Dalia M. Abdel Halim

Using trichloroacetic acid in the treatment of acanthosis nigricans: a pilot study.

Background: Despite several therapeutic modalities, acanthosis nigricans (AN) remains a difficult dermatosis to treat. Objective:This study aims to test the safety and efficacy of trichloroacetic acid (TCA) as a chemical peel in the treatment of AN in a random sample of Egyptian female patients. Method: Six females with AN lesions were included in this pilot study. All patients received chemical peeling sessions using TCA over the affected skin lesions. Sessions were carried out to all patients once per week. Treatment was continued for 1 month. Treatment efficacy was evaluated by determining the average rate of response of the lesions to the treatment on a weekly basis. Results: All patients showed improvement as regard hyperpigmentation, thickening, and the overall appearance. The physician assessment was excellent in three lesions, moderate in five, and was mild in two. No side effects had been reported. Conclusion: The study may present TCA as a safe, easy, and an effective method for the treatment of AN.

Propranolol versus captopril in the treatment of infantile hemangioma (IH): A randomized controlled trial

BACKGROUND Renin-angiotensin system components have been demonstrated in the biology of infantile hemangioma (IH). Captopril, an angiotensin-converting enzyme inhibitor, is proposed as a therapeutic alternative to oral propranolol. OBJECTIVES We sought to compare the benefit of propranolol and captopril in the treatment of IH, and to assess angiotensin-converting enzyme gene polymorphism in patients with IH and in control subjects. METHODS Thirty patients with IH and 35 healthy control subjects were enrolled in this study. Patients were randomly assigned to treatment with either propranolol or captopril. Assessment was done clinically and by measurement of serum vascular endothelial growth factor and angiotensin II in patients and control subjects. Angiotensin-converting enzyme gene polymorphism was also studied. RESULTS Clinical improvement was significantly better and faster in the patients treated with propranolol. Both groups showed reduced vascular endothelial growth factor and angiotensin II levels posttreatment, with a significantly higher percentage reduction in the propranolol-treated group. Cardiac side effects were reported only in the captopril-treated group. Baseline vascular endothelial growth factor level was significantly higher, and baseline angiotensin II level was significantly lower, in patients than control subjects. LIMITATIONS We studied a relatively small number of patients and control subjects. CONCLUSION Propranolol shows greater benefit than captopril in the treatment of IH.

Mycophenolate mofetil: a novel immunosuppressant in the treatment of dystrophic epidermolysis bullosa, a randomized controlled trial

Background: No effective treatment has been found for epidermolysis bullosa dystrophica (EBD). Objective: To evaluate the efficacy and safety mycophenolate mofetil (MMF) in treating EBD. Methods: This randomized controlled double-blinded study included 35 patients with severe generalized EBD. Patients were randomly divided into two groups: group I (18 patients) received cyclosporine therapy (5 mg/kg/day) and group II (17 patients) received MMF therapy (500–1500 mg/day). Clinical assessment was made weekly for 3 months from the start of the treatment. Patients were assessed by measuring the extent of the disease, the % of improvement, assessing the number of new blister formation and the time of complete healing of new blisters. Side effects were recorded when detected. Results: The % of improvement in the disease extent was statistically significantly higher (p = 0.009) in group I (mean ± SD: 59.21 ± 22.676) than in group II (mean ± SD: 44.03 ± 25.71). As regards the number of new blisters and the rate of healing of blisters, there was no statistically significant difference between both groups (p = 0.693 and 0.404, respectively). No serious side effects were reported. Conclusion: MMF seems to be a good therapeutic option for the long-term treatment of EBD, it can be a good alternative for patients who cannot tolerate cyclosporine.

Non-ablative 1540 fractional laser: How far could it help injection lipolysis and dermal fillers in lower-face rejuvenation? a randomized controlled trial

Abstract Background: Rejuvenation of the lower face can be challenging and no single modality can accomplish all its complex events. Patients and methods: This 18-month study included 24 female patients with a primary complaint of lower-face aging signs. They were randomly allocated to either Group A, who received injection lipolysis and hyaluronic acid dermal filler, or Group B who in addition received non-ablative 1540 fractional laser. The improvement evaluation score used was the global aesthetic improvement scale (GAIS). Patients satisfaction level was also recorded. Both were repeated at Months 6, 13 and 18. Results: At all evaluations, laser group showed higher degree of improvement. Interestingly, at short-term evaluation (6 month), there was no significant difference between both groups (P > 0.05). However, the laser group improvement in comparison to the other group became significant in the long-term evaluations (13 and 18 months) (P < 0.05). Conclusion: This study further documents the importance of combination therapy in facial rejuvenation, offering a treatment protocol combining injection lipolysis and hyaluronic acid as an effective, safe, short-term therapeutic option in lower-face rejuvenation. The addition of 1540 non-ablative fractional laser to the protocol offers a higher efficacy with longer-term effects and no adverse events.

