An Unusual Presentation of Erythema Multiforme Following the Administration of Pfizer-BioNTech COVID-19 mRNA Vaccine in a Pediatric Patient.

Coronavirus disease 2019 (COVID-19) caused a global calamity that forced emergency use authorization to Pfizer-BioNTech COVID-19 (BNT162b2) vaccine. It is efficacious in preventing symptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in seronegative recipients. The safety profile is still unclear; however, commonly reported symptoms post-vaccination are fatigue, headache, muscle pain, chills, and injection-site pain. COVID-19 disease elicits, to some extent, cutaneous side effects like urticaria, morbilliform rash, and chilblain-like eruption. Vaccination against COVID-19 was reported to induce similar dermatologic manifestations, such as urticarial rash, delayed large-local reaction, local injection-site reaction, and morbilliform eruption. Erythema multiforme (EM) is a rare manifestation post-vaccination, and only a few reports implicate it as a culprit in cutaneous eruptions following the BNT162b2 vaccine. This report delineates the presentation of a healthy 14-year-old girl to a dermatology clinic who developed EM post-vaccination with the first dose of BNT162b2. New-onset EM-eruption post-vaccination with BNT162b2 had been reported previously in 14 cases, and one case reported on the flare of preexisting-EM.

The Psychological Impact of Isotretinoin Therapy on Acne Vulgaris Patients.

Introduction Acne vulgaris is a dermatologic condition that affects the pilosebaceous unit. It is the most common skin disorder worldwide, and it is most prevalent during puberty. For patients with moderate to severe acne that is unresponsive to antibiotic treatment, the main treatment is oral isotretinoin. The objective of this study was to define the impact of isotretinoin and its well-established adverse effects on the psychological status of acne patients during treatment.  Methods The sample cohort included 80 patients with acne vulgaris who were treated with isotretinoin. The sample size was calculated using the Raosoft [Raosoft.com (2015) Sample Size Calculator by Raosoft, Inc.] sample size calculator to maintain a confidence interval of 95% and a margin of error of 5%. The participants were assessed using the Depression and Anxiety Stress Scale-21 (DASS-21). The DASS-21 is a self-reporting scale used to measure the emotional states of depression, anxiety, and stress. This study was a cross-sectional survey conducted at the dermatology outpatient clinic at King Abdulaziz Medical City, Jeddah, Saudi Arabia. All patients diagnosed with acne vulgaris between January and April 2020 were included in the study. A multivariate regression analysis was also conducted to determine the presence of any significant independent factors associated with depression, anxiety, and stress. A P-value of ≤0.05 was considered statistically significant. Results We observed that the most prevalent psychiatric disorder among acne patients on isotretinoin therapy was anxiety. Our results also indicate that a history of mental illness is an independent risk factor for developing depression when isotretinoin is used. In addition, known adverse physical effects of isotretinoin treatment, including muscle pain, arthralgia, and headaches significantly increase the likelihood of patients developing psychiatric morbidity during therapy.  Conclusion Isotretinoin is a highly potent therapy for acne. Overall, the physical side effects profile is well acknowledged, yet the exact psychological impact the treatment predisposes the patients to is yet to be determined.

Physicians' Attitude and Perception Towards Social Media Medical Consultation.

AIM: Social media plays a major role in modern healthcare. However, little is known about physicians' experience as related to medical consultation through social media, such as Twitter. This study aims to characterize physicians' attitudes and perceptions toward medical consultations through social media and estimate the use of social media for medical consultation purposes. MATERIALS AND METHODS: The study was conducted through the distribution of electronic questionnaires to physicians from different specialities. A total of 242 healthcare providers responded to the questionnaire. RESULTS: Our results demonstrated that 79% of the healthcare providers received consultations through social media at least "sometimes" and that 56% of them agreed that it is appropriate to have personal social media platforms that can be accessible by patients. They also agreed (87%) that it is appropriate to interact with patients on social media; however, most of them do not find social media platforms appropriate for diagnosis or treatment. CONCLUSION: Physicians think positively of social media consults, but do not consider it a proper method to manage medical conditions.

The Impact of Social Media on Seeking Dermatological Care.

