Khaled Gharib

Lichen myxedematosus: diagnostic criteria, classification, and severity grading

Lichen myxedematosus (LM) is a rare, chronic idiopathic disorder characterized clinically by waxy, closely set papules and histopathologically by diffuse dermal mucin deposition and fibroblast proliferation. The most recent classification of LM was proposed in 2001; however, it seems to be complex, confusing, and imprecise. Herein, we present seven cases of LM to evaluate the validity of the current classification, to propose new diagnostic criteria and classification, and to suggest a clinically relevant severity grading system for this rare disorder.

Sweet's syndrome: diagnostic criteria revisited

The diagnosis of Sweets syndrome (SS) is based on a set of criteria that requires the presence of two major and at least two minor criteria. In some cases, however, the diagnosis is not as straightforward due to the absence of certain criteria. The objective of the present study was to review the clinical, histopathological, and laboratory features of the current diagnostic criteria for SS, and to evaluate their validity in the cases reported in the literature as well as in 40 patients treated at our institution. Our comprehensive review of the current criteria for SS reveals that the two major criteria have been consistently present in all cases – including ours – since the first description of SS in 1964. With regard to the minor criteria, on the other hand, there has been marked variability between different studies, and many cases failed to fulfill the requirement of showing two minor criteria. In order to simplify the diagnosis, avoid misdiagnosis, and allow for prompt treatment, we propose two sets of revised diagnostic criteria for SS. The first set comprises constant clinical and histopathological features that must be present and are by themselves sufficient for the diagnosis of SS to be established. The second set includes variable features whose absence does not warrant ruling out SS.

Classical Kaposi sarcoma: case reports with unusual presentation on the penis and scrotum

Kaposi sarcoma (KS) is the most common vascular neoplasm. Any skin area could be involved, including the genitalia. Traditionally, classic KS lesions have a general distribution, often involving skin of the feet and legs, and to a lesser extent, that of the hands, arms, and trunk. KS limited to the external genitalia is extremely rare in HIV seronegative individuals.

Sweet-Syndrom: Revision der diagnostischen Kriterien

Die Diagnose des Sweet‐Syndroms (SS) gründet sich auf eine Reihe von Kriterien, von denen mindestens zwei Haupt‐ und zwei Nebenkriterien erfüllt sein müssen. In einigen Fällen ist die Diagnose aufgrund des Fehlens bestimmter Kriterien jedoch nicht so einfach. Ziel der vorliegenden Studie war es, die klinischen, histopathologischen und Labormerkmale der aktuellen Diagnosekriterien für das SS zu überprüfen und ihre Aussagekraft anhand der publizierten Fälle sowie bei 40 in unserem Institut behandelten Patienten zu beurteilen. Unsere umfassende Prüfung der aktuellen Kriterien für das SS ergab, dass seit seiner Erstbeschreibung im Jahr 1964 die beiden Hauptkriterien bei allen Fällen – einschließlich unserer – durchweg vorhanden waren. Andererseits gab es hinsichtlich der Nebenkriterien deutliche Unterschiede zwischen den verschiedenen Studien und bei vielen Patienten war die Bedingung, dass zwei Nebenkriterien vorhanden sein müssen, nicht erfüllt. Wir schlagen hier zwei Gruppen von revidierten Diagnosekriterien für das SS vor. Dies geschieht mit dem Ziel, die Diagnose zu vereinfachen, Fehldiagnosen zu vermeiden und eine sofortige Behandlung zu ermöglichen. Die erste Gruppe umfasst konstante klinische und histopathologische Merkmale, die vorhanden sein müssen und die per se für die Diagnose eines SS ausreichen. Die zweite Gruppe enthält veränderliche Merkmale, deren Fehlen es nicht erlaubt, ein SS auszuschließen.

Follicular Stem Cells in Androgenetic Alopecia

Although the pathogenesis of androgenetic alopecia (AGA) is poorly understood, recent studies suggest that compromising the integrity of the follicular bulge area and or sebaceous gland may play a role. This study was designed to evaluate the role of follicular bulge stem cells in AGA. Twenty patients with AGA (17 males and 3 females) with a mean age of 24.05 ± 1.6 were the subjects of this study. A 4 mm punch biopsy specimen was obtained from both occipital skin and frontal affected area of scalp of each patient and embedded in paraffin. Tissue sections were immunostained using the Cytokeratin 15(CK 15) Ab-1 mouse monoclonal antibody. Cytokeratin 15 immunoreactivity was observed both in the frontal and occipital skin biopsies in the follicular bulge region and outer root sheath in all 20 AGA patients (100%). This study suggests that follicular stem cells in the bulge region are not the target in AGA. Further studies using other stem cell markers are recommended to clarify the role of follicular stem cells in AGA pathogenesis.

