Isolated Palmoplantar Lentiginosis.

The distribution of lentigines offers great insight into the multitude of potential-associated genetic or acquired conditions. In this report, we described a unique presentation of lentigines limited to the palms and soles in a healthy individual. Personal and familial history, clinical examination, serological testing, and whole-genome sequencing were all unremarkable. The benign clinical features and absence of associated medical conditions support the likely lentigo simplex with an isolated palmoplantar distribution. To date, no similar distribution has been reported. This case extends the breadth of view into all possible presentations of lentigines.

Severe Cutaneous Adverse Drug Reactions at a Tertiary Care Center in Saudi Arabia.

Background: Severe cutaneous adverse drug reactions (SCARs), although rare, are known to be associated with significant morbidity and mortality. SCARs include drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), and acute generalized exanthematous pustulosis (AGEP). Studies on SCARs are limited in Saudi Arabia. This study aims to characterize SCARs at a tertiary care center in Saudi Arabia. Methods: A cross-sectional study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia. All inpatient and emergency department consultations to dermatology were electronically reviewed during the period from January 2016 to December 2020. All patients who developed an adverse cutaneous drug reaction were enrolled. Detailed analysis was performed only for SCARs. The culprit medication was determined based on the latency period, history of previous intake of the medication, and drug notoriety. Results: There were 3050 hospital consultations to dermatology during the study period. Cutaneous adverse drug reactions constituted 253 (8.3%) cases. A total of 41 patients with SCARs were identified, accounting for 16.2% of all cutaneous drug reactions. Antibiotics and anticonvulsants were the most common causative drug groups accounting for 28 (68.3%) and 9 (22%) cases, respectively. DRESS was the most common SCAR. The latency period was the longest for DRESS and shortest for AGEP. Vancomycin was responsible for approximately a third of DRESS cases. Piperacillin/tazobactam was the most common cause for SJS/TEN and AGEP. The majority of drugs causing AGEP were antibiotics. The mortality rate was the highest in SJS/TEN (5/11 (45.5%)), followed by DRESS (1/23 (4.4%)) and AGEP (1/7 (14.3%)). Conclusion: SCARs are rare in Saudis. DRESS appears to be the most common SCAR in our region. Vancomycin is responsible for most cases of DRESS. SJS/TEN had the highest mortality rate. More studies are required to further characterize SCARs in Saudi Arabia and Arabian Gulf countries. More importantly, thorough studies of HLA associations and lymphocyte transformation tests among Arabs with SCARs are likely to further improve patient care in the Arabian Gulf region.

Clinicopathologic characteristics and outcomes of patients with mycosis fungoides: A single tertiary center retrospective analysis in Saudi Arabia.

OBJECTIVES: To determine the distinctive clinical and pathological characteristics and outcomes of MF in a Saudi population. METHODS: We conducted a retrospective analysis of all MF cases diagnosed clinically with pathological confirmation at King Abdulaziz Medical City in Riyadh from January 2016 to July 2022. Variables include demographical, clinical, and pathological MF traits and disease outcomes. RESULTS: A sum of 73 patients were enrolled. The mean age was 44 years. The female-to-male ratio was 1.3:1.The mean duration between cutaneous manifestations and MF diagnosis was 33 months (2.7 years). Classic MF was the most common variant (60.3%), followed by hypopigmented MF (20.5%). Most patients (82.2%) had early-stage MF (IA, IB, and IIA). Patients who had CD4+/CD8+ with CD8 predominance had a favorable disease course (p=0.029). Topical corticosteroids were the most frequently prescribed treatment (79.5%). Three patients (4.1%) died from MF. The disease-specific survival rate for advanced-stage MF was 84.6%, which was significantly lower compared to early-stage MF (p=0.032). CONCLUSION: Among the Saudi population, MF has an earlier onset and slightly higher prevalence in females. Hypopigmented MF is more prevalent in this ethnic group. Immunohistochemical staining of CD4+/CD8+ with CD8 predominance may elucidate a favorable disease course.

Attitudes Towards Artificial Intelligence Among Dermatologists Working in Saudi Arabia.

