Assessment of prostaglandin F2-alpha (PGF2α) in lesional and nonlesional skin of vitiligo patients.

BACKGROUND: F2-isoprostane is one of the members of biologically active prostaglandins. It is considered a reliable marker of oxidative stress. This study aimed at investigating and studying the hypothesis of the possible role of prostaglandin F2-alpha (PGF2α) in the pathogenesis of vitiligo and to know if there is a possibility of using it in therapy. METHODS: This case-control study involved 30 patients with nonsegmental vitiligo and 30 healthy sex- and age-matched controls over a period of 7 months. Skin biopsies were taken from lesional and nonlesional vitiliginous skin of patients and from normal skin of controls for measurement of PGF2α in tissue by ELISA. RESULTS: The tissue levels of PGF2α in vitiligo patients were significantly higher in both lesional and nonlesional skin than in healthy controls (P < 0.001). The tissue levels of PGF2α in lesional skin were significantly higher than in nonlesional skin (P < 0.001). CONCLUSION: Based on the fact that PGF2α is a reliable biomarker of oxidative stress, in addition to our results that revealed higher tissue levels of PGF2α in vitiliginous skin than in healthy skin, we can conclude that PGF2α may be incriminated in the pathogenesis of vitiligo. This finding could help in the treatment of this disease by using anti-PGF2α drugs.

Crystalglobulinemia: A Rare Presenting Manifestation of Multiple Myeloma.

ABSTRACT: Crystalglobulinemia (CG) is a rare disorder characterized by crystallization of monoclonal immunoglobulins in the microcirculation leading to multiorgan vascular thrombosis and ischemic injury. The main cause of CG is multiple myeloma. We report a case of a 52-year-old man who presented with widespread necrotizing plaques and ulcerations. A skin biopsy revealed eosinophilic rectangular-shaped crystals occluding the lumina of blood vessels with no associated features of vasculitis. The crystals were Periodic acid-Schiff stain positive. The findings were diagnostic of CG. Extensive work up lead to the discovery of multiple myeloma. Awareness of CG is important because it may be the first presenting manifestation of an underlying serious hematological malignancy.

Oxidative stress and the cholinergic system in non-segmental vitiligo: Effect of narrow band ultraviolet b.

BACKGROUND: Despite exhaustive research, melanocyte disappearance and the evolution of vitiligo remain enigmatic, and although multi-factorial, oxidative stress appears as a major player. The role of cutaneous cholinergic system in vitiligo pathogenesis has also been reported in some studies. OBJECTIVE: To evaluate and correlate the influence of phototherapy on cutaneous cholinergic system and oxidative stress in vitiligo. METHODS: Acetyl choline (ACh), its receptors; nicotinic (nAChR) and muscarinic (mAChR); acetylcholine esterase (AChE) and H2 O2 levels were estimated in de-pigmented and re-pigmented lesions of 30 vitiligo patients before and after NB-UVB phototherapy and in 30 controls. ACh and H2 O2 levels were measured by colorimetry. AChE and acetylcholine receptors expression were measured by quantitative real-time PCR. RESULTS: Mean ACh and H2 O2 levels were significantly higher in vitiligo lesions before NB-UVB (P < .001) whereas AChE enzyme level was significantly lower (P < .001) compared to both re-pigmented and control skin. Additionally, mean mAChR was significantly higher and mean nAChR was significantly lower in vitiligo lesions before NB-UVB versus controls and re-pigmented skin (P < .001). Also, H2 O2 and AChE showed negative correlation whereas ACh and mAChR showed significant positive correlation. Although all the studied parameters showed significant changes after treatment and subsequent re-pigmentation, a significant difference continued to exist between all vitiligo skin and controls. CONCLUSION: Cholinergic system is strongly involved in vitiligo pathogenesis through H2 O2 inhibition of AChE which could be reversed by NB-UVB. Moreover, the strong activation of mAChRs may reflect genetic and/or acquired errors, direct up-regulation by ACh and H2 O2 or both.

Cutaneous expression of thymic stromal lymphopoietin (TSLP) in vitiligo patients: a case-control study.

