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ORIGINAL ARTICLES
Skin manifestations in Egyptian diabetic patients: a case series study
Eman M Sanad, Mona M ElFangary, Neveen E Sorour, Noha M ElNemisy
December 2013, 33(2):56-62
DOI:10.4103/1110-6530.123941  
Background Skin manifestations in diabetes mellitus (DM) are quite common. Skin changes can manifest in the prediabetic stage, in the acute metabolic situation and in the late diabetic degenerative stage. Objective To study the prevalence and the pattern of cutaneous manifestations among diabetic patients to aid in better management of diabetic skin diseases. Patients and methods One hundred patients with DM having at least one skin manifestation were selected and subjected to a detailed dermatological and systemic examination, and the findings were recorded. Blood samples were obtained for random blood glucose level. Results The most prevalent findings were cutaneous infections (40%), followed by pruritus (11%), local reactions at the site of insulin injection (8%), vitiligo (8%), diabetic dermopathy (7%), periungual telangectasia (6%), and xanthelasma (5%). The prevalence of skin manifestations was higher as the duration of diabetes increased and was more in type II than in type I diabetic patients. Conclusion The early detection of skin manifestations in DM is of prime importance to be able to avoid and/or properly manage the complications and prevent disability.
  4 3,119 330
Serum levels of homocysteine, vitamin B12, and folic acid in vitiligo
Hanan H Sabry, Jehan H Sabry, Hala M Hashim
January-June 2014, 34(1):65-69
DOI:10.4103/1110-6530.137315  
Background Vitiligo is an acquired depigmenting disorder. The exact etiopathogenesis of vitiligo is not fully understood. Vitamin B12 and folic acid levels are decreased in vitiligo, which are important cofactors required for the metabolism of homocysteine (Hcy). Consequently, the Hcy level increases in the circulation. Therefore, it is possible that increased Hcy plays a role in the destruction of melanocytes. Objective To determine the role of Hcy, vitamin B12, and folic acid in the pathogenesis of vitiligo. Patients and methods Thirty-five patients of both sexes with vitiligo and 35 age-matched healthy controls were included in the study. After excluding factors that may affect serum Hcy levels, blood samples from patients and controls were obtained for Hcy, vitamin B12, and folic acid determination by an enzyme immunoassay. Results The mean serum level of Hcy was significantly higher in patients with vitiligo than in the controls (17.77 ± 7.72 vs. 11.81 ± 3.41 μmol/l; P < 0.05), whereas the mean level of vitamin B12 was lower in patients with vitiligo than in the controls (208.64 ± 66.73 vs. 304.7 ± 89.9 pg/ml; P < 0.05). There was no statistically significant difference in the folic acid level in patients and controls (8.42 ± 2.06 vs. 9.39 ± 2.38 ng/ml; P > 0.05). Conclusion Elevation of serum Hcy level might be a precipitating factor for vitiligo in predisposed individuals. Hcy level may represent a new biomarker of the extent of vitiligo. Elevation in Hcy is associated with relative deficiencies of vitamin B12, suggesting that aggressive supplementation may benefit vitiligo patients.
  4 8,000 655
Androgenetic alopecia as an early marker for hypertension
Fatma M El-Esawy, Sherine H Abd El-Rahman
December 2013, 33(2):63-66
DOI:10.4103/1110-6530.123946  
Background and objectives The relationship between androgenetic alopecia (AGA) and cardiovascular diseases has been studied by some authors in the past, although the results of epidemiological studies have been variable. The objective of this study was to determine the prevalence of hypertension and aldosterone level in male patients with AGA. Patients and methods Sixty men were enrolled in this case-control study, 30 with a diagnosis of AGA and 30 control participants who consulted for other skin conditions. They were recruited from the outpatient clinic of the Dermatology and Andrology of Benha University Hospital. Data were collected included, age, AGA score with Ebling score (I-V), serum aldosterone and serum testosterone level, blood pressure or history of hypertension, smoking, family history of AGA, and treatment. Results Patients with AGA showed significantly higher aldosterone levels and blood pressure values (P < 0.05) versus controls. However, there was no statistically significant difference between patients and controls in the serum testosterone level. Conclusion Blood pressure screening of patients with AGA will enable earlier diagnosis of an unknown hypertension and initiation of appropriate treatment. Moreover, determination of aldosterone levels can enable early detection of individuals at risk and initiation of preventive treatment before cardiovascular disease becomes established.
