Isotretinoin-Induced Dyslipidemia: a Single-Center Study in Saudi Arabia.

Purpose: Acne is a chronic inflammatory skin disease with a high prevalence in Saudi Arabia. Isotretinoin is used to treat severe, resistant nodulocystic acne. Side effects include joint discomfort, headache, mucosal dryness, and nose bleeds. Elevated lipids and liver enzymes have also been recorded. The study goal is to identify the prevalence of increased lipid levels during and after isotretinoin use. Patients and Methods: This retrospective study was conducted in the dermatology polyclinic at King Faisal University, Al-Ahsa, Saudi Arabia. It included adults of different age groups diagnosed with acne vulgaris and treated with oral isotretinoin between January 2021 and December 2022. Parameters included baseline laboratory tests and follow-up laboratory results of cholesterol and triglycerides. Results: Among 88 patients, 48.9% were aged 21-23 years, with females dominating. In total, 47.7% of patients started using isotretinoin at age 20 years or less, with starting doses ranging from 10 to 20 mg. Fifty percent of the patients had five months or more of treatment duration and only 6.8% of the patients had previously used isotretinoin. For the cholesterol and triglycerides, 87.5% of patients had normal pre-treatment with cholesterol and 90.9% with triglycerides, followed by 81.8% and 95.5% in the second reading, respectively. In the last reading, results were 77.3% for cholesterol and 94.3% for triglycerides. Conclusion: The study found that most acne patients treated with isotretinoin had normal cholesterol and triglyceride levels at baseline, second, and last readings. The incidence of higher laboratory alterations was low, with 12.5% and 4.5% for cholesterol and triglycerides at baseline, and 18.2% and 3.4% at second, and 22.7% and 5.7% at last readings. Overall, age, gender, age of start of isotretinoin, isotretinoin dose, and previous use of isotretinoin are factors that could affect laboratory readings.

Cutaneous Leishmaniasis Prevalence and Clinical Overview: A Single Center Study from Saudi Arabia, Eastern Region, Al-Ahsa.

Cutaneous leishmaniasis (CL) is a vector-borne parasitic disease that is transmitted via the bites of infected female sandflies. CL has been endemic in several countries worldwide for many decades, and numerous cases have been reported in Saudi Arabia, particularly across six regions; one of which is AL-Ahsa. Our research aimed to evaluate the epidemiological situation of CL among the patients in Al-Ahsa, Eastern region, Kingdom of Saudi Arabia, during the period from 2017 to 2023. The data were collected from the patients' registries and included 245 patients who were diagnosed with CL in Al-Ahsa, Saudi Arabia. Fewer than half of the cases (47.8%) were Saudi patients, with a significant number of them being males (84.5%). Over half of the cases (52.7%) were aged between 21 and 40 years, and about three-quarters (74.7%) of the cases resided in rural areas. Regarding the nature of the lesions, 38.4% of the cases had one lesion, which was mainly distributed on a lower extremity (62.0%) or an upper extremity (52.2%). A high percentage of the lesions (75.2%) were wet lesions and caused by L. major. Concerning risk factors, a greater number of patients (71.4%) had been in rural areas within the last three months. Additionally, more than half of the cases (54.3%) had close contact with rodents, followed by birds (28.2%), sheep (22.0%), dogs (16.3%), and other animals (1.2%). The results showed a low number of reported CL cases in 2020 and 2021, followed by a surge in 2022 and 2023. The study shows that cutaneous leishmaniasis is still a public health problem in Al-Ahsa and is primarily associated with rural areas.

Isotretinoin Use and Liver Enzymes Changes: A Single-Center Study in Saudi Arabia.

Introduction Isotretinoin is a bioactive retinoic acid variant that is taken orally to treat moderate to severe acne vulgaris. One of the adverse effects of isotretinoin is elevated liver enzymes. This study estimated the prevalence of liver enzyme changes during isotretinoin use among dermatology clinic patients in Al-Ahsa, Kingdom of Saudi Arabia. Methods This study was a retrospective analysis that reviewed the medical data of 97 patients with acne at the King Faisal University Polyclinic who were taking systemic isotretinoin. It determined the baseline, second, and last readings of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Among the 97 patients, 67 (69.1%) were female and 30 (30.9%) were male. Results Of the patients, 41 (50.6%) weighed 51-70 kg, and 45 (46.4%) were 21-23 years old. The age of acne onset was 20 years or younger. Most patients had a starting isotretinoin dose of 10-20 mg and an ending dose of 30-40 mg over six months. Ninety (92.8%) patients had not used isotretinoin in the past. Before treatment, AST was elevated in three (3.1%) patients, and ALT was elevated in two (2.1%) patients. In the last readings, AST was elevated in eight (8.2%) patients, and ALT was elevated in four (4.1%) patients. Conclusion The result of this study indicates that the incidence of high levels of AST and ALT with oral isotretinoin was low. So frequent laboratory monitoring is not recommended since the elevation was not associated with any morbidity and carries financial and emotional burdens. An exception is patients with higher body weight, males, and those whose acne started at age 16-19, in whom frequent monitoring may be considered for AST more than ALT.