BACKGROUND: Thymic stromal lymphopoietin (TSLP) is a major pro-allergic cytokine promoting T helper-2 responses. Our aim was to study and verify the hypothesis of the role of TSLP in the pathogenesis of vitiligo. METHODS: This case-control study was conducted on 25 patients with generalized non-segmental vitiligo (recruited from the Dermatology outpatient clinic, Kasr El Ainy, Faculty of Medicine, Cairo University) and 25 healthy controls fulfilling the inclusion criteria over a period of 7 months (January 2017-July 2017). Patients underwent complete medical history, detailed assessment of vitiligo, and photographic documentation. Skin biopsies were taken from the back from both patients' vitiliginous skin and from normal skin of controls for which relative TSLP messenger RNA (mRNA) tissue expression levels were measured using quantitative real-time polymerase chain reaction technique. RESULTS: There was a statistically significant difference between the TSLP mRNA expression levels in patients and controls (P < 0.001) with lower levels in the former group. CONCLUSION: This study revealed lower TSLP mRNA expression levels in vitiliginous skin than in normal skin suggesting an imminent role of TSLP in the pathogenesis of vitiligo.

Assessment of gene expression levels of proopiomelanocortin (POMC) and melanocortin-1 receptor (MC1R) in vitiligo.

Proopiomelanocortin (POMC) and melanocortin 1 receptor (MC1R) are regulators of melanogenesis and pigmentation. Our objective was to estimate their levels, searching for a possible role of the melanocortin system in vitiligo. This study included 40 vitiligo patients and 40 controls. Skin biopsies were taken from lesional and non-lesional skin of patients and from the non-sun exposed skin of controls to detect the expression of POMC and MC1R using quantitative real-time polymerase chain reaction. Both factors were significantly lower in lesional than non-lesional skin and controls, while they were significantly higher in non-lesional skin than in controls. There was a statistically significant positive correlation between lesional levels of POMC and MC1R, as well as between non-lesional levels of POMC and MC1R in the patients. On the other hand, we found a statistically significant negative correlation between the lesional and non-lesional levels of POMC, as well as between the lesional and non-lesional levels of MC1R in the patients. As a conclusion, the melanocortin system could play a role in the pathogenesis of vitiligo or could be affected as the end result of the disease.

Effect of narrow band ultraviolet B on survivin in psoriatic skin lesions.

BACKGROUND: Suppression of apoptosis is responsible for epidermal thickness in psoriasis. Survivin is an anti-apoptotic protein that can be modulated by ultraviolet B (UVB). AIM: Our aim was to investigate the role of survivin in psoriasis and to evaluate the effect of narrow band (NB)-UVB on the survivin levels in psoriatic lesions. METHODS: This study included 20 psoriatic patients and 20 healthy controls. Patients were treated with 24 sessions of NB-UVB. Skin biopsies were taken from the affected skin of each patient before and after treatment, and from the controls, to examine survivin levels by ELISA. RESULTS: Survivin was significantly upregulated in psoriasis compared to controls (p<0.001). We found significant positive correlations between survivin levels before therapy and the extent of body involvement (r=0.675, p=0.002), as well as the PASI score (r=0.67, p=0.001). A significant decrease in survivin levels was observed post treatment compared to baseline levels (p<0.001). CONCLUSION: We found increased survivin levels in psoriasis and a significant reduction following NB-UVB induced clinical improvement of psoriasis.

Different therapeutic modalities for treatment of melasma.

BACKGROUND: Chemical peels and topical depigmenting agents have become a popular modality in the treatment of melasma. AIMS: To compare the clinical efficacy of trichloroacetic acid peel 20%vs. Jessner's solution peel vs. the topical mixture of hydroquinone 2% and kojic acid. PATIENTS AND METHODS: Forty five patients with melasma were randomly assigned into three groups of fifteen patients each. Group A received Jessner's solution peel, group B received trichloroacetic acid peel 20%, and group C received topical hydroquinone 2% and kojic acid. All patients were seen in follow-up period after 16 weeks; clinical evaluation using Melasma Area and Severity Index (MASI) score and photography were recorded before and after treatment and after 16 weeks. RESULTS: There was a decrease in MASI score in all three groups after treatment and after follow-up period but after treatment MASI score was statistically significantly lower in group A than group C (P = 0.01), and it was also statistically significantly lower in group B than group C (P < 0.001) but there was no statistically significant difference between groups A and B. After the follow-up period, MASI score was statistically significantly lower in group A than group C (P < 0.001), statistically significantly lower in group B than group C (P < 0.001), and statistically significantly lower in group B than group A (P = 0.035). The statistical analysis was done through one-way anova followed by least significant difference (LSD). CONCLUSION: Trichloroacetic acid 20% showed better results than Jessner's solution as peeling agent and hydroquinone 2% with kojic acid as a topical agent in the treatment of melasma.