1011P- PUBMED SEARCH : DERMATOLOGY and SAUDI ARABIA

OTHER/KAP: 1. Int J Dermatol. 2010 Oct;49(10):1141-5. Beliefs and perceptions of Arab vitiligo patients regarding their condition. AlGhamdi KM. Vitiligo Research Chair, Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia. kmgderm@yahoo.com. BACKGROUND: Patients' beliefs about their illness can result in positive and/or negative implications for the management of their disease. To examine the beliefs held by vitiligo patients about their condition and to explore the potential factors that might influence such beliefs. METHODS: The illness perception questionnaire (IPQ) was translated into the particular regional language (Arabic) and administered to adult vitiligo patients visiting our Dermatology Department, from 2006 to 2008. Demographic and illness details were obtained. RESULTS: We recruited 164 vitiligo patients (91 male subjects). The mean age was 27 years (SD = 13, range 15–57 years). It was believed that stress, altered immunity, and heredity were the cause of vitiligo by 33%, 26%, and 24% of the respondents respectively. Eighty-four percent and 28% believed in fate and evil eye as a cause of their illness respectively. Forty-two percent believed that their illness had a major effect on their lives and 44% believed that vitiligo had strongly affected the way others see them. For both beliefs, this was independent of the gender. Thirty-seven percent reported that they do not understand their illness. Six percent believed that their disease was contagious while 12% were not sure. Fifty-four and 57% reported feeling depressed and anxious respectively, because of their disease. This was more common in female patients (P = 0.019 and 0.031 respectively). CONCLUSION: Misconceptions and negative attitudes are widespread among vitiligo patients. The lack of disease-related understanding and the existence of anxiety and depression require targeted health education and psychosocial support.

OTHER/KAP: 2. Int J Dermatol. 2010 Sep;49(9):1063-7. doi: 10.1111/j.1365-4632.2010.04519.x.Reliability and validity of the Arabic version of "dermatitis family impact" questionnaire in children with atopic dermatitis.Al Robaee AA. Department of Dermatology, College of Medicine, Qassim University, Buraidah, Saudi Arabia. arobaee@gmail.com. The aim of this study was to develop an Arabic version of the original English version of Dermatitis Family Impact (DFI) questionnaire and to evaluate its reliability and validity among Saudi families having children with atopic dermatitis (AD). Participants were 379 families of affected pediatric patients with AD diagnosed by consultant dermatologists in addition to a control group of  124 parents, who denied the presence of any dermatologic disorders in their children. To develop an Arabic version of the DFI, rigorous international guidelines for translation-back-translation were followed. In addition, reliability and validity were evaluated by calculating Cronbach's alpha and correlation coefficients. Construct validity was assessed by comparing individual items and total scores among various case severity groups and controls. Cronbach's alpha (=0.90) was acceptable. The inter-item, item-total score and item-severity correlations ranged from moderate to high and were statistically  significant (∼0.60, P-values <0.001). The distribution of item responses evaluated by the ceiling and floor effects showed appropriate proportions and a good discrimination between cases and controls and between severity groups. The DFI scale scores (Mean ± SD) were 3.0 ± 1.50 for control, 9.6 ± 2.88 for mild, 14.67 ± 2.27 for moderate and 18.14 ± 2.0 for severe cases (P < 0.001). The results of this study showed that our translated Arabic version of the DFI is an  efficient tool in terms of its reliability and validity for the measurement of

the disease impact in families with AD.

CLINICAL PRESENTATION/CASE REPORT: 3. Int J Dermatol. 2010 Sep;49(9):1059-62. doi: 10.1111/j.1365-4632.2009.04341.x. Unusual combination of pigmentary lesions. Ben Saif GA, AlShehab SA, Almutawa A. Department of Dermatology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. gbinsaif@ksu.edu.sa

THERAPEUTIC/QUASI EXPERIMENTAL: 4. J Drugs Dermatol. 2010 Sep;9(9):1092-4. Failure of botulinum toxin treatment for localized vitiligo. BinSaif GA, Al Samary A, Al Mohizea S. Department of Dermatology, College of Medicine, King Saud University-Riyadh, Kingdom of Saudi Arabia. gbinsaif@ksu.edu.sa. BACKGROUND: It was found that acetylcholine concentration increased with a significantly reduced expression of acetylcholinesterase in vitiliginous patches that return to normal upon repigmentation. OBJECTIVE: To evaluate the efficacy and safety of botulinum toxin A in patients with localized vitiligo. METHODS: Ten patients were recruited. Eight patients had two or more focal vitiliginous patches. Two had segmental vitiligo. For each patient with focal vitiligo, one or two vitiliginous patches were treated. For each patient with segmental vitiligo, half of the lesion was treated. The untreated parts were used as a control. Botulinum toxin was injected. The response was analyzed at the initial visit, and then two weeks, two months and six months after therapy. RESULTS: Thirteen vitiliginous patches were treated. Reassessment showed no evidence of repigmentation. Comparing treated versus untreated sides, no differences were found. No adverse effects were reported. CONCLUSION: Botulinum toxin is not effective in the treatment of localized vitiligo.

ETIOLOGY/CASE REPORT: East Mediterr Health J. 2010 Apr;16(4):451-4. Penile juvenile xanthogranuloma and neurofibromatosis type-1: risk association with juvenile myelomonocytic leukaemia? AlGhamdi KM, Al Suwaidan SN. Department of Dermatology, King Khalid University Hospital, College of Medicine,

King Saud University, Riyadh, Saudi Arabia. kmgderm@yahoo.com

THERAPY/FOLLOW UP:  J Drugs Dermatol. 2010 Aug;9(8):989-91. The usefulness of narrowband UVB as a monotherapy for the treatment of chronic plaque psoriasis. Al Robaee AA. Department of Dermatology, College of Medicine, Qassim University, Buraidah, Saudi Arabia. arobaee@gmail.com. OBJECTIVE: To assess the efficacy and safety of narrowband ultraviolet B (UVB) phototherapy in dark-skinned Saudi patients with chronic plaque psoriasis. PATIENTS AND METHODS: This prospective study was performed on 63 patients of chronic plaque psoriasis attending Qassim University clinics from May 2004 through June 2009. Narrowband UVB irradiation was done three times per week using the 311 +/- 2 nm wavelength. RESULTS: Approximately 79 percent of patients achieved disease clearance (i.e., 90% or more reduction in PASI scores). The response to treatment was significantly better in females compared to males. No serious side effects were observed. CONCLUSION: The narrowband UVB phototherapy was found to be safe and effective in darker-skinned Saudi patients with chronic plaque psoriasis, especially among females. A longer period of treatment (minimum of six months) is recommended for complete clearance of psoriasis.

CLINICAL PRESENTATION/CROSS SECTION:  Indian J Dermatol Venereol Leprol. 2010 Jul-Aug;76(4):378-81. Pigmentary demarcation lines on the face in Saudi women. Al-Samary A, Al Mohizea S, Bin-Saif G, Al-Balbeesi A. Department of Dermatology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. BACKGROUND: Pigmentary demarcation lines (PDL) are physiological abrupt transition lines between hyperpigmented skin and lighter areas. Recent evidence suggests that they involve the face. AIMS: To survey facial PDL in Saudi females  referred to general dermatology clinics for various complaints and determine any associated risks. METHODS: Screening for facial lines was done in general dermatology clinics over a year. Whenever a patient was found to have facial PDL, a detailed questionnaire and examination were undertaken. RESULTS: Out of 1033 patients screened, 144 patients (14%) were found to have at least one of the facial PDLs. The median age of onset was 16 years. The most common line was F with 76 patients (53%). Family history was positive in 51 patients (35%). CONCLUSION: Facial PDL is a common and chronic pigmentary problem in Saudi women. It should be recognized and differentiated from other similar diseases like melasma. A significant proportion of patients have a milder presentation.

ETIOLOGY / FOLLOW UP: Int J Dermatol. 2010 Jul;49(7):829-33. Interferon-induced vitiligo in hepatitis C patients: a case series. Hamadah I, Binamer Y, Sanai FM, Abdo AA, Alajlan A. Dermatology Unit, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. ihamadah@kfshrc.edu.sa. BACKGROUND: Vitiligo is an autoimmune disease characterized by depigmented patches and macules. It is associated with many autoimmune diseases, the most common of which is thyroid disease. The association between Interferon (IFN) therapy and vitiligo is rarely reported in the literature, despite its common usage in hepatitis B viral infection, hepatitis C viral infection (HCV), hematological malignancies and melanoma. CASE: We are reporting eight cases of vitiligo that appeared after treating HCV with IFN. CONCLUSION: Interferon unmasks vitiligo in susceptible individuals.

ETIOLOGY / CASE REPORT: 12. J Cutan Med Surg. 2010 May-Jun;14(3):141-3. Permanent alopecia following cranial irradiation in a child. Al-Mohanna H, Al-Khenaizan S. Division of Dermatology, Department of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia. BACKGROUND: Cranial irradiation is commonly used in childhood leukemia, with many potential cutaneous adverse effects. Radiation-induced permanent alopecia owing to scalp fibrosis is a rare but disturbing side effect. OBJECTIVE AND CONCLUSION: Here we report a Saudi boy with acute T-cell lymphoblastic leukemia who developed radiation-induced cicatricial alopecia. Topical treatment using minoxidil solution was tried but was ineffective.

ETIOLOGY /?: 13. Int J Dermatol. 2010 Jan;49(1):67-9. Rippled hyperpigmentation in Wilson's disease. Al Mohizea S. Department of Dermatology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. rodomani@yahoo.com.

CLINICAL PRESENTATION / CASE REPORT: Int J Dermatol. 2010 Jan;49(1):53-5. Fish tank granuloma: misdiagnosed as cutaneous leishmaniasis. AlKhodair R, Al-Khenaizan S. Division of Dermatology, Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Mycobacterium marinum is an atypical mycobacterium that causes a skin infection known as fish tank granuloma or swimming pool granuloma affecting people who are exposed to aquatic environments. In general, it is managed medically with antimicrobials and variable treatment protocols. Here, we report a Saudi gentleman who acquired this infection in Thailand and was misdiagnosed as cutaneous leishmaniasis. After establishing the correct diagnosis, treatment with minocycline and trimethoprim-sulfamethoxazole resulted in rapid healing.

ETIOLOGY / REVIEW: Dermatol Ther. 2010 Mar;23(2):137-43. Psoriasis and the metabolic syndrome. Alsufyani MA, Golant AK, Lebwohl M. Department of Dermatology, Riyadh Military Hospital, Riyadh, Saudi Arabia. Psoriasis is an inflammatory, immune-mediated cutaneous disorder that has recently been recognized as systemic disease that is associated with multiple comorbidities such as depression, obesity, and the metabolic syndrome. The metabolic syndrome is the constellation of abdominal obesity, dyslipidemia, hypertension and insulin resistance, and presence of the metabolic syndrome significantly increases a patient's risk for cardiovascular disease, stroke and type 2 diabetes. Recent studies have found that psoriasis patients are at increased risk for metabolic syndrome as well as the individual components of metabolic syndrome, and the two diseases appear linked through a common mechanism of inflammation. Speculation exists as to whether this association is causative or whether it is the result of other habits seen in psoriasis patients, such as increased rates of smoking, alcohol consumption, and sedentary lifestyle, which add to the complexity of the association between psoriasis and the metabolic syndrome. However, psoriasis treatments have been shown to reduce the risk of developing metabolic syndrome components and comorbidities. Future studies are needed to better understand the nature of this relationship and the implications this could have for management and treatment of patients with psoriasis.

ETIOLOGY / CASE REPORT: Pediatr Dermatol. 2010 Apr 9. [Epub ahead of print],. A Case of Pityriasis Rosea Concurrent with the Novel Influenza A (H1N1) Infection. Mubki TF, Bin Dayel SA, Kadry R. Dermatology Department, Prince Salman Hospital, Riyadh, Saudi Arabia. Pityriasis rosea is a common skin disease with a self-limiting course. Multiple etiologies including viruses, bacteria, and fungi have been investigated in an attempt to confirm a casual association. Pityriasis rosea has not been associated with influenza virus, but has been associated with herpes simplex virus types 6 and 7. We encountered a case of a proven pandemic H1N1 infection associated with a clincopathological diagnosis of pityriasis rosea. We conclude that influenza A (H1N1) virus could either be a primary cause of pityriasis rosea or a trigger for reactivation of other viral causes.

KAP/CROSS SECTION: J Eur Acad Dermatol Venereol. 2010 Mar 5. [Epub ahead of print]. The use of topical bleaching agents among women: a cross-sectional study of knowledge, attitude and practices. Alghamdi KM. Dermatology Department, Vitiligo Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia. Abstract Background Although the practice of bleaching is common worldwide, there are few studies that discuss knowledge, attitudes and practices towards bleaching. Objective The aim of this study was to explore the knowledge, attitudes and practices towards the usage of topical bleaching agents among women. Methods A self-administered questionnaire on the use of bleaching creams was distributed randomly to women attending the outpatient clinics at a university hospital in Saudi Arabia during 2008. Results Five hundred and nine of 620 women responded (82% response rate). All the participants had dark skin (skin type 4-5). The mean age was 29.22 +/- 9 years. Of the participants, 38.9% (197/506) were current users of bleaching agents. Only 26.7% (106/397) of the respondents used bleaching agents for medical purposes to treat localized abnormal skin hyper-pigmentation; 20.8% (101/485) were ready to use any bleaching cream that gives fast results, even if the components were unknown. Of the respondents, 30% (152/509) used more than 100 g of bleaching creams monthly. These products were applied to the whole body in 7.3% of the cases. While 10.3% (28/271) continued applying the bleaching products during pregnancy, 20.8% (54/260) did so during lactation. No associations could be found between the various sociodemographic variables and differences in the attitude towards and practice of using bleaching creams. Conclusion A major proportion of our sample respondents have overused and/or misused bleaching agents. This was regardless of age, income, education or marital status. There is a need to educate women about

the possible risks.

CLINICAL PRESENTATION/CASE REPORT: Pediatr Dermatol. 2010 Jan 1;27(1):89-91. Acquired cutis laxa type II (Marshall syndrome) in an 18-month-old child: a case report. Haider M, Alfadley A, Kadry R, Almutawa A. Dermatology Unit, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. haiderssm@yahoo.com. Cutis laxa is a rare disorder resulting from degradation and clumping of elastic fibers in dermis. Type II acquired cutis laxa, shows only cutaneous changes without any systemic involvement. We describe an infant with acquired cutis laxa type II following a generalized inflammatory dermatitis.

QOL/CROSS SECTION: Acta Dermatovenerol Alp Panonica Adriat. 2009 Dec;18(4):157-64. Assessment of general health and quality of life in patients with acne using a validated generic questionnaire. Al Robaee AA. Department of Dermatology, College of Medicine, Qassim University, P.O. Box 6655, Buraidah 51452, Saudi Arabia. arobaee@gmail.com. OBJECTIVES: The study was designed to utilize the SF-36, a validated generic questionnaire, to assess acne patients' view of their general health and quality of life. METHODS: The subjects were 454 acne patients (237 males, 217 females) visiting an outpatient clinic at Qassim University. An Arabic translation of the SF-36 questionnaire, culturally adapted and validated, was used to assess eight life-quality dimensions. Data regarding demographics, disease grade, duration, and treatment were also included in the questionnaire. The internal consistency reliability of the multi-item scales was assessed using Cronbach's coefficient alpha. Descriptive statistics were conducted with independent and paired-sample t-tests as well as one-way ANOVA for metric variables; and Xi(2) and Fisher's exact tests were used for categorical variables. Spearman's rank correlation was used for associations. All tests were two-sided, and the level of significance was set at phi < 0.05. RESULTS: The scores for physical functioning, role physical, role emotional, and vitality dimensions were below 60%. About 81.5% of  respondents rated their health as either "fair" or "poor", and only 25% said their general health was better than the previous year. Females were more likely to report better general health than males (phi = 0.001). Education level negatively correlated with mental health, role emotional, social functioning, general health, and bodily pain. Rural patients showed better general health (phi = 0.003). Married persons rated their general health better than single patients (phi = 0.002). Mild and shorter-duration acne was associated with a better general health score compared to the previous year (phi = 0.01 and 0.001, respectively). Patients that had received treatment were significantly better regarding role physical, vitality, and mental health dimensions, whereas topical treatment was significantly better in the vitality dimension than oral therapy. The patients treated also rated their general health better than the previous year (phi = 0.0001). CONCLUSIONS: The presence of acne vulgaris per se is the most significant factor underlying patients' low perception of their general health. Patients' education about the disease and social support play a considerable role in better disease perception and can improve patients' quality of life.

CPE: Dermatol Nurs. 2009 Sep-Oct;21(5):295-6. How many ABCDs should we know in dermatology? Al Aboud KM. Department of Dermatology, King Faisal Hospital, Makkah, Saudi Arabia.

CPE/CROSS SECTION. BMC Dermatol. 2009 Oct 16;9:10. Professional use of the internet among Saudi Arabian dermatologists: across-sectional survey. Alghamdi KM. Dermatology Department, Vitiligo Research hair College of Medicine, King Saud University, PO Box 240997, Riyadh 11322, Saudi Arabia. kmgderm@yahoo.com. BACKGROUND: The internet is an increasingly important tool for physicians, but the extent to which it is used by dermatologists is unknown. We aimed to investigate the utilization of the internet by dermatologists in Saudi Arabia for medical purposes during their daily practice and to clarify the reasons for its use and non-use. METHODS: A self-administered questionnaire was distributed to all 160 dermatologists attending the National Dermatology conference in 2007. RESULTS: A total of 107 questionnaires were completed. Sixty-two percent of respondents had access to the internet in the workplace. The use of the internet to update medical knowledge was reported by 91%.Only 27% had internet access in consultation rooms. The majority of information retrieval occurred outside patient consultation hours (91%).Only 13% reported using the internet during patient consultation. Possible reasons included: lack of access (54%), time pressure (37%), possible interference with the physician-patient relationship (30%), and that use of the internet was too time-consuming (10%). The mean searching time used to solve a clinical problem was 34 +/- 3 minutes. Fifty-eight percent used Pubmed; however, 77% of the dermatologists had no training at all in how to use this tool. CONCLUSION: Professional medical use of the internet is widespread among dermatologists in Saudi Arabia. Providing access to the internet in the workplace and training of dermatologists to perform effective electronic searches are badly needed to improve the professional medical use of internet, which is expected to lead to better delivery of patient care.

ETIOLOGY/CROSS SECTION: Acta Dermatovenerol Alp Panonica Adriat. 2009 Sep;18(3):119-25.Genetic epidemiology and heritability of vitiligo in the Qassim region of Saudi Arabia. Alzolibani A. Department of Dermatology, College of Medicine, Qassim University, Saudi Arabia, PO Box 30109, Buraidah 51477, Qassim, Saudi Arabia. azolibani@yahoo.com. AIM: Assessment of consanguinity and inheritance patterns in relation to clinical subtypes of vitiligo among Saudi cases in the Qassim region based on a vitiligo case series during 2008 taken from the Qassim University-affiliated referral center. METHODS: This study included 111 randomly selected Saudi probands affected by vitiligo and their families. They included 61 males and 50 females. Their mean age of onset was 19.13 +/- 11.97 years. Data were collected using a questionnaire administered by professional dermatologists emphasizing the clinical features as well as consanguinity and segregation pattern. Genetic analyses for inbreeding coefficient, mode of inheritance, and heritability were statistically analyzed. RESULTS: Out of 111 probands, the frequencies of focal, vulgaris, universal, and acrofacial subtypes were 32.4%, 31.5%, 9.9%, and 26.1%,  respectively. Parental consanguinity was positive in 32.4% of cases and first-cousin consanguinity in 22.5% with an inbreeding coefficient of 0.015. The family history was positive in 56.8% of cases. The mean age of onset was 19.13 +/- 11.97 years with a median of 17 years. The median age of onset was lower for consanguineous cases and cases with a positive family history. Inheritance patterns coincided more with the multifactorial model, especially for the vulgaris subtype followed by the acrofacial subtype, and coincided least with the focal subtype. Heritability or the genetic contribution to the disease showed a high weighted mean of 0.54. CONCLUSION: Genetic factors contribute to the evolution of vitiligo among Saudi families. Discouraging consanguineous marriage is a potential prevention measure. Genetic factors contribute to the evolution of vitiligo among tribal areas of the Saudi community probably through the high consanguinity rate. In that respect, family counseling can be attempted that would discourage consanguinity and combat probable interactive environmental and health factors.

