Intralesional zinc sulfate 2% vs intralesional vitamin D in plantar warts: A clinicodermoscopic study.

Verrucae are benign proliferations seen in skin due to infection with papillomaviruses. There are different treatment strategies for warts but all of these treatments are painful, time consuming, expensive, and recurrence is common. To evaluate and compare the efficacy of intralesional 2% zinc sulfate solution vs vitamin D3 in the treatment of plantar warts, as well as reporting the side effects. This three-armed randomized clinical trial included 105 patients presented with plantar warts divided into three groups, 35 patients per group. The first group received intralesional 2% zinc sulfate, the second group received intralesional 2% vitamin D3, and the third group received normal saline. Four sessions were done, one every 2 weeks. At the end of the study, patients showing complete response were more in zinc group (71.4%), vitamin D3 group (62.9%) compared to saline group (40%). Most of the patients in zinc group showed severe pain during injection (48.6%), most of the patients in vitamin D3 group showed mild pain (80%), while most of the patients in saline group showed no pain (57.1%). Both intralesional 2% zinc sulfate and vitamin D3 are effective in treatment of plantar warts, with zinc sulfate being more effective.

The Unmet Need for Clinical Guidelines on the Management of Patients with Plaque Psoriasis in Africa and the Middle East.

PURPOSE: Dermatologists practicing in African and Middle Eastern countries face numerous challenges when managing patients with plaque psoriasis, especially those with disease in a difficult-to-treat anatomic area or those who are a pediatric, geriatric, or pregnant patient. The publication of comprehensive, up-to-date, region-specific clinical guidelines may help to address some of these challenges and improve outcomes. We conducted a literature review to identify recent guidelines and other publications describing patients with plaque psoriasis in Africa and the Middle East. PATIENTS AND METHODS: An online literature search of the PubMed database was conducted to identify publications reporting clinical guidelines and research studies on plaque psoriasis. The search included all articles published from January 2008 to March 2020 inclusive. The titles and abstracts of all search results were screened by a reader to identify those that described patients in Africa or the Middle East. RESULTS: A total of 145 publications were identified by the literature search and screened by a reader. There were 10 publications that described patients in Africa or the Middle East: 4 research articles, 3 reviews, 2 guidelines, and 1 case study. The 2010 guidelines from South Africa made recommendations for treating plaque psoriasis of varying severity, although without specific recommendations for difficult-to-treat anatomic areas or pediatric, geriatric, or pregnant patients. The 2014 guideline on biologics from Saudi Arabia included recommendations for the use of these agents in patients with plaque psoriasis, including difficult-to-treat anatomic areas and pediatric patients (TNF inhibitors only), but provided no recommendations for pregnant or geriatric patients. CONCLUSION: There is an urgent unmet need for comprehensive clinical guidelines on the management of patients with plaque psoriasis in Africa and the Middle East. Region-specific studies on the epidemiology, burden of disease, and the safety and effectiveness of newer pharmacotherapies are needed to support the development of such guidelines.

The dermoscopic features of facial aging among Egyptians: A comparative study between males and females.

BACKGROUND: Few studies have evaluated facial photoaging by dermoscopy. Only one study has been performed among Egyptians. OBJECTIVE: To study and compare the dermoscopic features of facial aging in males and females and to relate these features to clinical criteria. METHODS: This study included 217 subjects divided into two groups; 117 males and 100 females. Each group was classified into three subgroups according to age. The dermoscopic features were reported according to dermoscopy photoaging scale (DPAS) criteria besides diffuse erythema and seborrheic keratosis and were related to significant clinical factors. RESULTS: The most prominent DPAS features in males were yellowish discoloration, hypo-hyperpigmented macules, superficial wrinkles, criss-cross wrinkles, and deep wrinkles. The most prominent DPAS findings in females were yellow papules, hypo-hyperpigmented macules, solar lentigo, and superficial wrinkles. A significant difference between males and females was detected regarding yellowish discoloration, white lines, hypo-hyperpigmented macules, senile comedones, telangiectasia, all wrinkle types, and DPAS score besides diffuse erythema and seborrheic keratosis. The DPAS score and the dermoscopic features were more prominent with male gender, increase in age, sun exposure, Glogau's scale, and smoking and were detected early in skin phototypes II and III. CONCLUSION: We found a significant difference in various dermoscopic features in males compared to age-matched females. Also, we detected increase in DPAS features and score with male gender, aging, sun exposure, Glogau's scale, and smoking. Therefore, dermoscopy is an objective technique that detects selectively photoaging in males and females that aids in proper choice of various targeted treatment modalities.

Association of metabolic syndrome with female pattern hair loss in women: A case-control study.

BACKGROUND: Several studies have addressed the association of metabolic syndrome (MetS) with androgenetic alopecia (AGA) in men with few reports focusing on this association in females. The aim of this work was to investigate the association of MetS among Egyptian women with different stages of female pattern hair loss (FPHL) and to compare the results with age- and sex-matched controls. METHODS: This study included 90 female participants, 45 cases with different stages of FPHL classified according to the Ludwig scale and 45 healthy control participants that were age- and sex-matched with the cases. Assessment of MetS components was done according to the Adult Treatment Panel III criteria. RESULTS: Compared to the control group, a statistically significant association was found between FPHL and the presence of MetS with a tendency to increase with the severity of FPHL being greater in stage III > stage II > stage I. Among metabolic syndrome components, waist circumference (WC) (OR 5.6, 95% CI 2.2 -13.9, P = 0.0002) and hypertension (HTN) (OR 3.5, 95% CI 1.3-8.9, P = 0.008) were revealed as the most important factors associated with FPHL. WC also tended to increase with the severity of FPHL. CONCLUSIONS: We demonstrated a significant association between MetS and FPHL. Women with FPHL, particularly if associated with an increased WC or hypertension, should be screened for MetS criteria for early identification and management.

Study of telomerase reverse transcriptase (hTERT) expression in normal, aged, and photo-aged skin.

BACKGROUND: Telomerase is a ribonucleoprotein enzyme capable of extending chromosome ends with telomeric DNA sequences. It protects the germline and stem cells from senescence by preventing telomere attrition. Cutaneous aging includes intrinsic aging, and photo-aging. Telomere-associated cellular senescence contributes to certain age-related cutaneous disorders, including increased cancer incidence. Premature skin aging in xeroderma pigmentosa (XP) is expected to show increased telomere attrition. We aimed to study human telomerase reverse transcriptase (hTERT) expression in normal, aged and photo-aged skin and to investigate its possible role in the pathogenesis of aging and photo-aging. METHODS: hTERT expression using immunohistochemistry was studied in 75 subjects comprising four groups: group I, 10 subjects with aged skin; group II, 20 subjects with photo-aging; group III, Five patients with XP; and group IV, 40 subjects comprising the control groups. RESULTS: We found positive hTERT in normal skin and in the basal and sometimes in supra-basal layers. We reported positive hTERT expression in dermal fibroblasts, histiocytes, and skin appendages (other than hair follicles) in some cases from all the studied groups. Photo-aged and prematurely photo-aged skin showed greater hTERT expression than young and aged skin. CONCLUSION: Telomeres rather than telomerase are involved in cellular senescence. Yet, telomerase is intimately related to photo-aging in which lifetime cumulative sun exposure is an important factor. However, genetic damage in XP is the decisive factor and not merely ultraviolet exposure.