Common Dermatological Disorder Research Articles

Impact of vitamin D on ultraviolet-induced photoaging and skin diseases

Excessive exposure to ultraviolet (UV) radiation causes premature aging of the skin, known as photoaging. UV radiation induces DNA damage, oxidative stress, inflammatory reactions, and degradation of extracellular matrix (ECM) proteins, contributing to the aged skin phenotype. The skin synthesizes vitamin D upon UVB exposure, which plays a pivotal role in the proper function of multiple body systems. Vitamin D protects skin from photo-damage by repairing cyclobutane pyrimidine dimers, reversing oxidative stress, and reducing chronic inflammation. Moreover, various epidemiological studies have identified vitamin D deficiency as a marker for common dermatological disorders. Improvement of clinical outcomes with vitamin D supplementation further suggests its protective role against skin pathologies. This review comprehensively covers the involvement of vitamin D in combating UV-induced photoaging and various skin disorders, highlighting the significance of maintaining vitamin D adequacy for healthy skin.

Non-Cicatricial Alopecia and Its Association with Anthropometric Measurements and Nutritional Laboratory Markers.

Alopecia constitutes one of the most common dermatological disorders, and its steadily increasing prevalence is a cause for concern. Alopecia can be divided into two main categories, cicatricial/scarring and non-cicatricial/non-scarring, depending on the causes of hair loss and its patterns. The aim of this study was to investigate the relationship between anthropometric and nutritional laboratory parameters in Caucasian adult women and men with non-cicatricial alopecia. A total of 50 patients (37 with non-cicatricial alopecia and 13 healthy controls) were included in the study. Clinical examination and scalp trichoscopy were performed. The anthropometric and nutritional laboratory parameters were collected and analyzed. No statistically significant differences in the laboratory findings were found. The patients with non-cicatricial alopecia were statistically significantly younger as compared to the controls. An elevated risk of hair loss, which was detected among the younger participants, might be associated with a modern lifestyle and the so-called 'Western diet'. It seems safe to assume that suboptimal nutrition and poor eating habits during childhood might constitute risk factors for early hair loss.

Evaluation of the effectiveness of Berberis integerrima Bunge root extract combined with spearmint essential oil in the treatment of acne vulgaris: A randomized controlled clinical trial.

Acne vulgaris is one of the most common dermatological disorders. Berberis integerrima Bunge belongs to the Berberidaceae family. Several studies on different Berberis species in addition to B. integerrima have shown antimicrobial, antioxidant, and anti-inflammatory effects. Spearmint essential oil also has antioxidant, antibacterial, and anti-inflammatory activities. This study aimed to evaluate the clinical effectiveness of the topical combination of B. integerrima root extract and spearmint essential oil in the treatment of acne vulgaris. Patients with mild to moderate facial acne who met the inclusion criteria were randomly assigned to either drug (B. integerrima extract/spearmint essential oil topical solution) or control (clindamycin 1% topical solution) groups. Each group applied the solution twice a day for 4 weeks. Before and at the end of the intervention, the number of lesions and mGAGS (Modified Global Acne Grading Scale) score were recorded. Thirty patients in each group of drug and control completed the study. Topical B.integerrima root extract/spearmint essential oil significantly reduced the number of lesions (27.33 ± 26.17 vs. 21.58 ± 21.10; p < 0.001) and mGAGS (18.76 ± 8.61 vs. 13.87 ± 8.14; p < 0.001) at the end of the intervention. However, there was no significant difference between the two groups regarding the number of lesions (p = 0.906) and mGAGS (p = 0.882). B. integerrima root extract combined with spearmint essential oil has significant anti-acne effects, comparable to topical antibiotic clindamycin. It could be considered as a potential treatment for acne vulgaris. However, more studies with larger sample sizes and longer durations are required to confirm this effect.

