Association of CYP2C9 Genetic Variants with Vitiligo

BACKGROUND: Vitiligo is a depigmenting skin disorder in which genetic factors play an important role. OBJECTIVE: To examine the association of CYP2C9 *1/*2/*3 gene polymorphism with vitiligo. METHODS: In this case controlled study, 95 Saudi patients with vitiligo (50 men and 45 women), with a mean age of 27.3 years, were analyzed. Patients were compared to 86 healthy controls from the same locality (76 men and 10 women), with a mean age of 20.1 years. In all participants, DNA was extracted and processed for characterization of 2C9 *1/*2/*3 gene variants using real time-polymerase chain reaction. RESULTS: Vitiligo patients have a significantly higher CYP2C9 *3 allele carriage rate compared to controls (32.7% versus 4.7%, p=0.00, odds ratio=9.9, 95% confidence interval=3.3~29.6). On the other hand, frequencies of CYP2C9 *2 genotypes and alleles did not show any significant difference between vitiligo cases and controls. When the frequencies of CYP2C9 genotypes were compared among subgroups of age, gender, family history, and disease patterns, the cases with positive consanguinity had significantly higher frequencies of homozygous genotypes than others (p=0.029). CONCLUSION: CYP2C9 *3 allele carriage is probably associated with vitiligo susceptibility.

Preferential Recognition of Hydroxyl Radical-Modified Superoxide Dismutase by Circulating Autoantibodies in Patients with Alopecia Areata

BACKGROUND: Alopecia areata (AA) is a common form of localized, non-scarring hair loss. The cause of AA is unknown but reports suggest an autoimmune etiology, where oxygen free radicals play an important role. OBJECTIVE: The aim of this study was to investigate the role of a hydroxyl radicals (.OH)-modified antioxidant enzyme, superoxide dismutase (SOD), in AA autoimmunity. METHODS: SOD was modified by .OH radicals. Binding characteristics of autoantibodies in AA patients (n=26) against .OH-modified SOD (.OH-SOD) were evaluated by immunoassays and the results were compared with those of healthy, age-matched controls (n=30). The effects of .OH radicals on immunoglobulin G (IgG) isolated from AA patients were studied. RESULTS: Highly specific binding to .OH-SOD was observed in 32% of the samples of patient sera, whereas normal human sera showed negligible binding with either antigen. Competitive inhibition immunoassays reiterated the results from direct binding. Protein-A-purified IgG from AA patients (AA-IgG) also showed strong binding to .OH-SOD as compared to IgG from normal human controls (p<0.001). In addition, AA-IgG from patients with alopecia universalis recognized .OH-SOD to a greater extent than did AA-IgG from patients with the patchy, persistent type of alopecia. Furthermore, sera from AA patients had lower levels of SOD activity as compared to control sera. CONCLUSION: This is the first report showing an association between .OH-modified SOD and AA. These novel results demonstrate that .OH radical-mediated changes in SOD present unique neo-epitopes that might contribute to antigen-driven antibody induction in AA.

Impact of atopic dermatitis on the quality of life of Saudi children

To assess the impact of atopic dermatitis [AD] on the quality of life [QoL] of Saudi infants and children using a validated/culturally adapted Arabic version of the infants` dermatitis quality of life [IDQoL] index, and to investigate the correlation between IDQoL and disease severity. This study was performed in the Dermatology Clinics and Hospitals affiliated to Qassim University, Buraidah, Saudi Arabia between September 2012 and August 2013. The study was designed to investigate the role of IDQoL in AD patients with different severities. The AD patients [n=630] were evaluated for IDQoL and disease severity using the SCORing of Atopic Dermatitis index. The average [ +/- standard deviation] of IDQoL score was 12.3 +/- 5.1 for all studied subjects. The IDQoL scores were significantly different among the 3 studied severity groups, with a highest score in the severe group [p=0.000]. A positive correlation was observed between the severity of AD and IDQoL scores [r=0.596, p=0.000]. Three items with a negative impact on IDQoL were itching and scratching, the child's mood, and time to get the child to sleep. All these reached a significantly higher value in the severe group compared with the moderate or mild groups [p=0.000]. No significant differences were observed concerning gender or the association with other atopic disorders [p=0.99, and p=0.79]. This study demonstrates that AD manifestations impaired the IDQoL of Saudi patients and were also well correlated with the disease severity score

