Bilateral simultaneous quadriceps ruptures in an elite bodybuilder: A case report of treatment success.

Tendon injuries in weightlifters is known to be associated with steroid use. Bilateral simultaneous quadriceps tendon rupture (BSQTR) is extremely rare with few cases reported in literature in young athletes. Unlike patellar tendon ruptures, they are more common in older age individuals. These injuries can jeopardize an athlete's career. In this paper, we report a very rare case of BSQTR in an elite bodybuilder who sustained a high mechanism trauma while squatting heavyweights. He sustained bilateral anterior cruciate ligament (ACL) injury and a left ankle fracture. All injuries were treated surgically except for the left ACL as it was asymptomatic on follow-up. The challenge in this case was to treat his injuries and to regain his baseline functional status in the shortest period of time. Following treatment, the patient had a satisfactory clinical outcome with focused rehabilitation. Despite the devastating trauma, the patient was able to progress throughout the treatment plan and has regained his baseline functional status in less than 18 months and has resumed his competitive bodybuilding career. From the available literature, this is the first case to be reported with such combined injuries that was treated and showed a satisfactory outcome in a short period of time.

Childhood vitiligo: a long-term study of localized vitiligo treated by noncultured cellular grafting.

Segmental type was the second most commonly reported in childhood vitiligo. No significant difference has been reported in the prevalence of childhood and adult focal vitiligo. However, the prevalence of segmental vitiligo has been found to be higher in children compared with that in adults. All available medical and phototherapy options are limited by adverse effects or unsatisfactory efficacy. Surgical techniques may be preferred but are not recommended for children as they are time consuming and associated with technical difficulties. In a retrospective review, 25 children aged 4 to 16 years were treated by autologous, noncultured cellular grafting performed under sedation supplemented with local anaesthesia and were followed up for a period of 9 to 54 months postgrafting. Repigmentation was graded as excellent with 95% to 100% pigmentation, good with 65% to 94%, fair with 25% to 64%, and poor with 0% to 24% of the treated area. In the segmental group, eight (62%) showed excellent, two (15%) good, one (8%) fair, and two (15%) poor pigmentation, which was retained until the end of the respective follow-up period. In the focal group, nine (75%) showed excellent, and one (8%) each showed good, fair, and poor pigmentation, which was retained until the end of the respective follow-up period. Noncultured cellular grafting may be considered to treat childhood localized vitiligo.

Epidermodysplasia Verruciformis: A Rare Case Report.

Epidermodysplasia verruciformis (EV) is an uncommon disorder that is transmitted in an autosomal recessive manner. It is characterized by increased susceptibility to human papillomavirus (HPV) infection, which presents with hypo- or hyperpigmented macular lesions, pityriasis versicolor-like lesions, and an early tendency to transform into skin cancer. We present a case of a 36-year-old female with complaints of asymptomatic, multiform lesions over the face, neck, chest, and upper arms. Histopathology was suggestive of EV, and our patient was given oral isotretinoin 20 mg/day and advised strict photoprotection.

Facial Prurigo Pigmentosa After Bariatric Surgery.

Prurigo pigmentosa (PP) is a rare, inflammatory, idiopathic skin disorder, which typically presents as symmetrically scattered pruritic erythematous reticulated papules with occasional vesicles. PP has been primarily a disease of the trunk and the neck, and, to the authors' knowledge, there has been only two reported cases of PP where the forehead/facial areas were involved worldwide. Interestingly, there have not been any reported cases of after bariatric surgery PP with facial involvement. Herein, we present a case of PP after laparoscopic sleeve gastrectomy with involvement of the face, chest, and back.

Treatment of vitiligo on difficult-to-treat sites using autologous noncultured cellular grafting.

BACKGROUND: Because of the limitations of medical treatment, various surgical therapies have been developed and are being accepted to treat vitiligo. However, certain areas such as the fingers and toes, palms and soles, lips, eyelids, nipples and areolas, elbows and knees, and genitals are considered difficult-to-treat areas. OBJECTIVE: To evaluate data pertaining to individual sites considered to be difficult to treat and highlight that noncultured melanocyte-keratinocyte transplantation (MKT) does not require any special precautions to treat these anatomical sites. METHODS AND MATERIALS: Forty patients (13 male and 27 female) with bilateral vitiligo and nine (4 male and 5 female) with unilateral vitiligo were treated using noncultured MKT, for "difficult-to-treat" sites at the National Center for Vitiligo and Psoriasis, Riyadh, Saudi Arabia, and were analyzed for response according to region. Repigmentation was graded as excellent with 95% to 100% pigmentation, good with 65% to 94%, fair with 25% to 64%, and poor with 0% to 24% of the treated area. RESULTS: For bilateral vitiligo, more than 50% of patients treated for difficult sites showed more than 65% repigmentation of the treated areas. For unilateral vitiligo, all of the patients except for two treated for the eyelids showed more than 65% repigmentation of the treated area. CONCLUSIONS: The concept of a "difficult-to-treat site" is a relative term and depends upon the technique used. The noncultured MKT does not require any special precautions to treat these anatomical sites. This review may help physicians to change the concept of "difficult-to-treat site."

Uncommon responses of segmental vitiligo to melanocyte-keratinocyte transplantation procedure.

