Juvenile xanthogranuloma (JXG) is a histiocytic disorder that is usually benign and limited to the skin. Usually it regresses spontaneously, more often without or with limited skin changes. The systemic form of JXG is rare and may be associated with severe morbidity and mortality due to CNS involvement. Here, we describe a 15 year old boy with puzzling skin lesions evolving since last 6 months on the neck. A skin biopsy and immunohistochemistry confirmed the diagnosis of JXG.
Papular Elastorrhexis (PE) is a very rare acquired skin disease of unknown etiology characterized by asymptomatic, discrete, hypo-pigmented, non-follicular, tiny skin papules. We report a 52-year-old Saudi female patient who is otherwise healthy presented with a history of asymptomatic persistent skin lesions on her neck that have been increasing in number since adolescence. There are no similar skin lesions in the family. Skin examination showed multiple tiny non-scaly hypo-pigmented-skin colored dome-shaped papules on her neck. Skin biopsy showed normal epidermis and dermis. The elastic stain showed reduced and fragmented elastic fibers in the reticular dermis.
Chronic urticaria (CU) is a multifactorial disease, however, in a majority of patients, it is not possible to ascribe a specific aetiology, which is termed ‘idiopathic’. Although autoimmunity has been implicated as a principal cause in 30–50% of these idiopathic cases, activation of coagulatory and inflammatory cascades has gained attention in last few years.
To evaluate levels of mean platelet volume, an indicator of platelet activity, in patients with chronic urticaria and determine its correlation with its severity.
Mean platelet volume levels were assessed in 194 patients with chronic urticaria and were compared with equal number of age and sex matched controls. Its levels were also correlated with the severity of urticaria and results of autologous serum skin test.
Mean platelet volume (MPV) levels were found to be higher in patients with ASST positive chronic urticaria compared to patients with ASST negative chronic urticaria and controls. MPV levels also showed a positive correlation with the severity of chronic urticaria.
As platelets secrete and express a number of crucial mediators of coagulation and inflammation, coagulation and inflammatory cascades may play a positive role in chronic urticaria, paving the way for better understanding of pathogenesis and introduction of newer drugs.
Rosacea is a chronic inflammatory cutaneous disorder. Its pathogenesis was unclear and controversial; Helicobacter pylori (H. pylori) infection, genetic predisposition and climatic factors are implicated as triggers of rosacea.
To examine the epidemiological characteristics of rosacea patients, the triggered factors, and to assess the prevalence of H. pylori among the patients, and its relation to the subtypes and severity of rosacea.
Thirty-six Libyan patients with rosacea were assessed with a complete history and subjected to clinical examinations. Blood samples for the detection of IgG antibodies against H. pylori were collected.
Females were more frequently affected. The papulopustular subtype was seen in 61% of the patients. The precipitating factors were sun exposure seen in 63.9% and thermal stimuli in 41.7% of the patients. Serum IgG to H. pylori was positive in 58.3% of the patients, moreover, it was significantly higher in severe rosacea (P < 0.05) regardless of the type of the disease.
The papulopustular subtype of rosacea was the most common, moreover, many patients also had other subtypes of rosacea simultaneously. Sun exposure plays a critical role in its etiology. H. pylori represents a significant cofactor that may contribute to the severity of the disease.
Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma. Hypopigmented MF is one of the less common variants of MF. Although rare, the exact frequency of HMF is still unknown.
We performed a retrospective review of 17 cases of hypopigmented mycosis fungoides at two major tertiary centers in Saudi Arabia from the period 2010–2013. We described the clinical and important histological features of these cases. CD3, CD4, CD8, and CD7 stains performed for these cases have also been reviewed.
