Publications

Export 33 results:
Sort by: Author Title Type [ Year  (Desc)]
2020
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.

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.

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.
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.

2019
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.
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.

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.
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.
2018
EL-KOMY, M. O. H. A. M. E. D. H. U. S. S. E. I. N. M. E. D. H. A. T., N. A. Saleh, and M. A. Saleh, "Autologous platelet-rich plasma and triamcinolone acetonide intralesional injection in the treatment of oral erosions of pemphigus vulgaris: a pilot study.", Archives of dermatological research, vol. 310, issue 4, pp. 375-381, 2018 May. Abstract

Oral erosions of pemphigus vulgaris (PV) represent a therapeutic challenge. In this work we compared intralesional injection of steroids (ILS) and autologous platelet-rich plasma (PRP) treatment of oral erosions of PV. In this split-mouth randomized double blind study, one side of the buccal mucosa of 11 PV patients was injected with 10 mg/ml triamcinolone and the opposite side was injected with 1 millilitre of autologous PRP every 14 days for 3 months. The percentage of clinical improvement, pemphigus disease area index and pain score were recorded before and after therapy. Out of 11 recruited patients, only 9 completed the study. Seven out of the nine patients (78%) showed improvement in PDAI and/or pain score. The mean oral PDAI of the steroid injected sides decreased from 2.3 to 0.9. The mean oral PDAI of the PRP injected sides decreased from 2.6 to 1.0. No significant difference was detected in clinical improvement, PDAI and pain score between autologous PRP and ILS in the treatment of oral erosions of PV. Autologous PRP can be used for the treatment of resistant oral erosions of PV when ILS is contraindicated.

Saleh, M. A., "A prospective study comparing patients with early and late relapsing pemphigus treated with rituximab.", Journal of the American Academy of Dermatology, 2018 Jan 31. Abstract

BACKGROUND: Rituximab (RTX) is an effective therapy for patients with pemphigus; however, the therapy does not prevent relapse.

OBJECTIVES: To compare early relapsing patients (before 12 months) and late relapsing patients (after 24 months) following RTX therapy.

METHOD: In this prospective study, 19 patients were enrolled (14 with pemphigus vulgaris and 5 with pemphigus foliaceus). The baseline disease score, autoantibody levels, and percentage of CD20 cells of patients with pemphigus were measured. Patients received 1 cycle of RTX and were followed for 26 months.

RESULTS: Among early relapsing patients (n = 5), the time to relapse was 6 to 11 months. Among late relapsing patients (n = 6), the time to relapse was 24 to 26 months. A significant difference was observed in the mean baseline anti-desmoglein 1 (DSG1) index between early relapsing (705.72) and late relapsing patients (210.4) (P = .0014). A significant negative correlation was found between the baseline anti-DSG1 index and time to relapse (r = -0.777, P = .00009).

LIMITATIONS: The small number of patients with pemphigus foliaceus.

CONCLUSIONS: Because patients with high baseline anti-DSG1 indices relapsed earlier, it may be important to follow these patients closely for the initial 12 months after RTX therapy. These patients may require a maintenance RTX dose during the first 12 months after RTX therapy.

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 by an International Panel of Experts.", Journal of the American Academy of Dermatology, 2018 Feb 10. 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 recommendations.

METHODS: A preliminary survey, based on the European Dermatology Forum (EDF) and the European Academy of Dermatology and Venereology (EADV) 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 (AAD) conference. A second survey was sent following the meeting to more experts to achieve greater international consensus.

RESULTS: The 39 experts participated in the first round of the Delphi-survey while 54 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 based on 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.

2017
Esmat, S., D. M. ABDELHALIM, R. A. HEGAZY, S. Sayed, and M. A. Saleh, "Matrix metalloproteinase in acral and non-acral vitiligo.", Photodermatology, photoimmunology & photomedicine, 2017 Oct 04.
El-Zawahry, B., D. Bassiouny, R. Hegazy, H. E. B. A. GAWDAT, S. Shalaby, M. Khorshied, and M. A. Saleh, "Rituximab treatment in pemphigus vulgaris: effect on circulating Tregs.", Archives of dermatological research, 2017 Jun 19. Abstract

