Clinical implications of intermittent Ramadan fasting on stable plaque psoriasis: a prospective observational study.

Introduction: Psoriasis is a chronic immune-mediated inflammatory disease. Environmental factors including diet have been supposed to play a role in its pathogenesis. Fasting in Ramadan consists of intermittent fasting in which participating Muslims refrain from eating and drinking from dawn up to sunset. Aim: To validate the possible clinical consequences of Ramadan fasting for patients with psoriasis. Material and methods: The study was conducted in Ramadan 2019. It included patients over 18 years who were diagnosed with stable chronic plaque psoriasis. PASI and BSA scores, body mass index and biochemical tests (including blood lipids, fasting blood glucose) were compared before and after a month of Ramadan fasting. Results: The study included 121 psoriasis patients. The mean PASI score was 4.36 ±3.22 at the beginning of the study, which was reduced to 3.51 ±1.26 at the end of the study. The difference was statistically significant (p = 0.001). There was no difference in the change of weight. We found a statistically significant difference in fasting plasma glucose, HDL and triglycerides. Only mild adverse events were noted during the study period. Conclusions: Ramadan intermittent fasting has beneficial effects on severity of the disease in psoriasis patients with a reduction in PASI score and no serious health hazards. Thus, Ramadan intermittent fasting could be considered during treatment of psoriasis patients.

The effect of tumor necrosis factor inhibitor therapy on the incidence of myocardial infarction in patients with psoriasis: a retrospective study.

BACKGROUND: Psoriasis has been shown to be associated with increased incidence of myocardial infarction (MI). The data on the effect of tumor necrosis factor (TNF) inhibitors on MI in psoriasis are scarce. OBJECTIVE: To evaluate the effect of TNF inhibitors on the risk of MI in psoriasis patients compared with methotrexate (MTX) and topical agents. METHODS: Data were obtained from the Electronic Health Records database of Farwaniya Hospital from psoriasis patients seen from January 2008 to December 2014. Patients were categorized into TNF inhibitor, MTX and topical cohorts. RESULTS: The study included 4762 psoriasis patients. Both TNF inhibitor and MTX cohorts showed a statistically lower rate of MI compared with topical cohort. However, there was no statistically significant difference in MI rate between TNF inhibitor and MTX cohorts (P = .32). The probability of MI was lower in TNF inhibitor responders compared with non-responders (p = .001). CONCLUSIONS: The use of TNF inhibitors in psoriasis showed a significant reduction in the risk of MI compared with topical agents and a non-significant reduction compared with MTX. Responders to TNF inhibitor therapy showed a reduction in MI rate compared with non-responders.

Effect of narrowband ultraviolet B therapy on serum vitamin D and cathelicidin (LL-37) in patients with chronic plaque psoriasis.

BACKGROUND: Narrowband ultraviolet B (NB-UVB) has been widely used in the treatment of psoriasis. It has been shown that vitamin D is a major regulator of the expression of human antimicrobial peptide cathelicidin LL-37, which has a critical role in inflammatory cascade in psoriasis. OBJECTIVE: To evaluate the effect of NB-UVB therapy on serum levels of cathelicidin LL-37 and 25-hydroxyvitamin D [25(OH)D] in psoriasis patients. METHODS: Ninety-three psoriasis patients and 50 controls were included in the study. For psoriasis patients, serum levels of 25(OH)D and cathelicidin LL-37 were estimated before and after NB-UVB therapy. RESULTS: Before treatment, serum 25(OH)D levels were significantly lower in psoriasis patients (31.5 ± 14.41 nmol/L) compared to controls (53.5 ± 19.6 nmol/L), p  =  .015. In contrast, serum LL-37 was significantly higher in psoriasis patients (13.24 ± 3.2 ng/mL) than in controls (7.92 ± 5.33 ng/mL), p < .001. After NB-UVB treatment, there was a highly significant elevation of serum 25(OH)D to reach 56.85 ± 5.2 nmol/L (p < .001) and further elevation of serum LL-37 to reach 29.4 ± 4.2 (p  =  .02). CONCLUSIONS: The elevation of serum 25(OH)D and cathelicidin LL-37 could be an additional possible mechanism of action of NB-UVB therapy in the treatment of psoriasis.

A multicenter clinicomycological study evaluating the spectrum of adult tinea capitis in Egypt.

