Cascaded Hough Transform-Based Hair Mask Generation and Harmonic Inpainting for Automated Hair Removal from Dermoscopy Images.

Restoring information obstructed by hair is one of the main issues for the accurate analysis and segmentation of skin images. For retrieving pixels obstructed by hair, the proposed system converts dermoscopy images into the L*a*b* color space, then principal component analysis (PCA) is applied to produce grayscale images. Afterward, the contrast-limited adaptive histogram equalization (CLAHE) and the average filter are implemented to enhance the grayscale image. Subsequently, the binary image is generated using the iterative thresholding method. After that, the Hough transform (HT) is applied to each image block to generate the hair mask. Finally, the hair pixels are removed by harmonic inpainting. The performance of the proposed automated hair removal was evaluated by applying the proposed system to the International Skin Imaging Collaboration (ISIC) dermoscopy dataset as well as to clinical images. Six performance evaluation metrics were measured, namely the mean squared error (MSE), the peak signal-to-noise ratio (PSNR), the signal-to-noise ratio (SNR), the structural similarity index (SSIM), the universal quality image index (UQI), and the correlation (C). Using the clinical dataset, the system achieved MSE, PSNR, SNR, SSIM, UQI, and C values of 34.7957, 66.98, 42.39, 0.9813, 0.9801, and 0.9985, respectively. The results demonstrated that the proposed system could satisfy the medical diagnostic requirements and achieve the best performance compared to the state-of-art.

Ultrasound-Guided Erector Spinae Block Versus Ultrasound-Guided Thoracic Paravertebral Block for Pain Relief in Patients With Acute Thoracic Herpes Zoster: A Randomized Controlled Trial.

BACKGROUND: Severe acute pain is a significant risk factor for postherpetic neuralgia (PHN). The importance of early management in alleviating zoster pain cannot be overstated. OBJECTIVES: This study aimed to determine the efficiency and safety of one bolus injection thoracic paravertebral block (PVB) and erector spinae plane block (ESB) in individuals with acute thoracic herpes zoster (HZ) in preventing PHN. STUDY DESIGN: A prospective randomized controlled trial. SETTING: Tanta University Hospitals, Tanta, Egypt. METHODS: Ninety participants over the age of 50 years with chest wall herpetic eruption, lasting shorter than a week along with moderate to severe pain, who got adequate antiviral medication. Patients were chosen at random and classified into 3 equal groups. Group C (control group) did not receive any intervention. Group ESB received US-guided ESB with 25 mg bupivacaine 0.5%, plus 8 mg dexamethasone (10 mL volume). Group PVB received US-guided PVB with 25 mg bupivacaine 0.5%, plus 8 mg dexamethasone (10 mL volume). RESULTS: Numerical rating scale (NRS) showed insignificant differences at baseline. NRS for pain at 1, 3, 4, 12, and 24 weeks was significantly reduced in group ESB compared to group C and in group PVB than group C and insignificantly different between group ESB and group PVB. Doses of pregabalin and acetaminophen were comparable at 1 week among the studied groups. Doses of pregabalin and acetaminophen at 3, 4, 12, and 24 weeks were significantly lesser in group ESB compared to group C and in group PVB than group C and insignificantly different between group ESB and group PVB. After 3 months, the incidence of persistent herpetic pain was not significantly different between the study groups. After 6 months, the incidence of persistent herpetic pain was statistically significantly lower in groups ESB and PVB than in group C (P = 0.037 and 0.015, respectively) without significant difference between group ESB and group PVB. LIMITATIONS: Small sample size, single center study. CONCLUSIONS: Both ESB and PVB were effective in controlling acute pain and persistent herpetic pain after 6 months (which was evident by lower NRS for pain and doses of pregabalin and acetaminophen), but ESB is safer (no reported pneumothorax and hypotension).

A comparative study of intralesional injection of Candida albicans antigen, bleomycin and 5-fluorouracil for treatment of plane warts.

