Bullous striae distensae in a nephrotic syndrome patient: First case report from the Middle East of a rare presentation and review of the literature.

Striae distensae is a common cutaneous phenomenon that begins as reddish linear atrophic plaques (striae rubra) that over time progress to silvery-white coloration (stria alba). Striae distensae in rare occasions becomes edematous, ulcerative, emphysematous, or urticated. Bullous striae distensae is a sequela of conditions causing interstitial edema along with systemic glucocorticoids use. To our knowledge, only eight cases of bullous striae distensae have been reported in the literature. Herein, we report a 17-year-old female, known case of nephrotic syndrome, presented to our clinic with abdominal fluid-fill cutaneous lesions only for 5 days. She had used systemic glucocorticoids for more than a decade before she was labeled as steroid resistant nephrotic syndrome. Cushingoid body habitus were observed during physical examination, in addition to translucent bullae overlying her previously known stretch marks. Punch biopsy of the lesions revealed dermal edema with thinned collagen bundles. Based on these clinicopathological findings, a diagnosis of bullous striae distensae was made. Awareness of this rare complication and unusual clinical presentation is fundamental to avoid unnecessary and excessive interventions whether investigatory or therapeutic in order to provide appropriate management of the underlying condition.

Association Between Diet and Seborrheic Dermatitis: A Case-Control Study.

Introduction Seborrheic dermatitis (SD) is a chronic, inflammatory papulosquamous skin disease. The symptoms and signs of SD are typically managed by topical ketoconazole and topical corticosteroids. However, they don't provide a cure for SD, which explains the disease's chronic nature. With this study, we aimed to identify specific dietary modifications that can be implemented as an adjunctive to traditional treatment of SD. Methods A case-control retrospective study. Data was obtained from medical records of patients diagnosed with SD. Patients were invited to participate in an online self-reported questionnaire, and dietary intake was assessed using a validated food frequency questionnaire. The controls were collected by distributing the same questionnaire to healthy adult residents living in Jeddah via social media. Results Two hundred sixty-seven participants were included in the study, 59 of whom were SD patients. Participants who reported consuming the following food types once daily had a higher percentage of SD compared to those without SD: a slice of white bread (p=0.002), a cup of rice or pasta (p<0.001), non-acidic fruits (p=0.014), leafy green vegetables (p=0.007), other types of vegetables (p=0.001), roasted or fried nuts (p=0.047), raw nuts (p=0.022) and a cup of coffee (p=0.041). When asked about their impression of what food types triggered or relieved their disease, 29 (49.2%) of the diseased participants reported no flare-ups with any kind of food. On the other hand, the following food types were commonly reported to be associated with SD exacerbation: spicy food (16.9%), sweets (16.9%), fried food (13.5%), dairy products (11.9%), and citrus fruits (10.2%). In contrast, citrus fruits, leafy green vegetables (8.5% for each), and the other types of vegetables (6.8%) were frequently observed with SD improvement. Conclusion Several dietary factors have been associated with SD in our cohort. Thus, our findings could offer new insights into the application of adjuvant dietary measures that might play a role in the improvement of SD symptoms and potentially enhance therapeutic outcomes.

The Extent of Misconceptions, Negative Prejudices, and Discriminatory Behaviors Toward Psoriasis Patients: A Cross-Sectional Survey Study Among the Population of Jeddah, Saudi Arabia.

Background Psoriasis is a chronic inflammatory disease that affects around 2% of the population. The lives of psoriasis patients are greatly impacted by stigma and social exclusion, regardless of the severity of the condition. This is the first study of its kind to be conducted in Saudi Arabia. This study aimed to assess peoples' psoriasis-related misconceptions, negative prejudice, and discriminatory behaviors. Methodology A self-administered Google Forms survey was distributed between January and February 2023. The survey was conducted among residents of Jeddah, Saudi Arabia who were enrolled randomly via social media. We aimed to investigate their perception and awareness related to psoriasis, as well as how varying educational levels, age groups, and genders affected these variables. Results In total, 803 individuals participated in the survey. Results showed that 19.9% of the participants did not know about psoriasis. Only 5.1% of respondents stated that they were well knowledgeable about psoriasis. Moreover, psoriasis was more frequently perceived as a communicable disease by people in the age group of 18-29 years (p = 0.000). Surprisingly, only 43.5% of the participants reported that they would shake hands with someone with psoriasis without hesitation. Additionally, 40.7% of the participants were aware that psoriasis requires lifelong treatment. Moreover, the belief that psoriasis does not require lifelong therapy was more prevalent among university graduates (p = 0.000). Conclusions This study found that the residents of Jeddah need further education on skin disorders, in general, and psoriasis, in particular. Future studies should be conducted utilizing various approaches, with a greater emphasis on certain groups of people who engage physically with psoriasis patients.

Assessing the Ability of Non-dermatology Physicians to Recognize Urgent Skin Diseases.

