Serum Th1/Th2 and macrophage lineage cytokines in leprosy; correlation with circulating CD4(+) CD25(high) FoxP3(+) T-regs cells.

Not only macrophages, T-helper (Th)1 and Th2, but also CD4(+) CD25(high) FoxP3(+) regulatory T cells (T-regs) are involved in immune response to Mycobacterium leprae. We aimed to evaluate serum interleukin (IL)-1ß and IL-12p70 (macrophage cytokines), interferon-γ (IFN-γ) (Th1 cytokine), IL-4 (Th2 cytokine) and circulating CD4(+) CD25(high) FoxP3(+) T-regs, in untreated leprosy patients. Forty three patients and 40 controls were assessed for the mentioned cytokines using ELISA. Patients were assessed for circulating T-regs using flow cytometry. Patients were subgrouped into tuberculoid (TT), pure neural leprosy (PNL), borderline cases, lepromatous (LL), type 1 reactional leprosy (RL1) and erythema nodosum leprosum (ENL). Serum IL-12p70, IFN-γ and IL-4 were significantly higher in patients versus controls (P < 0.05). Serum IL-4 was highest in LL and lowest in RL1 (P = 0.003). Serum IL-1ß levels was significantly higher in multibacillary versus paucibacillary patients (P = 0.006). Significantly higher T-regs levels was detected in TT, RL1 and PNL, while the lowest levels in ENL(P < 0.001), with significant differences versus controls (P < 0.05). FoxP3 expression% was significantly lower in PNL than other patients and controls (P < 0.05). T-regs/T-effs was lowest in ENL(P < 0.05). IFN-γ correlated positively with T-regs but negatively with IL-1ß (P = 0.041&0.046 respectively), which correlated positively with T-effs%( P = 0.05). IL-4 correlated positively with T-regs FoxP3 expression% (P = 0.009). We concluded that: Circulating T-regs were increased in TT, RL1 and PNL patients, known of relatively high cell-mediated immunity. This finding was supported by low FoxP3 expression (in PNL) and correlation between T-regs count and IFN-γ level. Overproduction of IL-4 in LL may infer liability to develop ENL, with disease progression and immune hyperactivation, marked by deficient T-regs and increased T-regs FoxP3 expression%. IL-1ß probably has a pro-inflammatory role in multibacillary patients as correlated with T-effs%.

Evaluation of needling-induced autoinoculation in the management of genital warts.

BACKGROUND: Genital warts caused by human papillomavirus (HPV) are one of the most common sexually transmitted infections. Long latency, lesions' multiplicity, high recurrence rate, and the tendency to malignant transformation are essential challenges during management. Traditional treatment modalities are known to be lesion-directed while intralesional immunotherapy was introduced to act beyond individual lesions and to confront the previous challenges through injection of known antigens, such as measles, mumps and rubella (MMR) vaccine, to stimulate the immune system against HPV. Needling-induced autoinoculation is also considred as an immunotherapeutic procedure that does not include the injection of antigens. We evaluated the efficacy of needling-induced autoinoculation in the management of genital warts. METHODS: Fifty patients with multiple recurrent (≥4) genital warts were divided into two equal groups. One group was subjected to needling-induced autoinoculation and the other was subjected to intralesional MMR injection every 2 weeks for a maximum of three sessions. Follow-up was done for 8 weeks after the last session. RESULTS: Both needling and MMR showed statistically significant therapeutic outcome. Needling showed significant improvement with regard to the number (P = 0.000) and size (P = 0.003) of lesions. In parallel, MMR showed significant improvement with regard to the number (P = 0.001) and size (P = 0.021) of lesions. There was no statistically significant difference between both treatments outcomes in regard to number (P = 0.860) and size (P = 0.929) of lesions. CONCLUSIONS: Both needling and MMR are effective immunotherapeutic modalities in management of genital warts. Needling-induced autoinoculation, being more safe and inexpensive, may be considered as a competing choice.

The H syndrome.

The H syndrome is a recently defined autosomal recessive genodermatosis caused by mutations in the nucleoside transporter hENT3. It is characterized by cutaneous changes of progressive sclerosis, hyperpigmentation, and hypertrichosis that follow a specific pattern and are associated with multiple systemic manifestations. A case is presented and a brief review is introduced based on the few related reports.

Bullous congenital ichthyosiform erythroderma associated with hypocalcemic vitamin D-resistant rickets.

