Search Results (34)

Background: Oral isotretinoin is an effective treatment for refractory and moderate acne unresponsive to conventional therapies, considered the most effective option for such cases. Objective: This study aimed to evaluate the knowledge, concerns, and experiences of acne patients undergoing isotretinoin treatment in Qassim, Saudi Arabia, with a focus on commonly reported adverse effects. Methods: A cross-sectional study was conducted from December 2023 to February 2024 using a self-administered questionnaire. This study targeted male and female acne vulgaris patients from the Qassim region attending the outpatient dermatology clinic at King Saud Hospital (KSH). Results: A total of 131 acne patients participated. Of these, 97.7% had heard of isotretinoin, and 92.4% were aware of its side effects. The most common sources of information were colleagues, friends, or family (37.4%), followed by previous use (26%) and healthcare professionals (24%). The most frequently reported side effect was dryness (51.9%), followed by liver function changes (24.4%) and fetal abnormalities (13%). There was a significant association between educational level and knowledge of isotretinoin’s side effects (p = 0.003) and awareness of specific side effects (p < 0.001). Conclusion: Most acne patients had sufficient knowledge of isotretinoin and its adverse effects, with dryness being the most commonly reported side effect. The primary sources of information were non-medical, highlighting the need for health education to ensure informed and safe isotretinoin use. Full article

Background: Saudi Arabia is undertaking a comprehensive reform of its healthcare system to improve the efficiency and accessibility of public healthcare services. A key aspect of this initiative is outsourcing outpatient pharmacy services within the public health sector to retail pharmacies through an electronic prescribing platform known as Wasfaty. The National Unified Procurement Company (NUPCO) manages this platform to ensure spending efficiency and patient accessibility to essential medications. However, there has been a lack of research evaluating the adherence of the Wasfaty e-prescribing platform to established best practices for Computerized Provider Order Entry (CPOE), which are commonly used to assess the performance of various ambulatory e-prescribing systems globally. Objective: This study aimed to assess the level of adherence of Wasfaty to best practices for CPOE. Methods: This descriptive cross-sectional single-center study reviewed filled prescriptions through Wasfaty from May 2022 to December 2023. A list of 60 functional features, including but not limited to patient identification and data access, medication selection, alerts, patient education, data transmission and storage, monitoring and renewals, transparency and accountability, and feedback, was utilized to evaluate adherence. The adherence level was categorized into four groups: fully implemented, partially implemented, not implemented, and not applicable. Two pharmacy interns, a clinical pharmacist, and a researcher, reviewed the prescriptions to determine the platform’s adherence to these 60 CPOE features. Results: From May 2022 to December 2023, a total of 1965 prescriptions were filled in retail pharmacies for out-of-stock medications for 1367 patients. These prescriptions included medications for various areas, with the following distribution: gastroenterology (44.10%), cardiology (18.14%), anti-infectives (2.42%), urology (8.85%), dermatology (3.6%), hematology (0.29%), muscle relaxants (0.8%), neurology (19.17%), pulmonology (1.46%), and other categories (1.23%). Of the 60 functional characteristics a CPOE platform should include, only 19 (31.66%) were fully implemented, while 10 (16.66%) were partially implemented. Conclusions: The Wasfaty platform is deficient in several key functional features necessary for e-prescribing, which are essential for ensuring patient safety and enhancing the satisfaction of both prescribers and patients. This study underscores the importance of improving the Wasfaty platform to reduce the risk of adverse drug events. Full article

