Lichen Planus: a brief summary.




Lichen Planus is a chronic disorder that can present with a variety of dermatological manifestations. There are many clinical types of Lichen Planus which are based on the extent of involvement of different body parts, examples include Cutaneous, Mucosal and Nail Lichen Planus.


It is thought to be of an autoimmune etiology where the immune system attacks a protein within the skin and mucosal surfaces. Risk factors that may be involved include genetic predisposition, injury to the skin (Koebner’s Phenomenon) and skin diseases such as Herpes Zoster. Some drugs can induce a Lichenoid rash, examples include Quinine and Captopril.


Skin manifestations of Lichen Planus usually are in the form of papules and plaques. The plaques are crossed by fine white lines called Wickham’s striae. Lichen planus can occur anywhere on the skin but common sites include the wrists, ankles and the lower back. The plaques usually resolve after many months.


The diagnosis of Lichen Planus is usually clinical. In cases of diagnostic uncertainty, a skin biopsy may be needed to rule out competing diagnoses.


Mild Lichen Planus is usually treated with topical medications like steroids, calcineurin inhibitors and retinoids. More severe local disease, or in widely distributed disease, oral steroids are needed. Other immuno-modulators may be combined with oral steroids to reduce the dose, examples include Methotrexate and Azathioprine.



Written by: Turki Alsehli, Medical Student 



Microneedling: a new approach in dermatology



Microneedling (percutaneous collagen induction therapy) is a new promising mini-invasive therapeutic procedure where small holes are created across the stratum corneum while keeping the epidermis partially intact.


The method is called microtraumatization which leads to an activation of the healing cascade and growth factors, which in turn activate cell proliferation in the wound and increase the synthesis/deposition of collagen (elastin complex with successive transformation of collagen III to collagen I) and neoangiogenesis which ultimately accelerates scar remodeling with minimal damage to the epidermis. This produces microchannels that increase skin permeability which greatly increases the efficacy of topical treatments applied after the procedure. Microneedling has been widely used for the treatment of skin alterations of different etiologies, like burns, acne scars, and other textural skin anomalies.


Numerous studies are currently examining its potential in focal diseases of inflammation, dyschromia, and photodamage. In the meantime, many clinical experiences show that microneedling appears to be a suitable micro-invasive treatment for the improvement of scar quality which has less risk of infection, post-inflammatory hyperpigmentation, and scarring compared to other resurfacing modalities.




Written by: Bayan Alhazmi, Medical Student 




What is Rosacea? Causes, clinical features and treatment



Rosacea is a common condition and one that dermatologists come across all the time. It is characterized by either transient or persistent facial erythema involving a chronic rash, sometimes accompanied with conspicuous blood vessels and protruding lesions.


Although the cause is still unclear, several hypotheses have suggested a multifactorial etiology, whether it be genetic, environmental or chronic prolonged exposure to ultraviolet radiation.


Rosacea is subdivided into four stages: First stage consists of episodes of flushing often frequent, followed by the second stage which comprise persistent erythema and dilated vessels (telangiectases). A minority develop the third stage, mainly manifested as papules and pustules. The fourth and last stage is Rhinophyma, a skin deformity appearing as large, bumpy red nose. It is seen more in men than in women.


Diagnosis is based on diagnostic phenotype, and it usually does not require an invasive investigation. Sometimes skin biopsies are performed to confirm diagnosis.


There is no available treatment that provides desirable results for the redness. Precautionary and preventive measures, prescribing sunscreen and avoiding exposure to heat. Oral antibiotic treatment is available, but its side-effect in the long run outweigh the calming effect. Topical treatment are as effective as oral, azelaic acid cream is efficacious at treating mild forms of rosacea.


Addressing Rosacea is a tricky task; the pathophysiology is still not fully understood and more research is needed to be able to target rosacea at the root cause. For the time being, lifestyle changes such as wearing sunscreen and avoiding excessive cold or heat have profound impact on the severity of the disease.


