Pulse azathioprine (AZA) and low dose methotrexate (MTX) versus standard dose MTX 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. AIM: We aimed to compare the efficacy and safety of combined pulse azathioprine (AZA) and low dose methotrexate versus conventional dose of methotrexate (MTX) in patients with chronic plaque psoriasis. METHODS: In this randomized controlled trial, 67 patients with moderate to severe plaque psoriasis were randomized into 2 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/week) for 16 weeks. Patients were assessed for treatment response using PASI score and for the development of any adverse effects at weeks 12 and 16 and for a further 3 months after stoppage of treatment. RESULTS: A statistically significant higher proportion of the patients receiving combined pulse AZA and low dose MTX achieved PASI 90 and PASI 100 at week 12 and PASI 100 at week 16, compared to those receiving conventional dose of MTX monotherapy. No serious adverse events were reported during the entire study period in the two groups. CONCLUSION: 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.

Trichoscopic Diagnosis of Structural Hair Defects in a Clinical Setting: A Cross-Sectional Analytical Study.

BACKGROUND: Trichoscopy is a simple, noninvasive procedure practiced in the diagnosis of a multitude of scalp and hair disorders. Hair shaft abnormalities usually represent a diagnostic challenge to dermatologists. OBJECTIVES: The aim of the study was to determine the practicality, versatility, and value of using the handheld dermoscope in the assessment of hair shaft abnormalities and the diagnosis of different hair/scalp disorders. METHODS: Eight hundred and seven patients of both sexes, aged from 1 to 76 years, with complaints pertaining to scalp and hair, were the subjects of the study. All patients were examined by the handheld dermoscope, and 400 were additionally examined by the folliscope, digital dermoscope, or their hairs mounted for light microscopy. RESULTS: Based on trichoscopic findings, more than half the patients demonstrated thinned terminal hairs and a predominance of single-haired scalp pilosebaceous units (57% and 55.5%, respectively). Over a quarter of the patients showed hair diameter heterogeneity, upright regrowing hairs, and increased vellus hairs (37%, 31%, and 25%, respectively). Other trichoscopic findings included scalp scaling (19%), hair weathering (12%), thinned wavy hairs (10.5%), brush-like hair fractures (9%), exclamation mark hairs (9%), and longitudinal cleavage (trichoptilosis) (8%). The clinical diagnostic spectrum was topped by the following diagnoses in order of frequency: female pattern hair loss, telogen effluvium, traction alopecia, and trichotillomania. Trichodynia appeared to be significantly associated with numerous hair shaft abnormalities. CONCLUSION: Most hair shaft abnormalities can be reliably diagnosed with high accuracy using a handheld dermoscope in an office setting. Skillful knowledge of dermoscopy is an important aid in the diagnosis of hair and scalp disorders.

Efficacy and safety of combined fractional ablative CO2 laser and 5 fluorouracil in the treatment of acral vitiligo: An open, uncontrolled study.

BACKGROUND: Acral lesions of vitiligo are most likely recalcitrant to the known lines of treatment. Ablative fractional CO2 has shown efficacy in treatment of vitiligo in combination with other modalities. METHODS: Thirty non-segmental vitiligo patients with acral lesion were included in the study. Each patient was subjected to fractional Carbon Dioxide Laser Treatment followed by application of 5 fluorouracil (5FU) cream for five consecutive days. Evaluation was done 3 weeks from the start of treatment and 12 weeks after the last treatment session using VESTA score, evaluation of patients' photos by blinded investigation in addition to patients' satisfaction scores. RESULTS: Patients showed significant improvement of Vitiligo extent score for a target area (VESTA) score and developed considerable degree of repigmentation as assessed by blinded investigators. CONCLUSION: The combination of fractional ablative CO2 and 5FU is an effective and safe procedure for the treatment of acral vitiligo with promising results offering patients a new therapeutic window.

Trichoscopic features of hair and scalp in noncomplaining individuals: A descriptive study.