There were 5 male and 11 female patients. The age of onset of disease ranged between 5 and 60 with a mean of 17 years. All the patients presented with hypopigmented scaly patches. Most common sites of distribution of the lesions were upper and lower extremities (100%) then the trunk (76%). The presence of lymphocytes at the dermoepidermal junction was the most frequent finding seen in 100% cases. Basilar predilection of the lymphocytes was seen in 75.5%. CD8 positivity in epidermal and dermal lymphocytes was seen in 14/17 biopsies. Focal positivity CD4 of the dermal lymphocytes was evident in 5/17. Loss of CD7 is noted in 14/17 biopsies.
Senile purpura is a common, chronic skin disorder. It is induced by prolonged sun exposure, especially in fair skin people, on a genetic background and influenced by administration of aspirin, cytotoxic agents and topical and/or oral steroids.
We reported a 56 year-old female patient with purpura along the dorsal areas of superior limbs after Infliximab.
Juvenile hyaline fibromatosis (JHF) is a rare, autosomal recessive disease characterized by early onset papulonodular skin lesions, soft tissue masses, joint contractures, gingival hypertrophy, stunted growth and osteolytic bone lesions. Histopathological examination of the cutaneous lesions is unique and characterized by an accumulation of an amorphous, hyaline material in the dermis with increased number of fibroblasts. Herein, we report an 11 year-old girl who presented with papulonodular lesions on the scalp, chin, ears, elbows, knees, back and perianal skin. She had gingival hypertrophy and contractures of the elbows, hips, knees and ankles.
Little is known about the clinical patterns of vitiligo and its associations in Arab countries, particularly Saudi Arabia.
We performed a retrospective review of 135 medical records of patient with vitiligo seen at the Hera Hospital, Makkah, Saudi Arabia between January 2010 and June 2013.
Of the 135 patients (mean age, 24.5 years), 91 (67.4%) were females. Twenty-six patients (25%) had a positive family history, 12.6% with associated thyroid disorders, 9.6% diabetes mellitus, 8.9% atopic dermatitis, 3.7% leukotrichia, and 2.2% alopecia areata. Sixty percent of patients had localized vitiligo, 37% generalized, 9.6% acrofacial, and 1.5% universal. The commonest site for the first vitiligo lesion was the face (28% of patients), whereas the commonest site at the time of diagnosis was the lower limb (51% of cases). The commonest topical treatment for localized vitiligo was tacrolimus (34.8%), whereas narrow band ultraviolet B (14%) had most commonly been prescribed for those with generalized vitiligo.
The patients were predominantly females, with a large proportion having a positive family history. The mean age of onset of vitiligo in our study was 24.5 years. It was commonly associated with thyroid disorders. Localized vitiligo was the most prevalent type.
Cutaneous plasmacytosis is a rare entity that has been reported almost exclusively in Asian countries and is usually seen in adult males. Primary cutaneous plasmacytosis clinically is characterized by multiple red-brown plaques and nodules typically located on the trunk. We report a case of a Moroccan 65-year-old man presented multiple infiltrated red plaques on the extremities and the trunk, the diagnosis of cutaneous plasmacytosis was retained without systemic involvement. To our knowledge, this is the first case of this type reported in a Moroccan adult man.
Lichen planus pemphigoides (LPP) is a rare autoimmune subepidermal blistering disease characterized by evolution of vesico-bullous skin lesions in patients with active lichen planus. We describe a case of LPP in a 12-year-old girl with clinical, histological and direct immunofluorescence findings.
A 12-year-old Moroccan girl presented, after sun burn, pruritic violaceus papules on hands and feet complicated by the apparition of bullous lesions on apparent normal skin and on lichenoid eruption. A white reticulated pattern was present on the oral mucosa. Histopathology of lichenoid papule and bulla was consistent with the diagnosis of LPP. Direct immunofluorescence of peribullous skin showed linear deposits of IgG and C3 at the basal membrane zone. Treatment with Dapsone was successful.
LPP is exceptional in children; just fifteen cases were reported in the literature. This condition seems to be idiopathic. However, in rare cases it has been associated with some drugs or after PUVA therapy. In our patient, it was probably induced by prolonged sun exposure.
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