Ecthyma gangrenosum in Saudi Arabia

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. Pstudomonas 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

Dermatitis artefacta: a review of 14 cases

Dermatitis artefacta [DA] is a self-inflicted dermatologic injury sometimes produced for secondary gains. Laboratory investigations, including histologic examination of lesional tissue biopsy, are usually negative and do not give a clue to the correct diagnosis. Patients and Over a five-year period, 14 patients were diagnosed with DA at King Fahad Hospital [KFH] in Al Baha during routine outpatient and inpatient dermatologic consultations. The diagnoses were based on vagueness of history given by the patients, and the presence of bizarre skin lesions distributed over sites accessible to the patients' hands. Investigations excluded the possibility of other diseases. In some cases, consultant psychiatric assessment was sought in order to identify possible underlying psychopathologic factors. Seven patients were hospitalized while the rest were managed as outpatients. The 14 patients comprised 12 females and two males aged 12 to 71 [mean 25.9] years. All except one were Saudis. DA in the males was probably caused for secondary gains. The females, four of whom were married and eight single, were aged 12-36 [mean 21.8] years. Nine of the females [64%] had identifiable severe emotional or psychiatric problems. The remaining two were unmarried and had no identifiable underlying factors. This study reveals that the presentation of DA in Saudi Arabia is essentially similar to what has been reported from other parts of the world. It brings into focus a medical problem which needs to be recognized, as greater awareness may bring about earlier correct diagnosis and treatment