Rituximab (RTX) has been used successfully to treat refractory pemphigus. We aimed to assess the response of pemphigus vulgaris (PV) cases to RTX therapy and its effect on CD4+CD25+ (T regulatory) cells level. Sixteen PV patients were included in this study, each received one cycle of two RTX infusions (1000 mg on days 1 and 15). Five PV patients served as controls. All cases were on prednisolone ± adjuvant therapy. Pemphigus disease area index (PDAI), autoimmune bullous skin intensity score (ABSIS), anti-desmoglein antibodies, CD4, CD8, CD20 and CD4+CD25+ levels were assessed at baseline, 3, 6 and 12 months after therapy. Fourteen patients were followed up for a mean duration of 17 while two were lost to follow up 6 months after RTX therapy. A significant decrease in PDAI, ABSIS, Dsg3 (p < 0.0001) was found. The depletion of B cells lasted for 12 months in 11 (69%) patients and for 24 months in 3 (21.4%) patients. There was significant decrease in CD20+ and CD4+CD25+ cells after 12 months of RTX, p values were 0.005 and 0.02, respectively. While no similar change in CD8 and CD4 was found (p = 0.2 for both), no significant change of CD20 and CD4+CD25+ cells were detected in the control group. In conclusion RTX is safe and effective as an adjuvant therapy in refractory cases of PV. In addition to B cell depletion a significant reduction of T regulatory cells occurs in treated cases which may be due to increased skin homing of these cells.

Saleh, M. A., H. Salem, and H. E. Azizy, "Autoantibodies other than Anti-desmogleins in Pemphigus Vulgaris Patients.", Indian journal of dermatology, vol. 62, issue 1, pp. 47-51, 2017 Jan-Feb. Abstract

BACKGROUND: Pemphigus vulgaris (PV) is an immunoglobulin G-mediated autoimmune bullous skin disease. Nonorgan-specific antibodies were detected in Tunisian and Brazilian pemphigus patients with different prevalence.

MATERIALS AND METHODS: Fifty PV patients and fifty controls were screened for antinuclear antibodies (ANAs), anti-smooth muscle antibodies (ASMAs), anti-parietal antibodies (APAs), anti-mitochondrial antibodies, and Anti-nuclear cytoplasmic antibodies (ANCA) by indirect immunofluorescence.

RESULTS: Thirty-nine patients were female and 11 were male. Fifteen patients did not receive treatment before while 35 patients were on systemic steroid treatment ± azathioprine. Twenty (40%) of the PV patients and 1 (2%) control had positive ANA. ANA was significantly higher in PV patients than controls, P < 0.0001. ASMAs were detected in 20 (40%) PV patients and none of the controls. ASMA was significantly higher in PV patients than controls, P < 0.0001. No significant difference was detected between treated and untreated regarding ANA, P - 0.11. However, there was a significant difference between treated and untreated regarding ASMA, P - 0.03. Six patients (12%) and none of the controls had positive APA. There was a significant difference between the patients and the controls in APA. P - 0.027.

CONCLUSION: Egyptian PV patients showed more prevalent ANA, ASMA, and APA than normal controls. Follow-up of those patients is essential to detect the early development of concomitant autoimmune disease. Environmental factors might account for the variability of the nonorgan-specific antibodies among different populations.

El-Zawahry, B. M., S. Esmat, D. Bassiouny, N. S. Zaki, R. Sobhi, M. A. Saleh, D. Abdel-Halim, R. Hegazy, H. E. B. A. GAWDAT, N. E. S. R. I. N. SAMIR, et al., "Effect of Procedural-Related Variables on Melanocyte-Keratinocyte Suspension Transplantation in Nonsegmental Stable Vitiligo: A Clinical and Immunocytochemical Study.", Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], vol. 43, issue 2, pp. 226-235, 2017 Feb. Abstract

BACKGROUND: Melanocyte-keratinocyte suspension (M-K susp) is gaining popularity for vitiligo treatment. Few studies have addressed procedure-related variables.

OBJECTIVE: To assess the effect of different M-K susp procedure-related variables on the clinical outcome in stable vitiligo.

METHODS: This prospective multicenter comparative study included 40 cases with nonsegmental stable vitiligo. Donor site was either a skin graft in noncultured epidermal cell suspension (NCECS) or hair follicle units in outer root sheath hair follicle suspension (ORSHFS). Recipient site was prepared by either cryoblebbing or CO2 laser resurfacing. Cell counts and viability were recorded in the cell suspensions. Tissue melanocytes and keratinocytes were examined by melan-A and cytokeratin, respectively. Assessment of repigmentation was performed 18 months after the procedure.

RESULTS: Thirty-seven subjects completed the study. Cell count was significantly lower in the ORSHFS compared with NCECS with no significant difference in the repigmentation outcome. On comparing techniques of recipient site preparation, homogenicity was better in the CO2 group. Elbows and knees responded better to CO2 resurfacing, whereas distal fingers responded better to combination of cryoblebbing with NCECS.

