IntroductionHigh-dose methotrexate (HD-MTX) is a cornerstone in the treatment of acute lymphoblastic leukemia but carries a risk of severe toxicity. Toxic epidermal necrolysis (TEN) is a rare life-threatening adverse reaction.Case reportWe report the case of a 15-year-old male with high-risk T-cell acute lymphoblastic leukemia who developed fatal TEN following HD-MTX therapy during induction chemotherapy. Ten days after methotrexate administration, the patient developed rapidly progressive epidermal detachment with mucosal involvement.Management & outcomeThe clinical course was complicated by tumor lysis syndrome and acute renal failure requiring intensified leucovorin rescue. Skin biopsy confirmed drug-induced TEN, and pharmacovigilance analysis using the ALDEN score strongly implicated methotrexate. Despite intensive supportive care and broad-spectrum antimicrobial therapy, the patient deteriorated and died of multiorgan failure.DiscussionThis case highlights the importance of early recognition of methotrexate toxicity, strict renal monitoring, and awareness of drug interactions to prevent fatal outcomes.

Pressure-induced alopecia is an unusual cause of nonscarring alopecia that can become permanent scarring alopecia. It occurs due to ischemia resulting from prolonged head immobilization after surgery or hospitalization, especially in intensive care units. Trichoscopy as noninvasive technique may provide relevant clues for an accurate diagnosis. "Comedone-like black dots" is a unique trichoscopic feature which can help in rapid identification of the condition and especially in the differentiation from alopecia areata. This article describes the clinical and trichoscopic features of three cases of postoperative alopecia.

Juvenile dermatomyositis (JDM) is the leading cause of chronic idiopathic inflammatory myopathy of auto-immune origin in children. Seven patients with JDM found in the records from 1998-2019 of the Department of Dermatology Farhat Hached Hospital, Sousse, Tunisia. Our study concerned a total of six girls and one boy with a median age at disease onset of 8,16 years. The average time before diagnosis was 8,8 months. The onset of the disease was acute in 2 patients. All patients displayed skin manifestations at diagnosis, with proximal muscular weakness in 4 cases. Four patients had elevated muscle enzymes and all of them showed myopathic findings on electromyography. Oral corticosteroids were prescribed in 6 patients, in association with other systemic therapies. Three patients achieved a good outcome while two others relapsed. The two other patients showed corticosteroids resistance with a fatal outcome in one case. This study highlights the diagnostic features and management of juvenile dermatomyositis.

A 69-year-old patient with no personal or family history of ichthyosis consulted our dermatology department for diffused cutaneous xerosis with intense pruritus evolving for 3 weeks. Physical examination revealed diffused ichthyosis of large polygonal fine scales on the skin without erythema (Figure 1). The lesions spared the face. Examination of the mucous membranes, hair, and nails revealed no abnormalities. There was no fever or adenomegaly. A skin biopsy revealed an orthokeratotic hyperkeratosis with thinning of granular layer (Figure 2). The initial diagnosis of acquired ichthyosis was maintained. The patient also reported a change in bowel habits since 2 weeks with watery, non-bloody diarrhea and mild steatorrhea. His laboratory investigations presented low serum vitamin B12 level, mild anemia, hypoalbuminemia, and fecal leukocytes; however, antinuclear antibodies, perinuclear anti-neutrophil cytoplasmic antibodies (pANCA), rheumatoid factor, and complement components C3 and C4 were normal. A colonoscopy performed was also normal without any abnormalities. Colon biopsies revealed histologic aspects of lymphocytic colitis with more than 20% increase in lymphocytes in the surface epithelium of colorectal mucosa. Laboratory investigations excluded neoplasia, hemopathies, or autoimmune-associated diseases. The patient was treated with salazopyrin with a remarkable lessening of diarrhea and cutaneous manifestations within 4 weeks (Figure 3).

T-cell lymphoblastic lymphoma (T-LBL) is frequently revealed by amediastinal mass or peripheral lymphadenopathy. Skin lesions in T-LBLusually present as multiple nodules associated with multiple peripherallymphadenopathy and bone marrow invasion. Our patient is particular bythe revealing presentation of the lesions as Cutis verticis gyrate.