Maintenance Acne Treatment With Topical Tazarotene after Oral Isotretinoin: Overview and Case Reports

Introduction: Acne vulgaris is a common dermatologic disorder that may require treatment over months or years. Acne negatively impacts quality of life, and acne of any severity increases the risk of long-term sequelae such as scarring. Common treatments for severe/nodulocystic acne include oral isotretinoin, an oral antibiotic combined with a topical (benzoyl peroxide or a retinoid), an oral combined contraceptive, or oral spironolactone (females). Though oral antibiotics and isotretinoin are not recommended for long-term use, there is scarce guidance or published research on maintenance therapy. Topical retinoids—a mainstay of initial acne treatment—may be prescribed for maintenance once initial oral treatments are complete. Additionally, some retinoids such as tretinoin and tazarotene are indicated for the treatment of fine wrinkles and certain pigmentation disorders, and some studies have shown that adapalene and tazarotene may also reduce acne-induced scarring. Tazarotene 0.045% polymeric emulsion lotion is a well-tolerated retinoid that has demonstrated efficacy in acne treatment and may reduce acne-induced post-inflammatory hyperpigmentation (PIH) and melasma. Further, tazarotene lotion provides rapid and sustained improvements in skin barrier function/moisturization. Herein is presented a report of patients with acne who received maintenance treatment with topical tazarotene 0.045% lotion after an initial course of oral isotretinoin.&#x0D; Methods: Patients with severe recalcitrant acne vulgaris were treated with once daily oral isotretinoin for at least 20 weeks until deemed clinically clear. All patients received 40 mg isotretinoin once daily for the first 30 days. The dosage was then increased to 1 mg/kg of bodyweight (treatment naïve) or 1.5 mg/kg (repeat treatment). After 20 weeks, patients who achieved clinically clear skin initiated once-daily topical tazarotene 0.045% lotion monotherapy on the day of their last isotretinoin dose. Follow up visits occurred at 6 months and 1-year post-isotretinoin treatment.&#x0D; Results: Patients (n=12) had a mean age of 17.8 years (standard deviation [SD]: 3.8) and the majority were female (58.3%) and White (66.7%). Oral isotretinoin was used for an average of 24.3 weeks (SD: 6.7), with a mean cumulative dose of 184.6 mg/kg. One patient required a repeat course of isotretinoin prior to tazarotene initiation. Post-isotretinoin, patients received tazarotene 0.045% lotion for an average of 13.0 months (SD: 6.7). No patients relapsed and all showed subjective visual improvements in acne-related scarring with tazarotene maintenance treatment. None discontinued tazarotene lotion due to adverse events. &#x0D; Conclusions: There is little guidance or research published on acne maintenance treatment after initial oral isotretinoin or other treatments are complete. Topical tazarotene 0.045% polymeric emulsion lotion has previously demonstrated good efficacy, safety, and tolerability with acne and PIH reductions in patients with moderate-to-severe acne, as well as dyspigmentation reductions in patients with melasma and/or PIH. The case reports presented here show that tazarotene 0.045% lotion may be an effective and safe treatment to prevent relapse after initial oral isotretinoin treatment for severe recalcitrant acne.&#x0D; Funding: Ortho Dermatologics

Dietary Influences on Skin Health in Common Dermatological Disorders.

The role of diet in the development of skin disorders is well-established, with nutritional deficiency often identified as a risk factor for skin diseases. Imbalances in the skin can be caused by nutritional deficiencies, excessive intake, insufficient nutrients, and hazardous ingredients. Patients frequently inquire about the impact of dietary patterns on skin health when consulting dermatologists in clinical settings. Simultaneously, the popularity of using nutritional supplements containing vitamins, minerals, and nutraceutical blends has been on the rise. It is crucial for dermatologists, primary care physicians, and other healthcare providers to be acquainted with evidence-based dietary interventions, distinguishing them from those that are more market-driven than truly efficacious. This review explores the modification of diet, encompassing both dietary exclusion and supplementation, as a therapeutic approach for conditions such as psoriasis, atopic dermatitis, bullous disease, vitiligo, and alopecia areata. A comprehensive literature search, utilizing the PubMed/Medline, Google Scholar, and Medscape databases, was conducted to investigate the relationship between each nutrient and various inflammatory skin diseases. The findings emphasize the significance of a well-balanced and thoughtfully planned diet in supplying adequate amounts of proteins, vitamins, and minerals to support optimal skin health. Additionally, this comprehensive review navigates through various dietary recommendations, offering insights into their multifaceted impacts on the immune system, gut microbiome, and skin health. The goal is to pave the way for informed and targeted dietary interventions for individuals dealing with food allergies and associated skin conditions.