CONCLUSION: Using different techniques in M-K susp produces comparable results. However, the distal fingers showed better results using combination of donor NCECS and recipient cryoblebs.

El-Zawahry, M. B., N. S. Zaki, M. Y. Wissa, and M. A. Saleh, "Effect of combination of fractional CO2 laser and narrow-band ultraviolet B versus narrow-band ultraviolet B in the treatment of non-segmental vitiligo.", Lasers in medical science, vol. 32, issue 9, pp. 1953-1958, 2017 Dec. Abstract

The present study was designed to evaluate the effect of combining fractional CO2 laser with narrow-band ultraviolet B (NB-UVB) versus NB-UVB in the treatment of non-segmental vitiligo. The study included 20 patients with non-segmental stable vitiligo. They were divided into two groups. Group I received a single session of fractional CO2 laser therapy on the right side of the body followed by NB-UVB phototherapy twice per week for 8 weeks. Group II received a second session of fractional CO2 laser therapy after 4 weeks from starting treatment with NB-UVB. The vitiligo lesions were assessed before treatment and after 8 weeks of treatment by VASI. At the end of the study period, the vitiligo area score index (VASI) in group I decreased insignificantly on both the right (-2.6%) and left (-16.4%) sides. In group II, VASI increased insignificantly on the right (+14.4%) and left (+2.5%) sides. Using Adobe Photoshop CS6 extended program to measure the area of vitiligo lesions, group I showed a decrease of -1.02 and -6.12% in the mean area percentage change of vitiligo lesions on the right and left sides, respectively. In group II the change was +9.84 and +9.13% on the right and left sides, respectively. In conclusion, combining fractional CO2 laser with NB-UVB for the treatment of non-segmental vitiligo did not show any significant advantage over treatment with NB-UVB alone. Further study of this combination for longer durations in the treatment of vitiligo is recommended.

2016
Ali, R. A., R. H. Elsherif, M. A. Saleh, and M. H. Ismail, "Evaluation of exposure of pemphigus vulgaris patients to Mycobacterium tuberculosis and Aspergillus fumigatus.", European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, vol. 35, issue 11, pp. 1749-1752, 2016 Nov. Abstract

The purpose of this study was to screen pemphigus vulgaris (PV) (autoimmune bullous skin disease) for the presence of immunoglobulin G against Mycobacterium tuberculosis and Aspergillus fumigatus. The sera of 60 PV patients and 28 controls were screened for the presence of immunoglobulin G against M. tuberculosis and A. fumigatus by enzyme-linked immune-sorbent assay. Forty patients were females and 20 were males. The range of IgG against M. tuberculosis was from 0.9 to 152.6 (median = 2.95) in the patients and was from 0 to 2.2 (median = 1.6) in the controls. Seven (11.7 %) patients and none of the controls exceeded the cut-off value. Four patients were on systemic steroids and azathioprine and three did not receive treatment before. The results showed that PV patients had significantly more IgG against M. tuberculosis than the controls; the p value was 0.006. The range of IgG against A. fumigatus was from 1.3 to 76.3 (median = 4.9) in the patients and was from 1 to 105.3 (median = 5.25) in the controls. Six (10 %) patients and eight (28.6 %) controls exceeded the cut-off value. The six patients were on systemic steroids and azathioprine. No significant difference was detected between PV patients and controls regarding exposure to A. fumigatus; the p value was 0.308. PV patients showed significantly more exposure to the M. tuberculosis than the controls. This suggests that M. tuberculosis may contribute to the pathogenesis of PV.

El Darouti, M. A., O. A. Zeid, D. M. Abdel Halim, R. A. Hegazy, D. Kadry, D. I. Shehab, H. S. Abdelhaliem, and M. A. Saleh, "Salty and spicy food; are they involved in the pathogenesis of acne vulgaris? A case controlled study.", Journal of cosmetic dermatology, vol. 15, issue 2, pp. 145-9, 2016 Jun. Abstract

BACKGROUND: Many studies have suggested a strong relation between diet and acne. Many patients with acne believe that spicy and salty foods exacerbate acne.

AIM: To assess the relationship between the dietary intake of salty and spicy food and the onset, severity, duration of acne.

METHODS: Two hundred patients with acne vulgaris and 200 age- and gender-matched controls were subjected to a detailed questionnaire taking, clinical examination and dietary assessment through using "24 h recall" method. Sodium content of the 24-h food intake was computed by a computer program connecting participants' dietary information to the food composition table of National Nutrition Institute data base.

