Public Perception in Saudi Arabia Toward Herpes Zoster and Its Vaccination: A Cross-Sectional Study

Background Herpes zoster (HZ) or shingles, arises from the reactivation of the varicella zoster virus (VZV), mainly affecting older and immunocompromised individuals. Despite the efficacy of vaccines, vaccination rates in Saudi Arabia are low. Thus, this study aimed to assess the knowledge, attitude, and practice of the Saudi Arabian population toward HZ and its vaccination. Methods An observational cross-sectional study was carried out to evaluate the public perception in Saudi Arabia toward HZ and its vaccination, during the period from January to March 2024. Participants were selected using a non-probability, convenience sampling method, with recruitment facilitated through WhatsApp, a messaging app. Data has been analyzed using the statistical software Statistical Package for Social Sciences (SPSS), version 26.0 (IBM Corp., Armonk, NY). A p-value of <0.05 has been used to report the statistical significance. Results The study's demographic profile included 1237 participants, predominantly younger than 30 years (65.5%), with a female majority (65.7%). Public knowledge about HZ was limited, only 29.6% of participants recognized the risk of HZ post-chickenpox. More than half of the participants were not aware that the vaccine is provided by the Saudi Ministry of Health (MOH) for certain groups. However, over 75% are willing to receive the HZ vaccine upon physician recommendation. Conclusion This study shows a general lack of awareness about HZ and its vaccination in Saudi Arabia, including misconceptions about vaccination availability, recommendations, and the disease's complications. Gender differences in attitude and interest highlight the potential for tailored educational campaigns. Addressing these issues is essential for improving vaccination rates and mitigating HZ's impact.

Prurigo pigmentosa post-bariatric surgery: a case report

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.

Combining Isotretinoin and Topical Cholesterol/Atorvastatin in the Treatment of Linear Porokeratosis: A Case Report

Linear porokeratosis (LP) is an epidermal keratinization disorder manifesting in the form of annular plaques with an atrophic center and hyperkeratotic margins. Although rare, LP carries a significant risk of skin cancer. Histological examination usually reveals the cornoid lamella, a parakeratosis column visualized in the outer layer of the epidermis. First-line treatment of LP is retinoids. However, the effects of combination therapy of isotretinoin and topical statins on LP are not well-understood. Herein, we attempted treatment with both isotretinoin and 2% cholesterol/atorvastatin ointment, with considerable improvement observed using the former but not the latter. These findings suggest that 2% topical cholesterol/atorvastatin treatment may not carry any additional benefits, even if used alongside retinoids. Further studies are needed to assess the potential effects of statins on LP.

Generalized morphea following COVID-19 vaccine: Case report and literature review

Physicians should be vigilant for COVID-19 vaccine side effects and investigate any associated cutaneous manifestations. This will ultimately facilitate better understanding and recognition of various skin reactions related to the vaccine.

Sporadic Spinal Lumber Epidermoid Cyst in an Obese Adolescent: A Radiological and Pathological Review

BACKGROUND We report a case of a sporadic lumbar epidermoid cyst in a patient with no apparent risk factors for the condition. The lesion is considered an uncommon lesion that has a potentially debilitating effect on the spinal cord. CASE REPORT Our patient was a 17-year-old boy who presented to the neurosurgery clinic with lower back pain, accompanied by an electrical sensation radiating bilaterally to the buttocks, thighs, and knees. He has been increasingly reliant on a walking cane over the past few months. The patient was considered obese, with a BMI of 44. Otherwise, his physical examination was unremarkable, with no signs of dysraphism. He underwent magnetic resonance imaging (MRI) of the spine, which revealed a lumbar spine lesion, compressing the adjacent cauda equina nerve roots. MRI imaging showed the lesion was an intradural extramedullary mass showing hypointense signal on T1- and hyperintense on T2-weighted images, with diffusion restriction on diffusion-weighted imaging (DWI). The imaging findings were consistent with an epidermoid cyst. CONCLUSIONS Epidermoid cysts are benign lesions, usually found in the head and trunk. When found in the spine, they can cause a range of symptoms that can be debilitating. Patients presenting with signs and symptoms of spinal cord compression should be promptly investigated. MRI is an excellent tool for characterizing an epidermoid cyst. The lesion appears oval and hypointense on T1-weighted imaging, and characteristically shows diffusion restriction on diffusion-weighted imaging (DWI). With surgical treatment, the outcome is usually favorable.

