Generalized lymphatic anomaly: A case report and review of literature.

Generalized lymphatic anomaly (GLA), previously known as lymphangiomatosis, is a rare developmental disease characterized by abnormal proliferation of lymphatic vascular structures that may involve the dermis, soft tissue, bone, and visceral parenchyma. Being an uncommon condition and the lack of specific symptoms often result in a delayed diagnosis or even misdiagnosis, which, in addition to its progressive nature, can lead to dysfunction of vital organs, and ultimately, a poor prognosis. In this report, we present a unique case of GLA in an upper Egyptian female child. Increasing awareness of the possible phenotypic presentations of such anomalies can lead to early diagnosis and possibly more effective management before significant organ damage ensues.

Efficacy and safety of calcipotriol as a potential topical treatment of acne vulgaris: a randomized, controlled, triple blinded, split-face clinical trial.

BACKGROUND: Acne vulgaris is a common skin problem that may result in significant scarring and systemic comorbidities. Adverse effects and increasing resistance to available treatments urge the development of new therapeutics. Topical vitamin D analogues have been successfully used in psoriasis; however, the efficacy and safety of calcipotriol as a potential topical treatment of acne is yet to be established. OBJECTIVES: To evaluate the efficacy and safety of calcipotriol in treating acne compared with adapalene and placebo. METHODS: Sixty patients with acne were included and randomly divided into two groups of 30 patients each. Group I participants were treated by daily application of calcipotriol 0.005% cream on one facial side vs. placebo (petrolatum) over the other side. Group II were treated by daily application of adapalene 0.1% gel over one facial side vs. calcipotriol on the other. Therapeutic response was evaluated using the Japanese Acne Grading System (JAGS) and through photographic evaluation using Mean Improvement Score by Physician. RESULTS: Adapalene-treated skin gave the greatest improvement and the highest patient satisfaction compared with skin treated with calcipotriol or placebo (P = 0.001). Nonetheless, the calcipotriol-treated side showed a significantly greater reduction in post-treatment JAGS score and much greater satisfaction than placebo. As treatment continued, improved tolerability to calcipotriol was noted, with comparable side-effects between the three study arms. CONCLUSIONS: Calcipotriol seems to be a promising new safe topical therapeutic option for acne. However, adapalene is still superior in efficacy, tolerability and patient satisfaction.

Evaluation of different concentrations of hydrogen peroxide solution (3% and 6%) as a potential new therapeutic option of nongenital warts: A randomized controlled triple-blinded clinical trial.

BACKGROUND: Warts are common viral skin infections caused by human papillomavirus. None of the available treatment modalities fulfills the criteria of an ideal treatment option. OBJECTIVES: To evaluate the efficacy and safety of hydrogen peroxide (HP) 3% and 6% solution as a topical treatment of nongenital warts. METHODS: This prospective randomized controlled study included 145 patients with nongenital warts. They were divided into three groups. Group 1 used topical hydrogen peroxide 6% solution under occlusion with a plastic tape for one hour daily for 6 weeks, group 2 used hydrogen peroxide 3% solution, and group 3 used normal saline 0.9% as a placebo. Patients were evaluated at the third and sixth weeks of treatment and 12 weeks after treatment completion. RESULTS: Treatment responses were significantly better in groups 1 and 2 than in group 3 with a better overall responses in group 1 than in group 2 (P = 0.0001*). Apart from mild hypopigmentation which was detected in only two patients in groups 1 and 2, no other side effects could be detected. Three months after treatment completion, no recurrence was observed. CONCLUSION: Hydrogen peroxide solution (3% and 6%) is an effective, safe, and cheap treatment modality for nongenital warts which can be used simply at home. Since the overall response was better with the 6% concentration, it should be the better therapeutic option.

Microdermabrasion and topical tacrolimus: A novel combination therapy of vitiligo.

BACKGROUND: Topical immunomodulators have been successfully used as monotherapy or in combination with other therapeutic modalities in treating vitiligo. To the best of our knowledge, no previous studies have evaluated the combination of tacrolimus 0.03% ointment and microdermabrasion as a therapeutic modality to hasten response time and improve repigmentation rate in vitiligo vulgaris. AIMS: To explore the efficacy and safety of the combination of MDA and topical tacrolimus (0.03%) as a novel therapeutic approach for stable vitiligo vulgaris. METHODS: Thirty-five patients with vitiligo were enrolled in this randomized placebo-controlled study. Three vitiligenous patches were chosen in each patient. The first lesion (A) was treated by tacrolimus 0.03% ointment, the second lesion (B) was treated by tacrolimus and microdermabrasion, and the third lesion (C) was treated by petrolatum as a placebo. Treatment course was 3 months, and follow-up was done for three extra months. Vitiligenous patches were assessed at baseline and monthly for 6 months. RESULTS: Moderate to excellent response was observed in 65.7% of lesions B, compared with 25.8% of lesions A (P = .001). Improvement in VASI score was significantly better in patients treated by the combination therapy (P = .000). Disease duration has a negative impact on therapeutic response. Patients were more satisfied with the combination treatment. CONCLUSION: Microdermabrasion combined with tacrolimus 0.03% ointment represents a new therapeutic option for the treatment of vitiligo which appears to be an easy, safe, and effective.