BACKGROUND: Several therapeutic modalities for the treatment of verruca plana (VP) are available, but none has achieved complete cure in all cases with associated risk of side effects. OBJECTIVE: To evaluate efficacy and safety of intralesional injection of Candida albicans (C. albican) antigen, bleomycin and 5-fluorouracil (5-FU) in treatment of VP. METHODS: Sixty patients with VP were randomly divided into three equal groups who were treated using C. albicans antigen, bleomycin or 5- FU injections every 2 weeks till complete clearance of the lesions or for a maximum of four sessions and followed up for additional 8 weeks. RESULTS: A statistically significant higher incidence of complete response was achieved with bleomycin (85%) than C. albicans antigen (60%) which was higher than 5-FU (45%) with a significantly less number of required sessions to achieve best results with bleomycin and candida antigen than 5-FU. CONCLUSIONS: Candida albicans antigen, bleomycin and 5-FU are helpful modalities for treatment of VP. Bleomycin was the most effective, followed by C. albicans antigen then 5-FU (least effective). Single injection site, clearance of distant warts and decreased incidence of new lesion development - in situ or elsewhere - are additional merits of C. albicans immunotherapy. These modalities are cheap with only transient adverse effects.

Ablative Fractional Carbon Dioxide Laser and Autologous Platelet-Rich Plasma in the Treatment of Atrophic Acne Scars: A Comparative Clinico-Immuno-Histopathological Study.

BACKGROUND AND OBJECTIVES: To compare the efficacy of autologous platelet-rich plasma (PRP), ablative fractional carbon dioxide (FCO2 ) laser, and their combination in the treatment of atrophic acne scars, both clinically and immuno-histopathologically. STUDY DESIGN/MATERIALS AND METHODS: Sixty patients were randomly divided into three equal groups. Group 1 received intradermal PRP injection sessions. Group 2 received FCO2 laser sessions. Group 3 received FCO2 laser followed by intradermal PRP injection sessions. Each group received three sessions at monthly intervals. The final assessment took place 3 months after the last session. Skin biopsies were obtained before and 1 month after treatment sessions with pathological evaluation. RESULTS: Combined PRP and FCO2 laser-treated patients had a better clinical response, fewer side effects, and shorter downtime than FCO2 laser alone. PRP-treated patients had some improvement but significantly lower than the other two groups. CONCLUSION: The current study concluded that a combination of PRP and FCO2 laser is an effective and safe modality in the treatment of atrophic acne scars with better results than PRP or FCO2 laser alone. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Platelet-poor plasma gel vs platelet-rich plasma for infraorbital rejuvenation: A clinical and dermoscopic comparative study.

Infraorbital dark circles and tear trough deformity are considered common aesthetic problems. Numerous therapeutic modalities have been suggested with variable outcomes. The aim of this study was to compare the efficacy of platelet-poor plasma (PPP) gel vs platelet-rich plasma (PRP) in infraorbital rejuvenation. A total of 68 females presented with dark circles and/or tear trough deformity were recruited and treated by PPP gel injection in the right infraorbital region (Group A) and PRP injection in the left infraorbital region (Group B). They received three treatment sessions at 2-week interval, and followed up monthly for 3 months. They were evaluated clinically and dermoscopically before treatment and at the end of follow-up period. Both groups showed significant clinical improvements proved by significant reduction of degree of hyperpigmentation and tear trough rating scale. Obviously, more significant clinical and dermoscopic improvements were observed in Group A than Group B. Therefore, it could be concluded that both PPP gel and PRP were clinically effective procedures for aesthetic improvement of infraorbital region. Moreover, PPP gel seems to be significantly more effective than PRP as a therapeutic modality.

Glucose transporter-1 (GLUT-1) expression in psoriasis: correlation with disease severity.

