ABSTRACT
Langerhans cells, often referred to as the "macrophages of the skin", are dendritic cells that normally reside in the epidermis and papillary dermis. Just like macrophages, they function as antigenpresenting cells that activate naive T cells. Certain mutations such as those involving the BRAF gene can cause unopposed production of Langerhans cells, which is known as Langerhans cell histiocytosis (LCH). LCH triggers an inflammatory immune response that causes systemic manifestations such as fever and fatigue, as well as other manifestations depending on the affected organs. The pathogenesis behind LCH remains poorly understood. It is still unknown whether it is a neoplastic process or a reactive cancer-mimicking illness. Diagnosis of LCH is confirmed by biopsy, and treatment is largely dependent on the extent and severity of the disease. Common treatments include corticosteroids, excision, radiation, and chemotherapy. We present a case of a 1-year-old Saudi male with LCH.
ABSTRACT
Background: Prurigo pigmentosa (PP), also referred to as Nagashima disease, is an acquired dermatological condition that is characterized by pruritic erythematous eruptions including papules and plaques surrounded by a reticular pattern of hyperpigmentation. It was first described in 1971 when Japanese dermatologist Masaji Nagashima noticed similar dermatological manifestations among 8 patients of Asian descent. The disease has been strongly associated with ketosis and ketogenic diet; however, the underlying etiology is unknown. Effective treatment involves an oral antibiotic and a balanced diet. The disease classically affects young women of Asian descent, but cases affecting males and people of non-Asian ancestry have also been observed. We present an unusual case of PP in a Saudi male that started 18 days following bariatric surgery. Case Description: The patient is a 25-year-old morbidly obese Saudi male who complained of an intensely pruritic rash 3 weeks after undergoing bariatric surgery. His past medical history is positive for irritable bowel syndrome (IBS). A punch skin biopsy yielded the diagnosis, and a combination treatment consisting of minocycline and a topical corticosteroid was prescribed. The patient presented again 2 weeks after the initial visit with complete resolution of the rash. He reported adherence to the medication regimen. Pruritus had resolved. Upon examination, post-inflammatory hyperpigmentation in a reticular pattern was observed over the trunk, upper abdomen, and chest. Hydroquinone 4% cream was prescribed to treat the post-inflammatory hyperpigmentation. Conclusions: Nowadays, PP cases are being reported from all around the world, including cases of PP that appeared following bariatric surgery for weight loss without ketogenic dietary modification. Theoretically, the typical PP patient is a young adult female from Eastern Asia who has been adherent to a ketogenic diet. In contrast, we report a case of a Saudi male who did no dietary modifications, but underwent bariatric surgery. Treatment with minocycline resulted in successful complete resolution.
ABSTRACT
Oral propranolol is commonly used as a first-line treatment for infantile hemangioma. However, its use in PHACE (posterior fossa anomalies, hemangioma, arterial anomalies, cardiac anomalies, and eye anomalies) syndrome raises concerns that it might exacerbate the patient's risk of stroke. Here, we report the case of a four-month-old premature girl with PHACE syndrome, who presented with a large hemangioma involving the left side of her face, following the V1+V2+V3 distribution, including the upper lip, left ear, and left eye. This condition was successfully treated with propranolol, and no adverse side effects were reported.
ABSTRACT
Ulerythema ophryogenes (UO) or keratosis pilaris rubra atrophicans faciei is a disorder of keratinization that primarily affects the face. The inflammatory process in UO may eventually result in alopecia. The incidence of this disorder is still unknown. We present a case of UO in a 28-year-old male, the first of its kind in Saudi Arabia.