INTRODUCTION: Artificial intelligence (AI) and its applications are among the most discussed modern technologies today. Despite the rapidly expanding use of AI in medicine, and specifically in dermatology, only a few studies have studied the attitude of physicians toward AI. OBJECTIVE: To recognize the attitudes towards AI among dermatologists in the Kingdom of Saudi Arabia. METHODS: A cross-sectional survey was done among dermatologists in Saudi Arabia. Questionnaires were distributed through several online channels. RESULTS: Overall, 103 dermatologists filled out the survey. The majority saw very strong or strong potential for AI in the automated detection of skin diseases based on dermatological clinical images (50.9%), dermoscopic images (66.6%) and within dermatopathology (66.6%). In regard to results of attitudes towards AI, 56.6% and 52. 8% agreed that AI will revolutionize medicine and dermatology, respectively. However, many of the respondents disagreed that AI will replace physicians (41.5%) and human dermatologists (39.6%) in the future. Age did not impact the overall attitude of dermatologists. CONCLUSION: Dermatologists in Saudi Arabia showed an optimistic attitude towards AI in dermatology and medicine. However, dermatologists believe that AI will not replace humans in the future.

Secondary cutaneous diffuse large B-cell lymphoma presenting with focal vesicular lesions.

Blister formation as a presentation of B-cell lymphoma is extremely rare; only one case has been previously reported in the literature to our knowledge. We report a patient known to have refractory systemic diffuse large B-cell lymphoma who presented with nodules with overlying vesicular lesions, which was consistent with secondary cutaneous spread of diffuse large B-cell lymphoma.

Acne exacerbation after tofacitinib treatment for alopecia areata.

The major discovery of the novel therapeutic Janus kinase (JAK) inhibitors has been implicated in several dermatological diseases. Recently, studies have shown the efficacy and encouraging results of oral JAK inhibitors as a treatment for alopecia areata (AA). Due to the novelty of this treatment, potential side effects are not fully explored. In this paper, we present a case of a 28-year-old male with a 10-year history of alopecia totalis (AT) treated successfully with tofacitinib with encouraging effects on hair regrowth; however, a significant worsening of the patient's facial acne was observed four months after AT treatment initiation. JAK inhibitors have promising results in the management of different dermatological conditions including moderatesevere forms of AA with few reported adverse events. Acne exacerbation is a unique observed adverse effect of this therapy. More thorough larger sized studies are needed to further characterize the association between acne exacerbation and the use of JAK inhibitors.

Home-made topical therapy back applicator.

Self-application of topical therapy to the skin of the back skin can be challenging. Having a simple method to make an applicator at home might be useful. We describe a simple home-made device to apply topical therapy to the back.

The use of bubble wrap to simulate vesicle sampling for direct fluorescence assay.

Proper sampling from vesicles or bullae is important in order to reach the correct diagnosis and avoid false negative results. We demonstrate the use of bubble wrap to teach direct fluorescence assay for the diagnosis of herpes simplex virus or varicella zoster virus infections.

Novel methods for circumferential cryoanaesthesia: using doughnut pan or gauze.

Ice is effective for local anaesthesia but does not allow injecting without removing the ice device. This was partially solved by some recently described methods for circumferential cryoanaesthesia (CCA). CCA provides continuous anaesthesia along the peripheral part of the injection site while keeping the central part open for intervention. We describe additional novel methods for CCA using doughnut pan or gauze.

Risk Factors for Infection After Noncultured Melanocyte Keratinocyte Transplantation for Vitiligo.

BACKGROUND: Noncultured autologous melanocyte keratinocyte transplantation is considered a safe and effective treatment option in stable vitiligo. Factors associated with risk of infection are still poorly explored. OBJECTIVE: To search for factors associated with the risk of infection after noncultured autologous melanocyte keratinocyte transplantation (MKTP). METHOD: This was a retrospective multicentric study including all patients with vitiligo who had undergone noncultured autologous MKTP between January 2010 and December 2020. Data included age, sex, site, and size of the treated area, recipient area preparation method, and antibiotic prescription preceding the procedure. Univariate and multivariate analyses to search for factors associated with infection after MKTP were conducted. RESULTS: A total of 672 patients were included. Infection was present in 39 of the patients (6%) (95% confidence interval [CI]: 4.2%-7.7%). The following factors were independently associated with higher rate of infection: cryotherapy for recipient area preparation (OR 19.76, 95% CI: 3.21-121.74) and treated lesions on the trunk (OR 2.67, 95% CI: 1.21-5.90), lower extremity (OR 5.99, 95% CI: 2.49-14.40), and foot (OR 13.15, 95% CI: 4.37-39.62). CONCLUSION: Infection after noncultured autologous MKTP is not uncommon. Cryotherapy for recipient area preparation and lesions on the trunk, lower extremity, or foot was independently associated with an increased risk of infection.

Accuracy and Quality of YouTube Videos as a Source of Information on Vitiligo.

