Treatment of Post-acne Scarring with Long-pulsed and Q-switched 1,064nm Nd:YAG Laser.

Background: Acne scarring is one of the most dramatic consequences of inflammatory acne. It can lead to physical disfigurement and psychological burden on the affected individuals. Many treatment options for post-acne scarring are used, with variable results. Nonablative lasers, such as the 1,064nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, are known to ameliorate acne scar appearance by stimulating collagen production and dermal remodeling. Objectives: We sought to evaluate the clinical efficacy, safety, and long-term effects of long-pulsed and Q-switched 1,064nm Nd:YAG lasers in the treatment of acne scars. Methods: From March to December 2019, a total of 25 patients with different skin types with acne scars were treated. Patients were divided into two groups. In Group I, 12 patients received a combination of Q-switched 1,064nm Nd:YAG laser, then long-pulsed 1,064nm Nd:YAG laser. In Group II, 13 patients received a combination of long-pulsed 1,064nm Nd:YAG laser, then Q-switched 1,064nm Nd:YAG laser. All patients received a total of six sessions at two-week intervals. Results: There were no statistically significant differences between the studied groups in skin type, lesions, or scar type. A positive response with either good or excellent results was documented in 43 patients, corresponding to 86. Six percent of the patients included in this study. Excellent response was observed in a total of 17 patients (26.6%). Twenty-six patients (60%) showed a moderate-to-good response, while seven patients (13.4 %) showed a fair response. The majority of patients in this study had an excellent-to-good response, with an 86.6% improvement of post-acne scars after laser sessions. Conclusion: Q-switched and long-pulsed 1,064nm Nd:YAG lasers are considered an efficient and safe modality for the treatment of mild and moderate post-acne scars. Both lasers can enhance dermal collagen remodeling and spare the epidermis with minimal downtime after the procedure.

Methotrexate Gel Either Alone or Combined with Narrow Band Ultraviolet B or Excimer Light for the Treatment of Vitiligo.

Background: Methotrexate has been used successfully in the treatment of vitiligo. It leads to decrease in the number of TNF-α secreting T cells in association with increase in the number of interleukin (IL)-10 producing T cells. Topical forms of methotrexate do not have significant hematologic or hepatotoxic side effects unlike the systemic forms of the drug. Objective: We sought to evaluate the efficacy and safety of methotrexate gel for the treatment of vitiligo, either alone or combined with narrowband (NB) ultraviolet B (UVB) or with excimer light. Methods: Forty-eight patients with vitiligo were randomized into three treatment groups. Group I was treated with methotrexate gel twice daily. Group II was treated with methotrexate gel twice daily plus NB-UVB twice weekly. Group III was treated with methotrexate gel twice daily combined with excimer light twice weekly. Treatment was continued for three months followed by a one-month follow-up period. Results: There was a statistically significant difference between groups regarding the therapeutic response. The highest response was recorded in the group treated with methotrexate gel and NB-UVB. More patients in Group II showed good or excellent response than in the other groups. Conclusion: Methotrexate gel could increase the therapeutic effect of NB-UVB and excimer laser and shorten the treatment period of vitiligo. However, it was not effective enough to induce repigmentation when used alone.

Dermoscopic approach for differential diagnosing of autoimmune bullous disease: pemphigus vulgaris, pemphigus foliaceus, and IgA pemphigus.

INTRODUCTION: Dermoscopy is a noninvasive technique for the evaluation of different pigments and microstructures of the epidermis, dermoepidermal junction, and papillary dermis that are not apparent to the naked eye, which therefore improves diagnostic accuracy. AIM OF THE STUDY: This study aims to describe the characteristic dermoscopic features of bullous diseases and analyze the characteristic dermoscopic features of bullous diseases of the skin and hair. PATIENTS AND METHODS: A descriptive study was conducted to describe and analyze the characteristic dermoscopic features of bullous diseases in the Zagazig University Hospitals. RESULTS: This study enrolled 22 patients. Dermoscopy revealed yellow hemorrhagic crusts in all patients and white yellow structure with red halo in 90.9% of patients. Pemphigus vulgaris patients were identified by the presence of dermoscopic clues such as bluish deep discoloration, tubular scaling, black dots, hair casts, hair tufts, yellow dots with whitish halos (fried egg sign) and yellow follicular pustules that are not seen in pemphigus foliaceus and IgA pemphigus. DISCUSSION: Dermoscopy is an important tool that serves as a link between clinical and histopathological diagnoses, and it can easily be used in daily practice. Several suggestive dermoscopic features can help in the differential diagnosis of autoimmune bullous disease but only after making a provisional clinical diagnosis. Dermoscopy is a very useful tool in the differentiation of pemphigus subtypes.

