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   Table of Contents - Current issue
January-June 2019
Volume 23 | Issue 1
Page Nos. 1-55

Online since Friday, January 25, 2019

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We don't see things as they are; We see them as we are p. 1
Sree S Kolli, Steven R Feldman
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Surgical options in hidradenitis suppurativa p. 2
Sree S Kolli, Adrian Pona, Abigail Cline, Malcolm Marks, Steven R Feldman, Rita O Pichardo
Hidradenitis suppurativa is a chronic, debilitating disease managed by both medications and surgical therapies. The purpose of this study is to determine the indications for surgical therapies and compare the various surgical options for the treatment of hidradenitis suppurativa. A PubMed search found 32 articles on surgical therapies for hidradenitis. Search terms included hidradenitis suppurativa, cryoinsufflation, laser therapies, reconstructive surgery, and surgical therapies. About 88.9% of patients with Hurley Stage II/III are referred to surgery. Wide excision is superior to local excision based on consistently lower recurrence rates and high patient satisfaction. Healing by primary closure is inferior to skin graft and flap. Recurrence rate is most dependent on disease severity rather than the type of surgical procedure. Surgical options are offered alongside medical therapies as part of the treatment protocol. Procedures range from minimally invasive to aggressive therapies with variable recurrence rates. Minimally invasive surgeries produce better results in Hurley Stage I/II and aggressive options, such as wide excision, are superior to other options in patients with the more severe disease. Poor surgical candidates include those with comorbidities such type 2 diabetes mellitus which limits the use of more aggressive surgical interventions.
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Acne vulgaris: Prevalence, predictors, and factors influencing quality of life of female medical students at King Abdulaziz University, Jeddah Highly accessed article p. 7
Nahla Khamis Ibrahim, Sarah Abdulaziz Nagadi, Haifa Jamal Idrees, Logain Ghazi Alghanemi, Rawan Ishaq Essa, Walaa Sadik Gari
Context: Acne vulgaris is the most frequent skin condition that reduces patients' quality of life (QOL). Aims: The aim of the study is to determine the prevalence, clinical manifestations, predictors, and factors that influence QOL of female medical students with acne at King Abdulaziz University Hospital (KAUH), Jeddah. Settings and Design: A cross-sectional design was conducted at KAUH, Jeddah. Subjects and Methods: Four-hundred participants were selected through a stratified random sampling technique during the educational year 2016/2017. Data collection included the “Acne-Specific Quality of Life Questionnaire (Acne-QOL)” and “Hospital Anxiety and Depression Scale (HADS).” Clinical examination was conducted by a female clinician, with grading of acne by the global acne grading system. Statistical Analysis Used: Descriptive and inferential statistics were done. Logistic regression analysis was conducted. Results: The prevalence of acne among medical students was 58.8%. Combined type of acne was the most common clinical presentation. Predictors of acne were stress (P < 0.001), menstrual flaring (P < 0.001), and family history of the condition (P < 0.01). Females with severe acne had the lowest score (worse QOL) of all QOL domains compared to others (P < 0.05). Most of QOL domains were lower among students with psychological problems, anxiety, and depression (P < 0.5). Conclusions: Acne is prevalent among female medical students. Stress, menstrual flaring, and family history were the predictors. Acne-QOL was influenced by the severity of acne, psychological problems, anxiety, and depression. Screening of acne, with holistic management approach (by dermatologists and psychologists), is recommended.
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Women's experiences regarding isotretinoin risk reduction counseling in Riyadh p. 13
Shoug Algoblan, Sehrish Bakhsh, Ru'aa Alharithy
Context: Isotretinoin is an effective acne treatment and a known teratogen. Contraception counseling may reduce isotretinoin-exposed pregnancies. Aims: The aim of the study is to assess the efficacy of contraception counseling in married females of childbearing age who are on isotretinoin or have used isotretinoin in the past 6 months. Settings and Design: This cross-sectional study in dermatology clinics at multiple centers in Riyadh, Saudi Arabia, between June and November, 2017. Subjects and Methods: Cross sectional study using surveys filled out by married women of child bearing age who were taking isotretenoin during the past 6 months. The questionnaires were distributed in paper as well as electronic version. Statistical Methods Used: Descriptive analysis was primarily done. Results: Most of the patients who received isotretinoin belong to the age group of 33–40 years, married females. Doctors discussed teratogenicity risks in 81% of the patients, but only 44% of patients received written information about risks and 52% signed the consent form. Contraception methods were discussed in 58% of patients. Only 49% of patients were advised to start contraception 1 month before starting isotretinoin. About 79% did not do pregnancy tests while on isotretinoin. Conclusions: This study has identified a gap in risk reduction counseling in married females who are on isotretinoin. Measures such as providing written materials explaining teratogenicity risks associated with isotretinoin, referring patients to specialist for starting contraception before prescribing isotretinoin, and ensuring strict adherence to monthly pregnancy test starting 1 month before, during, and 1 month after the treatment may help minimize the teratogenicity risk.
