Multifocal congenital pyogenic granuloma successfully treated with oral propranolol.

Disseminated congenital pyogenic granuloma (DCPG) is an uncommon condition. Individual lesions of DCPG share clinical and histologic similarities with infantile hemangioma (IH); endothelial glucose transporter 1 (GLUT-1), which is highly expressed in IH but generally not in pyogenic granulomas (PG), is an important diagnostic tool. Treatment for DCPG remains difficult. We describe a case of DCPG effectively treated with propranolol.

Gender-specific differences in the awareness and intake of Vitamin D among adult population in Qassim Region.

BACKGROUND: Despite the abundance of sunshine throughout the year, Vitamin D deficiency is highly prevalent among different Saudi populations. The objective of the current study was to evaluate the awareness and intake of Vitamin D and their association among adults of both genders. MATERIALS AND METHODS: A cross-sectional study was done between June and August 2016 among adult patients and their family members (>18 years) presenting at 6 Primary Care Centers in the Qassim region, Saudi Arabia. RESULTS: A total of 500 study participants were included in the study; 54.6% of the participants were males and mostly aged most between 26-50 years. The majority of the participants had heard of Vitamin D (91.4%), believed in its importance for health (92.8%), were aware of the symptoms of Vitamin D deficiency (72.6%), and were able to identify exposure to sunlight (81.4%) and diet (70.4%) as sources. The sources of Vitamin D used by the participants were exposure to the sun (57.2%), Vitamin D-rich foods (51.2%) and supplements (18.8%). There was a significant association between overall awareness of Vitamin D and intake of at least 2 sources of Vitamin D in males (P < 0.001) but not females (P = 0.920). Although females had better awareness than males, exposure to the sun was much lower in females than males. CONCLUSION: As supplementation was very low in both genders, and since cultural factors that limit females' exposure to the sun are not easily modifiable, the current findings further underline the critical importance of Vitamin D supplementation, particularly in females in Saudi Arabia.

Botulinum Toxin for the Treatment of Gummv Smile.

AIM: The aim was to evaluate the effect of botulinum toxin (Botox) injections as a conservative treatment for gummy smile. MATERIALS AND METHODS: An experimental in vivo study was conducted at a dermatology clinic in Riyadh in January 2016. The study included 23 female patients who ranged from 20 to 50 years and were treated with Botox injections due to excessive maxillary gingival display. The patients with short clinical crowns or long maxilla, those who were pregnant or breastfeeding, and patients with neuromuscular disorders were excluded. Patients received Botox type I, injected 3 mm lateral to the alar-fascial groove at the level of the nostril opening at the insertion of the levator labii superioris alaeque nasi muscle. Photos were taken of the patient's smile before and after the treatment and were then uploaded to the SketchUp program to calculate improvements in gingival display. The distance from the lower margin of the upper lip to the gingival margin was calculated pre- and posttreatment. The amount of improvement was calculated as (pre-Botox treatment - post-Botox treatment/pre-Botox treatment × 100). The mean percentage of the total improvement was analyzed. RESULTS: A total of 23 female patients received treatment to improve their gummy smile. Improvement was clear 2 weeks after Botox injection. The mean percentage of improvement in the gingival display was 99.6%. CONCLUSION: Botox type I is an effective conservative technique to improve gummy smile caused by muscular hyperfunction. CLINICAL SIGNIFICANCE: Patients' retention highly indicated that they were satisfied with the provided treatment by Botox injections. Improving the quality of life with least painful experience and immediate results was the major advantage for Botox type I.

Alkyl Glucosides.

Alkyl glucosides are surfactants synthesized through the condensation of long-chain fatty alcohols and glucose, extracted from vegetal, renewable sources. Although available for more than 4 decades, they have been rediscovered in recent years because of their eco-friendly character. They are used in various leave-on and rinse-off cosmetics and are considered of low irritancy and allergenicity. However, since the early 2000s, cases of allergic contact dermatitis to this family of molecules have been repeatedly reported. Decyl glucoside was found to be a "hidden" allergen in the sunscreen ingredient Tinosorb M and is likely responsible for most allergic contact dermatitis reported to this compound. Members of the North American Contact Dermatitis Group have seen a steady increase of the rate of sensitization to decyl glucoside. Cross-reactions with other glucosides are common but not automatic; thus, patch testing multiple compounds is recommended.

Alkyl Glucosides in Contact Dermatitis.

Ecologically sound because they are synthesized from natural and renewable sources, the mild surfactants alkyl glucosides are being rediscovered by the cosmetic industry. They are currently found in rinse-off products such as shampoos, liquid cleansers, and shower gels, but also in leave-on products that include moisturizers, deodorants, and sunscreens. During the past 15 years, numerous cases of allergic contact dermatitis have been published, mostly to lauryl and decyl glucosides, and these compounds are considered emergent allergens. Interestingly, the sunscreen Tinosorb M contains decyl glucoside as a hidden allergen, and most cases of allergic contact dermatitis reported to this sunscreen ingredient are probably due to sensitization to decyl glucoside. This article will review the chemistry of alkyl glucosides, their sources of exposure, as well as their cutaneous adverse effects reported in the literature and encountered in various patch testing centers.

Contact Allergy to Polymyxin B Among Patients Referred for Patch Testing.

BACKGOUND: Polymyxin B is not included in most standard contact allergen series. The aim of this study was to determine the prevalence of contact sensitization to polymyxin B in a population of patients referred for patch testing. METHODS: A retrospective cohort study design was used to collect data on 795 patients referred to the contact dermatitis clinic of the McGill University Health Centre, as well as to the office of one of the authors (L.M.), between March 2014 and November 2015. Patients were patch tested to the North American Contact Dermatitis Group baseline series and polymyxin B sulfate 3% in petrolatum. RESULTS: Out of 795 tested individuals, 18 were allergic to polymyxin B, for a prevalence of 2.3%. The eruptions affected almost all body parts, but mostly the face. The degree of reaction ranged from 1+ to 2+. Isolated reactions to polymyxin B occurred in 9 (50%) patients, whereas reactions to bacitracin and polymyxin B were seen in the other 9. Only 1 patient reacted to bacitracin, polymyxin B, and neomycin (11.1%). Most reactions (12/18) were from past exposure to polymyxin B. CONCLUSIONS: Allergic reactions to polymyxin B are not rare, and this antibiotic warrants inclusion in the standard patch testing series.

"Parabenoia" Debunked, or "Who's Afraid of Parabens?".

Parabens have been used as preservatives in foods, injectables, and topical preparations for nearly 10 decades. Present in nature, rapidly metabolized by skin and liver enzymes, they have an excellent safety record. However, in the past 15 years, they have been under scrutiny for their alleged estrogenic and antiandrogenic effects, as well as their putative role in promoting cancerogenesis through endocrine disruption. Scientific articles supporting these assertions have led the European Community to ban or restrict the use of some parabens. Despite that methylparaben and ethylparaben have negligible endocrine disruption activity, the food, pharmaceutical, and cosmetic industries are under pressure from scare campaigns in the media and are responding by replacing parabens with other biocides that cause multiple cases, and even worldwide epidemics, of allergic contact sensitization. In the present review, we present a balanced account of the published literature about the metabolism and potential toxicology of parabens.