Background: Brodalumab is a fully human monoclonal antibody that selectively targets the interleukin-17 receptor A (IL-17RA), blocking the activity of pro-inflammatory IL-17 cytokines. Purpose: The purpose of this study was to describe the efficacy and safety of brodalumab in treating various forms of psoriasis. Methods: PubMed, Google Scholar, Scopus, and ResearchGate were searched for scholarly articles related to brodalumab and its utility in psoriasis vulgaris, including all other variants of psoriasis using the search terms “brodalumab” AND “plaque psoriasis” AND “psoriasis variants” AND “psoriatic arthropathy.” Results: Brodalumab is rapidly and consistently effective for moderate-to-severe plaque psoriasis, with high rates of skin clearance. It is also effective for difficult-to-treat variants such as scalp, nail, genital, palmoplantar, erythrodermic, and pustular psoriasis, as well as psoriatic arthritis with an acceptable safety profile. Conclusion: The unique mechanism of brodalumab in blocking multiple IL-17 cytokines may contribute to its efficacy in patients who have failed other biological therapies. Adverse effects observed with brodalumab are generally mild; candidiasis and flares of inflammatory bowel disease are potential risks. Brodalumab is a valuable therapeutic option for psoriatic disease including psoriatic arthropathy.
Background: Topical cosmetic and therapeutic agents are often limited in their effectiveness due to the skin barrier, which hinders the permeation of active ingredients. Enhancing the delivery of these agents through the skin is a critical challenge in dermatology. Purpose: This review aims to explore recent advancements in methods to overcome the skin barrier, focusing specifically on the role of permeation enhancers in improving transdermal absorption of active agents. Methods: A literature review was conducted, evaluating both chemical (passive) and physical (active) methods of permeation enhancement. The mechanisms of action, as well as the effects on the stratum corneum and dermal delivery, were analyzed for both methods. Results: Chemical methods typically enhance permeation by temporarily modifying the skin barrier, mainly through effects such as hydration and solubility changes. Physical methods, on the other hand, utilize external energy sources to facilitate active penetration. Each method was assessed for its effectiveness, advantages, and limitations in improving the delivery of cosmetic and therapeutic treatments. For example, microneedles and dermarollers enhanced drug delivery by 3–15 times, while chemical enhancers such as oleic acid increased permeation up to 30-fold. Physical methods create micro-channels, whereas chemicals modify skin barrier properties to boost absorption. Conclusion: Choosing appropriate permeation enhancers are critical for optimizing transdermal formulations. A thorough understanding of these enhancers’ mechanisms is essential for developing effective topical therapies that maximize absorption while minimizing adverse effects. Both chemical and physical methods are important for advancing dermatological treatment strategies.
Background: Melasma treatment poses a significant challenge due to its propensity for relapse despite initial clearance success. Given this, there are three important pillars: topical treatment, oral medication, and treatment with energy-based devices. Purpose: This systematic review aimed to investigate the efficacy of various oral supplementation regimens in improving treatment outcomes for melasma. Methods: Employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic literature search spanning December 2023 to May 2024 was conducted. Seventeen studies meeting inclusion criteria underwent rigorous analysis. Results: The review encompassed 17 articles, examining a range of supplements including Polypodium leucotomos , glutathione, probiotics, tomato extract, pycnogenol, red orange extract, astaxanthin, coenzyme Q10, collagen hydrolysate, and pomegranate extract. Conclusion: The findings underscore the potential benefits of these supplements in conjunction with conventional treatments for melasma, emphasizing the need for continued investigation and clinical validation.
Background:Skin cancer is a common malignant neoplasm worldwide. The prevalence of skin cancers in Saudi Arabia is not uncommon as well.Purpose:The present work aims to study the clinicopathological spectrum of skin cancers in the Al-Ahsa region from January 2008 to December 2024.Methods:A single-center retrospective study of skin cancer patients was conducted in King Fahad Hospital Hofuf at Al-Ahsa, for patients of any age, sex, and ethnicty from January 2008 to December 2024, from the laboratory information system.Results:Out of the 137 skin cancer cases, basal cell carcinoma was by far the leading skin cancer with squamous cell carcinoma being the second most common skin cancer, followed by atypical lymphoproliferative disease. The M:F ratio was 1.2:1, and the 7th decade was the most affected age group.Conclusion:The pattern of skin cancers at Al-Ahsa is very similar to skin cancers reported in other regions of Saudi Arabia. Although skin cancers in Saudi Arabia may not be as rampant as those seen in many Western countries, they are not uncommon. Measures need to be addressed for prevention, early diagnosis, and treatment.