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Knowledge, attitude, and misconceptions of public regarding vitiligo p. 16
Fawwaz Freih Alshammrie, Ibrahim G Al Reshidi, Maram O Al Rashidy, Salwa M Al Anazi
Background: Previous studies of vitiligo have discussed attitudes of vitiligo patients toward their disease. However, few studies have addressed this issue from the public's point of view. Objectives: The main objective is to explore the knowledge, perceptions, misconceptions, and attitudes of the public toward vitiligo. Subjects and Methods: This cross-sectional survey was done using a self-constructed questionnaire. Participants were recruited from the students and employees of Hail University from April 1, 2015 to the end of November 2015. The data were collected and analyzed using Statistical Package for the Social Sciences (SPSS release 20.0). P < 0.05 was accepted for statistical significance. Results: The study included 1004 participants; 440 (43.8%) were male and 564 (56.2%) were female. 231 participants (23%) had no information about vitiligo (P = 0.011). 90.2% of the participants reported that available sources of information about the disease in general are not enough. The main source of information for males and females was the internet. Majority of surveyed participants believed that vitiligo is an inherited disease (59%). Conclusion: The misconceptions and negative attitudes about vitiligo among public are generally prevalent. Educating the public about vitiligo could lead to increased self-confidence, psychological well-being, and resulting in better adaptation of vitiligo patients in the society.
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Hair smoothing treatments: Perceptions and wrong practices among females in Saudi Arabia p. 20
Bushra Algarni, Shahad Alghamdy, Faten Abdullah Albukhari, Rola Almasri
Introduction: In the last few years, smoothing hair treatments has taken the Saudi cosmetic industry by storm, all containing various levels of formaldehyde, a classified carcinogen by The World Health Organization (WHO), International Agency for Research on Cancer (IARC), United States Environmental Protection Agency (EPA) and Oregon Occupational Safety and Health Division (Oregon OSHA). With the lack of studies –in Saudi Arabia and worldwide- the level of public awareness and their malpractice is questionable. Materials and Methods: Online and paper self-administered questionnaires were distributed over 1039 females. Including questions assessing knowledge on hair treatments, previous experiences and side effects. Results: (60%) of participant had a poor knowledge score. When asked if formaldehyde is a carcinogen, (70.5%) did not know and (5.1%) answered incorrectly. (33.5%) of participants had done hair treatments before, but (52.3%) didn't read about them prior. The major motive was to facilitate hair management (76.1%). (57.5%) of participants said their hair wasn't examined before the treatment, and only (31%) applied scalp barriers. Flat irons were used in most cases (83.6%). Most importantly, (55.2%) did not know if the product used contains formaldehyde, and (15.2%) used formaldehyde-containing products. The majority (74.7%) reported having side effects, mostly hair fall (56.9%) and dandruff (30.5%). When asked if they would consider using hair treatments again, (61.2%) said no, mainly because of the damage and side effects (90.6%). Limitations: Majority of participants being from the central region of Saudi Arabia and the limited older age group (9.6%). Conclusion: Recently, in 2016, the Saudi Food and Drug Authority published a warning article on four products found in local markets containing high levels of formaldehyde. This shows the lack of industrial supervision and consumers protection and the need of strict monitoring regimens in stores and beauty salons. Future studies should be applied in assessing the public's misconceptions and practices, along with campaigns and social media efforts to raise the overall knowledge.