Acral Prurigo Nodularis: A Case Report

Prurigo nodularis (PN) is a chronic skin disease that manifests with severe itchy, firm, hyperkeratotic nodules distributed on the trunk and the extremities symmetrically. Here, we report a unique presentation of PN. A 26-year-old male presented with multiple itchy nodules over the hands and feet sparing the trunk, which were confirmed histologically as PN. This is the first reported case of PN with exclusive acral distribution.

Granular Parakeratosis With Spontaneous Resolution: A Case Report

Granular parakeratosis (GP) is a rare, idiopathic, and self-limiting cutaneous disorder. It clinically presents as erythematous to brown hyperkeratotic or scaly papules that can coalesce to form plaques. If GP is suspected clinically, histopathological confirmation is adequate for diagnosis. Several treatment modalities were tried with varying success, but none was consistently efficacious.

Given the rarity of GP and the variety in its clinical presentation and management, we report a case of a self-resolving infra-abdominal GP. Our patient is a 47-year-old female who presented with a one-week history of asymptomatic, multiple, linear, horizontal, brown, hyperpigmented scaly papules in the infra-abdominal fold. She had a three-year history of applying almond oil and Sudocrem Antiseptic Healing Cream®. Histopathology showed the retention of basophilic keratohyalin granules within the area of parakeratosis in the stratum corneum, which is consistent with GP. She was discharged on emollients, and on follow-up one month later, her lesions completely resolved.

In conclusion, GP is a rare cutaneous disorder characterized by hyperkeratotic plaques or papules typically on intertriginous areas. The natural history of the disease may vary from spontaneous resolution to a waxing and waning condition. In addition, given how uncommon the disease is and its variable etiologies and course, definite management is yet to be established and a standardized treatment recommendation is lacking.

Metastatic pleural mesothelioma presenting initially as multiple gastric and colonic polyps

It is extremely rare for malignant mesothelioma to present as gastrointestinal polyps. This case report documents the presentation of malignant mesothelioma in a 72-year-old as rectal bleeding and weight loss. Endoscopically, there were multiple gastric and colonic polyps. Histopathologically, there were atypical cells in the lamina propria with benign surface epithelium. The cells tested positive for cytokeratin, calretinin and D2–40 and negative for CD45, CD117, Ber-EP4 and CEA, confirming the diagnosis of metastatic mesothelioma. A computed tomography scan of the chest showed nodular thickening of the left lower pleura that was compatible with a diagnosis of primary pleural mesothelioma. We conclude that metastatic mesothelioma can sometimes present as gastrointestinal polyps.

A Case of Kikuchi-Fujimoto Disease Associated with Erosive Lichen Planus

Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a benign, self-limiting disorder with unknown etiology. The most frequent clinical manifestations include lymphadenopathy, fever, cutaneous lesions, arthritis, fatigue, and hepatosplenomegaly. Cutaneous manifestations of KFD, occurring in about one-third of patients, are typically non-specific, rarely presenting as symmetrically distributed lesions. The prevalence of erosive lichen planus in patients with KFD, as of this date, is unknown with no previously reported cases describing an association between the two conditions. In the following case report, we report a case presenting with bilateral symmetrical erosive lichen planus of the heel associated with KFD as being a possible, rather novel, cutaneous manifestation.

Invisible dermatosis, diagnostic discrepancy between the general pathologist and dermatopathologist

BACKGROUND

Many clinically indicated skin biopsies show minimal histological changes referred to as "invisible dermatoses." They pose a challenge to general pathologists and dermatopathologists. This study determines the discrepancy between the general pathologists' diagnosis and the dermatopathologist's diagnosis and helps define a pathway for reaching the correct diagnosis.

METHODS

In total, 81 skin cases were selected from a tertiary hospital pathology department. They were diagnosed by general pathologists as "no specific diagnosis," or "minimal pathologic changes." These cases were reviewed carefully and diagnosed by a dermatopathologist. His diagnoses were compared with the original diagnoses.

RESULTS

Out of the 81 cases, 43 cases (53%) were reported by the dermatopathologist to have a specific diagnosis while 38 cases (46.9%) remained nonspecific. Both inflammatory and neoplastic diagnoses of potential clinical significance were made in the first group of 43 cases. The remaining 38 cases with nonspecific results were due to inadequate biopsy, inactive lesions or inadequate clinical data.

