Prevalence of Female Sexual Dysfunction Among Psoriatic Females: A Cross Sectional Case Controlled Study.

INTRODUCTION: Sexual relationships are an integral part of females psychological and physiological wellbeing. OBJECTIVES: The study aimed to identify prevalence and impact of Female Sexual Dysfunction (FSD) in women affected with psoriasis. METHODS: This cross-sectional study was carried out on 150 married females who were interviewed to answer Female Sexual Function Index (FSFI) questionnaire and were divided into two groups: the first group included 100 female patients complaining of psoriasis (50 suffering from moderate psoriasis and 50 with severe psoriasis). The disease severity was graded according to the Psoriasis Area and Severity Index (PASI) while the second group included 50 age matched women who served as controls. RESULTS: Female sexual dysfunction (FSD) in psoriasis female groups was higher than that in the control group (47%, 24%, P < 0.05). The mean total scores of FSFI ranged from 12.30 to 34.20 and were significantly lower in the severe PASI affected group (22.34 ± 5.35) when compared to moderate PASI group (26.24 ± 2.67) or control group (28.79 ± 2.22). In addition, total scores were significantly lower among moderate PASI affected females when compared to control group. CONCLUSIONS: Sexual dysfunction should be routinely investigated in female patients with psoriasis in the case of moderate-severe disease due to its negative impact on quality of life. Further research over the effect of certain interventional programs on FSD should be considered for patients suffering from psoriasis.

Assessment of angiotensin converting enzyme gene polymorphism in patients with psoriasis.

Psoriatic patients had diversity of clinical presentations and complications. Psoriasis can have significant interference with the patient's quality of life, recovery, and outcome. Some evidences suggest that the angiotensin converting enzyme (ACE) is present in the skin of psoriatic patients. This study intended to assess the patterns of ACE insertion/deletion (ACE ID) polymorphism and the levels of serum ACE among psoriatic patients in comparison to normal controls. The study included two groups: 20 patients with psoriasis and 20 apparently healthy adults with negative family history of psoriasis as a control group. Psoriasis area and severity index (PASI) was used to measure of severity of psoriasis. In both groups, ACE ID gene polymorphism was assessed by quantitative real-time polymerase reaction and serum ACE levels was evaluated using an enzyme-linked immunosorbent assay. ACE ID genotype was significantly higher among the psoriatic group in comparison to the control group (40.0% versus 15.0%, respectively, p=0.016). D allele was significantly higher among the psoriatic group than the control group (25.0% versus 7.5%, respectively, p=0.034). ACE ID genotype carried significantly higher risk in psoriatic group versus control group (OR=3.8). The D allele carried higher risk in psoriatic group versus control group (OR=4.1). ACE serum levels were significantly higher among the psoriatic group compared to the control group (87.4±7.03 versus 2.3±0.7, respectively; p < 0.001). We concluded that ACE ID gene polymorphism may be considered as a risk factor for developing psoriasis.

Herpes zoster (shingles) complicating the course of COVID19 infection.

Different skin presentations and patterns of cutaneous signs were reported in COVID19 patients. Varicella-zoster virus (VZV) infection is responsible for two very common skin conditions. Varicella (chickenpox) is the initial presentation for infection with VZV and is characterized by a diffuse vesicular rash. It is after this initial attack, that VZV remains latent in the dorsal root ganglia before reactivating to present as herpes zoster (HZ) in middle age groups. Cutaneous skin findings remain to be emerging every day as a marker or a complication of COVID 19. We report a case of HZ complication in a 44 years old COVID 19 positive male.

Combined chemical peels versus trichloroacetic acid (TCA) for treating melasma: a split face study.

