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.

Keloid therapy: A neoteric comparative study.

BACKGROUND: Keloids are considered disorders of fibroproliferation characterized by accumulation of collagen fibers in hypodermis and dermis, caused by inflammation, surgery, and trauma. OBJECTIVES: The main goal of the study was to approach a better modality for the treatment of keloids by comparing the effects and the side effects of intralesional cryotherapy and intralesional injection of bleomycin. METHODS: This interventional, comparative clinical trial was conducted on 60 cases and was divided equally into the group (A), combined group who were subjected to intralesional bleomycin followed by cryotherapy in the same session, group (B) who were subjected to intralesional injection of bleomycin, and group (C) intralesional cryotherapy. All cases were subjected to clinical examination, complete history taking, dermatological examination, examination, and evaluation of scar lesion using the Vancouver scar scale. RESULTS: There was a statistically significant decrease in pliability among the combined group. Also, pliability decreased in the bleomycin group and cryotherapy, but this decrease wasn't statistically significant. Our results revealed that there was a statistically significant decrease in lesion height among all the studied groups, but the decrease was more among the combined group. CONCLUSION: Intralesional cryotherapy was effective as intralesional bleomycin. Combined therapy was a valid and more effective technique with few adverse effects than either alone for keloids as it achieved a decrease in volumes of scars or accompanied symptoms.

Itraconazole versus propranolol: therapeutic and pharmacologic effect on serum angiopoietin-2 in patients with infantile hemangioma.

BACKGROUND: The initial recommendation propranolol usage in managing infantile hemangioma was in 2008 followed by various researches assessing the dosage, efficacy, and other parameters. Itraconazole is a world-wide tolerated antifungal but only a few studies have focused on its assessment in the treatment of infantile hemangiomas (IH). OBJECTIVE: This study aimed to investigate the newly proposed antifungal drug ICZ and characterize different aspects of its usage as an antiangiogenic drug. METHODS: This was an interventional clinical trial to assess the efficacy of ICZ versus propranolol in the treatment of infantile hemangioma with studying the change in serum angiopoietin 2 (Ang2). A total of 36 pediatric patients were divided into two equal groups: firstly treated with oral itraconazole and secondly treated by oral propranolol. RESULTS: Response to treatment was observed using a modified IH score. In itraconazole-treated infants, good response was observed in 44.4% of the patients. This was slightly higher than the propranolol group which showed 22.2% with good response. We observed a decrease in serum ang2 level after usage of ICZ and propranolol and the change in serum Ang2 level before and after treatment in each group was statistically significant (p < .001). CONCLUSION: Oral itraconazole can be an equivalent option for oral propranolol while safer and shorter treatment periods.

Serum angiopoietin-2 level as a novel potential biomarker in oral lichen planus.

BACKGROUND: Lichen planus is a common chronic cutaneous inflammatory disease. Recent advances evidenced that angiogenesis is tightly connected to it. More recently, the endothelial specific growth factor angiopoietin-2 has been clarified to interact with vascular endothelial growth factor. Angiopoietin-2 level has not been investigated in lichen planus. AIM: To evaluate serum level of angiopoietin-2 in cutaneous and oral lichen planus. METHODS: Ninety patients were investigated, 45 patients with lichen planus. In addition to forty-five healthy control, the activity of the disease was estimated at the time of examination. The serum level of angiopoietin-2 had been estimated by enzyme-linked immunosorbent assay. The relationships between angiopoietin-2 serum level and disease severity, type of lichen, and visual analogue scale score (VAS) were determined. RESULTS: The serum levels of angiopoietin-2 were substantially higher in patients with both cutaneous and oral lesions than patients with cutaneous lichen planus only (P < .001). CONCLUSIONS: Serum angiopoietin-2 is elevated in patients compared with normal subjects and is correlated with the presence of oral lesions and disease severity, that reflects its role in angiogenesis and inflammation, and angiopoietin-2 serum level could be a potential marker for monitoring the oral lichen to identify possible malignant transformation.

Efficacy and safety of a new 10% topical minoxidil versus 5% topical minoxidil and placebo in the treatment of male androgenetic alopecia: a trichoscopic evaluation.

