11^th Global Dermatologists Congress November 14-15, 2016 Dubai, UAE

Dr Saher Tariq completed her MSc dermatology from Cardiff university. She did her dissertation on Facial hyperpigmentation for which she reviewed 170 primary and secondary research papers and suggested diagnostic and topical treatment algorithm. Some of her work in other fields of medicine has been published in reputed journals..

Facial hyperpigmentation is a major cause of embarrassment for the patient and adversely impacts the quality of life. It is more of a concern for dark skinned individuals due to the difference in structure and function of the skin among different skin types. There are many causes of facial hyperpigmentation; their pathogenesis differs depending on the factors influencing melanogenesis. Many depigmenting agents have been used for the treatment of facial hyperpigmentation but none of them has proven to be effective and safe for long term treatment. Hydroquinone has been used as gold standard treatment for facial hyperpigmentation for decades. Due to a concern regarding its long term safety, there is interest in developing new milder yet effective natural depigmenting agents. The aim of this poster is to provide an overview of the common acquired causes of facial hyperpigmentation and topical treatment options available. A comprehensive search was done on different scientific search engines, using facial hyperpigmentation as search key words. The plethora of existing treatment can be broadly divided into topical treatment and no- topical treatment. The emphasis in this study is on topical treatment. Common topical depigmenting agents have been used for decades and are well studied, however their long term safety is a concern. On the other hand alternative topical depigmenting agents are thought to be safe. However, lack of comparative studies with standard treatment (hydroquinone) and many gaps in literature has been identified. A multimodal diagnostic and treatment algorithm is proposed to guide clinicians on management of facial hyperpigmentation.

Dr Pooja Kadam, Dermatology and Phlebology Research Fellow from Sydney, Australia. She completed MBBS from the University of New South Wales in 2011 and currently pursuing her Master of Science (Medicine) through research. She have spent a year doing general medicine residency in Albany, New York. Currently She is also the unaccredited dermatology registrar at St Vincent's Hospital, Sydney and assist with the dermatology outpatient’s clinics. Her aim is to secure a position in Dermatology training in Sydney.

An 89 year old female presented with an eighteen-­‐month history of a large, protuberant, non-­‐tender left groin mass measuring15x8 cms (Fig1, black arrow). There were numerous melanocytic nevi present on her chest and abdomen. Past medical history was unremarkable. Computed Tomography (CT) of the pelvis showed a heterogeneously enhancing well-­‐circumscribed complex mass in the subcutaneous tissue with mixed solid and cystic components. Core biopsy was performed and histopathological analysis revealed scattered dissociated malignant cells with enlarged, eccentric nuclei and unevenly distributed chromatin, consistent with metastatic melanoma. A staging CT revealed bilateral lower lobe pulmonarymetastasis with left hilar lymphadenopathy. The primary site of the melanoma remains to be established. The patient declined any treatment and died within six months of diagnosis.The incidence of malignant melanoma is rising with majority of the cases being detected when the disease is curable. However a small proportion of cases present with metastatic disease at time of diagnosis and carry a poor prognosis (1,2). The 10-­year survival rate for patients with metastatic melanoma is known to be less than 10% (2). Although any organ can be involved, common sites for metastases include the liver, bone and brain. Cutaneous metastases are a frequent event in the progression of melanoma seen both in the early and late phases of disease (3). The site of metastasis is an important independent predictor of survival; patients with distal nodal and soft tissue metastases have a better survival than patients with visceral metastasis (3). Systemic therapy is the cornerstone of treatment for metastatic melanoma. Palliative surgery or radiotherapy to metastatic sites is generally performed to relieve symptoms secondary to tumor growth. In summary, melanoma is a potentially fatal form of skin cancer and early detection is crucial to improve survival and decrease mortality.

Ghaida Al-Hassan is an intern from King Saud University, Riyadh.He Graduated from medical school on April,2016. His Expected year of end of internship is June,2017.

Dissecting Cellulitis (DC) is rare but distinctive chronic inflammatory disease. It is characterized by follicular occlusion, fluctuant nodules and formation of sinuses that can lead eventually to scarring and alopecia. Treatment of DC includes topical or oral antibiotics, intralesional steroids, Isotretinoin, or surgical excision. Recurrence rate is usually high after medical treatment. This case report describes an adult male with recalcitrant DC successfully treated with Clindamycin and Rifampicin without recurrence for 5 years follow-up.

Ibrahim Ghazy Alreshidi is a medical Intern graduated in 20th april 2016 from University of Hail in Hail city, Saudi Arabia.

Objectives: The aim of the study was to assess the knowledge,perceptions, and attitudes of Saudi community toward vitiligo in Hail city, Northern Saudi Arabia. Methodology: This is a cross-sectional randomized survey performed in Hail City using a self-administered questionnaire. The study recruited 1004 volunteers representing students, and employees of Hail University. The study conducted during the period from the 1st of April, 2015 to the end of November, 2015. The data were collected and analyzed using Statistical Program for Social Sciences (SPSS release 20.0). p<0.05 was accepted for statistical significance. Results: Of the 1004 participants, 440/1004 (43.8%) were males and 564/1004 (56.2%) were females. Of the 1004 participants, 231/1004 (23%) ignore vitiligo, and the remaining 773/1004 (77%) knew the disease. Of the 1004 study subjects, 595/1004(59%)believed that vitiligo is an inherited disease (Figure 2) and 409/1004(41%) mistrusted. About 73.8% parsons stated prevention of marriage vitiligo person. Conclusion: The misconceptions and negative attitudes about vitiligo among public are generally prevalent. Raising public awareness about vitiligo could lead to increased self-confidence, psychological well-being and resulting in better adaptation of vitiligo individuals within the society.

