Objective: This study aims to determine retrospectively the nature and frequency of dermatologica... more Objective: This study aims to determine retrospectively the nature and frequency of dermatological diseases leading to hospitalization at Hôtel-Dieu de France Hospital (HDF) in Beirut, between 1998 and 2007 and to compare them with literature data. Patients & methods: For the patients who were hospitalized in dermatology at HDF, we studied: demographics, diagnosis of hospitalization, length of stay, service, mode of financial support, in-hospital evolution, diagnostic tests and treatment. The data were processed by SPSS program. Results: Alopecia areata, psoriatic erythroderma, acute urticaria and vasculitic purpura are the top four diagnoses (85% of hospitalizations). The third of the patients was admitted to same day care. The financial support of the hospitalization is based primarily on public insurance (57.6%). Corticosteroids are the most widely used treatment for patients in dermatology hospital with a frequency of 59.8%. The number of hospitalizations peaked at 44 in 2002 and since then has been declining (11 hospitalizations in 2007). Discussion: Pathologies encountered in hospital are different from those encountered during consultation. Management of skin diseases on an outpatient basis is often insufficient. In the literature, no profile of skin diseases leading to hospitalization is similar to our study.
Background: Erythromelanosis follicularis of the face and neck, originally described in Japan by ... more Background: Erythromelanosis follicularis of the face and neck, originally described in Japan by Kitamura et al. in 1960, is characterized by a clinical set of three: well-demarcated erythema, hyperpigmentation and follicular papules. It affects the face and the neck generally on both sides. Since the original description, it has seldom been reported in the literature. Case reports: This paper reports two patients with unilateral presentation. Discussion: Having discussed the various differential diagnoses all published cases were listed and analyzed. The prevalence of this disease appears higher than is shown by the limited number of cases reported in the literature. It deserves more recognition. Its nosologic and aetiologic frames still remain to be clarified.
Child marriage is a formal marriage or informal union entered into by an individual before reachi... more Child marriage is a formal marriage or informal union entered into by an individual before reaching the age of 18. The legally prescribed marriageable age in some jurisdictions is below 18 years, especially in the case of girls; and even when the age is set at 18 years, many jurisdictions permit earlier marriage with parental consent or in special circumstances, such as teenage pregnancy. In certain countries, even when the legal marriage age is 18, cultural traditions take priority over legislative law. Child marriage affects both boys and girls, though the overwhelming majority of those affected are girls, most of who are in poor socioeconomic situations.
Various treatment options are available for basal cell carcinoma (BCC). We report a case of a pat... more Various treatment options are available for basal cell carcinoma (BCC). We report a case of a patient with a nodular BCC on the nose who was treated with combination therapy consisting of cryotherapy with liquid nitrogen followed by imiquimod cream 5% 5 times weekly for 6 weeks. Clearance of the lesion was histologically confirmed.
For etiologic checking of cutaneous vasculitis, skin testing may be of valuable help: epicutaneou... more For etiologic checking of cutaneous vasculitis, skin testing may be of valuable help: epicutaneous patch-tests with delayed lecture (48 h.) performed with contact haptens (rubber allergens, azo dyes, resins ...) or drugs in pigmented progressive purpuric skin eruptions; prick-tests submitted to delayed (6-8 h.) clinic and histologic lecture, performed with miscellaneous drug or food-derived, microbial or environmental antigens in necrotizing vasculitis. In these conditions skin testing should be approached with great caution, because of the occurrence of non relevant positive reactions and the risk of precipitation of cutaneous or disseminated lesions of vasculitis.
Journal of Cosmetic and Laser Therapy, Jan 20, 2016
Skin grafts are widely used in reconstructive and plastic surgery, leaving an inevitable scar app... more Skin grafts are widely used in reconstructive and plastic surgery, leaving an inevitable scar appearance on the body, affecting the quality of life of the patients. Fractional ablative lasers have become a leading procedure for the treatment of acne and burn scars. We report a case of a skingraft showing excellent improvement in overall appearance after three sessions of fractional CO2 laser. The undamaged tissue left between the microthermal treatment zones is responsible of collagen formation and reepithelization. Remodeling and collagen formation are observed even 6 months after a fractional CO2 laser session.
