Leukemia Cutis Presenting as a Morbilliform Eruption: A Case Report and Literature Review.

Leukemia cutis (LC) is a broad term that describes the infiltration of neoplastic leukocytes into the skin. Classically, LC is characterized by erythematous papules and nodules. However, LC can have a widely variable presentation. Therefore, it is crucial to maintain a high index of suspicion for LC through a complete clinical assessment, histopathology, and immunohistochemistry to distinguish this entity from other clinical mimickers. Herein, we report a case of biopsy-proven LC presenting as a morbilliform eruption that was initially suspected to be a drug eruption in a child with acute monocytic leukemia.

The Association of Smoking with Contact Dermatitis: A Cross-Sectional Study.

Contact dermatitis is a chronic inflammatory skin disorder with a highly variable prevalence worldwide. Smoking plays a crucial role in mediating inflammatory skin conditions such as contact dermatitis. The present study aimed to investigate the association between smoking status and contact dermatitis in the Saudi population. The patients in the present study were individuals older than 18 years who were diagnosed with contact dermatitis and received a patch test at the Department of Dermatology of King Saud University Medical City from March 2003 through February 2019. All patients were interviewed by phone to complete a specific pre-designed questionnaire to assess tobacco use or exposure history. The total number of enrolled patients in the study was 308 (91 males and 217 females), all with contact dermatitis. Data from the present study suggest that the prevalence of allergic contact dermatitis in smokers may be less than that in non-smokers. Moreover, the prevalence of irritant contact dermatitis in smokers is more significant than in non-smokers. Finally, left-hand contact dermatitis is significantly associated with smoking. Therefore, there is a strong association between smoking and irritant contact dermatitis, especially in the Saudi population, regarding the left hand. Further epidemiologic studies are needed to further explore the role of smoking in the occurrence of contact dermatitis and to explore the possible mechanisms.

Conversion Rate of Tuberculosis Screening Tests among Dermatology Patients Treated with Tumor Necrosis Factor Inhibitors.

Background: The use of tumor necrosis factor-α inhibitors (TNFi) has been associated with an increased risk latent tuberculosis (TB) reactivation. The role of TB screening assays in monitoring patients during TNFi therapy remains uncertain. Spontaneous conversions and reversions have been described. Aims: This study aims to determine the conversion and reversion rate of TB screening tests among dermatology patients receiving TNFi in a country with moderate TB incidence. Subjects and Methods: A retrospective single-center study conducted on all patients in whom treatment with TNFi was initiated in our dermatology clinic in a tertiary university hospital, Riyadh, Saudi Arabia, until September 2018. Data were collected from the hospital electronic patient information system. Results: One hundred and eighteen patients were included. Majority (79.9%) of patients used adalimumab. Psoriasis was the most common indication (90%). Among patients with negative baseline TB screening who had been retested during TNFi therapy (n = 65; 55%), conversion to positive was observed in nine patients (13.8%) with a mean duration of exposure of 39.7 months, whereas among patients with positive TB testing result (n = 18), 10 (55.5%) reverted to negative. Conclusions: This study emphasizes the need for prospective large-scale multispecialty studies assessing the significance of TB retesting, which should be considered when designing rescreening protocols.

Erythrodermic CD4/CD8 Double-Negative Mycosis Fungoides: A Case Report.

Cutaneous T-cell lymphoma (CTCL) describes a group of lymphoproliferative disorders characterized by localization of neoplastic T lymphocytes to the skin. Mycosis fungoides (MF) represents the most common type of CTCL and accounts for ∼60% of all primary cutaneous lymphomas. Apart from the classic type of MF, many clinical and histopathologic variants have been described. The malignant lymphocytes in MF are usually CD3, CD4 and CD45RO positive and CD8 negative. An unusual immunohistochemical profile of a CD4-negative and CD8-positive mature T-cell phenotype has been reported in a minority of patients; up to 20% of early-stage MF demonstrates a CD8-positive phenotype. There are only a few cases of a double-negative CD4/CD8 MF phenotype reported in the literature. We present the case of a 60-year-old male presenting a double-negative CD4/CD8 MF phenotype.

