Background: The aim of this study was to investigate the association between pemphigus and cancer and to analyze the characteristics of pemphigus in which a neoplasm occurs. Materials and Methods: This was a retrospective, descriptive study conducted at the Dermatology Department of Ibn Sina Hospital in Rabat from January 1993 to December 2022, including all pemphigus cases in which cancer was diagnosed before, during, or after the onset of pemphigus. Results: Among 302 pemphigus cases, 13 patients presented an associated cancer (4,3%). Only one patient had a paraneoplastic pemphigus. There was an increased incidence of various solid cancers (11/13) in deep pemphigus types yet without temporal relationship. When hematological malignancy occurred (3/13), it was mainly non-lymphoproliferative and preceded deep pemphigus types with good prognosis. Patient comorbidities and immunosuppressive treatments did not influence the onset of cancer. Conclusion: Our manuscript suggests an increased incidence of solid cancers in deep pemphigus subtypes, independently of the timeline of the latter onset. These pemphigus cases carry a good prognosis. Key words: Pemphigus, Cancer, Paraneoplastic pemphigus, Paraneoplastic autoimmune multiorgan syndrome

A woman in her 50s presented with total scarring ulcerated alopecia evolving for 10 years, and a recent budding tumour on the lower lip. Clinical examination revealed an associated exfoliated and infiltrated erythroderma with ulcerated cutaneous tumours of the legs, palmoplantar hyperkeratosis, hepatosplenomegaly and diffuse lymphadenopathies. Dermatoscopy of the scalp, leg tumours and infiltrated skin showed a typical yellowish background overlaid by arborescent vessels and whitish areas. Cutaneous biopsies of the same areas found sarcoidotic granulomas. Lip biopsy found an associated well-differentiated squamous cell carcinoma. Investigations confirmed the diagnosis of systemic sarcoidosis with an elevated converting enzyme level, mediastinal calcified lymphadenopathies in CT scan and deep localisations in positron emission tomography scan (thyroid, lymph nodes, mediastinum, liver, spleen and adrenal glands). The patient was treated with oral prednisone for sarcoidosis and intramuscular bleomycin followed by surgery and radiotherapy for squamous cell carcinoma. Sarcoidotic lesions healed, but a recurrence of her carcinoma led to death.

Citation: Karrakchou B, Fliti A, El Fiboumi A, Kettani F, Senouci K, Meziane M. Folliculitis Decalvans with Frontal Fibrosing Alopecia in a Dark Phototype: Presentation of Folliculitis Decalvans and Lichen Planopilaris Phenotypic Spectrum. Dermatol Pract Concept. 2023;13(4):e2023229. DOI: https://doi.org/10.5826/dpc.1304a229

A thirty-year-old patient presented with an erythematous papule on the left nostril evolving for ten months. A clinical examination revealed an infiltrated, erythematous, well-limited plaque with a raised border, covered with multiple open and closed comedones. On dermoscopy, there was an erythematous background with some fine telangiectasias and horny plugs at the follicular orifices. A skin biopsy was performed, revealing orthokeratotic hyperkeratosis sinking into the follicular orifices dilated by sebum clumps with basal vacuolation associated with a subepidermal and periadnexal/perivascular lymphocyte band infiltrate. Direct immunofluorescence staining for immunoglobulin M was positive. The diagnosis of lupus comedones was retained, and the patient was put on topical tacrolimus 0.1% twice a day. A systemic damage assessment was negative. Our case highlighted, the importance of recognizing this rare variant of cutaneous lupus, confused with acne vulgaris, hence the delayed diagnosis, which may also be an early sign of a concomitant systemic involvement. Key words: Acne; Chronic Cutaneous Lupus Erythematosus; Comedonal Variant; Discoid Lupus Erythematosus

Dermatomyofibroma is an unusual benign mesenchymal tumour of fibrous or myofibroblastic differentiation with a chronic evolution. We report a particular case of dermatomyofibroma presenting as multiple nodules on the hand, with new dermoscopic features.

We report the case of a 34-year-old female patient with no medical history presented herself with a lesion near the intergluteal cleft evolving for more than five years and gradually increasing in size. An examination revealed a painless nodule 1.5 × 2 cm in size, of soft consistency, and with a flesh-colored pedicle base with central hyperpigmentation and a depigmented peripheral area (Fig. 1). Dermoscopy revealed a hyperpigmented cerebriform structure in the center surmounted by several white scales and bordered by an irregular melanocytic network and multiple ovoid nests (Fig. 2).

