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Pigmented fungiform papillae of the tongue in a Saudi woman
Nouf Alzahrani, Ruaa Alharithy
January-June 2018, 22(1):39-40
Pigmented fungiform papillae of the tongue are a benign condition that is characterized by pigmentation involving the fungiform papillae. Our patient is a 25-year-old female who has an asymptomatic pigmentation over the tongue for 13 years. Examination showed pigmentation confined to the fungiform papillae on the dorsum of the tongue. The diagnosis of pigmented fungiform papillae of the tongue was made clinically. The patient was reassured and was given a 3-month follow-up. We are reporting this case to increase the awareness of this diagnosis and to avoid unnecessary workup.
  29,190 829 3
Therapeutic use of caffeine in dermatology: A literature review
Michael J Visconti, Wasim Haidari, Steven R Feldman
January-June 2020, 24(1):18-24
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.
  19,374 1,428 4
Effect of oral isotretinoin therapy on thyroid function in patients with moderate-to-severe acne vulgaris: A prospective study
Fahad AlSaif, Hend AlOtaibi, Amal Balbisi, Ahmad AlAmari, Faisal AlSaif, AlBatool AlAmari, Abdulrhman AlDakhil, Arwa AlModayfer, Nourah AlSyefi
January-June 2020, 24(1):38-40
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 2nd, 4th, 6th, and 8th 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.
  18,762 451 -
Surgical excision of sebaceous nevus in children: What are the risks?
Man Yee Paula Tang, Sih Yin Nicholas Chao
July-December 2019, 23(2):73-75
Background: Sebaceous naevus is a common dermatological condition seen in children. Evidence on the incidence and prevalence of the complication of surgical excision is lacking. Objectives: We aim to review our single center's experience in managing paediatric patients with sebaceous naevus in the past ten years. Methods: We retrospectively reviewed the clinical records of patients with surgical excision of sebaceous naevus performed in our center in the past ten years. Results: 70 surgical excisions of sebaceous naevus were reviewed. 13% were planned staged excision while 5.7% were unplanned revisional excision. 84% of the excision were performed under general anaesthesia and 4.2% were performed under local anaesthetics. Conclusion: A complication rate of 5.7% for unplanned second operation was noted for paediatric patients undergoing sebaceous naevus excision.
  13,399 690 1
Pantoea agglomerans cutaneous infection
Nwanneka Okwundu, Jessica Mercer
January-June 2019, 23(1):41-43
Pantoea agglomerans is a rare Gram-negative bacterium most often implicated in plant diseases and opportunistic organ system infections in immunocompromised humans. Because P. agglomerans uncommonly causes skin infections and presents with nonspecific clinical and histological findings, dermatologic diagnosis may be delayed. Our patient had a unique skin eruption that persisted after multiple treatment regimens and was finally diagnosed as P. agglomerans cutaneous infection. It is important for clinicians to consider this uncommon skin infection in their differential diagnosis of erythematous papules and vesicles with systemic symptoms. Diagnosis is via bacterial culture as histology is usually nonspecific and may not offer a conclusive diagnosis. Risk factors that may be clues to this infection include the occupation of farming, recent hospitalization, immunosuppression, and skin compromise in the form of open wounds.
  12,022 527 4
The adjunctive effect of desloratadine on the combined azithromycin and isotretinoin in the treatment of severe acne: Randomized clinical trial
Samer A Dhaher, Zahraa M Jasim
January-June 2018, 22(1):21-25
Background: Desloratadine, when combined with isotretinoin, had a favorable effect in the treatment of moderate acne; however, its effect in severe nodulocystic acne remained to be elucidated. Aim of the Study: The aim of the study was to evaluate the effect of adding oral desloratadine to the combined azithromycin and isotretinoin regimen for severe acne. Patients and Methods: Patients were randomly classified into two groups: 1st (control) included 38 patients and received alternating isotretinoin and azithromycin orally and 2nd (intervention) group included 38 patients and received same regimen plus desloratadine 5 mg/day. Assessment was made at baseline, 4, 8, and 12 weeks of the trial. Results: In both groups, there was statistically significant reduction in count of inflammatory lesions at 12 weeks compared to baseline (59 ± 19–9 ± 7 for 2nd group and from 57 ± 18 to 21 ± 8 for control) (P < 0.05) and it was significantly higher in 2nd than in 1st control (P < 0.05). Significant reduction in non-inflammatory lesions count (from 18 ± 3 to 8 ± 2 and 18 ± 4 to11 ± 2 for 2nd and 1st group, respectively). At 12th week, 19 (50%) patients in the intervention and 12 (31.6%) of control groups were achieved excellent improvement (>80%). Conclusion: Oral desloratadine had antiacne properties, and when combined with azithromycin plus isotretinoin protocol, it significantly improves severe acne lesions and minimizes the adverse drug reactions.
