Mourad MOKNI
University of Tunis El Manar, Dermatology, Faculty Member
Research Interests: Dermatology and Medicine
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Research Interests: Dermatology, Medicine, Humans, Rosacea, Chronic Disease, and 4 moreFemale, Clinical Sciences, Adult, and Demodex
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Coexistence of mal de Meleda and congenital cataract in a consanguineous Tunisian family: two case reports
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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... more
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.
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A 70-year-old woman presented with an atypical erythematopapular zosteriform eruption of 3 weeks' duration. The patient had no history of previous vesicular eruption. She developed a painful burning sensation on the neck. Clinical... more
A 70-year-old woman presented with an atypical erythematopapular zosteriform eruption of 3 weeks' duration. The patient had no history of previous vesicular eruption. She developed a painful burning sensation on the neck. Clinical examination revealed a cluster of small erythematous firm papules and plaques in a zosteriform distribution on the left ear, face, neck, and shoulder (Figure 1A). The lesions were unilateral and did not cross the midline. Multiple cervical and axillary lymph nodes were palpable. Laboratory tests revealed an increase in white blood cells of 25,000/mm3, with 17,910/mm3 lymphocytes and a normal range of hemoglobin, platelets, creatinine, and liver enzymes. Erythrocyte sedimentation rate was 87 mm. Blood smear results showed small, morphologically mature lymphocyte cells. In immune phenotyping, lymphocyte cells co-express CD5 and B-cell-surface antigens CD19 and CD23, as well as a restriction of kappa immunoglobulin light chains. The cells were CD22-, CD79...
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A 30-year old man with no trauma history presented to our department of dermatology with a 2-year history of abdominal painful masses. The spontaneous pain and tenderness in the abdominal region gradually worsened. Physical examination... more
A 30-year old man with no trauma history presented to our department of dermatology with a 2-year history of abdominal painful masses. The spontaneous pain and tenderness in the abdominal region gradually worsened. Physical examination revealed 3 firm, irregular subcutaneous nodules measuring 1 x 0.5 cm, which were movable and unattached to the overlying skin. One of the nodules was ulcerated (Figure 1). Histopathologic examination showed spindle-shaped fibroblast cells intermingled with gangliocyte-like giant cells in the hypodermis with an infiltrate made of lymphocytes and histiocytes (Figure 2 and Figure 3). The immunohistochemical staining showed the negativity of the fusiform cells and the gangliocyte-like cells to anti-S100 protein and to anti-smooth muscle actin.
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Granuloma annulare is a benign skin disorder which cause is unknown. The aim of this work is to report the results of a retrospective study dealing with 18 cases of granuloma annulare carried in the dermatology department of la Rabta... more
Granuloma annulare is a benign skin disorder which cause is unknown. The aim of this work is to report the results of a retrospective study dealing with 18 cases of granuloma annulare carried in the dermatology department of la Rabta hospital over a nine year period. We describe 3 clinical forms: localized granuloma annulare: 9 cases, generalized granuloma anulare: 7 cases and deep granuloma annulare: 2 cases. Diabetes mellitus was associated to granuloma annulare in 6 patients, from which 3 presented with multiple lesions. Corticosteroids were used topically in 11 cases. The outcome was marked by a partial resolution in 15 cases. In our study. We didn't found any malignancy with our granuloma annulare patients.
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Research Interests: Dermatology, Rheumatoid Arthritis, Medicine, Humans, Male, and 3 moreMiddle Aged, Myositis, and Ichthyosis
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UC Davis Dermatology Online Journal Title Segmental phenolization for the treatment of Ingrown toenails: technique report, follow up of 146 patients, and review of the literature Permalink Publication Date Original Segmental phenolization for the treatment of Ingrown toenails: technique report, f...more
Background: Ingrown toenail is a common problem causing significant morbidity. Various procedures used for treating this painful condition were discussed in the literature.
