Tinea Incognito.

Tinea incognito (TI), or incognita, are superficial fungal dermatophyte infections that are changed in shape, most frequently because of topical, systemic steroids use and other immunosuppressants. There are different clinical presentations depending on host factors and the species of dermatophyte causing the disorder. Diagnosis can be challenging and might need combined methods. Once diagnosed the treatment is the usual antifungals, either topical or systemic or combined depending on the site, extent, and host factors.

Serum Inflammatory and Oxidative Stress Markers in Patients with Vitiligo.

BACKGROUND: Vitiligo is a common chronic hypomelanotic skin disorder. An intricate pool of markers associated with a complex combination of biological and environmental factors is thought to be implicated in etiology. This study aims to investigate the most important markers associated with vitiligo pathogenesis, including redox status, inflammation, and immune profile, in patients with vitiligo. MATERIALS AND METHODS: The study included a total of 96 subjects: 30 patients with active non-segmental vitiligo, 30 patients with stable non-segmental vitiligo, and 36 controls. The vitiligo area severity index (VASI) and vitiligo disease activity score (VIDA) were determined. The following serum parameters were assessed: antioxidant status (TAS), superoxide dismutase activity (SOD), catalase activity (CAT), glutathione peroxidase activity (GPx), glutathione-S-transferase activity (GST), malondialdehyde (MDA), advanced oxidation protein products (AOPP), C reactive protein (CRP), interleukin-15 (IL-15), and chemokines (CXCL9, CXCL10). RESULTS: The VASI score was not significantly different between active and stable vitiligo patients, as it was approximately 0.1. TAS, CAT, GPx, and GST were significantly lower in vitiligo patients compared to controls (p < 0.05). They were also significantly lower in active vitiligo when compared to stable vitiligo (p < 0.05). However, SOD levels were significantly higher in vitiligo patients than in controls and in the active vitiligo group than in the stable vitiligo group (p < 0.05). MDA and AOPP levels were significantly higher in patients with active and stable vitiligo compared to controls (p < 0.05). However, they did not significantly differ between active and stable vitiligo patients (p < 0.05). In both active and stable vitiligo, CRP and IL-15 were significantly higher than controls (p < 0.05). Whereas CRP was significantly higher in active (range = 2.0-7.2, mean = 4.46 ± 1.09) than in stable vitiligo (range = 1.6-6.7, mean = 3.75 ± 1.08) (p < 0.05). There was no significant difference in IL-15 levels between active and stable vitiligo. In both active and stable vitiligo, CXCL9 and CXCL10 were significantly higher than controls (p < 0.05), and they were significantly higher in active than stable vitiligo (p < 0.05). CONCLUSIONS: In vitiligo, oxidative damage induces an increase in pro-inflammatory IL-15, which in turn promotes IFN-γ-inducible chemokines such as CXCL9 and CXCL10. Further, there seems to be a link between the VASI score and IL-15 levels. These data imply that inhibiting IL-15 could be a promising method for developing a potentially targeted treatment that suppresses the early interplay between oxidant stress and IL-15 keratinocyte production, as well as between resident and recirculating memory T cells.

A transcriptomic signature of X chromosome overdosage in Saudi Klinefelter syndrome induced pluripotent stem cells.

Objective: The transcriptional landscape of Klinefelter syndromeduring early embryogenesis remains elusive. This study aimed to evaluate the impact of X chromosome overdosage in 47,XXY males induced pluripotent stem cells (iPSCs) obtained from patients with different genomic backgrounds and ethnicities. Design and method: We derived and characterized 15 iPSC lines from four Saudi 47,XXY KS patients and one Saudi 46,XY male. We performed a comparative transcriptional analysis using the Saudi KS-iPSCs and a cohort of European and North American KS-iPSCs. Results: We identified a panel of X-linked and autosomal genes commonly dysregulated in Saudi and European/North American KS-iPSCs vs 46,XY controls. Our findings demonstrate that seven PAR1 and nine non-PAR escape genes are consistently dysregulated and mostly display comparable transcriptional levels in both groups. Finally, we focused on genes commonly dysregulated in both iPSC cohorts and identified several gene-ontology categories highly relevant to KS physiopathology, including aberrant cardiac muscle contractility, skeletal muscle defects, abnormal synaptic transmission, and behavioral alterations. Conclusions: Our results indicate that a transcriptomic signature of X chromosome overdosage in KS is potentially attributable to a subset of X-linked genes sensitive to sex chromosome dosage and escaping X inactivation, regardless of the geographical area of origin, ethnicity, and genetic makeup.

