Acne is now considered a chronic disease and may occur at any age group contrary to previous beliefs. The presentation of acne is polymorphic and can manifest as comedones, papules, pustules, nodules, cysts, sinuses, and varying kinds of scars. It may occur in varied areas of the body. Although the diagnosis of acne is rarely difficult for the dermatologist, the occurrence of acne in different age groups, the pleomorphic lesions, the varying distribution, and its association with various systemic disorders or syndromes may cause difficulties in diagnosis even for an astute clinician. Here, we review various diagnostic possibilities of acne and their differentiating characteristics.

Background Female pattern hair loss (FPHL), also known as female androgenic alopecia, is a common dermatological disorder with a multifactorial pathogenesis. Oxidative status has been implicated in the pathogenesis of several skin diseases, including FPHL. Aim This study was aimed to investigate the levels of oxidative stress biomarkers in patients with FPHL with varying severities. Patients and methods The study involved 56 patients with FPHL and 46 healthy controls. Diagnosis was based on clinical examination and trichoscopic evaluation. Patients were grouped into three subgroups as follows: mild, moderate, and extensive. Oxidative stress was examined by measuring plasma levels of catalase (CAT), superoxide dismutase, total antioxidant capacity, and malondialdehyde (MDA). Results Plasma levels of MDA in FPHL were significantly higher as compared with that of the controls, whereas activities of the antioxidant enzymes superoxide dismutase and CAT were lower. Moreover, total antioxidant capacity was also low in patients with FPHL as compared with that of the controls. Higher MDA levels in the extensive FPHL subgroup as compared with that of the mild and moderate subgroups were also observed. Furthermore, in the extensive FPHL subgroup, a significant negative correlation was observed between MDA and CAT levels. Conclusion The data suggest that oxidative stress plays a key role in FPHL progress, which accelerates hair loss by causing microinflammation and fibrosis. The recognition of the effect of androgens and associated factors on the hair follicle cycle is essential for the development of new and effective treatment methods and may be employed as a biomarker index to assess the disease’s activity and to monitor its treatment.

Background So far, studies have not been performed regarding skin damage owing to protective measures against coronavirus disease 2019 (COVID-19) by health staff in Iran. Therefore, the present study was performed to assess skin damages owing to protecting measures against COVID-19 among health workers in Hamadan City located in the west of Iran. Materials and methods This cross-sectional study was conducted on 273 health staff working in hospitals affiliated to Hamadan University of Medical Sciences. The inclusion criteria were health personnel working in hospitals involved in the care and treatment of patients with COVID-19 in the city of Hamadan. The authors used a researcher-developed questionnaire to gather data. All the analyses were done using Stata version 14-2. P value less than 0.05 was considered as significant. Results The most common skin signs and symptoms of COVID-19 in health staff were dryness, redness, and itch, representing in 83.78, 53, and 40.99% of hospital staff, respectively. All participants used hand disinfectants, with a frequency in the range of 1–5 times in 29.33% and more than 20 times in 19.79% of them. Using a mask for more than 6 h in daily practice was significantly associated with skin dryness (P=0.007), skin redness (P=0.001), scaling (P=0.019), and skin pain (P=0.005). Conclusion The findings showed that the prevalence of skin damages related to using protective equipment is high, and simple interventions may help preserve health workers to care for patients infected by COVID-19.