Introduction Many patients present to the emergency department with skin conditions that are not true dermatologic emergencies. Urgent skin conditions are uncommon. Because these conditions are rare, they can be sometimes challenging to diagnose. Few works of literature discussed the accuracy of non-dermatologists' initial judgment on dermatologic conditions concluding that non-dermatologists misdiagnose many common and uncommon skin conditions. Because the study was never done in our region, we aim to conduct an online assessment using a questionnaire assessing the ability of non-dermatologists to recognize urgent skin diseases at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. Methods A cross-sectional study was conducted. Non-dermatologist physicians were contacted through their verified emails, provided by the secretaries of each department and the academic affairs unit. The questionnaire consisted of two main sections, the first section covered demographics, specialty, and academic level. The second part had eight questions, each containing a brief case scenario about an urgent dermatological condition with a picture of the condition attached. Participants were required to answer the questions and assess on a scale from one to 10 how confident they were about their answers. The responses were collected and analyzed. Results Out of all 161 responses, this study included 93 male physicians (57.8%) and 68 female physicians (42.2%). The mean age in the study was approximately 45 ± 3 years. This study showed that the percentage of accuracy by non-dermatologists in diagnosing urgent skin diseases given the typical presentation of the condition was (61.33%); nevertheless, the percentage decreased when it was recalculated in relation to the full level of confidence to (25.3%). Herpes zoster appeared to be the most recognizable urgent skin disease, and Pemphigus vulgaris was the least recognizable one. Conclusion This study shows that it is difficult for physicians to recognize some urgent skin diseases, which affects offering the optimum health care for the patients. Moreover, more dermatology-focused courses are needed to strengthen the knowledge about dermatological diseases.

The Influence of Social Media on the Treatment of Acne in Saudi Arabia.

Objectives The purpose of this study was to examine the effects of social media on acne treatment among the Saudi Arabian population. Methods This was a cross-sectional survey-based study conducted from January 2021 to August 2021. A self-administered survey was distributed through social media to different regions of Saudi Arabia. The survey obtained participants' sociodemographic information and details on whether people used social media for advice on acne treatment. It also asked whether they noticed any change in their acne based on social media recommendations. Results Of the 5,539 respondents, 4,227 experienced acne, of which 1,793 were influenced by social media. Most respondents were women. The majority of social media users were between 18 and 25 years old and chose social media as their first approach for acne advice. The most commonly used platform was Instagram (34%). The most frequent social media recommendation chosen was to increase water intake. Many noticed a slight change in their acne (64%), and 14.9% had side effects. There was a significant association between the use of social media for advice and gender (p-value < 0.001), education level (p-value = 0.002), and severity of acne (p-value < 0.001). Conclusion Social media has an influence on acne treatment, with many advice not recommended by established guidelines. These findings imply that dermatologists should pinpoint inaccuracies resulting from advice found on social media.

The Assessment of Dermatology Clinical Research in Saudi Arabia.

OBJECTIVES: To determine the level of evidence in dermatology research over the last five years and to assess the frequency of publication in different journals in the field of dermatology in the kingdom of Saudi Arabia, western region. METHODS: All published research were reviewed during the period of 2015 till 2020 using online research database through PubMed, Embase, and Google Scholar. A list of all Saudi dermatologists who are registered by the Saudi Commission for Health Specialties as consultants, and who worked in public institutions at Jeddah and Makkah was retrieved. The Oxford Level of Evidence Scale was utilized to determine the level of evidence of these studies. Descriptive statistics were used to determine the frequency of different study types and levels of evidence. RESULTS: A total of 125 articles were published in 62 different national and international journals. Majority of the published studies were level IV (76%). Case reports were the most common type of published research (56%) and meta-analysis studies accounted for (6.4%). Thirty-two articles were produced by academic institutions, compared to 68 published articles from governmental institutions, and 22 from military hospitals. CONCLUSION: Only a small percentage of publications in Saudi Arabia are considered high level clinical research. The number of publications during the past five years was high compared to the previous years and case reports constituted the majority. Authors should be encouraged to conduct higher-level studies to enhance patient care.

Females' Knowledge and Use of Isotretinoin (Roaccutane) in the Western Region of Saudi Arabia.

Background Acne vulgaris is one of the most common diseases worldwide. It is a chronic, relapsing inflammatory skin disease. Nearly anyone can be affected at any age. Adolescents and young adults are more susceptible, with a prevalence as high as 35% to 90% and reaching up to 100% in both sexes. Isotretinoin is the most effective medication to be used. It has been reported in the literature that many populations are non-adherents to or aware of safety recommendations. This study aims to assess females' awareness and safety of isotretinoin use in the western region of Saudi Arabia. Methods This is a cross-sectional, descriptive study. A semi-structured questionnaire was used, data was collected from an electronic validated survey and published on a social platform. Statistical analysis was conducted with the aid of Statistical Package for Social Sciences (SPSS) version 21 (IBM Corp., Armonk, NY, USA). Results The total number of included responses was 1066. Most of the participants were 12-22 years old (45.2%), single (72.2%) and had a bachelor's degree (69.6%). Among the total number of participants there were 285 participants who used isotretinoin. Ninety-three percent of them had a prescription of isotretinoin from a physician. The common dose given was approximately 20 mg and the common duration was more than six months. Conclusion There is a good amount of knowledge in our population regarding isotretinoin side effects, although only half of them were informed about them by their treating physicians. We noticed an obvious lack of awareness about safe practice during childbearing age and marriage. This highlights the need for optimal education by health care providers and the role of media is obvious to improve their practices and hopefully decrease the risks as it was the second most common source of information after dermatologists in our population. Also we recommend paying more attention to the psychological side effect which was reported by 9% of our participants.

