Epidemiological and biochemical factors (serum ferritin and vitamin D) associated with premature hair graying in Egyptian population.

BACKGROUND: The etiology of premature hair graying (PHG) remains incompletely understood with limited treatment options, although has profound impacts on patient's quality of life. AIMS: To assess demographic and clinical profiles of Egyptian PHG patients and explore association of various epidemiological risk factors and serum vitamin D and ferritin levels with PHG. PATIENTS AND METHODS: Three hundred PHG patients and equal number of controls, aged <30 years, were included. Assessment of epidemiological and clinical characteristics, biometric data and stress perception using perceived stress scale (PSS-10) was done, with measurement of serum vitamin D and ferritin levels for all subjects. PHG was graded into mild, moderate, and severe if <10, 10-100, and >100 gray hairs, respectively. Statistical significance for various compared parameters was done employing suitable tests, with P-value ≤ .05 considered significant. RESULTS: Results reported significant positive relation of PHG with family history, sedentary life style, and stress (P = .001, .029, and .001, respectively), while no significant relation with smoking, body mass index, or frequent hair dyes use (>3 per year) (P = .425, .5, and .65, respectively). No significant difference was found in mean vitamin D between patients and controls (23.79 ± 13.01 ng/mL vs 24.85 ± 13.19 ng/mL, P = .701), while low serum ferritin (<20 ng/mL) was significantly associated with PHG (14.7 % patients vs 2.7% controls, P = .017). CONCLUSION: PHG in Egyptian population is significantly associated with positive family history, stress, sedentary life style, and low serum ferritin level, while role of vitamin D deficiency should be further evaluated.

Neodymium-yttrium aluminum garnet laser versus pulsed dye laser in erythemato-telangiectatic rosacea: comparison of clinical efficacy and effect on cutaneous substance (P) expression.

BACKGROUND: Different laser systems are reported to be effective in treatment of telangiectasia and erythema, but comparative studies on 1064-nm neodymium-yttrium aluminum garnet (Nd-YAG) laser and pulsed dye laser (PDL) in treatment of erythemato-telangiectatic rosacea are lacking. Substance (P) is implicated in rosacea pathogenesis. OBJECTIVES: To compare the effect of Nd-YAG laser and PDL on erythemato-telangiectatic rosacea, both clinically and immunohistochemically on cutaneous substance (P) expression. METHODS: This split-face comparative study included 15 patients with erythemato-telangiectatic rosacea treated on the right side with Nd-YAG laser and on the left side with PDL: three sessions, 4 weeks apart. Evaluation of the patients was done using erythema and telangiectasia grading scores, patient's self-assessment, physicians' clinical assessment of the patient, and immunohistochemical assessment of substance (P). RESULTS: One month after the three laser sessions, excellent response was achieved in 73.3% of patients after Nd-YAG and in 53.3% of patients after PDL with significantly lower substance (P) concentration after Nd-YAG laser than after PDL. Positive correlations were found between the decrease in erythema and telangiectasia grading scores and the decrease in substance (P) concentration. CONCLUSIONS: The use of Nd-YAG laser and PDL appears to be safe and effective measures in treatment of erythemato-telangiectatic rosacea. Both types of laser decrease the concentration of substance (P) in the skin. This effect is more pronounced with Nd-YAG laser.

Assessment of serum leptin, insulin resistance and metabolic syndrome in patients with skin tags.

BACKGROUND: Skin tags are common cutaneous lesions with an indefinite aetiology. OBJECTIVES: To assess serum leptin, insulin resistance and metabolic syndrome in different body mass index (BMI) patients with skin tags. METHODS: Three equally distributed groups of patients with multiple skin tags: 30 normal BMI, 30 overweight and 30 obese were included. Controls were age-, gender- and BMI-matched healthy subjects. Serum leptin, insulin resistance based on homeostasis model assessment of insulin resistance (HOMA-IR) and metabolic syndrome were assessed in all groups. RESULTS: Number and extent of skin tags increase with the increase in BMI. Highest leptin levels were found in obese patients, with significant differences when compared to normal BMI and overweight patients. Similar findings existed in controls. Significantly higher leptin levels were found in obese patients compared to obese controls. HOMA-IR was significantly higher in all groups of patients compared to BMI-counterpart controls. Seventy-one per cent of patients fulfilled criteria of metabolic syndrome. Number of skin tags, leptin and HOMA-IR were significantly higher in patients with metabolic syndrome compared to patients without the syndrome. Positive correlations were found between serum leptin and HOMA-IR in obese patients and obese controls. Positive correlations were also found between number of skin tags and waist circumference in all groups of patients. CONCLUSIONS: Serum leptin displays an association with obesity and insulin resistance. Assessment of HOMA-IR in patients with skin tags may serve as a useful approach for diagnosis of insulin resistance. Waist circumference is the only criteria of metabolic syndrome that correlates with number of skin tags.

Evaluation of androgen receptor gene as a candidate gene in female androgenetic alopecia.

