Safety and efficacy of intralesional injection of enalapril versus triamcinolone acetonide in the treatment of keloids.

INTRODUCTION: Keloids are pathologic conditions characterized by fibroblast hyper-proliferation and excess collagen deposition. Enalapril, one of the angiotensin-converting enzyme inhibitors, has recently been highlighted as a new therapeutic modality in treating keloids. This study evaluates the effectiveness of intralesional injection of enalapril versus triamcinolone acetonide (TAA) in keloids. METHODS: Forty patients with multiple keloids were enrolled in our study. Enalapril and TAA were injected intralesionally in one session per month for three sessions. The clinical outcomes were assessed via the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). RESULTS: In both groups, according to VSS and POSAS, there was a high statistically significant difference (p-value ≤ 0.01) before treatment, at the end of each session, and 3 months after treatment. There was no significant difference between both groups regarding degree of improvement. Patients treated with TAA developed more significant complications than those in the enalapril group (p-value < 0.05). CONCLUSIONS: Both enalapril and TAA had the same clinical effect. Enalapril could be a safe alternative to steroids in the treatment of keloid and hypertrophic scars. Further studies on enalapril are needed on a large sample of patients with further focus on the mechanism of this innovative drug.

Expression of Long Noncoding RNA, HOTAIR, and MicroRNA-205 and Their Relation to Transforming Growth Factor ß1 in Patients with Alopecia Areata.

Introduction: Alopecia areata (AA) is a common autoimmune condition that affects anagen hair follicles. The most commonly recognized theory is that it is a T-cell-mediated autoimmune disorder in a genetically susceptible individual. MicroRNAs (miRNAs) and long noncoding RNAs (lncRNAs) were thought to play a function in the pathogenesis. The expression of lncRNA HOTAIR and miRNA-205 and their relation to transforming growth factor ß1 (TGF-ß1) in AA were not studied. Aim: The aim of the studywas to evaluate the role of miRNA-205, lncRNA, HOTAIR, and TGF-ß1 levels in AA pathogenesis, clinical course, and severity of AA. Methods: Two groups of subjects were included in this case-control study: 50 patients with AA and 50 healthy matched controls. miRNA-205 and lncRNA HOTAIR expression levels were assayed using quantitative RT-PCR, while serum levels of TGF-ß1 were assayed using ELISA techniques. Results: The serum expression of lncRNA HOTAIR was significantly downregulated in AA patients with a p value < 0.001, while the serum expression of both miRNA-205 and TGF-ß1 were significantly upregulated in patients. Discussion/Conclusion: This study highlights the potential role of high serum expression of miRNA-205 and TGF-ß1 and the low serum expression of lncRNA HOTAIR in AA pathogenesis. This could be used as a therapeutic target to treat AA.

Involvement of high-mobility group box-1 and Dermoscopy in diagnosis of psoriasis severity.

BACKGROUND/OBJECTIVES: The diagnosis of psoriasis is usually established on clinical grounds but there is lacking of such diagnostic tools to stratify its severity. Psoriasis is a chronic inflammatory disease of skin, nails, and joints. Dermoscopy represent a novel diagnostic tool to diagnose and assess psoriasis severity. The main purpose of this study is to assess the value of dermoscopy associated with serum level of high-mobility group box-1 level (HMGB-1) in the diagnosis and stratification of psoriasis severity. METHODS: This study included 60 Egyptians subdivided into two equal groups, psoriatic patients, and controls. All patients were subjected first to dermoscopic examination, and then we evaluated the serum levels of HMGB-1 among all studied groups. RESULTS: The level of HMGB-1 increased in psoriatic patients than controls. There was significant difference between patients and controls in the serum levels of HMGB -1. There were also a positive significant correlation between HMGB-1 and different stages of disease severity. There were also significant correlations between HMGB-1 and specific dermoscopic findings like vascular pattern and vascular number, erythema grades as well as types of scales (Fine, coarse) and (Fine, thick). CONCLUSIONS: Dermoscopy and HMGB-1 can be considered as a combined novel diagnostic tool for psoriasis severity.

