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Background Different therapeutic modalities have been tried for hypertrophic scar treatment. To our knowledge, intense pulsed light (IPL) has not been previously evaluated in comparison with cryotherapy as a stand-alone treatment for hypertrophic scars. Objective We aimed to evaluate the efficacy of IPL as a monotherapy for hypertrophic scar treatment as compared with cryotherapy both clinically and histopathologically. Methods This study included 28 patients with hypertrophic scars. Patients were divided randomly and equally into two groups; group I patients received cryotherapy while group II patients received IPL. All patients received treatments for a total of six sessions or until resolution of the lesion whichever was nearer. The outcome was evaluated clinically and histopathologically. Results Scar height showed a significant decrease and scar color and pliability showed a significant improvement in group I. No significant changes were detected in group II except in scar pliability. Vancouver scar scale (VSS) mean decreased by -53.7% in group I versus -11.5% decrease in group II. Histopathologically, group I showed a significantly increased epidermal thickness and decreased dermal and collagen bundle thickness, while group II showed insignificant histopathological changes. Group I exhibited a statistically significant clinical and histopathological improvement compared to group II, yet with more complications. Conclusion Cryotherapy is more effective than IPL in the treatment of hypertrophic scars both on clinical and histopathological level yet with more complications.

Background Vitiligo is an acquired pigmentary disorder of unknown etiology, affecting approximately 1 % of the world population, without predilection for race or sex. It is characterized by white macules and patches, whose size increases over time, due to the loss of melanocytes. Vitiligo can appear at any time, and it significantly impairs the patients’ quality-of-life. Objectives The aim of the work was to study the influence of the NB-UVB radiation therapy on tissue level of IL-33 in patients with vitiligo. Patients and Methods This prospective study was carried out on 10 patients diagnosed as having non -segmental vitiligo stable for 6 months duration. All patients were selected from the dermatology outpatient clinic of vitiligo, Ain-Shams University Hospitals. All patients were subjected to full history taking, general examination and dermatological examination. The disease characteristics of vitiligo were recorded as regards stability, duration and extent of vitiliginous lesions. The activity of the disease was evaluated according to VIDA score, and the disease severity was evaluated according to VASI score. Digital photographic documentation was done. Results Hydropic degeneration of lower epidermis was also detected in (40%) of them and apoptotic keratinocytes were found in (10%) of them. After therapy, these inflammatory changes were significantly reduced this can be partially explained by immunosuppressive properties of NB-UVB as it is believed to cause a reduction of T cells by inducing apoptosis and impairs in-vitro antigen presentation by both murine DCs and human Langerhans cells. The main limitation of our study was the small cohort of the studied patients. Further large-scale studies are needed. Investigatory techniques other than immunohistochemical analysis may be also used to evaluate abnormalities of keratinocytes in vitiligo skin. Conclusion We concluded that NB-UVB has no effect on tissue expression of IL-33 and and that NB-UVB was effective in treating vitiligo as manifested by VASI score change after treatment with NB-UVB. Based on our results we recommend further studies with larger sample size and studying the effect of treatment on IL-33 expression in active vitiligo cases is also recommended.

Background Vitiligo is an acquired pigmentary disorder resulting from loss of melanocytes which causes depigmentation of the skin. Clinically, it is characterized by the progressive loss of melanocytes causing the appearance of well-circumscribed milky white cutaneous macules and patches Aim of the Work to evaluate the efficacy of PRP as an additive treatment to the minigraft/NB-UVB treatments for stable localized vitiligo and the effect of this treatment on the expression of bFGF in the lesional treated vitiliginous skin compared before and after the course of treatment. Patients and Methods The study represents a prospective interventional comparative study. It was conducted on 17 patients diagnosed as stable vitiligo. All patients were selected from the dermatology outpatient vitiligo clinic of Ain-Shams University hospital from April 2018 to June 2019. All subjects who participated in this study gave written informed consents. The study was approved by the research ethical committee of Ain-Shams University (Approval Number: FWA 000017585) and fulfilled all the ethical aspects required in human research. Results We found that the addition of PRP to minigraft resulted in earlier repigmentation as assessed by VESTA score; however, at the follow up end (one month following the end of treatment), both modalities resulted in a similar response as regards the repigmentation percent and improvement in VESTA score. The addition of the PRP to the minigraft didn’t result in a superior improvement than minigraft alone. Conclusion Both minigraft and PRP-assisted minigraft followed by NB-UVB sessions are effective method to induce repigmentation in stable vitiligo.