BACKGROUND: Genetic polymorphisms of the androgen receptor (AR) gene have been studied in male androgenetic alopecia (AGA); however, little is known about gene polymorphism and female AGA. AIM: To evaluate the AR gene as a candidate gene for female AGA. METHODS: Thirty premenopausal Egyptian female patients with AGA (mean age, 32.3 +/- 7 years) and 11 age- and sex-matched controls were included. All subjects underwent laboratory and pelvic ultrasound evaluation to exclude other precipitating cause(s) of hair loss. Scalp biopsy was taken and the AR gene was evaluated using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: According to Ludwig's classification, all patients had type II AGA. Statistical analysis showed no statistically significant difference in genotype (chi(2) = 5.513, P > or = 0.05) or allele frequency (chi(2) = 1.312, P > or = 0.05) between patients and controls. There was also no statistically significant difference between the genotype and allele frequency with disease duration. CONCLUSION: In contrast with male AGA, no association was found between type II AGA in Egyptian women and the AR gene. Therefore, the genetic study of this gene does not serve as a biomarker for the identification of women with a predisposition to AGA.

Assessment of anti-cyclic citrullinated peptide in psoriatic arthritis.

BACKGROUND: Anti-cyclic citrullinated peptides (anti-CCP) are highly specific diagnostic and prognostic markers for rheumatoid arthritis (RA). They have been also found in psoriatic arthritis (PsA), with controversies as regards clinical and radiological associations. The current study assessed anti-CCP in PsA and determined its clinical and radiological associations. METHODS: Four groups contributed to this study. 40 PsA, 40 psoriasis without arthritis, 40 RA and 40 healthy controls. They were tested for anti-CCP. Clinical and radiological data were collected and statistically compared between anti-CCP-positive and -negative PsA patients. RESULTS: Seven PsA (17.5%) and 34 RA (85%) were seropositive for anti-CCP. Patients of other groups were anti-CCP-negative. Regarding anti-CCP concentrations, highly significant difference existed between different groups and between anti-CCP-positive and -negative PsA. Significantly higher numbers of involved, swollen and tender joints, deformities and functional impairment of peripheral joints and radiological changes were found in anti-CCP-positive PsA. CONCLUSION: Anti-CCP may be found in PsA and are associated with higher number of involved, swollen and tender joints, with deformities and functional impairment of peripheral joints and with erosive arthritis.

Is there a role for insulin resistance in nonobese patients with idiopathic hirsutism?

BACKGROUND: Hirsutism is the presence of terminal hairs in women in a male-like pattern. It may result from various causes of androgen excess or may be idiopathic. Controversies exist concerning the presence of insulin resistance in idiopathic hirsutism (IH) or if it is a manifestation of a high body mass index (BMI). OBJECTIVES: To assess insulin resistance in nonobese patients with IH. METHODS: The study included three groups of age- and BMI-matched nonobese women: 30 patients with IH (group 1), 20 patients with hirsutism associated with polycystic ovary syndrome (PCOS) (group 2) and 20 healthy controls (group 3). The pattern of obesity based on waist to hip ratio (WHR), and insulin resistance based on fasting insulin levels and the homeostasis model assessment of insulin resistance (HOMA-IR) were assessed in all the groups. RESULTS: Sixteen patients with IH and 17 with PCOS had insulin resistance with statistically significant differences in fasting insulin levels and HOMA-IR between the three groups, between patients with IH and healthy controls and between patients with PCOS and healthy controls; there were no significant differences between patients with IH and patients with PCOS. When classified according to the pattern of obesity, 23 patients in group 1, 17 in group 2 and two in group 3 had a WHR >or= 0.85 (android obesity) with highly significant higher values of fasting insulin levels and HOMA-IR in patients with a WHR >or= 0.85 when compared with those with a WHR < 0.85. CONCLUSIONS: Insulin resistance occurs in nonobese patients with IH and appears to be related to android obesity.

Tissue and blood superoxide dismutase activities and malondialdehyde levels in different clinical severities of acne vulgaris.

BACKGROUND: Acne vulgaris is one of the commonest dermatological diseases and its pathogenesis is multifactorial. OBJECTIVES: To determine the role of oxidative stress in acne vulgaris and to determine a possible link with the clinical severity. METHODS: Twenty-three patients with different grades of acne vulgaris and 23 age- and sex-matched controls were enrolled. Superoxide dismutase (SOD) activities and malondialdehyde (MDA) levels were measured spectrophotometrically at tissue and blood levels. RESULTS: There were no significant differences in SOD activities and MDA levels between patients and controls. However, significant differences were found in patients with severe acne in comparison with those with mild and moderate acne. Moreover, comparison between different patient subgroups and controls revealed statistically significantly higher SOD activities in patients with mild acne in comparison with patients with moderate and severe acne, and with controls. Furthermore, severe acne showed statistically significantly lower SOD activities and higher MDA levels when compared with other patient subgroups and controls. CONCLUSIONS: Oxidative stress exists in patients with acne vulgaris and may play a role in aetiopathogenesis and/or progression of the disease. The addition of drugs with antioxidative effects seems to be valuable in the treatment of acne vulgaris.