Severe Nodulocystic Acne Induced by Mercury-Containing Skin-Whitening Cream: A Case Report and Call for Public Awareness.

Introduction: Skin-whitening products, often containing mercury, are used worldwide for cosmetic purposes but pose significant health risks. Mercury, a melanotoxin, can cause severe dermatological, renal, and neurological complications. Case Presentation: We report the case of a 27-year-old woman who developed severe nodulocystic acne due to chronic use of a mercury-containing skin-whitening cream. Treatment with isotretinoin and prednisolone led to significant improvement within 3 months. Conclusion: This case underscores the need for public awareness and stricter regulatory actions to prevent mercury-related health hazards from skin-whitening products.

The Prevalence and Awareness of Regular Follow Up of Patients Treated with Phototherapy for Skin Cancer Surveillance.

Objective Background: Regular full-body skin examination is commonly ignored in patients post-phototherapy, despite ultraviolet (UV) radiation being carcinogenic. Our objectives are to assess the prevalence of regular follow-up and full-body skin examination for patients treated with phototherapy, as well as the relationship between phototherapy exposure and the development of skin cancer in Saudi Arabia. Methods Settings Design: This was a cross-sectional retrospective study conducted from January 2022 to July 2022. The study included 99 patients, selected via simple random sampling, from King Saud University Medical City, Riyadh, Saudi Arabia, who underwent phototherapy for at least 8 weeks and were followed for a minimum of 18 months post-treatment. Patients who met the inclusion criteria were called and given a questionnaire. Results: Out of 99 patients, only 26 (26.26%) underwent full-body skin examinations by their physicians after phototherapy treatment. The average follow-up time after phototherapy was 3.2 years. Most study participants (85.85%) were unaware that cancer was a possible complication of phototherapy. Participants with knowledge about skin cancer complications were more likely to have undergone a full-body exam (P = 0.001). None of the participants developed any type of skin cancer after phototherapy. Conclusion: Patients treated with phototherapy had no adequate information about the risk of skin cancer. The incidence of skin cancer was zero in our small cohort. Dermatologists in Saudi Arabia do not have an evidence-based notion regarding the risk of skin cancer among the Arab population after phototherapy. Since There is a lack of data examining the relationship between phototherapy and skin cancer in the Arab region, this study should trigger future studies with large populations and longer follow up periods.

Macular amyloidosis diagnostic outcomes of skin biopsy: A systematic review.

Macular amyloidosis (MA) is a primary localized cutaneous amyloidosis, characterized by amyloid deposition in the papillary dermis. The clinical presentation includes pruritic hyperpigmented macules and patches with a reticulated or rippled pattern, primarily found on the upper back and extremities. Biopsy is an essential diagnostic tool for confirming MA. This systematic review focused on the biopsy outcomes in patients diagnosed with MA.

Is It Possible for Light-Based Hair Removal Home Devices to Induce Ocular Damage? Systematic Review.

Light-based hair removal home devices emit intense pulse light (IPL) or Diode laser. While the Food and Drug Administration controls them in the US, Europe continues to classify them as cosmetic products. Emerging concerns are: what if an unprotected eye is inadvertently exposed to light emission? Or if the consumer tries to overcome the protective safety features? We performed this systematic review by searching the Medline, CENTRAL, and Google Scholar databases to investigate the ocular damage reported after exposure to IPL for hair removal. We could not identify any case reported following exposure to home devices; however, a total of 20 patients were identified with iris atrophy, anterior chamber inflammation, and/or retinal pigment epithelium damage following exposure to office IPL or Diode lights. 40% were not using any protective eyewear during the light procedure. The reported fluences were in the range of 20-24 J/cm2. Although the ocular damage was identified following office devices, the reported fluences were within the home device's limits. For that, manufacturers should provide clear instructions on the package regarding the ocular hazards, the importance of using protective goggles, and a firm warning not to overcome the contact sensors. Home device-induced ocular damage is still a concern, perhaps under-reported.

Efficacy of non-ablative 1927-nm fractional thulium fiber laser for the treatment of Becker's nevus: Intra- and interobserver agreement study.

OBJECTIVE: To assess the efficacy and safety of a 1927-nm fractional thulium fiber laser treatment for Becker's nevus. METHODS: A retrospective analysis of patients with Becker's nevus who were treated with a 1927-nm fractional thulium fiber laser was conducted. Grading for lightening was set quarterly by physician global assessment of the pre- and postphotographs (I: <25%; II: 25%-50%; III: 51%-75%; and IV: >75% for marked lightening). Grading validation was exercised using intra- and interobserver agreement analysis among 10 dermatologists to determine the percent of agreement and the intraclass correlation coefficient. Grades I and II were classified as treatment failure. RESULTS: A total of 21 patients were recruited for analysis. The average number of treatment sessions was 2.1 per patient. A total of 13 patients achieved successful outcomes (grades III and IV) while 8 patients experienced treatment failure (grades I and II). Partial recurrence and transient hypopigmentation on adjacent skin were the main adverse effects. Only one patient reported worsening of the nevus. Overall agreement among the raters for the outcomes was graded from "very good" to "excellent," and the intraclass correlation coefficient, kappa, was 0.8. CONCLUSION: A 1927-nm fractional thulium fiber laser may be effective to ameliorate the pigment of Becker's nevus and achieve acceptable cosmetic outcomes. However, further studies are required in this area to improve and optimize the results.

Prevalence of Alopecia Areata in Saudi Arabia: Cross-Sectional Descriptive Study.

