Epidemiological spectrum of common dermatological conditions of patients attending dermatological consultations in Al-Majmaah Region (Kingdom of Saudi Arabia)

AbstractBackgroundSkin diseases and their complications are a significant burden on the health system of many nations. Epidemiological studies to determine the burden of skin diseases are important for proper healthcare planning. A paucity of data exists concerning the epidemiological status among patients attending dermatologic consultations in university-affiliated clinics in the Al-Majmaah Region (Kingdom of Saudi Arabia), prompting a need for conducting this study in this area.ObjectiveTo identify the patter/spectrum of dermatological disorders in the outpatient setting by dermatologists in order to improve future patient care and cost reduction through physician education.MethodsIn this retrospective follow up, a multistage sampling technique was employed and 1006 patients with skin disorders were randomly selected from dermatology clinics between September 2011 and March 2012.ResultsA total of 1006 collected patient’s data included males 47.2% (mean age 27.24±15.2) and females 52.8% (mean age 27.62±14.2). The patients were divided into different age groups as 0–10 (n=102), 11–20 (n=273), 21–30 (n=293), 31–40 (n=178), 41–50 (n=71), 51–60 (n=56) and 61 ears and above (n=33). The dermatological referrals randomly selected in the present study showed that the maximum number of disorders were present in patients under the age group 21–30years (293/1006). Eczema was the most frequent diagnosis, comprising 15.81% (159/1006) while acne 14.71% (148/1006) was the second most common diagnosis followed by dermatitis 12.33% (124/1006) among noninfectious dermatological disorders. The infectious dermatological conditions largely included viral infection 13.32% (134/1006), fungal infection 7.56% (76/1006) and bacterial infection 6.96% (70/1006). Under noninfectious dermatological disorders, the number of patients infected with eczema was significantly higher (p<0.05) in females 18.6% (99/531) as compared to males 12.6% (60/475). However the male exhibited significantly higher cases of dermatitis than females [male: 69 (14.5%) vs. female: 55 (10.4%), p<0.05]. Of all the infectious disorders related to dermatological conditions, the viral infection was more prevalent in males 13.7% (65/4750) and in females 13% (60/531). In the age group 21–30years (293), eczema 16.4% (48/293), dermatitis 11.3% (33/293) and psoriasis 5.1% (15/293) were prevalent among the noninfectious dermatological disorders. The infectious dermatological disorders showed the prevalence of viral infection 9.2% (32/293) significantly higher than bacterial infection 3.8% (11/293) and fungal infection 3.4% (10/293).ConclusionsThe spectrum of different dermatological conditions in Al-Majmaah Region (Kingdom of Saudi Arabia) is alarming and seems to be highly neglected by the community. Eczema was the most frequent diagnosis among all skin diseases and parasitic infections were the least frequent diseases in this study. Health education is therefore necessary to curb their spread, reduce the associated morbidity, and improve the health status of the population. This will provide a better understanding of the epidemiology of skin disorders

Impairment of quality of life among adults with skin disease in King Fahad Medical City, Saudi Arabia

Objectives: The objective of the study was to assess the quality of life in patients with skin disease. Subjects and Methods: A 6-month cross-sectional study was conducted in the Dermatology Clinic at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. The study sample consisted of all 297 adult patients with dermatological conditions attending clinic but without associated psychiatric disease. They completed a self-administered Arabic version of the Dermatology Life Quality Index questionnaire (DLQI), containing ten items. The data was analyzed according to disease, age and gender. Results: The gender distribution of the study sample was 73% female and 27% male. The mean age was 29.4 years. The proportions of patients with various diagnoses were: sebaceous and apocrine gland disorders 31.3%, eczematous dermatitis 18.5%, cutaneous infections 13.5%, and pigmentary disorders 10.8%. The mean DLQI of all patients was 8.32. Patients with papulosquamous disorders recorded the highest mean DLQI score of 15.28, followed by immunological disorders with 11.11, eczematous dermatitis with 9.55, and miscellaneous disorders with 10.91. The mean DLQI was higher among females (9.02) than males (6.46). Age had no influence on the degree of impairment. Conclusion: Measuring the impairment of the quality of life in dermatology patients is an important aspect of management. It allows clinicians to assess the extent and nature of the disability so that an appropriate management regimen can be implemented and its effectiveness assessed

Biologic systemic therapy for moderate-to-severe psoriasis: A review

AbstractTo perform a systematic review and meta-analysis of randomized controlled trials (RCT’s) reporting efficacy of systematic treatments approved for moderate-to-severe psoriasis by means of the Psoriasis Area And severity Index (PASI). We identified relevant articles by systematic electronic searches (Cochrane Library, Medline,). Efficacy was defined as proportion of participants with > 75% decrease in PASI (PASI-75) at primary efficacy measurement (week8-16). PASI-75 response rates of double-blind placebo-controlled trials were summarized as risk differences (RDs) and pooled using random effect models. Tolerability was assessed from rates of withdrawals and adverse events. Twenty-one RCT’s totaling 7877 patients were analyzed qualitatively. Sixteen double-blind placebo-controlled trials were eligible for meta-analysis. Infliximab was significantly superior to all other interventions (RD 77%, 95% confidence interval (CI) 72-81%). Adalimumab (RD 64%, 95% CI 61-68%) was superior to efalizumab (RD 24%, 95% CI 19-30%). Etanercept 50 mg twice weekly (RD 44%, 95% CI 40-48%) and etanercept 25 mg twice weekly (RD 30%, 95% CI 25-35%). Rates of withdrawals due to adverse events were highest for methotrexate and fumaric acid esters.There are considerable differences in efficacy between systemic biologic therapies which are approved for the treatment of moderate-to-severe psoriasis. Infliximab is most efficacious, followed by adalimumab. Patients receiving infliximab have an excess chance of 77% over placebo to achieve PASI-75 response. Published evidence questions regulatory guidelines that recommend biologics as second-line therapy for moderate-to-severe plaque psoriasis