Eman Salah

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.

Intralesional Antigen Immunotherapy for the Treatment of Warts: Current Concepts and Future Prospects

Many destructive and immunotherapeutic modalities have been used for the management of warts; however, an optimal treatment with high efficacy and absent or low recurrence has not been explored to date. Recently, the use of intralesional immunotherapy with different antigens has shown promising efficacy in the treatment of warts. We review the different aspects of this new modality, including candidates, types of warts treated, dosage, number and interval between treatment sessions, mode of action, efficacy, adverse effects, recurrence rate, advantages, disadvantages, current place and future prospects. A literature review revealed that healthy immune subjects are the best candidates, and a pre-sensitization test is usually done before the start of therapy. The dosage, the number and interval between sessions, and the success rates varied among the different studies. The mode of action is still uncertain, but is essentially mediated through stimulation of T helper-1 cell cytokine response. Adverse effects are mild and generally insignificant, and the recurrence rate is absent or low. Intralesional antigen immunotherapy seems to be a promising, effective and safe treatment modality for viral warts. Future well-designed and controlled studies would help to more clearly define its place in the challenging field of wart therapy.

Treatment of recalcitrant warts with Bacillus Calmette–Guérin: a promising new approach

Recalcitrant warts represent a therapeutic challenge for both patients and physicians. Recently, intralesional immunotherapy by different antigens has been proved effective in the treatment of different types of warts. We describe a case of a 48‐year‐old male who presented with troublesome huge common wart on the left little toe of 5 years duration and not responding to many lines of therapy. Nearby and distant common and plantar warts have also been observed. Intralesional Bacillus Calmette–Guérin (BCG) vaccine was injected into the huge wart of the little toe at 2‐week intervals for five sessions. Follow‐up was made every month for 6 months. A gradual decrease in the size of the injected wart was observed until reaching complete clearance by the end of the fifth session. Untreated nearby common and distant warts disappeared completely by the end of the third session. BCG injection was associated with erythema and edema with or without pustules, at the site of injection. A flu‐like illness that rapidly subsided within 3 days was also observed with each injection. No recurrence was observed after the 6‐month follow‐up period. Intralesional immunotherapy with BCG vaccine seems to be a promising effective and safe treatment modality for recalcitrant warts.

Primary cutaneous aggressive epidermotropic CD8+ T cell lymphoma: a diagnostic and therapeutic challenge

Primary cutaneous aggressive epidermotropic CD8+ T cell lymphoma is an extremely rare, recently recognized cytotoxic lymphoma first reported by Berti et al., who described the tumor as a distinct clinicopathologic entity with aggressive clinical behavior. It is characterized by widespread, rapidly evolving papules, plaques, and tumors, often showing central necrosis and ulceration, prominent epidermotropism, CD8+/CD4) phenotype, an aggressive course, a high tendency to spread to extranodal sites, poor response to conventional therapies for classic CD4+ cutaneous T cell lymphomas (CTCLs), and an unfavorable prognosis. Primary cutaneous aggressive epidermotropic CD8+ T cell lymphoma is classified as a provisional, ill-defined entity within a heterogeneous group of ‘‘primary cutaneous peripheral T cell lymphoma, unspecified’’ according to the World Health Organization and European Organization for Research and Treatment of Cancer (WHO– EORTC) classification of 2005 and the 4th edition of the WHO classification of 2008. The diagnosis of primary cutaneous aggressive epidermotropic CD8+ T cell lymphoma is based on the integration of clinical, histologic, and immunohistochemical features. However, some cases do not present with classic lesions and a typical course from the start, and others present with atypical clinical features, leading to diagnostic difficulties. Similarly, no optimum treatment able to control the very aggressive course of this disease and improve the very low associated survival rate is yet available. Herein, we describe a patient who presented with unique clinical and histopathologic features that posed a diagnostic difficulty but showed an excellent response to hyper-CVAD (cyclophosphamide, vincristine, adriamycin, and dexamethasone) chemotherapy. We hope that insight gained from this case might improve treatment outcomes.