Surgical methods are favorably used for treatment of stable vitiligo, and platelet-rich plasma (PRP) can be added to augment the effect. The additive value of PRP, however, remains elusive. Basic fibroblast growth factor (bFGF) is released from activated platelets with a capacity for stimulating melanocyte proliferation and migration. The treatment outcomes for the mini-punch grafting (MPG)/phototherapy treatment with and without PRP were assessed and the relation between bFGF and the obtained results were evaluated. Thirty-four vitiliginous patches, two per each patient with stable vitiligo, were enrolled in this intrapatient-controlled study and treated with autologous MPG and subsequent exposure to phototherapy with and without enhancement via PRP procedure at the time of the procedure, and monthly for the subsequent 3 months. Re-pigmentation assessment via vitiligo scores as well as measurement of lesional bFGF were done. PRP assistance to MPG/phototherapy treatment resulted in earlier re-pigmentation at week 8. However, this enhancement effect vanished at the study end (week 20) as ideal re-pigmentation (>75% re-pigmentation) was encountered in 10 patches (58.8%) treated with MPG/phototherapy modality, and in 12 patches (70.6%) treated with PRP-assisted method without significant difference between them. Lesional bFGF increased after both treatments with a higher expression with PRP assistance but without clinical reflection on the final outcome. PRP can speed the re-pigmentation response for MPG/phototherapy procedure without any significant effect on the final outcome.

Background: S100B protein was reported to be elevated in psoriatic patients' serum, with no previous evaluation of its skin expression, in contrast to the extensively studied S100 protein. Objective: To evaluate the serum level and skin expression of S100B in psoriasis to assess its possible involvement in its pathogenesis. Methods: Serum level of S100B protein was estimated in 40 psoriatic patients of different clinical varieties and 10 healthy controls. S100B protein expression was assessed immunohistochemically in lesional and non-lesional skin of patients and in normal skin of controls. Relation to disease severity was also evaluated. Results: Serum level of S100B protein was significantly higher in psoriatic patients (0.15±0.03 µg/l) than in controls (0.03±0.007 µg/l) (P-value

Summary Background/Purpose Skin aging can be classified into chronological aging and photoaging. Cyclooxygenase-2 (COX-2) may be involved in ultraviolet-induced inflammation, photocarcinogenesis and the aging process. Studies done focused on assessing COX-2 expression after acute ultraviolet exposure and in photocarcinogenesis. Comparative assessment of COX-2 expression in chronological aging and photoaging was not previously studied. We aimed to compare COX-2 expression in chronological aging and photoaging. Methods Sixty participants were included (20 with chronological aging, 20 with photoaging, and 20 non-skin-aged contributors as controls). Fitzpatrick skin type and Glogau's photoaging type were assessed. Immunohistochemical evaluation of COX-2 was done in biopsies from sun-protected skin in the chronological aging and control groups, and from sun-exposed skin in the photoaging group. Results Comparison between each two groups showed a high statistically significant difference, with the highest percentage of mild, moderate and marked expression in the control, chronological aging and photoaging groups, respectively. A high statistically significant positive correlation was found between grading of solar elastosis in the photoaging group and COX-2 expression parameters. Conclusion COX-2 expression is significantly higher in chronologically aged and photoaged skin than the normal young skin. This level of expression is significantly higher in photoaging than in chronological aging. COX-2 expression is positively related with the degree of solar elastosis in photoaging.