Background Alopecia areata (AA) is a common autoimmune disorder worldwide that affects the hair. Population differences have been observed in disease prevalence and clinical features, but no studies have examined AA prevalence at a large scale. In Saudi Arabia, information is lacking about AA characteristics. Objectives A quantitative, observational, cross-sectional study was conducted to assess AA prevalence, characteristics, and gender differences in Saudi Arabia. Materials and methods The study has used a validated Arabic questionnaire that targeted Saudi Arabia residents with a history of AA. A validated Arabic questionnaire was used to target Saudi Arabia residents with a history of AA, and the data collection instrument and written informed consent were distributed on Twitter and Facebook after permission from the Institutional Review Board. Prior to the study, accuracy validation for correct diagnosis by participants was performed in a 50-volunteer pilot test, which indicated an acceptable level of 96% accuracy. The questionnaire included high-quality images of different AA types and the collected data focused on variables such as the age of onset, affected body parts, treatment type, and family history of AA. Results A total of 5,362 participants returned completed questionnaires, of whom 741 (13.8%) had experienced AA at least once in their lives. Most were aged 11-30 years (69%), and the mean age of diagnosis was 18.6 years. Thirty-six percent (36%) of those with AA reported having a first-degree relative with the disease, and cross-sectional prevalence was 5.2%. Three-hundred fifty-nine (359; 18.9%) males and 382 (11%) females had AA. Twenty-nine point four percent (29.4%) of AA patients recovered in less than three months of AA onset, and 59.4% recovered in less than one year. Conclusion AA prevalence in Saudi Arabia is higher than in Western countries with a lower age of onset than in the former. AA affected males more than females and the mean age of onset was lower in the latter. Both male gender and young age of onset implied a worse prognosis.

Topical corticosteroids knowledge, attitudes, and practices of primary care physicians.

OBJECTIVES: To assess knowledge, attitudes, and practices of primary care physicians (PCPs) toward topical corticosteroids (TCs). Methods: A cross-sectional, 53-item questionnaire based study on TCs was conducted among PCPs in Riyadh, Kingdom of Saudi Arabia between January and March 2015. A maximum score of 30 was calculated for the knowledge portion. Results: Out of 420 PCPs, 336 responded (80%). Most participants (89.6%) reported prescribing TCs. The mean knowledge score was 17.14 (SD=5.48). Only 39% PCPs correctly identified that there are 7 or 4 TCs potency groups (2 different classification systems). The MBBS/MD and diploma-certified physicians scored lower than board-qualified PCPs (p less than 0.05). Family medicine physicians scored higher than general practitioners (GPs) (p less than 0.05). Hospital-based PCPs scored better than private practice PCPs (p less than 0.05). Moreover, those who felt somewhat comfortable (32.5%) in treating dermatology patients were more knowledgeable (p less than 0.05). Lastly, 76.5% of physicians were interested in attending courses on dermatologic therapies.  Conclusion: Knowledge of TCs among PCPs was inadequate. Targeted educational interventions delivered by dermatologists are recommended.

PHACES syndrome in association with airway hemangioma: First report from Saudi Arabia and literature review.

"PHACES" is a neurocutaneous syndrome that refers to the following associations: Posterior fossa malformations, Hemangiomas, Arterial malformations, Coarctation of the aorta/Cardiac defects, Eye abnormalities, and Sternal defects. Herein, we report the association of PHACES syndrome with airway hemangioma, a serious association that should not be overlooked. The findings of such an association presented here are the first to be reported from Saudi Arabia.

Acne scars in ethnic skin treated with both non-ablative fractional 1,550 nm and ablative fractional CO2 lasers: comparative retrospective analysis with recommended guidelines.

BACKGROUND: Fractional technology has changed the dermatologists view in how to treat acne scars in ethnic skin as a result of its favorable safety profile. OBJECTIVES: To evaluate the safety and efficacy of non-ablative fractional (NAF) 1,550 nm and ablative fractional (AF) CO(2) Lasers in the treatment of acne scars in ethnic skin. METHODOLOGY: In this retrospective analysis patients with acne scars who were treated with NAF 1,550 nm or AF CO(2) lasers from January 2008 until July 2009 were included. Evaluation was made through comparing pre- and post-photographs and physician global assessment. Patients' satisfaction rate was also recorded. Assessment of improvement was based on a quartile grading scale. Bleaching creams and oral antibiotics were routinely given after each session. Adverse effects were recorded. Follow up visits were scheduled at weeks 1 and 4 of each session and 12 weeks post-last session. RESULTS: A total of 82 patients were recruited in the study. Forty-five patients treated with NAF 1,550 nm laser and 37 patients with AF CO(2) laser. Skin phototype was mainly type IV (III-V). An overall patient satisfaction was 71% for NAF 1,550 nm laser group and 65% for AF CO(2) laser group. Thirty-five percent and 37% of patients attained more than 50% improvement with NAF 1,550 nm and AF CO(2) lasers, respectively. Patients treated with NAF 1,550 nm laser had less down time. Transient post-inflammatory hyperpigmentation (PIH) was noted in 17% of patients treated with NAF 1,550 nm laser compared to 14% with AF CO(2) . CONCLUSION: Both NAF 1,550 nm and AF CO(2) lasers are effective in treating acne scars in ethnic skin with good patient satisfaction rate and high safety profile. PIH decreased with routine use of prophylactic bleaching creams. Fractional laser resurfacing open a wide horizon for treating acne scars in ethnic skin.