Search

Normal human cultured melanocytes were exposed to various glutathione concentrations (0.1, 0.5, 1.0, 5.0, and 10.0 mg/mL) for 72 hours. At the end of the experiment, proliferation, viability, migration, and ultrastructural changes were monitored. Glutathione at the doses of 0.5 to 10.0 mg/mL reduced the viability of melanocytes significantly as compared to the control (P < .05). Glutathione significantly reduced the proliferation of melanocytes at the doses of 0.5 to 10.0 mg/mL as compared to the control (P < .001). Glutathione at 0.5 to 10.0 mg/mL significantly reduced the migration of melanocytes as compared to the control (P < .001). The percentage of mature melanosomes was 53.43% in control and 50.58%, 41.83%, 33.4%, and 8.95% in 0.1, 0.5, 1.0, and 5.0 mg/mL glutathione exposed cells, respectively. This reduction in the number of mature melanosomes was statistically significant as compared to the control. However, no cytotoxic effects were recognized by electron micrographs. These results encourage the potential implementation of glutathione as a skin-lightening agent. However, this study is limited by cell culture and ultrastructural. It should therefore be expanded in the future to include patients with pigmentary disorders.

Nano-erythrocyte coating has been developed as an interesting biomimetic platform to provide hybrid nano-carriers with innate functions to target liver cancer. This goal was achieved by coating nano-erythrocyte membranes (NEMs) onto 5-fluorouracil (5-FU)-loaded liposomes (LPs) to produce NEM-5-FU-LPs. This framework is used to promote the escape of 5-FU-LPs from degradation during systemic circulation. NEMs were obtained by hypotonic lysis of erythrocytes to produce ghost erythrocytes (GEs) followed by extrusion through polycarbonate membranes. Chimeric NEM-5-FU-LPs were fabricated via the fusion of NEMs and artificial LPs. The resultant chaperoned LPs were characterized based on particle size, morphology, entrapment efficiency (EE %), stability, protein content and phosphatidylserine exposure and their in vitro release profiles and cytotoxic efficacy were also determined. The present results revealed that 5-FU-LPs, NEM-5-FU and NEM-5-FU-LPs exhibited nanosize, spherical shapes and unimodal size distributions0.3. In addition, the vesicles presented a zeta potential with EE% of 24.6-30.7% and an appropriate stability for 3 weeks. NEM-5-FU-LPs retained the erythrocyte membrane proteins as confirmed by PAGE and displayed a sustained release profile up to 48 h when compared to NEM-5-FU and the 5-FU solution. Moreover, hybrid NEM-5-FU-LPs induced a late cytotoxic effect after 48 h compared to the other formulations. Thus, mantling of 5-FU-LPs by NEMs could enhance vesicle controllability and their targetability to liver cancer cells.

A conventional skin punch biopsy instrument has a circular hollow blade, which can be used to make a full circular incision to evacuate subcutaneous abnormalities such as lipomas. Here, we present a modified punch instrument, in which the cutting element has a C-shape to form a pivotal skin fragment (miniflap) to access subcutaneous tissues. The "C" part comprises almost half of a circle. The C-punch incision gives access to subcutaneous abnormalities, while keeping a connecting neck to the surrounding skin, which allows for efficient resealing of the skin surface. Therefore, there is less potential for subsequent scarring.

Background: The onset of vitiligo during childhood is common. Limited data exist that compare the clinical associations of prepubertal and postpubertal vitiligo in Arabs. Objective: To compare the clinical profile of pre and postpubertal onset vitiligo. Methods: A cross-sectional observational study was conducted. The Vitiligo European Task Force questionnaire was completed for each patient. Results: A total of 375 patients were included; 199 had postpubertal vitiligo (>12 years), and 176 had prepubertal onset vitiligo (

Chronic idiopathic urticaria (CIU) is one of the mysteries of dermatology. An association between spontaneous CIU and contact allergy sensitization is possible. In this study, we aimed to test the hypothesis that contact allergy might play a role in disease in CIU patients. Furthermore, we examined if patch testing should be routinely performed in patients with chronic urticaria (CU). Ultimately, we concluded that patch testing should be included among the diagnostic procedures for CU.

Ingrown toenail (IGTN) is a common problem that can affect walking and can preclude daily activities.To compare the safety and efficacy of lateral nail avulsion with phenolization (LNAP) versus sleeve (nail tube splinting) surgical techniques in the treatment of IGTN.Patients older than 15 years with IGTN were included. Patients were evaluated for the duration and severity of pain, drainage, complete healing periods, recurrence rate, and overall success rate. Assessment was performed at baseline and at 1, 3, and 6 months. Complications were noted.A total of 53 patients, including 46 males (87.8%), were treated. The mean age was 27.7 ± 1.3 years. Thirty patients underwent LNAP, and 23 underwent sleeve methods. The surgical success rate, defined as90% improvement, was found to be 80% to 82% for both groups. Recurrence was observed in only 1 patient of each group. None of the observed differences in healing, discharge, and recovery were statistically significant except in reporting shoe-wear discomfort, which was shorter in the sleeve group (p.05). Postoperative pain experience was also noted to be less in the sleeve group (p = .057).Both methods, LNAP and sleeve, seem to be equally effective for the treatment of IGTNs. Postoperative shoe-wearing discomfort and pain are shorter when the sleeve method was used.

Background: A permanent, unpleasant atrophic leishmaniasis scar is a potentially disfiguring condition that causes social stigma with limited treatment choices. Fractionated carbon dioxide (CO2) laser resurfacing is expected to be a safe and effective treatment for leishmaniasis scars. Objective: To assess the safety and efficacy of ablative fractional resurfacing (AFR) with a CO2 laser for facial leishmaniasis atrophic scars. Methods: Eleven patients (five males, age 18–47 years) underwent the fractional CO2 laser procedure. The mean duration for scars was 18.3 years. Three to five treatment sessions with the fractional laser eCO2 (10,600 nm, Lutronic Corporation, Gyeonggi-do, Korea) were performed for each patient, at 2-month intervals, under topical anesthesia. Two passes (with tip type 120, density 150 spots/cm2 in static mode, and peak power of 30 watts) were performed on each leishmaniasis scar. Pulse energies ranged between 100 and 140 mJ. Posttreatment improvements in texture, atrophy, and overall satisfaction with appearance were graded on a quartile scale 1 month after the second session and 3 months after the final session. Scar improvement was graded using a 4-point score with a maximum score of 20. Results: At the 3-month posttreatment follow-up, all subjects were rated as having at least 50% improvement in texture, atrophy, borders, and overall appearance of scars. The median score of improvement was 18 of 20 (range 11–19). Mild postinflammatory hyperpigmentation was the only adverse effect, observed in 18% (2 of 11) of subjects. After the procedure, moderate to severe erythema and edema typically resolved within 24 to 48 hours. No additional adverse effects were observed. Conclusion: Fractional CO2 resurfacing represents a safe, effective, and well-tolerated potential treatment for atrophic facial leishmaniasis scars in ethnic skin.