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1. Hodi FS, Chiarion-Sileni V, Gonzalez R et al. Nivolumab plus ipilimumab or nivolumab alone versus ipilimumab alone in advanced melanoma (CheckMate 067): 4-year outcomes of a multicentre, randomised, phase 3 trial. Lancet Oncol. 2018;19... more
1. Hodi FS, Chiarion-Sileni V, Gonzalez R et al. Nivolumab plus ipilimumab or nivolumab alone versus ipilimumab alone in advanced melanoma (CheckMate 067): 4-year outcomes of a multicentre, randomised, phase 3 trial. Lancet Oncol. 2018;19 (11):1480–92. 2. Da Gama Duarte J, Peyper JM, Blackburn JM. B cells and antibody production in melanoma. Mamm Genome. 2018; 29(1112): 790–805. 3. Giavina-Bianchi M, Giavina-Bianchi P, Sotto MN et al. Increased NY-ESO-1 expression and reduced infiltrating CD3+ T cells in cutaneous melanoma. J. Immunol. Res. 2015; 2015: 761378. 4. Taube JM, Anders RA, Young GD et al. Colocalization of inflammatory response with B7–h1 expression in human melanocytic lesions supports an adaptive resistance mechanism of immune escape. Sci. Transl. Med. 2012; 4(127): 127ra37. 5. Thierauf J, Veit JA, Affolter A et al. Identification and clinical relevance of PD-L1 expression in primary mucosal malignant melanoma of the head and neck. Melanoma Res. 2015; 25(6): 503–9. 6. K...
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Seborrheic keratoses are one of the most common, benign epidermal tumours encountered in clinical practice. Malignant transformation is exceptional. We report a case of seborrheic keratosis of the back, in a 57-year-old woman, which, on... more
Seborrheic keratoses are one of the most common, benign epidermal tumours encountered in clinical practice. Malignant transformation is exceptional. We report a case of seborrheic keratosis of the back, in a 57-year-old woman, which, on biopsy, revealed the presence of a squamous cell carcinoma in situ.
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Introduction La rosacee granulomateuse (RG) ou lupoide est une variante clinique de la rosacee caracterisee par des papules jaunâtres et des nodules pouvant laisser des cicatrices atrophiques. Ces lesions sont moins inflammatoires que... more
Introduction La rosacee granulomateuse (RG) ou lupoide est une variante clinique de la rosacee caracterisee par des papules jaunâtres et des nodules pouvant laisser des cicatrices atrophiques. Ces lesions sont moins inflammatoires que dans une rosacee classique et reposent sur une peau non erythemateuse et non couperosique. L’aspect clinique est souvent trompeur et peut mimer en particulier une sarcoidose cutanee. Observation Une patiente âgee de 44 ans, sans antecedents, consultait pour des lesions du visage evoluant depuis 5 ans. A l’examen cutane, on notait des papules erythemateuses et des nodules lupoides a la vitropression reposant sur un fond peu inflammatoire siegeant au niveau de la joue gauche, de la levre superieure blanche et des paupieres superieure et inferieure droites. Des pustules etaient observees au niveau des joues. Une biopsie cutanee a ete realisee. L’histologie avait revele un abondant infiltrat lympho-plasmocytaire associe a des granulomes epitheloides avec p...
Research Interests: Medicine and Gynecology
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Research Interests: Medicine and Gynecology
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Blastomycosis is an uncommon mycotic infection in Africa. Isolated cutaneous disease is extremely rare. The purpose of this report is to describe 2 cases of cutaneous blastomycosis. The first case Involved a 70-year-old rural woman who... more
Blastomycosis is an uncommon mycotic infection in Africa. Isolated cutaneous disease is extremely rare. The purpose of this report is to describe 2 cases of cutaneous blastomycosis. The first case Involved a 70-year-old rural woman who presented papulonodules associated with scars on the upper extremities and right leg, ongoing for 2 months. The second patient was a 47-year-old woman who presented 2 vegetating plaque areas above the left knee and on the left shoulder, ongoing for 4 months. In addition a bow-shaped scar resulting from a dog bite was observed. Histologic examination and culture on Sabouraud's medium and brain heart agar confirmed diagnosis of cutaneous blastomycosis in both patients. No visceral involvement was found. Blastomycosis is uncommon in Tunisia with only 6 previously published cases. The two cases reported here are interesting because involvement was confined to the skin suggesting cutaneous inoculation of Blastomyces dermatitidis.