BACKGROUND: Trichoscopy is a simple noninvasive tool that is used in calculating different hair parameters and the diagnosis of different hair/scalp diseases at variable magnifications. OBJECTIVE: The aim of this work is to describe the features and parameters of hair and scalp in a healthy sample of Egyptian population using videodermoscopy. This may help to provide standard range of measurements of normal hair in both males and females. METHODS: A nonrandomized, observational study for features and parameters of hair structure, performed on 368 healthy Egyptian subjects with no hair/scalp complaint. RESULTS: Each scalp area has its own vascular pattern. Male subjects showed different values regarding their hair parameters from the female subjects. No significant difference was seen after application of hair dye, except for few values. In both genders, there was a change in hair parameters with age. Smoking had a negative influence on hair parameters. CONCLUSION: Hair features and parameters observed in our population are different from those reported by other populations. Smoking affects hair thickness and density. Dyed hair has greater thickness mostly due to the protective effect of hair conditioners.

The efficacy of intradermal injections of botulinum toxin in the management of enlarged facial pores and seborrhea: a split face-controlled study.

BACKGROUND: Enlarged facial pores are becoming a matter of cosmetic concern. Injections of (botulinum toxin type A) have an increasing popularity among cosmetic procedures. OBJECTIVE: To determine the efficacy and safety of intradermal injection of botulinum toxin in treatment of excess sebum secretion and enlarged facial pores. MATERIALS AND METHODS: This split face-controlled pilot study was conducted on 20 patients with enlarged facial pores and seborrhea. One cheek was treated by intradermal injection of botulinum toxin, and the other was injected by saline. Patient assessment was performed after 1 and then after 4 months. RESULTS: At 1-month assessment, both sides showed significant reduction in their sebum and pore scores (p = .001), with significantly more improvement on the botulinum toxin-treated side. Dermoscopy documented a significant decrease in the average size of facial pores (p < .001), and the OCT demonstrated a significant increase in the dermal thickness (p < .001) with non-significant deference between both sides. Four months after treatment, the botulinum toxin-treated side maintained its improvement in both scores. CONCLUSION: Intradermal injection of botulinum toxin is an effective and safe procedure for the management of excess sebum and facial pores with acceptable results lasting for an average of 4 months.

Trichoscopy as an evaluation method for alopecia areata treatment: A comparative study.

BACKGROUND: Trichoscopy is a useful tool for diagnosis and follow-up of alopecia areata (AA) patients. Both platelet-rich plasma (PRP) and intralesional corticosteroids (ILCs) are important treatment modalities of patchy AA. AIM: Trichoscopic diagnosis of AA and monitoring the treatment response to PRP versus ILCs in patchy AA treatment. PATIENTS/METHODS: This comparative study included 31 patients with patchy AA, divided into two groups: (group A) received ILCs while (group B) received PRP once monthly for 3 months. Evaluation was done by Severity of Alopecia Tool (SALT) score, Alopecia Areata Symptom Impact Scale (AASIS), photography, and dermoscopy. RESULTS: There was a significant improvement in trichoscopic findings in both groups with regard to the number of follicular units per opening, black dots, broken hairs, and dystrophic changes. Final SALT score showed significant lower levels in both groups compared to baseline levels (P = .025 & P = .008). Final AASIS showed significant decrease in group B (P = .006) not in group A (P = .062). CONCLUSION: Trichoscopy can help in the diagnosis, evaluation of the efficacy and safety of both modalities and might give a clue for treatment response. Both ILCs and PRP were effective in patchy AA treatment.

Q-Switched Nd:YAG (532 nm) Laser Versus Intra-Dermal Tranexamic Acid for Treatment of Facial Ephelides: A Split Face, Randomized, Comparative Trial.