INTRODUCTION: Androgenetic alopecia is a stressful condition for males. Minoxidil 2% and 5% have been FDA approved for treatment of this condition. In literature, all studies have compared minoxidil 5% with 2%. Although other concentrations (2% to 12.5%) are available nowadays, we believe our study is the first to compare 10% versus 5% topical minoxidil in treatment of AGA. OBJECTIVE: To compare the efficacy and safety of 5% topical minoxidil with 10% topical minoxidil and placebo in AGA treatment. MATERIALS AND METHODS: 36-weeks, double-blinded, placebo-controlled, randomized trial. A total of 90 men with AGA. First group have applied 5% minoxidil solution, second group applied 10% minoxidil solution; or third placebo group. Efficacy was evaluated clinically and trichoscopically. RESULTS: After 36 weeks of therapy; 5% topical minoxidil (0.47 ± 0.26) (0.59 ± 0.64) was significantly superior to 10% topical minoxidil (0.05 ± 0.13) (0.45 ± 0.74) and placebo (0.01 ± 0.05) (-0.03 ± 0.08) in terms of change from baseline in total vertex and frontal hair mean count respectively. Pull test change to negative in minoxidil 5%: (37%) patients after 6 month treatment, Minoxidil 10% group (37.5%) patients changed and in placebo group all patients after 6 month were the same (0%) change. No reported sexual dysfunction in all three groups. CONCLUSION: Five percent of topical minoxidil was moderately superior to 10% topical minoxidil and placebo in increasing hair regrowth opposite to the expected, the irritation was marked for 10% topical minoxidil. Psychosocial stress after 10% usage were worsen by the shedding, irritation compared to their high expectation in comparison to 5% usage.

Ki67 and CD31 Differential Expression in Cutaneous T-Cell Lymphoma and Its Mimickers: Association with Clinicopathological Criteria and Disease Advancement.

BACKGROUND: Cell proliferation and angiogenesis are important in progression of cancerous processes. Differentiating cutaneous T-cell lymphoma (CTCL) from its mimicking dermatoses and prognosticating it are challenging. AIM: This study assesses cell proliferation and angiogenesis in different CTCL subtypes using immunohistochemistry (IHC) for Ki67 and CD31 to testify their usability in differentiating CTCL from mimicking dermatoses and discriminating CTCL subtypes from each other with correlation to clinicopathological parameters and disease advancement. PATIENTS AND METHODS: IHC for Ki67 and CD31 were applied to skin biopsies from 81 patients divided into CTCL (n=59) and dermatoses (n=22) groups. Hot-spot analysis was used to score Ki67 and CD31 microvascular density (MVD) semiquantitatively. Statistical analysis was performed to compare Ki67 index and MVD between CTCL and dermatoses. CTCL subgroups were compared to each other. Ki67 index and CD31 were compared to age, gender, skin and nodal involvement, blood tumor burden and TNMB stage. RESULTS AND CONCLUSION: There were significant differences in proliferation index and MVD between dermatoses and CTCL, and between dermatoses and all CTCL subtypes with exception of Ki67 in early mycosis fungoides (MF) and CD31 in patch lesions. Increased cell proliferation and MVD were significantly associated with older age, T3 and 4 skin involvement, significant nodes (N1-3), positive blood tumor burden (B1,2) in CTCL and TNMB stage of MF. Both markers differentiated significantly late from early MF, classic MF from its variants and non-MF CTCL from total MF, but not from late MF. In conclusion, Ki67 and CD31 expression in skin biopsies using IHC reproduces the role of proliferation and angiogenesis in the differential diagnosis and prognostication of CTCL being expressed at higher levels in aggressive than indolent CTCL. Therapeutic targeting of cell proliferation and angiogenesis may improve patient's outcome in CTCL. Usability of these markers into patient's stratification should be considered in further studies.

Combination of pulsed dye laser and verapamil in comparison with verapamil alone in the treatment of keloid.

Background and objective: Many modalities of treatment have been advocated for Keloid ,but the success rates of these have been variable. The present study is an attempt to evaluate and compare the efficacy of a combination of pulsed dye laser (PDL) and intralesional verapamil against intralesional verapamil alone in the treatment of keloids.Methods: 40 Patients with keloids were divided into two groups randomly of 20 each receiving four sessions of therapy. Group A intralesional verapamil alone 2.5mg/ml. Group B received a combination of PDL and intralesional verapamil alone 2.5mg/ml. Pretreatment measurements and photographs were taken.Results: Statistically significant improvement was seen in the height and length of the lesions. Overall appearance criteria of modified MQS showed an improvement of more than 50% in 43.3% of the lesions by the end of four sessions. The improvement of these parameters in the verampil only group was significantly lower than the improvement seen in the PDL+ intralesional verapamil group.Conclusion: Combination therapy with PDL+ intralesional verapamil was superior in efficacy when compared to intralesional verapamil alone, in the treatment of keloids.

Accelerated hair growth by combining thread monofilament and minoxidil in female androgenetic alopecia.

