Rania Abdel Hay

Enlarged facial pores are becoming a matter of cosmetic concern. Injections of (botulinum toxin type A) have an increasing popularity among cosmetic procedures. To determine the efficacy and safety of intradermal injection of botulinum toxin in treatment of excess sebum secretion and enlarged facial pores. This split face-controlled pilot study was conducted on 20 patients with enlarged facial pores and seborrhea. One cheek was treated by intradermal injection of botulinum toxin, and the other was injected by saline. Patient assessment was performed after 1 and then after 4 months. At 1-month assessment, both sides showed significant reduction in their sebum and pore scores ( = .001), with significantly more improvement on the botulinum toxin-treated side. Dermoscopy documented a significant decrease in the average size of facial pores ( < .001), and the OCT demonstrated a significant increase in the dermal thickness ( < .001) with non-significant deference between both sides. Four months after treatment, the botulinum toxin-treated side maintained its improvement in both scores. Intradermal injection of botulinum toxin is an effective and safe procedure for the management of excess sebum and facial pores with acceptable results lasting for an average of 4 months.

Background: Normal immune functioning requires sufficient levels of trace elements including zinc and selenium, while elements such as nickel can be immunotoxic.

Aim: To assess long-term abnormalities in zinc, selenium and nickel levels in patients with chronic recurrent warts.

Methods: Toenail samples were taken from 28 patients with chronic recurrent warts and 30 apparently healthy matching controls were analysed. Toenail concentrations of zinc, selenium and nickel were measured using inductively-coupled plasma-optical emission spectroscopy.

Results: Selenium levels were significantly higher in patients than in controls (P = 0.03). Levels of trace elements did not correlate with the number or duration of warts. Toenail nickel levels in all subjects were higher than globally reported values.

Limitations: A small sample size and the absence of regional reference ranges for concentrations of trace elements in toenails.

Conclusion: Zinc does not seem to be involved in the chronicity of warts, and it is unclear if selenium has a protective role against warts. Our finding of high concentrations of nickel in both patients and controls raises concerns about environmental exposure.

The efficacy of mesotherapy in the treatment of female pattern hair loss (FPHL) has not yet been evaluated. Aim of the study was to compare the initial efficacy and safety of mesotherapy containing nutritional supplements to topical minoxidil 5% solution in FPHL. 30 patients with FPHL were randomly classified into two equal groups: Group A applied minoxidil 5% lotion twice daily; Group B was injected with mesotherapy once weekly. For both groups ultrasound biomicroscopy (UBM) was performed before and at the end of the 12th week of treatment. After treatment, no significant difference was found between both groups with regard to either improvement of hair density and hair loss (P=0.27 and 0.056, respectively), nor the degree of improvement of Ludwig's classification as assessed by the investigator (P=0.210). A significant difference was observed between both groups (P=0.001) with the highest degree of satisfaction in the mesotherapy group. In group A, no significant difference was found in the number of hair follicles or the diameter of the largest hair follicle (P=0.244 and 0.925, respectively). In group B, a significant difference was found in the number of hair follicles (P=0.001), with no significant difference in the diameter of the largest hair follicle (P=0.105). The mesotherapy group showed more improvement with regard to the increase in the number of the hair follicles after treatment (P=0.007). Limitation of the study is small sample size, and relatively short duration of treatment. Mesotherapy, containing nutritional supplements only, is an effective, more acceptable to patients, and more tolerable modality compared with topical minoxidil in the treatment of FPHL.

BACKGROUND: Cyclooxygenase-2 (COX-2) is an inducible modulator of inflammation that acts through increasing prostaglandin levels and has been described as a major mediator linking inflammation to cancer. Previous studies supported that COX-2-765G>C and -1195A>G polymorphisms were associated with increased risk of several solid tissue cancers as well as some hematological malignancies.

OBJECTIVE: The aim of the study was to elucidate the association between functional COX-2 genotypes (-765G>C and -1195A>G) polymorphisms and the risk of developing mycosis fungoides (MF).

METHODS: This was a hospital-based, case-control study of 70 MF patients and 100 MF-free controls. We genotyped COX-2 -1195A>G, -765G>C, and -8473T>C polymorphisms by using the PCR-restriction fragment length polymorphism method.