CLINICAL PRESENTATION/CASE REPORT J Cutan Med Surg. 2009 Sep-Oct;13(5):276-9. A wolf in sheep's disguise: rhabdomyosarcoma misdiagnosed as infantile hemangioma. Al-Mubarak L, Al-Khenaizan S. College of Medicine, Division of Dermatology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. BACKGROUND: Rhabdomyosarcomas are a heterogeneous group of malignant tumors representing the most common soft tissue sarcoma of childhood. A delay in diagnosis is not uncommon. OBJECTIVE: To report a boy with paranasal rhabdomyosarcoma who was misdiagnosed and treated for infantile hemangioma. METHODS AND RESULTS: A 2-year-old Saudi boy who presented with a progressively increasing nasal mass for 18 months was misdiagnosed and treated for infantile hemangioma at an outside hospital. Histopathologic examination revealed paranasal rhabdomyosarcoma. CONCLUSION: We review some clinical clues that can alert the physician to malignant childhood tumors. We also review management options for childhood rhabdomyosarcoma.

CLINICAL PRESENTATION/CASE REPORT: Breast J. 2010 Jan;16(1):88-9. Epub 2009 Sep 17. Male breast carcinoma with zosteriform metastasis. Al Zouman A, Al Harthi F. Department of Dermatology, Riyadh Military Hospital, Riyadh, Saudi Arabia.

CONCEPT: Curr Vasc Pharmacol. 2010 May 1;8(3):432-6. Personalized medicine in psoriasis: concept and applications. Al-Hoqail IA. Department of Dermatology, Faculty of Medicine, King Saud University & King Fahad Medical City, P.O. Box 7805, Riyadh 11472, Kingdom of Saudi Arabia. ialhoqail@ksu.edu.sa. Personalized medicine is a new treatment modality where patients are the center of interest. Thus, one drug does not fit all; rather we look for a drug which fits the individual patients' disease. Treatment is moving towards molecular medicine driven by the growing knowledge and understanding of pharmacogenetics. Psoriasis is a common dermatological disease characterized by genetic polymorphism. The association of biomarkers and psoriasis is helpful to evaluate susceptibility to the disease, its severity and its progression. Additionally, the response to treatment will be anticipated. The growing expenses of health care systems worldwide are primarily due to increasing costs of chronic disease management. Hence, activation of preventive medicine will minimize treatment costs. A revolution in treatment modalities is expected to start at the level of  pharmaceutical companies, as personalization of medicine will decrease the cost of clinical trials by minimizing the number of subjects required. In turn, this will decrease the cost of developing new medications. My vision for the future is that personalized medicine will mandate special physicians capable of understanding molecular medicine and using genetics and biomarkers for diagnosis, evaluation of the effect of drugs and overall prognosis. This new therapeutic modality will need special training.

CLINICAL PRESENTATION/CFROSS SECTION: J Drugs Dermatol. 2009 Aug;8(8):745-8. Clinicopathologic profile of Becker's melanosis with atypical features. AlGhamdi KM, AlKhalifah AI, AlSheikh AM, AlSaif FM. Dermatology Department, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. kmgderm@yahoo.com. Becker's melanosis (BM) is an uncommon cutaneous hamartoma. The classical descriptionof the lesion is of a macular, pigmented patch found on the upper trunk, with onset at or around adolescence. The aim of this study is to describe the clinicopathologic features of cases of BM which do not fit this typical description. Biopsy registry and laser clinic records from 2000-2006 at the authors' institution were searched for cases with a diagnosis or differential diagnosis of BM. A chart review was then undertaken to record clinical data and histological features of each case. Eleven cases which fit criteria for inclusion in the study were identified. The authors found that these eleven cases could all be described as BM with atypical features but were still clearly within the spectrum of this condition. Contrary to widely held belief, cases of Becker's melanosis with atypical features are not uncommon and might be under-reported.

CLINICAL PRESENTATION /CASE REPORT. Mymensingh Med J. 2009 Jul;18(2):260-3. Cutaneous leishmaniasis. Ahmed Z, Chowdhury SA, Bhuiyan SI. Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, Bangladesh. drsaifulib@yahoo.com. Leishmaniasis is an increasingly prevalent, major world health problem caused by infection with a protozoan which is transmitted by sand fly bites. It is endemic in 88 countries on 4 countries. More than 90% of visceral leishmaniasis cases occur in Bangladesh, Brazil, India and Sudan. Although Bangladesh is one of four countries those bearing the most burden of visceral leishmaniasis, cutaneous leishmaniasis is rare in Bangladesh. Cases of cutaneous leishmaniasis (CL) are usually imported to Bangladesh from other endemic countries. A patient from an endemic area of cutaneous leishmaniasis, a non-healing nodulo-ulcerative lesion with "volcanic crater" on exposed part of the body, constant dermal infiltration with lymphocytes, histiocytes and plasma cells and demonstration of intracellular parasites in lesional skin establish the diagnosis of cutaneous leishmaniasis. We here represent a case of cutaneous leishmaniasis in an overseas worker, returned from Saudi Arabia. He presented with multiple asymptomatic nodulo-ulcerative lesions on exposed part of the body. The patient's clinical history, morphology of lesions, laboratory analysis and histopathological examination of lesional skin were consistent with cutaneous leishmaniasis, a rare disease for Bangladesh. Cutaneous leishmaniasis may arise as a health problem among people returned from the Middle-East. Our findings of high titre (>1:64000) direct agglutination test (DAT) in cutaneous leishmaniasis may be an additional point of further study.

CLINICAL PRESENTATION/CASE REPORT. Int J Dermatol. 2009 Jun;48(6):617-22. Acute hemorrhagic edema of infancy: unusual scarring and review of the English language literature. AlSufyani MA. Department of Dermatology, Armed Forces Hospital, Al Kharj, Middle Province, Saudi Arabia. dr.alsufyani@gmail.com. BACKGROUND: Acute hemorrhagic edema of infancy (AHEI) is a benign and self-limiting disease that usually resolves completely without sequelae and without the need for active therapy. Most consider AHEI to be a separate entity from Henoch-Schonlein purpura (HSP), but others believe that they are different clinical presentations of the same disease. METHODS: We report a patient with AHEI who resolved with unusual scarring. We also present a review and update of AHEI synonyms, epidemiology, pathogenesis, clinical features, laboratory findings, histopathology, diagnosis and differentials, management, and prognosis. RESULTS: A comprehensive Medline search using the Pubmed search engine in the English-language literature, for relative articles addressing AHEI disease. Thirty-three articles were cited, in addition to our case report. CONCLUSION: Controversy still exists with regard to the separation of AHEI and HSP as distinct entities, as well as with regard to a conservative or active approach for AHEI treatment, and its effect on the course of the disease.

CLINICAL PRESENTATION. Saudi Med J. 2009 Jun;30(6):844-6. An unusual association of recurrent pyogenic granuloma on nevus flammeus in a patient with Von Recklinghausen's disease. Alotaibi HM. Department of Dermatology, College of Medicine, King Saud University, PO Box 62690, Riyadh 11595, Kingdom of Saudi Arabia. dr_halotaibi@yahoo.com. Pyogenic granuloma is a common benign vascular lesion of the skin and mucosa. There are a few reports on the rare association between it and port wine stain, but there is no clear description of an association with neurofibromatosis type 1 in the literature. This report presents a 29-year-old Saudi male with Von Recklinghausen's disease with recurrent pyogenic granuloma on the nevus flammeus over his neck. He was treated with shave excision and electrocautery with clearance and no recurrence of pyogenic granuloma for the last 5 years follow-up.

THERAPEUTIC/CROSS SECTION. J Eur Acad Dermatol Venereol. 2009 Nov;23(11):1282-8. Epub 2009 Jun 1. A survey of vitiligo management among dermatologists in Saudi Arabia. AlGhamdi KM. Dermatology Department, Vitiligo Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia. kmgderm@yahoo.com. BACKGROUND: There are concerns that there is no uniform approach towards the management of vitiligo. Objectives To explore attitudes and strategies for the management of vitiligo among dermatologists. METHODS: A self-administered questionnaire containing 22 questions was distributed to 160 dermatologists attending a national dermatology conference in 2007. RESULTS: One hundred and twelve dermatologists responded to the questionnaire (70% response rate). We had 105 completed questionnaires (seven were excluded due to incompleteness). Active treatment of vitiligo was recommended by 96% in more than half of patients, while 79% recommended treatment at non-visible sites. Repigmentation was regarded as main treatment goal by 54%. Mid-potent topical steroids were widely prescribed for focal vitiligo (72% in children and 65% in adults). Use of tacrolimus and pimecrolimus was limited. The most common used phototherapy was 'narrowband ultraviolet B' (NBUVB; 36% and 40% for generaliased vitiligo in children and adults, respectively). The use of oral psoralen plus UVA (PUVA) was limited (8% for generalized vitiligo in adults). Few respondents (1-8% for different types of vitiligo) prescribed outdoor topical PUVA. Vitiligo surgery was advised mainly for segmental type (18% in adults and 5% in children). Depigmentation was the first option for universal vitiligo by 50% and 30% in adults and children, respectively. CONCLUSIONS: Most dermatologists are enthusiastic about active treatment of vitiligo even in hidden sites. Overall, the most two common treatment modalities were topical steroids and NBUVB. Vitiligo surgery is underutilized. Development of national practice guidelines is needed.

CLINICAL PRESENTATION/CROSS SECTION. Saudi Med J. 2009 Apr;30(4):577-8. Clinical patterns of cutaneous tuberculosis at King Fahad Hospital of the University in Al-Khobar, Saudi Arabia over 13 years. Bukhari IA. Dermatology Department, King Faisal University and King Fahad Hospital of University, PO Box 40189, Al-Khobar 31952, Kingdom of Saudi Arabia. consultant@dermatologyclinics.net. Comment in: Saudi Med J. 2009 Oct;30(10):1363-4; author reply 1363-4.

CLINICAL PRESENTATION/CASE REPORT: 35. Eur J Pediatr. 2010 Jan;169(1):117-9. Epub 2009 Apr 8. Cutaneous presentation of kwashiorkor due to infantile Crohn's disease. Al-Mubarak L, Al-Khenaizan S, Al Goufi T. Division of Dermatology, Department of Medicine, King Saud Bin Abdulaziz University, King Fahad National Guard Hospital, King Abdulaziz Medical City, P.O. Box 22490, Riyadh 11426, Kingdom of Saudi Arabia. Kwashiorkor is one of the severe forms of protein-energy malnutrition. Manycharacteristic dermatoses can be seen in children suffering from kwashiorkor, and some are pathognomonic. Here, we report an infant who presented with diarrhea and skin signs of kwashiorkor, and duodenal biopsy was consistent with Crohn's disease. The patient was treated with prednisolone administered orally in a tapering course plus azathioprine, in addition to nutritional supplementation. The general condition of the patient quickly improved and his skin lesions completely resolved within 2 weeks. Kwashiorkor is a serious potentially fatal disease that occurs less often in developed countries leading to low index of suspicion by physicians and pediatricians in those regions. Occasionally, dermatologists have the rare chance of alerting pediatricians to the diagnosis of kwashiorkor, thus making a difference in the care of this disease.

CLINICAL PRESENTATION/?. Dermatol Online J. 2009 Feb 15;15(2):10. New pigmented papule on forearm of adult. Bukhari IA, Al-Faraidy N. Dermatology Department, King Faisal University, College of Medicine, Dammam,

Saudi Arabia.

THERAPEUTIC/LABORATORY. Saudi Med J. 2009 Mar;30(3):443-5. Thymoquinone inhibits germination of dermatophyte arthrospores. Aljabre SH, Randhawa MA, Alakloby OM, Alzahrani AJ. Department of Dermatology, College of Medicine, King Faisal University, Dammam, and King Fahd Hospital of the University, Alkhobar, Kingdom of Saudi Arabia.

CPE/CROSS SECTION. East Mediterr Health J. 2008 Sep-Oct;14(5):1185-91. Current status of dermatology residency training in Saudi Arabia: trainees' perspectives. AlGhamdi KM. Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia. kmgderm@yahoo.com. A cross-sectional survey was conducted to look at different aspects of dermatology residency programmes in Saudi Arabia from the residents' perspective. Self-administered questionnaires about future plans, academic activities, examinations, training, workload, surgical procedures, residents' rights and satisfaction were distributed to all 27 residents in all training centres during March-May 2004; 22 (81%) responded. The survey found that 50% of residents were not satisfied with their training and felt they were inadequately trained. Experience of performing certain procedures was much less than for residents in asimilar study in the United States of America, and 50% of residents had not received any dermatologic surgery training. Moreover, 36% of residents had been verbally humiliated during their training.

CLINICAL PRESENTATION/REVIEW. Acta Dermatovenerol Alp Panonica Adriat. 2008 Sep;17(3):103-19. Update on hirsutism. Al Robaee A, Al-Zolibani A, Al Shobaili HA, Aslam M. Department of Dermatology, College of Medicine, Qassim University, P.O. Box 6655 Buraidah 51452, Saudi Arabia. arobaee@gmail.com. Hirsutism is an important medical problem affecting about 8% of women. Despite an extensive amount of published work, some aspects of hirsutism are still controversial or understudied. This paper reviews the current data that have been published in recent years on this subject.

CLINICAL PRESENTATION/CASE SERIES. Saudi Med J. 2008 Aug;29(8):1188-91. Lipoid proteinosis. A report of 2 siblings and a brief review of the literature. Al-Natour SH. Department of Dermatology, King Faisal University, College of Medicine, Dammam,Kingdom of Saudi Arabia. saharnatour@yahoo.com. Comment in: Saudi Med J. 2008 Dec;29(12):1835; author reply 1835. Lipoid proteinosis is a rare autosomal recessive inherited metabolic disorder characterized by deposition of a hyaline-like material in the skin, oral laryngeal mucosa, and in other sites. In this report, the author describes 2 Saudi siblings who had characteristic skin findings, oral and mucosal lesions, histological findings along with few rarely encountered manifestations including pathognomonic calcifications in the hippocampus, electroencephalogram findings and briefly reviews the literature. These cases are presented to emphasize the occurrence of this condition in Saudi Arabia, and to update information on the latest developments of this disorder.

CLINICAL PRESENTATION/REVIEW. Eur J Pediatr. 2008 Nov;167(11):1221-30. Epub 2008 Jul 26. Cutaneous mimickers of child abuse: a primer for pediatricians. AlJasser M, Al-Khenaizan S. Department of Medicine, Division of Dermatology, King Saud Bin Abdulaziz University for Health Sciences and King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. The annual incidence of child abuse was estimated to be 2.8 million by the national incidence study conducted in the USA in 1993, which is a two-fold increase compared to 1986. Awareness of child abuse has been increasing since the 1960s. Although most victims of child abuse present with cutaneous lesions, many genuine skin diseases may appear as non-accidental injuries which, if not recognized, may lead to misdiagnosis of child abuse. Here, we review the most common cutaneous mimickers of child abuse in order to increase awareness of these disorders and reduce erroneous diagnosis of child abuse.

ETIOLOGY/?. Ann Saudi Med. 2008 Jul-Aug;28(4):300-2. Topical steroid-induced Cushing syndrome. Al-Khenaizan S, Al Alwan I. Division of Dermatology, Department of Medicine, King Saud Bin Abdulaziz University For Health Sciences, King Fahad National Guard Hospital, Riyadh, Saudi Arabia. khenaizans@ngha.med.sa

CLINICAL PRESENTATION/CROSS SECTIONAL. Indian J Dermatol Venereol Leprol. 2008 May-Jun;74(3):298. Acne neonatorum in the eastern Saudi Arabia. Alakloby OM, Bukhari IA, Awary BH, Al-Wunais KM. Department of Dermatology, College of Medicine, King Faisal University, Dammam, Saudi Arabia. BACKGROUND: Acne neonatorum (AN) is characterized by a facial eruption of inflammatory and noninflammatory acne lesions in a neonate. Hyperactivity of sebaceous glands, stimulated by neonatal androgens, is implicated in itspathogenesis. AIM: To elucidate the clinical profile of AN in eastern Saudi Arabia. METHODS: All patients diagnosed with AN in King Fahd Hospital of theUniversity in Khobar, Saudi Arabia, during the year 2005 were evaluated clinically.RESULTS: AN was diagnosed in 26 patients (male/female ratio 1:1). The lesions included mainly facial comedones (30.8%); papules and pustules (15.3% each); and combination of papules, pustules, and cysts (53.4%). CONCLUSION: All patients recovered spontaneously. In 50% of the cases, one of the parents reported having had acne vulgaris during adolescence. Hereditary factors seem to play a significant role in our series.

CLINICAL PRESENTATION / CASE REPORT. Eur J Pediatr. 2009 Mar;168(3):363-5. Epub 2008 Jun 18. Infantile systemic hyalinosis presenting as intractable infantile diarrhea. Al-Mubarak L, Al-Makadma A, Al-Khenaizan S. Division of Dermatology, Department of Medicine, King Fahad National Guard Hospital, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. dr.almubarak@hotmail.com. Infantile systemic hyalinosis is an autosomal recessive disease characterized by severe progressive flexion contractures, multiple recurring subcutaneous tumours, and gingival hypertrophy. It is caused by mutations in the gene encoding capillary morphogenesis protein-2 (CMG2). Here we report a Saudi infant with infantile systemic hyalinosis who presented with intractable diarrhea, and we review the literature emphasizing recent developments in the molecular genetics of this disease.

CLINICAL PRESENTATION / CROSS SECTIONAL. J Drugs Dermatol. 2008 May;7(5):457-62. Herpes zoster in eastern Saudi Arabia: clinical presentation and management. Alakloby OM, AlJabre SH, Randhawa MA, Alzahrani AJ, AlWunais KM, Bukhari IA. Department of Dermatology, College of Medicine, King Faisal University, Dammam, Saudi Arabia. oakloby1@yahoo.com. BACKGROUND: Herpes zoster (HZ), caused by varicella zoster virus (VZV), initially produces chicken-pox, then the virus lies dormant in the dorsal root ganglia. The virus can reactivate after many years and results in HZ along ganglion'sdistribution. Old age, trauma, stress, diabetes mellitus, and immune suppression are important risk factors for the reactivation. Herpes zoster is characterized by unilateral radicular pain and vesicular eruption that is generally limited to the dermatome innervated by the affected ganglion. In immunocompromised individuals, disseminated zoster may develop. The aims of therapy in HZ are to control pain or reduce its severity by the use of analgesics, reduce the duration and eruption of new lesions, and prevent complications, particularly postherpetic neuralgia (PHN) by appropriate antiviral therapy. METHODS: All cases of HZ seen in the dermatology clinic at King Fahd Hospital of the University (KFHU) from 1988 to 2006 were included in the study. Their diagnoses were based on the clinical presentation. The following parameters were collected and analyzed: age, sex, nationality, symptoms, dermatomal distribution, complications, coexisting diseases, and disease management. RESULTS: Of 22 749 new cases seen in the dermatology clinic over 18 years, 141 were HZ, with an occurrence of 0.62%. Male to female ratio was 2:1 and the age ranged from 14 months to 80 years. The thoracic dermatomes were the most commonly involved. The most frequent coexisting disease was diabetes mellitus, and the most common complication of HZ was PHN. Most patients with HZ ophthalmicus developed eye complications. CONCLUSION: The occurrence of HZ is 0.62% in patients reporting to the dermatology clinic of the hospital. Males are little more affected than females. The thoracic dermatomes are the most frequently involved. Diabetes mellitus is the most frequent coexisting disease. Postherpetic neuralgia is the most common complication of HZ.