Skin irritation induced by tretinoin is commonly observed, whereas allergic contact dermatitis to... more Skin irritation induced by tretinoin is commonly observed, whereas allergic contact dermatitis to this drug is very rarely found in the literature. We report the case of a 34-year-old man who developed contact dermatitis in areas where a topical tretinoin preparation was applied. Patch tests were positive to tretinoin in low concentration and to isotretinoin. Oral administration of isotretinoin to this patient would carry a risk of systemic complications.
Background: Skin ulcerations are rarely reported in dermatomyositis of the adult. We report on a ... more Background: Skin ulcerations are rarely reported in dermatomyositis of the adult. We report on a case of perforating ulcers resistant to classical treatments in a woman with dermatomyositis. Case report: A 34 year-old woman, treated for typical dermatomyositis, developed a few weeks after starting her treatment, multiple perforating skin ulcers on her shoulders, elbows and wrists though general signs had completely disappeared. In spite of the increase in oral steroids, the patient presented again with worsened lesions and a new perforating ulcer on the hand which lead to the breaking of a tendon. She underwent hand surgery and was also treated with a bolus of steroids IV (1 g daily during 3 days), followed by oral steroids, IM methotrexate and antimalarial drugs. The lesions healed completely after one month, with no atrophy. Discussion: Skin ulcers are rarely described in dermatomyosites of the adult and are associated with underlying vasculitis and bad prognosis. Our case is remarkable by the absence of vasculitis, a very slow cure requiring aggressive treatment and excellent prognosis after three years of follow-up.
Background: Verrucous carcinoma of the oral cavity is a rare entity that was formerly controversi... more Background: Verrucous carcinoma of the oral cavity is a rare entity that was formerly controversial. Etiopathogenesis remains unclear, notably as for its possible association with lichen planus. We report a case of verrucous carcinoma occurring in lesions of lichen planus of the tongue. Case report: A 78-year old, non smoking patient, with past history of cutaneous lichen planus presented for lesions of oral lichen planus affecting both the tongue and the palate. A treatment by topical tretinoin improved him in a spectacular way and brought about a remission which lasted 5 years. A recurrence occurred when the treatment was stopped; new whitish, warty cauliflower-like lesions appeared on the tongue. A biopsy confirmed the clinical suspicion of verrucous carcinoma. A laser resection was performed. Three months later, another recurrence was observed. A chemotherapy associating isotretinoin and methotrexate eliminated all lesions. The patient's condition is considered stable, under treatment, one year later. Discussion: Verrucous carcinoma is a rare slow-growing oral tumor that is chiefly exophytic and does not metastasize, but it can invade and destroy oral tissues. Its clinical presentation contrasts with benign histologic features: papillomatosis, acanthosis, dysplasia in variable degrees. The occurrence on lesions of lichen planus, although "classic", is very rarely found in the literature. The treatment is not well codified. An additional chemotherapy seems necessary to prevent recurrences.
Journal of Cosmetic and Laser Therapy, Apr 6, 2015
Laser treatment is a widespread method for hair removal. Despite its very common use, side effect... more Laser treatment is a widespread method for hair removal. Despite its very common use, side effects remain relatively rare and transient. Axillary hyperhidrosis and bromhidrosis have already been reported in the literature after depilatory lasers. We report here a novel side effect of total body bromhidrosis following hair removal laser. A 27-year-old man, phototype 3 underwent four sessions of total body depilatory laser, combining pulsed alexandrite and pulsed diode lasers. A few days afterwards, a generalized foul odor was noted and was resistant to regular deodorants and Aluminum chloride based antiperspirants. Possible mechanisms include the activation of dormant bacteria in the skin flora, sweat gland dysfunction, altered skin flora, sweat gland hormone receptor disturbances, and genetic factors. Total body bromhidrosis and hyperhidrosis are potential complications of total body laser hair removal.
