Common Chronic Disease Patterns in Arabian Gulf, Saudi Arabia & YemenDr. O. P. Kapoor
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Common Venereal and Skin Diseases

Venereal diseases :
  1. Gonorrhoea is the most common venereal disease seen in Arab population. The main complaint is milky discharge from the penile urethra ("Gaddaa Min Zib" or "Bukhit"). Often they have had injections and a course of antibiotic capsules.
    More often they suffer from mixed infections of gonorrhoea and organisms causing non-specific urethritis syndrome. These patients continue to complain of slight discharge per urethra. Smear examinations of the secretions, no more show any evidence of gram negative diplococci. Though it is difficult to culture, chlamydia organisms, in a few patients, staphylococcus aureus is grown on culture showing sensitivity to gentamycin and cephalosporidine group of drugs. But these organisms are invariably resistant to penicillin.
    Often these patients harbour infection in the deep pockets of the prostate gland and do not get completely cured. Some of them develop symptoms of "urethritis syndrome" and stricture urethra and run from doctor to doctor. Many of them also develop superadded neurosis.
  2. Syphilis : This venereal disease is not common in Arabs. It is uncommon for an Arab to present with a chancre, though once in a way all the venerealogists have treated a primary chancre. This low incidence cannot be explained by the half hearted treatment, often given by some general practitioners, for treating gonococcal infection. Often in the latter case, penicillin is not administered and they are treated with broad spectrum antibiotics, which have no known action on spirochaetes.
    Hardly ever has any skin specialist or venerealogist seen a case of secondary syphilis in an Arab. Also, hardly ever a case of cardiovascular syphilis or neuro-syphilis has been seen in my clinic during the last fifteen years.
  3. V.D.R.L. Test : I must have asked for this blood test in more than a thousand Arab patients (in those with a history of exposure) and got it done at different laboratories. On a dozen occasions, the test was positive and often this was a residual, low titre positive result, after a full course of treatment in the past. At the pathology laboratory of Jaslok Hospital, in 500 Arab patients in whom blood V.D.R.L. test was asked for, it was found positive only in 4.4 per cent. In a similar number of Indian patients, this incidence was 7.6 per cent.
  4. Chancroid : Although this is the most common venereal disease amongst the local Indian patients, it is rare in Arabs.
  5. Viral venereal infections seem to be common. These present as venereal warts or herpes progenitalis. Although the latter appears to be more common in Indian population, the reverse is true in Arab population.
  6. Venereal warts are often seen in the perianal region and very few are noticed on the genitalia.
  7. Herpes progenitalis is seen off and on in this population. Very often it is associated with symptoms of neurosis and impotence. In spite of the extensive treatment advised by a number of skin specialists, the response is poor and the eruptions continue to appear.

Skin diseases :

The skin diseases commonly encountered in Arabs are Tinea Versicolor, Candidiasis, Ringworm Infection, Acne, Dandruff, Atopic Dermatitis, Allergic Contact Dermatitis and Verruca Vulgaris.

  1. Tinea Versicolor : Majority of the Arabs, more commonly males, have this superficial fungal infection. It is seen as hypopigmented, scaly, sometimes pruritic eruptions on the chest, back, upper arms and neck. Only occasionally a patient comes with more extensive involvement, on the lower extremities.
    This is obviouslydue to climatic environment, excessive sweating and use of synthetic garments. Basically there are two types of Arab patients. There are those who do not complain of this skin lesion even though it may be extensive. They consider it as part of their normal health! There are others who become neurotic, because this "disease" has persisted inspite of lot of treatment!!
    This affection is recurrent and the patients have to be assured that it is harmless. Some of them come back complaining of a mild reaction, noted more after treatment with 'selsun shampoo'.
  2. Candidiasis : This fungal infection is noticed commonly in the overweight and fat female Arabs. The clinical picture is in the form of red erythematous, chapped areas in the groins and perianal regions (around the anus) and under the pendulous breasts. Only about one-third of the patients are diabetics.
  3. Ringworm is comparatively less common than Tinea Versicolor. It is sometimes seen in obese and diabetic Arabs. The duration of the infection is from a few days to few months. The lesions seen are on the gluteal region, abdomen, groins and feet. Rarely, other sites may be affected, but it is uncommon to find involvement of the nails or scalp in adults.
  4. Acne : Patients with acne are the young adult males and females, usually Bahrainis. Some of the most pretty young faces are scarred due to acne. I am also surprised at the cool attitude of these women to their skin condition. Sometimes they do not even complain of the lesions. Although all stages of acne are seen, majority have Grade I and 11 only i.e. black heads, papules and pustules.
  5. Atopic dermatitis : In the adults, the lesions are on the antecubital and popliteal fossae and are often lichenified. A variant of atopic dermatitis is seen in the form of bilateral, lichenified lesions on the ankles, which are of a few years in duration.
  6. Allergic contact dermatitis is seen more commonly than atopic dermatitis. A detailed history reveals allergy to detergents.
  7. Dry eczymatous patches above the ankles, seen very often do not bother most of the Arabs. Usually these have been present for a few years and itch off and on.
  8. Pruritus :Many Arabs, especially Yemenis complain of generalised pruritus ("Hakk") for no obvious reason. Often they complain of it, only when asked as a leading question.
  9. Vitiligo :The incidence of vitiligo seems to be increasing In Arab population.