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   2014| January-June  | Volume 34 | Issue 1  
    Online since July 24, 2014

 
 
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ORIGINAL ARTICLES
Skin rejuvenation with autologous concentrated platelet-rich plasma
Nancy W Mikhael, Fatma M El-Esawy
January-June 2014, 34(1):5-9
DOI:10.4103/1110-6530.136452  
Objective The aim of this study was to assess the efficacy of autologous platelet-rich plasma (PRP) injection for facial rejuvenation. Patients and methods In a 6-month study, 20 female patients were treated with three sessions of injection with PRP every month from October 2011 to March 2012. Patients received 3 ml of PRP, activated with calcium chloride into face and neck skin. The study was evaluated by comparing the preinjection and postinjection photographs using digital camera, by final patient's satisfaction questionnaire, and by physician's impression. Results A definitive graduated score was found for each patient by adding the final result of each single parameter. Good results were observed in the skin homogeneity and emotional status of the patient without serious side effects. Conclusion PRP had an effective treatment in skin rejuvenation without serious side effects.
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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.
  8,000 655 4
Assessment of fractional CO 2 laser in stable scars
Abdel Aziz I El Taweel, Sherine H Abd El-Rahman
January-June 2014, 34(1):74-80
DOI:10.4103/1110-6530.137317  
Background A variety of modalities have been used and, depending on the scar type, treatment may be invasive and/or conservative. Objective The aim of this study is to assess the safety and efficacy of treating stable nonhypertrophic scars using a fractional carbon dioxide (CO 2 ) laser. Patients and methods This is a prospective study of 25 patients (skin types III-IV, aged 6-37 years) with stable nonhypertrophic scars who underwent at least three sessions with a fractional CO 2 laser at 1-month interval. Side effects as well as improvements in texture, atrophy, and overall satisfaction with appearance were graded on a quartile scale by the patients and investigators after each treatment and 4 weeks after the final treatment. Before-after scores were compared using the Student t-test, with significance assigned to P values less than 0.05. Results All patients showed clinical improvement. There was no significant difference between the assessment of the investigator and the two blinded dermatologists. In terms of patient satisfaction, 32% of patients were not satisfied to slightly satisfied, whereas 68% were satisfied and 20% were very satisfied to extremely satisfied. Side effects were minimal and transient. Conclusion Fractional CO 2 laser treatment represents a safe, well-tolerated, effective, and promising treatment modality for nonhypertrophic traumatic and postinflammatory scars, with minimal downtime and fewer side effects.
  4,490 310 -
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.
  4,106 307 2
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.
  3,820 371 2
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.
  3,822 367 3
Study of oxidative stress in different clinical severities of acne vulgaris
Yehia F El Garem, Rana AM Ahmed, Magdy A Ragab, Abla A AbouZeid
January-June 2014, 34(1):53-57
DOI:10.4103/1110-6530.137313  
Background Acne vulgaris is a multifactorial disease, but recent studies have focused on the role of oxygen free radicals and antioxidant enzymes. Malondialdehyde (MDA) is the end product of lipid peroxidation and is a good marker of free radical-mediated damage and oxidative stress. Superoxide dismutase (SOD) represents the major cellular defense against superoxide anions. Objective The objective of this study was to study the role of oxidative stress in acne vulgaris and to detect a possible link with the different clinical severities. Patients and methods Fifty patients with acne vulgaris and 20 healthy controls were included in this study. The severity of the disease was assessed using the Global Acne Grading System. The levels of SOD in erythrocytes and MDA in plasma were measured using a spectrophotometer. Results Although higher SOD levels and mean values were present in patients, there was no statistically significant difference compared with the controls. MDA levels showed a significant difference between patients and controls (P < 0.05), with MDA being higher in patients, indicating a condition of oxidative stress that had resulted from a high level of lipid peroxidation in acne patients. Comparison of SOD levels in patients showed that patients with severe acne had the lowest levels in comparison with patients with mild and moderate acne (P < 0.001). SOD levels were the highest in patients with mild acne. In terms of MDA levels, patients with severe acne showed the highest plasma MDA levels compared with those with mild and moderate (P < 0.05) acne, suggesting an increase in reactive oxygen species production overwhelming the antioxidant capacity. The lowest MDA levels were observed in mild acne. Conclusion Oxidative stress may play a role in the etiopathogenesis of acne and⁄or the progression of the disease. Coadministration of antioxidant drugs with various lines of treatment of acne might be helpful, especially for those with inflammatory lesions.
  3,344 417 -
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.
  2,843 276 1
Assessment of serum leptin, atherogenic lipids, glucose level, insulin resistance and metabolic syndrome in patients with skin tags
Naglaa F Agamia, Salwa H Gomaa
January-June 2014, 34(1):58-64
DOI:10.4103/1110-6530.137314  
Background Skin tags (STs) are papillomas commonly found on the neck and on the axillae of middle-aged and elderly people. Metabolic syndrome is a complex of interrelated risk factors for cardiovascular disease and diabetes. Epidemiologic studies on different ethnic populations have indicated that hyperleptinaemia and leptin resistance are strongly associated with metabolic syndrome. Aim The aim of the study was to investigate the relationship between serum leptin, homoeostasis model assessment of insulin resistance (HOMA-IR) and atherogenic lipid in patients with STs and to compare them with the levels in healthy controls. Patients This study included 90 participants, 60 ST patients and 30 apparently healthy age-matched and sex-matched controls. Fasting glucose level, insulin level and insulin resistance were estimated in addition to cholesterol, triglycerides, high-density lipoprotein, leptin and HOMA-IR levels. Results The univariate analysis showed that waist circumference, BMI, fasting glucose, insulin levels, insulin resistance, cholesterol, triglycerides, HDL, leptin and HOMA-IR levels were significantly higher in ST patients compared with controls (P < 0.001). The multivariate analysis between metabolic syndrome components and ST showed that only high triglyceride levels and low HDL levels were significantly associated with ST. Multivariate linear regression analysis of the predictors of high plasma leptin levels showed that high triglyceride levels and low HDL levels were significant predictors. Conclusion The results of this study suggested that the presence of both ST and hyperleptinaemia in patients with STs may be associated with high levels of triglycerides and low levels of HDL, and this could suggest that changing the life style of patients with ST may have a beneficial role.