Objective: This study aims to determine retrospectively the nature and frequency of dermatologica... more Objective: This study aims to determine retrospectively the nature and frequency of dermatological diseases leading to hospitalization at Hôtel-Dieu de France Hospital (HDF) in Beirut, between 1998 and 2007 and to compare them with literature data. Patients & methods: For the patients who were hospitalized in dermatology at HDF, we studied: demographics, diagnosis of hospitalization, length of stay, service, mode of financial support, in-hospital evolution, diagnostic tests and treatment. The data were processed by SPSS program. Results: Alopecia areata, psoriatic erythroderma, acute urticaria and vasculitic purpura are the top four diagnoses (85% of hospitalizations). The third of the patients was admitted to same day care. The financial support of the hospitalization is based primarily on public insurance (57.6%). Corticosteroids are the most widely used treatment for patients in dermatology hospital with a frequency of 59.8%. The number of hospitalizations peaked at 44 in 2002 and since then has been declining (11 hospitalizations in 2007). Discussion: Pathologies encountered in hospital are different from those encountered during consultation. Management of skin diseases on an outpatient basis is often insufficient. In the literature, no profile of skin diseases leading to hospitalization is similar to our study.
Background: Erythromelanosis follicularis of the face and neck, originally described in Japan by ... more Background: Erythromelanosis follicularis of the face and neck, originally described in Japan by Kitamura et al. in 1960, is characterized by a clinical set of three: well-demarcated erythema, hyperpigmentation and follicular papules. It affects the face and the neck generally on both sides. Since the original description, it has seldom been reported in the literature. Case reports: This paper reports two patients with unilateral presentation. Discussion: Having discussed the various differential diagnoses all published cases were listed and analyzed. The prevalence of this disease appears higher than is shown by the limited number of cases reported in the literature. It deserves more recognition. Its nosologic and aetiologic frames still remain to be clarified.
Child marriage is a formal marriage or informal union entered into by an individual before reachi... more Child marriage is a formal marriage or informal union entered into by an individual before reaching the age of 18. The legally prescribed marriageable age in some jurisdictions is below 18 years, especially in the case of girls; and even when the age is set at 18 years, many jurisdictions permit earlier marriage with parental consent or in special circumstances, such as teenage pregnancy. In certain countries, even when the legal marriage age is 18, cultural traditions take priority over legislative law. Child marriage affects both boys and girls, though the overwhelming majority of those affected are girls, most of who are in poor socioeconomic situations.
Various treatment options are available for basal cell carcinoma (BCC). We report a case of a pat... more Various treatment options are available for basal cell carcinoma (BCC). We report a case of a patient with a nodular BCC on the nose who was treated with combination therapy consisting of cryotherapy with liquid nitrogen followed by imiquimod cream 5% 5 times weekly for 6 weeks. Clearance of the lesion was histologically confirmed.
For etiologic checking of cutaneous vasculitis, skin testing may be of valuable help: epicutaneou... more For etiologic checking of cutaneous vasculitis, skin testing may be of valuable help: epicutaneous patch-tests with delayed lecture (48 h.) performed with contact haptens (rubber allergens, azo dyes, resins ...) or drugs in pigmented progressive purpuric skin eruptions; prick-tests submitted to delayed (6-8 h.) clinic and histologic lecture, performed with miscellaneous drug or food-derived, microbial or environmental antigens in necrotizing vasculitis. In these conditions skin testing should be approached with great caution, because of the occurrence of non relevant positive reactions and the risk of precipitation of cutaneous or disseminated lesions of vasculitis.
Journal of Cosmetic and Laser Therapy, Jan 20, 2016
Skin grafts are widely used in reconstructive and plastic surgery, leaving an inevitable scar app... more Skin grafts are widely used in reconstructive and plastic surgery, leaving an inevitable scar appearance on the body, affecting the quality of life of the patients. Fractional ablative lasers have become a leading procedure for the treatment of acne and burn scars. We report a case of a skingraft showing excellent improvement in overall appearance after three sessions of fractional CO2 laser. The undamaged tissue left between the microthermal treatment zones is responsible of collagen formation and reepithelization. Remodeling and collagen formation are observed even 6 months after a fractional CO2 laser session.
Skin irritation induced by tretinoin is commonly observed, whereas allergic contact dermatitis to... more Skin irritation induced by tretinoin is commonly observed, whereas allergic contact dermatitis to this drug is very rarely found in the literature. We report the case of a 34-year-old man who developed contact dermatitis in areas where a topical tretinoin preparation was applied. Patch tests were positive to tretinoin in low concentration and to isotretinoin. Oral administration of isotretinoin to this patient would carry a risk of systemic complications.