Summary Background Previous success rates of psoralen and ultraviolet A (PUVA) and narrowband UVB (NB-UVB) in the treatment of chronic urticaria are reported in few studies with no previous reports on the comparable efficacy of both modalities in the disease. Aim We aimed to compare the efficacy of PUVA versus NB-UVB in the treatment of chronic urticaria. Methods Twenty-four patients with chronic urticaria were included and divided into two groups: 12 patients subjected to PUVA and 12 subjected to NB-UVB. They were compared according to the urticaria Total Severity Score (TSS) before and after treatment, cumulative dose, and side effects. Results There was a statistically significant decrease in urticaria TSS in both the NB-UVB- and PUVA-treated groups after than before treatment (P 0.05). Gastrointestinal upset was reported at a significantly higher percentage in the PUVA-treated group than in the NB-UVB-treated group. Conclusion Both NB-UVB and PUVA show comparable efficacy in the treatment of chronic urticaria with minimal reversible side effects.

Angiogenesis and microvascular endothelial injury play a role in the pathogenesis of systemic lupus erythematosus (SLE). Vascular endothelial growth factor (VEGF), a key regulator of angiogenesis, and nail fold capillaroscopy (NFC) have been investigated in few studies in SLE with no reports targeting SLE with cutaneous manifestations. To evaluate NFC changes and VEGF serum level in relation to disease activity in SLE patients with versus without cutaneous manifestations. Thirty SLE patients (15 with cutaneous manifestations [group I], 15 without [group II]) and 15 healthy controls were evaluated for VEGF serum levels, NFC changes and were related to disease activity. VEGF serum levels were significantly higher in patients than controls (median and interquartile range [IQR]: 2110.77, 471.09-4714.30 vs. 60.00, 14-366, respectively, P < 0.0001). VEGF cut-off value to predict SLE patients was more than 293 and to detect moderate and severe SLE activity was more than 422 pg/mL and more than 3800 pg/mL, respectively. Serum VEGF levels increased with increased disease activity (P < 0.05). It was significantly higher in group I than group II (median and IQR: 2624.74, 1801.39-4141.70 vs. 862.50, 180-2426.95, respectively, P < 0.05). Mean serum VEGF was significantly higher with NFC score 3 than 1 (P = 0.008). NFC score and SLE activity were significantly associated in patients (P < 0.05). Serum VEGF is significantly elevated in SLE patients with cutaneous manifestations and its cut-off values to detect different activity grades of SLE are identified. Abnormalities in NFC reflect the extent of microvascular involvement in SLE.

Neo-angiogenesis is reported to be essential in the pathogenesis of oral lichen planus (LP). We aimed to investigate angiogenesis through CD34 staining and vascular endothelial growth factor (VEGF) expression in cutaneous LP lesions and to evaluate the relation of these markers with the degree of inflammation. Thirty patients with cutaneous LP and 10 healthy controls were included. Skin biopsies from all subjects were studied immunohistochemically for microvessel density (MVD) by CD34 staining and for VEGF expression. Relation of these parameters with the grade of inflammation was evaluated. The mean MVD was significantly higher in patients than controls (32.60, 95% CI: 27.71-37.49 vs. 9.60, 95% CI: 6.86-12.34; t = 5.43; P < 0.001). Positive VEGF expression was detected at a significantly higher rate in LP patients compared with controls (76.7% vs. 30.0%, OR (95% CI) 7.67(1.56-37.80), P < 0.05). Patients with positive VEGF expression showed significantly higher mean MVD compared with those having negative VEGF expression (37.39, 95% CI 32.66-42.12 vs. 16.86, 95%CI 13.59-20.12 respectively, P < 0.001). Increasing mean MVD and VEGF positivity were significantly observed with higher grades of inflammation (P < 0.05). This work confirms a role for angiogenesis and increased VEGF expression in cutaneous LP and a relation of these events with the degree of inflammation in the disease.