Liposomes and Other Nanocarriers for the Treatment of Acne Vulgaris: Improved Therapeutic Efficacy and Skin Tolerability.

Acne vulgaris is a common dermatologic disorder that affects approximately 85% of teenagers, which significantly impacts the quality of life in adolescents. It is a chronic disease of the sebaceous follicles that is multifactorial in etiology. Topical treatment is the first choice for mild and moderate acne, while systemic therapy is reserved for severe and certain moderate cases. Topical treatments include retinoids (e.g., tretinoin and adapalene), antibiotics (e.g., clindamycine), and other agents (e.g., benzoyl peroxide and azelaic acid), often applied in combination. The mechanisms of action include antimicrobial, anti-inflammatory, and keratolytic activities, as well as sebum secretion reduction, and the normalization of follicular keratinization. However, these topical agents commonly induce side effects, such as dryness, burning, stinging, peeling, redness, erythema, and photosensitivity. Therefore, there is a need to reduce the side effects of anti-acne drugs, while maintaining or enhancing their therapeutic effectiveness. This article aims to comprehensively outline nanotechnology strategies, particularly the use of phospholipid-based nanocarriers like liposomes and related vesicles, to enhance therapeutic efficacy, skin tolerability, and patient compliance in the treatment of acne vulgaris. In addition, novel active ingredients encapsulated in vesicles beyond those recommended in official guidelines are discussed.

Skin Cancer

ABSTRACT Basal cell nevus syndrome is a genetically linked multisystem disorder with a hallmark tendency for development of multiple basal cell carcinomas at a young age. It is associated with a multitude of other anomalies including keratocytes of the jaw, palmar or plantar pits, and ectopic intracranial calcifications. This disease is most commonly caused by loss of function in tumor suppressor gene PTCH1 resulting in overactivation of the Hedgehog pathway and basal cell carcinoma formation. Diagnosis is largely clinical; patients must meet criteria of both major and minor categories. Genetic testing is warranted in specific situations where clinical diagnosis is unclear or for genetic counseling purposes. Given that basal cell carcinoma is a very common dermatologic disorder, it is important to recognize when it arises in the setting of genetically associated diseases. Early detection allows for proper management and surveillance of not only basal cell carcinomas but also the other multisystem effects of basal cell nevus syndrome. This review gives an in-depth overview of the etiology, pathogenesis, diagnosis, and management of basal cell nevus syndrome.

Oral lichen planus post COVID-19 vaccination: report of two cases

Manifestations of сoronavirus disease 2019, caused by SARS-CoV-2 virus, are diverse and can vary from asymptomatic infection to respiratory failure needing intensive care. Vaccines against SARS‐CoV‐2 focusing on the spike glycoprotein have shown promise in diminishing the spread of Covid‐19. Adverse effects, however, are associated with every vaccination. Currently, there are literature reports of some cases of lichen planus eruption following COVID-19 vaccine injection. Oral lichen planus is a relatively common immune-mediated dermatologic disorder that can occur isolated or associated with cutaneous lichen planus. Postvaccination lichen planus has previously been reported in the literature as a rare adverse event following various vaccinations, especially hepatitis A and B, influenza, and varicella. The majority of patients presented with classic cutaneous lichen planus, although some reports highlighted primarily mucosal involvement. Herein we describe two rare cases of erosive-ulcerous oral lichen planus among SARS-CoV-2 vaccine recipients. The first is a case of a 67-year-old male who developed mucocutaneous lichen planus 5 days after administration of the single-dose of Ad26.COV2.S COVID-19 vaccine. In the second case, a 56-year-old female presented with reactivation of oral lichen planus after receiving a first dose of Pfizer COVID-19 vaccination 2 days earlier. The mechanism of the association between vaccines and lichen planus is not known, it is attributed to cell-mediated autoimmunity. Although there is currently no evidence of a causal relationship between SARS-CoV-2 vaccination and lichen planus, these clinical observations suggest that the COVID-19 vaccine is a possible key initiating event leading to the development or recurrence of this disease.

