Introduction: Acne vulgaris is one of the most common inflammatory disorders worldwide and mainly affects young people. The frequency of acne and how it is treated in Saudi Arabia is not well characterized. Purpose: The aim of the study was to determine the prevalence of acne vulgaris among the Saudi population in Riyadh, Saudi Arabia. Methods: This was a cross-sectional survey study that was carried out in Riyadh, Saudi Arabia, in the period from March to July 2019. The questionnaire was filled by a convenience sample of 346 Saudi participants aged 15–30 years. The survey questions were related to acne prevalence, associated factors, treatment practices, and depression. Results: Seventy-eight percent of the participants reported having acne. Females were more commonly affected (86.1%) than males (69.9%, P < 0.001). Only 31.5% of the individuals who had acne consulted a dermatologist in the past 12 months. The most frequently prescribed medication was isotretinoin (19.2%), and 71.4% were happy with the results of using it compared to only 38.2% who used topical antibiotics (P= 0.012). Males reported a less depression (21.5%) compared to females (46.3%, P < 0.001). Conclusions: Acne vulgaris has a high prevalence in Saudi Arabia, but only one-third are getting treated by health-care providers. Efforts should be made to increase awareness about acne vulgaris and its treatment.

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Introduction: Caffeine is a naturally occurring methylxanthine alkaloid, with numerous molecular properties that make its application to the field of dermatology promising. Purpose: This review aims to describe the dermatological implications and applications of caffeine. Methods: PubMed was searched for literature related to caffeine use in dermatology using the search terms “caffeine and dermatology.” Results: Caffeine may stimulate the hair growth in androgenetic alopecia and may prevent the risks of incident rosacea and both nonmelanoma and melanoma skin cancers. Numerous limitations exist for caffeine's application in dermatology, including few well-designed, clinically based trials in the treatment of hair loss, blurring of caffeine's potential therapeutic effects through combination with other active ingredients, potential for recall bias in prospective questionnaire-based studies, and lack of reporting on absolute effects in data analysis. Conclusion: Caffeine's numerous effects at the cellular level have potential application in the treatment of disorders related to the skin and hair. Caffeine may be beneficial in the treatment of hair loss and prevention of rosacea and skin cancer, but numerous limitations restrict the practical application of these findings.

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Shiitake mushroom (SM)-induced flagellate dermatitis follows the ingestion of undercooked SMs. Pathogenesis is thought to be a delayed-type hypersensitivity reaction to lentinan, a heat-sensitive polysaccharide found in SM. Eruption is self-resolving and lasts from 2 days to 6 weeks. It presents as pruritic, linear, whiplash-like, erythematous plaques on the trunk. Flagellate eruption differential diagnoses include bleomycin-induced dermatitis, dermatomyositis, and adult-onset Still's disease.

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Lichen planopilaris (LPP) is an uncommon scalp disorder of unknown etiology and prevalence. It may be an autoimmune process triggered by unknown genetic and/or environmental factors that attack hair follicles of the scalp. LPP can present in association with various autoimmune diseases and immunomodulatory therapies. We present an atypical case of LPP occurring during the treatment of breast cancer with paclitaxel, after complete resolution of alopecia areata and anagen effluvium. Shortly after initiation of the paclitaxel therapy, the patient experienced a pruritic acneiform facial eruption and hair loss that was localized to her frontal scalp with complete loss of eyebrows and significant loss of her eyelashes. The lesions were biopsied revealing LPP. LPP should be considered among other causes of alopecia in patients treated with paclitaxel.

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Cold-induced sweating is a rare condition, which is reported in the literature as part of Crisponi syndrome in which patients have many neurological and skeletal abnormalities. We report a case of isolated nonsyndromic cold-induced sweating in a 24-year-old Saudi male. The patient was treated with many treatments, including clonidine 0.1 mg, amitriptyline, and fluoxetine, but these were discontinued due to side effects. The patient was treated with onabotulinum toxin A with partial satisfactory result. Treatment options for cold-induced sweating are limited, and in this case, inadequate.

