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2019
El-Enany, G., M. M. Fawzy, M. R. E. Abdel-Halim, E. El-Nabarawy, A. El-Tawdy, M. A. El-latif, H. A. Abdelkader, S. Doss, and H. El-Sayed, "Lichenoid papules in the periorbital area.", International journal of dermatology, 2019.
Youssef, R., M. R. E. Abdel-Halim, D. M. ABDELHALIM, M. M. Fawzy, M. F. Hussein, M. F. Elmasry, S. S. Sayed, and N. M. Abo Eid, "PUVA-induced pityriasis lichenoides chronica-like papular lesions in patients with mycosis fungoides: a clinical, histopathological and immunohistochemical study.", Archives of dermatological research, 2019. Abstract

Mycosis fungoides (MF) is the most common form of cutaneous T cell lymphoma (CTCL) with many clinical variants including papular and pityriasis lichenoides chronica (PLC)-like variants. During psoralen and ultraviolet A (PUVA) treatment of MF, PLC-like papular lesions were observed to appear. The exact nature of these lesions is not fully understood. This work aimed to study PLC-like papular lesions arising in MF patients receiving PUVA therapy clinically, histopathologically and immunohistochemically (using monoclonal antibodies against CD4 and CD8) and to compare them with lesions in classic PLC patients. Fifteen MF patients with PLC-like papular lesions arising during PUVA treatment were included and 15 patients with classic PLC served as controls. While the extent of these lesions significantly correlated with their duration (p < 0.05), it showed no significant correlation with the TNMB stage of MF, number of phototherapy sessions or cumulative UVA dose at which they started to appear. The response status of MF to PUVA did not affect their development. Compared to classic PLC, these lesions showed significantly more acute onset (p = 0.003). None of these lesions showed histopathological features essential to diagnose papular/PLC-like MF and no significant difference existed with regard to their histopathological and CD4/CD8 phenotypic features compared to classic PLC. Papular lesions mimicking PLC in MF patients receiving PUVA mostly represent an upgrading reaction with possible good prognostic implication.

AbdElhalim, M., M. Fawzy, M. Saleh, S. Ismail, S. Doss, E. El Nabarawy, A. E. L. Tawdy, M. A. Latif, S. Shalaby, M. Amer, et al., "Unilateral facial papules and plaques", Cutis, vol. 103, issue 4, pp. 198-, 201-202, 2019.
Abdel-Halim, M. R. E., E. El Nabarawy, A. El-Tawdy, G. El-Enany, M. Soliman, H. Weshahy, H. A. S. Fayed, and R. Hegazy, "Sclerotic Ulcerated Plaque on the Back.", The American Journal of dermatopathology, vol. 41, issue 4, pp. 314-315, 2018 Apr 11, 2019.
El-Nabarawy, E. A., N. Saleh, and M. R. E. Abdel-Halim, "Peculiar papular eruption on the vulva and inguinal folds.", Journal of clinical pathology, vol. 72, issue 2, pp. 185, 2018 Dec 20, 2019. Abstract

CLINICAL QUESTION: A 26-year-old woman presented with asymptomatic skin coloured to whitish keratotic papules on the vulva, inguinal folds and inner thighs of 6 years duration. She had no similar lesions elsewhere and no family history. A biopsy was taken from one of the papules.Review the high-quality, interactive digital Aperio slide at http://virtualacp.com/JCPCases/jclinpath-2018-205434/ and consider your diagnosis. WHAT IS YOUR DIAGNOSIS?: Darrier's diseaseHailey-Hailey diseaseGenital wartsPapular acantholytic dyskeratosis of genitocrural areaPemphigus vegetansThe correct answer is after the discussion.

