Noha H. Moftah

Forehead wrinkles: a histological and immunohistochemical evaluation

Wrinkles are associated with cutaneous aging especially on sun‐exposed skin. Despite they are considered a major topic in cosmetic dermatology, very few reports have studied the specific histological and immunohistochemical changes characteristic for wrinkles.

Effect of PUVA therapy on melanocytes and keratinocytes in non‐segmental vitiligo: histopathological, immuno‐histochemical and ultrastructural study

Psoralen ultraviolet A (PUVA) is an important modality in treating vitiligo. Its effect on melanocytes and keratinocytes is not sufficiently studied. In this work, we investigated 30 cases of non‐segmental vitiligo regarding the changes of melanocytes and keratinocytes in both vitiliginous and nearby areas before and after PUVA therapy.

Evaluation of apoptosis regulatory proteins in response to PUVA therapy for psoriasis

The histopathologic changes characteristic of psoriasis might be related to suppressed apoptosis. One of the actions of psoralen ultraviolet A (PUVA) in psoriasis could be exerted through induction of apoptosis of keratinocytes and lymphocytes; however, its exact molecular mechanism is still confusing.

Phospholipid membrane tubulation using ceramide doping “Cerosomes”: Characterization and clinical application in psoriasis treatment

ABSTRACT Nanotechnology and material surface modification have provided a functional platform for the advancement of several medical fields such as dermatology. Furthermore, the smart choice of preparation material was proven to confer unique properties to the developed nanosystems. In this context, we focused on the sphingolipid “ceramide”, whose deficiency was found to negatively affect psoriasis. Ceramide was doped into surfactant based vesicular phospholipid systems to create tubulated vesicles “cerosomes” loaded with a model anti‐psoriatic drug “tazarotene”, and their properties were tested as compared to ceramide free vesicles. Cerosomes were characterized for their drug entrapment, viscosity, in vitro drug release, morphology, ex vivo drug skin deposition, thermal behavior, and were clinically tested on psoriatic patients. The factorial design study revealed that the surfactant type, the ceramide: surfactant ratio, and the presence of ethanol in the hydration buffer affected the entrapment efficiency and the viscosity of the vesicles. Ceramide increased the entrapment of tazarotene, decreased its release while enhancing its deposition within the skin, correlating with better clinical therapeutic outcome compared to the topical marketed product. Ceramide was also able to cause significant membrane tubulation in the vesicles, causing them to deviate from the conventional spherical morphology. As a conclusion, cerosomes present a new functional treatment modality for psoriasis which is worthy of future experimentation. Graphical abstract Figure. No Caption available.

The use of Botulinum toxin-A injection for facial wrinkles: a histological and immunohistochemical evaluation

Botulinum toxin (BTX)‐A has been used for years in the reduction of facial wrinkles; however, histological and immunohistochemical changes after its use were not previously investigated. To evaluate histological and immunohistochemical changes after BTX‐A injection for facial wrinkles, sixteen volunteers, with wrinkles on the upper third of the face, were subjected to single injection of BTX‐A. Skin biopsy specimens were obtained from peri‐orbital wrinkle site (crows feet area) before and after 3 months of BTX‐A injection. Using histological and immunohistochemical evaluation coupled with computerized morphometric analysis, measurement of epidermal thickness, wrinkle depth and width as well as quantitative evaluation of collagen types I and III and elastin was performed for skin biopsies. After BTX‐A injections, there were significant increase in wrinkle width and granular layer thickness (P < 0.001), while the other histometrical measures as well as the immunohistochemical expression of collagen types I and III and elastin showed no significant difference (P > 0.05). However, collagen fibers showed better organization and orientation after BTX‐A injection. The histological changes observed after BTX‐A injection for facial wrinkles may help in better understanding of its mechanism of action.

Jojoba oil soft colloidal nanocarrier of a synthetic retinoid: preparation, characterization and clinical efficacy in psoriatic patients.

BACKGROUND Nanotechnology has provided substantial benefits in drug delivery, especially in the treatment of dermatological diseases. Psoriasis is a chronic inflammatory skin disease in which topical delivery of antipsoriatic agents is considered the first line treatment. OBJECTIVE To investigate whether the encapsulation of the synthetic retinoid tazarotene in a nanocarrier based on jojoba oil would decrease its irritation potential and clinically improve its therapeutic outcome in psoriatic patients. METHOD A microemulsion system based on jojoba wax and labrasol/plurol isostearique was prepared and characterized. RESULTS The selected formula displayed spherical morphology, particle size of 15.49±2.41 nm, polydispersity index of 0.20 ±0.08, negative charge and low viscosity. The microemulsion provided two folds increase in skin deposition of tazarotene, correlating with higher reduction in psoriatic patients PASI scores after treatment (68% reduction in PASI scores versus 8.96% reduction with the marketed gel). No irritation was encountered in patients using microemulsion, with redness and inflammation reported with the marketed gel-treated patients. CONCLUSION Jojoba oil microemulsion proved to be advantageous in reducing the irritancy of tazarotene, enhancing its skin deposition and achieving better therapeutic outcome in psoriatic patients.