Evaluating serum level of thymidylate synthase in post burn keloid patients before and after intralesional injection of 5-fluorouracil.

BACKGROUND: Keloids are fibrous lesions formed at the site of trauma due to types I and III collagen irregular production. The presence of thymidylate synthase (TS) is a must for DNA synthesis and repairs causing cell death. 5-fluorouracil (5-FU) is a fluorinated pyrimidine analogue acting as an anti-metabolic agent that inhibits thymidylate synthase and interferes with ribo-nucleic acid (RNA) synthesis. OBJECTIVES: we aimed to evaluate the level of thymidylate synthase in post burn keloid patients before and after intralesional injection of 5-fluorouracil. METHODS: The study included 20 keloid patients and 20 healthy subjects as a control. Serum TS was estimated using commercially available enzyme-linked immunosorbent assay (ELISA) kits before and after treatment with 5-fluorouracil. RESULTS: There was a statistically significant difference in TS levels before and after 5-FU treatment (p < 0.05). Also, results have shown that 5-FU injection has good satisfactory results in treatment of keloid causing reduction in scar volume and symptoms improvement (90% of the patients improved). On the other hand, there was no statistically significant difference in TS levels and the outcomes of the treatment. CONCLUSION: Our findings suggest that intralesional 5-FU injection in keloid has very satisfactory results. However, thymidylate synthase enzyme has a minimal role in evaluating the treatment of keloid, so further studies are required to elaborate the relation between this enzyme and keloid scars.

Comparative study between the effectiveness of plasma skin regeneration versus micro-needling in the treatment of striae distensae.

BACKGROUND: Striae distensae (SD) or stretch marks, a common condition causing significant cosmetic concern and distress, are linear dermal scars associated with epidermal atrophy that occur due to overstretching. Recently, micro-needling with dermapen is considered as one of the therapeutic modalities for SD. Also, plasma skin regeneration with plasma jet has been recommended as an effective method for the treatment of SD. AIM: The aim was to compare between the efficacy of both methods in the treatment of SD. METHODS: This study included 30 patients with striae distensae. Body was divided into two halves; one was treated with plasma jet for two sessions with 1 month interval and follow-up one month after the last session and the other half was treated with dermapen for four sessions with two weeks interval and follow-up one month after. RESULTS: There was no statistically significant difference (p- value >0.05) between dermapen and plasma jet procedures as regard to width, Total Atwal Score, Atwal score component, score of erythema, and skin texture after treatment. There was high statistically significant difference (p value <0.01) between dermapen and plasma jet as regards pain with higher values with plasma jet while there were statistical higher values concerning hyperpigmentation and erythema with dermapen. There was high statistically significant difference (p value <0.001) between width of striae before and after treatment with dermapen. CONCLUSIONS: Both lines of treatments are effective and promising therapeutic modalities for striae distensae with minimal side effects.

Direct-acting antiviral drugs improve the female sexual burden associated with chronic HCV infection.

Background: The impact of patient cure by direct-acting antiviral agents (DAAs) on female sexual dysfunction (FSD) associated with HCV hasn't been studied.Aim: To study the impact of DAAs on associated FSD in patients with chronic HCV infection.Methods: In patients with chronic HCV infection who were eligible for DAAs, the self-administered female-sexual-function index (FSFI) questionnaire was completed by 300 sexually active females' patients before treatment and compared to equal number of age and socioeconomically matched controls. FSFI questionnaire results after treatment were compared to patients' baseline results.Results: The mean total score for the patients was significantly lower than that for controls (16.77 ± 1.36 versus 17.52 ± 0.99, P < 0.001). Patients after treatment with DAAs significantly scored better results than baseline results in the total score and all domains of the questionnaire and significantly less patients had FSD compared to baseline (2.7% versus 29.3% P < 0.05). Patients' mean FSFI score significantly improved after cure (18.8 ± 0.27 vs. 16.77 ± 1.36, P < 0.001).Conclusion: Hepatitis C has negative impacts on FSF and affecting all domains of FSFI. The DAAS improve the sexual burden associated with hepatitis C in patients who achieved sustained virologic response.