RESULTS: The AA genotype in the COX-2 -1195A>G gene polymorphism and the GC genotype in the COX-2 -765G>C gene were significantly more frequent among MF patients compared to controls (p< 0.001 and p = 0.002, respectively).

CONCLUSION: The -results indicate a possible role of COX-2 genes in the pathogenesis of MF. These novel findings may allow for notable future advances, as it will enable the identification of the -individuals most susceptible to MF.

BACKGROUND: Alopecia areata (AA) is, an organ-specific autoimmune disease, characterized by an aberrant expression of cytokines of the T helper 1 type. Tumour necrosis factor-like weak inducer of apoptosis (TWEAK) is a multifactorial cytokine that exerts a role in the pathogenesis of inflammatory and autoimmune diseases, especially in cutaneous diseases.

AIM: To estimate the serum level of TWEAK in AA and to correlate it with different parameters.

METHODS: This case-control study enrolled 40 patients with AA and 50 clinically healthy volunteers matched for age and sex. A blood sample (5 mL) was extracted from each participant for analysis of serum TWEAK levels by ELISA.

RESULTS: Levels of TWEAK were significantly higher in patients with AA (mean ± SD 213.7 ± 59.2 pg/mL, range 109.1-341.6 pg/mL) than in controls (95.97 ± 13.28 pg/mL, range 80.1-152.3 pg/mL) (P < 0.001). A significant positive correlation was found between serum TWEAK level and the Severity of Alopecia Tool (SALT) score (r = 0.56, P < 0.001).

CONCLUSION: To our knowledge, this study highlights for the first time a possible link between higher serum TWEAK level and AA. Serum TWEAK level appears to reflect AA disease severity.

BACKGROUND: Guttate psoriasis displays distinctive epidemiological and clinical features, making it a separate entity within the heterogeneous group of cutaneous psoriasis types. It is associated with genetic, immune, and environmental factors (such as stress and infections) and usually arises in younger age groups (including children, teenagers, and young adults). There is currently no cure for psoriasis, but various treatments can help to relieve the symptoms and signs. The objectives of treatment when managing an acute flare of guttate psoriasis are to reduce time to clearance and induction of long-term remission after resolution. This is an update of a Cochrane Review first published in 2000; since then, new treatments have expanded the therapeutic spectrum of systemic treatments used for psoriasis.

OBJECTIVES: To assess the effects of non-antistreptococcal interventions for acute guttate psoriasis or an acute guttate flare of chronic psoriasis.

SEARCH METHODS: We searched the following databases up to June 2018: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We searched five trials registers and checked the reference lists of included studies for further references to relevant randomised controlled trials. We checked the proceedings of key dermatology conferences from 2004 to 2018, and also searched for trials in the US Food and Drug Administration (FDA) database for drug registration.

SELECTION CRITERIA: All randomised controlled trials assessing the effects of treatments for acute guttate psoriasis or an acute guttate flare of chronic psoriasis clinically diagnosed in children and adults. This included all topical and systemic drugs, biological therapy, phototherapy (all forms: topical and systemic), and complementary and alternative therapies. We compared these treatments against placebo or against another treatment. We did not include studies on drugs that aim to eradicate streptococcal infection. We did not include studies when separate results for guttate psoriasis participants were not available.

DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility and methodological quality and extracted data. We used standard methodological procedures expected by Cochrane. Our primary outcomes were 'percentage of participants clear or almost clear (i.e. obtaining Psoriasis Area Severity Index (PASI) 100/90 and/or Physician's Global Assessment (PGA) of 0 or 1)' and 'percentage of participants with adverse effects and severe adverse effects'. Our secondary outcomes were 'number of relapses of guttate psoriasis or flares within a period of six months after the treatment has finished', 'percentage of participants achieving a PASI 75 or PGA of 1 or 2', and 'improvement in participant satisfaction measures and quality of life assessment measures'. We used GRADE to assess the quality of the evidence for each outcome.

