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Say M, Tella E, Boccara O, Sauvage M, Bourrat E, Tian Y, Monfort JB, Lok C, Desierier F, Beneton N, Abasq-Thomas C, Kupfer-Bessaguet I, Mallet S, Lacour JP, Plantin P, Sigal ML, Mazereeuw-Hautier J, Mahé E. Leg ulcers in childhood: A multicenter study in France. Ann Dermatol Venereol 2021; 149:51-55. [PMID: 34218940 DOI: 10.1016/j.annder.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/30/2021] [Accepted: 05/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Leg ulcers in adults are a major public health concern. Their incidence increases with age and many causes have been identified, predominantly associated with vascular diseases. Leg ulcers in children and teenagers are less frequent. The aim of our study was to identify the causes of leg ulcers in children and teenagers, and to evaluate their management. METHODS This retrospective multicenter study was conducted by members of the Angio-dermatology Group of the French Society of Dermatology and of the French Society of Pediatric Dermatology. Data from children and teenagers (< 18 years), seen between 2008 and 2020 in 12 French hospitals for chronic leg ulcer (disease course>4 weeks), were included. RESULTS We included 27 patients, aged from 2.3 to 17.0 years. The most frequent causes of leg ulcer were: general diseases (n=9: pyoderma gangrenosum, dermatomyositis, interferonopathy, sickle cell disease, prolidase deficiency, scleroderma, Ehlers-Danlos syndrome), vasculopathies (n=8: hemangioma, capillary malformation, arteriovenous malformation), trauma (n=4: bedsores, pressure ulcers under plaster cast), infectious diseases (n=4: pyoderma, tuberculosis, Buruli ulcer) and neuropathies (n=2). Comorbidities (59.3%) and chronic treatments (18.5%) identified as risk factors for delayed healing were frequent. The average time to healing was 9.1 months. DISCUSSION Leg ulcers are less frequent in children and teenagers than in adults and their causes differ from those in adults. Comorbidities associated with delayed healing must be identified and managed. Children and teenagers tend to heal faster than adults, but a multidisciplinary management approach is necessary.
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Affiliation(s)
- M Say
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France.
| | - E Tella
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France
| | - O Boccara
- Service de dermatologie, centre hospitalier universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - M Sauvage
- Service de dermatologie, centre de référence des Maladies Rares de la Peau, centre hospitalier universitaire Larrey, Université Paul-Sabatier, Toulouse, France
| | - E Bourrat
- Service de pédiatrie générale, centre hospitalier universitaire Robert-Debré, AP-HP, Paris, France
| | - Y Tian
- Service de pédiatrie générale, centre hospitalier universitaire Robert-Debré, AP-HP, Paris, France
| | - J-B Monfort
- Service de dermatologie, centre hospitalier universitaire Tenon, AP-HP, Paris, France
| | - C Lok
- Service de dermatologie, centre hospitalier universitaire Amiens-Picardie, Amiens, France
| | - F Desierier
- Service de dermatologie, centre hospitalier universitaire Amiens-Picardie, Amiens, France
| | - N Beneton
- Service de dermatologie, centre hospitalier du Mans, Le Mans, France
| | - C Abasq-Thomas
- Service de dermatologie, centre hospitalier Régional Universitaire de Brest, Brest, France
| | | | - S Mallet
- Service de dermatologie, centre hospitalier universitaire La Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - J-P Lacour
- Service de dermatologie, centre hospitalier universitaire L'archet, Nice, France
| | - P Plantin
- Service de dermatologie, centre hospitalier de Cornouaille, Quimper, France
| | - M-L Sigal
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France
| | - J Mazereeuw-Hautier
- Service de dermatologie, centre de référence des Maladies Rares de la Peau, centre hospitalier universitaire Larrey, Université Paul-Sabatier, Toulouse, France
| | - E Mahé
- Service de dermatologie et médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France
