Publications by authors named "Litaiem Noureddine"

74 Publications

Nail changes in systemic amyloidosis.

Clin Case Rep 2021 Aug 21;9(8):e04685. Epub 2021 Aug 21.

Department of Dermatology Charles Nicolle Hospital Tunis Tunisia.

Nail examination must be an essential part of physical examination in our daily clinical practice, as nail changes may be the revealing sign of systemic diseases in the absence of other alarming signs.
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http://dx.doi.org/10.1002/ccr3.4685DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8380092PMC
August 2021

Miliaria crystallina in an intensive care patient.

Clin Case Rep 2021 Aug 16;9(8):e04665. Epub 2021 Aug 16.

Department of Anesthesiology Traumatology and Severe Burns Center of Ben Arous Tunis Tunisia.

Miliaria crystallina is frequently seen in intensive care patients. This skin condition should be known by both anesthesiologists and dermatologists to avoid unnecessary investigations.
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http://dx.doi.org/10.1002/ccr3.4665DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365851PMC
August 2021

Acute localized exanthematous pustulosis: Clinical features, pathophysiology, and therapy.

Dermatol Ther 2021 Sep 25;34(5):e15087. Epub 2021 Aug 25.

Department of Dermatology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.

Acute localized exanthematous pustulosis (ALEP) is a rare disease characterized by the acute onset of multiple localized non-follicular, pinhead-sized pustules. ALEP is considered a localized form of acute generalized exanthematous pustulosis but its pathogeny is not well identified. We performed a systematic review of the literature of all publications regarding ALEP cases using the term "acute localized exanthematous pustulosis," to provide an update on this disease and its management. Results and conclusion ALEP is an uncommon skin condition attributed primarily to a hypersensitivity reaction to a systemic drug (classical or herbal); though a contact mechanism has been reported. It may be misdiagnosed as infectious or inflammatory disease but the clinico-pathological correlation in addition to the rapid response to withdrawal of the culprit agent supports this diagnosis. The pathogenesis of ALEP is still unclear, and there are no standardized treatment guidelines to manage this disease. Both AGEP and ALEP have a good prognosis if an early diagnosis is made.
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http://dx.doi.org/10.1111/dth.15087DOI Listing
September 2021

Infectious-mononucleosis-like exanthema associated with COVID-19 in a child.

Clin Case Rep 2021 Jul 23;9(7):e04481. Epub 2021 Jul 23.

Pediatry Department Charles Nicolle Hospital Tunis Tunisia.

Cutaneous manifestations of childhood COVID-19 differ from those of adults. Maculopapular rash is not specific and could be mistaken with other viral exanthema. A nasopharyngeal swab is strongly recommended to confirm the possible COVID-19 diagnosis.
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http://dx.doi.org/10.1002/ccr3.4481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299092PMC
July 2021

Koilonychia in a Patient with Alopecia Areata.

J Clin Aesthet Dermatol 2021 Feb 1;14(2):42-43. Epub 2021 Feb 1.

All authors are with the Department of Dermatology at Charles Nicolle Hospital in Tunis, Tunisia.

Alopecia areata (AA) is an autoimmune disease that affects the hair follicles and leads to nonscarring alopecia. Nails changes are a common manifestation in AA, with an average prevalence of 30 percent. Both nail changes and hair loss in AA are associated with lymphocytic inflammation and are thought to be a result of a loss of immune privilege in both hair follicle and nail apparatus. Koilonychia, or "spoon nails," is a nail dystrophy where the nail plate is depressed centrally and everted laterally. Causes of nail spooning are various, but koilonychia is usually associated with iron deficiency and inflammatory dermatoses, such as psoriasis and lichen planus. Koilonychia is very rarely reported in association with AA in the English literature and its prognostic significance is still unknown. We report a case of a 25-year-old female patient who presented with AA focalis and koilonychia that regressed almost completely after oral corticosteroids, with an accompanying discussion of the pathogenesis and prognostic value of koilonychia.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8211338PMC
February 2021

[Eumycetoma].

Rev Prat 2021 03;71(3):287

"Service de dermatologie, hôpital Charles-Nicolle, université Tunis El Manar, Tunis, Tunisie".

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March 2021

Dermoscopic features of mucosal lichen planus.

Int J Dermatol 2021 Nov 3;60(11):1368-1372. Epub 2021 Jun 3.

Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia.

Background: Lichen planus (LP) is a chronic inflammatory dermatosis that affects the skin and the mucous membranes. The literature on the dermoscopic aspects of mucosal LP is still scarce. This study aimed to describe the dermoscopic aspects of mucosal LP and to provide a comprehensive updated summary of the literature.