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Comparative study of efficacy of radiofrequency ablation, electrodesiccation, and cryosurgery in the treatment of cutaneous warts p. 24
Prashansa Jaiswal, Tapan Kumar Dhali, Paschal D'Souza
Background: Even though the older and most common treatment for the wart is a destructive method, there is no published randomized control trial comparing the efficacy of radiofrequency ablation, electrodesiccation, and cryosurgery in warts. Objective: The objective of the study is to compare the efficacy and adverse effect of radiofrequency ablation, electrodesiccation, and cryosurgery in the treatment of cutaneous warts. Methods: It was a randomized control trial. Seventy-five patients were randomly divided into three groups of radiofrequency ablation A (Group A), electrodesiccation (Group B), and cryosurgery (Group C) with a sample size of 25 per group by the computer-generated randomized table. Clinical cases of common and plane warts with age >12 years were included in the study. The assessment was based on the reduction of the total surface area of the reference lesion(s), pigmentation, scarring, reappearance of dermatoglyphics, and patient's satisfaction. Results: Complete cure in Group A was 22 (95%), in Group B was 17 (73%), and in Group C was 14 (58%) which was statistically significant (P ≤ 0.001). Majority (>90%) of the patients were very much satisfied with treatment outcome, particularly with radiofrequency which was statistically significant (P = 0.001). Conclusion: Radiofrequency was seen to have the highest cure rate.
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Clinicopathological correlation of leprosy and response to treatment in Eastern Saudi Arabia p. 30
Omar M Alakloby, Adnan Suliaman Alabdulkareem, Salih Hamad M Aljabre, Mohammad A Randhawa, Esra Omar Alakloby, Abdullah Salih Aljabr, Afnan Majed Almutairi
Background: Leprosy is a chronic, progressing, and disabling disease caused by Mycobacterium leprae, predominantly affecting the skin and peripheral nerves. Aim: The aim is to study clinicopathological correlation and response to treatment in leprosy patients attending King Fahd Hospital of University (KFHU), Al-Khobar, Eastern Saudi Arabia. Methodology: Records of all cases attending Dermatology Department of KFHU from 1985 to 2005 and labeled clinically as leprosy were retrieved. Their clinical data and histopathologic slides were reviewed. Many of the expatriates left Saudi Arabia after diagnosis. The remaining ones and Saudi nationals received the WHO standard treatment for 12 months and 18 months for paucibacillary and multibacillary leprosy, respectively. Results: Among 87 cases, there was a good clinicopathological correlation; the most common forms of leprosy clinically and histologically were of borderline leprosy (BB), 31 (35.63%) and 34 (39.08%), followed by tuberculoid type (TT), 22 (25.29%) and 27 (31.03%); lepromatous leprosy, 18 (20.69%) and 17 (19.54%); erythema nodosum leprosum (ENL), 6 (6.9%) and 5 (5.75%); indeterminate leprosy, 4 (4.6%) and 4 (4.6%); and nonspecific, 6 (6.9%). Thirty-two patients received the WHO standard treatment for paucibacillary and multibacillary leprosy, respectively; all cases showed complete clinical improvement with 24-month follow-up, except for two paucibacillary cases who developed ENL and lost follow-up after 16 months. Conclusions: There was a good clinicopathological correlation. The response to treatment was good in those who continued treatment and better in TT than lepromatous type of leprosy.
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Novel genetic inheritance with a rare presentation of Adams–Oliver syndrome p. 35
Abdullah Abualait, Salaheldin Alfadni, Hala Edris, Mohammed Alshahrani, Mohamed Hanifa, Tariq Aziz, Wifag Alobeid, Ayed Al-Mordy
Adams–Oliver syndrome (AOS) is a rare heterogeneous inherited disorder, characterized by the combination of the congenital scalp and terminal transverse limb defects. Various expressions of AOS have been reported. Most cases of the syndrome appear to follow autosomal dominant inheritance, but autosomal recessive inheritance has also been reported. However, genetic inheritance involving both autosomal recessive and dominant genes within the same patient was not previously reported. We report a newborn case of AOS with novel genetic profile and a rare clinical presentation.