Background/Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) poses significant treatment challenges, particularly in community settings. Limited data are available on S. aureus-associated infected dermatoses (ID) in outpatient dermatology clinics. This study examines the clinical characteristics, microbiological profiles, resistance patterns, and treatment outcomes of dermatoses caused by S. aureus. Methods: Between January 2023 and January 2025, consecutive patients with confirmed S. aureus-associated SD were recruited in a dermatology clinic in Heraklion, Greece. Demographic, clinical, and treatment data were collected. Skin swabs underwent bacterial culture and antimicrobial susceptibility testing following CLSI guidelines. Statistical analyses evaluated associations between clinical and microbiological findings. Results: Sixty-eight patients were included, 54.4% of whom were male, with a mean age of 46.7 years (± SD 25.1). MRSA was identified in 22.1% of cases and was significantly associated with female gender (p = 0.014). The most common diagnoses were eczema (35.3%) and folliculitis (19.1%). Oxacillin-resistant patients were more likely to receive systemic therapy (p = 0.039). Resistance rates were highest for benzylpenicillin (81.8%), levofloxacin (54.9%), and erythromycin (39.4%). Resistance rates for fusidic acid, clindamycin, mupirocin, and tetracycline were 38.2%, 20.6%, 16.9%, and 10.3%, respectively. Other pathogens, including Pseudomonas aeruginosa and Escherichia coli, were isolated in 27.9% of cases. Conclusions: This study highlights the high prevalence of MRSA in outpatient dermatology settings, emphasizing the need for local antimicrobial resistance surveillance to guide treatment strategies and improve outcomes in superinfected dermatoses. Full article

Background/Objectives: Eyelid dermatitis is an inflammatory disease affecting the palpebral skin characterized by itching, edema, and scaling of the periorbital area. This entity can be a manifestation of various underlying dermatological diseases, but allergic contact dermatitis (ACD) is the predominant etiology of eyelid dermatitis among patients, being diagnosed in 43.4% of cases. The thin and highly permeable nature of eyelid skin increases its susceptibility to allergens, making it a distinct clinical entity. This study aimed to identify the primary haptens associated with eyelid ACD and compare these findings with the allergens implicated in non-eyelid ACD over a 25-year period in a large cohort of patients. Methods: We conducted a monocentric, retrospective study on a dataset of 7955 patients patch-tested for ACD at the Outpatient Allergy Dermatology Clinic of the Azienda Ospedaliera Universitaria Senese (AOUS) from 1997 to 2021. Eyelid ACD cases were identified based on clinical features and positive patch test results. Data on demographics, occupation, and personal history of atopy were collected. The statistical analyses assessed the associations between allergens and eyelid ACD. The trends in the sensitization rates for the most prevalent allergens were also evaluated. Results: Eyelid ACD was identified in 4.6% of the study population, predominantly affecting women (88.6%). Patients with eyelid ACD were more likely to exhibit single-hapten positivity (54.6%) and an atopic phenotype (52.3%) compared to non-eyelid ACD cases. Nickel sulfate (54%), cobalt chloride (13.4%), and thimerosal (12.6%) were the most common allergens associated with eyelid ACD. While thimerosal sensitization decreased significantly following its removal from topical products, nickel sensitization increased, likely due to exposure from electronic devices and hand–eye contact. Conclusions: The haptens identified in eyelid ACD largely overlap with those found in other body regions, including metals, fragrances, and preservatives. However, the unique characteristics of eyelid skin and hand–eye contact patterns play a significant role in sensitization. This study highlights the need for further investigation into the pathophysiology of eyelid allergic contact dermatitis, with particular emphasis on elucidating the mechanisms of hapten sensitization. Such insights could contribute to the development of effective strategies aimed at reducing allergen exposure. Full article

Up to one-quarter of the United States population is affected by tinea pedis (athlete’s foot). Tinea pedis of the web space (interdigital tinea pedis) is a common clinical presentation causing skin macerations and fissures. A “dermatophytosis complex” (i.e., concomitant bacterial colonization) further complicates treatment. Here, we examined records of 14,429 skin specimens taken from the feet of dermatology and podiatry outpatients over a 4.6-year period; all specimens were subjected to multiplex qPCR diagnosis for the detection of dermatophytes, Candida, Corynebacterium minutissimum, Pseudomonas and Staphylococcus aureus. A literature search was conducted to review the reported prevalence of fungal and bacterial agents. In both interdigital and plantar foot specimens, dermatophytes (33.3–33.8%) and S. aureus (24.3–25%) were found to be the predominate pathogens. In the interdigital space, a higher prevalence of C. minutissimum (15.7% vs. 7.9%) and Pseudomonas (23.5% vs. 9.6%) was found. The detection of Pseudomonas was more likely to be observed in the presence of Candida, reflecting a higher risk of mixed infection. In dermatophyte-positive specimens, the “dermatophytosis complex” variant was observed at 45.5% (SD: 2.3). An analysis of patient characteristics showed male patients exhibiting higher likelihoods for dermatophyte, C. minutissimum, Pseudomonas and S. aureus detections. The elderly were disproportionately infected with Candida. In children, an S. aureus detection was more common, which could be attributed to impetigo. The recent literature lacks reporting on concomitant bacterial colonization in tinea pedis patients, likely due to the reliance on fungal culture supplemented with antibiotics. Geographical variation has been identified in the detection of the Trichophyton mentagrophytes complex. In conclusion, PCR diagnosis serves as a valuable tool for the management of tinea pedis. An accurate and timely detection of fungal pathogens and concomitant bacterial colonization can better inform healthcare providers of appropriate treatment selection. Full article

