Primary cutaneous B-cell lymphomas (PCBCLs) are very rare to be seen in pediatric and adolescent age group, especially primary cutaneous follicle center lymphoma (PCFCL) which is considered the least occurring main subtype. Here, we describe a 16-year-old girl who developed a slowly growing solitary firm smooth surfaced erythematous nodule over her forearm. Histopathological examination showed a dense dermal nodular, periadnexal and perivascular lymphoid infiltrate extending deep to the subcutis. Immunohistochemical staining showed a B-cell population with positivity for CD20, variable staining for BCL6 and CD10 and uniquely staining for BCL2. Although a primary cutaneous marginal zone lymphoma (PCMZL) was considered but the presences of interfollicular BCL6 and CD10 positivity established the diagnosis of PCFCL. To our knowledge, only 12 cases of pediatric and adolescent PCFCL have been described in the literature.

Demodex folliculorum is a common ectoparasite of humans that inhabits follicular infundibulum and sebaceous ducts. Its role in various dermatological diseases is well studied. However, data on demodex-induced skin pigmentation are very limited. A diagnosis of this entity can be easily missed for other causes of facial hyperpigmentation such as melasma, lichen planus pigmentosus, erythema dyschromicum perstans, post-inflammatory hyperpigmentation, and drug-induced hyperpigmentation. Here, we report a case of facial demodicosis-induced skin hyperpigmentation in a 35-year-old Saudi male who is on multiple immunosuppressive agents. He was successfully treated with ivermectin 1% cream and had a dramatic improvement at his 3-month follow-up. Our aim is to shed light on this underdiagnosed cause of facial hyperpigmentation which can be easily diagnosed and followed up by bed side dermoscopic examination and managed effectively by anti-demodectic therapies.

Pseudoxanthoma elasticum-like papillary dermal elastolysis (PXE-PDE) is a rare, acquired skin disorder characterized by multiple small papules arising from degeneration of elastic fibers in the dermis. It is often underrecognized due to its benign nature and resemblance to harmless age-related skin changes and may be misdiagnosed as conditions such as pseudoxanthoma elasticum (PXE). A 70-year-old woman presented with asymptomatic skin lesions on her neck, which had gradually increased over 2– 3 years. On physical examination, multiple confluent yellowish-white papules with a cobblestone appearance were observed on the neck. Skin biopsy confirmed the diagnosis of PXE-PDE, showing loss of elastic tissue in the superficial dermis. The patient underwent two sessions of CO₂ laser treatment, with approximately 40% improvement noted by both the physician and the patient. This case underscores the importance of clinicopathologic correlation in diagnosing PXE-PDE and distinguishing it from PXE and other mimickers. CO₂ laser therapy may be considered as a cosmetic treatment option in selected patients.

Background: Premature hair graying (PHG) is one of the most prevalent conditions affecting individuals worldwide. It has been recognized as an important cause of low self-esteem, with a significant physical and social impact. This study investigated the factors associated with PHG by comparing medical students and resident physicians to other non-medical majors at Imam Abdulrahman Bin Faisal University (IAU). Methods: This is a comparative cross-sectional study conducted on resident physicians and students from 10 different colleges of IAU, Eastern Province, Saudi Arabia. This study evaluated the characteristics of PHG and its associated risk factors using an online distributed questionnaire. Results: A total of 2644 students and resident physicians were included in this study, with 45.6% coming from medical colleges. The findings show that the premature graying of hair was higher among obese and overweight individuals and those with a combined deficiency of vitamins B12 and vitamin D. Other factors associated with PHG included a family history of PHG, a lack of exercise, smoking, and allergic rhinitis. Gray hair onset before 25 years old was higher among those with high stress levels (95%) than those with moderate (90%) and or mild (86%) stress levels (p = 0.029). Conclusions: In our study, higher stress levels were related to an earlier age of PHG onset, and there was no difference between medical and non-medical students in PHG. Recommendations for future research include randomized clinical trials and larger cohort studies regarding the characteristics of PHG in the Middle East and those with Arabic ethnicity and assessing the medications that induce possible hair repigmentation.

T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) is a lymphoproliferative disorder in which the majority of cells are reactive T cells with only a minor population of neoplastic large B cells. THRLBCL is a very rare lymphoma, and most cases are nodal THRLBCL; an extranodal case of THRLBCL presenting primarily on the skin is an extremely rare occurrence with only a few cases reported in the literature. Here, we report a case of a primary cutaneous THRLBCL in a 41-year-old Saudi male who presented unusually with multiple skin lesions. He was successfully treated with electron beam radiotherapy and had a complete resolution with no recurrence as of his 24-month follow-up.