Melasma is common skin condition presenting with hyperpigmentation. To evaluate the efficacy, tolerance, and complications of one session of combined chemical peels compared to traditional serial sessions of trichloroacetic acid (TCA) peeling in treating melasma. One session of combined chemical peels was carried out at the left side of the face, while six sessions of TCA 15% peel were carried out at the right side of the face every 10 days. The Modified Melasma Area and Severity Index (MASI) score was calculated at baseline (before starting peeling sessions), after one month (at the fourth TCA peeling session), and after three months (one month after the last TCA peeling session). Both sides of the face showed gradual reduction in modified MASI score throughout sessions. By the end of the study, the TCA-treated side showed slightly lower mean modified MASI score than the combined chemical peels-treated side of the face; however this difference was not statistically significant, (p = .405). A single session of combined chemical peels is as effective as six sessions of TCA peel in treatment of melasma. Combined chemical peels can be used as a convenient, tolerable and time saving safe procedure for treating melasma.

Split-face comparative study of fractional Er:YAG laser versus microneedling radiofrequency in treatment of atrophic acne scars, using optical coherence tomography for assessment.

BACKGROUND: Efficacy and safety of ablative fractional laser used for treatment of acne scars have been described in several studies. Recently, microneedling radiofrequency treatment has been showing promising results with low risk of side effects and rapid healing time. OBJECTIVE: To study efficacy and safety of ablative fractional Er:YAG laser 2940 nm and microneedling radiofrequency for facial atrophic acne scar. METHODS: 21 patients with atrophic postacne scars were randomized to MRF for one half of the face and laser for the other half. Four sessions were performed monthly. For evaluation, the validated scale "Quantitative Global Grading System for Postacne Scarring" and patient's satisfaction were used before and 3 months after treatment. Optical coherence tomography imaging of the skin was used as an objective tool for assessment. RESULTS: Both sides showed significant improvement on clinical evaluation with no significant difference. Optical coherence tomography assessment showed significant increase of both epidermal and dermal thickness compared to baseline. CONCLUSION: Both MRF and ablative fractional Er. YAG laser 2940 nm are effective in the treatment of post acne scars. Microneedling radiofrequency is better tolerated, with lower downtime and fewer side effects.

Implications of narrowband ultraviolet B treatment on psoriasis severity and serum levels of angiopoietin-2: A cross-sectional controlled study.

BACKGROUND: Psoriasis is a chronic inflammatory hyper proliferative skin disease. Angiogenesis play an important role in Psoriasis pathogenesis, occurring even before plaque formation. Angiopoietins play an important role in angiogenesis and hence are described as angiogenic factors. AIMS: To evaluate serum levels of angiopoeitin 2 (Ang-2) following treatment with narrowband ultraviolet B (NBUVB) in patients with moderate-severe plaque psoriasis and correlate it to psoriasis area and severity index (PASI). PATIENTS/METHODS: This cross sectional study included 38 patients complaining of moderate to severe plaque psoriasis and 38 healthy controls. Psoriasis area and severity index (PASI) was determined and was correlated to serum levels of Ang-2 before and after treatment with NBUVB. RESULTS: PASI scores and serum values of angiopoietin 2 demonstrated a significant difference between the baseline and at the end of the 12 weeks NBUVB treatment. A statistically significant positive correlation was established between psoriasis severity and Ang-2 serum levels before and after treatment. CONCLUSION: The study demonstrated a potential contribution of Ang-2 in the pathogenesis of psoriasis, as well as its usefulness as a biomarker of psoriasis severity.

Laser-assisted topical steroid application versus steroid injection for treating keloids: A split side study.

BACKGROUND: Approaches to improve keloid scars include intralesional corticosteroid injections and fractional lasers exclusively. The combinative use of ablative fractional laser therapy and occluded topical corticosteroid as a drug delivery method enhances therapeutic outcome of two efficient scar therapy modules into one simple synergistic module. AIM: To compare the therapeutic effect of combining two modalities of scar treatment, the first is fractional ablative laser treatment and the other is occluded topical corticosteroid to the standard use of intralesional steroid injection. METHODS: Keloids from thirty suffering patients were split faced into two identical parts; one part received an intralesional corticosteroid injection while the other part was treated first with fractional ablative 2940 nm Er: YAG laser followed by occluded topical application of steroid cream. Four treatment sessions were performed with 4-week interval between sessions. Every session was assessed photographically and using the Vancouver Scar Scale (VSS). RESULTS: The mean keloid VSS before treatment was 6.9 ± 1.9. After treatment, the mean keloid VSS of the injection side became 2.63 ± 2.09, and mean keloid VSS of the laser-treated side became 2.07 ± 2.02. Each of the treated halves showed a statistically significant improvement in their VSS. However, no statistically significant differences were observed for either of the treated halves over the other one. CONCLUSION: Although intralesional steroids injection is the standard procedure for treatment of keloid scars, the use of ablative fractional laser-assisted delivery of topical steroid can offer a safer and a better aesthetic treatment option.