INTRODUCTION: Social media is used by more than half of the world's population. Social media is becoming more widely recognized as a significant factor when looking for healthcare services because of its capacity to affect an individual's decision. Therefore, we aim to investigate the influence of social media and the use of filters on seeking cosmetic dermatological procedures among the general population of Jeddah, Saudi Arabia. METHODS: This cross-sectional study utilized an online form for data collection. The questionnaire was developed by the authors after an extensive literature review. The data collection took place in October 2022 in Jeddah, Saudi Arabia. Participants were recruited using convenience and snowball sampling methods. RESULTS: A total of 1,031 responses were analyzed, with females representing the majority (85.2%, n = 878). About half (47.4%, n = 489) indicated a willingness to undergo an aesthetic procedure, 16.3% (n = 168) had already done one procedure at least, and 53.2% (n = 548) had a specific procedure to do in the future. Healthcare professionals were the most common source of information (53.9; n = 556), followed by social media (22.7%; n = 234). In the Snapchat application, 94.5% (n = 974) of the participants used face filters. Undergoing an aesthetic procedure showed statistically significant associations with age, gender, educational level, employment, and income. CONCLUSION: Hiding skin lesions or acne was the most frequently reported reason for using photo editing apps or filters. While healthcare providers were the most frequently reported source of information, Snapchat influenced around 33% of the study's participants to undergo an aesthetic procedure.

Ablative fractional carbon dioxide laser combined with autologous platelet-rich plasma in the treatment of atrophic acne scars: A systematic review and meta-analysis.

Atrophic acne scars are the most common cutaneous seqaule of acne vulgaris, representing 80%-90% of all acne scars. Ablative fractional carbon dioxide (FCO2 ) laser is the gold standard treatment for atrophic scars. Additionally, platelet-rich plasma (PRP) is suggested to accelerate the healing process and collagen synthesis. The aim of the present systematic review and meta-analysis was to determine the efficacy and safety of PRP combined with Ablative FCO2 laser in the treatment of moderate to severe atrophic acne scars. Randomized controlled trials (RCTs) that have compared PRP in combination with ablative FCO2 laser to ablative FCO2 laser alone with respect to the efficacy and safety measures were included. We have systematically explored Embase, Medline, and CENTRAL databases via Ovid. The outcomes that our systematic review sought to evaluate were clinical improvement, patient satisfaction, and Goodman and Baron's qualitative acne scar score. The dichotomous outcomes were presented as odds ratio (OR) while the continuous outcomes were presented as standardized mean difference (SMD). Eleven RCTs that represents 313 participants were included. The combined use of laser and PRP showed a statistically significant clinical improvement and patient satisfaction compared to the use of laser alone (OR = 2.56, 95% CI 1.37-4.78 and OR = 3.38, 95% CI 1.80-6.34, respectively). Also, a significant improvement in Goodman and Baron's score was achieved by combining PRP with laser (SMD = -0.40, 95% CI -0.65 to -0.14). The combined treatment of laser and PRP was highly synergistic, effective, and safe in treating moderate to severe atrophic acne scars.

The Association Between Facial Dermatosis and Face-Mask Wearing During COVID-19 in Saudi Arabia.

BACKGROUND: During the coronavirus pandemic of 2019, there has been an upsurge in the number of reported cases of facial dermatosis caused by face masks wearing within the general population. Face mask-induced facial dermatosis has been investigated previously in healthcare workers without involving the general population. However, as a precautionary measure against the coronavirus disease 2019 (COVID-19) pandemic, wearing a face mask has become mandatory for the general population, similar to healthcare workers.  Objective: To measure the prevalence of COVID-19 pandemic-induced facial dermatosis. Also, to determine the type of face mask used that causes the most facial dermatosis and the association between prolonged usage of face masks and facial dermatosis in Western Saudi Arabia's population. METHODS: The study covers the Western region of Saudi Arabia. A self-administered Google survey was shared on social media. The study used prior surveys from similar studies. The data collection included participants' demographic information, pre-existing skin conditions, mask type, and mask-related skin conditions. The data were analyzed using the statistical package for the social sciences (SPSS) version 20.0 (IBM Corp., Armonk, NY). RESULTS: The median age was 30 years (interquartile range {IQR} 23-43). Females represented 65.5% of our sample. Face mask-wearing was associated with skin changes in 41.7% of the population. The most common skin condition associated with mask use was pimples and pustules representing 28.7%, of which the most common site was on the cheeks 31.4%. Acne vulgaris was the most common pre-existing skin condition, affecting 8.7% of the total population. Of the total, 46.2% experienced an exacerbation of their pre-existing skin condition with or after wearing masks. Skin changes were significantly associated with skin type and duration of wearing the mask (P<0.001). CONCLUSION: The prevalence of facial mask-induced facial dermatosis is 41.7% of the general population in which surgical mask was responsible for most cases. In addition, there is a strong association between the duration of wearing the mask and facial dermatosis.

The efficacy and safety of lebrikizumab monotherapy for the management of moderate-to-severe atopic dermatitis: A systematic review and meta-analysis.