Clinical Images in Dermatology Manuscripts - A Study of Journal Submission Guidelines.

Background: Images are an important element of any scientific publication, more so for a very visual specialty such as dermatology. Dermatology journals generally include detailed instructions related to images submitted with the manuscripts, including technical aspects such as file format, resolution, and editing. We aimed to review and critically analyze instructions for images in the top 50 dermatology journals [as per the latest Clarivate journal citation report (JCR) ranking]. Methods: The top 50 journals as per the latest Clarivate JCR were included in the study. Instructions for images were reviewed for each of the journals. The main points analyzed included file type, resolution, size limits, editing limits, support for post-processing of images and details regarding patient consent. Results: Only half the journals (25) had clear, detailed, and specific instructions for the images. Only one journal specifically mentioned pixels per inch (PPI) as the descriptive term, and the remaining used dots per inch (DPI), whereas 6 did not mention either. Twenty-three journals did not mention the recommended size of the image. The most common minimum resolution mentioned was 300 DPI (41 journals). Although 24 of the journals mentioned editing limits, none of the journals elaborated on image plagiarism in the instructions. Twenty-one of the fifty did not mention a clear policy on patient consent. Conclusions: Image submission guidelines for dermatology journals need to be made more elaborate yet easier to understand. Developing a consensus, followed by standardization of these submission guidelines, can help both authors and journals.

Use of Potassium Hydroxide in Dermatology Daily Practice: A Local Study From Saudi Arabia.

Introduction Potassium hydroxide (KOH) is an inorganic keratolytic test. It is considered one of the most worldwide methods used in the dermatological field with reasonable reliability and sensitivity. One of its major uses is in identifying fungal elements in the skin, hair, nails, and different body secretions. In this study, we aimed to identify the prevalence of KOH usage in different hospitals in the Al-Ahsa region, Saudi Arabia. Additionally, we aimed to identify the dermatological conditions in which KOH is being used and practiced by physicians. Methods This was an anonymous questionnaire-based cross-sectional study that was distributed and carried out among dermatologists in Al-Ahsa city in the Eastern province of Saudi Arabia. Results A total of 30 dermatologists completed the study questionnaire. Participants' ages ranged from 29 to 59 years old with a mean age of 39.5 ± 11.4 years old. 14 (46.7%) dermatologists reported that the KOH test is available in their clinic. Using KOH once a day was reported among 14.3% while 21.4% used it once a week. The most reported condition for KOH use was hair dermatophytes (100%). Conclusion There is a clear lack of usage and availability of KOH in clinics. The shortage of availability of diagnostic tools, including KOH might affect the diagnosis of several diseases and may cause a waste of resources, wrong prescriptions, and patient's burden.

Knowledge, Attitudes, and Practices toward First Aid Management of Skin Burns in Saudi Arabia.

Background: Burns are considered a serious health affection that leads to several consequences affecting a person both physically and emotionally. Herbal and traditional medicine have become popular remedies among patients worldwide. Aim: This study explores common practices followed in burns as first aid management. Methods: A cross-sectional study was conducted in the Eastern province of Saudi Arabia using a designed questionnaire distributed electronically through different social media. The questionnaire consisted of socio-demographic details, history of burns, causative material, and practices followed in response to burns. Results: 461 individuals have participated in this study. The commonest reason for burns was hot water or steam. The majority of the respondents (63%) had a satisfactory response to self-aid alone at home. The most common first aid options for managing burns at home were cold water alone 195 (42%), any sort of cream alone 177 (38%), or both 317 (69%). Overall, the result shows no statistically significant difference between the outcome of burn injury and the most commonly used burn aids. Conclusions: Most people use creams and water as the first-aid management of burns, while a good number of people use traditional medicine. Overall, people who receive hospital treatment after getting first aid at home give a better outcome.

Topical Steroid Damaged Face: A Cross-Sectional Study from Saudi Arabia.

