Lobular capillary hemangioma post-chemotherapy for T-cell leukemia treated with an antibiotic: a case report.

Background: Lobular capillary hemangioma, also known as pyogenic granuloma (PG), is a relatively common benign rapidly growing friable vascular tumor of the skin and mucus membranes. Although the exact pathogenesis of PG is unknown, many theories discussed the potential of an angiogenic stimulus and an imbalance of inducers and inhibitors triggering the hyperplastic and neovascular response. The most frequently used modality for treatment of PG is surgical treatment. The proposed case represents an unexpected evolution to a possible therapeutic measure. Case Description: We represent a case of a 32-year-old male, known to have T-cell acute lymphoblastic leukemia treated successfully with chemotherapy, currently maintained on methotrexate (MTX) 40 mg and 6-mercaptopurine, 100 mg, presented with 1-month history of painful rapidly growing ulcerated nodules on his right-hand palm and middle finger. Both skin lesions developed approximately 3 months following patient initiation of maintenance treatment. Physical examination revealed two crusted nodules. A proximal lesion was observed over the palmar aspect between the second and third fingers, with the other one occurring alongside the distal phalanx of the third finger, measuring 2.5 cm × 1.5 cm, and 2.5 cm × 3.5 cm respectively. Skin biopsy was obtained from both lesions. The results of the histologic examination both revealed inflamed PG. Tissue cultures of both specimens tested positive for Pseudomonas aeruginosa growth while no fungal and tuberculosis were cultured. Ciprofloxacin 500 mg twice daily, a 2-week course was started. Both lesions completely resolved at 10th-day of antibiotic course with no recurrence. Conclusions: This is a case of a patient with lobular capillary hemangioma of the hand treated successfully with no recurrence using an oral antibiotic. The proposed case represents an unexpected evolution to a possible therapeutic measure. The unexpected role of a conservative measure rather than the conventional surgical method in treating vascular tumors has been highlighted. Moreover, the contribution to an excellent cosmetic outcome has also been demonstrated.

Which one is the most accurate naming convention: cutaneous lipofibroma or pedunculated lipofibroma?

This is a case of a large pedunculated lipofibroma on the left axilla in a 36-year-old woman. The lesion was excised completely with no recurrence after one year of follow-up. A new name for this rare entity is proposed to be more inclusive of all lesions of pedunculated lipofibroma and to differentiate it from another entity called fibrolipoma.

Rare Association Between Lichen Planus and Vogt-Koyanagi-Harada Syndrome: A Case Report.

Vogt-Koyanagi-Harada syndrome (VKHS) is a rare inflammatory autoimmune condition that affects tissues with high melanocyte concentrations such as the skin, inner ears, eyes, and central nervous system. VKHS has previously been reported to be associated with various autoimmune diseases, but we have observed the first known co-occurrence of VKHS and lichen planus (LP). In this report, we examine the similarities between these two diseases and discuss how they relate to each other.

Humanistic and Economic Burden of Atopic Dermatitis for Adults and Adolescents in the Middle East and Africa Region.

INTRODUCTION: Atopic dermatitis (AD) is a chronic skin disease that poses a significant burden on both patients and the society. AD causes the highest loss in disability-adjusted life years compared with other skin diseases. This study aimed to estimate the economic and humanistic burden of AD in adults and adolescents in seven countries in the Middle East and Africa region (Egypt, Lebanon, Saudi Arabia, Kuwait, Algeria, South Africa, and United Arab Emirates). METHODS: We conducted a literature review to identify country-specific data on this disease. Subsequently, meetings were organized with experts from each country to complete the missing data. The data were aggregated and calculation models were created to estimate the value of the humanistic and economic burden of the disease in each country. Finally, we conducted meetings with local experts to validate the results, and the necessary adjustments were made. RESULTS: On average, a patient with AD loses 0.19 quality-adjusted life years (QALYs) annually owing to this disease. The average annual healthcare cost per patient is highest in the United Arab Emirates, with an estimated value of US $3569 and a population-level indirect cost of US $112.5 million. The included countries allocated a range of 0.20-0.77% of their healthcare expenditure to AD-related healthcare services and technologies. The indirect cost of AD represents approximately 67% of the total disease cost and, on average, approximately 0.043% (range 0.022-0.059%) of the gross domestic product (GDP) of each country. CONCLUSION: Although the humanistic and economic burdens differ from country to country, AD carries a significant socioeconomic burden in all countries. The quality of life is severely affected by the disease. If AD is controlled, the costs, especially indirect costs, could decrease and the disease burden could be alleviated significantly.

