A brief outline on the management of Psoriasis

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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

Probiotics and the skin

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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

Source

Electronic cigarettes and dermatological manifestations

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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

Source

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

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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
Dermatology

Eczema in a nutshell

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   October is eczema awareness month, which is a month-long campaign directed at people and families of those who suffer from eczema all over the world. The main goals of the campaign are to raise awareness, reduce stigma and show the impact of eczema. Because not only does eczema affect the skin, it also has psychological effects such as depression and anxiety.

    When we say eczema (dermatitis) we’re not referring to one disease, there are many types of eczema, so when we talk about it here, we’re merely “scratching” the surface. What people usually mean by eczema is the atopic type, which is the most common type, the hallmark of this disease is pruritus, which is basically just a fancy word for “itching”. There isn’t one single cause for atopic dermatitis, a few hypotheses have been suggested but they all revolve around the patient’s genetical tendency to develop allergic diseases, a term called “atopy”, there is also strong association with asthma, hay fever and other allergic diseases. Atopic dermatitis is usually diagnosed at childhood, but it could be diagnosed later in life. Educating the patient to stop scratching and to avoid triggers such as soaps with certain chemicals is important. Topical treatment is also initially used (steroids, tacrolimus), phototherapy and systemic steroids are usually reserved for non-responsive cases.

     In conclusion, eczema is a serious autoimmune disease affecting the skin, which has both physical and psychological impact. Eczema awareness month is there to shed some light on these issues and the impact of it on individuals.

Happy Eczema Awareness Month!

 

Written by: Khalid Al Dakheel, Medical Student @ KSU

Reference: Fitzpatrick Color Atlas and Synopsis of Clinical
Dermatology (Vienna) By Klauss Wolff and
Richard Allen Johnson. (6th Edition)