  11,377 914 2
Follicular occlusion triad
Yugal Kishore Sharma, Shivanti Chauhan, Kirti Deo
July-December 2018, 22(2):90-92
Follicular occlusion triad is a complex comprising three conditions – hidradenitis suppurativa (HS), acne conglobata, and dissecting cellulitis of the scalp – which share the same underlying pathological process of follicular occlusion. Although these constituents are frequently occurring conditions, the triad per se is not commonly reported. We report the case of a 32-year-old male with Hurley Stage II HS, acne conglobata, and dissecting cellulitis of the scalp with mild anemia (hemoglobin: 10.2 g/dL) and raised C-reactive proteins (15 mg/dL). To the best of our knowledge, this appears to be the third case of follicular occlusion triad from India; also probably, only one case has earlier been reported from India with the additional condition of pilonidal cyst, i.e., a follicular occlusion tetrad.
  11,125 731 2
Stem cell therapy and hair loss: Present evidence and future perspectives
Saad Sami AlSogair
July-December 2019, 23(2):61-65
Stem cells may have potential as a treatment for regenerating hair. Initially, methods to obtain stem cells have concentrated on isolating the primary cells from the tissue of interest through biopsy and growing these cells outside the body to be transplanted into the patient. Stem cell treatment of nonautoimmune hair loss like androgenetic alopecia is promising. Although an autologous transplant is viewed as the standard, its use is limited because of a lack of data and the diminished viability of cells that are made available using this method. Adipose-derived stem cells are a promising alternative because of their limited immunogenicity. They are easy to obtain, are multipotent, and can differentiate into different cell lines. They also have significant potential for angiogenesis. More studies are needed to establish the efficacy of the various types of stem cell-based treatments for people with hair loss.
  10,746 1,078 -
Acne vulgaris: Prevalence, predictors, and factors influencing quality of life of female medical students at King Abdulaziz University, Jeddah
Nahla Khamis Ibrahim, Sarah Abdulaziz Nagadi, Haifa Jamal Idrees, Logain Ghazi Alghanemi, Rawan Ishaq Essa, Walaa Sadik Gari
January-June 2019, 23(1):7-12
Context: Acne vulgaris is the most frequent skin condition that reduces patients' quality of life (QOL). Aims: The aim of the study is to determine the prevalence, clinical manifestations, predictors, and factors that influence QOL of female medical students with acne at King Abdulaziz University Hospital (KAUH), Jeddah. Settings and Design: A cross-sectional design was conducted at KAUH, Jeddah. Subjects and Methods: Four-hundred participants were selected through a stratified random sampling technique during the educational year 2016/2017. Data collection included the “Acne-Specific Quality of Life Questionnaire (Acne-QOL)” and “Hospital Anxiety and Depression Scale (HADS).” Clinical examination was conducted by a female clinician, with grading of acne by the global acne grading system. Statistical Analysis Used: Descriptive and inferential statistics were done. Logistic regression analysis was conducted. Results: The prevalence of acne among medical students was 58.8%. Combined type of acne was the most common clinical presentation. Predictors of acne were stress (P < 0.001), menstrual flaring (P < 0.001), and family history of the condition (P < 0.01). Females with severe acne had the lowest score (worse QOL) of all QOL domains compared to others (P < 0.05). Most of QOL domains were lower among students with psychological problems, anxiety, and depression (P < 0.5). Conclusions: Acne is prevalent among female medical students. Stress, menstrual flaring, and family history were the predictors. Acne-QOL was influenced by the severity of acne, psychological problems, anxiety, and depression. Screening of acne, with holistic management approach (by dermatologists and psychologists), is recommended.
