Dermatology Patients' Knowledge of Sunscreen Guidelines at a University Hospital in Saudi Arabia.

Objective: The goal of this study is to assess the knowledge and attitude of dermatology patients regarding sunscreen use as recommended by the American Academy of Dermatology. Methods: This was an observational cross-sectional study at a university hospital in Riyadh. Participants were asked to complete a questionnaire to measure their knowledge and attitude regarding sunscreen use. Results were analyzed using a chi-square test. Results: Most participants heard about sunscreen (93.4%) and had indicated previous sunscreen use (72%). Sunscreen use was higher among women and participants with a postgraduate education. Sunscreen knowledge was higher among women, participants with non-photosensitive disorders, and participants with Fitzpatrick I, II, and III skin types. A total of 80% knew the worst time for sun exposure, but only 20.5% of the participants knew that sunscreen should be applied daily throughout the year, and 13.5% knew the correct minimum recommended SPF. A total of 34% were aware of the minimum time allowed for sunscreen application before sun exposure, and 20% were aware of the longest period allowed between reapplications. Only 4.5% knew the proper amount of sunscreen to cover the entire body. Conclusion: Our study revealed that most participants had heard of sunscreen, however their knowledge of the guidelines for sunscreen use was poor. Only 33% of the participants had received a recommendation for using sunscreen from their general practitioner or dermatologist. More comprehensive and directed efforts need to be made in counselling and educating these patients on proper sunscreen practice.

Adult Blaschkitis With Lichenoid Features and Blood Eosinophilia.

There have been many reports of congenital and acquired dermatoses that trail Blaschko lines. Lichen striatus is representative of an acquired cutaneous linear inflammatory dermatosis running along the lines of Blaschko, characterized histopathologically by the predominance of lichenoid infiltration. Adult blaschkitis, however, is considered under the same disease spectrum as lichen striatus and is characterized by a spongiotic reaction pattern. Few differences have been recognized between lichen striatus and adult blaschkitis such as age of onset, triggers, distribution, histopathology, and response to treatment. A case of male patient with adult blaschkitis presenting as unilateral asymptomatic erythematous edematous papules, papulovesicles, and plaques over Blaschko's lines, in which skin biopsy revealed coexistent pathological features of lichen striatus and adult blaschkitis along with blood eosinophilia, has been presented here. This may add to the cumulative evidence on the pathogenesis of adult blaschkitis as an allergic reaction to an unknown inciting allergen. Evidence to consider adult blaschkitis as part of the lichen striatus spectrum is growing. Triggers for such skin reactions remain diverse. This case presentation suggests that adult blaschkitis could be triggered by an allergic response evidenced by the blood eosinophilia when other causes of eosinophilia are excluded.

Coexistence of Polyarteritis Nodosa of the Vulva and Retina in a Behçet's Disease Patient: A Case Report.

Polyarteritis nodosa (PAN) is a multisystem disease that may affect the vessels of multiple organ systems. It has clinical variants including single-organ disease and cutaneous-only PAN. To our knowledge, this is a unique case report describing the coexistence of PAN of the vulva and retina in a Behçet's disease (BD) patient.  We report a case of a 31-year-old Lebanese woman with painful genital ulcers and multiple oral aphthae associated with arthralgia, light flashes, blurry vision, and photosensitivity. There were well-defined, punched-out erosions over the buccal and gingival mucosa; specifically, multiple punched-out, deep ulcers with unremarkable borders and black eschar involving two-thirds of both labia majora and minora sparing the clitoris with bilateral inguinal lymphadenopathy. Dilated fundus examination showed a few cotton wool spots and intraretinal hemorrhage. Fundus fluorescein angiography showed multiple arteriolar infarctions involving the macula in both eyes, more so in the right eye. Vulvar biopsy was consistent with PAN due to the involvement of a medium-sized subcutaneous artery and showed neutrophilic infiltration of its wall. Stain for elastic lamina showed medium-sized subcutaneous artery involvement. After ruling out infectious aetiologies, she was managed by intravenous pulse methylprednisolone 1,000 mg for three days, followed by oral prednisolone 50 mg with a slow taper, oral colchicine 0.5 mg twice daily, and adalimumab 40 mg once every two weeks to stop the progression of the ocular insult and genital mutilation. There was significant improvement of the ulcer with no new cutaneous or systemic manifestations. This case report highlights the importance of considering PAN-like lesions in cases of Behçet's disease. We emphasized the addition of cutaneous PAN as one of the cutaneous manifestations of BD.

