Cosmetic dermatology training: Perceptions and experiences of dermatologists and residents in Saudi Arabia

Background: According to the American Society for Dermatologic Surgery, nearly 12 million dermatological procedures were performed in 2017, of which more than half were cosmetic surgeries. The Saudi population has a positive attitude toward and acceptance of cosmetic surgeries, with a dramatic increase in demand from female patients. Dermatologists are expected to be familiar with several cosmetic procedures, therefore, the quality of residency cosmetic training must be of the highest standards. Purpose: The objective of this study was to assess the experience of dermatologists and dermatology residents regarding cosmetic dermatology training in Saudi Arabia. Methods: A quantitative, cross-sectional, online, questionnaire-based study was conducted from March 2020 to July 2020 among 101 dermatologists and dermatology residents (postgraduate years 2, 3, and 4) in Saudi Arabia. Results: Laser surgery was the most performed procedure (65%), followed by botulinum toxin injection (50%). Experience was lacking and additional training was needed for soft-tissue filling (77%) and chemical peels (60%). A large majority (90%) reported not receiving adequate cosmetic procedures training during their residency. Conclusion: The growing demand for cosmetic operations has increased the need for cosmetic dermatological training. Although most trainees were exposed to esthetic dermatology at some point, this exposure appears inadequate. Improving the curriculum in the dermatology residency program for training in cosmetic procedures may be a priority

Leishmania major Infection in Humanized Mice Induces Systemic Infection and Provokes a Nonprotective Human Immune Response

Background Leishmania (L.) species are the causative agent of leishmaniasis. Due to the lack of efficient vaccine candidates, drug therapies are the only option to deal with cutaneous leishmaniasis. Unfortunately, chemotherapeutic interventions show high toxicity in addition to an increased risk of dissemination of drug-resistant parasites. An appropriate laboratory animal based model is still missing which allows testing of new drug strategies in the context of human immune cells in vivo. Methodology/Principal Findings Humanized mice were infected subcutaneously with stationary phase promastigote L. major into the footpad. The human immune response against the pathogen and the parasite host interactions were analyzed. In addition we proved the versatility of this new model to conduct drug research studies by the inclusion of orally given Miltefosine. We show that inflammatory human macrophages get infected with Leishmania parasites at the site of infection. Furthermore, a Leishmania-specific human-derived T cell response is initiated. However, the human immune system is not able to prevent systemic infection. Thus, we treated the mice with Miltefosine to reduce the parasitic load. Notably, this chemotherapy resulted in a reduction of the parasite load in distinct organs. Comparable to some Miltefosine treated patients, humanized mice developed severe side effects, which are not detectable in the classical murine model of experimental leishmaniasis. Conclusions/Significance This study describes for the first time L. major infection in humanized mice, characterizes the disease development, the induction of human adaptive and innate immune response including cytokine production and the efficiency of Miltefosine treatment in these animals. In summary, humanized mice might be beneficial for future preclinical chemotherapeutic studies in systemic (visceral) leishmaniasis allowing the investigation of human immune response, side effects of the drug due to cytokine production of activated humane immune cells and the efficiency of the treatment to eliminate also not replicating (“hiding”) parasites