The combined effect of CO2 laser, topical diclofenac 3%, and imiquimod 5% in treating high-risk basal cell carcinoma.

BACKGROUND: Some basal cell carcinoma (BCC) patients are considered as a high risk regarding the site, size, histopathological variant, or recurrence. High-risk BCC is a challenging therapeutic problem due to the trial to balance between complete surgical excision from one side and tissue preservation from the other side. AIM: To evaluate the efficacy of combining ablative CO2  laser, imiquimod 5%, and diclofenac 3% as a therapeutic regimen in high-risk and inoperable BCC. PATIENTS/METHODS: The study was conducted on 14 patients that were assessed clinically and pathologically then categorized regarding the site, size, histopathology, and fitness for surgery as high-risk inoperable BCC. They received an ablative session of CO2  laser, followed by application of diclofenac sodium 3% gel once daily for 5 days and imiquimod 5% cream for another 2 days. RESULTS: The study included 11 males and 3 females. Nine lesions were located on the scalp, 4 on the face, and one lesion on the trunk. All lesions were of large size >5 cm in diameter. Histopathology showed 4 patterns: nodular type in 8 patients, infiltrating type in 3 patients, metatypical type in 2 patients, and micronodular type in one patient. At the end of the treatment period, 9 patients showed significant (moderate to marked) improvement while 5 patients showed weak (poor to mild) response. Significant improvement was more observed in nodular type. Relapse was more observed during the 5th to 6th months with 2 patients showed no relapse. CONCLUSION: This combined regimen is a good alternative therapeutic modality in high-risk inoperable BCC especially the nodular pathologic pattern.

Vitamin D receptor (VDR) gene polymorphism in Egyptian vitiligo patients.

BACKGROUND: Vitiligo is an autoimmune dermatological disorder, precipitated by genetic and nongenetic factors leading to destruction of epidermal melanocytes. In Egypt, it has a prevalence rate of 1.2%. Vitamin D has stimulatory and protective effects on melanocytes and acts through its nuclear vitamin D receptor (VDR) on target cells. The consequences of polymorphisms in VDR have been previously studied for mapping their link with various disorders of autoimmune etiology. AIM OF THIS WORK: To study Apa-I and Taq-I VDR single-nucleotide polymorphisms (SNPs) and the risk to develop vitiligo. METHODS: Extracted genomic DNA from the venous blood of 60 patients and controls was amplified and analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) for analysis of VDR gene polymorphisms. Serum 25-hydroxyvitamin D3 (25-OH-D3) level was measured using ELISA technique. RESULTS: The most common VDR genotypes were AA and TT among both groups with no significant difference. Analysis of the frequency of combinations of genotypes revealed AATT as the most common among patients (36.7%) while in the control group, AATt is the most common (33.3%) but no significant difference was noted on comparison of both groups. The genotype allele tt appeared to be more expressed in patients with marginal significance value (P 0.053). Serum 25-OH-D3 showed a relatively decreased level among patients and controls with no statistically significant difference. CONCLUSION: Although VDR SNPs are not correlated with vitiligo, the elevated frequency of tt genotype among vitiligo patients may suggest the risk to develop the disease.

Early fractional carbon dioxide laser intervention for postsurgical scars in skin of color.

BACKGROUND: Fractional CO2 laser is one of the most effective treatment options used to resurface scars. OBJECTIVE: To evaluate the efficacy and safety of early treatment of postsurgical scar by fractional ablative CO2 laser. METHODS: A total of 27 Egyptian patients with recent postoperative scars were enrolled in this study. Three sessions of fractional CO2 laser with a 1-month interval were started 4 weeks after surgery. Vancouver Scar Scale (VSS) was used as an assessment tool at 1 and 3 months after the final treatment. Patients reported their satisfaction using a subjective 4-point scale. RESULTS: Results demonstrated a statistically significant overall average improvement of the VSS (5.33±1.33) before compared with (2.55±1.06) 3 months after the last laser treatment (P≤0.001). Among the individual parameters in the VSS, the most significant improvements were found in pigmentation, height, and pliability. Patient's subjective satisfaction scores showed a significant greater degree of satisfaction after laser treatment. CONCLUSION: Fractional ablative CO2 laser is an effective and safe treatment modality for surgical scars in the early postsurgical period.

Associations among two vitamin D receptor (VDR) gene polymorphisms (ApaI and TaqI) in acne vulgaris: A pilot susceptibility study.