Written by: Naif Alshaikh, Medical Student 



DermaNet NZ
The Journal of Investigative Dermatology

Rebora, Alfredo. “Rosacea.” Journal of investigative dermatology 88.s 3 (1987): 56-60

Association of Psoriasis with the Risk for Obesity and Type 2 Diabetes Mellitus




Psoriasis is a chronic immune-mediated inflammatory skin disease characterized by uncontrolled proliferation of keratinocytes, release of proinflammatory cytokines, and recruitment of T cells to the skin that causes skin cells to multiply up to 10 times faster than normal which create red patches covered with white scales. these patches can grow anywhere, but mostly on the scalp, elbows, and knees.

Metabolic syndrome is a cluster of conditions that occur together, increasing the risk of heart diseases and type 2 diabetes mellitus characterized by abdominal obesity, insulin resistance, dyslipidemia, and elevated blood pressure.

Like in psoriasis, systemic inflammation also occurs in patients with metabolic syndrome, and levels of a number of inflammatory markers, such as Tumor Necrosis Factor, are elevated in both diseases. This made researchers question if there is a common etiology.

A cross-sectional, population-based twin study published by JAMA Dermatology, included 34 781 Danish twins, 20 to 71 years of age. Revealed a link between psoriasis and metabolic syndrome, in particular, obesity and type 2 diabetes mellitus, this connection is rather important as those two comorbidities can lead to increased mortality, especially due to cardiovascular diseases.

The study found that obesity is about twice as prevalent in patients with psoriasis compared with the general population. The same results have been obtained for type 2 diabetes mellitus.

Several factors might explain the association between psoriasis and the metabolic syndrome, notably genetics and environmental exposures (such as tobacco smoking, alcohol consumption…etc.). The twin design shows the relative contribution of genetic and environmental factors to a given disease which is necessary for this area of research.

The results support that Psoriasis, type 2 diabetes mellitus, and obesity are strongly associated with adults after taking key confounding factors (sex, age, and smoking …etc.) into account which indicates a common genetic etiology of psoriasis and obesity.

Conducting future studies on specific genes and epigenetic factors will unravel the direct correlation between those 3 disorders.




Written by: Bayan Alhazmi, Medical Student 



Vitiligo: causes, clinical features, diagnosis and general management



Vitiligo is an acquired disorder of the skin characterized by well-circumscribed macules or patches of depigmentation. Vitiligo can be cosmetically disabling, especially in people of darker skin. It is caused by destruction of melanocytes in the skin, which are essential for the production of melanin. The etiology is thought to be due to an autoimmune process, triggered in people with certain genetic susceptibilities.  

Vitiligo can affect any part of the body, common sites are sun-exposed areas (face, neck and hands) and skin folds (armpits, groin). Vitiligo may appear following trauma to the skin, this is known as Koebner’s phenomenon. The pattern of depigmentation in Vitiligo is variable. It may affect a single patch of skin or it may involve multiple areas distributed throughout the body. Vitiligo lesions usually extend for a few months before stabilizing for variable periods. This cycle of pigment loss followed by stability of lesions may continue for years.

Vitiligo may be classified as segmental or non-segmental. In segmental vitiligo, there is usually a single patch of depigmented skin. This type also more commonly affects younger people and is more likely to be stable after the initial period of extension. Non-segmental vitiligo is characterized by lesions that are bilateral and symmetrical. Each of these types (Segmental and non-segmental) includes many other subtypes which are based on the distribution of lesions.

Vitiligo is typically a clinical diagnosis. Depigmented lesions are readily seen on Wood’s lamp examination. At times of diagnostic difficulty, a skin biopsy may be needed to rule out other possible causes of depigmentation. Blood tests such as thyroid function markers and Vitamin B12 levels may be ordered to check for possible co-existing autoimmune disorders.

General measures for the management of Vitiligo include preventing skin injury and wearing sunscreen. Specific treatment for Vitiligo may include topical medications such as steroids or Calcineurin inhibitors. Phototherapy is another option which aims at achieving re-pigmentation of the involved area. Systemic therapies for Vitiligo are available, examples include oral steroids, Methotrexate, and Cyclosporin. These all have immune-modulating properties and target the possible etiology of the disease. JAK2 inhibitors such as Ruxolitinib are currently being investigated for the treatment of Vitiligo and may be used in the future as a second-line medication. Depigmentation therapy may be an option for severely affected patients in whom other methods of treatment are not effective.



