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 

Resources:

www.DermNetNZ.org

www.UpToDate.com

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.

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 12^th 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

Resources:

https://www.researchgate.net/publication/340477835_Review_Review_Coronavirus_COVID-19_and_Relevance_for_Dermatologists_-Are_We_Ready_for_the_Battle

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102542/

https://onlinelibrary.wiley.com/doi/abs/10.1111/jdv.16387

https://www.uclahealth.org/body.cfm?id=1397&action=detail&ref=5741&fr=true

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:

UpToDate.com, Dermnetnz.org, 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

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

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