Journal of Dermatology & Dermatologic Surgery-JDDS最新文献

Background

Skin lesions are commonly observed in newborns. They have been studied in different regions of the world. There are limited reports from Arab countries and they have not been studied in Saudi Arabia.

Objective

To determine the occurrence rate of cutaneous findings in Saudi newborns and evaluate their association with maternal and newborn factors.

Method

This is a prospective study of cutaneous findings in newborns delivered at King Fahd Hospital of the University between November 2015 and May 2016.

Through performing dermatologic examinations, the relationships between the neonatal skin findings and gender, neonatal age, route of delivery, nationality, skin type, maternal age, illnesses, intake of drugs, and consanguinity were statistically evaluated.

Results

A total of 313 newborns were included in this descriptive prospective cohort study. Skin findings were found in all the examined infants.

The commonest skin finding were Mongolian spot (63.07%) followed by milia (61.34%), erythema toxicum neonatorum (24.92%) and physiological scaling (18.01%). The prevalence of salmon patch was higher in females, milia was more common in newborn examined at the age of 24–48 h.

Mongolian spots were more frequent in babies whose mothers were having diabetes mellitus and physiological scaling was more prevalent in newborns whose parents were relatives.

Conclusion

All newborns had cutaneous lesions. Skin type, baby gender, nationality and age of the baby at the time of examination were influential factors in congenital melanocytic nevus, linea nigra, salmon patch and milia.

Moreover, illnesses during pregnancy and consanguinity had a role on Mongolian spot and physiological scaling occurrences.

The practice of dermatology remains to be one that mainly deals with outpatients, but the role dermatologic consultations also play in the care of inpatients should not be undermined. A few studies examined the significance of dermatologic consultations/referrals.

Methods

25 cases, randomly chosen from recent referrals to the dermatology service at King Fahd Hospital of the University, a tertiary health facility, were studied to determine whether the referral was necessary.

Results

The primary reasons for referral were for reevaluation of diagnosis and therapy (44%), therapy (52%) and diagnosis only in 4% (Table 2). Most frequent requesting services were primary care (32%), general practitioners (28%) and nonspecialist dermatologists (25%). The details of the 25 cases are discussed. The differences between dermatologists vs. non-dermatologists, non-specialists in the evaluation of the individual cases are discussed (Table 1). In 88% of cases, additional testing and tissue confirmation were needed in the evaluation and confirmation of the referrals (Table 3).

Conclusion

Complicated cases and those not responding to therapies given by non-dermatologist practitioners or non-specialists need to have access to tertiary care specialists. Such referrals are of value; however our findings are not informative about quality of care of patients who were not referred.

Background: Acne vulgaris is a very common skin disease and several modalities are used to manage the condition. Among those is Complementary Alternative Medicine (CAM). This study aims to evaluate the prevalence of CAM usage among acne vulgaris patients, and to determine possible factors associated with its adoption over the prescribed modern medicines.

Methods: A cross-sectional survey, conducted during an acne awareness campaign at King Abdulaziz University Hospital (KAUH), in Jeddah, Saudi Arabia. The survey was conducted between January 21st and 28th 2016.

Results: A total of 658 subjects were interviewed of which 68% were female and 32% were male; 72% reported a positive past-history of acne. The face was the most frequently affected site (90.7%). Among all acne sufferers, 77% admitted using CAM. Honey was the most common CAM type used by 53.4%, followed by yogurt (43.4%). Both gender and past history of side effects to medical treatment were associated with CAM use, but the levels of education was not.

Conclusions: CAM users were mainly middle-aged females: their high levels of education did not lower the CAM adoption rates. Their choices could have been driven by cultural beliefs and boundaries embedded in the community.

Lupus erythematosus panniculitis (LEP), an uncommon variant in the clinicopathological spectrum of lupus erythematosus (LE), is rare. There are only a few reported series of patients with this condition; none in individuals of North African ancestry. LEP is characterized by inflammation of the deep dermis and subcutaneous tissue. It usually consists of nodules and hardened subcutaneous plaques on the forehead, cheeks, proximal extremities, and buttocks. Leg involvement is rare and can lead to misdiagnosis. A case of LEP, with unusual involvement of legs, is reported in a 40-year-old woman who had the diagnosis of systemic lupus erythematosus (SLE) four years ago.

Rosai-Dorfman disease is a benign, self-limited non-Langerhans cell histiocytosis of unknown etiology. Its most common clinical feature is extraordinary massive painless cervical lymphadenopathy. This entity may be limited to the lymph nodes; however, more than 40% of patients have extranodal involvement, with the skin being the most frequently affected site. Cutaneous disease without the presence of lymphadenopathy is extremely rare but has been reported. We report the intriguing case of exclusively cutaneous Rosai-Dorfman disease in an 80-year-old African-American woman.

