Evaluation of the effect of combined intralesional injection of prostaglandin F2α with narrow band UVB phototherapy in treatment of resistant cases of vitiligo.

BACKGROUND: Vitiligo is a chronic cutaneous disease characterized with hypopigmented patches that leave psychological impact on the patients. There is increasing need for new treatment modalities to shorten the duration of treatment of vitiligo with the least side effects. OBJECTIVE: To explore the effect of intralesional injection of prostaglandin F2α on the outcome of narrow band ultraviolet rays B (NBUVB) for patients with stable vitiligo. PATIENTS AND METHODS: The study included 27 stable vitiligo patients with overall symmetrical lesions. For each patient, one patch was treated with NBUVB alone (control side), while another symmetrical patch was treated with combined intralesional injection of prostaglandin F2α with NBUVB therapy, weekly for 3 months. RESULTS: There was statistically significant improvement in the repigmentation in the combination group compared with NBUVB group. Side effects were minimal. CONCLUSION: Intralesional injection of prostaglandin F2α in combination with NBUVB therapy could be considered as safe and tolerable technique for treatment of vitiligo, it shortens the duration of NBUVB therapy. Longer follow up is needed.

Efficacy and safety of plasma gel as a new modality in treatment of atrophic acne scars.

BACKGROUND: Postacne scarring is an unfortunate and frequent complication of acne, with varied morphological forms and associated significant psychological distress to patients. AIM OF THE WORK: To evaluate the efficacy and safety of plasma gel injection alone and in combination with microneedling in treatment of atrophic postacne scars. PATIENTS AND METHODS: Sixty patients with atrophic postacne scars were enrolled in this single blinded randomized controlled study. The patients were divided into three groups with 20 patients being treated with intradermal injection of plasma gel, 20 patients treated with dermaroller, and 20 patients subjected to combined plasma gel and dermaroller. Patients received four sessions at monthly intervals and were evaluated by clinical, histopathological, and immunohistochemical analysis. RESULTS: There was statistically significant improvement in postacne scars after treatment in all studied groups with variable degrees; the combined technique showed the best clinical improvement in postacne scars. There was an increase in newly formed collagen and elastic fibers with more organized and condensed bundles after the end of treatment. CONCLUSION: Plasma gel showed a remarkable improvement for most patients after one session, providing a quick and easy solution for acne scars. The combination of dermaroller and plasma gel potentiated its effect with more improvement in scars.

Podoplanin as a Predictive Marker for Identification of High-Risk Mycosis Fungoides Patients: An Immunohistochemical Study.

BACKGROUND: Podoplanin, an important protein, has been implicated in various cellular processes, including lymphangiogenesis. Podoplanin is a mucin-type transmembrane glycoprotein that is accepted as a novel marker of lymphatic endothelial cells. OBJECTIVES: To study the immunohistochemical expression of podoplanin in the different stages of mycosis fungoides (MF) in comparison to control and to correlate their expression with disease severity and progression. MATERIALS AND METHODS: The study included 50 patients of MF, clinically diagnosed and assessed by World Health Organization/European Organization for Research And Treatment Of Cancer Consensus and 20 normal persons as control. Skin biopsy specimens were taken from all and examined for expression of podoplanin immunohistochemically. RESULTS: Significant upregulation of podoplanin expression was detected in all studied patients of MF in comparison to control group. Podoplanin expression in malignant lymphocytes and also lymph vessel density showed significant upregulation in the aggressive clinical presentations as well as the highest stages regarding TNMB staging of MF. CONCLUSIONS: Evaluation of podoplanin expression may be taken into consideration in the future as a useful tool to identify high-risk MF patients. Furthermore, it may open new therapeutic options for the clinical management of those patients.

Pulsed dye laser versus intense pulsed light in melasma: a split-face comparative study.

BACKGROUND: Recent reports suggest that melasma may have a vascular component. Vascular targeting lasers and light treatment can be a therapeutic option that will provide benefits to the patients. OBJECTIVES: To compare the efficacy and tolerability of pulsed dye laser (PDL) and intense pulsed light in treatment of melasma. PATIENTS AND METHODS: Twenty-eight Egyptian female patients with melasma were treated with PDL on the right hemiface (Group A) and with the intense pulsed light on the left hemiface (Group B). Clinical assessment was performed according to the hemifacial modified Melasma Area and Severity Index score (mMASI). Tissue biopsies were taken from patients for immunohistochemical staining with vascular endothelial growth factor (VEGF) antibody. RESULTS: The hemifacial mMASI score was significantly reduced after treatment in studied groups with no statistically significant difference. Intense pulsed light (IPL) group showed higher efficacy of treatment than PDL group in the epidermal melasma and in melasma lesions which had a vascular component. The expression level and intensity score of VEGF were significantly reduced after treatment in both groups. CONCLUSIONS: Both PDL and IPL were effective and safe treatment modalities for lightening of melasma. VEGF can be proved as a possible mechanism underlying the action of both PDL and IPL on melasma.

