Les leishmanioses cutanées à Leishmania major et àLeishmania tropica au Maroc: aspects épidémio-cliniques comparatifs de 268 cas

Introduction: Depuis 1995, le Maroc a connu une réactivation des foyers de leishmanioses cutanées (LC) à L. major et une nouvelle répartition géographique des foyers à L. tropica. Le but de cette étude est de comparer les aspects épidémio-cliniques associés aux LC potentiellement dûes à L. major et à L. tropica. Méthodes: Une étude rétrospective a colligé 268 cas de LC au service de dermatologie du CHU  Ibn Rochd de Casablanca entre Janvier 1995 et Septembre 2010. Les données étaient analysées par Epi info version 3.5.1 .Le test X2 était appliqué (Différence significative=p< 0,05).Résultats: Deux cent soixante-huit cas de LC ont été colligés, dont 160 femmes et 108 hommes .Ils ont été répartis en 123 patients originaires des foyers à L .major et 145 patients originaires des foyers à L. tropica. L'aspect ulcéronodulaire, ulcérovégétant ou végétant était retrouvé dans 58 cas (47,2%) des cas de LC à L. major versus 24 cas (16,7%) dans la L.C à L. tropica. L'aspect papulonodulaire était retrouvé dans 84 cas (58%) de LC à L. tropica contre 41 cas (33,3%) de LC à L. major. Conclusion: Dans la LC à L. major, l'atteinte des membres et les aspects cliniques végétant ou ulcéro-végétant restent toujours prédominants. Dans la L.C à L. tropica, l'atteinte papulonodulaire unique du visage reste prédominante mais des formes ulcéronodulaires, végétantes ou ulcérovégétantes existent également dans les foyers récents à L. tropica, prêtant à confusion cliniquement avec des LC à L. major.Key words: Major, tropica, polymorphisme, Maro

Case Series

Au Maroc peu d'études ont été menées concernant les facteurs pronostiques du mélanome.L'objectif de cette étude était d'identifier les facteurs de survenue de métastases viscérales à distance à 1an et de mortalité à 2ans chez des patients atteints de mélanome cutané épais. Ont été colligés rétrospectivement tous les cas de mélanomes suivis au service de dermatologie et d'oncologie du CHU de Casablanca de 2006 à 2010.On été inclus les patients qui présentaient un mélanome à localisation  cutanée et/ou muqueuse buccogénitale, confirmés histologiquement ayant un Breslow>2mm. Ont été exclus les patients présentant des métastases viscérales à distance au moment du diagnostic. Les  données sociodémographiques, cliniques et thérapeutiques ont été recueillies au niveau des dossiers; celles relatives à l'évolution ont été complétées par contact téléphonique. L'analyse statistique était de type uni et bivarié. Soixante patients ont été inclus:41hommes et19femmes (sexe ratio de 2,15).La moyenne d'âge était de 60 ans (17-96). L'indice de Breslow était en moyenne de10mm+/-7et78%des  patients(32) avaient un Breslow>4mm. Vingt trois patients (38,3%) avaient des adénopathies  régionales. Quatorze patients ont présenté des métastases à distance après 1an (23,3%) et13patients étaient décédés après 2ans d'évolution (21,7%). Les facteurs associés à la survenue de métastases à distance étaient l'indice de Breslow. Des métastases à 1an ont été retrouvées chez 61,5%des patients avec un Breslow >10mm contre18,8% avec un BreslowKey words: Mélanome, épais, métastases, mortalité, Breslo

Psoriasis and staphylococcus aureus skin colonization in Moroccan patients

Psoriatic lesions are rarely complicated by recurrent infections. The aim of our study is to determine skin colonisation and nasal carriage of Staphylococcus aureus in patients with psoriasis and in healthy  persons. Patients and methods: a comparative study that include 33 patients with psoriasis and 33  healthy persons.Samples were taken from lesional and non lesional psoriatic skin and from healthy skin of control group. For S. aureus nasal carriage, we used sterile cotton tipped swabs. Out of165 samples (66 skin samples and 33 nasal swabs), 26 S. Aureus strains were isolated in 26 persons, 57.69% in the  control group and 42.3% in the psoriasisgroup. S. aureus skin colonization was found in one case (3%) inlesional psoriatic skin vs 9 cases (27.3%) in control skin OR=0.08 IC 95% (0.01-0.70) p=0.02 and in 12,1% in non lesional soriatic skin vs 27, 3% in control skin (p =0,13). This colonization was less important in lesional psoriatic skin (3%) than in non lesional psoriatic skin (12.1%) p= 0.20. Nasal screening identified (7/33) 21, 21% S. aureus carriers in psoriasis group and in control group. Our results are in consensus withliterature findings. They have confirmed the importance of antimicrobial peptides in Innateimmunity of human skin. These peptides are normally produced bykeratinocytes in response to inflammatory stimuli such as psoriasis. Their high  expression in psoriasis skin reduces the risk of skin infection and skin colonization with S. Aureus.Key words: Antimicrobial peptides, innate immunity, nasal carriage, psoriasis, skin colonization, staphylococcus aureu

