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Noncultured autologous melanocyte keratinocyte transplantation is considered a safe and effective treatment option in stable vitiligo. Factors associated with risk of infection are still poorly explored.To search for factors associated with the risk of infection after noncultured autologous melanocyte keratinocyte transplantation (MKTP).This was a retrospective multicentric study including all patients with vitiligo who had undergone noncultured autologous MKTP between January 2010 and December 2020. Data included age, sex, site, and size of the treated area, recipient area preparation method, and antibiotic prescription preceding the procedure. Univariate and multivariate analyses to search for factors associated with infection after MKTP were conducted.A total of 672 patients were included. Infection was present in 39 of the patients (6%) (95% confidence interval [CI]: 4.2%-7.7%). The following factors were independently associated with higher rate of infection: cryotherapy for recipient area preparation (OR 19.76, 95% CI: 3.21-121.74) and treated lesions on the trunk (OR 2.67, 95% CI: 1.21-5.90), lower extremity (OR 5.99, 95% CI: 2.49-14.40), and foot (OR 13.15, 95% CI: 4.37-39.62).Infection after noncultured autologous MKTP is not uncommon. Cryotherapy for recipient area preparation and lesions on the trunk, lower extremity, or foot was independently associated with an increased risk of infection.

Background: In recent years, telemedicine has led to a dramatic shift in healthcare service delivery, mainly due to the ease with which telemedicine can be integrated into a multitude of specialties and its flexibility as a means of providing care. Over the last 2 decades, technological advancements have made telemedicine integral to healthcare in many countries. In particular, dermatology was benefited from telemedicine as a new tool, thanks to the visual character that pervades this practice. Teledermatology is the interactive practice of remote dermatological assessment, involving live contact with patients (“live interactive”) and data access and retrieval (“store-and-forward”). This review discusses the role of this new discipline in medical education, inpatient care, and primary care through the analysis of several studies addressing this topic. Also examined are the status and limitations of teledermatology in Saudi Arabia and some proposed solutions. Summary: Visual assessment of dermatological conditions is common practice among dermatologists. However, due to the scarcity of specialists in some areas, wait times have been a hindrance for patients requiring an assessment. Teledermatology improves access by reducing wait times, speeding up the referral process, and streamlining assessments. Furthermore, teledermatology effectively serves as a form of triage, particularly for cases of suspected cutaneous malignancy that typically require the shortest referral time. Earlier diagnoses, more effective management of chronic skin disease, and inpatient care are all additional benefits offered by the teledermatology practice. The use of teledermatology is now widespread, with roles extending beyond patient care to medical teaching and training in residency programs. This perhaps reflects physicians’ highly positive perceptions regarding teledermatology; however, patient perception in Saudi Arabia is still lagging behind the global standard, possibly due to privacy concerns. Key Message: Teledermatology can be reliably utilized to advance healthcare services and medical education. Improving patient awareness and perception of this emerging discipline is crucial; to that end, the practice must address privacy concerns. Patient uploads of photographs and videos should be stored on an end-to-end encrypted platform to provide optimal service and encourage patients’ participation. Ultimately, physicians should be well acquainted with the medical, ethical, and technical aspects of teledermatology.

Linear hyperpigmentation is an unusual anatomical configuration in clinical dermatology. Owing to its rarity, consensus on the most effective method of classification is lacking. While linear hyperpigmentation generally follows Blaschko’s lines, this is not universal. Clinical findings such as adherence to Blaschko’s lines, associated morphological findings (including other cutaneous lesions), and systemic manifestations can be used to further characterize and diagnose variants of the disorder. Early detection of any underlying disease is vital, especially in cases with effective management, because the disorder may make it difficult to manage hyperpigmentation. Herein, we introduce a logical clinical diagnostic approach that represents a useful tool for dermatologists to efficiently evaluate patients presenting with linear hyperpigmentation. A simplified systematic and evidence-based approach is useful for this clinical condition owing to the heterogeneous causes and lack of specific diagnostic tools.

Introduction: Laser hair removal (LHR) is a common procedure in dermatology. LHR using quality-switched (QS) 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) is very popular in our community despite lack of sufficient evidence on its efficacy and safety. Purpose: We report the characteristics of nine patients who developed hypopigmented macules after being treated with QS 1064 nm laser for hair removal. Methods: This was a retrospective study at a laser center in Saudi Arabia conducted between June 2014 and September 2018. Patients who developed white macules following treatment with QS 1064 nm Nd:YAG laser for removal of unwanted hair were included in the study. Results: All patients were Saudi females with a mean age of 28.8 years (range: 25–37 years). Well-defined hypopigmented to depigmented 1–3 mm macules developed after being treated with QS 1064 nm Nd:YAG laser for hair removal. The most commonly affected area was the face. Majority of patients had skin phototype IV. Hypopigmented macules developed after an average of 22 laser sessions (range: 4–48 sessions). None of the patients had either personal or family history of vitiligo. Lesions seem to be difficult to treat, with only two patients responding to topical tacrolimus and excimer laser. Conclusion: Hypopigmented macules might develop after QS 1064 nm LHR. Those macules appear to be resistant to treatment. Further prospective controlled studies needed to elaborate more on the safety profile of this procedure.

