Dermatology workforce over a decade in Saudi Arabia: demographics, distributions, and future challenges.

BACKGROUND: The dermatology workforce is an important topic, as many countries are facing an undersupply of dermatologists, while some are expecting a surplus. Therefore, we conducted this study to identify the current dermatology workforce demographics in Saudi Arabia (SA) and the changes in such demographics over the last 10 years to identify future workforce-related challenges. METHODS: This study was conducted in SA, and it included all the practicing dermatologists in the country over the last decade (2010-2020). The number of practicing dermatologists, their gender, their nationality, and dermatology residency candidates and graduates were obtained from the Saudi Commission for Health Specialties (SCFHS). The geographic distribution of dermatologists was obtained from the Ministry of Health Statistical Yearbook 2018. RESULTS: As of September 2020, there were 2678 practicing dermatologists in SA at a ratio of 7.82 dermatologists per 100 000 people. Of the 2678 dermatologists, only 24.8% were Saudis. The Saudi dermatologist ratio has been almost constant over 10 years, ranging from 1.3 to 1.9 per 100 000 people. Of all Saudi dermatologists, 42% were female. The number of residents who graduated from the residency program was not consistent for each year and ranged from 4 to 25. The number of dermatologists varied by region, with 9.2 in Riyadh and 3.4 in Najran per 100 000 people. CONCLUSIONS: The results of our study revealed that a quarter of dermatologists in SA are Saudis. In addition, the number of non-Saudi dermatologists has increased in the last 10 years, while the number of Saudi dermatologists to the population has remained almost constant. There is also a geographic maldistribution of dermatologists, with urban areas having a higher number of dermatologists than rural areas. We encourage local studies that can elucidate the factors influencing the workforce, such as the dermatologist appointment waiting time, dermatologists' working hours, and the geographic maldistribution of dermatologists in the country.

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.

Cross-cultural validation of a short-form of the Vitiligo Impact Patient scale (VIPs).

BACKGROUND: There is a lack of short-form questionnaires evaluating the burden of vitiligo according to skin phototype. OBJECTIVE: To develop and validate a 12-item short-form of the Vitiligo Impact Patient scale (VIPs) that takes into account skin phototype. METHODS: Multicenter, prospective, cross-sectional study conducted in France (Créteil and Bordeaux) and the US (Worcester, Massachusetts, and Dallas, Texas). RESULTS: In total, 891 patients completed the questionnaire. Of these, 509 patients belonged to the French Development sample-313 with dark skin (DS) (phototypes IV to VI) and 196 with fair skin (FS) (phototypes I to III). The US validation sample comprised 382 patients-113 DS and 269 FS. There was a very high correlation between VIPs-FS and its 12-item short-form, VIPs-12-FS, in both the development and validation samples (respectively, rho = 0.96, P < .0001 and rho = 0.98, P < .0001). Similarly, the correlations between VIPs-DS and its short-form, VIPs-12-DS, in both the development and validation samples were very high (respectively, rho = 0.95, P < .0001 and rho = 0.96, P < .0001). LIMITATIONS: Responsiveness of the 12-item short-forms should be confirmed. CONCLUSIONS: These data enabled the development and validation of 12-item short-forms of the VIPs questionnaires for fair (VIPs-12-FS) and dark (VIPs-12-DS) skin.

Effect of quality-switched laser exposure in patients with history of edible gold consumption.

Injectable gold is known to deposit in the dermis for life, and such patients are at risk of developing chrysiasis post-laser exposure. It is unknown if patients with history of edible gold consumption would develop a similar reaction after quality-switched laser exposure. Our aim is to assess if patients with history of edible gold consumption develop chrysiasis after quality-switched laser exposure. This is a proof of concept pilot study conducted between September 2017 and September 2018 at two dermatology clinics in Riyadh, Saudi Arabia. Adult patients who have history of edible gold consumption were recruited to receive a spot test with different quality-switched lasers in a hidden, non-sun-exposed skin site. The test area was photographed before, immediately after, and 10 min after laser exposure. The test area was examined by two independent investigators for the development of chrysiasis. A total of 10 patients (five male and five female) were enrolled. The mean age was 31.7 years. Forty percent of subjects consumed edible gold more than once, and the duration of last intake ranged from 3 weeks to 3 months. Chocolate was the main source of edible gold. All participants had no chrysiasis reaction post-quality-switched laser exposure. Contrary to our hypothesis, all participants with history of short-term edible gold consumption did not develop chrysiasis after quality-switched laser exposure. Further controlled studies including more patients with longer duration and higher frequency of edible gold consumption are needed.

