Efficacy and Best Mode of Delivery for Tranexamic Acid in Post-Inflammatory Hyperpigmentation: A Systematic Review.

Background: Post-inflammatory hyperpigmentation (PIH) is skin hyperpigmentation that occurs due to any inflammatory condition. Triggering the melanocytes by inflammation leads to melanin overproduction and deposition. Tranexamic acid (TXA) is an antifibrinolytic medication prescribed to treat bleeding. Recently, there are some studies about the use of TXA in the treatment of PIH. Objective: The aim of this study is to identify the efficacy and the best mode of delivery for tranexamic acid in the treatment of PIH. Methods: This systematic review is reported in accordance with PRISMA guidance. We included all relevant English-language studies that were published up to September 2022 in the following electronic databases: Cochrane Library, PubMed, Embase, and Google Scholar. The initial search yielded 61 articles, 9 of which were included after applying inclusion and exclusion criteria. Results: The systematic review included a total of 196 patients who were over the age of 16 years old. Tranexamic acid was delivered orally in 4 studies, topically in 2 studies, and both simultaneously in 1 study. In addition, intradermal injection was used in 2 other studies. Almost all studies advocated the use of all routes for accelerating the clearance of hyperpigmentation with more favor towards topical and intradermal routes due to their mild reported side effects when compared to oral routes. Conclusion: Intradermal TXA is considered the best route, which exhibits fewer side effects with less cost and excellent outcomes, while oral TXA is found to be less preferable than other routes due to the incidence of undesirable adverse events.

Tofacitinib Treatment in Patients With Active COVID-19 Infection.

Alopecia areata is a chronic autoimmune disorder attacking the hair follicle epithelium; hence, causing non-scarring hair loss. It has been found that Janus kinase 3 (JAK3) hyperactivity plays a key role in the pathogenesis of the disease. Tofacitinib is an effective JAK1 and JAK3 inhibitor that can block several cytokines such as IL-2, IL-7, and IL-6. Several studies have demonstrated the efficacy of oral tofacitinib in hair regrowth in alopecia areata patients. With the recent COVID-19 pandemic, it has been advised to withhold JAK inhibitors during the period of active infection due to possible immunosuppression. We herein report two cases of patients with alopecia universalis who continued to use tofacitinib during their active COVID-19 infection and showed no deterioration in their course of illness.

Palmoplantar Psoriasis Successfully Treated With Risankizumab.

Palmoplantar psoriasis is a variant of psoriasis that affects the palms and soles. Despite the small body surface area affected, palmoplantar psoriasis can have significant implications on a patient's mental health, justifying the urgency in treating this condition. Palmoplantar psoriasis is also known to be challenging to treat. In this case report, we present a male who presented with a 15-year history of psoriasis with significant palmoplantar involvement, managed with topical and systemic therapies, achieving a minimal response. After trying other therapies including acitretin and adalimumab, we eventually started the patient on risankizumab, an anti-IL-23 antibody. Following the fourth dose of risankizumab, the patient's palmoplantar lesions completely resolved. We further discuss why risankizumab may be considered a treatment option in resistant palmoplantar psoriasis cases.

Topical corticosteroids knowledge, attitudes, and practices of primary care physicians.

OBJECTIVES: To assess knowledge, attitudes, and practices of primary care physicians (PCPs) toward topical corticosteroids (TCs). Methods: A cross-sectional, 53-item questionnaire based study on TCs was conducted among PCPs in Riyadh, Kingdom of Saudi Arabia between January and March 2015. A maximum score of 30 was calculated for the knowledge portion. Results: Out of 420 PCPs, 336 responded (80%). Most participants (89.6%) reported prescribing TCs. The mean knowledge score was 17.14 (SD=5.48). Only 39% PCPs correctly identified that there are 7 or 4 TCs potency groups (2 different classification systems). The MBBS/MD and diploma-certified physicians scored lower than board-qualified PCPs (p less than 0.05). Family medicine physicians scored higher than general practitioners (GPs) (p less than 0.05). Hospital-based PCPs scored better than private practice PCPs (p less than 0.05). Moreover, those who felt somewhat comfortable (32.5%) in treating dermatology patients were more knowledgeable (p less than 0.05). Lastly, 76.5% of physicians were interested in attending courses on dermatologic therapies.  Conclusion: Knowledge of TCs among PCPs was inadequate. Targeted educational interventions delivered by dermatologists are recommended.

Acne scars in ethnic skin treated with both non-ablative fractional 1,550 nm and ablative fractional CO2 lasers: comparative retrospective analysis with recommended guidelines.

BACKGROUND: Fractional technology has changed the dermatologists view in how to treat acne scars in ethnic skin as a result of its favorable safety profile. OBJECTIVES: To evaluate the safety and efficacy of non-ablative fractional (NAF) 1,550 nm and ablative fractional (AF) CO(2) Lasers in the treatment of acne scars in ethnic skin. METHODOLOGY: In this retrospective analysis patients with acne scars who were treated with NAF 1,550 nm or AF CO(2) lasers from January 2008 until July 2009 were included. Evaluation was made through comparing pre- and post-photographs and physician global assessment. Patients' satisfaction rate was also recorded. Assessment of improvement was based on a quartile grading scale. Bleaching creams and oral antibiotics were routinely given after each session. Adverse effects were recorded. Follow up visits were scheduled at weeks 1 and 4 of each session and 12 weeks post-last session. RESULTS: A total of 82 patients were recruited in the study. Forty-five patients treated with NAF 1,550 nm laser and 37 patients with AF CO(2) laser. Skin phototype was mainly type IV (III-V). An overall patient satisfaction was 71% for NAF 1,550 nm laser group and 65% for AF CO(2) laser group. Thirty-five percent and 37% of patients attained more than 50% improvement with NAF 1,550 nm and AF CO(2) lasers, respectively. Patients treated with NAF 1,550 nm laser had less down time. Transient post-inflammatory hyperpigmentation (PIH) was noted in 17% of patients treated with NAF 1,550 nm laser compared to 14% with AF CO(2) . CONCLUSION: Both NAF 1,550 nm and AF CO(2) lasers are effective in treating acne scars in ethnic skin with good patient satisfaction rate and high safety profile. PIH decreased with routine use of prophylactic bleaching creams. Fractional laser resurfacing open a wide horizon for treating acne scars in ethnic skin.