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Abdullah Alakeel,1 Afaf Al Sheikh,2,3 Ali A Alraddadi,4– 6 Khalid Mohammed Alattas,7 Maha Aldayel,8 Mohammed Abdulaziz Alajlan,9 Mohammed Al-Haddab,1 Mohammad Almohideb,3,10 Mohamed Fatani,11 Issam R Hamadah,12 Ruaa Alharithy,13,14 Yousef Binamer,15,16 Kim Papp,17 Ahmed Elaraby18 1Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Division of Dermatology, Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 3Department of Dermatology, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 4Department of Dermatology, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia; 5King Abdullah International Research Center, Jeddah, Saudi Arabia; 6King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 7King Fahad Central Hospital, Jazan, Saudi Arabia; 8Dammam Medical Complex, Dammam, Saudi Arabia; 9Dermatology Section MSD, King Fahad Medical City, Riyadh, Saudi Arabia; 10King Abdulaziz Medical City, Riyadh, Saudi Arabia; 11Hera General Hospital, Makkah, Saudi Arabia; 12King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; 13Security Forces Hospital, Riyadh, Saudi Arabia; 14Princess Nourah University, Riyadh, Saudi Arabia; 15Department of Dermatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; 16Department of Dermatology, Alfaisal University, Riyadh, Saudi Arabia; 17Probity Medical Research Inc. and K. Papp Clinical Research Inc., Waterloo, ON, Canada; 18Bachelor of pharmacy, Cairo University, Giza, EgyptCorrespondence: Issam R Hamadah, Email ihamadah@kfshrc.edu.sa; issamhamadah@gmail.comBackground: Atopic dermatitis (AD) is a long-term, pruritic, recurrent, systemic, inflammatory skin disorder. In the Middle East region, the burden of AD is understudied, and there is a dearth of AD guideline documents for practitioners.Methods: An expert panel meeting, encompassing 12 dermatologists from the Kingdom of Saudi Arabia (KSA), was congregated to develop evidence- and experience-based consensus recommendations for AD management, especially in adults in KSA. They completed a questionnaire with seven clinical statements, and a consensus was defined when the responses of ≥ 75% of participants coincided.Results: The expert recommendations were as follows: American Association of Dermatology guidelines are to be followed for defining AD; Eczema Area and Severity Index or SCORing atopic dermatitis index may be used to quantify the disease severity; Dermatology Life Quality Index may be used to determine the impact of AD on patients’ quality of life; Atopic Dermatitis Control Tool may be used to assess long-term disease control in AD patients; and the European guidelines are to be followed for the management of AD. In AD patients who are inadequately controlled with topical or systemic therapies, the preferred systemic agent for use either alone or in combination with topical treatments is dupilumab, cyclosporine, methotrexate, phototherapy, or other available systemic treatments that may include mycophenolate mofetil or oral corticosteroids.Conclusion: These expert recommendations assist physicians by providing a reference framework for optimal care of adult AD patients.Keywords: atopic dermatitis, Dermatology Life Quality Index, Eczema Area and Severity Index, SCORing atopic dermatitis

Introduction: Secukinumab has demonstrated sustained long-term efficacy with a favourable safety profile in various manifestations of psoriatic disease. We investigated effectiveness and safety of secukinumab, other biologics and conventional systemic therapies in patients with chronic plaque psoriasis in a real-world setting., Methods: REALIA was a non-interventional, multicentre, prospective, parallel group study. Eligible patients were ≥ 18 years old with chronic plaque psoriasis commencing a new treatment with a biologic agent or conventional systemic therapies., Results: At baseline, 541 patients were divided into three cohorts based on treatment initiated: conventional systemics (173), secukinumab (184) and other biologics (184). A significantly higher proportion of patients achieved almost clear to clear skin based on physician's judgement in secukinumab versus conventional systemics at month 3 (64.7% versus 22.8%, P < 0.001) and month 6 (61.8% versus 20.8%, P < 0.001). At month 12, clear to almost clear skin was achieved by 52.1% of the patients in secukinumab versus 35.8% in conventional systemics (P = 0.066). The proportion of patients achieving Psoriasis Area Severity Index (PASI) 90 on conventional systemics, secukinumab and other biologics was 18.8%, 59.7% and 40.0% at month 3 and 35.3%, 60.8% and 50.0% at month 12, respectively. Secukinumab patients showed significantly higher change in PASI total score from baseline versus conventional systemics at month 3 {least squares [LS] mean [standard error (SE)]: -14.49 [0.648] versus -8.48 [1.149], P < 0.001} and numerically higher [LS mean (SE): -13.60 (0.475) versus -10.84 (1.733), P = 0.122] at month 12. The proportion of patients with Dermatology Life Quality Index 0/1 score on conventional systemics, secukinumab and other biologics was 22.6%, 65.0% and 41.6% at month 3 and 32.0%, 63.5% and 41.3% at month 12, respectively. Safety profile was comparable across cohorts., Conclusions: Secukinumab is effective and well tolerated in patients with chronic plaque psoriasis in a real-world setting in an Asia-Pacific and Middle East population, and these results are in agreement with clinical outcomes of secukinumab reported in randomised clinical trials., Trial Registration Number: 170803-001645., (© 2022. The Author(s).)

