Expert consensus on unmet needs, referral criteria and treatment goals for hidradenitis suppurativa in Saudi Arabia.

Purpose: There is limited information about the diagnosis and treatment of hidradenitis suppurativa (HS) in the Kingdom of Saudi Arabia (KSA). This Delphi consensus study was conducted to develop recommendations for the management of HS in the KSA.Methods: The expert panel including 12 dermatologists with extensive experience treating HS patients provided nine consensus statements and recommendations on diagnosis and assessment, management, comorbidities and multidisciplinary approach, and education. The experts also developed clinical questions pertaining to the management of HS and rolled out as a survey to 119 dermatologists practising in the KSA.Results: The topics covered included: referring physicians' awareness of HS; referral criteria for HS; definition of moderate-to-severe HS; treatment goals; definition of treatment success; treatment and biologic initiation; comorbidities and multidisciplinary approach; patient education and awareness of HS. Full consensus (100%) from the expert dermatologists was received on all the topics except referring physicians' awareness of HS, definition of treatment success, and treatment and biologic initiation. The survey results resonated with the expert opinion.Conclusion: As HS is a chronic disease with negative impact on quality-of-life, timely diagnosis and treatment, early identification of comorbid conditions and a multidisciplinary care approach are crucial for effective management of HS.

Topical minoxidil reported hair discoloration: a cross-sectional study.

Minoxidil is a widely utilized medication androgenic alopecia. An original investigation on its potential to cause hair darkening in treated people is lacking. We conducted an observational study using two face-validated questionnaires that dermatologists altered to assess minoxidil's hair discolouration risk. This Saudi Arabian survey collected data in October and November 2022. One questionnaire targeted the population, while the other targeted dermatologists. Survey 1 included 453 patients, 56.7% of whom were 18-24 and mostly female. It's interesting that 26% (n=118) detected hair greying and 14.8% (n=67) noticed other color changes. With P-values of 0.0001, longer-term minoxidil users and those with a family history of hair greying had higher hair discolouration. Dermatologists completed Survey 2 (57 participants). Nearly 60% of dermatologists have ten years of experience. 42.1% of dermatologists saw grey hair after minoxidil use. 17.5% of doctors blame minoxidil for hair graying. This observational study examined the data of over 400 patients to determine if minoxidil could cause hair discoloration. Based on the data, we hypothesize that this drug may cause hair discoloration with prolonged use and in people with a family history of hair greying.

Burnout phenomenon in Saudi dermatology residents: a national assessment of prevalence and contributing factors.

A cross-sectional study was conducted between March and August 2021; an electronic survey was administered to all dermatology residents (n=79) in all centers with the Saudi Board Dermatology Training Program in the western, eastern and southern regions. Participation was voluntary, and written informed consent was obtained before the study. The survey was completed by 70 dermatology residents, for an 88.61% response rate. All the participants were aware of the study's aims, and their informed consent was obtained. The study design complied with the Declaration of Helsinki ethical standards and was approved by the Institutional Review Board at Imam Muhammad Ibn Saud Islamic University in Saudi Arabia. A total of 70 respondents completed the questionnaire. High emotional exhaustion (EE) was present in 47.1% of respondents, low personal accomplishment (PA) was present in 65.7%, and high depersonalization (DP) was the least prevalent (24.3%) across all burnout dimensions of dermatology residents. Overall burnout was present in 21.4% of the dermatology residents. Multivariate analysis showed that the odds of EE were significantly lower in males than females [odds ratio (OR)=0.2, P=0.016] and the higher number of patients seen per clinic (OR=1.09, P=0.032) was associated with higher odds of having a high risk of EE, while higher satisfaction with work-life balance was associated with lower odds of a high risk of EE (OR=0.47, P=0.005). A higher number of study hours/week was associated with lower odds of low PA (OR=0.95, P=0.02). Similarly, higher satisfaction with career was associated with lower odds of low PA (OR=0.35, P=0.042). Multivariate analysis showed that only exercise (OR=0.21, P=0.05) and satisfaction with work-life balance (OR=0.42, P=0.008) were associated with a lower risk of burnout. Our study adds the burnout rates among dermatology residents in Saudi Arabia, in addition to possible risk factors that can predict burnout, to the literature. These findings can be applied to improve training programs and reduce the burnout rate among residents.

