Background: Miliary osteoma cutis (OC) of the face is a rare benign extra skeletal bone formation. For our knowledge, only 23 cases have been reported in the English literature. These lesions may be primary or secondary. They cause diagnostic, therapeutic and cosmetic concern especially in women who are usually concerned. Our purpose is to present a case which is completely documented with the clinical, histological and radiological findings. We also report a possible pathogenic theory according to our histologic findings.Main observation: We report a case of a multiple miliary OC of the face in a 45-year-old woman which suffered from gravidarum acne. These lesions were treated by focal surgical treatment.Conclusions: Based on our histological findings, an osteoblastic metaplasia seems to be a possible pathogenic theory. This metaplasia seems to be secondary to a chronic inflammation. Concerning therapeutic procedures, they are non consensual and debated and are based on surgical or medical treatment. More reports are needed in order to assess the therapeutic management of this disease and its inducing factors.

Transient neonatal pustular melanosis is a common, benign, but little known dermatosis in newborns. Diagnosis of transient neonatal pustular melanosis is made clinically, by the presence of vesiculopustular and pigmented macular skin lesions. This benign spontaneously regressive dermatosis should be distinguished from several serious infectious neonatal diseases. We report a case of transient neonatal pustular melanosis and discuss the nosologic problems and differential diagnosis of this entity.

No therapy can remove acne scars completely, but the discerning use of lasers can help to relieve patients of related symptoms. Electro-optical synergy (ELOS), a technology that combines radiofrequency (RF) with optical energy, shows multiple application potential, including hair removal and reversal of photoaging. Using the case reported here as an example, we discuss the role of the ELOS technology in the treatment of acne scars. The acne scars of a female patient (age 34, Fitzpatrick skin type IV) were treated with ELOS. The patient was treated monthly for a total of 4 sessions with a Matrix IR™ system (Syneron Medical Ltd.), a combination of a fractional diode laser (915 nm) and bipolar conducted RF energy, using the following parameters: 60 J/cm2 (laser energy) and 80 J/cm3 (RF energy). Acne scars were markedly reduced 1–3 months after the final treatment. This technology encompasses a combination of optical and RF energies which are simultaneously applied to the tissue and demonstrate the safety and efficacy in the treatment of acne scars. Derzeit gibt es keine Behandlungsmethode, die Aknenarben vollständig entfernen kann, auch wenn durch den Einsatz von Lasern eine Verbesserung des Hautbildes erzielt werden kann. Die ELOS-Technologie, aus dem Englischen kommend für "electro-optical synergy", ist ein Verfahren, das die Applikation von Radiofrequenzstrom (RF) und optischer Energie kombiniert und dadurch eine Reihe von Anwendungsmöglichkeiten birgt, z.B. zur Haarentfernung oder der Behandlung von lichtbedingten Hautschäden. Mit der vorliegenden Fallbeschreibung wird die Rolle der ELOS-Technologie in der Behandlung von Aknenarben diskutiert. Eine 34-jährige Patientin (Hauttyp IV nach Fitzpatrick) mit prominenten Aknenarben wurde 4x im Abstand von jeweils einem Monat mit dem Matrix IR™-System (Syneron Medical Ltd.) behandelt, welches einen Diodenlaser (Wellenlänge: 915 nm) mit einem bipolaren RF-System kombiniert. Es wurden folgende Energien appliziert: 60 J/cm2 (Laserenergie) und 80 J/cm3 (RF-Energie). Die Aknenarben waren 1 und 3 Monate nach der Behandlung merklich reduziert. Die ELOS-Therapie konnte im beschriebenen Fall sicher und effizient angewendet werden.

Dystrophic epidermolysis bullosa (DEB) is a group of inherited mechano-bullous disorders with a broad range of clinical severity characterized by blistering. Ultrastructurally, DEB shows abnormalities of the anchoring fibrils, which are composed of type VII collagen [ [1] Bruckner-Tuderman L. Hereditary skin diseases of anchoring fibrils. J Dermatol Sci. 1999; 20: 122-133 Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar ]. On the basis of the mode of inheritance and the clinical manifestations, DEB is classified into 3 major forms: one dominant (DDEB) and two recessive (RDEB), the severe generalized RDEB subtype (RDEBsg) and “RDEB generalized other” (RDEB-O) which designates the other groups of generalized RDEB [ [2] Fine J.D. Eady R.A. Bauer E.A. Bauer J.W. Bruckner-Tuderman L. Heagerty A. et al. The classification of inherited epidermolysis bullosa (EB): report of the Third International Consensus Meeting on Diagnosis and Classification of EB. J Am Acad Dermatol. 2008; 58: 931-950 Abstract Full Text Full Text PDF PubMed Scopus (708) Google Scholar ]. All forms of DEB are known to be caused by mutations in the COL7A1 gene encoding type VII collagen. This gene consists of 118 exons, and over 300 COL7A1 mutations have been reported [ [3] Varki R. Sadowski S. Uitto J. Pfendner E. Epidermolysis bullosa. II. Type VII collagen mutations and phenotype–genotype correlations in the dystrophic subtypes. J Med Genet. 2007; 44: 181-192 Crossref PubMed Scopus (206) Google Scholar ], most of them being family specific.