Background: Previous studies have discussed attitudes of vitiligo patients toward their disease. However, no studies have addressed this issue from the public's point of view. Objective: To explore the perceptions, attitudes, and misconceptions of the public toward vitiligo. Methods: A self-administered questionnaire was distributed to attendees of primary health care centers in Riyadh, Saudi Arabia, between January and August 2010. Results: Overall, 924 of the 1,000 distributed questionnaires were returned, and 429 were males (46.8%). Moreover, 33.1% (303 of 916) believed that vitiligo is contagious or did not know that it is not. The cause of vitiligo was thought to be infectious by 20.4% of respondents (182 of 894), inherited by 40.5% (365 of 902), autoimmune by 41.2% (370 of 899), and due to a lack of hygiene by 22.5% (199 of 883). Unmarried individuals and those with less education were more likely to state that vitiligo is caused by an infection ( p = .02, p = .03, respectively). Younger individuals and those with less education were more likely to think that vitiligo is caused by a lack of hygiene ( p = .01, p = .001, respectively). More than half of the participants (56.1%, 504 of 898) would be unwilling to marry a vitiligo patient. Younger individuals and males were less likely to marry a vitiligo patient ( p = .01, p = .05, respectively), whereas those of lower income were more likely to accept it ( p = .002). Conclusions: Various misconceptions and negative attitudes about vitiligo among the public are prevalent. Educating the public about vitiligo could ultimately lead to better psychosocial well-being of vitiligo patients. Contexte: Des études ont déjà porté sur la perception des personnes atteintes de vitiligo à l'égard de leur propre maladie, mais aucune étude n'a porté sur la perception du public à l'égard de cette maladie. Objectif: L'étude visait à analyser les perceptions, les attitudes, et les idées fausses du public à l'égard du vitiligo. Méthodes: Un questionnaire autoadministré a été remis à des personnes présentes dans des centres de soins primaires à Riyad, en Arabie saoudite, entre janvier et août 2010. Résultats: En tout, 924 questionnaires sur 1,000 ont été remis. Sur ce nombre, 429 avaient été remplis par des hommes (46.8%). De plus, 33.1% (303 sur 916) des répondants croyaient que le vitiligo était contagieux ou ne savaient pas qu'il ne l'était pas. Quant à la cause du vitiligo, 20.4% des participants (182 sur 894) croyaient que c'était une maladie contagieuse; 40.5% (365 sur 902), que c'était une maladie héréditaire; 41.2% (370 sur 899), que c'était une maladie auto-immune; et 22.5% (199 sur 883), que c'était une maladie due à un manque d'hygiène. Les personnes célibataires et celles moins instruites étaient plus portées à croire que le vitiligo était causé par une infection ( p = .02 et p = .03, respectivement). Les jeunes et les personnes moins instruites étaient plus susceptibles de croire que le vitiligo était causé par un manque d'hygiène ( p = .01 et p = .001, respectivement). Plus de la moitié des participants (56.1%, 504 sur 898) ne voulaient pas se marier avec une personne atteinte de vitiligo. Les jeunes et les hommes étaient moins disposés à se marier avec une personne atteinte de vitiligo ( p = .01 et p = .05, respectivement), tandis que ceux à faible revenu étaient plus susceptibles d'accepter le fait ( p = .002). Conclusions: Il existe plusieurs idées fausses sur le vitiligo au sein de la population, et la maladie suscite des réactions négatives. L'éducation du public sur le vitiligo pourrait peut-être améliorer le bien-être psychosocial des personnes atteintes de vitiligo.

Background: Plantar warts are common and often painful. Treatment of plantar warts is difficult and requires multiple treatments. Several clinical trials have proven the efficacy of bleomycin, but relatively high concentrations have been required and considerable side effects have been experienced. Objective: To evaluate the efficacy and safety of low-concentration (0.1 U/mL) bleomycin using a translesional injection technique for the treatment of plantar warts. Methods: The study included 23 patients with single or multiple plantar warts. Very low-concentration bleomycin was injected into a single wart or the largest plantar wart in the case of multiple lesions. Injections were performed at 4-week intervals until resolution of the warts or development of side effects. The translesional multipuncture technique was used. Results: Thirteen patients were male (56.5%), and the mean age was 27.7 years. The results revealed complete clearance of warts in 17 of 23 (74%) patients, partial response in 1 (4.3%) patient, and no response in 3 (13%) patients. Recurrence was observed in 2 patients at 3 months of follow-up. Among those two, one patient showed complete clearance after the second injection at 6 months of follow-up. All patients were followed for 6 months after the initial treatment. No significant long-term adverse effects were noted. Only three patients (13%) had localized moderate pain for 2 to 3 days after the injection. Conclusion: Translesional injection by very low-concentration (0.1 U/mL) bleomycin appears to be a simple, effective, and safe treatment modality for plantar warts.

BACKGROUND AND OBJECTIVES: Mycosis fungoides (MF) is a rare disease; and to our knowledge, there are no reports on its profile in Arabs. The objective of this study was to preliminarily analyze the clinical characteristics of MF patients seen in our institution. DESIGN AND SETTING: Retrospective review of 140 patients with pathologic or clinical diagnosis or differential diagnosis of MF for the period 2000-2006. PATIENTS AND METHODS: Pathology reports with diagnosis or differential diagnosis of MF were retrieved and suspected cases were identified and reviewed. For pathologically confirmed cases, sociodemographic, clinical, laboratory, and radiological details were collected. Details of staging, treatment modalities, and disease status at the last follow-up were retrieved. RESULTS: A total of 43 pathologically confirmed MF patients (skin phototypes IV and V) with a mean age at diagnosis of 33.5 years were reviewed. This comprised 29 males (M:F ratio, 2:1), and the majority (86%) of patients had early-stage (I and II) MF. Twenty-one (48.8%) patients had classic MF; 18 (41.8%), hypopigmented MF; and 4 (9.3%), other variants. The male-to-female ratio was higher in the hypopigmented (3.5:1) than in the classic variant (1.6:1). The mean age at diagnosis was lower in the hypopigmented compared to the classic variant (25 versus 38.8 years, P=.019). The mean duration of follow-up was 27.6 months (range, 1-98 months). At the final assessment, 4 (9.5%) patients recovered; whereas 35 (83.3%) had MF skin disease; 1 had (2.4%) extracutaneous disease; and 2 (4.8%) died of MF. CONCLUSIONS: MF tends to affect younger Saudi patients. The hypopigmented variant constitutes a significant proportion of MF cases, especially in younger patients.