BACKGROUND AND OBJECTIVES: To compare the efficacy and safety of intradermal injection of tranexamic acid (TXA) versus Q switched (QS) KTP (532 nm) in the treatment of facial ephelides. STUDY DESIGN/MATERIALS AND METHODS: A randomized comparative split-face study included a total of 30 female patients with bilateral facial ephelides. One cheek was treated by intra-dermal TXA injections and the other was treated by QS-KTP (532 nm). Patient assessment was performed by photography, pigmentation area, severity index and spectrophotometry at baseline, 1 week after treatment, and 2 months after treatment. RESULTS: A significant difference was found between both sides regarding the percentage change of pigmentation area, severity score (PSI) and melanin index (MI) after treatment and during follow up, favoring laser (P = 0.001). PSI decreased after treatment by 66.5% and 15.4% (laser and TXA sides respectively), further decrease after follow-up was 69.4% with laser and 26.1% with TXA. MI improved by 3.7% after KTP laser to 7.7% after follow-up and by 2.4% after TXA injections to 6.5% after follow-up. Four patients developed post-inflammatory hyperpigmentation following QS-KTP. CONCLUSION: QS-KTP laser is superior to intradermal TXA injection in the treatment of facial ephelides. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Analysis of symmetricity in the three different (sagittal, transverse and frontal) planes in generalized nonsegmental vitiligo.

BACKGROUND: Nonsegmental vitiligo is defined as being "often symmetrical", however, no work has tackled the point as to how valid it is to depend upon the concept of symmetricity in generalized nonsegmental vitiligo. AIMS: To investigate vitiligo symmetry, taking into account sites of predilection, the clinical characteristics of patients were studied. METHODS: This multicentric study included 712 nonsegmental vitiligo patients with 2876 examined lesions. Three models were drawn for each patient. Sagittal, transverse and frontal planes were drawn to divide the body into right/left, upper/lower and anterior/posterior halves respectively. Patients were examined by Wood's light and analyzed for symmetry. RESULTS: Bilateral involvement was present in 78% (P < 0.001). Studying the similarity of clinical involvement in the upper and lower body parts revealed that such similarity was present in 38%, with a significant positive association in some areas. Studying clinical similarity in the anteroposterior distribution pattern revealed a significant positive association in 11%. LIMITATIONS: Relatively low number of patients. CONCLUSIONS: We found significant bilateral symmetry in the lesions of 78% of vitiligo patients. Our work could aid in drawing the anticipated vitiligo map in patients with active disease, helping in increasing our understanding of the clinical behaviour of this disease.

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.

JAK1 rs310241 and JAK3 rs3008 Genotypes May Increase Susceptibility to Psoriasis: A Case Control Study.

BACKGROUND: Janus kinases (JAKs) are a family of non-receptor protein tyrosine kinases that are expressed in a variety of tissues. Several JAK-controlled cytokine receptor pathways are incriminated in the initiation and progression of psoriasis. Genetic polymorphisms influencing JAK expression would be anticipated to have a great impact on disease activity. OBJECTIVE: The aim of the study was to evaluate the association between JAK1 rs310241 and JAK3 rs3008 polymorphisms and the risk of developing psoriasis. METHODS: Blood samples of 150 patients and 120 controls were screened for nucleotide polymorphisms in JAK1 rs310241 and JAK3 rs3008 genes by using polymerase chain reaction (PCR)-restriction fragment length polymorphism technique. RESULTS: The GG genotype of the JAK1 rs310241 and JAK3 rs3008 genes was significantly associated with an increase in psoriasis risk (p = 0.000, OR = 7.7, 95% CI = 2.8-21.5; p = 0.003, OR = 3.3, 95% CI = 1.5-6.9, respectively). The G allele of both genes was also associated with psoriasis susceptibility (p = 0.000, OR = 2.0, 95% CI = 1.4-2.8; p = 0.002, OR = 1.7, 95% CI = 1.2-2.4, respectively). CONCLUSION: The results indicate a possible association between JAK1 rs310241 and JAK3 rs3008 gene polymorphisms and susceptibility to psoriasis. These findings validate the importance of these molecules in psoriasis and may enable the identification of the individuals most susceptible to the disease.

