Background: Lymphatic malformations (LMs) are rare benign tumors that are at risk of various complications due to their progressive nature and critical locations. Considering the morbidity and mortality of such lesions, different therapeutic methods proposed are surgical excision, sclerotherapy, laser, aspiration, radiotherapy, and most recently sirolimus. Case Reports: We reviewed 3 cases with lymphatic malformation at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. Initially placed on various treatment sessions of surgical intervention, sclerotherapy or even both prior to sirolimus, minimal improvement was noted. Sirolimus initiation was associated with significant clinical improvement. However, sirolimus was associated with neutropenia, which was successfully managed by G-CSF. Conclusion: Sirolimus can cause bone marrow suppression due to cumulative effect.

Background Alopecia areata (AA) is an autoimmune disorder characterized by nonscarring hair loss that can involve the scalp, face, and body. Severe AA subtypes have a poorer prognosis and can be challenging to treat. Tofacitinib, a recently introduced Janus kinase inhibitor, has shown positive results in treating AA. This multicenter study demonstrates the efficacy of tofacitinib and the patient response rate in a Saudi population.It also highlights patient characteristics that may serve as predictors of the therapeutic response to tofacitinib. Methods A prospective cohort study design was utilized. Study participants were included from three medical centers in Riyadh, Saudi Arabia. The Severity of Alopecia Tool (SALT) score was used to assess the percentage of hair loss at baseline and the percentage of hair regrowth at 3 and 6 months. ResultsThe sample size was 68 with an average baseline SALT score of 76.8 AE 27.6%.Data at 6 months were available for 45 patients. Of these, 62.2% achieved a SALT score of >50%. Patients with a score of <50% had a significantly higher baseline SALT score compared to patients with >50% score. The past use of systemic steroids was associated with a diminished response to therapy (P = 0.015). The response to therapy was significantly higher in patients with AA compared to alopecia totalis and alopecia universalis.Conclusions Tofacitinib is an effective and well-tolerated treatment for severe AA and exhibits a good safety profile.

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