Merkel cell carcinoma associated with TNF inhibitor therapy: a systematic review of case reports.

A rare neuroendocrine skin cancer called Merkel cell carcinoma (MCC) primarily affects elderly people. The objective of this study is to comprehensively review the impact of immunosuppressive medications, particularly TNF inhibitors, on the emergence of MCC. METHODS: PubMed, Web of Science, Science Direct, and Cochrane Library were searched. Study articles were screened by title and abstract at Rayyan Qatar Computing Research Institute, then a full-text assessment was implemented. RESULTS: A total of eight case reports with 9 patients were included. Of the total population, seven were women and only two were men. Their age ranged from 31 to 73 years. More than half the population (5 cases) were being treated for rheumatoid arthritis. All received TNF inhibitors that were associated with the induction of MCC. CONCLUSION: We found that it is essential for physicians to explain potential cancer risks to patients before starting long-term immunosuppressive therapy and to conduct routine checks for MCC and other side effects. TNF inhibitors (infliximab, adalimumab, etanercept, and golimumab) were all associated with MCC development. Women constituted the majority of cases and most were elderly.

Intramuscular versus intradermal botulinum toxin for forehead wrinkles: a review of side effects and efficacy.

Botulinum toxin type A (BTA) is a neurotoxin used for both cosmetic and non-cosmetic purposes. BTA is commonly administered as an intramuscular injection to treat wrinkles. However, when it comes to treating forehead wrinkles, intramuscular injection is associated with a greater rate of ptosis. Intradermal injection is currently thought to be a better alternative. We searched PubMed and Google Scholar for research articles published between 1989 and 2023 using the following keywords: "intradermal," "intramuscular," "botulinum toxin," and "forehead wrinkle." The search yielded three randomized controlled trials and a double-blind, split-face case report on 58 patients. We found that although intradermal and intramuscular injections have symmetrical anti-wrinkle effects, the former results in a lower rate of ptosis and a greater degree of pain.

Prurigo pigmentosa post-bariatric surgery: a case report.

Background: Prurigo pigmentosa (PP), also referred to as Nagashima disease, is an acquired dermatological condition that is characterized by pruritic erythematous eruptions including papules and plaques surrounded by a reticular pattern of hyperpigmentation. It was first described in 1971 when Japanese dermatologist Masaji Nagashima noticed similar dermatological manifestations among 8 patients of Asian descent. The disease has been strongly associated with ketosis and ketogenic diet; however, the underlying etiology is unknown. Effective treatment involves an oral antibiotic and a balanced diet. The disease classically affects young women of Asian descent, but cases affecting males and people of non-Asian ancestry have also been observed. We present an unusual case of PP in a Saudi male that started 18 days following bariatric surgery. Case Description: The patient is a 25-year-old morbidly obese Saudi male who complained of an intensely pruritic rash 3 weeks after undergoing bariatric surgery. His past medical history is positive for irritable bowel syndrome (IBS). A punch skin biopsy yielded the diagnosis, and a combination treatment consisting of minocycline and a topical corticosteroid was prescribed. The patient presented again 2 weeks after the initial visit with complete resolution of the rash. He reported adherence to the medication regimen. Pruritus had resolved. Upon examination, post-inflammatory hyperpigmentation in a reticular pattern was observed over the trunk, upper abdomen, and chest. Hydroquinone 4% cream was prescribed to treat the post-inflammatory hyperpigmentation. Conclusions: Nowadays, PP cases are being reported from all around the world, including cases of PP that appeared following bariatric surgery for weight loss without ketogenic dietary modification. Theoretically, the typical PP patient is a young adult female from Eastern Asia who has been adherent to a ketogenic diet. In contrast, we report a case of a Saudi male who did no dietary modifications, but underwent bariatric surgery. Treatment with minocycline resulted in successful complete resolution.

The Use of 2D:4D Digit Ratio as a Predictor of Androgenetic Alopecia: A Review.

Androgenetic alopecia (AGA) is a widespread type of hair loss that affects both males and females. Advanced age and family history of AGA are well-established risk factors for developing AGA. The second to fourth digit ratio (2D:4D) is the ratio between the length of the index and ring fingers. This ratio has been utilized as a predictor for multiple hyperandrogenism-related medical conditions. More recently, 2D:4D was investigated as a predictor for AGA. This article aims to investigate the evidence supporting the use of 2D:4D as a predictor of AGA, and address areas of future research.