Background/Objectives: Cutaneous infections of fungal and bacterial origins are common. An accurate diagnosis—especially concerning pathogens that are difficult to isolate on culture—can be achieved using molecular methods (PCR) with a short turnaround time. Methods: We reviewed records of skin specimens (superficial scrapings) submitted by dermatologists across the United States with a clinically suspected dermatitis. As per physician’s order, specimens were tested for infections either fungal (N = 4262) or bacterial (N = 1707) in origin. All unique specimens (one per patient) were subjected to real-time PCR assays where cases suspected of a fungal etiology were tested for dermatophytes, Malassezia and Candida, and cases suspected of a bacterial etiology were tested for Streptococcus pyogenes, Staphylococcus aureus, and the mecA gene potentially conferring β-lactam resistance. Results: Fungal agents were detected in 32.8% (SD: 4.5) of the submitted specimens, with most attributed to dermatophytes (19.3% (SD: 4.9)), followed by Malassezia (8.7% (SD: 2.8)) and Candida (2.9% (SD: 1.0)). Dermatophyte detection was more common in the elderly (≥65 years) compared to young adults (18–44 years) (OR: 1.8 (95% CI: 1.5, 2.2)), whereas Malassezia was more commonly detected in younger age groups (12.1–13.6%) than the elderly (5.6%). Candida was more frequently observed in females while dermatophytes and Malassezia were more frequently observed in males. Approximately one quarter of the submitted skin specimens tested positive for S. aureus (23.6% (SD: 3.4)), of which 34.4% (SD: 9.8) exhibited concurrent detection of the mecA gene. An S. aureus detection was more frequently observed in males (OR: 1.5 (95% CI: 1.2, 1.9)) and in children (OR: 1.7 (95% CI: 1.2, 2.5)). Streptococcus pyogenes was rarely detected. Among specimens positive for dermatophytes, 12.0% (20/166) showed co-detection of S. aureus and mecA, which is in contrast to 6.8% (70/1023) detected in samples without a fungal co-detection and 6.2% (8/130) in samples positive for Malassezia. Conclusions: PCR testing, when available, can be valuable as a part of routine care for diagnosing patients with clinically suspected skin infections. Further studies are warranted to survey the prevalence of resistant S. aureus isolates in dermatology outpatients, in particular with regard to the association with dermatophyte infections. Full article

Background/Objectives: Hypertrophic and atrophic skin aging represent two distinct phenotypes: hypertrophic aging is marked by deep wrinkles and a leathery texture, whereas atrophic aging is characterized by overall skin thinning, increased vascularity, and a higher risk of non-melanoma skin cancers. This study aims to elucidate the characteristics and differences between hypertrophic and atrophic facial aging subtypes using two non-invasive imaging devices: VISIA^® and dynamic optical coherence tomography (D-OCT). Methods: We retrospectively evaluated patients who had presented to the outpatient dermatological clinic at Policlinico Umberto I hospital in Rome, Italy for a non-invasive facial imaging check-up. We included 40 patients aged 60–75 who were imaged with VISIA^® and dynamic optical coherence tomography (D-OCT). Based on the number of UV spots and amount of red found on VISIA^®, subjects were grouped into four subgroups (PIGM, RED, CONTROL, PIGM + RED), and trends among them were analyzed. Results: We found a strong correlation between VISIA^® red area scores and D-OCT vascular density at 300 µm depth, confirming VISIA^®’s effectiveness for assessing facial vascularity. Wrinkle count was highest in areas with UV spots, particularly in the PIGM and PIGM + RED groups. Conversely, low attenuation coefficients and dermal density were observed in regions with low UV spots but high red areas. Intermediate subgroups (CONTROL and PIGM + RED) displayed varying parameters. Conclusions: Non-invasive imaging devices are effective in evaluating facial aging and distinguishing between aging subtypes. This study identified two intermediate aging types in addition to the hypertrophic and atrophic subtypes. Full article