  3 3,440 330
Possible association of female-pattern hair loss with alteration in serum 25-hydroxyvitamin D levels
Hoda Moneib, Ghada Fathy, Alaa Ouda
January-June 2014, 34(1):15-20
DOI:10.4103/1110-6530.137254  
Background Female-pattern hair loss (FPHL) is the most common cause of diffuse hair loss in women. A possible role of non-androgen-dependent mechanisms was suggested. The association between serum 25-hydroxyvitamin D [25-(OH)D] and other hair 0 diseases such as male androgenetic alopecia, telogen effluvium, and alopecia areata has been indicated. Objective The aim of this study was to evaluate the association of altered serum 25-(OH)D levels in women with FPHL. Patients and methods We studied serum 25-(OH)D concentrations among 60 FPHL patients aged from 20 to 35 years in comparison with 60 healthy female controls matched for age, skin phototype, socioeconomic status, and outdoor exposure. Measurements were conducted by the radioimmunoassay technique. Results The mean serum 25-(OH)D level was significantly lower in FPHL patients (14.2 ± 7.31 ng/ml) than in controls (45.90 ± 18.83 ng/ml; P = 0.0001). There was no significant difference between patients with family history and those without family history regarding the mean vitamin D level (15.23 ± 7.56 and 13.6 ± 7.17 ng/ml, respectively; P = 0.363). A significant difference was found between the three Ludwig's degrees regarding the mean vitamin D level (12.96 ± 7.52, 14.16 ± 5.68, and 25 ± 5.35 ng/ml, respectively): between degrees I and III and between degrees II and III. Limitations This is a case-control study that supports the hypothesis of an association between vitamin D and FPHL, but does not establish a causal relationship. Conclusion Alteration in the serum 25-(OH)D level, being deficient or insufficient, might play a possible role in the pathogenesis of FPHL.
  3 3,822 367
Significance of topical propolis in the treatment of facial acne vulgaris
Basma M Mohammad Ali, Naglaa F Ghoname, Abeer A Hodeib, Marwa A Elbadawy
January-June 2015, 35(1):29-36
DOI:10.4103/1110-6530.162468  
Background Acne is a common skin disorder affecting the pilosebaceous unit, arising commonly during adolescence and causing psychological stress. The pathogenesis of acne is attributed to multiple factors. Clinically, it is characterized by the presence of comedones, inflammatory papules, pustules, and sometimes nodules and cysts. Propolis has been attracting the attention of researchers because of its antimicrobial, antioxidant, antiviral, and antifungal properties. Objectives The aim of this study was to evaluate the clinical and bacteriological significance of topical propolis extracts in the treatment of facial acne vulgaris. Patients and methods This study included 40 patients with facial acne vulgaris. The patients were classified into two groups: group I included 20 patients who were treated with a topical solution of ethanolic extract of propolis, and group II included 20 patients who were treated with a topical solution of ethanol only and served as the control group. Patients were evaluated clinically to assess the efficacy of therapy after treatment. Bacteriological examination was carried out before and after treatment to assess the antimicrobial effect of propolis. Results There was a highly significant clinical efficacy of topical solution of ethanolic extract of propolis in the treatment of acne vulgaris. There was a highly significant bacteriological efficacy of topical solution of ethanolic extract of propolis on gram-positive aerobic (Staphylococcus epidermidis) and gram-positive anaerobic bacteria (Propionibacterium acnes). Conclusion Topical propolis is a promising, effective, well-tolerated, safe, and alternative medication for acne vulgaris. It has anti-inflammatory and antibacterial properties. Further studies are needed for its application in different skin diseases.
  3 9,273 644
Quality-of-life assessment in pemphigus vulgaris in Upper Egypt using the Dermatology Life Quality Index and SF-36 questionnaires
Hanan Morsya, Amira A Abdel-Motaleba, Asmaa MA Solimanb
January-June 2016, 36(1):1-3
DOI:10.4103/1110-6530.194152  
Background Autoimmune bullous dermatoses are characterized by recurrent painful erosions in the mucus membranes and blisters all over the body. The objective of this study was to evaluate quality-of-life and mental health status in patients diagnosed as having pemphigus. Patients and methods A total of 40 patients with pemphigus were recruited from the Dermatology Clinic, Assiut University Hospitals, Egypt. They were assessed clinically, and then the Dermatology Life Quality Index (DLQI) was determined and SF-36 questionnaires were administered to patients. Results Of the 40 patients, there were 14 male and 26 female patients. Range of the DLQI for male patients was 8.0–22.0 and that for female patients was 3.0–27.0. The DLQI showed a significant correlation with surface area measured (P=0.048). Conclusion These results suggest that the DLQI and SF-36 can be very useful tools in assessing the outcome criteria for clinical studies of patients with pemphigus. Patient’s quality-of-life is much impaired with this type of disorders.