Hennekam syndrome: a rare cause of primary lymphedema

Hennekam syndrome (HS) is an autosomal recessive disorder characterized by the association of lymphedema, intestinal lymphangiectasia, moderate mental retardation, and facial dysmorphism. We describe a 14-year-old girl affected with Hennekam syndrome

Hennekam syndrome: a rare cause of primary lymphedema

Hennekam syndrome (HS) is an autosomal recessive disorder characterized by the association of lymphedema, intestinal lymphangiectasia, moderate mental retardation, and facial dysmorphism. We describe a 14-year-old girl affected with Hennekam syndrome

Hair lightening in an hemodialysis patient treated by heptaminol (heptamyl)

Hair lightening occurred in a patient treated with heptaminol (heptamyl). This patient had chronic renal failure and had been undergoing hemodialysis since 2003. The hair hypopigmentation reversed after stopping the drug. The mechanism of the hair color modification is not understood

Efficacy and safety of a gauze pad containing hyaluronic acid in treatment of leg ulcers of venous or mixed origin: a double-blind, randomised, controlled trial.

International audienceTopical hyaluronic acid (HA) is routinely used in the local treatment of chronic wounds, but few data have been reported to date. A 60-day double-blind, randomised, controlled superiority trial was designed to investigate the efficacy and safety of a gauze pad containing HA in local treatment of venous leg ulcers, compared with its neutral vehicle. The primary endpoint was the percentage of wound size reduction after 45 days. Totally 89 patients were included. At day 45, the percentage of ulcer surface reduction was significantly greater in the HA group (73 ± 4*6%) versus neutral vehicle group (46 ± 9*6%) (P = 0*011). The number of healed ulcers was significantly higher in the HA group at day 45 (31*1% versus 9*3% respectively) and day 60 (37*8% versus 16*3% respectively; P < 0*05). At day 30, pain intensity based on visual analogue scale was significantly lower in the HA group (12*4 mm ± 2*6 versus 22*8 mm ± 3*8; P = 0*026). Tolerance of both treatments was comparable in the two groups. HA gauze pad, in local treatment of venous leg ulcers, was significantly more effective than the neutral vehicle on wound size reduction, healed ulcers rate and pain management with a good safety profile

Risk factors in facial hyperpigmentation in Maghrebian population - a case-control study.

International audienceTriggering factors seem to be multiple in the pathogenesis of facial hyperpigmentation (FH), as dark skin types, pregnancy, sun exposure... The aim of this study was to investigate the risk factors for FH in Maghrebian population. Patients with FH were included in a case-controlled study. Following data were recorded: age, sex, parity, phototype, FH and hormonal-related history, endocrinological features, sunlight exposure, specific cultural behaviours, use of topic corticosteroids and sunscreens. One hundred women (mean age 29.5 ± 13.7 years) were included with 200 age-matched controls. Duration of FH was 32.9 ± 42.2 months. There was a statistically significant relation between FH and hirsutism (P = 0.009), troubles of menstruations (P = 0.008), but not with acne (P = 0.23) and contraceptive oral (P = 0.06) drugs or with history of thyroid disorders (P = 0.13). For cultural factors, there were a statistical significant relation with rubbing by flannel glove (P < 0.05), use of dark soap (P = 0.009) and traditional masks (P < 0.05) but both groups were used to go to hammam. A strong relation was observed between FH and use of topical corticosteroids: 40% in the FH group vs. 5% in the control group (P < 0.05). Both groups used to apply sunscreens: 70% in the FH group and 67% in the control group where as there were no differences in the two groups for sun exposure. No statistical differences were observed regarding to age, phototypes and grade of parity. Our study demonstrated a relation between FH and hyperestrogenemia, rubbing with a friction glove, use of moroccan traditional masks and application of topical steroids. The eviction of all these triggering factors could be an adjuvant recommendation in the assessment of FH