The current treatment of psoriasis patients with biologic agents in the Kingdom of Saudi Arabia (KSA) is mainly based on clinical experience. Although there are published international guidelines for treatment with biologics, such as the European S3 guidelines (a joint project of the European Dermatology Forum, the European Academy of Dermatology and Venereology, and the International Psoriasis Council), many nations have found it beneficial to develop country-based guidelines that incorporate specific regional aspects of therapy (legal and practical). With the expanded role of biologic agents in the treatment of psoriasis in Saudi Arabia, a need for local Saudi guidelines has become evident. Here we present a practical approach to the evidence-based clinical administration of biologics for professionals who treat patients with psoriasis.

Objective: The diagnosis of cutaneous T-cell lymphoid infiltrates may be difficult based on clinical and routine immunohistologic findings. In this situation, an ancillary technique demonstrating the presence of a monoclonal cell proliferation could help to rule in or out cutaneous T-cell lymphoma (CTCL) in cases that clinically and histopathologically do not allow a definitive diagnosis. Southern blot analysis is a time-consuming method with low sensitivity that should not be considered for the routine diagnosis of cutaneous lymphoid infiltrates. Moreover, it can be used only when fresh tissue is available. New assays based on the amplification of the T-cell receptor gamma (TCR gamma) chain gene rearrangement by polymerase chain reaction (PCR) have been proposed to overcome these limitations., Methods: We retrospectively studied 124 biopsies from 104 patients (66 biopsies with the clinical and histological diagnosis or suspicious of CTCL and 58 biopsies with histological diagnosis of benign reactive dermatological conditions who presented to the Dermatology Unit at King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia between 1996 and 2004. The specimens were morphologically examined and then analyzed by PCR for the gamma chain of the TCR gamma followed by gel electrophoresis., Results: The results showed 87.1% sensitivity and 92% specificity in detecting clonal T-cell gene rearrangements among CTCL cases with a positive predictive value of 93.1% and negative predictive value of 85.2%. Therefore, negative TCR gamma results in CTCL should be taken with caution., Conclusion: The detection of clonal TCR gamma gene rearrangement by PCR based method is an adjuvant diagnostic marker for CTCL, although it can be seen in some benign dermatoses.

Two siblings had hyperpigmented indurations over the inner aspects of both thighs extending to the lower abdomen. Skin biopsy showed plasma cell panniculitis favoring a diagnosis of morphea profundus. Family history of consanguinity was present, but both parents were unaffected. To our knowledge this is the first report of autosomal recessive plasma cell panniculitis with the clinical manifestations of morphea.

Background: Linear IgA bullous dermatosis of childhood is a rare autoimmune bullous disease that mainly affects preschool-aged children. Dapsone is considered the first-line therapy with prompt response from most patients. However, it may be contraindicated in certain conditions such as glucose-6-phosphate dehydrogenase deficiency., Objective: We sought to assess the efficacy of flucloxacillin in the treatment of linear IgA bullous dermatosis., Methods: This is an observational study in which all confirmed cases of linear IgA bullous dermatosis (by both histological and immunofluorescence studies) will be treated with flucloxacillin. Flucloxacillin will be continued according to the response or otherwise will be discontinued after 8 weeks in the case of resistance., Results: We describe 7 patients with linear IgA bullous dermatosis of childhood treated with flucloxacillin. In 4 cases, it induced complete remission within 3 to 4 months of starting therapy with no relapses. In the other 3 cases, it successfully controlled the disease but with prompt relapse on discontinuation of the treatment., Limitations: This is a case series study with a small number of patients., Conclusion: Flucloxacillin may be considered among the first alternative therapies for linear IgA bullous dermatosis of childhood. Further evaluation of the efficacy and safety of the long-term use is required.

Although the involvement of mucous membranes in Darier's disease is relatively uncommon, Darier's disease has been associated with mucosal lesions, especially in the oral mucosa. In the English literature there is only one report describing the involvement of esophageal mucous membranes in a patient with Darier's disease. Herein, we report the second case of Darier's disease with esophageal involvement.

We report a 19-year-old man with congenital erythematous plaque on his left arm that was found histopathologically to be composed of respiratory mucosa. The patient had a triphalangeal thumb and polydactyly in the left hand. This is, to our knowledge, only the third case of ectopic respiratory epithelium presenting as a superficial lesion in the skin to be reported in the English literature, and the first case associated with skeletal malformation and polydactyly.