Background: Teledermatology is the application of information and telecommunication technologies in the field of dermatology to provide remote care services based on the exchange of clinical information within a network of professionals or between professionals and patients. Tele-trichoscopy is a non-invasive, inexpensive, and easy-to-use method that applies the principle of surface microscopy at different magnifications. Alopecia areata is a non-scarring alopecia with a chronic evolution, which often needs a close follow-up. Objectives: The aim of our work was to analyze the possible benefits of telemedicine for the follow-up of patients with alopecia areata. Materials and Methods: We enrolled patients with alopecia areata, identified during the first trichological evaluation, and we divided the patients into two groups. One group was provided with the devices necessary for a telemedicine follow-up. The other group had a conventional follow-up. The total follow-up time was one year. All of the patients’ photos were blindly evaluated by a team of expert dermatologists who were asked to indicate the quality of the images. The photos were also evaluated to identify disease markers. During the follow-up period, questionnaires were administered to both groups of patients to assess the quality of the visit, the level of patient satisfaction, and to identify any issues encountered by the patients. Results: There was a high degree of concordance between the images obtained by outpatient trichoscopy and those obtained by telemedicine. The satisfaction levels were the same between the patients followed via telemedicine and those seen in the outpatient clinic. Conclusions: Telemedicine applied to trichology using trichoscopy was proven to be a valid system for managing the follow-up of patients suffering from chronic recurrent scalp diseases and, above all, for maintaining continuity of care. Full article

Introduction: To promote optimal healthcare delivery, safeguarding older adults from the risks associated with inappropriate medication use is paramount. Objective: This study aims to evaluate the effectiveness of implementing the Qatar Tool for Reducing Inappropriate Medication (QTRIM) in ambulatory older adults to enhance medication safety. Method: The QTRIM was developed by an expert consensus panel using the Beers Criteria and contained a list of potentially inappropriate medications (PIMs) based on the local formulary. Using quality improvement methodology, it was piloted and implemented in two outpatient pharmacy settings serving geriatric medicine and dermatology clinics at Rumailah Hospital, Qatar. Key performance indicators (KPIs) using implementation documentation as a process measure and the percentage reduction in PIM prescriptions as an outcome measure were assessed before and after QTRIM implementation. This study was conducted between July 2022 and September 2023. Results: In the outpatient department (OPD) geriatric pharmacy, the prescription rate of PIMs was reduced from an average of 1.2 ± 0.7 PIMs per 1000 orders in 2022 to an average of 0.8 ± 0.2 PIMs per 1000 orders in 2023. In the OPD geriatric pharmacy, the results showed a 66.6% reduction in tricyclic antidepressants (TCAs) (from 30 to 10), a reduction in first-generation antihistamines by 51.7% (29 to 14), and muscle relaxants by 33.3% (36 to 24). While in dermatology, the older adult prescription rate of PIMs was reduced from an average of 8 ± 3 PIMs per 1000 orders in 2022 to a rate of 5 ± 3 PIMs per 1000 orders in 2023; the most PIM reductions were (49.4%) in antihistamines (from 89 to 45), while muscle relaxants and TCAs showed a minimal reduction. Conclusions: Implementing QTRIM with pharmacy documentation monitoring markedly reduced the PIMs dispensed from two specialized outpatient pharmacies serving older adults. It may be a promising effective strategy to enhance medication safety in outpatient pharmacy settings. Full article