Written by: Turki Alsehli, Medical Student 



Front Immunol. 2019 Dec 3;10:2847. doi: 10.3389/fimmu.2019.02847. eCollection 2019.

Emerging Topical and Systemic JAK Inhibitors in Dermatology. Solimani F, Meier K, Ghoreschi K.

The elusive connection between vitamin D and skin health



Vitamin D is a fat-soluble vitamin that has an imperative role in health. It regulates calcium metabolism and homeostasis, but its scope of function extends beyond that, particularly the skin.


The production of vitamin D occurs in the skin in response to ultraviolet B radiation from sunlight. Once it is synthesized, it exerts an immunomodulatory effect on immune cells by dampening overactive signaling cells from secreting inflammatory mediators, in addition, vitamin D aids in the defense against opportunistic infections of the skin by upregulating antimicrobial gene expression, which collectively consolidates and maintains the integrity of the cutaneous barrier.


A myriad of studies in the literature have highlighted vitamin D’s potential therapeutic properties for a number of dermatological diseases, namely psoriasis, atopic dermatitis, vitiligo and many other skin maladies. One study elucidated that oral vitamin D conferred to an improvement of psoriasis in 88% of the patients. Another meta-analysis study demonstrated that the risk of vitiligo is inversely associated with vitamin D serum.


There are many sources in which you can ascertain vitamin D. Exposure to sunlight is remarkably efficient at converting vitamin D into its active form, followed by dietary supplementation, with negligible amount present in dietary intake, mostly in commercialized processed foods which has been fortified with essential compounds.


With a growing body of research on this matter and promising results, vitamin D has proven to be a quintessential vitamin for the skin. Insufficient levels are therefore associated with multiple dermatological disorders, and adequate sunlight exposure and supplementation with regular blood tests for vitamin D serum level are advisable for healthy skin.



Written by: Naif Alshaikh, Medical Student 


Bergqvist C, Ezzedine K. Vitamin D and the skin: what should a dermatologist know? G Ital Dermatol Venereol 2019;154:669-80. DOI: 10.23736/S0392-0488.19.06433-2


Wadhwa B, Relhan V, Goel K, Kochhar AM, Garg VK. Vitamin D and skin diseases: A review. Indian J Dermatol Venereol Leprol 2015;81:344-55


Perez A, Raab R, Chen TC, Turner A, Holick MF. Safety and efficacy of oral calcitriol (1,25-dihydroxyvitamin D3) for the treatment of psoriasis. Br J Dermatol 1996;134:1070–8.

COVID-19: how is it related to the skin?

In December 2019 unexplained pneumonia cases started arising in Wuhan, China due to a new pathogen called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and thus the disease was named Coronavirus Disease 2019 (COVID-19). Cases started spreading rapidly around the globe and on March 12th World Health Organization (WHO) declared it as a pandemic. Some of the clinical signs associated with it are fever, fatigue and dry cough. In addition to presenting symptoms and signs, nasopharyngeal and oropharyngeal swab can aid in diagnosis.


There are very limited data in literature about the cutaneous manifestation of COVID-19 so far, however, data collected from 88 patients in Lecco, Italy in which 14 of them presented with skin rash mostly affecting the trunk region. In addition, three patients presented with urticaria and one patient had chickenpox-like vesicles. It was concluded that the skin symptoms observed in COVID-19 were frequently seen in common viral infections. Furthermore, the severity of the skin symptoms did not seem to correlate with the severity of the disease. Due to additional infection prevention steps taken by first-line healthcare workers, 97% of them reported having skin damages, some of which are dryness and desquamation. Sites involved were mainly the nasal bridge, hands, cheek, and forehead. Therefore, preventive measures must be taken which include emollients, barrier creams, and moisturizers especially before applying personal protective equipment. Further steps should be taken to maintain hand hygiene and moisturization such as using unscented soap and avoiding using too much. Additionally, washing hands with warm water instead of hot water and applying moisturizers immediately after drying hands.