A prospective multicenter study on cutaneous reactions reported after Sinopharm COVID-19 vaccination.

BACKGROUND: The new coronavirus COVID-19 pandemic has had an unprecedented impact on global health and economic growth. A widely used vaccine is the weakened inactivated severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus (Sinopharm). Following major SARS-CoV-2 vaccination campaigns, cutaneous symptoms are on the rise. METHODS: This study is a prospective observational study evaluating cutaneous reactions and time of recovery after Sinopharm vaccination. The cases involved were over the age of 18. The data were anonymized. On the registry's vaccine section, we tracked vaccination dates, skin reactions, and recovery times. All respondents who reported only a cutaneous reaction to the first vaccination dose received a follow-up contact asking about a second vaccination dose cutaneous reaction. RESULTS: The study included 4560 cases. The mean age of all studied cases was 41.2 ± 6.1 years. There were dermatologic complications in 1190 patients (26.1%). There was induration at the injection site in 495 patients (10.9%), urticaria in 210 patients (4.6%), morbilliform eruption in 375 patients (8.2%), flare of skin site in 105 patients (2.3%), and angioedema in 105 patients (2.3%). The mean recovery days in all studied patients were 2.92 ± 0.94 days with a minimum recovery period of 2 days and a maximum of 7 days. CONCLUSIONS: Because Sinopharm's cutaneous reactions are frequently mild and self-limiting, vaccination should not be discouraged based on these findings. If the first vaccine dose creates a cutaneous reaction, there is no need to skip the second dose.

Treatment of Melasma with Intralesional Tranexamic Acid Versus Cryotherapy.

Background: Melasma is a relatively common, acquired facial skin disorder of hyperpigmentation. Though it occurs in both sexes, nearly 90% of patients are female. It manifests as hyperpigmented macules and patches distributed symmetrically on the face, neck, and, rarely, the upper limbs. OBJECTIVE: The aim of this study was to evaluate and compare the clinical efficacy and adverse effects of intralesional injection of tranexamic acid (TA) versus cryotherapy in the treatment of melasma. Methods: Patients were divided into two groups: Group A and Group B. Group A comprised 28 patients aged 27 to 50 years. They received localized intralesional injections of TA. According to Wood's light examination, patients were divided into two subtypes; 13 patients with mainly dermal-type melasma and 15 patients with mainly mixed-type melasma. Family history was obtained in 12 patients. Group B comprised 28 patients aged 29 to 46 years were included. They were treated with cryotherapy. According to Wood's light examination, the patients were divided into two subtypes of melasma; 8 patients with mainly dermal-type melasma and 10 patients with mainly mixed-type melasma. Results: There were no statistically significant differences between Group A and Group B according to contraception, sun exposure, and family history. There was a statistically significant difference between Group A and Group B according to previous treatment. There was no statistically significant difference between the two groups according to drug allergy. There were no statistically significant differences according to systemic disease or general examination. Conclusion: Intralesional tranexamic acid is a safe and effective method for the treatment of melasma with no risk of PIH, thrombosis, or bleeding; however, more sessions with longer follow-up periods are recommended, as the final response may take several months to occur. Cryotherapy was neither safe nor effective due to the risk of PIH.

Therapeutic Effect of Microneedling with Platelet-rich Plasma Versus Microneedling with Tranexamic Acid for Melasma.