BACKGROUND: Patients with segmental vitiligo (SV), unlike those with nonsegmental vitiligo (NSV), have a more predictable course and are more responsive to surgery. OBJECTIVE: To report 10 patients with SV treated with the melanocyte-keratinocyte transplantation procedure (MKTP), who responded with unusual responses not previously reported in the literature. METHODS: This is a retrospective, observational study that reports 10 patients with SV who underwent the MKTP between May 2003 and May 2012. RESULTS: Two patients had successful repigmentation after split-thickness skin grafting after failure of the MKTP. Two patients developed a hypopigmented ring at a margin of the MKTP-treated area. One patient had complete repigmentation after a second MKTP. Two patients developed koebnerization of the recipient site. Three patients developed new vitiligo patches in previously unaffected areas after the MKTP. CONCLUSIONS: Uncommon and even suboptimal responses can occur following the MKTP in SV patients. There is a need for studies to provide better understanding and outcomes for SV patients undergoing the MKTP.

Repigmentation of vitiligo-associated leukotrichia after autologous, non-cultured melanocyte-keratinocyte transplantation.

BACKGROUND: Many cases of leukotrichia are associated with vitiligo. Hair follicles are believed to be the source of melanocytes for skin repigmentation using standard medical therapy for vitiligo. Vitiliginous areas with overlying leukotrichia usually fail to achieve repigmentation by conventional medical treatments as a result of a deficient melanocyte reservoir. Even after the successful repigmentation of vitiliginous skin by medical therapies, leukotrichia hairs may remain depigmented, causing a major psychological impact to the patient. In such cases, surgical treatments may help to achieve the repigmentation of leukotrichia hairs. Reports of successful repigmentation in leukotrichia using different surgical treatments for vitiligo are few. OBJECTIVE: This study reports the benefit of autologous non-cultured melanocyte-keratinocyte transplantation (MKT) in patients with vitiligo-associated leukotrichia. METHODS: We report four cases of vitiligo-associated leukotrichia treated with MKT. RESULTS: All four patients showed significant repigmentation in vitiligo-associated leukotrichia after MKT. CONCLUSIONS: Melanocyte-keratinocyte transplantation may represent a good therapeutic option for the repigmentation of vitiligo-associated leukotrichia. This series includes only four responsive cases. Larger prospective studies are needed to determine the true response rate and mechanism of repigmentation.

Nevus depigmentosus treated by melanocyte-keratinocyte transplantation.

BACKGROUND: Nevus depigmentosus is a congenital, nonprogressive hypopigmented disorder. Various therapeutic methods have been attempted to repigment nevus with variable results. OBJECTIVE: The objective of this study is to report our experience of treatment of nevus depigmentosus with a combination of noncultured melanocyte-keratinocyte transplantation (MKTP) and excimer laser sessions. MATERIALS AND METHODS: Six patients (male 1, female 5) of nevus depigmentosus were treated with a combination of noncultured melanocyte-keratinocyte transplantation and excimer laser. One patient was lost to follow-up. Remaining five patients were observed for a period ranging from 7 to 30 months. RESULTS: Two patients responded poorly to MKTP. The remaining three patients responded with repigmentation ranging from 80% to 100% but the quality of repigmentation was unsatisfactory in two of them. CONCLUSION: Though repigmentation of nevus depigmentosus is possible by grafting techniques, the results are inconsistent and recurrence is possible.

Quality of life in saudi vitiligo patients.

BACKGROUND: Vitiligo has a devastating psychosocial effect. The cultural traditions of Saudi society are quite different compared with the western world. Hence, a quality of life study using a different questionnaire suitable to the cultural traditions of the society is necessary to measure qualify of life in vitiligo patients. OBJECTIVE: This study was conducted to assess the quality of life (QOL) in Saudi vitiligo patients and their family. MATERIALS AND METHODS: A prospective cross-sectional study at National Center for Vitiligo and Psoriasis, Saudi Arabia. A validated Arabic questionnaire of 41 questions was developed and utilized specifically for this study. Arabic language instrument was distributed to 260 vitiligo patients. Scores were compared in relation to demographic, clinical, and social variables in 4 dimensions of scale (relationship with colleagues, family relationship, social relationship, and self respect). RESULTS: Overall score QOL was 17.1. Mean score for males was 11.1, whereas that for females was 23.9 (P < 0.05). Females scored significantly higher in all the 4 dimensions. Patients with exposed disease lesions scored significantly higher than those with unexposed lesions 5 vs 3.4 (P < 0.05). CONCLUSION: The overall score of QOL in vitiligo is relatively high, indicating a negative impact of the disease on QOL. QOL in women is significantly more affected than in men.

Mixed vitiligo.

BACKGROUND: There are two commonly recognized forms of vitiligo-generalized and localized. This classification is important to understand the course of the disease and its prognosis. Most patients have generalized vitiligo; few patients have both segmented and generalized vitiligo. OBSERVATION: We report four more cases of mixed vtiligo, segmental with generalized type. This report is only the second to present a case of segmental with generalized vitiligo. CONCLUSION: Mixed vitiligo is not yet part of a standard classification. Its etiology is not yet fully defined. Further research is required to understand the course and prognosis of mixed vitiligo.

Genital vitiligo treated by autologous, noncultured melanocyte-keratinocyte cell transplantation.

BACKGROUND: Genital vitiligo is common and has a deleterious effect on the psychosexual function of patients. It is well known that glabrous skin (non-hair-bearing skin such as below the ankles, genitalia, lips, distal ends of fingers) rarely responds to the therapy unless it has some residual pigment. OBJECTIVE: The objective was to report genital vitiligo treated successfully by autologous, noncultured, melanocyte-keratinocyte cell transplantation. METHODS: Three cases of clinically stable genital vitiligo were treated by autologous, noncultured melanocyte-keratinocyte cell transplantation. RESULTS: All lesions treated repigmented almost completely. All patients were very satisfied with the excellent cosmetic results. CONCLUSION: Autologous, noncultured melanocyte-keratinocyte cell transplantation may be an effective surgical treatment for management of genital vitiligo.