In conclusion, further studies should be done on the specific skin symptoms associated with COVID-19 infection. Skin damage and dryness are common conditions, especially with frequent hand washing during the pandemic, therefore, additional measures need to be taken to prevent such conditions.


Written by: Khalid Al Dakheel, Medical Student @ KSU




The unexpected correlation between BMI index and acne vulgaris


It’s common knowledge that a healthy diet can improve skin condition greatly
as there are many products and food supplements that claim to refresh and
nourish the skin while preventing acne, but exactly how much can a conscious
diet affect our skin?

The most common form of acne is Acne Vulgaris which is “a chronic
inflammatory skin disease of pilosebaceous unit“ that many Adolescents
suffer from and deal with on a daily basis which is detrimental to their
mental and psychological health.

Many studies conducted in the last decade show a notable correlation
between different dietary factors (like dairy consumption and high glycemic
load diet) and acne vulgaris as they are thought to increase sebum
production which leads to blocking hair follicles hence causing acne and

In 2019 a new article published by The Journal of The American Academy of
Dermatology proposed a new idea into the table, that the BMI index level may
have an association with the risk of developing Acne Vulgaris.

The results suggest that in Youths, high BMI index and Obesity are “inversely
associated with acne in a dose-dependent manner” which is odd as a high
calorie diet doesn’t necessarily reflect a healthy nor desirable approach to
reduce acne vulgaris risk but is surely interesting.

The connection between acne vulgaris and the BMI index remains unclear
which provides space for future research to improve the current


Written by: Bayan Alhazmi, Medical Student @ KSU


A brief outline on the management of Psoriasis



Psoriasis is a chronic inflammatory skin condition characterized by well-defined, erythematous scaly plaques. Psoriasis can occur at any age, and is usually a lifelong disease with fluctuations in severity and extent. There are many subtypes of Psoriasis including Small Plaque Psoriasis, characterized by plaques less than 3 cm in size, Chronic Plaque Psoriasis, in which the plaques are larger than 3 cm in size, Palmoplantar Psoriasis which mainly affects the palms and soles, and many other types that vary in distribution and severity.

There are many modalities in the management of Psoriasis which usually depend on the severity of the disease at time of treatment initiation. These include simple lifestyle modifications such as smoking cessation and maintaining a healthy weight. Mild Psoriasis may be managed by topical drugs, such as Salicylic acid, Topical corticosteroids, Calcineurin inhibitors (tacrolimus,pimecrolimus). Management of more severe disease may include systemic agents such Methotrexate, Cyclosporin and Azathioprine. Systemic corticosteroids should be avoided as they can precipitate a flare of Psoriasis. Recently, there has been great interest in the use of biologic agents, some of these include Tumor Necrosis Factor inhibitors such as Infliximab and Etanarcept, The IL-12,23 antagonist Ustekinumab, and Guselkumab, a systemic anti-IL-23p19 agent. These biological agents are usually reserved for refractory disease which doesn’t respond to the conventional drugs.

Very recently (November 2019), new evidence emerged on the use Guselkumab for treatment-resistant Palmoplantar Psoriasis, the clinical trial found that guselkumab improved disease severity scores for PPP refractory to conventional treatment, it also supported that Guselkumab was well-tolerated with infrequent adverse effects.

In conclusion, Psoriasis is a life-long disease which may be debilitating without treatment. The discovery of new biological agents shows promise in controlling even the most severe forms of the disease with great success.



Written by: Turki Alsehli

Sources:,, PubMed

Efficacy and Safety of Guselkumab in Japanese Patients With Palmoplantar Pustulosis: A Phase 3 Randomized Clinical Trial. Terui T, Kobayashi S, Okubo Y, Murakami M, Zheng R, Morishima H, Goto R, Kimura T

JAMA Dermatol. 2019

Probiotics and the skin


Probiotics are live microorganisms administered for their beneficial effects. WHO (World Health Organization) defines them as live microorganisms that “when administered in adequate amounts, confer to a health benefit on the host”. Lactobacillus and Bifidobacterium are the most commonly used species. Probiotics are mainly used for gastrointestinal diseases however, some research suggests they could be beneficial to some skin conditions such as atopic dermatitis, acne and wound healing.


