Yousef Binamer | Hult International Business School (original) (raw)

Papers by Yousef Binamer

Research paper thumbnail of Effect of Atopic Dermatitis on Quality of Life and Healthcare Resource Utilization in Saudi Arabia

Saudi journal of medicine, May 9, 2023

The prevalence of atopic dermatitis (AD), spanning across from childhood through adolescence is i... more The prevalence of atopic dermatitis (AD), spanning across from childhood through adolescence is increasing in the Middle East region. Poor Quality of Life (QoL), excessive healthcare expenditure, loss of school and workdays are considered to be the significant burden of AD. Although, QoL data is available for children affected by AD in Saudi Arabia, there is limited data for adolescents and adults. Moreover, data on healthcare resource utilization (HCRU) in Saudi Arabia is lacking. The purpose of this review was to evaluate the association between AD severity and AD-related QoL and HCRU in adolescents and adults in Saudi Arabia. It also aimed to identify the gaps in literature on AD in the above two patient populations in Saudi Arabia and provide recommendations for better management of QoL and HCRUrelated issues. Extensive literature search was carried out through various search engines, such as PubMed, MEDLINE, Web of Science, and Google Scholar using different keywords. This review highlighted the lack of literature from Saudi Arabia with respect to the effect of AD on QoL and HCRU in adult and adolescent populations. The gaps in data regarding patient perception, physician knowledge, family and caregiver burden, and QoL for better AD management related HRQoL and HCRU in Saudi Arabia were also identified and recommendations to bridge these gaps were provided.

Research paper thumbnail of Gain-of-function variants in the <i>KDF1</i> gene cause hidradenitis suppurativa associated with ectodermal dysplasia by stabilizing IκB kinase α

British Journal of Dermatology, Apr 25, 2023

Research paper thumbnail of PBI19 Budget Impact Analysis of Ixekizumab, Guselkumab, Risankizumab And/Or Secukinumab for Management of Moderate-To-Severe Psoriasis in the Kingdom of Saudi Arabia

Value in Health, May 1, 2020

Objectives: To assess the cost-per-responder of biologic therapies available in Brazil to treat m... more Objectives: To assess the cost-per-responder of biologic therapies available in Brazil to treat moderate-to-severe plaque psoriasis (PsO) using as outcomes a reduction of 75%, 90%, and 100% in Psoriasis Area and Severity Index (PASI 75/90/ 100). Methods: Comparative cost-effectiveness of risankizumab, adalimumab, etanercept, guselkumab, infliximab, ixekizumab, secukinumab, and ustekinumab was evaluated for the Brazilian private healthcare system using a cost-perresponder analysis based on PASI score reduction. Efficacy data was extracted from a previously published network meta-analysis (NMA). Cost-per-responder included cost of drug acquisition (ex-factory price) in 3 time horizons (primary response period [12-16 weeks], 1-year and 2-years) multiplied by the number needed to treat (NNT) for each PASI endpoint. Results: Considering NMA base case, the lowest cost-per-responder considering primary response period was observed for risankizumab for PASI 75, 90, and 100 (BRL40,106; 47,729; 83,496, respectively), followed by guselkumab (BRL41,338, 50,906; 94,520, respectively). Overall, the differences in the mean cost-per-responder between risankizumab and other biologic drugs increased with higher PASI reduction. Highest cost-perresponder was observed for infliximab for PASI 75 (BRL64,096) and etanercept for

Research paper thumbnail of Effect of atopic dermatitis on quality of life and its psychosocial impact in Asian adolescents

Australasian Journal of Dermatology, 2017

Background/ObjectivesAtopic dermatitis (AD) is a common condition affecting up to 20% of the paed... more Background/ObjectivesAtopic dermatitis (AD) is a common condition affecting up to 20% of the paediatric population in Singapore. It is often associated with significant psychosocial morbidity and can affect patients' quality of life (QOL) tremendously. This study investigated the varying lifestyle impacts, and psychosocial domains most affected by AD in adolescent children in Singapore.MethodsA prospective study evaluating the impact of AD on the QOL of adolescents was conducted over a 6‐month period from July to December 2014. Adolescents aged 11–16 years with varying eczema severity were recruited. Eczema severity was determined by using the eczema area and severity index (EASI) scores. Lifestyle impact of AD was evaluated using patient‐reported children's dermatology life quality index (CDLQI) scores. Statistical analysis was performed using an analysis of one‐way variance and Student's t‐test.ResultsA total of 50 patients were enrolled and divided into three groups: ...