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Extraskeletal osteosarcoma is a rare soft tissue tumor. We report an exceptional case located in the forearm.A 62-year-old woman consulted for a tumor of the right forearm which she had noticed for six months. Physical examination... more
Extraskeletal osteosarcoma is a rare soft tissue tumor. We report an exceptional case located in the forearm.A 62-year-old woman consulted for a tumor of the right forearm which she had noticed for six months. Physical examination revealed a 10 x 12 cm tumor with an ulcerated center. MRI demonstrated a heterogenous mass exhibiting no connection with the bone or subjacent
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the erythrodermic psoriasis (EP) is a rare but severe form of psoriasis that may be potentially life-threatening. To study the characteristics of this severe form of psoriasis. We present a retrospective study, including all cases of EP... more
the erythrodermic psoriasis (EP) is a rare but severe form of psoriasis that may be potentially life-threatening. To study the characteristics of this severe form of psoriasis. We present a retrospective study, including all cases of EP followed in the dermatology department of the La Rabta hospital of Tunis over a 31-year-period from January, 1980 to June, 2010. sixty patients were included, concerning 46 men and 14 women, with an average age of 53.7. A history of psoriasis was reported in 78 % of the cases. A triggering factor was found in 53 % of the cases. Systemic treatments were required in 55 % of cases. An improvement was noted in 69.4 % of the cases. A recurrence of the EP was observed in 15% of the cases. Three cases of sepicemia and one of stroke were noted. Erythrodermic psoriasis is the most common etiology of erythroderma. It represents more than half of severe psoriasis. As shown in our study it affects mainly adults' males. It complicates usually a common psorias...
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Erysipelas is an acute infection occurring chiefly in the lower limbs, rarely in the upper limbs. A 45-year-old patient suffering from Charcot-Marie-Tooth disease with neuropathy of the limbs, presented with fever and a 24-hour history of... more
Erysipelas is an acute infection occurring chiefly in the lower limbs, rarely in the upper limbs. A 45-year-old patient suffering from Charcot-Marie-Tooth disease with neuropathy of the limbs, presented with fever and a 24-hour history of a well-circumscribed inflammatory and infiltrated plaque of the left arm. Erysipelas was diagnosed and intravenous penicillin was administered leading to regression of the inflammatory signs, however edema persisted in the inner part of the left elbow. An x-ray showed left elbow dislocation. The patient revealed trauma of the left upper limb 5 weeks before. The occurrence of erysipelas is usually associated with lymphatic edema or venous incontinence. Lymphatic lesions due to radiotherapy or surgery may afflict draining vessels leading to venous and lymphatic stasis and then infection occurs. We find no reported cases of erysipelas following elbow dislocation but we postulate its pathogenesis to be similar.
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Discoid lupus erythematosus (DLE) is rare in childhood. We report the case of a 15-month-old female infant who presented with erythematous telangectatic lesions and photosensitivity involving the sun-exposed areas. Histological... more
Discoid lupus erythematosus (DLE) is rare in childhood. We report the case of a 15-month-old female infant who presented with erythematous telangectatic lesions and photosensitivity involving the sun-exposed areas. Histological examination confirmed the diagnosis of DLE. Direct immunofluorescence (DIF) on lesional skin showed granular IgM deposits along basement membrane zone. Laboratory tests were normal. External photo-protection and topical corticosteroids lead to complete healing. Summer recurrences that responded to topical corticosteroids were noted but there was no progression to systemic lupus erythematosus. Several authors note the absence of female predominance in children with DLE; prevalence of photosensitivity is controversial. Histological confirmation of DLE is easy and important for diagnosis. DIF is not specific but can be helpful in establishing the diagnosis of DLE. Laboratory tests rarely show low titers of antinuclear antibodies. Treatment is based on sun avoidance and photoprotection. Topical corticosteroids are indicated for active lesions. For resistant cases antimalarials are the treatment of choice. Progression to SLE is probably more frequent in children than in adults.
