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   Table of Contents - Current issue
July-December 2022
Volume 26 | Issue 2
Page Nos. 61-102

Online since Friday, December 30, 2022

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Allergens in corticosteroid vehicles in Saudi Arabia p. 61
Mana Alharbi, Seba Almutairi, Maisa Alfalah
Background: Both the active steroid compounds and vehicle ingredients of the topical corticosteroid products can cause allergic contact dermatitis. Purpose: The objective of the current study was to assess the presence of allergens in topical corticosteroid vehicles used in Saudi Arabia. Methods: Package inserts of topical corticosteroid products available through February 2022 were reviewed independently by two dermatologists. Topical corticosteroids were excluded if they were not approved by the Saudi Food and Drug Authority. Results: Out of 79 products examined, 49 (62%) were included in the study. Out of the 49 products, 29 (59%) had one or more allergens (a total of 38 allergens). Three topical corticosteroids were responsible for more than 80% of all allergens. These included mometasone furoate (n = 12), clobetasol propionate (n = 7), and betamethasone valerate (n = 5). The most frequent allergens were propylene glycol (66%), parabens (16%), sorbitan (13%), and lanolin (5%). Formaldehyde(s), methylchloro-isothiazolinone, and methyl-isothiazolinone were not detected in any product. Approximately 48% of the products with allergens were creams, 41% were ointments, and 10% were lotions. With two exceptions, there were no statistically significant differences in the overall presence of allergens by the type, formulation, and concentration of topical corticosteroid products. Conclusion: Almost 60% of topical corticosteroid products widely used in dermatologic clinics in Saudi Arabia had one or more vehicle allergens. Since the best treatment for contact allergy is avoidance, dermatologists should be aware of vehicle allergens in topical corticosteroids and consider the use of allergen-free products.
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Serum Vitamin B12 in chronic telogen effluvium patients: A case–control study p. 67
P Mamatha, K Aparna
Background: Diffuse hair loss is a common complaint in dermatology clinics. Chronic telogen effluvium is a common form of diffuse hair loss. Chronic telogen effluvium is characterized usually by the abrupt onset of diffuse shedding of telogen hairs for more than 6 months. Micronutrients such as Vitamin B 12 are major elements in the normal hair follicle cycle. Vitamin B12 levels in chronic telogen effluvium are not well characterized. Purpose: The aim of this study is to compare Vitamin B12 levels in chronic telogen effluvium patients to controls. Methods: A case–control study was conducted in the department of dermatology of a tertiary care hospital; a total of 70 patients were included, 35 in each group. Results: Twenty-five(71%) chronic telogen effluvium patients were females; 60% had Vitamin B12 deficiency (<250 pg/ml). In controls, fewer (26%) subjects had Vitamin B12 deficiency (P = 0.004). Conclusion: As per our study, Vitamin B12 deficiency was more common in patients with telogen effluvium than in controls.
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Delayed-onset urticaria following vaccination for COVID-19 p. 70
Brandon L Clark, Brad A Yentzer
Background: As COVID-19 vaccines continue to be administered worldwide, there are an increasing number of studies documenting cutaneous reactions following vaccination. Systemic reactions, such as urticarial diseases, occur. Purpose: The main objective of this study was to investigate the association between urticaria and recent vaccination for COVID-19. Methods: A retrospective chart review examining the association of urticaria and COVID vaccination was conducted. Results: We report 17 patients who developed an urticarial reaction following vaccination against COVID and one patient who developed an urticarial reaction following a COVID infection. The vast majority of the patients were women with a mean age of 42.8 years. Conclusion: Cutaneous manifestations often follow COVID vaccination and infection. It may be helpful to inquire about recent infections and vaccinations in patients presenting with urticarial diseases.