Cultural adaptation of the Arabic version of the infants' dermatitis quality of life index

To create and validate an Arabic version of the Infants' Dermatitis Quality of Life Index [IDQoL], and to evaluate its reliability and validity in Saudi infants with atopic dermatitis [AD] of various grades of severity. This is a study involving a validation of a newly developed Arabic version of the IDQol. The research was conducted at the dermatology clinics and hospitals affiliated to Qassim University, Buraidah, Kingdom of Saudi Arabia between June 2011 and June 2012. This Arabic generic version of the IDQoL was developed using a translation/back-translation system by 2 bilingual Arabic and English scholars followed by validation and reliability assessment analysis. The developed IDQoL contains a 10-item questionnaire that assesses the impact of AD on different aspects of life. The IDQoL was applied to 370 families with infants with AD, and to 120 control families with infants without AD. The severity of AD was evaluated by the SCORAD Index. This newly developed IDQoL scale showed higher scores among AD infants compared with their respective controls [p=0.00], and the scores were also higher in the severe AD compared to moderate or mild AD groups [p=0.00]. The Cronbachs alpha was found to be 0.87. The item-item, item-total score, or item-severity correlations ranged from moderate to high [>/=0.6], and were statistically significant [p=0.00]. This novel Arabic version of the IDQoL proved to be an excellent tool to measure the disease impact in Arabic families with infants with AD

General practitioners' knowledge and practices related to alopecia areata in Qassim region, Saudi Arabia

The importance of alopecia areata [AA] originated from the social acceptance of its psychological and emotional consequences. This study aimed to explore the knowledge and practices of general practitioners regarding the disease in Qassim region, Saudi Arabia, to obtain baseline data to aid in quality improvement of the available health services. The study included 142 general practitioners working in primary healthcare centers in the Qassim region. Knowledge on causes, risk factors, and treatment practices was obtained using a self-administrated structured questionnaire. The mean [ +/- SD] age of participants was 42.9 +/- 7.8 years. More than 35.0% of them had work experience ofl ess than 10 years. Nineteen percent of the participants had low knowledge score, with significant difference in sex and years of work experience. Approximately 45.8% of surveyed doctors reported AA to be an autoimmune disease, 68.3% incorrectly responded that AA is more c ommon in male patients, 64.1% recognized that family history is important, 26.1% blamedpersonal hygiene, and 16.2% thought that AA is a communicable disease. With regard to man agement, 45.7% of participants prescribed local steroids for treatment; however, 25.3% prescribed only multivitamins. That general practitioners in the Qassim region have satisfactory knowledge of AA, and most of them engage in fair treatment practices. However, there are still some gaps in different aspects that warrant continuous educational programs to improve their quality and performance

Efficacy and safety of oral mega pulse methylprednisolone for severe therapy resistant Alopecia areata

To use intensive regimen of pulse steroid in the severe forms of Alopecia areata. This prospective randomized study was conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between 2003 to 2009. Patients with Alopecia universalis, Alopecia totalis, or Alopecia ophiasis were assigned to one of the 3 treatment groups: Group A received oral mega pulse methylprednisolone [MP] for 3 consecutive days once every 2 weeks for 24 weeks; Group B received 2 consecutive daily pulses every 3 weeks; and Group C received 3 consecutive daily pulses every 3 weeks. Patients who showed regrowth of 75% or more at 24 or 36 weeks continued their treatment, while intervals were increased gradually. Forty-two patients were included in this study, and 52.4% of them had atopic diathesis, while 35.7% had autoimmune thyroiditis. At 36 weeks, 12 [28.6%] patients had adequate response, 9 [21.4%] had inadequate response, and 21 [50%] patients had poor response. The response rate shows no statistically significant difference between treatment groups. There were statistically significant differences in age of onset, duration of the disease, and presence of subclinical hypothyroidism between different response groups. At follow-up: 13 [38.2%] patients relapsed; 5 [14.7%] patients developed moderate hair fall; 3 [8.8%] patients developed mild hair fall; 7 [20.1%] patients maintained their hair regrowth; and 6 [17.6%] patients were lost follow up. It was relatively well-tolerated among groups B and C. Oral mega pulse MP use in severe forms of Alopecia areata has relative efficacy and tolerance but with high relapse rate