Comedonal Darier’s Disease: A Rare Variant and a Common Misdiagnosis

Comedonal Darier’s disease is an extremely rare variant demonstrating unique clinical and histopathological findings; however, it is commonly misdiagnosed. Herein, we report a case of comedonal Darier’s disease and discuss its different diagnostic and therapeutic challenges.

Clinical and dermoscopic spectrum of discoid lupus erythematosus: novel observations from lips and oral mucosa

Under dermoscopy, discoid lupus erythematosus (DLE) exhibits specific findings. Commonly DLE lesions affect sun‐exposed sites, especially the face. However, most of the dermoscopic reports come from scalp DLE. To our knowledge, the dermoscopic pattern for mucosal and labial DLE has not been previously reported.

Impact of multiple extragenital warts on quality of life in immune-competent Egyptian adults: a comparative cross-sectional study

Background Extragenital warts (E-GWs) are common benign skin lesions caused by human papilloma virus. Surprisingly, there is no clear data about the impact of multiple E-GWs on quality of life in immune-competent adult patients in comparison to GWs, which have been frequently reported to exhibit a strong negative impact on life quality. Patients and methods This cross-sectional study investigated the impact of multiple E-GWs on quality of life in immune-competent adults as they are more commonly encountered in daily practice than their genital counterpart in the Egyptian population. Hundred patients with multiple E-GWs (aged 18–67 years, 46 females, 54 males) and 100 patients with multiple GWs (aged 18–55 years, 56 females, 44 males) were included. Cause for immune suppression in the patients was not known. A hard copy of the validated Arabic (Egypt) version of Dermatology Life Quality Index (DLQI) questionnaire was used with permission. Results The DLQI total scores range was 5–14 with a mean of 11.2 ± 2.5 in GWs and 1–24 with a mean of 13.0 ± 5.8 in E-GWs, which are statistically significant (P=0.009). To our knowledge, this is the first study to evaluate the impact of E-GWs on life quality of immune-competent adults. Conclusion E-GWs can have a very strong negative impact on patients’ daily life. We highly encourage all treating physicians to use the “bio-psycho-social” model when facing patients with E-GWs in an attempt to secure the best life quality for our patients.

A new piece of an old puzzle: lack of association between C-Rel (rs13031237-rs842647) single nucleotide polymorphisms and non-segmental vitiligo

BackgroundThe exact pathogenesis of vitiligo is still unclear; however, studies mostly support autoimmune mechanisms including altered T-regulatory cells and FOXP3. C-Rel is a NF-κB family member affecting the normal development of FOXP3+ regulatory T cells.MethodsThe aim was to examine the association between 2 C-Rel gene polymorphisms (rs13031237 and rs842647) and non-segmental vitiligo patients. Genomic DNA was isolated from blood samples of 100 patients plus 100 controls for genotyping using restriction fragment length polymorphism and DNA sequencing analyses. Statistical analysis was performed using SPSS program version 21 (IBM Corp., Chicago, IL, USA).ResultsThe genotype frequencies did not differ significantly from non-segmental vitiligo patients to controls for both alleles.ConclusionsC-Rel (rs13031237 and rs842647) polymorphisms are not associated with increased risk for non-segmental vitiligo. We recommend testing additional mutations in vitiligo patients from different populations to unravel Rel aspects among different autoimmune disorders.

Tamoxifen-induced radiation recall dermatitis: three calls from Egypt

Tamoxifen is a selective estrogen receptor modulator used for hormone receptor-positive breast cancer in addition to radiotherapy. Tamoxifen-induced radiation recall dermatitis (RRD) was 1st described in 1992 however only 7 cases have been reported1. Herein, we report 3 Egyptian patients with tamoxifen-induced RRD to highlight its diagnostic and therapeutic aspects. This article is protected by copyright. All rights reserved.