Diagnosis and Management of Alopecia Areata: A Saudi Expert Consensus Statement (2023).

Alopecia areata (AA) is a complex autoimmune disease manifesting as a chronic inflammatory disease characterized by non-scarring patches of hair loss over the face, scalp, and body. Several treatments have been proposed for AA, but none are curative nor achieve a state of remission. The present consensus statement aims to present the evidence- and experience-based recommendations on the diagnosis and management of AA in Saudi Arabia. The Ministry of Health in Saudi Arabia has opted to initiate a meeting of a multidisciplinary group to discuss and concede on this topic. Eight dermatology experts and clinical pharmacists convened in eight consensus meetings. All content presented in this document was agreed upon by this working group, including diagnosis and severity assessment, prognostic indicators, and therapeutic options for AA. Special consideration was given to special patient populations including pediatric patients and patients with less frequent presentations of AA. Updates of the current recommendations will take place as new evidence evolves in the treatment of AA.

Generalized morphea following COVID-19 vaccine: Case report and literature review.

Physicians should be vigilant for COVID-19 vaccine side effects and investigate any associated cutaneous manifestations. This will ultimately facilitate better understanding and recognition of various skin reactions related to the vaccine.

Dermatology residents as educators: a qualitative study of identity formation.

BACKGROUND: One of the many identities a physician comes to form during their career is their identity as an educator. Exploring formation of this identity may enrich our understanding of how physicians make decisions related to their roles as educators, their behaviors, and how this ultimately influences the educational environment. It is the aim of this study to investigate educator identity formation of dermatology residents while early in their careers. METHODS: Drawing on a social constructionist paradigm, we conducted a qualitative study, utilizing an interpretative approach. We examined longitudinal data over a 12-month period using dermatology residents' written reflections from their professional portfolios and semi-structured interviews. We collected this data as we progressed through and beyond a 4-month professional development program designed to encourage residents' growth as educators. Sixty residents in their second, third, or final year of residency programs located in Riyadh, Saudi Arabia were invited to take part in this study. Twenty residents participated with sixty written reflections and 20 semi-structured interviews. Qualitative data were analyzed using a thematic analysis approach. RESULTS: Sixty written reflections and 20 semi-structured interviews were analyzed. Data was categorized according to themes corresponding to the original research questions. For the first research question regarding identity formation, themes included definitions of education, the process of education, and identity development. For the second research question, 1 theme entitled professional development program included, the following sub-themes: individual act, interpersonal activity, and an organizational undertaking, with many believing that residency programs should prepare residents for their educator roles. Participants also described newfound leadership ambitions of creating new dermatology fellowship programs as a result of taking part in the Resident-as-Educator program. CONCLUSIONS: Our study provides insights on the dynamic formation of educator identities amongst dermatology residents. Investment in developing residents as educators through professional development programs may instigate transformational change on the individual physician level and profession's level.

COVID-19-induced hair shedding and related risk factors: A Saudi perspective.

Introduction: Many cases of telogen effluvium (TE), acute hair shedding, following coronavirus disease 2019 (COVID-19) were reported during the pandemic. Methodology: We conducted a cross-sectional study to assess the relationship between COVID-19 and TE in Saudi Arabia. Self-administered online questionnaires were distributed online between March and September 2022 in Saudi Arabia. A multivariate logistic regression model was used to determine risk factors associated with TE post-COVID-19 (significance at P < 0.05). Results: Of the 703 responders, 392 were included in the study. 59.70% (n = 234) recognized hair shedding during or after COVID-19. The time taken to realize hair shedding (3 or 6 months) and the duration varied (3, 6, >6 months). The risk factors significantly related to TE post-COVID-19 were: female sex (P < 0.001, odds ratio [OR] = 2.98), COVID-19 antiviral treatment (P = 0.032, OR = 3.02), and TE history (P = 0.001, OR = 3.78). Conclusion: Healthcare providers and physicians should be aware of the relationship between TE and COVID-19, to easily recognize, treat, and improve their patients' outcomes).

