Background: Severe cutaneous adverse reactions are rare but potentially life-threatening. Identifying the causative drug is crucial for managing and preventing recurrence. Two commonly used causality assessment methods are the Bégaud and the Naranjo algorithm, each with distinct approaches and limitations. The objective of our study is to compare these methods in assessing drug causality in severe cutaneous adverse reactions and to evaluate their concordance and practical applicability. Material and methods: We conducted a retrospective analysis of 116 cases reported to the Casablanca pharmacovigilance center between 2019 and 2023. Drugs implicated were assessed using both the Bégaud and Naranjo methods, and their scores were harmonized into four categories: doubtful, possible, probable, and highly probable. Statistical analysis was performed using Jamovi software. Results: A total of 442 drug observations were analyzed. Antibiotics were the most frequently involved drug class (34.5%). The Bégaud and Naranjo methods yielded identical causality classifications in only 37% of cases, with no statistical concordance (Kappa = 0.062). The Naranjo algorithm tended to implicate more drugs per case (median = 2.00) compared to the Bégaud method (median = 1.00; p < 0.001). Conclusion: The Bégaud and Naranjo methods demonstrated poor agreement in assessing the causality of severe cutaneous adverse reactions. The Naranjo algorithm offers simplicity and rapid application, making it suitable for emergency settings with limited drug exposure. The Bégaud method provides a more detailed analysis, better suited for complex and polymedicated cases. Both methods have complementary roles, and an integrated approach may improve diagnostic accuracy in pharmacovigilance.

Telangiectasia macularis eruptiva perstans (TMEP) is a rare vascular phenotype of cutaneous mastocytosis predominantly reported in adults; pediatric cases are exceptional and are particularly difficult to recognize in darker skin phototypes. We report the case of a 4-year-old girl who presented with subtle brown macules and faint telangiectasias, in whom dermoscopy and histopathology confirmed TMEP despite a normal serum tryptase level. Symptomatic management with antihistamines and topical tacrolimus achieved a favorable clinical outcome. This case highlights the diagnostic challenges of TMEP in skin of color and underscores the need for structured long-term surveillance.

Background Phototherapy remains central to the treatment of inflammatory and pigmentary skin disease and is especially relevant in populations with darker skin phototypes. As biologic and targeted therapies expand, the place of phototherapy in resource-limited settings is uncertain. We assessed the knowledge, perceptions, and practice of Moroccan dermatologists regarding phototherapy and identified barriers to its use. Methods A cross-sectional, self-administered, web-based survey (34 items) was distributed to Moroccan dermatologists via the Moroccan Society of Dermatology network between October and November 2025, covering demographics, access, technical competency, knowledge, prescribing, attitudes toward biologic and targeted therapies, and training needs. Exploratory cross-tabulations (Fisher's exact test) and 95% CIs (Clopper-Pearson method) were computed for the principal proportions. Results Of 53 respondents (91% female, 51% in private practice), 94% had ever prescribed phototherapy, but only 43% (95% CI: 30-58%) had access to a unit. Most respondents rated their knowledge of indications as sufficient or better; however, only 17% (95% CI: 8-30%) identified the guideline-based psoralen plus ultraviolet A risk-monitoring threshold, and 34% (95% CI: 22-48%) identified the recommended minimum age for narrowband ultraviolet B. Most (70%) considered phototherapy to retain a major role alongside biologic and targeted therapies, and a majority reported offering it before escalation in psoriasis (83%), vitiligo (76%), and atopic dermatitis (62%). Access to a phototherapy unit was strongly associated with public or university practice (p < 0.001) and with regular prescribing (p < 0.001). Logistical (79%), institutional (45%), and space-related (38%) barriers predominated; only 36% had received phototherapy training during residency. Conclusions Moroccan dermatologists express strong support for phototherapy and report offering it before biologic and targeted therapies across major indications, but deficits in equipment access, guideline-based knowledge, and postgraduate training represent barriers to optimal practice. These findings highlight the need for further research, including objective competency assessments and clinical outcome studies, to inform strategies for equipment deployment, structured training, and a national phototherapy network.