Optical Coherence Tomography-Assisted Evaluation of Fractional Er:YAG Laser Versus Fractional Microneedling Radiofrequency in Treating Striae Alba.

BACKGROUND AND OBJECTIVES: Striae distensae (SD) is a challenging skin condition. Striae alba (SA) represents the chronic late atrophic stage of SD. Fractional laser technology is among the modalities used for treating SD. Lately, fractional microneedling radiofrequency (FMR) is gaining increased popularity in treating SD. The aim of our study was to assess and compare the efficacy of FMR and fractional Er:YAG laser in the treatment of SA. STUDY DESIGN/MATERIALS AND METHODS: Twenty female patients were enrolled in the study fulfilling all inclusion and exclusion criteria. On a randomly selected half side of the body, the patients were treated with 2940 nm fractional Er:YAG laser while the other half side was treated with the FMR. RESULTS: Both modalities showed a significant reduction in the width of the widest striae (P < 0.005); however, there was no significant difference between them. Using optical coherence tomography, all patients demonstrated a mean significant increase in epidermal thickness; however, the FMR-treated sites showed significantly better results when compared with the ER:YAG-treated sides (P = 0.029). Scar improvements in both modalities did not correlate to skin type, duration, or site of the striae. CONCLUSION: Er:YAG and FMR represent two safe, effective, tolerable modalities for treating SA and are associated with minimal side effects. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Therapeutic implications and role of serum sphingolipids on psoriasis severity after narrow band ultraviolet B treatment: A cross sectional controlled study.

Sphingolipids (SLs), are structural components of the skin that contribute to the regulation of the proliferation and differentiation of keratinocytes as well as regulation of the skin epidermal barrier. A prospective cross sectional comparative controlled study was designed to evaluate the serum level of sphingosine 1 phosphate (S1P) and ceramide (CER) before and after narrow band ultraviolet B (NBUVB) in psoriatic patients. The study included 32 patients presented with psoriasis and 32 healthy age and sex matched control volunteers. (S1P and CER) levels were measured before and after NBUVB sessions for psoriatic patients and their levels were correlated to psoriasis area and severity index (PASI) improvements. PASI scores and serum values of the studied sphingolipids demonstrated a significant difference between the baseline and at the end of the 12 weeks NBUVB treatment. A statistically significant positive correlation was established between psoriasis severity and S1P serum levels before and after treatment while no correlation was observed between psoriasis severity and CER serum levels. Decreased total CER and increased S1P serum levels reflect altered sphingolipid metabolism in psoriasis and can be predictors of disease severity.

Insights into laser safety considerations during COVID 19 pandemic.

The World Health Organization has recently defined the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections as a pandemic. The infection, which may cause a potentially very severe respiratory disease, now called coronavirus disease 2019 (COVID-19), has airborne transmission via droplets while less attention focused on aerosol transmission. Surgical smoke and plumes in laser clinics represent a source for aerosol particles. The aim of this article is to provide the authors' opinion for the correct use of "laser devices" in the COVID-19 emergency and to reduce potential risks of laser airborne contaminants.

Measurement of serum glutathione peroxidase, catalase and superoxide dismutase concentration in patients with external anogenital warts before and after treatment with intralesional tuberculin purified protein derivative.