Background: The details of phototherapy practices for vitiligo have been rarely studied. Objective: To explore the details of phototherapy practices for vitiligo among dermatologists. Methods: A self-administered questionnaire about the details of phototherapy practices for vitiligo was distributed to all dermatologists attending a national general dermatology conference in Riyadh, Saudi Arabia, in 2008. Results: Questionnaires were returned by 121 of 140 participants (response rate = 86.4%). The mean age of the respondents was 39.34 ΁ 9.7 years, and 65% were males. One hundred eight of 110 (98.2%) respondents provided phototherapy to their vitiligo patients. The mean number of vitiligo patients who underwent phototherapy each week per dermatologist's office was 18 ΁ 2.26. Narrowband ultraviolet B (NB-UVB) was the most common modality chosen to treat generalized vitiligo (84%). Excimer laser was the most common modality used to treat focal and segmental vitiligo (53% and 39%, respectively). Sixty-eight percent of dermatologists administered a fixed starting dose of NB-UVB to all patients, whereas 31% used the minimal erythema dose as a guide. Fifty percent reported that NB-UVB resulted in better color matching with the surrounding skin. Thirty-seven percent favored NB-UVB over psoralen + ultraviolet A for a faster response, and 31% preferred NB-UVB for a pigmentation that is more durable. Forty-seven percent (50/106) of the respondents limited the number of phototherapy sessions to reduce the risks of skin cancer. However, no respondent reported any skin cancer incidence in phototherapy-treated vitiligo patients. Conclusion: There is a need for phototherapy guidelines for the treatment of vitiligo in patients with skin of color.

BACKGROUND The treatment of periungual warts is a therapeutic challenge. Various treatment modalities can be ineffective and may cause scarring and permanent nail changes. OBJECTIVES A prospective pilot study to investigate the efficacy and safety of a low concentration (0.1 U/mL) of bleomycin in the treatment of periungual warts. METHODS Periungual warts were injected with bleomycin (0.1 U/mL) every 4 weeks until elimination of the lesions or until the injections were discontinued because of adverse effects. Bleomycin was administered using the translesional multipuncture technique. RESULTS We recruited 15 patients with periungual warts from March 2007 to March 2008. Thirteen patients were male (86.6%); median age was 30. Seven patients (46.6%) demonstrated complete clearance 1 month after the first injection; two required two treatment sessions. Thirteen (86.6%) patients had complete clearance of the treated wart at the 6-month follow-up with only one injection. Wart recurrence was observed in two patients. All patients were followed for 6 months after the initial treatment. No significant long-term adverse effects were noted. Only one patient demonstrated mild postinflammatory hyperpigmentation, which resolved after 1 month, and nine (60%) had localized moderate pain for 2 to 3 days after the injection. CONCLUSION Translesional multipuncture treatment with a low concentration (0.1 U/mL) of bleomycin is an effective modality for periungual warts that results in minimal side effects. Larger controlled studies are needed.

The aim of this work is to review the available literature on the details of low-level laser therapy (LLLT) use for the enhancement of the proliferation of various cultured cell lines including stem cells. A cell culture is one of the most useful techniques in science, particularly in the production of viral vaccines and hybrid cell lines. However, the growth rate of some of the much-needed mammalian cells is slow. LLLT can enhance the proliferation rate of various cell lines. Literature review from 1923 to 2010. By investigating the outcome of LLLT on cell cultures, many articles report that it produces higher rates of ATP, RNA, and DNA synthesis in stem cells and other cell lines. Thus, LLLT improves the proliferation of the cells without causing any cytotoxic effects. Mainly, helium neon and gallium-aluminum-arsenide (Ga-Al-As) lasers are used for LLLT on cultured cells. The results of LLLT also vary according to the applied energy density and wavelengths to which the target cells are subjected. This review suggests that an energy density value of 0.5 to 4.0 J/cm(2) and a visible spectrum ranging from 600 to 700 nm of LLLT are very helpful in enhancing the proliferation rate of various cell lines. With the appropriate use of LLLT, the proliferation rate of cultured cells, including stem cells, can be increased, which would be very useful in tissue engineering and regenerative medicine.

The aim of this study was to investigate the effects of the different types of low-level laser therapy (LLLT) on the ultra-structure and number of melanosomes in normal cultured human melanocytes. Specific effects of various types of LLLT on the ultra-structure of melanosomes have not yet been reported. Melanocytes were exposed to LLLT at an energy level of 2.0 J/cm2, using a blue (457 nm), red (635 nm), or ultraviolet (UV) (355 nm) laser. After 72 h of irradiation, the melanocytes were fixed in 2.5 % glutaraldehyde (pH 7.2) phosphate buffer for 8 h and analyzed by transmission electron microscopy. Four developmental stages (I to IV) of melanosomes were observed, and their numbers were counted manually. The percentage of stages I, II, III, and IV melanosomes was 12.8, 14.2, 22.6, and 50.3 %, respectively, in the control (sham light). However, the melanosome percentages were 41.2, 5.4, 8.2, and 24.2 % in stages I, II, III, and IV, respectively, in the blue laser-treated group; 58.4, 6.1, 9.3, and 26.2 % for stages I, II, III, and IV, respectively, in the red laser-treated group; and 31.3, 11.1, 16.5, and 41.1 % for stages I, II, III, and IV, respectively, in the UV laser-treated group. The present data show that the amount of stage I is significantly higher (P

Background/Aim: There is scarce literature connecting vitiligo and primary open angle glaucoma (POAG). Most literature reports that secondary complications are a direct consequence of corticosteroid treatment of vitiligo. In this study, we aimed to investigate the prevalence of ocular problems in patients with vitiligo and to determine its association with periorbital topical corticosteroid use. Method: A cross-sectional study was carried out on 90 patients with vitiligo. The Vitiligo European Task Force questionnaire was completed for each patient. A control group comprising 90 healthy individuals who did not have vitiligo and who were matched on age and gender was used for comparison. A complete ophthalmologic examination was performed. A family history of glaucoma and the use of topical steroids were recorded. Results: Two (2/90, 2.2%) of the patients with vitiligo had glaucoma compared with none of the individuals in the control group ( P = .25). Nineteen of the 90 patients with vitiligo used periorbital steroids, and of these patients, 10.5% (2/19) developed glaucoma. The duration of periorbital corticosteroid use was 4.50 ± 2.1 years. Eighty-nine percent (17/19) of the vitiligo patients who applied the potent topical corticosteroid (class I) clobetasol propionate to the periorbital area did not develop glaucoma. In contrast, glaucoma was not observed in 79% (71/90) of the vitiligo patients who did not use steroids. Cataract, uveitis, or fundus problems were not observed in either group. Conclusion: The study suggests that patients who have vitiligo and use topical steroids periorbitally do not have an increased risk of glaucoma or cataracts. Future studies that have a larger sample size and use a detailed steroid use protocol are needed.

