Expert consensus on unmet needs, referral criteria and treatment goals for hidradenitis suppurativa in Saudi Arabia.

Purpose: There is limited information about the diagnosis and treatment of hidradenitis suppurativa (HS) in the Kingdom of Saudi Arabia (KSA). This Delphi consensus study was conducted to develop recommendations for the management of HS in the KSA.Methods: The expert panel including 12 dermatologists with extensive experience treating HS patients provided nine consensus statements and recommendations on diagnosis and assessment, management, comorbidities and multidisciplinary approach, and education. The experts also developed clinical questions pertaining to the management of HS and rolled out as a survey to 119 dermatologists practising in the KSA.Results: The topics covered included: referring physicians' awareness of HS; referral criteria for HS; definition of moderate-to-severe HS; treatment goals; definition of treatment success; treatment and biologic initiation; comorbidities and multidisciplinary approach; patient education and awareness of HS. Full consensus (100%) from the expert dermatologists was received on all the topics except referring physicians' awareness of HS, definition of treatment success, and treatment and biologic initiation. The survey results resonated with the expert opinion.Conclusion: As HS is a chronic disease with negative impact on quality-of-life, timely diagnosis and treatment, early identification of comorbid conditions and a multidisciplinary care approach are crucial for effective management of HS.

Folliculitis decalvans managed with adalimumab: A case report.

Folliculitis decalvans (FD) is a rare neutrophilic cicatricial alopecia of the scalp that manifest with inflammation, pruritus, pustules, and tufted hair. Most dermatologist treat FD with topical or oral antibiotics. We recommend considering treatment with biologics to preserve and stabilize the ongoing inflammatory process in moderate to severe FD.

Confluent and Reticulated Papillomatosis Successfully Treated with Topical Vitamin A Derivative.

Confluent and reticulated papillomatosis (CARP) is a rare dermatosis that typically develops in adolescents and young adults. Clinical characteristics include hyperkeratotic papules that coalesce centrally with a reticulated pattern peripherally on the central and upper trunk, neck, and axilla. Its etiology is not precisely known, and disordered keratinization has been postulated as one of the etiologies. Treatment options of the disease include systemic (such as antibiotics, antifungals, and retinoids) and topical treatments (such as lactic acid, antifungals, retinoids, salicylic acid, urea, tacrolimus, and vitamin D analogs). We report a case of a 17-year-old boy, otherwise healthy, presented with a new onset of asymptomatic, persistent, and slowly progressing brownish skin lesions over the trunk for 6 months. The diagnosis was revised to CARP based on clinical and histopathological examination. Treatment with topical tretinoin 0.025% cream once daily was begun. There was complete resolution of his lesions at the end of 8 weeks of therapy. There has been no relapse at 2 months follow-up. The effectiveness of tretinoin in this patient supports the theory that CARP is a keratinization disorder. Initiating treatment with topical tretinoin when no limitations for its use would be reasonable as it can provide a safer alternative to systemic therapy.

Recalcitrant Dissecting Cellulitis of the Scalp Treated Successfully with Adalimumab with Hair Regrowth: A Case Report.

Dissecting cellulitis (DC) of the scalp or perifolliculitis capitis abscedens et suffodiens is a rare chronic inflammatory condition of the scalp manifested by perifollicular pustules, nodules, abscesses and sinuses that result into scarring alopecia. Treatment of DC is challenging and often disappointing. We report a 38-year-old male patient with DC for 5 years, and multiple topical and systemic therapies had shown poor effect. This patient achieved excellent response to adalimumab with hair regrowth.

Therapy-Recalcitrant Folliculitis Decalvans Controlled Successfully with Adalimumab.

Folliculitis decalvans (FD) is a rare idiopathic primary cicatricial alopecia which leads to permanent destruction of hair follicular stem cell. Staphylococcus aureus as well as autoimmunity has been implicated in the pathogenesis. Treatment options include topical antiseptics, topical and systemic corticosteroids, systemic antibiotics, isotretinoin, dapsone, hydroxychloroquine, and immunomodulators. We present the therapy-recalcitrant case of FD which is controlled successfully by subcutaneous injections of Adalimumab (Humira®) with no serious adverse events throughout the treatment.

A comparative trial of ice application versus EMLA cream in alleviation of pain during botulinum toxin injections for palmar hyperhidrosis.