Background Acne vulgaris (AV) is a chronic inflammatory disease of the pilosebaceous unit characterized by increased sebum production in response to androgens. Adiponectin is a protein expressed in human adipocytes that reduces tissue triglyceride (TG) content. A contradictory relationship was detected between lipid profile and AV. Moreover, dietary glycemic index and glycemic load have been shown to be inversely associated with adiponectin concentrations. Objective We aimed to investigate the relationship between blood lipid profile, serum adiponectin, and quality of food in adolescent patients with AV and its correlation with AV severity. Patients and methods A total of 45 Egyptian adolescent male and female patients with AV were recruited from the Outpatient Clinics of Dermatology of Mansoura University Hospitals (with mean age 19.9 years); moreover, 35 apparently healthy individuals of matched age, sex, and BMI were selected as a control group. Serum adiponectin, total cholesterol (TC), TGs, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were assessed by appropriate kits. Results TC, TG, and LDL were significantly higher and HDL was significantly lower in AV cases when compared with control groups. AV cases showed significantly higher adiponectin concentration when compared with the control group. Adiponectin showed significant positive correlations with female sex, disease grade, TC, LDL, dairy+hyperglycemic food, hyperglycemic+fatty food, and dairy+hyperglycemic+fatty food and a significant negative correlation with HDL. Smoking, dairy+hyperglycemic food, hyperglycemic+fatty food, dairy+hyperglycemic+fatty food, high TC, LDL, and adiponectin were significantly associated with more severe AV. Conclusion Adiponectin and quality of food may play a role in the pathogenesis of AV and may affect its severity.

Introduction Since the discovery of vitamin D (Vit. D) in 1922, a plethora of researches has been conducted on it describing its role in many physiological and pathological processes. Aim This research targeted to assess both seminal and serum Vit. D levels in Egyptian males and to establish the relation between both serum and seminal Vit. D and the age, residence, education, marital and fertility states, and semen parameters of men in our community. Patients and methods A prospective cross-sectional hospital-based study targeted men who attended the andrology clinic during the period from the beginning of May 2019 to the end of August 2019 with various complaints. All participants were subjected to conventional semen analysis using the WHO 2010 as a reference. Both serum and seminal Vit. D levels were assessed using enzyme-linked immunosorbent assay technique. Results The study included 100 male participants. Their age ranged from 20.0 to 50.0 years, with a mean±SD of 34.97±8.37 years. Most of them were from rural areas of Upper Egypt (60 vs. 40% from urban areas). The participants were classified into groups according to semen analysis using the WHO 2010 criteria. Serum Vit. D deficiency, insufficiency, and normal levels were observed in 4, 25, and 71% of participants, respectively. Seminal Vit. D sufficiency and insufficiency were reported in 83 and 17%, respectively. Both serum and seminal Vit. D levels had nonsignificant correlations between their levels and all semen parameters. Conclusion As most Egyptian men are subjected to sunny climate of our country, the prevalence of Vit. D deficiency is low in both serum and seminal fluid. The results of the current study did not support any evidence for the role of Vit. D in semen parameters or male fertility status.

Background Alopecia areata (AA) is an autoimmune form of nonscarring hair loss that may affect any hair-bearing area. It is one of the most common forms of hair loss seen by dermatologists. The serum level of interleukin 15 (IL-15) is elevated in AA; subsequently, IL-15 limits the suppressive effect of regulatory T cells and activates CD8⁺NKG2D⁺ T cells to attack the cells of the hair bulb and initiate AA. Inhibiting IL-15 activity might be a breaking new therapeutic strategy in the treatment of AA. Patients and methods Serum IL-15 levels were measured by an enzyme-linked immunosorbent assay for 30 patients with active AA (group A), 30 patients with stable AA (group B), and 60 healthy participants of age-matched and sex-matched controls (group C). Results Serum levels of IL-15 were significantly increased in patients with AA and showed a significant positive correlation with severity (Severity of Alopecia Tool score) and activity of the disease. Receiver operating characteristics curve detected the validity of serum IL-15 in differentiating patients with AA from controls. The best cutoff point for IL-15 was determined to be more than or equal to 7.66 pg/ml, which was able to predict AA with 98.3 sensitivity and 100% specificity. Receiver operating characteristics curve of IL-15 was also conducted to evaluate the sensitivity and specificity of serum IL-15 as a diagnostic index for discrimination between active and stable AA cases, and the best cutoff point for IL-15 was determined to be more than or equal to 21.2 pg/ml, which was able to predict active AA, with 93.3 sensitivity and 100% specificity. Higher IL-15 levels were associated with prediction of severity and activity of AA. Conclusion Serum IL-15 may represent a new marker for AA diagnosis as well as a predictor of the disease severity and activity.

