Vitamin D in Acne

 

 

  Vitamin D is a fat-soluble hormone found in the body that serves many purposes, most famously bone formation. Although vitamin D is most important for bone health, it also plays a key role in many of the body’s other functions including but not limited to; antimicrobial, antiproliferative, anti comedogenic, and antioxidative processes. Vitamin D is gained through diet, supplements, and exposure to sunlight. In regards to dermatologic diseases, and more specifically in the treatment of acne vulgaris, the antimicrobial properties of vitamin D have been an interesting area of research in recent years.

 

  It has been established that acne vulgaris patients were more likely to have deficient vitamin D levels than controls. Variable associations have been made between the severity of acne lesions and deficient vitamin D levels, although some studies have shown improvement in inflammatory acne lesions when patients were given vitamin D supplementation. This improvement is restricted to inflammatory lesions, while non-inflammatory lesions showed no improvement. This could be due to vitamin D’s antimicrobial properties, as inflammation caused by propionibacterium acnes is significant to the pathogenesis of acne vulgaris. Another association between vitamin D levels and acne vulgaris is linked to sebaceous gland activity, in which it was found that lower levels of vitamin D stimulate lipogenesis in sebaceous glands. The increased lipogenesis promotes inflammatory lesions in acne vulgaris.

 

 These findings open the door to the possibility of using topical vitamin D analogues in the treatment of acne, as well as screening acne vulgaris patients for Vitamin D deficiency. As of today, using vitamin D in the treatment of acne is grade B recommendation with IIb level of evidence.

 

 

 

 

Written by: Hadeel Awartani, Medical Student

 

 

Resources:

1-Amal Ahmed Mohamed, Eman Mohamed Salah Ahmed, Rasha T.A. Abdel-Aziz, Halaa H. Eldeeb Abdallah, Hadeel El-Hanafi, Ghada Hussein, Maggie M. Abbassi & Radwa El Borolossy (2020) The impact of active vitamin D administration on the clinical outcomes of acne vulgaris, Journal of Dermatological Treatment, DOI: 10.1080/09546634.2019.1708852

2-Navarro-Triviño FJ, Arias-Santiago S, Gilaberte-Calzada Y. Vitamin D and the Skin: A Review for Dermatologists [Internet]. Actas Dermo-Sifiliográficas (English Edition). Elsevier Doyma; 2019 [cited 2021Apr23]. Available from: https://www.sciencedirect.com/science/article/pii/S157821901930112X

3-Mostafa WZ, Hegazy RA. Vitamin D and the skin: Focus on a complex relationship: A review [Internet]. Journal of advanced research. Elsevier; 2015 [cited 2021Apr23]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642156/

4-Study links vitamin D deficiency with acne [Internet]. Dermatology Times. [cited 2021Apr23]. Available from: https://www.dermatologytimes.com/view/study-links-vitamin-d-deficiency-with-acne

5-Vitamin D for Acne: Benefits, Uses, & Effects of Vitamin D Deficiency [Internet]. Healthline. 2021 [cited 23 April 2021]. Available from: https://www.healthline.com/health/vitamin-d-for-acne

Occupational skin manifestations

 

 

It is possible for some skin manifestations to arise due to an individual’s occupation, some of those occupations include hairdressers, food industry, health care, farmers, construction. Parts affected depend on exposure, mostly hands.

 

An individual’s likelihood of developing occupational skin manifestations includes an individual’s predisposition, hygiene, and exposure. These conditions arise due to exposure to chemicals such as rubber additives, hair dyes, cement, arsenic. Furthermore, biological exposure plays a role as well some of which include contact with an infected human, plants, and animals. In addition to the above, physical exposure may contribute which consist of mechanical trauma, heat, humidity, cold, and radiation. The most common conditions in these individuals are hand dermatitis, mechanical injury, and infections. Some precautions should be taken to prevent such skin manifestations by identifying, minimizing, and eliminating the causes. Moreover, monitoring the workers with relation to the exposure and appropriate treatment when indicated.

 

Occupational skin manifestations are common in wet working environments, for example, hairdressers, food industry, health care workers, and farmers. Steps should be taken to avoid such skin manifestations and injuries.