Dermatologists' Knowledge, Attitude, and Practice Pattern Toward Low-Dose Oral Minoxidil in Hair Loss in Saudi Arabia.

Background: The utilization of low-dose oral minoxidil (LDOM) has emerged as a relatively new treatment option for hair loss, gaining recognition among dermatologists worldwide. Objective: To assess the knowledge, attitude, and practice patterns among dermatologists in Saudi Arabia regarding the use of LDOM in the management of hair loss. Methods: An online survey, which was distributed to dermatologists practicing in Saudi Arabia through email and mobile messages. Both univariate and bivariate analyses were performed to investigate the factors that may be associated with enhanced knowledge and practice patterns concerning the utilization of LDOM for the management of hair loss. Results: A total of 84 dermatologists was included in this study, with 50 (60%) being male. It was found that 83 (99%) of the participants identified patterned hair loss as the most common indication for LDOM usage. Additionally, 77 (92%) recognized hypertrichosis as a well-known side effect. 48 (82%) of the dermatologists had never prescribed LDOM due to its unavailability in local pharmacies. Conclusion: The usage of LDOM for hair disorders is increasing. Nonetheless, many dermatologists abstain from prescribing this medication due to its limited availability in local pharmacies.

Modalities of treatment for Nevus depigmentosus: review of the literature.

BACKGROUND: Nevus depigmentosus (ND) is one of the pigmentary conditions that is characterized by a hypopigmented patch with an irregular border. It is usually present at birth or shortly after birth. It is not a progressive condition, but it may increase in size in proportion to the growth of the body. Despite many treatment modalities, there is no effective treatment for this condition. OBJECTIVE: To review all articles about the treatment options for ND. METHODS: Pubmed database were searched for this study, and relative clinical trials were included in the review. Descriptive findings, including age, gender, and treatment modality and response, were reported. RESULTS: A total of 62 articles were identified, and 16 relevant articles were included in this review after screening and removing the duplicates. CONCLUSION: In the literature, a limited number of treatment modalities have been employed for ND. Among these, surgical interventions and phototherapy have been the most commonly studied, but their efficacy has varied. Unfortunately, there is no definitive cure for ND, and recurrence of the lesion is not an uncommon occurrence even after complete clearance. Furthermore, there is a dearth of large-scale clinical studies that comprehensively analyze the different treatment modalities for ND.

Post-inflammatory hyperpigmentation after carbon dioxide laser: review of prevention and risk factors.

The CO2 laser has been widely utilized in dermatology; its expanding clinical applications include the management of neoplastic lesions, benign growths, cosmetic conditions, and reactive disorders. The laser's popularity is mainly due to the high precision and short recovery time this technology provides. However, postinflammatory hyperpigmentation (PIH) has been one of the challenging adverse effects of the CO2 laser. Therefore, several modalities have been studied for the prevention of PIH following CO2 laser treatment. This review aims to analyze the incidence of PIH after CO2 laser therapy, identify its risk factors, and assess the efficacy of the examined treatment modalities in preventing PIH. Pubmed and Embase databases were searched for this study, and relative clinical trials were included in the review. Descriptive findings - including age, gender, skin type, types of intervention, and incidence of PIH - were reported. When appropriate, the incidence of PIH was compared across each possible individual factor, such as skin type, gender, and type of intervention. A total of 211 articles were identified, and 14 relevant articles were included in this review. Seventy percent of the subjects were females (n=219), and 30% were males (n=94), with a mean age of 30 years (SD=7.8). The most common skin types were type IV (59%) followed by type III (25%). In total, eight studies investigated the prevention of PIH. The incidence of PIH after CO2 laser significantly varies between studies and differs based on the type of intervention. The studies indicate that the use of Clobetasol propionate 0.05% and fusidic acid cream appeared to effectively reduce PIH, recording an incidence rate of 39% and 53.3%, respectively. The Fitzpatrick-skinphenotype did not appear to influence the risk of PIH. There is a lack of high-powered clinical studies analyzing the incidence of PIH after CO2 laser treatment and the associated risk factors. PIH occurrence may be related to inflammation resulting from thermal damage by the CO2 laser. Consequently, the use of postoperative topical medications with anti-inflammatory properties might reduce its incidence. The use of ultra-potent topical corticosteroids and topical fusidic acid appeared to reduce PIH, possibly reducing postoperative inflammation effectively. Similarly, platelet-containing plasma may be beneficial in reducing CO2 side effects, including PIH. However, more studies are needed to further establish the influence of skin type on PIH and investigate modalities to reduce PIH occurrence after CO2 laser use.

