Background Vitiligo is a skin and less common hair disease characterized by a decline in melanocyte function with a prevalence of 0.5–1% in most populations. Micro-RNAs (miRNAs) are single-stranded, noncoding, short RNA molecules, they act as regulators of gene expression and play critical roles in many biological processes such as differentiation, development, and metabolism of the human-body cells. Aim This case–control study aimed at detection of the expression of miRNA-224-3p in lesional skin of vitiligo patients as compared with normal-control persons to detect the possible role of miRNA-224-3p in the pathogenesis of vitiligo. Patients and methods This study included 30 patients with vitiligo and 30 healthy controls. About 4-mm punch skin biopsy was taken from patients (vitiligo lesion) and controls and it was kept in lysis solution for the stability of the studied parameters and was kept frozen at −80°C till analysis of miRNA-224-3p by quantitative reverse-transcription-PCR. Results The level of miRNA-224-3p in lesional skin of vitiligo was significantly higher as compared with normal-control persons. Conclusion MiRNA-224-3p may play an important role in pathogenesis of vitiligo, so it can be used as a biomarker to evaluate its progression and effect of therapeutic interventions.

Background Psoriasis is a chronic hyperproliferative inflammatory disease, in which genetic and environmental factors have an important role, but the exact cause is yet unknown. Circular RNAs (circRNAs) are regulatory noncoding RNAs. They play an important role in multiple physiological and pathological processes, such as cancer, cardiovascular diseases, and neuronal diseases. Some circRNAs are involved in regulating immunity, inflammation, and cell proliferation in many types of cells. Aim To detect the expression of circRNA (Circ0061012) in psoriatic skin of diseased patients as compared with normal control persons to investigate the possible role of circRNA in psoriasis pathogenesis and its correlation with disease severity. Patients and methods The present study included 30 psoriatic patients and 30 healthy controls. A 4-mm punch skin biopsy was taken from patients (psoriatic lesion) and controls, and it was kept in the lysis solution for the stability of the studied parameters and was kept frozen at ‑80°Celsius till analysis of circRNA by real-time polymerase chain reaction. Results The tissue level of circRNA (Circ0061012) was significantly higher among patients with psoriasis as compared with normal control individuals. Conclusion circRNA could contribute to psoriasis pathogenesis through its immunomodulatory role, so it might be a therapeutic target in the future.

Background Vitiligo is a common acquired depigmentary disorder characterized by milky-white cutaneous macules devoid of identifiable functional melanocytes of unknown origin. Several hypotheses have been advanced to explain the link between matrix metalloproteinase-9 (MMP-9) and vitiligo. Aim We aimed to compare the tissue expression of MMP-9 in vitiligo lesions with that of healthy controls. Patients and methods A case–control study was performed to evaluate MMP-9 levels by punch biopsies using an immunohistochemistry technique in lesional and nonlesional tissues of the same patient with vitiligo and in comparison with healthy controls. The study included 20 patients (10 patients with vitiligo and 10 healthy controls). Patients included were 18 years of age and older of both sexes, any duration, and any subtype. Results MMP-9 expression was found to be lower in the lesional skin of patients with vitiligo at the basal cell layer, follicular epithelium, and stromal cell layer when compared with nonlesional skin of the same patient with vitiligo and matched control individuals. Conclusion Tissue MMP-9 imbalance has a role in the etiopathogenesis of vitiligo. The low MMP-9 tissue expression may not facilitate the migration of melanoblasts. Tissue MMP-9 is a significant predictor of severity of vitiligo.

Background Coronavirus disease 2019 (COVID-19) pandemic has resulted in remarkable changes in the profiles of diseases including dermatologic conditions. Aim To investigate the patterns of skin diseases in Egypt during the COVID-19 pandemic. Patients and methods In this cross-sectional study, we reviewed the data of patients who visited dermatology clinics between August 2020 and January 2021 and compared them with the data from the same clinics in the previous year. Results The total number of patients who attended the dermatology clinics between August 2020 and January 2021 was 803 as compared with 1611 patients in the corresponding period of the previous year (49.84% reduction). During the COVID-19 pandemic, there was a significant increase in the frequency of allergic contact dermatitis, irritant contact dermatitis, pityriasis rosea, alopecia areata, erythema multiforme, vasculitis, herpes zoster, and chicken pox (P<0.05). On the contrary, some dermatological conditions such as urticaria and nonscarring hair loss had significantly decreased frequencies during the COVID-19 pandemic (P<0.05). Several skin diseases had unchanged frequencies during the COVID-19 pandemic. These included skin infections (other than viral infections), bullous disorders, some eczematous skin diseases, papulosquamous disorders, and disorders of skin pigmentation. Conclusion This study indicates a significant reduction in the total number of patients attending dermatology clinics in Egypt during the COVID-19 pandemic. The frequency of some skin diseases increased significantly, whereas other skin diseases decreased significantly or remained unchanged during the pandemic. Periodic evaluation of the epidemiologic characteristics of skin diseases is required at different stages of evolution of the COVID-19 pandemic.

