Radiologically isolated syndrome and multiple sclerosis.

BACKGROUND: Incidental white matter lesions (WML) are increasingly seen on brain magnetic resonance imaging (MRI) in clinical practice. Demyelination consistent with MS is seen in 0.1-0.7% of the population as evident by autopsy and MRI studies. The term radiologically isolated syndrome (RIS) was coined to define a subgroup of patients with demyelinating lesions highly suggestive of multiple sclerosis (MS). The Okuda criteria for diagnosing RIS help in stratifying the risk of conversion to MS but RIS is still not considered a distinct MS phenotype. METHODS: The authors reviewed the current literature on diagnostic criteria, natural history and treatment indications in RIS, to assess the challenges faced in diagnosing and treating such patients in clinical practice. RESULTS: Typically, one-third of patients convert to clinically definite MS within 5 years, with some progressing directly into primary progressive MS (PPMS). The main risk factors for conversion are: age < 37 years, male gender and presence of spinal cord lesions. Patients with RIS have evidence of early axonal loss, brain atrophy, cognitive deficits, increased anxiety and depression, and subclinical inflammatory disease. CONCLUSION: Patients with RIS at high risk of clinical conversion might be considered for treatment, although this is still a controversial issue. Prospective follow-up of RIS patients by an MS specialist is recommended.

Photochemotherapy for vitiligo: Seven years' experience at a University Hospital.

Photochemotherapy has been the most successful treatment of vitiligo to date. In this study we tried to evaluate the efficacy, safety and patient acceptability of photochemotherapy (PUVA, or psoralen and ultraviolet A, therapy) for vitiligo patients treated in King Khalid University Hospital over the period of 1987-1994. The treatment success strongly depended on the number of treatments. More than 75% repigmentation was achieved in 42% of the patients who received 100 to more than 200 treatments. Unfortunately, however, only 27% of the patients received this number of treatments. Reasons for the failure of our patients to continue treatment to successful repigmentation, and recommendations for correction of this failure, are discussed.

Failure of interferon-alpha 2b in the treatment of mature keloids.

UNLABELLED: BACKGROUND> An unchecked proliferation of fibrous tissue after an injury to the skin is the basic mechanism for keloid formation. Recent studies have shown the inhibitory effect of interferons on dermal fibroblast growth and/or collagen production. Various therapeutic modalities have been used for the treatment of keloids, although only with limited success. There are only a few reports on the use of interferons in the treatment of keloids. To our knowledge no controlled clinical trials have examined the efficacy of intralesional interferon-alpha 2b on mature keloid lesions. In this study, recombinant human interferon-alpha 2b was examined for its ability to modify keloids clinically. METHODS: Twenty-two patients with at least two mature keloids were studied twice weekly for 3 weeks. Patients were treated by injection of recombinant human interferon-alpha 2b, 0.5 million per cm2 of keloid, into one lesional site and diluent alone into another lesional site. Lesions were measured before and on days 8, 15, 22, and 29 after starting treatment. RESULTS: Only 13 of 22 patients could be evaluated at the end of the study; seven patients withdrew from the study because of severe local pain during injection. Three of the 13 patients showed insignificant reduction in the height of keloids after interferon treatment. No serious laboratory abnormalities were detected.

Isotretinoin for acne vulgaris.

BACKGROUND: The clinical efficacy of oral isotretinoin in the treatment of severe acne is now well established and so are the clinical and laboratory adverse effects of the drug. Isotretinoin was first introduced in Saudi Arabia late in 1987. In this 7-year retrospective study, efficacy and side effects of isotretiunoin are reviewed in Saudi patients with acne vulgaris seen in a university skin clinic in Riyadh, Saudi Arabia. MATERIALS AND METHODS: A total of 262 patients had been treated with isotretinoin. Their case records were studied with reference to demographic data, clinical findings, dosage of isotretinoin, response to the drug, and the prevalence and severity of clinical and laboratory adverse effects. RESULTS: Only 156 case records (69.9% women) could be evaluated. Most patients received 0.60 to 0.75 mg of isotretinoin per kg per day for a period ranging from 16 to 35 weeks (mean +/- SD: 21.2 +/- 3.3 weeks); a total cumulative dose of 75 to 146 mg per kg (mean +/- SD: 104 +/- 10.6 mg per kg). Approximately 56% of the patients had therapy-resistant moderate acne and only 14% had nodulocystic acne. Of the patients, 90.4% had an excellent response and 3.8% were poor responders. Adverse effects occurred in 99% of the patients, but in no case did they lead to discontinuation of the drug. Except for minor differences in prevalence, the clinical side effects were similar to those reported in the literature. Elevation of plasma triglyceride levels was the most significant laboratory adverse effect. CONCLUSIONS: This is the first report on the experience with isotretinoin in the treatment of acne in the Middle East. Moderate doses of isotretinoin are well tolerated and produce excellent results in Saudi patients with acne.

Alopecia areata and associated diseases in Saudi patients.

Alopecia areata is a common presentation of Saudi patients seen at dermatology clinics. Although autoimmune factors have been suggested as pathogenic factors, alopecia areata remains a disease of unknown etiology. We investigated 92 patients with alopecia areata as compared to 88 sex- and age-matched healthy control subjects for the prevalence of associated diseases as well as abnormalities of thyroid function, and for the frequency of anti-thyroid antibodies. We found that atopy and pscychological stress constitute the most commonly associated disorders in our series. Except for two female patients with diabetes mellitus, none of the remaining patients displayed clinical evidence of endocrine or autoimmune disease. Only one patient had high T(3) and T(4) values and five (5.4%) had low titers of anti-thyroid antibodies, an acceptable finding for the normal population.

The black disease of Arabia, Sowda-onchocerciasis. New findings.

Sowda, the localized asymmetrical lesion of onchocerciasis endemic in Yemen and Southern Saudi Arabia, is characterized by hyperpigmented lichenified papular lesions on one leg with intense pruritus. There is enlargement of femoral and inguinal lymph glands. In our study, even the long standing cases do not show elephantiasis of the leg or genitalia. Microfilaria appeared to be scarce and adult worms could not be detected clinically, as well as by ultrasonography (except in one case). There was no significant lymphatic obstruction; such cases were studied by contrast lymphangiography and isotope lymphangiography.