herpes, like vesicles predominant in the umbilicus. The diagnosis of pemphigoid gestationis was confirmed by direct immunofluorescence in all cases demonstrated linear staining of C3 at the basement membrane zone. Systemic corticosteroids (0.5-1mg/kg/day) were used in 54% of reported cases. Dapsone was efficient in 26% of patients. 20% of patients were treated with oral antihistamine and topical glucocorticoid. Recurrence occurred in postpartum in 53,3% of patients. Two patients had recurrence during the following pregnancies.

CONCLUSION

PG remains a rare dermatitis of pregnancy. Our series is comparable to the literature: the late occurrence of PG during the course of pregnancy, the high frequency of multigravida women, the lack involvement in the newborn, however with some particularities: the frequent involvement of the face and the efficiency of dapsone.

[Cutaneous metastases revealing gastric linitis]

BACKGROUND

Cutaneous metastases from gastric carcinoma are uncommon and are exceptionally the first sign of disease.

CASE REPORT

A 33-year-old man presented with nodular lesions that had developed three months earlier on the trunk, scalp and limbs. A skin biopsy suggested a metastatic origin. The upper digestive fibroscopy with biopsy demonstrated gastric linitis. Due to the presence of bone metastasis, treatment was not initiated, the patient died four months later.

DISCUSSION

Metastatic dissemination of gastric carcinoma to the skin usually occurs in advanced stage disease. Generally, the skin lesions are painless hard nodules on the anterior abdominal wall. Our patient developed unusual inaugural skin metastases with an exceptional localization.

[Childhood plaque milia of the inner canthus]

BACKGROUND

Milia en plaque is an uncommon skin condition usually seen in adult women, typically in the retroauricular region. We report a new localization in a young child.

CASE REPORT

A 6-year-old girl with an uneventful history had developed over the last 7 months an erythematous plaque with numerous whitish-yellow microcysts on the left internal canthus. No local or general favoring factor was found. Skin biopsy showed numerous cystic cavities with an epidermal lining containing layers of keratin within a moderately inflammatory infiltration. The lesion resolved after enucleation of the cysts and no recurrence has been observed after 9 months follow-up.

DISCUSSION

Milia en plaque is a charateristic erythematous lesion covered with cysts. The usual localization is the retroauricular region, but other localizations have been reported, mainly on the head. This is the first report involving the internal canthus and also in such a young child. One case of a 15-year-old boy has been discribed. Milia en plaque is often a primary condition as in our case although local or general factors may rarely be inductive. Our case illustrates the different localizations possible for milia en plaque, with predominance on the head, and the possibility of childhood cases. We prefer the term milia en plaque rather than retroauricular milia en plaque.

[Pityriasis versicolor in children: a retrospective study of 164 cases]

INTRODUCTION

Pityriasis versicolor is a superficial mycosis uncommonly reported in children. It occurs frequently in warm humid climates. Clinical diagnosis can be confirmed by mycology examination of a biopsy sample or a patch-test. The aim of our work was to assess the frequency of pityriasis versicolor in children in our region and ascertain the contribution of the cutaneous patch test and its diagnostic specificity.

PATIENTS AND METHODS

A retrospective analysis was conducted in patients meeting the following inclusion criteria over a 5-year period: age < 14 years, clinical presentation compatible with pityriasis versicolor, a positive patch-test. Age, sex, clinical features and favoring factors were recorded for all patients. Patch tests were performed in a control group of age-matched children with eczema or vitiligo.

RESULTS

Pityriasis versicolor was diagnosed in 1,379 cases during the study period including 164 children (11.8 p. 100). Age varied from 5 months to 14 years (mean 11 years), with a slight female predominance. Facial lesions were the most frequent (n = 78; 47.5 p. 100), preferentially on the forehead (n = 53; 68 p. 100). An achromic and hypochromic aspect predominated (n = 118; 72 p. 100). The adhesive tape tests were negative in all controls.

DISCUSSION

Pityriasis versicolor is exceptional in children in our region. The adhesive tape test provides a specific diagnostic tool. Preferential facial localization and predominant achromic and hypochromic aspect are characteristic of childhood pityriasis versicolor in our region. These 2 features are also reported in the literature. Childhood cases suggests the pathogenic factors involved in pityriasis versicolor should be reconsidered. Pityriasis versicolor should be included in the differential diagnosis of childhood hypopigmentation of the face.

[Actinic lichen planus: 32 cases]

OBJECTIVES

Actinic lichen planus is a variant form of lichen planus located on light-exposed areas, generally in children or young adults with dark skin living in tropical countries. Three forms have been described: annular, pigmented and dyschromic forms. The aim of this work was to determine the epidemiological, anatomic and clinical features of actinic lichen planus in our region.

PATIENTS AND METHODS

A retrospective study included 32 patients with actinic lichen planus on the basis of clinical features and histological findings. The geographical origin, age, sex, phototype and clinical and histological characteristics were recorded for each case.

RESULTS

The incidence of actinic lichen planus was estimated at 1 case per million inhabitants per year. Age in our patients ranged from 7 to 47 years (mean = 17 years), with female predominance (F/M = 2.5). Twenty-six patients were from the Sfax area. Phototypes ranged from III to V, mainly type IV (43.7%). Onset was usually in spring (in 18 cases). Facial involvement was the most frequent (91%) and the annular form predominated (84%); the pigmented form was found in 4 patients and the dyschromic form in 1. Histology showed typical actinic lichen planus in 18 cases and lichen planus in 14 cases.

DISCUSSION

Compared with data reported in the literature, our series showed a low incidence, younger patients and greater female predominance. The annular form appeared to be the most specific. The pigmented form raises problems of differential diagnosis with melasma. Certain histological signs are highly suggestive.

[Systemic scleroderma in children. Apropos of 2 cases]

Two cases of systemic scleroderma in girls are reported. One patient, aged 11 years, has systemic scleroderma with Raynaud's phenomenon, and pulmonary involvement. The other, aged 8 years, has systemic scleroderma with lung involvement. The specific features of pediatric systemic scleroderma are reviewed briefly.