  2 1,383 317
A retrospective study of the clinical, histopathological, and direct immunofluorescence spectrum of immunobullous disorders
Viraktamath Chanabasayya, Jayaraman Jyothi, Martis Jacintha, Dandekeri Sukumar
July-December 2017, 37(2):62-68
DOI:10.4103/ejdv.ejdv_3_17  
Context Immunobullous disorders are a heterogenous group of dermatoses with a variety of frequently changing manifestations. They have remarkable impact on the patients and their family, and have severe economic consequences. The diseases have been the subject of intensive investigation in recent years. Aim The aim of this study was to investigate the clinical spectrum of immunobullous disorders and to analyze the correlation between clinical, histopathological, and direct immunofluorescence (DIF) diagnosis in immunobullous disorders of the skin. Patients and methods This cross-sectional, descriptive, chart-based, retrospective study was conducted on 91 clinically suspected immunobullous disorder patients who attended the Outpatient Department of Dermatology, Father Muller Medical College, Mangalore, Karnataka, India, between 1 January 2015 and 31 October 2016. Results In 91 cases of suspected immunobullous disorders (50 male and 41 female), bullous pemphigoid was the most common condition (46.15%), followed by pemphigus vulgaris (18.68%) and pemphigus foliaceus (10.98%). Of the 91 patients, histopathological diagnosis was positive in 67 (73.62%) patients and DIF was confirmatory in 55 (60.44%) patients. Conclusion We recommend that clinical, histopathological, and DIF features be taken into consideration to arrive at final diagnosis in immunobullous disorders, as these methods may not be diagnostic individually in each and every case.
  2 1,751 270
Evaluation of reactive oxygen species (ROS) and DNA integrity assessment in cases of idiopathic male infertility
Hassan A Khodair, Tarek Omran
December 2013, 33(2):51-55
DOI:10.4103/1110-6530.123932  
Background Studies suggest that reactive oxygen species (ROS) attack the integrity of DNA in the sperm nucleus by causing base modifications, DNA strand breaks, and chromatin cross-linking. Sperm DNA damage analysis may reveal hidden sperm DNA abnormalities in infertile men with normal standard semen analysis values who were diagnosed with idiopathic infertility. Aim of the work We explored the levels of ROS and their correlation with sperm DNA damage in patients with idiopathic male infertility. Patients and methods A total of 93 men were included in this study. Among them, 68 presented to our Andrology outpatient clinic with idiopathic infertility and were selected, and 25 were healthy fertile men, who were assigned to the control group. Both groups were subjected to the following laboratory investigations: semen analysis including peroxidase test, measurement of ROS levels by chemiluminescence assay, and sperm DNA damage assessment by terminal deoxyribonucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL). Results There were no significant differences in the semen parameters between idiopathic infertile men and controls. However, ROS and sperm DNA damage levels were significantly higher in idiopathic infertile men compared with controls ( P ͳ 0.001). In addition, the results showed a strong positive correlation between ROS levels and the percentage of sperm DNA damage ( P ͳ 0.001). Conclusion Traditional semen analysis does not reveal seminal defects at the molecular level that might be induced by ROS. Therefore, our results suggest that standard semen analysis should be coupled with measurement of ROS and assessment of DNA integrity in cases of idiopathic male infertility as even sperms with normal morphology and motility may harbor DNA damage.
  2 3,606 411
Testicular function in male patients with lepromatous leprosy
Faten A Abd-Elkawi, Seham A Bahgat, Abeer M Kamel, Asmaa S Farag, Omima M Ashor
January-June 2014, 34(1):41-45
DOI:10.4103/1110-6530.137307  
Background Leprosy is a chronic granulomatous infectious disease affecting mainly the skin and peripheral nerves. Testicular affection with leprosy occurs mainly in the lepromatous type. Objective The aim of the study was to investigate testicular function and potential infertility in male patients with lepromatous leprosy. Patients and methods This study included 40 patients and 40 healthy, age-matched and sex-matched controls. All participants were subjected to careful history taking, dermatological and genital examination, complete blood count, liver and renal function tests, complete urine analysis, assessment of follicular stimulating hormone (FSH), luteinizing hormone (LH), testosterone levels, and semen analysis. Results There was statistically significant difference between patients and controls regarding history, sexual examination, hormonal profile, and sperm count, with high mean FSH and LH hormonal levels among patients and high mean testosterone levels and sperm count among controls. There was statistically significant difference between patients with history of erythema nodosum leprosum and patients without history of erythema nodosum leprosum regarding sexual examination, hormonal profile, and sperm count. There was strong positive correlation between disease duration and hormonal levels of FSH and LH and strong negative correlation between disease duration and hormonal levels of testosterone and sperm count. Conclusion Lepromatous leprosy causes a pattern of primary testicular failure.
