RESUMEN
INTRODUCTION: In Morocco, tuberculosis is an endemic disease. The aim of this study was to trace the epidemiological, paraclinical, therapeutic, and progressive characteristics of cutaneous tuberculosis (CT) in children. MATERIALS AND METHOD: This multicenter retrospective and prospective study concerned all pediatric patients followed for CT in our region. The diagnosis was based on comparing clinical, immunological, bacteriological, and histological data. RESULTS: We found 147 cases of CT, of which 16 cases (10%) were children. The average age was 10.5 years, with extremes ranging from 15 months to 16 years. The sex ratio was 0.75. Deterioration in general condition and weight loss were noted in three cases, and none of the patients was immunocompromised. The clinical forms were essentially scrofuloderma tuberculosis in nine cases (57%), gummas in five cases (35%), a single case each of verrucous tuberculosis and lupus vulgaris. The histological study of the lesions confirmed the diagnosis for all cases by showing a tuberculous granuloma. Multifocal forms were found in one case. Antibacillary treatment was recommended for 6 months in all patients except in the child with a multifocal form whose treatment was prolonged to 9 months. The progression was favorable with total healing in all cases except in a single case that retained sequelae such as bone deformities and scars in most cases. DISCUSSION: Cutaneous tuberculosis in children is dominated by scrofuloderma and gummy lesions in our region. Despite deterioration in the general condition and weight loss in three cases, none of these children was immunocompromised. Therapeutic management was then carried out based on several clinical and paraclinical arguments and the histological study. Even if the compulsory BCG vaccine in Morocco prevents serious forms, early diagnosis remains the only way to reduce the risk of complications. CONCLUSION: Cutaneous tuberculosis concerns our pediatric population, multibacillary forms of cutaneous localization is the most frequent one, although the BCG vaccine in Morocco is compulsory.
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Tuberculosis Cutánea/diagnóstico , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Marruecos/epidemiología , Estudios Prospectivos , Estudios Retrospectivos , Piel/patología , Tuberculosis Cutánea/epidemiologíaRESUMEN
INTRODUCTION: Lichenoid cutaneous reactions to antituberculosis drugs are rare. Herein we report a new case. PATIENTS AND METHODS: A 41-year-old patient was seen for a profuse and pruriginous rash occurring 2 weeks after administration of rifampicin and isoniazid for pulmonary tuberculosis. Dermatological examination revealed polymorphic erythemato-squamous plaques with lichenoid, psoriatic and eczematous features, associated with cheilitis, erosions on the cheeks and diffuse onychodystrophy. The skin biopsy confirmed a lichenoid reaction. The pharmacovigilance investigation incriminated isoniazid and rifampicin. The patient was treated with topical corticosteroids and UVB phototherapy. The outcome involved complete regression of the eruption but with secondary anonychia. DISCUSSION: Antituberculosis drugs including isoniazid and rifampicin are known to induce lichenoid reactions. It is difficult to distinguish the results from lichen planus. The clinical polymorphism of the rash as well as the patient's drug intake militate in favour of a diagnosis of lichenoid reaction. Widespread ungual involvement, which is extremely rare, warranted early management in order to avert irreversible anonychia.