Adverse skin reactions have been reported in 2.7% of patients receiving oral terbinafine. Less common but life-threatening reactions include acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson syndrome, toxic epidermal necrolysis, exacerbation or induction of psoriasis.

We report a case of a 28 year-old woman with no history of psoriasis, the patient presented generalized pustular eruption, erythroderma, prolonged fever and altered general conditions, associated with initiation of oral terbinafine. The histological analysis of the cutaneous biopsy was compatible with pustular psoriasis. The intake of terbinafine was discontinued and treatment by acitretin 25 mg/day associated with emollient cream was started. The evolution was marked by resolution of skin eruption and disappearance of the fever in a few days. The complete remission was reached 2 months later.

The diagnosis of severe generalized pustular psoriasis (GPP), type Von Zumbusch associated with initiation of oral terbinafine was made.

The present case indicates that terbinafine is a drug that may be associated with the development of psoriasis de novo or its exacerbation.

Smart watches are an upcoming trend that provide quick access to smartphone notifications on the wearer’s wrist. Metal portions of the Apple Watch contain small amounts of nickel, however, the interchangeable bands can be made of a variety of different materials including methacrylate polymers and fluoroelastomer synthetic rubber. There are multiple reports in non-peer reviewed literature such as social media and blogs of the Apple Watch causing skin irritation. Here we present a case report of a patient presenting to Wake Forest Baptist Dermatology clinic with a skin rash following use of an Apple Watch with a synthetic rubber watch band. The patient presented with a pruritic erythematous rash distributed in a 2 cm band on the medial flexor aspect of the left wrist that developed after weeks of daily use of an Apple Watch. The presence of a rash focally under the band suggest contact urticaria, irritant contact dermatitis secondary to sweat and friction, or an allergic contact dermatitis process related to the metal of the watch or synthetic rubber of the band. The patient’s report that the rash resolves within hours of removal supports contact urticaria over a contact dermatitis process.

Objectives: To assess the association of vitiligo with thyroid dysfunction, vitamin B12 deficiency, diabetes mellitus and anemia; among Saudi Arab individuals using laboratory data in a controlled fashion. Methods: A case control study was conducted among Saudi nationals with a confirmed diagnosis of vitiligo presenting between July 2014 and December 2015. Sex- and age-matched randomly selected subjects were included as controls. Blood samples from both vitiligo patients and controls were collected and assayed for hemoglobin level, mean corpuscular volume, thyroid stimulating hormone level, free thyroxine level, vitamin B12, and fasting blood glucose. Results: Of the 115 vitiligo subjects, 15% had microcytic anemia compared to 7% of control (p = 0.072). Macrocytic anemia was diagnosed in 1% of vitiligo subjects and in 2% of control (p = 0.404). Vitiligo group had significantly higher prevalence (5%) of primary hypothyroidism compared to control (0%) (p = 0.030). Vitamin B12 deficiency was significantly more prevalent in vitiligo group (16%) compared to control (2%) (p = 0.001). The prevalence of diabetes mellitus was higher in vitiligo group (8%) as compared to control (4%) (p = 0.334). Conclusion: Primary hypothyroidism and vitamin B12 deficiency are significantly more prevalent in Saudi Arab vitiligo patients. Screening vitiligo patients for thyroid dysfunction and vitamin B12 deficiency may be warranted.

Tumor necrosis factor (TNF)-α is quickly released and initiates inflammation at wound tissues, but its precise role in wound healing is not fully understood. We examined the contribution of this cytokine to the early process of healing using a mouse model with full-thickness wounds in skin. TNF-α synthesis was detected just after wound creation, increased during the first several hours, reached a peak level on day 1, and then decreased to the basal level. In mice treated with anti-TNF-α mAb, wound closure was significantly delayed, and distances between the panniculus carnosus edges were significantly longer on day 3, compared with control. Inflammatory cell and fibroblast density were markedly decreased on day 3 in the anti-TNF-α mAb-treated mice compared with control. In contrast, wound healing was accelerated on day 3 when mice were treated with bioactive TNF-α. These results indicate that TNF-α is involved in the early process of wound healing.

Acute Hemorrhagic Edema (AHE) is a rare form of leukocytoclastic vasculitis with an unknown etiology. There are various possible triggers associated with the development of AHE such as Upper Respiratory Tract related infections which have been reported in the literature. A typical case of AHE is a child less than 2 years of age having the symptoms of fever, Acral Targetoid Purpura, and Edema. The course of this illness is benign with a complete resolution within few weeks. This case report involves a patient having the classical symptoms of fever, Purpura and Edema, but with an unusual extensive truncal involvement. Moreover, Rhinovirus infection testing was positive in the child’s case. The presence of the virus gives a suspicion of being the possible trigger for the boy’s AHE. In the previous hospital, the treatment started with steroid for a course of one week without a significant improvement which brought the patients to the Emergency department. A decision of continuing a supportive treatment led to a complete resolution. After 3 weeks the AHE symptoms were gone without any complications.