  2 4,106 307
Prevalence of cutaneous manifestations in chronic renal failure patients on regular hemodialysis: a hospital-based study
Eman M Sanad, Neveen E Sorour, Wael M Saudi, Afaf M Elmasry
January-June 2014, 34(1):27-35
DOI:10.4103/1110-6530.137278  
Background Chronic renal failure (CRF) presents with an array of cutaneous manifestations. Newer changes are being described since the advent of hemodialysis (HD), which prolongs life expectancy, providing time for these changes to manifest. Objective The aim of this study was to estimate the prevalence and pattern of cutaneous manifestations among patients with CRF on regular HD. Patients and methods This case-series study included 100 patients with CRF on regular HD. They were subjected to a full assessment of history, and general and dermatological examinations of the skin, hair, nails, and oral mucosa. Results All patients included in this study had at least one cutaneous manifestation attributed to CRF. The most prevalent finding was xerosis (72%), followed by pruritus (52%) and hyperpigmentation (44%), whereas purpura (2%) and bullous dermatosis (1%) were the least detected. Oral changes included xerostomia (46%), macroglossia with teeth markings (43%), fissured tongue (17%), ulcerative stomatitis (11%), and angular cheilitis (6%). The most common nail changes were absent lunula (61%), half and half nail (41%), and koilonychia (29%). Hair changes included sparse scalp hair (48%), sparse body hair (41%), and brittle and lusterless hair (39%). Hypertension and diabetes mellitus were the most common causes of CRF (53 and 18%, respectively). Conclusion Every CRF patient on HD had at least one cutaneous manifestation, which may appear before or after HD. The most common cutaneous manifestations were xerosis, pruritus, hyperpigmentation, xerostomia, macroglossia, absent lunula, half and half nail, sparse scalp hair, and sparse body hair.
  2 3,820 371
REVIEW ARTICLE
Immunotherapy of viral warts: myth and reality
Mohamed El-Khalawany, Dalia Shaaban, Soha Aboeldahab
January-June 2015, 35(1):1-13
DOI:10.4103/1110-6530.162451  
Immunotherapy has become one of the most important therapeutic tools for the treatment of warts. At present, immunotherapy for warts is usually limited to recalcitrant lesions that are not responding to conventional therapy. Although there are a lot of immunotherapeutic regimens, a minority seem to be really effective. Moreover, there is a lack of evidence-based data on their effectiveness. Common immunotherapeutic modalities used for the treatment of warts include contact sensitizers, imiquimod, intralesional interferon, and oral drugs such as levamisole, cimetidine, and zinc sulfate. Intralesional antigens such as MMR (measles, mumps, and rubella) vaccine, skin test antigens (mumps, Candida, and Trichophyton), BCG (bacillus Calmette-Guιrin) vaccine, and Candida antigen were reported as successful treatment modalities in various forms of warts. Moreover, intradermal injection of some vaccines such as purified protein derivatives was also reported as a successful regimen for the treatment of genital warts. Among the available options for treatment of warts, none is uniformly effective or viricidal. Moreover, in most cases their safety and efficacy has not been assessed in double-blind, controlled clinical trials, and thus the reproducibility of many of the listed treatments is difficult to evaluate and a possible placebo effect cannot be ruled out. In this report, the various forms of immunotherapy for warts are discussed and each regimen is evaluated in order to assess the efficacy of each form of treatment.
  2 27,743 1,431
ORIGINAL ARTICLES
Prevalence of metabolic syndrome in psoriatic arthritis compared with psoriasis: a cross-sectional study in a South Indian population
Neema Mohammed Ali, Kuruvila Maria, Unnikrishnan Bhaskaran
January-June 2015, 35(1):20-22
DOI:10.4103/1110-6530.162226  
Objective The objective of this study was to assess and compare the prevalence of metabolic syndrome (MetS) in patients with psoriasis (PsO) and in those with psoriatic arthritis (PsA). Materials and methods This was a cross-sectional study with no follow-up and was performed among outpatients attending the speciality clinics of an institutional tertiary referral centre. A consecutive sample of 100 patients with PsO was included in the study. Height, weight, BMI, blood pressure and waist circumference of patients were measured at the time of enrolment. Venous samples were taken after 8 h of overnight fasting for the estimation of serum cholesterol, triglycerides and plasma glucose levels. Results MetS was seen in 62.9% (17) of patients with PsO and in 32.8% of patients with PsA. This difference was statistically highly significant (P < 0.001). Conclusion MetS is common in Asian Indian patients with PsA than in patients with cutaneous PsO only.
  1 1,668 208
Tumor necrosis factor α promoter −308G/A polymorphism in patients with patchy alopecia areata
Mahira H El Sayed, Al-Hasan M El-Hefnawy, Faten SH Al-Mashaiky, Shereehan B El Sayed
January-June 2014, 34(1):36-40
DOI:10.4103/1110-6530.137295  
Background Alopecia areata (AA) is a common recurrent inflammatory nonscarring hair loss disease with a worldwide prevalence ranging from 1 to 2%. Although the exact etiology of AA is unknown, there is evidence for both genetic and autoimmune components. Recently, tumor necrosis factor a (TNF-a) promoter −308 polymorphism was suggested to contribute to the pathogenesis of a wide range of autoimmune and infectious diseases. There is a plausible association between TNF-α polymorphism and AA. Objective The aim of the study was to determine TNF-α 308 gene polymorphism in patients with patchy AA. Patients and methods The present case-control study included 20 patients with patchy AA and 20 age-matched and sex-matched apparently healthy controls. TNF-α 308 gene polymorphism was detected by restricted fragment length polymorphism PCR in all of them. Results The mutant TNF-α 308 gene was found in 28.6% of patients with patchy AA and in 4.8% of controls, with statistically nonsignificant difference (P = 0.093). No statistically significant differences were found between patients with normal genotype and those with mutant genotype with respect to age, sex, disease duration, medical associations, family history of autoimmune diseases, or history of previous attacks. Statistically significant difference was found with respect to family history of AA and number of lesions. Conclusion TNF-α 308 gene polymorphism was present in small percentage of patients with patchy AA, with statistically nonsignificant difference from controls.