Sweet syndrome is a rare inflammatory dermatosis that can be associated with various diseases, including leukemias. Physicians should be aware that a photodistributed clinical presentation of a pustular SS may reveal underlying malignancies, particularly hemopathies. If the hemopathy is known, recurrence lesions should be suspected of a relapse.

Pityriasis rosea is a common, acute, self limiting inflammatory skin disease. Pityriasis rosea-like eruptions (PR-LE) have been reported after drugs. The clinical presentation of PR-LE can be distinguished from pityriasis rosea. We reporte a 41-year-old woman who developed PR-LE 5 days after administration domperidone.

JDDG: Journal der Deutschen Dermatologischen GesellschaftVolume 20, Issue 9 p. 1237-1238 Diagnosequiz Große hypochrome ringförmige Plaques am Rumpf Ben Rejeb Mohamed, Corresponding Author Ben Rejeb Mohamed med.benrejeb@gmail.com Anatomopathology Department, Farhat Hached Hospital, Sousse, Tunisia Korrespondenzanschrift Ben Rejeb Mohamed, MD Dermatology Department Farhat Hached University Hospital of Sousse Sahloul4 N°34 4000 Sousse, Tunisia E-Mail: med.benrejeb@gmail.comSearch for more papers by this authorBelajouza Colandane Noueiri, Belajouza Colandane Noueiri Anatomopathology Department, Farhat Hached Hospital, Sousse, TunisiaSearch for more papers by this authorSaad Sarra, Saad Sarra Anatomopathology Department, Farhat Hached Hospital, Sousse, TunisiaSearch for more papers by this authorAounallah Amina, Aounallah Amina Anatomopathology Department, Farhat Hached Hospital, Sousse, TunisiaSearch for more papers by this authorSriha Baderedine, Sriha Baderedine Anatomopathology Department, Farhat Hached Hospital, Sousse, TunisiaSearch for more papers by this authorMokni Sana, Mokni Sana Anatomopathology Department, Farhat Hached Hospital, Sousse, TunisiaSearch for more papers by this authorDenguezli Mohamed, Denguezli Mohamed Anatomopathology Department, Farhat Hached Hospital, Sousse, TunisiaSearch for more papers by this author Ben Rejeb Mohamed, Corresponding Author Ben Rejeb Mohamed med.benrejeb@gmail.com Anatomopathology Department, Farhat Hached Hospital, Sousse, Tunisia Korrespondenzanschrift Ben Rejeb Mohamed, MD Dermatology Department Farhat Hached University Hospital of Sousse Sahloul4 N°34 4000 Sousse, Tunisia E-Mail: med.benrejeb@gmail.comSearch for more papers by this authorBelajouza Colandane Noueiri, Belajouza Colandane Noueiri Anatomopathology Department, Farhat Hached Hospital, Sousse, TunisiaSearch for more papers by this authorSaad Sarra, Saad Sarra Anatomopathology Department, Farhat Hached Hospital, Sousse, TunisiaSearch for more papers by this authorAounallah Amina, Aounallah Amina Anatomopathology Department, Farhat Hached Hospital, Sousse, TunisiaSearch for more papers by this authorSriha Baderedine, Sriha Baderedine Anatomopathology Department, Farhat Hached Hospital, Sousse, TunisiaSearch for more papers by this authorMokni Sana, Mokni Sana Anatomopathology Department, Farhat Hached Hospital, Sousse, TunisiaSearch for more papers by this authorDenguezli Mohamed, Denguezli Mohamed Anatomopathology Department, Farhat Hached Hospital, Sousse, TunisiaSearch for more papers by this author First published: 26 September 2022 https://doi.org/10.1111/ddg.14807_gAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume20, Issue9September 2022Pages 1237-1238 RelatedInformation

