Murrell, D. F., S. Peña, P. Joly, B. Marinovic, T. Hashimoto, L. A. Diaz, A. A. Sinha, A. S. Payne, M. Daneshpazhooh, R. Eming, et al., "Diagnosis and management of pemphigus: Recommendations of an international panel of experts.", Journal of the American Academy of Dermatology, vol. 82, issue 3, pp. 575-585.e1, 2020. Abstract

BACKGROUND: Several European countries recently developed international diagnostic and management guidelines for pemphigus, which have been instrumental in the standardization of pemphigus management.

OBJECTIVE: We now present results from a subsequent Delphi consensus to broaden the generalizability of the recommendations.

METHODS: A preliminary survey, based on the European Dermatology Forum and the European Academy of Dermatology and Venereology guidelines, was sent to a panel of international experts to determine the level of consensus. The results were discussed at the International Bullous Diseases Consensus Group in March 2016 during the annual American Academy of Dermatology conference. Following the meeting, a second survey was sent to more experts to achieve greater international consensus.

RESULTS: The 39 experts participated in the first round of the Delphi survey, and 54 experts from 21 countries completed the second round. The number of statements in the survey was reduced from 175 topics in Delphi I to 24 topics in Delphi II on the basis of Delphi results and meeting discussion.

LIMITATIONS: Each recommendation represents the majority opinion and therefore may not reflect all possible treatment options available.

CONCLUSIONS: We present here the recommendations resulting from this Delphi process. This international consensus includes intravenous CD20 inhibitors as a first-line therapy option for moderate-to-severe pemphigus.

Sobeih, S. A., M. A. Saleh, S. M. Kholoussi, E. E. M. Khateeb, and D. M. Kadry, "Phosphorylated p38 mitogen-activated kinase in patients with pemphigus vulgaris: a case–controlled study", Journal of the Egyptian Women’s Dermatologic Society, vol. 17, issue 1, pp. 31, 2020.
Abdelaal, N. H., N. G. Elhefnawy, S. R. Abdulmonem, S. Sayed, N. A. Saleh, and M. A. Saleh, "Evaluation of the expression of the stromal cell‐derived factor‐1 alpha (CXCL 12) in psoriatic patients after treatment with Methotrexate", Journal of cosmetic dermatology, vol. 19, issue 1, pp. 253-258, 2020.
Saleh, A. M., S. I. El-Samanoudy, L. A. Rashed, and M. A. Saleh, "Evaluation of the pathogenicity of anti-desmoglein antibodies of pemphigus vulgaris patients using human organ culture assay.", Archives of dermatological research, vol. 312, issue 4, pp. 289-294, 2020. Abstract

Anti-desmoglein (anti-Dsg) antibodies are key players in the pathogenesis of pemphigus vulgaris (PV) disease. We aimed to evaluate the pathogenicity of anti-Dsg antibodies of PV patients using human organ culture assay and to assess the correlation between the pathogenicity and the disease score. In this cross-sectional study, sera from 37 PV patients were included. The organ culture acantholysis index (OCAI) was calculated as (width of blister/total width of the specimen) × 100. The sera were analyzed using Dsg ELISAs and ethylenediaminetetraacetic acid (EDTA) treated ELISAs. OCAI ranged from 0 to 100%, median = 50%. There was a moderate significant correlation between OCAI and the disease severity, r = 0.503, p = 0.002. There was a moderate significant correlation between OCAI and non-Ca-dependent anti-Dsg3 and anti-Dsg1 antibodies, p values were 0.01 and 0.021, respectively. The OCAI was assessed along the disease time course of four patients. The OCAI fluctuated parallel to the disease severity along the time course of the four patients. Human organ culture assay is an objective tool that detects the pathogenicity of anti-desmoglein antibodies. It can be used before stopping systemic steroids especially in patients in remission with high titer or if the Dsg ELISA is not available.

Esmat, S., D. Bassiouny, M. A. Saleh, D. abd el halim, R. Hegazy, M. El Hawary, H. E. B. A. GAWDAT, H. Gouda, M. Khorshied, and N. E. S. R. I. N. SAMIR, "Studying the effect of adding growth factors to the autologous melanocyte keratinocyte suspension in segmental vitiligo.", Dermatologic therapy, pp. e13368, 2020. Abstract

Addition of different growth factors to the medium used in autologous melanocyte-keratinocyte transplantation procedure (MKTP) was reported in the literature. The aim of the current study was comparison of response to MKTP in segmental vitiligo (SV) with and without adding growth factors to the suspension medium. Eighteen cases with SV were randomly divided into two groups. In group A: Ham F12 medium was used for suspension and in group B: 5 ng/mL recombinant basic fibroblast growth factor (bFGF) and 25 mg/500 mL 3'5' cyclic adenosine monophosphate (cAMP) were added to the medium. All cases received NB-UVB twice weekly for 24 weeks. The area of vitiligo lesions was measured before and after therapy by point-counting technique and complications were recorded. Excellent response (90%-100% repigmentation) occurred in 5/9 cases (56%) in group A and 7/9 cases (78%) in group B (with growth factors). A significant decrease in the area of treated lesions before and after therapy was found in both groups A and B (P = .0012 and .0004, respectively), however, a higher percentage of reduction in area of vitiligo was seen in group B cases (70% in group A vs 90% in group B; P value: .028). Marginal halo was seen in five cases in group A and six in group B. In conclusion addition of bFGF and cAMP to MKTP medium improved the results of the procedure. It could be considered if economically feasible.