Publications pattern of dermatology research in Saudi Arabia.

OBJECTIVES: To analyze the quantity and characteristics of Saudi Arabia's (SA's) dermatology research publications throughout the years. Methods: A literature search was conducted between October 2018 and July 2019 in the Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia. PubMed was used as a search engine, to retrieve dermatology-related publications in SA - from the date of the first article publication in 1982 to December 31, 2018. Results: Five hundred publications were included. Two-thirds of them were written between 2010 and 2018. Approximately 50% were from the central region and only 3% were multiregional studies. Funding support was described in 13% of these publications. The top 5 most-researched fields were infectious disorders (12%), genodermatosis (10%), hypopigmentation disorders (9.4%), neoplastic disorders (9%), and hair disorders (7%). Two-thirds of the publications were observational studies, and mostly case reports (44%). Conclusion: Dermatology research in SA has increased over the past decade. However, the quality of research remains inadequate. Saudi Arabia's dermatology research output is affected b   y the availability of funding and national research projects, which could improve the studies' quality. We recommend the establishment of data registry units that can aid researchers in producing high-quality studies, while encouraging the collaboration of different centers in various SA regions (and abroad) to conduct research with generalizable results.

Papillon-Lefèvre Syndrome and Basal Cell Carcinoma: A Case Study.

Papillon-Lefèvre syndrome (PLS) is a rare autosomal recessive disorder characterized by palmoplantar keratoderma and early-onset periodontitis. It was first described by Papillon and Lefèvre in 1924. PLS is caused by mutations in the cathepsin-C (CTSC) gene. The development of malignant skin neoplasms in PLS patients is extremely rare. To date, there have been two cases of malignant melanoma (MM) in PLS patients reported in international journals. Further, only one case of squamous cell carcinoma (SCC) has been reported in PLS patients. To the best of our knowledge, no cases with basal cell carcinoma in PLS patients have been reported in literature. Thus, we report a case of a 55-year-old male from Arabic Saudi with PLS and basal cell carcinoma. The patient was homozygous for a G-to-C substitution at the nucleotide position 815 (CTSC, c.815G>Cp.(Arg272Pro), which is a pathogenic variant. Since this is not the first case of skin cancer in PLS patients, we are supporting the possibility that cathepsin-C play a role in cancer development.

Dupilumab side effect in a patient with atopic dermatitis: a case report study.

Atopic dermatitis (eczema) is a common chronic disease that is described as severe itching associated with recurrent eczematous lesions. In 2017 the US Food and Drug Administration approved dupilumab for treatment of adults with moderate to severe atopic dermatitis not well controlled with topical therapies or when other therapies are inadvisable. Dupilumab is a monoclonal antibody that inhibits interleukin-4 (IL-4) and IL-13 signaling by specifically binding to the IL-4R-alpha subunit shared by the IL-4 and IL-13 receptor complexes. There are many adverse effects reported after dupilumab therapy; commonly reported adverse effects include local injection site reactions, conjunctivitis, headache, and nasopharyngitis. Some adverse effects are rare, eg, alopecia areata and cicatricial extropion. We report a new case of a 28-year-old female who experienced face and neck rash after dupilumab injection.

Linear dermatomyofibroma over the nape of neck: a report of an unusual case and literature review.

Dermatomyofibroma is a rare cutaneous mesenchymal tumor of benign fibroblastic and myofibroblastic derivations. It predominantly affects young women, and it usually presents as a reddish-brown plaque or nodule, which is commonly located over the upper trunk. We report the case of a 41-year-old female patient who presented with progressive linear dermatomyofibroma over the nape of her neck. This case report expands the knowledge about the clinical and histopathological features of this rare, benign and cutaneous tumor.

Histologic characterization of cellular infiltration in autoimmune subepidermal bullous diseases in a tertiary hospital in Saudi Arabia.

