Rania M. Abdel Hay

Association between the leptin gene 2548G/A polymorphism, the plasma leptin and the metabolic syndrome with psoriasis

Abstract:  Background:  Psoriasis is a disorder with genetic and immunologic background. Leptin can regulate the T‐helper response.

Percutaneous Collagen Induction Versus Full-Concentration Trichloroacetic Acid in the Treatment of Atrophic Acne Scars

BACKGROUND Percutaneous collagen induction (PCI) promotes removal of damaged collagen and induces more collagen immediately under the epidermis. The chemical reconstruction of skin scars (CROSS) method is a focal application of full‐concentration trichloroacetic acid (TCA) to atrophic acne scars. The CROSS method has the advantage of reconstructing acne scars by increasing dermal thickening and collagen production. OBJECTIVE To compare the safety and efficacy of PCI and the 100% TCA CROSS method for the treatment of atrophic acne scars. MATERIALS AND METHODS Thirty participants were randomly equally divided into two groups; group 1 underwent four sessions (4 weeks apart) of PCI, and group 2 underwent four sessions (4 weeks apart) of 100% TCA CROSS. RESULTS Acne scarring improved in 100% of patients. Scar severity scores improved by a mean of 68.3% (p<.001) in group 1 and a mean of 75.3% (p<.001) in group 2. The difference in the degree of improvement was not statistically significant between the groups (p=.47). CONCLUSIONS PCI and 100% TCA CROSS were effective in the treatment of atrophic acne scars. The authors have indicated no significant interest with commercial supporters.

Intralesional cryosurgery and intralesional steroid injection: a good combination therapy for treatment of keloids and hypertrophic scars

Hypertrophic scars and keloids exhibit high recurrence rates following surgical excision. Intralesional cryosurgery (ILC) can achieve a higher degree of effectiveness than the surface cryotherapy. The aim of this study is to assess the clinical efficacy of ILC using Weshahy cryoneedles followed by IL steroid in a trial of getting rid of the fibrous mass by destruction, not by surgery to avoid being under tension of the new scar. This study included 22 patients. Evaluation of the volume reduction of the lesions was done after a single ILC session followed by IL steroid injections. There was a significant decrease in the volume of the lesions after 4 months (P < 0.01), with a volume reduction of 93.5%. By using ILC at the base of keloids or hypertrophic scars, we can change the old fibrous tissue into a recent scar or granulation tissue which will respond more successfully to IL steroid injection.

Intralesional botulinum toxin type A equally effective and better tolerated than intralesional steroid in the treatment of keloids: a randomized controlled trial.

Intralesional (IL) corticosteroid therapy is a treatment for keloids. IL botulinum toxin type A (BTA) has been postulated in such an indication with controversial reports. To compare efficacy and safety of IL BTA to the IL corticosteroid therapy in treatment of keloids. Twenty‐four patients with keloids were randomly divided into two equal groups: receiving IL steroid repeated every 4 weeks for six sessions (group A) and IL BTA 5 IU/cm3 repeated every 8 weeks for three sessions (group B). Objective parameters (hardness, elevation, and redness), subjective complaints (itching, pain, and tenderness), patient satisfaction, and side effects were evaluated. There was a significant decrease in the volume of the lesions after treatment (P < 0.01), with a volume reduction of 82.7% and 79.2%, respectively, in both groups. A significant softening of lesions vs. baseline was observed (P < 0.01), with statistically significant improvement in softening in group A (P < 0.01). There was a significant decrease in height of lesions and in redness score compared with baseline (P < 0.01) with no significant difference in between both groups. All patients mentioned a significant reduction of their subjective complaints (P < 0.01) that were more significant in group B. Skin atrophy and telangiectasia were evident in three patients of group A. The efficacy and safety of the IL BTA were clearly evident in the current work from the rapid significant amelioration of the subjective complaints and the comparable significant improvement of the objective parameters as well as the volume of the keloids in comparison with the IL corticosteroids.

Different therapeutic modalities for treatment of melasma.

Background  Chemical peels and topical depigmenting agents have become a popular modality in the treatment of melasma.

Treatment of dystrophic epidermolysis bullosa with bone marrow non‐hematopoeitic stem cells: a randomized controlled trial

Patients with dystrophic epidermolysis bullosa (DEB) have mutations in type VII collagen gene. Type VII collagen is synthesized by keratinocytes and fibroblasts. Based on the ability of bone marrow non‐hematopoeitic stem cells (NHBMSC) to develop into fibroblasts, we decided to investigate the use of NHBMSC in the treatment of recessive DEB (RDEB). This study included fourteen patients with RDEB; the first seven of them were given cyclosporine after the infusion of NHBMSC. As cyclosporine has been used for the treatment of RDEB we decided not to use cyclosporine for the second group of seven patients. Skin biopsies from the lesions were studied by electron microscopy before and after treatment. The number of new blisters decreased significantly after treatment in both groups (p = 0.003 and 0.004 respectively) and the rate of healing of new blisters became significantly faster after treatment in both groups (p < 0.001) with no significant difference between the two groups. Electron microscopic examination revealed increased number of anchoring fibrils after treatment in both groups. No major side effects were reported during the 1‐year follow‐up period. Our findings highlight the efficacy as well as the safety of NHBMSC in the treatment of RDEB.

