Expression of B and T lymphocyte attenuator, retinoid-related orphan receptor gamma-isoform-t and interleukin 7 in psoriasis vulgaris.

BACKGROUND/OBJECTIVES: Psoriasis is one of the immune-mediated inflammatory diseases where CD4+ T lymphocytes, mainly Th1 cells, and B lymphocytes contribute in their pathogenesis through a pro-inflammatory effect, production of antibodies, activation of T cells and cytokine synthesis. B and T lymphocyte attenuator (BTLA) is a co-inhibitory molecule expressed on T and B lymphocytes as well as other immune cells, and it is necessary to inhibit homoeostatic expansion and activation of lymph node and skin-resident γδ T cells. BTLA expression is regulated by RORγt and IL-7. The study aimed at adding more insight on the role played by co-inhibitory molecule BTLA in psoriasis vulgaris and its inter-relation with RORγt and IL-7 to establish a basis for novel treatment strategies. METHODS: This case-control study included 25 patients and 25 controls examined for gene expression of BTLA, RORγt and IL-7. RESULTS: B and T lymphocyte attenuator was significantly lower in psoriasis patients, whereas both RORγt and IL-7 were higher in comparison with controls. A significant positive correlation between disease severity (PASI) and both RORγt and IL-7 as well as between RORγt and IL-7 was found. A significant negative correlation between BTLA and both RORγt and IL-7 was found. Neither the age nor the duration of disease had any correlation with BTLA, RORγt or IL-7. BTLA had no correlation with PASI. Regarding the control group, a significant negative correlation between RORγt and IL-7 was found. CONCLUSION: B and T lymphocyte attenuator, RORγt and IL-7 play an important role in psoriasis.

Tretinoin-loaded liposomal formulations: from lab to comparative clinical study in acne patients.

Topical tretinoin is the most commonly used retinoid for acne. However, its irritative potential on the applied area and the barrier properties of the stratum corneum limit its use. The objective of the present study was to formulate tretinoin liposomal gel to obtain a formula with lower skin irritation potential and greater clinical effect. A statistical 2(4) factorial design was adopted. Sixteen formulae prepared and were properly evaluated. A candidate formula (F13G) prepared with 0.025% tretinoin, phospholipid- cholesterol-dicetylphosphate (9:1:0.01) and incorporated in 1% carbopol gel was selected for skin irritation test. Clinical study was conducted on acne patients and compared to marketed product. All liposomes formulations were spherical in shape. The addition of cholesterol in the film hydration method significantly decreased the vesicle size, and increased the percentage of incorporation efficiency at (p < 0.05). The presence of dicetylphosphate significantly increased drug release but did not affect the percentage of incorporation efficiency and vesicle size. The results of the clinical study in acne patients revealed that F13G showed significantly higher efficacy when compared to marketed product (p < 0.05).

Formulation of tretinoin-loaded topical proniosomes for treatment of acne: in-vitro characterization, skin irritation test and comparative clinical study.

Tretinoin (TRT) is a widely used retinoid for the topical treatment of acne, photo-aged skin, psoriasis and skin cancer which makes it a good candidate for topical formulation. Yet side effects, like redness, swelling, peeling, blistering and, erythema, in addition to its high lipophilicity make this challenging. Therefore, the aim of this study was the development of TRT-loaded proniosomes to improve the drug efficacy and to increase user acceptability and compliance by reducing its side effects. Nine formulae were prepared according to 3(2) factorial design and were evaluated for their morphology, vesicle size, entrapment efficiency (EE %), and% of drug released after 5 h. Hydrogel of the candidate formula, N8G (proniosomes prepared with 0.025% TRT, and Span60: cholesterol molar ratio of 3:1 and incorporated in 1% carbopol gel) was developed and evaluated for skin irritation test and clinical study in acne patients compared to marketed product. Candidate formula showed higher efficacy and very low irritation potential when compared to marketed product in human volunteers.

BB-UVA vs. NB-UVB in the treatment of vitiligo: a randomized controlled clinical study (single blinded).

BACKGROUND: Vitiligo is an acquired pigmentary disorder that affects between 1% and 2% of the general population. Phototherapy remains the cornerstone of treatment, with NB-UVB being the most frequently used. BB-UVA can be a plausible alternative for darker population; skin photo type III and IV. PATIENTS AND METHODS: The study was a prospective, randomized, controlled, and single-blinded clinical trial, conducted on 40 patients with bilateral symmetrical vitiligo. The patients were randomly divided into two equal groups; group (A) received a fixed dose of 15 J/cm(2) BB-UVA, while group (B) received NB-UVB. The study was conducted for a period of 16 weeks (48 sessions). RESULTS: The final percentage of clinical improvement was significantly higher (P = 0.047) within the BB-UVA group (63.82% ± 27.42), than within the NB-UVB group (44.32% ± 29.78). CONCLUSION: BB-UVA can be considered as an alternative treatment line for vitiligo.

