Abnormal nuclear expression of aquaporin-3 in lesional and perilesional skin of vitiligo patients: A novel immunohistochemical finding.

BACKGROUND: Vitiligo is a skin disease characterized by a complex etiopathogenesis. Keratinocyte apoptosis may play a role in vitiligo pathogenesis. Aquaporin-3 (AQP-3) is an aqua-glyceroporin that controls keratinocyte proliferation and differentiation. AIM: To assess the immunohistochemical expression of AQP-3 in lesional and perilesional skin of vitiligo patients compared to healthy control skin. METHODS: A total of 20 patients with generalized non-segmental vitiligo and 20 age- and sex-matched healthy controls were included. Lesional and perilesional skin of vitiligo patients, as well as normal skin of control subjects, were biopsied. The immunohistochemical expression of AQP3 in the epidermis was examined. RESULTS: Compared to control skin, both lesional and perilesional skin showed a significant reduction in the intensity of membranous staining of AQP-3 (p < 0.001, p = 0.002, respectively). Moreover, the membrano-cytoplasmic pattern of AQP-3 staining was significantly detected in 80% of lesions and 85% of perilesional biopsies, while it was absent in control skin (p < 0.001). Additionally, nuclear AQP-3 expression was significantly detected in 35% of lesions and 55% of perilesional biopsies, while it was not detected in control skin (p = 0.012, p < 0.001, respectively). No statistically significant difference was detected between lesional and perilesional skin. CONCLUSIONS: To our knowledge, this is the first immunohistochemical research to show a significant abnormal nuclear expression of AQP-3 in lesional and perilesional skin of vitiligo patients. This abnormality may reflect impaired functions of AQP-3, leading to keratinocyte apoptosis with subsequent melanocyte death and development of vitiligo.

Efficacy of long-pulsed Nd-YAG laser in the treatment of nail psoriasis: a clinical and dermoscopic evaluation.

BACKGROUND: Nail psoriasis (NP) is frequently seen in psoriatic patients. It is difficult to treat and shows unsatisfactory response to topical preparations. Recently, different types of Lasers have been shown to be effective in some nail disorders. AIM: The aim was to evaluate the efficacy and safety of long-pulsed Nd: YAG laser 1,064 nm as a method for NP treatment. METHODS: A prospective intra-patient left-to-right, randomized, placebo-controlled study conducted on 22 patients with bilateral fingernail psoriasis, randomly assigned into right or left-side therapy with either four sessions of long-pulsed Nd:YAG laser once monthly or daily topical placebo for 4 months, followed by 3 months follow-up. Evaluation was done using NP severity index at baseline, second month, fourth month and after follow-up period. Clinical and dermoscopic photographs were taken both at baseline and at 4th month. RESULTS: There was a statistically significant improvement in both NP severity index and dermoscopic features in laser side, along with significant difference between laser and placebo side. Nail bed showed obvious improvement than nail matrix. CONCLUSION: Nd:YAG laser represents an effective and safe modality for NP treatment and dermoscopy is a useful tool for treatment efficacy assessment.

Combined therapy of plantar warts with topical bleomycin and microneedling: a comparative controlled study .

Background: The aim of this study was to assess the efficacy of combination between microneedling with dermapen and topical bleomycin in the treatment of plantar warts in comparison with intralesional bleomycin and intralesional saline (placebo).Methods: Fifty-four patients were assigned into three groups, each containing 18 patients. The first group treated by micro-needling phenotype with topical bleomycin at 2 weeks interval, the second group received intralesional bleomycin at 3 weeks interval and the control group was intralesional saline for a maximum of four weeks.Results: Complete clearance of warts in 16 patients in the micro-needling group (88.9%) versus 15 patients (83.3%) in the intralesional bleomycin group versus one patient (5.6%) in the control group .Conclusions: Microneedling assisted topical bleomycin spraying seems to be a promising effective and noninvasive therapeutic modality for recalcitrant plantar warts that facilitates delivery and absorption of bleomycin into the lesion .

Comparison of intralesional triamcinolone acetonide, botulinum toxin type A, and their combination for the treatment of keloid lesions.