BACKGROUND: Autoimmune subepidermal bullous dermatoses have similar clinical features to those of a spectrum of immune reactants at the dermoepidermal junction (DEJ). It is difficult to obtain a precise diagnosis without an immunofluorescence assay because of their similar clinical presentations. The aim of this study was to describe the cellular cutaneous infiltration among autoimmune subepidermal bullous dermatoses. MATERIALS AND METHODS: This retrospective analysis was conducted at a hospital in Riyadh, Saudi Arabia using biopsy-based data collected from 65 patients. RESULTS: Spongiotic changes, neutrophils, and lymphocyte infiltrations in the epidermis differed among the subepidermal bullous diseases. The DEJ showed a difference in the extent of neutrophil infiltration. The dermis showed differences in perivascular lymphocytic infiltration, neutrophilic infiltration, eosinophilic infiltration, and dermal edema. CONCLUSION: The dermal and DEJ showed most of the histopathologic changes in subepidermal autoimmune bullous dermatoses.

Proxy molecular diagnosis from whole-exome sequencing reveals Papillon-Lefevre syndrome caused by a missense mutation in CTSC.

Papillon-Lefevre syndrome (PLS) is an autosomal recessive disorder characterised by severe early onset periodontitis and palmoplantar hyperkeratosis. A previously reported missense mutation in the CTSC gene (NM_001814.4:c.899G>A:p.(G300D)) was identified in a homozygous state in two siblings diagnosed with PLS in a consanguineous family of Arabic ancestry. The variant was initially identified in a heterozygous state in a PLS unaffected sibling whose whole exome had been sequenced as part of a previous Primary ciliary dyskinesia study. Using this information, a proxy molecular diagnosis was made on the PLS affected siblings after consent was given to study this second disorder found to be segregating within the family. The prevalence of the mutation was then assayed in the local population using a representative sample of 256 unrelated individuals. The variant was absent in all subjects indicating that the variant is rare in Saudi Arabia. This family study illustrates how whole-exome sequencing can generate findings and inferences beyond its primary goal.

Perceptions, attitudes, and satisfaction concerning resident participation in health care among dermatology outpatients.

BACKGROUND: A limited number of published studies have discussed patient attitudes toward resident physicians' participation in dermatology clinics. A literature search failed to identify any such study in the Middle East. OBJECTIVE: The aim of this study was to explore patient perceptions and attitudes toward resident participation in dermatology outpatient clinics. METHODS: A self-administered questionnaire focused on patient attitudes toward dermatology resident participation was distributed randomly to all adult outpatients attending dermatology clinics at a university hospital in Saudi Arabia between July and September 2010. RESULTS: The questionnaire was returned by 742 of 900 patients, for an 82% response rate. The mean patient age was 30.58 ± 11.67 years. Forty-two percent (311 of 742) of the respondents were male. The major reason for visiting the hospital was a medical dermatology consultation (80.4%). Only 35% of the patients self-reported an accurate understanding of the "resident" designation. In total, 86.4% of patients were satisfied with the residents' behavior. Furthermore, 98.4% of the patients were satisfied with the medical care provided by the residents. The patients agreed with resident participation in their health care. The majority of the patients expressed their willingness to provide a medical history and receive counseling from residents (87.6% and 86.3%, respectively). There was no gender-associated effect on the understanding of the resident position or the decision to receive a physical examination by a resident. CONCLUSION: Dermatology outpatients are satisfied and have positive perceptions and attitudes toward resident participation in the dermatology clinic.

Clinicopathologic profile of Becker's melanosis with atypical features.

Becker's melanosis (BM) is an uncommon cutaneous hamartoma. The classical descriptionof the lesion is of a macular, pigmented patch found on the upper trunk, with onset at or around adolescence. The aim of this study is to describe the clinicopathologic features of cases of BM which do not fit this typical description. Biopsy registry and laser clinic records from 2000-2006 at the authors' institution were searched for cases with a diagnosis or differential diagnosis of BM. A chart review was then undertaken to record clinical data and histological features of each case. Eleven cases which fit criteria for inclusion in the study were identified. The authors found that these eleven cases could all be described as BM with atypical features but were still clearly within the spectrum of this condition. Contrary to widely held belief, cases of Becker's melanosis with atypical features are not uncommon and might be under-reported.