Juvenile xanthogranuloma (XGJ) is a generally benign non-Langerhans cell histiocytosis (non-LCH) that primarily affects infants and children. It typically presents as a single skin lesion. Disseminated and profuse forms remain rare and can pose diagnostic or therapeutic challenges. The classification of histiocytoses has recently evolved, incorporating disseminated XGJ into group "C" of non-LCH cutaneous histiocytoses. While the prognosis for isolated cutaneous forms is excellent, vigilance regarding potential associations (type 1 neurofibromatosis and juvenile myelomonocytic leukemia) and systemic complications remains essential. We report the case of a four-month-old infant presenting with a purely cutaneous disseminated form of XGJ, confirmed by histopathology and immunohistochemistry, which required systemic corticosteroid therapy due to the rapid spread of the lesions. This study involves a four-month-old infant with no significant family history who has been presenting with gradually progressive papular skin lesions for one month. Clinical examination revealed multiple umbilicated, yellowish-brown papulonodules scattered across the face, trunk, limbs, skin folds, genital mucosa, and scalp; a café-au-lait spot was detected on one limb. Dermoscopy revealed a characteristic "sunset" pattern. Histopathological and immunohistochemical analysis (CD68+, CD163+, CD1a-, CD34-, S100-) confirmed the diagnosis. The staging evaluation revealed no abnormalities. After three months of simple monitoring, the extensive spread of the lesions prompted the initiation of oral corticosteroid therapy (1 mg/kg/day), resulting in partial regression at six weeks. Disseminated XGJ in infants remains a rare condition. Although the course is most often self-limiting, justifying an initial conservative approach, certain extensive forms may require systemic treatment. The dermatologist plays a central role in diagnosis, based on a combination of clinical, dermoscopic, histopathological, and immunohistochemical findings, and in the multidisciplinary decision-making regarding treatment.

Serpentine supravenous hyperpigmentation (SSH) is a rare cutaneous adverse reaction characterized by linear hyperpigmentation along superficial veins following intravenous drug administration, most commonly chemotherapy. We report a rare case of melphalan-induced SSH complicated by superficial venous thrombosis. A 54-year-old man treated for kappa light-chain multiple myeloma developed asymptomatic serpiginous hyperpigmented lesions along the superficial venous network one day after peripheral intravenous melphalan infusion prior to autologous stem cell transplantation. Ten days later, the lesions became painful, and Doppler ultrasound revealed thrombosis of the involved superficial veins. The patient was successfully treated with oral anticoagulation and local care. SSH is generally considered benign and self-limited; however, painful lesions should prompt evaluation for vascular complications such as thrombosis. This case expands the spectrum of chemotherapeutic agents associated with SSH and highlights the importance of early recognition of atypical presentations and complications.

STAT1 gain-of-function mutations cause chronic mucocutaneous candidiasis and broad immune dysregulation, yet African data are limited. In a Moroccan cohort, Baghad et al. describe clinical and genetic features of 12 patients, highlighting infectious predominance, phenotypic diversity, and the need for improved molecular diagnosis and targeted therapies.

Heterozygous gain-of-function (GOF) variants in STAT1 are the most frequent genetic cause of chronic mucocutaneous candidiasis (CMC). Data from Africa remain scarce. We conducted a cross-sectional study at Ibn Rochd University Hospital, Casablanca (2016-2021), enrolling patients with persistent or recurrent mucocutaneous and/or invasive fungal disease. Whole-exome and/or Sanger sequencing were performed, with pathogenicity assessed using ACMG/AMP criteria. We identified 12 patients from 11 kindreds carrying 10 distinct heterozygous STAT1 GOF variants. CMC was the dominant manifestation (11/12, 91%). Mycobacterial infections were documented in 42% of patients and bacterial infections in 50%; one patient presented with cryptococcal meningitis. Autoimmunity was observed in three patients. Two patients died. The c.194A>G (p.D65G) variant, found in a father-son pair, may represent the first clinical description of this substitution as a STAT1 GOF variant. This first dedicated Moroccan cohort demonstrates substantial allelic heterogeneity and a clinical phenotype dominated by infections, particularly tuberculosis, with less frequent autoimmune manifestations than in Western cohorts.

Extramedullary hematopoiesis (EMH) is the formation of hematopoietic cells outside the bone marrow, typically as a compensatory mechanism in the setting of marrow failure. Cutaneous EMH is an exceptionally rare manifestation, usually associated with chronic myeloproliferative disorders such as primary myelofibrosis. We report the case of a 54-year-old woman with Janus kinase 2 (JAK2)-positive primary myelofibrosis and long-standing transfusion-dependent cytopenias who presented with multiple firm, erythematous-to-violaceous nodular lesions on the trunk. Histological examination of a skin biopsy revealed a dermal infiltrate composed of myeloid precursors with diffuse myeloperoxidase expression, consistent with cutaneous EMH. Bone marrow evaluation confirmed advanced myelofibrosis without acute transformation. Despite supportive care, the patient's condition rapidly deteriorated, and she died two weeks after presentation. This case highlights the rarity of cutaneous EMH, its association with advanced marrow failure, and its poor prognostic significance. Recognition of this manifestation may provide insight into the severity of hematopoietic exhaustion and guide clinical management in patients with myeloproliferative disorders.