RESULTS: Patients with acne consumed significantly higher daily amounts of sodium chloride (NaCl) (median 3367.54 mg) compared to the controls (median 2271.8 mg) (P < 0.001). A negative correlation between the amount of NaCl in the diet of patients with acne and the age of onset of acne lesions was detected (r = -0.216, P = 0.031). However, neither salty nor spicy food correlated with duration or severity of the disease.

CONCLUSION: Consumption of salty foods was significantly higher among patients with acne compared to acne free subjects, making the consumption of salty food a possible participating factor in the development of acne.

Ramadan, S., D. Hossam, and M. A. Saleh, "Dermoscopy could be useful in differentiating sarcoidosis from necrobiotic granulomas even after treatment with systemic steroids.", Dermatology practical & conceptual, vol. 6, issue 3, pp. 17-22, 2016 Jul. Abstract

BACKGROUND: Diagnosing cutaneous sarcoidosis and necrobiotic granulomas is challenging.

OBJECTIVE: Assessing the value of dermoscopy in differentiating cutaneous sarcoidosis from necrobiotic granulomas and evaluating whether their dermoscopic features will be altered after treatment.

METHODS: Nineteen cutaneous sarcoidosis and 11 necrobiotic granuloma patients (2 necrobiosis lipoidica, 4 granuloma annulare and 5 rheumatoid nodule) were included in this study. The diagnosis was confirmed by skin biopsy. The lesions were examined using non-contact polarized dermoscope (Dermlite 2 HR-Pro; 3Gen, San Juan Capistrano, CA).

RESULTS: Ten out of 19 cutaneous sarcoidosis patients and 7/11 necrobiotic cases group were receiving treatments (topical, intralesional or systemic steroids ± chloroquine) but still have cutaneous lesions. Treatment duration in the sarcoidosis group ranged from 2 months to 10 years (median 3 years) and in the necrobiotic cases group ranged from 3 months to 16 years (median 2 years). Pink homogenous background, translucent orange areas, white scar-like depigmentation and fine white scales were significantly associated with the cutaneous sarcoidosis compared to necrobiotic cases group. On the other hand mixed pink, white and yellowish background was significantly associated with the necrobiotic cases group. No significant difference in the dermoscopic findings was detected between treated and non-treated patients.

CONCLUSION: Some dermoscopic findings are shared between the cutaneous sarcoidosis group and the necrobiotic cases group, yet dermoscopy could be a useful aid in differentiating them even after treatment.

Abdelaal, N. H., L. A. Rashed, S. Y. Ibrahim, M. H. Abd El Halim, N. Ghoneim, N. A. Saleh, and M. A. Saleh, "Cathelicidin (LL-37) level in the scalp hair of patients with tinea capitis.", Medical mycology, 2016 Dec 02. Abstract

Antimicrobial peptides (AMPs) are considered an important first line of defense against pathogens. Cathelicidin LL-37 was upregulated in response to fungal infection. In this work we aimed to evaluate cathelicidin LL-37 in the hair of tinea capitis and compare it to normal controls. Hair samples were collected from 30 children and 30 controls aged from 2 to10 years old, and the level of cathelicidin LL-37 in the hair was detected by quantitative real-time PCR. The 30 patients were further subdivided into three subgroups according to their clinical type. Ten patients were scaly type, 10 patients were black dots type, and 10 patients were kerion type. Cathelicidin level in patients ranged from 6.0 to 17.5 with mean ± SD (11.3 ± 2.3) and in control ranged from 1.02 to 6.2, with mean ± SD (2.8 ± 1.5). There was a significant difference between the patients and controls regarding the cathelicidin level; P value was 0. The mean cathelicidin level was lowest in the kerion type10.73 ± 2.6 and highest in the black dot type 12.05 ± 2.76. However, there was no significant difference between the cathelicidin level of the different clinical types of tinea capitis; P value was 0.58. In conclusion, the level of cathelicidin LL-37 in hair specimens of human tinea capitis was significantly higher than controls.

2015
Fawzi, M. M. T., S. B. Mahmoud, O. G. Shaker, and M. A. Saleh, "Assessment of tissue levels of dickkopf-1 in androgenetic alopecia and alopecia areata.", Journal of cosmetic dermatology, 2015 Jul 28. Abstract

BACKGROUND: Androgenetic alopecia (AGA) is the commonest form of hair loss in men. Alopecia areata (AA) is an organ-specific autoimmune disease. Studies revealed that Dickkopf 1 (DKK-1), a powerful suppressor of the Wnt/β-catenin signaling pathway, induced anagen-to-catagen transition in mice. Moreover, in vitro studies suggested that DKK-1 played a role in dihydrotestosterone (DHT)-induced balding.

