Different vitiligo characteristics as predictors of increased risk of metabolic syndrome and insulin resistance: A case-control study.

BACKGROUND: Autoimmune and metabolic disturbances have been reported in association with vitiligo, highlighting possible systemic associations that should be considered. AIMS: To assess the possible association of metabolic syndrome (MetS) as well as insulin resistance (IR) with vitiligo in different age groups. METHODS: This case-control study included 142 patients with vitiligo aging ≥ 6 years and 142 age- and sex-matched controls. Participants were assessed for MetS using the International Diabetes Federation (IDF) criteria in addition to IR via homeostasis model assessment of IR (HOMA-IR). The study was registered at Clinical Trials.gov, Identifier: NCT03622320, on August 9, 2018. RESULTS: As per the IDF criteria, patients with vitiligo showed significantly more frequent association with high fasting plasma glucose levels, high blood pressure readings, central obesity, dyslipidemia, and MetS than controls (p = 0.020, p = 0.034, p = 0.014, p < 0.001, and p = 0.002, respectively). Moreover, patients with vitiligo have significantly higher levels of fasting insulin and HOMA-IR (p ≤ 0.001). Results obtained from patients with vitiligo and controls with coexistent MetS/IR demonstrated vitiligo as a risk factor for both MetS and IR. Univariate and multivariate logistic regression highlighted that older age was the significant independent predictor for MetS and IR. CONCLUSION: Patients with vitiligo showed a significantly higher incidence of MetS than controls. Vitiligo per se can be considered a risk factor for MetS and IR. Therefore, regular follow-up and early metabolic derangement diagnoses are mandatory.

Platelet-rich plasma versus carboxytherapy in the treatment of periorbital dark circles: A split-face study.

BACKGROUND: Periorbital hyperpigmentation is a recurrent problem in dermatologic clinics that affect the patients' quality of life and their psychological status. Platelet-rich plasma (PRP) may serve as a source of different growth factors which may reduce the pigmentation in this problem. Carboxytherapy is carbon dioxide infusion into human tissue for therapeutic purposes. OBJECTIVE: To evaluate and compare the clinical efficacy of PRP and carboxytherapy in the treatment of periorbital dark circles (PODC). Histopathological evaluation was also done. PATIENTS AND METHODS: Split-face study of 23 patients with PODC treated with PRP at the right side and carboxytherapy at the left side. Patients received four sessions; one session/week. Final follow-up evaluation was done 3 months after the last session by clinical and histopathological assessment. RESULTS: PRP showed significant better response (p = 0.002), shorter downtime, and tolerable side effects than caboxytherapy. Reduction in area percent of melanin after PRP injections showed 46.6% improvement, while after carboxytherapy, it showed only 14.3% improvement. CONCLUSION: The present study showed that PRP is more effective and tolerable than caboxytherapy in the treatment of PODC.

Are programmed cell death protein-1 and Angiopoietins-2 effective biomarkers for detection the severity of psoriatic patients?

BACKGROUND: Early detection of psoriasis is still an open discussion. Psoriatic lesions are characterized by red/scaly plaques affecting different body-sites. OBJECTIVES: To evaluate the levels of programmed cell death protein-1(PD-1) and Angiopoietins-2(Ang-2) in serum, lesional, and perilesional of psoriatic patients and correlate them with controls and disease severity. SUBJECTS AND METHODS: Serum samples were obtained from 40 participants subdivided equally into psoriatic and healthy controls, 4 mm punch_biopsy equally from lesional and perilesional skin of individuals. PD-1/ANG-2 ELISA kits were used for determining the serum and tissue levels among groups. RESULTS: Serum and tissue levels of PD-1 and Ang-2 were overexpressed in psoriatic patients compared with controls. There was a statistical difference between patients and controls in level of PD-1(serum and tissue) with p-value 0.006 and 0.0001, respectively. There was a statistical difference between both groups for ANG-2(serum and tissue) with p-value 0.03 and 0.0001, respectively. There were positive correlations between PASI score and PD-1 in tissue (r = 0.467, p = 0.038). Also, positive correlation between the level of PD-1 in serum and tissue (r = 0.369, p = 0.019), the serum levels of PD-1 and ANG-2 (r = 0.78, p > 0.0001), PD-1 and Ang-2 in tissue (r = 0.583,p = 0.0001) were detected. CONCLUSION: PD-1 and ANG-2 can be highly recommended to determine the severity of psoriasis.

Possible enigmatic link between serum leptin and vitiligo with its metabolic derangements: A comparative controlled study.