MAIN RESULTS: This review included only one trial (21 participants), which compared fish oil-derived (n-3) fatty acid-based lipid emulsion (50 mL per infusion (1.05 g eicosapentaenoic and 10.5 g docosahexaenoic acid)) (10 participants) to soya oil-derived (n-6) fatty acid-based lipid emulsion (50 mL per infusion (1.05 g eicosapentaenoic and 10.5 g docosahexaenoic acid)) (11 participants) administered intravenously twice daily for 10 days, with a total follow-up of 40 days. The study was conducted in a single centre in Germany in 18 men and three women, aged between 21 and 65 years, who were in hospital with acute guttate psoriasis and had mean total body surface involvement of 25.7% ± 20.4% (range 10 to 90). The study was funded by a company that produces the oil emulsions. We found no other evidence regarding non-antistreptococcal interventions used in clinical practice for guttate psoriasis, such as topical treatments (corticosteroids, vitamin D₃ analogues), systemic drugs, biological therapy, and phototherapy.The primary outcomes of the review were not measured, and only one of our secondary outcomes was measured: improvement in participant satisfaction measures and quality of life assessment measures. However, the study authors did report that there was rare skin irritation at the site of peripheral intravenous route, but the number of affected participants was not provided.Improvement between baseline and day 10, using a non-validated score assessed by participants themselves daily based on five items (appearance of lesions, impairment of daily life, pruritus, burning, and pain), was greater in the group that received the fish oil-derived (n-3) fatty acid-based lipid emulsion (75%) than in the group receiving the soya oil-derived (n-6) fatty acid-based lipid emulsion (18%) (one trial, 21 participants). However, these results are uncertain as they are based on very low-quality evidence.

AUTHORS' CONCLUSIONS: There is no evidence regarding topical and systemic drugs, biotherapy, or phototherapy in guttate psoriasis (we did not consider drugs that aimed to eradicate streptococcal infection because these are assessed in another Cochrane Review). We are uncertain of the effect of intravenously administered lipid emulsion on guttate psoriasis because the quality of the evidence is very low, due to risk of bias (unclear risk of bias for all domains), indirectness (the trial only included adults, and the follow-up from baseline was only 10 days), and imprecision (small number of participants).This review highlights the need for trials assessing the efficacy and safety of phototherapy and topical and systemic drugs for guttate psoriasis. There is also a need for studies that clearly distinguish the specific population with guttate psoriasis from the larger group of people with chronic plaque psoriasis, and children and young adults should be assessed as a distinct group.

BACKGROUND: Lipocalin-2 (LCN2) is an adipokine related to insulin resistance and metabolic syndrome (MetS) in addition to its role in innate immunity and apoptosis.

OBJECTIVE: To estimate LCN2 tissue levels (lesional and non-lesional) in psoriasis. To assess the metabolic status of patients and to detect any possible associations between LCN2 and MetS. To evaluate the effect of narrow-band ultraviolet B (NBUVB) on tissue LCN2 in psoriasis.

METHODS: This case-control study was conducted on 25 psoriatic patients and 25 healthy controls. Dyslipidemia and MetS have been evaluated. Tissue LCN2 was estimated using ELISA technique before and after treatment with NBUVB.

RESULTS: Tissue LCN2 was significantly higher in psoriasis, with no significant difference as regards dyslipidemia or metabolic disturbance in these patients. Both lesional and non-lesional LCN2 and PASI score dropped significantly after NBUVB. No significant correlations have been detected between tissue LCN2 and disease extent or PASI score. Significant positive correlations were detected regarding tissue LCN2 levels between lesional and non-lesional samples before and after treatment.

CONCLUSIONS: Psoriatic patients were at higher risk of metabolic disorders. LCN2 was not related to metabolic disturbances in our patients. NBUVB might exert its therapeutic effect in psoriasis through reduction of tissue LCN2.

Context: Studying the link between prolactin and autoimmunity has gained much ground over the past years. Its role played in alopecia areata (AA) is not clear yet, as previous reports yielded controversial results.

Aims: This study aimed to measure the serum level of prolactin and to detect the expression of its receptor in AA, in an attempt to highlight its possible role in the pathogenesis of this disease.

Subjects and Methods: A case-control study of 30 AA patients and 20 controls from outpatient clinic were undertaken. Every patient was subjected to history taking and clinical examination to determine the severity of alopecia tool (SALT) score. Blood samples were taken from patients and controls to determine the serum prolactin level. Scalp biopsies were obtained from the lesional skin of patients and normal skin of controls for assessment of the prolactin receptor.