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Antituberculosos/efectos adversos , Erupciones por Medicamentos/etiología , Isoniazida/efectos adversos , Erupciones Liquenoides/inducido químicamente , Enfermedades de la Uña/inducido químicamente , Rifampin/efectos adversos , Adulto , Erupciones por Medicamentos/complicaciones , Humanos , Isoniazida/uso terapéutico , Erupciones Liquenoides/complicaciones , Masculino , Enfermedades de la Uña/complicaciones , Rifampin/uso terapéutico , Tuberculosis Pulmonar/tratamiento farmacológicoRESUMEN
The diagnosis of pigmented actinic keratosis (PAK) is often challenging because of overlapping features with lentigo maligna. Objective: To investigate dermoscopic patterns of PAK according to their different evolutionary stages, and to correlate the pattern with clinical characteristics of the patients. Methods: Descriptive and analytical study of 232 PAK. Dermoscopic patterns were divided into two categories: the follicule surroundings abnormalities (FSA) and follicular keratosis abnormalities (FKA). Results: FSA and FKA dermoscopic patterns were related to male gender, except for star-like appearance, double white clods and dermoscopic horn (p≤0.04). Rhomboidal, annular granular pattern, gray halo, white circle and double clods were dermoscopic pattern significantly related to xeroderma pigmentosum's type of skin. Based on the evolutionary stages of PAK, the jelly sign was significantly related to thin patches of PAK. Central crusts and scales were related to thick plaques and the star-like appearance to hypertrophic PAK. The presence of 2 or more dermoscopic signs in both FSA and FKA was noticed in 99.1% of lesions. Conclusions: The dermoscopic diagnosis of PAK vary according to the evolutionary stages of the disease, this will increase the diagnosis accuracy, with therapeutic implications. El diagnóstico de la queratosis actínica pigmentada (QAP) es a menudo difícil, debido a sus características, que se solapan con las propias del lentigo maligno (AU)
Objetivo: Investigar los patrones dermatoscópicos de la QAP con arreglo a sus distintos estadios evolutivos, y correlacionar dicho patrón con las características clínicas de los pacientes. Métodos: Estudio descriptivo y analítico de 232 QAP. Se dividieron los patrones dermatoscópicos en 2 categorías; alteraciones perifoliculares (APF) y la queratosis folicular (QF). Resultados: Se relacionaron los patrones dermatoscópicos de APF y QF con el sexo masculino, exceptuando las características de aspecto estrellado, double white clods y cuerno dermatoscópico (p≤0,04). Las características romboidal, anular-granular, de halo gris, círculo blanco y double clots constituyeron los patrones dermatoscópicos significativos relacionados con el tipo de piel del xeroderma pigmentoso. Sobre la base de los estadios evolutivos de la QAP, el signo de la jalea guardó relación significativa con los parches finos cutáneos de la QAP. Las costras y escamas centrales se relacionaron con las placas densas, y el aspecto estrellado de la QAP hipertrófica. La presencia de 2 o más signos dermatoscópicos, tanto en APF como en QF, se apreció en el 99,1% de las lesiones. Conclusiones: El diagnóstico dermatoscópico de QAP varía con arreglo a los estadios evolutivos de la enfermedad, incrementándose la precisión diagnóstica, con implicaciones terapéuticas (AU)
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Humanos , Dermoscopía/métodos , Queratosis Actínica/diagnóstico por imagen , Neoplasias Cutáneas/diagnóstico por imagen , Epidemiología Descriptiva , Factores de Riesgo , Trastornos de la Pigmentación/etiología , Cara/patología , Melanoma/diagnóstico por imagenRESUMEN
The diagnosis of pigmented actinic keratosis (PAK) is often challenging because of overlapping features with lentigo maligna. OBJECTIVE: To investigate dermoscopic patterns of PAK according to their different evolutionary stages, and to correlate the pattern with clinical characteristics of the patients. METHODS: Descriptive and analytical study of 232 PAK. Dermoscopic patterns were divided into two categories: the follicule surroundings' abnormalities (FSA) and follicular keratosis' abnormalities (FKA). RESULTS: FSA and FKA dermoscopic patterns were related to male gender, except for star-like appearance, double white clods and dermoscopic horn (p≤0.04). Rhomboidal, annular granular pattern, gray halo, white circle and double clods were dermoscopic pattern significantly related to xeroderma pigmentosum's type of skin. Based on the evolutionary stages of PAK, the jelly sign was significantly related to thin patches of PAK. Central crusts and scales were related to thick plaques and the star-like appearance to hypertrophic PAK. The presence of 2 or more dermoscopic signs in both FSA and FKA was noticed in 99.1% of lesions. CONCLUSIONS: The dermoscopic diagnosis of PAK vary according to the evolutionary stages of the disease, this will increase the diagnosis accuracy, with therapeutic implications.