  1 2,051 172
Role of vascular endothelial growth factor, survivin, and inducible nitric oxide synthase expression in psoriasis: an immunohistochemical study
Ahmed Salem, Amani Nasar, Abdalla Kandil, Randa Farag, Kamal El-Kasheshy
January-June 2014, 34(1):21-26
DOI:10.4103/1110-6530.137262  
Background Psoriasis (PS) is a common chronic, relapsing, immune-mediated disease involving the skin and joints of genetically predisposing individuals. Despite numerous studies, the pathogenesis of PS has not been fully elucidated. However, many pathogenic theories have been suggested. There is much evidence that PS is a polygenic disease modified to expression by triggering factors. PS is characterized by hyperproliferation and abnormal differentiation of epidermal keratinocytes, lymphocyte infiltration consisting mostly of T lymphocytes, and various endothelial vascular changes in the dermal layer, such as angiogenesis, dilation, and high endothelial venule formation. Vascular endothelial growth factor (VEGF) is a major regulator of physiological and pathological angiogenesis, causing aberrant angiogenesis and vascular leakage in the upper dermis; it may also contribute to keratinocyte proliferation and epidermal barrier homeostasis in PS. Inducible nitric oxide synthase (iNOS) was found to be expressed in the keratinocytes of psoriatic lesions; in addition, there is increased expression of iNOS-specific mRNA transcripts. Survivin upregulation in psoriatic lesion in comparison with normal skin was evident, suggesting its role in the pathogenesis of PS. The aim of this study was to investigate the immunohistochemical expression of VEGF, survivin, and iNOS in psoriatic skin and to detect their role in the pathogenesis of PS. Patients and methods This study was carried out on 20 patients with PS vulgaris. Immunohistochemical reactions were carried out using the streptavidin-biotin immunoperoxidase system in this study to detect the extent of expression of VEGF, survivin, and iNOS in each specimen of the skin biopsy. Results A strong VEGF expression through the epidermis (mean 46.4 ΁ 19.7) was observed. VEGF was significantly upregulated in psoriatic skin in comparison with normal healthy skin (P < 0.0001). Survivin was significantly upregulated in psoriatic specimen in comparison with healthy controls (P < 0.0001). INOS expression was significantly increased in psoriatic epidermis and dermis compared with healthy skin (P < 0.0001). Conclusion VEGF, survivin, and iNOS appeared to be important factors in the pathogenesis of PS.
  1 2,013 255
Expression of interleukin-17 mRNA in vitiligo patients
Ahmed M Habeb, Al Hassan M Al Hefnawy, Shereen B Elsayed, Amira Abd El-rahman Abo Bkr, Alhasan M Elhefnawy
December 2013, 33(2):67-70
DOI:10.4103/1110-6530.123951  
Background Vitiligo is a specific type of idiopathic acquired or inherited leukoderma which is characterized by patterned/circumscribed hypomelanosis of the skin and hair, with complete absence of melanocytes. The aetiology of vitiligo is unknown, several hypotheses have been proposed to explain its pathogenesis and a convergence theory was proposed which assumes that all hypotheses are not mutually exclusive. In vivo, immunohistochemical studies of perilesional area of active lesions in generalized vitiligo mainly detects predominant CD8+ and to lesser extent CD4+ T cells in the infiltrate, which express activation molecules such as the skin homing receptor; CLA antigen and the IL-17. IL17 mRNA is up-regulated in the blood of vitiligo patients therefore, it has been suggested as a crucial regulator of vitiligo. Aim of work In this study, we focused primarily on the regulatory pathways and role of IL-17 in vitiligo by determination of the level of expression of IL17 mRNA by Real-time RT-PCR.
  1 2,535 491
Estimation of nitric oxide level in psoriatic patients and its correlation with disease severity
Amany Mahmoud, Rabie Abo-Elmaged, Hanaa Fahmy, Hesham Nada
December 2013, 33(2):71-75
DOI:10.4103/1110-6530.123952  
Background Psoriasis is a genetically determined inflammatory and proliferative disease of the skin. There is now increased evidence for the role of nitric oxide in some diseases, including psoriasis. Nitric oxide is a potent regulator of keratinocyte growth and differentiation and stimulates angiogenesis. Aim This study aimed to detect serum nitric oxide level in active psoriasis patients, to correlate these levels with severity of the disease scored with psoriasis area and severity index, and compare them with those in normal individuals. Patients and methods Twenty-five patients with active psoriasis and 25 age-matched and sex-matched controls were recruited after their written consent was obtained. Patients on local or systemic treatment or with coexisting inflammatory skin disease were excluded. Serum nitric oxide levels were assessed using the Griess method. Results The mean serum nitric oxide levels (95.96 ± 12.7 μmol/l) were significantly higher in active psoriasis patients than that in the healthy controls (27.1 ± 6.85 μmol/l). Conclusion The significantly elevated serum levels of nitric oxide and their positive correlation with the severity of psoriasis may suggest the possible role of this mediator in the etiopathogenesis of the disease, and suggest a potential future therapy for the disease.
