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   Table of Contents - Current issue
July-December 2019
Volume 23 | Issue 2
Page Nos. 57-112

Online since Friday, July 26, 2019

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Artificial intelligence and dermatologists: Friends or foes? p. 57
Ahmad Alabdulkareem
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Stem cell therapy and hair loss: Present evidence and future perspectives Highly accessed article p. 61
Saad Sami AlSogair
Stem cells may have potential as a treatment for regenerating hair. Initially, methods to obtain stem cells have concentrated on isolating the primary cells from the tissue of interest through biopsy and growing these cells outside the body to be transplanted into the patient. Stem cell treatment of nonautoimmune hair loss like androgenetic alopecia is promising. Although an autologous transplant is viewed as the standard, its use is limited because of a lack of data and the diminished viability of cells that are made available using this method. Adipose-derived stem cells are a promising alternative because of their limited immunogenicity. They are easy to obtain, are multipotent, and can differentiate into different cell lines. They also have significant potential for angiogenesis. More studies are needed to establish the efficacy of the various types of stem cell-based treatments for people with hair loss.
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Recent insights in atopic dermatitis pathogenesis, treatment, and disease impact p. 66
Madison Nguyen, Adrian Pona, Sree S Kolli, Steven R Feldman, Lindsay C Strowd
Atopic dermatitis (AD) is the most common inflammatory skin condition impacting patient quality of life. Although AD is widely studied, investigators have explored recent advancements in AD pathogenesis, treatment, and disease impact. Therefore, this article summarizes recent advancements in AD pathogenesis, treatments, and disease impact on patient quality of life. A PubMed search was conducted using the keywords: “atopic dermatitis AND pathogenesis,” “atopic dermatitis AND microbiota,” “atopic dermatitis AND dupilumab,” “atopic dermatitis AND JAK$ inhibitors,” and “atopic dermatitis AND quality of life.” Epidermal barrier dysfunction and immune dysregulation play a key role in the pathogenesis of AD. Although most AD patients express a filaggrin mutation, such mutation alone does not predict disease severity. Immune dysregulation is characterized by T-helper-2 responses in acute AD and Th1 responses in chronic AD. Skin microbiota abnormalities and sweat exacerbate symptomatology. Dupilumab targets the interleukin (IL)-4Rα and is the only Food and Drug Administration-approved biologic that effectively treats AD. Newer alternative agents for AD treatment include IL-12 and IL-23 inhibitors, IL-31R inhibitors, and JAK inhibitors. AD patients have increased anxiety, depression, and sleep disorders (P < 0.001) and skin pain (P= 0.02) compared to control. AD is influenced by the epidermis, immune system, genetics, microbiota, sweat, and environment. AD has lasting impacts on patients' mental and physical health. Dupilumab is an effective biologic for treating the condition.
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Surgical excision of sebaceous nevus in children: What are the risks? p. 73
Man Yee Paula Tang, Sih Yin Nicholas Chao
Background: Sebaceous naevus is a common dermatological condition seen in children. Evidence on the incidence and prevalence of the complication of surgical excision is lacking. Objectives: We aim to review our single center's experience in managing paediatric patients with sebaceous naevus in the past ten years. Methods: We retrospectively reviewed the clinical records of patients with surgical excision of sebaceous naevus performed in our center in the past ten years. Results: 70 surgical excisions of sebaceous naevus were reviewed. 13% were planned staged excision while 5.7% were unplanned revisional excision. 84% of the excision were performed under general anaesthesia and 4.2% were performed under local anaesthetics. Conclusion: A complication rate of 5.7% for unplanned second operation was noted for paediatric patients undergoing sebaceous naevus excision.