INTRODUCTION: Tinea capitis (TC) is a common fungal infection in children but is less frequently encountered in adults. This study evaluates the clinical characteristics and mycological studies of adult TC among the Egyptian population. METHODS: A multicenter study included patients diagnosed with TC from 2002 to 2012. RESULTS: The study included 58 patients with a predominance of females (84.5%). The average age was 43.2 years and the mean duration of lesions was 7.1 ± 2.41 months. A history of close contact with animals was reported in 17.2% and Hepatitis C virus infection was recorded in 34.4%. Clinically, scaly scalp (37.9%), alopecia (22.4%), and pyoderma-like lesions (13.8%) were the most common presentations. The parietal (27.6%) and temporal (25.8%) regions were the most affected areas. KOH mounting showed endothrix spores in 56.9%, ectothrix spores in 34.5%, and favic chaplets (hyphae) in 8.6%. Fungal culture showed Trichophyton violaceum in 56.9%, Microsporum audouinii in 19%, Microsporum canis in 15.5%, and Trichophyton schoenleini in 8.6%. CONCLUSIONS: Trichophyton violaceum is the most common cause of adult TC among Egyptians. Increased awareness of variable clinical forms of TC will help in identifying more cases, especially those with HCV infection and close contact with animals.

Methotrexate versus cyclosporine in the treatment of severe atopic dermatitis in children: a multicenter experience from Egypt.

UNLABELLED: Topical therapy is usually of limited benefit in the treatment of severe atopic dermatitis (AD), and the need for a safe and effective systemic treatment may be required in certain cases especially in children. We evaluated the efficacy and safety of methotrexate and cyclosporine in the treatment of 40 children with severe AD. Patients were divided into two groups (each consisting of 20 patients); group A was treated with methotrexate (7.5 mg/week) while group B was treated with cyclosporine (2.5 mg/kg/day). The severity scoring for atopic dermatitis (SCORAD) was used to indicate efficacy of treatment. In group A, the mean SCORAD score at the beginning of the study was 57.90 ± 3.21 that was reduced at the end of the treatment period to reach 29.35 ± 6.32 with a mean absolute reduction of 26.25 ± 7.03. In group B, the mean SCORAD score was 56.54 ± 4.82 at the start of treatment and was 31.35 ± 8.89 at the end of 12 weeks of treatment. The mean absolute reduction was 25.02 ± 8.21. There was no statistically significant difference in the reduction of SCORAD score between both groups (P ± 0.93). Mild and temporary adverse effects were reported in some patients in both groups. CONCLUSION: Methotrexate or cyclosporine in low doses can be considered as effective, relatively safe, and well-tolerated treatments for severe AD in children.

Photodynamic therapy with intralesional 5-aminolevulinic acid and intense pulsed light versus intense pulsed light alone in the treatment of acne vulgaris: a comparative study.

Despite the availability of many treatment modalities for acne vulgaris (AV), few of which provide excellent results. Photodynamic therapy (PDT) was shown to be an effective treatment especially when used with topical 5-aminolevulenic acid (ALA). We compared the efficacy and safety of PDT using intralesional ALA (IL-ALA) with intense pulsed light (IPL) and IPL alone in the treatment of AV. This study was carried on 30 patients with nodulocystic and inflammatory AV on the face and back. The right side of the body was treated with IL-ALA plus IPL, while the left side was treated with IPL alone. All patients experienced a reduction in number of acne lesions on both sides of the body, but the reduction was significantly more in PDT side than IPL only side. Recurrence of the lesions was significantly more likely in the IPL only side. There was no statistically significant difference between the face and back lesions in drug side effects and recurrence of the lesions. We concluded that photodynamic therapy in this cohort is effective in the treatment of AV when combined with IL-ALA. It gives superior results compared with IPL alone with minimal and tolerable side effects and less recurrence rates.

Inhibition of angiogenesis as a new therapeutic target in the treatment of lepromatous leprosy.