Basal cell carcinoma (BCC) is the most frequent cutaneous malignancy in the light-skinned population worldwide. The large majority of BCCs arise around the head and neck, but they may occur at other sites, including the abdomen. Primary malignant tumors occurring at the umbilicus are unusual, and only a few case reports have been reported. Our case demonstrates the unique occurrence of pigmented BCC at the umbilicus in a patient with Fitzpatrick skin type V.
We present the case of a 73-year-old female with two squamous cell carcinoma lesions on the left scalp: a 3.0 cm x 2.1 cm lesion on the superior parietal region and a 6.0 cm angstrom similar to 2.7 cm carcinoma in situ on the frontal region. Following Mohs micrographic surgery (MMS), the defects required reconstructive closure due to their large size and the patient's desire for hair-bearing skin. A staged approach was used, involving debridement, wound matrix placement (Matriderm and Integra), and a split-thickness skin graft. To address the large defect and preserve hair-bearing tissue, tissue expanders were placed in the subgaleal plane, and gradual expansion was performed over three months. Once adequate tissue expansion was achieved, a bilateral rotation flap was performed, utilizing the expanded tissue to close the defects. The final flap dimensions were 22 cm x 22 cm, resulting in a well-contoured scalp with full hair regrowth. At 6-month follow-up, the patient reported an excellent cosmetic result with no complications. This case highlights the effectiveness of tissue expansion and bilateral rotation flaps for large scalp defects after MMS, particularly when hair-bearing tissue is a priority. The successful outcome emphasizes the importance of a multidisciplinary approach to managing complex scalp reconstructions.
Vitiligo has been linked with multiple myths and misconceptions, which impacts the diagnosis, treatment, and reporting of the condition. We live in a society where the stigma of vitiligo impairs the quality of life of the affected person. Owing to the stigma to which persons diagnosed with vitiligo are subjected for years together in different settings and across different phases of life, affected individuals may develop a feeling of being unattractive or defective, resulting in having low self-worth and poor self-esteem. Acknowledging the high prevalence of vitiligo, the associated myths and misconceptions about the condition, the surrounding stigma, and the adverse consequences of the same, there is an urgent need to implement targeted public health interventions to reduce the existing stigma. In conclusion, vitiligo is linked with a wide range of misconceptions and stigma, which interfere with the social life, growth opportunities, and quality of life of the affected person. A holistic package of services to reduce the stigma, clarify the myths, and help the individuals lead a dignified and respectful life is needed.
Extramammary Paget's disease (EMPD) is a rare form of malignancy affecting the skin of the genitals, perineum, or perianal region, which has clinical, histological, and immunohistochemical (IHC) features similar to Paget's disease of the breast. The frequency of occurrence of this disease in the population has not been studied in detail. The clinical picture of the disease is nonspecific and requires differential diagnosis with inflammatory diseases of the genitals. The main method of diagnosis is histological and IHC analysis. Due to the rare occurrence of this disease, there is no standard form of its treatment. Surgical excision is the primary method of treatment for local lesions without metastases. Systemic chemotherapy (vincristine, docetaxel, carboplatin, 5-fluorouracil, mitomycin C, and etoposide) is applicable for the metastatic forms of EMPD. In this clinical report, we have discussed the clinical, dermatoscopic, histological, and IHC features of three male patients with the treatments and results of the provided treatment.
Lichen planus pigmentosus (LPP) is a disorder of pigmentation usually involving the face, neck, and upper trunk. Rare presentations, including zosteriform, mucosal, and linear, have been reported in literature. Herein, we report a case of young female who presented with hyperpigmentation around both eyes for 6 months. Examination revealed homogenous diffuse slate gray pigmentation involving periocular region. Dermatoscopic evaluation of the lesion under polarized light demonstrated brown-black pigment dots and globules with sparing of the eccrine openings. On the basis of clinical examination and dermatoscopic evaluation, a diagnosis of periocular LPP was made. This case highlights the importance of dermoscopy in diagnosing pigmentary disorders over cosmetically important sites.
Intravenous administration of iodinated contrast agents (ICAs) is frequently employed for image enhancement while performing radiographic studies such as computed tomography and angiography. Extravasation injury is a rare complication of ICAs. Here, we report an unusual case of acute hand compartment syndrome following extravasation of iohexol in a 50-year-old female due to its rarity.