Background Seborrheic keratosis is one of the most common benign epidermal tumors seen in elderly individuals. It has slow growth and presents with a varied degree of pigmentation in skin color closely resembling many other pigmented dermatoses. Dermoscopy, a noninvasive technique, could increase the accuracy of diagnosis and can differentiate it from various closest mimickers and malignancies. Aim This study aims to describe the various dermoscopic features of seborrheic keratosis in a series of cases. Patients and methods A hospital-based, descriptive study was conducted over 12 months from January 2018 to December 2018 in the Department of Dermatology, a tertiary-care center. A total of 100 patients were selected and evaluated in a prestructured proforma concerning age, sex, site of lesion, number and duration, and associated comorbidities. The lesion is observed on dermoscopy, and the dermoscopic patterns were then documented and analyzed. Result Among a total of 100 (32%) cases, the most common age group was between 41 and 50 years with females (52%) outnumbering males (48%). The most common site was the face (38%), and the common morphology was plaque (60%). Sign of Leser-Trélat was observed in five patients of which three were associated with malignancy that includes two lymphomas and one breast carcinoma. The color on dermoscopy was predominant dark brown (43%) and brownish-black (32%). The common element was clod (39%) and combined clod and dots (18%). More than three colors and more than two elements in a single lesion were observed in 15 and 11% of cases, respectively. The dermoscopic clues of seborrheic keratosis with highest to lowest prevalence were cerebriform pattern (76%), sharp demarcation (64%), comedone-like opening (56%), milia-like cyst (54%), mica-like scales (52%), moth-eaten border (46%), jelly sign (40%), fingerprint-like pattern (40%), fat fingers (36%), peripheral globules/network (34%), coral-like structure (26%), papillary structures (26%), irregular globules (12%), irregular opaque brown pigmentation (12%), and yellow-orange areas (3%). The flat seborrheic keratosis predominantly showed an irregular network-like structure, fat fingers, milia-like cyst, and accentuation of two adjacent perifollicular pigmentations forming a double ring-like structure (16%). The raised lesions predominantly showed fissures/ridges (cerebriform pattern), exophytic papillary structures, opaque pigmentation, and a mica-like pattern. Ten lesions were misinterpreted as seborrheic keratosis clinically and on dermoscopy were verruca vulgaris (2/10, 20%), melanocytic nevus (3/10, 30%), and basal cell carcinoma (5/10, 50%), which were confirmed on histopathology. Conclusion The study emphasizes the use of dermoscopy in seborrheic keratosis to improve the clinical accuracy of diagnosis and also to differentiate from its common mimickers.

Objective The study was done to compare the clinical efficacy rate, patient satisfaction, and side effects of fractional carbon dioxide (CO₂) laser-assisted topical therapy with amorolfine versus amorolfine alone for the treatment of onychomycosis. Patients and methods In all, 100 patients were recruited for the study and were divided based on the lottery system into two groups. Group 1 (50 patients) received a combination of fractional CO₂ laser and topical amorolfine (5%) and group 2 (n=50) received 5% amorolfine alone. The overall treatment efficacy was determined using clinical examination, onychoscopic pattern, and mycological clearance by comparing the infected area at baseline and 12 weeks after last treatment. Results Compared with group 2, clinical efficacy rate was significantly more in group 1 (22 vs. 0%, P<0.0001). Patient satisfaction rate was also higher in group 1 (64 vs. 6%, P<0.0001). Among the side-effects, mild pain was noted in group 1 with none in group 2 patients. Conclusion Fractional CO₂ laser-assisted delivery of topical amorolfine (5%) therapy of onychomycosis showed a better clinical response than topical amorolfine (5%) alone. Fractional CO₂ lasers may be explored further for use by standardizing the parameters and number of sessions to achieve better cure rates and thereby can replace systemic treatment.

Background Plantar warts are a common viral infection affecting adults and children. Many studies concerning bleomycin show discrepancies in cure rates. Macrophage migration inhibitory factor (MIF) plays an important role in the skin regarding inflammation and immune response. However, little is known about its relation to cutaneous warts. Aim To assess serum MIF levels in patients with common warts before and after treatment by microneedling-assisted topical bleomycin (MATB). Patients and methods This quasi experimental study included 33 patients with cutaneous warts treated by MATB. MIF levels were assessed before and after treatment. Results The mean serum MIF level was significantly lower before bleomycin treatment and increased after treatment. Conclusion The serum MIF has a role in the immunity against human papillomavirus infection and MATB is a promising noninvasive therapeutic modality for cutaneous warts.

Aim To study the involvement of terminal and vellus hair follicle in dermatophytic infections. Objectives Methodology A 4mm punch biopsy was collected from the active border involving the hairy part of the skin and stained with Hematyoxylin and Eosin and Periodic acid schiff stain . Hair follicle portions were examined to check if there are any fungal elements in the follicle. Result It was found that there was correlation between duration of disease and involvement of hair follicle. Conclusion Chronicity is associated with hair follicle involvement, requiring longer duration of oral Antifungals for complete clearance of infection.

Median canaliform dystrophy of Heller is a rare entity characterized by median or midline split of nails in one or both thumb nails. Treatment of median canaliform dystrophy is at times challenging as no successful therapy is available till date. Recently reported treatments include topical steroids, calcineurin inhibitor tacrolimus 0.1%, and tazarotene 0.05% ointment. We report the case of a 30-year-old man who came to our institute with complaints of nail lesions over both thumb nails and great toe nails from the past 5 years, which was causing cosmetic disfigurement.

We report a case of a 22-year-old male patient with angiokeratoma corporis diffusum, which is a cutaneous feature of many lysosomal storage disorders, but we diagnosed it as Fabry disease (FD) as our patient had normal intelligence associated with coarse facies, acroparesthesia, ocular changes like dilated vessels in conjunctiva, and presence of vacuolated endothelial cells in histopathological examination. It is an X-linked inborn error of the glycosphingolipid metabolic pathway that is associated with protean manifestations and is a paradigm of a multi-system condition with symptoms expressing themselves in many organs. We report this rare case mainly to stress the importance of proper clinical evaluation in the diagnosis of FD in today’s era of costly investigations like enzyme assay, which is not feasible in our setting. It also shows the importance of proper dermatological assessment, which has a highly positive predictive value in terms of assessing systemic morbidity in FD.