BACKGROUND: Monofilament thread therapy (PLLA) and minoxidil have been used as alternative treatments for female androgenetic alopecia. AIM: The aim was to determine the efficacy and safety of thread therapy combined with minoxidil in female androgenetic alopecia. PATIENT AND METHODS: Twenty-seven women were enrolled in this randomized half-split study based on a left-head to the right-head pattern. Thread therapy (PLLA) treatment was unilaterally performed (once); minoxidil was bilaterally applied for 6 months. Global photographs and dermoscopy assessments were performed in the baseline and every 2 months till the end of treatment. Global photographs underwent blinded review by three independent dermatologists. RESULTS: Mean hair density increased from 114 ± 27 to 143 ± 25/cm2 (P < .001) in the combined group and from 113 ± 24 to 123 ± 19/cm2 in the minoxidil group (P < .001). The mean change from baseline between the two groups was also compared (P = .003). Global photographs showed improvement in 93% (25/27) patients in the combined group and 52% (14/27) patients in the minoxidil group. CONCLUSION: Poly-l-lactic acid microthread therapy combined with minoxidil may improve hair density, hair thickness, and hair appearance better than minoxidil alone.

Effects of topical methotrexate loaded gold nanoparticle in cutaneous inflammatory mouse model.

Gold nanoparticles functionalized with 3-mercapto-1-propansulfonate (AuNPs-3MPS) have been prepared and loaded with Methotrexate (MTX), an immunosuppressive agent used in the systemic treatment of moderate-severe inflammatory diseases. The effects of the AuNPs-3MPS@MTX topically administered in vitro on skin model and in vivo on imiquimod-induced psoriasis-like mice model, have been studied. Clinical response, epidermal thickness, cell proliferation rate and inflammation were tested. AuNPs-3MPS@MTX treated mice showed a decreasing of scaling and erythema score, reduction of epidermal thickness, parakeratosis and hyperkeratosis, compared to AuNPs-3MPS treated mice. Immunohistochemistry analysis staining displayed that Ki67, K6 CD3 and CD8 stainings were reduced in AuNPs-3MPS@MTX treated mice. Blood evaluation showed no differences in blood count and in ALT and AST levels before and after AuNPs-3MPS or AuNPs-3MPS@MTX treatment. Topical AuNPs-3MPS@MTX treatment is able to induce a reduction of keratinocytes hyperproliferation, epidermal thickness and also inflammatory infiltrate in vivo on imiquimod-induced psoriasis like mice model.

Functionalized gold nanoparticles for topical delivery of methotrexate for the possible treatment of psoriasis.

Gold nanoparticles (AuNPs) represent an effective choice for topical drug delivery systems thanks to their small size, general non-toxicity, ease of functionalization and high surface to volume ratio. Even if systemic, methotrexate still plays an important role in psoriasis treatment: its topical use shows insufficient percutaneus penetration owing to limited passive diffusion, high molecular weight and dissociation at physiological pH. The aim of our study was to design a new drug delivery nanocarrier for Methotrexate and to improve its solubility, stability and biodistribution. AuNPs were on purpose prepared with a hydrophilic stabilizing layer, in order to improve the colloidal stability in water. Water-soluble gold nanoparticles functionalized by sodium 3-mercapto-1-propansulfonate (Au-3MPS) were prepared and loaded with methotrexate (MTX). The loading efficiency of MTX on Au-3MPS was assessed in the range 70-80%, with a fast release (80% in one hour). The release was studied up to 24h reaching the value of 95%. The Au-3MPS@MTX conjugate was fully characterized by spectroscopic techniques (UV-vis, FTIR) and DLS. Preliminary toxicity tests in the presence of keratinocytes monolayers allowed to assess that the used Au-3MPS are not toxic. The conjugate was then topically used on C57BL/6 mouse normal skin in order to trace the absorption behavior. STEM images clearly revealed the distribution of gold nanoparticles inside the cells. In vitro studies showed that Methotrexate conjugated with Au-3MPS is much more efficient than Methotrexate alone. Moreover, DL50, based on MTT analysis, is 20 folds reduced at 48 h, by the presence of nanoparticles conjugation. UV-vis spectra for in vivo tracing of the conjugate on bare mouse skin after 24h of application, show increased delivery of Methotrexate in the epidermis and dermis using Au-3MPS@MTX conjugate, compared to MTX alone. Moreover we observed absence of the Au-3MPS in the dermis and in the epidermis, suggesting that these layers of the skin do not retain the nanoparticles. Based on our data, we found that the novel Au-3MPS@MTX conjugate is an effective non-toxic carrier for the satisfactory percutaneous absorption of Methotrexate and could help in possible topical treatment of psoriasis.