Treatment Satisfaction Among Bahraini Patients With Psoriasis: A Single Center Cross-Sectional Study Using the PsoSat Questionnaire.

INTRODUCTION: Psoriasis has a considerable negative impact on a patient's life. However, the treatment prescribed plays a crucial role in their quality of life. Treatment satisfaction is one of the fundamental elements when it comes to patient care for psoriasis (PsO). Dermatologists, just like any other healthcare physician, seek adherence to a specific treatment, and it has been shown that satisfaction influences treatment optimization and thereby the treatment outcome. METHODS: This was an observational cross-sectional study conducted to determine patient satisfaction with therapy and treatment of psoriasis. The final psoriasis satisfaction (PsoSat) questionnaire consisted of eight affirmations concerning treatment satisfaction. Each affirmation was rated by the patient on a 5-point Likert scale (0-4), indicating poor to perfect satisfaction levels. The study involved patients visiting the outpatient department of a multi-specialty medical complex in Bahrain, or patients contacted via teledermatology, between October 2019 and February. A total of 100 patients who were willing to participate in the survey and fulfilled the inclusion criteria, were considered. RESULTS: Most of the patients (89%) were moderately to very satisfied with their ongoing therapy. One patient was not satisfied with the treatment, and 10 (10%) patients reported that they were very dissatisfied with their treatment. CONCLUSION: Since psoriasis can negatively impact a patient's quality of life, treatment satisfaction is an essential factor when it comes to patient care. Dermatologists are always on the lookout for specific treatments that provide excellent results and satisfy a patient's needs.

Palisaded Neutrophilic and Granulomatous Dermatitis in a Patient With Churg-Strauss Syndrome: A Case Report and Literature Review.

Palisaded neutrophilic and granulomatous dermatitis (PNGD) is a rare reaction pattern that is frequently linked to several systemic diseases, including autoimmune disease, inflammatory bowel disease, and vasculitis. Churg-Strauss syndrome (CSS) is an uncommon systemic condition that occurs exclusively in patients with asthma or a history of atopy. It is characterized by extravascular necrotizing granuloma and hypereosinophilia. This case report describes an illustrative case of a 61-year-old Bahraini female who had been diagnosed with CSS and presented with PNGD. The PNGD appeared a few weeks after her oral corticosteroid medication was discontinued. The present case report aims to assist in accurately diagnosing PNGD, as rarely manifested in this case, thus aiding clinicians in improving patient care.

Idiopathic Atrophoderma of Pasini and Pierini: A Case Report and Literature Review.

Atrophoderma of Pasini and Pierini (APP) is a rare cutaneous condition of unknown etiology, predominantly affecting young women. It is a dermatologic disorder characterized by hyperpigmented depressed patches of dermal atrophy. Patients usually present with single or multiple asymptomatic, violaceous, and sharply demarcated areas of depressed plaques; of note, unlike morphea, there is no surrounding erythema or induration. In this report, we discuss a case of a 43-year-old South Asian male patient who presented with an eight-month history of multiple asymptomatic, and depressed bluish-brown plaques that had appeared over his body. The clinicopathological correlation was consistent with a diagnosis of idiopathic atrophoderma of Pasini and Pierini (IAPP). We also engage in a review of the literature on IAPP.

A Rare Case Report: Five Variants of Lichen Planus in a Young Male Patient.

Lichen planus is a common dermatological condition. It is described as a chronic inflammatory mucocutaneous disease that has characteristic clinical and histopathological findings. Classical lichen planus lesions occur as purple, pruritic polygonal papules or plaques with a lace-like pattern of whitish markings on the surface. Despite the large number of variants that exist with different clinical manifestations from the classic form, histopathology features are fairly similar among the subtypes and can aid in the diagnosis. Although most cases of lichen planus are often self-limiting with spontaneous resolution expected within one to two years, early diagnosis and treatment are encouraged to control severe pruritus and painful mucosal erosion, but most importantly to minimize the potential for malignant transformation in long-standing lesions. The main objective of this paper is to report the first case of five cutaneous variants of lichen planus occurring simultaneously in a young male patient.

An Unusual Presentation of Heat Rash: Bullous Miliaria in a Middle-Aged Woman.

Miliaria is a self-limiting cutaneous disease that may develop from skin exposure to humid climates, occlusion, or raised temperatures, forming groups of 1-3-mm-sized sweat-filled vesicles in the epidermis due to obstruction of the eccrine sweat duct. Here, we describe the first case of extensive bullous miliaria reported in a 47-year-old female with no comorbidities or significant medical history.

Cephradine-Induced Toxic Epidermal Necrolysis: A Case Report of Treatment With Etanercept.

Toxic epidermal necrolysis (TEN) is a rare yet life-threatening severe cutaneous adverse reaction (SCAR) to various causative agents, including medications, vaccinations, infections, and malignancies, in addition to some other uncommon external stimuli. TEN is characterized by the sudden appearance of generalizeddusky erythematous targetoid macules with a purpuric center, which coalesces to form bullae and flaccid blisters, leading to an eventual sheet-like epidermal detachment of all necrotic areas. Extensive epidermal denudation in TEN is usually accompanied by thermoregulatory impairment, insensible fluid loss, and hemodynamic instability. The severity of presentation for TEN is calculated through the use of a "Severity-of-Illness Score for Toxic Epidermal Necrolysis" (SCORTEN) score. Certain medications, including antibiotics, anticonvulsants, corticosteroids, and nonsteroidal anti-inflammatory drugs, are considered the primary cause of this dermatosis. In this report, we describe a case of TEN caused by Cephradine, a first-generation cephalosporin antibiotic drug, in a 43-year-old South Asian male who presented to the emergency department one day after receiving Cephradine for the treatment of cellulitis. At presentation, this patient had a calculated SCORTEN score of 4 according to the SCORTEN criteria found in the literature, placing his mortality rate at 58%. His treatment plan consisted of a single 50mg dose of Etanercept (ENBREL), a soluble anti-tumor necrosis factor alpha inhibitor (TNF-α) monoclonal antibody, as an emergent intervention at presentation, along with cyclosporine and hydrocortisone in tapered doses. This is the first reported case of severe TEN in the Kingdom of Bahrain successfully treated with a TNF-α inhibitor, Etanercept in this case, achieving complete healing and remission within 20 days of presentation, after initially showing a poor prognosis and a high risk of fatality.

De Novo Histoid Leprosy With Unusual Histological Features.

Histoid leprosy is a type of multibacillary leprosy that has unique clinical and histological characteristics. Some consider it to be an entity of its own, whereas others view it as a variant of lepromatous leprosy. Histoid leprosy can either occur 'de-novo', or secondarily in patients who relapse after dapsone monotherapy or in the presence of dapsone resistance. Here is a case that presented with clinical features of histoid leprosy but also with classic histologic features of lepromatous leprosy, deeming it very distinctive and unusual.

Purpura Fulminans Following Toxic Epidermal Necrolysis-Like Presentation of Spontaneous Linear IgA Bullous Disease.

Purpura fulminans (PF) is a life-threatening disease of cutaneous microvascular thrombosis and hemorrhagic necrosis. Linear IgA bullous disease (LABD) is an autoimmune disease of subepidermal blistering. We present the first known case of PF following a toxic epidermal necrolysis-like presentation of spontaneous LABD in a 70-year-old female.