Male Sexual Dysfunction Among Egyptian Patients with Chronic Hepatitis C Virus Infection Before and After Direct-Acting Antiviral Drugs.

BACKGROUND: Chronic hepatitis C virus (HCV) infection is a global health burden that affects quality of life, with a negative impact on sexual functioning (SF). AIM: To study male sexual dysfunction (MSD) among Egyptian men with chronic HCV infection and the impact of therapy with direct-acting antiviral drugs (DAAs) on their sexual health. METHODS: The self-administered International Index of Erectile Function (IIEF) questionnaire was completed by 400 sexually active male patients with chronic HCV infection without liver cirrhosis before the initiation of therapy with DAAs and then again at the completion of therapy. We compared these baseline questionnaires with those completed by a similar number of age-matched and socioeconomic status-matched controls. In the patients with HCV infection, we also compared IIEF questionnaires completed before and after DAA therapy. MAIN OUTCOME MEASURE: We determined the proportions of patients and controls who were dissatisfied with their sexual life and the impact of clearing HCV infection on MSD and evaluated the impact of DAA therapy on the total IIEF score and scores in all IIEF domains. RESULTS: Men with chronic HCV infection before DAA treatment had significantly higher erectile dysfunction (ED) scores compared with controls, and scores increased with age (P < .0001). The average scores in all IIEF domains was significantly lower in the patients compared with controls in all age groups. Men with chronic HCV infection had significantly higher ED scores before cure than after cure (P < .0001). CLINICAL IMPLICATIONS: Given the high prevalence of MSD in patients with chronic HCV infection, and given that curing the HCV virus can improve the MSD associated with HCV infection, it is recommended that sexual quality of life in men with HCV be addressed as part of the evaluation protocol before initiation of DAA treatment and again after cure in an effort to improve this particular aspect of quality of life. STRENGTHS & LIMITATIONS: This is the first study to report on MSD in the era of DAA therapy in Egyptian men with chronic HCV infection before the development of cirrhosis, with a relatively large study population. The use of a detailed version of the IIEF questionnaire reinforces the validity of our study. CONCLUSION: Chronic HCV infection negatively impacts MSD, affecting all domains of the IIEF, and effects increase with age. The MSD associated with HCV infection is significantly improved in patients who are cleared of the virus. These findings require further confirmation and need to be addressed as part of a comprehensive therapeutic plan to improve patients' quality of life. Elshimi E, Morad W, Mohamad NE. Male Sexual Dysfunction Among Egyptian Patients with Chronic Hepatitis C Virus Infection Before and After Direct-Acting Antiviral Drugs. J Sex Rev 2019;16:402-409.

Female sexual dysfunction among Egyptian patients with chronic hepatitis C.

INTRODUCTION: Chronic hepatitis C is associated with many extrahepatic manifestations that impact and impair the quality of life. Hepatitis C virus (HCV) infection has a high prevalence in Egypt and carries with the diagnosis many social impacts and stigmatization correlates that further impair social function. This might negatively impact patients and their sexual function. Sexuality and sexual function have not been studied well in patients with HCV, especially in women. AIM: To investigate sexual dysfunction in Egyptian women with chronic hepatitis C. MAIN OUTCOME MEASURES: Female Sexual Function Index (FSFI) scores of patients with hepatitis C, both total and for individual domains, were compared with those of controls. METHODS: The self-administered FSFI questionnaire was completed by 112 sexually active female patients with chronic hepatitis C without liver cirrhosis prior to initiation of therapy by pegylated interferon and ribavirin. Their results were compared to those of 225 age- and socioeconomic class-matched sexually active healthy females. RESULTS: Significantly more patients than controls had questionnaire scores below the threshold of female sexual dysfunction (FSD) (79% vs. 21%, P < 0.05), and the mean total score for the patients was significantly lower than that for controls (19.54 ± 6.2 vs. 28.43 ± 4.9 P < 0.001). The patients' scores in all domains of the questionnaire were significantly lower than those of the controls. CONCLUSION: Chronic hepatitis C negatively impacts female sexual function, affecting all domains of the sex cycle; this warrants further studies and needs to be addressed as part of a comprehensive therapy plan to improve patients' quality of life.