Patients' Awareness of the Ocular Side Effects of Isotretinoin Therapy: A Study From Saudi Arabia.

Introduction Isotretinoin is one of the most commonly prescribed drugs among dermatologists because it's used in the treatment of Acne vulgaris. Despite having an adequate safety profile, isotretinoin-related adverse events are common, with ocular manifestations being one of them. Although being generally mild, ophthalmologic manifestations associated with isotretinoin may cause significant ocular morbidity. Objectives The objective is to evaluate the awareness of the ocular side effects of isotretinoin treatment in patients with acne and to understand the treating physicians' practice of prescribing isotretinoin from the patient's point of view. Method A descriptive cross-sectional study was conducted on a Saudi Arabian population from June to September 2021. We used a self-administered questionnaire to collect data on drug dose, treatment duration, ocular adverse effects, patients' awareness, and patients' perception of treating physicians' practice. Results Of 1,157 responders, 452 (39.1%) consisted of participants who met the inclusion criteria, therefore they were enrolled in the study. Out of our responders, 308 (68.1%) were women. Approximately, 91.6% of participants had a dermatologist's prescription for isotretinoin. Eye dryness was the most commonly reported ocular adverse effect (83.4%). Blepharitis and conjunctivitis were the most commonly diagnosed complications after starting isotretinoin (5.4% for each). Approximately, 71.2% participants were not advised to see an ophthalmologist for ophthalmological screening. Physicians asked only 78 (17.3%) respondents about a recent refractive surgery before starting isotretinoin or if they intended to undergo a refractive surgery in the next six months. Approximately, 57.5% participants were unaware of possible contact lens intolerance. Lubricant eye drops were prescribed to 305 (67.5%) respondents during isotretinoin treatment. Approximately, 36.7% participants were advised to consult their treating physicians if they had any serious ocular signs or symptoms. Approximately, 67.9% participants reported their awareness of the ocular side effects of isotretinoin therapy. However, 236 (52.2%) participants responded that they were not provided with sufficient information on the ocular side effects of isotretinoin therapy.

The Evaluation of the Informational Content, Readability, and Quality of Online Information Related to Vitiligo in the Arabic Language.

Background Vitiligo is a common skin condition worldwide. It is an autoimmune disorder characterized by losing functional melanocytes, leading to chronic patchy depigmentation. People use the internet to seek health information, which is becoming one of the most commonly utilized sources. In this study, we aim to evaluate online information seen by patients about vitiligo by assessing the quality, content, and readability of widely used medical websites. Methodology All searches were conducted on February 16, 2022. The most popular search engines, Google, Yahoo, and Bing, were used to find websites, using vitiligo written in Arabic as a search term. An online readability calculator tool was used for the readability assessment of all websites. Two board-certified dermatology consultants (AK and LA) formulated a scoring sheet containing 19 questions based on commonly asked questions by patients in the dermatology clinics; 10 out of the 19 questions were designed to cover general information about vitiligo. In contrast, the other nine questions were designed to accommodate the management aspect of vitiligo. For the accountability assessment of each website, Journal of American Medical Association (JAMA) benchmarks were used. Statistical analysis has been performed using Statistical Package for the Social Sciences (SPSS) version 25 (IBM SPSS Statistics, Armonk, NY, USA). Main measures The following measures were used: a 19-question sheet, JAMA benchmarks, the Coleman-Liau index, and the Automated Readability Index (ARI). Results In this study, we analyzed 21 websites. The interobserver reproducibility was 0.946 between AK and LA (P < 0.001). For all websites, the mean (standard deviation (SD)) score of the questionnaire was 11.71 (3.45) (95% confidence interval (CI): 10.14-13.29) out of 19 possible points. Regarding all four JAMA benchmarks, no website achieved all benchmarks. Three of 21 websites (14.29%) completed three out of four JAMA benchmarks. No correlation was found between the content quality of the websites and JAMA benchmarks (r = 0.270, P = 0.237). Conclusion Online information about vitiligo in Arabic varies depending on the source, but overall, it is of low quality and written beyond the level of the general population. The "top 10 websites" outlined in our article may be used as a suggested reading list for vitiligo patients.