  9,976 1,010 5
Comparative study of efficacy of radiofrequency ablation, electrodesiccation, and cryosurgery in the treatment of cutaneous warts
Prashansa Jaiswal, Tapan Kumar Dhali, Paschal D'Souza
January-June 2019, 23(1):24-29
Background: Even though the older and most common treatment for the wart is a destructive method, there is no published randomized control trial comparing the efficacy of radiofrequency ablation, electrodesiccation, and cryosurgery in warts. Objective: The objective of the study is to compare the efficacy and adverse effect of radiofrequency ablation, electrodesiccation, and cryosurgery in the treatment of cutaneous warts. Methods: It was a randomized control trial. Seventy-five patients were randomly divided into three groups of radiofrequency ablation A (Group A), electrodesiccation (Group B), and cryosurgery (Group C) with a sample size of 25 per group by the computer-generated randomized table. Clinical cases of common and plane warts with age >12 years were included in the study. The assessment was based on the reduction of the total surface area of the reference lesion(s), pigmentation, scarring, reappearance of dermatoglyphics, and patient's satisfaction. Results: Complete cure in Group A was 22 (95%), in Group B was 17 (73%), and in Group C was 14 (58%) which was statistically significant (P ≤ 0.001). Majority (>90%) of the patients were very much satisfied with treatment outcome, particularly with radiofrequency which was statistically significant (P = 0.001). Conclusion: Radiofrequency was seen to have the highest cure rate.
  10,000 606 1
Surgical options in hidradenitis suppurativa
Sree S Kolli, Adrian Pona, Abigail Cline, Malcolm Marks, Steven R Feldman, Rita O Pichardo
January-June 2019, 23(1):2-6
Hidradenitis suppurativa is a chronic, debilitating disease managed by both medications and surgical therapies. The purpose of this study is to determine the indications for surgical therapies and compare the various surgical options for the treatment of hidradenitis suppurativa. A PubMed search found 32 articles on surgical therapies for hidradenitis. Search terms included hidradenitis suppurativa, cryoinsufflation, laser therapies, reconstructive surgery, and surgical therapies. About 88.9% of patients with Hurley Stage II/III are referred to surgery. Wide excision is superior to local excision based on consistently lower recurrence rates and high patient satisfaction. Healing by primary closure is inferior to skin graft and flap. Recurrence rate is most dependent on disease severity rather than the type of surgical procedure. Surgical options are offered alongside medical therapies as part of the treatment protocol. Procedures range from minimally invasive to aggressive therapies with variable recurrence rates. Minimally invasive surgeries produce better results in Hurley Stage I/II and aggressive options, such as wide excision, are superior to other options in patients with the more severe disease. Poor surgical candidates include those with comorbidities such type 2 diabetes mellitus which limits the use of more aggressive surgical interventions.
  9,657 624 -
Hair smoothing treatments: Perceptions and wrong practices among females in Saudi Arabia
Bushra Algarni, Shahad Alghamdy, Faten Abdullah Albukhari, Rola Almasri
January-June 2019, 23(1):20-23
Introduction: In the last few years, smoothing hair treatments has taken the Saudi cosmetic industry by storm, all containing various levels of formaldehyde, a classified carcinogen by The World Health Organization (WHO), International Agency for Research on Cancer (IARC), United States Environmental Protection Agency (EPA) and Oregon Occupational Safety and Health Division (Oregon OSHA). With the lack of studies –in Saudi Arabia and worldwide- the level of public awareness and their malpractice is questionable. Materials and Methods: Online and paper self-administered questionnaires were distributed over 1039 females. Including questions assessing knowledge on hair treatments, previous experiences and side effects. Results: (60%) of participant had a poor knowledge score. When asked if formaldehyde is a carcinogen, (70.5%) did not know and (5.1%) answered incorrectly. (33.5%) of participants had done hair treatments before, but (52.3%) didn't read about them prior. The major motive was to facilitate hair management (76.1%). (57.5%) of participants said their hair wasn't examined before the treatment, and only (31%) applied scalp barriers. Flat irons were used in most cases (83.6%). Most importantly, (55.2%) did not know if the product used contains formaldehyde, and (15.2%) used formaldehyde-containing products. The majority (74.7%) reported having side effects, mostly hair fall (56.9%) and dandruff (30.5%). When asked if they would consider using hair treatments again, (61.2%) said no, mainly because of the damage and side effects (90.6%). Limitations: Majority of participants being from the central region of Saudi Arabia and the limited older age group (9.6%). Conclusion: Recently, in 2016, the Saudi Food and Drug Authority published a warning article on four products found in local markets containing high levels of formaldehyde. This shows the lack of industrial supervision and consumers protection and the need of strict monitoring regimens in stores and beauty salons. Future studies should be applied in assessing the public's misconceptions and practices, along with campaigns and social media efforts to raise the overall knowledge.
