Langerhans cell histiocytosis presenting as a blueberry muffin rash

Langerhans cells, often referred to as the "macrophages of the skin", are dendritic cells that normally reside in the epidermis and papillary dermis. Just like macrophages, they function as antigenpresenting cells that activate naive T cells. Certain mutations such as those involving the BRAF gene can cause unopposed production of Langerhans cells, which is known as Langerhans cell histiocytosis (LCH). LCH triggers an inflammatory immune response that causes systemic manifestations such as fever and fatigue, as well as other manifestations depending on the affected organs. The pathogenesis behind LCH remains poorly understood. It is still unknown whether it is a neoplastic process or a reactive cancer-mimicking illness. Diagnosis of LCH is confirmed by biopsy, and treatment is largely dependent on the extent and severity of the disease. Common treatments include corticosteroids, excision, radiation, and chemotherapy. We present a case of a 1-year-old Saudi male with LCH.

Propranolol for the Treatment of Hemangioma in PHACE Syndrome: A Case Report

Oral propranolol is commonly used as a first-line treatment for infantile hemangioma. However, its use in PHACE (posterior fossa anomalies, hemangioma, arterial anomalies, cardiac anomalies, and eye anomalies) syndrome raises concerns that it might exacerbate the patient's risk of stroke. Here, we report the case of a four-month-old premature girl with PHACE syndrome, who presented with a large hemangioma involving the left side of her face, following the V1+V2+V3 distribution, including the upper lip, left ear, and left eye. This condition was successfully treated with propranolol, and no adverse side effects were reported.

Cowden syndrome. Early presentation, late diagnosis

Cowden syndrome is a rare genodermatosis characterized by the formation of hamartomas in various organs and increased risk of malignancy. This disease has variable expression and often presents with subtle skin signs, which can be missed. We report a 39-year-old Saudi male who presented with acral keratoses of Cowden syndrome, and misdiagnosed and treated by many dermatologists as viral wart. We aim to increase awareness of Cowden syndrome among health care workers.

Recurrent visits and admissions of children with asthma in central Saudi Arabia

OBJECTIVE

To identify the pediatric age group and most affected gender by asthma, and to determine the significant predictors of severity of asthma, and assess the appropriateness of asthma medication administration.

METHODS

This cross-sectional study was carried out at Emergency Department (ED) of children's Hospital at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia from January to March 2009. Interviews were carried out with the parents of 185 children, who presented to the Hospital with asthma exacerbation more than once over the last 6 months, to collect data of possible risk factors, and appropriateness of medication administration technique.

RESULTS

Most patients were males 71.9%, aged 1-6 years (58.9%), and 8.1% of them presented to the ED because of asthma exacerbation more than once over the last 6 months. Approximately two-thirds (65.9%) of the parents explained the way of meter dose inhaler administration correctly. Infants were significantly the least affected group (p=0.02). Severity was significantly higher among appropriate users of medications (p=0.046).

CONCLUSION

Appropriateness of medications administration was significantly associated with severity. However, this may not be considered a valid predictor of severity, as parents of children with recurrent attacks may have a better chance of being taught how to use medications.