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   Table of Contents - Current issue
Coverpage
July-December 2020
Volume 40 | Issue 2
Page Nos. 69-129

Online since Tuesday, June 9, 2020

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REVIEW ARTICLE  

Diet in dermatology: a review Highly accessed article p. 69
Rita V Vora, Modasia H Khushboo, Aishni J Shah, Dhruv R Patel, Trisha B Patel
DOI:10.4103/ejdv.ejdv_48_19  
Diet plays a very important role in various dermatological conditions. Many conditions occur due to deficiency or excess of a particular nutrient, while some conditions are related to abnormal metabolism of a particular nutrient. In this review, important dermatological conditions have been highlighted in which diet has a definite role and dietary change helps to control or prevent that particular condition. In diseases like dermatitis herpetiformis, dietary restrictions play a major role in their treatment. Dietary habits also play some role in diseases such as atopic dermatitis, acne vulgaris, psoriasis vulgaris, pemphigus, and urticaria. Genetic and metabolic disorders such as phenylketonuria, tyrosinemia, homocystinuria, galactosemia, Refsum’s disease, glucose-6-phosphate dehydrogenase deficiency, xanthomas, gout, and porphyria also require dietary modifications. Imbalanced diet leads to nutritional deficiency disorders such as kwashiorkar, marasmus, phrynoderma, pellagra, scurvy, acrodermatitis enteropathica, carotenemia, and lycopenemia
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ORIGINAL ARTICLES Top