Single nucleotide polymorphism T869C of transforming growth factor-beta 1 gene and systemic lupus erythematosus: association with disease susceptibility and lupus nephritis.

Transforming growth factor ß1 (TGF-ß1) has a large role in the control of autoimmunity. Single nucleotide polymorphisms (SNP) in the promoter of TGF-ß1 cytokine gene are known to alter the production of this important cytokine. Decreased levels of TGF-ß1 may contribute to systemic lupus erythematosus (SLE) susceptibility, activity and organ damage. Lupus nephritis (LN) occurs in more than one-third of patients with SLE. In this study we measured serum levels of TGF-ß1 and assessed TGF-ß1 single nucloetide polymorphism (SNP) at codon 10 (T869C) in Egyptian SLE population in order to verify whether there is a relationship between this polymorphism, serum level of TGF-ß1, SLE susceptibility, clinical manifestations and lupus nephritis. We studied 56 consecutive SLE female patients and 40 healthy female volunteers as control group. Serum levels of TGF-ß1 were measured by enzyme-linked immunosorbent assay (ELISA) and the polymorphism of the TGF-ß1 gene, T869C was analyzed using the method of amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). The genotype and allele frequencies of T869C of the TGF-ß1 gene did not differ between SLE patients and healthy controls. Serum levels of TGF-ß1 were significantly reduced in patients with SLE as compared with levels in healthy controls (P < 0.001). The genotype and allele frequencies of T869C of the TGF-ß1 gene did not differ between SLE patients with lupus nephritis (LN) and SLE patients without LN. Lower levels of TGF-ß1 were found in patients with LN than in patients without LN. TGF-ß1 was significantly decreased in TT group than in CC and TC groups (P < 0.001). No significant correlation was found between serum TGF-ß1 level, SLEDAI scores and clinical manifestations. In conclusion, these results suggest that T869C polymorphism of the TGF-ß1 gene is not associated with SLE disease susceptibility and specific clinical manifestations. However, this polymorphism may lead to the production of low serum level of TGF-ß1 especially with TT genotype and consequently plays an important role in the development of renal damage.

Diagnostic utility of deamidated gliadin peptide antibody in celiac disease compared to anti-tissue transglutaminase and IgA- endomysium antibodies.

Deamidated gliadin peptide antibodies have recently been suggested as reliable tools for celiac disease (CD) diagnosis. We compared their utility for diagnosis CD in comparison to the routinely used anti-endomysial, and anti-tissue transglutaminase antibodies. We studied 65 patients (17 men, 48 women; age range, 17- 63 years) who underwent intestinal biopsy because of clinical suspicion of small-bowel disorders. Serum samples were obtained at the time of biopsy for measuring IgA and IgG anti-tissue transglutaminase (tTG), IgA and IgG anti-deamidated gliadin peptide (DOP) by ELISA and IgA anti-endomesial antibody (EmA) by indirect immunoflouresce. Characterization of patients was based on histological criteria (Marsh type II lesion or greater). Biopsy revealed that 14 patients had positive criteria for CD. The remaining 51 negative patients were used as controls. Assay sensitivity and specificity for diagnosing celiac disease were 85.7% and 92.2% for IgA and 92.9 and 100% for IgG antibodies to DGP respectively. Serum IgA and IgG DGP, IgA and IgG -tTG and IgA EmA were significantly higher in CD patients than in control group (P = 0.000). None of the controls was positive for IgG DGP or IgA -EmA, but 4 of 51 (7.8 %) were positive for IgA- DGP, 6 of 51 (11.8 %) were positive for IgA anti-tTG, and 2 of 51 (3.9%) were positive for IgG anti-tTG. IgG-DGP has the best sensitivity (92.9%), specificity (100%), positive predictive value (100%), and negative predictive value (96.2%). In conclusion, the DGP antibodies tests, alone or in combination with the tTG antibodies, are useful tools for screening purposes and with better patient acceptance than intestinal biopsy.

The impact of acne vulgaris on the quality of life and psychologic status in patients from upper Egypt.

