Dermoscopy could be useful in differentiating sarcoidosis from necrobiotic granulomas even after treatment with systemic steroids.

BACKGROUND: Diagnosing cutaneous sarcoidosis and necrobiotic granulomas is challenging. OBJECTIVE: Assessing the value of dermoscopy in differentiating cutaneous sarcoidosis from necrobiotic granulomas and evaluating whether their dermoscopic features will be altered after treatment. METHODS: Nineteen cutaneous sarcoidosis and 11 necrobiotic granuloma patients (2 necrobiosis lipoidica, 4 granuloma annulare and 5 rheumatoid nodule) were included in this study. The diagnosis was confirmed by skin biopsy. The lesions were examined using non-contact polarized dermoscope (Dermlite 2 HR-Pro; 3Gen, San Juan Capistrano, CA). RESULTS: Ten out of 19 cutaneous sarcoidosis patients and 7/11 necrobiotic cases group were receiving treatments (topical, intralesional or systemic steroids ± chloroquine) but still have cutaneous lesions. Treatment duration in the sarcoidosis group ranged from 2 months to 10 years (median 3 years) and in the necrobiotic cases group ranged from 3 months to 16 years (median 2 years). Pink homogenous background, translucent orange areas, white scar-like depigmentation and fine white scales were significantly associated with the cutaneous sarcoidosis compared to necrobiotic cases group. On the other hand mixed pink, white and yellowish background was significantly associated with the necrobiotic cases group. No significant difference in the dermoscopic findings was detected between treated and non-treated patients. CONCLUSION: Some dermoscopic findings are shared between the cutaneous sarcoidosis group and the necrobiotic cases group, yet dermoscopy could be a useful aid in differentiating them even after treatment.

Broad band UVA: a possible reliable alternative to PUVA in the treatment of early-stage mycosis fungoides.

UVA1 phototherapy was found to induce marked improvement in skin lesions of patients with stages IA and IB mycosis fungoides (MF). Broad band UVA (BB-UVA) is composed of 80.1% UVA1, with similar mechanisms of action. Our aim was to evaluate the efficacy of BB-UVA in the treatment of early-stage MF. Thirty patients with early stage MF were included. They were divided into two equal groups receiving either BB-UVA at 20 J/cm2/ session or PUVA three times/week for 40 sessions. Clinical and histopathological evaluations were performed before and after therapy in addition to immunohistochemical measurement of CD4+ cells and Bcl-2. Patients were followed up for an average duration of 36 months. Comparable clinical and histopathological improvement was noted in MF patients in both groups. Clinical improvement graded 'Excellent' was achieved in 33% of patients in the BB-UVA versus 13.3% in the psoralen and UVA (PUVA) group. Long-term follow-up indicated superiority of BB-UVA over PUVA. BB-UVA group showed a more rapid clearance rate, shorter time to achieve complete clearance, a longer disease-free interval and lower relapse rate. The use of BB-UVA in the treatment of early-stage MF is comparable or even superior to PUVA regarding efficacy and remission periods.

Subcision versus 100% trichloroacetic acid in the treatment of rolling acne scars.

BACKGROUND: Acne scarring is common but surprisingly difficult to treat. Newer techniques and modifications to older ones may make this refractory problem more manageable. The 100% trichloroacetic acid (TCA) chemical reconstruction of skin scars (CROSS) method is a safe and effective single modality for the treatment of atrophic acne scars, whereas subcision appears to be a safe technique that provides significant improvement for rolling acne scars. OBJECTIVE: To compare the effect of the 100% TCA CROSS method with subcision in treating rolling acne scars. METHODS: Twenty patients of skin types III and IV with bilateral rolling acne scars received one to three sessions of the 100% TCA CROSS technique for scars on the left side of the face and subcision for scars on the right side. RESULTS: The mean decrease in size and depth of scars was significantly greater for the subcision side than the 100% TCA CROSS (p<.001). More side effects in the form of pigmentary alteration were observed with the 100% TCA CROSS method. CONCLUSION: For rolling acne scars in patients with Fitzpatrick skin types III and IV, subcision shows better results with fewer side effects than the 100% TCA CROSS technique, although further decrease in scar depth with time occurs more significantly after 100% TCA CROSS.