  1 3,538 320
Epidemiological study of leprosy in Egypt: 2005-2009
Ahmed Amer, Ali Mansour
January-June 2014, 34(1):70-73
DOI:10.4103/1110-6530.137316  
Background Leprosy is considered a major public health problem because of its capacity to cause permanent disabilities, with the social consequences of discrimination and stigma. In 1991, the World Health Assembly adopted a resolution to eliminate leprosy by the year 2000. Egypt has achieved the WHO goal as early as 1994; however, there are still focal points, especially in Upper Egypt, which have failed to achieve the WHO goal and are reporting higher figures than the national one. Objective The aim of the study was to assess the epidemiological trend of leprosy in Egypt from 2005 to 2009. Materials and methods This is a descriptive study of the National Leprosy Control program registry in Egypt from 2005 until the end of 2009. An analysis of the cases on the basis of the prevalence rate of leprosy, new case detection rates, active case detection among contacts, type of leprosy, and grade of disability was carried out. Results The prevalence rate in the study period is less than one case per 10 000 populations at the national level; however, there were certain foci showing prevalence rate more than one case per 10 000 populations. The disease affected men more than women. Male patients (93.14%) are more common than female patients (6.86%). Multibacillary cases were more common than paucibacillary cases. Grade 2 disability showed an increase from 2005 till 2008 and a decrease in 2009. Conclusion Although Egypt has achieved the WHO goal of leprosy elimination since 1994, yet, the presence of certain foci with prevalence rate more than one case per 10 000 populations reflects the need for more efforts for early case detection.
  1 2,843 276
Serum levels of tumor necrosis factor-α in patients with lichen planus
Abdullah Mahfouz Kato, Doaa Salah Hegab, Mohamed Abd El Rahman Sweilam, Eman Samy Abd El Gaffar
July-December 2014, 34(2):102-106
DOI:10.4103/1110-6530.150261  
Background Lichen planus (LP) is an inflammatory skin disorder of unknown etiology. Tumor necrosis factor-a (TNF-α) is a multifunctional proinflamatory cytokine, which plays an important role not only in immunity and inflammation but also in the control of cell proliferation, differentiation, and apoptosis. Aims The present study was designed to investigate the serum level of TNF-α in patients with LP of different clinical presentations in comparison with healthy participants to study its possible role in the pathogenesis of LP. Patients and methods A total of 30 patients with different clinical variants of LP (16 male and 14 female patients) and 30 controls matched for age and sex were enrolled in this prospective case-control study after exclusion of those who had received treatment for LP or immunological treatment within the preceding 6 weeks, or those whose serum levels of TNF-α were suspected to be elevated because of other causes or diseases. The serum level of TNF-α was measured by means of the ELISA method in both patients and controls. Results The serum TNF-α level was significantly higher (P < 0.05) in patients than in controls, and it was also significantly higher in patients with oral LP than in those with cutaneous types of LP who do not have oral lesions (P < 0.05). The sensitivity and specificity of serum TNF-α was 62.5 and 81.8%, respectively, (cutoff value of 151 pg/ml) for the diagnosis of oral lesions in LP. Conclusion The findings in our study support the role of TNF-α in the pathogenetical process of LP and suggest that markedly elevated serum TNF-α level might be an important indicator of the risk for developing oral lesions in patients with LP.
  1 1,853 232
Serum leptin, retinol-binding protein 4, lipid profile, and carotid intima - media thickness in psoriasis
Ghada A Al-Aziz, Nagla A Ahmed, Amal A El Aleim, Eman G Alsaadawy, Basma El-sayed Risha
July-December 2014, 34(2):114-119
DOI:10.4103/1110-6530.150266  
Background Patients with moderate to severe forms of psoriasis have been found to be at a greater risk of developing comorbidities such as metabolic syndrome and vascular disorders. White adipose tissue is a known source of adipokines and cytokines that can mediate the development of insulin resistance, endothelial dysfunction, and atherosclerosis. The interaction between adipocytokines [such as leptin and retinol-binding protein 4 (RBP4)] and chronic skin and systemic inflammation in psoriasis can be bidirectional. Th1 and Th17 lymphocyte activation in psoriasis is a shared pathway with adipokine activation. Aim Evaluation of serum leptin, RBP4, the lipid profile, and carotid - intima media thickness (CIMT) levels in psoriatic patients as indicators of subclinical atherosclerosis. Patients and methods This study included 45 patients with psoriasis vulgaris compared with 45 age-matched and sex-matched healthy individuals as a control group. Results A highly significant difference was found in the mean leptin (P < 0.001) and the mean RBP4 (P < 0.001) of patients compared with controls. There was a highly significant difference in the mean RT CIMT and in the mean LT CIMT of patients compared with controls. Conclusion Psoriatic patients must be advised to assess their lipid profile, serum leptin, and intima - media thickness routinely in order to predict early cardiovascular morbidity and mortality.