Sir, Eccrine spiradenoma (ES) is a rare and benign adnexal tumor originating from the eccrine glands. It is usually located in the truncal region and is most common in young adults twenty to forty years old. Herein, we report a clinical, dermoscopic, and histological description of the case of an elderly male with an atypical tumor localization. A 74-year-old male presented with a painless, nodular mass on the anterior aspect of the left forearm, growing progressively over the previous year. He had no medical history. A dermatological examination revealed a solid, skin-colored nodule with a central ulceration and a peripheral collar, measuring approx. 1 to 1.5 cm in diameter, not bleeding on contact (Fig. 1a). There were no similar nodules or palpable lymph nodes. Dermoscopy was performed with DermLite 4. It demonstrated a vascular pattern of branched vessels and a central ulceration with a reddish background and scattered blue clods. It also showed a yellowish-brown, serohematic crust surrounding the ulceration and the reddish background (Figs. 1b and 1c). Upon histopathologic examination, the excised nodule revealed a tumoral proliferation, which was well demarcated from the surrounding tissue. It consisted of sharply defined lobules and cords intertwined into a puzzle-like structure (Fig. 2a). Two cell populations were identified: small basaloid cells and larger cuboidal ones. The cells displayed high mitotic activity yet no abnormal mitotic figures and no necrotic background. The section also showed numerous amorphous eosinophilic deposits within the cell cords and a richly vascularized stroma (Fig. 2b). The excision was complete and there were no recurrences on subsequent checks.

Introduction X-linked recessive ichthyosis (XLI) is a genodermatosis, caused by a deficiency of the steroid sulphatase enzyme encoded by the STS gene (OMIM # 300,747). Adopted XLI molecular diagnosis approaches differ from one laboratory to another depending on available technical facilities. Our work aims to figure out a sound diagnostic strategy for XLI. Patients and methods We collected 8 patients with XLI, all males, from 3 unrelated Tunisian families from central Tunisia. Genetic diagnosis was conducted through a large panel of genetic techniques including: Sanger Sequencing, haplotype analysis of STR markers, MLPA analysis, FISH and array CGH. Results Direct Sanger sequencing of the STS gene showed the same deletion of 13 base pairs within the exon 4 in all patients resulting in a premature stop codon. However, all patients' mothers were not carriers of this variant and no common haplotype flanking STS gene was shared between affected patients. Sequence alignment with reference human genome revealed an unprocessed pseudogene of the STS gene located on the Y chromosome, on which the 13 bp deletion was actually located. STS MLPA analysis identified a deletion of the entire STS gene on X chromosome for all affected patients. This deletion was confirmed by FISH and delineated by array CGH. Conclusion All our patients shared a deletion of the entire STS gene revealed by MLPA, confirmed by FISH and improved by array CGH. Geneticists must be aware of the presence of pseudogenes that can lead to XLI genetic misdiagnosis.

BACKGROUND:Androgenetic alopecia (AGA) is a pathology involving the aesthetic prognosis. Hair transplantation is among best treatments. The principle of hair micro-grafts during AGA consists in taking hair from the non-androgen-dependent occipital area to transplant them with their root in the sparse androgen-dependent areas. Herein, we report 10 cases of the different types of post-transplant inflammatory complications.MATERIALS AND METHODS:We included patients referred to our center by their dermatologists or hair transplant surgeons for inflammatory cicatricial alopecia or hair loss observed after the hair transplant.RESULTS:Ten patients (eight men and two women) were included. These patients represented 0.08% of all consultations in our center. The indication for hair transplantation was AGA in all of our patients. The technique used for the transplant was follicular unit extraction (FUE) in seven cases and follicular unit transplantation (FUT) strip in three cases. None of the patients had pathology of the scalp or an inflammatory dermatosis before the operation. The inflammatory complications found were lichen planopilaris (LPP) in seven cases, erosive pustulosis of the scalp (EPS) in two cases, and superficial folliculitis (SF) in 1 case.CONCLUSION:Our series highlight the rarity of inflammatory complications that occur after a hair transplant. We demonstrate through this work that a hair transplant can trigger inflammatory pathology a few months after the act. We show also, the importance of detecting the rough forms of lichen before an intervention, hence the interest of the systematic dermatoscopic examination during the preoperative consultation.