Purpose: Treatment non-adherence leads to negative therapeutic outcomes and financial burdens on the healthcare system. This study aims to compare the mean adherence scores among patients with five dermatological diseases and four treatment types and to identify the associated patient-related factors. Patients and methods: This is a cross-sectional study conducted from January 2019 to August 2019. The questionnaire was distributed among patients attending the outpatient dermatology clinic at King Khalid University Hospital, Riyadh, Saudi Arabia. It included 2330 patients who were over 16 years old and diagnosed with any of the five dermatological diseases (psoriasis, chronic dermatitis, acne vulgaris, hair growth disorders, and vitiligo). The 12-item Medication Adherence Scale was used to quantify the mean adherence score. Results: Patients with psoriasis or chronic dermatitis were less adherent to treatments than patients with acne vulgaris, hair growth disorder, or vitiligo. Oral treatment and phototherapy had higher mean adherence scores than injection or topical treatment. High adherence was found in female, single patients; those who did not feel stigmatized from using treatment; those who did not have bad experience with the treatment; those who did not suffer from forgetfulness; those who connected receiving treatment with a habit; those who did not lack treatment responsiveness; those who had an excellent relationship with a dermatologist; and patients with a lesion in an exposed area. Stepwise multiple linear regression was also used to identify the independent variables related to adherence score. Conclusion: Psoriasis and chronic dermatitis patients had the lowest mean adherence scores. Patient who were on oral medication had the highest adherence score, while those on topical medication had the lowest score. The thoughtful consideration of factors associated with high adherence is important for optimal therapeutic outcomes.

BACKGROUND:Orf, also known as ecthyma contagiosum, is a zoonotic disease caused by a parapox virus, which is endemic in goats and sheep but rare in camels. Orf is usually transmitted to humans who are in contact with infected animals. The clinical manifestation of the disease and a personal history of contact with an infected animal are sufficient to diagnose orf virus infection. CASE REPORT:In this case report, we present a 42-year-old man with an unremarkable medical history who came into contact with an infected camel and developed a typical orf lesion. There were multiple erythematous, dome-shaped to round painless nodules on the right forearm of the patient. Some of them had coalesced, forming large plaques, and a few nodules had watery or yellowish discharge. The lesion was complicated by lymphadenopathy. The diagnosis of orf was made based upon clinical suspicion. The patient was treated with fusidic acid cream and observed until the lesion resolved spontaneously, leaving some post-inflammatory hyperpigmentation. We believe this is the first report of orf transmission from a camel to a human. CONCLUSIONS:All physicians should consider this disease as a differential diagnosis in any patient who has a history of contact with camels. Although orf is a self-limiting condition, its early clinical recognition is critical to avoid complications, unwarranted psychological stress, and unnecessary surgical intervention.

Background: Primary rhinoplasty outcomes may not meet individual expectations. Consequently, reoperation may be advocated to improve results. This study examines the prevalence of individuals considering revision rhinoplasty, while identifying the main cosmetic and functional complaints and factors associated. Methodology: This is a cross-sectional study conducted in Saudi Arabia using a self-reported online questionnaire distributed through social media channels. The sample included 1370 participants who were all Saudi nationals over the age of 16 who had undergone primary rhinoplasty at least 1 year prior. Results: The prevalence of individuals considering revision rhinoplasty was 44.7%. The primary reason for considering it was the desire for further esthetic improvement in an already acceptable result (50.16%). The most common cosmetic complaints subjectively reported were poorly defined nasal tip (32.35%). The most prevalent nasal function symptom was nasal obstruction (56.9%). Significant factors associated with considering revision rhinoplasty included the physician not understanding the patient’s complaints, short consultation time, low monthly income, inadequate information about the expected results, not using computer imaging to predict outcomes, lack of rapport with the surgeon, and inadequate information about the risks and complications. Conclusions: A thorough understanding of patient concerns and expectations, as well as thoughtful consideration of risk factors, may help surgeons achieve more successful outcomes and potentially reduce the incidence of revision rhinoplasties. Level of evidence: III

Polyarteritis nodosa (PAN) is a multisystem disease that may affect the vessels of multiple organ systems. It has clinical variants including single-organ disease and cutaneous-only PAN. To our knowledge, this is a unique case report describing the coexistence of PAN of the vulva and retina in a Behçet's disease (BD) patient. We report a case of a 31-year-old Lebanese woman with painful genital ulcers and multiple oral aphthae associated with arthralgia, light flashes, blurry vision, and photosensitivity. There were well-defined, punched-out erosions over the buccal and gingival mucosa; specifically, multiple punched-out, deep ulcers with unremarkable borders and black eschar involving two-thirds of both labia majora and minora sparing the clitoris with bilateral inguinal lymphadenopathy. Dilated fundus examination showed a few cotton wool spots and intraretinal hemorrhage. Fundus fluorescein angiography showed multiple arteriolar infarctions involving the macula in both eyes, more so in the right eye. Vulvar biopsy was consistent with PAN due to the involvement of a medium-sized subcutaneous artery and showed neutrophilic infiltration of its wall. Stain for elastic lamina showed medium-sized subcutaneous artery involvement. After ruling out infectious aetiologies, she was managed by intravenous pulse methylprednisolone 1,000 mg for three days, followed by oral prednisolone 50 mg with a slow taper, oral colchicine 0.5 mg twice daily, and adalimumab 40 mg once every two weeks to stop the progression of the ocular insult and genital mutilation. There was significant improvement of the ulcer with no new cutaneous or systemic manifestations. This case report highlights the importance of considering PAN-like lesions in cases of Behçet's disease. We emphasized the addition of cutaneous PAN as one of the cutaneous manifestations of BD.

Background: Ear piercing is one of the most commonly performed forms of body modification worldwide. While generally considered a simple procedure, it may be associated with a range of local and cosmetic complications. Objective: To evaluate current ear-piercing trends, determine the prevalence of ear-piercing complications, and identify factors independently associated with the development of these complications among females residing in Riyadh. Methods: A cross-sectional survey was conducted among females residing in Riyadh, Saudi Arabia. Participants were recruited through an online self-administered questionnaire distributed via social media platforms. Multivariable logistic regression was used to identify independent predictors of complications. Results: A total of 1018 participants were included. Ear piercing for aesthetic purposes was reported by 52.8% of respondents. Most participants (87.8%) reported not receiving information regarding procedural risks or aftercare instructions. Complications were reported by 26.5% of participants, with infection (57.0%) and ear pain (54.1%) being the most frequent. Independent predictors of complications included having multiple piercings, cartilage piercing, student status, and the use of piercing guns. Undergoing the first ear piercing before one year of age was associated with a lower risk of complications. Conclusions: Our findings indicate that nearly one-quarter of females reported experiencing complications from ear piercings and are associated with several potentially modifiable factors. This emphasizes the importance of informed consent before the procedure, along with proper education on associated risks.