Statistical Analysis: Depending upon the type of data, -test, analysis of variance test, Chi-square, receiver operator characteristic curve were undertaken.

Results: On comparing the serum prolactin level between patients and controls, no significant difference was found, while the mean tissue level of prolactin receptor was significantly higher in patients than in controls. In patients, a significant positive correlation was found between the prolactin receptor and the SALT score.

Conclusions: Prolactin plays a role in AA, and this role is probably through the prolactin receptors rather than the serum prolactin level.

BACKGROUND: High interleukin (IL)-17 contributes to vitiligo pathogenesis. Vitamin D has been assessed in vitiligo, with no reports targeting its relation to IL-17.

OBJECTIVE: To evaluate a possible regulatory effect of vitamin D on IL-17 and their relation to disease activity in vitiligo.

METHODS: This study included 30 vitiligo patients and 40 controls evaluated for IL-17 and vitamin D serum levels by ELISA technique.

RESULTS: IL-17 was significantly higher (p = 0.001) whereas vitamin D was found to be lower among the patients (p < 0.001). Multivariable regression was performed to evaluate the relationship between IL-17 and vitamin D levels with the demographic data on the patients, revealing a nonsignificant relationship (p > 0.05). A significant positive correlation was noted between vitamin D levels and disease duration.

CONCLUSION: Vitamin D represents a potential player in the pathogenesis of vitiligo. Its possible regulatory relation to IL-17, together with its weight as a screening tool in vitiligo, needs further evaluation.

BACKGROUND: Female pattern hair loss (FPHL) is the most common form of hair loss in women. Nevertheless, its management represents a real challenge. Among the FDA approved therapeutic modalities for FPHL are topical minoxidil and more recently low-level light therapy (LLLT).

AIM OF WORK: Assess the efficacy and safety of LLLT in comparison to topical minoxidil 5% and to a combination of both therapies in the treatment of FPHL.

PATIENTS AND METHODS: This study included 45 female patients with proven FPHL. They were randomly divided into three equal groups, where group (i) patients were instructed to apply topical minoxidil 5% twice daily, group (ii) patients received LLLT using the helmet iGrow® device for 25 minutes 3 days weekly, and group (iii) patients received a combination of both topical minoxidil 5% twice daily and LLLT for 25 minutes 3 days weekly for 4 months (study duration). Evaluation was done according to clinical, dermoscopic (folliscopic), and ultrasound bio-microscopic (UBM) parameters. Patient satisfaction and side effects were reported.

RESULTS: The efficacy and safety of both topical minoxidil and LLLT were highlighted with comparable results in all parameters. The combination group (iii) occupied the top position regarding Ludwig classification and patient satisfaction. UBM and dermoscopic findings showed significant increase in the number of regrowing hair follicles at 4 months in all groups, whereas only UBM showed such significant increase at 2 months in the combination group (iii). A non-significant increase in the hair diameter was also documented in the three groups.

CONCLUSION: LLLT is an effective and safe tool with comparable results to minoxidil 5% in the treatment of FPHL. Owing to the significantly better results of combination therapy, its usage is recommended to hasten hair regrowth. Lasers Surg. Med. © 2017 Wiley Periodicals, Inc.

BACKGROUND: Pityriasis rosea (PR) is a common papulosquamous skin disease in which an infective agent may be implicated. Toll-like receptors (TLRs) play an important role in immune responses and in the pathophysiology of inflammatory skin diseases. Our aim was to determine the possible roles of TLRs 3, 7, 8, and 9 in the pathogenesis of PR.

METHODS: Twenty-four PR patients and 24 healthy individuals (as controls) were included in this case control study. All recruits were subjected to routine laboratory investigations. Biopsies were obtained from one active PR lesion and from healthy skin of controls for the detection of TLR 3, 7, 8, and 9 gene expression using real-time polymerase chain reaction.

RESULTS: This study included 24 patients (8 females and 16 males) with active PR lesions, with a mean age of 28.62 years. Twenty four healthy age- and sex-matched individuals were included as controls (8 females and 16 males, with a mean age of 30.83 years). The results of the routine laboratory tests revealed no significant differences between both groups. Significantly elevated expression of all studied TLRs were detected in PR patients relative to healthy controls (p < .001).