Methods: This was a cross-sectional, multicenter study conducted in Charles Nicolle, La Rabta, and Habib Thameur hospitals from December 2019 to October 2020. We included patients with histologically confirmed mucosal LP for whom a dermoscopic examination was performed.

Results: Twenty-seven patients were enrolled. The main dermoscopic structures observed were as follows: Wickham's striae (WS) (91%), vessels (88%), pigmentated structures (41%), erosions (63%), scales (34%), and blunting of lingual papillae (3.1%). WS patterns were as follows: reticular (67%), radial (48%), annular (30%), globular (15%), dotted/starry sky (15%), and veil-like blue or grey-white homogenous pattern (19%). Vascular structures were as follows: linear (85%), dotted (70%), looped (22%), and peripheral sea anemone-like vessels (37%). These vessels were distributed in a radial arrangement at the periphery of the lesions in 67% of the cases. Pigmented structures included brown/blue globules (33%), grey-blue dots (30%), and brown dots (26%).

Conclusion: Dermoscopic features of mucosal LP are varied. WS is the hallmark of LP. The distribution and aspects of WS in mucosal LP were slightly different from those described in cutaneous LP. Physicians should be aware of these dermoscopic features that could help differentiate LP from other mucosal inflammatory diseases.
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http://dx.doi.org/10.1111/ijd.15683DOI Listing
November 2021

Chronic macrocheilia: a clinico-etiological series of 47 cases.

Int J Dermatol 2021 Jun 3. Epub 2021 Jun 3.

Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia.

Background: Macrocheilia is an inflammatory disfiguring condition responsible for the swelling of the lips. This multi-etiological entity represents a diagnostic and therapeutic challenge. Published data on macrocheilia is scarce, often limited to granulomatous cheilitis.

Methods: We conducted a retrospective study, including all patients presenting with chronic macrocheilia (CM) for nineteen years. CM was defined as a persistent enlargement of one or both lips for at least eight weeks. Both descriptive and analytical analyses were performed.

Results: Of the 47 patients identified, 20 (43%) had cutaneous leishmaniasis, 10 (21%) had Miescher's cheilitis, five (11%) had Melkersson-Rosenthal syndrome, five (11%) had sarcoidosis, one (2%) had lepromatous leprosy, one (2%) had systemic amyloidosis, and one (2%) had Crohn's disease. In four cases, the CM was unlabeled. Ulcerations were significantly associated with leishmaniasis (P < 0.05). Histological study showed a granulomatous infiltrate in 72% of cases. Medical treatment was adapted to the etiology of CM. Surgery was performed in two cases. Improvement of CM secondary to leishmaniasis was seen in all cases. In patients with idiopathic orofacial granulomatosis, partial improvement was noted in four cases and a total improvement in one case. Recurrences were noted in three cases after complete regression.

Conclusions: Macrocheilia is a rare and disfiguring condition that requires an etiological investigation, considering that it can reveal a serious underlying systemic disease. We identified several factors that could help recognize the cause of CM, including age, history of intermittent swelling, the extent of lip enlargement, the existence of ulceration, and systemic symptoms.
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http://dx.doi.org/10.1111/ijd.15685DOI Listing
June 2021

Intradermal tranexamic acid microinjections: a novel treatment option for erythematotelangiectatic rosacea.

J Cosmet Dermatol 2021 May 10. Epub 2021 May 10.

Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia.

Background: Treatment options for erythematotelangiectatic rosacea (ETR) are still scarce. Tranexamic acid (TXA) is an antifibrinolytic drug that was recently used for the treatment of ETR.

Aims: To evaluate the efficacy and safety of intradermal microinjections of TXA for ETR.

Patients/methods: This was a retrospective study enrolling patients, treated with TXA intradermal microinjections for ETR, from January 2019 to February 2020. Response to treatment was assessed based on subjective symptoms, clinical photographs, and the Investigator Global Assessment of Rosacea Severity Score (IGA-RSS).

Results: Six patients were included. The mean number of monthly intradermal TXA microinjections was 5.1 ± 1.3. The mean decrease of IGA-RSS was 2.4 ± 0.5. Local side effects, mainly transient erythema and swelling, were noticed in three cases. No systemic effects were noted. Clinical improvement, in respondent patients, lasted after 3 months of follow-up.

Conclusion: Intradermal TXA microinjections are a safe and effective treatment option for ETR. The optimal number of monthly sessions has yet to be determined.
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http://dx.doi.org/10.1111/jocd.14209DOI Listing
May 2021

Pharmacological Management of Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome Syndrome: A Proposal of a Treatment Algorithm.

