Melasma is a common acquired pigmentary disorder marked by irregular hyperpigmented macules or patches and most commonly occurs in women of darker skin color. It is a chronic often-relapsing condition that causes negative psychosocial effects in those affected. Current treatments such as hydroquinone, kojic acid, and retinoids, among others, demonstrate variable efficacy and side-effect profiles. We conducted a comprehensive literature review examining the use of tranexamic acid (TA), a well-known anti-fibrinolytic agent, in the treatment of melasma. TA delivered orally, topically, and through physical methods works via the inhibition of ultraviolet (UV)-induced plasmin activity in keratinocytes. Predefined search terms were entered into PubMed. Articles were then independently screened by two authors to include only those written in the English language and relating to human subjects with at least mild melasma. The search identified 28 articles, 15 of which met the criteria for full review. The review revealed that TA treatment for melasma is equally effective or more effective than other standard therapies and may induce fewer side effects. Our comprehensive review suggests that TA may be a promising treatment option for melasma because of its demonstrated effectiveness alone and in combination with other modalities as well as its limited side-effect profile.

Aim:The aim was to evaluate the effect of botulinum toxin (Botox) injections as a conservative treatment for gummy smile. Materials and methods:An experimental in vivo study was conducted at a dermatology clinic in Riyadh in January 2016. The study included 23 female patients who ranged from 20 to 50 years and were treated with Botox injections due to excessive maxillary gingival display. The patients with short clinical crowns or long maxilla, those who were pregnant or breastfeeding, and patients with neuromuscular disorders were excluded. Patients received Botox type I, injected 3 mm lateral to the alar-fascial groove at the level of the nostril opening at the insertion of the levator labii superioris alaeque nasi muscle. Photos were taken of the patient's smile before and after the treatment and were then uploaded to the SketchUp program to calculate improvements in gingival display. The distance from the lower margin of the upper lip to the gingival margin was calculated pre-and posttreatment. The amount of improvement was calculated as (pre-Botox treatment -post-Botox treatment/pre-Botox treatment × 100). The mean percentage of the total improvement was analyzed.Results: A total of 23 female patients received treatment to improve their gummy smile. Improvement was clear 2 weeks after Botox injection. The mean percentage of improvement in the gingival display was 99.6%. Conclusion:

Safe and effective treatment options for acne vulgaris are needed to address side effects and increasing rates of antibiotic resistance from current treatments. Nicotinamide is a vitamin with potent anti-inflammatory properties that could offer a potential treatment option. We aim to summarize the relevant literature on the role of nicotinamide in acne vulgaris and discuss the next steps necessary to move this approach into clinical practice. We searched PubMed for clinical studies using nicotinamide for treatment of acne vulgaris. We summarized the 10 studies that met our search criteria. Six of eight studies using topical nicotinamide led to a significant reduction in acne compared with the patient's baseline or performed similarly to another standard-of-care acne treatment. Both studies using an oral supplement containing nicotinamide resulted in a significant reduction in acne compared with baseline. No major adverse side effects were noted. Our review suggests that topical and oral nicotinamide has an unclear effect on acne vulgaris due to the limited nature of the available literature. Additional studies are needed comparing nicotinamide to other first-line acne treatments and evaluating the efficacy and side effect profile of nicotinamide over an extended period of time.

Body dysmorphic disorder is a chronic psychiatric disorder characterized by excessive preoccupation with an absent or minimal physical deformity. It causes severe distress and impairs normal functioning. In the last centuries, this disorder has been mentioned in the medical literature by important mental health practitioners by different names, such as "dysmorphophobia" or "dermatologic hypochondriasis". However, not until the last century was it included among the obsessive-compulsive disorders, although its classification has changed over time.Patients with body dysmorphic disorder constantly seek cosmetic treatments in order to improve their physical appearance, which more often deteriorates their mental condition. The high prevalence of psychiatric disorders in cosmetic medical practice has led in this field of study to the new science "cosmetic psychodermatology". This paper presents a summary of important facts about body dysmorphic disorder and its description throughout the history of medicine.

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Introduction: Chronic skin diseases including vitiligo could have profound psychological burden. The factors influencing the expression of depression in patients with vitiligo received little attention both nationally and internationally. Aim: The aim of the current study was to estimate the burden and severity of depression and to characterize their associated sociodemographic and clinical characteristics among patients with vitiligo. Methods: A cross-sectional survey study was conducted among patients with vitiligo of both genders attending dermatology outpatient clinics at a tertiary care hospital during 2019. Modified Beck Depression Inventory Scale was used for screening for depression. Results: A total 308 patients with vitiligo have been included in the current analysis. The average age was 27±14.5 years. Approximately 59.7% of the patients were males and the majority (63.6%) were single. A total 168 (54.5%) patients had some depressive symptoms. The majority of these patients had mild depression (52.4%), followed by moderate (33.3%) and severe (14.3%) depression. Moderate and/or severe depression were significantly higher among children and adolescents (p=0.036), single patients (p=0.006), those with lower than high school education (p<0.001), those with shorter duration of the disease (p<0.001), and those using phototherapy (p=0.003). Depression burden and severity were not significantly associated with gender and lesion distribution. Conclusion: Sociodemographic and clinical characteristics can easily characterize the risk of depression among patients with vitiligo. The current findings may help dermatologist to pick patients at higher risk of depression early after diagnosis of vitiligo. Dermatologists should have low threshold for referring such patients to psychiatry clinics.

Leprosy is a contagious infectious disease caused by the bacillus Mycobacterium leprae. This microorganism was discovered by Dr. Gerhard Hansen, and the illness was then baptized as Hansen's disease. For a long time, Hansen's disease was thought to be hereditary-a curse or a punishment from God. The disease affects skin and nerves and can cause severe damage. Due to its destructive effects, leprosy has caused fear, segregation, and prejudice in all societies since Biblical times. Patients with Hansen's disease have not been treated humanely around the world throughout the ages. This article is a summary of curious and interesting facts about the history and cultural aspects of Hansen's disease, which has chastised humanity for centuries. These facts are about the discovery of the disease, its propagation, the evolution of treatments, and the prejudice of society towards patients.

Disseminated congenital pyogenic granuloma (DCPG) is an uncommon condition. Individual lesions of DCPG share clinical and histologic similarities with infantile hemangioma (IH); endothelial glucose transporter 1 (GLUT‐1), which is highly expressed in IH but generally not in pyogenic granulomas (PG), is an important diagnostic tool. Treatment for DCPG remains difficult. We describe a case of DCPG effectively treated with propranolol.