THERAPEUTIC / CASE REPORT. Int J Dermatol. 2008 Jun;47(6):626-8. Ulcerative lichen planus of the sole: excellent response to topical tacrolimus. Al-Khenaizan S, Al Mubarak L. Division of Dermatology, Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia. khenaizans@ngha.med.sa. Ulcerative lichen planus of the sole is a rare variant of lichen planus, characterized by chronic painful disabling ulceration of the soles. Despite many treatment modalities used to treat ulcerative lichen planus, it is still considered a resistant disease. We report a Saudi female patient with ulcerative lichen planus of the soles resistant to many systemic and topical agents. We used topical tacrolimus 0.1% ointment with excellent response and complete healing in a few weeks as well as good maintenance during a follow-up period of more than 2 years.

THERAPEUTIC Dermatol Surg. 2008 Jun;34(6):803-5. Epub 2008 Mar 24.The gliding stitch. Alghamdi KM. Dermatology Department, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. kmgderm@yahoo.com

CLINICAL PRESENTATION/CASE REPORT. Nihon Hansenbyo Gakkai Zasshi. 2008 Feb;77(1):11-3. Midfacial leprosy. Al Aboud D, Al Aboud KM, Ramesh V, Jain N. Dermatology Department, King Khalid Military City Hospital, Hafer Al Baten, Saudi Arabia. Leprosy is a chronic bacterial disease that has many clinical presentations. We are reporting a patient who presented with an erythematous plaque over the nose, which was proved to be due to leprosy. We think that this type of clinical feature is not a common presentation for leprosy.

CLINICAL PRESENTATION/CROSS SECTIONAL. Int J Dermatol. 2008 Mar;47(3):229-35. Characteristics of superficial fungal infections in the Riyadh region of Saudi Arabia. Abanmi A, Bakheshwain S, El Khizzi N, Zouman AR, Hantirah S, Al Harthi F, AlJamal M, Rizvi SS, Ahmad M, Tariq M. Department of Dermatology, Research Center, Riyadh Military Hospital, Riyadh, Saudi Arabia. BACKGROUND: The prevalence and characteristics of superficial fungal infections (SFIs) vary with climatic conditions, lifestyle, and population migration patterns. This study was undertaken to determine the characteristics of SFIs amongst patients visiting the dermatology clinic of Riyadh Military Hospital, Riyadh, Saudi Arabia, during the period 2003-2005. METHODS: One hundred and nineteen patients with confirmed SFI (37 males and 82 females), aged between 5 months and 67 years, were included in this study. The diagnosis of SFI was based on clinical presentation confirmed by laboratory analysis. The type of mycotic pathogen and the site of infection were recorded as a function of age and sex. RESULTS: Onychomycosis (40.3%) was the most frequent infection, followed by tinea capitis (21.9%), tinea pedis (16%), tinea cruris (15.1%), and tinea corporis (6.7%). Tinea capitis was most prevalent (15.1%) in children (male to female ratio, 1 : 1.57), whereas tinea pedis was most common (11.8%) in adults (male to  female ratio, 1 : 2.5). Trichophyton mentagrophytes and Microsporum canis were the most common dermatophytes responsible for tinea infections, and T. mentagrophytes, Candida spp., and Aspergillus spp. were mainly responsible for onychomycosis. CONCLUSION: The prevalence of SFI was twofold greater in females than males. Children were most commonly affected by tinea capitis, whereas adults generally suffered from tinea pedis. The frequency of onychomycosis was nearly three times higher in adults. This study clearly shows that SFIs are of concern in both genders and in all age groups.

CLINICAL PRESENTATION/REVIEW. Clin Dermatol. 2008 Jan-Feb;26(1):52-61. Dermatologic challenges of pilgrimage. Mimesh SA, Al-Khenaizan S, Memish ZA. Aesthetic Dermatology and Laser Center, Royal Clinic, Riyadh, Saudi Arabia. Hajj is 1 of the 5 pillars of Islam. The Kingdom of Saudi Arabia has been privileged to host this event, which brings close to 2 million pilgrims from all over the world every year. During this holy ritual, the Muslims gather in Makkah before starting the journey. Recorded temperatures during the Hajj time is in the range between 37 degrees C and 45 degrees C. Overcrowding and the hot climate subject the pilgrims to environmental and health hazards. Dermatologic conditions, whether exacerbations of preexisting disease or the occurrence of new ones, account for 4.5% to 5.5% of all diseases seen during the 3-week periods of the Hajj. An overview of the mission of Hajj will be presented with an in-depth systematic review of dermatologic diseases seen at local hospitals in Makkah. Because the skin is the largest body organ and is the frontier defense for many environmental challenges, skin problems during the Hajj journey are not uncommon. The degree of heat and humidity may lead to exacerbation of preexisting cutaneous diseases or the occurrence of new ones. Overcrowding and poor hygiene also contribute to a myriad of infections: viral, bacterial, fungal, and/or parasitic. Skin diseases during Hajj can be divided into 2 broad categories, infectious and non-infectious. Unfortunately, despite the magnitude of Hajj and its existence for centuries, only a few reports and studies have been published about skin diseases. Preventative measures such as sunscreens, umbrellas, and protective footwear should be encouraged. The spread of cutaneous infections (fungal, viral, and bacterial) may be reduced with proper pretravel counseling and use of proper therapy.

CLINICAL PRESENTATION/CASE REPORT. Int J Dermatol. 2008 Feb;47(2):164. Acromegaly presenting as cutis verticis gyrata. Al-Bedaia M, Al-Khenaizan AS.Division of Dermatology, Department of Medicine, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia. A 17-year-old Saudi male patient presented with progressive asymptomatic skin changes on the scalp for 4 years. Upon examination, he was a well-built muscular male with coarse facial features with broadening of the nasal bridge and thick lips. Scalp examination revealed multiple gyriform oblong skin folds in the fronto-parietal region (Fig. 1). Extensive velvety dark brown plaques were seen on sides of the neck, axillae, and groin. Similar eruption was seen on the knuckles of both hands and around the eyes. Clinical diagnosis of cutis verticis gyrata of the scalp and acanthosis nigricans was made. Because of the extent and

the rapid progression of the above changes, acromegaly was suspected. Endocrinology referral confirmed this by the findings of high random growth hormone level at the value of 37.3 mIU/L (normal 0.2-13.0). Arrangement of magnetic resonance imaging (MRI) of the brain was made, but unfortunately the patient was lost to follow-up.

THERAPEUTIC. Dermatol Surg. 2008 Mar;34(3):378-9. Epub 2008 Jan 7. A better way to hold a Nokor needle during subcision. AlGhamdi KM. Dermatology Department, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. kmgderm@yahoo.com. Erratum in: Dermatol Surg. 2008 Apr;34(4):584. Al Ghamdi, Khalid M [corrected to AlGhamdi, Khalid M].

KAP/CROSS SECTION. Indian J Dermatol. 2008 Jan;53(1):12-4. Patients' attitude towards medical students rotating in the dermatology clinic. Bukhari I, AlAkloby O, Al Saeed W. Dermatology Department, Community Medicine Department, College of Medicine, King Faisal University, Dammam, Saudi Arabia. consultant@dermatologyclinics.net. OBJECTIVE: To study the attitudes of the patients towards medical students rotating in the dermatology clinic in the King Fahad Hospital of the University (KFHU). MATERIALS AND METHODS: One hundred and two adult outpatients attending the KFHU in Alkhobar, Saudi Arabia during the period March to June 2004 completed a questionnaire to evaluate their receptiveness towards medical students attending with the dermatologist. RESULTS: Almost 57% preferred physician and medical student participation in their care and 46% welcomed their presence during physical examination. The majority of patients (64.8%) felt comfortable disclosing personal information to the medical student and (68.7%) enjoyed the interaction with the medical students. Patients (63.7%) agreed that the students understood their healthcare needs. CONCLUSION: The majority of the patients in this study enjoyed their interactions with the students and felt comfortable disclosing information. Some patients want to spend time alone with the physician so permission for medical student participation should be requested.

ETIOLOGY/CASE CONTROL Dis Markers. 2008;24(1):51-7. Association of Interleukin-10 gene promoter polymorphisms in Saudi patients with vitiligo. Abanmi A, Al Harthi F, Zouman A, Kudwah A, Jamal MA, Arfin M, Tariq M. Department of Dermatology, Research Center, Armed Forces Hospital, Riyadh, Saudi Arabia. The promoter region of human Interleukin -10 gene is highly polymorphic and has been associated with numerous autoimmune diseases. Recent studies have linked vitiligo with defective autoimmune system. This study is aimed to explore a possible association between IL-10 gene polymorphism and vitiligo in Saudi population. This case control study consisted of 184 Saudi subjects including 83 vitiligo patients (40 males, 43 females mean age 27.85 +/- 12.43 years) and 101 matched controls. Genomic DNA was extracted from the blood samples of healthy controls and Vitiligo patients visiting out patient clinic of Department of Dermatology, Riyadh Armed Forces Hospital, using QIA ampR DNA mini kit (Qiagen CA, USA). Interleukin-10 gene was amplified by polymerase chain reaction (PCR) using Arms primers to detect any polymorphism involved at positions -592, -819 and -1082. The frequencies of GG genotype at -1082, and CC genotype at positions -592 and 819 were significantly higher in vitiligo patients compared to healthy subjects suggesting that GG and CC genotypes might be susceptible to vitiligo in Saudis. On the other hand genotypes -1082 GA, -819 CT, and -592 CA of IL-10 were more prevalent in healthy controls suggesting protective effects of GA, CT and CA genotypes against vitiligo. This study indicates that the IL-10 gene may play a significant role in the etiology of vitiligo among Saudis.

ETIOLOGY/CASE REPORT: Pediatr Diabetes. 2007 Dec;8(6):393-6. Lispro insulin-induced lipoatrophy: a new case. Al-Khenaizan S, Al Thubaiti M, Al Alwan I. Division of Dermatology, Department of Medicine, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. khenaizans@ngha.med.sa Lipoatrophy (LA) is a rare complication of insulin treatment in type 1 diabetes mellitus. The pathogenesis of insulin-induced LA is still unknown. Many theories suggest immunological reactions. We report a 4-yr-old Saudi girl with LA probably induced by lispro insulin. A review of the literature on the clinical features, pathophysiology, differential diagnosis, and treatment is briefly discussed.

THERAPEUTIC/CASE REPORT. Saudi Med J. 2007 Nov;28(11):1745-7. Multiple side effects of Efalizumab in a Saudi female with chronic persistent psoriasis followed by severe rebound after Efalizumab discontinuation. Bukhari IA. Department of Dermatology, College of Medicine, King Faisal University, Dammam, Kingdom of Saudi Arabia. consultant@dermatologyclinics.net. We are reporting a case of 23-year-old Saudi female with persistent chronic plaque psoriasis who was given subcutaneous Efalizumab 0.8 mg/kg/week for 14 weeks. During that period the patient developed multiple adverse reactions followed by severe rebound. The case is presented to highlight the importance of  managing patients on Efalizumab carefully and closely.

CLINICAL PRESENTATION/CASE SERIES. Saudi Med J. 2007 Nov;28(11):1741-4. Ecthyma gangrenosum in Saudi Arabia. Obasi OE, Osoba AO, Raddadi AA. Department of Dermatology, King Khalid National Guard Hospital, Jeddah, Kingdom of Saudi Arabia. oeobasi@hotmail.com. We report a diagnosis of ecthyma gangrenosum EG in 4 females of mean age 54.8 range 43-64 years, within 10 months. Severe drug reaction treated with high dose  systemic corticosteroids in patient one, acute myelocytic leukemia treated with high dose dexamethasone, and multiple broad-spectrum antibiotics in patient 2 preceded the onset of EG. Patients 3 and 4 had vasculitic purpura and hemodialysis. In addition, patient 3 was receiving multiple broad-spectrum antibiotics plus anti-tuberculosis TB drugs for gastric TB, while patient 4 was on melphalan and high dose systemic corticosteroids. Pseudomonas aeruginosa was isolated from blood culture of the first 3 patients, and skin culture of patient one. Blister aspirate from patient 4 yielded Candida albicans. Factors enhancing  skin invasion by pathogenic organisms in our patients were breached skin integrity, therapy with high dose corticosteroids and multiple broad-spectrum antibiotics, hematologic malignancies and chemotherapy with severe neutropenia.

THERAPY/CASE REPORT. Pediatr Dermatol. 2007 Sep-Oct;24(5):563-4. Childhood generalized pustular psoriasis: successful treatment with isotretinoin. Al-Shobaili H, Al-Khenaizan S. Division of Dermatology, Department of Medicine, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. hanisat@yahoo.com. Generalized pustular psoriasis is a rare form of psoriasis that is characterized by the eruption of sterile pustules. Because of the concern of the long term teratogenetic effect of acitretin in females of childbearing age, we treated a 16-year-old girl with pustular psoriasis with isotretinoin with excellent outcome.

CLINICAL PRESENTATIONS/REVIEW. Saudi J Gastroenterol. 2007 Oct-Dec;13(4):159-62. Cutaneous manifestations of inflammatory bowel disease. Al Roujayee A. Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia. abdulazizsr@gmail.com. Inflammatory bowel disease (IBD) has many extraintestinal manifestations, and skin lesions are one of the most frequently described extraintestinal findings. Reports indicate an incidence of cutaneous manifestations ranging from 2 to 34%, Cutaneous manifestations are usually related to the activity of the bowel disease but may have an independent course. In this review we aim to address the various cutaneous manifestations associated with IBD, their impact on the disease course, and the treatment options available.

CLINICAL PRESENTATION/CASE REPORT. Int J Dermatol. 2007 Sep;46(9):967-70. Fatal malignant melanoma in a child with neurofibromatosis type 1. Bin Amer Y, Al-Khenaizan S. Division of Dermatology, Department of Medicine, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. Neurofibromatosis type 1 is an autosomal dominant disease and is considered one of the most commonly inherited diseases in humans. Malignant melanoma has been reported in up to 5% of patients with neurofibromatosis type 1. We report a young Saudi boy with neurofibromatosis type 1 who developed fatal metastatic malignant melanoma arising from giant melanocytic nevi within speckled lentiginous nevus (SLN).

CLINICAL PRESENTATION/CASE REPORT. Saudi Med J. 2007 Sep;28(9):1441-2. Isolated nail lichen planus with primary sclerosing cholangitis in a child. Al-Ajroush N, Al-Khenaizan S. Division of Dermatology, Department of Medicine, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. Lichen planus LP is an uncommon, inflammatory dermatosis with characteristic lesions affecting the skin, the nails, and the mucous membranes. It is rare in childhood. Although nail abnormalities have been reported in 1 - 10% of patients with LP, the prevalence of nail involvement in affected children is unknown. Here we report a 2-year-old child with isolated nail LP, in association with primary sclerosing cholangitis.

QUALITY OF LIFE/CROSS SECTION. Saudi Med J. 2007 Sep;28(9):1414-7. Assessment of quality of life in Saudi patients with vitiligo in a medical school in Qassim province, Saudi Arabia. Al Robaee AA. Department of Dermatology, College of Medicine, Qassim University,

PO Box 6655 Buraidah 51452

, Kingdom of Saudi Arabia. arobaee@gmail.com. OBJECTIVE: To determine the quality of life in Saudi patients with vitiligo and to detect the variables that could influence it by using the Dermatology Life Quality Index (DLQI). METHODS: One hundred and nine Saudi vitiligo patients were recruited from Qassim Medical College clinics between November 2004 and September 2006. We included 61 males, 48 females with an age range of 18 to 47 years, and a mean of 26.94 (SD +/- 9.73) years. Quality of life was evaluated using DLQI questionnaire and related to variables as age, gender, marital status, and extent of cutaneous involvement. RESULTS: Family history of vitiligo in first degree relatives was positive in 27.5%. The mean DLQI for all cases was 14.72 (SD +/-5.173) that showed no statistical difference between males and females. Patients on light therapy and with generalized vitiligo had significantly higher DLQI scores than patients on topical treatments and localized cutaneous involvement. Women are more embarrassed and self-conscious on the disease with more impairment of their social life, personal relationships, sexual activities, and more influenced in their choice of clothing than men. CONCLUSION: Vitiligo is associated with severe impairment of quality of life among Saudi patients. Dermatologists should pay careful attention to the psychosocial impact of vitiligo in the patients' life. Involvement of psychologist and even psychiatrist should be an essential part in the management of these cases.

CLINICAL PRESENTATION/CASE REPORT. J Drugs Dermatol. 2007 May;6(5):540-3. Cystic sebaceous carcinoma: is it a constant pathognomic marker for Muir-Torre syndrome? Al-Shobaili HA, AlGhamdi KM, Al-Ghamdi WA. Dermatology Department, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. hanisat@yahoo.com. Sebaceous carcinoma (SC) is a rare and aggressive cutaneous neoplasm. It may arise in ocular or extraocular sites. Approximately 25% of all reported cases of SC are extraocular. Cystic presentation of sebaceous neoplasm is rare. So far, cystic sebaceous neoplasia (CSN) has been reported only in association with Muir-Torre syndrome (MTS). Furthermore, CSN has recently been characterized as a marker lesion of MTS. We report a case of CSN of the nose that was not associated with MTS. Mohs micrographic surgery was performed with no recurrence for 2 years. Patients with MTS need long-term follow-up to detect possible future presentation of MTS.

CLINICAL PRESENTATION/CASE REPORT. Indian J Dermatol Venereol Leprol. 2002 May-Jun;68(3):145-6. Unusual presentation of cutaneous leishmaniasis. Lahiry AK. Department of Dermatology, Bukayriyah General Hospital, Bukayriyah, Gassim, Saudi Arabia. Cutaneous leishmaniasis is endemic in some regions of Saudi Arabia. A case with uncommon hyperkeratotic type of lesion was seen. Being an endemic zone, a slit-skin smear was done and stained with Giemsa's stain. Smears showed Leishman Donovan bodies within and outside the macrophages. Significant improvement, followed by complete resolution of the lesion was seen with ketoconazole treatment.

CLINICAL PRESENTATION/?. Dermatol Surg. 2007 Apr;33(4):510-2. Verrucous carcinoma presenting as giant plantar horns. AlShahwan MA, AlGhamdi KM, AlSaif FM. Dermatology Department, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.

THERAPEUTIC. J Drugs Dermatol. 2007 Mar;6(3):343-4. Nokor needle marking: a simple method to maintain orientation during subcision. Al-Khenaizan S. Division of Dermatology, Department of Medicine Assistant Professor, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Fahad National Guard Hospital Riyadh, Kingdom of Saudi Arabia. khenaizans@ngha.med.sa.

THERAPEUTIC/. J Drugs Dermatol. 2006 Nov-Dec;5(10):1016. Elastic net instead of ink to mark botox injection sites for frontal. hyperhidrosis. Al-Khenaizan S. Division of Dermatology, Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. khenaizans@ngha.med.sa.

