Dina M. Kadry

Skin tags, leptin, metabolic syndrome and change of the life style

BACKGROUND Skin tags (STs), are papillomas commonly found in the neck and in the axillae of middle-aged and elderly people. Metabolic syndrome (MS) is a complex of interrelated risk factors for cardiovascular disease and diabetes. Epidemiologic studies of different ethnic populations have indicated that hyperleptinaemia and leptin resistance are strongly associated with MS. AIM To study the possible relation of skin tags and leptin levels to MS guided by the International Diabetes Federation (IDF) diagnostic criteria. METHODS This study included 80 participants, 40 ST patients and 40 apparently healthy controls. Age, sex, waist circumference (WC), body mass index (BMI), smoking status, fasting glucose level, insulin level and insulin resistance were estimated as well as cholesterol, triglycerides, HDL, criteria of MS, and leptin levels. RESULTS The univariate analysis showed that WC, BMI, fasting glucose, insulin levels, insulin resistance, cholesterol, triglycerides, HDL, and leptin levels were significantly higher in ST patients compared to controls (P<0.001). The multivariate analysis between MS components and ST showed that only high triglyceride levels (OR 1.205/95% CI 1.044-1.391/P=0.011) and low HDL levels (OR 0.554/95% CI 0.384-0.800/P=0.002) were significantly associated with ST. Multivariate linear regression analysis of the predictors of high plasma leptin levels, showed that high triglyceride levels (OR 0.287/95% CI 0.410-3.56/P=0.014), and low HDL levels (OR -0.404/95% CI -8.7 to -2.08/P=0.002) were significant predictors. CONCLUSION The results of this study suggested that the presence of both ST and hyperleptinaemia in patients with STs may be associated with high levels of triglycerides and low levels of HDL and this could suggest that changing the life style of patients with ST may have a beneficial role.

Insulin-like growth factor-1 in psoriatic plaques treated with PUVA and methotrexate

Background  The pathogenesis of psoriasis is thought to depend on the activation of immune cells and their secreted cytokines, chemokines and growth factors like IGF‐1 which may contribute to the epidermal hyperplasia of psoriasis. Treatment of psoriasis with PUVA and methotrexate are associated with clinical improvement and decrease in epidermal hyperplasia.

DNA polymorphisms and tissue cyclooxygenase-2 expression in oral lichen planus: a case-control study

Background  Oral lichen planus (OLP) is a chronic inflammatory disorder defined as a precancerous condition. Special attention has been paid to the expression of cyclooxygenase‐2 (COX‐2) and its potential role in development of oral squamous cell carcinoma. The identification of single nucleotide polymorphisms that affect gene function or expression and contribute to disease predisposition has become a major area of investigation toward understanding the mechanisms for cancer.

Clinical and dermoscopic evaluation of patients with periorbital darkening

BackgroundMany factors contribute to periorbital darkening, including melanin deposition and skin redundancy. Therapeutic options are still limited and usually unsatisfactory. Dermoscopy allows the identification of different colors and structures not seen by naked-eye examination. ObjectiveTo assess patients with periorbital darkening by dermoscopy. Patients and methodsIn this descriptive study, 35 patients complaining of periorbital darkening were included. Clinical and dermoscopic evaluation was performed. Both pigmentary and vascular components were assessed. Clinical and dermoscopic photographs were evaluated, graded, and results were statistically analyzed. ResultsClinically, pigmentation was mild, moderate, and marked. Textural changes and periorbital edema were observed. Dermoscopically, three patterns were described: pseudonetwork, blotchy, and multicomponent. Erythema and telangiectasia were documented. The degree of pigmentation correlated positively with patient age, skin type, and presence of anemia. LimitationsSmall number of patients and no controls were the limitations. ConclusionDermoscopic evaluation of periorbital darkening/melanosis appears valuable, particularly in the determination of the degree and pattern of pigmentation as well as the extent of vascular involvement, which in turn would reflect on the choice of therapy.