BACKGROUND: Epidermal hyperproliferation with abnormal differentiation, inflammation, and angiogenesis are the key features of psoriasis. Glucose transporter-1 (GLUT-1) is a member of facilitative sugar transporters that are integral membrane glycoproteins moving sugar across cell membrane. OBJECTIVE: The objective of this study was to study the GLUT-1 expression in psoriasis. PATIENTS AND METHODS: Forty patients with psoriasis vulgaris and 20 healthy individuals were included in the study. Skin biopsies were taken from lesional and nonlesional skin of psoriasis patients as well as normal skin of control subjects. All were examined for GLUT-1 antibody expression by immunohistochemistry and GLUT-1 mRNA expression by real-time polymerase chain reaction (RT-PCR). In addition, specimens of psoriasis lesions were stained by hematoxylin and eosin and CD31 for morphometric analysis of histopathological parameters. RESULTS: The intensity of GLUT-1 immunohistochemical expression and the relative levels of GLUT-1 mRNA expression in psoriasis lesions were upregulated in lesional skin of psoriasis patients in comparison with their nonlesional skin as well as normal control skin. GLUT-1 expression in psoriasis lesions showed significant positive correlations with Psoriasis Area and Severity Index (PASI) score, mean of epidermal thickness, inflammatory cell density, and microvessel density. CONCLUSION: Glucose transporter-1 could play a role not only in the onset of psoriasis but also in the progression and severity of the disease. It may participate in the pathogenesis of psoriasis through the facilitation of epidermal hyperproliferation, inflammation, and angiogenesis.

Clinical and immunohistochemical comparative study of the efficacy of carboxytherapy vs platelet-rich plasma in treatment of stretch marks.

BACKGROUND: Striae distensae are dermal scars with a linear atrophic depression. The exact origin of striae distensae remains unrevealed, but low expression of collagen and fibronectin genes in the affected tissue was found. Several treatment modalities have been proposed, yet no consistent modality is available. AIM OF THE WORK: To evaluate and compare the efficacy and safety of carboxytherapy vs platelet-rich plasma (PRP) in treatment of stretch marks. PATIENTS AND METHODS: This study included 20 patients with striae alba. Every patient received treatment in the form of PRP injection in their right side (group A) and carboxytherapy session in their left side (group B) every 3-4 weeks for 4 sessions. Skin biopsies were taken before and after treatment, and they were subjected to fibronectin immunohistochemical stain. RESULTS: There was a significant improvement in striae alba in both groups after than before treatment. There was no significant difference between both groups as regards either percentage of improvement, response (grading scale), or patient satisfaction. The fibronectin-stained area was significantly higher in both groups after than before treatment, and it was significantly higher after treatment in group (B) than group (A). CONCLUSIONS: Both methods were safe and effective with minimal side effects. There was no significant difference between both methods of treatments. This was confirmed histopathologically by fibronectin expression which is found to be low in striae and increased significantly after treatment. But fibronectin expression was higher in group (B) than (A).

Immunohistochemical expression of AQP-3 in vitiligo: a new potential guide for disease activity.

BACKGROUND: Vitiligo is a depigmenting skin disorder, with disappearance of functioning epidermal melanocytes. Aquaporin-3 (AQP-3) is an aquaglyceroporin expressed in epidermal keratinocytes, where it shares in regulating their proliferation and differentiation, and so it might affect melanocytes indirectly. So far, little is known regarding its possible role in vitiligo. This work aimed to study the changes in immunohistochemical expression of AQP-3 protein in vitiligo to detect its possible role in disease pathogenesis. METHODS: Skin biopsies were taken from lesional skin of 30 vitiligo patients in addition to 20 normal controls. Epidermal immunohistochemical expression of AQP-3 was assessed as: +3 = strong expression, +2 = moderate, +1= weak and 0= negative expression. RESULTS: AQP-3 was significantly less expressed in vitiligo epidermis than control (P<0.001) with an inverse correlation with Vitiligo Index of Disease Activity (r =-0.505, P=0.004). CONCLUSIONS: Reduced epidermal AQP-3 may have a role in impaired melanocyte survival in vitiligo, and might be a potential negative biological marker for vitiligo activity. Larger trials should further elucidate the effect of changes in epidermal AQP-3 expression in development of vitiligo, and that might pave the road for discovering new therapeutic modalities for the disease.