Background:The pursuit of physical attractiveness and self-enhancement has witnessed a growing trend globally, with cosmetic procedures gaining popularity.Purpose:The present study focuses on understanding the prevalence of seeking cosmetic procedures in the Saudi Arabian population and its association with perfectionism and self-esteem. It determines the other related factors of cosmetic procedure-seeking behavior.Methods:An online-based questionnaire was distributed to the Saudi Arabian general population, including four sections: sociodemographic information, assessment of cosmetic procedure-seeking behavior, the Rosenberg Self-Esteem Scale, and the Physical Appearance Perfectionism Scale.Results:The study included 1978 participants with an average age of 27.9 years. Most of the participants were young, female, single, and well-educated. Of these, 17.7% of the participants reported having undergone cosmetic procedures, with a preference for nonsurgical interventions (58%). Over three-quarters of these individuals were satisfied with their cosmetic procedures. The most influential factors behind seeking cosmetic procedures were psychological/internal factors. Lip-related procedures were the most common (26%). Cosmetic procedure-seeking behavior was correlated with physical appearance perfectionism (P = 0.017), but not with self-esteem (P = 0.362).Conclusion:The prevalence of cosmetic procedures in Saudi Arabia is increasing among young, well-educated individuals. Psychological factors were the primary motivators, and perfectionism significantly drove them to seek procedures. Healthcare providers must consider these psychological aspects when dealing with patients seeking cosmetic procedures.
Alopecia areata (AA) is an autoimmune dermatosis that causes nonscarring hair loss on the scalp and/or body. Although AA has been identified as a polygenic disease, environmental factors are thought to be a major pathogenetic trigger for AA. We hereby report a unique case of identical twins with simultaneously appearing identical AA.
Dermatitis herpetiformis (DH) is a cutaneous autoimmune eruption most commonly associated with celiac disease. DH has also been linked to medications including gonadotropin-releasing hormone analogs, tumor necrosis factor-alpha inhibitors, and nonsteroidal anti-inflammatory drugs. We report a novel case of DH induced by the immunotherapies: enfortumab and pembrolizumab, not previously described in the literature. The underlying cause of our patient's DH was difficult to determine as he was treated with both pembrolizumab and enfortumab immunotherapies while having newly diagnosed celiac disease. Our patient responded well to dapsone initiated 1 week before and continuing 1 week after receiving the immunotherapy infusions.
Background: Chronic nonhealing ulcers of the lower extremity are a cause of morbidity and mortality. Platelets are cells that play a central role in wound healing, and they are the main source of the growth factor complex that plays the main role in natural wound healing. Purpose: To assess the safety and efficacy of the autologous platelet-rich fibrin matrix (PRFM) as wound dressing in the treatment of chronic nonhealing leg ulcers. Methods: This prospective study included 17 patients with chronic nonhealing leg ulcers >6-week duration, which failed conventional treatment. PRFM dressings were applied at weekly intervals till a maximum of 8 weeks. Results: The mean number of sittings required for complete healing of the ulcer was 5. The mean number of sittings required for complete healing of the ulcer in leprosy patients' group was 4, venous ulcer group was 5.4, diabetic ulcer group was 7, traumatic ulcer group was 5, and vasculitic ulcer group was 5. Conclusion: PRFM dressings are a simple, safe, and feasible method for the treatment of nonhealing leg ulcers.
Background:Scar formation is a normal wound-healing process, but prolonged inflammation can lead to abnormal scarring such as hypertrophic scars and keloids, which are unique to humans. While intralesional steroids (ILSs) are the standard treatment, intralesional verapamil remains underexplored despite some promising results.Purpose:The purpose of this study was to compare the safety and efficacy of intralesional corticosteroids versus intralesional verapamil in keloid and hypertrophic scars.Methods:A randomized, parallel-group comparative study was conducted in the outpatient department of dermatology in a tertiary hospital. Fifty patients, aged over 18 years with keloid or hypertrophic scars, were randomly assigned to two groups: Group A (n = 25) received corticosteroids, and Group B (n = 25) received verapamil. Scar outcomes were assessed using the Vancouver Scar Scale (VSS), across five visits. Safety was monitored through adverse event documentation. Data were compiled in Excel and analyzed with SPSS 24.0. Quantitative data were expressed as means, standard deviations, and categorical data as percentages with visual aids.Results:The VSS scores consistently decreased in both the verapamil and ILS groups at all visits. Significant improvements in scar height, vascularity, and pliability were observed starting from the second (P < 0.05). However, pigmentation showed no change in the first two visits for both the groups. The incidence of adverse effects was lower with verapamil.Conclusion:Both corticosteroids and verapamil demonstrated a reduction in scar height, pliability, and vascularity over time. However, the rate of improvement was more pronounced with triamcinolone. Verapamil presents a viable alternative with more favorable safety profile.
The wonder drug "steroid" is widely used all over the word for its beneficial effects in the wide variety of diseases. However, unjustified use of steroids is also prevalent and does harm rather than being beneficial, especially in the dermatological cases. The authors take this opportunity to report a case of cutaneous leishmaniasis, where the undue topical steroid use significantly exacerbated the lesion, which could have been easily avoided by careful examination and correct management.