THERAPEUTIC/CASE SERIES. Int J Dermatol. 2007 Mar;46(3):290-4. Netherton syndrome: successful use of topical tacrolimus and pimecrolimus in four siblings. Saif GB, Al-Khenaizan S. Division of Dermatology, Department of Medicine, King Fahad National Guard Hospital, King Abdulaziz Medical City-Riyadh, Saudi Arabia. Netherton's syndrome (NS) is a rare autosomal recessive disease comprised of ichthyosis in the form of ichthyosis linearis circumflexa, hair shaft defects and atopic manifestations with an elevated IgE level. Various therapeutic options have been used in NS with variable success. Tacrolimus and pimecrolimus belong to the family of calcineurin inhibitors. They bind cytoplasmic proteins and the resulting complex binds calcineurin, inhibiting its ability to dephosphorylate the nuclear factor of activated T cells, thus suppressing gene transcription. There have been conflicting reports of the usefulness of tacrolimus in NS patients, with systemic absorption being the main adverse outcome. Here we report four Saudi siblings (two boys and two girls) with NS who were treated with topical tacrolimus and pimecrolimus with good control of their skin disease without any toxic effect. To our knowledge, this is the second report of the use of topical pimecrolimus in NS in the English literature.

QUALITY OF LIFE/CROSS SECTION. Int J Dermatol. 2007 Mar;46(3):247-52. Arabic version of Skindex-16: translation and cultural adaptation, with assessment of reliability and validity. AlGhamdi KM, AlShammari SA. Dermatology Department and Family Medicine Department, King Saud University, Riyadh, Saudi Arabia. BACKGROUND: Quality-of-life is increasingly recognized as an important measure in dermatology; however, most currently available dermatologic quality-of-life measures were originally created for the English language. Skindex-16 being one, is a self-administered questionnaire covering the symptoms, emotions and functioning aspects. OBJECTIVES: Our aim was to translate into Arabic and culturally adapt Skindex-16 following the international guidelines for cross-cultural adaptation of health-related quality-of-life measures. Moreover, its validity and reliability would be assessed. METHODS: Translation and transcultural adaptation of Skindex-16 were performed. Subsequently, a cross-sectional study was conducted where 678 persons (338 patients and 340 healthy people) responded to the Arabic version of Skindex-16. Evaluations of the semantic equivalence of back-translated items, reliability, construct validity, and content validity of the Arabic version were the main outcome measures. RESULTS: Two problematic items as well as the introductory (header) statement required a second translation and back-translation to achieve satisfactory agreement with the original instrument. The final Arabic version of Skindex-16 was internally reliable (Cronbach's alpha-range for the scales 0.81-0.92). The instrument demonstrated both construct and content validity. As hypothesized, the scores for dermatologic patients were higher than those for healthy persons (mean 31.5 vs. 21.1, P < 0.001, respectively). Similarly, scores for patients with inflammatory dermatosis were higher than those for patients with isolated skin lesions (mean 32.99 vs. 25.3, P < 0.05), indicating a poorer quality-of-life. However, greater than 63% of the patients' responses to an open-ended question about their skin disease were addressed by items in the instrument. CONCLUSION: We have developed a semantically equivalent translation with cultural adaptation  of Skindex-16 into Arabic. The assessment of its measurement properties shows that it is quite reliable and a valid measure of the effects of skin diseases on the quality-of-life in Saudi patients.

CPE. Skinmed. 2007 Mar-Apr;6(2):55-6. Caricatures in medicine and dermatology--an underutilized tool. Al Aboud D, Al Aboud KM, Ramesh V, Jain N. Dermatology Department, King Khalid Military City Hospital, Hafer Al Baten, Saudi Arabia.

THERAPEUTIC/LABORATORY. Acta Derm Venereol. 2007;87(2):118-26. Skin-homing CD8+ T lymphocytes show preferential growth in vitro and suppress CD4+ T-cell proliferation in patients with early stages of cutaneous T-cell lymphoma. Thestrup-Pedersen K, Parhar R, Wu K, Bertilsson PA, Meyer B, Abu-Amero S, Hainau B, Aleisa A, Alfadley A, Hamadah I, Alajlan A, Al-Hussein K, Al-Mohanna F. Section of Dermatology, Department of Internal Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia. Ktp5@hotmail.com. A total of 27 T-lymphocyte cell strains were established from skin biopsies of 24 patients with various stages of cutaneous T-cell lymphoma (CTCL) by addition of the T-cell growth factors interleukin (IL)-2 and IL-4. Cellular proliferation and phenotypic changes were measured over 3 months in culture, and T-cell clones were studied using T-cell receptor-? re-arrangement techniques. An average outgrowth of 134 million T-lymphocytes from a 4-mm skin biopsy was observed over 2 months. Initially, most T-cells expressed the CD4+ phenotype. In 17 cell strains from patients with early CTCL a statistically significant predominance of CD8+ T-lymphocytes developed over 8-weeks' culture, indicating that CD8+ T-cells controlled the growth of CD4+ T cells, whereas CD4+ T-cells were predominant in cell strains from advanced CTCL (p <0.05). TCR-? re-arrangement studies revealed, on average, 12 T-cell clones per cell strain, which was reduced over time to 6 T-cell clones per cell strain. Lymphocytes from peripheral blood could kill lymphocytes from an autologous cell strain, suggesting the presence of autoreactive cytotoxic T-cells. Our study suggests how skin-homing CD8+ T-lymphocytes from patients with early stage CTCL can suppress the in vitro growth of skin-homing CD4+ T-lymphocytes, indicating immune surveillance.

THERAPEUTIC/CASE SERIES. J Cutan Med Surg. 2006 Mar-Apr;10(2):96-8. Pili bigemini and terminal hair growth induced by low-fluence alexandrite laser hair removal. Bukhari IA. Dermatology Department, King Faisal University, College of Medicine, Alkhobar, Saudi Arabia. consultant@dermatologyclinics.net BACKGROUND: Different types of lasers are used in the removal of undesirable hair by targeting the hair follicles, with the melanin pigment acting as the chromophore, and through the mechanism of selective photothermolysis. OBJECTIVES: This report documents an unusual increase in terminal hair growth after alexandrite laser hair removal in three female patients. CONCLUSION: Excessive hair growth after alexandrite laser hair removal must be listed as one of the complications resulting from the use of a laser with a fluence that is too low and can possibly be prevented if we use higher energy to fully destroy the hair follicles, with consideration given to the skin type and an effective cooling system.

CLINICAL PRESENTATION/CASE SERIES. Skinmed. 2007 Jan-Feb;6(1):40-1. Lamellar ichthyosis in a Saudi kindred. Al Aboud D, Al Aboud K, Ramesh V, Kumar J. Dermatology Department, King Khalid Military City Hospital, Hafer Al Baten, Saudi Arabia. A series of 20 patients aged 4-16 years presented with lamellar ichthyosis at the dermatology unit of King Faisal Hospital at Taif in western Saudi Arabia. Though they had come from different families, they all belonged to the same tribe that was confined to a rural area in the precincts of Taif. The tribe is known for consanguineous marriages. The affected children are from 5 sibships. All the children presented with generalized thick dark scales. The history revealed that they all were born with a thick membrane around them, which was shed soon after. Gradually over months and years there was development of generalized scaling. A prototype is shown in the Figure. The scales had become darker and thicker with the passage of time. There was no pruritus. Teeth and mucous membranes were normal. None of the patients had erythroderma. The associated findings in some of the children were ectropion and alopecia. Contractures including pseudoainhum were also observed in some children. None of the patients' parents was found to be affected with a similar condition. There was no improvement with age. Skin biopsies from several of the patients revealed only hyperkeratosis. All had to be managed with topical emollients since they could not afford oral retinoids.

THERAPEUTIC/CROSS SECTION. J Cosmet Dermatol. 2005 Jun;4(2):107-10. Removal of amateur blue-black tattoos in Arabic women of skin type (III-IV) with Q-switched alexandrite laser. Bukhari IA. King Faisal University, College of Medicine, Dermatology Department, Alkhobar, Saudi Arabia. consultant@dermatologyclinics.net. BACKGROUND AND OBJECTIVES: Tattoos in Arabic society used to have a cosmetic importance on the face of females. These were usually amateur tattoos done by non-professional women in the tribe. Because Islam as a religion prohibited its practice and its application, people became concerned about removing the old tattoos by any means. Nowadays, laser is considered an effective method of tattoo removal. Here, we report our experience in the removal of tattoos in Arabic women of skin type III-IV using the Q-switched alexandrite laser. STUDY DESIGN/MATERIALS AND METHODS: Twenty female subjects aged 35-50 years from similar racial and ethnic background with amateur tattoos were treated using the Q-switched alexandrite laser. Fluence threshold was determined and a spot test was made. Q-switched alexandrite laser with a fluence range 4.0-7.5 J/cm(2) (mean 6.05) was used at 6-12-week intervals. Total treatment numbers ranged from three to six sessions (mean 4.15) with single-pulse technique application. RESULTS: More than 95% lightening was achieved in five patients after three to six sessions at fluence range of 6-7.5 J/cm(2) and > 75% lightening in 10 subjects after three to six sessions of treatment at fluence range of 4-7.5 J/cm(2). Pinpoint bleeding was observed in one case but no pigmentary alteration or scarring was seen. CONCLUSION: Tattoo pigment removal by Q-switched alexandrite laser is an effective method in skin type (III-IV) with minimal side effects, which gives high patient satisfaction.

THERAPEUTIC/CASE REPORT. J Cosmet Dermatol. 2005 Jan;4(1):27-8. Effective treatment of Futcher's lines with Q-switched alexandrite laser. Bukhari IA. Dermatology Department, College of Medicine, King Faisal University, Dammam, Saudi Arabia. consultant@dermatologyclinics.net. This is a case report of a young female patient who presented with pigmentary demarcation lines type A on the anterolateral aspect of both arms, which were satisfactorily treated with a Q-switched alexandrite laser with no adverse effects.

ETIOLOGY/CASE REPORT. Saudi Med J. 2006 Nov;27(11):1761-3. Black (samsum) ant induced anaphylaxis in Saudi Arabia. Al-Shahwan M, Al-Khenaizan S, Al-Khalifa M. Division of Dermatology, Department of Medicine, King Fahad National GuardHospital, King Abdul-Aziz Medical City, Riyadh, Kingdom of Saudi Arabia. Ant allergy is a rare clinical problem that ranges from local to systemic reaction and life-threatening anaphylaxis. Different types of ants including the imported fire ants, the black (samsum) ants, and others, are considered health hazard in many parts of the world. We report a 32-year-old Saudi female from Hafr-Al-Batin in the Northern region of Saudi Arabia, with history of recurrent anaphylaxis following black (samsum) ant stings and we review the related literature. This is the first report of black (samsum) ant allergy in Saudi Arabia.

CLINICAL PRESENTATION / . Int J Dermatol. 2006 Oct;45(10):1196-8.Trichotillomania or alopecia areata? Shelleh HH, Khan SA, Al-Hatiti HS. Dermatology Department, Najran General Hospital, Najran, Saudi Arabia. hhs_s2000@hotmail.com

ETIOLOGICAL/CASE CONTROL. Arch Dermatol Res. 2006 Dec;298(7):347-52. Epub 2006 Sep 22. Association of HLA loci alleles and antigens in Saudi patients with vitiligo. Abanmi A, Al Harthi F, Al Baqami R, Al Assaf S, Zouman A, Arfin M, Tariq M. Department of Dermatology, Armed Forces Hospital, Riyadh 11159, Saudi Arabia. HLA complex is composed of several closely linked loci, each containing several alleles, yielding a high expression of polymorphism. Vitiligo, a commonly acquired dermatological disorder, has been associated with different HLA antigens in different ethnic groups. In this study, HLA classes I (HLA-A, B, and C) and II (HLA-DR, DQ) antigens/alleles were analyzed in a group of 80 Saudi subjects consisting of vitiligo patients (40) and matched controls (40). The frequency of  antigens of various HLA loci was tested using two-stage microcytotoxicity assays, while the frequency of alleles of HLA-DR was screened by polymerase chain reaction/sequence specific primers (PCR/SSP) method. The frequencies of HLA-B7, B15, Bw6, Cw6, Cw7, and DRB4*010101 were found to be significantly higher in vitiligo patients compared to controls [P = 0.029, 0.015, 0.033, 0.009, 0.043, and 0.015, respectively, with relative risk (RR) > or = 3, etiologic fraction (EF) > or = 0.4]. On the other hand, HLA-A9, B5, DQ1, and DRB3*010101 were significantly decreased in vitiligo patients compared to healthy Saudis [P = 0.008, 0.004, 0.028, and 0.04, respectively, with RR < 1 and preventive fraction  (PF) < 0.5]. Among the patients, the highest allele frequency was noted for DRB4*010101(70%), while in controls it was for DRB3*010101 (72.5%). These results for antigens and allele frequency of various HLA Loci in vitiligo patients and control subjects suggested that HLA-B7, Bw6, Cw6, Cw7, and DRB4*010101 could be susceptible to vitiligo, while HLA-A9, B5, DQ1, and DRB3*010101 might be negatively associated with the development of vitiligo in Saudis.

CLINICAL PRESENTATION/CROSS SECTION. Ann Saudi Med. 2006 Sep-Oct;26(5):352-7. Peeling skin syndrome: 11 cases from Saudi Arabia. Al-Ghamdi F, Al-Raddadi A, Satti M. Department of Dermatology, King Abdulaziz Medical City, Jeddah, Saudi Arabia. BACKGROUND: Peeling skin syndrome (PSS) is a rare genodermatoses of probable autosomal recessive inheritance. In Saudi Arabia, consanguinity of parents is common and consequently the occurrence of familial disease, including that of the skin, is not uncommon. METHODS: To characterize the clinical and pathological features of PSS in Saudi Arabia, we reviewed the medical records and clinical photographs of patients with recurring blistering diseases and conducted a histopathologic evaluation of skin biopsies to identify the site of cleavage. RESULTS: Eleven patients with PSS were seen at King Khalid National Guard Hospital in Jeddah between the years 1986 and 2005. Ages ranged between 2 and 15 years and there were 9 males (81.8%) and 2 females (18.2%). The most common presentation in the majority of patients was localized spontaneous peeling of theskin. Eight patients (72.7%) had a history of vesicles that were small, dry and peeled away. Trauma did not play a role in blister formation. All patients were local from Bedouin tribes where a family history of a similar complaint was documented in 8 cases (72.7%) and consanguinity of marriage was evident in 6 patients (54.5%). Histological examination of skin biopsies showed either intracorneal or superficial subcorneal cleavage above the granular layer in all biopsied patients. CONCLUSION: Although rare, PSS occurs in Saudi Arabia and is most likely related to consanguinity of marriages. This disease is generally mild and is characterized by intracorneal cleavage within the superficial epidermis. The disease should be recognized and not confused with other vesicobullous disease.

CLINICAL PRESENTATION. Saudi Med J. 2006 Oct;27(10):1600-1. Tonsure alopecia on the wrists. Unreported site of trichotillotic and relation with unemployment. Shelleh HH, Radwan M, Dawoud S. Department of Dermatology, Najran General Hospital, PO Box 52, Najran, Kingdom of Saudi Arabia. hhs_s2000@hotmail.com

CLINICAL PRESENTATION/CASE REPORT. Skinmed. 2006 Sep-Oct;5(5):248-9. Primary palmoplantar Kaposi's sarcoma: an unusual presentation. Al Zolibani AA, Al Robaee AA. Department of Dermatology, College of Medicine, Qassim University, Buraidah, Saudi Arabia. azolibani@yahoo.com. A 65-year-old diabetic Saudi Arabian man taking glibenclamide for 9 years presented with painful reddish patches and plaques involving the palms and soles of 6 months' duration. These lesions started as small faint purple-red macules and gradually increased in number and size. The patient did not seek any medical advice other than for these painful lesions. His medical history was insignificant. On examination, the patient had multiple, discrete, dull red-to-violaceous and tender patches and plaques of variable sizes on both palms and soles (Figure 1 and Figure 2). His mucous membranes, scalp, and nails were normal. A systemic clinical examination was unremarkable other than an amputation of the distal phalanx of the left index. Result of routine laboratory investigations including complete blood cell count, liver and renal function tests, and chest x-ray were normal. An HIV test was negative. A punch skin biopsy taken from the left palm showed acanthosis and spongiosis in the epidermis. The dermis showed a large number of dilated, medium-sized capillaries with scanty extravasated red blood cells, marked infiltration of lymphocytes and histiocytes, and a few plasma cells (Figure 3 and Figure 4). Immunohistochemistry results were positive for CD34 and CD68. Polymerase chain reaction for human herpesvirus 8 was also positive. The treatment options, including cryotherapy and intralesional chemotherapy, were discussed with the patient but, unfortunately, he did not return for follow-up.

THERAPEUTIC/REVIEW. Acta Dermatovenerol Alp Panonica Adriat. 2006 Mar;15(1):20-4. Blood transfusion and dermatology. Al Aboud K, Al Hawsawi K, Al Alaboud A, Ramesh V, Jain N. Dermatology Department, King Faisal Hospital, Dr. Bakhsh Hospital, Makkah, Saudi Arabia. amoa65@hotmail.com. Blood transfusion is an accepted therapeutic procedure in all specialties of medicine. In dermatology, specialized techniques like plasmapheresis and extracorporeal photochemotherapy have provided a good treatment option in immune-mediated disorders like bullous dermatoses, collagen vascular diseases and cutaneous lymphomas. Other anecdotal and less substantiated reports point to its  use in chronic disorders like atopic dermatitis and psoriasis. Untoward

dermatological manifestations include mainly purpuric rash and GVHD. Since planned studies may not be possible, pertinent observations from chance situations on the effect of blood transfusion in dermatoses would add valuable information.

CLINICAL PRESENTATION/LABORATORY DIAGNOSIS. Saudi Med J. 2006 Jul;27(7):951-4. The applicability of T-cell receptor gamma gene rearrangement as an adjuvant diagnostic tool in skin biopsies for cutaneous T-cell lymphoma. Khalil SH, Hamadah IR. Department of Pathology and Laboratory Medicine (MBC-10), King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh 11211, Kingdom of Saudi Arabia. khalil@kfshrc.edu.sa. OBJECTIVE: The diagnosis of cutaneous T-cell lymphoid infiltrates may be difficult based on clinical and routine immunohistologic findings. In this situation, an ancillary technique demonstrating the presence of a monoclonal cell proliferation could help to rule in or out cutaneous T-cell lymphoma (CTCL) in cases that clinically and histopathologically do not allow a definitive diagnosis. Southern blot analysis is a time-consuming method with low sensitivity that should not be considered for the routine diagnosis of cutaneous lymphoid infiltrates. Moreover, it can be used only when fresh tissue is available. New assays based on the amplification of the T-cell receptor gamma (TCR gamma) chain gene rearrangement by polymerase chain reaction (PCR) have been proposed to overcome these limitations. METHODS: We retrospectively studied 124 biopsies from 104 patients (66 biopsies with the clinical and histological diagnosis or suspicious of CTCL and 58 biopsies with histological diagnosis of benign reactive dermatological conditions who presented to the Dermatology Unit at King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia between 1996 and 2004. The specimens were morphologically examined and then analyzed by PCR for the gamma chain of the TCR gamma followed by gel electrophoresis. RESULTS: The results showed 87.1% sensitivity and 92% specificity in detecting clonal T-cell gene rearrangements among CTCL cases with a positive predictive value of 93.1% and negative predictive value of 85.2%. Therefore, negative TCR gamma results in CTCL should be taken with caution. CONCLUSION: The detection of clonal TCR gamma gene rearrangement by PCR based method is an adjuvant diagnostic marker for CTCL, although it can be seen in some benign dermatoses.

CPE. J Ayub Med Coll Abbottabad. 2006 Jan-Mar;18(1):78-80. Awards in medicine and dermatology. Al Aboud KM, Al Aboud AM, Al Hawsawi KA, Ramesh V. Dermatology Department, King Faisal Hospital, Makkah, Saudi Arabia. amoa65@hotmail.com

CLINICAL PRESENTATION/CASE REPORT. Am J Clin Dermatol. 2006;7(3):201-3.  Malignant peripheral nerve sheath tumor of the skin: case report. Al Akloby O, Bukhari IA, El-Shawarby M, Al Mulhim F. Dermatology Department, King Faisal University, College of Medicine, Alkhobar, Saudi Arabia. Malignant peripheral nerve sheath tumors (MPNSTs) are rare tumors derived from Schwann cells or pluripotent cells of the neural crest. In this report, we describe a 21-year-old Saudi woman who presented with an asymptomatic, solid, round, protruding tumor on the right upper back which was diagnosed as an MPNST with no stigmata of neurofibromatosis. It was completely excised with a wide surgical margin. The patient was followed up for 9 months with no evidence of recurrence.