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Necrolytic Migratory Erythema (NME) is a rare cutaneous paraneoplastic manifestation of glucagonoma. We report a case of a woman with a 6-year history of delayed diagnosis of Glucagonoma. This case highlights the atypical clinical... more
Necrolytic Migratory Erythema (NME) is a rare cutaneous paraneoplastic manifestation of glucagonoma. We report a case of a woman with a 6-year history of delayed diagnosis of Glucagonoma. This case highlights the atypical clinical features of NME which makes the diagnosis difficult.
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Punctate palmoplantar keratoderma type I (PPPK‐BFB), also called Buschke‐Fischer‐Brauer disease (MIM 148600) is a rare autosomal dominant disorder of keratinization, characterized by multiple hyperkeratotic lesions on the palms and soles.... more
Punctate palmoplantar keratoderma type I (PPPK‐BFB), also called Buschke‐Fischer‐Brauer disease (MIM 148600) is a rare autosomal dominant disorder of keratinization, characterized by multiple hyperkeratotic lesions on the palms and soles. Recently, PPPK‐BFB has been shown to be associated with mutations in the AAGAB gene in several families of European, African, Canadian and Asian origins.
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Lesion features in cutaneous leishmaniasis (CL) depend on the infecting Leishmania species as well as on host immune reponse. In this study, we evaluated the histological and immunological differences between two forms of CL described in... more
Lesion features in cutaneous leishmaniasis (CL) depend on the infecting Leishmania species as well as on host immune reponse. In this study, we evaluated the histological and immunological differences between two forms of CL described in Tunisia: zoonotic cutaneous leishmaniasis (ZCL) caused by L. major and sporadic cutaneous leishmaniasis (SCL) caused by L. infantum. Histological analysis showed a mild to moderate infiltrate within ZCL lesions. In contrast, massive infiltration of the dermis was observed within SCL lesions. Contrary to ZCL, infiltrates within SCL lesions were organized and showed granuloma composed of macrophages and lymphocytes. In addition, immunohistochemical analysis showed a predominance of CD4+ T cells within both CL forms. Furthermore, expression of interferon-γ, interleukin (IL)-10, IL-8, IL-13 and monocyte chemotactic protein (MCP)-1 was evaluated using real-time quantitative polymerase chain reaction (RT-qPCR). MCP-1 and IL-10 were expressed at comparable...
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Basal cell carcinoma (BCC) is the most common malignant tumour of the skin frequently located on the head and chiefly on the nose. Cryosurgery is one of the methods to treat BCC. To determine the efficacy of cryosurgery of 17 BCC of the... more
Basal cell carcinoma (BCC) is the most common malignant tumour of the skin frequently located on the head and chiefly on the nose. Cryosurgery is one of the methods to treat BCC. To determine the efficacy of cryosurgery of 17 BCC of the nose in terms of recurrence rates and cosmetic results. 15 patients were included with a median age of 73 years and a photo type III or IV in 86% of cases. Mean size of tumours was 12 mm. Lesions were chiefly located on the alae nasi (70.5%). Complications were few and minor. After an average follow-up of 13.5 months, recurrence rate was about 5.8% (one case). Cosmetic results were good or excellent in 14 cases/17; only one patient had developed a notch of the nose. Cryosurgery is a rapid, of a low cost technique and chiefly with good oncological and cosmetic results.
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Atopic dermatitis (AD) is a chronic relapsing eczematous skin disease. It represents one of the symptoms of atopic diathesis. DA affects usually infants and children. aim : The aim of our study is to draw up the epidemiological, clinical... more
Atopic dermatitis (AD) is a chronic relapsing eczematous skin disease. It represents one of the symptoms of atopic diathesis. DA affects usually infants and children. aim : The aim of our study is to draw up the epidemiological, clinical features, treatment and outcome of severe childhood AD through a hospital series. methods: A retrospective study of 24 cases of severe childhood AD hospitalized in the Dermatology Department of La Rabta hospital of Tunis was conducted during a 28 year-period (1981 - 2009). results: The hospital incidence of severe childhood AD was 0,085‰. Patient's mean age at the beginning was 14 months. The sex ratio H/F was 1.66. Cutaneous manifestations occurred preferentially in face (75%). Generalized eczema was observed in 37.5% of cases. Pruritus and xerosis were constant. The mean duration of hospitalization was 11 days. Topical corticosteroids was the most effective method of treating severe DA, associated with antiseptic solutions emollient and antihi...