Relationship between Trace Elements and Premature Hair Graying.

CONTEXT: Hair is said to gray prematurely when a minimum of five gray hairs occurs before the age of 20 in fair skinned, 25 in Asians, and 30 in Africans. It may be genetically associated with autoimmune syndromes or certain environmental factors. AIMS: The aim of this study was to evaluate the serum level of iron, copper, and calcium and to assess their role in premature hair graying. SUBJECTS AND METHODS: This study was carried out on 60 patients with premature hair graying (PHG) and 30 age- and sex-matched healthy individuals served as a control group. The severity of PHG was assessed by the hair whitening scoring system. Serum iron, copper, and calcium concentrations were measured using Beckman Coulter instrument and spectrophotometric method. RESULTS: There was a reduction in serum levels of iron, copper, and calcium in patients with PHG in comparison with controls. There was a statistically negative significant correlation between the severity of PHG and serum iron and calcium levels. There was a negative nonsignificant correlation between body mass index and serum iron, copper, and calcium levels. CONCLUSIONS: Serum iron, copper, and calcium levels were reduced in association with PHG and correlated with its severity. Premature graying may be an indicator that hair is not getting enough nutrients and minerals, and supplementation with these trace elements might reverse and is expected to prevent progression of canities; however, further studies are needed to find the underlying mechanism of this relationship.

Dermoscopic features of acral pigmented lesions in Egyptian patients: a descriptive study.

BACKGROUND: Dermoscopy is a non-invasive technique allowing rapid and magnified in vivo observation of the skin. The anatomical structure of acral volar skin results in unique dermoscopic features in this location. OBJECTIVE: To describe and analyze the characteristic dermoscopic features of various kinds of acral pigmented lesions and emphasize the diagnostic value of the dermoscope in early melanoma at this anatomic site in a sample of Egyptians. PATIENTS AND METHODS: This study included 200 patients with 224 acral pigmented lesions. Dermoscopic examination was done to evaluate different dermoscopic patterns of these lesions. Clinically and dermoscopically suspicious lesions for malignancy were selected for more evaluation by histopathological examination by hematoxylin-eosin staining. RESULTS: The most frequent dermoscopic pattern was the parallel furrow pattern, (66.1%), followed by the lattice-like (8.9%), homogeneous (7.6%), fibrillar (6.3%), non-typical (5.4%), and then parallel ridge (2.2%). The least commonly reported patterns in our cases were the reticular and globular patterns (1.8% each). There was one case of acral lentiginous melanoma of the palm with a multicomponent dermoscopic pattern. CONCLUSION: The recognition of different dermoscopic patterns is essential for diagnosis of various types of acral pigmented lesions. In addition, dermoscopy is useful in discriminating between acral nevi and early acral melanoma and narrows down the number of biopsies needed.

Serum level of receptor activator of nuclear factor kappa-B ligand in patients with psoriasis.

BACKGROUND: Psoriasis usually precedes the onset of psoriatic arthritis by an average of 10 years in about 70% of patients. Receptor activator of nuclear factor kappa-B ligand (RANKL) is a natural and necessary surface-bound molecule, which is a ligand for osteoprotegrin and functions as a key factor for osteoclast differentiation and activation. OBJECTIVE: Evaluation of the serum level of RANKL in psoriasis and psoriatic arthritis and its correlation with severity of the disease as a trial to predict the occurrence of psoriatic arthritis in such patients. METHOD: This study included 80 subjects; 40 patients had chronic plaque psoriasis, 20 patients had chronic plaque psoriasis with psoriatic arthritis, and 20 were healthy controls. Patients with psoriasis were divided into three subgroups according to psoriasis area severity index score: mild, moderate, and severe. Serum RANKL levels were estimated for all subjects using enzyme-linked immunosorbent assay. RESULTS: Serum RANKL level in psoriatic arthritis was significantly higher compared to both patients with plaque psoriasis and control groups. Serum RANKL level significantly correlated to the severity of psoriasis, with a very high correlation coefficient in groups I and II. The diagnostic performance of serum RANKL level for the early prediction of psoriatic arthritis in patients with psoriasis was >170 pg/ml. CONCLUSION: Serum RANKL level could be considered as a useful diagnostic marker for the early prediction of psoriatic arthritis in patients with moderate and severe psoriasis. Assessment of soluble RANKL in psoriasis could identify those at increased risk for psoriatic arthritis, and anti-RANKL agents may be effective in decreasing incidence of psoriatic arthritis.