Immunohistochemical expression of hypoxia-inducible factor-1 alpha in psoriatic patients p. 76
Soha Abdalla Hawwam, Mohamed Moustafa Shareef
DOI:10.4103/ejdv.ejdv_32_19  
Introduction Psoriasis is a chronic inflammatory skin disease characterized by aberrant differentiation and excessive growth of keratinocytes, with dermal and epidermal mixed leukocytic infiltrate and angiogenesis in the dermis. Oxygen consumption could be increased by the proliferation of cells, and impaired oxygen supply might occur from the thickening of the epidermis. A primary role in the maintenance of oxygen and energy homeostasis is hypoxia-inducible factor-1 (HIF-1). Several gene expression-encoding inflammatory proteins are stimulated by HIF-1. The pathogenesis of various forms of inflammation shows the involvement of hypoxia. Aim This immunohistochemical study was done to evaluate the role of HIF-1α in the pathogenesis of psoriasis. Patients and methods This study was conducted on 20 patients with chronic plaque psoriasis, and 10 healthy individuals as a control group. They underwent hematoxylin and eosin staining and immunohistochemical staining detection of HIF-1α expression. Results Regarding the correlation between HIF-1α expression and clinical parameters of the patients, there was a statistically significant positive correlation with the Psoriasis Area and Severity Index score. Conclusion In this study, there was significantly increased HIF-1α expression in psoriatic patients’ skin in comparison with normal control, and also its increase with elevated Psoriasis Area and Severity Index score might represent new promising therapeutic approaches and pharmacological research target for psoriasis treatment.
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Immunohistochemical study assessing stem cell factor receptor C-kit in patients with alopecia p. 84
Basma Mourad, Eiman Hasby, Nashwa Elfar
DOI:10.4103/ejdv.ejdv_40_19  
Background Stem cell factor receptor c-kit is a transmembrane protein with tyrosine kinase activity encoded by the oncogene c-kit. The stem cell factor/c-kit signaling may be involved in the pathological processes of alopecia. Objective The aim was to elucidate the role of the stem cell factor receptor c-kit in the pathogenesis of some types of alopecia. Patients and methods The study included 80 patients (52 had alopecia areata and 28 had androgenetic alopecia), in addition to 40 normal healthy persons who served as a control group. Skin biopsies were obtained from each participant and stained with hematoxylin and eosin and stem cell factor receptor c-kit. Results There was a statistically significant increase in intensity and count of stem cell factor receptor c-kit-positive cell expression in alopecia areata and androgenetic alopecia than in normal control specimens. There was a positive correlation between the intensity and count of stem cell factor receptor c-kit-positive cells in relation to the severity of alopecia. Conclusions Stem cell factor receptor c-kit was implicated in the pathogenesis of alopecia areata and androgenic alopecia, and it could have a predictive role in the progression of alopecia in high-risk patients.
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Direct immunofluorescence of the hair follicle in pemphigus: a less invasive method for diagnosis p. 92
Hatem Zedan Mohamed, Hisham Zayan Abdel Hafez, Nashwa Ahmed Mohamed, Reham Ahmed Abdel Rahim
DOI:10.4103/ejdv.ejdv_47_19  
Background Demonstration of intercellular deposition of immunoglobulin (Ig)G on the cell surface of keratinocytes by direct immunofluorescence (DIF) of the skin is the gold standard in diagnosis of pemphigus. In the past few years, the intercellular deposition of IgG in the outer root sheath has shown to be useful. Objective The aim was to compare the DIF of hair (plucked anagen and telogen and telogen obtained by combing) with that of skin for diagnosis of patients with pemphigus vulgaris (PV) and those with pemphigus foliaceus (PF). Materials and methods A total of 30 patients [24 with PV and six with PF] with active disease were included. Clinical evaluation (ABASIS score), histopathological examination, and DIF of skin and hair were done. Presence of intercellular deposits of IgG and or C3 in skin and outer root sheath of the hair was considered positive. Results DIF of skin was positive in all patients for IgG and in 25 patients for C3 and also DIF in anagen hair was positive in all patients, whereas in telogen hair, it was positive in 23 patients (17 with PV for both IgG and C3, and six with PF for IgG, and four of them for C3). All patients showed a positive relation between clinical, histopathological, DIF skin, and DIF of anagen hair in both PV and PF. Regarding telogen hair, the same findings was found in all six (100%) patients with PF, but in PV, only 17 (70.83%) patients showed these positive relations, whereas the other seven (29.2%) had positive DIF of both skin and anagen hair only. The sensitivity of hair DIF was 100% for anagen hair and 76.67% for telogen hair in patients with pemphigus. Conclusion Anagen and telogen hair DIF is a simple, noninvasive, and cost-effective procedure and can be used as an additional procedure for diagnosis in patients with PV and PF.
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Assessment of depression and anxiety in relation to quality of life in patients with vitiligo p. 99
Ensaf M Abdelmaguid, Hossam Khalifa, Manal M Salah, Doaa S Sayed
DOI:10.4103/ejdv.ejdv_54_19  
Background Vitiligo is a common skin disease that has been reported to affect ∼1% of the population worldwide. Many patients with vitiligo feel distressed and stigmatized by their condition. Objective The aim was to assess the effect of vitiligo on the patients’ quality of life and to ascertain comorbidity of depression and anxiety associated with the disease using Hamilton rating scale for anxiety and depression. Patients and methods One hundred patients with vitiligo and 50 control participants were subjected to clinical examination with assessment of vitiligo severity by vitiligo area scoring index (VASI) in addition to their assessment by dermatology life quality index (DLQI), Hamilton depression rating scale, and Hamilton anxiety rating scale. Results In this study, there was a significantly higher DLQI score among the study group compared with controls (P<0.001). Moreover, there was a highly significant difference in the Hamilton depression score (P<0.001) between the study group (24±7) and control group (3.8±1.6). Moreover, the study group scored higher on the Hamilton anxiety scale in comparison with the control groups, and this difference was statistically significant (P<0.001). A significant positive correlation was found between VASI score and both DLQI and Hamilton depression score (r=0.41 and 0.33, respectively). These correlations were statistically significant (P<0.001). Moreover, there was a significant positive correlation between VASI score and Hamilton anxiety score (r=0.20, P=0.022). Conclusion Vitiligo has a negative effect on patient’s psychological status in terms of anxiety and depression, especially in female patients, patients with increased body surface involvement, and those with lesions on exposed parts of the body.
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Role of serum androgens and prostate-specific antigen levels in men with androgenetic alopecia p. 106
Hesham N Khaled, Azza M Abdu Allah, Ahmad A Abdelhameed, Wafaa A Shehata
DOI:10.4103/ejdv.ejdv_46_19  
Background Androgenetic alopecia (AGA) is the most common form of hair loss. It is caused by continuous miniaturization of affected hair follicles. Genetic factors and androgenic factors especially dihydrotestosterone (DHT), which is a testosterone tissue metabolite, play major roles in the pathogenesis of AGA. Many studies suggest that AGA may be a marker of increased risk of prostate cancer. Objective The aim of the study was to determine the role of serum androgens and prostate-specific antigen (PSA) in men with AGA. Patients and methods The study included 80 participants: 40 men were diagnosed with AGA and 40 age-matched healthy male volunteers served as a control group. The authors also divided patient groups into two subgroups: frontal AGA group and vertical AGA group. All participants were subjected to measurement of serum level of T, DHT, and PSA by enzyme-linked immunosorbent assay. Results This study showed that mean serum level of testosterone and DHT in patients with AGA was higher than that in the control group and mean serum level of testosterone in the vertical AGA group was higher than that in the frontal AGA group. There was no significant difference between patients and controls regarding mean serum level of PSA. Conclusion This study showed that serum androgens play an important role in the development of AGA and there is a strong association between serum level of androgens and staging of AGA, whether frontal or vertical.
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Is there a difference in female sexuality in urban and rural areas: an Egyptian experience p. 112
Ihab Younis, Amany Ibrahim, Radwa A El-Helaly
DOI:10.4103/ejdv.ejdv_56_19  
Background There are known variations in social, cultural, demographic, and health characteristics across urban and rural residence areas that affect the sexual behavior and degree of sexual knowledge and beliefs between urban and rural couples. Objective The aim of our work was to compare female sexuality among urban and rural married women in a sample of Egyptian women. Patients and methods The study included 404 women, who were equally distributed regarding residence between rural and urban areas. All the women answered a self-report questionnaire including 25 questions, and other questions were added to suit the purpose of the study. Privacy was guaranteed for all the participants. Results No significant differences were observed in sexual activity between women living in urban areas and those living in rural areas. However, four statistically significant differences were observed. Urban women reported more initiation of coitus, preferred more man on top as a sexual position, more of them reported not having enough time for foreplay as a cause of inability to have orgasms, and more of them stated that the purpose of intercourse was having pleasure for them and their husbands. Conclusion Rural and urban communities in Egypt differ from each other in a few sexual aspects. A significantly high percentages of Egyptian women are still exposed to female genital cutting.
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CASE REPORTS Top