DISCUSSION: Papular acantholytic dyskeratosis (PAD) of the genitocrural area is a peculiar acantholytic dermatosis with dyskeratosis localised to the vulva and inguinal folds with possible extension to the thighs and perineum.1 It mainly involves young or middle-aged females.1 Cases affecting males and involving genitalia, thighs and perianal region have been reported.2 It represents an allelic variant of Hailey-Hailey disease as heterozygous mutations in gene (intron 5 and exon 24) have been reported in some cases.3 Clinically, PAD of the genitocrural area is typically characterised by solitary or grouped keratotic flesh coloured or white papules.1 Other clinical presentations include: vesicles, bullae, patches and plaques.4 Although the lesions are mainly asymptomatic, patients may experience variable degrees of itching or burning sensation.Histopathologically, the lesions show hyperkeratosis, hypergranulosis, acanthosis and acantholytic dyskeratosis in the spinous layer (figure 1). Typically, direct immunoflourescence (DIF) is negative.5 jclinpath;jclinpath-2018-205434v1/F1F1F1Figure 1Photomicrograph representing histopathological findings: hyperkeratosis, hypergranulosis, acanthosis and acanthloytic dyskeratosis involving the spinous layer; 254×143 mm.The most important differential diagnoses of this sporadic condition include: Darier's and Hailey-Hailey, both of which are familial. Hailey-Hailey involves also other flexural areas and presents with eroded crusted lesions with foul odour. Pathologically, the acantholytic process in PAD of the genitocrural area is rather focal compared with the broad zone of acantholysis in Hailey-Hailey, and columns of parakeratosis overlying suprabasilar acantholysis are characteristic of Darier's disease. Although, some cases of PAD of the genitocrural area can present with vesicles and bullae, the presence of dyskeratotic cells and the negative DIF speaks against pemphigus.Treatment options for this condition include topical and systemic retinoids. Cryotherapy and laser have been also reported to be effective. Topical steroids might be effective in reducing pruritus.

Esmat, S. M., M. R. E. Abdel-Halim, H. I. GAWDAT, M. Kamel, A. E. Ramly, K. Helmy, and S. M. Esmat, "Persistent Pixel Stamping Marks: a novel complication of fractional CO laser in scar treatment.", Lasers in medical science, 2019 Jan 04. Abstract

Fractional CO laser rejuvenation of scars offers a high safety profile. Laser marks usually disappear clinically within 1 week. The authors observed occasional persistence of the laser marks on the scar surface. The purpose of this study is to report the incidence and to describe the clinical, dermoscopic, and histological features of a novel observed complication of fractional CO laser scar rejuvenation "Persistent Pixel Stamping Marks (PPSM)".One hundred seventy-one cases were consecutively recruited from patients assigned for fractional CO laser scar rejuvenation. Patients who developed the phenomenon 1 month post laser session were recorded and subjected to clinical photography, dermoscopy, and optical coherence tomography (OCT) as well as a 4-mm punch biopsy from pixelated scars. The evolution of PPSM was followed up for 6 months. PPSM developed in 16 patients (9.4%), 15 of which were post burn hypertrophic scars. PPSM was significantly related to darker skin type, darker scar color, and longer scar duration. Histopathological findings included characteristic holes in stratum corneum and superficial dermis, thick collagen bundles perpendicular to the skin surface with loss of elastic tissue, focal interface changes, and triangular focus of fibroblastic proliferation. The marks disappeared in 5 and lasted in 11 patients. Their longevity was significantly related to longer dwell times and lower densities. PPSM represent miniature scarring at the sites of the microscopic thermal zones or a sign of their delayed healing. They tend to follow fractional CO laser resurfacing of hyperpigmented, long-standing burn scars. Longer dwell times and lower densities make them last longer.