BACKGROUND: Melasma is a chronic acquired focal pigment disorder showing symmetrical hyperpigmentation or hypermelanosis of photoexposed areas on the face. Tranexamic acid (TXA) is a treatment for melasma. The regression of melasma after platelet-rich-plasma (PRP) treatment is an interesting finding. OBJECTIVE: We investigated the effect of microneedling followed by PRP versus microneedling followed by tranexamic acid in the treatment of patients with melasma. METHODS: The study included 26 patients with melasma divided into two groups of 13 patients each. Group 1 was treated with microneedling and PRP, and Group 2 was treated with microneedling and tranexamic acid. RESULTS: The response to treatment was assessed using the Melasma Area and Severity Index scoring system before and after treatment. At the start of the study and at the first session, there were no statistically significant differences (p>0.05). At the second and third treatment sessions, there were statistically significant differences (p<0.05). There were no statistically significant differences between the two groups regarding side effects of pain, erythema and postinflammatory hyperpigmentation. CONCLUSION: Microneedling with PRP offers better results than microneedling with TXA in treating melasma.

Efficacy of Intralesional Bacillus Calmette-Guérin Polysaccharide Nucleic Acid and Vitamin D Injections in the Treatment of Lichen Planus.

BACKGROUND: Lichen planus is a multifactorial chronic inflammatory disease with diverse clinical manifestations involving the skin, hair, nails, and mucous membranes. OBJECTIVE: We evaluated the clinical efficacy and adverse effects of Bacillus Calmette-Guérin polysaccharide nucleic acid (BCG-PSN) injection, vitamin D injection, and the combination of both in the treatment of different types of lichen planus. METHODS: Thirty patients ranging in age from 12 to 70 years with clinically diagnosed lichen planus were enrolled in this study and divided into three groups according to treatment regimen. RESULTS: A partial therapeutic response in three patients and no improvement in seven patients were achieved in the intramuscular vitamin D injection group. Meanwhile, the intralesional injection of BCG-PSN was associated with complete response in three patients, partial response in three patients, and no response in four patients. The combination of both intralesional injection of BCG-PSN and intramuscular injection of vitamin D was associated with complete response in two patients, partial response in four patients, and no response in four patients. CONCLUSION: BCG-PSN alone appears to be efficacious in the treatment of lichen planus, and vitamin D in combination with BCG-PSN had no effect on cutaneous lichen planus.

Evaluation of efficacy and safety of chemical peeling and long-pulse Nd:YAG laser in treatment of pseudofolliculitis barbae.

Pseudofolliculitis barbae (PFB) presents as chronic inflammation of the beard area that affect males but also females may affect if have coarse hair. Its treatment can be challenging. Laser-assisted hair removal causes miniaturization of hair shafts which are the principal contributors to inflammation in PFB. Also chemical peeling is used in treatment of PFB. To assess and compare the efficacy and safety of long pulsed Nd:YAG laser vs chemical peeling in the treatment of PFB. Twenty male patients with PFB were divided randomly into two groups. Group A treated by long pulsed Nd: Yag laser and group B treated by chemical peeling, all were subjected to treatment until complete clearance or maximum five sessions. Clinical assessment of skin lesions was done at baseline, end of sessions, follow-up at 3 months after end of therapy by counting of papules. Subjective evaluations were also obtained from both subjects and investigators. Assessments of any abnormal side effects caused by laser treatment or by chemical peeling were also evaluated. A reduction in the quantity of papules/pustules when compared with baseline data was statistically significant more in laser group than peeling group for treatment of PFB in the mandibular and neck regions at the end of session and follow-up evaluations. Subject evaluations ranged from satisfied to very satisfied. Side effects of chemical peeling included transient hyperpigmentation, mild erythema, and burning and side effects of laser included pain. Both therapy are effective and safe in the treatment of PFB but laser therapy more effective than peeling therapy.

Chemokines in Vitiligo Pathogenesis: CXCL10 and 12.