J Clin Rheumatol 2021 Apr 9. Epub 2021 Apr 9.

From the Department of Internal Medicine, Military Hospital Tunis El Manar University Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia.

Abstract: Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare chronic disease with marked clinical and radiological heterogeneity. It is characterized by a combination of dermatological and osteoarticular manifestations. The treatment of SAPHO syndrome is not yet codified. It includes several therapeutic options such as anti-inflammatory drugs, bisphosphonates, antibiotics, conventional disease-modifying antirheumatic drugs, and biological treatment.This article aims to provide an updated review of the different pharmacological options for SAPHO syndrome. We also propose a therapeutic algorithm for the management of this disease.
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http://dx.doi.org/10.1097/RHU.0000000000001740DOI Listing
April 2021

Eosinophilic annular erythema in adults: a new case of this rare entity.

Int J Dermatol 2020 Oct 9;59(10):e380-e381. Epub 2020 Aug 9.

Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia.

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http://dx.doi.org/10.1111/ijd.15115DOI Listing
October 2020

Subcutaneous Panniculitis-Like T-Cell Lymphoma Presenting with Full Facial Edema and Hemophagocytic Syndrome.

Skinmed 2020 1;18(6):386-389. Epub 2020 Dec 1.

Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia.

A 42-year-old previously healthy woman presented with a 2-month history of recurrent fever and painful swelling on the left thigh. She was given a presumptive diagnosis of cellulitis and an antimicrobial. Because the response was not significant and fever remained moderate to high grade, with the appearance of gradually increasing periorbital edema (Figure 1), the diagnosis was reconsidered, and she was referred to a tertiary referral center for further study.
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http://dx.doi.org/DOI Listing
September 2021

Pediatric rosacea in a patient with a dark phototype: Clinical and dermoscopic features.

Clin Case Rep 2020 Dec 13;8(12):3257-3259. Epub 2020 Oct 13.

Department of Dermatology Charles Nicolle Hospital Tunis Tunisia.

Rosacea is rare in children and patients with dark phototype. Dermoscopy helps make the correct diagnosis. Positive family history of rosacea is reported in affected children, which suggests a strong familial inheritance of the disorder.
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http://dx.doi.org/10.1002/ccr3.3404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752331PMC
December 2020

Acquired epidermodysplasia verruciformis in renal-transplant recipients.

Clin Case Rep 2020 Dec 20;8(12):2678-2681. Epub 2020 Aug 20.

Department of Dermatology Charles Nicolle Hospital Tunis Tunisia.

Acquired epidermodysplasia verruciformis in renal-transplant recipients is associated with a high risk for developing squamous cell carcinoma. An accurate diagnosis and a regular monitoring in this high-risk population must be stressed.
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http://dx.doi.org/10.1002/ccr3.3251DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752617PMC
December 2020

Cutaneous leiomyosarcoma mimicking arteriovenous malformation.

Clin Case Rep 2020 Dec 6;8(12):2538-2540. Epub 2020 Aug 6.

Department of Dermatology Charles Nicolle Hospital Tunis Tunisia.

There is a clinical overlap between hypervascularized sarcomas and arteriovenous malformations (AVM). MRI imaging should be interpreted with caution keeping in mind that some cancers could mimic AVM. A biopsy is mandatory in doubtful cases.
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http://dx.doi.org/10.1002/ccr3.3222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752489PMC
December 2020

Bicipitoradial bursitis: A diagnosis challenge!

Clin Case Rep 2020 Nov 18;8(11):2265-2268. Epub 2020 Jul 18.

Department of Internal Medicine Military Hospital Tunis Tunisia.

Bicipitoradial bursitis should be considered in patients with antecubital mass and painful forearm pronation and supination movement. It can be due to several conditions such as calcium pyrophosphate dihydrate deposition, even in young patients. Ultrasound is useful to confirm the diagnosis, determine the etiology and to guide the treatment of bicipitoradial bursitis.
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http://dx.doi.org/10.1002/ccr3.3125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7669374PMC
November 2020

sQUIZ your knowledge! A rare aetiology of diffuse facial hyperpigmentation.

Eur J Dermatol 2020 Oct;30(5):641-643

Charles Nicolle Hospital.

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http://dx.doi.org/10.1684/ejd.2020.3899DOI Listing
October 2020

Dermoscopic features of lupus miliaris disseminatus faciei: Distinct aspects depending on disease stage.

Clin Case Rep 2020 Sep 16;8(9):1793-1796. Epub 2020 Jun 16.