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Introduction: The Psoriasis Disability Index (PDI) is a pre-validated, self-administered questionnaire assessing quality of life in adults suffering from psoriasis. The English version contains 15 items measuring five components – activities, work/school performance, personal, leisure, and treatment. Purpose: We aimed to translate the PDI into Bengali and examine its psychometric properties. Methods: The PDI-Bengali version (PDI-B) was produced by standardized forward-backward translations. A cross-sectional study was conducted to gather responses by consecutive sampling. Reliability was tested using internal consistency and test-retest reliability analyses, concurrent validity by comparing with Psoriasis Area and Severity Index (PASI) and Dermatological Life Quality Index scores, while construct validity by exploratory factor analysis (n= 83) using principal component analysis (varimax rotation). Subsequently, confirmatory factor analysis (CFA; n = 85) was performed to verify the a priori scales by the goodness of fit model. Results: The internal consistency (Cronbach's alpha) and the intra-class correlation coefficients were 0.877 and 0.882, respectively. Acceptable values of internal consistency, test-retest reliability, and concurrent validity were found. All the items loaded above the pre-specified value of 0.4. Factor analyses using Varimax identified three components (social activities, concern, and personal activities) explaining 56.8% of the variation. The Kaiser-Meyer-Olkin was 0.836 and Bartlett's test of sphericity was P < 0.001. The goodness of fit of CFA model was excellent. Conclusion: The PDI-B, consisting of 15 items and framed within three components, is a valid and reliable questionnaire, but measured different dimensions from the English version.

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Introduction: Acne vulgaris (AV) is one of the most common dermatological disorders. However, data of AV in Saudi Arabia are not well documented. Purpose: To determine the prevalence, potential risk factors, psychological impact, and treatment modality of AV in the Kingdom of Saudi Arabia and highlights the gaps of knowledge related to this disease. Methods: The literature search was performed using the keywords “acne vulgaris,” “Saudi Arabia,” and “KSA” in four electronic databases: PubMed, Google Scholar, Web of Science, and Embase. The search was restricted by the locational filter of Saudi Arabia and a timeframe of 2010–2019. Results: 453 potentially relevant titles and abstracts being identified, of which 18 articles met the inclusion criteria. AV is becoming more prevalent among the Saudi population, particularly among Saudi women. The knowledge and awareness of the public is relatively low. Conclusion: Community-based interventions on acne are needed to increase the awareness and to improve the perception and belief of acne patients. Further studies are needed to evaluate the effects and side effects of different complementary medicine and over-the-counter modalities.

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Subcision using a Nokor needle is commonly performed to treat acne scars. We describe a new method to maintain proper needle orientation during subcision.

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Dissecting cellulitis (DC) of the scalp is a chronic, clinically refractory inflammatory skin disorder. Herein is a presentation of a male with refractory DC with concurrent hidradenitis suppurativa, who had failed treatment with multiple topical and systemic therapies. After receiving guselkumab, 100 mg subcutaneously every 8 weeks, the patient exhibited marked improvement, with normalization of symptoms and signs.

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Palisaded neutrophilic granulomatous dermatitis (PNGD) is a rare inflammatory dermatosis. We report a 45-year-old female with a 2-year history of asymptomatic persistent skin lesions. The patient had rheumatoid arthritis well controlled with abatacept, methotrexate, and hydroxychloroquine. Multiple nonscaly umbilicated papules with crusted center were scattered on her abdomen, chest wall, and back. Biopsy showed pandermal infiltrate of neutrophils and areas of basophilic degenerated collagen surrounded by palisades of histiocytes, neutrophils deep in the dermis, and subcutaneous fat. A diagnosis of PNGD was made. The patient was treated with betamethasone dipropionate (0.05%) ointment and oral colchicine with good improvement.