Preservation of stem cells in androgenetic alopecia

30 patients with BP (20% compared to 2% in controls), while Taylor et al. did not report any difference between 108 patients with BP and controls. Downham and Chapel reported the highest frequency of diabetes (i.e. 41%) in a series of 34 patients with BP. In our work, most of patients were affected by complicated type-2 DM (data not shown). This could lead to an underestimation of the prevalence of diabetes. A limitation of our study is that, being a national reference centre, IDI-IRCCS tends to cure more severe patients; therefore, our estimates of prevalence of complicated DM are likely to be overestimated. In addition, DM is frequently precipitated by corticosteroid treatment. Thus, in our study, the frequency of diabetes could be increased in both the two diseases because of the steroid therapy. While our observations do not allow us to draw any conclusion about the possible relation between the use of DPP-IV inhibitors and BP appearance, it is difficult to ignore that our data indicate that starting from 2007 DM prevalence in the two diseases diverges. In conclusion, our study shows a higher frequency of DM in BP than in pemphigus during the last decade. To understand the significance of this increasing prevalence, design and implementation of analytic studies will be necessary. This study was partially supported by the ‘Progetto Ricerca Corrente’ of the Italian Ministry of Health, Rome, Italy.

Diagnostic accuracy of immunohistochemical markers in differentiation between basal cell carcinoma and trichoepithelioma in small biopsy specimens

The distinction of trichoepithelioma from basal cell carcinoma in small superficial biopsies is important but often challenging. This has inspired many scientists to test the validity of immunohistochemical markers in the differential diagnosis.

Correction of nasolabial folds wrinkle using intraoral non-ablative Er:YAG laser

ABSTRACT Background: The accentuated nasolabial folds (NLFs) is the most pronounced sign of aging. Non-ablative erbium:yttrium aluminum garnet laser (ER:YAG), Smooth mode was used for the treatment of mucosal tissue. It was reported that it is effective in facial rejuvenation. Aim: To assess the safety and the effectiveness of intraoral ER:YAG Smooth mode laser in the treatment of NLFs wrinkle. Materials and methods: A total of 20 patients with different grades of NLFs wrinkle treated with 2940 nm Er:YAG laser intraorally. Six sessions were done every 2 weeks. The efficacy was assessed by two blinded dermatologists. Photographs were taken at the baseline, end of treatment and 6 months after the final session to document visible changes in NLFs wrinkle. The assessment was based on Modified Fitzpatrick Wrinkle Scale (MFWS) and by comparing the photographs. Patient’s self-assessment and patient’s satisfaction were used for assessment of final results and any side effects associated to treatment were observed. Results: There was significant reduction of the NLFs wrinkle. The MFWS was significantly improved 6 months after treatment compared to before treatment (p < 0.001). At the end of the follow-up period, there was improvement in overall appearance of the wrinkles. Patient’s self -assessment and satisfaction demonstrated better cosmetic outcomes. Conclusion: Intraoral Er:YAG laser is safe, painless, and effective treatment option for NLFs wrinkle.

Tranexamic for Treatment of Melasma

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Vitiligo and Associated Autoimmune Diseases in Zagazig University Hospitlas,Sharkia Governate, Egypt

Although the pathogenesis of vitiligo is not yet fully understood, the autoimmune hypothesis is the most commonly accepted. The aim of this study was to study the frequency of autoimmune diseases in a group of Egyptian patients with vitiligo compared with control. This study involved 50 Egyptian patients with vitiligo and 50 healthy subjects as control group. Patients should be made aware of signs and symptoms that suggest the onset of thyroid dysfunction, diabetes, or other autoimmune disease. If signs or symptoms occur, appropriate tests were performed. Screenings for thyroid disease were through evaluation of thyroid antibodies (anti-thyroidperoxidase, anti-thyroglobulin antibody), serum thyrotropin (TSH), free tri-iodothyronine (T3) and free thyroxine (T4). Screening for diabetes was done with fasting blood glucose or glycosylated hemoglobin testing. A complete blood count with indices helped rule out anemia. Antinuclear antibody screening was also done. Screening for celiac disease, IgA anti-glutaminase antibody was measured. The frequencies of autoimmune disorders were significantly elevated in vitiligo patients: vitiligo itself, autoimmune thyroid disease (particularly hypothyroidism), alopecia areata, pernicious anaemia, adult-onset type 1 diabetes mellitus, psoriasis and probably inflammatory bowel disease. These associations indicate that vitiligo shares common genetic aetiologic links with these other autoimmune disorders.