Introduction:Nail unit melanoma is a rare and potentially aggressive variant of acral lentiginous melanoma. Diagnosing amelanotic variants can be particularly challenging due to the absence of typical pigmentation. Here, we report a case of chronic onychodystrophy revealing amelanotic nail unit melanoma. Case Presentation:A 48-year-old Moroccan patient presented with chronic persistent monodactylic nail dystrophy. Dermoscopy showed subungual hyperkeratosis with an atypical vascular pattern but no pigmented structures. A biopsy of the nail unit confirmed amelanotic melanoma. Staging (PET scan, lymph node ultrasound, and bone CT) excluded metastases. Surgical management led to metacarpophalangeal amputation of the thumb. Conclusion:This case underscores the need to consider amelanotic melanoma in patients with atypical or persistent nail lesions. Early recognition and prompt treatment can significantly affect prognosis. Monodactylous involvement with nail dystrophy, including nail plate destruction, should lead to a nail biopsy for an early and accurate diagnosis.

BACKGROUND:Cutaneous leishmaniasis (CL) represents a global public health challenge. In Morocco, the disease raises several concerns, such as geographical expansion, clinical heterogeneity, and the emergence of new Leishmania species. Our objective was to describe a new epidemiological and clinical profile caused by Leishmania infantum in patients diagnosed in Casablanca, Morocco. METHODS:We performed a cross-sectional study from 2012 to 2023. Epidemiological and clinical data were collected from patients meeting the inclusion criteria using a standardized clinical and epidemiological data collection tool. Parasitological and molecular analyses were performed on samples obtained from each patient. Only patients with confirmed positive polymerase chain reaction (PCR) and genotyping results were included in the study. RESULTS:PCR identified L. infantum as the causative agent of CL in 20 patients, who were predominantly female and from various rural regions across Morocco. All patients resided in areas characterized by inadequate sanitation and the presence of stray dogs. Clinical presentations were diverse, with the papulonodular form being the most frequently observed. Parasitological examinations yielded positive results in 70% of cases. CONCLUSIONS:This study underscores the emergence of CL due to L. infantum as a growing public health concern in Morocco. It highlights the urgent need for enhanced awareness, targeted surveillance, preventive measures to mitigate the spread of the disease, and therapeutic strategies that consider its visceralizing potential.

Piloleiomyomas are uncommon benign tumors that originate from the arrector pili muscle and can resemble other skin lesions, such as keloids. We report the case of a 32-year-old female who presented with a solitary, painful, erythematous nodule on the extensor surface of the right arm, evolving over three years without preceding trauma. Initially misdiagnosed as a keloid and unresponsive to corticosteroid injections, the lesion was surgically excised, and histological and immunohistochemical analysis confirmed a piloleiomyoma. Postoperative recovery was favorable, with no recurrence at three months. This case highlights the diagnostic challenge posed by isolated piloleiomyomas and the importance of histological confirmation in atypical or treatment-resistant lesions resembling keloids.

Nail melanoma is rare and has a poor prognosis. It represents between 0.18 and 2.8% of all cutaneous melanomas. Amputation is usually performed for invasive nail melanoma, but not all invasive melanomas invade or attach to the distal phalanx. Our aim was to report a case of 56-year-old patient with history of a manipulated melanonychial band of the right big toe since 5 years presenting a nail melanoma with bone infiltration .Our patient illustrates the consequences of the late diagnosis of nail melanoma which led to a deep progression and the invasion of bone by the malignant melanocytes.

Melanoma is a malignant tumour with an adverse prognosis. It arises in the nail unit in 1–3% of the cases. There are few studies dealing with this entity in particular in Morocco. The objective of this study was to explore the epidemiological, clinical and histological aspects of nail apparatus melanoma at the Dermatology Department of IBN ROCHD University Hospital in Casablanca. We retrospectively analysed the epidemiological, clinical and histological characteristics of 34 patients diagnosed with nail apparatus melanoma (NAM) from 2009 to 2023. We compared our findings to those reported in the literature. Thirty-four cases of nail melanoma were identified. A female predominance was observed with a sex ratio (M/F) of 0.47. The median age at diagnosis was 55 years, and the most common reason for consultation was an ulcerated nodule of the nail (50% cases). The fingernails were more commonly involved. In histopathology, nodular melanoma was the most frequent histological type (47%). Metastases were found in 47% cases. Excision of the nail unit was the reference treatment, performed in 67.64%. The overall 5-year survival rate was 46%. NAM in our cohort was associated with poor prognosis, mainly due to late diagnosis and restricted therapeutic resources. Early detection remains crucial to improving outcomes. Strengthening awareness and education among healthcare professionals and the public is essential to promote timely diagnosis and better management of this aggressive malignancy.