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Dermatosis Facial/patología , Queratosis Actínica/patología , Adulto , Anciano , Dermoscopía , Diagnóstico Diferencial , Dermatosis Facial/diagnóstico , Neoplasias Faciales/diagnóstico , Femenino , Humanos , Peca Melanótica de Hutchinson/diagnóstico , Queratosis Actínica/diagnóstico , Masculino , Persona de Mediana Edad , Factores Sexuales , Neoplasias Cutáneas/diagnóstico , Adulto JovenRESUMEN
UNLABELLED: To date, there is little data in the literature describing the anxiety and depressive disorders iatrogenic to corticosteroids. These disorders are common, underestimated, with potentially serious consequences that may jeopardize the patient's prognosis; their management is not consensual. OBJECTIVES: The objective of our work is to determine the prevalence of anxiety and depressive disorders induced by corticosteroids, assessing their accountability to the corticosteroids and studying their risk factors. METHODS: We conducted a prospective longitudinal study over 12months evaluating the prevalence of anxiety and depressive disorders in patients followed for chronic skin diseases treated with prolonged corticosteroid-therapy. Our patients were assessed using standardized instruments: the Mini International Neuropsychiatric Interview (MINI), the Hamilton Anxiety Scale (HAS) and the Beck Depression Inventory (BDI). RESULTS: Of 54 patients included, our study showed a high prevalence of anxiety and depressive disorders estimated at 27%. These disorders were divided into depressive disorder in 16% of cases, and anxiety disorder in 11% of cases. The early onset of these disorders was found during the first weeks of treatment. According to the Beck Depression Inventory (BDI), depression was moderate in 67% of cases; severe with suicide attempts in 22% of cases, and mild in 11% of cases. According to the Hamilton Anxiety Scale (HAS), anxiety was mild in 33% of cases and moderate in 67% of cases. The disorders observed were mainly distributed into: 33% deep pemphigus, 27% lupus, 13% bullous pemphigoid and 13% dermatomyositis. In this study the statistically significant risk factors are dose of corticosteroids and personal psychiatric history of the patient; in addition, there is a high prevalence of disorders in patients whose age exceeds 40 years, female gender, and patients treated for deep pemphigus. The evolution after pharmacological treatment and supportive psychotherapy was favorable in most patients. CONCLUSION: The psychiatric examination prior to prescription of long-term corticosteroid-therapy use should be standard practice to identify patients at risk, discuss the treatment modalities, and provide comprehensive care.
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Corticoesteroides/efectos adversos , Trastornos de Ansiedad/inducido químicamente , Trastorno Depresivo/inducido químicamente , Corticoesteroides/administración & dosificación , Adulto , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicología , Estudios Transversales , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/epidemiología , Trastorno Depresivo/psicología , Trastorno Depresivo Mayor/inducido químicamente , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/epidemiología , Trastorno Depresivo Mayor/psicología , Dermatomiositis/tratamiento farmacológico , Dermatomiositis/epidemiología , Dermatomiositis/psicología , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Enfermedad Iatrogénica , Entrevista Psicológica , Cuidados a Largo Plazo , Estudios Longitudinales , Lupus Eritematoso Sistémico/tratamiento farmacológico , Lupus Eritematoso Sistémico/epidemiología , Lupus Eritematoso Sistémico/psicología , Masculino , Penfigoide Ampolloso/tratamiento farmacológico , Penfigoide Ampolloso/epidemiología , Penfigoide Ampolloso/psicología , Pénfigo/tratamiento farmacológico , Pénfigo/epidemiología , Pénfigo/psicología , Inventario de Personalidad , Estudios Prospectivos , Psicoterapia , Factores de Riesgo , Intento de Suicidio/psicologíaRESUMEN
BACKGROUND: Acquired ichthyosis is a rare condition that can reveal an unsuspected haematological malignancy, thus allowing early diagnosis and management. If ichthyosis regresses under treatment for the haematological disorder, its recurrence reflects a turning point in the course of the disease and implies worsening of the prognosis. PATIENTS AND METHODS: The patients were examined at a joint dermatology/haematology consultation. The diagnosis of ichthyosis was based on clinical examination alone with no patients undergoing skin biopsy. RESULTS: Our series included three men and two women aged 38 to 65 years consulting for a variety of reasons including asthenia, anaemia and adenopathy. Ichthyosis occurred 2 to 9 months after the initial symptoms of the blood disease. Lesions consisted of diffuse brown scales. The disease was associated with lymphadenopathy and biological inflammatory syndrome. Two patients were presenting non-Hodgkin lymphoma, one had Hodgkin's disease, one had chronic myeloid leukaemia in progression and one had an undifferentiated lymphomatous process. Treatment was based on chemotherapy and emollients. The ichthyosis progressed in step with the underlying malignancy in all cases, with regression being complete in three cases, partial in one case and absent in one case. DISCUSSION: In rare cases, acquired ichthyosis reveals systemic disease, and may be of infectious, endocrine or drug origin; it may also be idiopathic. However, it is most often a paraneoplastic syndrome with cutaneous expression encountered during haematological malignancies. Because of the variety of causative blood dyscrasias, ichthyosis cannot be used to guide their diagnosis, although it remains a reliable monitoring tool. CONCLUSION: Acquired ichthyosis should prompt the clinician to search for a neoplastic condition, primarily a haematological disorder, guided by other associated signs, given that in our study, skin lesions generally appear to precede signs of the blood disease.