Atopic dermatitis is a chronic condition characterized by inflamed and itchy skin. The prevalence and symptoms of atopic dermatitis are observed to increase in dry weather. Owing to its high prevalence in children, the majority of studies on atopic dermatitis are in children. Although it is also prevalent in adults and adolescents, its burden on adults has not been sufficiently studied, especially in Africa and the Middle East. This study quantified the burden of atopic dermatitis in adults and adolescents in seven countries in the Middle East and Africa. We estimated the economic and humanistic burden of this disease. We conducted a literature review and expert interviews to determine the effects on patients and caregivers. We created mathematical models to calculate the disease burden in each country, and local experts in each country validated the data. The study results showed that atopic dermatitis significantly affects the quality of life of patients. The direct medical costs of treatment in each country were calculated. The management of atopic dermatitis consumes around 0.20­0.77% of the healthcare expenditure in a country. The indirect cost of atopic dermatitis represents 0.022­0.059% of the gross domestic product (GDP) of a country. The country-specific burden data are essential to guide decision-makers in arriving at evidence-based decisions and efficiently allocating available resources. This study focused on the significant indirect economic burden of the disease, which can sometimes be underestimated because the disease is not fatal.

The humanistic and economic burden of atopic dermatitis among adults and adolescents in Saudi Arabia.

Aims: Atopic dermatitis (AD) is a chronic skin disease that creates a significant burden to patients and society. There is scarcity in local data about the burden of AD in the Kingdom of Saudi Arabia (KSA). We aimed to fill in this gap and quantify the humanistic and economic burden of AD among adults and adolescents in KSA.Materials and methods: A literature search and local expert interviews were conducted to assess the disease burden. Prevalence values were estimated through the literature. International data about health-related quality of life lost owing to AD was adjusted to age and prevalence in KSA. Direct and indirect costs were calculated using a bottom-up approach. Resource utilization data were collected from local dermatologists through online interviews, and indirect costs were based on absenteeism and presenteeism estimates. Validation meetings were conducted with local experts to adjust the final estimates.Results: The age-standardized health loss per patient due to AD is 0.187 quality-adjusted life-years (QALYs) annually, aggregating to 64 thousand lost QALYs in KSA. The annual average direct cost for a patient with AD was 2924 Saudi Riyal (SAR; 780 USD), totaling 373 million SAR in KSA (99.5 million USD). This value represents 0.2% of the annual health expenditure in KSA. The total productivity loss due to AD was 1.36 billion SAR (363.7 million USD). Overall, the economic burden of AD consumes up to 0.059% of the national gross domestic product.Limitations: Local quality of life and productivity lost data were not available for KSA, so global averages were used, assuming these numbers also apply to KSA.Conclusion: Indirect costs represent a large proportion of AD burden in KSA. The disease has a substantial effect on patient quality of life and social well-being. Alleviating the burden might result in significant savings in resources to society.

Atopic dermatitis is one of the most common skin diseases. Mild cases of the disease cause inflamed and itchy skin, while severe cases may cause painful episodes of itching and cracked skin. Patients with atopic dermatitis and their families suffer lower quality of life as the severity of the disease increases. In countries with hot weather like Saudi Arabia, skin is more susceptible to become dry, so the disease is very prevalent. Therefore, the disease poses a significant quality of life burden as well as an economic burden due to the direct costs of treatment and the indirect costs that arise because patients become non-productive or absent from work or school. Our study aimed to quantify the economic and quality of life burden of atopic dermatitis in Saudi Arabia to understand it's real burden and help decision makers quantify its impact on the patients and society. We conducted a literature search and interviewed local experts to determine estimates of costs and quality of life effects. The results of this study should help in prioritizing treatment disease areas in Saudi Arabia and other countries with similar circumstances.

Management of Atopic Dermatitis in Adults in Saudi Arabia: Consensus Recommendations from the Dermatological Expert Group.

Background: Atopic dermatitis (AD) is a long-term, pruritic, recurrent, systemic, inflammatory skin disorder. In the Middle East region, the burden of AD is understudied, and there is a dearth of AD guideline documents for practitioners. Methods: An expert panel meeting, encompassing 12 dermatologists from the Kingdom of Saudi Arabia (KSA), was congregated to develop evidence- and experience-based consensus recommendations for AD management, especially in adults in KSA. They completed a questionnaire with seven clinical statements, and a consensus was defined when the responses of ≥75% of participants coincided. Results: The expert recommendations were as follows: American Association of Dermatology guidelines are to be followed for defining AD; Eczema Area and Severity Index or SCORing atopic dermatitis index may be used to quantify the disease severity; Dermatology Life Quality Index may be used to determine the impact of AD on patients' quality of life; Atopic Dermatitis Control Tool may be used to assess long-term disease control in AD patients; and the European guidelines are to be followed for the management of AD. In AD patients who are inadequately controlled with topical or systemic therapies, the preferred systemic agent for use either alone or in combination with topical treatments is dupilumab, cyclosporine, methotrexate, phototherapy, or other available systemic treatments that may include mycophenolate mofetil or oral corticosteroids. Conclusion: These expert recommendations assist physicians by providing a reference framework for optimal care of adult AD patients.