  2,248 256 -
Advances in photodermatology in 2013: part I (preclinical and laboratory research)
Medhat El-Mofty, Wedad Z Mostafa, Rehab A Hegazy
January-June 2014, 34(1):1-4
DOI:10.4103/1110-6530.136451  
Photodermatology is the study of the interaction between light, visible and ultraviolet, and the skin. It is one of the major areas of interest for research. The endless pursuit for profound understanding of its mechanisms of action, the real players involved in delivering its therapeutic effects, and those responsible for its deleterious implications deem 'photodermatology' a constantly developing territory. In the coming review, we will discuss some of the important preclinical and laboratory research studies in the domain of photodermatology published during the past year attempting to highlight the latest achievements and findings.
  2,041 238 -
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.
  2,012 255 1
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.
  2,050 172 1
Chronic idiopathic urticaria: autologous skin tests and treatment
Noha N Dogheim, Shereen F Gheida, Nahla R Ghaly, Amany H Mahmoud Ibrahim, Amany M Abo El-Enein
January-June 2014, 34(1):46-52
DOI:10.4103/1110-6530.137312  
Background Chronic urticaria is defined as urticaria persisting daily or almost daily for more than 6 weeks. It affects 0.1% of the population. Intradermal injection of autologous serum and plasma elicits a cutaneous reactivity in almost 45-60% of patients with chronic idiopathic urticaria (CIU). Activation of coagulation process seems to play an important role in the pathogenesis of CIU. Oral anticoagulant therapy has been shown to be effective in the treatment of CIU. Objective The aim of this study was to evaluate and compare autologous serum skin test (ASST) and autologous plasma skin test (APST) in the diagnosis of CIU and to determine the effect of treatment with antihistamine (loratadine) and anticoagulant (dipyridamole). Patients and methods This study included 30 patients suffering from CIU. All patients were subjected to intradermal testing with their serum (ASST) and their plasma (APST). The patients were classified into three equal groups, according to treatment: 10 patients were treated with loratidine, 10 patients were treated with dipyridamole, and 10 patients were treated with combination of loratidine and dipyridamole for 1 month. Follow-up for the three groups was carried out at the first, second, and fourth week of treatment evaluating the effectiveness and adverse effects of drugs. Assessment of the symptom score reduce index (SSRI) in positive and negative ASST and APST patients was evaluated. Results The ASST was positive in 40% of patients, whereas APST was positive in 90% of patients. Loratadine, dipyridamole, and combination of both were effective in the management of patients with CIU. However, best results occurred with combination of both. No serious side effects of treatment were encountered. Conclusion Both ASST and APST can be used for diagnostic purposes in patients with CIU. APST is superior to ASST in diagnosis of CIU. Combined treatment with antihistamines and anticoagulants provides an effective management of chronic urticaria in positive autologous serum and plasma skin tests patients.
  1,881 201 -
The effect of narrow-band ultraviolet-B phototherapy on soluble intercellular adhesion molecule-1 and soluble E-selectin in psoriasis vulgaris patients
Ahmed A Saleha, Jehan H Sabry, Neveen E Sorour
January-June 2014, 34(1):10-14
DOI:10.4103/1110-6530.137247  
Background Increased levels of soluble E-selectin (sE-selectin) and soluble intercellular cell adhesion molecule-1 (sICAM-1) have been reported in patients with psoriasis vulgaris compared with controls. Objective The aim of this study was to investigate the effects of narrow-band ultraviolet-B (NB-UVB) phototherapy on sE-selectin and sICAM-1 serum levels in patients with psoriasis vulgaris. Patients and methods This case-control study included 30 patients with psoriasis vulgaris and 20 apparently healthy participants as a control group. Both patients and controls were subjected to full history taking, dermatological examination, and measurement of sE-selectin and sICAM-1 using enzyme-linked immunosorbent assay kits. In the patient group, sE-selectin and sICAM-1 were measured after treatment with NB-UVB phototherapy, and the response was assessed by the Psoriasis Area and Severity Index (PASI) score. sE-selectin and sICAM-1 serum levels were compared before and after treatment and correlated with PASI scores. Results In this study, sE-selectin and sICAM-1 serum levels were significantly higher in the patient group than in the control group (P = 0.001 for both). There were statistically significant reductions in sE-selectin and sICAM-1 serum levels after NB-UVB phototherapy (P = 0.001 for both), but still the levels were higher than those of controls. PASI scores significantly decreased after treatment, confirming the efficacy of NB-UVB phototherapy. Both sE-selectin and sICAM-1 serum levels were positively correlated with PASI scores before and after NB-UVB phototherapy (P = 0.001 for both). Conclusion The present study emphasizes the complex nature of the roles played by cell adhesion molecules in the immune-pathogenesis of psoriasis and the effect of NB-UVB phototherapy on their values in relation to the PASI score. Also, results of this study provide a rationale for the possible application of sE-selectin and sICAM-1 measurements as biomarkers of psoriasis activity and predictors of possible exacerbation.
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