BACKGROUND: Acne vulgaris (AV) pathogenesis is multifactorial. Vitamin D (VitD) plays an important role in sebocytes' differentiation and function. Most VitD functions are mediated by the nuclear VitD receptor (VDR) following binding of its biologically active form (1,25 dihydroxyvitamin D3). Genetic variations in VDR gene may cause significant receptor dysfunction and have been found to be associated with many inflammatory skin diseases. Two adjacent single nucleotide polymorphisms of VDR, ApaI (rs7975232) and TaqI (rs731236), were commonly studied. OBJECTIVE: To evaluate the association between VDR ApaI and TaqI gene polymorphism and AV. METHODS: This case control study included 30 Egyptian acne patients who attended Dermatology Outpatient Clinic of Al-Zahraa University and Misr University for Science and Technology Hospitals. Thirty age- and sex-matched healthy individuals participated as controls. VDR gene ApaI and TaqI polymorphisms were examined by polymerase chain reaction restriction fragment length polymorphism. Serum 25(OH)D was measured in all participants. RESULTS: Patients had significant decrease in ApaI A allele and AATT combined genotype (60%, 3.3%) than controls (78.3%, 20%), respectively, and significant increase in TaqI tt genotype and t allele (46.7%, 63.3%) than controls (13.3%, 41.7%), respectively. Patients showed significantly lower serum 25(OH)D3 concentration than controls. CONCLUSION: Polymorphisms of ApaI and TaqI may have a role in the pathogenesis of AV as A allele and AATT combined genotype could be considered protective against acne development and tt genotype and t allele may increase the risk of AV development. VitD deficiency can be considered as a risk factor for AV development.

Ablative Fractional 10 600 nm Carbon Dioxide Laser Versus Non-ablative Fractional 1540 nm Erbium-Glass Laser in Egyptian Post-acne Scar patients.

Introduction: Non-ablative fractional erbium-doped glass 1540 nm and fractional ablative 10600 nm carbon dioxide lasers are regarded as effective modalities for treating acne atrophic scars. In this study, we aimed to compare the effectiveness of fractional CO2 laser and fractional nonablative 1540 nm erbium doped glass laser in treating post acne atrophic scars in Egyptian patients. Methods: Fifty-eight patients complaining of moderate and severe acne atrophic scars were randomly divided into 2 groups of 29 patients each. Both groups were subjected to 4 treatment sessions with 3 weeks interval and were followed up for 3 months. In group A, enrolled patient sreceived C2 laser, while in group B, patients were treated with 1540 nm erbium glass fractional laser. Results: Clinical assessment revealed that the mean grades of progress and improvement were higher with fractional 10600 nm CO2 laser but with non-significant difference between both treatments (P = 0.1). The overall patients' satisfaction with both lasers were not significantly different (P = 0.44). Conclusion: Both fractional ablative CO2 and fractional non-ablative erbium glass lasers are good modalities for treating acne scars with a high efficacy and safety profile and good patient satisfaction. The fractional ablative laser showed higher efficacy while non-ablative laser offered less pain and shorter downtime.

Pseudoperforation: an uncommon histologic phenomenon in prurigo misleading for the diagnosis of reactive perforating collagenosis.

Prurigo is a common skin condition characterized by vigorous scratching. Although ulceration is not uncommon in prurigo, a perforating-like lesion was not previously reported. In this study we described series of cases of prurigo with perforating-like lesions and discussed its relation to acquired perforating dermatoses. The study included 32 cases, during the period from 2008 to 2013. Clinical data and histological features were recorded and analyzed. The study included 78.1% males and 21.9% females with a mean age of 39.3 ± 5.61 years. History of insect bite was evident in 28.1%, hepatitis C virus infection in 46.9%, and diabetes mellitus in 9.4% of patients. Histologically, well developed lesions showed full thickness epidermal degeneration overlay by a cup-shaped crater. The contents of the crater included collagen and elastic fibers, bacterial colonies, inflammatory cells and necrotic keratin. The dermis showed non-altered collagen, increased vascularity and mixed inflammatory infiltrate. We believe that this pseudoperforation process is a secondary response to vigorous scratching in prurigo patients and not a primary mechanism as occurred in perforating dermatoses. The absence of altered collagen, the presence of full thickness epidermal necrosis and concomitant elimination of elastic fibers are significant histologic clues for differentiation between both conditions.