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Knowledge and use of isotretinoin in Saudi female college students: Cross -sectional study p. 76
Thuraya Ahmed Albadr, Danah Khalid Alruhaimi, Peter M B. Cahusac, Dileep Kumar Rohra
Background: The most effective treatment for severe acne is isotretinoin. However, it carries major side effects, such as teratogenicity, depression, and increased lipid profiles. It is advised to monitor the lipid profile and to use two forms of contraception during isotretinoin use. Although it is commonly prescribed, little data are available regarding patients' understanding of isotretinoin. Objectives: The aim of this study is to assess Saudi female college students' knowledge about isotretinoin use and side effects. Methods: Data were collected by a validated online questionnaire disseminated through social media, allowing the collection of information from students from different regions of the country. Results: The total number of responses was 622. The majority of respondents were 18–24 years old, single, and college students; all were female. About 48.6% (282) of the sample used isotretinoin. Most had good knowledge of isotretinoin side effects. Medical students were more knowledgeable than students of other majors, and users were more knowledgeable than nonusers. The most common side effect was dryness. Use among married females was 2.8%, the majority of whom were instructed by their physicians to use only one method of contraception. One respondent got pregnant while using the drug. Conclusion: College-aged females generally have good knowledge of isotretinoin and its side effects. However, awareness about proper contraceptive use while on the drug is lacking.
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Headcover and male-pattern hair loss: A cross-sectional study p. 81
Mohammed I AlJasser, Mohammed Alshaya, Khaled Alabduljabbar, Sara I Altraif, Sultan Aleshaiwi, Emad Masuadi
Background: Androgenetic alopecia (AGA) is the most common form of alopecia. The interaction of genetics and environmental factors likely plays a role in its pathogenesis. Several environmental factors have been studied in relation to the severity of AGA; however, the effect of headcover has not been properly assessed. Objectives: The objective of this study is to assess the severity of male-pattern hair loss (MPHL) in relation to headcover. Methods: Adult males with varying degrees of MPHL were recruited during the period from May 2016 to August 2017. Data included demographics and type of headcover. The total duration of headcover was calculated for every participant in years. Assessment of MPHL was performed using the Norwood–Hamilton classification. Results: A total of 865 participants with MPHL were enrolled. No statistically significant difference in the severity of MPHL was found between participants who covered their head frequently as compared to those who did not (P = 0.952). Multivariate logistic regression analysis showed that age was the only factor associated with increased severity of MPHL. Conclusions: Males who cover their head do not appear to have increased overall severity of MPHL.
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Labial Melanotic Macules in Atopic Dermatitis: An Observational Study p. 86
Mohammed I Aljasser, Joseph Lam, Harvey Lui, Sunil Kalia
Background: Labial melanotic macules (LMMs) are benign hyperpigmented macules of unknown etiology. They can affect one or both lips. Their description in patients with atopic dermatitis (AD) is limited in the published literature. Objectives: The aim of the study was to describe the clinical characteristics of LMMs developing in Canadian patients with AD. Methods: This observational retrospective study was conducted in the period from November 2012 to March 2014. All patients with AD and lip pigmentation were included. Data collected included demographics and other information including AD clinical features, presence or absence of cheilitis, and lip pigmentation characteristics. Results: A total of 27 patients with LMMs and AD were enrolled. The condition was more common in females with a female: male ratio of 2.4:1. The median age at presentation was 16 years, and a majority of patients were Asian and had a prior history of cheilitis. There was a strong correlation between the duration of cheilitis and duration of LMMs (ρ =0.735, P= 0.001). Lesions presented as oval or round light-to-dark brown macules with a smooth border. The majority of patients (93%) had multiple LMMs and had involvement of both lips. Conclusion: Multiple LMMs are seen in Asian patients with AD and are associated with preceding cheilitis. LMMs secondary to AD should be considered among the differential diagnosis of lip pigmentation.
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Carbamazepine-Induced Stevens–Johnson Syndrome and HLA-B*1502 Screening among First-degree Relatives of Index Patients p. 90
Siqing Ee, Siew-Kiang Tan, Yong-Kwang Tay
Background: Carbamazepine (CBZ) is often implicated in drug-induced Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). CBZ-induced SJS/TEN is strongly associated with the HLA-B*1502 allele in Southeast Asia. Objectives: The objective was to determine the prevalence of HLA-B*1502 allele in patients with CBZ-induced SJS/TEN and in their first-degree relatives. Materials and Methods: Ten cases of CBZ-induced SJS/TEN from a single center were contacted and offered HLA-B*1502 genotyping for themselves and their first-degree relatives. Eight patients and 12 relatives consented for genotyping. Results: HLA-B *1502 was positive in all patients who were tested, of whom 50% of them were Malay and 50% were Chinese. The frequency of the HLA-B*1502 allele in the first-degree relatives was 58%. Conclusion: HLA-B*1502 is common in first-degree relatives of patients with CBZ-induced SJS/TEN.