THERAPEUTIC/CASE REPORT. Saudi Med J. 2006 May;27(5):717-20. Oral mega pulse methylprednisolone in alopecia universalis. Bin Saif GA. Department of Dermatology, King Saud University,

PO Box 54753, Riyadh 11524

, Kingdom of Saudi Arabia. gbinsaif@gmail.com. Intravenous pulse corticosteroids is an alternative method of corticosteroids delivery, which proved to be safe with rapid and potent efficacy. It is an effective treatment of alopecia areata, but not for the totalis, universalis or ophiasis types, for which no effective therapy is available yet. Recently, it has been confirmed that oral and intravenous pulse methylprednisolone MP have comparable efficacy. Here, we report a 9-year-old Saudi boy with alopecia universalis who was treated with MP sodium succinate 15 mg/kg ideal body weight orally for 3 consecutive days bimonthly for 12 sessions. Complete hair regrowth was obtained without toxic effects. When the interval was increased to 4 weeks, he showed partial relapse. So, 2 more pulses were given with an interval of 3 weeks in between. This maintained his regrown hair for a year without treatment.

THERAPEUTIC/CASE SERIES. J Am Acad Dermatol. 2006 Apr;54(4):652-6. Treatment of linear IgA bullous dermatosis of childhood with flucloxacillin. Alajlan A, Al-Khawajah M, Al-Sheikh O, Al-Saif F, Al-Rasheed S, Al-Hoqail I, Hamadah IR. Department of Dermatology, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia. drajlan@yahoo.com. BACKGROUND: Linear IgA bullous dermatosis of childhood is a rare autoimmune bullous disease that mainly affects preschool-aged children. Dapsone is considered the first-line therapy with prompt response from most patients. However, it may be contraindicated in certain conditions such as glucose-6-phosphate dehydrogenase deficiency. OBJECTIVE: We sought to assess the  efficacy of flucloxacillin in the treatment of linear IgA bullous dermatosis. METHODS: This is an observational study in which all confirmed cases of linear IgA bullous dermatosis (by both histological and immunofluorescence studies) will be treated with flucloxacillin. Flucloxacillin will be continued according to the response or otherwise will be discontinued after 8 weeks in the case of resistance. RESULTS: We describe 7 patients with linear IgA bullous dermatosis of childhood treated with flucloxacillin. In 4 cases, it induced complete remission within 3 to 4 months of starting therapy with no relapses. In the other 3 cases, it successfully controlled the disease but with prompt relapse on discontinuation of the treatment. LIMITATIONS: This is a case series study with a small number of patients. CONCLUSION: Flucloxacillin may be considered among the first alternative therapies for linear IgA bullous dermatosis of childhood. Further evaluation of the efficacy and safety of the long-term use is required.

CLINICAL PRESENTATION/CROSS SECTION. Int J Dermatol. 2006 Mar;45(3):257-64. Clinico-epidemiological features of primary hereditary ichthyoses in the Eastern province of Saudi Arabia. Al-Zayir AA, Al-Amro Al-Alakloby OM. Department of Dermatology, College of Medicine, King Faisal University, Dammam, Saudi Arabia. alzayir@yahoo.co.uk. Erratum in: Int J Dermatol. 2006 Apr;45(4):488. BACKGROUND: A total of 10 455 new dermatology patients were seen in the dermatology clinics of King Fahad Hospital of the University (KFHU), Al-Khobar, Saudi Arabia, between January 1990 and December 1995. We identified 71 patients with a histopathologically confirmed diagnosis of specific forms of primary hereditary ichthyoses (PHI). We have reviewed the epidemiological and clinical features of these patients. OBJECTIVE: To document the epidemiological and  clinical features of patients with PHI in the Eastern Province of Saudi Arabia. METHODS: We used the dermatology out-patient department (OPD) logbooks to identify cases of PHI from new patients presenting with different dermatological problems over a 6-year period. We used specifically designed protocol forms to extract epidemiological and clinical data from the study patients' medical records. These were entered into a computer database and analyzed using standard statistical software. RESULTS: A total of 71 patients, 44 males and 27 females (male : female sex ratio of 1.63 : 1), were identified from a total of 10 455 new patients seen in our dermatology clinics between January 1990 and December 1995. The occurrence rate of PHI, in our clinics, was 0.67% or 7 per 1000 newdermatology cases. The clinical pattern of PHI showed that Icthyosis Vulgaris was the most common form seen, followed by Nonbullous Ichthyosiform Erythroderma. Thirty-one patients (44.7%) with Ichthyosis Vulgaris (IV) were seen: 12 patients (16.9%) with X-linked Recessive Ichthyosis (XLRI), four patients (5.6%) with Lamellar Ichthyosis (LI), three patients (4.2%) with Bullous Ichthyosiform Erythroderma (BIE) and 21 patients (29.6%) with Nonbullous Ichthyosiform Erythroderma (NBIE). There was a significantly high consanguinity rate in our patients (85%), and the family history was positive in 53 cases out of the 71 (75%). CONCLUSIONS: This preliminary study is the first report of its kind from Saudi Arabia and documents the clinico-epidemiological features of PHI patients in the Eastern Province. The high rate of parental consanguinity among our Saudi patients may account for the high proportion of patients with a positive family history. Consanguinity also probably explains why the most severe forms of PHI were seen in a significant number of new patients' siblings. These severe forms of PHI (Nonbullous Ichthyosiform Erythroderma, Bullous Ichthyosiform Erythroderma and Lamellar Ichthyosis) together constituted nearly 40% of all cases.

CLINICAL PRESENTATION/CASE REPORT. Saudi Med J. 2006 Mar;27(3):395-6. Childhood solitary collagenoma. Al-Breiki SH, Bukhari IA. Department of Dermatology, King Fahad Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia. Familial cutaneous collagenoma is an inherited connective tissue nevus, which presents with asymptomatic symmetrically distributed skin nodules on the trunk or upper limbs. Here, we describe a case of a 12-year-old girl with collagenoma affecting the lower back.

CLINICAL PRESENTATION. Skinmed. 2006 Jan-Feb;5(1):42-6. Multiple hereditary trichoepitheliomas in a Saudi kindred. Al Aboud K, Al Hawsawi K, Al Aboud A, Mohamed AA. Dermatology Department, King Faisal Hospital, Makkah, Saudi Arabia. amoa65@hotmail.com

CLINICAL PRESENTATION/CASE REPORT. Ann Saudi Med. 2006 Jan-Feb;26(1):62-4. Calcinosis cutis: a rare complication of chronic myeloid leukemia. Samdani A. Department of Dermatology, King Abdul Aziz Hospital, Makkah, Saudi Arabia. azamsamdani@hotmail.com

CLINICAL PRESENTATION / CASE REPORT. J Drugs Dermatol. 2006 Feb;5(2):190-2. Poiklodermatous variant of mycosis fungoides. Bukhari IA. Dermatology Department, King Fiasal University, College of Medicine, Dammam, Saudi Arabia. consultant@dermatologyclinics.net. Mycosis Fungoides (MF) is a T-cell lymphoma initially presenting in the skin. Many clinical variants exist including follicular, vesicular, poikilodermic, hypo- and hyperpigmented, ichthyosiform and pigmented purpura-like lesions. We present an unusual variant in a case of poikilodermic MF.

GENERAL  Acta Dermatovenerol Alp Panonica Adriat. 2005 Dec;14(4):167-70. Editors of dermatological journals. Al Aboud Kh, Al Aboud A, Al Hawsawi Kh, Ramesh V. Dermatology Department, King Faisal Hospital, Makkah, Saudi Arabia. oa65@hotmail.com

CLINICAL PRESENTATION / CASE REPORT. Saudi Med J. 2006 Jan;27(1):93-4. Vulvar basal cell carcinoma misdiagnosed for 4 years. Bukhari IA, Khalid AJ. Department of Dermatology, College of Medicine, King Faisal University, Dammam, Kingdom of Saudi Arabia. consultant@dermatologyclinics.net. Vulvar basal cell carcinoma is a rare cutaneous neoplasm occurring mainly in white postmenopausal females. It can be misdiagnosed due to its nonspecific physical appearance. Here, we report a 59-year-old white female who had vulvar basal cell carcinoma misdiagnosed for 4 years.

THERAPEUTIC / CASE REPORT. Saudi Med J. 2005 Dec;26(12):1989-91. Successful treatment of chronic persistent vesicular hand dermatitis with topical pimecrolimus. Bukhari IA.  Dermatology Department, College of Medicine, King Faisal University, Al-Khobar, Kingdom of Saudi Arabia. consultant@dermatologyclinics.net. Hand dermatitis is a common chronic skin condition that has many clinical forms including contact, hyperkeratotic, frictional, nummular, atopic, pompholyx and chronic vesicular hand dermatitis. Topical steroids are the first line agents used. Here, we report the successful response to topical pimecrolimus 1% cream in a patient with steroid resistant chronic vesicular hand dermatitis.

KAP /CROSS SECTION. Saudi Med J. 2005 Dec;26(12):1958-61. Prevalence, knowledge, beliefs and psychosocial impact of acne in University students in Central Saudi Arabia. Al Robaee AA. Department of Dermatology, Qassim University,

PO Box 30109 Buraidah 51477

, Qassim, Kingdom of Saudi Arabia. arobaee@yahoo.com. OBJECTIVES: To describe the prevalence of acne among Qassim University students, and to evaluate the knowledge, beliefs, and its psychosocial impact on them. METHODS: We observed 717 students (381 males, and 336 females), at Qassim University Medical clinics during February and March 2005. We interviewed and examined the subjects for the presence of acne. After confirming the diagnosis, we asked the patients several questions about acne, history, knowledge, perceptions, beliefs, and its psychosocial impact on them. We performedstatistical analysis using the chi-square test with a 5% significance level. RESULTS: We found 56.2% of the students to have acne. The difference between both gender was statistically insignificant, and 47.9% of patients suffered from acne for more than one year. Of those who sought medical advice, 40.3% had their consultation within 3 months of the disease onset, and 58.9% of patients sought medical advice as a self-decision. Fifty-six percent believed they have an adequate knowledge of acne, and the most common source of information was newspapers. The most believed factor responsible for acne was hormones, and the most aggravating factor was stress. In 46% of patients, acne had no, or minimal effect on their self-image and in most of the patients (73%) it had no or minimal effect on their relationships. CONCLUSION: Acne is a common skin disease among Qassim university students, affecting both gender. We need health education in our community to encourage people to seek appropriate help for skin problems. We require further community based research to evaluate the effectiveness of such educational interventions in under-standing the natural history, pathogenesis and the sequelae of acne, increasing help-seeking behavior, and improving the awareness of patients about acne.

GENERAL  J Ayub Med Coll Abbottabad. 2005 Jul-Sep;17(3):84-5. King Faisal International Prize for Medicine. Al Aboud KM, Al Aboud AM, Al Hawsawi KA. Dermatology Department, King Faisal Hospital, Makkah, Saudi Arabia. amoa65@hotmail.com. This is a brief commentary about the King Faisal International Prize for Medicine and its previous winners.

CLINICAL PRESENTATION / CASE REPORT. Rev Iberoam Micol. 2005 Sep;22(3):167-8. Sparing of the upper axillary area in pityriasis versicolor. Aljabre SH. Department of Dermatology, King Fahd Hospital of the University, King Faisal University, Damman, Saudi Arabia. saljabre@yahoo.com. Increased temperature and sweating are considered factors predisposing to pityriasis versicolor. In this case report, sparing of the vaults of the axillae which are naturally occluded and sweaty areas, in a patient with widespread lesions of pityriasis versicolor is discussed. It is the second observation in this regard and further contributions are invited.

CLINICAL PRESENTATION. Ann Saudi Med. 2005 Sep-Oct;25(5):422-4. Plantar keratoderma: a manifestation of tyrosinemia type II (Richner-Hanhart syndrome). Al-Ratrout JT, Al-Muzian M, Al-Nazer M, Ansari NA. Qatif Central Hospital, Department of Dermatology, Qatif, Saudi Arabia. alratjeh@hotmail.com

THERAPEUTIC CASE REPORT. Ann Saudi Med. 2005 Sep-Oct;25(5):415-8. Calciphylaxis in a 33-year-old man with end-stage renal disease. Al-Ghamdi KM. King Saud University, College of Medicine, Dermatology Department, Riyadh, Saudi Arabia. mgderm@yahoo.com

CLINICAL PRESENTATION / CROSS SECTION. Saudi Med J. 2005 Oct;26(10):1607-10. Pattern of skin diseases in Eastern Saudi Arabia. Alakloby OM. Department of Dermatology, King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia. akloby1@yahoo.com. OBJECTIVES: To describe the pattern of skin disease in the Eastern Province and compare it with similar studies carried out in other regions of Saudi Arabia. METHODS: All new dermatology cases reporting at King Fahd Hospital of the University in Al-Khobar, Saudi Arabia, seen between August 2002 to July 2003 were reviewed. RESULTS: One thousand and seventy-six new patients within the period of the study were seen. Dermatitis/ eczema was the most frequent dermatosis (19.6%) with atopic dermatitis forming 35.9% among eczemas, followed by acne (13.8%), viral infection (13.5%), of which 11.9% had viral warts; pigmentary disorders (9.7%) with vitiligo comprising 5% of the total. In fungal infections (9.6%), dermatophytoses formed 6.3% of the total patients, alopecias 7.2%, papulosquamous disorders 6.4%, of which 3.4% had psoriasis and 1.7% had lichen planus; urticaria 5.7%, pyoderma 4.8%, and the parasitic infections, 1%. CONCLUSION: This comparative study showed that eczema was the most frequent diagnosis among all skin diseases and parasitic infections were the least frequent diseases. Generally, the Eastern Province study is closely comparable to other studies in the country with higher frequencies of viral and fungal infections and acne.

CLINICAL PRESENTATION / CASE REPORT. J Eur Acad Dermatol Venereol. 2005 Sep;19(5):600-2. Idiopathic nodular panniculitis in Niemann-Pick disease. Bukhari I. Dermatology Department, College of Medicine, King Faisal University, Dammam, Saudi Arabia. consultant@dermatologyclinics.net. Idiopathic nodular panniculitis is a condition characterized by the recurrent appearance of inflammatory nodules in the subcutaneous fat. In this report, an infant affected with Niemann-Pick disease and recurrent lobular panniculitis is described and discussed.

CLINICAL PRESENTATION / CASE REPORT. Dermatol Online J. 2005 Aug 1;11(2):26. Symmetrical interdigital hyperkeratosis of the hands: a case report. Raddadi AA. Department of Dermatology, King Abdulaziz Medical City, King Khalid NationalGuard Hospital, Jeddah, Kingdom of Saudi Arabia. ftajem@yahoo.com

CLINICAL PRESENTATION / CASE REPORT. Eur J Dermatol. 2005 Jul-Aug;15(4):288-90. Transient intra-epidermal bullous dermatosis. Bukhari I. Dermatology Department, College of Medicine, King Faisal University, Dammam, Saudi Arabia. consultant@dermatologyclinics.net. Transient acantholytic dermatosis is an acquired, mildly pruritic, papulovesicular disease affecting the trunk and extremities. In this report a case of the bullous variant of this disease is described, with a brief review of

the literature.

CLINICAL PRESENTATION / CROSS SECTION. J Eur Acad Dermatol Venereol. 2005 Jul;19(4):431-6. Clinical and histopathological features of zoonotic cutaneous leishmaniasis in Saudi Arabia.Uthman MA, Satir AA, Tabbara KS. Department of Dermatology, Solmaniya Medical Center, Manama, Bahrain. mirghani@agu.edu.bh. BACKGROUND: Zoonotic cutaneous leishmaniasis (ZCL) caused by Leishmania major is a growing public health problem and endemic in many parts of the Kingdom of Saudi Arabia. The vector is Phlebotomus papatasi and the animal reservoirs are mainly desert rodents. METHODS: In this prospective study, the clinical and histopathological features of ZCL in 120 patients are described and classified. The majority of these patients (n = 84) were non-Saudi expatriate workers who suffered mostly from multiple and severely inflamed nodulo-ulcerative lesions on the exposed parts of the body. Saudi patients were mainly children (n = 21) with few(1-3) lesions on their limbs or sometimes unique erysipeloid facial lesions. RESULTS: Histopathological grouping of ZCL lesions showed four types of granulomatous reactions based on the predominant types of inflammatory cells, presence or absence of necrosis and ranking of parasitic index. CONCLUSION: A possible correlation between histopathologic evolution of ZCL lesions and the immune status of the host is discussed.

ETIOLOGIC / LABORATORY. J Biochem Mol Biol. 2005 May 31;38(3):350-3. Study of alanine-73 and aspartate-9 of HLA-C locus in Saudi psoriasis patients, using sequence-specific primers (PCR-SSP). Abanmi A, Al Harthi F, Al Agla R, Khan HA, Tariq M. Department of Dermatology, Armed Forces Hospital, Riyadh, Saudi Arabia. Alanine at residue 73 (Ala-73) and aspartate at residue 9 (Asp-9) are characteristic to both Cw6 and Cw7 alleles of HLA-C gene and have been suggested as possible markers for psoriasis vulgaris (PsV). However, the results from various ethnic groups/populations are contradictory and inconclusive. In this study, an attempt has been made to examine the association between HLA-C (Ala-73 and Asp-9) and susceptibility to PsV among Saudi patients. Genomic DNA was extracted from 25 Saudi PsV patients and 75 control subjects. Polymerase chain reaction (PCR) was performed to amplify HLA-C sequences using earlier reported primers, C133P and C243PR. Sequence-specific primers were used to specifically detect nucleotide coding for Ala-73 and Asp-9 in all the subjects. The results showed significantly higher frequency of Asp-9 (84.0 % versus 61.3 %) in PsV patients as compared to controls (p < 0.05, 2-tailed Fisher's exact test). The frequencies of Ala-73 among PsV patients (92 %) and controls (88 %) did not differ significantly.

THERAPEUTIC / LABORATORY. J Ethnopharmacol. 2005 Oct 3;101(1-3):116-9. Antidermatophyte activity of ether extract of Nigella sativa and its active principle, thymoquinone. Aljabre SH, Randhawa MA, Akhtar N, Alakloby OM, Alqurashi AM, Aldossary A. Department of Dermatology, College of Medicine, King Faisal University, P.O. Box 10011, Dammam 31442, Saudi Arabia. saljabre@yahoo.com. The antifungal activity of ether extract of Nigella sativa seed and its active principle thymoquinone was tested against eight species of dermatophytes: four species of Trichophyton rubrum and one each of Trichophyton interdigitale, Trichophyton mentagrophytes, Epidermophyton floccosum and Microsporum canis. Agar diffusion method with serial dilutions of ether extract of Nigella sativa, thymoquinone and griseofulvin was employed. The incubation was carried out at 30 degrees C for 14 days. The diameter of fungal colonies and the percentage inhibition of the fungal growth at each dilution were determined, taking those of the controls as 100%. The minimum inhibitory concentration (MIC) was considered as the minimum concentration of the drug, which inhibited 80-100% of the fungal growth. The MICs of the ether extract of Nigella sativa and thymoquinone were between 10 and 40 and 0.125 and 0.25 mg/ml, respectively, while those of griseofulvin ranged from 0.00095 to 0.0155 mg/ml. These results denote the potentiality of Nigella sativa as a source for antidermatophyte drugs and support its use in folk medicine for the treatment of fungal skin infections.