Are mosque carpets' reservoirs for fungi causing superficial foot mycosis? A cross-sectional study in Riyadh, Saudi Arabia.

The possibility of superficial foot mycoses to spread through contaminated mosque carpets between worshipers imposes a great health burden and is never addressed in Riyadh, SA. We aimed to assess the prevalence of fungal infections, especially human dermatophytosis acquired from mosque carpets, in five different regions of Riyadh, Saudi Arabia and establish a means of contamination control. A cross-sectional study of 100 mosques in Riyadh, Saudi Arabia, was conducted, using a multistage random cluster sampling technique. The study included mosques that had an ablution area and regularly hosted five prayers a day. Sterile swabs were used for sampling, and the samples were transported to the laboratory for culture and analysis using a micro-scan system. A total of 199 (65%) samples contained several fungal species. Rhodotorula (74%), Cladosporium (47%), Bipolaris (46.6%), other yeasts (43.7%), Alternaria (40%), dematiaceous molds (34%), Curvularia (32.4%), and Candida (31%) were the most frequently isolated species. Species belonging to several other genera were also detected. This study revealed a relatively high prevalence of fungal organisms in mosque carpets in Riyadh, suggesting the need for implementing new strategies and laws to increase the level of hygiene awareness among worshipers and mosque caretakers to limit the spread of foot fungal infections.

Association between polymorphisms in PRNCR1 and risk of colorectal cancer in the Saudi population.

LncRNA Prostate cancer non-coding RNA (PRNCR1) is downregulated in many types of cancer. The current case-control study was performed on 144 patients with colorectal cancer and 130 matching controls. Genotyping was performed using TaqMan assays for four Single Nucleotide Polymorphisms (SNPs) in PRNCR1. RNAsnp Web Server was used to detect variations in the secondary structure for each SNP. The genotyping analysis for SNP rs1456315 showed increased association with colorectal cancer with the homozygous CC variant allele (OR: 2.09; χ2 = 4.95; CI: 1.08-4.02; p = 0.02), the minor allele frequency, and additive genotype, respectively (OR: 1.55; χ2 = 6.24; CI: 1.09-2.19; p = 0.01) & (OR: 1.64; χ2 = 4.04; CI: 1.01-2.67; p = 0.04). A risk association was also observed among younger age patients (≤57) and in female patients as well as in patients with tumors of the colon. For the other SNPs tested (rs16901946, rs13252298, rs1016343), no significant association was observed. The secondary structure of the rs1456315 mutant is different from that of the wild-type. Our findings suggest that the upregulation of PRNCR1 and its variants is associated with increased risk of colorectal cancer in Saudi patients, indicating that PRNCR1 might be a unique and valuable signature for predicting the risk of colorectal cancer in a Saudi population.

Manifestations of ocular rosacea in females with dark skin types.

BACKGROUND: Current knowledge about ocular rosacea in dark skin individuals is lacking. The prevalence of ocular rosacea varies considerably among studies and is probably higher than previously presumed. OBJECTIVE: To estimate the prevalence and pattern of ocular rosacea among dark skinned female patients, compare it with fair skinned, and to correlate the severity of cutaneous disease with ocular findings. METHOD: Female patients diagnosed with rosacea between 2011 and 2013 were studied prospectively. They were referred to ophthalmology for clinical observations and slit lamp examination. In all patients Schirmer and Tear break up time tests to diagnose dry eye were performed. RESULT: Fifty six consecutive female patients, joined the study with different skin types ranging from skin type 4 to 6. A total of 43 patients (76.8%) were positive for ophthalmologic findings. The most frequent symptoms were itching, burning sensation and redness, while the most frequent signs were meibomian gland dysfunction, dry eyes, eyelid telangiectasia and irregular margin. Significant correlation was noted between meibomian gland dysfunction and irregular lid margin (P = 0.003). Dry eye and Schirmer test significantly correlated with eye lid telangiectasia (p = 0.004; 0.015) respectively. No significant correlation was found between the severity of cutaneous disease and ocular findings. CONCLUSION: Ocular rosacea in dark skinned females is a common presentation and is comparable to that reported for fair skin, with eyelid telangiectasia and meibomian gland dysfunction being early phenomena. Earlier onset and more benign course were seen compared to other studies. Ocular and cutaneous rosacea are independent of each other.

Knowledge and misconceptions of Saudi women about sexually transmitted infections.

