Q-switched 532 nm Nd:YAG laser therapy for physiological lip hyperpigmentation: novel classification, efficacy, and safety.

BACKGROUND: Physiological lip hyperpigmentation (PLH) is a common cosmetic concern in the Middle East and Asia. It is characterized by homogeneous symmetric diffuse hyperpigmentation affecting both lips. There is no satisfactory treatment for this condition. The aim of this study is to evaluate the efficacy and safety of Q-switched (QS) 532 nm Nd:YAG laser for PLH. METHODS: A total of 30 patients with clinical diagnosis of PLH were retrospectively reviewed and included in the study. Patients underwent at least one laser treatment using QS 532 nm with a minimum follow up of six months. Laser parameters were as follows: spot size 2-3 mm, pulse duration 20 ns, fluence 2-4 J/cm2. One to three sessions were performed depending on clinical response. Two methods were used for assessment: patient satisfaction and independent physician assessment. PLH was classified as grade 1 (upper lip fully affected plus only border of lower lip), grade 2 (upper lip fully affected plus most of lower lip), and grade 3 (majority of both lips hyperpigmented). RESULTS: Excellent (>75% improvement) response was achieved in 30% of patients. Good (51-75% improvement) response was seen in 37% and 43% of patients according to patient satisfaction and independent physician assessment, respectively. Majority of patients required only one treatment session. Reactivation of herpes labialis occurred in two patients, and mottled hypopigmentation in three patients. None of the patients developed persistent hyperpigmentation or scarring. CONCLUSIONS: PLH can be effectively treated with QS 532 nm Nd:YAG laser and is well tolerated by patients.

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.

Vitiligo-Like Depigmentation following Treatment with Imiquimod 5% Cream for Condylomata Acuminata.

Imiquimod cream is an immunomodulatory agent that has been approved by the US Food and Drug Administration for use in the treatment of anogenital warts (condylomata acuminata) due to its local immune effects in activating Toll-like receptors 7 and 8 on antigen-presenting cells, resulting in reduction of the viral load of human papillomavirus with subsequent wart regression. After its application, some side effects are commonly reported, including erythema, edema, scaling, erosion, and ulceration. While pigmentary changes, including vitiligo-like depigmentation, have been mentioned as a possible side effect, they have rarely been reported in the literature. Alterations in pigmentation occur because imiquimod application causes human melanocyte apoptosis and autodestruction resulting in loss of melanocytes. Herein, we report the rare case of a 34-year-old healthy male who developed vitiligo-like depigmentation following imiquimod application for his genital warts. This case report aims to increase physicians' awareness of this possible side effect that could be irreversible and difficult for the patient to accept.

Effect of quality-switched laser exposure in patients with history of edible gold consumption.

Injectable gold is known to deposit in the dermis for life, and such patients are at risk of developing chrysiasis post-laser exposure. It is unknown if patients with history of edible gold consumption would develop a similar reaction after quality-switched laser exposure. Our aim is to assess if patients with history of edible gold consumption develop chrysiasis after quality-switched laser exposure. This is a proof of concept pilot study conducted between September 2017 and September 2018 at two dermatology clinics in Riyadh, Saudi Arabia. Adult patients who have history of edible gold consumption were recruited to receive a spot test with different quality-switched lasers in a hidden, non-sun-exposed skin site. The test area was photographed before, immediately after, and 10 min after laser exposure. The test area was examined by two independent investigators for the development of chrysiasis. A total of 10 patients (five male and five female) were enrolled. The mean age was 31.7 years. Forty percent of subjects consumed edible gold more than once, and the duration of last intake ranged from 3 weeks to 3 months. Chocolate was the main source of edible gold. All participants had no chrysiasis reaction post-quality-switched laser exposure. Contrary to our hypothesis, all participants with history of short-term edible gold consumption did not develop chrysiasis after quality-switched laser exposure. Further controlled studies including more patients with longer duration and higher frequency of edible gold consumption are needed.

Vitiligo-epidemiological study of 4134 patients at the National Center for Vitiligo and Psoriasis in Central Saudi Arabia.

OBJECTIVE: To assess the clinical patterns, epidemiological profile of vitiligo, and its awareness among Saudi nationals. METHODS: A retrospective study was conducted among Saudi nationals with a confirmed diagnosis of vitiligo presenting to the National Center for Vitiligo and Psoriasis, Riyadh, Saudi Arabia, from August 2002 to August 2006 using a retrospective questionnaire based on the history and medical records of patients. RESULTS: Of the 4134 cases, 53.5% were females. The mean age of onset of vitiligo was 17.4 years. Vitiligo vulgaris was the most common type in 42.3% of cases, 90.5% had no associated autoimmune conditions. The family history was positive in 42.8%. Twenty-nine percent developed depigmentation on multiple sites, and 68.2% over exposed areas. Nearly 1912 (46.2%) were not aware of its cause, and 2682 (64.9%) were unaware of aggravating factors. Stress as an aggravating factor was considered by 15.1%. Herbal treatments were considered very effective by 45.8%. CONCLUSION: Vitiligo is affecting Saudi women more than men with an early age of onset. Vitiligo vulgaris being the most prevalent form with a high rate of positive family history and low rate of associated autoimmune diseases. Knowledge of genetic and environmental factors affecting vitiligo is poorly conveyed and explored.