Clinical study of nail changes in vitiligo

Both vitiligo and alopecia areata (AA) are associated together, associated with other autoimmune diseases, and autoimmunity is one of the important theories in their etiology. Nail changes are a known association with AA, thus we hypothesized that nail changes can be found in vitiligo patients. On revising the literature, only two types of nail changes were described in association with vitiligo. Our aim was to study the frequency and types of nail changes among vitiligo patients in comparison with normal healthy volunteers. This multi‐centric study was carried on 91 patients with vitiligo, as well as 91 normal healthy control subjects who were age‐ and sex‐matched. Nails were examined for changes in nail plates as regards striations, texture, curvature, dystrophy, and pigmentation. The presence or absence of the thumb lunula was also reported. Nail changes were observed in 62 patients (68.1%) and 46 (50.5%) control subjects with a statistically significant difference (P = 0.016). Longitudinal ridging and absent lunula were significantly higher in patients than in the controls (P = 0.001 and 0.037, respectively). Other reported nail abnormalities in the current study included punctate leukonychia, pitting, flag sign, and Terrys nails. Awareness of this association will widen the clinicians perspective to carefully examine the nail changes in vitiligo patients and conversely examine patients with nail changes for vitiligo.

Significant reduction of inflammation and sebaceous glands size in acne vulgaris lesions after intense pulsed light treatment

Intense pulsed light (IPL) has been used for years in treatment of acne vulgaris. However, quantitative evaluation of histopathological changes after its use as a sole therapy was poorly investigated. Accordingly, this study aims to objectively evaluate inflammatory infiltrate and sebaceous glands in acne vulgaris after IPL. Twenty‐four patients of acne were treated with six IPL sessions. Clinical evaluation was done at 2 weeks after last session by counting acne lesions. Patient satisfaction using Cardiff Acne Disability Index (CADI) was recorded at baseline, 2 weeks and 3 months after IPL. Using histopathological and computerized morphometric analysis, quantitative evaluation of inflammatory infiltrate and measurement of surface area of sebaceous glands were performed for skin biopsies at baseline and 2 weeks after last session. After IPL, there was significant reduction of all acne lesions especially inflammatory variety with significant decrease of CADI score at 2 weeks and 3 months after IPL (p < .05). Microscopically, there was significant decrease in density of inflammatory infiltrate and surface area of sebaceous glands (p < .05). So, IPL is fairly effective therapy in acne vulgaris especially inflammatory variety. The results suggest that IPL could improve acne lesions through targeting both inflammation and sebaceous glands.

Expression of IFN-γ, IL-4, and IL-17 in cutaneous schistosomal granuloma

Cutaneous schistosomal granuloma (CSG) is a rare dermatological disease, the clinical and histopathological features of which are well defined. Although a panoramic picture of its immunopathogenesis in humans is not yet available, it is believed to be induced by T helper 1 (Th1), Th2, or Th17 cytokines in animals. This study evaluated the expression of different types of Th cytokines, including Th1 cytokine interferon‐γ (IFN‐γ), Th2 cytokine interleukin‐4 (IL‐4), and Th17 cytokine IL‐17, in human CSG.

The changes in melanocyte number and melanin density occurring in vitiligo patches during 180 days of narrow band-ultraviolet B therapy

BackgroundNarrow band-ultraviolet B (NB-UVB) has been used in the treatment of vitiligo for years, but the sequence of events of repigmentation, occurring throughout the period of NB-UVB treatment for restoring melanocytes and melanin density, is not clear. ObjectiveThis study aimed to follow up the changes in melanocyte number and melanin density in vitiliginous patches during NB-UVB therapy for vitiligo patients. Patients and methodsThis study included 25 patients with nonsegmental vitiligo. NB-UVB therapy was given twice weekly for 6 months. Four skin biopsies were obtained from each patient at days 0, 30, 90, and 180. Biopsies were stained using hematoxylin and eosin stain, Masson–Fontana stain, and human melanoma black-45 (HMB-45) antibody. Qualitative and quantitative measurements were determined for both melanocyte number and melanin density. ResultsThere was a significant increase in the number of HMB-45-negative melanocytes (P<0.000) at day 30 of therapy compared with day 0. At day 90, there was a significant increase in the number of HMB-45-positive melanocytes (P<0.001) and melanin (P<0.001) compared with days 0 and 30. As regards HMB-45-negative cells at day 90, there was a significant increase in its number compared with day 0 (P<0.001) with no significant increase compared with day 30 (P=0.13). At day 180, there was a significant increase in the number of HMB-45-positive melanocytes (P<0.001) and melanin (P<0.001) but with a significant decrease in HMB-45-negative melanocytes (P<0.001) compared with days 30 and 90. ConclusionWe concluded that the sequence of events of repigmentation started with the appearance of inactive melanocytes, which were first detected at day 30, followed by the appearance of active melanocytes, melanin, and clinical repigmentation at day 90, which reached its highest levels at day 180. Moreover, we concluded that the presence of inactive melanocytes at day 30 might represent an index of favorable prognosis.