CONCLUSION

"Invisible dermatoses" describes skin diseases with clinically evident but histologically hidden changes. They are difficult cases for general pathologists and dermatopathologists to diagnose. Hence, it is important to be aware that minor changes on a skin biopsy do not mean it is disease-free.

Steatocystoma Multiplex Suppurativa: A Case with Unusual Giant Cysts over the Scalp and Neck

Steatocystoma multiplex (SM) is a rare hamartomatous malformation of the pilosebaceous duct junction. Most cases of SM are sporadic, although less common autosomal dominant inherited forms have been reported. Steatocystoma multiplex suppurativa (SMS) is a much rarer inflammatory variant of SM, associated with severe inflammatory lesions resembling those of hidradenitis suppurativa. We describe herein a 28-year-old male with SMS who presented with extensive giant cysts on his neck, face, and scalp.

Dyschromatosis symmetrica hereditaria with cutaneous lupus erythematosus and hyperthyroidism

Dyschromatosis symmetrica hereditaria (DSH) is a rare genodermatosis characterized by various sizes of both hyper- and hypopigmented macules arranged in reticulated patterns on the face and the dorsal aspects of the extremities. There are also cutaneous and extracutaneous abnormalities, but they are rare. As far as we know, DSH associated with immune-mediated conditions has not been reported. We report the first case of DSH, which is associated with cutaneous lupus erythematosus and hyperthyroidism.

Cutaneous Intravascular NK/T-cell lymphoma mimic panniculitis clinically, case report and literature brief review

Intravascular large cell lymphoma is a rare subtype of extranodal large cell lymphoma characterized by the presence of neoplastic cells within the lumina of small vessels. Most cases of intravascular large cell lymphoma have a B-cell phenotype. To date, 12 cases of intravascular natural killer (NK/)/T–cell lymphoma (IVNKL) have been reported. Our case is A 47-year-old female presented with erythematous patches and plaques on the lower extremities mimicking panniculitis clinically. A skin biopsy revealed intravascular lymphoma (IVL) with a NK/T cell phenotype (positive for CD3, and granzyme B and negative for CD20, CD4, CD8, CD5). The lymphoma cells were also positive for Epstein-Barr virus by Epstein-Barr virus-encoded RNA in situ hybridization test. Because this type of lymphoma is extremely rare, our case is documented and compared with the previously reported cases.

Yolk sac tumor of vagina: a case report

Malignant germ-cell tumors (MGCT) are rare tumors of childhood accounting for less than 3% of pediatric malignancies. Yolk sac (endodermal sinus) tumor is one of the malignant germ cell tumor that usually involves the gonads (ovaries and testes). Its occurrence in the vagina is extremely rare. We report a 6-months old girl presented with a vaginal mass diagnosed as a yolk sac tumor. This diagnosis is confirmed by histopathologic examination, immunehistochemical studies as well as elevated serum alpha fetoprotein (AFP).

Acantholytic squamous cell carcinoma arising in a nevus sebaceous: A case report

Although nevus sebaceous (NS) is known to develop various types of secondary neoplasms, it rarely causes carcinoma and only fifteen cases of secondary squamous cell carcinoma (SCC) have been reported. We report a rare variant of SCC (acantholytic type) arising in nevus sebaceus.

The neurologic aspects of hypomelanosis of Ito: Case report and review of the literature

The term hypomelanosis of Ito (HI) is applied to individuals with skin hypopigmentation along the lines of Blaschko. Although it was originally described as a purely cutaneous disease, subsequent studies describing HI reported a 33% to 94% association with multiple extracutaneous manifestations, mostly of the central nervous and musculoskeletal systems. This leads to characterization of HI as a neurocutaneous disorder. We report a 10-year-old boy who presented with constellation of multiple congenital anomalies including facial dysmorphism, skin hypopigmentation, musculoskeletal, and nervous system abnormalities. The latter manifested as hypotonia, generalized seizures, and mild mental retardation. Cranial magnetic resonance imaging revealed normal finding initially, however; follow-up diffusion weighted images were suggestive of a possible iron accumulation. The facial phenotype coupled with the bilateral globus pallidi lesions were never been reported in association with HI. Thus, our patient represents a possible novel example of HI.