Department of Dermatology Charles Nicolle Hospital Tunis Tunisia.

Dermoscopy is a useful tool that helps distinguish lupus miliaris disseminatus faciei (LPDF) from sarcoidosis and tuberculosis. Follicular keratotic plugs (FKP) represent the hallmark of LPDF. Dermoscopic aspect of LPDF changes through the course of the disease.
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http://dx.doi.org/10.1002/ccr3.2979DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495779PMC
September 2020

sQUIZ your knowledge! A photosensitive rash in a patient with Crohn's disease.

Eur J Dermatol 2020 Aug;30(4):461-462

Department of dermatology, Charles Nicolle Hospital, Tunis, Tunisia.

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http://dx.doi.org/10.1684/ejd.2020.3830DOI Listing
August 2020

[Localized canitia subita in alopecia areata].

Rev Prat 2020 01;70(1):65

Service de dermatologie, hôpital Charles-Nicolle, Tunis, Tunisie.

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January 2020

Systemic allergic dermatitis caused by a copper-containing intra-uterine device.

Contact Dermatitis 2021 Feb 25;84(2):132-134. Epub 2020 Sep 25.

Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia.

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http://dx.doi.org/10.1111/cod.13696DOI Listing
February 2021

Effectiveness of dermoscopy in the demarcation of surgical margins in slow Mohs surgery.

Dermatol Ther 2020 11 7;33(6):e14196. Epub 2020 Sep 7.

Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia.

There is a need for adjuvant imaging techniques that would allow reducing the number of slow Mohs stages. This study aimed to evaluate the use of dermoscopy in the demarcation of basal cell carcinoma (BCC) surgical margins for slow Mohs surgery. This was a retrospective study over 3 years (2016-2019), including patients with BCC excised using slow Mohs surgery. On the basis of the treatment received, the patients were divided into 2 groups: group 1 (28 BCC) and group 2 (26 BCC). In group 2, BCC margins were demarcated using dermoscopy. A total of 54 patients were enrolled in the study. The number of positive lateral margins was significantly lower in the group where BCC margins were demarcated using dermoscopy (19% vs 53%, P = .012). In this group, the number of Mohs stages needed to achieve complete clearance was significantly lower. However, the mean interval between the first Mohs excision and Mohs clearance was not significantly different between the 2 groups (9 ± 4 vs 12 ± 7 days). In conclusion, preoperative dermoscopy is useful for reducing the number of positive lateral margins and the number of slow Mohs stages in treating BCC especially pigmented tumors.
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http://dx.doi.org/10.1111/dth.14196DOI Listing
November 2020

Dermoscopic Features of Toenail Onychomycosis.

J Am Podiatr Med Assoc 2020 May;110(3)

Background: Onychomycosis is the most common infectious nail disorder. Direct mycologic examination is still the cornerstone of diagnosis; however, it may take several weeks to obtain a result. Recently some dermoscopic patterns that can be useful in the diagnosis of onychomycosis were described. However, published data on dermoscopic features of onychomycosis are still limited.

Methods: We performed a prospective dermoscopic study of patients with positive fungal culture between April and December 2016. Patients with a final diagnosis of psoriasis or lichen planus were excluded from the study. Dermoscopy (polarized and nonpolarized) was performed.

Results: Thirty-seven patients were enrolled, 24 women and 13 men (median ± SD age, 48.6 ± 16.1 years). Nail samples were culture positive for Trichophyton rubrum (89.2%), Trichophyton interdigitale (8.1%), and Candida albicans (2.7%). Distal and lateral subungual onychomycosis was the most frequent clinical subtype (59.5%). The most frequent dermoscopic features were subungual keratosis (73.0%), distal subungual longitudinal striae (70.3%), spikes of the proximal margin of an onycholytic area (59.5%), transverse superficial leukonychia (29.7%), and linear hemorrhage (13.5%). Brown chromonychia was most frequently seen with nonpolarized dermoscopy (66.6% versus 24%; P = .027).

Conclusions: Specific dermoscopic signs of onychomycosis are mostly related to the proximal invasion of the nail plate. Detection of these signs is simple and can, in some cases, help avoid mycologic testing.
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http://dx.doi.org/10.7547/18-102DOI Listing
May 2020

Multiple endocrine neoplasia type 1 revealed by a hip pathologic fracture.

Clin Rheumatol 2021 Feb 14;40(2):775-782. Epub 2020 Jul 14.

Department of Internal Medicine, Military Hospital, 1007, Tunis, Tunisia.