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Autologous platelet-rich fibrin membrane as a wound dressing in the treatment of chronic nonhealing leg ulcers: A prospective study p. 73
Amina Asfiya, Sacchidanand Sarvajnamurthy, Fardeen Shariff, Leelavathy Budamakuntala
Background: Chronic nonhealing ulcers of the lower extremity are a cause of morbidity and mortality. The various treatment options available are limited and unsatisfactory. Promoting wound healing with an autologous platelet membrane could be a safe, easy, and inexpensive modality. Purpose: To assess an autologous platelet-rich fibrin (PRF) membrane as a wound dressing in the treatment of chronic nonhealing leg ulcers. Methods: A prospective study enrolled 30 patients with chronic nonhealing leg ulcers. Autologous PRF was applied weekly for 6 weeks. At each visit, the ulcer healing was assessed with wound measurements and photographs. The treatment outcome was defined as a percentage in a change of area and volume of the ulcer at the end of the study period. Results: Thirty patients with chronic nonhealing leg ulcers were treated for 6 weeks. 100% improvement in area of the ulcer was seen in 43% ulcers. The mean percentage of improvement in area of the ulcer was 72%. The mean percentage of improvement in volume of the ulcer was 77%. The mean duration of healing was 5 weeks. Conclusion: This study was limited by the lack of a control group. Autologous PRF may be useful for the treatment of chronic nonhealing leg ulcers which can be done on an outpatient basis with minimum adverse effects.
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Linezolid-induced black hairy tongue: A case report and review of literature p. 77
Moin A Siddiqui, Mohammad Adil, Syed S Amin, Kritika Xess
Black hairy tongue is an asymptomatic and benign condition presenting with black-to-brownish discoloration of the dorsum of the tongue with elongated filiform papillae. Several medications, particularly antibiotics, are implicated in its causation. Xerostomia, abnormal desquamation of the tongue, use of oxidizing mouthwashes, excessive intake of nicotine, coffee, and tea, and immunosuppressive states predispose to the development of this condition. Herein, we describe a case of a young female who developed black hairy tongue within 5 days of linezolid intake. The discoloration disappeared after 7 days of stopping the drug. We also summarize the various reports of black hairy tongue due to linezolid in a tabular form. We aim to highlight the importance of medication history in the identification of this uncommon condition. We also emphasize identifying risk factors for this condition and educating the patients about them.
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Seborrheic keratosis-like changes in epidermal inclusion cyst: An unusual feature in a usual entity p. 80
Seetu Palo, Chitrawati B Gargade
A 58-year-old male presented with an asymptomatic, slowly growing, cystic and mobile swelling on the left leg calf of 6 months duration. Fine-needle aspiration cytology was suggestive of epidermal inclusion cyst. Histopathological examination revealed seborrheic keratosis-like changes in the cyst wall comprising of marked acanthosis, papillomatosis, pseudohorn cysts, squamous eddies, and clumps of keratohyalin granules. This is a very rare variant of epidermal inclusion cyst, possibly induced by infection with human papillomavirus.
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Vaccine-induced pityriasis rosea and pityriasis rosea-like Eruptions: A review of literature and a case report of COVID-19 vaccine-induced pityriasis rosea p. 82
Eman Almukhadeb, Faisal A Alghubaywi, Yousef Alharthi, Amer Alharbi
Pityriasis rosea (PR) is frequently proposed to result from a viral etiology. In line with the current pandemic, COVID-19 vaccines are noticed to trigger PR development. Our patient is a 23-year-old female who developed an itchy skin rash following the Pfizer–BioNTech COVID-19 vaccine. Examination showed one erythematous plaque on the left shoulder and multiple small scaly plaques of similar appearance distributed over the trunk and proximal extremities. The patient was clinically diagnosed, educated, reassured, prescribed topical mometasone ointment and oral chlorpheniramine, and was given a follow-up appointment. We report this case to increase awareness on COVID-19 vaccines as potential triggers of PR.