Objective: Despite the myriad options available, there is no universally the accepted treatment for keloids. Our objective was to compare three regiments and establish superiority in terms of objective and subjective outcomes.Approach: In this intervention study, 50 patients were enrolled. The Group I: included 26 patients with at least two keloid lesions subjected to intralesional triamcinolone acetonide in left-sided lesions and intralesional botulinum toxin type A in right-sided lesions. While group II included 24 patients subjected to a combination of both intralesional TAC and BTX-A. Injections were done for a total of three sessions 4 weeks apart. Color Doppler ultrasound (CDU) was done before and one month after treatment.Results: In terms of thickness and surface area the keloids responded significantly better to combined TCA and BTX versus TCA alone or BTX alone (p .0001). Also improvement in transverse and longitudinal axis was significantly higher in combined therapy (p < .0001 and .004, respectively). Conclusion: Combined injection of intralesional steroids with BTX-A appears to be superior to either therapy alone and offer the best benefit of safer and more efficacious response with lesser side effects.

Successful treatment of acne keloidalis nuchae with erbium:YAG laser: a comparative study.

Background: Acne keloidalis nuchae (AKN) is a chronic inflammatory disease involving hair follicles of the neck. It is a form of keloidal scarring alopecia that is often refractory to medical or surgical management. Objective: To evaluate the efficacy of Er:YAG laser in the treatment of AKN as compared to long pulsed Nd:YAG laser. Patients and Methods: This study was conducted on 30 male patients with AKN. Their ages ranged from 19 to 47 years with a mean age of 36.87 ± 7.8 years. Patients were divided randomly into two groups of 15 patients, each receiving six sessions of either Er:YAG or long-pulsed Nd:YAG laser therapy. Results: A statistically significant decrease in the number of papules was detected at the end of therapy in both groups, with a mean of 91.8% improvement in the Er:YAG group versus 88% in the Nd:YAG group. A significant decrease in plaques count was detected only in the Er: YAG group while a significant decrease in plaques size and consistency was recorded in both groups. Conclusion: The Er: YAG laser proved to be a potentially effective and safe modality both in the early and late AKN lesions.

Platelet-Rich Plasma Versus Tretinoin in Treatment of Striae Distensae: A Comparative Study.

BACKGROUND: Striae distensae (SD) are dermal scars associated with atrophy of the epidermis. OBJECTIVE: To evaluate the effect and safety of intralesional injection of platelet-rich plasma (PRP) versus topical tretinoin 0.05% in treatment of SD. METHODS: Thirty patients (27 females and 3 males) had bilateral striae distensae were enrolled in this study. In every patient, half of the selected striae were treated with PRP intralesional injection. The other half was treated by topical tretinoin. Skin biopsies were taken from both sides before and after the treatment. Digital photographs were taken at the baseline and at the end of follow-up period. Clinical improvement was evaluated by 2 blind dermatologists in addition to the patient's satisfaction rating. RESULTS: There was statistically significant improvement in the SD treated with PRP and topical tretinoin cream. The improvement was more in the SD treated with PRP injections (p = .015). Patient's satisfaction showed that the improvement was more in the PRP-treated side (p = .003). Collagen and elastic fibers in the dermis were increased in all biopsies after treatment. CONCLUSION: PRP injection and topical tretinoin are safe for the treatment of SD, but PRP is more effective and it gives better therapeutic response than tretinoin.

Over-expression of tumor necrosis factor-α in vitiligo lesions after narrow-band UVB therapy: an immunohistochemical study.

There is a growing evidence that cytokines are important in the depigmentation process of vitiligo, however, the exact mechanism is not fully understood. The aim of this work was to study the possible role of the tumor necrosis factor-α (TNF-α) cytokine in the depigmentation process of the disease. Twenty patients with generalized vitiligo were exposed to narrow-band ultraviolet B (NB-UVB) therapy thrice weekly for a total of 60 sessions. Immunohistochemical examination was done, to assess the TNF-α expression in lesional and perilesional skin as compared to normal control skin, before and after therapy. At baseline, positive lesional TNF-α expression was detected in 60 % of patients which was significantly higher as compared to perilesional skin (20 %) and negative expression in healthy control skin. Post-treatment, a statistically significant increase in TNF-α expression was detected in both lesional (90 %) and perilesional skin (70 %) as compared to baseline (P < 0.05). The significant increase of TNF-α in vitiligo lesions compared with perilesional and healthy skin suggests a possible involvement of this cytokine in the depigmentation of vitiligo. The increase in TNF-α expression after NB-UVB phototherapy suggests another role in repigmentation.