Background: The efficacy of a phototoxic dose of ultraviolet A (UVA) after topical application of 8-methoxypsoralen (8-MOP) in the treatment of alopecia areata (AA) was evaluated previously in only one study. However, the possibility of spontaneous regrowth of hair cannot be excluded as sessions were carried out every 3 months. Objective: To determine the efficacy of a phototoxic dose of UVA after topical application of 8-MOP in the treatment of AA resistant to other lines of treatment. Subjects/Methods: Thirty-five patients with AA were treated by topical 8-MOP application to the lesions followed by UVA irradiation using a phototoxic dose every 3 months for a maximum of four sessions. Severity grading of AA was carried out using the Severity of Alopecia Tool (SALT) score before and after treatment. Results: Fifty-seven percent of patients showed a positive treatment response (40% showed complete and 17% showed partial response) with significant improvement of SALT score. The mean cumulative UVA dose was 22±8.3 J/cm2. Mild reversible side effects were observed in 63% of patients after the first session. Conclusion: Phototoxic psoralen and ultraviolet A therapy after topical application of 0.1% 8-MOP is an effective treatment option for resistant AA, with low total cumulative UVA dose, few treatment sessions, and minimal reversible side effects.

Background: Comparative success rates of bath psoralen+ultraviolet A (PUVA) and narrow band-ultraviolet B (NB-UVB) in psoriasis treatment are variably reported with no previous studies on the possible effect of bath PUVA on circulating CD4+ and CD8+ T cells. Objective: We aimed to compare the effect of bath PUVA and NB-UVB clinically and on circulating T-helper and T-suppressor/cytotoxic cells in psoriasis. Patients and methods: Thirty-four psoriatic patients divided into a bath PUVA-treated group (18 patients) and a NB-UVB-treated group (16 patients) were compared regarding the disease severity by psoriasis area and severity index (PASI) score and percentage of circulating CD4+ and CD8+ T cells by flowcytometry before and after treatment. Results: After treatment, the bath PUVA group showed a significantly higher reduction of PASI score (85.44%) than the NB-UVB group (58.72%). Mean peripheral CD4+ T-cell percentage was significantly lower after [36.8; 95% confidence interval (CI) 33.80, 39.97] compared with before treatment (42.06; 95% CI 38.29, 45.83) (P 0.05). Conclusion: Bath PUVA therapy is superior to NB-UVB in the treatment of moderate and severe psoriasis with mild reversible side effects. Both modalities have a systemic effect decreasing peripheral CD4+ T cells, which is more with bath PUVA.

Background: Psoriasis is a proliferative disease, and human papilloma virus (HPV) may be one of the causative factors underlying its pathogenesis. Aim of the study: To study whether the presence of the virus in psoriatic patients is due to the proliferative nature of the disease or due to the immunosuppression induced in patients receiving phototherapy. Patients and methods: Using a nested polymerase chain reaction, a skin biopsy was taken and examined for HPV expression in 20 untreated psoriatic patients, 20 psoriasis patients under phototherapy [narrow band ultraviolet B (UVB)], 20 psoriasis patients under systemic photochemotherapy (psoralen and UVA), 10 healthy controls, and 10 non-psoriatic patients under UV treatment. Results: The virus detection rate in psoriatic patients under photochemotherapy (60%) was significantly higher (P

