Female Genital Dialogues: Female Genital Self-Image, Sexual Dysfunction, and Quality of Life in Patients With Vitiligo With and Without Genital Affection.

Vitiligo has a major effect on sexual health because of the disfiguring skin lesions affecting self-image and self-esteem. However, this topic has not explored. This article aimed to assess the effect of vitiligo on genital self-image, sexual function, and quality of life in female patients. This cross-sectional study included 50 sexually active women with vitiligo and 25 women without vitiligo. All participants subjected to full history taking and examination. Extent of vitiligo was assessed with the Vitiligo Area Scoring Index score, sexual function with the Female Sexual Function Index, genital self-image with Female Genital Self-Image Score and quality of life with the Dermatology Life Quality Index questionnaires. The main outcome measures were correlation between Vitiligo Area Scoring Index, Female Genital Self-Image Score, Female Sexual Function Index, and Dermatology Life Quality Index domains was determined using t test and Pearson correlation. This study revealed a negative correlation between the Vitiligo Area Scoring Index score and sexual satisfaction. Vitiligo Area Scoring Index and Dermatology Life Quality Index score was significantly correlated with Arabic Version of the Female Genital Self-Image Score alone and with Arabic Version of the Female Sexual Functioning Index alone and with both the Arabic Version of the Female Genital Self-Image Score and the Arabic Version of the Female Sexual Functioning Index (p <.05). Sexual and psychological assessment of patients with vitiligo is imperative to improve outcomes and increase patients' compliance with treatment.

Carbon dioxide laser plus topical 5-fluorouracil: a new combination therapeutic modality for acral vitiligo.

BACKGROUND: Acral vitiligo (AV) is resistant to treatment. AIM: To evaluate efficacy and safety of combining carbon dioxide (CO2) laser and 5-fluorouracil (5FU) in treating AV. METHODS: This study included 68 adult patients with AV. After randomly assigning patients into 3 groups, patients in group I were treated using 5FU, group II were treated using CO2 laser, and group III were treated using CO2 laser followed by 5FU for a maximum period of 5 months. The lesions were then evaluated both qualitatively and quantitatively. RESULTS: Almost half (49.8%) of the lesions in group III achieved G4, and 6.1% of lesions achieved G3 re-pigmentation. This response was statistically significantly higher than that in the other two groups. This was not achieved in periungual areas in the hands and feet. The pain was tolerable during sessions or at sites of 5FU application. Transient hyperpigmentation, brownish spot on nail plates, itching, and infection were temporary side effects; however, Koebnerization was not detected. CONCLUSION: We concluded that prior use of CO2 laser skin ablation, followed by 5FU application for AV is a safe and tolerable technique that improves the outcome and increases patient compliance.

Female genital mutilation/cutting: will it continue?

INTRODUCTION: Female genital mutilation/cutting (FGM/C) is a prevalent, deeply rooted traditional practice in Egypt. AIMS: Specification of the motives behind the continuation of FGM/C in Egyptian community and evaluation of the sexual function in women with FGM/C. METHODS: This cross-sectional study, involved 2,106 sexually active female participants with FGM/C. Full history-taking and general examination to evaluate the type of FGM/C were conducted. Sexual function was assessed by using the Female Sexual Function Index (FSFI) questionnaire. MAIN OUTCOME MEASURES: Enumerate and specify the motivational factors and its percent among the participants. The correlation between FGM/C and FSFI domain scores was done with Pearson's correlation. RESULTS: Tradition, cleanliness, and virginity were the most common motives empowering the continuation of FGM/C (100%), followed by men's wish, esthetic factors, marriage, and religion factors (45.2-100%). Type I FGM/C was the most common, followed by type II. There was only negative correlation between the type II FGM/C and sexual satisfaction. No statistically significant difference between type I and non-FGM/C was found. CONCLUSIONS: FGM/C remains high. A variety of socio-cultural myths, religious misbelievers, and hygienic and esthetic concerns were behind the FGM/C. Overall, a large proportion of the participants supported the continuation of FGM/C in spite of adverse effect and sexual dysfunction associated with FGM/C.

Assessment of female sexual function in patients with psoriasis.