  9,305 566 -
Management of localized juvenile spongiotic gingival hyperplasia: A systematic review
Hani H Mawardi, Soulafa A Almazrooa, Heba A Turkstani, Razan S Balkhair, Alaa G Almasoudi, Bushra A Bakhamis, Lujain Z Azzouz, Tahani A Alshareef, Soha E Alsulami, Sarah A Alsahafi, Asma A Albarqi
January-June 2021, 25(1):1-5
Background: Localized juvenile spongiotic gingival hyperplasia (LJSGH) is an uncommon condition presenting as a well-circumscribed, papillary, and exophytic red soft-tissue lesion commonly on the gingival margin and attached gingiva with distinctive histological features. Up to date, the exact etiology is yet to be determined, while a reactive nature of the disease was suggested. Purpose: The aim of this systematic review is to investigate various LJSGH treatment options for the best outcome. Methods: A search was conducted using PubMed/Medline and Medscape up to April 2019. All English literature on management of LJSGH was included and systematically reviewed for bias and using different levels of elimination by multiple reviewers. The required data from eligible studies were extracted and analyzed. Results: Twelve articles met the inclusion criteria following the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. In total, 97 cases were treated by surgical excision in which 12 had recurrence within a median follow-up of 29 months. Two cases were treated with cryotherapy, one with photodynamic therapy, and one case with surface cauterization with topical clobetasol all with no reported recurrence. In addition, one case was treated with scaling and chlorhexidine application without significant response. Conclusion: Based on the available evidence, the complete excision of LJSGH using any method may have the most predictable outcome. Further studies are needed to confirm these findings and explore alternative management options.
  9,034 641 1
Liraglutide-induced injection site reaction
Nada Fouda Neel, Yasser Ghobara, Mohammed Turkmani
July-December 2019, 23(2):97-98
Liraglutide is an antidiabetic drug given subcutaneously for weight reduction. We report a 35-year-old woman who presented with a rash after starting liraglutide. The rash consisted of erythematous well-defined plaques surrounded by ecchymotic patches on extensor aspects of the thighs at the sites of liraglutide injection with gradual onset and progressive course. The exact cause of the reaction is unknown. The eruption resolved after discontinuation of treatment.
  8,549 598 2
Noninvasive arm fat reduction
Logan William Thomas, Margit Juhasz, Lance Chapman, Michele Van Hal, Ruzica Conic, Ashley Magovern, Natasha Mesinkovska
January-June 2018, 22(1):2-11
The demand for new approaches for noninvasive procedures of the upper arm is increasing. This review will present the most recent literature addressing modalities for arm fat reduction. Thirteen papers met inclusion criteria. The greatest arm circumference reduction (2.75 cm) is accomplished with the combination of cryolipolysis and shock therapy. Limited side effects are noted with each treatment modality. The most painful treatment is cryolipolysis. Physicians should be aware of the most common treatment modalities, new advances in devices, and possible side effects that may occur. There is a need to design and implement a universal patient satisfaction scale, such as the Global Aesthetic Improvement Scale. We recommend a standard approach to fat reduction measurement using three-dimensional imaging and suggest using US at a standardized location such as the midpoint between the olecranon and acromion processes. Although preliminary research suggests that noninvasive contouring of the upper arm is successful with limited adverse events, further research in this field will need to be completed to determine the long-term safety.
  8,277 783 1
Eruptive milia associated with isotretinoin
Saad Mohammed Altalhab, Rasha Abdulaziz Zainalabidin
January-June 2019, 23(1):44-45
Isotretinoin is the most effective treatment for severe acne, although its potential side effects and monitoring requirements restrict its use. We are reporting eruptive milia of the eyelid/periorbital area associated with low-dose isotretinoin treatment in three adults.