Background: Low vitamin D levels have been associated with several autoimmune diseases. Vitiligo could be associated with low vitamin D levels. Objective: To determine the level of serum vitamin D in vitiligo patients compared to controls and reveal the possible association of vitamin levels with the pathogenesis of vitiligo. Patients and Methods: A case-controlled study was conducted. After excluding factors that may affect serum vitamin D levels, blood samples were taken from vitiligo patients and controls. The association between vitamin D levels and various vitiligo subgroups (duration of vitiligo, site of onset, age, etc) was measured and correlated. Results: A total of 150 vitiligo patients, 90 (60%) males with a mean age of 30.6 ± 11.4 years, were recruited. The study also had 150 age- and gender-matched vitiligo-free control subjects. There was no significant difference in median serum vitamin D levels between the cases and the controls ( P = .25). The serum levels of vitamin D of the vitiligo patients were found to be lower in males ( P = .01), the younger age group ( P = .01), and patients not treated with ultraviolet (UV) treatment ( P = .01). Conclusion: There is no difference between the vitamin D levels of the vitiligo patients and the control subjects. However, deficiency of 25(OH)D levels within the vitiligo subgroups may be linked to younger age, male gender, short duration of vitiligo, and non-use of phototherapy.

Background:Little is known about the prevalence and practice of complementary and alternative medicine (CAM) among dermatology patients in the Arab world. The aim of this study was to determine knowledge and attitudes about CAM, prevalence of its use, reasons for its use, and types of CAM used in dermatology patients in Saudi Arabia.Methods:This was a national survey of various regions of Saudi Arabia. In this cross-sectional study, dermatology outpatients were interviewed using a questionnaire. Sociodemographic characteristics, acceptability, utilization pattern, and reasons for CAM use were elicited. Dermatology life quality index (DLQI) was obtained.Results:Overall, 1901 patients returned complete questionnaires out of 2500 distributed (76% response rate). Of these, 808 (40%) were CAM users, and the majority were woman (55.1%), with a mean age of 31.6 ± 12 years. Most were literate (71.2%) and just over half were married (51.9%). Patients with acute skin diseases were found to be more likely to use CAM ( P = .027). The mean DLQI score was higher (worse quality of life) among CAM users than among nonusers ( P = .002). The results showed that 315 of 801 (40%) and 250 of 601 (30%) CAM users agreed that CAM methods are safer and more effective than modern medicine, respectively, and 83% will continue to use CAM in future. The most commonly used CAM modalities were vitamins, prayers, natural products, and herbs. Responses indicated that 379 of 803 (47.2%) CAM users did not consult their doctor before using CAM, and 219 of 743 (30%) did not obtain sufficient answers regarding CAM use from their dermatologists.Conclusions:There is a significant use of CAM among dermatology outpatients in Saudi Arabia. In view of the common belief that CAM has fewer side effects than conventional medicine, dermatologists need to increase their awareness of CAM.

The aim of this study was to investigate the effects of different low-level laser therapies (LLLTs) of various wavelengths and energies on normal cultured human melanocytes. Various studies have shown the effects of LLLs on various types of cultured cells. Presently, little is known about the biological effects of LLLTs on melanocytes. Melanocytes were exposed to LLLT at 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 4.5, or 5.0 J/cm(2) using a blue (457 nm), red (635 nm), or ultraviolet (UV) (355 nm) laser. Melanocyte viability, proliferation, and migration were monitored at 72 h after irradiation. The blue (P 0.001) and red (P 0.001 and P 0.01) lasers significantly enhanced viability at 0.5 to 2.0 J/cm(2), whereas the UV laser (P 0.001) could significantly enhance viability only at 0.5 and 1.0 J/cm(2) compared with controls. The blue and red lasers also significantly enhanced the proliferation of the melanocytes at 0.5 to 2.0 J/cm(2) (P 0.001), and the UV laser significantly enhanced proliferation at 0.5 to 1.5 J/cm(2) (P 0.001 and P 0.01) compared with controls. The blue laser significantly enhanced melanocyte migration at 0.5 to 4.0 J/cm(2) (P 0.001 to P 0.05), but the red (P 0.001 and P 0.01) and UV (P 0.001 to P 0.05) lasers could significantly enhance such migration at 0.5 to 1.0 J/cm(2) and 0.5 to 2.0 J/cm(2), respectively, compared with controls. LLLT at low energy densities is able to significantly increase melanocyte viability, proliferation, and migration in vitro, and at higher energy densities, it gives non-stimulatory results. Additionally, the blue laser was the best among the three lasers. These findings might have potential application in vitiligo treatment in future.

Lauren V. Ackerman coined the name verrucous carcinoma (VC) for an uncommon low-grade squamous cell carcinoma of the oral cavity. It is characterized by a slowly enlarging warty tumor with a locally destructive behavior and minimal if any metastasis. Through the years similar tumors have been described in other locations. According to the anatomic localization, four types are now recognized: (1) VC of the oral cavity known as Ackerman’s tumor or oral florid papillomatosis; (2) VC of the anogenital area also known as giant condyloma of Buschke and Lowenstein or warty squamous cell carcinoma; (3) VC of the soles also known as epithelioma cuniculatum (EC); and (4) VC at other sites.

