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   2018| July-December  | Volume 38 | Issue 2  
    Online since August 17, 2018

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Becker’s nevus on face with asymmetric hair growth and acne: a rare case
Riti Acharya, Jayamani Shrestha
July-December 2018, 38(2):92-94
Becker’s nevus (BN), a cutaneous hamartoma, is usually seen in the upper half of the trunk during puberty. Location of BN at other sites is an exception. The theory of somatic mosaicism and androgen sensitivity supports the origin and characteristics of BN. Here, we report an interesting and unusual case of BN on face with asymmetric growth of beard and acne on the same with complete absence of hair on other side of the face. The author aims to highlight a rare clinical presentation of common condition and the first of its kind from Nepal.
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Clinicoepidemiological analysis of patients with oral mucosal lesions attending dermatology clinics
Mohammed Abu El-Hamd, Soha Aboeldahab
July-December 2018, 38(2):73-79
Background/Objectives The prevalence of oral mucosal lesions (OMLs) has a wide variety in different regions of the world. This study aimed to assess the prevalence, clinical presentations, and associated risk factors of OMLs among patients treated at Outpatient Clinics of the Dermatology, Venereology, and Andrology Department, Faculty of Medicine, Sohag University, Egypt. Patients and methods This observational study included all patients with OMLs among patients treated at the Outpatient Clinics of the Dermatology, Venereology, and Andrology Department, Faculty of Medicine, Sohag University, Egypt, from January 2016 to June 2016. Patients underwent complete history taking, and general and local oral cavity examination. The OMLs were examined and diagnosed according to the WHO 1995 criteria. Results Of the patients, 125 (2.6%) were diagnosed with different clinical types of OMLs (66 men and 59 women; mean age 28.59±14.8 years). Of these, 43 (34.4%) patients had a positive history of smoking. The most common types of OMLs were recurrent aphthous stomatitis (n=28, 22.4%), oral candidiasis (n=15, 12%), Behcet’s disease (n=12, 9.6%), recurrent herpes labialis (n=12, 9.6%), and oral lichen planus (n=7, 5.6%). Conclusion The prevalence and distribution of OMLs were elucidated at Sohag University Hospital, Upper Egypt and the importance of smoking in the pathogenesis of OMLs was evidenced.
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Evaluation of macrophage migration inhibitory factor in patients with alopecia areata before and after the treatment
Shereen Farouk Gheida, Ghada Abdel-Moemen Soliman
July-December 2018, 38(2):52-58
Background Alopecia areata (AA) is a common disease affecting the anagen phase of the hair follicles. It is considered as an autoimmune disorder. Many cytokines play a role in its pathogenesis; one of these cytokines is macrophage migration inhibitory factor (MIF). Aim The aim of this study was to evaluate the MIF level to elucidate its role in the pathogenesis of AA. Patients and methods This study included 50 patients with AA and 30 normal healthy individuals who served as the control group. Serum MIF levels were evaluated by enzyme-linked immunosorbent assay in patients (before and after the treatment) and in the controls. The clinical severity of the disease was done using severity of alopecia tool scoring system and it was correlated with the serum MIF levels. Results There was a statistically significant increase in the serum MIF level in patients before the treatment, compared to the controls. In addition to this, a significant elevation in its level was found before than found after the treatment. There was a positive significant correlation between the MIF level and both duration of the disease and its clinical severity, whereas there was a negative significant correlation between MIF level and the age of the patients. Conclusion Macrophage MIF plays an important role in the etiopathogenesis of AA as it is increased in patients when compared to the controls and in patients before than after the treatment. So, it could be considered as a prognostic factor for disease severity and might be a potential new target as a future therapy.