Anxiety and depression in patients with hand eczema: A population-based study among 853 middle-aged subjects.

Hand eczema (HE) is a common dermatological disorder with considerable effect on the health-related quality of life (HRQoL). The data on mental comorbidities of HE is sparse and mostly studied among selected patient groups. We aimed to investigate symptoms of depression and anxiety in patients with HE in general population. Study subjects (n = 6695) belonging to the Northern Finland Birth Cohort 1966 Study (NFBC1966) responded to an extensive health questionnaire including questions about HE. Depression and anxiety symptoms were evaluated according to the Hopkins Symptom Checklist-25 (HSCL-25). Having ever suffered from HE was reported by 853 (12.8%) study subjects. Symptoms scores of depression were significantly higher among (n = 172, 20.3%) HE subjects compared with (n = 884, 15.4%) subjects without HE (Odds ratio [OR] 1.40, 95% confidence interval [CI]: 1.17-1.68, P < 0.001). Correspondingly, symptoms scores of anxiety were also more common among (n = 90, 10.6%) HE subjects than among (n = 448, 7.8%) subjects without HE (OR 1.40, 95% CI: 1.10-1.78, P = 0.007). In an adjusted model, the associations remained statistically significant (OR 1.30, 95% CI: 1.08-1.57, P = 0.007 and OR 1.34, 95% CI: 1.04-1.72, P = 0.021, respectively). Symptoms associated with mental health should be taken into account when managing patients with HE.

A multicentric, prospective, observational study evaluating the practice pattern and use of fixed dose topical regimen for hyperpigmentation in intimate and high friction areas

Background: Hyperpigmentation is the third most common dermatological disorder and has major psychosocial impairment. It comes in a variety of forms. The most well-known are age spots, freckles, melasma and post-inflammatory hyperpigmentation. Hyperpigmentation in friction-prone areas (armpits, inner thighs, elbows, knees, groin, etc.) has a significant impact on affected individuals. Unfortunately, there are currently no well-tolerated options available that are intended particularly for these sensitive areas. Methods: Dermatologists across India were provided a questionnaire consisting of questions related to number of the patients seen with hyperpigmentation in intimate &amp; high friction areas every week and their clinical experience regarding the use of Pigmentbio Sensitive areas containing active ingredients (Andrographolide+Glabridin+Lysine azelate+Laminaria ochroleuca extract). The results were analyzed using a visual analogue scale. Results: The study included a total of 1402 patients, and 75 dermatologists provided complete responses. The majority (96%) of the dermatologists recommended Pigmentbio Sensitive areas for intimate &amp; high friction areas. These dermatologists also rated tolerability and safety of Pigmentbio Sensitive areas as "excellent" to "good" based on various criteria. These included tolerability after waxing and shaving the bikini line, soothing effect after mechanical erythema from taking off tight clothing, hydrating power when compared to other products, cosmetic acceptability for frictional and intimate areas, and safety on intimate areas. Conclusions: This study findings indicated that Pigmentbio Sensitive areas is a preferred formulation by dermatologists across India for the management of hyperpigmentation in intimate &amp; high friction areas with proven tolerability and safety.

A Case of Verrucae Resolution by Homoeopathic Medicine: A Case Report

Warts are one of the common dermatological disorders caused by human papilloma viruses encountered in our day to day life. These are cutaneous or mucosal infection needs proper care and treatment to prevent its transmission and complete healing. Although mostly warts are dealt with the therapeutic approach, i.e. on the basis of its peculiar type and location but it can even be successfully treated by constitutional approach. This article is regarding a case of warts treated successfully with Rhus Tox followed by Ferrum Met selected as the simillimum and proved its effectiveness in a short period of time.