INTRODUCTION: Psoriasis has a major impact on sexual health due to the disfiguring skin lesions affecting self-image and self-esteem. However, this topic has not been fully explored. AIM: The study aims to assess sexual function in female patients with psoriasis. METHODS: This cross-sectional study included 52 sexually active female patients with psoriasis regardless of their age (group I) and 30 normal volunteers (who were age matched with the patients) who served as a control group (group II). Full history taking, general and systemic examination, including sexual history, together with clinical examination to evaluate the extent of skin disease using Psoriasis Assessment Severity Index (PASI) score and evaluation of sexual function using the Female Sexual Function Index (FSFI) Questionnaire, were done for all the subjects enrolled in the study. MAIN OUTCOME MEASURES: Correlation between PASI and FSFI domain scores was determined in matched groups using Pearson correlation. RESULTS: This study revealed a negative correlation between the PASI score and the overall sexual satisfaction in the studied group. Also, psoriatic female patients with genital psoriasis have more significantly impaired sexual function compared with either those without genital lesions or those with lesions elsewhere in the body. CONCLUSIONS: It is imperative to do full sexual and psychological assessment of psoriatic patients to improve outcomes and increase patients' compliance with treatment.

Hybrid high- and low-molecular weight chains of hyaluronan is an effective modality treatment for increasing female sexual satisfaction: An interventional, randomized-control parallel study.

Background and Aims: Psychological, behavioral, hormonal, surgical, and psychopharmacologic approaches are the only acknowledged treatments for Female Sexual Dysfunction (FSD). The study is conducted to assess the efficacy of hybrid cooperative complexes of high and low molecular weight hyaluronan (hybrid H-HA/L-HA) in treating females with varying of sexual dysfunction and to assess the female genital self-image scale (FGSIS), female sexual function index (FSFI), and dermatology life quality index (DLQI) before and after treatment. Methods: Sixty female patients were divided into two groups. The study group enrolled 30 female patients injected with hybrid H-HA/L-HA, while the control group enrolled 30 female patients injected with saline. Patients were recruited from the clinic searching for medical advice. Controls were selected from close associates of the cases who were attending with the patients or healthy escorts of dermatology patients attending the dermatology outpatient clinic. We assessed socio-demographic, clinical evaluation, the (FGSIS), (FSFI), and (DLQI) before and after treatment. The first assessment was conducted at the first visit, and the second assessment was conducted after 1 month of the second injection. Result: Significant increase in the frequency of sexual intercourse/week in the study group after the first and second injection sessions compared to the controls was observed (p < 0.05). There was statistically significant amelioration in desire, arousal, lubrication, orgasm, satisfaction domains, and total score of the FSFI (p ≤ 0.05). The study demonstrated significant increasing differences in all domains of the FGSIS (p ≤ 0.05). The symptoms and feelings, leisure, personal relationships, and total scores were significantly higher post first and second injection of (hybrid H-HA/L-HA) sessions compared to the controls (p < 0.05). Conclusion: The (hybrid H-HA/L-HA) injection for rejuvenating the genital area appears to be a safe and effective way to enhance female genital self-image, sexuality, and quality of life with high levels of satisfaction as a minimally invasive method.

Cutaneous larva migrans: A case report diagnosed using teledermatology.

Teledermatology is a branch of dermatology that transmits medical data over several miles using telecommunications technologies. It involves the diagnosis of skin lesions using digital photographs and related patient data, and it can be especially helpful for patients in remote areas who might not have convenient access to dermatologists. Cutaneous larva migrans (CLM) is a zoonotic parasitic disease found in tropical and subtropical areas that are sunny and hot; however, cases of allocated resources have been disclosed in Saudi Arabia. There is little information about the frequency of CLM as a work-related illness among employees who are exposed to potentially polluted soil or have close contact with pets. In this paper, we present an ancestral case of CLM in Saudi Arabia, explaining the hazards of CLM infection. CLM may pose a challenge for physicians in non-endemic areas regarding assessment, therapeutic interventions, and protection, especially at work. The holistic strategy to CLM assessment, which includes the participation of numerous science competencies (e.g., veterinarians, dermatologists, and occupational physicians), may contribute to a better understanding of the expansion of human CLM and related risk factors, lowering the chance of infection.

A simple method for controlling depth of skin piercing using simple injection needles.

Piercing the skin is imperative in many procedures such as hair transplantation and skin lifting with threads.

The effectiveness of Cyperus rotundus essential oil in reducing the side effects of laser hair removal.

