Pulse azathioprine and low-dose methotrexate vs. standard-dose methotrexate in treatment of patients with moderate-to-severe psoriasis: a randomized controlled trial.

BACKGROUND: Psoriasis is a common chronic, immune-mediated inflammatory skin disease. Despite the availability of several systemic therapeutic agents, treatment of psoriasis remains a challenge because of the associated adverse effects and/or the financial burden of these medications, given the chronicity of the disease. OBJECTIVES: We aimed to compare the efficacy and safety of combined pulse azathioprine (AZA) and low-dose methotrexate (MTX) vs. a conventional dose of MTX in patients with chronic plaque psoriasis. METHODS: In this randomized controlled trial, 67 patients with moderate-to-severe plaque psoriasis were randomized into two groups, receiving either combined pulse AZA (300 mg weekly dose) and low-dose MTX (10 mg weekly) or conventional-dose MTX (0.3 mg kg-1 per week) for 16 weeks. Patients were assessed for treatment response using the Psoriasis Area and Severity Index (PASI) score and for the development of any adverse effects at weeks 12 and 16, and for a further 3 months after stopping treatment. RESULTS: A statistically significantly higher proportion of the patients receiving combined pulse AZA and low-dose MTX achieved ≥ 90% improvement in PASI and 100% improvement (PASI 100) at week 12, and PASI 100 at week 16, compared with those receiving the conventional dose of MTX as monotherapy. No serious adverse events were reported during the entire study period in the two groups. CONCLUSIONS: Combination therapy using pulse AZA and low-dose MTX can be an efficacious treatment for moderate-to-severe plaque psoriasis, with a relatively good safety profile.

Acral Speckled Hypomelanosis: A Case Report and a Review of Literature.

BACKGROUND: Acral speckled hypomelanosis is a very rare pigmentation disorder that appears early in life with hypopigmented macules on background of normal skin, occurring on the acral parts. CASE REPORT: We report a 9-year-old female patient with a 3-year duration of progressive, hypopigmented, confetti-like macules occurring symmetrically on the dorsum of both hands and feet. Biopsy showed normal number of melanocytes with no evidence of macromelanosomes using special stains for melanocytes. CONCLUSION: Acral speckled hypomelanosis is a relatively, recently, discovered entity, with only 9 cases reported to date, and our case is the 10th. The exact etiopathogenesis is not yet known.

Extensive cutaneous leukocytoclastic vasculitis after Sinopharm vaccine: Case report and review of the literature.

Cutaneous leukocytoclastic vasculitis (LCV) has been reported as a rare form of cutaneous reaction to different SARS-Cov-2 vaccines. Herein, we present the first case of cutaneous LCV following BBIBP-CorV (Sinopharm) vaccine that occurred in a female patient with no prior comorbidities. A literature review about similar cases following different COVID-19 vaccines is discussed.

Support for increased cardiovascular risk in non-segmental vitiligo among Egyptians: A hospital-based, case-control study.

BACKGROUND: Data have been accumulating in the past few years that identify vitiligo as a disorder with systemic implications. RESULTS AND METHODS: In this hospital-based, cross-sectional, case-control study, 50 patients with non-segmental vitiligo and 50 age- and sex-matched controls underwent analysis of serum lipid profile, oxidative stress biomarkers and carotid duplex. Hydrogen peroxide (H2 O2 ) and malondialdehyde (MDA) were significantly higher in patients than controls (p-value < .001, <.001, respectively); on the other hand, total antioxidant capacity (TAC) was significantly lower in patients than controls (p-value = .001). A significantly higher percentage of patients had hypercholesterolemia and borderline high, high or very high levels of LDL-C, compared to controls (p-value = .001 and .001, respectively). Atherosclerotic plaques and increased common carotid intima media thickness were significantly detected in patients versus controls. DISCUSSION: Results of the present study suggest that a subset of patients with vitiligo are at a higher risk of developing dyslipidemia and atherosclerosis, which might increase their future risk for the development of cardiovascular disease. Confirmation of these findings would subsequently influence investigative and the treatment strategies in the management plan of vitiligo patients in the near future. SIGNIFICANCE: Vitiligo patients might be at a higher risk of developing dyslipidemia and atherosclerosis, which might increase their risk for the development of cardiovascular disease necessitating prophylactic measures to improve prognosis. Our results might influence the investigative and treatment strategies in the management plan of vitiligo patients in the near future.

Clinical and epidemiologic features of psoriasis patients in an Egyptian medical center.

BACKGROUND: Identification of epidemiologic and phenotypic variations of psoriasis among different ethnic groups can further our understanding of this perplexing disease, aiming at better management of patients worldwide. OBJECTIVE: To provide a descriptive analysis of psoriasis patients registered at Kasr Al-Ainy Psoriasis Unit Disease Registry. METHODS: This retrospective single-center registry study included patient records between November 2015 and November 2018 (2534 patients). Sociodemographic and phenotypic data were analyzed. RESULTS: The mean age of the registered patients was 39.3 years and 56.3% were men. Stress was the main precipitating factor (48.3%), whereas the most common symptom reported was itching (82.4%). The median body mass index was 27.5, and the median percentage of body surface area involved was 10.0. The mean Psoriasis Area Severity Index score was 8.7, and the mean Psoriasis Disability Index score was 13.0. Both parameters correlated positively, and both showed significantly higher means in smokers. LIMITATIONS: Despite that the study was performed at a highly specialized tertiary care center with a high flow of patients, this was still a single-center registry. CONCLUSIONS: This work shows that the characteristics of Egyptian patients with psoriasis are comparable to those of other studied ethnic groups, with minor differences.