RNA sequencing and metabolic analysis of imiquimod-induced psoriasis-like mice with chronic restrain stress

AimPsoriasis is one of the most common dermatological disorders, characterized by increased epidermal hyperplasia and immune cell infiltration. Psychological stress has been reported to contribute to the severity, aggravation, and relapse of psoriasis. However, the exact mechanism involved in psychological stress's impact on psoriasis is still unclear. We aim to investigate the role of psychological stress in psoriasis from a transcriptomic and metabolomic perspective. Main methodWe developed a chronic restrain stress (CRS)-imiquimod (IMQ)-induced psoriasis-like mouse model and performed a comprehensive comparative transcriptomic and metabolic analysis with control mice, CRS-treated mice, and IMQ-treated mice to investigate how psychological stress affects psoriasis. Key findingWe found that CRS-IMQ-induced psoriasis-like mice showed significant exacerbation of psoriasis-like skin inflammation compared with mice treated with IMQ only. Mice of the CRS + IMQ group showed increased expression of keratinocyte proliferation and differentiation genes, differential regulation of cytokines, and promotion of linoleic acid metabolism. Correlation analysis of differentially expressed genes in the CRS-IMQ-induced psoriasis-like mice and human psoriasis datasets compared with respective controls revealed 96 overlapping genes of which 30 genes showed consistent induced or repressed expression in all human and mouse datasets. SignificanceOur study provides new insights into the effects of psychological stress on psoriasis pathogenesis and the mechanisms involved, which provides clues for development of therapeutics or biomarkers.

Effects of argan spinosa oil in the treatment of diaper dermatitis in infants and toddlers: A quasi-experimental study

ObjectivesDiaper dermatitis (DD) is one of the most common dermatological disorders in children. Commonly used drugs for treatment have several adverse effects; therefore, assessment of safe therapeutic strategies is necessary. We, therefore, aimed at comparing the efficacy of argan spinosa oil and 1% hydrocortisone ointment on DD healing. MethodsA quasi-experimental study was conducted in Jordan on children 2 years old or younger with mild to severe DD. Initially, 73 participants were enrolled in the argan spinosa oil group, and 74 participants were enrolled in the 1% hydrocortisone ointment group. Participants were assigned to groups randomly after the baseline measurement of DD. Healing was measured on a 5-point scale on days 1, 3, and 7, through home visits. Data were analyzed with Fisher's exact test, the Mann–Whitney U test, and generalized estimating equation (GEE) models in SPSS version 25 software, with a significance level of p < 0.05. ResultsOf the 147 enrolled children, 140 completed the study. A significant decrease in the DD grades was observed in both groups. After the exclusion of confounding factors, the GEE models revealed that children treated with argan spinosa oil were approximately 0.25 times less likely to have severe DD grades and to show faster improvement than children treated with 1% hydrocortisone (p < 0.025). Multiple logistic regression on the baseline data revealed that the use of barrier cream (OR: 0.35; 95% CI: 0.18, 0.72; p = 0.004) and a frequency of bathing one or fewer times per week (OR: 1.15; 95% CI: 0.65, 2.10; p = 0.002) predicted DD occurrence. ConclusionArgan spinosa oil is more effective than 1% hydrocortisone in healing DD and might be used as a complementary treatment. However, further clinical trials on larger samples will be essential for confirming the results and making a reliable judgment. Trial registrationNCT04210674.