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Depilatory radiotherapy was used in the sixties as a treatment for ringworm in Tunisia. Subsequently some of these patients developed radio-induced carcinomas of the scalp. To present the epidemiological, clinical,... more
Depilatory radiotherapy was used in the sixties as a treatment for ringworm in Tunisia. Subsequently some of these patients developed radio-induced carcinomas of the scalp. To present the epidemiological, clinical, pathological,therapeutic features and out come of radio-induced cutaneous carcinomas. We conducted a retrospective study performed in the dermatology department of the La Rabta hospital of Tunis over a 6- year-period recording all histologically confirmed carcinomas in patients irradiated in childhood for tinea capitis. Thirty one patients were included with 49 tumors: 47 basal cell carcinomas and 2 squamous cell carcinomas. The average latent period between the irradiation and the appearance of the carcinomas was of 35.7 years. The average age was 53 years. A male predominance was noted, with a sex ratioM/F of 6.75. Clinically, basal cell carcinomas were nodular in all cases. Surgery was indicated in 90% of cases. Cryosurgery and radiotherapy were used respectively in 1 ...
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Kaposi's sarcoma (KS) is a mutifocal angiogenic process characterized by cellular and vascular proliferation. To identify the epidemio-clinical, histological and therapeutic features of KS. Retrospective study of 75 cases of KS at the... more
Kaposi's sarcoma (KS) is a mutifocal angiogenic process characterized by cellular and vascular proliferation. To identify the epidemio-clinical, histological and therapeutic features of KS. Retrospective study of 75 cases of KS at the dermatology department of Rabta hospital in Tunis during a period of 25 years (1982-2007). Three epidemio-clinical forms of KS were observed in our study: the classic KS (70 cases), the AIDS-related KS (4 cases) and the iatrogenic KS (1 case). The mean age of our patients at diagnosis was 69.16 years with a sex ratio of 2.33. Elective site of cutaneous lesions in the classic KS was the limbs (87.1%). The cephalic part was concerned in 17.1% of cases. Mucosal involvement was found in 28.5% of patients. Extra dermatological localizations of KS were observed in 32.9%. Our study identified some epidemio-clinical features of the classic KS especially the high frequency of mucosal and cephalic involvement as well as extra dermatological localizations. Th...
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Behçet's disease (BD) is a systemic inflammatory disease involving many systemic lesions characterized by vasculitis as a common basic pathologic process. Mucocutaneous (MC) features are considered as the diagnostic hallmarks. To... more
Behçet's disease (BD) is a systemic inflammatory disease involving many systemic lesions characterized by vasculitis as a common basic pathologic process. Mucocutaneous (MC) features are considered as the diagnostic hallmarks. To retrospectively determine the epidemiological and clinical aspects of BD mucocutaneous symptoms in Tunisia compared to those found in the literature. Twenty-eight patients were involved in a single-center dermatological recruitment for a 27-year period (1980-2007) on the basis of international BD criteria. Our series included 19 males and 9 females. The mean age at onset was 28 years and the mean age at diagnosis was 37.9 years. The frequency of MC manifestations was as follows: oral ulcers (100%), genital ulcers (92.8%), other cutaneous signs (82.1%) such as papulopustular lesions (53.5%), and dermohypodermal nodes (11.53%), aphthous cutaneous ulcers (17.8%), and other lesions (leg ulcer: three cases, erythema multiform: one case, and infected pyoderma...