Importance of the reflective logbook in improving the residents' perception of reflective learning in the dermatology residency program in Saudi Arabia: findings from a cross-sectional study.

BACKGROUND: Reflection is an essential feature of the learning process in all medical education and training fields. While writing the logbooks has been considered to improve learners' reflection in several disciplines, it is unknown whether writing reflective logbooks improves the learning perception of dermatology residents. Therefore, this study was carried out to assess the role of the reflective logbook in improving the residents' perception of reflective learning in the dermatology residency program. METHODS: This cross-sectional study was conducted on 32 dermatology residents from year two (R2) to year four (R4) enrolled in different hospitals in Riyadh, Saudi Arabia. A baseline electronic survey was emailed to all residents before and after implementing the reflective logbook for six months. The survey included 28 close-ended questions assessing their point of view on a Likert scale, and responses varied from agreeing to disagreeing strongly. Frequencies and proportions were generated for the categorical variables such as sex and level of residency. The graphs were generated to assess the proportion of residents correctly responding to the knowledge questions. The data were analyzed using SPSS version 23. RESULTS: Almost 80% of dermatology residents considered reflection as an important element of their learning, and 47% of the residents agreed that a reflective log book increases understanding in medical education. About 44% of the residents agreed that the reflective logbook assisted in their learning, and about 19% strongly agreed on the same. However, only 37.5% agreed that logbooks helped them acquire theoretical knowledge, and 9.4% and 18.8% agreed that they helped them acquire practical and research skills, respectively. Almost 68% of the residents had support in writing the logbook, and 34.4% agreed that logbooks helped them address their patient's needs and enhance their diagnostic skills. CONCLUSION: The study findings revealed that dermatology residents perceived reflection and writing a reflective logbook as important and potentially beneficial. However, knowing the importance of reflection and what reflection means was not optimal. Not all dermatology residents were aware of the reflection and reflective logbooks as tools for reflective learning. Thereby warranting regular workshops or fostering continuous medical education on the importance of reflection.

Acral Prurigo Nodularis: A Case Report.

Prurigo nodularis (PN) is a chronic skin disease that manifests with severe itchy, firm, hyperkeratotic nodules distributed on the trunk and the extremities symmetrically. Here, we report a unique presentation of PN. A 26-year-old male presented with multiple itchy nodules over the hands and feet sparing the trunk, which were confirmed histologically as PN. This is the first reported case of PN with exclusive acral distribution.

Management of Atopic Dermatitis in Adults in Saudi Arabia: Consensus Recommendations from the Dermatological Expert Group.

Background: Atopic dermatitis (AD) is a long-term, pruritic, recurrent, systemic, inflammatory skin disorder. In the Middle East region, the burden of AD is understudied, and there is a dearth of AD guideline documents for practitioners. Methods: An expert panel meeting, encompassing 12 dermatologists from the Kingdom of Saudi Arabia (KSA), was congregated to develop evidence- and experience-based consensus recommendations for AD management, especially in adults in KSA. They completed a questionnaire with seven clinical statements, and a consensus was defined when the responses of ≥75% of participants coincided. Results: The expert recommendations were as follows: American Association of Dermatology guidelines are to be followed for defining AD; Eczema Area and Severity Index or SCORing atopic dermatitis index may be used to quantify the disease severity; Dermatology Life Quality Index may be used to determine the impact of AD on patients' quality of life; Atopic Dermatitis Control Tool may be used to assess long-term disease control in AD patients; and the European guidelines are to be followed for the management of AD. In AD patients who are inadequately controlled with topical or systemic therapies, the preferred systemic agent for use either alone or in combination with topical treatments is dupilumab, cyclosporine, methotrexate, phototherapy, or other available systemic treatments that may include mycophenolate mofetil or oral corticosteroids. Conclusion: These expert recommendations assist physicians by providing a reference framework for optimal care of adult AD patients.

National Saudi Consensus Statement on the Management of Atopic Dermatitis (2021).