BACKGROUND: Vitiligo is a common pigmentary disease that affects 0.5% to 1% of the global population. The main manifestation of vitiligo is skin depigmentation, which significantly influences appearance and brings enormous psychological stress for patients. C-X-C motif chemokine ligand 9 (CXCL9), CXCL10 , CXCL11 and CXCL12 are linked to the Th1 pattern and have been suggested as one of the most relevant chemokine axes that promote T cell migration in different autoimmune and inflammatory process . These were suggested to promote melanocyte-specific cytotoxic T lymphocyte (CTLs) to infiltrate into the basal layer of the epidermis to attack melanocytes, resulting in the deficiency of melanin. OBJECTIVE: The aim of this study was to evaluate the role of CXCL10 and CXCL12 in the pathogenesis of vitiligo and to detect its relationship to disease activity. METHODS: Forty patients with non-segmental vitiligo (NSV; 20 patients with active disease and 20 stable patients). This group included 20 male patients and 20 female patients, with ages ranging from 10 to 65 years. Twenty healthy age- and sex-matched controls were included. The control group included 10 males and 10 females with ages ranging from 10 to 65 years. We measured the serum level of CXCL10 and CXCL12 in the patients and controls using the enzyme-linked immunosorbent assay (ELISA) method. RESULTS: Serum CXCL10 level was highly significantly increased in patients with vitiligo compared to controls. There was a high statistically significant difference between patients with active disease and those with stable disease regarding serum level of CXCL10 with higher level of CXCL10 in active type. CONCLUSION: Our results suggest that vitiligo might be associated with increased serum levels of CXCL10 and CXCL12. There is a positive relationship to disease activity, indicating that CXCL10 and CXCL12 may play a significant role in the pathogenesis of vitiligo.

The Role of antiFcεRIα Autoantibodies Detection and Autologous Serum Skin Test in Comparison To Histamine Release Assay in Diagnosis of Chronic Autoimmune Urticaria.

Chronic autoimmune urticaria is manifested by wheals and itching for 6 weeks, which is mediated mainly by autoantibodies against IgE receptors (FcεRIα). We aimed to assess the role of IgG autoantibody against FcεRIα in combination with autologous plasma skin test (APST), and autologous serum skin test (ASST) for autoimmune urticaria (AIU) diagnosis. This study was a case control study of 47 chronic spontaneous urticaria (CSU) patients and 47 healthy controls. Patients and control were subjected to ASST, APST, and ELISA assay of serum autoantibodies to FcεRIα. Histamine release assay (HRA) as the gold standard method for autoimmune urticaria diagnosis was performed after basophil percoll isolation and subjected to sera of both patients and control. The validity of ASST and autoantibodies to FcεRIα were determined in comparison to HRA. Autologous serum skin test was positive in 30 (63.8%) of CSU patients, and 12.7% of the healthy control (P=0.000). IgG autoantibodies to FcεRIα were demonstrated in 55.5% of the patients and were more common in patients with positive (80%) than negative ASST (11.7%) (P=0.000). There was significant positive correlation between "ASST" and "APST" positivity, and clinical severity as Spearman coefficient for this correlation was 0.477 (P=0.001). There was a significant association between IgG positivity to FcεRIα and disease severity as Spearman coefficient was 0.360 (P=0.02). Combined "ASST", "APST" and FcεRIα autoantibody tests revealed 100% sensitivity and 100% specificity for autoimmune urticaria diagnosis. In conclusion, combined anti-FcεRIα assay, with ASST, and APST improved the diagnosis of chronic autoimmune urticaria among patients with chronic spontaneous urticaria.

Tranexamic Acid for Melasma Treatment: A Split-Face Study.

BACKGROUND: Melasma is an acquired hyperpigmented skin disorder. Tranexamic acid (TXA) prevents ultraviolet radiation induced pigmentation in melasma through interfering with the plasminogen-plasmin pathway. OBJECTIVE: This study was conducted to evaluate the therapeutic effect and safety of TXA by intradermal injection versus TXA with microneedling for melasma treatment. METHODS: Fifty-six female patients with bilateral symmetrical melasma were recruited in a split-face study. All patients received an intradermal injection of TXA on one side of the face, and the other side received TXA with microneedling for 6 sessions at 2 weeks intervals. Clinical efficacy was assessed using a modified Melasma Area Severity Index (mMASI) score at the baseline and after treatment. Global photographs underwent blinded review by 2 dermatologists. Patient self-assessment and satisfaction were recorded. RESULTS: After the treatment, the mMASI score was significantly reduced compared with the baseline in both treated sides (p < .001). No significant difference between both treated sides (p > .05). Patient satisfaction was higher in the microneedling-treated side than the intradermal-injected side (p < .001). No significant adverse effects were observed in both treated sides. CONCLUSION: Intradermal injection and microneedling of TXA could be safe and effective in melasma treatment. Microneedling of TXA was significantly more satisfying to the patients.