Saleh, M. A., I. Zaraa, N. Doss, N. A. Saleh, and D. F. Murrell, "Assessment of the quality of life of Egyptian and Tunisian autoimmune bullous diseases' patients using an Arabic version of the autoimmune bullous disease quality of life and the treatment of autoimmune bullous disease quality of life questionnaires.", Anais brasileiros de dermatologia, vol. 94, issue 4, pp. 399-404, 2019. Abstract

BACKGROUND: The Autoimmune Bullous Disease Quality of Life (ABQOL) and the Treatment of Autoimmune Bullous Disease Quality of Life (TABQOL) questionnaires proved to be reliable tools that measure the disease and treatment burden.

OBJECTIVES: We aimed to assess the ABQOL and TABQOL in the Arabic population.

METHODS: The English questionnaires were translated into the Arabic language by a certified translation agency. Eighty autoimmune bullous disease (AIBD) patients were included in this study. Patients were asked to answer 2 questionnaires. After 1 week the same patients were asked to answer the same questionnaires again.

RESULTS: The age of the patients ranged from 19 to 81 years (mean=46), 19 males, 61 females. The ABQOL ranged from 0-37 (mean=16.4±9.2). The TABQOL ranged from 2-43 (mean=21.5±9.4). Test-retest reliability was acceptable, Cronbach's alpha was 0.76 for ABQOL and 0.74 for TABQOL. There was no significant correlation between the age of the patients and ABQOL, r =-0.2, p value was 0.183. There was a significant negative correlation between the age of the patients and the TABQOL, r=-0.2, p value was 0.039. There was a significant negative correlation between the education of the patients and the TABQOL, r=-0.3, p value was 0.007.

STUDY LIMITATIONS: Small sample size of some AIBDs and patients with severe disease.

CONCLUSION: Objective and valuable measurements such as ABQOL and TABQOL are now available to help physicians understand their patient's distress and should be used in every patient with AIBD. Younger and less educated patients appear to have more effects on their QOL from the treatments.

Raheem, H. M. A., H. A. Shehata, L. A. Rashed, and M. A. Saleh, "Decreased level of PAR2 in Psoriasis and MF patients receiving Phototherapy.", Photodermatology, photoimmunology & photomedicine, vol. 35, issue 4, pp. 282-283, 2019.
Abdel-Halim, M. R. E., M. Fawzy, M. A. Saleh, S. Ismail, S. Doss, E. El Nabarawy, A. E. L. Tawdy, M. A. El-latif, S. Shalaby, M. Amer, et al., "Unilateral facial papules and plaques.", Cutis, vol. 103, issue 4, pp. 198;201;202, 2019.
Bosseila, M., E. A. Nabarawy, M. A. Latif, S. Doss, M. ElKalioby, and M. A. Saleh, "Scalp Pemphigus Vulgaris Mimicking Folliculitis Decalvans: A Case Report.", Dermatology practical & conceptual, vol. 9, issue 3, pp. 215-217, 2019.
Korany, M. M., M. A. Amer, L. A. Rashed, and M. A. Saleh, "Downregulation of aquaporin 3 in bullous pemphigoid patients.", Archives of dermatological research, vol. 311, issue 2, pp. 93-97, 2019. Abstract

Bullous pemphigoid (BP) is a chronic autoimmune skin disease. Aquaporin 3 (AQP 3) has a possible role in the pathogenesis of many dermatological diseases. In this work, we aimed to evaluate the expression of AQP 3 in BP. Perilesional skin biopsies were taken from 24 BP patients and 13 controls. The biopsies were stained by direct immunofluorescence using rabbit anti-human AQP 3 FITC antibody. The expression of AQP 3 was weak in 5 patients (20.8%), moderate in 18 patients (75%), strong in 1 patient (4.2%) in the suprabasal layers. It was negative in 4 patients (16.7%), weak in 18 patients (75%), moderate in 2 patients (8.3%) and no strong fluorescence was seen in the basal layers. In the controls, the expression was strong in ten controls (76.9%), moderate in three controls (23.1%) and no controls showed weak fluorescence in the suprabasal layer. The basal layer showed strong fluorescence in 11 controls (84.6%), moderate in 2 controls (15.4%) and no controls showed mild or no fluorescence. There was a statistically significant difference in the expression of AQP 3 between basal and suprabasal layers of BP patients but not of the controls. There was statistically significant difference in the expression of AQP 3 between patients and controls in both the basal (P value < 0.001) and the suprabasal layers (P value < 0.001). In conclusion, AQP 3 was downregulated in BP patients especially in the basal cell layer. This suggests that AQP 3 plays a role in the pathogenesis of BP.