External anogenital warts are considered the commonest viral sexually transmitted infection that has serious negative psychological effects on both males and females such as anxiety and marked stress. Aim of this work is to measure serum glutathione peroxidase (GSH-Px), catalase and superoxide dismutase enzyme level in patients with external anogenital warts before and after intralesional tuberculin purified protein derivative (PPD) injection. This study carried out 59 patients with anogenital warts recruited from the dermatology clinic and the andrology clinic, Suez Canal University hospital. Each patient was injected with 10 units (0.2 ml) of PPD intralesionally in the mother or largest wart with 2 weeks interval till complete resolution or maximum of six injections. Serum GSH-Px, catalase and superoxide dismutase were measured using ELISA before and after injection. Results of PPD injection showed that 69.5% of patients were responders while 30.5% were nonresponders. The mean level of serum GSH-Px, catalase and superoxide dismutase dropped significantly after injection with levels pre- and post-injection, 91.1 ng/ml versus 52.6 ng/ml, 88.5 ng/ml versus 67.4 ng/ml and 28.6 ng/ml versus 21.8 ng/ml respectively. Antioxidant enzyme levels decrease significantly after PPD injection. Serum GSH-Px and catalase were significantly related to PPD response.

Herpes zoster might be an indicator for latent COVID 19 infection.

Various cutaneous manifestations have been observed in patients with COVID-19 infection. Herpes zoster is a viral skin disease caused by varicella zoster that remains dormant in the dorsal root ganglia of cutaneous nerves following a primary chicken pox infection. In this report, we describe two cases COVID infection who first presented with herpes zoster. We are here by suggesting that the clinical presentation of HZ at the time of the current pandemic even in patients giving mild or no suggestive history of upper respiratory symptoms should be considered as an alarming sign for a recent subclinical SARS CoV2 infection.

Herpes zoster may be a marker for COVID-19 infection during pregnancy.

Varicella-zoster virus infection causes 2 distinct forms of disease: varicella (commonly known as chickenpox) and herpes zoster (HZ)(commonly known as shingles). Primary varicella-zoster virus infection results in the diffuse vesicular rash that is characteristic of chickenpox. Following primary infection, varicella-zoster virus remains dormant in the dorsal root ganglia. This latent phase usually lasts for several decades before reactivation occurs. Varicella-zoster virus reactivation normally presents as HZ in middle-aged adults. A number of cutaneous skin manifestations have appeared in relation to the newly diagnosed coronavirus disease 2019 (COVID-19) pandemic and continue to emerge every day. We report a case of HZ complication in a COVID-19-positive woman who was 27 weeks pregnant.

Skin colonization by superantigen-producing Staphylococcus aureus in Egyptian patients with atopic dermatitis and its relation to disease severity and serum interleukin-4 level.

OBJECTIVE: The objective of the current study was to detect Staphylococcus aureus colonization and the presence of superantigen in atopic dermatitis (AD) in Egyptian patients, and to determine its effect on disease severity and serum interleukin (IL)-4 levels. METHODS: Swabs were taken from the skin of 30 patients with AD. S. aureus isolates were screened for the presence of genes of exotoxins with superantigen properties by multiplex PCR. Serum IL-4 was determined by ELISA. The rate of S. aureus colonization and the presence of superantigen were correlated with disease severity and IL-4 level. RESULTS: Twenty-six of 30 patients (87%) were colonized by S. aureus, and 14 of the 26 (54%) patients were colonized with toxigenic strains. The most frequent superantigen gene present in S. aureus isolates was that coding for staphylococcal enterotoxin B (SEB), followed by both staphylococcal enterotoxin C (SEC) and toxic shock syndrome toxin-1 (TSST-1) genes. The mean 'severity scoring in AD' (SCORAD) score of AD patients colonized with S. aureus harboring superantigen genes (74 ± 8) was significantly higher than that in those colonized with S. aureus isolates without superantigen genes (56 ± 6) (p<0.001). Serum IL-4 levels followed the same pattern. CONCLUSIONS: S. aureus may play an important role as an aggravating factor in AD patients. Reducing the colonization of atopic skin by S. aureus is therefore the best way to reduce superantigen-induced allergic skin inflammation.