Background: Skin ulcerations are rarely reported in dermatomyositis of the adult. We report on a ... more Background: Skin ulcerations are rarely reported in dermatomyositis of the adult. We report on a case of perforating ulcers resistant to classical treatments in a woman with dermatomyositis. Case report: A 34 year-old woman, treated for typical dermatomyositis, developed a few weeks after starting her treatment, multiple perforating skin ulcers on her shoulders, elbows and wrists though general signs had completely disappeared. In spite of the increase in oral steroids, the patient presented again with worsened lesions and a new perforating ulcer on the hand which lead to the breaking of a tendon. She underwent hand surgery and was also treated with a bolus of steroids IV (1 g daily during 3 days), followed by oral steroids, IM methotrexate and antimalarial drugs. The lesions healed completely after one month, with no atrophy. Discussion: Skin ulcers are rarely described in dermatomyosites of the adult and are associated with underlying vasculitis and bad prognosis. Our case is remarkable by the absence of vasculitis, a very slow cure requiring aggressive treatment and excellent prognosis after three years of follow-up.
Background: Verrucous carcinoma of the oral cavity is a rare entity that was formerly controversi... more Background: Verrucous carcinoma of the oral cavity is a rare entity that was formerly controversial. Etiopathogenesis remains unclear, notably as for its possible association with lichen planus. We report a case of verrucous carcinoma occurring in lesions of lichen planus of the tongue. Case report: A 78-year old, non smoking patient, with past history of cutaneous lichen planus presented for lesions of oral lichen planus affecting both the tongue and the palate. A treatment by topical tretinoin improved him in a spectacular way and brought about a remission which lasted 5 years. A recurrence occurred when the treatment was stopped; new whitish, warty cauliflower-like lesions appeared on the tongue. A biopsy confirmed the clinical suspicion of verrucous carcinoma. A laser resection was performed. Three months later, another recurrence was observed. A chemotherapy associating isotretinoin and methotrexate eliminated all lesions. The patient's condition is considered stable, under treatment, one year later. Discussion: Verrucous carcinoma is a rare slow-growing oral tumor that is chiefly exophytic and does not metastasize, but it can invade and destroy oral tissues. Its clinical presentation contrasts with benign histologic features: papillomatosis, acanthosis, dysplasia in variable degrees. The occurrence on lesions of lichen planus, although "classic", is very rarely found in the literature. The treatment is not well codified. An additional chemotherapy seems necessary to prevent recurrences.
Journal of Cosmetic and Laser Therapy, Apr 6, 2015
Laser treatment is a widespread method for hair removal. Despite its very common use, side effect... more Laser treatment is a widespread method for hair removal. Despite its very common use, side effects remain relatively rare and transient. Axillary hyperhidrosis and bromhidrosis have already been reported in the literature after depilatory lasers. We report here a novel side effect of total body bromhidrosis following hair removal laser. A 27-year-old man, phototype 3 underwent four sessions of total body depilatory laser, combining pulsed alexandrite and pulsed diode lasers. A few days afterwards, a generalized foul odor was noted and was resistant to regular deodorants and Aluminum chloride based antiperspirants. Possible mechanisms include the activation of dormant bacteria in the skin flora, sweat gland dysfunction, altered skin flora, sweat gland hormone receptor disturbances, and genetic factors. Total body bromhidrosis and hyperhidrosis are potential complications of total body laser hair removal.
Que Sais-Je ?, Histoire de la circoncision. , 2022
The origin of circumcision is lost in the mists of time: no one knows where, when, or how this cu... more The origin of circumcision is lost in the mists of time: no one knows where, when, or how this curious surgical procedure could have arisen.
Since when did man have the surprising idea of cutting off a piece of his own penis or that of his young son to at the same time institute a ritual that defies time? Symbolic castration or prenuptial act? Substitute for human sacrifice or fertility ritual? Rite of passage or stigma of belonging? Or all of this at once? We remain struck by the antiquity, the universality and the incredible diversity of forms of circumcision, whose origins and justifying myths are found among peoples without writing as in two of the great monotheistic religions.