PURPOSE: Vitiligo is a skin condition characterized by patchy depigmentation in the skin, affecting not just the physical well-being of patients, but also the mental, emotional, and social aspects of their lives. Social media provides a platform where patients can interact and share experiences, and for physicians and experts to disseminate knowledge on the disease. This study aimed to evaluate the accuracy and overall quality of vitiligo-related content on YouTube. METHODS: Thirty videos were screened by relevance according to the inclusion criteria. Videos were categorized as either healthcare or non-healthcare sources, and viewer engagement ratio was calculated for each. Three independent vitiligo experts rated the content using the following assessment tools: DISCERN, Accuracy in Digital-health Instrument (ANDI), and Global Quality Scale (GQS). Lastly, Cronbach's alpha was used to estimate the inter-rater reliability and consistency. RESULTS: Most of the screened videos came from health-care sources (57%). Non-healthcare sources achieved a slightly higher viewer engagement ratio, although the difference is not statistically significant (p = 0.23). DISCERN score was low overall in most videos. However, DISCERN score was higher for health-care sources as compared to non-healthcare sources (30.5 ± 9.4 vs 22.7 ± 4,2, p = 0.009). Scores of ANDI and GQS were higher for health-care sources but not statistically significant. There was a good internal consistency in DISCERN rating among the evaluators (0.86). CONCLUSION: Our study shows a low overall accuracy and quality of YouTube videos on vitiligo. It is recommended that health-care sources improve their information material in terms of quality and viewer engagement, as very little can be done to prevent non-healthcare sources in publishing their own videos. Efforts in educating the public on making distinction between evidence and non-evidence-based claims should also be taken.

Laser safety in isotretinoin use: online survey of public perception.

BACKGROUND: The safety of laser therapy in patients taking isotretinoin is controversial. Recent evidence suggests that laser during isotretinoin treatment is safe. Our study aims to assess public perception and willingness to undergo laser intervention while receiving isotretinoin. METHODS: An online-based cross-sectional survey was conducted between November 2019 and March 2020. Information on participants knowledge about isotretinoin precautions with laser therapy and their willingness to undergo laser intervention while on isotretinoin therapy was collected. RESULTS: Out of 509 respondents, almost one-third used laser therapy while on isotretinoin treatment. Those who did not use laser therapy most commonly attributed to isotretinoin treatment (43%). Forty-two percent of participants thought that laser therapy while on isotretinoin is harmful. Almost half of the participants were aware that current guidelines recommend waiting for six months after isotretinoin. Nearly, half of the participants decided to postpone laser therapy for acne scars even after knowing that recent studies reported the safety of laser therapy for acne scars while on isotretinoin. CONCLUSION: Even with the knowledge of recent safety data of laser during isotretinoin therapy, a significant proportion of patients are still concerned about potential complications. Increasing awareness regarding the safety of laser skin therapy during isotretinoin treatment might be needed.

Q-switched 532 nm Nd:YAG laser therapy for physiological lip hyperpigmentation: novel classification, efficacy, and safety.

BACKGROUND: Physiological lip hyperpigmentation (PLH) is a common cosmetic concern in the Middle East and Asia. It is characterized by homogeneous symmetric diffuse hyperpigmentation affecting both lips. There is no satisfactory treatment for this condition. The aim of this study is to evaluate the efficacy and safety of Q-switched (QS) 532 nm Nd:YAG laser for PLH. METHODS: A total of 30 patients with clinical diagnosis of PLH were retrospectively reviewed and included in the study. Patients underwent at least one laser treatment using QS 532 nm with a minimum follow up of six months. Laser parameters were as follows: spot size 2-3 mm, pulse duration 20 ns, fluence 2-4 J/cm2. One to three sessions were performed depending on clinical response. Two methods were used for assessment: patient satisfaction and independent physician assessment. PLH was classified as grade 1 (upper lip fully affected plus only border of lower lip), grade 2 (upper lip fully affected plus most of lower lip), and grade 3 (majority of both lips hyperpigmented). RESULTS: Excellent (>75% improvement) response was achieved in 30% of patients. Good (51-75% improvement) response was seen in 37% and 43% of patients according to patient satisfaction and independent physician assessment, respectively. Majority of patients required only one treatment session. Reactivation of herpes labialis occurred in two patients, and mottled hypopigmentation in three patients. None of the patients developed persistent hyperpigmentation or scarring. CONCLUSIONS: PLH can be effectively treated with QS 532 nm Nd:YAG laser and is well tolerated by patients.