Background Atopic dermatitis (AD) is a common skin disease that not only severely burdens patients but also their families and society. AD is a chronic inflammatory disease that is usually detected in childhood. Objectives We aim to evaluate the quality of life of parents of children with AD and to crosscheck it with the intensity of the disease. Patients and methods This is a cross-sectional study, where the data of parents of 100 children with AD were collected from the outpatient clinic of the Dermatology, Venereology, and Andrology Department, Assiut University Hospitals, from May 2017 to May 2019. Parents answered the validated Arabic version of the Dermatitis Family Impact (DFI) questionnaire. The disease severity was assessed using the SCORAD index. Results Families of children with severe dermatitis had quite high DFI scores (16.37±3.727) compared with the families of those with dermatitis of moderate intensity (12.10±3.356) and dermatitis of low intensity (8.50±0.707) (P<0.001). It was observed that the impact of dermatitis on families had a positive significant correlation with the degree of intensity of AD (P<0.001, r=0.658). The highest-scoring DFI domains were sleep time, followed by a feeling of tiredness, emotional stability, general life, household work, and expenditure. Conclusion AD directly affects the quality of life of patients’ parents, and the adverse effects on the quality of life are significantly correlated with the disease severity.

Background Onychomycosis is a nail fungal infection that significantly affects the patient’s quality of life. It represents a treatment challenge for dermatologists. Aim The aim was to compare the efficacy of pulse therapy of itraconazole, fluconazole, and terbinafine in the treatment of onychomycosis. Patients and methods Sixty patients clinically and mycologically diagnosed with onychomycosis were included in this study. Patients were randomly divided into three groups: group A received itraconazole (400 mg/day for 1 week/month); group B received fluconazole (300 mg/week); and group C received terbinafine (500 mg/day for 1 week/month). All patients received the treatment for 3 months and were followed up for another 3 months. They were evaluated clinically by photography, mycologically (microscopy and culture), and by the ‘Naildex score questionnaire’. Results The clinical, mycological, and complete cure rates were the highest among group A (80, 70, and 70%, respectively), followed by group C (60, 55, and 55%, respectively) and finally group B (50, 35, and 35%, respectively), with no statistical difference between them. Also, group A showed greater improvement in the nail function index compared with the other two groups. Conclusion Pulse therapy of itraconazole, terbinafine, or fluconazole was effective in the treatment of onychomycosis with increasing patient compliance. The best response was achieved with itraconazole, followed by terbinafine and finally fluconazole.

Background Trappin-2/Elafin is a 9.9 KDa molecule released from its precursor Preproelafin that exists principally in immune cells, skin, the lungs, the vagina, and other organs. Clusterin is a heterodimeric glycoprotein that plays a major role in many biological processes such as interaction with lipids, apoptosis regulation, weakening of complement activation, toxin removal, response to damage, and stress as well as autoimmune damage. Both Trappin-2/Elafin and Clusterin serum levels have been studied in various immunologically mediated dermatological and nondermatological diseases. However, it still unknown whether their circulating levels are altered in pemphigus vulgaris (PV) and whether they play a role in this disease. Objective This study aimed to elucidate the potential link between both Trappin-2/Elafin and Clusterin levels and PV through a quantitative assessment of their serum levels by enzyme-linked immunosorbent assay and also to detect their possible correlations with PV severity using the pemphigus disease area index. Patients and methods Fifty patients with PV and 40 matched healthy controls were enrolled in this study. After a full assessment of history and complete dermatological examination, the severity score was calculated using pemphigus disease area index, and then serum samples were collected and subjected to quantitative measurements of serum Trappin-2/Elafin and Clusterin levels by enzyme-linked immunosorbent assay. Results Serum levels of both Trappin-2/Elafin and Clusterin were significantly higher in the patients than in the controls (P<0.001); still, their levels were not correlated with the severity of the disease. Conclusion The finding indicates that both Trappin-2/Elafin and Clusterin serum levels become elevated in patients with PV; however, the increase is not specific for the disease. None of the markers are correlated with the severity score of PV. Increased Trappin-2/Elafin levels indicate the existence of chronic inflammation, autoimmunity and skin or other system damage. Increased Clusterin levels suggest autoimmune damage, stress or transforming growth factor stimulation.

