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.

A case of nail psoriasis improved with treatment by risankizumab.

Nail psoriasis causes significant aesthetic and functional disabilities. The treatment of nail psoriasis is essential to improve the health outcomes and quality of life among patients. Pain associated with intralesional injections, inadequate penetration into the nail and underlying tissue, poor adherence to therapy, limited efficacy and recurrent relapses are among the many challenging issues with topical therapy. While conventional systemic therapies are still useful and often appropriate for some patients, current evidence indicates that highly selective agents including anti-tumor necrosis factor-alpha, anti-interleukin (IL)-17 and anti-IL-12/23 antibodies that are primarily available for plaque psoriasis and psoriatic arthritis have also demonstrated long-term efficacy in the treatment of nail psoriasis. We report a case of nail psoriasis improved with treatment by risankizumab.

Erythrodermic Psoriasis Managed with Risankizumab.

Erythrodermic psoriasis (EP) is a severe, often refractory, variant of psoriasis. Due to the high morbidity and mortality rate associated with EP and other causes of erythroderma, they are often classified as dermatologic emergencies. EP is usually a therapeutic challenge, where topical and conventional systemic therapies have yielded a less than satisfactory result in several patients. Furthermore, there are a limited number of studies evaluating other therapeutic modalities, such as biologic agents, with no clear treatment guidelines. In this case report, we present a patient who was diagnosed as a case of EP and showed an impressive response to risankizumab.

Evidence-based clinical practice guidelines for the management of psoriasis: systematic review, critical appraisal, and quality assessment with the AGREE II instrument.

BACKGROUND: Psoriasis is considered one of the stubborn lifelong dermatologic diseases, making the patients seized in their social cage. Evidence-based clinical practice guidelines (CPGs) and expert opinions ensure that patients with psoriasis render the most recent and developed care. This systematic review assessed and compared the most recently approved international CPGs with the AGREE II instrument. METHODS: After we identified our research question, we searched the bibliographic international databases to identify and screen for relevant and eligible guidelines that address the topic of interest. Four independent reviewers (Senior Expert Dermatologist in Psoriasis) have critically appraised the selected guidelines via the AGREE II instrument. We conducted inter-rater analysis and percent agreement among raters and calculation of intra-class correlation coefficient (ICC) 'Kappa'. RESULTS: Out of 33 articles for CPGs, only Four eligible CPGs fulfill the inclusion criteria. Selected CPGs were critically appraised; first from the American College of Rheumatology that is also National Psoriasis Foundation (ACR/NPF-2018), second from the UK's National Institute for Health and Care Excellence (NICE-2017) for Psoriasis: Assessment and Management, third from the Saudi practical guidelines on the biologic treatment for Psoriasis (Saudi CPGs, 2015), and lastly from the American Academy of Dermatology (AAD/NPF-2019) Management and Treatment of Psoriasis with Awareness and Attention to Comorbidities. The complete assessments (OA) of two CPGs (AAD/NPF and NICE) scored greater than 80%; 'six domains' of AGREE II had greater score that is congruent with results; (1) scope and motive, (2) shareholder involvement, (3) rigor of growth, (4) clarity of speech, (5) validity, and (6) journalistic independence domains. Domain (3) scored (84, 71, and 90%), domain (5) (51%, 47, and 90%), domain (6) (70, 52, and 90%) for (Saudi CPGs, AAD/NPF, and NICE), respectively. Generally, the clinical recommendations were significantly better for NICE CPGs. CONCLUSIONS: Four evidence-based 'CPGs' introduced a high-quality methodological analysis. NICE indicated the greatest quality followed by Saudi CPGs and AAD/NPF and all four CPGs were suggested for practice.

Efficacy and Best Mode of Delivery for Tranexamic Acid in Post-Inflammatory Hyperpigmentation: A Systematic Review.

Background: Post-inflammatory hyperpigmentation (PIH) is skin hyperpigmentation that occurs due to any inflammatory condition. Triggering the melanocytes by inflammation leads to melanin overproduction and deposition. Tranexamic acid (TXA) is an antifibrinolytic medication prescribed to treat bleeding. Recently, there are some studies about the use of TXA in the treatment of PIH. Objective: The aim of this study is to identify the efficacy and the best mode of delivery for tranexamic acid in the treatment of PIH. Methods: This systematic review is reported in accordance with PRISMA guidance. We included all relevant English-language studies that were published up to September 2022 in the following electronic databases: Cochrane Library, PubMed, Embase, and Google Scholar. The initial search yielded 61 articles, 9 of which were included after applying inclusion and exclusion criteria. Results: The systematic review included a total of 196 patients who were over the age of 16 years old. Tranexamic acid was delivered orally in 4 studies, topically in 2 studies, and both simultaneously in 1 study. In addition, intradermal injection was used in 2 other studies. Almost all studies advocated the use of all routes for accelerating the clearance of hyperpigmentation with more favor towards topical and intradermal routes due to their mild reported side effects when compared to oral routes. Conclusion: Intradermal TXA is considered the best route, which exhibits fewer side effects with less cost and excellent outcomes, while oral TXA is found to be less preferable than other routes due to the incidence of undesirable adverse events.