CONCLUSIONS: TLRs 3, 7, 8, and 9 might be involved in the pathogenesis of PR.

BACKGROUND: Toll-like receptors (TLRs) have been implicated in various dermatological diseases. TLR agonists have the capacity to potently activate the innate immune cells of patients with advanced, refractory, cutaneous T-cell lymphoma (CTCL).

AIM: To detect TLR7 gene expression in mycosis fungoides (MF) (a neoplastic skin condition) and to compare it with psoriasis (an inflammatory skin condition) in an attempt to clarify the pathogenic role played by TLR7 in both conditions.

METHODS: This case-control study enrolled 28 patients with MF: 30 patients with psoriasis, and 30 age- and sex-matched healthy controls (HCs). A 4-mm punch skin biopsy was obtained from lesional skin of patients and from normal skin of HCs for detection of TLR7 gene expression using real-time PCR.

RESULTS: Mean TLR7 level in patients with MF (0.4 ± 0.23) was significantly lower than in patients with psoriasis (1.49 ± 0.46) and in HCs (1.22 ± 0.44) (P < 0.001), and mean TLR7 level in patients with psoriasis was significantly higher than in HCs (P < 0.03). Based on MF staging, 21.4% of patients had stage Ia, 28.6% had stage Ib, 28.6% had stage IIa and 21.4% had stage IIb disease. Comparing the TLR7 levels in relation to MF staging revealed the lowest mean value was in stage IIb and highest mean value in stage Ia, and this was significant (P < 0.001).

CONCLUSION: Disturbed innate immunity might play a role in the pathogenesis of neoplastic and inflammatory skin conditions. TLR7 could be useful as a prognostic factor in MF.

BACKGROUND: There is a reported relation between hyperhomocysteinemia and lichen planus (LP). An increase in homocysteine (Hcy) and the risk of cardiovascular disease (CVD) in patients with methylenetetrahydrofolate reductase (MTHFR) mutation has been described OBJECTIVE: To detect MTHFR (C677T) gene polymorphism, and to find its association with CVD risk, Hcy and folic acid levels in patients with LP METHODS: This hospital-based case-control study included 110 patients with LP; 70 with cutaneous LP (CLP) and 40 with oral LP (OLP). 120 age and sex matched healthy subjects were used as controls. Three ml venous blood sample was taken for detection of MTHFR gene polymorphism by PCR-RFLP technique and for measurement of the lipid profile. Hcy and folic acid were measured by ELISA. Hypertension was evaluated RESULTS: There were significantly higher prevalence of hypertension with higher Hcy, triglycerides and cholesterol levels and lower folic acid and HDL levels among patients' groups. Hypertension with higher Hcy and cholesterol levels together with lower folic acid and HDL levels have been found in OLP when compared to CLP. Patients showed a significant higher percentage of the MTHFR 677 TT genotype (P=0.003) and of the MTHFR 677 T allele (P=0.042) compared to controls. Moreover, there was higher a prevalence of MTHFR 677 T allele in patients with CLP.

CONCLUSION: MTHFR 677 gene polymorphism may be a risk factor for the development of the LP, and to predispose these patients to higher risk of CVD. This article is protected by copyright. All rights reserved.

BACKGROUND: A poloxamer solution acting as a vehicle for the lipid base particulate system (cubosome dispersions) containing alpha lipoic acid (ALA) has achieved encouraging results in skin aging.

OBJECTIVE: Evaluate the efficacy of 5% Cubosomal ALA as an anti-aging formulation.

METHODS: This single-blinded, placebo-controlled, comparative study was conducted on 20 females. Patients were instructed to apply a gel formulation containing the active ingredient over the right half of their face and a placebo gel on the left half twice daily for 6 months. Global aesthetic improvement scale (GAIS) was utilized as a measure of clinical progress. The thicknesses of the epidermis and dermis were assessed before and after treatment using an ultrasound biomicroscope.

RESULTS: The GAIS score assessment at 3 and 6 months showed a significantly greater improvement on the right sides in comparison with the left sides. At the end of the treatment period, the mean epidermal thickness significantly increased on the right side in comparison with the left side and the mean dermal thickness increased more on the right side in comparison with the left side; however, this difference was not significant.

CONCLUSION: 5% Cubosomal ALA is an effective and safe modality for improving aging face.

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