Hailey-Hailey disease (HHD) is a rare autosomal dominant genodermatosis characterized by recurrent intraepidermal blistering and erosions, most often affecting flexural and intertriginous areas. Although its clinical presentation is distinctive, the disease exhibits considerable variability and is often misdiagnosed, particularly in early or atypical forms. Nail involvement, historically considered absent, has recently been recognized as an underappreciated feature that may provide valuable diagnostic clues. We report a familial case of HHD spanning three generations, in which a single longitudinal leukonychia in the proband preceded the onset of typical skin lesions. The initial nail change, unassociated with trauma or systemic disease, prompted a detailed family history revealing recurrent erosive lesions in relatives. Months later, the proband developed painful, fissured, erythematous plaques in flexural regions, confirmed histologically as HHD. Treatment with topical calcineurin inhibitors, oral doxycycline, and ultraviolet B (UVB) phototherapy led to marked clinical improvement and reduced flare frequency, although the leukonychia remained unchanged. This case highlights the diagnostic importance of subtle nail findings in HHD. Early-onset or isolated leukonychia, often asymptomatic and easily overlooked, may precede cutaneous involvement and thus represent a valuable marker for early detection in at-risk individuals. Recognition of such signs can facilitate timely diagnosis, genetic counseling, and preventive management within affected families. Nail alterations in HHD appear long-lasting and independent of disease activity, underscoring their potential role as a stable phenotypic manifestation of this disorder. Early identification of these subtle nail changes can therefore improve patient outcomes by guiding early therapeutic intervention and reducing the delay in diagnosis often associated with this underrecognized condition.

Background: Susceptibility to common infectious diseases is often linked to innate immune deficiencies. Patients may present normal standard immunological profiles but remain highly vulnerable to infections, complicating diagnosis. This study investigates innate and intrinsic immune deficiencies and their genetic underpinnings in Moroccan patients, emphasizing early detection and personalized care. Methods: A retrospective analysis was conducted using data from the Moroccan Inborn Errors of Immunity (IEI) registry (2008–2024). Included were patients with confirmed innate or intrinsic immunodeficiencies based on CBC, CRP, immunoglobulin levels, lymphocyte subpopulations, and whole-exome sequencing. Classification followed the 2022 IUIS criteria. Results: Among 884 patients with IEI, 79 (~9%) had innate or intrinsic immunodeficiencies, with genetic confirmation in 46 (58%). Of these, 23 (50%) were diagnosed with Mendelian susceptibility to mycobacterial disease (MSMD), involving mutations in the IL12RB1, STAT1, IFNGR1, SPPL2A, TYK2, and TBX21 (T-bet) genes. Chronic mucocutaneous candidiasis (CMC) was found in 15 (32%) patients, linked to STAT1 and IL17RA mutations. Severe viral infection predisposition was seen in 3 patients (POLR3A, IFIH1, TLR7XL) and bacterial susceptibility in 3 others (IRF4, IFNGR1, NCSTN). Novel variants were identified, including IRAK4 c.277delT (p.F93fsX26), not previously reported, and SNORA31 (n.36T>C), previously seen in Saudi Arabia, now found in a Moroccan case of herpes simplex encephalitis. Conclusion: This study reveals the genetic complexity of innate immune disorders in Morocco, with a notable prevalence of MSMD and CMC. It underscores the value of early genetic screening to guide diagnosis and improve patient outcomes.