Research paper thumbnail of Combining treat‐to‐target principles and shared decision‐making: International expert consensus‐based recommendations with a novel concept for minimal disease activity criteria in atopic dermatitis

JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology, Jul 11, 2024

Research paper thumbnail of National Saudi Consensus Statement on the Management of Atopic Dermatitis (2021)

Dermatology and Therapy

Atopic dermatitis (AD) is a chronic inflammatory skin disease with an increasing prevalence regio... more Atopic dermatitis (AD) is a chronic inflammatory skin disease with an increasing prevalence regionally and globally. It is characterized by intense itching and recurrent eczematous lesions. With the increase in the availability of treatment options for healthcare practitioner and patients, new challenges arise for treatment selection and approach. The current consensus statement has been developed to provide up-todate evidence and evidence-based recommendations to guide dermatologists and healthcare professionals managing patients with AD in Saudi Arabia. By an initiative from the Ministry of Health (MOH), a multidisciplinary work group of 11 experts was convened to review and discuss aspects of AD management. Four consensus meetings were held on January 14,

Research paper thumbnail of Management of Atopic Dermatitis in Adults in Saudi Arabia: Consensus Recommendations from the Dermatological Expert Group

Clinical, Cosmetic and Investigational Dermatology

Background: Atopic dermatitis (AD) is a long-term, pruritic, recurrent, systemic, inflammatory sk... more Background: 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.

Research paper thumbnail of 403 Achievement of minimal disease activity is associated with improvements in symptoms, quality of life and treatment satisfaction in patients with atopic dermatitis

British Journal of Dermatology

There is a need for clear criteria to guide treatment decisions and disease management in patient... more There is a need for clear criteria to guide treatment decisions and disease management in patients with atopic dermatitis (AD). The recently developed minimal disease activity (MDA) concept aims to optimize AD management through shared decision-making between patients and clinicians in a treat-to-target approach, and is based on consensus recommendations from 87 physicians and insights from 88 patients globally.This study aims to evaluate how achieving MDA affects outcomes in patients with AD. Observed-case data from three phase 3 clinical trials involving adolescents and adults with moderate-to-severe AD were integrated and analysed (NCT03568318, NCT03569293 and NCT03607422). The MDA criteria were applied to clinician-reported measures [Eczema Area and Severity Index (EASI), SCORing of Atopic Dermatitis, validated Investigator Global Assessment, and body surface area] and patient-reported measures [Worst Pruritus Numerical Rating Scale (WP-NRS), Patient-Oriented Eczema Measure, Ato...

Research paper thumbnail of 328 Understanding the impact of atopic dermatitis on patients: a large international, ethnically diverse survey-based qualitative study

British Journal of Dermatology

Atopic dermatitis (AD) is a common, chronic inflammatory skin disease often associated with a sig... more Atopic dermatitis (AD) is a common, chronic inflammatory skin disease often associated with a significant long-term disease burden. AD can profoundly impact a patient’s physical and mental health. Current AD management recommendations do not capture patient perspectives on their treatment needs, expectations and drivers of decision-making. Qualitative patient research is needed to support the creation of patient-centric recommendations for AD assessment and management. To study a large, international, ethnically diverse population of patients with AD that will enable the creation of patient-centric recommendations for AD management. Adult patients (≥18 years old) receiving treatment for AD were recruited from patient market research databases, clinician referrals, and local advertising. All patients were screened via a questionnaire to ensure a balanced and diverse range of ages, gender, educational levels, geographic locations, and AD severities, and to confirm that they were curre...

Research paper thumbnail of 327 Optimizing the management of atopic dermatitis with a new minimal disease activity concept and criteria and consensus-based recommendations for systemic therapy

British Journal of Dermatology

Inconsistent criteria are used to identify patients with atopic dermatitis (AD) who are candidate... more Inconsistent criteria are used to identify patients with atopic dermatitis (AD) who are candidates for systemic therapy and assess their response to systemic therapy. This may lead to undertreatment and treatment dissatisfaction. A treat-to-target (T2T) framework was previously proposed to guide systemic treatment decisions in patients with moderate-to-severe AD.1 While patient representatives were included in the T2T consensus voting process, no patient or caregiver stakeholders were included in the development of the T2T recommendations. Additionally, a recent analysis of the cross-sectional, 28-country MEASURE-AD study suggests that the treatment targets in the T2T criteria may be insufficient to ensure optimal treatment outcomes.2 To develop optimized and practical criteria for identifying patients who should receive systemic therapy, including definitions of treatment goals, treatment failure and disease severity. An executive steering committee (ESC) of seven international exp...

Research paper thumbnail of Gorlin Syndrome in a type IV-skin person with a novel PTCH1 mutation: Case report and literature review

Journal of Dermatology & Dermatologic Surgery, 2016

Nevoid basal cell carcinoma syndrome (NBCCS), or Gorlin Syndrome, is an autosomal dominant multis... more Nevoid basal cell carcinoma syndrome (NBCCS), or Gorlin Syndrome, is an autosomal dominant multisystem disorder, characterized by multiple developmental abnormalities and inactivation germline mutations in the human homolog of the patched (PTCH) gene. We are presenting a case of NBCCS in a skin type 4 Saudi male with a novel PTCH1 gene mutation. To the best of our knowledge, this is the third case reported in Saudi Arabia but the first in adult population. Moreover, our patient harbors a novel heterozygosity mutation in patch1 gene.

