Ahmad Nofal

Primary cutaneous aggressive epidermotropic CD8+ T-cell lymphoma: Proposed diagnostic criteria and therapeutic evaluation

Primary cutaneous aggressive epidermotropic CD8(+) T-cell lymphoma is a rare cytotoxic lymphoma characterized clinically by aggressive behavior and histologically by prominent epidermotropism of atypical CD8(+) lymphocytes. Despite the continuous addition of new case reports, no definite diagnostic criteria have been established, and an optimum treatment is still awaiting. Herein, we study and analyze the different clinical, histopathological, and immunohistochemical features described in the reported cases. Different therapeutic modalities and their impact on the prognosis of the tumor are also evaluated and presented. We propose two sets of diagnostic criteria. The first comprises constant clinical, histopathological, and immunohistochemical features that are always present in every case, and the combination of which is necessary for the diagnosis. The second set helps to avoid missing cases and includes variable features that may be present in some cases, and to which any emerging finding could be added. Although different therapeutic options have been used, either as single agents or in combinations, there is no standard therapy for primary cutaneous aggressive epidermotropic CD8(+) T-cell lymphoma and the tumor still represents a therapeutic challenge with very poor prognosis.

Vascular endothelial growth factor in psoriasis: an indicator of disease severity and control.

Background  Psoriasis is a chronic disease characterized by abnormal epidermal proliferation, inflammation and angiogenesis. It has been reported that vascular endothelial growth factor (VEGF) is overexpressed in lesional psoriatic skin and its serum levels are significantly elevated in patients with moderate to severe disease.

Platelet-Rich Plasma Versus CROSS Technique With 100% Trichloroacetic Acid Versus Combined Skin Needling and Platelet Rich Plasma in the Treatment of Atrophic Acne Scars: A Comparative Study

BACKGROUND Platelet-rich plasma (PRP) is an autologous preparation of platelets in concentrated plasma that may be beneficial in the treatment of atrophic acne scars by promoting collagen deposition. Skin needling is a technique that uses a sterile dermaroller to puncture the skin and release growth factors. The combination of skin needling and PRP could enhance the efficacy of both modalities. Chemical reconstruction of skin scars technique consists of focal application of high concentration of trichloroacetic acid (TCA) on the acne scars to stimulate collagen production. OBJECTIVE To evaluate the efficacy and safety of intradermal injection of PRP, 100% focal TCA, and combined skin needling plus topical PRP in the treatment of atrophic acne scars. PATIENTS AND METHODS Forty-five patients with atrophic acne scars were randomly assigned to 3 equal groups; Group A received intradermal injection of PRP, Group B received chemical reconstruction of skin scars technique with TCA 100%, and Group C was treated by combined skin needling and PRP. Each patient underwent 3 sessions at 2-week interval. RESULTS All the patients completed the study. The 3 groups showed statistically highly significant improvement in the degree of acne scars after treatment (p < .001). No major adverse effects were observed in the studied groups. CONCLUSION This is the first study to use intradermal injection of PRP alone for the treatment of atrophic acne scars. The 3 modalities showed a promising efficacy and safety in the treatment of atrophic acne scars.

Role of vascular endothelial growth factor in keloids: a clinicopathologic study

Background  Despite their benign nature, keloids are usually associated with considerable cosmetic effects and may lead to functional problems. Recently, it has been reported that vascular endothelial growth factor (VEGF), a potent angiogenic factor, is overexpressed in keloid tissue and may have a potential role in its evolution.

Necrolytic acral erythema: a variant of necrolytic migratory erythema or a distinct entity?

Background  Hepatitis C is a major health problem in Egypt. Necrolytic acral erythema (NAE) is a recently described necrolytic erythema that has a distinctive acral distribution and a uniform association with hepatitis C. Some authors believe that NAE is a distinct entity and others consider it as a variant of necrolytic migratory erythema (NME).