Dermoscopy as a useful tool for evaluating melasma and assessing the response to 1064-nm Q-switched Nd:YAG laser.

Melasma is a hard-to-manage disorder with considerable relapsing behavior. Dermoscopy emerged to help in comprehensive evaluation of pigmentary disorders and melasma. The aim of the study was to evaluate the potential role of dermoscopy in assessing melasma and monitoring the efficacy of 1064-nm low-fluence Q-switched neodymium:yttrium-aluminum-garnet (QS Nd:YAG) laser. A total of 31 patients with facial melasma were included. A total of five laser sessions were performed with 2-week intervals. Patients were evaluated at baseline and 2 weeks after the last session (at the 10th week) by using digital photography, modified melasma area and severity index (mMASI), and colorimetry, as well as dermoscopic score for pigment and vascular elements. Adverse effects were reported. Postlaser sessions, mMASI scores as well as the colorimetric melanin and erythema indices had showed significant improvement. The "dermoscopic score of pigmentary and vascular elements" displayed significant change and confirmed the improvement. Side effects were tolerable. mMASI, colorimetry, and dermoscopy had ascertained the efficacy of low-fluence 1064-nm QS Nd:YAG laser in melasma; however, dermoscopy is superior to other assessments as it can help in the diagnosis of melasma besides the follow-up assessment and can precisely detect the detailed changes in response to treatment.

Clinical and Histological Assessment of Combined Fractional CO2 Laser and Growth Factors Versus Fractional CO2 Laser Alone in the Treatment of Facial Mature Burn Scars: A Pilot Split-Face Study.

BACKGROUND AND OBJECTIVES: To investigate the therapeutic efficacy and safety of growth factors combined with fractional carbon dioxide (CO2 ) laser in comparison with fractional CO2 alone in a sample of patients with facial mature burn scars. STUDY DESIGN/MATERIALS AND METHODS: Fifteen Egyptian patients with bilateral facial burn scars were treated with six sessions of fractional CO2 laser at 6-week intervals. Following each laser session, a topical growth factors cocktail was applied to one side of the face in a split-face manner. Clinical evaluation by Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (PSOS), and photography before and 2 months after the last laser session was done. Three millimeter punch biopsies were obtained from each side of the face pre- and 1-month posttreatment to measure the mean area percent of collagen. RESULTS: Posttreatment, both VSS and PSOS scores decreased on both sides of the face being more significant on the growth factors treated side, showing more scar pliability and shorter downtime (P = 0.001). A significant difference in the mean area percent of collagen was also noted on both sides. CONCLUSION: Adding topical growth factors to fractional CO2 laser treatments is effective and safe with better results as regards scar pliability and shorter downtime than fractional CO2 laser alone. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

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.

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.

Gene expression of osteopontin in alopecia areata? A case-controlled study.

PURPOSE OF THE STUDY: To study the expression of osteopontin (OPN) in alopecia areata (AA) lesions in a trial to clarify its possible role in the pathogenesis of such a disease. PROCEDURES: Tissue level of OPN was measured in 28 AA patients as well as 25 age- and sex-matched healthy controls using both real-time polymerase chain reaction (PCR) and immunohistochemistry. RESULTS: The tissue level of OPN by real-time PCR (4.5-12.8, 8.93 ± 1.9) and immunohistochemical expression of positive OPN mean area percent (7.1-21.2%, 12 ± 5.5%) were significantly higher in patients compared to controls (1-4.6, 2.11 ± 0.93; 3.9-12.02%, 6.8 ± 2.8%, respectively; p < 0.0000). The Severity of Alopecia Tool score showed no significant correlation with the OPN mRNA expression (r = 0.11, p = 0.55). CONCLUSION: High OPN mRNA expression is associated with AA. OPN might play an important role in the pathogenesis of AA.