As far as healthy skin goes, few studies were done on the matter, it does however, suggest that probiotics have beneficial effects on skin’s hydration and elasticity. Some research has shown the role of probiotics in prevention and improvement in the symptoms of atopic dermatitis in children. In one study, a combination of probiotics was given to children suffering from atopic dermatitis in which their symptoms were alleviated by 56%. In addition, another study was done where pregnant women were given probiotics four weeks before delivery and 6 months after delivery showed a noticeable reduction in the risk of developing atopic dermatitis in the first few years of life. A small number of studies were done on the role of probiotics in the prevention of acne, in one study, the side effects of minocycline were alleviated with the administration of probiotics while still maintaining its potency. Furthermore, Probiotics and Minocycline both demonstrated a synergistic anti-inflammatory effect against acne vulgaris. Probiotics could also influence wound healing; a study was done where burn wounds were given a type of yeast called Saccharomyces cerevisiae and the wound exhibited an improvement in the healing process. In addition, there was an increase in the levels of collagen and TGF beta 1.


In conclusion, probiotics could potentially have positive results on normal skin, however, the use of probiotics as means of prevention and/or treatment of some skin conditions requires further studies as the exact mechanism to how they exhibit their effects is still not fully understood.

Written by: Khalid Al Dakheel, Medical Student @ KSU


Electronic cigarettes and dermatological manifestations

Electronic cigarette usage has become quite frequent in the last couple of years, mainly due to it being marketed as a substitute for traditional cigarettes. There’s a lot of controversy revolving around whether it is truly a safe substitute to traditional cigarettes. However, some harmful dermatological manifestations have been linked with e-cigs.


Some of the dermatological manifestations associated with the usage of e-cigs are contact dermatitis, thermal injury, and oral mucosal lesions. Contact dermatitis usually affects the dominant hand, and it’s caused by the release of nickel from the heating coil, which is the component that vaporizes the liquid. Thermal, blast and chemical injuries reported were due to overheating, leakage and/or explosion of lithium-containing batteries used in e-cigs. There is also an increased prevalence of oral mucosal lesions such as nicotine stomatitis, hyperplastic candidiasis, and black hairy tongue among consumers of electronic cigarettes.


In conclusion, the increased consumption of electronic cigarettes is due to it being advertised as a safer alternative to tobacco cigarettes. However, electronic cigarettes can cause some harmful skin-related conditions outlined above. Currently, electronic cigarettes are not a safe alternative and further studies are needed on the topic.


Written by: Khalid Al Dakheel, Medical Student @ KSU


Pattern hair loss: What causes it? How can it be treated?


Baldness or “Alopecia” is a common condition, it has many types and causes, but the most common type is pattern hair loss, which is what will be addressed here. Hair loss has a lot of psychological impact on affected individuals, especially when it occurs at a young age. A common misconception is that every old person suffers from baldness which is false, hair loss does NOT only occur with age. Another misconception is that shampoo causes hair loss, which is just a myth. when you wash your hair, you’re just washing off already dislodged hair.


Pattern hair loss occurs in both males and females, but it’s more common in males. You might ask what is the cause of pattern hair loss?  The cause of it is a combination of hair follicles being more sensitized to androgens, and androgens’ effect on them. It occurs at any time in genetically predisposed people after puberty, however it’s usually fully expressed in 40’s. There’s a lot of frustration with progressive hair loss, so before you pull out your hair out of frustration, there are a few options for the treatment of such a condition. The easiest would be to just wear a hairpiece, however if treatment using medications is preferred minoxidil and finasteride can be used. There’s also the option of getting a hair transplant where androgen-insensitive hair is taken and implanted into the scalp.


Finally, pattern hair loss is common and there are a lot of misconceptions associated with it. It has a psychological impact on those who suffer from it. It can be treated using both medical and surgical methods.



Written by: Khalid Al Dakheel, Medical Student @ KSU
Reference: Fitzpatrick Color Atlas and Synopsis of Clinical