Magnitude and associated factors of Pityriasis Versicolor among patients attending Dermatovenereology Outpatient Department at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Pityriasis versicolor (PV) is a chronic superficial fungal infection caused by Malassezia species. It is the most common dermatologic disorder in tropical countries including Ethiopia and skin discoloration is the principal morbidity resulting from pityriasis versicolor. Therefore, this study assess the prevalence and associated factors of PV among patients attending Dermatovenereology clinic at the University of Gondar Comprehensive Specialized Hospital. Hospital based cross sectional study design was employed. Systematic random sampling was used and a total of 406 participants who attended Dermatovenereology OPD were included in the study. Data were collected by interview and physical examination. Then it was checked, coded, entered into Epi-Info version 7 and analyzed using Stata version 14. Both bivariable and multivariable logistic regression were employed to identify factors associated with PV. Adjusted odds ratio with their corresponding 95% CI and P-value were calculated. A P-value less than 0.05 was used to declare statistically significant variables. The overall magnitude of PV among patients attending Dermatovenereology OPD at the UGCSH was 12.6% (95%CI; 9.2%, 15.0%).Those who had a diploma and above education [AOR: 95% CI; 4.67 (1.18, 18.47)], excessive sweating [AOR: 95% CI; 4.75 ( 1.92, 8.76)] being male [AOR: 95%CI; 4.19 (1.92, 9.14)], practicing regular exercise [AOR: 95% CI; 4.11 (1.93, 8.76)] and wearing heavy clothes [AOR: 95% CI; 2.53 (1.24, 5.15)] were found to be statistically significantly associated with PV. This study found that the magnitude of Pityriasis versicolor was relatively lower. The study revealed that educational status (diploma and above), male gender, habit of regular exercise, excessive sweating and wearing heavy cloths were significantly associated with Pityriasis Versicolor. It is recommended that high risk patients receive close follow up and health professionals should provide health education sessions in waiting rooms about the identified risk factors.

ROLE OF GLYCOLIC ACID PEELING (35%) IN MANAGEMENT OF ACNE VULGARIS: A PROSPECTIVE COMPARATIVE STUDY

Introduction: Acne vulgaris is a common dermatological disorder primarily affecting adolescents and young adults. In spite of various modalities of treatment available, it still poses a therapeutic problem to the dermatologists. The advent of new and potent topical therapeutic modalities such as chemical peeling has resulted in signicant improvement in the treatment of acne. This study aims to observe the therapeutic res Objective: ponse of 35% glycolic acid peeling in active acne lesions as an adjuvant to conventional anti acne therapy. This Materials &amp; Methods: was randomized control study in which 100 patients of mild – moderate grade acne vulgaris were taken and divided into 2 groups of 50 each. Group A was given conventional anti acne management and group B was given Glycolic acid peeling every 3 weeks in addition to the conventional anti acne management. Follow up was done for 4 months and results were compared between the 2 groups. we found that acne grade improved faster in Group B patients (patients undergoi Result &amp; Conclusion: ng GLA peel). Although Group B patients showed faster improvement in clearance of acne lesions but by the end of the study i.e., at 15 weeks both the group had equal response rate. This means that glycolic acid peeling can be used as an adjuvant with conventional antiacne management to fasten the resolution of acne lesions but nal response after full course of treatment is similar in both group

CLINICAL EFFICACY AND SAFETY OF 20% SALICYLIC ACID PEEL IN PATIENTS OF MELASMA

Background &amp; Objectives Melasma is a common dermatological disorder resulting in the hyperpigmentation of most commonly face. Approximately 90% of all cases are female. Chemical peeling is a procedure, where certain chemicals of a particular strength is applied to the skin surface to produce controlled destruction of portions of epidermis and/or dermis that results in improvement of the color, skin texture , and supercial wrinkles due to regeneration of the epidermis and dermis. Chemical peels are the second line treatment of choice for melasma

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Few most common dermatological disorders like Psoriasis, Scabies, and lichen planus are described here. Knowing the common clinical features of the diseases would help physicians to diagnose the entity correctly which would prevent mismanagement of the disorder.

Effective Role of Teledermatology in Managing Chronic Urticaria Patients during the COVID-19 Pandemic