  8,544 469 1
Recent insights in atopic dermatitis pathogenesis, treatment, and disease impact
Madison Nguyen, Adrian Pona, Sree S Kolli, Steven R Feldman, Lindsay C Strowd
July-December 2019, 23(2):66-72
Atopic dermatitis (AD) is the most common inflammatory skin condition impacting patient quality of life. Although AD is widely studied, investigators have explored recent advancements in AD pathogenesis, treatment, and disease impact. Therefore, this article summarizes recent advancements in AD pathogenesis, treatments, and disease impact on patient quality of life. A PubMed search was conducted using the keywords: “atopic dermatitis AND pathogenesis,” “atopic dermatitis AND microbiota,” “atopic dermatitis AND dupilumab,” “atopic dermatitis AND JAK$ inhibitors,” and “atopic dermatitis AND quality of life.” Epidermal barrier dysfunction and immune dysregulation play a key role in the pathogenesis of AD. Although most AD patients express a filaggrin mutation, such mutation alone does not predict disease severity. Immune dysregulation is characterized by T-helper-2 responses in acute AD and Th1 responses in chronic AD. Skin microbiota abnormalities and sweat exacerbate symptomatology. Dupilumab targets the interleukin (IL)-4Rα and is the only Food and Drug Administration-approved biologic that effectively treats AD. Newer alternative agents for AD treatment include IL-12 and IL-23 inhibitors, IL-31R inhibitors, and JAK inhibitors. AD patients have increased anxiety, depression, and sleep disorders (P < 0.001) and skin pain (P= 0.02) compared to control. AD is influenced by the epidermis, immune system, genetics, microbiota, sweat, and environment. AD has lasting impacts on patients' mental and physical health. Dupilumab is an effective biologic for treating the condition.
  7,919 1,015 2
Hyperpigmentation post laser hair removal in patients taking Vitamin D supplements
Saad Altalhab, Mohammed I AlJasser, Ziad M Alshaalan, Rima M Ahmad, Leena Alghamdi, Abdulaziz A Alnoshan
January-June 2021, 25(1):33-36
Background: Laser hair removal (LHR) is a common procedure for the removal of unwanted hair. Although it is generally safe, it is associated with some adverse effects including hyperpigmentation. Purpose: In this study, we aimed to assess the prevalence of postlaser hyperpigmentation in patients taking Vitamin D supplements. Methods: This is a cross-sectional study of patients who underwent LHR. Each patient was interviewed and asked about their intake of Vitamin D supplements, and the primary outcome was whether hyperpigmentation was reported after LHR in the past 6 months. LHR treatment details were also documented. Results: A total of 508 patients were included with a mean age of 29 ± 9 years. Post-LHR hyperpigmentation was more prevalent in females and in those taking oral Vitamin D. Multivariate logistic regression analysis showed that Vitamin D intake was independently associated with more risk of hyperpigmentation post LHR (odds ratio [95% confidence interval]; 2.6 [1.17–5.80], P = 0.020). Conclusion: Vitamin D intake may be associated with an increased risk of hyperpigmentation post LHR. Causality cannot be assessed.
  8,593 285 -
Idiopathic aquagenic syringeal acrokeratoderma
Nwanneka Okwundu, Stephanie Snyder-Howerte, John Young, Bill William Lear
January-June 2019, 23(1):46-48
Aquagenic syringeal acrokeratoderma (ASA), also known as transient reactive papulotranslucent acrokeratoderma, is an uncommon disorder that usually affects the palms. It is characterized by transient, translucent, white papules and plaques that develop upon exposure to water. Skin lesions are typically accompanied by itching and burning sensation. While many theories exist in regard to the etiology of this condition, we present a case of ASA that appears to be idiopathic in nature.
  8,342 506 2
Distended striae distensae in a patient with nephrotic syndrome
Archana J Lokhande, Tapan Kumar Dhali, Priya Chaudhary, Rishi Goel, Soni Rathore
July-December 2018, 22(2):82-84
Striae distensae (SD) are very common dermatological condition produced as a result of overstretching of skin leading to depressed linear irreversible atrophic dermal scars. We report a case of oral corticosteroid induced extensive striae distensae in a patient with nephrotic syndrome, who developed sudden bulging and fluid collection in these atrophic skin scars during the course of disease. Laboratory analysis of aspirated fluid from the oedematous SD revealed it to be transudate in nature. Thus it was concluded that, as part of anasarca the extracellular fluid got preferentially accumulated within the weaker atrophic scarred skin of striae.