BACKGROUND: In many ailments, Cyperus rotundus is an effective and safe treatment option. Flavonoids in the oil have anti-inflammatory and analgesic properties. There have been no randomized controlled trials comparing topical C. rotundus oil to the available allopathic modalities for treating post-hair removal laser side effects. OBJECTIVES: Participants in this study were prospectively evaluated for the efficacy of C. rotundus essential oil, compared with hydrocortisone and saline, in managing pain and erythema after laser hair removal. METHODS: Eligible participants (n = 153) were randomly assigned to one of three study groups: topical C. rotundus oil (group 1), hydrocortisone (group 2), or saline (group 3). The following methods were used to assess the results: The Wong-Baker FACES Pain Scale was used to rate pain. Erythema was graded on a six-point scale: "no erythema," "slight erythema," "marked erythema," "severe erythema without vesicles," and "severe erythema with vesicles." RESULTS: In terms of anti-inflammatory effects, C. rotundus oil and hydrocortisone did not differ significantly (p > 0.05). However, statistically significant differences in the analgesic effect (P.05) were observed, favoring the oil. CONCLUSIONS: Cyperus rotundus essential oil is a safe and cost-effective treatment for post-laser pain and erythema.

Triple steps acne scar revision technique: A new combination therapeutic modality for atrophic acne scars.

BACKGROUND: Atrophic acne scarring is an unfortunate, permanent complication of acne vulgaris, associated with significant psychological distress. OBJECTIVE: A new complementary treatment of atrophic acne scars using subcision and injection of hybrid cooperative complexes of high and low molecular weight hyaluronan (hybrid H-HA/L-HA). METHODS: This study included eighty-two patients divided into two groups with predominantly atrophic acne scarring. Group 1 received subcision with saline injection, while group 2 received triple steps acne scar revision technique (TSASRT). After topical anesthesia, the procedure of combining subcision and hybrid H-HA/L-HA technique was done in which the first step started using subcision technique done to release fibrous cords at the dermal or deep dermal, subcutaneous plane using Nokor needles-18 g. The second step is to inject the scar's atrophic dermal component with a 29 g needle, applying an average amount of hybrid H-HA/L-HA (0.02-0.1 mL) to the dermal component. The third step was to fill the subcisied space with hybrid H-HA/L-HA (0.02-0.1 mL) using a 25 g cannula. RESULTS: Clinical improvement was achieved in both groups. There were statistically significant improvements in the TSASRT versus subcision (p ≤ 0.05) in acne scar severity index and qualitative scarring grading system. CONCLUSION: The triple step acne scar revision technique appears to be a safe and effective way to treat atrophic acne scars on the face.

Genital whitening with topical Cyperus rotundus oil enhances sexuality and quality of life.

BACKGROUND: Cyperus rotundus essential oil (CREO) is an anti-inflammatory and depigmenting agent that helps treat hyperpigmentation. OBJECTIVES: The purpose of this study was to evaluate the depigmenting effect of CREO on genital hyperpigmentation to that of arbutin (ARB), and to evaluate the association between genital lightening, genital self-image, sexual performance, and life quality. MATERIAL AND METHODS: Three hundred and eight healthy people were categorized into three groups: the CREO group, the ARB group, and the cold cream group (CC). In genital pigmentation, the tristimulus colorimeter is used to assess erythema and pigmentation. In addition, we aided in the development of the female genital self-image scale (FGSIS-4), the female sexual function index (FSFI), and the dermatology life quality index (DLQI). RESULT: The reduction in genital hyperpigmentation was significantly greater in the CREO and ARB groups than in the CC group; in physician global assessment and patients' self-assessment, the results in treated bikini with the CREO and ARB groups were excellent when compared with the CC. Furthermore, no adverse effects were found in the CREO group, but mild irritation was found in the ARB group; additionally, the percentage of hair growth, color and luminance reduction, and hair thickness were significantly reduced in the CREO group only. In addition, there were significantly different in FGSIS, FSFI, and DLQI between the CREO and ARB groups and the CC group. CONCLUSION: CREO is equivalently efficacious in decreasing pigmentation, inflammation, and hair growth in the genital area. Positive changes boost female genital self-image, self-esteem, and sexual performance. Improving sexual health has a positive impact on quality of life.

Highlights in pathogenesis of vitiligo.

Vitiligo is a common pigmentary disorder. Many studies across decades and all over the world have attempted to illustrate the pathogenesis behind it; however, the pathogenesis of vitiligo remains elusive. This review article, we present the findings behind the most and updated theories behind this psychologically debilitating and disfiguring disease. The discussion begun with the role of genetic predisposition followed by neural theory first proposed in the 1950s. We highlight the autoimmune hypothesis, followed by the reactive oxygen species model, zinc-α2-glycoprotein deficiency hypothesis, viral theory, intrinsic theory and biochemical, molecular and cellular alterations accounting for loss of functioning melanocytes in vitiligo. Many theories were elaborated to clarify vitiligo pathogenesis. It is a multifactorial disease involving the interplay of several factors. Future research is needed to clarify the interaction of these factors for better understanding of vitiligo pathogenesis and subsequent successful treatment.