Sir, Chronic urticaria (CU) is a common dermatological disorder characterized by pruritus and weals with or without angioedema. More than 50 million patients are affected globally by CU.[1] Coronavirus disease 2019 (COVID-19) continues to be a threat even today, disrupting the healthcare systems and patient care. Patients with CU are also affected by the variable durations of lockdowns, social distancing measures, and travel restrictions. CU may be severe at times, requiring immediate medical care. However, usual patients of CU can be managed through teledermatology effectively. Teledermatology is a way of communication where personal information such as age, gender, medical history, and images of the skin lesions are shared by a patient to a physician. It can have real-time online consultation (synchronous) with a physician or can undertake sharing personal information through E-mails and messaging platforms (store-and forward technique, asynchronous), which is the most widely used method. Teledermatology can also be hybrid where both asynchronous and synchronous can be combined.[2] A multicenter study by Kocatürk et al.[1] which shared the experiences of Urticaria centers of Reference and Excellence (UCAREs) during this pandemic in managing CU found that there was a significant decrease in the face-to-face consultations during the pandemic due to obvious reasons and simultaneous increase in the teleconsultations by 600%. They have also mentioned that remote consultations have been a useful tool during the COVID-19 pandemic, but the long-term consequences of remote care of CU patients are yet to be characterized. There have been a few studies regarding the long-term outcomes of telehealth especially for allergy consultations. Waibel[3] found that both new and follow-up visits to the allergist were well complied by patients and demonstrated significant monetary savings. In another multicenter study by Waibel et al.,[4] tele-allergy supported most of the patients without in-person consultation with high patient satisfaction and significant time and cost savings. We have been interviewing and providing consultations to CU patients during the pandemic. Most of the old patients under follow-up are satisfied by the teledermatology. However, new-onset urticaria with fever needs attention and face-to-face consultation in lieu of early manifestation of COVID-19. CU patients do not require vigorous mucocutaneous examinations to be performed at every visit in face-to-face consultations. Patient’s disease exacerbations or control can be objectively calculated through the valid Urticaria Activity Scores over 7 days and Urticaria Control Test, which can well be filled and discussed through telephonic consultations or Internet and communication technologies (ICTs). Moreover, antihistamines dosages can also be titrated in CU patients with disease exacerbations or remissions through teledermatology and may alleviate the need to visit the centers amidst the pandemic. Patients have been treating using teledermatology with updosing of antihistamines or short course of corticosteroids to control CU. A recent study during the COVID-19 pandemic by Thomas et al.[5] which was performed in a tertiary allergy center with 23.2% of urticaria/angioedema referrals found that teleconsultation-based allergy service models may be more time and cost-effective and also improve patient accessibility to a specialized care. None of the studies during the literature search demonstrated any counter to remote consultation of urticaria/angioedema during the pandemic. It is also recommended to maintain the ongoing treatments with antihistamines and omalizumab during the present pandemic, but to be cautious with the use of immunosuppressives for CU.[1] This can well be monitored through teledermatology. However, in a resistant-CU patient, short courses of low-dose oral corticosteroids and cyclosporine may be utilized for disease control. Treating dermatologists or allergists should be cautious and should not forbid their use. Recalcitrant or refractory CU in the COVID-19 pandemic may be treated with short courses of corticosteroids and cyclosporine as there are reports of improved clinical outcomes with cyclosporine and low-dose corticosteroids treatment in patients with moderate-to-severe COVID-19.[6] The experience with teleconsultation or ICTs has been satisfactory as per various studies. Moreover, in our experience also, it provided a great relief and satisfaction to the urticaria patients especially who required tailoring of dosages and counseling regularly. Monitoring patients with CU on treatment may be well managed by teledermatology as there is no requirement of repeated clinical examination in already-established cases of CU. Validated scores and questionnaires are sufficient to assess the disease severity or disease control in CU patients and can be obtained through teleconsultation or ICTs. Non-face-to-face consultations during COVID-19 in CU patients may be more time saving and cost effective; moreover, it may also significantly decrease the chances of contracting severe acute respiratory syndrome-coronavirus-2 infection. However, face-to-face consultations may not be replaced fully by teleconsultations using ICTs, but it may be an effective alternative during the present pandemic. Further, large and long-term studies are required in future to provide much improved and validated results. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Knowledge on the Use of Isotretinoin and Its Side Effects and Awareness towards Saudi FDA-Pregnancy Prevention Program among the Female Acne Patients: A Northern Saudi Study.