Levels of osteopontin in plasma and tissue in relation to metabolic status in patients with lichen planus

Background Chronic inflammation with lichen planus (LP) has been suggested as a component of the metabolic syndrome (MetS). LP is assumed to be related closely to dyslipidemia. Plasma osteopontin (OPN) has been reported to be a potential clinical marker for the prediction of atherosclerosis. Selenium (Se), an essential trace element, involved in the defense against oxidative stress, has been hypothesized to prevent cardiovascular disease (CVD). Se compounds are effective in the downregulation of OPN expression. Moreover, an inverse relation has been detected between the levels of plasma OPN and plasma Se in patients with psoriasis. Objective To determine the possible role of OPN and Se in the pathogenesis of LP and their relation to the metabolic status in patients. Patients and methods Thirty patients with LP and 30 controls were included. Participants were assessed for the presence of MetS and/or its components. In all participants, plasma and tissue OPN levels were assessed using an enzyme-linked immunosorbant assay, plasma Se levels were assessed by flame atomic absorption spectrophometry, and high-sensitivity C-reactive protein levels were assessed using a solid-phase enzyme-linked immunosorbant assay. Results Patients with LP showed a significant association with MetS parameters than the controls. Plasma and tissue OPN were significantly higher in LP patients than those in the control group. Plasma Se levels were significantly lower in patients than those in the control group. In patients, plasma OPN levels were associated positively with the presence of diabetes mellitus, dyslipidemia, and MetS. Conclusion The presence of LP in patients was associated strongly with MetS parameters, most probably because of long-standing inflammation. OPN may be a critical regulator of chronic inflammation in patients with LP and may explain its association with components of the MetS such as diabetes mellitus and dyslipidemia.

Serum and tissue transforming growth factor β1 expression in vitiligo

BackgroundVitiligo is believed to result from progressive autoimmune-mediated loss of melanocytes. Although a number of studies suggest the involvement of several autoimmune influencing cytokines in the pathogenesis of vitiligo, these reports are still limited and contradictory. ObjectiveTo examine the degree of expression of transforming growth factor &bgr;1 (TGF-&bgr;1) in both the serum and the tissue of vitiligo patients and their relation to disease development, progression, and severity. Patients and methodsIn this case control study, 20 vitiligo patients and 10 age-matched and sex-matched controls were recruited. TGF-&bgr;1 levels were detected in serum and lesional as well as nonlesional specimens of cases and controls. The relations of TGF-&bgr;1 levels with disease parameters including disease extent, type, and vitiligo disease activity score were analyzed statistically. ResultsSerum and tissue levels of TGF-&bgr;1 were significantly lower in patients than the controls (P=0.001 and P<0.001, respectively). There was no significant difference between the TGF-&bgr;1 levels between the lesional and the nonlesional skin of patients (P=0.634). ConclusionDownregulation of serum and tissue TGF-&bgr;1 may result in the loss of peripheral tolerance mediated by T regulatory cells and should be further investigated as a prerequisite for disease initiation in susceptible individuals.

Cyclooxygenase-2 and prostaglandin E2 in vitiligo patients: plasma and tissue levels

BackgroundVitiligo is an acquired depigmenting disorder characterized by the selective destruction of melanocytes. Cyclooxygenases (COXs) are key enzymes in the conversion of arachidonic acid into prostaglandins. COX-2 expression plays a major role in prostaglandin E2 (PGE2) production. PGE2 plays an important role in tyrosinase activation and melanogenesis. ObjectiveTo determine the possible role of COX-2 and PGE2 in the pathogenesis of vitiligo. Patients and methodsThis analytic cross-sectional study included 22 vitiligo patients and 20 controls. Two skin biopsies were obtained from depigmented lesions and clinically normal skin from patients and one skin biopsy from the controls. COX-2 gene expression was semiquantified in skin biopsies using a reverse transcriptase-PCR and the PGE2 level was determined by an enzyme-linked immunosorbent assay. Blood samples were withdrawn from patients and controls to assess the plasma levels of PGE2 and COX-2 using the enzyme-linked immunosorbent assay technique and COX-2 activity using the Cyclooxygenase Enzyme Immunometric Assay Kit. ResultsThe expression of COX-2 mRNA was significantly decreased in lesional and nonlesional skin of patients compared with the controls (P<0.001). In addition, the level of PGE2 was significantly decreased in lesional and nonlesional skin of patients compared with the controls (P<0.001, P=0.003, respectively). The plasma levels and activity of COX-2 and the levels of PGE2 were significantly elevated in patients compared with the controls (P<0.001). ConclusionCOX-2 and PGE2 could contribute toward the development of vitiligo through their immunomodulatory role or locally through their role in melanogenesis.