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Evaluation of the effectiveness of erbium yttrium–aluminum–garnet fractional laser, carbon dioxide therapy and platelet-rich plasma in treating striae distensae
Enas A.M. Mahrous
July-December 2018, 38(2):65-72
Objective This study aims to compare the efficiency of erbium: yttrium–aluminum–garnet (Er: YAG) laser, carboxytherapy, and platelet-4rich plasma (PRP) in the treatment of striae distensae. Background Striae distance or striae distensae are common dermal scars characterized by flattening and atrophy of the epidermis, and result in considerable aesthetic concern. Patients and methods The study was conducted on 60 female patients with striae in the area between the diaphragm and the knee, whose ages ranged between 16 and 50 years. Cases were collected from the inpatient and outpatient dermatology clinics, Shebin El-Kom Teaching Hospital, in the period from October 2016 to April 2017. Detailed history, and full general and dermatological examination were done; photography and CO2 injection were performed on 20 patients (group A), while PRP injection was done to the resting 20 (group B), and 20 patients were treated by Er: YAG laser (group C). All the potential side effects were discussed with all patients’ group prior to their participation. Results The mean age of the patients was 26.39±11.51 years. The most common sites affected by striae distensae were the abdomen, thighs and the hips. There was no significant difference regarding the patients’ skin type, duration of striae, and the result at the end of treatment sessions (P>0.05). However, there was a statistically significant difference (P<0.05) regarding the color of striae (P=0.036) and width of striae (P=0.023). Additionally, highly statistically significant (P=0.001) difference was obtained between the studied maneuvers regarding the type of pain and the modality of treatment and the improvement degree (P=0.00). The overall patient’s satisfaction after the end of the eighth session of carboxytherapy and the fourth session of PRP and the sixth session of Er: YAG laser was evaluated. The Er: YAG laser has an upper hand on carboxytherapy and PRP injection in the treatment of striae distensae regarding the results and patient’s satisfaction. Conclusion The clinical improvement of striae distensae can be obtained with the use of the Er: YAG fractional laser. The results of this study demonstrated the safety and efficacy as well as low-incidence side effects of Er: YAG fractional laser in the treatment of striae distensae as compared with CO2 and PRP. So, more randomized, controlled studies are needed to further evaluate the efficacy of lasers for the treatment of striae distensae among different skin types and different ages.
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Serum interleukin-6 and interferon-γ in patients with leprosy
Essam Nada, Moustafa El Taieb, Hanan Fayed, Hasan Ibrahim, Yasmin Yasin
July-December 2018, 38(2):80-84
Background Leprosy is a chronic infectious disease caused by Mycobacterium leprae and manifested by an immunological and clinical outcome, ranging from borderline lepromatous and lepromatous infections to tuberculoid and borderline tuberculoid infections. Cytokines such as interleukin (IL)-6, IL-10, interferon-γ (IFN-γ), and tumor necrosis factor-α are associated with leprosy. Objective The aim was to assess IL-6 and IFN-γ in untreated patients with leprosy and compare these levels with those in healthy controls and with different parts of the disease spectrum. Patients and methods A case–control study was conducted on 90 untreated patients with leprosy and 30 healthy controls randomly selected from patients attending the Dermatology and Leprosy Hospital, Qena Governorate, Egypt. The patients were classified into tuberculoid, borderline tuberculoid, borderline-borderline, borderline lepromatous, and lepromatous (LL). IFN-γ and IL-6 were measured by enzyme-linked immunosorbent assay technique. Results IL-6 and INF-γ were significantly higher in the patients than in the control group, with P value of 0.001 and 0.002, respectively. Regarding the serum level of INF-γ in all types of leprosy, there was a statistically significantly increase in paucibacillary leprosy and a nonsignificant increase in multibacillary leprosy; on the contrary, the results showed that serum level of IL-6 was statistically significantly increased in multibacillary leprosy and nonsignificantly increased in paucibacillary leprosy. Conclusion This study concluded that INF-γ and IL-6 may have a significant role in classifying various forms of leprosy and can be used as leprosy disease markers to predict the course and the prognosis of the disease.
