RESUMO
Scleredema is a rare sclerotic skin disorder that typically develops in conjunction with diabetes, monoclonal gammopathy, or infection and commonly involves the neck, back, trunk, and arms. Scleredema can be categorized into three types according to its cause. The local examination of the lesion is characterized by non-pitting induration that follows a symmetrical spread with sparing of the hands and feet. We present a case of a 19-year-old female patient that presented to the outpatient clinic complaining of facial skin lesions that have been progressive for four years. The skin lesions were found to involve the neck, back, trunk and both arms sparing the hands and there was no systemic involvement of the disease. The patient is non-diabetic but reported frequent attacks of tonsillitis over the past months. Initially, punch biopsy showed no signs of scleredema; however, repeated biopsy at follow-up confirmed the presence of mucin deposits which are suggestive features of scleredema. Due to the similarities with various other diseases, the diagnosis requires clinical and histopathological exclusion which makes the diagnosis quite challenging. It almost always starts in the neck but can present initially in rare cases from the face spreading symmetrically. Close follow-up and continuous monitoring are necessary for systemic organ involvement.
RESUMO
Background Routine vaccines are essential for the well-being of children. Due to the coronavirus disease 2019 (COVID-19) pandemic, some restrictions have been applied in the Kingdom of Saudi Arabia (KSA), causing parental concern about visiting healthcare facilities. Objectives To examine the attitudes and factors that influence parents' decisions regarding their children's vaccination during the COVID-19 pandemic. Methods In this cross-sectional study, 1,704 caregivers from KSA participated. An implemented Arabic questionnaire directed to the caregivers of children at the age of routine immunizations was filled. It included questions on parent demographics, child data, the decision regarding the vaccines, cause-related questions, and the preferred means to receive the vaccines during the COVID-19 pandemic. Results A total of 1,360 participants were included. The majority were from the middle region of KSA. Thirty-nine point five percent (39.5%) of participants chose not to administer the scheduled vaccines to their children, and the main reason was the fear of COVID-19 infection. The main sources of information that encouraged administering the vaccines were the advice of physicians, Saudi Ministry of Health (SMOH) services, 937, and the Sehha application. The majority of the participants chose home immunization visits as the preferred means of vaccination during the COVID-19 pandemic (46.8%). The study showed that approximately 60% of the respondents believed that routine childhood immunizations had no role in spreading the COVID-19 infection, and 59% believed that despite the COVID-19 pandemic, routine childhood vaccines have to be administrated on time. Conclusion The study indicated the negative impact of the COVID-19 pandemic on the compliance of Saudi society toward routine pediatric immunization.