Burnout phenomenon in Saudi dermatology residents: a national assessment of prevalence and contributing factors.

A cross-sectional study was conducted between March and August 2021; an electronic survey was administered to all dermatology residents (n=79) in all centers with the Saudi Board Dermatology Training Program in the western, eastern and southern regions. Participation was voluntary, and written informed consent was obtained before the study. The survey was completed by 70 dermatology residents, for an 88.61% response rate. All the participants were aware of the study's aims, and their informed consent was obtained. The study design complied with the Declaration of Helsinki ethical standards and was approved by the Institutional Review Board at Imam Muhammad Ibn Saud Islamic University in Saudi Arabia. A total of 70 respondents completed the questionnaire. High emotional exhaustion (EE) was present in 47.1% of respondents, low personal accomplishment (PA) was present in 65.7%, and high depersonalization (DP) was the least prevalent (24.3%) across all burnout dimensions of dermatology residents. Overall burnout was present in 21.4% of the dermatology residents. Multivariate analysis showed that the odds of EE were significantly lower in males than females [odds ratio (OR)=0.2, P=0.016] and the higher number of patients seen per clinic (OR=1.09, P=0.032) was associated with higher odds of having a high risk of EE, while higher satisfaction with work-life balance was associated with lower odds of a high risk of EE (OR=0.47, P=0.005). A higher number of study hours/week was associated with lower odds of low PA (OR=0.95, P=0.02). Similarly, higher satisfaction with career was associated with lower odds of low PA (OR=0.35, P=0.042). Multivariate analysis showed that only exercise (OR=0.21, P=0.05) and satisfaction with work-life balance (OR=0.42, P=0.008) were associated with a lower risk of burnout. Our study adds the burnout rates among dermatology residents in Saudi Arabia, in addition to possible risk factors that can predict burnout, to the literature. These findings can be applied to improve training programs and reduce the burnout rate among residents.

COVID-19-induced hair shedding and related risk factors: A Saudi perspective.

Introduction: Many cases of telogen effluvium (TE), acute hair shedding, following coronavirus disease 2019 (COVID-19) were reported during the pandemic. Methodology: We conducted a cross-sectional study to assess the relationship between COVID-19 and TE in Saudi Arabia. Self-administered online questionnaires were distributed online between March and September 2022 in Saudi Arabia. A multivariate logistic regression model was used to determine risk factors associated with TE post-COVID-19 (significance at P < 0.05). Results: Of the 703 responders, 392 were included in the study. 59.70% (n = 234) recognized hair shedding during or after COVID-19. The time taken to realize hair shedding (3 or 6 months) and the duration varied (3, 6, >6 months). The risk factors significantly related to TE post-COVID-19 were: female sex (P < 0.001, odds ratio [OR] = 2.98), COVID-19 antiviral treatment (P = 0.032, OR = 3.02), and TE history (P = 0.001, OR = 3.78). Conclusion: Healthcare providers and physicians should be aware of the relationship between TE and COVID-19, to easily recognize, treat, and improve their patients' outcomes).

Complete clearance of periungual warts in an immunocompromised patient using diluted intralesional bleomycin.

Periungual warts are commonly resistant to treatment, especially in immunocompromised patients. Many treatment modalities have been used with variable results. Bleomycin is one of the most effective treatments for recalcitrant warts, including the periungual type. It can be used either as a topical application after needling or as a direct injection. We report complete clearance of multiple periungual warts in an immunocompromised patient after diluted bleomycin injection. The patient did not have a recurrence after eight months of follow up.

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.

Clinical Approach to Linear Hyperpigmentation: A Review Article.

Linear hyperpigmentation is an unusual anatomical configuration in clinical dermatology. Owing to its rarity, consensus on the most effective method of classification is lacking. While linear hyperpigmentation generally follows Blaschko's lines, this is not universal. Clinical findings such as adherence to Blaschko's lines, associated morphological findings (including other cutaneous lesions), and systemic manifestations can be used to further characterize and diagnose variants of the disorder. Early detection of any underlying disease is vital, especially in cases with effective management, because the disorder may make it difficult to manage hyperpigmentation. Herein, we introduce a logical clinical diagnostic approach that represents a useful tool for dermatologists to efficiently evaluate patients presenting with linear hyperpigmentation. A simplified systematic and evidence-based approach is useful for this clinical condition owing to the heterogeneous causes and lack of specific diagnostic tools.