Vitiligo is a common pigmentary disorder caused by the destruction of functional melanocytes. Vitamin D is an essential hormone synthesized in the skin and is responsible for skin pigmentation. Low levels of vitamin D have been observed in vitiligo patients and in patients with other autoimmune diseases. Therefore, the relationship between vitamin D and vitiligo needs to be investigated more thoroughly. We reviewed the literature to date regarding the role of vitamin D in skin pigmentation. Our review revealed that vitamin D deficiency has been identified in many conditions, including premature and dysmature birth, pigmented skin, obesity, advanced age, and malabsorption. Vitamin D increases melanogenesis and the tyrosinase content of cultured human melanocytes by its antiapoptotic effect. However, a few growth-inhibitory effects on melanocytes were also reported. Vitamin D regulates calcium and bone metabolism, controls cell proliferation and differentiation, and exerts immunoregulatory activities. Vitamin D exerts its effect via a nuclear hormone receptor for vitamin D. The topical application of vitamin D increased the number of L-3,4-dihydroxyphenylalanine-positive melanocytes. The topical application of vitamin D yields significant results when used in combination with phototherapy and ultraviolet exposure to treat vitiligo in humans. Vitamin D decreases the expression of various cytokines that cause vitiligo. In conclusion, application of vitamin D might help in preventing destruction of melanocytes thus causing vitiligo and other autoimmune disorders. The association between low vitamin D levels and the occurrence of vitiligo and other forms of autoimmunity is to be further evaluated.

To compare factors associated with halo nevi with nonsegmental vitiligo (NSV) vs NSV alone.Prospective observational study in 553 patients with a confirmed diagnosis of NSV attending a vitiligo clinic between January 1, 2006, and July 1, 2010.Vitiligo Clinic at the Department of Dermatology, University Hospital Center of Bordeaux, Bordeaux, France.The Vitiligo European Task Force questionnaire was informed for each patient attending the clinic with a confirmed diagnosis of NSV after the exclusion of other forms of vitiligo (focal, mucosal, and not classifiable). Thyroid function and antithyroid antibodies were screened if not obtained in the previous year.Extent of disease and markers of autoimmunity or autoinflammation.Of the 553 patients, 130 had halo nevi-NSV and 423 had NSV. Family history of premature hair graying (odds ratio, 1.74; P.01) was positively associated with halo nevi-NSV by univariate analysis. Using multivariate analysis, age at onset younger than 18 years, phototype, total body area, localization on the trunk, involvement of hands and feet, and total staging were found to be independent factors. Age at onset younger than 18 years; phototypes I, II, and III; trunk involvement; and staging were positively associated with halo nevi-NSV, whereas this association was negative for total affected area and involvement of hands and feet.Halo nevi association in NSV affects age at onset and depigmentation pattern and has a stronger link with familial premature hair graying, suggesting that premature hair graying may involve, at least partly, an autoimmune pathway.

Although the exact pathogenesis of vitiligo is not fully understood, it appears to be an autoimmune disease. It is hypothesized that tumor necrosis factor alpha (TNF-?) plays an important role in vitiligo. TNF-? can destroy melanocytes through the induction of various apoptotic pathways. In addition, TNF-? can inhibit melanocyte stem cell differentiation.To evaluate the efficacy and safety of treating vitiligo patients with anti-TNF-? agents.A total of 6 patients were recruited. All patients had widespread non-segmental vitiligo. Biologics, including infliximab, etanercept, and adalimumab, were given according to treatment regimens used for psoriasis. Photographs were taken at the initial visit, every two months during the therapy and then six months after therapy completion.All patients completed the treatment; two patients were treated with infliximab, two with etanercept, and two with adalimumab. All of the biologics were well tolerated throughout the treatment period, and none of the patients reported any significant adverse events. Digital images were compared before, during and after treatment. Repigmentation of the vitiliginous areas was not observed in any of the patients. Vitiligo worsened in one patient who was treated with infliximab and developed a psoriasiform rash. However, the remaining patients did not develop any new depigmented patches during treatment or at the six-month follow-up; vitiligo was considered stable in these five patients.Although the anti-TNF-? agents were well tolerated in all six vitiligo patients, efficacy was not observed. Further evaluation with larger studies may be required.

Neurothekeoma is a rare neoplasm assigned to the broad category of benign peripheral nerve sheath tumors. Its cell of origin is still unknown, but most ultrastructural and immunohistochemical studies have favoured the Schwann cell perineurium or fibroblast. Neurothekeoma most commonly presents in females, especially in the second and third decades of life. Typically it presents as an asymptomatic solitary, firm, flesh-coloured or hyperpigmented slow-growing papule or nodule that involves the skin and superficial subcutis. It usually involves the face, neck, arm or shoulder but can also involve extracutaneous sites. Neurothekeoma occurs in myxoid (classic), cellular and intermediate (mixed) variants. Here, we report a 45-year-old male patient presenting with a nodule on the nose that was found to be a myxoid variant of neurothekeoma. It was treated with a simple shave excision followed by removal of the lobulated deeper part by forceps. He had no recurrence after three years of follow-up. To the best of our knowledge, this is the first case of a myxoid neurothekeoma of the nose to be reported in the Middle East.

Potent teratogenicity limits the use of isotretinoin among females of childbearing potential (FCBP).To explore the current practice of dermatologists for pregnancy prevention when prescribing isotretinoin for FCBP.A self-administered questionnaire was distributed to 160 dermatologists attending a national conference in Riyadh, Saudi Arabia, in 2008. The survey was designed to capture the details of precautions taken by dermatologists to prevent pregnancy among isotretinoin users.Ultimately, 134 dermatologists completed the questionnaire (84% response rate). Their mean age was 39 ± 9.5 years. A total of 82 were female (65%). The median number of FCBP for whom isotretinoin was prescribed by each dermatologist during the previous 12 months was two (range from 0 to 30). Of the 792 total FCBP, seven were reported to have become pregnant (incidence rate of 8.8/1000) while on isotretinoin. Out of those seven, three women terminated the pregnancy (elective abortions: 42.7%). The majority of the dermatologists (79%) always obtained written consent and discussed teratogenic risks (98%); 44% provided written information about potential isotretinoin teratogenicity, and 30% offered printed information on contraception. Survey results also revealed that 62% recommended double contraception for FCBP, 60% always recommended pregnancy testing prior to therapy, but only 16% requested monthly pregnancy tests. In general, 62.4% avoided isotretinoin prescription to FCBP, which was independent of dermatologists' gender, years of experience, or having a previous incident of isotretinoin-exposed pregnancy.Some dermatologists still do not follow the recommendations for isotretinoin prescription to FCBP. This needs to be corrected, especially in countries with restrictions on abortion.