2020
Osama, R., H. A. Abdelkader, S. Ahmad, and M. R. E. Abdel-Halim, "Clustered yellowish papules on the cheek.", International journal of dermatology, 2020.
Khatery, B. H. M., M. R. E. Abdel-Halim, and S. Adel, "Comedonal Lesions on the Trunk and Proximal Extremities: Challenge.", The American Journal of dermatopathology, vol. Publish Ahead of Print, 2020.
Elbendary, A., H. A. Abdelkader, Y. Abdel-Galeil, M. El-Mofty, A. M. Sultan, A. S. Elkomi, and M. R. E. Abdel-Halim, "Cytoplasmic CD3 Positivity as the Only Clue for the Diagnosis of T-Acute Lymphoblastic Leukemia With Cutaneous Deposits: A Case Report.", The American Journal of dermatopathology, vol. 42(1), pp. 43-45, 2020.
Enany, G. E., H. Nada, N. Nagui, I. Sany, A. Nada, S. Ibrahim, O. EGhannam, and M. R. E. Abdel-Halim, Diffuse cicatricial alopecia and multiple telangiectatic indurated leg plaques, , 2020.
El-Enany, G., N. Nagui, H. Nada, O. El Ghanam, N. Kadry, M. R. E. Abdel-Halim, and A. Elbendary, "Swollen fissured vulva.", Clinical and experimental dermatology, 2020.
Ragab, G., M. T. Hegazy, M. Ali, M. R. E. Abdel-Halim, and X. Puéchal, "Three Patterns of Cutaneous Involvement in Granulomatosis with Polyangiitis.", Journal of advanced research, vol. 24, pp. 311-315, 2020. Abstract

Background: Skin involvement in granulomatosis with polyangiitis (GPA) is common and can appear as an initial presentation of the disease or more commonly through its course.

Case presentation: We report a case of a 24-year-old male patient, previously diagnosed as having GPA, admitted with fever, hemoptysis, generalized hemorrhagic blisters associated with arthralgia, fatigue, myalgia, nasal crusting, and vertigo. Three weeks prior to admission, he developed erythematous papules on both elbows, and purpuric papules on both lower limbs. Histopathological examination revealed: interstitial granulomatous dermatitis (elbows) and foci of dermal hemorrhage, foci of interstitial histiocytes and zones of altered necrobiotic collagen (lower limbs) consistent with cutaneous lesions of GPA. Two weeks later, his rash progressed to widespread purpura associated with hemorrhagic blisters. Another biopsy revealed leukocytoclastic vasculitis with fibrinoid necrosis of the vessel walls associated with perivascular infiltrate of neutrophils, nuclear dust and extravasated erythrocytes without an associated granulomatous inflammation or necrobiosis. The constellation of the results of the three biopsies together with clinical correlation pointed to a flare of GPA.

Conclusion: Skin involvement in GPA is quite common, and it can manifest in different forms in the same patient. Our patient developed three different skin pathologies within a short period of time.

Adel, A., M. R. E. Abdel-Halim, and Y. Abdel-Galeil, "Ulcerated Nipple Nodule, Clinicopathologic Challenge: Challenge.", The American Journal of dermatopathology, 2020.
Enany, G. E., N. Nagui, H. Nada, S. Shalaby, I. Sany, A. Nada, S. Orabi, O. El Ghanam, and M. R. E. Abdel-Halim, "Widespread Keratotic Spiky Follicular Papules Associated With Hyperpigmentation: Answer.", The American Journal of dermatopathology, vol. 42, issue 10, pp. 787-788, 2020.
Abdelkader, H. A., Y. Abdel-Galeil, A. Elbendary, M. El-Mofty, and M. R. E. Abdel-Halim, "Multiple Skin Ulcers in a Rheumatoid Arthritis Patient: Challenge.", The American Journal of dermatopathology, vol. 42(2), pp. e20-e21, 2018 Dec 07, 2020.
2021
Enany, G. E., N. Nagui, H. Nada, H. A. Abdelkader, I. Sany, A. Nada, M. Mostafa, O. El-Ghanam, and M. R. E. Abdel-Halim, "Crystalglobulinemia: A Rare Presenting Manifestation of Multiple Myeloma.", The American Journal of dermatopathology, 2021. Abstract

ABSTRACT: Crystalglobulinemia (CG) is a rare disorder characterized by crystallization of monoclonal immunoglobulins in the microcirculation leading to multiorgan vascular thrombosis and ischemic injury. The main cause of CG is multiple myeloma. We report a case of a 52-year-old man who presented with widespread necrotizing plaques and ulcerations. A skin biopsy revealed eosinophilic rectangular-shaped crystals occluding the lumina of blood vessels with no associated features of vasculitis. The crystals were Periodic acid-Schiff stain positive. The findings were diagnostic of CG. Extensive work up lead to the discovery of multiple myeloma. Awareness of CG is important because it may be the first presenting manifestation of an underlying serious hematological malignancy.