Background:Telogen effluvium (TE) is a type of nonscarring alopecia, which can be acute or chronic. Hair is an important factor that completes individuals' physical appearance; feelings of worthlessness and a decreased quality of life (QoL) may be observed in patients with TE.Purpose:This study investigated the impact of TE on self-esteem and QoL.Methods:This case-control study included 100 patients with TE and 100 controls. The sociodemographic and clinical features of the patients with TE were recorded. The TE and control groups were asked to fill out the Rosenberg Self-Esteem Scale (RSES) and Dermatology Life Quality Index (DLQI) to assess their self-esteem and QoL.Results:Of the 100 patients with TE, 82 (82%) were females, and 18 (18%) were males with a median age of 34 years. In the TE group, the median RSES score was 32, and the DLQI score was 4, while in the control group, they were 31 and 1, respectively. There was no significant difference in self-esteem between the TE and control group. However, the TE group displayed higher QoL scores than the control group.Conclusion:Interventions focusing on improving QoL may be more helpful for patients with TE than those solely targeting self-esteem.
Erosive pustular dermatosis (EPD) is a rare inflammatory condition characterized by sterile pustules, crusting, and cicatricial alopecia. A 99-year-old Caucasian male with extensive sun damage and a history of multiple skin cancers presented with recurrent hyperkeratotic plaques on the scalp refractory to standard treatments, including high-potency topical corticosteroids, topical calcineurin inhibitors, topical and oral antibiotics, and intralesional corticosteroid injections. Photodynamic therapy (PDT) using aminolevulinic acid and blue light was initiated as an alternative approach. After four sessions, clinical improvement was demonstrated by a significant reduction in serous crusting and plaque burden. This case highlights the role of PDT as an effective treatment for refractory EPD and underscores the need for further research into its long-term efficacy.
A male in his 20s presented to the hospital with a rash, abdominal pain, blood in the stool, and fatigue. The rash, originally diagnosed as urticarial vasculitis, developed 4 months prior and had been treated with several courses of low-dose steroids without resolution. Physical examination revealed erythematous plaques with older lesions in a generalized distribution across the face, trunk, and extremities. Laboratory workup revealed an elevated C-reactive protein and total complement. Histopathology revealed a leukocytoclastic vasculitis, and direct immunofluorescence confirmed the diagnosis of immunoglobulin A (IgA) vasculitis. His clinical course improved with intravenous corticosteroids, and the patient was discharged home on a prednisone taper. We present a cutaneous manifestation of this disease that differs from the typical palpable purpura associated with IgA vasculitis. This case highlights the importance of recognizing the diverse cutaneous morphology of IgA vasculitis and performing the appropriate work-up so that early diagnosis can be achieved and treatment can be promptly started.
Background: Atopic dermatitis (AD), also known as eczema, is a chronic skin condition characterized by inflammation, itching, redness, and irritation of the skin. It affects a significant percentage of the global and local population. Eczema is associated with mood disturbances such as anxiety and depression. However, data on the impact of eczema severity on psychological health in adult eczema patients remain scarce. Addressing this correlation is crucial for improving therapy and clinical outcomes for eczema patients. Purpose: This study was carried out to assess the correlation between AD disease severity and mood disturbance in adult AD patients in King Khalid University Hospital (KKUH); a teaching facility with general and subspecialty medical services in King Saud University Medical City, Riyadh, Saudi Arabia. Methods: This study is a cross-sectional study targeting adults diagnosed with AD in KKUH. Patients visiting the dermatology clinic during the study period from March 2023 to August 2023 were asked to fill out an online based self-administered questionnaire to assess AD severity and psychological distress using the Patient-Oriented Eczema Measure (POEM) tool and the Patient-Reported Outcomes Measurement Information System Itch Questionnaire Mood and Sleep instruments respectively. Only patients who fulfilled the inclusion criteria were included in the study. Data were analyzed using SPSS 22.0 version statistical software. Results: Among 507 participants with AD, allergic rhinitis, sinusitis, and asthma were the highest concomitant associations. About 42.8% of participants with very severe AD had moderate mood disturbance. Among participants with very severe AD, 66% of them were diagnosed more than 5 years ago, and 71% had their last AD symptoms less than 6 months ago. AD severity was significantly associated with female gender, longer disease duration, and more recent episodes of AD symptoms. Mood disturbances were significantly associated with AD severity, disease duration, and the presence of sinusitis (55.6%, P = 0.009). Conclusion: Given the high prevalence of mood disturbances among AD patients, it is critical for health-care professionals and caregivers to recognize the mental health impact of AD and incorporate appropriate psychiatric screening methods into the management plan of AD patients so that they can be properly assessed and referred for appropriate therapy.