Severity of Acne Vulgaris: Comparison of Two Assessment Methods.

PURPOSE: Numerous tools are available to assess acne severity. It is important to have an acceptable and easy to use tool for acne assessment for many reasons, such as initial assessment and follow-ups, clinical trials, and comparisons of clinical studies. The aim was to investigate the agreement between different observers (inter-observer variation) in the evaluation using the Global Acne Grading System (GAGS) and Investigator Global Assessment of Acne (IGA). Besides, to investigate the correlation between the assessment scores and its relation to the quality of life scales Dermatology Life Quality Index (DLQI) and the Cardiff Acne Disability Index (CADI). PATIENTS AND METHODS: This was a prospective study. Four investigators involved to evaluate the study subject surveyed 54 patients complaining of acne using IGA and GAGS scores (DLQI and CADI). RESULTS: A significant relation was seen between GAGS and IGA (Pearson chi-square test p= 0.001), and they demonstrated excellent inter-rater reliability. There was no correlation between IGA and quality of life measures (CADI nor DLQI). However, there was a significant weak correlation between GAGS and CADI. CONCLUSION: The two methods for acne severity assessment are reliable, and they are correlated. Quality of life concerning acne is not correlated with the severity of the disease.

Exome Analysis Identifies a Novel Compound Heterozygous Alteration in TGM1 Gene Leading to Lamellar Ichthyosis in a Child From Saudi Arabia: Case Presentation.

Background: Lamellar ichthyosis is an autosomal recessive type of rare skin disorders characterized with defective epidermis leading hyperkeratosis with brownish-gray scales over the body. These patients are born as collodion babies and may also exhibit additional features like erythema, ectropion, and eclabium. This disease is mainly caused by homozygous and compound heterozygous alterations in transglutaminase 1 encoding gene (TGM1), which is located on 14q12. Case presentation: This study reports the genetic analysis of a 4-year Saudi girl presenting lamellar ichthyosis. She was the first child of unrelated parents. The family had no previous history of the disease phenotype. She was born as a collodion baby without any prenatal complications. At the time of this study she had developed rough scaly skin on her legs, arms and trunk regions with thick palms and soles. Whole exome sequencing (WES) followed by Sanger sequence validation identified a novel compound heterozygous variant in TGM1 gene. The paternal variant was a missense transition (c.1141G>A; p.Ala381Thr) present at exon 7, while maternal variant (c.758-1G>C) was present at the intron4-exon5 boundary. To the best of our knowledge these variants had not been reported before in TGM1 gene. Conclusion: In isolated and inbred populations, homozygous variants are identified more frequently; however, our results suggest that compound heterozygous variants should also be considered especially when the marriages are not consanguineous.

Vitiligo Appearing after Oral Isotretinoin Therapy for Acne.

Isotretinoin is an effective treatment for severe and scarring acne. In this report, we describe a case developing vitiligo after isotretinoin therapy for scarring acne. It is not known whether this was a coincidence or might be precipitated by the treatment.

Evaluation of acne quality of life and clinical severity in acne female adults.

Acne is a common disease especially among teenagers. It has a considerable psychological impact on affected individuals. The aim of this paper was to assess if the effect of acne on acne-related quality of life is correlated to acne clinical severity. 112 university female students attending the university medical clinics with acne complaints were examined. Cardiff Acne Disability Index (CADI) was used to assess acne-related quality of life, and global acne grading system (GAGS) was used to assess clinical severity of acne. There was no correlation between acne severity (GAGS scoring system) and quality of life impairment as assessed by CADI score (r = 0.145, P = .127). Additionally, CADI score did not correlate with disease duration or age of patients. We therefore conclude that acne clinical severity alone does not affect acne-related quality of life changes. Many other factors might play a role.