Intralesional purified protein derivative (PPD) or mumps, measles, rubella (MMR) were not previously compared regarding their efficacy or mechanism of action in treatment of warts. We aimed to compare their efficacy in treatment of multiple warts and investigate their effect on serum interleukin (IL)-4 and IL-12. Thirty patients with multiple warts were included (10 treated with PPD, 10 with MMR, and 10 with normal saline (control)). Injection was done every 3 weeks until clearance or maximum of three treatments. Clinical response of target and distant warts was evaluated. Serum ILs-4 and -12 were assessed before and after treatment. A significantly higher rate of complete response was found in target and distant warts with PPD (60% each) and MMR (80%, 40%, respectively) compared with controls (0%), with no significant difference between both treatments. After treatment, the control group showed the lowest serum IL-12 and IL-4 levels compared with the MMR- and PPD-treated groups with statistically significant difference in between. MMR resulted in a significantly higher serum IL-12 than PPD. With PPD, IL-4 was increased with statistically significant change compared with pretreat-ment level. Intralesional PPD and MMR show comparable efficacy and safety in treatment of multiple warts. Serum ILs-4 and-12 increase following antigen injection.

Summary Background Different laser systems are reported to be effective in treatment of telangiectasia and erythema, but comparative studies on 1064-nm neodymium-yttrium aluminum garnet (Nd-YAG) laser and pulsed dye laser (PDL) in treatment of erythemato-telangiectatic rosacea are lacking. Substance (P) is implicated in rosacea pathogenesis. Objectives To compare the effect of Nd-YAG laser and PDL on erythemato-telangiectatic rosacea, both clinically and immunohistochemically on cutaneous substance (P) expression. Methods This split-face comparative study included 15 patients with erythemato-telangiectatic rosacea treated on the right side with Nd-YAG laser and on the left side with PDL: three sessions, 4 weeks apart. Evaluation of the patients was done using erythema and telangiectasia grading scores, patient's self-assessment, physicians' clinical assessment of the patient, and immunohistochemical assessment of substance (P). Results One month after the three laser sessions, excellent response was achieved in 73.3% of patients after Nd-YAG and in 53.3% of patients after PDL with significantly lower substance (P) concentration after Nd-YAG laser than after PDL. Positive correlations were found between the decrease in erythema and telangiectasia grading scores and the decrease in substance (P) concentration. Conclusions The use of Nd-YAG laser and PDL appears to be safe and effective measures in treatment of erythemato-telangiectatic rosacea. Both types of laser decrease the concentration of substance (P) in the skin. This effect is more pronounced with Nd-YAG laser.

Previous success rates of psoralen and ultraviolet A (PUVA) and narrowband UVB (NB-UVB) in the treatment of chronic urticaria are reported in few studies with no previous reports on the comparable efficacy of both modalities in the disease.We aimed to compare the efficacy of PUVA versus NB-UVB in the treatment of chronic urticaria.Twenty-four patients with chronic urticaria were included and divided into two groups: 12 patients subjected to PUVA and 12 subjected to NB-UVB. They were compared according to the urticaria Total Severity Score (TSS) before and after treatment, cumulative dose, and side effects.There was a statistically significant decrease in urticaria TSS in both the NB-UVB- and PUVA-treated groups after than before treatment (P 0.05), with no significant difference between both groups regarding the percentage of improved patients and the mean decrease of urticaria TSS (P 0.05). Gastrointestinal upset was reported at a significantly higher percentage in the PUVA-treated group than in the NB-UVB-treated group.Both NB-UVB and PUVA show comparable efficacy in the treatment of chronic urticaria with minimal reversible side effects.

Lichen planus (LP) is a chronic inflammatory, T cell-mediated autoimmune skin disease. Innate immunity could explain the interplay between environmental triggers and the autoimmune cascade leading to disease development. Toll-like receptors (TLRs) are important components of the innate immune system, with no previous evaluation of TLRs 1 and 2 in cutaneous LP. This work aims to investigate TLRs 1 and 2 expression in cutaneous LP. This case–control study included 30 patients with LP and 15 healthy controls. Biopsies from the patients’ lesional skin and from the controls’ normal skin were examined immunohistochemically for TLR 1 and 2 expression. A significant re-localization was found in TLR1 expression with a higher percentage of basal and a significantly lower percentage of homogenous epidermal expression in patients (73.3 and 0 %, respectively) compared with controls (13.3 and 73.3 %, respectively) (P < 0.001). TLR2 showed a significantly higher percentage of epidermal expression (more in the upper spinous layer) and significantly lower percentage of epidermal but more basal expression in patients (66.6 and 10 %, respectively) compared with controls (0 and 73.3 %, respectively) (P < 0.001). The median (IQR) of TLR1 [1 (0.75–1)] and TLR2 [1 (1–1)] staining score in patients was significantly lower than that of the controls [2 (1–2) and 1 (1–2), respectively] (P < 0.05). This work thus shows a re-localization of TLR 1 and 2 expression sites with decreased grade of expression in LP lesions. Targeting TLR signaling is expected to be a novel treatment strategy for cutaneous LP.