BACKGROUND: Acne vulgaris is a common skin disease. Although neither life threatening nor physically debilitating, acne can severely affect social and psychologic functioning. Aim To study the overall impact of acne vulgaris on the quality of life and psychologic functioning of patients in Egypt. METHODS: One hundred and fifty patients with acne vulgaris and 50 healthy controls were evaluated. Acne patients were evaluated using the Dermatology Life Quality Index (DLQI), Culture Free Self-Esteem Inventory - Adult Version (CFSEI-AD), and Symptom Check List-90 - Revised (SCL-90-R). The controls were evaluated using SCL-90-R and CFSEI-AD. RESULTS: The mean DLQI scores of male acne patients were found to be higher than those of female patients with regard to symptoms and feelings, daily activities, personal relationships, and treatment; however, the differences were significant for leisure (P = 0.005) and total score (P = 0.022) only. The CFSEI-AD score of patients was significantly lower than that of controls (P = 0.001). Acne patients had significantly higher scores than controls in all items of the SCL-90-R. Significant positive correlations were found between the duration and severity of illness and DLQI and SCL-90-R scores. There was a significant negative correlation between the duration and severity of acne and CFSEI-AD scores. CONCLUSION: Acne vulgaris has a significant effect on the quality of life. Our results highlight the importance of recognizing psychiatric comorbidity in acne patients.

Is Helicobacter pylori infection associated with alopecia areata?

BACKGROUND: Alopecia areata (AA) is an immune-mediated form of hair loss that occurs in all ethnic groups, ages, and both sexes. Helicobacter pylori has been associated with certain extra-digestive dermatological conditions, including chronic urticaria, rosacea, Schönlein-Henoch purpura, Sweet syndrome, systemic sclerosis, and atopic dermatitis. OBJECTIVE: The causal relation between alopecia areata and H. pylori is discussed. We have screened for the presence of H. pylori in patients with AA in order to determine any potential role in its pathophysiology. PATIENTS AND METHODS: We have prospectively studied 31 patients with AA and 24 healthy volunteers of similar gender for the presence of H. pylori surface antigen (HpSag) in stool. RESULTS: Optical density values for H. pylori infection were positive in 18 of all 31 patients evaluated (58.1%), while in 13 patients, values did not support H. pylori infection (41.9%). While in the control group, 10 of 24 (41.7%) had positive results. Within the group of AA, there was no significant difference between HpSag-positive and HpSag-negative patients. CONCLUSIONS: Based on these results, the relation between H. pylori and AA is not supported. We advise that H. pylori detection should not be included in the laboratory workup of AA.

Alopecia areata is not associated with Helicobacter pylori.

BACKGROUND: Alopecia areata (AA) is an immune-mediated form of hair loss that occurs in all ethnic groups, ages, and both sexes. Helicobacter pylori has been associated with many extra-digestive dermatological conditions. The causal relation between alopecia areata and Helicobacter pylori is discussed in this study. MATERIALS AND METHODS: We have screened for the presence of H. pylori in patients with AA, in order to determine any potential role in its patho-physiology. We have prospectively studied 31 patients with alopecia areata and 24 healthy volunteers of similar gender, for the presence of H. pylori stool antigen (HpSAg). RESULTS: Optical density values for H. pylori infection was positive in 18 of the 31 patients evaluated (58.1%), while in 13 patients, the values did not support H. pylori infection (41.9%). In the control group, 10 of the 24 (41.7%) had positive results. Within the group of alopecia areata, there was no significant difference between HpSAg positive and negative patients. CONCLUSIONS: The results have shown that a relation between Helicobacter pylori and alopecia areata is not supported. We advise that H. pylori detection need not to be included in the laboratory work up of alopecia areata.

Sperm cryopreservation for men with nonmalignant, systemic diseases: a descriptive study.

Cytotoxic drugs and immunosuppressive therapies are used to treat patients with nonmalignant, nontesticular systemic diseases. These therapies can permanently suppress spermatogenesis. Sperm cryopreservation before treatment theoretically could give these men the opportunity to achieve a pregnancy with a woman later in life when the couple decides to do so. However, it is not known whether pretreatment sperm quality in these men is good enough to be used for assisted reproductive techniques. The main objective of this study was to determine the usefulness of cryopreservation in this patient population by: 1) assessing their pretreatment semen quality (eg, count, motility, and motion kinetics) and comparing it with that of healthy donors before and after cryopreservation; 2) comparing patients' pretreatment semen characteristics with World Health Organization reference values for normal sperm; and 3) examining the differences in semen parameters among patient groups. Semen specimens were obtained from 25 healthy donors and from 23 patients with a variety of disorders (12 had autoimmune disorders, 4 had kidney disorders, 3 had diabetes, 2 had ulcerative colitis, and 2 had heart transplants). All patients, except those with diabetes, required immunosuppressive or cytotoxic therapy. Although the pretreatment quality of the semen of these patients was not as good as that of donors, semen samples were within the normal reference range of the World Health Organization. No statistically significant differences in sperm parameters were found within the 4 patient groups except for those with diabetes (n = 3), who showed poorer sperm counts (P < .04). However, no conclusive evidence can be reached due to the small sample size. Our results indicate that pretreatment semen quality in these patients is adequate for reproductive techniques. We believe that cryopreservation should be offered to patients of reproductive age with disease or treatment regimens that may cause infertility.