Ultrasound biomicroscopy in the diagnosis of skin diseases.

Ultrasound scanning is becoming an important diagnostic tool in dermatology. The major advantages of this technique are its non invasive non-ionizing nature and its relatively low cost. We aimed to evaluate the accuracy of ultrasound biomicroscopy (UBM) in the diagnosis of eight skin disorders namely, morphea, keloid, lichen planus, chronic eczema, psoriasis, port wine stain, seborrheic keratosis, and photo-aged skin, through correlation of its findings with clinical and pathological assessment. Fifty seven patients with the above diseases were examined by ultrasound biomicroscopy (UBM). Two areas, one of normal skin and the other from lesional skin, were examined for each patient. Skin biopsies were taken from the same lesion examined by UBM. In morphea, the dermal echogenicity was increased and the thickness of morphea plaques correlated significantly with disease severity. Keloids appeared as low echogenic images. In lichen planus and chronic eczema the dermis appeared as sound shadow. In psoriasis, an intermediate zone between the epidermis and dermis (B zone) was detected. Its thickness correlated significantly with the PASI score. Port wine stain lesions appeared hypoechoic. Seborrheic keratosis appeared as a sound shadow. In photo-aged skin a subepidermal low echogenic band (SLEB) was detected. We conclude that UBM is a non-invasive diagnostic tool in dermatology which can be used to give valuable information about disease progress and the effectiveness of therapy.

Combined trichloroacetic acid peel and topical ascorbic acid versus trichloroacetic acid peel alone in the treatment of melasma: a comparative study.

BACKGROUND: Melasma is a common acquired hypermelanosis that is difficult to treat. Several chemical peeling agents were used in treatment of melasma. Topical vitamin C was also used with minimal side effects. AIM: To compare the effect of 20% trichloroacetic acid (TCA) peel alone vs. 20% TCA peel combined with topical 5% ascorbic acid in cases of epidermal melasma. PATIENTS AND METHODS: Thirty women with bilateral epidermal melasma (Fitzpatrick skin types III and IV) were divided into two groups (A and B, 15 patients each). Before therapy, digital photography and a melasma area and severity index (MASI) score were done for each patient. Groups A and B were primed for 2 weeks before TCA peel. Group B also applied 5% ascorbic acid topically once daily; 20% TCA peel was done for all patients weekly until clearance of melasma or for a maximum of six peels. Group B continued to use 5% ascorbic acid topically in between peels and during the 16-week follow-up period. Patients were assessed at the end of peeling sessions and at the end of follow-up by photography, MASI score, and a global evaluation by the patient. RESULTS: Group B compared with group A showed a significant decrease in MASI score at the end of TCA peels (P < 0.001) and at the end of the 16-week follow-up period (P < 0.003). Global evaluation showed that 13 patients (87%) in group B improved or maintained their improvement compared with only 10 patients (67%) in group A. CONCLUSION: Topical ascorbic acid combined with 20% TCA peel in melasma improves the results and helps in maintaining the response to therapy.

Serum levels of tissue inhibitors of metalloproteinase 2 in patients with systemic sclerosis with duration more than 2 years: correlation with cardiac and pulmonary abnormalities.

In this study, we measured the serum concentration of TIMP-2 in patients with systemic sclerosis (SSc) and explored its possible correlation with cardiac and pulmonary lesions. We studied 42 patients with SSc, with duration equal to or more than 2 years. CT chest, ECG, echocardiography, and serum TIMP-2 concentration measurement using ELISA technique were performed in all patients and in 25 normal controls. The mean serum levels of TIMP-2 in patients was higher than in controls (P = .005). The mean CT score of dSSc patients with elevated TIMP-2 levels was significantly higher than dSSc patients with normal levels (P = .013). Four patients out of five with elevated TIMP-2 levels showed diastolic dysfunction (80%), compared to 2 out of 15 lSSc patients with normal levels (13.3%), with P = .014. Our research, though involving a small group of patients, points to the probable role of TIMP-2 in the development of pulmonary lesions in dSSc patients and cardiac lesions in lSSc patients with duration equal to or more than 2 years.