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Immunohistochemical study of interleukin-31 in patients with atopic dermatitis
Tarek E Amin, Nashwa N Elfar, Fersan A Sallam
July-December 2018, 38(2):59-64
Background Atopic dermatitis (AD) is a common chronic inflammatory skin disease of unknown etiology. Reduction of pruritus as one of the hallmarks of AD is the most effective therapeutic strategy for improving quality of life and for preventing aggravation of skin lesion. Interleukin-31 (IL-31) has been suggested to play a role in pathogenesis of AD through itch stimulation and correlation with development of pruritus. Aim The aim of this work was to study the immunohistochemical expression of IL-31 in skin lesions of patients with AD. Patients and methods The current study comprised 20 patients with AD. The severity of AD was assessed according to Six Area, Six Sign Atopic Dermatitis score. From the patients, 3-mm punch biopsy specimens were taken from lesional skin and nearby apparently normal skin to serve as control. Histopathological examination and immunohistochemical staining for IL-31 were done. Results IL-31 expression was significantly increased in lesional skin of patients with AD in comparison with nearby apparently normal skin of the same patients. IL-31 expression in the lesional skin of patients with AD showed a significant positive correlation with severity of the disease evaluated by Six Area, Six Sign Atopic Dermatitis score. Conclusion IL-31 expression was increased in the lesional skin of patients with AD compared with control specimens, and it was positively correlated with severity of AD. IL-31 may be a therapeutic target for AD and associated pruritus.
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Ichthyosis and severe acute malnutrition
Ibrahim Aliyu, Sani Mado
July-December 2018, 38(2):95-96
Ichthyosis is a cutaneous disorder characterized by hyperkeratosis of the skin. It is mostly congenital; however, acquired cases have been reported in patients with severe malnutrition. Furthermore, congenital ichthyosis has been associated with micronutrient deficiency such as vitamin D deficiency, resulting in rickets in ∼41% of cases. The two cases reported in this communication were 12 and 11 months old, correspondingly, with congenital lamellar ichthyosis. They had similarly feeding pattern and absence of family history of malnutrition in other siblings, but they developed severe acute malnutrition. The association of congenital ichthyosis with severe acute malnutrition is poorly understood; however, malnutrition has been reported to cause acquired ichthyosis.
  1,269 104 -
Effect of onychomycosis on pulse oximeter
Hülya Nazik, Selçuk Nazik, Feride Ç Gül, Betül Demir, Mehmet K Mülayim
July-December 2018, 38(2):85-88
Objective Onychomycosis causes nail thickness and discoloration of the dorsum of the nail plate. This study was aimed to investigate the effect of discoloration and nail thickness associated with onychomycosis on pulse oximetry measurement. Materials and methods The involvement degree of onychomycosis was determined using onychomycosis severity index (OSI). Two different measurements were recorded by pulse oximetry. The first one was from the nail with onychomycosis, and the second one was from the normal nail of the same hand. Results A total of 93 onychomycosis cases were included in the study. When SpO2 values of white nail color were measured, it was statistically significant higher in the onychomycosis group than the control (P<0.001). On the contrary, in the yellow nail, SpO2 values were lower in the onychomycosis group (P<0.001). Similarly in the brown nail, SpO2 values were lower in the onychomycosis group, but there was no statistically significance (P=0.083). It was determined that there was no statistically significant difference between SpO2 values and OSI (P=0.563). Conclusion As a result, SpO2 values were affected by discoloration owing to onychomycosis. SpO2 values were found lower in patients with moderate and severe OSI, which is related to nail thickness than the control. It was concluded that the discoloration and nail thickness associated with onychomycosis were effective on pulse oximetry measurement.
  1,225 130 -
A case of hyperkeratotic cutaneous leishmaniasis on the hallux: an unusual presentation of American tegumentary leishmaniasis
Marcus H. de S.B Xavier, Sabha Mushtaq, Luiz A.B Pôrto, Ana C.R Fonseca, Moisés S Pedrosa
July-December 2018, 38(2):89-91
Cutaneous leishmaniasis (CL) is endemic in various parts of Brazil and is known for its clinical pleiomorphism in humans. Beyond the classical picture, CL may appear at unusual sites or with atypical morphologies which may elude the diagnosis at first instance. Herein, we report the case of a 48-year-old Brazilian male, who presented with a 2-year history of persistent hyperkeratotic plaque on the left hallux, which turned out to be cutaneous leishmaniasis. The wide variety of cutaneous findings and unusual presentations of CL often pose a diagnostic challenge especially for inexperienced physicians. The objective of this case report is to emphasize on the unpredictability of clinical expressions of CL and to apprise the clinicians of its masquerading potential.
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Erratum: Role of prolactin in activity of systemic lupus erythematosus

July-December 2018, 38(2):97-97
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