Dermatitis artefacta: A review of 14 cases.

BACKGROUND: Dermatitis artefacta (DA) is a self-inflicted dermatologic injury sometimes produced for secondary gains. Laboratory investigations, including histologic examination of lesional tissue biopsy, are usually negative and do not give a clue to the correct diagnosis. PATIENTS AND METHODS: Over a five-year period, 14 patients were diagnosed with DA at King Fahad Hospital (KFH) in Al Baha during routine outpatient and inpatient dermatologic consultations. The diagnoses were based on vagueness of history given by the patients, and the presence of bizarre skin lesions distributed over sites accessible to the patientsA centAA hands. Investigations excluded the possibility of other diseases. In some cases, consultant psychiatric assessment was sought in order to identify possible underlying psychopathologic factors. Seven patients were hospitalized while the rest were managed as outpatients. RESULTS: The 14 patients comprised 12 females and two males aged 12 to 71 (mean 25.9) years. All except one were Saudis. DA in the males was probably caused for secondary gains. The females, four of whom were married and eight single, were aged 12-36 (mean 21.8) years. Nine of the females (64%) had identifiable severe emotional or psychiatric problems. The remaining two were unmarried and had no identifiable underlying factors. CONCLUSION: This study reveals that the presentation of DA in Saudi Arabia is essentially similar to what has been reported from other parts of the world. It brings into focus a medical problem which needs to be recognized, as greater awareness may bring about earlier correct diagnosis and treatment.

Spider bite envenomation in Al Baha Region, Saudi Arabia.

BACKGROUND: The purpose of this study was to highlight the clinical features of spider bite envenomation, a subject which has not, to our knowledge, been previously published in Saudi Arabia. PATIENTS AND METHODS: Ten patients (8 males and 2 females) aged between 13 and 75 years (mean 36.8) were hospitalized at King Fahad Hospital, Al Baha, with the diagnosis of spider bites during the 9-year period from June 1988 to May 1997. RESULTS: One of the patients was bitten on the right hand by a brown spider, causing severe cellulitis and tissue necrosis, and requiring surgical debridement and pedicle skin flap graft. The nine other patients (90%) had bites from black spiders identified as black widow spiders. Two of the nine (22.2%) suffered only local reactions in the form of pain, erythema and swelling at the site of bite. The remaining seven (77.8%), had varying symptoms of systemic envenomation, including pulmonary edema, myocardial dysfunction with elevated creatinine kinase, electrocardiographic and echocardiographic abnormalities, progressive paresthesia, generalized body ache, etc. Therapy included analgesics, muscle relaxants, intravenous infusion of calcium gluconate and oxygen where indicated. Specific antivenin therapy was available for only four of the nine patients (44%) with black widow spider bite. Antivenin therapy still produced dramatic relief of the symptoms in the patient with pulmonary edema, even after a delay of 30 hours. CONCLUSION: Spider bite envenomation should be considered in the differential diagnosis of acute surgical abdomen and myocardial infarction.

Cutaneous leishmaniasis in Nigeria.

Twenty-one of 18,000 (0.1%) dermatology patients seen at the Ahmadu Bello University (ABU) Teaching Hospital, Kaduna, Nigeria, during the 9-year period October, 1979-August, 1988, had cutaneous leishmaniasis (CL). Their age range was 14 to 50 years (mean 28.7 years), with a peak at the 14- to 25-year age group. Eleven of the 21 patients (52%) were students in Government Colleges located within the leishmaniasis belt of Nigeria.

Pyoderma gangrenosum and malignant pyoderma in Nigeria.

Five patients (four black Nigerian males and one Polynesian) with pyoderma gangrenosum (PG) were seen between May 1974 and March 1984, at the Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria. Their age range was 12-42 years (mean 25.6 years). The female expatriate Polynesian patient had PG localized to the upper back while the other four patients had severe and extensive PG lesions. Local cleansing and dressing of the ulcers combined with appropriate systemic antibiotics produced healing in two of these patients. The empirical addition of dapsone and rifampicin led to complete healing in two others, but only transient remission in one patient who, after 22 years of disease activity, died at home from an aggressive and accelerated form of the disease best described as 'malignant pyoderma' gangrenosum.

Dermatophyte fungi in the Guinea Savannah region of Nigeria and the changing phase of dermatophytosis in Nigeria.

Approximately 8,000 patients with various skin diseases were seen at the Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria between January 1983 and December 1986. 174 (2.2%) presented with features in which a clinical diagnosis of superficial fungal infection was made or suspected. 69 out of 190 (36.3%) of specimens taken from skin lesions or nails from these patients were mycologically positive. The fungi isolated were Trichophyton rubrum (24.6%), Tr. soudanense (13.0%), Candida albicans (5.8%) Hendersonula toruloidea (2.9%), Microsporum audouinii (1.5%) and Epidermophyton floccosum (1.5%); 34.8% of the specimens were positive on microscopy but failed to grow. Malassezia furfur was demonstrated in 15.9% of the 69 positive specimens.

Bazex paraneoplastic acrokeratosis in prostate carcinoma.

We describe a patient in whom symmetrical acrokeratosis appeared 6 years before the diagnosis of metastatic carcinoma of the prostate causing paraplegia. The paraneoplastic dermatosis and paraplegia regressed following treatment with stilboestrol and topical applications of 2% salicylic acid in vaseline. To our knowledge, Bazex acrokeratosis has not been reported previously in association with carcinoma of the prostate.

Cutaneous schistosomiasis in Nigeria. An update.

Two patients with schistosomiasis of the skin were seen at the Ahmadu Bello University Teaching Hospital, Kaduna, Northern Nigeria, between June 1978 and December 1980. The first case was not suspected on clinical grounds, but was diagnosed only after terminally-spined ova of Schistosoma haematobium were found in histological sections of the skin lesions. Both patients were successfully treated with niridazole (Ambilhar). These bring to eight the total number of cases of cutaneous schistosomiasis recorded in Nigeria in the past 40 years, four of which were in indigenous Nigerians. It seems that the high endemicity of the disease confers some degree of natural immunity to the indigenous population, making ectopic forms rare. Clinicians should be aware of the existence of cutaneous forms of the disease and of their excellent response to specific chemotherapy.

Psoriasis vulgaris in the Guinea Savanah region of Nigeria.

Psoriasis vulgaris is an uncommon skin disease among Nigerians. There were only 44 cases out of a total of about 5,250 skin patients (0.8%) seen during the 7-year period from 1977 to 1984 at the consultant skin clinic, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria. Males were predominant. The age range was 1 1/2 months to 65 years, with a mean age of 29.8 years. The peak incidence was in the 21-30-year group. Clinical features were the same as in Europeans, but morbidity was very low. Arthropathy and nail involvement were rare, comprising only 4.5 and 15.9% of cases, respectively.

This is not leprosy but porphyria cutanea tarda.

Three cases of porphyria cutanea tarda (PCT) misdiagnosed as leprosy were seen between 1978 and 1984 at Kaduna, Nigeria. All three patients had been heavy drinkers of a native alcoholic beverage, "burukutu" as well as beer, for several years. Alcohol abstinence and oral chloroquine therapy produced satisfactory remission of the disease. This is believed to be the first report of cases of porphyria cutanea tarda from Nigeria.