  1 1,360 136
Role of interleukin-23 in the immunopathogenesis of systemic lupus erythematosus
Doaa Salah Hegab, Mohamed Mahmoud Gamei, Wael Mohamed Saudi, Desoky Ezzat Abou Ammo, Mohamed Mohamed El Bedewy, Naglaa Fathy Elhabian
July-December 2014, 34(2):120-125
DOI:10.4103/1110-6530.150269  
Background Systemic lupus erythematosus (SLE) is a complex and multifactorial autoimmune disease. T-helper 17 (Th17) cells are essential modulators for propagation of immune response in several autoimmune diseases. Interleukin-23 (IL-23) is a proinflammatory mediator that is necessary for the development of T-cell-dependent inflammation. IL-23 is essential to expand and maintain Th17 cells. Increased amounts of IL-23 have been associated with several autoimmune diseases. Aims This work aimed to study the alteration in the serum level of IL-23 in patients with SLE in comparison with healthy individuals, and to correlate its serum level with disease activity to speculate on its possible role in the pathogenesis of SLE. Participants and methods Thirty-four adult patients with SLE (31 women and three men) and 30 healthy age and sex-matched controls were included. SLE patients were divided according to SLE disease activity index (SLEDAI) into active and inactive groups. IL-23 serum level was determined for all patients and controls using a quantitative enzyme-linked immunosorbent assay. Results Serum IL-23 concentration was significantly elevated in SLE patients than in the healthy controls (P = 0.001), and it correlated significantly with disease activity (P = 0.001). The median serum IL-23 concentrations were significantly higher in active SLE patients with renal involvement. Conclusion Findings support the presence of an important role of IL-23 in the pathogenesis of SLE. Our results indicate a possible relationship between the elevated serum levels of IL-23 and SLE activity. Marked elevation might be a predictor of renal insult in active cases.
  1 1,771 227
A retrospective study of chromomycosis in a tertiary care institution in South India
Ramesh M Bhat, Asha Ramayivadakayil, Rochelle Monteiro, D Sukumar, MK Srinath
July-December 2014, 34(2):126-129
DOI:10.4103/1110-6530.150272  
Background Chromomycosis is a chronic fungal infection that affects the skin and subcutaneous tissue and occurs mainly following trauma. The most frequently isolated agent is Fonsecaea pedrosoi. Objective The aim of this study was to analyze the various epidemiological, clinical, mycological, and treatment aspects of chromomycosis in coastal Karnataka. Materials and methods This is a retrospective analysis of 20 patients with chromomycosis who attended the dermatology outpatient department of a tertiary care institution in coastal Karnataka, South India, from January 2005 to January 2013. Results The disease was found to be more common in male agricultural workers, especially rubber tappers. The lower limbs were more commonly affected (58%), with verrucous lesion being the most common clinical type. The most common species isolated was F. pedrosoi. Histopathological correlation was present in all cases. A good clinical response was seen in patients treated with potassium iodide who were refractory to terbinafine and fluconazole. Conclusion Chromomycosis mainly affects male agricultural workers, especially rubber tappers. Potassium iodide is an effective alternative for the treatment of chromomycosis, especially in a developing country like India.
  1 1,494 164
Human semen hyperviscosity: prevalence and effects on physical and biochemical semen parameters in subfertile Egyptian men
Zakaria Mahran, Mohammed El-Eraki Saleh
July-December 2014, 34(2):135-139
DOI:10.4103/1110-6530.150276  
Background Semen hyperviscosity (SHV) is a condition that can markedly impair the physical and chemical characteristics of seminal fluid, which leads to an adverse impact on sperm function. The aim of this study was to assess the prevalence of SHV in infertile Egyptian men and to evaluate its effects on physical and biochemical semen parameters, and also to identify any correlation between SHV and infections or inflammation of the genital tract. Participants and methods Semen samples were studied for 300 infertile men; of these, 225 men had normal semen viscosity and were excluded from the study. Seventy-five men with SHV were selected and included in this study. In addition, 25 fertile men with completely normal semen parameters who had recently fathered children were included as a control group. All participants underwent seminal analysis and measurement of seminal plasma fructose, ascorbic acid, calcium, and zinc, in addition to a peroxidase test and polymorphonuclear granulocyte elastase (PMN elastase). Results Our study showed that the prevalence of SHV was 25% in infertile Egyptian men. Sperm motility and sperm vitality, in addition to fructose, ascorbic acid, calcium, and zinc levels, were significantly reduced, whereas PMN elastase levels were significantly increased in samples with hyperviscosity (P < 0.05). There was a strong positive correlation between PMN elastase levels and increasing viscosity. Conclusion Our results showed that hyperviscosity seems to be the result of infection or inflammation in 75% in our cases and hyperviscosity seems not to be because of a single pathogenic factor, but rather because of several (biochemical, enzymatic, and genetic) factors that act in synergy. These factors should be studied further.