Skin manifestations in diabetic patients attending a diabetic clinic in the Qassim region, Saudi Arabia

To investigate the prevalence of skin manifestations in diabetic patients attending a diabetic clinic in the Qassim region, Saudi Arabia. A prospective observational study was performed on 320 patients [174 males and 146 females] attending the diabetic clinic. A detailed dermatological examination was carried out by a consultant dermatologist and the cutaneous findings were recorded. The overall prevalence of skin manifestations was 91.2%. Cutaneous lesions were seen in 12 patients [34.3%] of type 1 diabetes mellitus [DM] and 280 [98.2%] of type 2 diabetics. There was a statistically significant difference [p < 0.001] in skin manifestations between type 1 and type 2 DM patients. For those patients having diabetes of less than 5 years' duration, the incidence of skin manifestations was 80.6%; for those having had diabetes for more than 5 years, the incidence was 98%. This difference was statistically significant [p < 0.001]. The skin manifestations that had a statistically significant difference [p < 0.05] in prevalence between the 2 durational groups were gangrene, diabetic dermopathy, paresthesia, diabetic feet, diabetic bullae and fungal infections. Diabetics had a greater prevalence of skin manifestations in type 2 than type 1, and as the duration of diabetes increased, the likelihood of developing skin manifestations also increased. Early referral to the dermatologist may help to detect complications of the skin in diabetes at an early stage and may prevent disability caused by these complications

[Knowledge, attitudes and practices related to cutaneous leishmaniasis among attendants of primary health care centers in Qassim Region - Saudi Arabia]

To determine knowledge of/and attitudes towards the infection with cutaneous leishmaniasis and the related practices among attendants of primary care centers of Qassim region. A descriptive cross sectional study. Participants [398] were interviewed and completed a structured questionnaire focusing on disease knowledge, attitudes and preventive practices. Approximately 43.2% of the participants showed an insufficient level of knowledge about the disease. The lowest level of knowledge was about how the disease is transmitted or prevented. The most common symptoms reported were: a lesion [54.0%] and a scar [30.4%]. The infectious nature of the disease was known to 14.6% while 29.9% didn't know that the disease can be treated. The majority failed to link the disease spreads with vector bites [91.5%]. Most of participants [73.6%] did not recognized the biting time of the vector. Regression analysis ranked education, high income and presence or history of a case within the family the most significant determinants of knowledge variable. Participants showed insufficient knowledge regarding the disease transmission and the poor related protective practices against the transmitting vector. Educational interventions using different media are recommended

Narrowband ultraviolet B phototherapy improves the quality of life in patients with psoriasis

To examine whether narrowband ultraviolet B [NBUVB] phototherapy administration to plaque-type psoriatic patients leads to an improvement in patient's quality of life [QoL]. A total of 95 patients with plaque-type psoriasis were recruited in the Outpatient Dermatology Clinics of Qassim University affiliated hospitals, Buraydah, Kingdom of Saudi Arabia from January to October 2010. The NBUVB phototherapy was administrated 3 times a week for 6 months in a standardized fashion. Patients were asked to complete pre- and post-phototherapy Dermatology Life Quality Index [DLQI] questionnaire. Seventy-two patients were included in the study, while the remaining 23 were excluded, as they had not completed the post-phototherapy DLQI questionnaire. The statistical differences in mean +/- standard deviation of QoL were measured using Origin 6.1 software package [one paired two tailed t-test with one way analysis of variance] based on pre- and post-phototherapy questionnaires. The administration of NBUVB phototherapy to plaque-type psoriasis patients significantly improved the QoL, and was well-correlated with the reduction in psoriasis area and severity index [PASI] score. Data showed that DLQI significantly improved in both male and female patients [p=0.00] after NBUVB phototherapy. The visual analogue scale [VAS] scores also significantly improved [p=0.00] with NBUVB. In this study, we found that NBUVB phototherapy improves the QoL of plaque-type psoriasis patients