Background and Objectives: This study demonstrates the factor structure and reliability of the Croatian version of the TOPICOP (Topical Corticosteroid Phobia) questionnaire, thereby contributing to further validation and standardization of the measurement of topical corticophobia with dermatological patients or their parents, which directly affects patient or parent compliance, as well as the final therapeutic effect. Materials and Methods: The cross-sectional, observational study was conducted at the University Hospital Centre Split, Department of Dermatovenerology. The research involved inviting 120 participants (age 12–68) who attended the University Hospital Centre Split’s Atopy School, patients examined in the Dermatology Outpatient Clinic of the University Hospital Centre Split and diagnosed with atopic dermatitis (AD) or allergic contact dermatitis (ACD), and parents or legal representatives of patients younger than 12 years old. The TOPICOP questionnaire consists of 12 items assessing the three different components of topical corticophobia (worries, beliefs, and behaviour). Respondents evaluated their perception of the correctness of each statement within 10 min of filling out the questionnaire on a four-point Likert scale. Results: The response rate was 94%, resulting in a sample of 113 respondents (109 adults and 4 children). Factor analysis yielded one common factor of relatively high reliability (Cronbach α = 0.85, 95% CI 0.81 to 0.89). No differences were found in questionnaire scores between male and female participants, nor between the parents/legal representatives of dermatological patients and other patients. Conclusions: This research contributes to further development of the appropriate measuring instrument, its practical application, and thus, the better recognition, resolution, and prevention of topical corticophobia as part of the better overall healthcare and treatment of chronic dermatological patients. Full article

Demodex mites are acari, common ectoparasites of humans and other mammalian pilosebaceous units. Demodicosis occurs when mites overpopulate the skin, causing several skin disorders. Our aim was to investigate the prevalence of demodicosis in patients with suspicious clinical features, such as cheek redness, itching, and skin sensitivity, who presented at the outpatient clinic of the Andreas Syggros Dermatology Hospital in Greece. We studied 184 individuals aged between 18 and 97 years and analyzed the content of pilosebaceous units by microscopy to determine the density of Demodex mites. Samples were evaluated as positive when Demodex spp. densities equaled or exceeded 5 mites per square cm. Sixty-six percent of the examined subjects were positive for demodicosis. The age distribution was statistically normal (p = 0.2), and the median age was 51.29 years. Seventy percent of the patients were females, and 30% were males, while 64.46% of the demodicosis-positive individuals were females, and 35.54% were males. We observed a rise in the percentage of males as the age of the patients increased. Demodicosis can be a challenging disease because it presents apart from the typical symptoms, with a variety of nonspecific symptoms mimicking other dermatological skin conditions. Therefore, it is important to investigate Demodex spp. in patients who present with common facial dermatological diseases to improve treatment results. Further studies could contribute to a better understanding of the pathogenic role of Demodex mites and how this role is affected by mite density, host sex and age. Full article

Background: this study aimed to investigate the relationship between acne severity and depression, anxiety, stress, and negative eating attitudes in patients with acne vulgaris. Method: This study was conducted with 81 patients with acne vulgaris who applied to the dermatology outpatient clinic of Karaman Training and Research Hospital. The patients were asked to complete a sociodemographic data form, the three-factor nutrition questionnaire (TFEQ-21), and the depression anxiety stress scale (DASS-21). Acne severity was assessed using the global acne grading system (GAGS) by an expert dermatologist. Results: Of the 81 patients, 74.1% were female and the average age of the cohort was 22.86 years. The average body mass index of the patients was 21.78 and the GAGS average score was 24.25. Correlation tests revealed the lack of any relationship between the GAGS score and the DASS-21 and TFEQ-21 scale scores (and their subscales). The DASS-21 depression subscale was correlated with the TFEQ-21 total score, and TFEQ-21 emotional eating and TFEQ-21 uncontrolled eating scores. Additionally, a relationship was identified between the DASS21-stress subscale score and TFEQ-21 uncontrolled Eating and TFEQ-21 total score, as well as between the DASS21-anxiety scale and the TFEQ-21 total score and TFEQ-21 uncontrolled eating subscale score. Conclusions: Although no relationship was found between acne severity and depression, anxiety, or eating disorders, these conditions can increase the risk of eating disorders among acne patients. Therefore, it is critical to take the necessary precautions for the treatment of depression and anxiety disorders in this patient population. Full article