CLINICAL PRESENTATION / CASE REPORT. J Pak Med Assoc. 2005 Jan;55(1):40-2. Menke's kinky hair syndrome--a rare medical condition. Al-Bitar Y, Azam-Jah-Samdani, Azam T. Department of Dermatology, King Abdul Aziz Hospital, Makkah, Saudi Arabia. The case of a 16-month-old boy is described who had typical clinical and radiological features and was proven biochemically to be a case of Menke's disease. Clinical manifestations began in the first few months with hypothermia, hypotonia, seizures and death occurring at the age of 18 months.

CLINICAL PRESENTATION / CASE REPORT. Int J Dermatol. 2005 Apr;44(4):317-20. Lichen sclerosus mistaken for child sexual abuse. Al-Khenaizan S, Almuneef M, Kentab O. Department of Medicine, Division of Dermatology, King Abdulaziz Medical City, King Fahad National Guard Hospital, Riyadh, Saudi Arabia. khenaizans@ngha.med.sa

CLINICAL PRESENTATION / CASE SERIES. Skinmed. 2005 Mar-Apr;4(2):120-1. Pigmentary mosaicism of hyperpigmented type in two sisters. Al Aboud A, Al Aboud K, Al Hawsawi K, Al Aboud D, Ramesh V. Dermatology Department, Hera General Hospital, Makkah, Saudi Arabia. amoa65@hotmail.com. A 17-year-old girl and her 15-year-old sister presented with progressively increasing streaks of reticulate hyperpigmented macules arranged in a whorled pattern over the trunk and extremities (Figure), which appeared soon after birth. The face, palms, soles, eyes, and mucous membranes were spared. Both parents were unrelated Saudis. There was no history of any preceding eruption or any associated systemic abnormality, except for recurrent oral ulcers in both patients for several years. The younger one also had one episode of genital ulcers. Dermatological examination of both parents and the patients' three brothers and one sister were normal with no history of oral ulceration. Examination revealed few aphthous ulcers in either cases, but no joint or eye symptoms. Pathergy testing in both cases was negative. Ophthalmological examination and consultation revealed no signs of Behcet's disease. Routine blood tests did not show any abnormalities. Skin biopsies were taken from pigmented and normal skin in both patients. Histopathological examination of pigmented skin in both cases revealed basal cell hyperpigmentation with pigmentary incontinence. Similar features but in milder form were seen in the biopsies of normal skin in both cases.

CLINICAL PRESENTATION / CASE REPORT. Saudi Med J. 2005 Feb;26(2):317-9. Parry-Romberg syndrome. Overlap with linear morphea. Al-Khenaizan S, Al-Watban L. Division of Dermatology, Department of Medicine, King Fahad National Guard Hospital, PO Box 22490, Riyadh 11426, Kingdom of Saudi Arabia. khenaizans@ngha.med.sa. Parry-Romberg syndrome, also known as progressive hemifacial atrophy, was first described by Parry in 1825 then Romberg in 1846. It is a poorly understood rare disorder characterized by progressive hemifacial atrophy of the skin, subcutaneous tissue, and sometimes, the underlying structures including muscles, cartilages and bones. A case report of a Saudi female with this rare disorder is presented with a brief review of the literature.

CLINICAL PRESENTATION / CASE REPORT. Am J Clin Dermatol. 2005;6(1):61-4. Dermatofibrosarcoma protuberans at the site of a central venous line. Case report. Bukhari I, Al Akloby O, Bedaiwi Y. Dermatology Department, King Faisal University, College of Medicine, Alkhobar, Saudi Arabia. Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive cutaneous tumor that usually does not metastasize. Clinically, it may present as a reddish macule to protuberant nodule affecting the trunk and proximal extremities of young and middle-aged adults. Histologically, it is characterized by a monomorphous storiform proliferation of spindle cells, involving the dermis and hypodermis,with a honeycomb pattern of infiltration of the subcutaneous fat. In case of difficulty in diagnosis, immunohistochemical markers (especially CD34) are highly sensitive for DFSP. It is important to remember that the rarity of DFSP, its resemblance to hypertrophied scars and keloids, and its appearance at trauma sites sometimes make the diagnosis of DFSP difficult and delayed. In the literature, DSFP was not described in a child until 1957. Here we report an instance of DFSP at an unusual site in a 9-year-old child, which was the location of a previous central venous line insertion in the left supraclavicular area. A complete excision of the tumor with a wide surgical margin of 3cm of visibly uninvolved tissue was performed, followed by a deltopectoral flap and skin split graft. Postoperatively, the patient's general condition was stable and he was discharged after 5 days to be followed up 3 months later in our clinic.

CLINICAL PRESENTATION / CASE SERIES. Int J Dermatol. 2005 Jan;44(1):20-4.Becker's melanosis: a report of 12 cases with atypical presentation. Alfadley A, Hainau B, Al Robaee A, Banka N. Dermatology Division, Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. alfadley@kfshrc.edu.sa. Becker's melanosis is a distinct clinical entity. It usually presents in adolescence as a unilateral, hyperpigmented, hairy cutaneous hamartoma. We report herein 12 cases of Becker's melanosis that differ in their presentation from classical Becker's melanosis, and we believe that such presentations are not uncommon.

CLINICAL PRESENTATION. Ann Saudi Med. 2004 Nov-Dec;24(6):484-5.Hyperlipidemia and lipedematous scalp. Bukhari I, Al Mulhim F, Al Hoqail R. Department of Dermatology, College of Medicine, King Faisal University, Al Khobar, Saudi Arabia. consultant@dermatologyclinics.net.

CLINICAL PRESENTATION / CROSS SECTION. J Ayub Med Coll Abbottabad. 2004 Jul-Sep;16(3):10-3. Spectrum of skin disorders presenting to King Abdul Aziz Hospital during Hajj season-2000. Samdani AJ. King Abdul Aziz Hospital, Makkah, Saudi Arabia. azamsamdani@hotmail.com. BACKGROUND: The pilgrimage (Hajj) to the holy mosque in the city of Makkah takes place once every year and during this huge gathering skin diseases are quite common due to hot weather and over crowding. The aim of this study was to collect and report data regarding different dermatological problems occurring during the holy month of Zil-hajj. METHODS: Data regarding skin diseases was collected from pilgrims which were examined and diagnosed clinically at the Department of Dermatology King Abdul Aziz Hospital, during the month of Zil-Hajja of the year 2000. These patients were referred from various primary health centers, medical

hajj missions of various countries and Children and Maternity hospital in Makkah. RESULTS: During the month of Zil-hajja of the year 2000, 1510 cases were seen, of these 1143 were males and 367 were females. The criteria for diagnosis for most of the cases were mainly clinical. The highest number of patients was in the age group of 20-50 years. Eczemas of different types were the most common skin disease observed in these pilgrims, intertrigo was the next most common presenting condition this was followed by fungal and bacterial infections. CONCLUSION: A high frequency of skin diseases such as eczemas, intertrigo, pyoderma and fungal infections was found among the pilgrims. More detailed studies regarding skin conditions during this season would enable us to have better understanding of skin problems there management and prevention in full.

CLINICAL PRESENTATION / CASE SERIES. J Drugs Dermatol. 2004 Nov-Dec;3(6):687-8. Acrokeratosis Verruciformis of Hopf: a localized variant. Bukhari I. Department of Dermatology, King Faisal University, College of Medicine and Medical Sciences, Alkobar, Saudi Arabia. consultant@dermatologyclinics.net. Acrokeratosis Verruciformis of Hopf (AKV) is a rare autosomal dominant genodermatosis. It usually develops during early childhood affecting both sexes equally. Typically, the lesions are warty to convex, brownish to skin-colored papules on the dorsa of the hands and feet, forearms and legs. A possible relationship with Darier disease has long been postulated on a clinical basis mainly. But recently, evidence has suggested that AKV and Darier disease are allelic disorders. I am reporting these two unrelated cases as a unilateral localized variant of AKV.

ETIOLOGICAL  Saudi Med J. 2004 Nov;25(11):1736-8. Epidermolysis bullosa acquisita and Crohn's disease. Al-Ratrout JT, Ansari NA. Department of Dermatology, Qatif Central Hospital, Qatif, Kingdom of Saudi Arabia.

INTRODUCTION / REVIEW. Saudi Med J. 2004 Nov;25(11):1652-5. Dermatological publications in the Gulf Cooperation Council countries. An analysis of 1966-2004 Medline papers. Al-Aboud FM, Al-Aboud KM, Al-Hawsawi KA, Ramesh V. Statistics Department, College of Science, King Abdul-Aziz University, Jeddah, Kingdom of Saudi Arabia. OBJECTIVE: To investigate the publications in dermatology cited in the Medline from 6 countries of the Gulf Cooperation Council (GCC) from 1966 to 2004. METHODS: Medline was searched with the aid of Internet provider Pubmed using the same strategy at a given time for all countries. RESULTS: At the time of search, the Medline listed biomedical research papers from the GCC countries totaled 12837. Of these, 140 were in Dermatology. The Kingdom of Saudi Arabia followed by Kuwait was by far the most prolific contributor, whereas almost none were noted from Bahrain. The publications were highest during the year 2002 (19) followed by 2003 (13), most of them being in the English language in the International Journal of Dermatology (60 citations) and Pediatric Dermatology (13 citations). CONCLUSION: Though the GCC countries have seen a relatively small period in the history of development of medical research, data show that they are trying to keep pace with the rest of the developed world. What remains to be exploited is their good economy that should be directed to provide better infrastructure and improve the quality of training programs. Professional societies within the region must play an active role in ensuring optimum and judicious use of funds.

CLINICAL PRESENTATION / CASE SERIES. J Drugs Dermatol. 2004 Sep-Oct;3(5):560-2. Undifferentiated connective tissue disease with various pigmentary patterns: a study of three patients. Bukhari IA. Department of Dermatology, King Faisal University College of Medicine and Medical Sciences Alkhobar, Saudi Arabia. consultant@dermatologyclinics.net. Undifferentiated connective tissue disease (UCTD) is a condition characterized by the presence of clinical manifestations suggestive of a connective tissue disease and at least one non-organ specific autoantibody. In this report I am presenting three types of cutaneous pigmentary changes are presented in three patients which were the clue to the diagnosis of UCTD.

CLINICAL PRESENTATION / CROSS SECTION. J Eur Acad Dermatol Venereol. 2004 Nov;18(6):659-64. Clinico-epidemiological features of congenital nonbullous ichthyosiform erythroderma in the eastern province of Saudi Arabia. Al-Amro Al-Akloby OM, Al-Zayir AA. Department of Dermatology, College of Medicine, King Faisal University, Dammam, Saudi Arabia. akloby1@yahoo.com. BACKGROUND: A total of 10 455 new dermatology patients were seen in the dermatology clinics of King Fahd Hospital of the University (KFHU), Al-Khobar, Eastern Saudi Arabia, between January 1990 and December 1995. We identified 21 patients with a histopathologically confirmed diagnosis of congenital nonbullous  ichthyosiform erythroderma (CNBIE). We have reviewed the epidemiological and clinical features of these patients. OBJECTIVE: To document the epidemiological and clinical features of patients with CNBIE in eastern Saudi Arabia. METHODS: We used the dermatology outpatient department (OPD) logbooks to identify diagnosed cases of CNBIE from new patients presenting with different dermatological problems over a 6-year period. We used specifically designed data-collection protocol forms to extract epidemiological and clinical data from the patients' medical records. These were entered into a computer database and analysed using standard statistical software. RESULTS: A total of 21 patients (five males, 16 females) with a male : female ratio of 0.31 : 1 were identified from a total of 10 455 new patients seen in our dermatology clinics over the study period. The occurrence rate of CNBIE in our clinics was 0.2%, or two per 1000 new dermatology cases. Nineteen (90%) of 21 CNBIE patients were born with collodion membranes. Eighty-one per cent of our patients had a positive family history of CNBIE. Consanguinity among the parents of our CNBIE patients was significantly high at 95%. CONCLUSIONS: To the best of our knowledge, this preliminary study is the first report of its kind from Saudi Arabia (documenting the clinico-epidemiological features of CNBIE patients in the Eastern Province). The high rate of parental consanguinity among the parents of our Saudi CNBIE patients may account for the high incidence rate of this genodermatosis in eastern Saudi Arabia. In comparison with results of other studies that reported a low occurrence rate of CNBIE among dermatology patients, our results were of a significantly higher rate.

CLINICAL PRESENTATION / CASE REPORT. J Coll Physicians Surg Pak. 2004 Oct;14(10):626-7. Ectodermal dysplasia with acanthosis nigricans (Lelis' syndrome). Samdani AJ. Department of Dermatology, King Abdul Aziz Hospital, Makkah, Saudi Arabia. azamsamdani@hotmail.com. Autosomal recessive ectodermal dysplasia with acanthosis nigricans is termed Lelis' syndrome. It is a rare condition and one case is described with overall clinical, dermatological and dental findings.

CLINICAL PRESENTATION / CASE REPORT. J Eur Acad Dermatol Venereol. 2004 Sep;18(5):614-6. Naxos disease in Saudi Arabia. Bukhari I, Juma'a N. Dermatology Department, College of Medicine, King Faisal University, Alkhobar, Saudi Arabia. onsultant@dermatologyclinics.net. Naxos disease is an autosomal recessive genodermatosis characterized by palmoplantar keratoderma, woolly hair and cardiomyopathy. In this report we describe an early case of Naxos disease and we briefly review the literature of this disorder.

ETIOLOGY / CROSS SECTION. Saudi Med J. 2004 Aug;25(8):1097-9. Association of atopic dermatitis with primary hereditary ichthyoses. Al-Akloby OM. Department of Dermatology, King Fahd Hospital of the University, PO Box 40130, Al-Khobar 31952, Kingdom of Saudi Arabia. akloby1@yahoo.com. OBJECTIVE: The aim of this study is to find out the association of atopic dermatitis and other atopic features with primary hereditary ichthyosis (PHI) among Saudi patients in King Fahd Hospital of the University, Al-Khobar, Kingdom  of Saudi Arabia. METHODS: From the out-patient Department of Dermatology logbooks, all Saudi patients with clinically and histopathologically confirmed PHI seen between January 1990 and December 1995 were included in this study. Clinical findings regarding the atopic manifestations of PHI were extracted into data collection forms and computer-analyzed, using Statistical Package for Social Sciences. RESULTS: Over a 6-year study period, 10,455 new patients were seen in our Dermatology Clinics. Of these, 61 had PHI, there were 37 males and 24 females with a ratio of 1.5:1. Atopic dermatitis (AD), diagnosed according to Hanifin and Rajka criteria, was found in 7 (11.5%) patients of PHI; 5 of which were ichthyosis vulgaris and 2 with x-linked recessive ichthyosis. Isolated features of atopy were observed in the form of pruritus 49 (80%), elevated immunoglobulin E 27 (44.3%), dandruff 24 (39%), keratosis pilaris (KP) 15 (25%) and asthma 3 (5%). CONCLUSION: In the present study, there was an 11.5% association between AD and PHI. However, isolated features of atopy were found in PHI in variable proportions ranging from 5-80%.

CPE. Skinmed. 2004 Jul-Aug;3(4):187-8. Symbols for dermatologists. Al Aboud K, Stransky L, Broshtilova V, Al Hawsawi K, Ramesh V. Dermatology Department, King Faisal Hospital, Taif, Saudi Arabia. amoa65@hotmail.com

CLINICAL PRESENTATION / CROSS SECTION. Int J Dermatol. 2004 Jun;43(6):415-9. Primary hereditary ichthyoses in the Eastern Province of Saudi Arabia. Al-Zayir AA, Al-Amro Alakloby OM. Department of Dermatology, College of Medicine, King Faisal University, Dammam, Saudi Arabia. alzayir@yahoo.co.uk. BACKGROUND: Of 10,455 new dermatology patients seen at the Dermatology Clinic of King Fahad Hospital of the University, Al-Khobar, Saudi Arabia, between January 1990 and December 1995, the epidemiologic and demographic features of 71 patients, each with a histopathologically confirmed diagnosis of one specific type of primary hereditary ichthyosis (PHI), have been reviewed. OBJECTIVE: To study and document the epidemiologic and demographic profiles of patients with PHI in the Eastern Province of Saudi Arabia. METHODS: From the outpatient department dermatology logbooks, 71 patients with PHI, from 10,455 new cases with different dermatologic problems seen during the 5-year period, were included in this study. Using specially designed protocol forms, epidemiologic and demographic data were extracted from the medical records of the patients, entered into a computer, and analyzed using the SPSS program. RESULTS: Seventy-one patients with PHI, 44 males and 27 females (ratio, 1.63 : 1), were seen at our

Dermatology Clinic between January 1990 and December 1995. The occurrence rate of PHI in our clinic is 0.67%, i.e. approximately 7 per 1000 new cases. The clinical pattern of PHI was as follows: 31 patients (44.7%) with ichthyosis vulgaris (IV), 12 (16.9%) with X-linked recessive ichthyosis (XLRI), four (5.6%) with lamellar ichthyosis (LI), three (4.2%) with bullous ichthyosiform erythroderma (BIE), and  21 (29.6%) with nonbullous ichthyosiform erythroderma (NBIE). IV was most common, followed by NBIE. Parental consanguinity was high (approximately 85%), and the family history was positive in 53 of the 71 cases (75%). CONCLUSIONS: This preliminary study has attempted to document the epidemiologic patterns of PHI patients in Saudi Arabia and, to our knowledge, this is the first report of its kind in this country. We found a high rate of parental consanguinity, a high percentage of patients with a positive family history, and many siblings affected by the severest forms of PHI, namely NBIE, BIE, and LI, which accounted for 39.4% of all cases of PHI.

THERAPEUTIC CASE REPORT. J Drugs Dermatol. 2004 May-Jun;3(3):309-10. Solitary mastocytoma successfully treated with a moderate potency topical steroid. Bukhari IA. Dermatology Dept., College of Medicine, King Faisal University Hospital, PO Box 40189, Alkhobar 31952, Saudi Arabia. consultant@dermatologyclinics.net. We report a case of solitary mastocytoma in a child which was successfully treated with a topical steroid of moderate potency. The patient was an 18-month-old girl who presented with localized oval shape yellowish to hyperpigmented lesion on the medial aspect of her right forearm noticed accidentally by the parents since the age of 6 months. The lesion was observed to get urticated mainly after bathing, toweling, and scratching of the area, associated with reddening and itching confined to the lesion (Figure 1). No other area of the body was affected with any similar lesion. Examination of the skin revealed a yellow-tan oval shape patch 1 x 3 cm in diameter which was firm to the touch with intact overlying skin. The lesion became swollen and itchy when it was rubbed vigorously (positive Darier's sign). Systemic examination was unremarkable. The patient investigations including complete blood count, routine  biochemical data, plasma histamine level, and urinalysis were within normal levels. Skin biopsy was cancelled because the parents refused, so our clinical diagnosis was solitary mastocytoma even though it was not confirmedhistologically. We started the patient on a moderate potency corticosteroid (betamethasone valerate 0.1% cream) twice a day for six weeks after which the lesion became softer with a weak Darier's sign. This treatment was continued for another four months which led to resolution of the lesion with residual hyperpigmentation, negative Darier's sign, and no signs of atrophy (Figure 2). Follow up of the patient for another 8 weeks without treatment did not reveal any recurrence of the lesion.

CPE. Skinmed. 2004 May-Jun;3(3):128-9. Which symbol should be used to represent medicine? Al-Aboud K, Stransky L, Ramesh V, Broshtilova V, Al-Hawsawi K. Department of Dermatology, King Faisal Hospital, Al Taif, Saudi Arabia. amoa65@hotmail.com.