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.

Propranolol for the Treatment of Hemangioma in PHACE Syndrome: A Case Report.

Oral propranolol is commonly used as a first-line treatment for infantile hemangioma. However, its use in PHACE (posterior fossa anomalies, hemangioma, arterial anomalies, cardiac anomalies, and eye anomalies) syndrome raises concerns that it might exacerbate the patient's risk of stroke. Here, we report the case of a four-month-old premature girl with PHACE syndrome, who presented with a large hemangioma involving the left side of her face, following the V1+V2+V3 distribution, including the upper lip, left ear, and left eye. This condition was successfully treated with propranolol, and no adverse side effects were reported.

Certolizumab to treat hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that affects apocrine gland-bearing skin. The management of HS with biologics has expanded significantly over the past few years. Certolizumab pegol is a pegylated (polyethylene glycol) antigen-binding fragment of a recombinant humanized anti-TNF-α monoclonal antibody, which is approved for psoriasis, rheumatoid arthritis, ankylosing spondylitis, and Crohn's disease. In recent years many reports have been merging on the use of certolizumab in treating hidradenitis suppurativa. The electronic database MEDLINE was searched through PubMed in February 2022 using the following search terms: Certolizumab "[All Fields] OR" certolizumab pegol"[All Fields] AND "Hidradenitis suppurativa"[ All Fields]. The search revealed that certolizumab was used in 6 case reports to treat HS with a total of 7 patients. We can conclude that there are few cases in the literature discussing the use of certolizumab in HS, all of which, show a good and promising response with no reported side effects.

Childhood Atopic Dermatitis: A Nationwide Measurement of Quality of Life among Saudi Patients.

Background: Atopic dermatitis (AD) negatively affects the quality of life (QoL). However, few studies from Saudi Arabia have assessed the effect AD has on the QoL of pediatric patients. Objective: To determine the psychological impact of AD on pediatric Saudi patients using the Children's Dermatology Life Quality Index (CDLQI). Methods: This cross-sectional was conducted across five tertiary hospitals located across five cities of Saudi Arabia from December 2018 to December 2019. The study included all Saudi patients aged 5-16 years who were diagnosed with AD for at least 6 months prior to visiting the dermatology clinic of the included hospitals. The quality of life in children with AD was assessed using the Arabic version of the CDLQI. Results: A total of 476 patients were included, of which 67.4% were boys. AD had a very large and extremely large effect on the QoL in 17.4% and 11.3% of the patients, respectively; the QoL of only 5.7% of the patients was not impacted due to AD. The average CDLQI score was not significantly different between males and females (9.7 vs. 9.1, respectively; P = 0.4255). Domains related to symptoms and emotions were affected to a greater extent compared with the remaining domains, while the school domain was the least affected. The correlation between age and CDLQI (r = 0.04, P = 0.52) and between the duration of the disease and CDLQI (r = 0.062, P = 0.18) was not significant. Conclusions: This study found that AD affects the QoL of a significant proportion of the Saudi pediatric patients, thereby highlighting the need to consider QoL as a measure of treatment success.

Cutaneous Necrosis Over the Nose and Lower Limbs Induced by Acenocoumarol: A Case Report and Literature Review.

Coumarin derivatives are the most used class of oral anticoagulants, and almost 1-2% of adults worldwide take it in the form of warfarin (WA) or acenocoumarol (AC). Cutaneous necrosis is a rare and severe complication of oral anticoagulant therapy. Most commonly, it occurs in the first 10 days, and the incidence peaks between the third and sixth day of starting treatment. Cutaneous necrosis due to AC therapy is underreported in the literature, and studies refer to this condition as "coumarin-induced skin necrosis"; however, this term is not totally accurate, as coumarin itself has no anticoagulant properties. We report a case of a 78-year-old female patient with AC-induced skin necrosis, who presented with cutaneous ecchymosis purpura over her face, arms, and lower extremities 3 hours after AC intake.

The psychosocial burden of androgenetic alopecia in Saudi Arabia: A cross-sectional study.