AIM: To evaluate the tissue levels of DKK-1 in patients with AGA and AA, to assess its possible role as a pathogenetic mechanism in both disorders.

METHODS: This study included 24 patients with AGA, 31 patients with AA, and 33 healthy controls. Scalp biopsies were taken from all participants for the detection of tissue DKK-1 levels.

RESULTS: Tissue DKK-1 levels were significantly higher in patients with AGA than in controls (P = 0.000) as well as in patients with AA than in controls (P = 0.001). In addition, they were significantly higher in patients with AGA than in patients with AA (P = 0.000). DKK-1 was higher in male than in female patients with AGA. DKK-1 was negatively correlated with disease duration in AGA.

CONCLUSION: In conclusion, this study suggests an important role for DKK-1 in the pathogenesis of AGA and AA through documenting higher tissue DKK-1 levels in patients with both hair disorders compared to controls and suggests that DKK-1 may be a promising therapeutic target for these hair diseases.

Saleh, M. A., R. Hashimoto, Y. Kase, M. Amagai, and J. Yamagami, "Low pathogenicity of anti-desmoglein 3 immunoglobulin G autoantibodies contributes to the atypical clinical phenotypes in pemphigus.", The Journal of dermatology, vol. 42, issue 7, pp. 685-9, 2015 Jul. Abstract

The clinical phenotypes of pemphigus can be explained by the desmoglein (Dsg) compensation theory. However, some atypical cases such as cutaneous pemphigus vulgaris (cPV), in which patients have anti-Dsg3 antibodies without oral erosions, do not conform to this theory. To explain the discrepancy between clinical phenotypes and anti-Dsg antibody profiles, the pathogenic strength of immunoglobulin (Ig)G autoantibodies against Dsg3 must be taken into consideration. We analyzed the epitopes and blister-inducing pathogenic strength of the sera from three patients having IgG against Dsg3 without oral erosions with domain-swapped recombinant proteins and dissociation assay using cultured normal human epidermal keratinocytes. The results showed that all sera contained IgG directed against the amino terminal EC1 domain of Dsg3, as is found in most PV sera. However, dissociation assays revealed that the pathogenic strength of the anti-Dsg3 antibodies in all three cases was extremely lower than that of typical PV cases with mucosal involvement. In conclusion, when anti-Dsg3 IgG antibodies are not sufficient to inhibit the expression of Dsg3 in the oral mucosa, but can inhibit the expression in the skin, skin blisters can result. Therefore, the pathogenicity of anti-Dsg3 antibodies should be regarded as a key factor contributing to the clinical phenotype in pemphigus patients with conflicting antibody profiles.

Saleh, M. A., "Pemphigus in the Arab world.", The Journal of dermatology, vol. 42, issue 1, pp. 27-30, 2015 Jan. Abstract

The Arab world lies geographically between the Atlantic coasts of northern Africa and the Arabian Gulf. This area has wide latitudinal differences as well as variable environmental conditions ranging from deserts to forests. Approximately 370 million individuals who share the Arabic language live in this area. Pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are the main subtypes of the pemphigus disease. Both pemphigus subtypes are present in many Arab countries; however, there is variation in the predominant subtype among countries. PV is the most common subtype in Egypt, Sudan, Morocco, Syria, Kuwait, Saudi Arabia and Yemen. On the other hand, PF is more prevalent in Libya and is endemic in Tunisia. Interestingly, there is variation in the dominant subtype in some cities within Morocco. For example, PF is more common in Marrakech which is the second largest city. The presence of anti-desmoglein 1 antibodies in the sera of normal Tunisians and the presence of anti-desmoglein 3 in normal Egyptians' sera suggested that environmental factors played a role in the disease pathogenesis in those areas. Further researches detected that traditional cosmetics were among the risk factors in Tunisia. Moreover, farming was suggested as a risk factor in Egypt, Tunisia and Sudan. Because there is no consensus for pemphigus treatment among the Arab countries, there is diversity in their pemphigus treatment regimens. Studying the demographic characteristics and the environmental conditions which caused the variations in the prevailing clinical phenotype will help us fill the gaps to understand the pathogenesis of the pemphigus disease.

Tourism