Background: Depilatory radiotherapy for ringworm was largely used before antifungals were available. Patients who underwent this treatment are at high risk of developing scalp tumors or other cancers. The aim of this study was to characterize scalp tumors occurring after X-ray therapy for ringworm. Methods: We included cases of postradiotherapy scalp tumors recorded at the Dermatology Department of the Charles Nicolle Hospital, Tunis between 1988 and 2001. We recorded clinical descriptions and all cases were resubmitted to microscopic analysis. Results: Sixty-one tumors occurred in 33 men and 12 women with a mean age of 49.8 years. Radiodermatitis was present in 21% of patients. Tumors were basal cell carcinomas in 47 cases, trichoblastomas in 10 cases and trichoblastic carcinomas in 4 cases. Twelve patients had 2–5 tumors, with combinations of tumor types in 3 of them. Mean delay of onset of tumors after radiotherapy was 39.4 years in basal cell carcinoma cases, 38.3 years in trichoblastoma cases and 35.6 years in trichoblastic carcinoma cases. Conclusions: This series shows that although basal cell carcinoma is the most frequent tumor in this situation, trichoblastomas are common. We describe, for the first time, radio-induced trichoblastic carcinomas. Trichoblastic tumors have not yet been described in this context because this concept is relatively recent.

stopped ART long back. Investigations revealed CD4 + counts 12 cells/mL, reactive Toxoplasma-IgM ELISA, haemoglobulin 8 g% and ESR 95 mm in first hour. He could not afford viral load studies. With reinstitution of triple ART and prophylaxis for opportunistic infections, he was free of all skin/scrotal lesions within a week. DiscussionHIV-associated psoriasis usually develops in non-terminal stages of AIDS and is frequently severe, recalcitrant to therapy and has associated arthritis six times more often. 4 The clinical appearance is rather uniform with facial seborrhea, scalp, flexural and acral involvement, palmoplantar pustulosis and asymptomatic arthritis. 5 A considerable clinical overlap occurs between psoriasis, psoriatic arthropathy and Reiter's syndrome that correlates with the presence of HLA-B27, suggesting that HIV-associated psoriasis and Reiter's syndrome perhaps constitutes a continuum of similarly expressed cutaneous disease in genetically predisposed individuals manifesting with a psoriatic spectrum having Reiter's dsyndrome as its severest manifestation. 2,4 Although his past immune status was uncertain, he had similar manifestations at that time and a diagnostic/therapeutic dilemma of Reiter's syndrome for years.HIV infection shares many immunologic features with psoriasis including increased production of cytokines relevant to pathogenesis of psoriasis. 6,7 There is evidence that HIV plays a direct role in the pathogenesis of HIV-related psoriasis in genetically predisposed patients. 3,8,9 However, degree of immunosuppression and the type or severity of HIV-related psoriasis show no correlation. Paradoxically, it worsens with immunosuppression unlike classical psoriasis. Falling CD4 + cell counts (as observed in our patient) or ART resistance precipitates psoriasis relapses while clinical improvement occurs in the absence of viral replication implying that efficacy of ART in HIV-related psoriasis is attributable to improved cytokine imbalance/ immunosuppression following reduction of HIV load rather than to CD4 + cells. 3,10 Excellent response to triple ART in our patient substantiates foregoing observations. As the therapeutic effect seems only suppressive, ART irrespective of CD4 + cell counts would greatly improve survival and quality of life in these patients. VK Mahajan, NL References1 Buccheri L, Katchen BR, Karte AJ, Cohen SR. Acitretin therapy is effective for psoriasis associated with Human Immunodeficiency virus infection. Arch Dermatol 1997; 133: 711-715. 2 Breuer-McHam J, Marshall G, Adu-Oppong A et al. Alterations in HIV expression with psoriasis or pruritus treated with phototherapy. J Am Acad Dermatol 1999; 40: 48 -60. 3 Duvic M, Crane MM, Conant M, Mahoney SE, Reveille JD, Lehrman SN. Zidovudine improves psoriasis in human immunodeficiency virus-positive males. Arch Dermatol 1994; 130: 447-451. 4 Reveille JD, Conant MA, Duvic M. Human immunodeficiency virus-associated psoriasis, psoriatic arthritis and Reiter's syndrome: a disease continuum. Arthritis Rheum 1990; 33: 1574-157...

