Survey of acne-related post-inflammatory hyperpigmentation in the Middle East.

Aim: Acne vulgaris is a common inflammatory skin disease in the Middle East, similar to other regions of the world. In the Middle East, there are a relatively large proportion of patients with darker pigmentation (Fitzgerald skin types III-VI) who are prone to developing post-inflammatory hyperpigmentation (PIH) as a sequela of acne. Data are sparse on the frequency and characteristics of PIH throughout the world. What information is available indicates that pigmentation problems can be very bothersome for patients and are often quite long-lasting. Thus, it is important for clinicians to be aware of the scope of the problem of acne-associated PIH as well as potential treatment options. Methods: Prospective non-interventional study of acne patients consulting dermatologists (n = 262) in the Middle East. Results: PIH was present in 87.2% of subjects. The majority of subjects (52.6%) reported that PIH had been present for one year or longer. Of note, 69.0% of subjects reported excoriating their acne lesions, suggesting that this may be a key modifiable risk factor for clinicians to stress during patient education efforts. Conclusions: PIH was bothersome for patients, with half of subjects indicating that PIH was more bothersome than acne. In addition to our study results, we present here a brief overview of PIH and its treatment.

Managing acne in the Middle East: consensus recommendations.

Acne has been estimated to affect the majority of people at some point in their life and is common in Middle Eastern countries. While acne is frequently perceived to be a self-limited disease of adolescence, there is an increasing population of adults with acne. Information about the management of acne in the Middle East is somewhat sparse; however, several studies have recently been conducted and will be discussed in this supplement.

A consensus-based practical and daily guide for the treatment of acne patients.

BACKGROUND: Many current guidelines provide detailed evidence-based recommendations for acne treatment. OBJECTIVE: To create consensus-based, simple, easy-to-use algorithms for clinical acne treatment in daily office-based practice and to provide checklists to assist in determining why a patient may not have responded to treatment and what action to take. METHODS: Existing treatment guidelines and consensus papers were reviewed. The information in them was extracted and simplified according to daily clinical practice needs using a consensus-based approach and based on the authors' clinical expertise. RESULTS: As outcomes, separate simple algorithms are presented for the treatment of predominant comedonal, predominant papulopustular and nodular/conglobate acne. Patients with predominant comedonal acne should initially be treated with a topical retinoid, azelaic acid or salicylic acid. Fixed combination topicals are recommended for patients with predominant papulopustular acne with treatment tailored according to the severity of disease. Treatment recommendations for nodular/conglobate acne include oral isotretinoin or fixed combinations plus oral antibiotics in men, and these options may be supplemented with oral anti-androgenic hormonal therapy in women. Further decisions regarding treatment responses should be evaluated 8 weeks after treatment initiation in patients with predominant comedonal or papulopustular acne and 12 weeks after in those with nodular/conglobate acne. Maintenance therapy with a topical retinoid or azelaic acid should be commenced once a patient is clear or almost clear of their acne to prevent the disease from recurring. The principal explanations for lack of treatment response fall into 5 main categories: disease progression, non-drug-related reasons, drug-related reasons, poor adherence, and adverse events. CONCLUSION: This practical guide provides dermatologists with treatment algorithms adapted to different clinical features of acne which are simple and easy to use in daily clinical practice. The checklists to establish the causes for a lack of treatment response and subsequent action to take will facilitate successful acne management.

Contact dermatitis in UAE.

Twenty five cases (22 females) who attended the Dermatology out-patient in Dubai dermatology clinic, U.A.E were entered in this study. All of them complained of hand eczema which was diagnosed as contact dermatitis (C D) of the hands. The closed patch test technique was performed for all of them using the standard European battery containing 22 allergens. The results were interpreted and analyzed using the ICDG mode of interpretation after 48 and 96 hours, respectively. We found that nickel sensitivity represented the most common type of sensitivity in hand eczema in both citizens and expatriates living in Dubai, while parabens of perfumes represented the second common sensitizers. We think that patch testing in case of C D of hand is a very good tool for investigating hand eczema.