There are several reports of an association between ichthyosis and rickets based mainly on a causative relationship through the impaired ability of ichthyotic skin to synthesize vitamin D. Hypocalcemic vitamin D-resistant rickets represents a specific type of rickets that is attributed to vitamin D receptor defect rather than to vitamin D deficiency. Nevertheless, an extremely rare association between bullous congenital ichthyosiform erythroderma and hypocalcemic vitamin D-resistant rickets is presented.

Prevalences of skin diseases among primary schoolchildren in Damietta, Egypt.

OBJECTIVES: Information on prevalences of pediatric dermatoses in Egypt is scanty. This study aimed to supplement existing data. METHODS: A cross-sectional study was conducted in Damietta, Egypt between October 2011 and March 2012. It involved 6162 pupils randomly selected from 30 primary schools. The sample was equally divided (3081 pupils/15 schools) between urban and rural areas. Each participant was interviewed for age, gender, residence and complaint. Hygiene status was evaluated and a clinical examination was carried out for skin diseases. Data were coded and analyzed. RESULTS: Although most children revealed more than one dermatosis, the majority (76.2%) had not complained of disease. The most common disease group included benign neoplasms (87.0%), followed by pigmentary disorders (68.3%), infections (50.9%), adnexal disorders (14.1%), hypersensitivity diseases (14.0%), genodermatoses (0.3%) and papulosquamous diseases (0.2%). The most common subgroup of diseases comprised parasitic infections (47.5%), among which pediculosis prevailed (47.5%), followed by dermatitis (10.0%) in which pityriasis alba dominated (6.0%), followed by hair disorders (9.3%), bacterial infections (5.9%), urticaria (4.4%), sebaceous gland disorders (2.7%), sweat gland disorders (2.3%), viral infections (1.6%) and fungal infections (0.7%). The most commonly found diseases included, in descending order, acquired melanocytic nevus, post-inflammatory hyperpigmentation, pediculosis, leukoderma, café au lait spots, atrophic scar, cicatricial alopecia, hypertrophic scar, pityriasis alba, papular urticaria, xerosis and impetigo. CONCLUSIONS: The high prevalence of skin diseases, especially of trauma-related disorders and infections, may be mainly attributable to a lack of appropriate health awareness and care, which has created a tendency within the population to adapt without complaining or seeking medical help. Such circumstances, unfortunately, have resulted in a growing community of silent patients.

Pattern of skin diseases in Cairo, Egypt.

BACKGROUND: Information on patterns of skin diseases in Egypt is scanty. METHODS: The medical records of patients attending dermatology outpatient clinics at Ain Shams University Hospitals from January 2001 to December 2001 were retrieved. Valid data of 7528 patients were included in the study. Demographic data (age and sex) and diagnoses of skin disease were extracted, coded, and analyzed. RESULTS: Patients' attendance revealed mean age of 23.5 ± 15.6 years and female predominance in a female to male ratio of 1.6:1. Most patients presented in summer (40.7%). Infections constituted most of the dermatoses (45.4%), and scabies was the most common disease (9.26%). Hypersensitivity diseases came after (22%) and, interestingly, the dermatitis subgroup (12.94%) followed fungal infections (15.83%) immediately, preceding other infection subgroups. Females predominated in most dermatoses. Urticaria predominated in infants, bacterial infections in preschool stage, fungal infections in school and young adult stages, and dermatitis in old adult and geriatric stages. Fungal infections predominated in all seasons. The peak presentation of all diseases was in summer except urticaria that was represented more in spring. CONCLUSION: Dermatitis preceded many infectious diseases as an index of the development and urbanization of a community. However, infections still represent the most common dermatoses. Fortunately, they are potentially controllable and, therefore, healthcare strategies that target infections may represent the key for an efficient national healthcare program.

Prolactin level is significantly elevated in lesional skin of patients with psoriasis.

BACKGROUND: Accumulating data point to a potential role of prolactin in the pathogenesis of psoriasis. METHODS: We initiated a study including psoriasis patients (n = 15) and healthy volunteers (n = 15) as controls. Psoriasis area and severity index (PASI) score was evaluated, and prolactin levels in serum and blister fluid were assessed by enzyme-linked immunosorbent assay (ELISA). RESULTS: Prolactin levels were significantly (P < 0.01) elevated in blister fluid of psoriatic lesional skin. Correlations between PASI score and different serum prolactin levels in lesional and non-lesional skin were insignificant. Significant positive correlations of prolactin level were observed between lesional and non-lesional skin in psoriasis (P < 0.05) and between serum and clinically normal skin in both psoriasis and control subjects (P < 0.05). CONCLUSIONS: Locally produced prolactin may be involved in the pathogenesis of psoriatic lesions.