BACKGROUND: Botulinum toxin is a safe and effective therapy for palmar hyperhidrosis, but the associated pain from injections limits the usefulness of this method of treatment. PURPOSE: To evaluate the efficacy of Eutectic Mixture of Local Anesthetics (EMLA) cream versus ice application in alleviation of pain during botulinum toxin injections for palmar hyperhidrosis. METHODS: In this prospective study, 23 patients underwent palm Botox injections to treat their excessive sweating. In each patient, EMLA cream was applied to one palm and ice was applied directly before the injections in the other palm. Pain was evaluated using a Visual Analog Scale. RESULTS: Statistically, there was a significant difference in pain control between EMLA cream group and ice application group (p<0.05). The average pain score on the hands where EMLA cream was applied was 8.9 (SD=0.81), whereas it was 4.8 (±0.9) in the ice group. CONCLUSION: In this study, the successful use of ice application in reducing pain by 40% in comparison to EMLA cream during Botox toxin injection for palmar hyperhidrosis is demonstrated.

Alopecia areata: a new treatment plan.

Many therapeutic modalities have been used to treat alopecia areata, with variable efficacy and safety profiles. Unfortunately, none of these agents is curative or preventive. Also, many of these therapeutic agents have not been subjected to randomized, controlled trials, and, except for topical immunotherapy, there are few published studies on long-term outcomes. The treatment plan is designed according to the patient's age and extent of disease. In this paper, the therapeutic agents are organized according to their efficacy and safety profiles into first-line, second-line, and third-line options.

Alopecia areata update: part I. Clinical picture, histopathology, and pathogenesis.

UNLABELLED: Alopecia areata (AA) is an autoimmune disease that presents as nonscarring hair loss, although the exact pathogenesis of the disease remains to be clarified. Disease prevalence rates from 0.1% to 0.2% have been estimated for the United States. AA can affect any hair-bearing area. It often presents as well demarcated patches of nonscarring alopecia on skin of overtly normal appearance. Recently, newer clinical variants have been described. The presence of AA is associated with a higher frequency of other autoimmune diseases. Controversially, there may also be increased psychiatric morbidity in patients with AA. Although some AA features are known poor prognostic signs, the course of the disease is unpredictable and the response to treatment can be variable. Part one of this two-part series on AA describes the clinical presentation and the associated histopathologic picture. It also proposes a hypothesis for AA development based on the most recent knowledge of disease pathogenesis. LEARNING OBJECTIVES: After completing this learning activity, participants should be familiar with the most recent advances in AA pathogenesis, recognize the rare and recently described variants of AA, and be able to distinguish between different histopathologic stages of AA.

Alopecia areata update: part II. Treatment.

UNLABELLED: Various therapeutic agents have been described for the treatment of alopecia areata (AA), but none are curative or preventive. The aim of AA treatment is to suppress the activity of the disease. The high rate of spontaneous remission and the paucity of randomized, double-blind, placebo-controlled studies make the evidence-based assessment of these therapies difficult. The second part of this two-part series on AA discusses treatment options in detail and suggests treatment plans according to specific disease presentation. It also reviews recently reported experimental treatment options and potential directions for future disease management. LEARNING OBJECTIVES: After completing this learning activity, participants should be able to compare the efficacy and safety of various treatment options, formulate a treatment plan tailored to individual patients, and recognize recently described treatments and potential therapeutic approaches.

Androgens and hair loss.

PURPOSE OF REVIEW: Androgenetic alopecia (AGA) or male pattern hair loss is a very common condition that has a significant psychosocial impact for patients. Many advances in the pathogenesis and treatment of AGA have been discovered recently. We discuss the pathogenesis and treatment of AGA. RECENT FINDINGS: Wide genome analysis showed an association of AGA and chromosome 20pll in addition to androgen-receptor gene. Also, a locus on chromosome 3q26 was found to have a linkage with AGA. Dutasteride has been shown to be more effective than finasteride in the treatment of AGA but is not yet a recommended therapy. In an in-vitro study, a new topical liposomal finasteride formulation showed more than five-fold higher deposition of drug in skin than the corresponding plain drug solution. SUMMARY: These recent developments in the field of AGA hold some promise and may play a role in the future management.