Background: Pilonidal sinus disease (PNS) is a chronic inflammatory disease of the natal cleft occurring in young adults. We report our experience with laser hair removal using Nd: YAG laser and IPL for the treatment of pilonidal cysts. Materials and Methods: Twelve patients presenting with pilonidal disease with or without a history of surgery were examined and treated from October 2016 to October 2021. All patients had modifiable risk factors. Treatments were performed with intense pulsed light (IPL) in nine patients and Nd: YAG laser at a wavelength of 1064 nm in five patients, and occasionally both were used in two patients. The number of treatments ranged from three to five, performed at four-to-eight-week intervals. Results: Progressive hair depilation of the gluteal cleft was achieved in all patients. None of the patients have required further surgical treatments to date. No side effects were reported. All patients experienced a partial or complete remission of the pilonidal disease. Conclusion: Laser hair depilation is a promising therapy in the prevention and management of pilonidal disease.

Sir, An 83-year-old patient hospitalized in the intensive care unit (ICU) of the pulmonary department for chronic respiratory failure complicated by severe COVID-19 pneumonia with respiratory involvement of 50% of the lungs. The comorbidities included diabetes, uncontrolled hypertension, ischemic heart disease, Parkinson’s disease, and bronchial asthma. The patient was unable to maintain adequate arterial oxygen saturation with a face mask and nasal prongs. The attending physician ordered non-invasive ventilation (NIV) and a continuous positive airway pressure (CPAP) mask was applied. On day ten of the patient’s ICU stay, his attending physician noticed a grade II cheekbone ulcer. The patient was put on a paraffin dressing. The evolution was marked five days later by a worsening in the stage of the pressure ulcer, which had become a stage III ulcer and, therefore, our opinion was requested. An examination of the patient revealed a well-adjusted, full-face mask with pressure against the zygomatic bone aggravated by the application of compresses, which further increased the aggression against the bone. A dermatological examination found two necrotic patches on both cheekbones without a peripheral detachment or inflammatory border (Fig. 1). There were no signs of bacterial infection. Upon investigation, the caregivers revealed that the CPAP mask had been left in place for nearly eighteen hours daily without formal monitoring or the inspection of the pressure areas. Fortunately, the patient’s condition began to improve as did her arterial oxygen saturation. The pulmonologist was gradually attempting to remove the patient from NIV. Strict monitoring of the pressure points was recommended and the patient was put on a hydrogel dressing for five days until the necrosis was eliminated, then on a hydrocolloid dressing after the mechanical removal of the remnants of the necrosis and fibrin with good improvement of the ulcer. The COVID-19 epidemic represents a new challenge for critical care physicians (ICU). In the context of this epidemic, the management of arterial oxygenation during critical care procedures is one of the main challenges for ICU physicians. As an effective means of ensuring satisfactory arterial oxygenation during COVID-19 pneumonia, more than 50% of patients treated in China required non-invasive ventilation (NIV) [1]. During NIV with headgear, ICU nurses should focus on interventions that help to improve the patient’s comfort to maximize the acceptability of the device and minimize mask-induced skin irritability [1]. Skin pressure sores secondary to helmet application may be prevented by applying hydrocolloid dressings associated with close monitoring of the patient’s tolerance to the pressure exerted by the mask [2]. The development of NIV-related pressure sores is due to a combination of pressure effects and shear forces exerted by the presence of a mask, pressure changes during the different phases of ventilation, and the tension of the mask’s strap [3]. The use of oronasal masks and increased time on NIV increases the risk of pressure ulcer formation, as do patient factors such as age, sensory impairment, chronic skin conditions, and hypotension [4]. Oronasal masks remain the most popular interface, with a European survey revealing that they are the first choice in 70% of cases. The reasons given by respondents for their choice were the reduction of air leakage, patient comfort, and cost [5].

Abrikossoff’s tumor, also known as granular cell tumor, is a rare tumor first described on the tongue by Ivanovich Abrikossoff in 1926. It is mainly located in the head and neck regions with preferential mucosal involvement and may occur at any age and in both sexes, although with a female predominance. Herein, we report two cases: the case of a nodule under the left breast in a 47-year-old female with a history of breast cancer and of a subcutaneous lesion on the right thigh in a 46-year-old female. The diagnosis of granular cell tumor was reached by biopsy with immunohistochemical staining, then treatment was completed by a large surgical excision. Key words: Abrikossoff; Skin; Granular cell tumor

Pruritic papular eruption (PPE) described in HIV is a skin disease often encountered in HIV-positive patients. It is most often a sign of severe immunodeficiency and is commonly reported in African, Southeast Asian, and Indian populations [1,2]. It affects both adult females and males and may also be seen in children. The elementary lesion is a discrete, firm, erythematous, urticarial, very itchy papule of the extremities, face, and trunk, sparing the palms and soles. Painful excoriations in the genital mucosa are sometimes described. The CD4+ lymphocyte count (CD4) is usually below 250 cells/mm3. Histopathology reveals a lymphohistiocytic, inflammatory, perivascular, and periannexal infiltrate with a variable number of eosinophils. According to the World Health Organization (WHO), it is recommended to all HIV patients with antiretroviral therapy (ART), regardless of the staging and the CD4 count [3]. However, an elective treatment for PPE has not yet been found. Regression has been noted in some cases after the initiation of antiretroviral therapy. UVB therapy seems to be the most successful method in cases not improving with antiretroviral therapy [4]. Herein, we report the case of a patient who presented with PPE revealing HIV.

Poromas are rare, benign neoplasms arising from the terminal ductal portion of the sweat glands. They are mainly characterized by flesh-colored or pink papules or nodules, usually located at the extremities. The pigmented variant is rare. Collisions with other benign epithelial tumors have been reported. The clinical appearance may be confused with several benign or malignant tumor pathologies, yet thanks to dermoscopy, which is a non-invasive means of exploration, some signs are highly useful in the diagnosis and in suspecting the collision of two distinct tumors before proceeding to histological confirmation. Herein, we report the original case of a collision between pigmented eccrine poroma of the leg and seborrheic keratosis. Key words: Pigmented poroma; Collision; Dermoscopy; Histology; Seborrheic keratosis