“…Thus his immunological imbalance added to a reported sunlight chronic exposure might have had role in the S-KA development 10 . The second individual, 20 years old, was a "goza" (also called narghile, hookah, shisha, and water-pipe) user 15 which mutagenic potential may have a role in the development of S-KA 24 . Disregarding those two patients, the main age at clinical presentation rose to 53 years old and 17/21 1, 3-9, 11, 13, 14, 16, 17 patients were above 45 years old.…”