CLINICAL PRESENTATION. Int J Dermatol. 2004 Feb;43(2):145-7. Linear and whorled nevoid hypermelanosis associated with developmental delay and  generalized convulsions. Alrobaee AA, Alsaif F. Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia. aasrss@yahoo.com

CLINICAL PRESENTATION / CASE REPORT. Saudi Med J. 2004 Apr;25(4):522-3. Subungual epidermoid inclusions. Bukhari IA, Al-Mugharbel R. Department of Dermatology, King Fahad Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia. consultant@dermatologyclinics.net. Subungual epidermoid inclusions are protrusions of the nail bed epithelium into the upper most bed stroma. They may be associated with hyperplasia of the bed epithelium resulting in subungual keratosis, onycholysis or even clubbing. An 11-year-old girl presented to our dermatology clinic with a one year history of progressive increase in the size of the distal part of her left thumb associated with mild pain on pressure. The diagnosis became evident perioperatively, which showed multiple subungual epidermoid inclusions.

CLINICAL PRESENTATION / INCIDENCE. Saudi Med J. 2004 Apr;25(4):507-10. Pattern of skin diseases in a hospital in southwestern Saudi Arabia. Shelleh HH, Al-Hatiti HS. Department of Dermatology, Najran General Hospital, Najran, Kingdom of Saudi Arabia. hhs_s2000@hotmail.com.OBJECTIVE: To ascertain the type of skin diseases in Najran General Hospital as a rough pattern of skin diseases in Najran region and to compare this with other similar regional studies in the Kingdom of Saudi Arabia (KSA). METHODS: A retrospective 12 months study of the common skin dermatoses, which were recorded  in Najran General Hospital, Najran, KSA, within the period December 2000 to December 2001. RESULTS: We recorded 1192 new patients within the study period, 37% had one of the dermatitis or eczema group of diseases, 12.75% had acne, 7% had vitiligo, 5.9% had viral infections 5.6% had superficial mycoses, 5% had bacterial infections, 1.51% had psoriasis and only 1.1% had lichen planus. By comparison, the incidence of dermatitis or eczema, acne and vitiligo was slightly higher in Najran compared to other regions such as Asir, Hail, Al-Jouf and Jeddah, KSA owing, probably, to the genetic predilection of Najran community to these disorders. Najran was lower than others in psoriasis and in lichen planus,  but in minimal deviations. However, Najran was comparable to others in infective  diseases including viral warts, superficial mycoses and bacterial infections. CONCLUSION: This comparison indicates that there were no large differences between Najran and other compared regions of KSA and this region is present in the heart of health development.

ETIOLOGY / CASE REPORT. Ann Pharmacother. 2004 May;38(5):795-8. Epub 2004 Mar 16. Lichenoid drug eruption probably associated with rofecoxib. Abu-Shraie NA, Alfadley AA. Department of Pharmacy Services, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia. Nada@kfshrc.edu.sa. OBJECTIVE: To report a case of lichenoid drug eruption (LDE) probably induced by  rofecoxib. CASE SUMMARY: A 73-year-old woman was prescribed rofecoxib 25 mg/day for rheumatoid arthritis in addition to other medications on which the patient had been stabilized. Six months after initiation of rofecoxib, linear plaques over the infra-orbital and bitemporal areas of both eyes were observed. Several itchy violaceous papules also developed on her right wrist and dorsum of the left foot. She also had a hyperpigmented macule on her right buccal mucosa. As the skin rash was localized and the patient was initially unwilling to undergo skin biopsy, rofecoxib was continued and a topical steroid was started. One month later, the patient was seen in the dermatology clinic, and the improvement of her skin reaction was significant. A skin biopsy performed during this visit was consistent with LDE. On the next day, her rheumatologist decided to discontinue the offending drug, rofecoxib. Two months later, all skin lesions had completely resolved. No rechallenge with rofecoxib was attempted. DISCUSSION: LDE is a rare skin reaction that can be associated with several drugs. Rofecoxib, a cyclooxygenase-2 inhibitor, has never before been reported to cause LDE. An objective causality assessment indicates that rofecoxib was the probable cause of the skin reaction. CONCLUSIONS: As of this writing, to our knowledge, this is the first case report in the English literature in which rofecoxib had led to the development of LDE.

ETIOLOGY. Skinmed. 2004 Mar-Apr;3(2):107. Misconceptions surrounding genetic diseases in developing countries. Al Hawsawi K, Al Aboud K, Wolf R. Department of Dermatology, King Faisal Hospital, Al Taif, Saudi Arabia. khawsawi2002@yahoo.com

CPE: cpeinmed. 2004 Jan-Feb;3(1):11-2. Eponyms in dermatology. Al Aboud K, Al Hawsawi K, Ramesh V, Al Aboud D, Al Githami A. Dermatology Unit, Department of Medicine, King Faisal Hospital, Taif, Saudi Arabia. amoa65@hotmail.com Comment in:    Skinmed. 2004 Nov-Dec;3(6):306. Comment on: Skinmed. 2003 May-Jun;2(3):145-6.

CLINICAL PRESENTATION / CASE REPORT. J Drugs Dermatol. 2003 Dec;2(6):658-9. Fixed drug eruption to ibuprofen in daughter and father. Al Aboud K, Ramesh V, Al Hawsawi K. Dermatology Unit, Department of Medicine, King Faisal Hospital, Taif, Saudi Arabia. amoa65@hotmail.com.Fixed drug eruption (FDE) is a common cutaneous reaction which may be seen in reaction to several medications. The usual etiologic agents associated with FDE are phenazones, sulfonamides, and tetracyclines. Often the causative agent is made out from the patients history; in some cases, oral challenge or topicaltesting may be required. The pathophysiology of FDE is unclear. Cell-mediated,rather than humoral immunity is thought to be involved. Herein we report a case of FDE in a daughter and father.

CLINICAL PRESENTATION / CROSS SECTION. Saudi Med J. 2003 Dec;24(12):1381-7. Skin cancers in Western Saudi Arabia. Al Aboud KM, Al Hawsawi KA, Bhat MA, Ramesh V, Ali SM. Dermatology Unit, Department of Medicine, King Faisal Hospital, Taif, Kingdom of  Saudi Arabia. amoa65@hotmail.com. OBJECTIVE: A retrospective analysis of skin cancers in a major referral centre in Taif region, Kingdom of Saudi Arabia, (KSA). METHODS: The case records of all malignant skin cancers diagnosed during a 10 year period, from 1992 through to 2001 were taken for the study. The clinical and histopathological details were noted. These were compared to reports from the rest of KSA and other countries. RESULTS: One hundred and four cases of malignant skin lesions including primary and metastatic tumors were seen. The majority were Saudis. The male to female ratio was 2.25:1. Most of the patients were over the age of 60 years. Basal cell carcinoma was the most frequent (51%) followed by squamous cell carcinoma (26%) and malignant melanoma (12.5%). Other rare primary tumors were those arising from the skin appendages, dermatofibrosarcoma protuberans and Kaposi's sarcoma. Metastatic skin lesions were seen in 5; in one it resulted from a surgical procedure and in the others the primary site could not be determined. CONCLUSION: The number of patients seen in this report is not high indicating that protective factors like clothing and skin type of the individual played a protective role. However, we feel that more studies should be encouraged in other regions along with the creation of a registry within each area to monitor the information regarding skin cancers. This could then be incorporated in health education programmes to be imparted to the public.

CLINICAL PRESENTATION. Skinmed. 2003 Jan-Feb;2(1):57-8. First branchial cleft sinus. Al Aboud K, Al Hawsawi K, Ramesh V, Al Aboud D, Al Githami A. The Dermatology Unit, Department of Medicine, King Faisal Hospital, Taif, Saudi

Arabia. amoa65@hotmail.com.

CLINICAL PRESENTATION / REVIEW. Skinmed. 2003 Mar-Apr;2(2):104-7. Cutaneous signs. Al Aboud K, Al Hawsawi K, Ramesh V, Al Aboud D, Al Githami A. The Department of Dermatology, King Faisal Hospital, Taif, Saudi Arabia. amoa65@hotmail.com. Comment in:  Skinmed. 2003 Mar-Apr;2(2):78-9. Skinmed. 2003 Nov-Dec;2(6):337; author reply 337. Cutaneous signs play a significant role in clinical medicine. Signs have often been named after the initial observer. They may indicate either dermatologic or systemic illness and aid the examiner in diagnosis and relevant investigations. Some are specific, some have been described in other conditions, and few have lost their relevance. Most of the signs are related to the pathogenesis of the disease but the cause of some is not clear.

CPE. Skinmed. 2003 May-Jun;2(3):151-3. An appraisal of terms used in dermatology. Al Aboud K, Al Hawsawi K, Ramesh V, Al Aboud D, Al Githami A. The Dermatology Unit, Department of Medicine, King Faisal Hospital, Taif, Saudi Arabia. amoa65@hotmail.com.

CLINICAL PRESENTATION / CASE REPORT. Saudi Med J. 2003 Nov;24(11):1264-6. Erythrokeratoderma variabilis. Bukhari IA, Juma'a NA. Department of Dermatology, King Fahad Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia. consultant@dermatologyclinics.net. Erythrokeratoderma variabilis is a rare autosomal dominant genodermatosis of variable expressivity. In this report, we describe the clinical features and microscopic findings in one of our patients born to unaffected parents. We also briefly review the literature on this disorder.

CLINICAL PRESENTATION / CASE REPORT. J Am Acad Dermatol. 2003 Nov;49(5 Suppl):S244-6. Hyperpigmentation in Chediak-Higashi syndrome. Al-Khenaizan S. Division of Dermatology, Department of Medicine, King Fahad National Guard Hospital, Riyadh, Saudi Arabia. salkehenaizan@hotmail.com. We describe a 4 1/2 -year-old Saudi Arabian boy born to consanguineous parents who was initially seen with gradual onset of fever and abdominal distention. The  patient was found to have speckled hypopigmentation and hyperpigmentation of the sun-exposed areas. The finding of large cytoplasmic granules in blood and bone marrow leukocytes established the diagnosis of Chediak-Higashi syndrome. We review the literature on this finding, which might be underreported, especially in darkly pigmented races.

CLINICAL PRESENTATION / CASE REPORT. Dermatology. 2003;207(3):329-30. Imatinib (STI-571)-induced exfoliative dermatitis in a Saudi patient with deck chair sign. Banka N, Aljurf M, Hamadah I.

CPE. Saudi Med J. 2003 Sep;24(9):1006-9. Electives during medical internship. Al-Sultan AI, Parashar SK, Al-Ghamdi AA. Department of Internal Medicine, King Faisal University, PO Box 3479, Al-Khobar, 31952, Kingdom of Saudi Arabia. alialsultan@yahoo.com. OBJECTIVE: The purpose of the study was to find out the reasons for selecting elective rotations during a rotating medical internship. METHODS: One hundred and seventy-eight medical interns in the College of Medicine, King Faisal University, Dammam, Kingdom of Saudi Arabia during the period March 2001 to August 2002 completed a questionnaire for their selection reasons with responses on a scale of 1-5. RESULTS: The study comprised 60% males and 98.3% Saudis. The most frequently chosen electives are dermatology 28.1%, radiology 20.8%, anesthesia 9.6% and otorhinolaryngology (ear, nose and throat [ENT]) 9%. Significantly, more males (89.2%) chose radiology rotation and more females (75%) chose ENT rotation. The leading reasons to choose an elective rotation are: 1. to gain broad medical  training and education, 2. to assist in choice of future specialty, and 3. being relevant to future specialty. The mean score for ENT and dermatology is higher than radiology and anesthesia for the response "to participate in medical practice in different institute", while dermatology is higher than anesthesia for the response "to help getting acceptance for job in the same institute", and radiology is higher than ENT and anesthesia for the response "it has infrequent or no night duties". CONCLUSION: The reasons chosen reflect the educational value of the electives and their important role in choosing future career. Dermatology and radiology rotations are most popular electives, with additional though different reasons.

ETIOLOGICAL / CASE REPORT. Int J Dermatol. 2003 Sep;42(9):682-5. Vitamin D-dependent rickets Type II with alopecia: two case reports and review of the literature. Sultan Al-Khenaizan, Vitale P. Division of Dermatology/Department of Medicine, King Abdulaziz Medical City, King Fahad National Guard Hospital, and the Consulting Clinic, Riyadh, Saudi Arabia. salkhenaizan@hotmail.com. Vitamin D-dependent rickets Type II is a rare autosomal recessive disorder. It usually presents with rachitic changes not responsive to Vitamin D treatment with elevated circulating levels of 1,25-Dihydroxyvitamin D3, thus differentiating it from Vitamin D-dependent rickets Type I. Alopecia of the scalp or the body is seen in some families with Vitamin D-dependent rickets Type II. This is usually associated with more severe resistance to Vitamin D. We report two Saudi brothers with this disease, and review the salient features of this disease with emphasis on the associated alopecia.

CLINICAL PRESENTATION / CASE REPORT. Dermatol Online J. 2003 Aug;9(3):20.Kindler syndrome: two additional features. Al Aboud K, Al Hawsawi K, Ramesh V. Department of Dermatology, King Faisal Hospital, Taif, Saudi Arabia. amoa65@hotmail.com. Kindler syndrome is a hereditary condition that combines the features of blistering and photosensitivity in infancy and early childhood with progressive poikiloderma. We report additional features observed in one affected individual.

KAP / CROSS SECTION. Saudi Med J. 2003 Jul;24(7):765-8. Knowledge, beliefs and perception of youth toward acne vulgaris. Al-Hoqail IA. Department of Dermatology, King Saud University, Riyadh, Kingdom of Saudi Arabia. dermapath@yahoo.com. OBJECTIVE: This study was carried out to assess the knowledge, concepts and perceptions of the youth towards Acne. METHODS: This cross-sectional study included 700 students of both genders from all geographic areas in Riyadh, Kingdom of Saudi Arabia during the year 2001. They were asked to complete a self  administered questionnaire that contained several items measuring different areas in there beliefs, knowledge and perceptions about acne. Acne and non-acne sufferers were included. Responses were matched with demographic data. RESULTS: Five hundred and seventeen students (73.9%) responded to the questionnaire. Male  and female responders were 267 (51.6%) and 250 (48.4%). More than half of them reported that they suffered from acne 276 (53.4%). Three quarters (76%) of the sample considered psychological conditions contribute to occurrence of acne, 72.1% believe that diet is one of etiologic factor. Only 15.9% reported that acne is an infectious disease. Sixty-two percent believed that acne is not a serious problem, while 56.7% consider it as both a cosmetic and health problem. CONCLUSION: The results of this study pointed out that misconceptions and false beliefs on acne are widespread and enduring among the youth. Health education program on acne is needed to improve their understanding of the condition.

CLINICAL PRESENTATION / CASE REPORT. Pediatr Dermatol. 2003 Mar-Apr;20(2):167-8. Linear angioma serpiginosum. Al Hawsawi K, Al Aboud K, Al Aboud D, Al Githami A. Dermatology Unit, Department of Medicine, King Faisal Hospital, Taif, Saudi Arabia. khawsawi2002@yahoo.com. Angioma serpiginosum distributed in a linear fashion along the upper extremity of an adolescent boy is described. Histopathologic examination revealed the characteristic numerous thick-walled capillaries in the dermal papillae.

CLINICAL PRESENTATION / CROSS SECTION. J Am Acad Dermatol. 2003 Mar;48(3):345-51. Dermatologic and oral findings in a cohort of 47 patients with Papillon-Lefèvre syndrome. Ullbro C, Crossner CG, Nederfors T, Alfadley A, Thestrup-Pedersen K. Department of Dentistry, Section of Dermatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. ullbro@kfshrc.edu.sa. Papillon-Lefèvre syndrome is an autosomal recessive disorder characterized by palmoplantar hyperkeratosis and early development of aggressive periodontal infection. The aims of this study were to rank the severity of dermatologic and oral affections using a semiquantitative scoring system, and to evaluate whether the severity of the dermatologic changes were correlated to age, degree of periodontal infection, or both. The study included 47 patients with Papillon-Lefèvre syndrome. With no exception both skin and oral changes developed early in life. The dermatologic involvement showed no correlation with age, whereas the periodontal infection was significantly worse in young children with deciduous teeth. A strong correlation was found between the condition of feet and hands, although the scores for the feet were significantly higher. No significant correlation could be demonstrated between the level of periodontal infection and severity of skin affections, supporting the concept that these 2 major components of Papillon-Lefèvre syndrome are unrelated to each other.

CLINICAL PRESENTATION / CASE REPORT. Afr J Med Med Sci. 2002 Jun;31(2):175-8. Calciphylaxis: case report and literature review. Somorin AO, Al Harbi A, Subaity Y, Zaman AU. Department of Medicine, North West Armed Forces Hospital,

PO Box 100

, Tabuk, KSA. Tissue calcification is a well-recognized common metabolic disease, but calciphylaxis still remains an enigmatic rarity. The latter may be induced experimentally and acquired naturally in human diseases. Although many chronic azotemic or end stage renal disease patients (ESRD) with hyperparathyroidism (HPT) are at risk of calciphylaxis not all of them do develop the disease, even non-renal, patients may also develop this disease. Out of a total of about 2000 hemodialysis, 15,000 dermatology and 26,000 medical patients seen over a three year period in a busy Saudi Arabian tertiary medical centre, we report a sentinel nephrology patient with sudden excruciatingly painful cutaneous calciphylaxis that necessitated acute dermatology emergency consultation, and present a review of the medical literature. In order to institute appropriate total quality management of this life-threatening, rare disease, it is advisable that a high index of suspicion should be entertained by dermatologists, general physicians, nephrologists, and pulmonologists in an appropriate clinical scenario.

CLINICAL PRESENTATION. Eur J Dermatol. 2002 Nov-Dec;12(6):588. Becker nevus on the hand. Al Aboud K, Al Hawsawi K. Department of Medicine, Dermatology Unit, King Faisal Hospital, Taif, Saudi Arabia. amoa65@hotmail.com.

ETIOLOGICAL / CASE REPORT. Saudi Med J. 2002 Nov;23(11):1408-10. Acquired reactive perforating collagenosis associated with sick euthyroid syndrome. Fatani MI, Al-Ghamdi YM, Al-Afif KA, Abdulghani MR, Karima TM. Department of Dermatology, King Faisal Hospital, PO Box 5970, Makkah, Kingdom of Saudi Arabia. m_fatani@yahoo.com. Acquired reactive perforating collagenosis is a rare skin disorder associated with several systemic diseases, particularly diabetes and chronic renal failure. A 52-year-old Saudi female patient with a known case of diabetes mellitus type II, chronic renal impairment, hypertension, peripheral vascular disease, congestive heart failure, stroke and left hemiplegia presented with multiple pruritic skin eruption on the trunk and extremities. We believe that this is the first case of acquired reactive perforating collagenosis in association with sick euthyroid syndrome to be reported.

THERAPEUTIC / CASE REPORT. Int J Dermatol. 2002 Dec;41(12):938-41. Papillon-Lefévre syndrome: the response to acitretin. Al-Khenaizan S. Division Of Dermatology/Department of Medicine, King Abdulaziz Medical City, King Fahad National Guard Hospital, Saudi Arabia. salkhenaizan@hotmail.com. Papillon-Lefévre syndrome is a rare autosomal recessive disease comprising palmoplantar keratoderma and periodontitis. Palmoplantar keratoderma can be severe, necessitating systemic treatment. Different systemic retinoids were found to be highly efficacious. We describe the successful use of acitretin in one patient who had severe palmoplantar keratoderma, with maintenance of the improvement using topical treatment.