 

 

 

Written by: Khalid Al Dakheel, Medical Student 

 

Resources:

www.DermNetNZ.org

What is dermaplaning?

 

 

  Dermaplaning is a simple non-invasive outpatient procedure which has gained popularity through social media platforms as an easy way to achieve a smoother skin complexion, remove unwanted hair on the face and prevent acne vulgaris. Although this procedure has only recently become well-known, it has been performed by dermatologists and licensed aestheticians for many years.

 

  Dermaplaning exfoliates the face by using a small scalpel blade to remove dead skin cells from the upper epidermis and facial hair. The removal of this superficial layer of skin offers the cosmetic benefit of achieving a more radiant and even texture complexion, as well as minimizing fine wrinkles and reducing the appearance of acne scars. As with any exfoliating procedure, dermaplaning allows deeper penetration of skin products such as moisturizers and serums which may contribute to the improved appearance of skin post-procedure. This is why dermaplaning may be of great benefit in patients with hyperproliferative disorders such as eczema or psoriasis, as removal of the cellular debris would allow proper penetration of hydrating treatments.

 

  Although dermaplaning is considered a low-risk procedure, it does not come without side effects such as skin hypersensitivity directly after or infection in rare cases. It is advised to apply protective sunscreen to reduce the risk of hyperpigmentation of the new skin layer and apply soothing agents to reduce inflammation.

 

  Despite the renewed public interest, patients should take into consideration the possible risks of dermaplaning especially if they plan to do it themselves. Improper tools or technique may result in injury or infection, and it is best to consult your dermatologist before self-performing this procedure.

 

 

Written by: Hadeel Awartani, Medical Student

 

 

Resources:

1- Dermabrasion and Dermaplaning  https://www.hopkinsmedicine.org/health/wellness-and-prevention/dermabrasion-and-dermaplaning

2- Townsend R (2017) The Use of Advance Dermaplaning in Clinical Skin Care and Treatment. Clin Dermatol Res J 2:2. doi: 10.4172/2576-1439.1000117

3- Dermaplaning: Efficacy, Side Effects, and More https://www.healthline.com/health/beauty-skin-care/dermaplaning

4- Pryor L, Gordon CR, Swanson EW, Reish RG, Horton-Beeman K, Cohen SR. Dermaplaning, topical oxygen, and photodynamic therapy: a systematic review of the literature. Aesthetic Plast Surg. 2011 Dec;35(6):1151-9. doi: 10.1007/s00266-011-9730-z. Epub 2011 May 2. PMID: 21533984.

A Brief History on Modern Clinical Dermatology

 

Scholars date back the start of modern dermatology to November first of the year 1801, with St Louis hospital in France being turned into an exclusively dermatological hospital; which was the catalyst for the rapid interest in dermatology in France at the time. The hospital was a centre for dermatological studies and with its success, it kindled the establishment of other centres in Paris.

 

Physician Jean-Louis Alibert (1736-1837) was made physician in 1803, It is thought that he was responsible for making St Louis Hospital a hospital for skin diseases, due to his high social status.

 

In 1816, Laurent Théodore Biett, was put in charge of the out-patient department of St Louis Hospital, where he made many advances in the field such as creating the Asiatic pill and protiodide and biniodide of mercury for the treatment of syphilis.

 

He also taught the next generation of French dermatologists whom will take over in the next half of the century. Some of which are Cazenave, Gibert, Devergie, and Bazin whose contributions range from adding to the knowledge of tuberculosis at the time, to the treatment of scabies. At that period, the development of modern clinical dermatology was a fact of the first importance in modern clinical dermatology.

 

 

 

Written by: Abdulaziz Mohammed Alqahtani, Medical Student 

 

Reference:

Pusey, William. (1933). The History of Dermatology. (first edition).

Dermatological Manifestations in Patients With SARS-CoV-2.

 

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been initially defined as a disease of the respiratory tract; however, with the increasing number of patients and announcing that the virus became a pandemic, new systemic clinical manifestations are observed, including dermatological manifestations. However, the identification and characteristics of these manifestations are still controversial. This review article aims to evaluate the medical literature and explore the dermatological clinical manifestations in patients with SARS-CoV-2.