Assessment of serum homocysteine, endothelin-1, and nitric oxide levels in behçet's disease.

BACKGROUND: Some prominent features of Behçet's disease (BD) are arterial and venous thromboses as a result of endothelial dysfunction. Hyperhomocysteinemia is responsible for vascular endothelial injury due to an increased frequency of thrombogenesis. Endothelin-1 (ET-1) is a vasoconstrictor whereas nitric oxide (NO) is an endothelial vasorelaxing peptide that is responsible for the inhibition of platelet adhesion. AIM: To evaluate serum levels of homocysteine (Hcy) and determine whether hyperhomocysteinemia is considered as a contributing risk factor for venous and arterial thromboses of BD, and to correlate serum levels of ET-1 and NO with disease activity. MATERIALS AND METHODS: We measured serum levels of Hcy, ET-1, and nitrite (NO(2) (-)) in 25 patients who fulfilled the criteria of the International Study Group for BD, and compared them to those of 15 healthy control subjects. Levels of Hcy and ET-1 were measured by using enzyme-linked immunosorbent assay (ELISA), whereas serum nitrite (NO(2) (-)) levels were measured by using Griess reaction as an indicator for NO production. All the patients were screened for a history of venous thrombosis and subdivided into thrombotic and nonthrombotic subgroups according to their thrombotic history. Patients with BD were divided into two subgroups, active and inactive, according to their clinical and laboratory findings. RESULTS: There were significant increases in serum levels of Hcy, ET-1, and nitrite in BD patients compared to those in controls. There was a significant increase in serum Hcy levels in thrombotic compared to nonthrombotic subgroups. Positive correlations were detected between the serum ET-1 and nitrite levels with disease activity in BD patients. CONCLUSION: Hyperhomocysteinemia may play some role in the development of venous and arterial thromboses in BD. Increased NO production might ave critical biological activities that are relevant to pathological events in the active period of the disease.

Nerve growth factor, neuropeptides and cutaneous nerves in atopic dermatitis.

INTRODUCTION: Neurogenic components, as neurotrophic factors and neuropeptides, are probably involved in the pathogenesis of atopic dermatitis (AD) with the neuroimmunocutaneous system as they modify the functions of immunoactive cells in the skin. Nerve growth factor (NGF) is the best-characterized member of the neurotrophin family. Both NGF and neuropeptides (NPs) may be associated with the disease pathogenesis. AIM: This study aims to evaluate the plasma level of NGF and NPs in AD patients and correlate them with the disease activity and nerve changes in the skin by electron microscopy. MATERIALS AND METHODS: Plasma levels of NGF and vasoactive intestinal peptide (+VIP) were measured by an immunoenzymatic assay while plasma levels of calcitonine gene related peptide (CGRP) and neuropeptide Y (NPY) were measured by radioimmunoassay in 30 AD patients in comparison to 10 normal non-atopic controls. Electron microscopic study was done in 10 AD patients. RESULTS: It has been found that there is significant increase of plasma levels of NGF and NPs in AD patients compared with controls. There is a positive correlation between the plasma levels of NGF and disease activity (correlation coefficient = 0.750, P<0.005). There is a significant correlation between the number of Schwann axon complex, evidenced by electron microscopic examination and plasma level of NGF in AD patients. CONCLUSION: It has been concluded that these neurogenic factors; NGF and NPs modulate the allergic response in AD, probably through interactions with cells of the immune-inflammatory component. NGF might be considered as a marker of the disease activity.