Wednesday, December 19, 2007


The zebibah, Arabic for raisin, is a dark circle of callused skin, or in some cases a protruding bump, between the hairline and the eyebrows. It emerges on the spot where worshipers press their foreheads into the ground during their daily prayers.

Here is a fine article in the NY Times on the ZEBIBAH.

One of our editors, Ben Barankin, published a letter on prayer marks in the International Journal of Dermatology. Barankin Letter

Dr. Barankin's letter was a comment on:

Prayer marks.
Abanmi AA, et. al.
Int J Dermatol. 2002 Jul;41(7):411-4.
Dermatology Department, Research Center,
Riyadh Al Kharj Armed Forces Hospital

Tuesday, December 11, 2007

Iatrogenic or Not?

Your opinion is sought.
The patient is a 42 y.o. woman with a long history of cystic acne. Typically she gets a few lesions a year. She has many ice pick scars from previous lesions. She was offered isotretinoin years ago but declined and indeed the lesions are less frequent now. She presents for intralesional triamcinalone when whe wishes to have the cysts treated. She was seen on December 5, 2007 with a tender cyst on the medial aspect of the left eyebrow. It looked like a typical acne cyst and was injected with Kenalog 3 mg per cc. Two days later she started to develop eyelid edema. She went to the Emergency Room and was given parenteral Rocephin and Cipro 500 mg bid. The swelling persists.

On examination, one can see where the initial cyst was. It's ~ 90% resolved. Below it there's a firm linear band that feels like a lymphangitic vessel.

I assume this must be related to the initial inflammatory lesion or the intralesional injection. I searched MEDLINE but could come up with no similar cases. If this is secondary to intralesional steroids, it is not reported. Could the original lesion have been a pyogenic infection that looked like her past cysts and could eyelid edema be secondary to lymphatic obstruction? The ER doc recommended another dose of Rocephin.
Addendum: The patient has never had fever, headache or other findings suggestive of a pyogenic infection.

Has anyone seen a similar case? Diagnostic and therapeutic suggestions are welcome.

Thursday, December 06, 2007

Palmar Lichen Planus?

This case was presented by Dr Khalil Alhamdi, Basrah Medical College, Iraq.
S.G, 62 yo woman, presented with bilateral itchy palms 2 years duration with poor response to treatment. Physical examination is normal apart from bilateral diffuse hyperkeratotic violaceous palms. All laboratory investigations were normal

Histopathology: histopathological examination showed typical features of lichen plaus.

Diagnosis: palmer lichen planus.
What is the experience of our colleagues in seeing such a presentation of palmer lichen planus? comment please.

Wednesday, December 05, 2007

Epidermal nevus affecting foot

A 22 year old man presented with a history of linear hyperkeratotic lesion on the right foot since age 7 yrs. It hurts his foot when he wear his shoes.
Examination of the right foot showed a localised hyperkeratotic plaque extending linearly to the medial malleolus. It was not tender or inflamed. My impression is that of an epidemal nevus. Appreciate your thoughts on diagnosis and treatment options.