Research paper thumbnail of Certolizumab on treating hidradenitis suppurativa: a brief report

Dermatology Reports

Background: Hidradenitis suppurativa (HS), is a chronic inflammatory skin condition that affects ... more Background: Hidradenitis suppurativa (HS), is a chronic inflammatory skin condition that affects apocrine gland-bearing skin. The management of HS with biologics has expanded significantly over the past few years. Certolizumab pegol (CZP) is a pegylated (polyethylene glycol) antigen-binding fragment (Fab) of a recombinant humanized anti-TNF-α monoclonal antibody, which is approved for psoriasis, rheumatoid arthritis, ankylosing spondylitis and Crohn’s disease. In recent years many reports have been merging on the use of Certolizumab in treating Hidradenitis suppurativa. Methods: The electronic database MEDLINE was searched through PubMed in February 2022 using the following search terms: Certolizumab "[All Fields] OR "certolizumab pegol"[All Fields] AND "Hidradenitis suppurativa" [All Fields Results: The search revealed that Certolizumab was used in 6 case reports to treat Hidradenitis suppurativa with a total of 7 patients. Conclusions: There are few cases ...

Research paper thumbnail of Author response for "PLACK Syndrome is Potentially Treatable with Intralipids

Research paper thumbnail of PUVA - Induced Skin Cancer in Dark - Skin Patient : A Case Report

The Egyptian Journal of Hospital Medicine, 2018

Non-melanoma skin cancer is reported to be a cancer with highest prevalence in the world. Differe... more Non-melanoma skin cancer is reported to be a cancer with highest prevalence in the world. Different risk factors have been identified, e.g., Genetic factors, skin-type, ethnicity, and iatrogenic. The main iatrogenic factors are radiation and drugs, mainly immunosuppressive medications, and oral psoralen and ultraviolet-A (PUVA). It is known in the literature that exposure to more than 250 sessions of PUVA could be a risk for developing skin cancer. However, it was reported in fair skin patients. Herein, we report for the first time, a PUVA-induced basal cell cancer in a type-4 skin patient after receiving 400 sessions.

Research paper thumbnail of Saudi consensus statement on biologic treatment of chronic plaque psoriasis (2020)

Psoriasis is a common chronic and complex inflammatory skin disease that affects over 125 million... more Psoriasis is a common chronic and complex inflammatory skin disease that affects over 125 million people worldwide. Management of psoriasis in daily clinical practice in Saudi Arabia is variable. Local preferences for management differ, which may have a bearing on the treatment selection. Biologic therapy is now a well-established strategy for managing moderate-to-severe plaque psoriasis. There is a clear need for national consensus statements due to the extended role and high availability of literature on these agents. As a result of an initiative of the Ministry of Health, a multidisciplinary expert panel of dermatologists and pharmacists with practical experience in the clinical management of psoriasis were invited to be part of a work group to update the previous practical guidelines on the biologic treatment of psoriasis published in the Journal of Dermatological Treatment, 2014. The overall aim of this consensus document is to deliver evidence-based recommendations on the use,...

Research paper thumbnail of The impact of social media on dermatologists and in captivating their patients: a cross-sectional study

Journal of Dermatological Treatment, 2021

Background Dermatology practice has been impacted in the modern era of connectivity and social me... more Background Dermatology practice has been impacted in the modern era of connectivity and social media (SM). Users' choice of dermatology practice may be influenced by SM. This study surveyed dermatologists for the use of SM as part of their practice, and the general population to assess the effect of SM on the practice of dermatology.Methods This nationwide, cross-sectional study among dermatologists and the general population used two questionnaires, with the first (S1) targeting a random sample of the Saudi general population and the second (S2) addressing dermatologists.Results Out of 965 participants in the first questionnaire. 53.78% (n = 519) of the responders followed dermatologists on SM, 57.8% did so to learn about treatment of dermatologic diseases. On the other hand, the S2 was completed by 58 dermatologists. Of them, 82.8% believed that SM had changed the practice of dermatology, 98.3% (n = 57) believed that it changed their own practice. When following a dermatologist on SM, a main reason (26.5%) was to evaluate before-and-after images.Conclusion SM plays a significant role in a physician's reputation and the practice of dermatology. It is a new era that is mainly fueled by technology; keeping pace with these advancements is an essential way to thrive.

