Varicella zoster is an omnipresent virus which commonly affects childhood as chicken pox. Although the primary infection is self-limiting and seldom severe, the virus remains dormant in the body. The virus resides in the dorsal root or cranial nerve ganglion and reactivation may occur years later as herpes zoster or "Shingles". Herpes zoster (HZ) can occur at any age but is rare in childhood and adolescents. Old aged and immunosuppressed subjects are at risk for developing the disease. The most common area involved in HZ is the trunk (dermatomes innervated by the thoracic nerves) and rarely presents exclusively in the upper extremity. We report a case of HZ isolated to the radial nerve distribution in a healthy 8 years boy. The reported case reveals the importance of considering zoster infection in young age, or uncommon sites when evaluating the onset of pain in a dermatomal distribution specially if associated with vesiculobullous rash.

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Tuberous sclerosis complex (TSC) is an inherited neurocutaneous disorder with multisystem involvement and highly variable expression of the disease. Common cutaneous manifestations include angiofibromas, periungual fibroma, ash-leaf-shaped macules and shagreen patch which is slightly elevated soft skin-coloured plaque usually found in lumbosacral region.  We report a case of TSC in a 21- year- old Saudi man with a 13 years history of asymptomatic skin lesions and generalized tonic-clonic seizures. Dermatological examination revealed facial angiofibromas, ash leaf macules, pedunculated fibromas on trunk, and shagreen patch on the back. Scalp swelling was found and confirmed to be shagreen patch by the histopathology findings. In conclusion, scalp shagreen patch is an unusual presentation of TSC. It should be considered in clinical examination of suspected cases of TSC with relevant histopathology to confirm the lesion.

Pyoderma Gangrenosum (PG) is a rare chronic immune-mediated inflammatory dermatosis manifested as painful skin ulceration, commonly affecting the lower limbs. The pathogenesis of the disease is complex. Abnormalities in neutrophil function, dysregulation of the innate immune system, and Tumor Necrosis Factor (TNF) were postulated. An underlying associated systemic disease was reported in more than 50% of PG patients, including inflammatory bowel disease, rheumatoid arthritis, and malignancies, with few cases reported an associated thyroid disease. Authors report a case of extensive PG associated with both ulcerative colitis and thyrotoxicosis co-morbidities not mentioned before in one patient. The patient was successfully treated with the anti-TNF alpha infliximab.

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