  8,147 506 -
Reverdin pinch grafts for surgical closure after removal of nonmelanoma skin cancer lesions of the leg
Frank Hofmann, Ammar Faisal Hameed, Thomas Schleussinger, Field Lawrence
January-June 2018, 22(1):16-20
Background: Surgical closure after removal of nonmelanoma skin cancer on the leg can be challenging. Objective: Reverdin pinch grafting is an old skin transplant approach to treat leg ulcers. We present our experience using Reverdin pinch graft to close leg surgical defects following excision of nonmelanoma skin cancers. Patients and Methods: This was a retrospective study of 35 patients with medium-large sized defects with a median ± standard deviation of 20 ± 2.7 mm. Pinch grafts harvested from the thigh were used to cover the surgical leg defects with a 6-year follow-up period. Results: The average healing time after pinch grafting was 4 weeks ± 1.12 weeks. Ten patients (28.6%) had a failure of one or two single pinch grafts. There was no hypertrophic or keloid scarring in any grafted patients. Wound infection occurred in two patients (5.7%) and postoperative hemorrhage in only one patient (2.8%). Basal cell carcinoma arose in one patient (2.8%). Conclusion: Reverdin pinch graft technique is an easy and effective closure option for medium-large surgical defects of the leg after nonmelanoma skin cancer excision.
  7,772 658 2
Bullous pemphigoid: Profile and outcome in a series of 100 cases in Singapore
Siew-Kiang Tan, Yong-Kwang Tay
January-June 2018, 22(1):12-15
Background: Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disease. Objective: We report the profile and outcome of 100 cases of BP seen at our center. Patients and Methods: This was a retrospective study of patients with BP seen at Changi General Hospital, Singapore from 2004 to 2012. Results: There were 57 female and 43 male patients. Other than the usual comorbidities such as diabetes mellitus and neurological diseases, there were a high incidence of osteoporosis (29%), hypothyroidism (6%), malignancy (6%), and hepatitis B carrier (3%). Peripheral blood eosinophilia is seen in almost half of the patients. The study results showed the higher sensitivity of direct immunofluorescence (93.5%) as compared to indirect immunofluorescence (89.1%). Topical and systemic corticosteroids were the standard treatment (96%). The duration to remission ranged from 2 weeks to 34 months, with a mean age of 7 months. Doxycycline and nicotinamide were effective for localized BP. The mortality rate was 35%. Conclusion: In Singapore, BP is associated with significant morbidity and mortality. High mortality of BP is related to the advanced age of the patients, associated medical conditions and complications from the treatment.
  7,454 695 3
Knowledge and use of isotretinoin in Saudi female college students: Cross -sectional study
Thuraya Ahmed Albadr, Danah Khalid Alruhaimi, Peter M B. Cahusac, Dileep Kumar Rohra
July-December 2019, 23(2):76-80
Background: The most effective treatment for severe acne is isotretinoin. However, it carries major side effects, such as teratogenicity, depression, and increased lipid profiles. It is advised to monitor the lipid profile and to use two forms of contraception during isotretinoin use. Although it is commonly prescribed, little data are available regarding patients' understanding of isotretinoin. Objectives: The aim of this study is to assess Saudi female college students' knowledge about isotretinoin use and side effects. Methods: Data were collected by a validated online questionnaire disseminated through social media, allowing the collection of information from students from different regions of the country. Results: The total number of responses was 622. The majority of respondents were 18–24 years old, single, and college students; all were female. About 48.6% (282) of the sample used isotretinoin. Most had good knowledge of isotretinoin side effects. Medical students were more knowledgeable than students of other majors, and users were more knowledgeable than nonusers. The most common side effect was dryness. Use among married females was 2.8%, the majority of whom were instructed by their physicians to use only one method of contraception. One respondent got pregnant while using the drug. Conclusion: College-aged females generally have good knowledge of isotretinoin and its side effects. However, awareness about proper contraceptive use while on the drug is lacking.