Rapid detection of IgM and IgG antibodies to herpesviridae virus.

In this study, the immunoconcepts EA indirect enzyme antibody technique (colorzyme) was used not only for detection of IgG antibodies but also for quantitative detection of IgM antibodies to Herpes Simplex virus (HSV), Cytomegalovirus (CMV) and Epstein Barr Virus (EBV) to diagnose recent iactivei infection. Reference reactive and negative antisera and randomly collected human sera were tested by complement fixation test (CFT) against HSV antigens and tested also by immunofluorescent (IF) and colorzyme Immunoconcepts EA tests. All sera that were negative to HSV, CMV and EBV antibodies by CFT were negative by IF and colorzyme EA tests. All antibody positive sera and reference positive antisera were also positive by IF and colorzyme EA tests with slight variation in antibody titres between CFT and colorzyme test results. Human sera which were negative or IgM positive to HSV, CMV and EBV by ELISA as well as negative and positive reference sera from different diagnostic kits were retested by IF and colorzyme EA for IgM antiviral reactivity results were concordance by the three rests. All incubations in colorzyme test were at room temperature and only an ordinary microscope used in IF test or plate washers and readers needed for ELISA test. The colorzyme immunoconcepts is a simple, rapid and sensitive for viral diagnosis and can be used in any private laboratory.

A comparative study between viral isolation and indirect immunofluorescence in the diagnosis of herpes simplex virus.

Fifty patients with oral ulcers were studied clinically and investigated for the detections of Herpes Simplex Virus (HSV) through virus isolation from their lesions (vesicles and ulcers) and detection of the presence of antiviral antibodies (both, IgM and IgG) in their sera using the indirect immunofluorescene (IIF) technique. The results of this study proved that virus isolation is the most reliable method for diagnosis, though the use of antibody serological tests could be a useful adjunct to virus isolation in situations where a rapid laboratory diagnosis is needed. Oral Herpes Simplex virus infection can be viewed, in the main, as a trivial disorder causing patients minor physical discomfort. The prevalence of HSV may be high in innocent infections, as high as 1/3 of the population. However, HSV infection and its complications with troublesome recurrences may make the problem worse. The apparent increase in HSV infection over recent years may be partly due to increased publicity about the disease, the current antiviral treatment, the inclusion of both primary and recurrent cases in clinic follow up and the increased use of viral cultures for diagnosis. The aim of this work is to share in the study of the detection of HSV through virus isolation and detection of antiviral antibodies using IIF technique, as well as the evaluation of the diagnosis by the above mentioned methods.

Serum levels of the soluble interleukin-2 receptor in vitiligo patients in UAE.

OBJECTIVE: To determine serum level of slL-2 receptor in patients with vitiligo in a population in Al Ain, UAE. DESIGN: This is a prospective, descriptive, hospital based study. SETTING: Al Ain Medical District, Al Ain Hospital, UAE. SUBJECTS: Vitiligo patients seen at Al Ain hospital in 2003. RESULTS: The study was based on 32 patients. The sample consisted 21 males and 11 females. 15 healthy individuals were selected as control group. Serum level of slL-2R were significantly higher in vitiligo patient (112 +/- 129.2) than in healthy control (61.1 +/- 44.3 Pmol/L) P < 0.0001. Patient with short duration of the disease shows higher the serum level slL-2R. CONCLUSION: slL-2R showed significant difference between vitiligo patients and control.

Prostatic-specific antigen and idiopathic hirsutism in females.

Serum prostatic-specific antigens (PSA) were found recently to be present in several female tissues and fluids. High concentrations of PSA were found in hirsute women in comparison with nonhirsute, as was found in other studies. In our study we measured the level of PSA in 20 hirsute and 10 control subjects by using an IMx machine from Abbot Laboratories (Diagnostic division, Abbot Park, Illinois 60064, USA). The age, BMI, F-G score, duration and family history of hirsutism were recorded for both groups. The results were analyzed by using SPSS. We conclude that there is no significant association between the level of PSA and the presence of hirsutism. Usage of this test as a marker of idiopathic hirsutism needs further evaluation.