Undoubtedly the oldest enigma in the history of surgery, circumcision has nevertheless become – especially in the Anglo-Saxon world – a trivialized intervention, emptied of any symbolic meaning, but loaded, according to medical fashions. , hygienic and prophylactic virtues. How did this secularization take place? A look back at a bloody act of immemorial origin, which concerns more than a billion boys around the world.
L’origine de la circoncision se perd dans la nuit des temps : personne ne sait ni où, ni quand, ni comment cette curieuse intervention chirurgicale a pu surgir.
Depuis quand l’homme a-t-il eu la surprenante idée de couper un morceau de son propre pénis ou de celui de son jeune garçon pour instituer du même coup un rituel qui défie le temps ? Castration symbolique ou acte prénuptial ? Substitut de sacrifice humain ou rituel de fertilité ? Rite de passage ou stigmate d’appartenance ? Ou tout cela à la fois ? On reste frappé par l’ancienneté, l’universalité et l’incroyable diversité de formes de la circoncision, dont les origines et les mythes justificateurs se retrouvent chez les peuples sans écriture comme dans deux des grandes religions monothéistes.
Sans aucun doute plus vieille énigme de l’histoire de la chirurgie, la circoncision n’en est pas moins devenue – surtout dans le monde anglo-saxon – une intervention banalisée, vidée de toute signification symbolique, mais chargée, au gré des modes médicales, de vertus hygiéniques et prophylactiques. Comment s’est opérée cette sécularisation ? Retour sur un geste sanglant à l’origine immémoriale, qui concerne plus d’un milliard de garçons à travers le monde.
Bioéthicien et médecin dermatologue franco-libanais, Roland Tomb est doyen honoraire de la Faculté de médecine de l’Université Saint-Joseph de Beyrouth. Il est également membre des Comités de bioéthique de l’Unesco.
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Since when did man have the surprising idea of cutting off a piece of his own penis or that of his young son to at the same time institute a ritual that defies time? Symbolic castration or prenuptial act? Substitute for human sacrifice or fertility ritual? Rite of passage or stigma of belonging? Or all of this at once? We remain struck by the antiquity, the universality and the incredible diversity of forms of circumcision, whose origins and justifying myths are found among peoples without writing as in two of the great monotheistic religions.
Undoubtedly the oldest enigma in the history of surgery, circumcision has nevertheless become – especially in the Anglo-Saxon world – a trivialized intervention, emptied of any symbolic meaning, but loaded, according to medical fashions. , hygienic and prophylactic virtues. How did this secularization take place? A look back at a bloody act of immemorial origin, which concerns more than a billion boys around the world.
L’origine de la circoncision se perd dans la nuit des temps : personne ne sait ni où, ni quand, ni comment cette curieuse intervention chirurgicale a pu surgir.
Depuis quand l’homme a-t-il eu la surprenante idée de couper un morceau de son propre pénis ou de celui de son jeune garçon pour instituer du même coup un rituel qui défie le temps ? Castration symbolique ou acte prénuptial ? Substitut de sacrifice humain ou rituel de fertilité ? Rite de passage ou stigmate d’appartenance ? Ou tout cela à la fois ? On reste frappé par l’ancienneté, l’universalité et l’incroyable diversité de formes de la circoncision, dont les origines et les mythes justificateurs se retrouvent chez les peuples sans écriture comme dans deux des grandes religions monothéistes.
Sans aucun doute plus vieille énigme de l’histoire de la chirurgie, la circoncision n’en est pas moins devenue – surtout dans le monde anglo-saxon – une intervention banalisée, vidée de toute signification symbolique, mais chargée, au gré des modes médicales, de vertus hygiéniques et prophylactiques. Comment s’est opérée cette sécularisation ? Retour sur un geste sanglant à l’origine immémoriale, qui concerne plus d’un milliard de garçons à travers le monde.
Bioéthicien et médecin dermatologue franco-libanais, Roland Tomb est doyen honoraire de la Faculté de médecine de l’Université Saint-Joseph de Beyrouth. Il est également membre des Comités de bioéthique de l’Unesco.