Etiology of toe-web disease in Al-Ain, United Arab Emirates: bacteriological and mycological studies

We examined and sampled 45 patients with toe-web intertrigo for bacteriological and mycological studies. Prominent isolated pathogens were the genus Candida [57.7%], genus Aspergillus [28.8%], Pseudomonas aeruginosa [26.7%] and coliforms [24.4%]. Dermatophytes scored 4.4% [Trichophyton rubrum]. There were 43 patents [95.5%] who presented with marked hyperkeratosis and maceration of the toe-webs involved. The tradition of the Emirati population of sitting cross-legged may, over time, induce in the toe-webs of overweight individuals a macerated pressure-reaction hyperkeratosis that is colonized by environmental germs. T. rubrum and T. mentagrophytes are uncommon in the Al-Ain environment and this may explain the rarity of dermatophytes in toe-web intertrigo in our study

Acanthosis nigricans, hyperinsulinaemia and risk factors for cardiovascular disease

We examined the association between acanthosis nigricans, hyperinsulinaemia and other risk factors for cardiovascular disease in patients from the United Arab Emirates. Height, weight and sitting blood pressure were recorded in 122 patients with acanthosis nigricans, and blood samples were obtained for measuring fasting cholesterol, high-density lipoprotein cholesterol, triglyceride and uric acid levels. In addition, a glucose tolerance test was performed and blood was sampled for insulin and glucose. Our results indicate that the patients with acanthosis nigricans had a high prevalence of abnormal glucose tolerance and hyperinsulinaemia. In addition, euglycaemic patients with hyperinsulinaemia had a cluster of risk factors for cardiovascular disease

Richner-Hanhart syndrome: oculocutaneous tyrosinosis

Two cases of tyrosinaemia type II, an extremely rare inborn error of metabolism with a deficiency in tyrosine aminotransferase, are reported. Our patients presented with elevated tyrosinaemia, tender patchy palmoplantar keratoderma and pseudoherpetic keratitis, characteristic of the syndrome, but were not mentally retarded. Etretinate relieved pain, eye and skin lesions rapidly, and prevented recurrences, without lowering serum tyrosine. Skin lesions contain crystal-like intractyoplasmic inclusions of tyrosine. An acidic type I Keratine 64kd, which is present in palmoplantar skin only, may be altered and/or provide a more favourable terrain for crystallisation. Etretinate decreases this type of keratin, which explains the long term benefit of maintenance therapy. In addition, its rapid action in alleviating pain may be ascribed to competition with tyrosine at the cell receptor level, thus increasing the threshold for crystallisation and/or clinical manifestations