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Neoplasias Hematológicas/complicaciones , Ictiosis/etiología , Síndromes Paraneoplásicos/etiología , Adulto , Anciano , Alopurinol/uso terapéutico , Anemia/etiología , Anticuerpos Monoclonales de Origen Murino/administración & dosificación , Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Benzamidas , Bleomicina/administración & dosificación , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Etopósido/administración & dosificación , Femenino , Enfermedad de Hodgkin/complicaciones , Enfermedad de Hodgkin/tratamiento farmacológico , Humanos , Ictiosis/tratamiento farmacológico , Mesilato de Imatinib , Leucemia Mieloide de Fase Acelerada/sangre , Leucemia Mieloide de Fase Acelerada/complicaciones , Leucemia Mieloide de Fase Acelerada/tratamiento farmacológico , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/tratamiento farmacológico , Linfoma de Células B/complicaciones , Linfoma de Células B/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Síndromes Paraneoplásicos/tratamiento farmacológico , Neoplasias de la Parótida/complicaciones , Piperazinas/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Prednisona/administración & dosificación , Procarbazina/administración & dosificación , Pirimidinas/uso terapéutico , Estudios Retrospectivos , Rituximab , Esquizofrenia/complicaciones , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/tratamiento farmacológico , Vincristina/administración & dosificaciónAsunto(s)
Antibacterianos/efectos adversos , Ciprofloxacina/efectos adversos , Erupciones por Medicamentos/etiología , Síndrome de Sweet/inducido químicamente , Dacriocistitis/tratamiento farmacológico , Dermatosis Facial/inducido químicamente , Femenino , Dermatosis del Pie/inducido químicamente , Dermatosis de la Mano/inducido químicamente , Humanos , Persona de Mediana EdadRESUMEN
A prospective study of syphilis cases over a period of 2 years (January 2008 to September 2009) was carried out in the Department of Dermatology of the Hassan II University Hospital Center in Fes, Morocco. A total of 57 cases were identified. The M/F sex ratio was 0.89. Mean patient age was 40.5 years (range, 22-80). Risk factors included unprotected sex in 96.5% of cases and multiple partners in 42.1%. Nine patients had a history of sexually transmitted infection. No patient had received blood transfusion. Clinical picture was late latent syphilis in 70.2% of cases (n = 41). Only one case was associated with human immunodeficiency virus. The mainstay treatment was intramuscular benzathine benzylpenicillin. Outcome was favorable in 48 cases.
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Sífilis/epidemiología , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Marruecos/epidemiología , Penicilina G Benzatina/uso terapéutico , Estudios Prospectivos , Factores de Riesgo , Distribución por Sexo , Parejas Sexuales , Sífilis/diagnóstico , Sífilis/tratamiento farmacológico , Sexo InseguroRESUMEN
Tuberculosis is still endemic in Morocco. Cutaneous tuberculosis is the fifth most common form after pleuropulmonary, glandular, digestive and urogenital tract tuberculosis. The purpose of this single-center prospective study is to describe all cases of cutaneous tuberculosis treated between May 2006 and June 2009. Diagnosis was suspected based on clinical, immunological and histological features. The main clinical presentations, i.e., scrofuloderma and gumma, were consistent with endemicity of tuberculosis in Morocco. Since definitive diagnosis by detection of the tubercle bacillus was rarely possible, therapy was usually undertaken presumptively based on clinical and laboratory findings and therapeutic response.