BACKGROUND: Angiogenesis was suggested to have a significant role in the pathogenesis of leprosy. However, the benefit of inhibiting angiogenesis in lepromatous leprosy patients has not previously been studied. The purpose of this study was to evaluate angiogenesis in leprosy patients before and after treatment with multidrug therapy (MDT) with and without minocycline. METHODS: A total of 40 patients with lepromatous leprosy were enrolled in this study. They were categorized into two equal groups (A and B), each formed of 20 patients. Group A received World Health Organization MDT, and Group B received MDT combined with minocycline, which has a known antiangiogenic effect. Microvascular density (MVD) in dermal granuloma was evaluated in both groups by immunostaining with CD31 and CD34 markers before and after 6 months of treatment. RESULTS: With CD31 immunostaining, the mean MVD in Group A significantly decreased from 39.1 ± 3.1 vessels (v)/high power field (HPF) to 16.5 ± 2.7 v/HPF, and in Group B it significantly decreased from 38.3 ± 2.5 v/HPF to 7.6 ± 1.9 v/HPF. CD34 immunostaining also showed a significant decrease of MVD from 42.2 ± 3.1 v/HPF to 18.8 ± 2.4 v/HPF in Group A, and in Group B it significantly decreased from 43.7 ± 2.3 v/HPF to 11.5 ± 1.6 v/HPF. The reduction of MVD was significantly higher in Group B compared with in Group A (P < 0.0001). Moreover, there was a significant reduction in bacterial density (assessed by bacterial index) in the cutaneous lesions of in Group B (decreased from 4.9 ± 0.3 to 1.4 ± 0.2) compared with in Group A (decreased from 5.1 ± 0.4 to 2.3 ± 0.4). CONCLUSION: The synergistic effect of MDT and minocycline seems to be promising in the treatment of lepromatous leprosy. It significantly reduces angiogenesis and rapidly eliminates lepra bacilli from the skin that enables a rapid control and elimination of the disease.

Treatment of localized non-segmental vitiligo with intradermal 5-flurouracil injection combined with narrow-band ultraviolet B: a preliminary study.

BACKGROUND: Several treatment modalities had been used for the treatment of vitiligo but the optimal treatment has not yet been identified. AIM: To evaluate the efficacy and safety of intradermal injection of 5-flurouracil (5-FU) combined with narrow-band ultraviolet B (NB-UVB) as a treatment option for vitiligo. PATIENTS AND METHODS: The study included 60 vitiligo patients with overall symmetrical lesions affecting less than 30% of body surface area. For each patient, one side of the body was treated with NB-UVB alone (control side) while the other side was treated with NB-UVB therapy in addition to intradermal injection of 5-FU (50 mg/ml), 0.01-0.02 ml per injection with 1 cm apart in skin of vitiligo, every 2 weeks for 4 months. RESULTS: The overall repigmentation was significantly higher in the 5-FU side compared with control side in all body parts (p < 0.001) except for the acral lesions where the difference was not significant (p = 0.561). No systemic side effects of 5-FU were detected, and the majority of the patients reported pain during injections. CONCLUSIONS: Intradermal 5-FU injection in combination with NB-UVB could be considered as a simple, safe, tolerable and cheap technique for treatment of vitiligo. It shortens the duration of NB-UVB therapy and improves the outcome, repigmentation. Longer follow-up is needed.

Flowcytometric study of expression of perforin and CD134 in patients with systemic lupus erythematosus.

Perforin is a membrane-disrupting protein that allows the entry of granzymes into a target cell inducing degradation of target substances in the cytoplasm and nucleus thus leading to programmed cell death or apoptosis. CD134 was originally described as an activation antigen found on activated T cells. In this work Flowcytometry was used to evaluate the expression of perforin and CD134, as a costimulatory molecule on T cells, in patients with Systemic Lupus Erythematosus (SLE) to elucidate their role in the pathogenesis of SLE and disease severity. The study was conducted on 15 patients with SLE, 6 patients out of the 15 patients were suffering from lupus nephritis, 10 healthy subjects were included as controls. The results revealed that absolute number of circulating CD3+ lymphocytes in the patients was significantly lower than the controls (P = 0.013). The percentage of CD8+ CD3+ T cells was significantly increased in the SLE group when compared to that of CD4+ CD3+ T cells in same group (P = 0.001) Perforin expression on both CD4+ and CD8+ cells was significantly increased in patients compared to controls. (P = 0.002 & P = 0.001, respectively). In addition, a significant increase was observed in the percent of pf+CD8+CD3+ in the patient group compared to that of pf+CD4+CD3+ in the same group (P = 0.001). There was a significant increase in the expression of CD134 on CD4+ and CD8+ cells (P = 0.001 & P = 0.001 respectively). Also, in the same group of patients a significant increase was detected in the frequency of CD134+CD4+CD3+ T cells compared to that of CD134+CD8+CD3+ T cells (P = 0.032). A significant positive correlation was detected in the patient group between CD134 and perforin expression on both CD4+ and CD8+ T cells (p = 0.045, r = 0.523). Moreover, CD134+CD4+CD3+ was also correlated positively with urinary proteinuria (P = 0.023, r = 0.524). Our data suggest the role of Perforin + cytotoxic T lymphocytes and CD134+ cells in the pathogenesis of autoimmunity of SLE. Thus, inhibition of perforin could be beneficial for SLE patients. Targeting pf and CD134 could be a new therapeutic approach in patients with SLE.