Injectable gold is known to deposit in the dermis for life, and such patients are at risk of developing chrysiasis post-laser exposure. It is unknown if patients with history of edible gold consumption would develop a similar reaction after quality-switched laser exposure. Our aim is to assess if patients with history of edible gold consumption develop chrysiasis after quality-switched laser exposure. This is a proof of concept pilot study conducted between September 2017 and September 2018 at two dermatology clinics in Riyadh, Saudi Arabia. Adult patients who have history of edible gold consumption were recruited to receive a spot test with different quality-switched lasers in a hidden, non-sun-exposed skin site. The test area was photographed before, immediately after, and 10 min after laser exposure. The test area was examined by two independent investigators for the development of chrysiasis. A total of 10 patients (five male and five female) were enrolled. The mean age was 31.7 years. Forty percent of subjects consumed edible gold more than once, and the duration of last intake ranged from 3 weeks to 3 months. Chocolate was the main source of edible gold. All participants had no chrysiasis reaction post-quality-switched laser exposure. Contrary to our hypothesis, all participants with history of short-term edible gold consumption did not develop chrysiasis after quality-switched laser exposure. Further controlled studies including more patients with longer duration and higher frequency of edible gold consumption are needed.

Objective Social media have become the platform of choice for people seeking immediate access to information. They have become so ubiquitous and pervasive that many people are using them to research health care providers and communicate with them about their issues. This study looks into this phenomenon, focusing on how it affects people’s thinking when deciding which doctor to see for skin-related concerns. Methodology A cross-sectional study was conducted among patients at Derma Clinic in Riyadh, Saudi Arabia. Data were collected using a validated self-administered questionnaire. A total of 365 patients were included in the analysis. Results Out of 365 participants, 44.9% visited the center for medical purposes, while 45.8% visited for cosmetic purposes. Sixty-six percent of the participants (n=241) went to a dermatologist they knew, and only 21% of those participants knew their dermatologist from social media (Twitter, Instagram, Snapchat, Facebook, and Telegram). About 44.54% preferred to know more about their dermatologists from Twitter, followed by Instagram 27.96%, Snapchat 24.64%, and Facebook 2.84%. A significant proportion of Instagram users came to the dermatology clinic for cosmetic purposes. Conclusion As per the findings of this study, we found the highest preferred way of knowing the doctor for medical or cosmetic purposes was through a friend, followed by a family member and social media. Although most of the participants still preferred to visit a dermatologist based on their friend’s recommendation, social media offer patients a platform upon which to launch their search for a dermatologist. Among social media users, patients who visit dermatology clinics for medical reasons preferred Twitter, while those who came for cosmetic reasons preferred Instagram to follow their doctors, underlining the importance of aesthetic dermatology as a visual field.

Background: The safety of laser therapy in patients taking isotretinoin is controversial. Recent evidence suggests that laser during isotretinoin treatment is safe. Our study aims to assess public perception and willingness to undergo laser intervention while receiving isotretinoin.Methods: An online-based cross-sectional survey was conducted between November 2019 and March 2020. Information on participants knowledge about isotretinoin precautions with laser therapy and their willingness to undergo laser intervention while on isotretinoin therapy was collected.Results: Out of 509 respondents, almost one-third used laser therapy while on isotretinoin treatment. Those who did not use laser therapy most commonly attributed to isotretinoin treatment (43%). Forty-two percent of participants thought that laser therapy while on isotretinoin is harmful. Almost half of the participants were aware that current guidelines recommend waiting for six months after isotretinoin. Nearly, half of the participants decided to postpone laser therapy for acne scars even after knowing that recent studies reported the safety of laser therapy for acne scars while on isotretinoin.Conclusion: Even with the knowledge of recent safety data of laser during isotretinoin therapy, a significant proportion of patients are still concerned about potential complications. Increasing awareness regarding the safety of laser skin therapy during isotretinoin treatment might be needed.