Leptin and leptin receptors in psoriatic skin before and after PUVA: a possible marker of psoriasis severity

BackgroundPsoriasis is a multifactorial disease in which genetic and inflammatory factors play an important role. Leptin has been shown to have proinflammmatory effects and to play a regulatory role in the T-helper cell response. Although recent studies support the relation of psoriasis with obesity and cardiovascular disease, the relation of psoriasis and leptin still remains controversial. ObjectiveTo estimate the tissue levels of leptin and leptin receptor (leptin R) mRNA in psoriatic lesions and to determine the effect of Psoralen Ultraviolet Rays (PUVA) on their levels. Patients and methodsTwenty-one psoriatic patients and 15 age-matched, sex-matched and weight-matched normal individuals were recruited for this work. Skin biopsies were taken from psoriatic lesions before the initiation of PUVA therapy and at the end of 30 sessions as well as from the normal skin of controls for the detection of leptin by enzyme-linked immunosorbent assay and the detection of leptin R mRNA by reverse transcriptase PCR. ResultsBefore PUVA therapy, leptin and leptin R mRNA were significantly higher in psoriatic tissue compared with the normal tissue of control individuals (P<0.0001). Their pretreatment values decreased significantly after therapy (P<0.0001 and P=0.001, respectively). Pretreatment leptin and leptin R mRNA values correlated positively with the pretreatment psoriasis area and severity index score (P=0.008 and 0.002, respectively). ConclusionWe suggest that leptin plays a role in the pathogenesis of psoriasis and might be considered as a marker of severity in psoriasis. Moreover, the reduction in the tissue levels of leptin might be related to the efficacy of PUVA in the treatment of psoriasis.

Healthcare-associated infections in the dermatology wards in a University Hospital in Egypt

BackgroundHealthcare-associated infection (HCAI) is a growing problem in healthcare today. Thus, surveillance of HCAI is an important aspect of modern infection control. ObjectiveTo identify the incidence, etiology, and outcome of HCAI in the dermatology wards at Cairo University Hospital. Patients and methodsIn a cross-sectional study, over a period of 3 months, 180 patients were surveyed for HCAI and its risk factors according to the criteria set by the Centers for Disease Control and Prevention. Samples were obtained from skin lesions upon admission and after 72 h. Whenever infection was suspected, samples were obtained from the corresponding site or body fluids and submitted for microbiological evaluation. ResultsTen patients out of 180 (5.6%) inpatients developed HCAI: four cases with urinary tract infection, three cases with skin and soft tissue infection, two cases with conjunctivitis, and one with respiratory tract infection. The intravenous cannula was the only medical device used during the study period. Methicillin-resistant Staphylococcus aureus was obtained in 50% of cultures. The nurse-to-patient ratio was 1: 8, the median length of stay of patients who developed HCAI was 40 days. The HCAI mortality was one out of 10 patients, with a 10% rate. This was a 45-year-old male patient with pemphigus vulgaris; methicillin-resistant Staphylococcus aureus growth was only obtained from the conjunctival mucosal surface. ConclusionThe present study documents for the first time, to our knowledge, the status of HCAI in an Egyptian University Hospital dermatology inpatient. Prolonged length of stay, progressive disease course, empirical use of antibiotics, and a low nurse-to-patient ratio were the main causes for the development of HCAI. The incidence of HCAI in the dermatology wards (5.6%) appears to be within the reported international levels; however, this value could be reduced by addressing the predisposing factors.