Evaluation of Botulinum Toxin Type A Injection in the Treatment of Localized Chronic Pruritus.

BACKGROUND: Botulinum toxin is a neurotoxin produced by the bacterium Clostridium botulinum that causes a flaccid muscle paralysis. It is currently used for aesthetic procedures and to treat focal hyperhidrosis. The botulinum toxin has also been used experimentally in many other dermatological conditions with positive results. OBJECTIVE: We sought to evaluate the efficacy and safety of intradermal injection of botulinum toxin A in the treatment of localized recalcitrant chronic pruritus in lichen simplex, inverse psoriasis, post-burn itching, lichen planus (hypertrophic), and postherpetic neuralgia. METHODS: This was a clinical trial study of 32 patients (12 with lichen simplex chronicus [LSC], 4 with inverse psoriasis, 4 with post-burning itch, 4 with lichen planus, 4 with hypertrophic lichen planus, and 4 with post-herpetic neuralgia). We used 2 to 3mL of unpreserved saline to dilute each vial (50 units) of botulinum toxin A. This led to a final concentration of 2 to 2.5U/0.1cc; injections were typically made into the dermis. RESULTS: The ages of patients in the group studied ranged from 13 to 85 years, with a mean of 37.38 years, and 59.4 percent were female. There were statistical reductions in visual analog scale in all the studied cases. CONCLUSION: Botulinum toxin A appears to be a safe and effective therapy for the improvement of localized recalcitrant itching in LSC, inverse psoriasis, burns, hypertrophic lichen planus, lichen planus, and symptoms of postherpetic neuralgia.

Diagnostic accuracy of immunohistochemical markers in differentiation between basal cell carcinoma and trichoepithelioma in small biopsy specimens.

BACKGROUND: The distinction of trichoepithelioma from basal cell carcinoma in small superficial biopsies is important but often challenging. This has inspired many scientists to test the validity of immunohistochemical markers in the differential diagnosis. OBJECTIVES: To develop an immunohistochemical protocol that helps in differentiation between both trichoepithelioma (TE) and basal cell carcinoma (BCC) with higher sensitivity and specificity. METHODS: Using standard immunohistochemical techniques, we examined 10 TEs and 19 BCCs for the expression of CK19, Ki-67, androgen receptors (AR), CD10, and PHLDA1. RESULTS: Immunoreactivity of AR, Ki-67, and CD10 in tumor cells was significantly higher in BCC than TE with a diagnostic accuracy in BCC of 75.5%, 75.8%, and 79.3% respectively, whereas immunoreactivity of PHLDA1 in tumor cells and stromal CD10 was significantly higher in TE than BCC with a diagnostic accuracy in TE of 100% and 82.8%, respectively. In contrast, immunoreactivity for CK19 showed no statistically significant differences between both tumors. CONCLUSION: The analysis of CD10, Ki-67, and PHLDA1 can be used as a helpful immunohistochemical panel in the distinction between TE and BCC especially in small and superficial biopsies.

Correction of nasolabial folds wrinkle using intraoral non-ablative Er:YAG laser.