BACKGROUND: Sexually transmitted infections (STIs) are increasingly becoming one of the most important health challenges , especially among women, as they bear long-term consequences such as infertility and cervical cancer owing to STIs. This study aimed to assess the knowledge and misconceptions of Saudi women about STIs. MATERIALS AND METHODS: A descriptive study was conducted among adult women attending the dermatology clinic at King Saud University Medical City, Riyadh, Saudi Arabia, for reasons other than STIs. They were randomly approached and asked to complete an anonymous prevalidated questionnaire. Uneducated females were guided by an interviewer during the filling up of the survey questionnaire. Of 1150 women approached, 843 adult Saudi women responded to the survey (response rate: 73.3%). RESULTS: The mean age was 30.6±10.9 years. Knowledge of STIs was highest for HIV (85.9%) and lowest for genital warts (17.0%). Respondents believed that genital pruritus, foul discharge, and painful micturition are symptoms of STIs (71.1, 69.1, and 56.4%, respectively). A considerable percentage believed that STIs are transmitted by masturbation (54.8%), sleeping on contaminated beds (39.3%), and by eating and drinking from contaminated utensils (26.3%) whereas 8% believed that STIs are transmitted by shaking hands. Nearly two-thirds of women thought that condoms protect against STIs. Knowledge on the modes of transmission and symptoms of STIs was significantly correlated with younger age, higher level of education, and higher monthly income. CONCLUSION AND RECOMMENDATIONS: Despite the huge campaigns and information about STIs seen on the internet and television by these women, there is still scarcity of knowledge on the more important aspects of STIs, especially the recognition of clinical features and modes of transmission/spread of STIs. There is still a need for health authorities to intensify information-dissemination campaigns about STIs to the grassroots level, particularly among women in Saudi Arabia.

Novel mutations in IL-10 promoter region -377 (C>T), -150 (C>A) and their association with psoriasis in the saudi population.

BACKGROUND: Psoriasis, a common cutaneous disorder characterized by inflammation and abnormal epidermal proliferation with a prevalence of 2-3% in the general population, may be linked to certain types of cancer. Several studies have reported an association between interleukin 10 (IL-10) variant polymorphisms and inflammatory diseases such as psoriasis vulgaris although the results vary according to the population studied. No studies have been performed in the Saudi population. The present study concerned novel variants and other genetic polymorphisms of the promoter and exonic regions of the IL10 gene in patients with moderate to severe psoriasis and potential differences in genotype compared to a group of healthy volunteers. MATERIALS AND METHODS: Patients with moderate to severe psoriasis and healthy controls with no personal or family history of psoriasis were selected from the central region of Saudi Arabia. Polymorphisms of the IL 10 gene of both groups were genotyped. RESULTS: We observed two novel variants in 5'UTR region of the promoter precursor with higher prevalence of the genotype with both wild-type alleles in patients compared to the healthy control group. The differences at positions -377 and -150 were significantly associated with disease, both the variants conferred strong protection against psoriasis in Saudi patients. CONCLUSIONS: This observation provides further support for the importance of the part that IL10 plays in the pathophysiology of this disease. Confirmation of our findings in larger populations of different ethnicities would provide evidence for the role of IL-10 in psoriasis.

Unusual features of rosacea in saudi females with dark skin.

BACKGROUND: Data on the clinical presentation of rosacea among darker-skinned ethnic groups is scarce. This article presents the clinical spectrum of rosacea in Saudi female patients with differences highlighted according to skin types. METHODS: Female patients diagnosed with rosacea at the dermatology clinic in King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, between February 2010 and May 2011 were studied prospectively. Data collected included demographics, duration of the disease, personal history of any atopic disorder, aggravating factors, cutaneous and ocular symptoms, the presence of migraine, Helicobacter pylori infection, skin phototypes, and the clinical types and severity of rosacea. RESULTS: FIFTY PATIENTS CONSENTED TO JOIN THE STUDY: 20 (40%) were patients with skin type 4, 9 (18%) had skin type 5, and 21 (42%) had skin type 6. The cheeks, glabella, and chin were involved in 26 (52%) patients. Extrafacial lesions affecting chest, back, and ears were identified in 7 patients (14%). Severe erythematotelangiectatic rosacea was diagnosed in 21 patients (42%): skin type 4 comprised 50%, higher than the incidences for skin type 5 (22%) and skin type 6 (42.9%). The severe papulopustular subtype of rosacea was noted in 7 patients (14.0%), affecting 20% with skin type 4 and 14% with skin type 6. Severity of the erythematotelangiectatic or papulopustular subtypes of rosacea was not significantly associated with skin type (P=0.5691 and P=0.7740, respectively). CONCLUSION: This study addresses the growing interest in skin diseases in dark-skinned individuals. Rosacea is one of the skin disorders that had always been described for fair-skinned populations, but our results indicate that darker-skinned individuals also can be affected by rosacea and the clinical presentation is similar to that seen in patients with fair skin.