Background: Atopic dermatitis (AD) is a chronically relapsing disease. Few biologics are approved for moderate-to-severe AD, and novel interventions are emerging. We aimed to evaluate the safety and efficacy of lebrikizumab, an IL-13 immunomodulator, as monotherapy vs. placebo in treating moderate-to-severe AD. Methods: Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, and ClinicalTrials.gov registry (CT.gov) databases were systematically searched. We evaluated lebrikizumab vs. placebo and measured efficacy using Eczema Area and Severity Index (EASI), Body Surface Area (BSA), and Investigator's Global Assessment (IGA) change from baseline to week 16. Safety was evaluated by the incidence of serious adverse events (SAEs), non-serious adverse events (NSAEs), and mortality. The risk of bias was investigated using the Revised Cochrane risk of bias tool. Results: Three RCTs (n = 1,149) included 543 (47.25%) men vs. 606 (52.75%) women. Meta-analysis showed statistically significant improvement in EASI, IGA, and BSA. EASI75 at week 16 for all regimens was (RR = 2.62, 95% CI [2.06, 3.34], p < 0.00001) with the first regimen (500 mg loading dose then 200 mg every 2 weeks) showing the most significant improvement (RR = 3.02, 95% CI [2.39, 3.82], p < 0.00001). The pooled analysis of safety outcomes concluded that lebrikizumab did not correlate significantly with the incidence of SAEs, NSAEs, and mortality. Conclusion: Overall, lebrikizumab showed a significant improvement in all efficacy outcomes. Additionally, it did not contribute to any significant incidence of SAEs, NSAEs, or mortality. The risk of bias in included RCTs was minor except in the randomization domain. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment of the outcomes ranged from low to high, but predominantly high certainty of evidence. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022362438.

The Association of the Prolonged Use of Personal Protective Equipment and Face Mask During COVID-19 Pandemic With Various Dermatologic Disease Manifestations: A Systematic Review.

COVID-19 is a novel coronavirus that represents a great global health concern. It is transmitted between individuals through respiratory particles, and as there is no established effective treatment currently for the virus, it is necessary to use protective strategies such as face masks. Healthcare providers and individuals serving outdoors are required to work for long durations wearing personal protective equipment (PPE). Wearing such protective equipment may have short- or long-term effects on the skin health of these individuals. We aim to assess the prevalence and types of dermatological manifestations associated with wearing PPE for a long time during the COVID-19 pandemic period by reviewing the previous studies conducted on this subject. The medical literature, including the databases of PubMed and Google Scholar, from 2019 to 2021 was explored. The search terms included a combination of "Impact of PPE and dermatological outcome," "Wearing PPE for a long time and dermatological manifestations," "Face mask-wearing and dermatological complications," and "Wearing PPE and dermatological manifestations." The inclusion criteria are original full-text articles that reported the association of wearing PPE and dermatological manifestations and outcomes. A total of 70 articles were obtained, among which only 10 articles were eligible for the inclusion criteria. These 10 studies included a total number of 7,643 participants and covered different countries of the world. The extracted data were summarized in a table to facilitate the collection of the important findings. Dermatological complications are frequently reported in people wearing PPE and face masks, especially the ones caused due to PPE among healthcare providers as they tend to use these protective measures for longer durations.

A review on laser and light-based therapies for alopecia areata.

Alopecia areata is a form of non-scarring alopecia that results from a hyperactive immune response of T cells against hair follicles. Many patients with visible hair loss experience psychological and emotional distress, as a result of their cosmetic disfigurement, and frequently seek treatment. However, existing treatment methods, such as corticosteroids, topical irritants, sensitizing agents, immunosuppressants, and psoralen plus ultraviolet light A, may result in various adverse effects and often lack efficacy. Laser and light treatments offer a safe and effective alternative. This review aims to provide clinicians with a comprehensive summary of laser and light-based modalities used for the treatment of alopecia areata. Currently, the excimer laser is the most widely studied device and has shown positive results thus far. However, the development of future randomized controlled clinical trials will help determine the appropriate treatment protocols necessary, in order to achieve superior clinical outcomes.

Origin of the Zika virus revealed: a historical journey across the world.