Background: The accentuated nasolabial folds (NLFs) is the most pronounced sign of aging. Non-ablative erbium:yttrium aluminum garnet laser (ER:YAG), Smooth mode was used for the treatment of mucosal tissue. It was reported that it is effective in facial rejuvenation. Aim: To assess the safety and the effectiveness of intraoral ER:YAG Smooth mode laser in the treatment of NLFs wrinkle. Materials and methods: A total of 20 patients with different grades of NLFs wrinkle treated with 2940 nm Er:YAG laser intraorally. Six sessions were done every 2 weeks. The efficacy was assessed by two blinded dermatologists. Photographs were taken at the baseline, end of treatment and 6 months after the final session to document visible changes in NLFs wrinkle. The assessment was based on Modified Fitzpatrick Wrinkle Scale (MFWS) and by comparing the photographs. Patient's self-assessment and patient's satisfaction were used for assessment of final results and any side effects associated to treatment were observed. Results: There was significant reduction of the NLFs wrinkle. The MFWS was significantly improved 6 months after treatment compared to before treatment (p < 0.001). At the end of the follow-up period, there was improvement in overall appearance of the wrinkles. Patient's self -assessment and satisfaction demonstrated better cosmetic outcomes. Conclusion: Intraoral Er:YAG laser is safe, painless, and effective treatment option for NLFs wrinkle.

Sweet's syndrome: diagnostic criteria revisited.

The diagnosis of Sweet's syndrome (SS) is based on a set of criteria that requires the presence of two major and at least two minor criteria. In some cases, however, the diagnosis is not as straightforward due to the absence of certain criteria. The objective of the present study was to review the clinical, histopathological, and laboratory features of the current diagnostic criteria for SS, and to evaluate their validity in the cases reported in the literature as well as in 40 patients treated at our institution. Our comprehensive review of the current criteria for SS reveals that the two major criteria have been consistently present in all cases - including ours - since the first description of SS in 1964. With regard to the minor criteria, on the other hand, there has been marked variability between different studies, and many cases failed to fulfill the requirement of showing two minor criteria. In order to simplify the diagnosis, avoid misdiagnosis, and allow for prompt treatment, we propose two sets of revised diagnostic criteria for SS. The first set comprises constant clinical and histopathological features that must be present and are by themselves sufficient for the diagnosis of SS to be established. The second set includes variable features whose absence does not warrant ruling out SS.

Lichen myxedematosus: diagnostic criteria, classification, and severity grading.

BACKGROUND: Lichen myxedematosus (LM) is a rare, chronic idiopathic disorder characterized clinically by waxy, closely set papules and histopathologically by diffuse dermal mucin deposition and fibroblast proliferation. The most recent classification of LM was proposed in 2001; however, it seems to be complex, confusing, and imprecise. Herein, we present seven cases of LM to evaluate the validity of the current classification, to propose new diagnostic criteria and classification, and to suggest a clinically relevant severity grading system for this rare disorder. MATERIALS AND METHODS: The study included seven patients with different presentations and severities of LM. All patients were subjected to thorough dermatological and systemic examination, routine laboratory tests, evaluation of thyroid function, protein electrophoresis, and detailed investigations to detect systemic involvement. RESULTS: The current classification does not meet the requirements of proper diagnosis of different presentations of LM. Subtyping of the studied patients differs greatly according to the old classification and the newly proposed one. New diagnostic criteria, classification, and grading are consequently suggested. CONCLUSIONS: We propose two sets of diagnostic criteria to define the disease more precisely and to avoid confusion associated with the other classification. The first set comprises constant clinical and histopathological features that are always present in every case, and the second set includes associated features that were variably reported in some patients. LM is then subclassified according to the presence or absence of systemic manifestations into a systemic severe form (scleromyxedema) and a non-disabling, pure cutaneous form.

Classical Kaposi sarcoma: case reports with unusual presentation on the penis and scrotum.

BACKGROUND: Kaposi sarcoma (KS) is the most common vascular neoplasm. Any skin area could be involved, including the genitalia. Traditionally, classic KS lesions have a general distribution, often involving skin of the feet and legs, and to a lesser extent, that of the hands, arms, and trunk. KS limited to the external genitalia is extremely rare in HIV seronegative individuals. METHODS: We report six patients of classic KS with generalized dermal KS lesions. RESULTS: Two of them presenting with unusual KS lesions on the penis and scrotum beside the other dermal lesions. Patients were HIV negative and human herpes virus eight positive. Histological examination showed classical KS. CONCLUSIONS: Primary KS of the penis and scrotum is rare but could occur in HIV-negative patients.