Research paper thumbnail of Importance of CD109 and Transforming Growth Factor-β Signaling in Psoriasis

Psoriasis Forum, 2010

Psoriasis is a chronic inflammatory skin disorder characterized by keratinocyte hyperproliferatio... more Psoriasis is a chronic inflammatory skin disorder characterized by keratinocyte hyperproliferation, leukocyte infiltration, and alterations in cytokine production. Recent work documented that the inappropriately activated T helper cells 1 and 17 lymphocytes play a critical role in disease initiation and progression by elaborating an array of inflammatory cytokines that deregulate normal keratinocyte proliferation and differentiation. The key signal to suppress keratinocyte growth is the transforming growth factor (3 (TGF-β) protein, the expression of which is documented to be increased in psoriatic patients. Despite the observed upregulation in TGF-β signal, psoriatic keratinocytes continue to proliferate in response to other signals. Thus, there appears to be discordance between high levels of TGF-β at a lesion site and increased keratinocyte growth. Recently we identified CD109, a glycosyl-phosphatidylinositol (GPI)-anchored protein, as a novel regulator of the TGF-β signaling. CD...

Research paper thumbnail of Kindler's Syndrome with Recurrent Neutropenia: Report of Two Cases from Saudi Arabia

Journal of Pediatric Genetics, 2020

Kindler syndrome (KS) is a rare photosensitivity disorder with autosomal recessive mode of inheri... more Kindler syndrome (KS) is a rare photosensitivity disorder with autosomal recessive mode of inheritance. It is characterized by acral blistering in infancy and childhood, progressive poikiloderma, skin atrophy, abnormal photosensitivity, and gingival fragility. Besides these major features, many minor presentations have also been reported in the literature. We are reporting two cases with atypical features of the syndrome and a new feature of recurrent neutropenia. Whole exome sequencing analysis was done using next-generation sequencing which detected a homozygous loss-of-function (LOF) variant of FERMT1 in both patients. The variant is classified as a pathogenic variant as per the American College of Medical Genetics and Genomics guidelines. Homozygous LOF variants of FERMT1 are a common mechanism of KS and as such confirm the diagnosis of KS in our patients even though the presentation was atypical.

Research paper thumbnail of Giant extramucosal verruciform xanthoma over a discoid lupus erythematosus plaque in a patient with systemic lupus erythematosus

International Journal of Dermatology, 2020

with subnephrotic proteinuria. Clinically, PNM presents as asymptomatic papulonodules that mostly... more with subnephrotic proteinuria. Clinically, PNM presents as asymptomatic papulonodules that mostly appear on the trunk and upper extremities, although the face and other locations can also be affected. The histological picture is dominated by marked dermal pallor, because of diffuse mucin deposition in the papillary and reticular dermis, and lacks the typical epidermal and interface changes of specific LE lesions. The pathogenesis of PNM is unknown. Increased synthesis of glycosaminoglycans induced by circulating autoantibodies or serum cytokines was suggested. A possible role for androgens has also been postulated, as PNM most frequently occurs in men, contrasting with the female predominance in SLE. Exposure to ultraviolet light appears to aggravate skin lesions and may act as a contributing factor. Cutaneous mucinoses comprise a vast group of disorders that may present with similar clinicopathological features, leading to confusion between them. In our patient, the presence of paraproteinemia and the initial absence of LE features hampered the correct diagnosis; only with long-term, thorough assessment was an accurate classification possible. The clinical response of PNM to treatment is variable but mainly unsatisfactory. A minority of patients show improvement with antimalarials, however, most of them require additional treatment with oral corticosteroids. Herein, we report a case of PNM associated with SLE, in which correct identification of this entity proved to be challenging. We therefore highlight the diagnostic difficulties in such cases and the importance of recognizing this atypical presentation, as to ensure an early diagnosis of the underlying disease.

Research paper thumbnail of PLACK syndrome is potentially treatable with intralipids

Clinical Genetics, 2021

We describe an 11‐year‐old girl with PLACK Syndrome (peeling skin, leukonychia, acral punctate ke... more We describe an 11‐year‐old girl with PLACK Syndrome (peeling skin, leukonychia, acral punctate keratosis, cheilitis, and knuckle pads), who was found to have a novel homozygous variant in CAST, the pathogenicity of which was confirmed using blood‐derived RNA. There is no established treatment for PLACK syndrome. However, we demonstrate for the first time that this condition is associated with low levels of vitamin A and essential fatty acids, which prompted us to consider a potential treatment strategy. Indeed, we initiated this patient on intravenous lipid infusion (Vitalipid®; an emulsion of fat‐soluble vitamins and lipofundin‐MCT/LCT 20%) and the response was dramatic. Following the fourth monthly course of treatment, pruritis disappeared and the skin lesions showed remarkable objective improvement. PLACK syndrome is a very rare genodermatosis and only six families have been described to date with pathogenic CAST variants. This is the first report of an objective response to a therapeutic agent, which suggests that PLACK is a potentially treatable condition. The remarkable response we report and the relative safety of the intervention should prompt healthcare providers who care for PLACK syndrome patients to explore this as a potential treatment strategy in future studies.