BACKGROUND: Zika virus (ZIKV) is an arbovirus within the Flaviviridae family, the recent spread of which has promoted public concern. METHODS: This study outlines the clinical features, potential for teratogenicity, diagnosis, and treatment of ZIKV infection. RESULTS: Zika virus is transmitted through the bite of an infected Stegomyia (= Aedes) mosquito, blood transfusion, sexual intercourse, and perinatal routes. Infection has been characterized as mildly symptomatic. Symptoms include mild fever, headache, arthralgia, myalgia, non-purulent conjunctivitis, and a pruritic maculopapular rash. It is rarely life-threatening, but both Guillain-Barré syndrome and fetal microcephaly have been reported. ZIKV belongs to the same family as bovine viral diarrhea virus, which causes hydrocephalus and microcephaly in newborn calves, and hepatitis C virus, which can be vertically transmitted in human pregnancies, and hence there remains concern for potential similarities. Diagnostic methods include polymerase chain reaction performed in blood samples during infection, and in urine and saliva. Pregnant women undergo antibody testing for immunoglobulin M. Treatment involves supportive care, and acetaminophen and antihistamines to control symptoms. CONCLUSIONS: Although there was no evidence of the circulation of ZIKV in the Western hemisphere prior to 2014, the global spread of Stegomyia aegypti and increases in urban populations and international travel have fostered its evolution. Adherence to current guidelines for the prevention of ZIKV transmission is especially relevant in regions experiencing ongoing outbreaks. Concern for microcephaly in newborns warrants further investigation into the potential long-term effects of ZIKV infection, especially in relation to reproductive health and mother-fetus transmission.

5-Fluorouracil in the Treatment of Keloids and Hypertrophic Scars: A Comprehensive Review of the Literature.

Hypertrophic (HTSs) and keloid scars are common dermatological complaints produced by disruption of the normal wound-healing process. Despite a wide array of therapeutic options available to treat these lesions, HTSs and keloids continue to pose a significant challenge to clinicians in everyday practice. The chemotherapeutic drug 5-fluorouracil (5-FU) is a well-known treatment option reserved for recalcitrant HTSs and keloid lesions. We present clinicians with a comprehensive review of the published data concerning the use of 5-FU in the treatment of HTSs and keloids. The current evidence suggests that 5-FU is a safe and practical alternative for the treatment of HTSs and keloids as it may substantially improve the appearance of proliferative scars and reduce the chance of recurrence. This therapeutic option is most effective in conjunction with adjuvant therapy such as corticosteroids. Additional randomized controlled clinical trials with large sample sizes should be conducted to corroborate the existing efficacy and safety data in patients with HTSs and keloids.

Laser and Light Treatments for Striae Distensae: A Comprehensive Review of the Literature.

Striae distensae (SD) are common dermatologic lesions that often arise as a result of rapid weight change, certain endocrine conditions, or prolonged exposure to steroids. SD initially present as raised edematous plaques (striae rubra), after which they become white and atrophic (striae alba) owing to local breakdown and reorganization of collagen and elastin. There currently exists no reliable treatment option, though numerous topical applications have been attempted. Lasers and light represent emerging noninvasive therapies that have demonstrated some success targeting vascular chromophores in striae rubra and stimulating collagen and elastin production in striae alba. An extensive literature review was performed to gather all available articles studying laser and light treatments for SD. Lasers and light can significantly improve the appearance of both striae rubra and striae alba. Generally, striae rubra are more responsive to therapy and can be treated successfully with a variety of lasers without major adverse effects. Fractional lasers exhibit the strongest results for striae alba repigmentation and collagen induction, and several other lasers produce temporary repigmentation. Lasers in combination with other modalities such as topical agents and additional energy devices have also demonstrated promising preliminary results; however, large comparative studies are necessary to validate these outcomes.

Efficacy of intralesional immunotherapy for the treatment of warts: A review of the literature.

Warts are common epidermal growths caused by human papillomavirus that often cause significant discomfort and embarrassment. Current treatment options include topical therapies, cryotherapy, laser vaporization, and surgical excision. Many of these options are destructive and may result in scarring, while less aggressive approaches can lead to lesion recurrence. Additionally, these local modalities are not practical for patients with a large number of warts. Systemic approaches such as immunotherapy have demonstrated success in treating multiple lesions by combining a targeted approach with upregulation of the host immune system. An extensive literature review was performed to evaluate the various vaccine antigens that have been used intralesionally to treat cutaneous and anogenital warts. The specific intralesional immunotherapies that have been studied include: Candida albicans; measles, mumps, and rubella; Trichophyton; and tuberculin antigens such as purified protein derivative, Mycobacterium w vaccine, and Bacillus Calmette-Guerin. Intralesional vaccine injection represents a safe, effective, and tolerable treatment for warts, including recalcitrant and anogenital warts. This approach has been somewhat overlooked in the past despite substantial evidence of high response rates with a low side effect profile. Large comparative trials are necessary to determine the most effective immunotherapy treatment option as well as the most appropriate dosing parameters.