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Spotted fever rickettsioses should be considered in the differential diagnosis of “Fever with Purpuric Rash” in Saudi Arabia: A Case report p. 86
Ahmed H Nassar, Abdullah S Abu-Aliat, Salim Jamil, Mohammed S Alshahrani, Soha A Hawwam, Esmat R Eid
There is a paucity of literature about human spotted fever rickettsioses (SFR) from the Arab Gulf Region, including Saudi Arabia. Here, we present an elderly Saudi man who had fever, headache, purpuric maculopapular skin rash, and an eschar. Together, the clinical findings, the serologic positivity, the presence of a vector tick in addition to the histopathologic changes, and the dramatic clinical response to oral doxycycline confirmed the diagnosis of SFR. This may be the first case of SFR reported to the health-care authorities in Saudi Arabia. We recommend considering SFR in the differential diagnosis of “fever with purpuric rash” in Saudi Arabia. Ideally, treatment with a tetracycline antibiotic should be considered for patients with fever and headache even before a purpuric rash develops.
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CD1a-positive dendritic cell-enriched pigmented purpuric dermatosis in association with dyslipidemia p. 89
Tiffany Hinojosa, Daniel J Lewis, Madeleine Duvic, Carlos A Torres-Cabala
Indeterminate cells (ICs) are dendritic cells (DCs) that share the histologic features of Langerhans cells and macrophages but lack Birbeck granules. It remains unclear whether IC histiocytosis is a separate disease entity or a reactive process. We report the case of a male with an 8-year history of dyslipidemia who developed extensive pigmented purpuric papules. Laboratory studies revealed peripheral monocytosis (8.2%), and two skin biopsies showed a dermal lichenoid lymphohistiocytic infiltrate composed of CD4+ T cells and CD8+ T cells and CD68+CD163+CD1a+Langerin histiocytes. PD-1/PD-L1+T cells were present in the dermis. Our case may help in understanding the pathogenesis of IC histiocytosis, and we hypothesize that expression of CD1a+ dermal DCs and T-cell dysfunction is a reactive process to dyslipidemia.
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Topical immunotherapy for alopecia areata: A successful diphenylcyclopropenone protocol p. 92
Melika Motamedi, Kush Bapujib, Navdeep Dhaliwal
Alopecia areata (AA) is an autoimmune disorder that involves the destruction of anagenic hair follicles, resulting in non-scarring patchy hair loss. The patient presented in the following case had not seen improvement by use of conventional treatments and was started on topical immunotherapy, diphenylcyclopropenone (DPCP). This agent is commonly left as a last resort due to its constant need for follow-up, clinician-required administration, and risk of adverse effects. The following case presents a titration schedule using DPCP, resulting in minimal adverse effects and dramatic improvement in hair regeneration.
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Saudi adolescent present with new-onset vitiligo post-COVID-19 vaccination: Case report p. 96
Abdullah A Alnaim, Amnah N Al-Mulhim, Mohammed M Al-Momen, Lenah Y Shaikh
Coronavirus disease of 2019 (COVID-19) is a relatively new pandemic; the first reported case was in late 2019, and the first vaccine was given in December 2020. To this date, multiple side effects have been reported with COVID-19 vaccines. Nonetheless, autoimmune (AI) diseases with the COVID-19 vaccine have rarely been associated. We described herein a case of sudden onset of vitiligo occurring after the first dose of the COVID-19 vaccine. To date, there are less than 10 reported cases of vitiligo post-COVID-19 vaccine. This report aims to recognize AI disease presentation with vaccines, specifically COVID-19.
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A 3-year-old girl with old face appearance: Case report p. 99
Hamad A Alfahaad
Hutchinson–Gilford Progeria Syndrome (HGPS) is a genetic disorder. Patients who suffer from this disorder show premature aging and a “plucked-bird” appearance on the face. This case reports a 3-year-old female, who manifested the symptoms of HGPS. The patient has a large head and eyes, receded jaws, a narrow nose, protruded forehead, decreased eyebrows and eyelash hair, stunted growth, and severe wrinkles. A genetic test was conducted to confirm the existence of the disease. The case is reported due to its rarity.
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Retraction: Atypical presentation of bullous herpes zoster and necrotizing fasciitis in immunocompromised patients p. 102

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