The Psoriatic Arthritis Experience in Saudi Arabia from the Rheumatologist and Patient Perspectives.

BACKGROUND: Psoriatic arthritis (PsA) is a musculoskeletal disease that adversely affects physical mobility and quality of life. It is challenging to manage because of the heterogeneous nature of the symptoms and the current treatment options. PURPOSE: To explore the patient and rheumatologist perspectives of PsA to help improve understanding of the disease experience and improve disease management. METHODS: A descriptive, observational cross-sectional study of Saudi Arabian dermatologists and rheumatologists and patients with psoriasis or PsA was conducted. Questionnaire data were collected from 31 dermatologists, 34 rheumatologists, 90 patients with psoriasis, and 98 patients with PsA and analysed using descriptive statistics. Here, data from rheumatologists and patients with PsA are presented. RESULTS: The results revealed similarities and differences in the rheumatologist and patient perspectives of PsA. Rheumatologists and patients agreed on the impact that PsA had on patients' quality of life and that more education was needed. However, they differed on several aspects of disease management. Rheumatologists estimated the time to diagnosis as four times shorter than what patients experienced. Patients accepted their diagnosis more than rheumatologists perceived them to; rheumatologists perceived patients to be worried or fearful. Patients perceived joint pain as their most severe symptom, in contrast to rheumatologists, who presumed skin appearance was the most severe symptom. Reported input into PsA treatment goals differed significantly. More than half of the rheumatologists reported equal patient-physician input into goal development as opposed to <10% of patients reporting the same. Almost half of patients reported no input into the development of their treatment goals. CONCLUSION: The management of PsA could benefit from enhanced screening and re-evaluation of what PsA outcomes have the most value to patients and rheumatologists. A multidisciplinary approach is recommended with increased patient involvement in disease management and individualized treatment options.

Primary Cutaneous Follicle Center Lymphoma Presenting as a Solitary Nodule on the Forearm of an Adolescent Girl: A Case Report and Literature Review.

Primary cutaneous B-cell lymphomas (PCBCLs) are very rare to be seen in pediatric and adolescent age group, especially primary cutaneous follicle center lymphoma (PCFCL) which is considered the least occurring main subtype. Here, we describe a 16-year-old girl who developed a slowly growing solitary firm smooth surfaced erythematous nodule over her forearm. Histopathological examination showed a dense dermal nodular, periadnexal and perivascular lymphoid infiltrate extending deep to the subcutis. Immunohistochemical staining showed a B-cell population with positivity for CD20, variable staining for BCL6 and CD10 and uniquely staining for BCL2. Although a primary cutaneous marginal zone lymphoma (PCMZL) was considered but the presences of interfollicular BCL6 and CD10 positivity established the diagnosis of PCFCL. To our knowledge, only 12 cases of pediatric and adolescent PCFCL have been described in the literature.

Multidermatomal Shingles Occurrence Post-therapeutic Dry Needling (TDN) in a Saudi Woman.

This is a case report of the occurrence of shingles (herpes zoster) in a multidermatomal distribution following therapeutic dry needling. The patient developed acute reactivation of varicella-zoster virus two days after the third session of dry needling for the relief of long-standing pain in the hip and sacroiliac joints. The lesions initially presented with severe pain along lumbar dermatomes with later rash development. The patient was treated with oral valacyclovir 1,000 mg three times daily for seven days, and the pain was controlled with ibuprofen. The lesions resolved two weeks later without any complications or sequelae.

Trichilemmoma Arising in a Sebaceous Nevus Successfully Treated with Cryotherapy.

Nevus sebaceous of Jadassohn (NSJ) is a benign congenital hamartoma composed of follicular, adnexal appendages and epidermal hyperplasia. Various secondary neoplasms, mostly adnexal in origin, can arise within nevus sebaceous. We report the case of a 16-year-old female who had NSJ associated with trichilemmoma, which was successfully treated with cryotherapy. We found cryotherapy to be an effective, satisfactory therapy, with acceptable cosmetic results, especially for patients who have visible lesions that can be easily followed.

Eruptive Granuloma Annulare in an Elderly Man With Diabetes.

Although the etiology of granuloma annulare (GA) remains unknown, it has been associated with many reported triggers, including chronic medical illnesses and malignancy. Herein, we present a case of an elderly man with diabetes who has a generalized variant of granuloma annulare. The patient had a six-month history of multiple skin-colored, scattered, itchy papules disseminated over the trunk. Clinical features with histological findings are described. Therefore, this case report aimed to present a rare type of diffuse, eruptive granuloma annulare.

Medical Students' Perceptions of their Educational Environment at a Saudi University.