Atopic dermatitis (AD) is a chronic inflammatory skin disease with an increasing prevalence regionally and globally. It is characterized by intense itching and recurrent eczematous lesions. With the increase in the availability of treatment options for healthcare practitioner and patients, new challenges arise for treatment selection and approach. The current consensus statement has been developed to provide up-to-date evidence and evidence-based recommendations to guide dermatologists and healthcare professionals managing patients with AD in Saudi Arabia. By an initiative from the Ministry of Health (MOH), a multidisciplinary work group of 11 experts was convened to review and discuss aspects of AD management. Four consensus meetings were held on January 14, February 4, February 25, and March 18 of 2021. All consensus content was voted on by the work group, including diagnostic criteria, AD severity assessment, comorbidities, and therapeutic options for AD. Special consideration for the pediatric population, as well as women during pregnancy and lactation, was also discussed. The present consensus document will be updated as needed to incorporate new data or therapeutic agents.

Alopecia areata and tofacitinib: a prospective multicenter study from a Saudi population.

BACKGROUND: Alopecia areata (AA) is an autoimmune disorder characterized by nonscarring hair loss that can involve the scalp, face, and body. Severe AA subtypes have a poorer prognosis and can be challenging to treat. Tofacitinib, a recently introduced Janus kinase inhibitor, has shown positive results in treating AA. This multicenter study demonstrates the efficacy of tofacitinib and the patient response rate in a Saudi population. It also highlights patient characteristics that may serve as predictors of the therapeutic response to tofacitinib. METHODS: A prospective cohort study design was utilized. Study participants were included from three medical centers in Riyadh, Saudi Arabia. The Severity of Alopecia Tool (SALT) score was used to assess the percentage of hair loss at baseline and the percentage of hair regrowth at 3 and 6 months. RESULTS: The sample size was 68 with an average baseline SALT score of 76.8 ± 27.6%. Data at 6 months were available for 45 patients. Of these, 62.2% achieved a SALT score of >50%. Patients with a score of <50% had a significantly higher baseline SALT score compared to patients with >50% score. The past use of systemic steroids was associated with a diminished response to therapy (P = 0.015). The response to therapy was significantly higher in patients with AA compared to alopecia totalis and alopecia universalis. CONCLUSIONS: Tofacitinib is an effective and well-tolerated treatment for severe AA and exhibits a good safety profile.

The Influence of Modern Social Media on Dermatologist Selection by Patients.

Objective Social media have become the platform of choice for people seeking immediate access to information. They have become so ubiquitous and pervasive that many people are using them to research health care providers and communicate with them about their issues. This study looks into this phenomenon, focusing on how it affects people's thinking when deciding which doctor to see for skin-related concerns. Methodology A cross-sectional study was conducted among patients at Derma Clinic in Riyadh, Saudi Arabia. Data were collected using a validated self-administered questionnaire. A total of 365 patients were included in the analysis. Results Out of 365 participants, 44.9% visited the center for medical purposes, while 45.8% visited for cosmetic purposes. Sixty-six percent of the participants (n=241) went to a dermatologist they knew, and only 21% of those participants knew their dermatologist from social media (Twitter, Instagram, Snapchat, Facebook, and Telegram). About 44.54% preferred to know more about their dermatologists from Twitter, followed by Instagram 27.96%, Snapchat 24.64%, and Facebook 2.84%. A significant proportion of Instagram users came to the dermatology clinic for cosmetic purposes. Conclusion As per the findings of this study, we found the highest preferred way of knowing the doctor for medical or cosmetic purposes was through a friend, followed by a family member and social media. Although most of the participants still preferred to visit a dermatologist based on their friend's recommendation, social media offer patients a platform upon which to launch their search for a dermatologist. Among social media users, patients who visit dermatology clinics for medical reasons preferred Twitter, while those who came for cosmetic reasons preferred Instagram to follow their doctors, underlining the importance of aesthetic dermatology as a visual field.

Pemphigoid nodularis.

BACKGROUND: Pemphigoid nodularis is a rare clinical variant of bullous pemphigoid characterized by overlapping clinical features of both prurigo nodularis lesions and bullous pemphigoid blisters. The condition appears to be more common in females and is often resistant to treatment. OBJECTIVE: To raise awareness of this rare variant of bullous pemphigoid. METHODS: Case report. RESULTS AND CONCLUSION: Dermatologists should include this variant in differential diagnosis of prurigo nodularis because early recognition can lead to an effective treatment for the prurigo component.