Diphenylcyclopropenone (diphencyprone, DPCP) in the treatment of chronic severe alopecia areata (AA).

BACKGROUND: Diphenylcyclopropenone (DPCP) has been reported to be an effective topical immunotherapy of extensive alopecia areata (AA) with highly variable reported results. OBJECTIVE: The purposes of this study were to assess the efficacy, side effects, and adverse prognostic factors in the treatment of alopecia areata with DPCP. METHODS: 21 patients were included in the study with chronic and extensive AA. Patients were sensitized in the beginning with 2% DPCP, and the concentrations were increased gradually beginning with 0.000001% every one to two weeks for a period of 6 months. RESULTS: 15 patients (71.4%) had a complete or partial recovery at the end of the treatment period. Most frequent side effects were erythema at the site of application, pigmentation, and lymph node enlargement. The most important adverse prognostic factors were duration of AA, history of atopy, and presence of nail changes. CONCLUSION: Treatment of AA with topical DPCP is effective. Though the treatment may have some side effects, in most cases they are tolerable and respond well to treatment.

Allergic contact dermatitis in the United Arab Emirates.

BACKGROUND: No data exist on allergic contact dermatitis (ACD) in the United Arab Emirates (UAE). AIM: Our aim was threefold: (i) to determine the incidence of ACD; (ii) to identify responsible allergens using the European Standard Series, TRUE TEST, and other substances; (iii) to tentatively explore population-specific reactions in Al Ain, UAE. DESIGN: This is a prospective, descriptive, hospital-based, study. SETTING: Tawam Hospital, Al Ain Medical District, UAE. PATIENTS: During the years 1989-1996, 373 patients (male: female = 2 : 3), presenting with cutaneous manifestations possibly related to contact allergy, were patch tested. RESULTS: 93.8% of patients presented with dermatitis affecting mostly the hands (45.1%), feet (21.4%), face (12.6%), and legs (4.6%). Two hundred and twenty-four patients (60%) (male : female = 1 : 2) tested positive for at least one substance. Nickel was the commonest sensitizer (15%) in both genders. "Fragrance mix" (8%), p-tertiary butylphenolformaldehyde (p-TBPF) resin (7.5%), thiomersal (7.5%), chromium (7.2%), cobalt (6.4%), ethylenediamine (6.4%), neomycin (5.1%), and parabens (5.1%) were prominent allergens. Glutardialdehyde, an additional substance tested together with the European Standard Series, scored significantly (4.8%). Variations from the results reported from other countries may be explained by the specific lifestyles and customs of the UAE population. CONCLUSIONS: Substances contained in the TRUE TEST, plus glutardialdehyde, may be considered as the standard series for patch testing in the UAE population.

Respiratory symptoms and lung function in garage workers and taxi drivers.

The aim of this study was to determine the prevalence of some respiratory symptoms and possible diseases among occupationally-exposed garage workers and taxi drivers. This study involved 158 garage workers and 165 taxi drivers, matched for age, sex, nationality and duration of employment. The mean age of 158 Indian subcontinent garage workers was 34.4 +/- 10.4 years; their mean height and weight were 167.7 +/- 6.6 cm and 72.0 +/- 12.3 kg respectively, and the mean duration of employment garage workers was 8.8 +/- 7.6 years. The mean age of 165 Indian subcontinent male taxi drivers was 34.5 +/- 7.7 years; their mean height and weight were 168.7 +/- 6.1 cm and 71.3 +/- 12.6 kg respectively; and the mean duration of employment was 7.5 +/- 5.4 years. The data on chronic respiratory symptoms showed that garage workers had higher prevalence of symptoms than taxi drivers being significantly greater for chronic phlegm, (p < 0.007); dyspneoa (p < 0.001); and sinusitis (p < 0.03). A higher prevalence of all acute symptoms was recorded in garage workers than in taxi drivers, although the differences were significant only for throat (p < 0.02), hearing problems (p < 0.002); nose (dryness, bleeding and secretion) (p < 0.008); and low back pain (p < 0.05). Almost all forced spirometric tests in the exposed garage workers were lower than in taxi drivers. The results of stepwise multiple regression analysis showed that only phlegm, sinusitis, hearing problems, nasal catarrh, throat, low back pain, smoking and FEF25-75, variables were statistically significant predictors as risk factors. In conclusion, the present study suggests that a high prevalence of respiratory symptoms is associated with exposure to motor vehicle exhaust emission in garage working places. Long-term working as garage workers in the United Arab Emirates (UAE), may be associated with the development of chronic respiratory symptoms and have effects on their daily life and health.