 

 

Dermatological lesions are frequent in patients with SARS-CoV-2, especially erythema, urticaria, and varicella-like rash. Differential diagnosis should be thoroughly considered before deciding that the present rash is related to SARS-CoV-2 infections. Till present, the rash is not correlated to the severity of SARS-CoV-2 infection, which needs to be confirmed with studies with a more robust design and larger sample sizes. These findings should be considered by clinicians working with patients with SARS-CoV-2 in order not to misdiagnose the occurrence of dermatological lesions, which may delay therapy or increase the risk of complications.

 

 

Written by: Abdulelah Khalaf Nasser Almutairi, MBBS

 

Reference:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402433

 

Keratosis Pilaris (Chicken Skin)

 

 

 

Keratosis pilaris is a very common inherited condition where small keratotic papules in hair follicles appear as patches of bumps on the skin.  The bumps can be red, white, or darker than the skin.

 

Keratosis pilaris is stealthy in that patients who develop this condition are asymptomatic and it goes unnoticed. The disorder usually affects upper arms, upper legs, and buttocks. Certain age groups have a higher prevalence of this disorder, adolescents to be exact.

 

It is caused by excess keratin in the hair follicles, and although the causes have not been understood, a hormonal influence may be involved considering the high prevalence in adolescents.

 

No cure is available for keratosis pilaris, preventive measures like avoiding excessive skin dryness by moisturizing, staying away from long hot baths, and using mild soaps decrease the symptoms. In severe cases, keratolytic agents such as lactic acid, salicylic acid and urea cream are effective at reducing the appearance.

 

 

 

Written by: Naif Alshaikh, Medical Student 

 

References:

Pediatric dermatology

DermNet NZ

Werewolf syndrome: A brief touch on the different causes of excessive body hair.

 

 

 

 

Hypertrichosis (also known as Werewolf syndrome) is the presence of abnormal amounts of hair on the body in non-androgenic sensitive areas. This needs to be differentiated from hirsutism, which is a condition associated with male-like pattern growth of hair in females, mostly due to endocrine causes.

 

Excess hair growth associated with hypertrichosis may include any hair type (terminal, vellus, and lanugo), this hair growth particularly involves non-androgenic sensitive areas. Congenital form of hypertrichosis is believed to be due to inheritance or a spontaneous mutation. In addition, this form of hypertrichosis is extremely rare, and only a few cases have ever been reported. Furthermore, hypertrichosis could also be acquired and presents in late stages of cancer by an unknown mechanism, this hair growth is termed “malignant down”. However, cancer is not the only cause of the acquired form, it can also be caused by certain medications, such as minoxidil, phenytoin, and cyclosporine. There is not a known cure for the congenital form of hypertrichosis, however, the mainstay of treatment for the acquired form is addressing the culprit and using cosmetic hair removal methods (shaving, waxing, eflornithine cream, etc.).

 

Hypertrichosis is a rare disorder that presents with excessive unwanted hair growth. It could be congenital or acquired, however, the congenital is very rare. Treatment involves treating the underlying cause and using hair removal techniques.

 

 

 

Written by: Khalid Al Dakheel, Medical Student 

 

Resources:

Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, Seventh Edition

https://www.mayoclinic.org/

www.DermNetNZ.org

Keloid scarring

 

 

Keloids form following dermal scarring of tissue with abnormal wound healing. The scarring’s origin can be multifaceted, developing from any level of skin trauma or inflammation including surgery, burns, acne, insect bites and a multitude of other reasons.

 

How do keloids develop?

 

The etiology is not fully understood yet. Genetic and environmental factors are strongly implicated in its development in that incidents are higher in darker-skinned individuals of African, Asian, or Hispanic descent. Subsequent to an injury, fibroblasts produce exuberant and indefinite collagen and growth factors that cause aberrant wound healing.

 

How do keloids appear?

 

Keloids manifest as sturdy, enlarged raised scar that is pink or darker in color than the surrounding tissue. They appear hairless and shiny in relation to the tissue within proximity.  Keloids can arise anywhere on the body; however the upper chest, ears, and shoulders are more prone to them. Sometimes keloids can be misconstrued with hypertrophic scar, both have separate clinical and histochemical entities; hypertrophic scar is confined to the area of damaged skin, whereas keloids extend to nearby cells in the dermis.