Research paper thumbnail of Effect of Atopic Dermatitis on Quality of Life and Healthcare Resource Utilization in Saudi Arabia

Saudi journal of medicine, May 9, 2023

The prevalence of atopic dermatitis (AD), spanning across from childhood through adolescence is i... more The prevalence of atopic dermatitis (AD), spanning across from childhood through adolescence is increasing in the Middle East region. Poor Quality of Life (QoL), excessive healthcare expenditure, loss of school and workdays are considered to be the significant burden of AD. Although, QoL data is available for children affected by AD in Saudi Arabia, there is limited data for adolescents and adults. Moreover, data on healthcare resource utilization (HCRU) in Saudi Arabia is lacking. The purpose of this review was to evaluate the association between AD severity and AD-related QoL and HCRU in adolescents and adults in Saudi Arabia. It also aimed to identify the gaps in literature on AD in the above two patient populations in Saudi Arabia and provide recommendations for better management of QoL and HCRUrelated issues. Extensive literature search was carried out through various search engines, such as PubMed, MEDLINE, Web of Science, and Google Scholar using different keywords. This review highlighted the lack of literature from Saudi Arabia with respect to the effect of AD on QoL and HCRU in adult and adolescent populations. The gaps in data regarding patient perception, physician knowledge, family and caregiver burden, and QoL for better AD management related HRQoL and HCRU in Saudi Arabia were also identified and recommendations to bridge these gaps were provided.

Research paper thumbnail of Gain-of-function variants in the <i>KDF1</i> gene cause hidradenitis suppurativa associated with ectodermal dysplasia by stabilizing IκB kinase α

British Journal of Dermatology, Apr 25, 2023

Research paper thumbnail of PBI19 Budget Impact Analysis of Ixekizumab, Guselkumab, Risankizumab And/Or Secukinumab for Management of Moderate-To-Severe Psoriasis in the Kingdom of Saudi Arabia

Value in Health, May 1, 2020

Objectives: To assess the cost-per-responder of biologic therapies available in Brazil to treat m... more Objectives: To assess the cost-per-responder of biologic therapies available in Brazil to treat moderate-to-severe plaque psoriasis (PsO) using as outcomes a reduction of 75%, 90%, and 100% in Psoriasis Area and Severity Index (PASI 75/90/ 100). Methods: Comparative cost-effectiveness of risankizumab, adalimumab, etanercept, guselkumab, infliximab, ixekizumab, secukinumab, and ustekinumab was evaluated for the Brazilian private healthcare system using a cost-perresponder analysis based on PASI score reduction. Efficacy data was extracted from a previously published network meta-analysis (NMA). Cost-per-responder included cost of drug acquisition (ex-factory price) in 3 time horizons (primary response period [12-16 weeks], 1-year and 2-years) multiplied by the number needed to treat (NNT) for each PASI endpoint. Results: Considering NMA base case, the lowest cost-per-responder considering primary response period was observed for risankizumab for PASI 75, 90, and 100 (BRL40,106; 47,729; 83,496, respectively), followed by guselkumab (BRL41,338, 50,906; 94,520, respectively). Overall, the differences in the mean cost-per-responder between risankizumab and other biologic drugs increased with higher PASI reduction. Highest cost-perresponder was observed for infliximab for PASI 75 (BRL64,096) and etanercept for

Research paper thumbnail of Effect of atopic dermatitis on quality of life and its psychosocial impact in Asian adolescents

Australasian Journal of Dermatology, 2017

Background/ObjectivesAtopic dermatitis (AD) is a common condition affecting up to 20% of the paed... more Background/ObjectivesAtopic dermatitis (AD) is a common condition affecting up to 20% of the paediatric population in Singapore. It is often associated with significant psychosocial morbidity and can affect patients' quality of life (QOL) tremendously. This study investigated the varying lifestyle impacts, and psychosocial domains most affected by AD in adolescent children in Singapore.MethodsA prospective study evaluating the impact of AD on the QOL of adolescents was conducted over a 6‐month period from July to December 2014. Adolescents aged 11–16 years with varying eczema severity were recruited. Eczema severity was determined by using the eczema area and severity index (EASI) scores. Lifestyle impact of AD was evaluated using patient‐reported children's dermatology life quality index (CDLQI) scores. Statistical analysis was performed using an analysis of one‐way variance and Student's t‐test.ResultsA total of 50 patients were enrolled and divided into three groups: ...