Efficacy and Safety of Q-switched Double-frequency 532-nm Neodymium-doped Yttrium Aluminum Garnet Laser in the Treatment of Lip Hyperpigmentation: A Pilot Study.

BACKGROUND: Lip hyperpigmentation is a common cosmetic problem with multiple causative factors and limited treatment options. OBJECTIVE: This study sought to assess the efficacy and safety of Q-switched (QS) double-frequency 532-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser therapy for dark lips. METHODS: A prospective pilot study of 24 patients with lip hyperpigmenation treated with a QS double-frequency 532-nm Nd:YAG laser was performed. Photographs taken before and three months after the laser therapy sessions were evaluated for improvement and/or any complication by two blinded dermatologists using the color score chart and a visual analog scale (VAS). Patients were asked to assess their pain and satisfaction scores following the procedure using a VAS. RESULTS: The mean VAS scores of the photographs decreased by 10.18 percent, from a baseline of 6.09±1.53 to 5.47±1.72 (p=0.16). Also, the color score decreased by 9.38 percent, from 2.44±0.61 to 2.23±0.71 points (p=0.23) after the last treatment. Overall, the photographic assessment indicated that, of the 24 participants, 14 (58.3%) showed moderate to excellent improvement, four (16.7%) showed mild or no improvement, and six (25.0%) showed worsening/mottling of the pigmentation. The overall mean pain and satisfaction scores were 4.08±1.14 and 6.50±2.92, respectively. CONCLUSION: QS Nd:YAG 532-nm laser therapy appears to be a safe and moderately effective treatment for hyperpigmentation of the lips. Further studies should evaluate a larger number of patients and undertake a longer period of follow-up.

Association between isotretinoin (Roaccutanne) use and changes in periodontal clinical parameters and MMP-8 and MMP-9 salivary levels.

Aims: to evaluate changes in clinical periodontal parameters, salivary levels of MMP-8 and MMP-9, in individuals taking Isotretinoin (INN), and compare with individuals not taking the medication and to compare findings among different stages of periodontal disease and healthy periodontium. Material and methods: A case-control study was conducted with a total of 180 human adults divided into six groups. Clinical parameters, including pocket depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were measured at six sites per tooth. Whole unstimulated saliva samples were collected from all subjects to detect salivary level of MMP-8, MMP-9 using Enzyme-linked immunosorbent assay (ELISA). Data were analyzed using IBM SPSS Software. Kruskal Wallis test and Mann-Whitney U-tests were used to test any significant differences in any of the groups on all parameters. Pearson Chi-square test was used to compare the distribution of categorical responses across the study groups. All tests were compared at a significance level of 0.05. Results: In Gingivitis cases, INN group was found to have significantly less BOP (P < 0.0001). In Periodontitis cases, INN group showed significant difference in BOP (P < 0.0001). MMP-8 and MMP-9 were significantly lower among Periodontitis cases taking INN compared to the same group not taking the medication (P < 0.0001). Conclusion: INN assists in reducing clinical and biological signs of inflammation related to periodontal disease progression. INN may be a future additive medication to be further evaluated for treating periodontal disease.

Results of Laboratory Monitoring in Patients Taking Isotretinoin for Acne.

Isotretinoin is one of the most effective drugs for the treatment of all forms of acne vulgaris. It has been suspected of causing alterations in lipids and liver enzymes. The aim of this retrospective study was to determine the prevalence of laboratory changes among 371 patients with acne receiving isotretinoin therapy. Each patient's medical records were evaluated to determine baseline alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol, and triglycerides (TGs) compared to levels recorded at 2 later readings following initiation of treatment with oral isotretinoin. Results indicated that isotretinoin can be administered with minimal concern regarding changes in serum transaminase and lipid profiles. Nevertheless, physicians should be cautious when administering isotretinoin in patients with a history of abnormal findings.

The Sterility of Partially Used Hyaluronic Acid Fillers After Long Storage.