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Participation in athletic activities is associated with a variety of skin problems. We aimed to precise the most important sports related dermatoses in athletes. We conducted transversal study on 30 athletes of 2 teams: one of soccer and... more
Participation in athletic activities is associated with a variety of skin problems. We aimed to precise the most important sports related dermatoses in athletes. We conducted transversal study on 30 athletes of 2 teams: one of soccer and the other of basketball players. For each athlete dermatological exam was practiced. 18 soccer players and 12 basketball players were enrolled; the mean age was about 25.3 years [18-35 years]. The results suggest that athletic activity seems to be a predisposing factor for cutaneous infections (87%) especially fungal infections (90%). Traumatic lesions were also frequent in our athletes (20/30), dominated by calluses and nail disorders (80%). Sports-related dermatoses include infections, traumatic entities, allergic contact dermatitis, environmental encounters, exacerbation of preexisting dermatoses, thus regular dermatological screening of athletes is critical for rapid identification and treatment of dermatoses distrusting sport performance.
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Nevus lipomatosus cutaneous superficialis (NLCS) is a rare hamartomatous skin lesion histologically characterised by the presence of mature fat tissue within the dermis. Clinically, two types of NLCS can be distinguished: a multiple type... more
Nevus lipomatosus cutaneous superficialis (NLCS) is a rare hamartomatous skin lesion histologically characterised by the presence of mature fat tissue within the dermis. Clinically, two types of NLCS can be distinguished: a multiple type of Hoffmann-Zurhelle and a solitary type. We report a retrospective study of 13 cases of NLCS seen in the Anatomopathological department of La Rabta hospital of Tunis during a period of 12 years (1992-2004). Two clinical forms were distinguished: the solitary form (11 cases) consisting of a unique papulo-nodular lesion and the multiple form (2 cases). Histologically, the tumor consisted in all cases on mature fat tissue.
Research Interests: Pathology, Adolescent, Medicine, Humans, Child, and 12 moreFemale, Male, Aged, Middle Aged, Adult, Dermis, Retrospective Studies, Lesion, Pathological, Skin Neoplasms, Nevus, and Subcutaneous fat
Pseudoxanthoma elasticum (PXE) is an inherited disorder of elastic tissue with many systemic manifestations We performed a retrospective study from all the patients diagnosed with PXE at the department of dermatology of La Rabta hospital... more
Pseudoxanthoma elasticum (PXE) is an inherited disorder of elastic tissue with many systemic manifestations We performed a retrospective study from all the patients diagnosed with PXE at the department of dermatology of La Rabta hospital of Tunis, between 1986 and 2003. During the observation period, we identified 11 patients with PXE, 5 males and 6 females with a mean age of 28 years (10-47 years). Family history was found in 5 patients. Exhibit yellowish, pigskin, and popular lesions on the sides of the neck were observed in all cases. Systematic ophthalmologic examination revealed angioïd streaks in 4 patients. No abnormalities were found in cardiovascular and metabolic explorations. Diagnosis of PXE is based on clinical, histological and genetic criteria. Ocular and cardiovascular damage make all the gravity of the disease, from where interest of an ophthalmologic and cardiovascular examination systematic.
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The paraneoplastic acanthosis nigricans occurs in association with visceral neoplasms. We report a case of acanthosis nigricans that seat at a dorsal face of the second, third and fourth right toe of a 63 year-old patient. The exploration... more
The paraneoplastic acanthosis nigricans occurs in association with visceral neoplasms. We report a case of acanthosis nigricans that seat at a dorsal face of the second, third and fourth right toe of a 63 year-old patient. The exploration has been put in evidence a carcinoma of the right lung. The acanthosis nigricans has been nearly disappeared after resection of the pulmonary lobe. The relapses of the acanthosis nigricans in a same sit after five years has been reveal a carcinoma of the bladder. The resection of the bladder tumour has been followed by disappearance of the acanthosis nigricans.
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Some cases of skin cancer developping from chronic discoid lupus erythematosus were publied among the world. We make know our experience about two cases suffering with a chronic discoid lupus erythematosus from 16 and 11 years and... more
Some cases of skin cancer developping from chronic discoid lupus erythematosus were publied among the world. We make know our experience about two cases suffering with a chronic discoid lupus erythematosus from 16 and 11 years and developped a squamous cell carcinoma from the elbow and the lower lip.