Background: The most prevalent cause of hair loss is androgenetic alopecia. Improved therapeutic modalities may result from knowing how stress affects hair growth, incorporating stress-coping methods into the treatment of hair loss disorders, and developing new pharmacotherapeutic approaches. This study aimed to examine the psychosocial burden of androgenetic alopecia in Saudi Arabia. Materials and Methods: A cross-sectional online survey study was conducted among patients with androgenetic alopecia in Saudi Arabia in February 2023. A previously developed questionnaire was adapted from a previously published tool and used in this study. This association between patients' characteristics and the level of psychosocial disease was identified using binary logistic regression analysis. Results: This study included 1230 patients. The majority of the patients (78.0%) reported that they felt embarrassed by their androgenetic alopecia. The median score of the psychosocial impact of androgenetic alopecia on the patients was 1.00 (0.00-2.00), which is equal to 10.0%, reflecting a low level of psychosocial burden on the patients by their condition. Binary logistic regression analysis identified that patients without a family history of androgenetic alopecia were 36.0% less likely to be affected psychosocially by their condition (P < 0.01). Conclusions: A low-level psychosocial effect was seen in our study among individuals with androgenetic alopecia. Further research should be done to determine how the type of alopecia affects patients' psychological results, as well as the influence of the disease's duration on those outcomes. Dermatologists are recommended to raise patients' knowledge of their disease and lessen stigmatization in the meantime.

Post-inflammatory hyperpigmentation after carbon dioxide laser: review of prevention and risk factors.

The CO2 laser has been widely utilized in dermatology; its expanding clinical applications include the management of neoplastic lesions, benign growths, cosmetic conditions, and reactive disorders. The laser's popularity is mainly due to the high precision and short recovery time this technology provides. However, postinflammatory hyperpigmentation (PIH) has been one of the challenging adverse effects of the CO2 laser. Therefore, several modalities have been studied for the prevention of PIH following CO2 laser treatment. This review aims to analyze the incidence of PIH after CO2 laser therapy, identify its risk factors, and assess the efficacy of the examined treatment modalities in preventing PIH. Pubmed and Embase databases were searched for this study, and relative clinical trials were included in the review. Descriptive findings - including age, gender, skin type, types of intervention, and incidence of PIH - were reported. When appropriate, the incidence of PIH was compared across each possible individual factor, such as skin type, gender, and type of intervention. A total of 211 articles were identified, and 14 relevant articles were included in this review. Seventy percent of the subjects were females (n=219), and 30% were males (n=94), with a mean age of 30 years (SD=7.8). The most common skin types were type IV (59%) followed by type III (25%). In total, eight studies investigated the prevention of PIH. The incidence of PIH after CO2 laser significantly varies between studies and differs based on the type of intervention. The studies indicate that the use of Clobetasol propionate 0.05% and fusidic acid cream appeared to effectively reduce PIH, recording an incidence rate of 39% and 53.3%, respectively. The Fitzpatrick-skinphenotype did not appear to influence the risk of PIH. There is a lack of high-powered clinical studies analyzing the incidence of PIH after CO2 laser treatment and the associated risk factors. PIH occurrence may be related to inflammation resulting from thermal damage by the CO2 laser. Consequently, the use of postoperative topical medications with anti-inflammatory properties might reduce its incidence. The use of ultra-potent topical corticosteroids and topical fusidic acid appeared to reduce PIH, possibly reducing postoperative inflammation effectively. Similarly, platelet-containing plasma may be beneficial in reducing CO2 side effects, including PIH. However, more studies are needed to further establish the influence of skin type on PIH and investigate modalities to reduce PIH occurrence after CO2 laser use.

Factors affecting the choice of dermatology as a specialty by medical students: Data from 28 KSA medical schools.

Objectives: Choosing a future career path is a very important decision for undergraduate medical students. Determining the factors that affect specialty choices is essential to attaining a balanced distribution. Dermatology is known to be one of the most appealing and highly competitive specialties. The aim of this study was to determine the factors influencing the choice of dermatology as a future career by medical students. Materials and Methods: A cross-sectional study was carried out in 28 medical schools throughout Saudi Arabia. The questionnaire was prepared following a literature search of relevant studies and was distributed electronically to medical students and interns. The self-administered questionnaire included sociodemographic data, interest in dermatology as a future career, and factors that may affect specialty choices. Results: The study included 1087 participants. Sixty percent were female, and 39% were male. Approximately half of the participants considered dermatology as their preferred specialty. We found that 53.6% of females were more interested in dermatology. Students who were exposed to dermatology in both pre-clinical and clinical years showed greater interest. Personal interest, lifestyle/flexible work schedule, and private sector opportunities were the most captivating factors. Personal interest and high competition in dermatology residency program matching were the main factors among students who did not consider dermatology as a future career choice. Conclusions: Several factors are influencing medical students when choosing dermatology as their future specialty; the lifestyle/flexible work schedule and personal interest were the most attractive factors. Recognizing these factors could be a useful tool that may lead mentors and residency training program directors to reach a balanced distribution of doctors in the various specialties.