Do combined alternating sessions of 1540 nm nonablative fractional laser and percutaneous collagen induction with trichloroacetic acid 20% show better results than each individual modality in the treatment of atrophic acne scars? A randomized controlled trial.

Background: There have been no well-controlled studies evaluating the efficacy of combining 1540 nm nonablative fractional laser with percutaneous collagen induction (PCI) and trichloroacetic acid (TCA) 20% in the treatment of atrophic acne scars. Objective: We hypothesized that combined alternating sessions of both modalities would show better results than each individual modality. Methods and materials: Thirty-nine patients with post acne atrophic scars were included in this study. Patients were randomly equally divided into three groups; group 1 was subjected to six sessions of PCI combined with TCA 20% in the same session, group 2 was subjected to six sessions of 1540 nm fractional laser and group 3 was subjected to combined alternating sessions of the previously mentioned two modalities. Results: Scar severity scores improved by a mean of 59.79% (95% CI 47.38–72.21) (p < 0.001) in group 1, a mean of 61.83% (95% CI 54.09–69.56) (p < 0.001) in group 2 and a mean of 78.27% (95% CI 74.39–82.15) (p < 0.001) in group 3. The difference in the degree of improvement was statistically significant when comparing the three groups using ANOVA test (p = 0.004). Conclusion: The current work recommends combining 1540 nm nonablative fractional laser in alternation with PCI and TCA 20% in the treatment of atrophic acne scars.

Psoriasis: Highlights on Pathogenesis, Adjuvant Therapy and Treatment of Resistant and Problematic Cases (Part I)

Psoriasis is a common inflammatory disease of the skin and joints. Its etiology has been linked to complex interactions between predisposing genes and the environment. The pathophysiology of psoriasis is characterized by epidermal hyperproliferation, enhanced antigen presentation, T-helper1 cytokine production, T-cell expansion, and angiogenesis. Tremendous advances in our understanding of this disorder have led to the development of novel therapeutics. In this review, we focus on specific advances in our understanding of the pathogenesis and the unrecognized severe effects of psoriasis, and the systemic treatment of resistant and problematic cases that are of major clinical relevance to the clinician.

Psoriasis and metabolic syndrome: Is peroxisome proliferator-activated receptor-γ part of the missing link?

BACKGROUND Growing evidence points to a causative relationship between altered activity of peroxisome proliferator-activated receptor γ (PPARγ) and psoriasis on the one hand, and its relationship with metabolic syndrome (MS) on the other. OBJECTIVE Could altered PPARγ levels be one of the culprits responsible for translating the metabolic state among psoriatic patients? MATERIALS AND METHODS This investigational cross-sectional study included 60 psoriatics and 60 controls. Subjects were subgrouped according to the presence or absence of MS. Biopsies were taken from all subjects for immunohistochemical staining for PPARγ and western blot technique was carried out. RESULTS PPARγ immunostaining in psoriatics was significantly lower than in controls with the lowest levels documented in patients with MS (P<0.001). PPARγ immunostaining level was significantly lower in diabetics, hypertensive and insulin resistance patients (P<0.05). It also showed a significant positive correlation with high density lipoprotein (HDL) levels and significant negative correlation with age, psoriasis area and severity index (PASI), body mass index, and blood glucose levels. Similar results were obtained by western blot technique. CONCLUSION Reduced PPARγ could be added to the factors responsible for translating the metabolic state among psoriatic patients. PPARγ agonists can present an adjuvant therapeutic tool in treatment of psoriatics with MS.

Increased tissue leptin hormone level and mast cell count in skin tags: a possible role of adipoimmune in the growth of benign skin growths.

BACKGROUND Skin tags (ST) are common tumors. They mainly consist of loose fibrous tissue and occur on the neck and major flexures as small, soft, pedunculated protrusions. Decrease in endocrine, hormone level and other factors are thought to play a role in the evolution of ST. Leptin is an adipocyte-derived hormone that acts as a major regulatory hormone for food intake and energy homeostasis. Leptin deficiency or resistance can result in profound obesity and diabetes in humans. A role of mast cell in the pathogenesis of ST is well recognized. AIMS To investigate the role of leptin in the pathogenesis of ST and to clarify whether there is a correlation between mast cell count and leptin level in ST. METHODS Forty-five skin biopsies were taken from 15 patients with ST. From each patient, a biopsy of a large ST (length >4 mm), a small ST (length <2 mm) and a normal skin biopsy (as a control) were taken. The samples were processed for leptin level. Skin biopsies were stained with hematoxylin and eosin and toluidine blue-uranyl nitrate metachromatic method for mast cell count was used. RESULTS There was a significant increased level of leptin in the ST compared to the normal skin. It was highly significant in small ST than in big ST (P = 0.0001) and it was highly significant in small and big ST compared to controls, P = 0.0001 and P = 0.001, respectively. There was a significant increase in mast cell count in the ST, which did not correlate with the increased levels of leptin. CONCLUSION This is the first report to demonstrate that tissue leptin may play a role in the pathogenesis of ST. The significant increase in the levels of leptin and mast cell count in ST may indicate a possible role of adipoimmune in the benign skin growths.