Serum IgE level and clinical allergic diseases in the United Arab Emirates.

OBJECTIVE: To determine the serum IgE level in population and its association with allergic diseases in Al-Ain, United Arab Emirates (UAE). DESIGN: This is a prospective descriptive hospital-based study. SETTING: Al-Ain Medical District, Tawam Hospital, United Arab Emirates. SUBJECTS: Patients who were seen at Tawam Hospital for skin, allergic and respiratory diseases during 1996. RESULTS: The study was based on 228 patients. The sample consisted 95 (41.7%) males and 133 (58.3%) females. The mean and standard deviation of age were 25.89 +/- 15.87 years with range 1 and 72 years. The present study revealed that there were no statistically significant differences between serum IgE level and age groups, gender, clinical diagnosis and respiratory symptoms (p > 0.05). Of 59.2% of patients clinically diagnosed were possible IgE related. There was statistically significant differences between serum IgE level and cut (p < 0.030). There was a positive correlation between clinical diagnosis and cut. CONCLUSION: Consistencies and discrepancies between our findings and those from other studies with respect to allergic diseases and IgE level which support the hypothesis that allergic diseases are a multi-factorial diseases related to both familial and environmental influences.

Co-existence of leukoderma with features of Dowling-Degos disease: reticulate acropigmentation of Kitamura spectrum in five unrelated patients.

BACKGROUND: The spectrum of Dowling-Degos disease-reticulate acropigmentation of Kitamura (DDD-RAK) is a group of rare autosomal dominant disorders that have in common a unique histological picture of hyperpigmented digitate epidermal 'downgrowths'. Patients with the DDD-RAK spectrum may show hyperpigmented macules and papules, facial pits, breaks in dermatoglyphics and epidermoid cysts. OBSERVATIONS: We examined 5 unrelated patients, 3 females and 2 males (age range 22-35 years), who presented with clinical and histological features of the DDD-RAK spectrum. In addition, the patients presented with hypo- or depigmented macules and papules. Histopathology of the lesions revealed features that were identical to DDD-RAK; there were, however, diminution or absence of pigmentation. Family histories for pigmented lesions and leukoderma were positive in all patients and consistent with autosomal dominant modes of inheritance. CONCLUSION: These 5 cases, together with isolated reports in the literature of achromic lesions with histological features of DDD-RAK, point to the hypothesis that achromic macules and papules may be a feature of the DDD-RAK spectrum.

Pattern of cancer in the United Arab Emirates referred to Al-Ain Hospital.

To determine the safety, complication rate and cost saving of outpatient percutaneous blind needle liver biopsy in a single tertiary care center, we retrospectively reviewed the records of all 117 patients who had had outpatient percutaneous blind needle liver biopsy from March 1994 to September 1995. We reviewed data including demography, ChildA centAAs classification, histopathology report and complications, and attempted to compare the cost involved with inpatient liver biopsy. Of the 117 records studied, two were incomplete. Of the 115 patients who had complete records, 43 (37.4%) had minor complications, 2 (1.7%) required overnight hospitalization for pain and hypotension, and the procedure failed in one patient (0.9%). There was no correlation between complications and ChildA centAAs classification, or concomitant chronic renal failure. In comparison to inpatient liver biopsy, we calculated that the saving made is about 1800 Saudi Riyals ($478.70) per operation, if performed on an outpatient basis. We conclude that outpatient percutaneous blind needle liver biopsy is safe, successful in more than 99% of cases, associated with no mortality, has negligible major complications requiring hospital admission, and results in considerable savings per biopsy. We therefore strongly recommend performing most liver biopsies on an outpatient basis, in the appropriate hospital setting, unless hospital admission is otherwise indicated.