OBJECTIVE: Serum leptin, an adipocytokine of interleukin-6 family, has been linked to vitiligo-associated metabolic derangements. Additionally, it has been proposed as an inflammatory mediator with possible influence on vitiligo pathogenesis. This study aimed at assessing serum leptin in vitiligo patients compared to controls and whether different vitiligo characteristics have an influence on serum leptin levels. METHODS: In this hospital-based, cross-sectional case-control study, 70 vitiligo (35 segmental vitiligo (SV) and 35 Non-segmental vitiligo (NSV)) and 70 age- and sex-matched controls were assessed for different anthropometric measurements including waist circumference (WC), index of central obesity (ICO), and body mass index (BMI) as well as serum leptin levels. RESULTS: Central obesity as per ICO showed no significant difference between patients and controls. Additionally, patients of SV and NSV collectively showed significant higher incidence of +ve serum leptin than their controls (41.4% vs. 22.9%%, P: 0.019). Mere presence of vitiligo and ICO >0.5 were highlighted as independent predictors of +ve serum leptin (P: 0.009 and <0.001, respectively). LIMITATION: Inability to determine a cause/effect relationship based on a cross-sectional study. Larger scale studies are needed to affirm our findings. CONCLUSION: Mere presence of vitiligo being an independent predictor for high serum leptin could be either a contributor to pathogenesis of vitiligo or a sequel to accumulating evidence of metabolic nature of vitiligo. This is likely to influence the investigative panel and treatment protocol for vitiligo patients.

Estimation of Homocysteine Level and Methylenetetrahydrofolate Reductase (MTHFR) Gene and Cystathionine B Synthase (CBS) Gene Polymorphisms in Vitiligo Patients.

BACKGROUND: Vitiligo is an acquired, multifactorial disorder of the skin and mucous membranes. An elevated homocysteine level has been described in vitiligo. Methylenetetrahydrofolate reductase (MTHFR) and cystathionine B synthase (CBS) are major determinants of the homocysteine metabolism. OBJECTIVES: Determine serum homocysteine levels in vitiligo patients as well as the association between MTHFR (C677T, A1298C) and CBSgene polymorphisms and susceptibility to vitiligo in a sample of those populations. METHODS: Homocysteine levels were estimated by radioimmunoassay while MTHFR (C677T, A1298C) and CBSgene polymorphisms were detected by the polymerase chain reaction-restriction fragment length polymorphism technique in 100 vitiligo patients and 80 healthy controls. RESULTS: The homocysteine level was significantly higher in vitiligo patients than controls (p = 0.000). Significant differences in the genotype and allele distributions of single nucleotide polymorphisms of the MTHFR (C677T, A1298C) with the mutant genotypes are more common in the controls than patients (p = 0.001, 0.029, respectively). CBS gene mutant genotypes and alleles are more common in vitiligo patients than controls (p = 0.002). CONCLUSION: CBSand MTHFRgene polymorphisms may play a major role in the genetic susceptibility to vitiligo.

Survivin and insulin-like growth factor-I: potential role in the pathogenesis of acne and post-acne scar.

BACKGROUNDS/OBJECTIVES: Acne is an inflammatory disease of the pilosebaceous unit (PSU). The over-expression of survivin and insulin-like growth factor (IGF)-I in some fibrotic disorders suggests a possible implication in the pathogenesis of acne and or post-acne scar. We aimed to evaluate their potential role in pathogenesis in acne and post-acne scar. METHODS: Serum survivin and IGF-I levels were estimated in 30 patients with acne and post-acne scar compared to 30 controls. RESULTS: There was a statistically significant difference in survivin and IGF-I levels between controls and patients (P < 0.05). However, there was no linear correlation between survivin and IGF-I. CONCLUSIONS: Survivin and IGF-I could have a possible role in the pathogenesis of active acne and in post-inflammatory acne scar.

Do Prolactin and its Receptor Play a Role in Alopecia Areata?

CONTEXT: Studying the link between prolactin and autoimmunity has gained much ground over the past years. Its role played in alopecia areata (AA) is not clear yet, as previous reports yielded controversial results. AIMS: This study aimed to measure the serum level of prolactin and to detect the expression of its receptor in AA, in an attempt to highlight its possible role in the pathogenesis of this disease. SUBJECTS AND METHODS: A case-control study of 30 AA patients and 20 controls from outpatient clinic were undertaken. Every patient was subjected to history taking and clinical examination to determine the severity of alopecia tool (SALT) score. Blood samples were taken from patients and controls to determine the serum prolactin level. Scalp biopsies were obtained from the lesional skin of patients and normal skin of controls for assessment of the prolactin receptor. STATISTICAL ANALYSIS: Depending upon the type of data, t-test, analysis of variance test, Chi-square, receiver operator characteristic curve were undertaken. RESULTS: On comparing the serum prolactin level between patients and controls, no significant difference was found, while the mean tissue level of prolactin receptor was significantly higher in patients than in controls. In patients, a significant positive correlation was found between the prolactin receptor and the SALT score. CONCLUSIONS: Prolactin plays a role in AA, and this role is probably through the prolactin receptors rather than the serum prolactin level.