Psoriasis is a common, chronic, systemic, inflammatory disease of the skin that is often associated with inflammatory musculoskeletal disease. Psoriasis impacts on affected individuals and on society at many levels, being associated with considerable economic burden and impaired quality of life. This article aims to provide dermatologists and their allied healthcare professionals, particularly those practicing in Africa and the Middle East, with a review of the current understanding of psoriasis, its treatment and impact, as a backdrop for further discussion of the management of psoriasis in these regions. Insight into the real-life, day-to-day challenges and unmet needs currently facing dermatologists in Africa and the Middle East is provided by the authors, most of whom are experienced dermatologists practicing in this region.

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Only 13 of 22 patients could be evaluated at the end of the study; seven patients withdrew from the study because of severe local pain during injection. Three of the 13 patients showed insignificant reduction in the height of keloids after interferon treatment. No serious laboratory abnormalities were detected.

A few open studies on small groups of patients have reported the efficacy of oral vitamin D, in the treatment of psoriasis. To further characterize the therapeutic potential of this agent a placebo-controlled double-blind study was undertaken on a larger group of patients. Vitamin D, (the active lu-hydroxy form) 1pg/day and a placebo in a similar presentation were given in coded vials to 50 patients. Slight improvement was observed in 9 (45%) patients receiving vitamin D, and 8 (38%) patients receiving placebo showed similar improvement, indicating that this regimen is not effective in the treatment of moderate to severe psoriasis. (J Dermarol Treat (1990) 1: 243-245) rats exposed to ultraviolet irradiation. Biochemistry (1977) 3. Morimoto S, Kumahara Y, A patient with psoriasis cured by I-hydroxy vit D,. Med J Osaka Univ (1985) 3 5 51-4.

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Photochemotherapy has been the most successful treatment of vitiligo to date. In this study we tried to evaluate the efficacy, safety and patient acceptability of photochemotherapy (PUVA, or psoralen and ultraviolet A, therapy) for vitiligo patients treated in King Khalid University Hospital over the period of 1987-1994. The treatment success strongly depended on the number of treatments. More than 75% repigmentation was achieved in 42% of the patients who received 100 to more than 200 treatments. Unfortunately, however, only 27% of the patients received this number of treatments. Reasons for the failure of our patients to continue treatment to successful repigmentation, and recommendations for correction of this failure, are discussed. Ann Saudi Med 1997;17(2) Photochemotherapy has been the most successful treatment of vitiligo to date.1-4 Historically, photochemotherapy of "leukoderma" can be traced back as far as 3000 B. C. in Egypt and India.5 Modern photochemotherapy of vitiligo with psoralen and ultraviolet A (PUVA) was introduced in 1948 by El Mofty in Egypt. 6 Since then, detailed information has become available on the efficacy and the limitations of this treatment. 3,4,7 This therapy carries certain health risks and is time-consuming for both patients and doctors. We therefore thought it would be interesting to evaluate the efficacy of the treatment at King Khalid University Hospital. To our knowledge, this is the first report of its kind in the Middle East. Patients and MethodsThe study is retrospective and includes 142 patients with vitiligo. Patients with focal vitiligo or with the lip-tip variant were excluded from the study. Eighty-three females and 59 males were treated with PUVA in the Department of Dermatology, King Khalid University Hospital, Riyadh, over the period between 1987 and 1994. Every vitiligo patient treated with PUVA in our clinic has a PUVA chart (incorporating structured entry questionnaires and continuation sheets) in which all relevant data about his treatment, e.g., previous treatment, history of skin cancer, history of photosensitive disorders, concurrent medication, advice on contraception/fertility, psoralen dosage, UVA dosage, exposure time, degree of improvement, side effects, laboratory work results, etc., are recorded. Data from 47 patient records were not complete and could not be used in the final analyses of the study. The charts of 95 patients (46 female and 49 male, age range 10-70 years; mean age 26) were examined for clinical data including age, sex, duration of disease, family history, previous treatment, adjuvant treatment with topical corticosteroids, localization of vitiligo (face, trunk, arms, legs, hands, feet), stability of the disease, number of treatments before start of repigmentation, total number of treatments, cumulative UVA dose, clinical side effects and laboratory abnormalities. They were also checked for the quality of data recordings. The response to treatment was graded as follows: poor or nil = 0%-25% repigmentation of amelanotic skin; fair = ...

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