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B Jomaa

Publications and source records attributed to B Jomaa.

At least 19 recordsLinked to original sources

Comparative epidemiology of pemphigus in Tunisia and France: unusual incidence of pemphigus foliaceus in young Tunisian women.

Recent studies have suggested that in Tunisia, pemphigus foliaceus is more frequent in young women than expected. To confirm these findings, we compared the incidence rates of pemphigus in Tunisia as a whole and in a large area of France. New cases of pemphigus were detected retrospectively from dermatology departments and pathology laboratories over a 6-year period and classified as pemphigus vulgaris or foliaceus according to the pathology. In France, the incidence rate was 1.7 cases per million per year (95% confidence interval 1.4 to 2.1). Pemphigus vulgaris accounted for 73% of all cases, incidence increased with age, and the female-to-male sex ratio was 1.2. The incidence rate was significantly higher in Tunisia than in France: 6.7 cases per million per year (95% confidence interval 5.8 to 7.7); pemphigus foliaceus was more frequent (61%), the female-to-male sex ratio was 4.1, and the incidence rate was higher in young women. The incidence rate was 15.5 cases per million per year for pemphigus foliaceus among women aged 25 to 34 years and was even higher in some rural areas. No case was observed among household members or in neonates, and only one case occurred in childhood. Thus, we confirmed that the epidemiology of pemphigus in Tunisia is unusual. High rates of pemphigus foliaceus among young people living in rural areas are reminiscent of Brazilian pemphigus. However, the absence of cases among genetically related household members and during childhood, and the large predominance of women, contrast with Brazilian pemphigus.

Adult

[Iga linear bullous dermatosis in children. A series of 12 Tunisian patients].

BACKGROUND: Linear IgA bullous dermatosis (LABD) of childhood is one of the chronic, non-hereditary blistering diseases of childhood in which clinical, histologic and therapeutic findings are similar to those associated with bullous pemphigoid (BP) and dermatitis herpetiformis (DH). LABD, however, can be distinguished from BP of DH by direct immunofluorescence (IF) demonstration of linear IgA deposits along the basement membrane zone (BMZ). RESULTS: During the period 1984-1993, 12 children with LABD were studied. Their ages ranged from 2 years to 15 years with a mean of 8.5 years. There were 7 males and 5 females. All children had a generalized eruption consisting of large tense blisters arising on normal skin. The blisters were more profuse on the lower trunk, pelvic region and limbs. Face and scalp were also affected. Occasionally, annular blister formation producing a "rosette" or "cluster of jewels" was found. Pruritus was frequent. Histological features of BP and DH were seen. Direct IF showed linear deposits of IgA at the BMZ in all cases. IgM, IgG, and complement were also seen in 8 cases. Four patients showed IgA BMZ antibodies by indirect IF. There were no symptoms of malabsorption and 3 patients had a mild bowel lesions. HLA studies showed the B8DR3 antigen in 7 of the 10 patients studied. Nine patients were treated with dapsone associated in 3 patients with prednisone. Three patients were controlled on oxacillin. CONCLUSION: LABD of childhood is a definite clinical entity. It is the most frequent chronic, non hereditary bullous disease of childhood in Tunisia. It is characterized by a self limiting blistering eruption which resembles BP or DH histologically and has a characteristic linear deposits of IgA at the BMZ of the skin. The treatment consisted on dapsone therapy, but 3 patients in our study were well controlled on oxacillin.

Adolescent

[Actinic lichen planus. An anatomoclinical study of 10 Tunisian cases].

BACKGROUND: Actinic lichen planus is a distinct variant of lichen planus involving mainly children and teenagers with racial predilection to orientals. The clinical and histopathologic features of actinic lichen planus in ten tunisian patients were studied. RESULTS: The mean age was 14 years. The eruption was distributed over sun-exposed areas, with particular predilection for the face. In most cases the lesions consisted of erythematous brownish plaques with an annular configuration. Less commonly, hypermelanotic patches, sometimes assuming a melasma-like appearance, were present. The histopathologic feature consisted of a lichenoid dermatitis. CONCLUSION: The cause of actinic lichen planus is unknown. Sunlight appears to be the major precipitating factor and therefore the disease would best be included among the photodermatoses.

Adolescent

[Cutaneopulmonary blastomycosis].

We observed a new case of blastomycosis in a patient with haemoptysis. The chest X-ray revealed a lesion confined to the upper right lobe of the lung and there was an ulcerating vegetation at the medial angle of the right eye. Skin biopsy and bronchial aspiration led to the identification of typical Blastomyces dermatitidis. Outcome was favourable after oral therapy with ketoconazole. Cutaneo-pulmonary blastomycosis is weakly endemic in Tunisia. Pulmonary lesions are more frequent because of airborne transmission. Cutaneous lesions may be clinically misleading. This disease is sensitive to antifungal imidazole derivatives.

Blastomycosis

Pemphigus foliaceus in young women. An endemic focus in the Sousse area of Tunisia.

BACKGROUND AND DESIGN: With the exception of some areas in Brazil, pemphigus is an exceptional disease. Several previous observations suggested that pemphigus foliaceus occurred more frequently than expected in Tunisia. To confirm these observations, a 15-month prospective survey was undertaken at the University Hospital of Sousse in Tunisia. RESULTS: During the survey, 23 patients with pemphigus were observed. Twenty of 23 cases were of pemphigus foliaceus that affected only young women. Seven patients had the clinical features of pemphigus herpetiformis. The estimated incidence of pemphigus foliaceus in the Sousse area was four new cases per million inhabitants per year, far above European or North American incidence but lower than the incidence in the most severely affected areas in Brazil. The high prevalence of the herpetiform clinical variant, the young age, the feminine exclusivity, and the absence of familial cases differentiated this Tunisian pemphigus both from pemphigus foliaceus observed in Europe and North America and from the Brazilian fogo selvagem. No etiologic factor was identified. CONCLUSIONS: This study suggests the existence in Tunisia (and possibly in all North Africa) of an endemic form of pemphigus foliaceus restricted to young women.

Adult

[Bone anomalies in von Recklinghausen disease].

28 cases of neurofibromatosis are reported. Principals bone anomalies are reviewed. The skeletal manifestations are numerous and varied. These anomalies interest specially cranial vault, spheno-orbital area and vertebral spine. It is imperative to keep in mind skeletal manifestations because neurologic and cutaneous signs can be absent.

Adolescent