Intralesional immunotherapy of plantar warts: report of a new antigen combination.

BACKGROUND: Treatment of plantar warts represents a continuing challenge for dermatologists because many of the available therapeutic modalities are associated with unsatisfactory results and high recurrence rates. Several clinical trials have proved the efficacy of intralesional immunotherapy by different antigens in the treatment of different types of warts. OBJECTIVE: To evaluate the efficacy and safety of a new antigen combination-mumps, measles, and rubella (MMR) vaccine in the treatment of plantar warts. METHODS: The study included 40 patients with single or multiple, recalcitrant or nonrecalcitrant plantar warts. MMR vaccine was injected into single lesions or largest wart in case of multiple lesions at 3-week intervals until complete clearance or for a maximum of 3 treatments. Follow-up was done every 3 months for 9 months to detect any recurrence. RESULTS: Only 23 patients completed the study. The results revealed complete clearance of the warts in 20 patients (87%), partial response in one patient (4.3%), and no response in two patients (8.7%). Complete response was achieved in 75% of patients with recalcitrant plantar warts and 83.3% of patients with warts at sites other than the soles. Recurrence was observed in only one patient (4.3%). A significant relationship was found between therapeutic response and wart duration, but not with other clinical variables. Side effects include pain during injection (82.6%) and flu-like symptoms (4.3%). No erythema, edema, or scarring has been reported. LIMITATIONS: Small study sample and absence of control. CONCLUSIONS: Intralesional immunotherapy by MMR vaccine seems to be a simple, effective, and safe treatment modality for plantar warts.

Use of the Q-switched Nd:YAG laser for the treatment of pigmentary disorders in Egyptians.

BACKGROUND AND OBJECTIVE: Laser treatment of cutaneous pigmentation is one of the most interesting areas in cutaneous surgery. Our purpose was to study the efficacy of Q-switched Nd:YAG at 1064 nm and 532 nm for the treatment of some pigmented lesions in our locality in Egypt. METHODS: A total of 60 subjects were treated with the Q-switched Nd:YAG laser with fluences ranging from 8 to 10 J/cm(2) for dermal lesions and 2.5-5 J/cm(2) for epidermal lesions. The number of sessions ranged from one to six sittings for epidermal lesions, four to six sessions for dermal lesions, while the mixed group required two to three sessions. RESULTS: A total of 34 patients (56.7%) showed excellent response, seven patients (11.7%) showed good response, nine patients (15%) showed fair response, and 10 (16.6%) showed poor response. Transient postinflammatory hyperpigmentation occurred in five patients (8.33%) and erythema in seven patients (11.66%). Complications were common in darker skin types V and VI. CONCLUSION: The Q-switched Nd:YAG laser is an effective and safe technique for the treatment of pigmented skin lesions. Adverse hyperpigmentation can occur but is transient.

Melasma: treatment evaluation.

INTRODUCTION: Melasma is a common disorder of facial hyperpigmentation that can be resistant to treatment. Our purpose is to evaluate the clinical efficacy of the different available modalities of treatment of melasma among Egyptian patients who have mostly skin types IV-V under a sunny climate. METHODS: A total of 45 patients with moderate-to-severe melasma were subjected to topical application of hydroquinone 4% cream, chemical peeling with 30% trichloroacetic acid (TCA) and/or frequency-doubled Q-switched Nd:YAG laser therapy for an average of 6 months. Clinical evaluation and melasma severity were recorded using the melasma area and severity index (MASI) score. RESULTS: The improvement score was significantly higher among the topically treated group compared with other lines of therapy (p<0.0001). No significant difference in improvement score was detected in the laser group compared with the peeling group. The epidermal type of melasma was also significantly improved compared with the dermal type (p<0.01). CONCLUSION: Topical hydroquinone remains the most effective agent for the treatment of melasma in dark-skinned people with rare side effects.