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BACKGROUND: Isotretinoin is a commonly prescribed medication for moderate-to-severe acne. Elevated triglycerides and total cholesterol, as well as eye dryness, are frequent side effects of isotretinoin. Objective: This study aims to examine the association between serum baseline levels of triglycerides and total cholesterol with regards to the severity of dry eye symptoms in acne patients treated with isotretinoin. METHOD: The study was a retrospective review of acne patients treated with isotretinoin for at least four months at the dermatology clinics of Qassim University Medical City, Saudi Arabia. Thirty patients were included in the study as they met the inclusion criteria. Baseline levels of triglycerides and total cholesterol were reviewed for these patients. The Ocular Surface Disease Index (OSDI) questionnaire was sent and filled out by the study participants to assess the severity of eye dryness. RESULT: 30 patients were included in the study, with 16 (53.3%) females and 14 (46.7%) males. The average age of participants was 22.1 years. The duration of treatment was between 120 and 140 days in 13 (43.3%) participants and 140 and 180 days in 17 (56.7%) participants. The mean ± 1 standard deviation (SD) was reported for each of the three variables, with an Ocular Surface Disease Index (OSDI) score of 27.6 ± 19.2, a baseline total cholesterol of 4.4 ± 0.9 mmol/L, and a baseline triglyceride level of 0.83 ± 0.4 mmol/L. Using a multiple linear regression model, baseline triglycerides and total cholesterol were used as predictors of the OSDI score. There was a significant dependent interaction between baseline total cholesterol and triglycerides and their effect on the OSDI score, with a higher OSDI score at higher levels of both triglycerides and cholesterol and a lower OSDI score at lower levels of both triglycerides and cholesterol. The study result showed that, in acne patients treated with isotretinoin for at least four months, a higher baseline level of both triglycerides and total cholesterol is associated with worse dry eye symptoms compared to those with lower baseline levels. CONCLUSION: The study concluded that baseline levels of triglycerides and total cholesterol are both significant predictors of the severity of dry eye symptoms in acne patients treated with isotretinoin. Despite study limitations due to the small sample size, we hope that, based on our findings, this will open the door to future studies with a larger sample size to further confirm our findings generalize the result, and apply it to clinical practice so that clinicians may identify those at higher risk of severe eye dryness before starting isotretinoin and subsequently be able to recommend specific measures to minimize symptoms of eye dryness.
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Allergy to hair products is an increasingly common issue among people given the exposure to these products on a daily basis. Allergic reactions could be in the form of delayed-type contact dermatitis or the form of immediate-type hypersensitivity reactions. Hair products contain many ingredients and chemicals that patients may have allergies to, but common allergens are hair dyes, fragrances, persulfate salts, ammonium thioglycolate, coconut fatty acid derivatives, and acrylates. Allergy to hair dye is the most common followed by other allergens such as fragrances and persulfate salts. We discussed testing for hair dye allergy along with suggestions for alternative hair dyes that patients may use. Allergy to topical scalp medications is also seen in patients using those products. Allergy to topical minoxidil is seen more often due to the increased use of minoxidil sprays and foams among patients to increase hair growth. We will discuss in this review the diagnosis and alternatives for patients with minoxidil allergy. Hairdressers are at higher risk of allergy to hair products compared to the general population due to prolonged exposure to allergens and specific measures should be implemented to minimize the hazards of exposure.
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Background Isotretinoin is a commonly prescribed agent mainly used to treat acne vulgaris. Since its Food and Drug Administration (FDA) approval, the subject of its associations with various medical conditions has become a growing interest in many investigational studies. Methodology A retrospective study was conducted using the validated Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaire. All statistical calculations were performed using the Statistical Package for the Social Sciences (SPSS) version 27.0.1 (IBM SPSS Statistics, Armonk, NY). Results The research study involved 107 participants, predominantly Saudi nationals (98.1%), with an average age of 22 years. Regarding the total cumulative dose (TCD), 40.2% had less than 50 mg/kg, 33.6% had between 50 and 100 mg/kg, and 15.9% had more than 100 mg/kg. The majority (73.8%) did not stop using isotretinoin. The average Ocular Surface Disease Index (OSDI) score, indicating ocular surface disease symptoms, was 26.78. There was no significant association between gender, dose/duration of isotretinoin, TCD, and age, and OSDI scores. However, participants with severe OSDI scores were more likely to have worsened pre-existing eye symptoms compared to those with non-severe OSDI scores (35.1% versus 11.4%, p = 0.011). Conclusions This study contributes to the understanding of the impact of isotretinoin usage on ocular surface health. While no significant associations were found between gender, dose, duration, TCD, and age, and OSDI scores, participants with pre-existing eye symptoms were more likely to experience worsened symptoms during isotretinoin treatment.