Research paper thumbnail of Combining treat‐to‐target principles and shared decision‐making: International expert consensus‐based recommendations with a novel concept for minimal disease activity criteria in atopic dermatitis

JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology, Jul 11, 2024

Research paper thumbnail of National Saudi Consensus Statement on the Management of Atopic Dermatitis (2021)

Dermatology and Therapy

Atopic dermatitis (AD) is a chronic inflammatory skin disease with an increasing prevalence regio... more Atopic dermatitis (AD) is a chronic inflammatory skin disease with an increasing prevalence regionally and globally. It is characterized by intense itching and recurrent eczematous lesions. With the increase in the availability of treatment options for healthcare practitioner and patients, new challenges arise for treatment selection and approach. The current consensus statement has been developed to provide up-todate evidence and evidence-based recommendations to guide dermatologists and healthcare professionals managing patients with AD in Saudi Arabia. By an initiative from the Ministry of Health (MOH), a multidisciplinary work group of 11 experts was convened to review and discuss aspects of AD management. Four consensus meetings were held on January 14,

Research paper thumbnail of Management of Atopic Dermatitis in Adults in Saudi Arabia: Consensus Recommendations from the Dermatological Expert Group

Clinical, Cosmetic and Investigational Dermatology

Background: Atopic dermatitis (AD) is a long-term, pruritic, recurrent, systemic, inflammatory sk... more Background: 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.

Research paper thumbnail of 403 Achievement of minimal disease activity is associated with improvements in symptoms, quality of life and treatment satisfaction in patients with atopic dermatitis

British Journal of Dermatology

There is a need for clear criteria to guide treatment decisions and disease management in patient... more There is a need for clear criteria to guide treatment decisions and disease management in patients with atopic dermatitis (AD). The recently developed minimal disease activity (MDA) concept aims to optimize AD management through shared decision-making between patients and clinicians in a treat-to-target approach, and is based on consensus recommendations from 87 physicians and insights from 88 patients globally.This study aims to evaluate how achieving MDA affects outcomes in patients with AD. Observed-case data from three phase 3 clinical trials involving adolescents and adults with moderate-to-severe AD were integrated and analysed (NCT03568318, NCT03569293 and NCT03607422). The MDA criteria were applied to clinician-reported measures [Eczema Area and Severity Index (EASI), SCORing of Atopic Dermatitis, validated Investigator Global Assessment, and body surface area] and patient-reported measures [Worst Pruritus Numerical Rating Scale (WP-NRS), Patient-Oriented Eczema Measure, Ato...

Research paper thumbnail of 328 Understanding the impact of atopic dermatitis on patients: a large international, ethnically diverse survey-based qualitative study

British Journal of Dermatology

Atopic dermatitis (AD) is a common, chronic inflammatory skin disease often associated with a sig... more Atopic dermatitis (AD) is a common, chronic inflammatory skin disease often associated with a significant long-term disease burden. AD can profoundly impact a patient’s physical and mental health. Current AD management recommendations do not capture patient perspectives on their treatment needs, expectations and drivers of decision-making. Qualitative patient research is needed to support the creation of patient-centric recommendations for AD assessment and management. To study a large, international, ethnically diverse population of patients with AD that will enable the creation of patient-centric recommendations for AD management. Adult patients (≥18 years old) receiving treatment for AD were recruited from patient market research databases, clinician referrals, and local advertising. All patients were screened via a questionnaire to ensure a balanced and diverse range of ages, gender, educational levels, geographic locations, and AD severities, and to confirm that they were curre...

Research paper thumbnail of 327 Optimizing the management of atopic dermatitis with a new minimal disease activity concept and criteria and consensus-based recommendations for systemic therapy

British Journal of Dermatology

Inconsistent criteria are used to identify patients with atopic dermatitis (AD) who are candidate... more Inconsistent criteria are used to identify patients with atopic dermatitis (AD) who are candidates for systemic therapy and assess their response to systemic therapy. This may lead to undertreatment and treatment dissatisfaction. A treat-to-target (T2T) framework was previously proposed to guide systemic treatment decisions in patients with moderate-to-severe AD.1 While patient representatives were included in the T2T consensus voting process, no patient or caregiver stakeholders were included in the development of the T2T recommendations. Additionally, a recent analysis of the cross-sectional, 28-country MEASURE-AD study suggests that the treatment targets in the T2T criteria may be insufficient to ensure optimal treatment outcomes.2 To develop optimized and practical criteria for identifying patients who should receive systemic therapy, including definitions of treatment goals, treatment failure and disease severity. An executive steering committee (ESC) of seven international exp...

Research paper thumbnail of Gorlin Syndrome in a type IV-skin person with a novel PTCH1 mutation: Case report and literature review

Journal of Dermatology & Dermatologic Surgery, 2016

Nevoid basal cell carcinoma syndrome (NBCCS), or Gorlin Syndrome, is an autosomal dominant multis... more Nevoid basal cell carcinoma syndrome (NBCCS), or Gorlin Syndrome, is an autosomal dominant multisystem disorder, characterized by multiple developmental abnormalities and inactivation germline mutations in the human homolog of the patched (PTCH) gene. We are presenting a case of NBCCS in a skin type 4 Saudi male with a novel PTCH1 gene mutation. To the best of our knowledge, this is the third case reported in Saudi Arabia but the first in adult population. Moreover, our patient harbors a novel heterozygosity mutation in patch1 gene.