  6,663 669 5
Hidradenitis suppurativa: A comparison of guidelines
Verena Isak, Steve R Feldman, Rita O Pichardo
July-December 2018, 22(2):48-59
Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the folliculopilosebaceous unit (FPSU) in the intertriginous skin areas, especially axilla, groin, perineum, and peri- or sub-mammary fold in women, with secondary inflammation of eccrine and apocrine glands. HS disease activity and severity can be divided into three different stages according to the Hurley staging system. Stage I disease consists of single or multiple abscesses, while in Stage II, additional sinus tract formation or scarring can be seen, and in Stage III, interconnected tracts and abscesses have developed over a complete anatomic area. Due to its high disease burden, the extent to which HS negatively impacts patients' quality of life is higher than that of most other chronic dermatological conditions. Pain is considered one of the worst aspects of HS. In this article, we compare different guidelines for the management of HS between hospitals in Europe and the U.S. for Hurley Stage I, II, and III. Existing treatment guidelines were identified through systematic review of medical databases, including PubMed, using the search terms “hidradenitis suppurativa treatment guidelines” as well as “acne inversa treatment guidelines” for the European and German treatment guidelines, as well as American hospital-specific treatment algorithms, including Henry Ford Hospital, Detroit, Michigan, and Mayo Clinic, Rochester, Minnesota. In the German S1 guidelines, the goal is an improvement of one Hurley stage and/or a 25% improvement of the Sartorius score or the dermatology life quality index within 12 weeks. Radical surgical or laser excision, oral combination therapy of clindamycin and rifampin, or alternatively tetracycline, topical clindamycin, and hormonal therapy are recommended, while topical resorcinol, dapsone, finasteride, zinc gluconate, and acitretin are the treatment options that can be taken into consideration. Unlike the European or German S1 guidelines or the algorithm proposed by the Henry Ford Hospital, more systemic antibiotic therapy options are suggested in the Mayo Clinic algorithm before the addition of immunosuppressive therapy. Evaluation for efficacy happens every 3 months, and in case of treatment failure, the antibiotic regimen is changed and reevaluated 3 months later. Options include Trimethoprim-sulfamethoxazole, amoxicillin-clavulanate, fluoroquinolones, clindamycin, and rifampin, as well as rifampin plus moxifloxacin plus metronidazole. If none of the proposed antibiotic therapies help, acitretin, dapsone, or cyclosporine may be used instead. In refractory HS, infliximab or adalimumab is added to the regimen. For Stage III disease or in case of treatment failure so far, wide local excision as an addition to medical therapies can be considered. With the literature of the existing treatment options mostly being low evidence, scarce new randomized controlled trials, and the existing guidelines leaving room to interpretation, a gold standard for the treatment of HS does not yet exist. Further large-scale, randomized studies are necessary to continue treatment exploration and improve treatment regimens.
  6,654 647 2
Cutaneous manifestations of human immunodeficiency virus/acquired immunodeficiency syndrome: A comprehensive review
Daniel J Lewis, Steven R Feldman
July-December 2020, 24(2):66-73
Background: Cutaneous manifestations of human immunodeficiency virus (HIV) may be among the initial signs of HIV-related immunosuppression. As such, recognizing HIV-related cutaneous manifestations may lead to the early diagnosis of HIV infection, enabling the prompt initiation of antiretroviral therapy. Purpose: The objective of this article is to discuss the disease history, clinical findings, serologic findings, and treatment options of cutaneous manifestations of HIV. Methods: A nonsystematic review of the literature was performed using PubMed/MEDLINE and Scopus from which relevant articles were analyzed and summarized in the article. Results: There are a number of dermatologic conditions associated with HIV infection, which can be grouped into various categories: acute HIV infection, bacterial infections, viral infections, fungal infections, parasitic infections, papulosquamous dermatoses, eczematous dermatoses, and miscellaneous disorders. Skin-related disorders observed in HIV may result from the viral infection itself or from opportunistic infections or skin disorders secondary to the immunocompromised state inherent to the infection. Many associated skin diseases are more severe in HIV-infected patients, particularly those with severe immunosuppression as seen in acquired immunodeficiency syndrome. Conclusion: Prompt recognition of these skin manifestations is critical to the initiation of disease-modifying antiretroviral therapy.
  6,290 615 -