Ulerythema Ophryogenes in a Saudi Male: A Case Report.

Ulerythema ophryogenes (UO) or keratosis pilaris rubra atrophicans faciei is a disorder of keratinization that primarily affects the face. The inflammatory process in UO may eventually result in alopecia. The incidence of this disorder is still unknown. We present a case of UO in a 28-year-old male, the first of its kind in Saudi Arabia.

Skeletal Mets From Squamous Cell Carcinoma of the Lower Limb: A Case Report.

Squamous cell carcinoma (SCC) is the second most common non-melanoma skin cancer worldwide and one of the most capable of metastasis. The bone is a common metastatic site of cancers, which is a major cause of morbidity, with an estimated 350,000 people dying yearly from bone metastases. However, bone metastasis from an SCC in the lower limb is rarely reported in the literature and the role of systemic chemotherapy is not well established. We report a case of a 72-year-old gentleman with an SCC metastasis of the bone. This patient received six cycles of platinum-based chemotherapy with no surgical or radiation intervention.

Do Saudi medical schools consider the core topics in undergraduate medical curricula?

BACKGROUND: Most of the medical schools in Saudi Arabia are currently evolving their curricula in accordance with the most recognized medical education trends worldwide. Undergraduate medical school's curriculum should be compatible with community health needs. Therefore, the study aims to explore the current contents of Saudi undergraduate medical curricula and to check if the core topics that were internationally recognized were implemented in their curriculum. METHODOLOGY: An online questionnaire was designed and sent to 37 deans of medical schools in Saudi Arabia. The deans or the vice-deans in charge of the curriculum were asked to complete the pre-designed questionnaire, which assessed the status of inclusion of the core topics in the curriculum of their affiliated schools. Each listed core topic was evaluated according to five options for each subject: not included, separate required course, part of the required course, separate elective course, and part of an elective course. RESULTS: Twenty four out of 37 (65%) Saudi medical schools completed the survey questionnaire. Almost all core topics, such as communication skills, evidence-based medicine, patient safety, professionalism were included in the curricula of Saudi medical schools as separate required courses or as part of required courses or elective courses. Complementary and alternative medicine and the history of medicine were the topics least taught in Saudi medical colleges, as 25% of the schools did not include them in their curricula. CONCLUSION: The majority (65%) of the internationally recognized core topics were included in the Saudi undergraduate medical curricula. Evidence-based medicine, complementary medicine, the Saudi healthcare system, patient safety, and professionalism/medical ethics should be part of compulsory credited courses in all Saudi undergraduate medical curricula.

Prevalence of Helicobacter pylori Infection Among Rosacea and Chronic Spontaneous Urticaria Patients in a Tertiary Hospital in Riyadh, Saudi Arabia.

BACKGROUND: The multifactorial nature of rosacea and chronic spontaneous urticaria (CSU) pathogenesis complicates the achievement of satisfactory treatment outcomes. 13C urea breath test (UBT) has been identified as an accurate, non-invasive, and quick procedure to detect the presence of Helicobacter pylori (H. pylori) with high sensitivity and specificity. OBJECTIVE: In this study, we aim to assess the correlation between H. pylori infection and rosacea and CSU patients. METHODS: A cross-sectional, observational study was conducted on patients with rosacea and CSU in the dermatology clinic at King Khalid University Hospital in Riyadh, Saudi Arabia. History and physical examination were performed by a dermatologist. H. pylori 13C-UBT detection was performed in all subjects. RESULTS: In total, 114 patients were included in this current study, with 41 rosacea and 73 urticaria patients. The vast majority of our subjects were females (96.5%). The mean (±SD) age was 42.3 (±12.7). More than half (58.8%) of the examined samples were positive for 13C-UBT; however, positive results were significantly higher in the rosacea patients (73.2%) compared to the urticaria group (50.7%), with a p-value of 0.019. CONCLUSION: Our findings underline the significant association of H. pylori with rosacea and CSU regardless of the presence or absence of gastrointestinal symptoms. We thus recommend the inclusion of H. pylori testing in the routine workup of CSU and rosacea patients.