BACKGROUND: Students' perception of their educational environment has a significant impact on their behavior and academic progress. AIM: The aim of the study is to assess the perceptions of undergraduate medical students regarding their educational environment at Imam Abdulrahman Bin Faisal University, Saudi Arabia. SUBJECTS AND METHODS: This cross-sectional study utilized the Dundee Ready Education Environment Measure (DREEM) inventory to collect data from 5th-year medical students at Imam Abdulrahman Bin Faisal University during the academic year 2010-2011 (score range: 0-200). The mean scores for each individual item and for the following five contributing DREEM domains were calculated: Perception of learning, perception of teaching, academic self-perception, perception of atmosphere and social self-perception. RESULTS: The questionnaire was distributed to 121 students, all of whom completed the questionnaire. Of these, 65.3% were male and 34.7% were female. The mean total score was 126.4 (63%), indicating that the educational environment is satisfactory. The two lowest scoring contributory domains were academic self-perception (17.4/28; 60%) and perception of learning (29.3/48; 61%). No areas of excellence were identified (i.e., mean scores of >3.5); however, four main problematic areas were identified (mean scores of ≤2.0): Overemphasis of factual learning (1.66), difficulty with authoritarianism of teachers (1.55), students unable to memorize everything (1.82) and boredom in course (1.81). CONCLUSION: This study found that the overall educational environment at Imam Abdulrahman Bin Faisal University is satisfactory, with further scope of improvement. The author recommends implementation of remedial measures such as modifications in curriculum and using innovative teaching strategies to overcome problematic areas and further improve the overall educational environment.

Acne vulgaris: Perceptions and beliefs of Saudi adolescent males.

INTRODUCTION: Although acne vulgaris is common in adolescents, information on their understanding of acne is minimal. OBJECTIVES: To evaluate the perceptions and beliefs of Saudi youth on acne. MATERIALS AND METHODS: Three hundred twenty-nine male students (aged 13-22 years) from 6 secondary schools in the Eastern Saudi Arabia completed a self-reported questionnaire on knowledge, causation, exacerbating and relieving factors of acne. Data were analyzed by SPSS version 15.0. Results of subjects with acne, a family history of acne, and parents' educational levels were compared. Differences between the analyzed groups were assessed by a Chi-square test; p ≤ 0.05 was considered statistically significant. RESULTS: Over half (58.9%) of the participants considered acne a transient condition not requiring therapy. Only 13.1% knew that the proper treatment of acne could take a long time, even several years. Over half (52%) thought acne can be treated from the first or after few visits to the doctor. Popular sources of information were television/radio (47.7%), friends (45.6%), and the internet (38%). Only 23.4% indicated school as a source of knowledge. Reported causal factors included scratching (88.5%) and squeezing (82.1%) of pimples, poor hygiene (83.9%), poor dietary habits (71.5%), and stress (54.1%). Ameliorating factors included frequent washing of the face (52.9%), exercise (41.1%), sunbathing (24.1%), and drinking of mineral water (21%). The correlations of these facts are discussed. CONCLUSION: Results of this study point out that misconceptions of acne are widespread among Saudi youth. A health education program is needed to improve the understanding of the condition.

Use of Complementary and Alternative Medicine Among Dermatology Outpatients: Results From a National Survey.

BACKGROUND: Little is known about the prevalence and practice of complementary and alternative medicine (CAM) among dermatology patients in the Arab world. The aim of this study was to determine knowledge and attitudes about CAM, prevalence of its use, reasons for its use, and types of CAM used in dermatology patients in Saudi Arabia. METHODS: This was a national survey of various regions of Saudi Arabia. In this cross-sectional study, dermatology outpatients were interviewed using a questionnaire. Sociodemographic characteristics, acceptability, utilization pattern, and reasons for CAM use were elicited. Dermatology life quality index (DLQI) was obtained. RESULTS: Overall, 1901 patients returned complete questionnaires out of 2500 distributed (76% response rate). Of these, 808 (40%) were CAM users, and the majority were woman (55.1%), with a mean age of 31.6±12 years. Most were literate (71.2%) and just over half were married (51.9%). Patients with acute skin diseases were found to be more likely to use CAM (P=.027). The mean DLQI score was higher (worse quality of life) among CAM users than among nonusers (P=.002). The results showed that 315 of 801 (40%) and 250 of 601 (30%) CAM users agreed that CAM methods are safer and more effective than modern medicine, respectively, and 83% will continue to use CAM in future. The most commonly used CAM modalities were vitamins, prayers, natural products, and herbs. Responses indicated that 379 of 803 (47.2%) CAM users did not consult their doctor before using CAM, and 219 of 743 (30%) did not obtain sufficient answers regarding CAM use from their dermatologists. CONCLUSIONS: There is a significant use of CAM among dermatology outpatients in Saudi Arabia. In view of the common belief that CAM has fewer side effects than conventional medicine, dermatologists need to increase their awareness of CAM.

Motives for cosmetic procedures in Saudi women.