Research paper thumbnail of Certolizumab on treating hidradenitis suppurativa: a brief report

Dermatology Reports

Background: Hidradenitis suppurativa (HS), is a chronic inflammatory skin condition that affects ... more Background: Hidradenitis suppurativa (HS), is a chronic inflammatory skin condition that affects apocrine gland-bearing skin. The management of HS with biologics has expanded significantly over the past few years. Certolizumab pegol (CZP) is a pegylated (polyethylene glycol) antigen-binding fragment (Fab) of a recombinant humanized anti-TNF-α monoclonal antibody, which is approved for psoriasis, rheumatoid arthritis, ankylosing spondylitis and Crohn’s disease. In recent years many reports have been merging on the use of Certolizumab in treating Hidradenitis suppurativa. Methods: The electronic database MEDLINE was searched through PubMed in February 2022 using the following search terms: Certolizumab "[All Fields] OR "certolizumab pegol"[All Fields] AND "Hidradenitis suppurativa" [All Fields Results: The search revealed that Certolizumab was used in 6 case reports to treat Hidradenitis suppurativa with a total of 7 patients. Conclusions: There are few cases ...

Research paper thumbnail of Author response for "PLACK Syndrome is Potentially Treatable with Intralipids

Research paper thumbnail of PUVA - Induced Skin Cancer in Dark - Skin Patient : A Case Report

The Egyptian Journal of Hospital Medicine, 2018

Non-melanoma skin cancer is reported to be a cancer with highest prevalence in the world. Differe... more Non-melanoma skin cancer is reported to be a cancer with highest prevalence in the world. Different risk factors have been identified, e.g., Genetic factors, skin-type, ethnicity, and iatrogenic. The main iatrogenic factors are radiation and drugs, mainly immunosuppressive medications, and oral psoralen and ultraviolet-A (PUVA). It is known in the literature that exposure to more than 250 sessions of PUVA could be a risk for developing skin cancer. However, it was reported in fair skin patients. Herein, we report for the first time, a PUVA-induced basal cell cancer in a type-4 skin patient after receiving 400 sessions.

Research paper thumbnail of Saudi consensus statement on biologic treatment of chronic plaque psoriasis (2020)

Psoriasis is a common chronic and complex inflammatory skin disease that affects over 125 million... more Psoriasis is a common chronic and complex inflammatory skin disease that affects over 125 million people worldwide. Management of psoriasis in daily clinical practice in Saudi Arabia is variable. Local preferences for management differ, which may have a bearing on the treatment selection. Biologic therapy is now a well-established strategy for managing moderate-to-severe plaque psoriasis. There is a clear need for national consensus statements due to the extended role and high availability of literature on these agents. As a result of an initiative of the Ministry of Health, a multidisciplinary expert panel of dermatologists and pharmacists with practical experience in the clinical management of psoriasis were invited to be part of a work group to update the previous practical guidelines on the biologic treatment of psoriasis published in the Journal of Dermatological Treatment, 2014. The overall aim of this consensus document is to deliver evidence-based recommendations on the use,...

Research paper thumbnail of The impact of social media on dermatologists and in captivating their patients: a cross-sectional study

Journal of Dermatological Treatment, 2021

Background Dermatology practice has been impacted in the modern era of connectivity and social me... more Background Dermatology practice has been impacted in the modern era of connectivity and social media (SM). Users' choice of dermatology practice may be influenced by SM. This study surveyed dermatologists for the use of SM as part of their practice, and the general population to assess the effect of SM on the practice of dermatology.Methods This nationwide, cross-sectional study among dermatologists and the general population used two questionnaires, with the first (S1) targeting a random sample of the Saudi general population and the second (S2) addressing dermatologists.Results Out of 965 participants in the first questionnaire. 53.78% (n = 519) of the responders followed dermatologists on SM, 57.8% did so to learn about treatment of dermatologic diseases. On the other hand, the S2 was completed by 58 dermatologists. Of them, 82.8% believed that SM had changed the practice of dermatology, 98.3% (n = 57) believed that it changed their own practice. When following a dermatologist on SM, a main reason (26.5%) was to evaluate before-and-after images.Conclusion SM plays a significant role in a physician's reputation and the practice of dermatology. It is a new era that is mainly fueled by technology; keeping pace with these advancements is an essential way to thrive.