BACKGROUND AND OBJECTIVES: Use of hair dye is extremely common worldwide. However, our literature search failed to find studies concerning the knowledge and attitudes of the public with regard to hair dyes. We sought to explore the knowledge and practices of, and attitudes towards, the use of hair dye among females. DESIGN AND SETTING: A cross-sectional survey conducted on females who attended various outpatient clinics at King Khalid University Hospital in Riyadh, Saudi Arabia, a tertiary referral hospital open to the general public. PATIENTS AND METHODS: A self-administered questionnaire about the use of hair dyes was distributed randomly among females attending the outpatient clinics at a university hospital in 2008. RESULTS: The response rate was 87.2%, with completion of 567 of the 650 distributed questionnaires. The mean (SD) age of respondents was 32.0 (10.2) years. Among respondents, 82.6% (464/562) had at some point dyed their hair. Furthermore, 69.3% (334/482) had dyed their hair in the past 12 months. The mean (SD) age of the participants when they first dyed their hair was 22.2 (7.1) years (range, 7-50). Of the participants, 76.8% (354/461) used permanent dyes, and about the same percentage of participants believed such dyes were the safest hair dye type. However, 52.4% (278/531) of the participants believed that hair dyes are harmful, and 36% (191/531) believed that hair dyes could cause cancer. Younger females tend to dye their hair less frequently (P

Background The use of lasers is very common in dermatology; however, many patients fear it and have various misconceptions about it. A literature search failed to show any studies on this topic. Objective To explore the various misconceptions of patients about lasers in dermatology. Methods A self-administered questionnaire containing 21 questions about laser use in dermatology was distributed randomly to patients attending the dermatology clinic at King Khalid University Hospital in Riyadh, Saudi Arabia, from February to April 2009. Results The response rate was 79.3%, with 714 of the 900 distributed questionnaires being returned; the individuals sampled included 348 men (48.73%). When asked about the nature of laser, 40% (279 of 698) reported that they did not know. About 36% (251 of 698) knew it was radiation of stimulated light amplification, while 10.2% (71 of 698) reported it to be nuclear radiation. Among study participants, 51.5% (364 of 707) believed that laser was harmful to children, while 51.1% (357 of 699) believed it was unsafe during pregnancy, and 21.4% (146 of 683) thought it could cause skin cancer. Laser was believed to treat most skin diseases by 47.7% (330 of 692) of those interviewed, among whom 24.1% said that they would not accept laser treatment if it was suggested to them by a dermatologist. A stance against laser (16.3%) was most common among men (P < 0.001), the illiterate (P = 0.006), and those with lower education (P = 0.001). Conclusion Various misconceptions about laser treatment among patients are prevalent, especially among less educated individuals. Educating the community about laser could solve this problem.

Background: Vitiligo is a depigmentation disorder caused by melanocyte destruction that possibly results from an autoimmune mechanism. Psoriasis is an immune-mediated, chronic, inflammatory dermatosis. Although tumor necrosis factor α antagonists (anti-TNF-α), such as infliximab, are effective in treating psoriasis, many cases reported in the literature indicate that psoriasis might also be induced by treatment with infliximab. Some studies also suggest that TNF-α antagonists might be an effective treatment for vitiligo because the disorder is characterized by increased levels of TNF-α, indicating that it might play a role in the pathogenesis of this disease. Objective: We report a case of psoriasiform dermatitis with vacuolar interface reaction that occurred after infliximab therapy in a patient with vitiligo. Method: A 17-year-old male patient with vitiligo vulgaris was treated with an intravenous infusion of 5 mg/kg of infliximab at 0, 2, and 6 weeks and then once every 6 weeks over a span of 6 months. The patient was monitored both clinically and with laboratory investigations. He had no personal or family history of psoriasis. He tolerated the treatment well, without side effects. However, he developed a biopsy-proven psoriasiform lesion for the first time 4 months after he completed his sixth dose of infliximab. His vitiligo also worsened. Conclusion: This case report shows that infliximab given for vitiligo did not improve the disorder and that the vitiligo actually progressed. Moreover, psoriasiform lesions developed after this therapy. Further studies are needed to identify the effects of infliximab in patients with vitiligo.

Lymphangioma circumscriptum is a rare lymphatic malformation that involves the skin and may extend to subcutaneous tissue and muscle. It usually presents as grouped micro- to macroscopic vesicles filled with lymph. Surgical excision has been the standard treatment, but it is associated with scarring, infection, injury to the surrounding structures, and a high recurrence rate. Herein, we report a 24-year-old male patient with a lymphangioma circumscriptum on the nape of the neck that was treated with two sessions of an intralesional injection of 1% sodium tetradecyl sulfate sclerotherapy with a very good result. After this treatment, there was no more discharge and a reduction in the lesion's size by 70%. Sclerotherapy using sodium tetradecyl sulfate can be considered a successful minimally invasive treatment option for lymphangioma circumscriptum.

Eyebrow bleaching is a common practice among women with dark hair that allows for alterations in the eyebrows' shape without the use of hair removal. A literature search on this topic failed to reveal any extant studies.To explore the prevalence, associated motives, and side effects of eyebrow bleaching among women. Methods A questionnaire about eyebrow bleaching was distributed randomly to female patients attending the outpatient clinics at a university hospital between June and August 2008.The response rate was 87.2%; with 567 of the 650 distributed questionnaires returned. The mean age was 32.01±10.17 years. 48.4% (253/522) of the participants reported having bleached their eyebrows. Of these individuals, 55.8% (101/181) experienced side effects related to eyebrow bleaching. These side effects included increased or decreased density of the eyebrow hair, and redness, itching, and scaling of the eyebrow skin. The motives behind eyebrow bleaching varied widely, but were primarily esthetic in nature. Younger women, students, and participants with higher monthly incomes reported bleaching their eyebrows a greater number of times than others (P0.001, 0.04 and 0.003, respectively).In this sample of female patients, eyebrow bleaching was reported to be a common practice. Bleaching was associated with local side effects in over 50% of those who use the technique. Thus, there is a need to educate the public about these side effects.