CLINICAL PRESENTATION / CROSS SECTION. Int J Dermatol. 2002 Dec;41(12):870-1. Demographic features and seasonal variations in patients with acne vulgaris in Saudi Arabia: a hospital-based study. Al-Ameer AM, Al-Akloby OM. King Fahad Hospital of the University, Al-Khobar, Saudi Arabia. am_ameer@hotmail.com. AIM: To review the demographic features and seasonal variations of acne vulgaris  in patients diagnosed at the Dermatology Outpatient Clinic, King Fahad Hospital of the University (KFHU), Al-Khobar, Saudi Arabia. METHODS: Two hundred and twenty cases (142 females, 78 males; mean age, 14.8 and 16.3 years, respectively) seen between January 1, 1999 and December 31, 2000 were studied. RESULTS: Patients suffering from acne vulgaris made up 19.6% of the new cases seen at the  clinic. The male to female ratio was 1 : 1.8. The mean age of onset was 16.3 +/- 2.1 years for males and 14.8 +/- 3.9 years for females (P = 0.003). The largest numbers of patients were seen during the cold months of the year (November to February). CONCLUSIONS: Acne vulgaris constituted nearly one fifth of all visits to the dermatologist with female predominance. It appears nearly one and a half years earlier in females than in males. Seasonal variations were observed in acne as the condition exacerbates in winter, while if often improves during the summer months.

CLINICAL PRESENTATION / CASE SERIES. Clin Exp Dermatol. 2002 Nov;27(8):673-6. Kindler syndrome in a Saudi kindred. Al Aboud K, Al Hawsawi K, Al Aboud D, Al Githami A. Dermatology Department, King Faisal Hospital,Taif, Saudi Arabia. moa65@hotmail.com. We report a large consanguineous Saudi-Arabian pedigree containing 11 individuals with the autosomal recessive genodermatosis, Kindler syndrome. Three affected cases died in infancy but the remaining eight had signs of photosensitivity, generalized poikiloderma, webbed fingers, loss of dermatoglyphics and nail dystrophy. The majority also had oral involvement with bleeding gums. Additional features seen in some cases included pseudoainhum of the toes, sclerotic bands on the wrists and hand deformities. The aetiology of Kindler syndrome is not yet known, but the underlying defect leads to both cutaneous and oral inflammation, along with photosensitivity and scarring.

CLINICAL PRESENTATION / CASE REPORT. Pediatr Dermatol. 2002 Nov-Dec;19(6):523-6. Dyschromatosis universalis hereditaria: report of a case and review of the literature. Al Hawsawi K, Al Aboud K, Ramesh V, Al Aboud D. Dermatology Unit, Department of Medicine, King Faisal Hospital, Taif, Saudi Arabia. khawsawi2002@yahoo.com. We describe dyschromatosis universalis in a 19-month-old Saudi Arabian girl. She  had no associated defects and none of the other family members were affected. Similar cases reported from countries other than the Far East, where the disease was first described, are discussed.

CPE Int J Dermatol. 2002 Sep;41(9):594-5. Mnemonics in dermatology; an appraisal. Al Aboud K, Al Hawsawi K, Ramesh V, Al Aboud D. Dermatology Unit, Department of Medicine, King Faisal Hospital, Taif, Saudi Arabia. amoa65@hotmail.com

CLINICAL PRESENTATION / CASE REPORT. Saudi Med J. 2002 Aug;23(8):1002-4. Cold cellulitis. An unusual presentation of cutaneous leishmaniasis. Shelleh HH, Khan SA, Al-Shayeb AM, Al-Hateeti H, Khan LA, Kasabah MN. Department of Dermatology, Najran General Hospital, Kingdom of Saudi Arabia. hhs_s2000@hotmail.com. We describe a case of cutaneous leishmaniasis, which presented as what we call "cold cellulitis". This may be differentiated from classical cellulitis/erysipelas by 1. Lesser local reaction like pain and tenderness 2. No systemic symptoms 3. No leucocytosis 4. Negative bacteriological and serological  assay for bacterial cellulitis/erysipelas, 5. Longer course of illness and 6. Failure to respond to antibiotics. However, awareness of this type and frequent skin smears or skin biopsy will settle the right diagnosis. A review of different leishmanial presentations is given for comparison.

CLINICAL PRESENTATION / CASE SERIES. Pediatr Dermatol. 2002 Jul-Aug;19(4):333-5. Congenital insensitivity to pain in four related Saudi families. Karkashan EM, Joharji HS, Al-Harbi NN. Department of Dermatology and Venereology, Asir Central Hospital, and Department of Pediatrics, King Khalid University, Abha, Saudi Arabia. Congenital insensitivity to pain (hereditary sensory and autonomic neuropathy [HSAN] type V) is a rare disorder of pain perception in which pain sensation is absent from birth, with no other neurologic deficits. We report five Saudi patients (three male and two female) age 10 months to 23 years who lacked pain sensation from birth but have normal appreciation of other sensory modalities. They are from four related families who are descended from one grandfather. The patients had sustained many painless injuries resulting in fractures and disfigurement, but otherwise are completely normal.

CLINICAL PRESENTATION / CROSS SECTION. Saudi Med J. 2002 Jul;23(7):782-5. Pyoderma among Hajj Pilgrims in Makkah. Fatani MI, Bukhari SZ, Al-Afif KA, Karima TM, Abdulghani MR, Al-Kaltham MI. Department of Dermatology and Microbiology, King Faisal Hospital, PO Box 5970, Makkah, Kingdom of Saudi Arabia. m_fatani@yahoo.com. Erratum in: Saudi Med J. 2002 Oct;23(10):1296. OBJECTIVE: Bacterial skin infections have been considered as a possible health problem of the Hajj pilgrims. Significant increase in the rate of resistance to commonly used antibiotics against gram positive organisms has been observed. The present study was planned to obtain the microbiological profile of bacterial skin infections and their susceptibility to antimicrobials. METHODS: Pyodermas were investigated clinically and bacteriologically by a prospective study conducted on patients attending the dermatology clinic at the King Faisal Hospital, Makkah, Kingdom of Saudi Arabia during 2 Hajj periods (2000 - 2001). RESULTS: Of a total of 80 pyoderma patients, 52.5% were primary and 47.5% secondary. The leading cause of primary pyoderma was found to be impetigo in 28.8% cases, and of secondary pyoderma was infected eczema in 18.8% cases. Positive cultures were found in 87.5% cases. The organisms responsible for primary pyoderma were: Staphylococcus aureus (65.6%), Streptococcus pyogenes (28.1%) or both (6.4%) while in secondary pydermas were: Staphylococcus aureus (44.7%), Streptococcus pyogenes (15.8%), or both (18.4%), and gram negative bacilli (21.1%). The resistant pattern of antimicrobials against Staphylococcus aureus was as follows: penicillin 80.85%, tetracycline 10.6%, gentamicin 6.4%, erythromycin 4.3% and cotrimoxazole [corrected] 4.3%. Oxacillin and cephalothin were found least resistant (2.1%). CONCLUSION: Pyoderma appeared as one of the common health hazard of our Hajj pilgrims. Penicillin and tetracycline are found ineffective in treating skin infections caused by Staphylococcus aureus while oxacillin is recommended as first line of treatment.

CLINICAL PRESENTATION / CROSS SECTION Int J Dermatol. 2002 Jul;41(7):411-4. Prayer marks. Abanmi AA, Al Zouman AY, Al Hussaini H, Al-Asmari A. Dermatology Department, Research Center, Riyadh Al Kharj Armed Forces Hospital, PO Box 7897, Riyadh 11159, Saudi Arabia. abanamidr@yahoo.com. Comment in: Int J Dermatol. 2004 Dec;43(12):985-6. BACKGROUND: Prayer marks (PMs) are asymptomatic, chronic skin changes that consist mainly of thickening, lichenification, and hyperpigmentation, and develop over a long period of time as a consequence of repeated, extended pressure on bony prominences during prayer. METHODS: Three hundred and forty-nine Muslims and 24 non-Muslims were examined for the appearance of PMs at different body sites. RESULTS: The prospective study of 349 Muslims (both males and females) with regular praying habits showed the occurrence of PMs on specific locations, such as the forehead, knees, ankles, and dorsa of the feet, leading to dermatologic changes consisting of lichenification and hyperpigmentation. The incidence of PMs was significantly higher in males than in females. Older subjects (over 50 years of age) demonstrated a significantly higher frequency of lichenification and hyperpigmentation, suggesting that repeated pressure and friction for prolonged periods are the causative factors for the development of PMs. Histologic examination of skin biopsies from the affected sites showed compact orthokeratosis, hypergranulosis, dermal papillary fibrosis, and dermal vascularization. PMs were not associated with any risk of secondary complications, such as erythema, bullous formation, and infections. CONCLUSIONS: PMs are commonly occurring dermatologic changes in Muslims who pray for prolonged periods.

CLINICAL PRESENTATION / CASE REPORT. Int J Dermatol. 2002 Jul;41(7):397-9. Anonychia congenita totalis: a case report and review of the literature. Al Hawsawi K, Al Aboud K, Alfadley A, Al Aboud D. Dermatology Unit, Department of Medicine, King Faisal Hospital, Taif, Saudi Arabia. khawsawi2002@yahoo.com

CLINICAL PRESENTATION / CASE REPORT. Int J Dermatol. 2002 May;41(5):293-5. Cutaneous foreign bodies: elusive presentation. Case report and review of the literature. Al-Jasmi F, Al-Khenaizan S. Division of Dermatology, Department of Medicine, King Fahad National Guard Hospital, Riyadh, Saudi Arabia. Injuries by foreign bodies are a common problem in children, and sewing needles are not uncommonly found foreign bodies. Cutaneous foreign bodies are also occasionally seen, and these patients are referred to dermatologists because of skin findings resulting from body reactions. In this report we present an unusual case of a foreign body presenting as a linear skin eruption.

CLINICAL PRESENTATION / CROSS SECTION. J Cutan Pathol. 2002 May;29(5):291-4. Benign lichenoid keratoses with histologic features of mycosis fungoides: clinicopathologic description of a clinically significant histologic pattern. Al-Hoqail IA, Crawford RI. Department of Dermatology, King Khalid University Hospital and Faculty of Medicine at King Saud University, Riyadh, Saudi Arabia. BACKGROUND: Benign lichenoid keratosis (BLK) is a well-known clinicopathologic entity and several histopathologic patterns have been described. Features mimicking mycosis fungoides (MF) in clinically typical BLKs have not yet been emphasized. The aim of this study was to confirm the occurrence of an MF-like pattern of BLK. METHODS: A retrospective survey was conducted on cases diagnosed as BLK over a 9-month period in a regional dermatopathology service. Seven histologic parameters, previously confirmed as diagnostically suggestive of MF, were applied. Inclusion criteria were: three or more MF-related histologic features and a size less than 2 cm. The clinical features were reviewed. RESULTS: Fifteen cases of MF-pattern BLK were identified. The number of MF-like parameters present in individual cases exceeded the inclusion criteria by variable amounts. Pautrier microabscesses and alignment of lymphocytes along the basal layer were the most frequent (14/15). The age of the patients ranged from 28 to 83 years, with a mean of 50. The size of the lesions ranged from 0.2 to 1.8 cm, with a mean of 0.6 cm. The upper trunk was the favored site. Most of the lesions had been removed because of suspicion of cutaneous malignancy; basal cell carcinoma was the most frequent clinical diagnosis. CONCLUSION: We describe an MF-like histologic pattern of BLK. Pathologists and dermatopathologists should be aware of this novel histologic pattern to facilitate distinction between the two disorders.

CLINICAL PRESENTATION / CROSS SECTION. Saudi Med J. 2002 Feb;23(2):213-7. Psoriasis in the eastern Saudi Arabia. Fatani MI, Abdulghani MH, Al-Afif KA. Department of Dermatology, King Fahd Hospital of the University, Al-Khobar,  Kingdom of Saudi Arabia. m_fatani@yahoo.com. OBJECTIVE: To determine the percentage occurrence, demographic and clinical features of psoriasis in adult patients at King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia. METHODS: The medical records of all the adult patients with psoriasis were analyzed from January 1991 to December 1994 at the dermatology clinic, King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia. RESULTS: A total of 263 adult psoriatic patients were studied with the percentage occurrence of 5.3%. There was a male preponderance with sex ratio

of 1.4:1. The mean age of onset in males was 26.9 years while in females it was 22.3 years. Fifty-three percent of psoriatic cases developed before the age of 30 years. Family history of psoriasis was recorded in 8.4% of the cases. Itching was the only symptom reported by patients in 43% of cases. The sites of involvement were as follows: lower extremity 44.9%, scalp 41.8%, nail 26.6% and palmoplanter 12.6%. Plaque psoriasis was the most common clinical type (87.1%), followed by erythrodermic (4.2%), pustular (3%), guttate (1.9%), flexural, (2.3%) and follicular (0.4%). CONCLUSION: The present study represents the apparent magnitude of psoriasis in the eastern province of Saudi Arabia, which may reflect that the disease is common in our area as elsewhere. The clinical features of psoriasis in our patients were similar to those reported from other parts of the world.

ETIOLOGIC / CASE REPORT. J Am Acad Dermatol. 2002 Apr;46(4):606-10. Transfer of vitiligo after allogeneic bone marrow transplantation. Alajlan A, Alfadley A, Pedersen KT. Section of Dermatology, Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia. Adoptive transfer of donor immunity has been demonstrated in animals after bone marrow transplantation (BMT). In humans, several autoimmune diseases have been similarly transferred. Although BMT may, per se, be associated with a modulation of the recipient's immune system, which could trigger or even cause autoimmune diseases, both animal experiments and experience with humans show the likeliness of adoptive transfer of donor immunity to the recipient. We describe a patient with multiple myeloma in whom generalized vitiligo developed within 3 monthsafter allogeneic BMT from his HLA-matched sister with vitiligo. We believe that a form of adoptive transfer of donor immunity to the recipient might play a role in the development of vitiligo. In spite of this, neither de novo development of vitiligo in a genetically predisposed patient nor autoimmune phenomena associated with graft-versus-host disease can be completely excluded as a contributing factor for development of vitiligo in our patient. To our knowledge, this is the first case report of transfer of vitiligo after BMT from a donor with vitiligo.

CLINICAL PRESENTATION / CROSS SECTION. J Am Acad Dermatol. 2002 Apr;46(4):510-6. Junctional epidermolysis bullosa in the Middle East: clinical and genetic studies in a series of consanguineous families. Nakano A, Lestringant GG, Paperna T, Bergman R, Gershoni R, Frossard P, Kanaan M, Meneguzzi G, Richard G, Pfendner E, Uitto J, Pulkkinen L, Sprecher E. Department of Dermatology and Cutaneous Biology, Jefferson Medical College and Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA, USA. BACKGROUND: Junctional epidermolysis bullosa (JEB) is a group of inherited blistering diseases characterized by epidermal-dermal separation resulting from mutations that affect the function of critical components of the basement membrane zone. This group of autosomal recessive diseases is especially prevalent in regions where consanguinity is common, such as the Middle East. However, the clinical and genetic epidemiology of JEB in this region remains largely unexplored. OBJECTIVE: The aim of the present study was to assess a series of consanguineous JEB families originating from the Middle East. METHODS: We identified 7 families referred to us between 1998 and 1999 and originating from the United Arab Emirates, Saudi Arabia, Sudan, Yemen, and Israel. Histologic, immunofluorescence, and electron microscopy studies were performed to direct the subsequent molecular analysis. DNA obtained from all family members was amplified by means of polymerase chain reaction and analyzed by conformation-sensitive gel electrophoresis with subsequent direct sequencing. RESULTS: In 6 families presenting with the clinical and histologic features distinctive for JEB, mutations in genes encoding 1 of the 3 subunit polypeptides of laminin-5 were identified. Two families each had mutations in LAMB3, 2 in LAMA3, and 2 in LAMC2. Out of 7 distinct mutations, 5 were novel and 2 were recurrent. No relationship was found between the presence of nonsense/frameshift mutations in laminin-5 genes and perinatal mortality, contradicting a major genotype-phenotype correlation previously reported in the European and US literature. Similarly, none of the recurrent LAMB3 hot spot mutations previously described in other populations was found in our series. Finally, in a family with the clinical diagnosis of generalized atrophic benign epidermolysis bullosa, a homozygous non-sense mutation in Col17A1 gene (encoding the BPAG2 antigen) was identified. CONCLUSION: The present report suggests (1) the existence of a unique spectrum of mutations in the Middle East populations and (2) the need for the implementation of a diagnostic strategy tailored to the genetic features of JEB in this region.

PRACTICE. Int J Dermatol. 2002 Jan;41(1):4-7. Dermatology practice in primary health care services: where do we stand in the Middle East? Al-Hoqail IA, Gad A, Crawford RI. Dermatology Department, King Khalid University Hospital and Faculty of Medicine. King Saud University, Riyadh, Saudi Arabia. dermapath@yahoo.com. BACKGROUND: There has been a distinct expansion of the primary health care services in the Middle East over the past two decades. As a consequence, the exposure of primary care physicians (PCPs) to skin disorders has increased. However, information is lacking regarding the level of proficiency of PCPs in this field. OBJECTIVE: The purpose of our study is to assess the ability of the primary care physicians, with or without training in dermatology, to identify, diagnose and manage skin disorders. MATERIAL AND METHODS: Physicians at university-hospital primary-care clinics were asked to answer a multiple-choice questionnaire regarding various dermatoses. These were grouped into: common, infrequent and rare. Questions included identification of the correct description of the skin lesion, diagnosis, treatment and the desirability of referral. Demographic characteristics of the physicians were also assessed. RESULTS: Nineteen PCPs were included. The eight PCPs who had had specific training in dermatology showed performance superior to that of the PCPs who did not (P =0.04). Not surprisingly, PCPs were able to make the correct diagnosis more frequently for the common dermatoses than for the infrequent or rare dermatoses (P = 0.001). On the other hand, when asked to recognize a correct description of the skin lesion, the PCPs were most often correct with rare dermatoses, and least often correct with common dermatoses (P = 0.04). CONCLUSION: PCPs with a short period of specific clinical training in dermatology perform better in identifying, diagnosing and managing skin disorders than those without. Such training for PCPs should be considered to provide more effective delivery of

health care.

CLINICAL PRESENTATION. Saudi Med J. 2001 Dec;22(12):1133-5. Leukemia cutis in a middle aged Saudi patient with acute myeloid leukemia. Al-Akloby OM, Al-Ameer AM,

Bashwari LA.

Department of Dermatology, College of Medicine, King Faisal University, Damman, Kingdom of Saudi Arabia.

ETIOLOGY / CASE REPORT. J Am Acad Dermatol. 2001 Oct;45(4):614-5. Lichen planus occurring after hepatitis B vaccination: a new case. Al-Khenaizan S. Division of Dermatology, Department of Medicine, King Fahad National Guard Hospital, Riyadh, Saudi Arabia. Lichen planus is a pruritic inflammatory dermatosis of unknown origin. An increased prevalence of a wide range of liver disease in lichen planus has been observed by many authors. Most recently, many reports appeared of the occurrence  of lichen planus after administration of different types of hepatitis B vaccines. We report one case and briefly review this intriguing observation.

CLINICAL PRESENTATION / CROSS SECTION. Int J Dermatol. 2001 Apr;40(4):273-5. Pigmentary changes of tinea versicolor in dark-skinned patients. Aljabre SH, Alzayir AA, Abdulghani M, Osman OO. Department of Dermatology, King Fahd Hospital of the University, King Faisal University, Alkhobar, Saudi Arabia. saljabre@hospital.kfu.edu.sa. BACKGROUND: Tinea versicolor causes scaly macular lesions which vary in color from white to brown. In patients with dark skin, tinea versicolor is thought to have a tendency to be hypopigmented. This view has not been formally documented. OBJECTIVE: Our objective was to determine the pigmentary changes of lesions of tinea versicolor in patients with skin types IV and V. METHODS: One hundred cases of tinea versicolor in persons with skin types IV and V were studied. The pigmentary changes and their correlation with the age and sex of the patients and the duration, recurrence, site, and symptomatology of the lesions were determined. RESULTS: There was no correlation between the pigmentary variations of tinea versicolor and the type of skin, sex, and age of our patients or the duration, recurrence, site, and symptomatology of the lesions. CONCLUSIONS: In dark-skinned individuals, tinea versicolor does not tend to be significantly hypopigmented.