The media-fuelled obsession with beauty in modern society has led more women to seek elective cosmetic procedures to meet the portrayed ideals of beauty in different cultures. This study gives insights into incentives and desires to undergo cosmetic procedures in a conservative society with strict religious practices where women are veiled. Questionnaire data were obtained from 509 Saudi women who responded to a survey distributed randomly to a sample of Saudi women aged 17 to 72 years. At least 1 elective cosmetic procedure was performed in 42% of the women, of whom 77.8% wore a veil. Another 33% considered having a procedure. The motives for seeking a cosmetic procedure were to improve self-esteem in 83.7%, attract a husband in 63.3%, or prevent a husband from seeking another wife in 36.2%. The decision to seek a procedure was affected by the media, with high peer influence. Motivation for elective cosmetic procedures in Saudi women is influenced by a combination of emotional and cultural factors, level of education, marital status, and religious beliefs. The veil is not an impediment for seeking such procedures. The limitation of the study was missing data analysis as some items in the questionnaire were completed inaccurately or left unanswered.

Nestin-positive stem cells in neurofibromas from patients with neurofibromatosis type 1-tumorigenic or incidental?

BACKGROUND: Recently, we found discrete foci of melanin deposits but diffuse positivity with MART-1/MelanA in a neurofibroma from a patient with neurofibromatosis type 1 (NF1). OBJECTIVES: To ascertain the frequency of cells that had the capacity for melanogenesis in neurofibromas from patients with NF1. Given that nestin-positive mammalian neural crest cells are potentially capable of forming neurons and Schwann cells, an additional aim was to assess the proportion of nestin-positive cells to test our hypothesis that the frequency of melanogenic cells is a direct function of the stem cell population harbored. METHODS: Antibodies used included MART-1/MelanA, a transmembrane protein that is present in normal melanocytes and nestin, a type VI intermediate filament protein present in neuronal precursor cells. Seventy-two neurofibromas from 18 patients (10 with multiple and 8 with single) with NF1 were studied. The control group included solitary sporadic neurofibromas from 24 patients. RESULTS: Expression of markers was as follows: MART-1/MelanA staining in 5/72 cases (7%) from neurofibromas from 2/18 patients with NF1 versus 0/24 (0%) in the sporadic neurofibroma group (P = 0.33) and nestin in 33/72 cases (49%) from neurofibromas from 9/18 patients with NF1 versus 3/24 (12.5%) in the sporadic neurofibroma group (P = 0.003). All 5 cases of neurofibroma that were MART-1/MelanA positive also demonstrated positive staining with nestin. CONCLUSIONS: Although we found no difference in melanogenic cells in neurofibromas from patients with NF1 relative to the sporadic group, we did find a significant population of nestin-positive progenitor cells in neurofibromas from patients with NF1. In light of recent evidence linking formation of neural neoplasms such as neurofibroma to alterations in the self-renewal program of stem/progenitor cells, our findings reinforce the potentially tumorigenic role of nestin-positive progenitor cells in neurofibromas from patients with NF1.

A forgotten complication of diaper dermatitis: Granuloma gluteale infantum.

Granuloma Gluteale Infantum (GGI) is a rare condition of unclear etiology,[1] presenting as asymptomatic cherry red nodules in the diaper area appearing in the setting of primary irritant contact dermatitis.[2] A 50 day old infant with GGI is presented to emphasize that the condition may be easily missed, and that it may result from the misuse of fluorinated topical steroids used to treat a rash in the diaper area. This is the first case reported from Saudi Arabia.

Update in the treatment of cutaneous leishmaniasis.

BACKGROUND: Cutaneous leishmaniasis (CL) is still a major health problem in many countries including Saudi Arabia. Patients with CL are seen, not only by dermatologists, but also by pediatricians and community physicians. Knowledge of available treatment options is essential. DESIGN: A literature review utilizing PubMed and Cochrane evidence-based library was undertaken in the last five years. RESULTS: Several medications and therapeutic modalities are currently in use, though the gold standard remains systemic antimonials. Drug resistance and serious side effects preclude the use of available medications. Newer therapies like liposomal amphotericin B, miltefosine and pentamidine are being used; while it is hoped that other drugs like imiquimod, tamoxifen, PDT and pentamidine structural analogs being tested would offer better efficacy, easier administration and lower toxicity. CONCLUSION: After decades of little advance in the treatment of leishmaniasis, there are now several options with newer compounds and combinations of these.

Lipoid proteinosis. A report of 2 siblings and a brief review of the literature.

Lipoid proteinosis is a rare autosomal recessive inherited metabolic disorder characterized by deposition of a hyaline-like material in the skin, oral laryngeal mucosa, and in other sites. In this report, the author describes 2 Saudi siblings who had characteristic skin findings, oral and mucosal lesions, histological findings along with few rarely encountered manifestations including pathognomonic calcifications in the hippocampus, electroencephalogram findings and briefly reviews the literature. These cases are presented to emphasize the occurrence of this condition in Saudi Arabia, and to update information on the latest developments of this disorder.