Sulfasalazine and pentoxifylline in psoriasis: a possible safe alternative.

BACKGROUND: Conventional therapy of extensive psoriasis is effective but has complications. Biologics are safer but expensive. OBJECTIVE: To assess the efficacy of sulfasalazine and pentoxifylline, which have TNF antagonizing and anti-proliferative action in the treatment of psoriasis. METHODS: In this randomized controlled trial, 32 patients with extensive psoriasis were divided into four groups: group A received sulfasalazine; group B received pentoxifylline; group C received both drugs; and group D received methotrexate. The Psoriasis Area and Severity Index (PASI) score was done at weeks 0, 2, 4, 6 and 8. RESULTS: A significant reduction in PASI score occurred in groups C and D (p = 0.043 and 0.018, respectively). A significantly higher percentage of PASI score reduction occurred in group D compared with groups A, B and C (p = 0.006, 0.003 and 0.030, respectively). An excellent response occurred in one patient (14.3%) in group D. A very good response occurred in two patients (22.2%) in group C, and in five patients (71.4%) in group D. A moderate response occurred in three patients (37.5%) in group A, one patient (12.5%) in group B, and one patient (14.3%) in group D. CONCLUSION: Although incomparable to methotrexate, combined sulfasalazine and pentoxifylline produced a good response in cases of extensive psoriasis. Multicentre studies are needed to validate these results.

Microscopic study of normal skin in cases of mycosis fungoides.

BACKGROUND: During therapy of patients with mycosis fungoides (MF) at the Department of Dermatology, Kasr El-Aini Hospital, follow-up biopsies are routinely taken every 2 months. It was noticed that lesions of MF might become clinically normal during treatment, and yet still show microscopical evidence of MF. This finding raised the possibility that clinically normal skin in MF could be microscopically involved. AIM: The aim of our work was to evaluate the degree of histopathological involvement of normal-looking skin in patients with MF. PATIENTS AND METHODS: Thirty patients with stage IB were biopsied from their normal skin. Two biopsies were taken: one proximal (2 cm) and the other distal (> 5 cm) from any visible lesion. Ten normal controls were included in the study. All specimens were stained with H&E and examined microscopically. The microscopical diagnosis was confirmed by immunophenotyping. RESULTS: Epidermotropism was detected in 21 (70%) of the proximal skin biopsies and 14 (47%) of the distal skin biopsies, whereas no biopsy from the control group showed epidermotropism. All the proximal skin biopsies showed dermal infiltrate and 90% of the biopsies from the distal normal skin showed dermal infiltrate (mostly superficial perivascular). CONCLUSION: Normal skin in patients with MF could be affected microscopically and this may raise questions regarding the credibility of the current staging classification of MF, and may necessitate taking biopsies from normal skin before starting topical treatment. During MF treatment, biopsies from cured lesions are required before starting withdrawal.

Role of human papilloma virus (HPV) in common and genital warts and its relation to P53 expression.

BACKGROUND AND AIM: Human papilloma viruses (HPVs) are small DNA tumor viruses that infect epithelial tissues and cause warts. One of the viral genes responsible for HPV's oncogenic activity is E6 which is known to inactivate the cellular p53 tumor suppressor gene. We aim to detect the presence of HPV infection and its different types in human warts, and to identify the relation between HPV and p53 expression in skin and genital lesions. PATIENTS AND METHODS: We studied markers of HPV infection in overall of 30 patients (20 with common warts, and 10 with genital warts). Also, 30 normal skin samples were taken from each patient as a normal control. Detection of HPV was done using polymerase chain reaction (PCR), and HPV typing was performed using LiPA (Line immuno Probe Assay). In addition, all skin lesions were examined by immunohistochemistry for p53 expression. RESULTS: In patients with common warts, HPV DNA was found in 4/20 (20%) of cases which was of HPV types 11, 31, 6, 33 (p=0.28). Also, P53 expression was found in 4/20 (20%) of cases (p=0.26). No single patient showed reactivity of both HPV and p53 expression. In patients with genital warts, however, HPV DNA was found in 6/10 (60%) of cases. Of these, 5 cases were positive for HPV type 6 and one case had HPV type 11. Three patients (30%) were positive for p53, and two of them (66%) were positive for both HPV and p53. In the normal skin control, 2/30 (6.6%) were positive for HPV DNA which were of types 5, and 31. CONCLUSIONS: We conclude that; (1) Prevalence rate of HPV infection in warts is higher than those of normal control group, and Egyptian patients with genital warts had higher prevalence rate of HPV than those with common warts, (2) In Egypt, HPV types 6, and 11 are the most prevalent genotypes associated with genital warts and HPV types 6, 11, 31, and 33 are associated with common warts, (3) There was no definite relation between p53 expression and HPV detection, (4) Also, there was no association between the different HPV types and p53 detection in these non-cancerous lesions.