Background Although autologous non-cultured melanocyte-keratinocyte transplantation is a treatment option for stable vitiligo, there is lack of long-term maintenance data for this specific treatment. Objective To search for factors associated with long-term maintenance of patients with stable vitiligo successfully treated with melanocyte-keratinocyte transplantation. Methods This was a single-centre retrospective study including stable vitiligo patients who underwent successful melanocyte-keratinocyte transplantation in the National Center for Vitiligo, Riyadh, Saudi Arabia, between 1 January 2004 and 30 June 2015. Cox proportional hazard model was used to estimate factors associated with relapse at 6 years of followup. Co-variates included, gender, type of vitiligo, age at vitiligo onset, age at surgical procedure, disease duration, disease stability, affected body surface area, treated surface area, fingertip involvement, type of recipient area treatment and recurrence defined as the onset of new lesions on previously untreated areas. The risk of developing relapse defined as re-appearance of more than 10% depigmentation in a previously treated and repigmented site was considered as the main outcome. Results In total, 602 patients were included in the study of whom 410 (67%) were women. Mean age was 24.25 years [4.0-67.0]. Affected body surface area of less than 1% (adjusted HR = 0.37; P = 0.04) and mechanical dermabrasion (adjusted HR = 0.26; P = 0.03) were independently associated with lower rates of relapse. On the contrary, non-segmental type of vitiligo (adjusted HR = 2.11; P = 0.03) and fingertip involvement (adjusted HR = 3.75; P = 0.01) were independently associated with higher rates of relapse. Conclusions Criteria for selecting patients with stable vitiligo for surgery should include careful assessment of vitiligo type including body surface area of vitiligo and involvement of fingertip before undergoing surgical procedure.

Background: Laser hair removal (LHR) is a common procedure for the removal of unwanted hair. Although it is generally safe, it is associated with some adverse effects including hyperpigmentation. Purpose: In this study, we aimed to assess the prevalence of postlaser hyperpigmentation in patients taking Vitamin D supplements. Methods: This is a cross-sectional study of patients who underwent LHR. Each patient was interviewed and asked about their intake of Vitamin D supplements, and the primary outcome was whether hyperpigmentation was reported after LHR in the past 6 months. LHR treatment details were also documented. Results: A total of 508 patients were included with a mean age of 29 ± 9 years. Post-LHR hyperpigmentation was more prevalent in females and in those taking oral Vitamin D. Multivariate logistic regression analysis showed that Vitamin D intake was independently associated with more risk of hyperpigmentation post LHR (odds ratio [95% confidence interval]; 2.6 [1.17–5.80], P = 0.020). Conclusion: Vitamin D intake may be associated with an increased risk of hyperpigmentation post LHR. Causality cannot be assessed.

Fox–Fordyce disease (FFD) is a rare chronic pruritic inflammatory disorder that affect apocrine glands. It affects axillae, anogenital, and periareolar regions in young female. Treatment of this condition remains difficult and unsatisfactory. In this report, a 27-years-old female present with multiple follicular, skin-colored papules, measuring around 1-2 mm in diameter on both axillae. She was diagnosed with FFD and showed a good response to treatment with multiple sessions of 2940-nm Erbium laser, which to the best of our knowledge had not been described before. Keywords: Axilla, Erbium, Fox, Fordyce, Laser.&nbsp

BACKGROUND Imiquimod 5% cream is currently approved to treat several dermatologic conditions including actinic keratoses (AK), superficial basal cell carcinoma (sBCC), and genital warts. However, there are numerous studies published on the alternative off-label uses of imiquimod cream. Photoaging of facial skin is an important use for topical skin treatments, yet few studies have evaluated the effect of imiquimod cream for this dermatological condition. METHODS This was a prospective, noncomparative pilot study. We included 15 healthy subjects; out of them, 11 subjects completed the study. The subjects were instructed to apply imiquimod 5% cream to the periorbital area on three nonconsecutive days per week for eight consecutive weeks. Photographs were obtained at baseline and after 8 weeks of treatment. Improvement in overall periorbital skin appearance was assessed by an independent investigator who compared the baseline and post-treatment clinical photographs. In addition, post-treatment self-assessment was completed by the subjects using a 5-point Likert scale. RESULTS Eleven of the 15 subjects completed the 8-week regimen. Eight participants (72.7%) noticed at least a fair improvement in periorbital skin changes based on the self-assessed 5-point Likert scale. Quartile score was also assessed by the investigator which indicated that seven subjects (63.6%) had at least 26% improvement. Based on Fitzpatrick wrinkle-scoring system, there was a significant reduction in the subjects' wrinkle severity following treatment (6.8 [mean] ± 1.7 [SD] vs 4.6 ± 2.5 [P

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.