Background The use of the Internet to search for health-related information (HRI) has become a common practice worldwide. Our literature review failed to find any evidence of previous studies on this topic from Saudi Arabia. Objective To determine the public use of the Internet in Saudi Arabia to search for HRI and to evaluate patients’ perceptions of the quality of the information available on the Internet compared to that provided by their health care providers. Methods A self-administered questionnaire about Internet use to search for HRI was distributed randomly to male and female outpatients and visitors attending a public University Hospital in Riyadh, Saudi Arabia from January to May 2010. A Chi-squared test was used to assess the association between different categorical variables. Multiple logistic regression was used to relate the use of the Internet to search for HRI with various socio-demographic variables. Results The questionnaire response was 80.1%, with completion of 801 of the 1000 distributed questionnaires; 50% (400/801) of respondents were males. The mean age of respondents was 32 ± 11 years. The majority of respondents used the Internet in general (87.8%), and 58.4% of them (363/622) used the Internet to search for HRI. The majority stated a doctor was their primary source of HRI (89.3%, 654/732). This practice was considered useful by 84.2%, and the main reason behind it was sheer curiosity (92.7%, 418/451). Other reasons included not getting enough information from their doctor (58.5%, 227/413) and not trusting the information given by their doctor (28.2%, 101/443). Forty-four percent (205/466) searched for HRI before coming to the clinic; 72.5% of those discussed the information with their doctors and 71.7% (119/166) of those who did so believed that this positively affected their relationship with their doctor. Searching the Internet for health information was observed more frequently among the 30–39 year age group (OR = 2.0, 95% CI 1.1–3.7), females (OR = 3.8, 95% CI 2.3–6.4), individuals with university or higher education (OR = 1.7, 95% CI 1.1–2.8), employed individuals (OR = 2.7, 95% CI 1.4–4.9) and high income groups (OR = 2.8, 95% CI 1.5–5.1). Conclusions A proportion of the public searches the Internet to obtain HRI for various reasons, which could have consequences on their health and relationship with their doctors. Therefore, doctors should be aware of the health information available online to help guide patients to reliable websites. Health authorities should also be aware of the issue to offer regulations and solutions.

Background: Punch instrument is a circular blade that can be used for many diagnostic and therapeutic purposes in different medical and surgical specialties. Punch surgery (or biopsy) is achieved by using this versatile punch blade under local anesthesia. Basic punch surgery is quick and easy to learn. Complications such as bleeding and infection are minimal. Diagnostic punch surgery can obtain a part of or whole skin lesion for histologic examination. In addition to the skin, nail and mucous membrane tissue can be obtained by punch biopsy. Interestingly, punch biopsy can be used as an adjunctive to fine-needle aspiration to establish the diagnosis of tumors of solid organ such as the breast. Diagnostic punch surgery can be modified to overcome certain problems. The split-punch technique helps avoid crushing the tissue punch when trying to divide it for different examinations. The double-trephine punch facilitates obtaining subcutaneous tissue without the need for full elliptical excision. The string-of-beads technique obviates the need for dissection of tissue into pieces. In other nondermatology and dermatology conditions, such as nerve pathology, arteriosclerosis, melanoma mapping, and eyelid tumors, the diagnosis can be enhanced with the use of punch surgery. Therapeutic punch surgery can be used for excision of unwanted lesions such as nevi, as well as pathologic bone and cartilage tissues. Punch grafting is used in vitiligo surgery and hair transplantion. Punch evacuative surgery can help in the evacuation of unwanted tissue or materials such as lipoma, subungual hematoma, scrotal calcinosis, pseudocyst of the auricle, pilar cyst, and others. Reconstructive punch surgery includes correction of ear lobe defects and acne scars. Enhancement of wound healing can be achieved by use of the punch; therefore, it can help nonhealing ulcers.

As the use of the Internet increases, it is important to gain insight into how it is used by patients to obtain health-related information.We aimed to explore the attitudes and practices of dermatology outpatients regarding their use of the Internet to find health information. We also aimed to investigate the consequences of this Internet use on the patient-doctor relationship.A self-administered questionnaire on Internet use was given to adult dermatology outpatients attending the Dermatology Department at King Saud University, Riyadh, Saudi Arabia, from January to June 2008.A total of 86% (432/500) of distributed questionnaires were returned. The mean age of respondents was 29.7 ± 10.0 years. Of the respondents who answered the relevant items, 42% (185/431) were females, 87% (376/432) were Internet users, and 47% (190/404) stated that they had accessed the Internet to obtain general medical information. Younger women educated to college level and with higher incomes tended to search for online health-related information more often than other groups. More than 93% (343/367) of respondents reported that they relied on their doctors as their primary source of information, but 69% (277/401) indicated that online medical information was beneficial, and almost 8% (30/399) stated that they would always trust data obtained from the Internet.A significant proportion of patients use the Internet to search for medical information. This has a positive effect on the patients' skin diseases and on their relationships with their doctors. Therefore, doctors should be more aware of the health-related information available online and should guide patients to reliable websites.

Background: Cutaneous leishmaniasis can lead to unsightly atrophic scars, which have limited treatment options. There is a scarcity of literature on its treatment modalities. Fractional lasers have been successfully used in treating a variety of skin conditions with minimal downtime and side effects. Methods: We report a successful treatment of a 25-year-old female patient with an atrophic scar from cutaneous leishmaniasis on the nose with a fractional laser (Fraxel Re:store SR 1500). Ten treatment sessions were performed at a pulse energy of 45 to 70 mJ. The treatment response was assessed by comparing pre- and posttreatment clinical photographs. Results: After three sessions, the patient observed 40% improvement. More than 90% improvement was noticed after the tenth session. No significant adverse effects were noted. The improvement was persistent at the 3-month follow-up. Conclusion: The excellent improvement in this patient should encourage further studies to achieve more efficacy and optimize the treatment parameters.

Patients' beliefs about their illness can result in positive and/or negative implications for the management of their disease. To examine the beliefs held by vitiligo patients about their condition and to explore the potential factors that might influence such beliefs.The illness perception questionnaire (IPQ) was translated into the particular regional language (Arabic) and administered to adult vitiligo patients visiting our Dermatology Department, from 2006 to 2008. Demographic and illness details were obtained.We recruited 164 vitiligo patients (91 male subjects). The mean age was 27 years (SD = 13, range 15–57 years). It was believed that stress, altered immunity, and heredity were the cause of vitiligo by 33%, 26%, and 24% of the respondents respectively. Eighty-four percent and 28% believed in fate and evil eye as a cause of their illness respectively. Forty-two percent believed that their illness had a major effect on their lives and 44% believed that vitiligo had strongly affected the way others see them. For both beliefs, this was independent of the gender. Thirty-seven percent reported that they do not understand their illness. Six percent believed that their disease was contagious while 12% were not sure. Fifty-four and 57% reported feeling depressed and anxious respectively, because of their disease. This was more common in female patients (P = 0.019 and 0.031 respectively).Misconceptions and negative attitudes are widespread among vitiligo patients. The lack of disease-related understanding and the existence of anxiety and depression require targeted health education and psychosocial support.