Histopathological Coexistence of Extragenital Lichen Sclerosus and Morphea in a Single Lesion.

Lichen sclerosus (LS) and morphea are two infrequent inflammatory dermatoses of unknown etiology. LS is characterized by, polygonal, bluish-white, slightly elevated papules that coalesce into plaques, which become increasingly atrophic overtime.it mostly affects genitals, however, it can affect any site on the skin and mucosa. Morphea characterized by, erythematous to violaceous patches or plaque with a white, sclerotic center, and the outer edge of the lesions take on the characteristic violaceous ring. The overlapping clinical and histopathologic features of both LS and morphea in the same patient have led some to speculate that they may have a common pathologic link or that both conditions represent the same disease spectrum. The coexistence of LS and morphea in the same lesion is a rare finding. We present a patient, who was diagnosed with what appeared clinically to be extragenital LS, but with histopathologic features of both LS and morphea.

Dermatologists' Adherence to the Latest Recommendations for Screening of Hydroxychloroquine Retinopathy in Saudi Arabia: Cross-Sectional Study.

BACKGROUND: Hydroxychloroquine (HCQ) has been used to manage many inflammatory skin conditions. Nevertheless, retinopathy continues to be its most significant adverse effect. The American Academy of Ophthalmology (AAO) recommends baseline ophthalmologic screening in the first year of HCQ treatment. However, a recent study found an inadequate awareness of the recommendations. Furthermore, limited data are available regarding the implementation of the recommendations among dermatologists. OBJECTIVE: The aim of this study was to assess dermatologists' adherence to recommendations pertaining to their current practice regarding HCQ toxicity detection. METHODS: A self-administrated questionnaire was distributed between February 2 and May 4, 2018, among members of the Saudi Society of Dermatology. The questionnaire comprised demographic-related questions and questions pertaining to each physician's routine practice about the follow-up of HCQ-treated patients. RESULTS: A total of 76 dermatologists completed the questionnaire. We achieved a response rate of 62.54%. More than half (43/76, 56%) of the dermatologists were male. Furthermore, more than half (41/76, 53%) of them reported treating 1 to 3 patients with HCQ during the last year. Furthermore, two-thirds (47/76, 61%) of them reported screening patients before initiating HCQ treatment. Regarding follow-up recommendations, 59% (45/76) of dermatologists reported yearly after starting treatment for no-risk patients, whereas 94% (72/76) reported "yearly within 5 years of treatment" for at-risk patients. Data were considered significant at P<.05. All analyses were performed using SPSS, version 20 (IBM). CONCLUSIONS: Dermatologists in Saudi Arabia are not well informed about some aspects of the latest recommendations regarding screening for HCQ toxicity in terms of tests, follow-up timing, cessation of the drug, and causative agents. Therefore, we recommend conducting more studies in Saudi Arabia to determine the adherence of more physicians to the AAO recommendations. Furthermore, patient education regarding HCQ toxicity and increased patient awareness are recommended for effective and safe HCQ use.

Skin metastasis from squamous cell carcinoma of the cervix to the lower extremities: Case report and review of the literature.

Squamous cell carcinoma of cervix commonly metastasizes to the lymph nodes of the pelvis and skin metastasis is a rare presentation even in the late stages of cervical cancer. We report here the first case of cervical cancer with skin metastasis in Saudi Arabia in a 69-year-old female that preceded the diagnosis of cervical carcinoma. Microscopic examination of the skin lesion revealed poorly differentiated squamous cell carcinoma. The patient was in stage IVB based on the International Federation of Gynecology and Obstetrics (FIGO) staging system. Due to her late presentation and advanced stage, the decision was to place the patient on palliative therapy. Later, the patient passed away due to the progression of her disease. The case reported in this paper emphasizes the need for a complete clinical assessment to rule out metastatic disease from cases with known cervical cancer and include skin examination in their follow-up.

A Case Series of Pseudoxanthoma Elasticum-like Disorders.

Pseudoxanthoma elasticum (PXE)-like papillary dermal elastolysis and focal dermal elastosis are acquired noninflammatory elastic tissue disorders. The skin lesions clinically resemble PXE without systemic involvement. We report the clinicopathological features of five cases and discuss the pathogenesis and differential diagnosis. Increased awareness of this newly described entity will broaden the differential diagnosis for dermatologists when encountering a similar case scenario.