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Introduction: Despite its growing use, the side effects of isotretinoin therapy are not fully understood. Studies have suggested that isotretinoin can cause thyroid dysfunction, suggesting the need to investigate thyroid dysfunction as a possible side effect of oral isotretinoin therapy. Purpose: The main objective of the study is to investigate the association between isotretinoin therapy and thyroid dysfunction. Methods: In all, 51 patients (male, 21; female, 30; aged 18–25 years) with moderate-to-severe acne vulgaris were treated with 0.5 mg/kg/day oral isotretinoin (cumulative dose: 120–150 mg/kg). Serum-free thyroxine (T4), thyroid-stimulating hormone (TSH), and thyroglobulin (TGA) and thyroid peroxidase (TPO) antibody levels were measured. Results: TSH levels at baseline and at the 2^nd, 4^th, 6^th, and 8^th months of treatment were 2.3307 ± 1.097, 2.5824 ± 1.34, 2.678 ± 1.133, 2.3 ± 1.17, and 2.7 ± 2.17 IU·mL, respectively, with no significant change from baseline (P = 0.526, P = 0.552, P = 0.530, and P = 0.910 at 2, 4, 6, and 8 months, respectively). Serum levels of free T4, TGA, and TPO antibodies were unchanged. Conclusions: Follow-up screening for thyroid dysfunction may not be necessary for patients receiving oral isotretinoin.

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Introduction: The uses of general anesthesia in outpatient invasive procedures have increased, especially in dermatology. Being uncooperative, children often require general anesthesia since surgical skin operations are mostly painful. Purpose: The aim of this study is to evaluate the safety, significant adverse events, and the complication rates related to general anesthesia when used among pediatric population underwent skin procedures. Methods: A retrospective cohort study of a patient chart review from the period (September 1, 2017, to September 2019). All patients admitted for pediatric skin procedures during this period have participated in our study. We reviewed selected charts to document any unexpected admissions, adverse events, or complications. Surgical outcomes and anesthesia complications were reviewed by three anesthesiologists. We assessed inter-rater reliability. Results: A total of 211 procedures were reported for 211 patients with 19 diagnoses. No adverse events related to anesthesia were recognized, apart from minor complications noticed in 12 patients. Kappa value ranges between 0.78 and 1.00 (95% confidence interval, 0.46809–1.00). Conclusion: Dermatologists and pediatricians can safely do necessary procedures under general anesthesia with the supervision of pediatric-trained anesthesiologists while considering other safety and risk precautions and pediatric age group.

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Introduction: Laser hair removal (LHR) is a common procedure in dermatology. LHR using quality-switched (QS) 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) is very popular in our community despite lack of sufficient evidence on its efficacy and safety. Purpose: We report the characteristics of nine patients who developed hypopigmented macules after being treated with QS 1064 nm laser for hair removal. Methods: This was a retrospective study at a laser center in Saudi Arabia conducted between June 2014 and September 2018. Patients who developed white macules following treatment with QS 1064 nm Nd:YAG laser for removal of unwanted hair were included in the study. Results: All patients were Saudi females with a mean age of 28.8 years (range: 25–37 years). Well-defined hypopigmented to depigmented 1–3 mm macules developed after being treated with QS 1064 nm Nd:YAG laser for hair removal. The most commonly affected area was the face. Majority of patients had skin phototype IV. Hypopigmented macules developed after an average of 22 laser sessions (range: 4–48 sessions). None of the patients had either personal or family history of vitiligo. Lesions seem to be difficult to treat, with only two patients responding to topical tacrolimus and excimer laser. Conclusion: Hypopigmented macules might develop after QS 1064 nm LHR. Those macules appear to be resistant to treatment. Further prospective controlled studies needed to elaborate more on the safety profile of this procedure.

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Introduction: Rothmund-Thomson syndrome (RTS) is a rare genodermatosis which manifests a wide array of symptoms affecting skin and skin appendages. The first two cases were reported in 1957. Purpose: To present a comprehensive clinical and molecular perspective of RTS. Methods: A clinical review of the reported cases. Results: A variety of nonspecific symptoms make it difficult to reach an early diagnosis and to provide an appropriate counseling. Conclusion: This review highlight the major clinical variations to help reach a prompt diagnosis and take appropriate preventative measures.

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