Our aim was to assess the relationship of keratinocyte and lymphocyte apoptosis and macrophage function to disease outcome in systemic lupus erythematosus patients with and without cutaneous manifestations. 50 systemic lupus erythematosus patients [25 with cutaneous manifestations (group I), 25 without cutaneous manifestations (group II)] and 20 normal controls (group III) were studied. Assessments of disease activity, peripheral lymphocyte apoptosis, macrophage function and apoptotic cells in skin and renal biopsies were carried out. The mean systemic lupus erythematosus disease activity index score was significantly higher in group I than II (18.6 +/- 6, 8.8 +/- 2.7 respectively, p < 0.001). The mean percentage of peripheral apoptotic lymphocytes was significantly higher in group I than groups II, III (55.3 +/- 21.4, 25.6 +/- 8.7 & 19.4 +/- 3.2 respectively, P < 0.001), so was serum neopterin level (27.5 +/- 7.3, 14.9 +/- 2.7, 9.4 +/- 1.1 respectively, p < 0.001), and the mean number of protein53 positive apoptotic keratinocytes in skin (20.6 +/- 5.4, 1.6 +/- 0.5, 1.7 +/- 0.4 respectively, p < 0.001). A higher percentage of class IV, V glomerulonephritis was found in group I (47%, 26%, respectively) compared to group II (11% both) (p < 0.001). The mean number of protein53 positive apoptotic skin keratinocytes showed a significant positive correlation to disease activity, percentage of peripheral apoptotic lymphocytes and serum neopterin (P < 0.001). In conclusion, an accumulation of apoptotic keratinocytes and lymphocytes in systemic lupus erythematosus with cutaneous manifestations is associated with a worse disease outcome.

Background: The etiology of skin tags (STs) is not fully understood. A relation to diabetes mellitus and obesity was suggested. Few studies of possible mast cells (MCs) involvement were reported. Tyrptase is a mast cell mediator and a potent fibroblast growth factor. It may provide a molecular link between mast cell activation and fibrosis. Aims: The aim was to assess clinical and laboratory findings in patients with STs, and the possible link between obesity, dyslipidemia, and lesional MC count/tryptase expression. Materials and Methods: A total of 20 patients with STs were subjected to clinical examination, estimation of body mass index (BMI), fasting blood glucose (FBG), postprandial blood glucose (PPBG), serum cholesterol and triglycerides, abdominal ultrasound for fatty liver assessment, in addition to study of MCs through staining for MC tryptase in two skin biopsies; lesional and nonlesional (control). Results: All patients showed abnormally high BMI and hypertriglyceridemia, with abnormal sonographic pattern in 15 patients (75%). STs number positively correlated with the age of patients. STs showed significantly higher MC counts and tryptase expression, compared with control skin (P < 0.001), with no correlation of the STs number or MC count with BMI, FBG, PPBG or serum cholesterol. Obese patients showed a significantly higher MC count than overweight and there was a positive correlation between MC count and serum triglycerides. Axilla and under breast STs showed a higher MC count compared with other sites. Conclusions: STs seem to be related to obesity and hypertriglyceridemia. MCs with their tryptase are possibly involved in pathogenesis of STs. MC count is related to the associated factors; obesity and serum triglycerides. MC tryptase expression is a reliable method for accurate tissue MC counting.