generalized pustular eruption occurred 3 days after the delivery. A partial resolution was achieved with oral prednisolone (40 mg od) slowly tapered, but a satisfactory clinical response was only obtained with methotrexate (20 mg/week), leading to a complete resolution of the skin lesions at the 8th week of therapy. The newborn was a healthy male with no significant skin lesions.A new episode of generalized pustular eruption arose 1 year later, during the 20th week of an additional pregnancy. The patient was readmitted, and a very satisfactory clinical response was obtained with oral prednisolone (30 mg od), but a complete resolution was only observed 2 months after the delivery. The second son was also a male with no skin lesions until the age of 3 months, when he was observed with several well-demarcated erythematous plaques with superficial silver-white coloured crusts on the scalp and anterior aspect of lower limbs, clinically suggestive of plaquetype psoriasis.IH is a rare pustular eruption of pregnancy with unknown aetiology. It is frequently classified as a form of generalized pustular psoriasis, 1,2 and it normally occurs during the third trimester of pregnancy, significantly improving in the puerperium with possible recurrences in subsequent pregnancies. 3 It is associated with increased mother/foetal morbidity and mortality. 4 Systemic steroids are the mainstay of treatment. However, other drugs such as PUVA, retinoids and cyclosporin have been used either as single-agent or in combination therapies, particularly in poorly controlled disease. 5 The use of methotrexate in IH has been reported in three cases, two of them successfully. 3,5,6 Principally during the puerperium, a good outcome with methotrexate can be expected, as occurred in our patient.Several remarkable features have to be signalled in this case (i.e. the manifestation of the disease in a primigravida, the uncommon puerperal outbreak obligating to perform an aggressive systemic treatment, the recurrence during the second pregnancy at an early stage and the presence of psoriatic lesions in the second 3-monthold son). According to the clinical and histopathologic signs, the excellent response to methotrexate, which has proven efficacy in pustular psoriasis, and the coexistence of early onset psoriasis on the second son, we believe that IH can be really considered a variety of generalized pustular psoriasis. References1 Chang SE, Kim HH, Choi JH, Sung KJ, Moon KC, Koh JK. Impetigo herpetiformis followed by generalized pustular psoriasis: more evidence of the same disease entity. Int J Dermatol 2003; 42: 754-755. 2 Breier-Maly J, Ortel B, Breier F, Schmidt JB, Hönigsmann H. Generalized pustular psoriasis of pregnancy (impetigo herpetiformis). Dermatology 1999; 198: 61-64. 3 Katsambas A, Stavropoulos PG, Katsiboulas V et al. Impetigo herpetiformis during the puerperium. Dermatology 1999; 198: 400-402. 4 Brightman L, Stefanato CM, Bhawan J, Phillips TJ. Third-trimester impetigo herpetiformis treated with cyclosporine. J Am Acad Dermatol 2007; 56...

Background : Phototherapy has been a mainstay of treatment of early stages (Ia-IIa) of mycosis fungoides (MF). Despite this, there is no internationally standardized phototherapy regimen schedule for MF. Efficacy of maintenance therapy is poorly evaluated especially in patients with dark phototype (IV-VI). Methods : Thirty patients with early stage MF treated with PUVA therapy and narrowband UVB therapy from January 2004 to January 2016 at a single institution were retrospectively reviewed. Recurrence rate and recurrence-free survival were assessed in patients who received maintenance phase and in those who underwent follow-up. Results : Seventeen patients had patch stage disease while 16 patients had plaque stage disease. Most of the patients (22, 73%) had dark phototype. Nineteen patients received NB-UVB therapy, while 11 patients received PUVA. Mean follow-up period was 36,1 + 13 months. There was no significant association between the recurrence rate and recurrence free survival in patients who received maintenance phase and those who underwent follow-up. Conclusions: Phototherapy is a safe and effective treatment option for patients with early stage MF. Evidence supporting the use of maintenance phase for the treatment of early stages MF is lacking.

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