Osama Nour-Eldin

Nail Changes in Childhood Psoriasis: A Study from Kuwait

Abstract:  Psoriasis is a widespread skin disorder in which nail involvement can be seen in up to two‐thirds of those affected. Childhood psoriasis is a distinct entity and the literature focused on nail changes associated with childhood psoriasis is scant. Our objectives were to evaluate the frequency of nail involvement in childhood psoriatic patients, assess the types of nail changes in childhood psoriasis, and compare our clinical findings with the few reports available in the literature. Two hundred and one consecutive new patients with childhood (age ≤ 16 years) psoriasis of both sexes were selected for the study of nail changes. The diagnosis of psoriasis was made on clinical grounds. Each patient underwent a thorough dermatologic examination with special attention paid to the nail changes. If a clinical suspicion of fungal infection of the nails existed, further mycologic investigations were performed. We found the prevalence of nail changes to be 37.81% (boys > girls) in children who had psoriasis. Nail pitting was found to be the most common manifestation (61.84%) followed by onycholysis (30.26%), subungual hyperkeratosis (13.16%), and discoloration of the nail plate (7.90%). Nail involvement had no relationship to the type of psoriasis, patients sex, or duration or extent of disease.

Childhood vitiligo: A prospective hospital‐based study

Eighty‐eight consecutive children presenting with vitiligo to a hospital dermatology clinic in a 1‐year period were assessed clinically, and for autoimmune and endocrine disorders. Vitiligo started between 8 and 12 years of age in 51% of our patients. A positive family history was obtained in 27.3% of the patients. Vitiligo vulgaris was the most common clinical type seen. Three patients, though clinically asymptomatic, showed antithyroid antibodies. Our results are compared with those published previously on the subject.

Generalized Lichen Nitidus

Abstract:  Lichen nitidus is a rare chronic condition of unknown etiology. Generalized lichen nitidus is even rarer. We report here a 5‐year‐old girl who had multiple, asymptomatic, discrete, 1 to 2 mm flesh‐colored, shiny, flat, papules on her face, upper limbs, and thighs with relative sparing of the trunk. Resolution of these papular lesions was followed by hyperpigmented macules in those areas. Histopathologic examination of a papular lesion revealed a localized granulomatous lymphohistiocytic infiltrate in an expanded dermal papilla with thinning of overlying epidermis and downward extension of the rete ridges at the lateral margin of the infiltrate, producing a typical “claw clutching a ball” picture, confirming our clinical diagnosis of lichen nitidus. The pigmented macules showed melanin pigmentation on histology. There was no response to oral astemizole treatment for 3 months. However, the lichen nitidus lesions resolved spontaneously without any further treatment over the next year, leaving behind a prominent pigmentary disturbance.

Hypertrophic Lupus Erythematosus Treated Successfully with Acitretin as Monotherapy

Hypertrophic lupus erythematosus (HLE) is a distinct and rare subset of chronic cutaneous lupus erythematosus characterized by verrucous lesions which are chronic in course and resistant to treatment ( 1 ). We describe the successful use of acitretin in a patient with HLE who had multiple hyperkeratotic verrucous plaques over the dorsa of his hands, feet, and legs and who failed to respond to local steroids and antimalarials.

Naevus lipomatosus cutaneous superficialis of Hoffmann-Zurhelle with angiokeratoma of fordyce

Sir, Naevus lipomatosus cutaneous superficialis (NLCS) of Hoffmann-Zurhelle is a rare disorder that is characterized by groups of mature fat cells situated within the dermis (1). It is also known as pedunculated lipofibroma (2). It is a naevoid fatty growth within the papillary and reticular dermis. Two clinical types are distinguished: the classical type, consisting of multiple lesions occurring in a zonal or segmental distribution, and the solitary papule or nodule (3). We report here a patient with classical NLCS and angiokeratoma of Fordyce, partially treated with cryotherapy.

Acute allergic contact dermatitis due to para-phenylenediamine after temporary henna painting.

The use of temporary natural henna painting for body adornment and hair dyeing is very common in several countries of the Indian subcontinent, Middle East, and North Africa, and the fad is spreading in other parts of the world. Several cases of para‐phenylenediamine (PPD) contaminated, temporary traditional/natural henna induced sensitization and acute allergic reaction have been reported, along with occasional serious long term and rare fatal consequences. We report here a 17‐year‐old girl with blisters over her hands of five‐days duration that appeared within 72 hours of applying a temporary henna paint to her hands during a social occasion. Similar lesions were noted on her face. She had previously applied black henna only once, a year earlier without developing any lesions. Clinical diagnosis of acute allergic contact dermatitis (ACD) was made. After a short course of oral corticosteroids, topical mometasone furaote 1.0% cream, and oral antihistamines, the lesions healed completerly over the next four weeks leaving post‐inflammatory hypopigmentation. Patch testing done with standard European battery, PPD 1% in petrolatum, and commercially available natural henna powder revealed a 3+ reaction to PPD at 48 hours. No reaction was seen at the natural henna site. Awareness of the condition among physicians and the public and regulation regarding warnings of the risks of using such products is urgently warranted.

Clinical patterns of sexually transmitted diseases, associated sociodemographic characteristics, and sexual practices in the Farwaniya region of Kuwait

Background  Sexually transmitted diseases (STDs) are common worldwide, but there are few studies available on STDs from the Gulf countries, including Kuwait. Our goal was to determine the clinical patterns, sociodemographic factors, and sexual practices of patients with STDs who attended a government hospital in the Farwaniya region of Kuwait.

Olmsted syndrome: report of a new case with unusual features

Olmsted syndrome is a rare disorder characterized by the combination of periorificial keratotic plaques and bilateral palmoplantar keratoderma. New associated features continue to be reported. Olmsted syndrome in a female patient is particularly rare, and we report such a case having a haemangioma in addition to other features of the syndrome.

Penile self-injections: an unusual act

A 42‐year‐old healthy Thai male presented with a 1‐week history of painful swelling of the penis following self‐injection of two tablets of vitamin A dissolved in 10 mL of tap water with an unsterilized syringe, in order to achieve a more prolonged erection for sexual intercourse, on a friends advice. He injected himself all around the penile shaft “just under the skin.” Eight hours after injection, the penis started to become progressively swollen and painful, but it was a further 2 days before he presented to our clinic. He denied a history of any urinary obstructive or irritative symptoms. There was no history of genital ulceration or urethral discharge or any similar acts of self‐injection in the past.