 

Treatments for keloid scarring:

Various treatment modalities are available, but there aren’t any gold standard treatments that supersedes the others.

Options include:

  • Steroid injection- considered as a first line of treatment, it may be used alone or in conjunction with other treatments.
  • Cryotherapy- freezing early keloids to stunt their growth. This method is less recommended for darker people as it can lead to pigmentation.
  • Surgical removal- often accompanied by another modality to remove the scar (high reoccurrence rate)

Keloids are generally harmless and painless and do not change into cancer; they are benign. Dark-skinned individuals and familial tendencies play an important role in the development and formation of keloids. The treatments address symptom alleviation, and since keloids have significant cosmetic repercussions, many of the treatments are directed towards cosmetic concerns.

 

 

Written by: Naif Alshaikh, Medical Student 

 

Resources:
dermnetnz.org
www.nhs.uk
Plast. Reconstr. Surg. 117: 286, 2006
https://www.ncbi.nlm.nih.gov/books/NBK507899

 

Herpes zoster

 

 

 

Herpes zoster (also known as shingles) is a localized, blistering, and painful rash caused by reactivation of varicella-zoster virus (VZV) (as known as herpesvirus 3 member of the Herpesviruses). Herpes zoster is characterized by blisters that are confined to the cutaneous distribution of one or two adjacent sensory nerves, which are usually unilateral with a sharp cut-off at the anterior and posterior midlines.

 

 

the clinical presentation includes pain, which may be severe, relating to one or more sensory nerves. The patients usually feel quite unwell with fever and headache with the lymph nodes draining the affected area being enlarged and tender. The chest (thoracic), neck (cervical), forehead (ophthalmic), and lumbar/sacral sensory nerve supply regions are most commonly affected at all ages, with the frequency of ophthalmic herpes zoster increases with age. Anyone with previous varicella (chickenpox) may subsequently develop zoster. they may occur in childhood but are more common in adults, especially the elderly. After primary infection, VZV remains dormant in dorsal root ganglia nerve cells in the spine for many years before reactivating and migrating down sensory nerves to the skin causing herpes zoster. it’s still unknown why certain nerves are at higher risk, but the currently acknowledged trigger factors are: Pressure on the nerve roots, radiotherapy at the level of the affected nerve root and Spinal surgery.  Common complications are: Involvement of several dermatomes or bilateral eruptions in unique dermatomes. Eye complications when the ophthalmic division of the fifth cranial nerve is involved. Deep blisters that destroy the skin. Muscle weakness in about one in 20 patients, with Facial nerve palsy being the most common result (Ramsey Hunt syndrome). Post-herpetic neuralgia is the persistence or recurrence of pain in the same area, more than a month after the onset of herpes zoster and It becomes increasingly common with age.

 

 

Antiviral treatment can reduce pain and the duration of symptoms if started within one to three days after the onset of herpes zoster. Because the risk of severe complications from herpes zoster is higher in older people, those aged over 60 years might consider the zoster vaccine, which can reduce the incidence of herpes zoster by half, and if they get herpes zoster despite being vaccinated, the symptoms are usually less severe and post-herpetic neuralgia is less likely to develop.

 

 

 

Written by: Bayan Alhazmi, Medical Student 

 

Resources:

https://www.dermnetnz.org/

Infantile Hemangiomas

 

 

 

Infantile hemangiomas are the most common vascular tumor in infants and children. The majority of hemangiomas are not evident at birth but most become apparent in the first few months of life. Infantile hemangiomas may occur anywhere in the skin, mucous membranes and even internal organs. However, they are usually seen in the head and neck area.

 

Hemangiomas may range in size from a few millimeters to huge sizes covering a large area of the skin. Hemangiomas may be categorized as focal, segmental, or multiple, depending on the pattern of skin or organ involvement. Most hemangiomas undergo a proliferative phase of accelerated growth, usually during the first few months after diagnosis. Depending on the type of hemangioma, the proliferative phase may or may not be followed by a phase of involution, in which the tumor regresses in size and may even disappear completely.