Corticosteroids are one of the anti-inflammatory drugs that are used widely by dermatologists. Significant local adverse effects can happen if topical corticosteroids (TCs) are used incorrectly. This study aimed to assess the prevalence of facial TCs misuse and its adverse effects. This was cross-sectional research: a self-reported questionnaire was distributed among a population of Saudi Arabians aged 16 years and above who were using TCs consecutively. Statistical analysis was performed using SPSS version 26. A total of 611 participants were enrolled in the survey: 401 (65.6%) were university graduates, while 187 (30.6%) were below high school level of education. The number of participants using TCs was 279 (45.7%), while 332 (54.3%) did not use steroids topically. The most used TCs were Mometasone furoate 0.1% cream (18.2%), followed by Fusidic acid/Betamethasone cream (16.7%). A total of 46 reported facial TCs' side effects. Peeling (52.2%) was the most reported side effect, followed by redness (41.3%). In conclusion, the use of facial TCs among the Saudi population is not uncommon (16.5%). A large population are not aware of the side effects of the unsupervised use of TCs. An effort should be made to increase awareness of the adverse effects of TCs.

Attitudes toward organic cosmetics: A cross-sectional population-based survey from the Middle East.

INTRODUCTION: The exponential increase in the market for cosmetics has been accompanied by an increasing demand for organic cosmetics. However, this demand and awareness of organic cosmetics and awareness of its relation to environmental sustainability is likely to vary according to the geographical region. The available literature related to the subject is sparse in our region. OBJECTIVE: To study the attitudes, awareness, and practices related to organic cosmetics in our population. METHODS: A cross-sectional, observational study was conducted among a population of Saudi adult females (18-50 years). An electronic questionnaire was used as the data collection tool. Statistics included percentages and chi-square test was used to compare between groups, with a P value < 0.05 taken as significant. RESULTS: Out of a total of 413 respondents, 278 (67.3%) agreed/strongly agreed that ingredients in cosmetics need to be environment friendly, but only 193 (46.7%) regularly checked ingredient details before use. 338 subjects (81.8%) agreed/agreed strongly that cosmetics with organic ingredients were better for the environment and 233 (56.4%) agreed/strongly agreed that they would prefer using cosmetics with organic ingredients; however, only 199 (48.1%) were willing to pay extra for these cosmetics. There was no statistically significant difference between the groups according to the level of education. Regarding the willingness to pay more for organic cosmetics, the consensus was higher in younger respondents. CONCLUSION: There was a high level of awareness in our study about organic cosmetics and their environmental implications. Although organic cosmetics were preferred by the majority, cost appeared to be a factor impeding actual use. Younger respondents were more likely to prefer organic cosmetics.

Attitude Toward Using the Triple Combination Bleaching Formula and Related Outcomes: A Cross-Sectional Study.

Introduction Kligman's formula is a topical triple combination consisting of hydroquinone, tretinoin, and topical corticosteroid. It has recently become widely popular among the general population for different purposes. Its improper use can lead to unsatisfactory results and unpleasant side effects. Aim This study aimed to assess the attitude, satisfaction, and complications related to topical usage of Kligman's formula among the general population in Saudi Arabia. Materials and methods A cross-sectional study was conducted among the general population of Saudi Arabia. A self-administered questionnaire was distributed among the targeted population using an online survey. The questionnaire includes socio-demographic characteristics, assessment of attitude, and satisfaction in using Kligman's formula. Data were tabulated and cleaned, and all statistical analyses were performed. Results A total of 292 participants met the inclusion criteria (26 males vs. 266 females) with a mean age of 26.9 (SD 7.71) years. Nearly 40% of participants showed a positive attitude in using Kligman's formula, while 46.9% were satisfied with using it. The most common reason for using Kligman's formula was to lighten the skin (55.8%), while skin redness was the most commonly reported adverse effect. Factors associated with increased attitude and satisfaction were using Kligman's formula based on a doctor's prescription and regular follow-up with a dermatologist. Conclusion The general population showed an improper attitude toward using Kligman's formula. However, a better attitude and satisfaction rate can be seen among those using Kligman's formula with prescription and those who regularly visit a dermatologist.

Effectiveness of lenalidomide in relapsed primary cutaneous diffuse large B-cell lymphoma, leg type.

The primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT) has a poor prognosis. R-CHOP with or without radiotherapy is the available recommendations for first-line treatment. Relapses/refractory cases are frequent with no standardized therapeutic guidelines. Lenalidomide seems to be an excellent therapeutic option as a second-line treatment of relapsed PCDLBCL-LT.

[Nail alterations in children]. / Altérations unguéales de l'enfant.

Alterations of the nail unit in children may be congenital or acquired, may be an isolated finding or part of a systemic problem or a syndrome. In this article we describe the most common childhood nail changes and underscore some important clinical clues that should motivate further investigations. Moreover we give a brief overview of the management of these nail pathologies.

Parmi les atteintes unguéales chez l'enfant, on différencie les atteintes congénitales des acquises et les affections isolées des manifestations témoignant d'une possible atteinte systémique ou syndromique. Le but de cet article est de revoir les atteintes unguéales pédiatriques les plus couramment observées et de souligner les signes unguéaux nécessitant des investigations plus approfondies. De plus, un bref aperçu de la prise en charge de ces différentes atteintes unguéales est donné.