Background and Objectives: Psoriasis is a chronic, long-term, incurable skin inflammatory disease characterized by the excessive proliferation of epidermal keratinocytes, dilation of blood vessels, thickening of the skin, and the formation of visible red patches of variable sizes. The impact on patients differs with the severity of the disease, leading to physiological discomfort and psychological distress, which significantly affect the quality of life. The etiology of psoriasis is not completely clear, but immune cells, including type 1 and type 17 cytokine-producing cells modulated by regulatory T cells (Tregs), play a critical role in driving the disease pathogenesis. With the ability to specifically target inflammatory markers, biologics can efficiently inhibit the spread of inflammation to achieve therapeutic effects. The goal was to explore the changes in body image and quality of life in psoriasis patients undertaking therapies with biologic agents. Materials and Methods: This study employed a quasi-experimental, single-sample, pretest–posttest design. Forty-four psoriasis patients were recruited from the dermatology outpatient clinics at two medical centers in northern Taiwan. A structured questionnaire, including demographic information, the Body Image Scale (BIS), and the Dermatology Life Quality Index (DLQI), was used as a research tool. Questionnaire assessments were conducted both before and three months after the biologic agent intervention. Statistical analyses were performed using SPSS version 22.0. Results: Our results indicated a significant difference in body image between psoriasis patients before and after intervention with biologic agents. In addition, overall quality of life (QoL) also showed significant improvements before and after biologic agent intervention. There was a positive correlation between body image and quality of life in psoriasis patients. Conclusions: The treatment for psoriasis has evolved rapidly in recent years, and biologic agents have proven to be effective therapies to improve the quality of life for psoriasis patients. Our study suggests that health-related education and psychological support can further benefit psoriasis patients to willingly and positively undertake treatment and therefore improve their positive body image and quality of life. Full article

The COVID-19 pandemic resulted in a decline in outpatient attendance. Therefore, this study aimed to clarify long- and short-term clinic attendance trends by speciality in Japan between 2009 and 2021. A retrospective observational study of Japan’s claims between 2009 and 2021 was conducted using the Estimated Medical Expenses Database. The number of monthly outpatient claims in clinics was used as a proxy indicator for monthly outpatient attendance, and specialities were categorised into internal medicine, paediatrics, surgery, orthopaedics, dermatology, obstetrics and gynaecology, ophthalmology, otolaryngology, and dentistry. The annually summarised age-standardised proportions and the percentage of change were calculated. Joinpoint regression analysis was used to evaluate long-term secular trends. The data set included 4,975,464,894 outpatient claims. A long-term statistically significant decrease was observed in outpatient attendance in internal medicine, paediatrics, surgery, ophthalmology, and otolaryngology during the pandemic. From March 2020 to December 2021, which includes the COVID-19 pandemic period, outpatient attendance in paediatrics, surgery, and otolaryngology decreased in all months compared with that of the corresponding months in 2019. For some specialities, the impact of the pandemic was substantial, even in the context of long-term trends. Speciality-specific preparedness is required to ensure essential outpatient services in future public health emergencies. Full article

The patient was a 44-year-old woman with Stevens–Johnson syndrome due to receiving Baktar^® (sulfamethoxazole trimethoprim) medication at our outpatient dermatology clinic. The epidermis, dermis, and subcutaneous adipose tissue samples showed numerous necrotic keratinocytes in the epidermis. Apoptotic nuclei were visualized as diaminobenzidine brown deposits with immunoperoxidase staining for cleaved caspase-3. The cleaved caspase-3-positive findings were consistent with eosinophilic material that appeared to be necrotic cells within the epidermis. Therefore, these eosinophilic materials may be apoptotic bodies. Generally speaking, eosinophilic cells are considered necrotic keratinocytes, especially in Japan. To the best of our knowledge, no studies have used apoptotic immunohistochemical markers to examine whether these structures are apoptotic in a human specimen. Full article