 

The diagnosis of hemangiomas is clinical and requires no investigations. Most cutaneous hemangiomas are asymptomatic and require no treatment. However, hemangiomas may lead to ulceration, bleeding, functional impairment, and disfigurement.

 

Management of hemangiomas differs by case and should be individualized. Options for management may include active observation, medical therapy such as propranolol and corticosteroids, surgery especially if the hemangioma is causing functional impairment and laser therapy.

 

 

Written by: Turki Alsehli, Medical Student 

 

Resources:

www.UpToDate.com

www.DermNetNZ.org

A brief touch on some of the skin manifestations associated with diabetes mellitus

 

 

 

Diabetes mellitus is a disorder occurring when the body is unable to process glucose resulting in high blood glucose. It is a very common disease; it has been estimated that around 18% of the adult population in Saudi Arabia suffer from diabetes mellitus. There are 3 types of diabetes mellitus, type 1, type 2, and gestational. Type 1 occurs due to autoimmune destruction of insulin-producing pancreatic beta cells causing little to no insulin to be released. On the other hand, type 2 is due to insulin resistance rather than destruction of insulin-producing cells.

 

 

There are a couple of skin manifestations occurring in diabetics, and they are usually more common in type 2 than type 1. Furthermore, poorly controlled diabetes mellitus is associated with an increased incidence of skin infections and “diabetic foot”. Acanthosis nigricans (AN) associated with diabetes mellitus (benign AN) has an insidious onset and often described as velvety thickening and hyperpigmentation of the skin. Another disorder often associated with diabetes mellitus is Necrobiosis lipoidica (NL). NL lesions start as a papule that slowly develops into a well-demarcated plaque. A combination of peripheral arterial disease and peripheral neuropathy causes something known as “diabetic foot”. Patients suffering from diabetic foot have reduced sensation in their extremities, thus making them more prone to acquire undiscovered minor injuries that may later progress to full-thickness ulcers.

 

 

Diabetes mellitus is linked with some skin manifestations, we have briefly touched on a few of them such as acanthosis nigricans, necrobiosis lipoidica, and diabetic foot. Maintaining proper blood glucose and frequent foot care is important in the prevention of ulcers in the foot and infections.

 

 

 

Written by: Khalid Al Dakheel, Medical Student 

 

Resources:

Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, Seventh Edition

https://www.mayoclinic.org/

www.DermNetNZ.org

Viral warts

 

 

 

Viral warts are ubiquitous and harmless skin growths caused by human papillomavirus (HPV). It infects epidermal or mucosal cells creating a warty knoll lesion called verruca.

 

Diagnosis is clear-cut and based on clinical grounds, but in some cases uncertainty emerges. Facial warts can be mistaken for lichen nitidus, in such instances, histological differences confirm the diagnosis.

 

Common locations for warts include the hands and feet, but they manifest differently depending on the location. Palmar or hand warts appear as hyperkeratotic papules, whereas plantar or feet warts are exhibited as thick plaques. Both arise under pressure points and may cause pain.

 

Treatments are discounted due to the nature of warts; they resolve spontaneously and appear to be for the most part asymptomatic. If treatment is pursued, different modalities can be used to tackle it. The use of topical salicylic acid treatment, which is typically tolerated, works gently at exfoliating the skin from the epidermal layer, softening the skin, and encouraging cell turnover. Another modality, which the commonest, utilizes liquid nitrogen, formerly called “cryotherapy”, to directly destroy and induce secondary inflammation.

 

In general, cutaneous viral warts are uncommon, nonetheless, they do appear often in children, particularly schoolchildren and immunocompromised. Patients choose to excise warts for cosmetic reasons, pain, or discomfort, but they do not pose a health threat as they are benign, however, they are mischievously contagious and can be spread through contact.

 

 

 

Written by: Naif Alshaikh, Medical Student 

 

Resources:

https://dermnetnz.org/topics/viral-wart/

https://www.huidhuis.nl/sites/huidhuis.nl/files/inline-images/PDF/BMJ_cutaneous_viral_warts.pdf

https://www.yalemedicine.org/conditions/viral-warts/