Research paper thumbnail of Importance of CD109 and Transforming Growth Factor-β Signaling in Psoriasis

Psoriasis Forum, 2010

Psoriasis is a chronic inflammatory skin disorder characterized by keratinocyte hyperproliferatio... more Psoriasis is a chronic inflammatory skin disorder characterized by keratinocyte hyperproliferation, leukocyte infiltration, and alterations in cytokine production. Recent work documented that the inappropriately activated T helper cells 1 and 17 lymphocytes play a critical role in disease initiation and progression by elaborating an array of inflammatory cytokines that deregulate normal keratinocyte proliferation and differentiation. The key signal to suppress keratinocyte growth is the transforming growth factor (3 (TGF-β) protein, the expression of which is documented to be increased in psoriatic patients. Despite the observed upregulation in TGF-β signal, psoriatic keratinocytes continue to proliferate in response to other signals. Thus, there appears to be discordance between high levels of TGF-β at a lesion site and increased keratinocyte growth. Recently we identified CD109, a glycosyl-phosphatidylinositol (GPI)-anchored protein, as a novel regulator of the TGF-β signaling. CD...

Research paper thumbnail of Kindler's Syndrome with Recurrent Neutropenia: Report of Two Cases from Saudi Arabia

Journal of Pediatric Genetics, 2020

Kindler syndrome (KS) is a rare photosensitivity disorder with autosomal recessive mode of inheri... more Kindler syndrome (KS) is a rare photosensitivity disorder with autosomal recessive mode of inheritance. It is characterized by acral blistering in infancy and childhood, progressive poikiloderma, skin atrophy, abnormal photosensitivity, and gingival fragility. Besides these major features, many minor presentations have also been reported in the literature. We are reporting two cases with atypical features of the syndrome and a new feature of recurrent neutropenia. Whole exome sequencing analysis was done using next-generation sequencing which detected a homozygous loss-of-function (LOF) variant of FERMT1 in both patients. The variant is classified as a pathogenic variant as per the American College of Medical Genetics and Genomics guidelines. Homozygous LOF variants of FERMT1 are a common mechanism of KS and as such confirm the diagnosis of KS in our patients even though the presentation was atypical.

Research paper thumbnail of Giant extramucosal verruciform xanthoma over a discoid lupus erythematosus plaque in a patient with systemic lupus erythematosus

International Journal of Dermatology, 2020

with subnephrotic proteinuria. Clinically, PNM presents as asymptomatic papulonodules that mostly... more with subnephrotic proteinuria. Clinically, PNM presents as asymptomatic papulonodules that mostly appear on the trunk and upper extremities, although the face and other locations can also be affected. The histological picture is dominated by marked dermal pallor, because of diffuse mucin deposition in the papillary and reticular dermis, and lacks the typical epidermal and interface changes of specific LE lesions. The pathogenesis of PNM is unknown. Increased synthesis of glycosaminoglycans induced by circulating autoantibodies or serum cytokines was suggested. A possible role for androgens has also been postulated, as PNM most frequently occurs in men, contrasting with the female predominance in SLE. Exposure to ultraviolet light appears to aggravate skin lesions and may act as a contributing factor. Cutaneous mucinoses comprise a vast group of disorders that may present with similar clinicopathological features, leading to confusion between them. In our patient, the presence of paraproteinemia and the initial absence of LE features hampered the correct diagnosis; only with long-term, thorough assessment was an accurate classification possible. The clinical response of PNM to treatment is variable but mainly unsatisfactory. A minority of patients show improvement with antimalarials, however, most of them require additional treatment with oral corticosteroids. Herein, we report a case of PNM associated with SLE, in which correct identification of this entity proved to be challenging. We therefore highlight the diagnostic difficulties in such cases and the importance of recognizing this atypical presentation, as to ensure an early diagnosis of the underlying disease.

Research paper thumbnail of PLACK syndrome is potentially treatable with intralipids

Clinical Genetics, 2021

We describe an 11‐year‐old girl with PLACK Syndrome (peeling skin, leukonychia, acral punctate ke... more We describe an 11‐year‐old girl with PLACK Syndrome (peeling skin, leukonychia, acral punctate keratosis, cheilitis, and knuckle pads), who was found to have a novel homozygous variant in CAST, the pathogenicity of which was confirmed using blood‐derived RNA. There is no established treatment for PLACK syndrome. However, we demonstrate for the first time that this condition is associated with low levels of vitamin A and essential fatty acids, which prompted us to consider a potential treatment strategy. Indeed, we initiated this patient on intravenous lipid infusion (Vitalipid®; an emulsion of fat‐soluble vitamins and lipofundin‐MCT/LCT 20%) and the response was dramatic. Following the fourth monthly course of treatment, pruritis disappeared and the skin lesions showed remarkable objective improvement. PLACK syndrome is a very rare genodermatosis and only six families have been described to date with pathogenic CAST variants. This is the first report of an objective response to a therapeutic agent, which suggests that PLACK is a potentially treatable condition. The remarkable response we report and the relative safety of the intervention should prompt healthcare providers who care for PLACK syndrome patients to explore this as a potential treatment strategy in future studies.