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A tender plantar swelling p. 93
Manal Alsabbagh
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Dermatologic approach to an umbilical mass p. 95
Joan Fernandez, Jacqueline A Guidry, Ida Orengo
The potential for bowel perforation in dermatology is rare; however, perforation remains an important consideration for lesions in and around the umbilicus. We present a case of a 74-year-old female who presented to the outpatient dermatology office for evaluation and biopsy of an umbilical mass. Due to the location, biopsy was deferred and the patient was sent for surgical consultation. The patient was later diagnosed with an incarcerated ventral hernia. We will discuss the differential diagnosis of umbilical masses and the possible complications associated with performing biopsies on lesions in this area.
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Liraglutide-induced injection site reaction p. 97
Nada Fouda Neel, Yasser Ghobara, Mohammed Turkmani
Liraglutide is an antidiabetic drug given subcutaneously for weight reduction. We report a 35-year-old woman who presented with a rash after starting liraglutide. The rash consisted of erythematous well-defined plaques surrounded by ecchymotic patches on extensor aspects of the thighs at the sites of liraglutide injection with gradual onset and progressive course. The exact cause of the reaction is unknown. The eruption resolved after discontinuation of treatment.
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Cutaneous metastasis of carcinoma tongue: A rare case report p. 99
Kuldeep Verma, Mudita Gupta, Anchana Gulati, Reena Kumari Sharma
Carcinoma of the oral cavity is one of the most common cancers of the head-and-neck region with frequent metastasis to internal organs, especially the lungs, liver, and bone. However, cutaneous metastasis of head-and-neck squamous cell carcinoma is rarely reported in the literature, with only a few cases reported in the past. Here, we report a case of relapse of squamous cell carcinoma of the tongue which metastasized to the upper trunk region.
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Isolated cutaneous epithelioid hemangioendothelioma of the nose: Case report and comprehensive literature review p. 102
Anwar Alramthan, Aida Abdulkader, Mohammed Alenezi
Here, we report a rare case of isolated cutaneous epithelioid hemangioendothelioma (EHE) occurring on the nose of a 56-year-old female patient, without any systemic involvement. This article will also briefly highlight the clinical, pathological, as well as the molecular features of EHE.
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Epidermolysis bullosa Simplex-Dowling–Meara mimicking epidermolysis bullosa simplex with mottled pigmentation p. 106
Wei-Liang Koh, Yong-Kwang Tay
Epidermolysis bullosa simplex-Dowling–Meara (EBS-DM) variant is an autosomal dominant blistering genodermatosis due to mutations in genes coding for keratin 5 (K5) or keratin 14 (K14), specifically at the rod domain. Postinflammatory dyspigmentation can arise at sites of blistering, sometimes in a reticulate or mottled configuration. This mimics EBS with mottled pigmentation (EBS-MP), usually due to mutation in the head domain of K5, for which the pigmentation is not preceded by blisters. We report a case of an adult Malay male with recurrent blisters and mottled hyperpigmentation over his trunk and limbs, consistent with EBS-DM clinically, and confirmed on genetic mutation sequencing. Different K5 or K14 mutations, by altering keratinocyte adhesion and interfering with melanin pigment transport, can lead to variable phenotypes of skin fragility and/or hyperpigmentation, possibly modulated by other genetic or environmental factors.
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Cirsoid aneurysm of upper eyelid p. 109
Gaurish Laad, Bhushan Madke, Balkrishna Nikam
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Erratum: Idiopathic Aquagenic Syringeal Acrokeratoderma p. 111

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Retraction: Successful use of combined corticosteroids and rituximab in a patient with refractory cutaneous polyarteritis nodosa p. 112

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