Matrix metalloproteinase in acral and non-acral vitiligo

Repigmentation in vitiligo requires activation, proliferation, and migration of the melanoblasts and melanocytes into the depigmented epidermis.1 Cell migration involves modifications of the architecture of cells which requires activation of enzymes that are involved in ECM degradation such as matrix metalloproteinases (MMPs). The significant reduction in their expression in vitiliginous skin has been previously demonstrated 2 and thereby incriminated to share in reducing the migration of melanocytes and their precursors. Phototherapy in the form of narrow band UVB and photochemotherapy (PUVA) are still considered the pillar in the treatment of vitiligo.3 Among a vast array of effects that could account for their efficacy, it has been demonstrated that UVA can lead to increased expression of MMPs 4 which could aid in the process of repigmentation of vitiliginous lesions. In the current work, we aimed at detection of the differences between acral and nonacral vitiligo skin as regards the expression of three members of the MMP family; MMP1, MMP2, and MMP9, and how would they change after PUVA therapy.

Dermoscopy: an easy, noninvasive tool for distinguishing mycosis fungoides from other inflammatory mimics

BackgroundMycosis fungoides (MF), the most common type of cutaneous T-cell lymphoma, can sometimes be indistinguishable from plaque psoriasis (PP), chronic dermatitis, and lichen planus (LP). ObjectiveThe aim of the study was to assess the value of dermoscopy as a quick screening tool to distinguish MF from PP, chronic dermatitis, and LP. Patients and methodsThe dermoscopic profiles of 21 MF, 20 PP, 20 chronic dermatitis, and 20 LP patients were included in this study. ResultsAll 20 PP patients (100%) showed homogenous red globules on a red background with white scales. All 20 LP patients (100%) showed whitish projections. In chronic dermatitis, all 20 (100%) patients showed patchy red dots and globules with yellowish scales. All MF patients showed pinkish homogeneous backgrounds. Whitish scales were seen in 15/21 (71.4%) MF patients. In recent-onset MF (disease duration ⩽2months), fine short linear vessels were seen in 4/21 (19%) patients and spermatozoa-like vessels in 3/21 (14.2%) patients. These features were statistically significant when compared with all the 81 examined patients (P=0.0036 and 0.0156, respectively). In contrast, in hyperpigmented MF lesions, dark globules were seen in 10/21 (47.6%) and light brown multifocal pigmentation was seen in 10/21 (47.6%) patients. These features were statistically significant when compared with all the 81 examined patients (P<0.0001). ConclusionFine short linear vessels, spermatozoa-like vessels, dark globules, and light brown multifocal pigmentation on a pink homogenous background are highly suggestive of MF. Dermoscopy proved to be a useful tool in distinguishing between MF, PP, chronic dermatitis, and LP.

Alteration of serum and tissue tumor necrosis factor alpha levels: A possible mechanism of action of oral pulse steroids in the treatment of alopecia areata

Alopecia areata (AA) is a multifactorial disease in which tumor necrosis factor alpha (TNF‐α) plays an important role.

Hyperpigmented and flesh-colored skin tags: what is the difference? A histopathological and immunohistochemical study

BackgroundSkin tags (STs) are soft pedunculated benign tumors that occur mainly on the neck and major flexures. STs can be normochromic or hyperchromic, and although asymptomatic, they represent a cosmetic problem for patients. ObjectiveThe aim of the study was to detect and compare the difference between skin-colored and pigmented STs with respect to BMI, glucose tolerance, degree of acanthosis/papillomatosis, melanocyte, and mast cell counts. Patients and methodsA total of 20 adults with both types of STs within the neck area were included. Two biopsies were taken, one from a flesh-colored and another from a hyperpigmented ST, and stained using hematoxylin and eosin (for acanthosis/papillomatosis), melanoma marker (for melanocytes), and mast cell chymase (for mast cells). ResultsThe degree of acanthosis/papillomatosis, melanocyte, and mast cell counts were significantly higher in pigmented STs (P=0.001), which was found more in those with impaired glucose tolerance and in severely obese patients. ConclusionWe attribute the change in STs color to melanocyte–mast cell interaction as well as to the degree of acanthosis/papillomatosis. Further studies are still required for a deeper understanding of reasons behind such change and for the clinical implications of such findings.