Photochemotherapy is considered a key tool for dermatologists in treating numerous, diverse conditions. Accordingly, there is a continuous effort to evaluate the well-settled indications, seek new ones for these lines of treatment, singly or in combination, aiming at better results and fewer side effects. The limitations and risks that photochemotherapy bears and the proper management plans are other fields of interest. In this article we will discuss some of the important clinical research studies in the domain of photochemotherapy published during the past year in an attempt to emphasize the up-to-date recommendations, widen our therapeutic scope, and expand our forthcoming research plans as dermatologists and researchers.

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.

Background Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by intense pruritus with marked exacerbation and remission. α-Melanocyte-stimulating hormone (α-MSH) is a neuropeptide produced at different sites including the skin. It has immunomodulatory and anti-inflammatory properties. However, its role in the etiopathogenesis of AD still remains largely unclear. Objective The aim of this work was to evaluate the plasma level of α-MSH in patients with AD to assess its role in the severity of the disease. Patients and methods This study included 30 patients with AD whose severity of disease was assessed by means of the scoring atopic dermatitis (SCORAD) score, in addition to 18 healthy individuals who served as controls. Blood samples were taken from all patients and controls for detection of plasma α-MSH level by means of the enzyme-linked immunosorbent assay. Results A highly significant increase was found in the mean plasma α-MSH level of AD patients compared with controls. Further, the plasma α-MSH level was significantly positively correlated with the severity of AD. Conclusion T he mean plasma α-MSH level in AD patients was significantly higher than that in normal healthy controls. Moreover, the plasma α-MSH level showed a significant positive correlation with disease severity.

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.

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.

Introduction Psoriasis is a common chronic inflammatory skin condition that varies in severity. Psoriasis is associated with the complex disorder of metabolic syndrome, which incorporates hypertension, dyslipidemia, obesity, and impaired glucose tolerance, and the association is stronger for severe psoriasis compared with mild psoriasis. Adipose tissue is an important endocrine organ; it secretes several hormones and cytokines that are involved in the metabolic syndrome. Visfatin is a 52-kDa protein secreted primarily by visceral fat. Various cells such as neutrophils, monocytes, macrophages as well as epithelial and endothelial cells might be a source of visfatin after induction with inflammatory stimuli. Aim The aim of this work was to evaluate the serum levels of visfatin in psoriatic patients and its relation to the duration, severity of psoriasis, and BMI. Patients and methods This study was carried out on 40 psoriatic patients and 40 normal healthy control participants. Venous samples were obtained to measure the serum visfatin level using the ELISA technique. Results The serum level of visfatin in the patient group was statistically significantly higher than the serum level of visfatin in the control group. In addition, there was a positive significant correlation between the serum level of visfatin and the PASI score (R = 0.951, P = 0.0001). There was a positive significant correlation between the serum level of visfatin and the duration of psoriasis (R = 0.942, P = 0.0001). Conclusion This study concluded that visfatin is one of the adipokines that may play a role in the pathogenesis of psoriasis and its severity in addition to its role in diseases of the cardiovascular system, which could also explain the relation between psoriasis and cardiovascular complications and their severity in psoriatic patients.

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.

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.

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.

Background Antigliadin antibodies (AGA) are markers of celiac disease (CD). Elevated levels of these antibodies are also seen in many other autoimmune, neurological, hematological, collagen vascular, and cutaneous disorders, even in the absence of clinically overt gastrointestinal disease. The possible relationship between psoriasis and CD has been attributed to the common pathogenic mechanisms of the two diseases. Aim of work The aim of the study was to assess the prevalence of serum level of immunoglobulin A [(IgA); AGA] in psoriatic patients and its correlation with disease severity. Patients and methods This study included 60 patients with psoriasis in whom severity was assessed with the Psoriasis Area and Severity Index (PASI) score, in addition to 30 healthy individuals who served as controls. Blood samples were taken from all patients and controls for detection of serum IgA (AGA) level by means of the enzyme-linked immunosorbent assay. Results A highly significant increase was found in the mean serum level of IgA (AGA) in psoriatic patients compared with controls. The serum level of IgA (AGA) was significantly correlated with the severity of psoriasis and with a history for food intolerance. Conclusion A high serum IgA (AGA) positivity rate was detected in severe psoriatic patients, and therefore these patients are at risk for latent and/or overt CD. Serological evaluation for serum level of IgA (AGA) should be considered in patients with severe psoriasis and a gluten-free diet must be prescribed.

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.

Capecitabine is an oral fluoropyrimidine carbamate and a prodrug of 5- fluorouracil, used in treatment of colorectal and breast carcinoma, which fail to respond to standard chemotherapies. A variety of muco-cutaneous adverse effects has been recognized. The pathogenesis of such manifestations still remains an enigma though various theories have been proposed. We report a case of localized cutaneous hyperpigmentation of the palms and soles secondary to capecitabine in a woman that underwent sigmoidectomy and was in her second cycle of chemotherapy. Since these drugs causing HFS has become commoner in its use in the recent years, due to its relative ease in administration and the relative unawareness of this syndrome among dermatologists makes it a prudent topic to be reported.