Background and Objectives: Acne vulgaris is one of the most common dermatological disorders among adolescents and adults in the Kingdom of Saudi Arabia (KSA). Isotretinoin is a cost-effective way of treating severe acne patients compared to other methods used for severe forms of acne management. The present study investigated the knowledge of the use of isotretinoin and its side effects among female acne patients of the reproductive age group who were on isotretinoin. This study also assessed participants' awareness of the Saudi FDA-Pregnancy Prevention Program (SFDA-PPP). Materials and Methods: The present population-based cross-sectional survey was conducted among 768 participants using a standard and validated Arabic version questionnaire. We have applied logistic regression analysis to determine the predictors for awareness of SFDA-PPP. A Chi-square test was applied to identify the factors associated with knowledge related to isotretinoin. Results: Regarding the side effects of isotretinoin, participated female acne patients were most commonly aware of dry mouth and lips (84.5%), teratogenicity (68.2%), and headache (44.8%). Nearly 60% of the participants belonged to the low knowledge category. The present study participants' knowledge was significantly associated with education status (p = 0.007), occupation (p = 0.01), and those participants who were aware of SFDA-PPP (p = 0.001). Furthermore, we explored that only 37.5% were aware of the SFDA-PPP program implemented in Saudi Arabia. The awareness of SFDA-PPP was significantly higher among those participants belonging to health sectors (Adjusted OR (95% CI) = 1.39 (1.01-1.92), p = 0.049). Conclusion: The present survey explored inadequate knowledge among reproductive age group female acne patients regarding isotretinoin uses, precautions to be followed, and side effects, especially teratogenic effects. This survey findings suggest that improving female acne patients' knowledge of isotretinoin through health promotion activities is crucial, especially by giving them precise instructions about the teratogenic effects.

Improvement of Quality of Life in Dialysis and Diabetic Patients by Skin Dryness and Pruritus Management with an Ecobiological Dermo-Cosmetic Product.

PurposeXerosis and pruritus are common chronic dermatological disorders among dialysis and diabetic patients that are frequently underdiagnosed or neglected, which can impact the quality of life of these patients. This study aimed to evaluate the efficacy and safety of a specific dermo-cosmetic product in the treatment of dry skin and pruritus associated with dialysis and diabetes.Patients and MethodsTwenty-nine dialysis patients (mean age 62 years) and 40 diabetic patients (mean age 57 years, 88% type 2) were included in two different single-center open-label uncontrolled clinical trials. All patients presented skin dryness according to the Scaling Roughness Redness and Cracks (SRRC) scale, and pruritus and/or insomnia. They applied the dermo-cosmetic product Medi-Secure Atoderm Xereane (NAOS, Laboratoire Bioderma) once or twice a day. The clinical efficacy (SRRC, pruritus, and insomnia), the skin-related quality of life (Dermatological Life Quality Index, DLQI), and the subjective efficacy were assessed at the inclusion visit and after 28 days of product application, as well as the safety.ResultsAfter 28 days of application, the product significantly reduced the SRRC global score of 83% (0.9±0.8 vs 5.1±1.2) and 66% (1.4±1.2 vs 4.2±0.5), pruritus intensity of 76% (1.1±1.3 vs 4.6±2.1) and 78% (0.9±1.7 vs 4.2±2.6), and insomnia intensity of 61% (0.9±1.3 vs 2.4±2.3) and 82% (0.9±1.7 vs 4.8±2.7) in dialysis and diabetic patients, respectively. Furthermore, the product’s application led to an improvement of the skin-related quality of life of 50% (5.4 vs 2.7; p<0.0001) in dialysis patients and 71% (6.6 vs 1.9; p<0.0001) in diabetic patients at D28. In addition, the product was greatly appreciated by all patients for its soothing, comforting, repairing, nourishing, and hydrating effects and was very well tolerated by the entire panels.ConclusionThis specific dermo-cosmetic product significantly reduces skin dryness, pruritus, and insomnia in dialysis and diabetic patients, thereby greatly improves their skin-related quality of life. By managing and avoiding bothersome symptoms associated with their disease or treatment, this ecobiological dermo-cosmetic can prevent serious complications that constitute a substantial burden on their daily life.