  1 6,653 329
Dermatoses in Indian neonates: A clinical study
Noopur Jain, Bhagirath S Rathore, Arvind Krishna
July-December 2014, 34(2):86-92
DOI:10.4103/1110-6530.150255  
Background Neonatal dermatology, by definition, encompasses the spectrum of cutaneous disorders that arise during the first 4 weeks of life. A host of aberrations varying from physiological and transient to grossly pathological are observed in the skin of a neonate. Objective The aim of this work was to study the prevalence of dermatoses in neonates and to establish the correlation between various neonatal factors, maternal factors, and the occurrence of dermatoses. Patients and methods A total of 200 randomly selected live-born neonates delivered and admitted to the postpartum ward, neonates admitted to the Neonatal Intensive Care Unit, and neonates attending the Dermatology Outpatient Department were included in this study. A detailed assessment of history was performed and a detailed dermatological examination of each of the neonates was carried out. Laboratory procedures were performed as required. Results The most prevalent findings were miniature puberty (71%), Mongolian spot (64.5%), lanugo hair (63%), sebaceous gland hyperplasia (62%), erythema toxicum neonatorum (38%), salmon patch (35%), physiological scaling of the newborn (30.5%), milia (27%), miliaria (18.5%), Epstein's pearls (17.5%), and iatrogenic bruises (17.5%). Conclusion A thorough knowledge of the skin changes, physiological as well as pathological, in neonates is of prime importance for the dermatologist as well as pediatrician.
  1 2,901 1,486
Combined cryotherapy and topical 5-fluorouracil for treatment of basal cell carcinoma
Nevien A Samy, Ahmed Sadek
July-December 2014, 34(2):98-101
DOI:10.4103/1110-6530.150259  
Background Cryotherapy (Cryo) and topical 5-fluorouracil (5FU) are both considered as successful noninvasive therapeutic options for basal cell carcinoma (BCC). Objective The aim of the study was to investigate the efficacy of combined Cryo and topical 5FU (Cryo+5FU) in patients suffering from BCC. Design This was a prospective clinical trial with a 6-month follow-up. Duration The study was carried out during a period of 11 months from March 2012 to February 2013. Patients and methods Fifteen patients complaining of BCC were included. Intervention Intervention included combined weekly regimen of Cryo followed after 3 days by twice daily 5FU application for four successive days for a maximum of 6 weeks. Main outcome measures Assessments of clinical improvement by examination, dermatological photography, and skin biopsy were the main outcome. Results All 15 patients achieved complete response with minimal side effects, good cosmetic outcome, and relatively shorter duration of treatment. Conclusion Combined Cryo+5FU offers a new effective modality for treatment of BCC.
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REVIEW ARTICLE
Prevalence of pediculosis capitis among primary school students at Sharkia Governorate by using dermoscopy
Manal M El-Sayed, Mohammed A Toama, Ahmed S Abdelshafy, Abdulla M Esawy, Safaa A El-Naggar
July-December 2017, 37(2):33-42
DOI:10.4103/ejdv.ejdv_47_16  
Background Pediculosis capitis is the infestation of human hair and scalp by head lice. Dermoscopy was used to improve the health of students in Sharkia Governorate by decreasing the prevalence of pediculosis capitis among them. Aim The aim of the present study was to determine the prevalence of pediculosis capitis among primary school students in Sharkia Governorate, find the risk factors associated with this infestation, and to compare the traditional methods in diagnosis of pediculosis capitis with dermoscopy. Participants and methods This study was conducted on 242 students in Sharkia Governorate. Clinical and dermoscopic examinations were carried out for all children. Results Dermoscopic examination of the studied children was as follows: 44.6% of them were free of infestation or dandruff, 17.8% were also free of infestation but showed dandruff, which may be misdiagnosed as nits, and 4.1% showed empty nits only. Thus, the total negative was 162 (66.9%). Only 0.4% of them showed empty nits with dandruff. About 7.4% of them were with empty and filled nits, 21.9% were with filled nits only, and 0.4% of them showed mobile lice. Hence, the prevalence of pediculosis capitis was 33.0% by using dermoscopic examination. Conclusion Prevalence of pediculosis capitis among primary school students in Sharkia Governorate was 33.0% by using dermoscopic examination. Pediculosis capitis was found to be affected by some sociodemographic characteristics as sex, residence, social class, father’s and mother’s education, and some behaviors as combing of hair and sharing tools; moreover, hair length was shown to increase infestation. Overall, dermoscopy was found to be better in diagnosis pediculosis capitis compared with visual examination.
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* Source: CrossRef
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