Multiple endocrine neoplasia type 1 is a rare autosomal inherited syndrome that affects a variety of endocrine tissues such as the parathyroid, endocrine pancreas, and anterior pituitary. Osseous complications are often misdiagnosed. We presented a case of a 46-year-old woman with pathological fractures of the lower limb. She had a history of type 1 diabetes and galactorrhea. Laboratory examinations showed hypercalcemia and an increased level of parathyroid hormone related to hyperparathyroidism. Serum chromogranin A level was increased at 9369 ng/mL (N < 102). A somatostatin receptor scintigraphy (octreoscan) revealed pathological uptake in the gastric wall, later cave adenopathy, and liver. The diagnosis of multiple endocrine neoplasia type 1 was made based on radiological and histological findings. The patient underwent a subtotal parathyroidectomy associated with somatostatin analog treatment leading to significant improvement. A literature review was conducted by searching PubMed using these following terms: multiple endocrine neoplasia type 1, hyperparathyroidism, fracture, menin, osteoporosis. We emphasized bone involvement related to multiple endocrine neoplasia type 1 syndrome. This diagnosis should be considered when pathological fractures occur in young patients with a history of endocrine disorder. We highlighted the importance of imaging features in making the diagnosis of multiple endocrine neoplasia type 1. Early management of this disease is necessary. Treatment including parathyroidectomy and somatostatin analogs leads to bone preservation and functional improvement.
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http://dx.doi.org/10.1007/s10067-020-05281-3DOI Listing
February 2021

Rickets in association with skin diseases and conditions: A review with emphasis on screening and prevention.

Photodermatol Photoimmunol Photomed 2020 Sep 24;36(5):339-350. Epub 2020 Jul 24.

State University of New York Downstate and Veterans Affairs Medical Center, Brooklyn, NY, USA.

Background: Rickets is a common disease worldwide. In the developed world, its prevalence dramatically decreased but still diagnosed in at-risk populations. The skin plays a critical role in vitamin D synthesis. Therefore, several skin diseases, especially keratinization disorders, could lead to impaired vitamin D metabolism and vitamin D deficient rickets.

Objective: The article aimed to summarize the current knowledge of skin diseases and conditions associated with rickets.

Methods: To examine the association between rickets and skin diseases, we performed a systematic review of the literature using PubMed database. The search included studies published from the database inception to August 2019.

Results: A total number of 75 articles were included. Identified conditions associated with rickets were ichthyosis being a more common skin diseases, alopecia, epidermal and melanocytic nevi, xeroderma pigmentosum, mastocytosis, psoriasis, and atopic dermatitis. Three types of rickets were identified: vitamin D-dependent rickets, hypocalcemic vitamin D-dependent rickets type 2, and hypophosphatemic rickets. Cutaneous skeletal hypophosphatemia syndrome is a newly described and under-recognized condition. It is defined by the association of epidermal or melanocytic nevi, hypophosphatemic rickets, and elevated levels of fibroblast growth factor 23. Rickets in patients with ichthyosis was mainly due to impaired ability of ichthyotic skin to synthesize vitamin D, poor UV penetration of the skin caused by keratinocyte proliferation, and dark phototype. The latter may be considered a risk factor for rickets in patients with ichthyosis.

Conclusion: Despite its rarity, these associations should be properly recognized by dermatologists. Early diagnosis of rickets is important to prevent growth retardation and skeletal deformities.
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http://dx.doi.org/10.1111/phpp.12590DOI Listing
September 2020

Acute generalized exanthematous pustulosis after COVID-19 treatment with hydroxychloroquine.

Dermatol Ther 2020 07 26;33(4):e13565. Epub 2020 May 26.

Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia.

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http://dx.doi.org/10.1111/dth.13565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261985PMC
July 2020

Hypopigmentation as a side effect of melasma treatment with tranexamic acid intradermal microinjections.

Dermatol Ther 2020 07 16;33(4):e13503. Epub 2020 Jun 16.

Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia.

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http://dx.doi.org/10.1111/dth.13503DOI Listing
July 2020

Dermoscopy is a useful tool for diagnosing lisch nodules on brown eyes.

Int J Dermatol 2020 Jul 21;59(7):880-881. Epub 2020 Apr 21.

Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia.

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http://dx.doi.org/10.1111/ijd.14886DOI Listing
July 2020

A tale of a vegetative inflammatory umbilical plaque.

Int J Dermatol 2020 Aug 14;59(8):938-940. Epub 2020 Feb 14.

Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia.

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http://dx.doi.org/10.1111/ijd.14813DOI Listing
August 2020
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