Variations in lipid and lipoprotein levels during isotretinoin treatment for acne vulgaris with special emphasis on HDL-cholesterol.

BACKGROUND: Many studies have demonstrated an increase in total cholesterol and triglycerides on oral isotretinoin therapy. This has led several investigators to comment on the possibility of increased risk for cardiovascular disease. Yet, the status of high density lipoprotein (HDL) in patients on isotretinoin therapy has not been studied extensively. PATIENTS AND METHODS: We studied 104 United Arab Emirates (UAE) nationals (78 women, 26 men) who underwent isotretinoin therapy for acne at doses ranging from 0.2 to 1.6 mg/kg, and determined the lipid and lipoprotein levels before and after an 8-week period of treatment. The risk for cardiovascular disease was evaluated as the ratio of cholesterol/HDL-cholesterol. RESULTS: Mean cholesterol, triglycerides, and low density lipoprotein-cholesterol (LDL-cholesterol) levels rose significantly after treatment (p = 0.01) whereas HDL-cholesterol values decreased significantly (p = 0.01). In the entire subject population, the overall risk for cardiovascular disease rose from 3.45 to 3.67, indicating that these subjects remained in the category considered to have "half-average" to "average" risk of cardiovascular disease. CONCLUSIONS: In young and healthy individuals, significant variations in lipid and lipoprotein levels, resulting from isotretinoin treatment for acne, do not influence the overall risk for cardiovascular disease. Isotretinoin is thus a safe and efficient drug for the treatment of acne in these subjects.

Clinical and immunological studies in vitiligo in the United Arab Emirates.

OBJECTIVE: To determine the clinical and immunological changes encountered in patients with vitiligo in Al-Ain population, United Arab Emirates (UAE). DESIGN: This is a prospective descriptive hospital-based study. SETTING: Al-Ain Medical District, Al-Ain Hospital, United Arab Emirates. SUBJECTS: Patients who were seen at Al-Ain hospital for skin diseases during 1996. RESULTS: The study was based on 65 patients. The sample consisted 32 (49%) males and 33 (51%) females. The mean and standard deviation of age for males were 38.6 +/- 13.5 years and for females were 35.1 +/- 15.9 years. Most of the patients were UAE, Omani and Pakistani nationals. Positive family history of vitiligo was found in 19% of the patients. Association with other immune diseases was found in 6% of the patients while one or more organ specific antibodies, all of whom were females, most of them had positive history of autoimmune diseases. CONCLUSION: Vitiligo is more common among UAE nationals since the UAE community including a multi-national society.

Serologic tests for treponematoses in the United Arab Emirates.

BACKGROUND AND OBJECTIVE: Venereal syphilis is uncommon in the United Arab Emirates (UAE) and other Gulf states in the Middle East. Although nonvenereal syphilis (bejel) has been reported to be endemic in some of these countries, the extent of treponematoses in the UAE is unknown. The objectives were therefore, to investigate those who attended the outpatient clinic of a hospital in the UAE and to establish the seroprevalence of treponematoses and related clinical conditions. METHODS: One thousand and eighty-four patients were serologically screened with a Rapid Plasma Reagin (RPR) and Treponema pallidum hemagglutination (TPHA) tests. The charts of seropositive and seronegative patients, matched for age and sex, were reviewed and compared for clinical problems. RESULTS: A total of 47 people tested had antitreponema antibodies. The positivity rates varied considerably and rose with age from 0.36% for persons < 16 years to 8.3% for those > 50 years. Among the seropositive group, there were no obvious clinical signs of bejel on presentation, but osteoarthritis was significantly more common than in the seronegative group. CONCLUSIONS: In the UAE, although venereal syphilis is uncommon, there is a high seropositivity rate in the > 50-year age range possibly due to old or attenuated bejel.