Efficacy of the apitherapy in the treatment of recalcitrant localized plaque psoriasis and evaluation of tumor necrosis factor-alpha (TNF-α) serum level: A double-blind randomized clinical trial.

BACKGROUND: No universal consensus about optimal modality for treating the recalcitrant localized plaque psoriasis (RLPP) is available. OBJECTIVE: To evaluate the immunological and clinical therapeutic effect of using apitherapy in the treatment of RLPP. METHODS: Randomized 50 patients with RLPP received apitherapy (n = 25) and placebo (n = 25) every week. Both treatments were injected into lesions at weekly intervals for a maximum of 12 treatments. Following up was 6 months later. Tumor necrosis factor-alpha (TNF-α) level was measured at pre-study and at 12th week. RESULTS: A significant difference was found between the therapeutic responses of RLPP to the apitherapy and placebo groups (p<0.001). In the apitherapy group, complete response was achieved in 92% of patients. There was statistically significant decrease in TNF-α in the apitherapy group compared to the placebo group. No recurrence was observed in the apitherapy group. CONCLUSION: Apitherapy is effective and a safe treatment for recalcitrant localized plaque psoriasis, when other topical or physical therapies have failed.

Real-Time PCR of cytomegalovirus and Epstein-Barr virus in adult Egyptian patients with systemic lupus erythematosus.

OBJECTIVE: Infections may act as environmental triggers for induction of systemic lupus erythematosus (SLE). We sought to explore the relative frequencies of Epstein-Barr virus (EBV) and human cytomegalovirus (CMV) in adult Egyptian patients with SLE and their correlation with disease activity and damage. METHODS: Thirty-three consecutive adult patients satisfying the 1997 American College of Rheumatology (ACR) Classification Criteria for SLE and 30 healthy controls were included in this case-control study. All patients were subjected to complete clinical and laboratory evaluation to determine the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR). Sera from both groups were analyzed for immunoglobulin M (IgM) and IgG antibodies against CMV and EBV. Qualitative real time polymerase chain reaction (PCR) for both viruses was performed for all SLE patients. RESULTS: Almost all SLE patients 32/33 (96.9%) were positive for IgG anti-CMV antibodies versus 20/30 in the control group (66.6%) (P = 0.002). All SLE patients were positive for IgG anti-EBV antibodies compared to 25 in the control group (100% vs. 83.3%, P = 0.02). CMV and EBV DNA were detected by PCR in 30.3% and 51.5% of SLE patients, respectively. A statistically significant lower SLEDAI was found in PCR positive patients for EBV compared to negative patients (9.6 ± 5.2 vs. 13.1 ± 3.1, respectively P = 0.041). CONCLUSIONS: Adult Egyptian patients with SLE had higher frequencies of anti-CMV and EBV IgG compared to healthy controls. Furthermore, our single point assessment of SLEDAI suggested that exposure to EBV infection might be associated with a lower disease activity.

Evaluation of IL-12 serum level in patients with recalcitrant multiple common warts, treated by intralesional tuberculin antigen.

BACKGROUND: No universal consensus about optimal modality for treating the recalcitrant multiple common warts (RMCW). OBJECTIVE: To evaluate the immunological mechanisms and clinical therapeutic effect of using of intralesional purified protein derivative (PPD) in the treatment of RMCW. METHODS: The study included 40 patients with RMCW. They were randomly assigned to 2 groups: first group (20 patients) received intralesional PPD antigen, and second group (20 patients) received intralesional saline as a control group. In both groups, injections were made into single lesions, or largest wart in case of multiple lesions, at weekly intervals, until complete clearance or for a maximum of six treatments. Blood serum was taken at pre-study and at week 6 to measure IL-12 level. RESULTS: A significant difference was found between the therapeutic responses of RMCW to PPD antigen and saline control group (p < 0.001). In the PPD group, complete response was achieved in 75% after 5.8 ± 0.7 sessions' patients presenting with RMCW. There was a statistically significant increase in IL-12 of PPD group versus saline group. No recurrence was observed in the PPD group. CONCLUSION: Intralesional immunotherapy by PPD antigen is an effective and a safe treatment for RMCW in previously immunized patients.