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.

Alexandrite laser hair removal is safe for Fitzpatrick skin types IV-VI.

BACKGROUND: Various lasers have been developed for epilation of unwanted hair. Most studies, however, have been done in white patients with minimal reference to dark-skinned individuals. OBJECTIVE: To determine the safety profile of a long-pulsed alexandrite laser for hair removal in patients with Fitzpatrick skin types IV-VI exclusively. METHODS: Prospective clinical evaluation conducted from June 1998 to April 1999 at a referral private clinic. Prelaser skin testing was performed starting at 16 J/cm2 and energy fluence selected according to response. Complications were recorded at each visit. RESULTS: One hundred and fifty patients are reported (18 men and 132 women) ranging in age from 15 to 50 years, for a total of 550 treatment sites. Complications occurred in only 2% of cases. CONCLUSION: The long-pulsed alexandrite laser is safe for hair removal in darker skin tones. Prelaser skin testing was not helpful in this study, as there was no relationship between skin reaction and the incidence of complications.

Effects of itraconazole and terbinafine on Leishmania major lesions in BALB/c mice.

The effects of two antifungal compounds, the azole itraconazole and the allylamine terbinafine, on Leishmania major infections in mice are reported. Sixty BALB/c mice were each inoculated subcutaneously with metacyclic promastigotes of L. major at the base of the tail. From 4 weeks post-inoculation, 40 of the mice were treated for 4 weeks (20 with itraconazole and 20 with terbinafine) and the rest were left untreated. Lesion sizes were estimated weekly for 10 weeks post-infection. Both drugs appeared effective in treating the cutaneous lesions but response to itraconazole was faster and, at the end of the experiment, the mean size of the lesions on the mice treated with itraconazole was smaller than that of the lesions on the terbinafine-treated mice.

Prevalence of antibody to hepatitis D virus among HBsAg-positive drug-dependent patients in Jeddah, Saudi Arabia.

Over a period of ten months, all the patients admitted for drug dependence were tested for HBsAg. The positive cases were tested for anti-HDV. The anti-HDV-positive patients were further tested for liver function tests (LFTs) and anti-HCV. A total of one thousand three hundred and twenty one patients were tested. Out of this, 1038 were intravenous drug users (IDUs) and 283 were non-IDUs. Eighty one patients were HBsAg positive (75 IDUs and six non-IDUs). Eleven patients were anti-HDV positive--all were IDUs. The overall prevalence of anti-HDV among HBsAg-positive patients was 13.6%. Among HBsAg-positive IDUs, it was 14.7% and it was 0.0% for HBsAg-positive non-IDUs. Nine (81.8%) of the eleven anti-HDV-positive patients were also positive for anti-HCV and eight (72.7%) had abnormal LFTs. In view of the association of hepatitis B, C and D viruses with chronic liver disease recommendations have been made to control the spread of these viruses and to prevent liver disease.

Prevalence of antibodies to hepatitis C virus in drug-dependent patients in Jeddah, Saudi Arabia.

The prevalence of antibodies to hepatitis C virus (anti-HCV) in a population of intravenous drug users in Jeddah, Saudi Arabia was 74.6%. The anti-HCV prevalence in drug dependent patients who did not use the intravenous route was 10.5%. The anti-HCV prevalence in healthy Saudi males and in healthy non-Saudi's was 1.7% and 3.2% respectively. There is a need for public education to control the spread of the virus.

The prevalence of human immunodeficiency virus among drug-dependent patients in Jeddah, Saudi Arabia.

This study was carried out to determine the prevalence of HIV among drug-dependent patients in Jeddah. Between January 1 1995 and May 31 1996, all the patients admitted into the Al Amal Hospital for drug dependence were screened for HIV by Enzyme Immunoassay (EIA) and confirmed by Western blot. Those positive by the two tests were questioned about exposure to the risk factors for HIV infection and examined for clinical evidence of Acquired Immunodeficiency Syndrome (AIDS). Of 2628 admitted, 5 tested positive by EIA but only 4 were confirmed by Western blot, giving an overall prevalence of 0.15%. Three of the four HIV carriers used the intravenous route for drug use and the calculated prevalence for 2102 intravenous drug users was 0.14%. None of the patients showed any clinical evidence of AIDS. In view of the known preference by drug-dependent patients in Jeddah for the parenteral route and their sharing of needles and syringes, recommendations are made to prevent the spread of HIV through this group and into the community.

PIP: The prevalence of HIV infection among drug-dependent patients in Saudi Arabia was investigated for the first time in a study conducted at the Al Amal Hospital in Jeddah. 2628 men admitted to this rehabilitation facility from January 1995 to May 1996 were screened for HIV-1 and/or HIV-2. 81.2% of participants were aware of HIV/AIDS and two-thirds knew that the virus can be transmitted by sharing needles and syringes. Five samples were positive by enzyme immunoassay, but only 4 were confirmed by Western blot, for an HIV prevalence of 0.15%. An earlier report on drug-dependent Saudi nationals at this hospital found that at least 80% used the parenteral route of administration. In the 4 confirmed HIV cases in the present series, the risk factor was intravenous drug use in 2 cases, multiple sexual partners in 1 case, and both intravenous drug use and multiple sexual partners in another case. The low HIV prevalence detected in this study among a high-risk group suggests that Saudi Arabia is in a pre-epidemic stage. However, community-based data are necessary to establish the true situation in the country. Recommended, to prevent HIV spread among drug-dependent patients and into the community, are continued public awareness campaigns on the modes of HIV infection.

Pattern of liver disease in the western region of Saudi Arabia.

In a series of 124 patients admitted to hospital with liver disease, 23 (18.6%) had malignant liver disease, either primary or secondary; 12 (9.7%) had cirrhosis of the liver, while another 25 (20.2%) had inflammatory liver disease, including such parasitic infections as hydatid disease and schistosomiasis. The remaining biopsies showed non-specific changes or normal livers.