Background Acne vulgaris (AV) is one of the diseases that are widespread in Egypt. It is a disease that mainly affects the pilosebaceous units of the face, neck, and others. Aim To analyze and assess the role of 25-hydroxyvitamin D levels in serum as well as different vitamin D receptor (VDR) genes (Taq-1, Apa-1, Fok-1, and Cdx-2 polymorphisms) among Egyptian patients having AV. Patients and methods A total of 300 patients with acne and another 300 healthy controls were included in the study. Patients were subdivided into four different groups: group 1 received cholecalciferol 8000 IU/day for 3 months; group 2 applied 1–2 g of topical vitamin D analog for 3 months, group 3 had no treatment, and lastly, group 4 included healthy controls. For all patients, skin manifestations were assessed. Serum 25(OH)₃ D was measured in all participants before and after treatment. Different VDR gene polymorphisms were measured. Results Patients with acne showed a statistically significant decrease in serum 25(OH) D₃ concentration than controls, with P value of 0.001. Regarding VDR polymorphisms (rs731236 for Taq-1, rs7975232 for Apa-1, rs2228570 for Fok-1, and rs11568820 Cdx-2 polymorphisms), the results revealed that there was a statistically significant difference between patients with acne and controls regarding Taq-1 and Apa-1 genotypes, with P values of 0.001 and 0.026, respectively, whereas regarding Fok-1 and Cdx-2 genotypes, the results revealed that there were no statistically significant differences between the studied patients and the controls (P=0.690 and 0.113, respectively). Conclusion Vitamin D and VDR polymorphisms (Taq-1, Apa-1, Fok-1, and Cdx-2) play important roles in AV.

Background Psoriasis is a chronic disease, in which genetic and environmental factors play an important role, but the exact cause is yet unknown. It includes inflammation and increased proliferation of skin cells. MicroRNAs (miRNAs) are small, single-stranded, ∼22-nucleotide-long, noncoding gene-regulatory RNA molecules that inhibit gene expression through translational repression or mRNA turnover. MicroRNA-520 suppresses the mitotic entry and proliferation of keratinocytes. Aim This case–control study is to detect the expression of miRNA-520 in serum samples of diseased patients as compared with normal control persons to investigate the possible role of miRNA-520 in the pathogenesis of psoriasis. Patients and methods This study included 30 psoriatic patients and 30 age-matched and sex-matched healthy controls. Peripheral blood samples for serum miRNA-520 were taken. Blood samples were centrifuged and the serum was stored at 80°C and used for quantitative real-time PCR. Results The expression of miRNA-520 was significantly lower in psoriasis patients as compared with healthy controls. Conclusion MiRNA-520 may play an important role in the pathogenesis of psoriasis; hence, it can be used as a biomarker to evaluate its progression and effect of therapeutic interventions.

Perforating folliculitis is a primary perforating disorder, characterized by the phenomenon of transepidermal elimination. It is associated with various disorders such as psoriasis, juvenile acanthosis nigricans, diabetic mellitus, renal failure, cardiac failure, and malignant neoplasia. Other primary perforating dermatoses are Kyrle’s disease, reactive perforating collagenosis, and elastosis perforans serpiginosa. Among the association of perforating dermatoses with genetic diseases like Down’s syndrome, elastosis perforans serpiginosa and very rarely reactive perforating collagenosis have been reported. We report the first case of an 11-year-old boy who is a known case of Down syndrome presented with perforating folliculitis.