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Diop A, Ndiaye MT, Ndiaye M, Seck B, Diouf A, Diatta BH, Diallo M, Ly F. Rare cutaneous tuberculosis in Sub-Saharan Africa developed on discoid lupus erythematous lesion. ACTA ACUST UNITED AC 2017; 110:230-233. [PMID: 28247256 DOI: 10.1007/s13149-017-0550-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 11/22/2016] [Indexed: 11/28/2022]
Abstract
Lupus vulgaris is a common presentation of cutaneous tuberculosis (TB), but its ulcerative or vegetating form also called vorax is rare.We report a case of lupus vulgaris in its vorax form, which occurred in a patient with discoid lupus erythematous. A 42-year-old patient monitored for chronic lupus erythematosus consulted again for a facial tumor and fever. Physical examination revealed painful ulcerative and crusted lesions on an old discoid lupus lesion and covered the entire upper lip. Similar lesions were noted on cheeks. Moreover, there were cervical lymphadenopathy, a bilateral pulmonary condensation syndrome, and dysphonia. Cutaneous histopathology had revealed a tuberculoid granuloma without caseating, and nucleic acid amplification tests (GeneXpert®) performed on sputum were positive. Thus, the diagnosis of multifocal TB with skin involvement of vorax type was confirmed. The outcome was favorable following TB treatment. Our observation is distinctive as it is a granulomatosis and ulcerative form of lupus vulgaris, which occurred on a discoid lupus erythematous lesion. This is a rare form of lupus vulgaris. This scarcity can be explained by diagnostic difficulties as there are numerous differential diagnoses and histopathology is not often helpful.
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Affiliation(s)
- A Diop
- Dermatologie, hôpital institut d'hygiène sociale de Dakar, université Cheikh-Anta-Diop de Dakar, BP 7045, Dakar, Sénégal.
| | - M T Ndiaye
- Dermatologie, hôpital institut d'hygiène sociale de Dakar, université Cheikh-Anta-Diop de Dakar, BP 7045, Dakar, Sénégal
| | - M Ndiaye
- Dermatologie, hôpital Aristide-Le-Dantec Dakar, université Cheikh-Anta-Diop de Dakar, Dakar, Sénégal
| | - B Seck
- Dermatologie, hôpital institut d'hygiène sociale de Dakar, université Cheikh-Anta-Diop de Dakar, BP 7045, Dakar, Sénégal
| | - A Diouf
- Dermatologie, hôpital institut d'hygiène sociale de Dakar, université Cheikh-Anta-Diop de Dakar, BP 7045, Dakar, Sénégal
| | - B H Diatta
- Dermatologie, hôpital institut d'hygiène sociale de Dakar, université Cheikh-Anta-Diop de Dakar, BP 7045, Dakar, Sénégal
| | - M Diallo
- Dermatologie, hôpital Aristide-Le-Dantec Dakar, université Cheikh-Anta-Diop de Dakar, Dakar, Sénégal
| | - F Ly
- Dermatologie, hôpital institut d'hygiène sociale de Dakar, université Cheikh-Anta-Diop de Dakar, BP 7045, Dakar, Sénégal
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[Cutaneous tuberculosis of the ear due to Mycobacterium bovis]. Ann Dermatol Venereol 2016; 143:611-615. [PMID: 27375171 DOI: 10.1016/j.annder.2016.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 03/19/2016] [Accepted: 05/13/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Isolated cutaneous tuberculosis is uncommon, accounting for only 0.14 to 5% of Mycobacterium tuberculosis infections. We report a rare case of ear cutaneous tuberculosis due to Mycobacterium bovis in an immunocompetent woman. CASE REPORT A 59-year-old woman presented an erythematous and scaly lesion of the ear present for two years. The histological findings were compatible with a diagnosis of sarcoidosis, with non-necrotic granuloma. After failure of dermal corticosteroid therapy, a further biopsy identified M. bovis; the patient was cured following anti-tubercular treatment. DISCUSSION Ear lesions are predominantly associated with tumors, fungal infections, chondritis, lupus and sarcoidosis. The ear, like the face in general, is a classic localization of lupus vulgaris, a chronic form of confined tuberculosis infection with progressive evolution. The paucibacillary nature of these lesions is the reason why their diagnosis is based in some cases on clinical, histological and immunological findings without bacteriological evidence. However, given the potential therapeutic implications, it is important to push the microbiological analysis as far as possible. In our case, culture and identification provided evidence of M. bovis infection, enabling suitable and effective therapy to be given.
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