BACKGROUND: Hyaluronic acid (HA) gel fillers represent most soft tissue augmentation procedures currently used, because they have lower rates of complications compared with other materials. Many patients do not consume an entire syringe of filler but may require a retouch or intermittent augmentation after some time. The remaining material is commonly stored in a specific environment for reuse by the same patient. OBJECTIVE: There are an insufficient number of recommendations concerning the safety of storing and reusing dermal fillers in the literature because of the paucity of studies. The aim of this study was to investigate the potential infectious contamination associated with the storage of HA fillers after patient treatment. METHODS: Hyaluronic acid from previously used syringes was stored at room temperature under sterile conditions for varying durations beginning from 2009. Later, the material was submitted for panculture, including gram-positive and gram-negative bacteria, mycobacteria, and fungi. RESULTS: No fungal or mycobacterial agents were cultured from any of the samples. There were a few positive bacterial cultures, but they were predominantly contaminated with normal skin surface flora. CONCLUSION: Although it is commonly practiced, the storage of HA fillers after initial patient injection carries a real but small risk of contamination.

The Effect of Waxing Versus Shaving on the Efficacy of Laser Hair Removal.

BACKGROUND: Excessive hair is undesirable and represents both a social and emotional burden, especially among females. Laser hair removal (LHR) has gained popularity in the past 2 decades. It is a common practice to instruct patients not to pluck or wax their hair before undergoing LHR; only shaving is allowed to improve the efficacy of the LHR. OBJECTIVE: To compare the percentage of hair reduction in preshaved versus prewax epilated axillae after LHR in healthy adult Saudi females. METHODS AND MATERIALS: This study is a quantitative experimental pilot clinical trial. Twenty female volunteers were enrolled into this study; all underwent 3 laser sessions using a long-pulsed alexandrite laser. Their left axilla was prewaxed and right axilla was preshaved immediately before laser treatment. Hair was counted manually before and 6 months after the third laser session. RESULTS: The right and left axillae both showed significant hair reduction, between the first session and the hair count 6 months after the third laser session. However, there was no statistically significant difference between these 2 means (p = .44). CONCLUSION: There is no statistical difference in hair reduction after LHR whether the area is preshaved or prewax epilated.

Cutaneous wound closure materials: an overview and update.

INTRODUCTION: On a daily basis, dermasurgeons are faced with different kinds of wounds that have to be closed. With a plethora of skin closure materials currently available, choosing a solution that combines excellent and rapid cosmetic results with practicality and cost-effectiveness can be difficult, if not tricky. OBJECTIVES: We aimed to review the available skin closure materials over the past 20 years and the scientific claims behind their effectiveness in repairing various kinds of wounds. MATERIALS AND METHODS: The two authors independently searched and scrutinised the literature. The search was performed electronically using Pub Med, the Cochrane Database, Google Scholar and Ovid as search engines to find articles concerning skin closure materials written since 1990. CONCLUSION: Many factors are involved in the choice of skin closure material, including the type and place of the wound, available materials, physician expertise and preferences, and patient age and health. Evidence-based main uses of different skin closure materials are provided to help surgeons choose the appropriate material for different wounds.

The Dermatology workforce in Saudi Arabia: Current trends, challenges and future directions.

OBJECTIVES: To provide a snapshot of the dermatology work force in Saudi Arabia. METHODS: We collected data on the supply and distribution of dermatologists in Saudi Arabia. We discussed the current status of dermatology manpower issues in Saudi Arabia. RESULTS: We found that between 1987 and 2007, the availability of dermatologists to population in Saudi Arabia rose by 60 %, from 2.35 to 3.76 dermatologists per 100,000 Saudi Arabian individuals. However, the current workforce is already out of balance in several ways. We have an excess of non-Saudi citizen dermatologists and a barely adequate supply of Saudi dermatologists. The dermatologist population is unbalanced with regard to gender and uneven in terms of geographic distribution. CONCLUSIONS: The dermatology workforce does not match well with the nation's health care goals. We should create a more successful and stable match between the talent supply and health care system requirements.

Dermatologic treatment during pregnancy: practical overview.

BACKGROUND: This article provides a practical overview of dermatologic medication use in pregnancy. OBJECTIVE: The therapeutics of the following common dermatoses are reviewed: acne, psoriasis, and bacterial, fungal, viral, and parasitic infections. Antipruritic, analgesic, and topical anesthetic use in pregnancy is reviewed as well. CONCLUSIONS: At the end, the reader is challenged with a series of applied clinical scenarios that highlight the presented material and provide information on additional important medications.