Rosacea and chronic rhinosinusitis: a case-controlled study.

OBJECTIVE: To determine the relationship between rosacea, chronic rhinosinusitis (CRS), and the clinical presentation of rosacea. SUBJECTS AND METHOD: Twenty-eight female Saudi patients diagnosed with rosacea at the Dermatology Clinic, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, between September 2011 and September 2012 and 20 age- and sex-matched control patients were included in the study. Paranasal sinus X-rays and assessments of the serum concentration of IgE (ImmunoCAP test; Phadia Laboratory Systems) were performed in both groups. RESULT: The rosacea patients had significantly more radiological evidence of CRS than the patients without rosacea [19 (67.9%) vs. 4 (20%), p = 0.003]. The median IgE concentration was similar in both groups (225.4 vs. 223.1 kU/l). Nine rosacea patients (32.1%) without radiological evidence of CRS did not have a significantly different median concentration of IgE compared with those who had radiological evidence of CRS (190.5 vs. 111.5 kU/l, p = 0.859). Erythematotelangiectatic severity was significantly associated with CRS (p = 0.038). Serum IgE did not correlate with the severity of the facial condition. CONCLUSION: Patients with rosacea and CRS manifested severe erythematotelangiectatic rosacea. There was enough evidence to suggest an association between rosacea and CRS. Clinical and radiological assessments of the paranasal sinuses are recommended.

Quality of life in family members of vitiligo patients: a questionnaire study in Saudi Arabia.

BACKGROUND: Many dermatologic disorders are known to adversely affect quality of life (QoL) in close relatives or partners of patients; however, it is unknown whether vitiligo impacts the QoL of family members. OBJECTIVE: The aim of this study was to identify the level and domains in which the QoL of partners/relatives of patients with vitiligo are affected by the disease. METHODS: A total of 141 patients with vitiligo, along with their family members, were recruited to complete validated QoL questionnaires, including the Dermatology Life Quality Index (DLQI) and the Family Dermatology Life Quality Index (FDLQI). RESULTS: Family member QoL was affected in 129 (91.5 %) of subjects. Mean FDLQI score was 10.3 ± 6.4 standard deviation. Higher FDLQI score (greater impairment in QoL) was significantly associated with male patients, a shorter duration of disease, and higher educational levels in family members. The most affected FDLQI items in order of decreasing incidence were emotional impact, burden of care, impact on the physical well-being of the family member, problems due to the reaction of others in response to the patient's skin appearance and effect on social life. Overall FDLQI score and the number of items affected correlated with overall patient DLQI score (p < 0.001, r = 0.56 and p < 0.001, r = 0.53, respectively). CONCLUSIONS: Vitiligo has a major impact on the QoL of family members of patients and often significantly impairs many aspects of their lives. Educational and supportive programs are recommended for family members of vitiligo patients who are at an increased risk for QoL impairments.

Pigmentary demarcation lines on the face in Saudi women.

BACKGROUND: Pigmentary demarcation lines (PDL) are physiological abrupt transition lines between hyperpigmented skin and lighter areas. Recent evidence suggests that they involve the face. AIMS: To survey facial PDL in Saudi females referred to general dermatology clinics for various complaints and determine any associated risks. METHODS: Screening for facial lines was done in general dermatology clinics over a year. Whenever a patient was found to have facial PDL, a detailed questionnaire and examination were undertaken. RESULTS: Out of 1033 patients screened, 144 patients (14%) were found to have at least one of the facial PDLs. The median age of onset was 16 years. The most common line was F with 76 patients (53%). Family history was positive in 51 patients (35%). CONCLUSION: Facial PDL is a common and chronic pigmentary problem in Saudi women. It should be recognized and differentiated from other similar diseases like melasma. A significant proportion of patients have a milder presentation.

Acral Lentigines, Is it a Paraneoplastic Syndrome?

We report a 34 years old gentleman who was referred to us with multiple brown spots on the palms, soles and scalp. He had those three months prior to being diagnosed with non-Hodgkin's lymphoma. His past history includes both Evan's syndrome and membranoproilferative glomerulonephritis treated by mycophenolate mofetil (MMF). On examination he had multiple brownish macules over the palms, soles and scalp. Biopsy from one of the lesions on the palms showed pigmentation of the basal cell layer with increased melanocytes. His lentigines are most likely induced by immunosuppression due to Non-Hodgkin's lymphoma.