BackgroundDystrophic epidermolysis bullosa (DEB) is a clinically heterogeneous blistering disorder of the skin and mucous membranes. DEB is caused by mutations in the COL7A1 gene encoding type VII collagen, the major component of anchoring fibrils. On the basis of the mode of inheritance and the clinical manifestations, DEB is classified into two major subtypes: one dominant (DDEB) and one recessive (RDEB).ObjectiveWe report, here, clinical, histological and genetic investigation of a large Tunisian family presenting with a wide range of clinical manifestations of DEB and a pedigree suggestive for a pseudodominant pattern of inheritance of a recessive mutation.MethodsIndirect immunofluorescence (IF) with the antibody LH7:2 against collagen VII and electron microscopy (EM) analyses were performed. The members of the family were genotyped with five markers flanking COL7A1, and screening for the deleterious mutation by DHPLC and direct sequencing.ResultsThe family presented four pretibial DEB patients and one generalized RDEB. Molecular investigation showed that all family members, unaffected and affected by the pretibial form, were heterozygous for the c.7178delT mutation, except for the member with the generalized form who was homozygous. IF showed that heterozygous individuals, independently of their clinical status, have a slightly reduced staining, and the homozygous individual with generalized DEB has markedly reduced staining at the dermal–epidermal junction.ConclusionThese results are suggestive for an autosomal semidominant model of inheritance with incomplete penetrance and variable expression for the identified mutation. No genotype phenotype correlation was observed suggesting the existence of other genetic determinants influencing dermo-epidermal junction cohesion.

La pratique des injections de toxine botulinique est incontournable dans la prise en charge du vieillissement facial. En effet, la toxine botulinique A permet d’estomper les rides d’expression par relaxation transitoire et réversible (6 mois) du muscle responsable. Elle est le traitement d’excellence des rides du tiers supérieur : rides du lion, du front et de la patte d’oie. Cette technique nécessite une bonne connaissance de l’anatomie musculaire fonctionnelle faciale, afin d’appliquer correctement les bases techniques consensuelles d’injection ici décrites. Chaque patient est unique et seule l’expérience permettra d’affiner et de personnaliser les injections.The practice of botulinum toxin injections is unavoidable in the correction of facial aging. In effect botulinum toxin allows to erase dynamic wrinkles, by transient and reversible muscular relaxation. This is the best wrinckle treatment for the upper part of the face: glabellar lines, horizontal forehead lines and crow's feet. This technique requires a good understanding of facial muscular anatomy, in order to correctly apply the basics of injection. Every patient is unique and only a big experience will allow to refine and personalise injections.

We report on a case of macrocystic lymphatic malformation of the forearm. A male infant, without any medical history, was followed up in our department since the age of 7 months because of a subcutaneous, soft, painless mass of the left forearm. Ultrasonography and the magnetic reasonance imaging (MRI) were evocative of a macrocystic lymphatic malformation. Five sessions of sclerotherapy led to the reduction of the size of the mass but another axillary tumor appeared afterwards. A surgical excision, unfortunately incomplete, was performed rapidly followed by a recurrence of the macrocystic lymphatic malformation. Macrocystic lymphatic malformations are localized in the neck in 75% and axilla in 20% of the cases. Involvement of the upper extremity and particularly the forearm is very rare. MRI is useful for the diagnosis and the definition of tumor limits. The treatment is usually challenging because of their location and rough delimitation.

But. Nous avons etudie le profil epidemio-clinique des teignes du cuir chevelu a partir de 1222 cas observes dans le service de Dermatologie de l'hopital La Rabta. Materiel et methodes. C'est une etude retrospective realisee durant une periode de 14 ans (1985-1998). Les patients dont le diagnostic a ete suspecte cliniquement et confirme par l'examen mycologique (examen direct et/ou culture) ont ete inclus. Resultats. Un nombre total de 1222 cas de teignes sont recenses de 1985 a 1998, ce qui represente 1,3 % des nouveaux consultants/an. L'âge moyen des patients est de 7 ans. Le sex-ratio est de 1,05. Les teignes se repartissent en teignes trichophytiques dans 55,8 % des cas, microsporiques dans 41,7 %, inflammatoires dans 1,8 % et faviques dans 0,6 % des cas. Conclusion, Dans notre etude, les teignes du cuir chevelu atteignent l'enfant en âge scolaire sans predominance de sexe. Les teignes tondantes constituent la majorite des teignes du cuir chevelu. Elles se repartissent de facon egale en teignes trichophytiques et microsporiques. Les teignes inflammatoires sont rares. Elles sont plus frequentes en milieu rural. Les teignes faviques sont devenues exceptionnelles. Trichophyton violaceum (53 %) et Microsporum canis (44,7 %) sont les principaux dermatophytes isoles. Le profil epidemiologique des teignes dans les differentes etudes tunisiennes est proche de celui des autres pays maghrebins.