Background:Cutaneous leishmaniasis (CL) is an endemic parasitic disease in Morocco that exhibits an increasing diversity of clinical manifestations. This clinical polymorphism often leads to misdiagnosis and delays in treatment. The aim of our study was to illustrate the atypical presentations of CL through a series of six cases diagnosed in our department, highlighting the diagnostic challenges and public health implications. Case presentations:We report six atypical cases of CL. Case 1: a 33-year-old male with an ulcerative and crusty lesion on the lower lip mucosa, mimicking epidermoid carcinoma. Case 2: a 44-year-old male with a chondritis-like erythematosquamous plaque on the left ear. Case 3: a 25-year-old male with a well-limited erosive plaque on the right arm, developed leishmaniasis recidivans. Case 4: a 53-year-old female with ulcero-verrucous facial lesions and concomitant cutaneous lupus. Case 5: a 69-year-old female with sarcoidosis-like papulo-nodular facial lesions and an infiltrated nasal plaque mimicking lupus pernio. Case 6: a 75-year-old female with a crateriform lesion on the nose suggestive of keratoacanthoma. Conclusion:These cases illustrate the changing clinical and epidemiological profile of CL in Morocco, highlighting the importance of early recognition and precise diagnosis through detailed anamnesis and parasitological examinations. It underlines the necessity for enhanced epidemiological surveillance and awareness-raising among practitioners to improve the management and control of the disease.

Infantile hemangiomas (IHs) are the most prevalent benign vascular tumors in pediatric populations, with an incidence of approximately 5 to 10% in infants under one year of age. IHs in the otorhinolaryngological (ENT) region present significant diagnostic and therapeutic challenges due to their potential impact on critical functions such as respiration and phonation. This study provides a comprehensive analysis of the epidemiological and clinical characteristics, therapeutic modalities, and outcomes of IHs in the ENT region. Despite therapeutic advancements, the complex nature of IHs in the ENT region necessitates a multidisciplinary approach for optimal management. This study highlights the imperative of early diagnosis and individualized therapeutic strategies to mitigate complications and enhance patient outcomes.

Cutaneous leishmaniasis (CL) is commonly seen in pediatric patients in endemic areas, including Morocco. This retrospective, single center study details 64 confirmed pediatric cases of CL treated with oral clarithromycin 15 mg/kg/day for 10 days per month, for a total of three months. Lesions improved in 96.8% of cases and the treatment was well tolerated. Clarithromycin seems a safe and effective alternative to intralesional injections of meglumine antimoniate.

Introduction Les urgences dermatologiques sont fréquentes et peuvent mettre en jeu le pronostic vital ou fonctionnel. Les internes aux urgences sont les premiers à recevoir et à gérer les patients se présentant pour ce motif de consultation. Notre objectif était d’évaluer les connaissances et la perception des internes en matière d’urgences dermatologiques et de mettre en évidence leurs besoins en formation dans cette spécialité. Matériel et méthodes Une étude prospective évaluant les connaissances et la perception des urgences dermatologiques a été réalisée entre le 1er et le 31 mai 2024 à travers un questionnaire remis aux internes des urgences incluant 16 questions. Résultats Au total, 115 internes ont répondu à notre questionnaire. L’âge moyen des internes était de 24,6 [23–28ans] avec un sexe ratio F/H de 2,19.Parmi eux, 37,4 % affirmaient avoir été initiés aux lésions élémentaires en dermatologie grâce à un stage dans un service de dermatologie.Le nombre de patients consultant pour une urgence dermatologique était estimé entre 1 et 5 patients/j. Dans 73% des cas, le prurit et la grosse jambe rouge aiguë étaient les motifs de consultations les plus fréquents aux urgences, suivis des maladies bulleuses dans 38 % et des angioedèmes dans 21 % des cas. Cinquante-quatre internes (47 %) affirmaient avoir des difficultés à poser un diagnostic précis de l’urgence dermatologique et à évaluer ses complications potentielles nécessitant le recours à un avis spécialisé d’un dermatologue. Cent-onze internes (97 %) ont exprimé leur besoin d’une formation continue sur la gestion des affections dermatologiques aux urgences. Discussion Nos résultats reflètent la difficulté des internes aux urgences à reconnaître et à gérer les urgences dermatologiques. Ces derniers sont les médecins de première ligne à faire face à des tableaux cliniques aigus dont le retard de prise en charge diagnostique ou thérapeutique est associé à une morbi-mortalité non négligeable.Ces difficultés peuvent être expliquées par la non-connaissance des lésions élémentaires et des principes de gestion des urgences dermatologiques, ainsi que par la difficulté et l’hésitation à décider entre une prise en charge en ambulatoire ou une hospitalisation et à déterminer quand demander l’avis du spécialiste.Ainsi, il est crucial de renforcer et de cibler leur formation dans ce domaine pour améliorer la gestion des urgences dermatologiques. Conclusion La détection et le diagnostic des urgences en dermatologie constituent un challenge pour les internes. Une meilleure sensibilisation et une meilleure formation des internes à la reconnaissance de ces tableaux aigus à travers des filières ou réseaux de soins spécialisés sont indispensables pour limiter les conséquences et les séquelles liées au retard d’une prise en charge rapide adaptée.