Plusieurs manifestations cutanées satellites de la COVID-19 ont été rapportées ces derniers mois, notamment de multiples cas de pseudo-engelures (les « COVID-toes »), sans que le rôle direct du SARS-CoV-2 dans leur développement ait été formellement démontré. L'hypothèse la plus probable est celle de l'existence chez ces patients d'une réponse antivirale interféron de type 1 exacerbée, expliquant d'une part l'absence de manifestations cliniques de la COVID-19 et la négativité des tests sérologiques, et d'autre part le développement de ces lésions cutanées, similaires à celles observées dans les interféronopathies de type 1. Les quelques observations récentes de pseudo engelures post vaccinales supportent cette hypothèse : nous en rapportons un nouveau cas. Une patiente de 82 ans consultait en urgence pour des lésions palmoplantaires. Elle n'avait pas d'antécédents de syndrome de Raynaud ou d'engelures, n'avait présenté aucun symptôme général évocateur de COVID-19 et ne rapportait pas de contact récent. Ces lésions douloureuses avaient débuté 24 h après la première injection du vaccin à ARNm BNT162b2 (Pfizer), en dehors de toute exposition au froid. L'examen clinique retrouvait des macules érythémato-violacées acrales évocatrices de pseudo-engelures sans autre signe associé. Le bilan biologique standard était normal, le bilan auto-immun négatif (ACAN, cryoglobulinémie, cryogibrinogène). L'examen histologique) d'une lésion palmaire retrouvait un infiltrat lymphocytaire dermique dense(a) formant des agrégats péri-vasculaires(b), péri-sudoraux(c) et péri-nerveux, caractéristique d'engelures. L'immunofluorescence directe était négative. La recherche sérologique d'anticorps IgG anti-SARS-CoV-2 était négative mais positive pour les anticorps anti-Spike, évoquant le début d'une immunité vaccinale sans immunité préalable. La signature interféron sanguine était positive. Des manifestations cutanées post-vaccins à ARN anti-SARS-CoV-2 commencent à être rapportées, au premier rang desquelles des réactions locales retardées et des réactions au point d'injection, mais également des éruptions urticariennes et morbilliformes. Quelques cas de pseudo-engelures ont également été signalés dans les jours suivant ce type de vaccination. Chez notre patiente, les caractéristiques cliniques et histologiques des lésions étaient indiscernables de celles des pseudo-engelures observées lors de la première vague pandémique. L'absence d'antécédents d'engelures et d'exposition au froid allait à l'encontre d'engelures classiques. Ceci, associé à la positivité de la signature Interféron sanguine de notre patiente, renforce donc l'hypothèse d'une origine immunitaire, plutôt que celle d'un rôle cytopathogène direct du SARS-CoV-2, dans le développement de ces lésions.

Background Mycetoma is an uncommon chronic granulomatous infection of cutaneous and subcutaneous tissues that can be caused by filamentous bacteria (actinomycetoma) or fungi (eumycetoma). It is the prerogative of young men between the third and fourth decade and is transmitted through any trauma causing an inoculating point. The classic clinical triad associates a painless hard and swelling subcutaneous mass, multiple fistulas, and the pathognomonic discharge of grains. Although endemic in many tropical and subtropical countries, mycetoma can also be found in non-endemic areas as in Morocco, and causes then diagnosis problems leading to long lasting complications. Therefore, we should raise awareness of this neglected disease for an earlier management. Under medical treatment however, mycetoma has a slow healing and surgery is often needed, and relapses are possible. Case presentation Herein we report a case of a 64 years old patient, with a history of eumycetoma occurring ten years ago treated with oral terbinafine coupled with surgery. A complete remission was seen after 2 years. He presented a relapse on the previous scar 6 months ago. There wasn’t any bone involvement in the magnetic resonance imaging (MRI). The patient was put under oral terbinafine with a slow but positive outcome. Conclusion Through this case report, we perform a literature review and highlight the importance of increase awareness of mycetoma in clinical practice especially in non-endemic regions.