Tofacitinib Treatment in Patients With Active COVID-19 Infection.

Alopecia areata is a chronic autoimmune disorder attacking the hair follicle epithelium; hence, causing non-scarring hair loss. It has been found that Janus kinase 3 (JAK3) hyperactivity plays a key role in the pathogenesis of the disease. Tofacitinib is an effective JAK1 and JAK3 inhibitor that can block several cytokines such as IL-2, IL-7, and IL-6. Several studies have demonstrated the efficacy of oral tofacitinib in hair regrowth in alopecia areata patients. With the recent COVID-19 pandemic, it has been advised to withhold JAK inhibitors during the period of active infection due to possible immunosuppression. We herein report two cases of patients with alopecia universalis who continued to use tofacitinib during their active COVID-19 infection and showed no deterioration in their course of illness.

Palmoplantar Psoriasis Successfully Treated With Risankizumab.

Palmoplantar psoriasis is a variant of psoriasis that affects the palms and soles. Despite the small body surface area affected, palmoplantar psoriasis can have significant implications on a patient's mental health, justifying the urgency in treating this condition. Palmoplantar psoriasis is also known to be challenging to treat. In this case report, we present a male who presented with a 15-year history of psoriasis with significant palmoplantar involvement, managed with topical and systemic therapies, achieving a minimal response. After trying other therapies including acitretin and adalimumab, we eventually started the patient on risankizumab, an anti-IL-23 antibody. Following the fourth dose of risankizumab, the patient's palmoplantar lesions completely resolved. We further discuss why risankizumab may be considered a treatment option in resistant palmoplantar psoriasis cases.

Schwannoma of the Lower Lip: A Case Report of an Unusual Presentation.

Schwannoma is a benign neoplasm that originates from the neural sheath of Schwann cells. Although extracranial schwannomas are commonly observed in the head and neck region, only 1% are found in the intraoral cavity. This article describes the first case in the Eastern Mediterranean region of a lower lip schwannoma in a 17-year-old male patient.

Crescent-Shaped Hyperpigmentation Following Laser Hair Removal: Case Series of Fifteen Patients.

BACKGROUND AND OBJECTIVES: Post-inflammatory hyperpigmentation (PIH) is a common adverse effect of laser hair removal procedures. This case series emphasizes the under-reported crescent-shaped form of PIH that may occur following laser therapy. This case series sought to assess the potential causes of the distinct, crescent-shaped form of PIH that may arise following laser hair removal procedures, and to examine the concept of thermal versus cryogenic damage, which was discovered accidentally due misalignments between laser-cryogen spurts. STUDY DESIGN/MATERIALS AND METHODS: A retrospective, multicentre case recruitment was undertaken, involving three laser centers and presented in the form of a case series. The included patients were individuals with crescent-shaped PIH following laser hair removal. RESULTS: Fifteen patients were recruited over 12 months. All patients were treated with the GentleLase system (Candella) with built-in cryogen spurt. Prior to the study, only one patient had suffered from PIH following laser hair removal. Most patients improved partially or completely both with and without the use of bleaching compounds. After testing one machine, it was found that the cryogen spurt was misaligned. It was not located in the circle of the laser beam, thereby leaving a crescent shape of uncooled but laser-treated skin. A trial on one patient with cryogen alone did not cause PIH, whereas a trial with the laser alone caused PIH. CONCLUSION: The appearance of crescent-shaped marks following PIH is a distinct and uncommon adverse effect associated with laser hair removal procedures. This case series suggests that it arises due to the malfunctioning of the built-in cryogen spurt device, leading to a deficit in cooling a portion of the treated skin, urging checking the built-in cryogen spurt device. Lasers Surg. Med. © 2020 Wiley Periodicals, LLC.

Orf (Ecthyma Contagiosum) Transmitted from a Camel to a Human: A Case Report.

BACKGROUND Orf, also known as ecthyma contagiosum, is a zoonotic disease caused by a parapox virus, which is endemic in goats and sheep but rare in camels. Orf is usually transmitted to humans who are in contact with infected animals. The clinical manifestation of the disease and a personal history of contact with an infected animal are sufficient to diagnose orf virus infection. CASE REPORT In this case report, we present a 42-year-old man with an unremarkable medical history who came into contact with an infected camel and developed a typical orf lesion. There were multiple erythematous, dome-shaped to round painless nodules on the right forearm of the patient. Some of them had coalesced, forming large plaques, and a few nodules had watery or yellowish discharge. The lesion was complicated by lymphadenopathy. The diagnosis of orf was made based upon clinical suspicion. The patient was treated with fusidic acid cream and observed until the lesion resolved spontaneously, leaving some post-inflammatory hyperpigmentation. We believe this is the first report of orf transmission from a camel to a human. CONCLUSIONS All physicians should consider this disease as a differential diagnosis in any patient who has a history of contact with camels. Although orf is a self-limiting condition, its early clinical recognition is critical to avoid complications, unwarranted psychological stress, and unnecessary surgical intervention.