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Extensive onychomycosis in a patient with good syndrome p. 38
Ghadah AlHammad, Hatoun AlMaziad, Rayan AlKhodair
Thymoma with immunodeficiency was first reported by Dr. Robert Alan Good and was termed Good Syndrome. It is a rare acquired immunological disorder with <200 cases reported in the literature. Although described more than 60 years ago, the syndrome is still largely underrecognized by physicians who deal with the variable manifestations in the absence of diagnostic criteria. Here, we describe a patient with Good Syndrome diagnosed with extensive candidal onychomycosis. The patient had a history of excised thymoma and had myasthenia gravis. Further, laboratory investigations showed very low B-cells, CD4 helper T-cells and reduced CD4/CD8 consistent with the described abnormalities associated with Good Syndrome in the literature. Atypically severe variants of onychomycosis could indicate the presence of an immunodeficiency.
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Pantoea agglomerans cutaneous infection p. 41
Nwanneka Okwundu, Jessica Mercer
Pantoea agglomerans is a rare Gram-negative bacterium most often implicated in plant diseases and opportunistic organ system infections in immunocompromised humans. Because P. agglomerans uncommonly causes skin infections and presents with nonspecific clinical and histological findings, dermatologic diagnosis may be delayed. Our patient had a unique skin eruption that persisted after multiple treatment regimens and was finally diagnosed as P. agglomerans cutaneous infection. It is important for clinicians to consider this uncommon skin infection in their differential diagnosis of erythematous papules and vesicles with systemic symptoms. Diagnosis is via bacterial culture as histology is usually nonspecific and may not offer a conclusive diagnosis. Risk factors that may be clues to this infection include the occupation of farming, recent hospitalization, immunosuppression, and skin compromise in the form of open wounds.
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Eruptive milia associated with isotretinoin p. 44
Saad Mohammed Altalhab, Rasha Abdulaziz Zainalabidin
Isotretinoin is the most effective treatment for severe acne, although its potential side effects and monitoring requirements restrict its use. We are reporting eruptive milia of the eyelid/periorbital area associated with low-dose isotretinoin treatment in three adults.
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Idiopathic aquagenic syringeal acrokeratoderma p. 46
Nwanneka Okwundu, Stephanie Snyder-Howerte, John Young, Bill William Lear
Aquagenic syringeal acrokeratoderma (ASA), also known as transient reactive papulotranslucent acrokeratoderma, is an uncommon disorder that usually affects the palms. It is characterized by transient, translucent, white papules and plaques that develop upon exposure to water. Skin lesions are typically accompanied by itching and burning sensation. While many theories exist in regard to the etiology of this condition, we present a case of ASA that appears to be idiopathic in nature.
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Fibroepithelioma of Pinkus masquerading as a widely distributed papulosquamous disease p. 49
Anwar Alramthan, Moushira Elbohy, Manaf Shaban, Mohammed Alenezi
Fibroepithelioma of Pinkus (FeP) is generally considered a rare tumor that usually presents as a solitary lesion. Multiple tumors are extremely exceptional and usually associated with certain risk factors. We are presenting a peculiar case of FeP presenting with multiple scaly erythematous papules and plaques masquerading as a papulosquamous disease. This patient had no risk factors that could predispose him to develop multiple skin tumors. Up to our knowledge, the case we are reporting is the fourth case in literature of multiple FeP without a history of antecedent radiation and occurring independently of genetics diseases predisposing to skin malignancy.
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Apocrine hidrocystomas: An unusual case presentation and review of literature p. 52
Khalid Ali Al Hawsawi, Luai Mohammed Assaedi, Amnah Gefri, Rahaf Bukhari
Apocrine hidrocystomas (AHs) are cystic benign lesions of the skin that originates from the apocrine sweat glands. It is usually solitary and occasionally multiple. Herein, we report an unusual case of multiple apocrine hidrocystomas. A 65-year-old Saudi male patient presented with asymptomatic recurrent skin lesions on his face for 2 years. The skin lesions appear during hot weather and regress in cooler temperatures. Skin examination revealed multiple skin-colored papules around both the eyes. Skin biopsy showed normal epidermis. The dermis showed cystic structure lined by columnar epithelium with decapitation secretion and some apical snouts. Based on the above clinicopathological findings, the diagnosis of AHs was made. The patient was reassured.
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Hidradenitis suppurativa: Presenting at atypical sites p. 55
Mahmood Dhahir Al-Mendalawi
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