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Background Isotretinoin has been used to treat moderate to severe acne. It is well known that isotretinoin can cause an elevation in liver enzymes, triglycerides, and cholesterol. Laboratory monitoring is indicated while patients are on isotretinoin, but the frequency of laboratory monitoring is very variable among physicians who prescribe it. Study objectives This study aimed to determine the frequency of laboratory abnormalities of triglycerides, cholesterol, and liver aminotransferases in acne patients treated with oral isotretinoin in order to assess the need for frequent laboratory monitoring while on isotretinoin and to study the association between body weight and laboratory abnormalities. Methods A retrospective chart review has been conducted using data extracted from electronic medical records of the Department of Dermatology, Qassim University Medical City, Saudi Arabia. We included all acne patients who were treated with Isotretinoin for at least four months. Data were analyzed using the statistical program SPSS version 25 (Armonk, NY: IBM Corp.). Results A total of 407 patients met the inclusion criteria and were included in our study, 198 (48.6%) were female and 209 (51.4%) were males. Patients' age ranged from 10 to 51 years, with a mean age of 22.15 years. At baseline, aspartate aminotransferase (AST) was elevated in 5.4% of patients and alanine aminotransferase (ALT) was elevated in 12.7% of patients. At the last visit, AST was elevated in 3.9% of patients while ALT was elevated in 9% of patients. Triglycerides level was elevated in 12.7% of patients at the last visit compared to 6.5% of patients at baseline. Total cholesterol was elevated in 9% of patients at the last visit compared to 10.5% of patients at baseline. The increase in triglyceride levels and differences between triglycerides (TG) classifications between baseline and last visit was statistically significant (P<0.001). Higher body weight was associated with a higher incidence of elevation in ALT and triglycerides levels, and this association was statistically significant. There was no statistically significant relationship between total cumulative dose and laboratory abnormalities in ALT, AST, triglycerides, or total cholesterol. Conclusion The findings of this study indicate that oral isotretinoin can cause an elevation in ALT, AST, total cholesterol, and triglyceride levels but the incidence of these laboratory abnormalities is low and the elevation was not associated with significant morbidity, and therefore the practice of monthly laboratory monitoring for all patients while on isotretinoin needs to be revised as there is no strong evidence for such practice. We also found that patients with higher body weight are at higher risk of laboratory abnormalities and may require more frequent laboratory monitoring. Our findings support less frequent laboratory monitoring for acne patients on isotretinoin who had normal baseline labs. Frequent laboratory monitoring in these patients carries financial and emotional implications and lacks strong evidence to support this practice.
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Background: Persulfate is an oxidizing agent used for multiple purposes, including bleaching hair, bleaching flour, and as pool/spa water disinfectant. Objective: To identify the prevalence and clinical characteristics of patients allergic to ammonium persulfate (APS) among patients who underwent patch testing in our clinic. Methods: A retrospective chart review of 2138 patients who underwent patch testing at Brigham and Women's hospital in Boston between July 2015 to November 2019. All patients were tested to our standard series including APS 2.5% petrolatum. Given the irritant nature of APS, we included for analysis only patients with 2+ or 3+ reactions. Results: Among 2138 patients, 61 (2.85%) had 2+ or 3+ reactions to APS. In this study, 72% were female. 75% had an atopic diathesis; 56% had 2+ reactions, and 44% had 3+ reactions. Clinical relevance was definite in 11%, probable in 10%, and unknown/possible in 79%. In patients with definite clinical relevance, 6/7 had occupational allergic contact dermatitis: 4 hairdressers, 1 hair salon cleaner, and 1 aquarium worker; 1/7 was bleaching her hair. Conclusion: Prevalence of 2+ or 3+ APS reactions in this single-center study was higher than that reported by the North American Contact Dermatitis Group, 2015-2016, (0.75% vs. 2.85% in our study). APS is an important occupational allergen, and clinicians should be aware of this when treating patients with exposure to APS.
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BACKGROUND: Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are life-threatening conditions caused by drug reactions. There are multiple causative drugs and different risk factors associated with SJS/TEN. OBJECTIVES: To study the epidemiology of SJS/TEN and associated mortality rate in Qassim region, Saudi Arabia. Methodology. A retrospective chart review of all patients with the diagnosis of SJS/TEN who were admitted to King Fahad Specialist Hospital (KFSH) in Qassim region, Saudi Arabia, for the period between Jan 2014 to Jan 2019. The Careware information health system is used at KFSH, and patients were identified searching the diagnosis SJS/TEN. RESULTS: Total of 10 patients with diagnosis of SJS/TEN were admitted to KFSH for the period from Jan 2014 to Jan 2019. Antibiotics were the culprit in 5 out of 10 patients. 9 out of 10 patients survived with good outcome. One patient with the diagnosis of TEN died, given extensive skin involvement complicated by sepsis. CONCLUSION: Despite the limitation of this study given small sample size, this is the first study of its kind that discusses the epidemiology of SJS/TEN in Saudi Arabia. We found the estimated incidence rate of SJS/TEN in Qassim region to be 7.6 cases per million person-years. Antibiotics and antiepileptics were the culprits in 8 out of 10 patients.
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Porokeratotic eccrine ostial and dermal duct nevus (PEODDN) is a rare eccrine hamartoma, with treatment generally being unsatisfactory. The unique features of PEODDN presented include bilateral and facial lesions, and extensive body involvement. Management with CO2 laser was successful, and follow-up will be necessary to monitor for recurrent lesions.