Paederus dermatitis in Egypt: a clinicopathological and ultrastructural study

Background  Outbreaks of paederus dermatitis (PD) have been observed in different parts of the world, yet the histopathological and ultrastructural changes and their relationship to pederin toxin have not been described.

RETRACTED: Intralesional immunotherapy of plantar warts: Report of a new antigen combination

BACKGROUND Treatment of plantar warts represents a continuing challenge for dermatologists because many of the available therapeutic modalities are associated with unsatisfactory results and high recurrence rates. Several clinical trials have proved the efficacy of intralesional immunotherapy by different antigens in the treatment of different types of warts. OBJECTIVE To evaluate the efficacy and safety of a new antigen combination-mumps, measles, and rubella (MMR) vaccine in the treatment of plantar warts. METHODS The study included 40 patients with single or multiple, recalcitrant or nonrecalcitrant plantar warts. MMR vaccine was injected into single lesions or largest wart in case of multiple lesions at 3-week intervals until complete clearance or for a maximum of 3 treatments. Follow-up was done every 3 months for 9 months to detect any recurrence. RESULTS Only 23 patients completed the study. The results revealed complete clearance of the warts in 20 patients (87%), partial response in one patient (4.3%), and no response in two patients (8.7%). Complete response was achieved in 75% of patients with recalcitrant plantar warts and 83.3% of patients with warts at sites other than the soles. Recurrence was observed in only one patient (4.3%). A significant relationship was found between therapeutic response and wart duration, but not with other clinical variables. Side effects include pain during injection (82.6%) and flu-like symptoms (4.3%). No erythema, edema, or scarring has been reported. LIMITATIONS Small study sample and absence of control. CONCLUSIONS Intralesional immunotherapy by MMR vaccine seems to be a simple, effective, and safe treatment modality for plantar warts.

Oral ivermectin for head lice: a comparison with 0.5 % topical malathion lotion.

Background: Reports of treatment failure of head lice have become increasingly common. Oral ivermectin has been proposed as a potential alternative for the treatment of head lice infestation. The aim of this study was to compare the efficacy of oral ivermectin with topical malathion lotion in the treatment of head lice.

Treatment of recalcitrant warts with intralesional measles, mumps, and rubella vaccine: a promising approach

Recalcitrant warts represent a frustrating challenge for both patients and physicians. Although many destructive and immunotherapeutic modalities are available for the treatment of warts, an ideal, universally effective approach has not been explored to date. Recently, intralesional antigen immunotherapy has shown promising efficacy in the treatment of warts. The aim of the study was to evaluate the efficacy and safety of intralesional measles, mumps, and rubella (MMR) vaccine in the treatment of recalcitrant warts.

Gabapentin: A promising therapy for uremic pruritus in hemodialysis patients: A randomized-controlled trial and review of literature

Abstract Background: Treatment of uremic pruritus (UP) is a big challenge. Objectives: To evaluate efficacy, appropriate dosing regimen and safety of gabapentin on UP in hemodialysis (HD) patients. Patients and methods: Fifty-four uremic patients undergoing HD and complaining of UP were randomly classified into two equal groups. Gabapentin group: 27 patients received gabapentin capsules starting with 100 mg and gradually titrated up to a maximum of 300 mg after each HD session for one month. Placebo group: 27 patients received placebo thrice weekly after each HD session. Severity of pruritus was measured by visual analog scale (VAS) and 5-D pruritus scale. Results: In gabapentin group, 88.9% of patients responded well to gabapentin versus 22.2% in placebo group. A highly statistical difference was detected in favor of gabapentin group (p< 0.001). The frequency of the use of the lowest dose (100 mg thrice weekly) was significantly higher than other doses (p < 0.0001). Adverse effects were mild and tolerated. Conclusion: Gabapentin is a promising and a well-tolerated treatment option for patients with UP. We recommend it as a first line therapy with a maintenance post-HD dose of 100–300 mg. We also recommend the 5-D scale in the assessment of the severity of pruritus.