Risk of General Anesthesia in Pediatric Skin Procedures with Projection on Tumescent Anesthesia.

BACKGROUND: Uses of general anaesthesia in outpatient invasive procedures have increased, especially in dermatology. Being uncooperative, children often require general anaesthesia, since surgical skin operations are mostly painful. AIM: The purpose of this study is to evaluate the safety, significant adverse events, and the complication rates related to general anaesthesia, when used among pediatric population undergoing skin procedures. METHODS: We conducted a first retrospective cohort study of patient chart review during the period from September 1, 2017 through September 2019. All patients admitted for pediatric skin procedures during this period have participated in our study. We reviewed selected charts to document any unexpected admissions, adverse events, or complications. Surgical outcomes and anaesthesia complications were reviewed by three anesthesiologists. We assessed inter-rater reliability. RESULTS: A total of 211 procedures were reported for 211 patients with 19 diagnoses. No adverse events related to anaesthesia were recognized, apart from minor complications noticed in twelve patients. The kappa value range is between 0.78 and 1.00 (95% C.I., 0.46809 to 1.00). CONCLUSION: Dermatologist and pediatricians can safely do necessary procedures under general anaesthesia with the supervision of pediatric-trained anesthesiologists while considering other safety and risk precautions and the pediatric age group.

Treatment Adherence Among Patients with Five Dermatological Diseases and Four Treatment Types - a Cross-Sectional Study.

PURPOSE: Treatment non-adherence leads to negative therapeutic outcomes and financial burdens on the healthcare system. This study aims to compare the mean adherence scores among patients with five dermatological diseases and four treatment types and to identify the associated patient-related factors. PATIENTS AND METHODS: This is a cross-sectional study conducted from January 2019 to August 2019. The questionnaire was distributed among patients attending the outpatient dermatology clinic at King Khalid University Hospital, Riyadh, Saudi Arabia. It included 2330 patients who were over 16 years old and diagnosed with any of the five dermatological diseases (psoriasis, chronic dermatitis, acne vulgaris, hair growth disorders, and vitiligo). The 12-item Medication Adherence Scale was used to quantify the mean adherence score. RESULTS: Patients with psoriasis or chronic dermatitis were less adherent to treatments than patients with acne vulgaris, hair growth disorder, or vitiligo. Oral treatment and phototherapy had higher mean adherence scores than injection or topical treatment. High adherence was found in female, single patients; those who did not feel stigmatized from using treatment; those who did not have bad experience with the treatment; those who did not suffer from forgetfulness; those who connected receiving treatment with a habit; those who did not lack treatment responsiveness; those who had an excellent relationship with a dermatologist; and patients with a lesion in an exposed area. Stepwise multiple linear regression was also used to identify the independent variables related to adherence score. CONCLUSION: Psoriasis and chronic dermatitis patients had the lowest mean adherence scores. Patient who were on oral medication had the highest adherence score, while those on topical medication had the lowest score. The thoughtful consideration of factors associated with high adherence is important for optimal therapeutic outcomes.

Penile pyoderma gangrenousm treated with cyclosporine: Case report.

Pyoderma gangrenosum (PG) of the penis is a very rare entity in medicine and it can be destructive. Generally, pyoderma gangrenosum is known to be common among patients with systemic diseases such as inflammatory bowel diseases, polyarthritis, diverticulosis, paraproteinaemia, myeloma, leukaemia, active chronic hepatitis, and Behcet syndrome. Early diagnosis and administrating effective treatment can prevent permanent damage to the penis and save the patient's social life. Herein we report a delayed diagnosis of Pyoderma gangrenosum of the penis resulting in partial damage and was effectively treated with cyclosporine.

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.

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.

Interferon-induced vitiligo in hepatitis C patients: a case series.

BACKGROUND: Vitiligo is an autoimmune disease characterized by depigmented patches and macules. It is associated with many autoimmune diseases, the most common of which is thyroid disease. The association between Interferon (IFN) therapy and vitiligo is rarely reported in the literature, despite its common usage in hepatitis B viral infection, hepatitis C viral infection (HCV), hematological malignancies and melanoma. CASE: We are reporting eight cases of vitiligo that appeared after treating HCV with IFN. CONCLUSION: Interferon unmasks vitiligo in susceptible individuals.