Shayma Saud Al Eid is currently working at King Fahad University Hospital at Al Khobar in KSA as a Medical Intern. Shayma Saud Al Eid recently graduated from Medical School at University of Dammam, KSA.

Lipoid proteinosis is considered as a rare disorder with autosomal recessive pattern of inheritance. Patients affected with lipoid proteinosis can show multiple clinical manifestations as progressive hyaline material deposition in the skin, mucous membrane and different organs of the body. The classic manifestation is onset in infancy with a hoarse cry due to laryngeal infiltration. In the present report, we describe a 41 years old Saudi male with a known medical history of GERD and epilepsy. He shows symptoms of a hoarse voice since infancy, beading of the papules around the eyelids, acneiform scars on the face and extremities and thickened oral mucosa including the tongue and buccal mucosa. Oral mucosa biopsy was done for him, according to the biopsy result and clinical presentation, the patient was diagnosed as a case of lipoid proteinosis. The objective of the present work is to report on middle adulthood male with classical manifestations of lipoid proteinosis, which is largely uncharacterized in Arab population.

Erythema annulare centrifugum (EAC) is one of the figurate or annular erythemas. It is uncommon inflammatory condition characterized by persistent annular or arcuate erythematous eruptions that slowly enlarge centrifugally. Although EAC can be recurrent, annual recurrence is an unusual feature of EAC. Here in we present a 60 year-old female who is a known case of hypothyroidism on thyroxine treatment, presented with 3 years history of recurrent slightly itchy skin lesions that recur once every year. Skin examination revealed multiple annular scaly erythematous plaques, ranging in size as small as 2 cm to as large as 10 cm over her arms, chest and thighs with a characteristic pattern of the scales that are arranged in a trail like pattern. Skin biopsy showed mild hyperkeratosis, mild spongiosis and sparse perivascular mononuclear cellular infiltrate in the upper dermis. The patient was empirically treated with itraconazole capsule 200 mg once daily for one month. The lesion disappeared.

Ibtihal Malawi is currently a Medical Intern graduated from Umm Al-Qura University in Saudi Arabia and is interested in dermatology.

Phakomatosis Pigmentovascularis (PPV) is a rare sporadic developmental disorder characterized by co-existence of a cutaneous vascular malformation and pigmentary nevi. There are different classifications of PPV. When systemic involvement is there, a designation ‘b’ is used, whereas if no systemic involvement, a designation ‘a’ is used. Herein, we reported a 12 years old girl presented with a symptomatic persistent progressive skin lesions since birth. Systemic review and past medical history were all unremarkable. Skin examination revealed mixture of diffuse non-scaly, bleachable erythematous patches, greenish patches and hypopigmented patches over her trunk. Ophthalmologist and neurologist consultations did not reveal any abnormalities. Based on the above clinical findings, the patient was diagnosed to have port-wine stains, Mongolian spots and nevus anemicus. Constellation of these clinical findings without presence of extracutaneous manifestations made the diagnosis of PPV type IIa.

Lina Alyousif is a Intern doctor , MBBS at Qassim University , KSA and head of medical student's club. She is Interested in Dermatopathology and Dermatology researches.

Cutaneous squamous cell carcinoma (SCC) accounts for 20% of all dermatologic malignancies and has been defined as a proliferation of keratinocytes with potential for local and metastatic disease. HER2, a member of the Erb family of transmembrane receptor tyrosine kinases (RTK), is responsible for communicating extracellular signals to the nucleus and is implicated in tumorgenesis in several malignancies with potentially poor outcome. To date, the expression of HER2 has not been evaluated in primary cutaneous squamous cell carcinoma (SCC). This study was carried out with cooperation of Pathology Department, King Fahd Specialist Hospital, Buraidah and other hospitals in Qassim region. The study was conducted on about 40 skin specimens from patients with non melanoma skin cancer (squamous cell carcinoma) diagnosed and confirmed by biopsy. Immunohistochemical analysis for HER2 was carried out on formalin, fixed-paraffin embedded sections of skin tissues using avidin biotin peroxidase method. The age and sex of the patients, the main complaints, the clinical presentations, the tumor size and sites were recorded and analyzed. In this study, nearly all normal stratified squamous epithelium of the skin were negative, whereas cases of SCC showed positivity to HER2. HER2 expression was observed in approximately 70% of SCC cases. There was statistically significant correlation between HER2 expression histologic grade, lymph node metastasis and distant metastasis (P=0.006, 0.043, 0.009, respectively). HER2 overexpression was initially seen to be present in of breast cancer patients and more recently in a similar percentage of stomach and esophagogastric junction tumors. Previous study showed HER2 to be expressed only in 25% of metastatic SCC of the skin. To date, however, HER2 has not been evaluated in primary cutaneous SCC. There are significant clinical implications associated with the expression of this receptor; each is an independent prognostic indicator of poor outcome. In this study, 40 cases of primary cutaneous SCC were evaluated for the expression of HER2. IHC demonstrated (28/40) 70% immunoreactivity for HER2. Though a limited series, our results suggest that HER2 are overexpressed in SCC. Our findings indicate that metastatic potential of cutaneous SCC are cognate with the association of increased HER2 expression inferring a worse prognosis and greater metastatic potential. Further studies are needed to examine the expression of HER2 in the different subtypes of primary and metastatic SCC. In conclusion, we found that HER2 expression in cutaneous SCC correlated strongly with a well established negative prognostic marker. HER2 expression correlated with high tumor grade, lymph node, and distant metastasis, which indicates that HER2 can be used as an independent prognostic marker indicative of poor prognosis and a probable target in the development of novel therapies. Thus, we recommend that HER2 be routinely added as a new negative prognostic marker in all cutaneous squamous cell carcinoma patients.