Background The internet is an increasingly important tool for physicians, but the extent to which it is used by dermatologists is unknown. We aimed to investigate the utilization of the internet by dermatologists in Saudi Arabia for medical purposes during their daily practice and to clarify the reasons for its use and non-use. Methods A self-administered questionnaire was distributed to all 160 dermatologists attending the National Dermatology conference in 2007. Results A total of 107 questionnaires were completed. Sixty-two percent of respondents had access to the internet in the workplace. The use of the internet to update medical knowledge was reported by 91%. Only 27% had internet access in consultation rooms. The majority of information retrieval occurred outside patient consultation hours (91%). Only 13% reported using the internet during patient consultation. Possible reasons included: lack of access (54%), time pressure (37%), possible interference with the physician-patient relationship (30%), and that use of the internet was too time-consuming (10%). The mean searching time used to solve a clinical problem was 34 ± 3 minutes. Fifty-eight percent used Pubmed; however, 77% of the dermatologists had no training at all in how to use this tool. Conclusion Professional medical use of the internet is widespread among dermatologists in Saudi Arabia. Providing access to the internet in the workplace and training of dermatologists to perform effective electronic searches are badly needed to improve the professional medical use of internet, which is expected to lead to better delivery of patient care.

Becker's melanosis (BM) is an uncommon cutaneous hamartoma. The classical descriptionof the lesion is of a macular, pigmented patch found on the upper trunk, with onset at or around adolescence. The aim of this study is to describe the clinicopathologic features of cases of BM which do not fit this typical description. Biopsy registry and laser clinic records from 2000-2006 at the authors' institution were searched for cases with a diagnosis or differential diagnosis of BM. A chart review was then undertaken to record clinical data and histological features of each case. Eleven cases which fit criteria for inclusion in the study were identified. The authors found that these eleven cases could all be described as BM with atypical features but were still clearly within the spectrum of this condition. Contrary to widely held belief, cases of Becker's melanosis with atypical features are not uncommon and might be under-reported.

Background There are concerns that there is no uniform approach towards the management of vitiligo. Objectives To explore attitudes and strategies for the management of vitiligo among dermatologists. Methods A self-administered questionnaire containing 22 questions was distributed to 160 dermatologists attending a national dermatology conference in 2007. Results One hundred and twelve dermatologists responded to the questionnaire (70% response rate). We had 105 completed questionnaires (seven were excluded due to incompleteness). Active treatment of vitiligo was recommended by 96% in more than half of patients, while 79% recommended treatment at non-visible sites. Repigmentation was regarded as main treatment goal by 54%. Mid-potent topical steroids were widely prescribed for focal vitiligo (72% in children and 65% in adults). Use of tacrolimus and pimecrolimus was limited. The most common used phototherapy was ‘narrowband ultraviolet B’ (NBUVB; 36% and 40% for generaliased vitiligo in children and adults, respectively). The use of oral psoralen plus UVA (PUVA) was limited (8% for generalized vitiligo in adults). Few respondents (1–8% for different types of vitiligo) prescribed outdoor topical PUVA. Vitiligo surgery was advised mainly for segmental type (18% in adults and 5% in children). Depigmentation was the first option for universal vitiligo by 50% and 30% in adults and children, respectively. Conclusions Most dermatologists are enthusiastic about active treatment of vitiligo even in hidden sites. Overall, the most two common treatment modalities were topical steroids and NBUVB. Vitiligo surgery is underutilized. Development of national practice guidelines is needed.

The gliding stitch could be an important addition tothe above-mentioned techniques. It is indicated inwounds with tension especially in areas with thickskin like the scalp or back. The technique is thefollowing:Step 1: The needle is attached to the needle holder.It then penetrates the epidermis, dermis, and uppersubcutaneous tissue. The wound is crossed to theopposite side, looping a substantial portion ofdermis and possibly subcutaneous tissue. As aconsequence, the needle appears on the skin sur-face of the opposite side.Step 2: A simple instrument tie is done, with onlyone throw of the longer tail (the needle side; la-beled as ‘‘A’’ in Figure 1) in either a clockwise oranticlockwise direction. The tip of the shorter tailis held by the needle holder and pulled within theloop. It should not be tied to the end (i.e., a smallloop should be left over the wound; labeled as ‘‘B’’in Figure 1).Step 3: The needle holder is used again to makeone throw in the same direction of that in Step 2.The short tail is then grasped with the needleholder and pulled within the loop. It should not betied to the end (i.e., a small loop should be left). Bythis stage, two loose loops will be seen (Figure 1).Step 4: The longer tail ‘‘A’’ (needle side) is pulled bythe hand in an upward direction till the end.Therefore, the lower loop will glide over the longertail. As a consequence the lower loop is completelytied (Figure 2).

Sebaceous carcinoma (SC) is a rare and aggressive cutaneous neoplasm. It may arise in ocular or extraocular sites. Approximately 25% of all reported cases of SC are extraocular. Cystic presentation of sebaceous neoplasm is rare. So far, cystic sebaceous neoplasia (CSN) has been reported only in association with Muir-Torre syndrome (MTS). Furthermore, CSN has recently been characterized as a marker lesion of MTS. We report a case of CSN of the nose that was not associated with MTS. Mohs micrographic surgery was performed with no recurrence for 2 years. Patients with MTS need long-term follow-up to detect possible future presentation of MTS.

Background Middle Eastern Respiratory Syndrome coronavirus (MERS-CoV) is a poorly understood disease with no known treatments. We describe the clinical features and treatment outcomes of patients with laboratory confirmed MERS-CoV at a regional referral center in the Kingdom of Saudi Arabia. Methods In 2014, a retrospective chart review was performed on patients with a laboratory confirmed diagnosis of MERS-CoV to determine clinical and treatment characteristics associated with death. Confounding was evaluated and a multivariate logistic regression was performed to assess the independent effect of treatments administered. Results Fifty-one patients had an overall mortality of 37 %. Most patients were male (78 %) with a mean age of 54 years. Almost a quarter of the patients were healthcare workers (23.5 %) and 41 % had a known exposure to another person with MERS-CoV. Survival was associated with male gender, working as a healthcare worker, history of hypertension, vomiting on admission, elevated respiratory rate, abnormal lung exam, elevated alanine transaminase (ALT), clearance of MERS-CoV on repeat PCR polymerase chain reaction (PCR) testing, and mycophenolate mofetil treatment. Survival was reduced in the presence of coronary artery disease, hypotension, hypoxemia, CXR (chest X-ray) abnormalities, leukocytosis, creatinine >1 · 5 mg/dL, thrombocytopenia, anemia, and renal failure. In a multivariate analysis of treatments administered, severity of illness was the greatest predictor of reduced survival. Conclusions Care for patients with MERS-CoV remains a challenge. In this retrospective cohort, interferon beta and mycophenolate mofetil treatment were predictors of increased survival in the univariate analysis. Severity of illness was the greatest predictor of reduced survival in the multivariate analysis. Larger randomized trials are needed to better evaluate the efficacy of these treatment regimens for MERS-CoV.