Enany, G. E., K. E. Hoshy, R. Yousef, H. Nada, M. Abdel-Halim, A. Nada, D. A. Antably, and I. Sany, "Fluorscopy induced chronic radiodermatitis: three cases presenting after cardiac catheterization.", JEWDS, vol. 18, issue 2, pp. 153-156, 2021.
Elbendary, A., M. R. E. Abdel-Halim, R. Youssef, D. abd el halim, M. F. Elmasry, A. A. Gad, and D. A. El Sharkawy, "Hypopigmented lesions in pityriasis lichenoides chronica patients: Are they only post-inflammatory hypopigmentation?", The Australasian journal of dermatology, 2021. Abstract

BACKGROUND/OBJECTIVES: Pityriasis lichenoides chronica (PLC) lesions are reported to subside with post-inflammatory hypopigmentation (PIH); hence, the most widely perceived nature of hypopigmented macules in PLC is PIH. However, to the best of our knowledge, no studies describing histopathological findings in these lesions are reported in literature. The aim of this study is to evaluate the hypopigmented lesions encountered in PLC patients and to shed light on their histopathological features.

METHODS: A cross-sectional observational study included twenty-one patients with PLC recruited in a period of twelve months. Clinical characteristics of each patient were collected. A skin biopsy from hypopigmented lesions whenever present was taken and assessed with routine haematoxylin and eosin stain.

RESULTS: Seventeen patients (81%) were less than 13 years old. Most patients (85.7%) demonstrated diffuse distribution of lesions. Hypopigmented lesions were present on the face in 12 (57.14%) patients. Histopathologically, hypopigmented lesions showed features of post-inflammatory hypopigmentation in 19% of patients, residual PLC in 52.4% and active PLC 28.6% of patients.

CONCLUSION: Hypopigmented lesions in PLC were noted mainly in younger ages, histopathologically they may show features of active or residual disease, beyond post-inflammatory hypopigmentation. Consequently active treatment for patients presenting predominantly with hypopigmented lesions could be required to control the disease.

Komy, M. E. L., B. Gaballa, and M. R. E. Abdel-Halim, "Longitudinal erythro-leukoxanthonychia developing after PUVA therapy", Skin Appendage Disorders, 2021.
Abdelkader, H. A., J. Hamdan, A. Elbendary, and M. R. E. Abdel-Halim, "Papillary eccrine adenoma presenting as a cutaneous horn.", International journal of dermatology, 2021.
Komy, M. E. L., E. El-Nabarawy, H. Abdelkader, M. R. E. Abdel-Halim, and R. AlAguizy, "Pigmentary mosaicism and extracutaneous defects: a case report of a rare form of twin spotting", Pigment International, vol. 8, pp. 176-8, 2021.
Shahin, A., R. Yousef, S. Hussein, M. Niazy, D. Attia, M. AlMasry, S. Shalaby, H. A. El-Kader, M. Bahgat, D. Teleb, et al., "Widespread Necrotizing Purpura and Lucio Phenomenon as the First Diagnostic Presentation of Diffuse Nonnodular Lepromatous Leprosy", CUTIS, vol. 108, pp. E4-E8, 2021.
2022
Pioltelli, P., P. T. Atkinson, M. Mattar, A. Edrees, H. M. A. Ahmad, A. Laymouna, M. R. E. Abdel-Halim, and G. Ragab, Monoclonal gammopathies with miscellaneous associations, , 2022.
El-Komy, M. H. M., Y. Azzazi, R. El Naggar, and M. R. E. Abdel-Halim, "Chronic Atrophic Scar-like Plaque: Challenge.", The American Journal of dermatopathology, vol. 44, issue 1, pp. e6-e7, 2022.
Abdel-Halim, M. R. E., A. Mahmoud, and G. Ragab, "Cutaneous manifestations of ANCA associated vasculitis", Vessel Plus, vol. 6, 2022.