Diffuse nonscarring hair loss of the scalp is an early sign of juvenile systemic lupus erythematosus: a case report p. 118
Mohammed Abu El-Hamd, Soha Aboeldahab
DOI:10.4103/ejdv.ejdv_44_19  
Juvenile systemic lupus erythematosus is a rare multisystemic autoimmune disorder characterized by several clinical and immunological features. In the present case, a 13-year-old female presented with diffuse nonscarring hair loss at the frontal and vertex of the scalp. The hairs were dry, fragile, and easily detached. She had patches of erythema on the palmar aspects of both hands. She had no other cutaneous, nail, or mucous membrane manifestations. Erythrocyte sedimentation rates were elevated. The titer of antinuclear antibody was positive, and anti-double strand DNA antibody was positive. Otherwise, all laboratory and radiological investigations were normal.
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Mononeuritis multiplex with multiple skin ulcers p. 121
Mansoor C Abdulla
DOI:10.4103/ejdv.ejdv_25_19  
A heterogeneous group of diseases lead to mononeuritis multiplex and multiple skin ulcers. A 45-year-old man presented with multiple painful subcutaneous nodules with ulcerations, distal predominant weakness of both upper and lower limbs, reduced sensations over ulnar distribution of the right hand and high-grade intermittent fever for 2 months. The patient was diagnosed to have cutaneous polyarteritis nodosa based on clinical and histopathological evidence after ruling out other conditions. The patient was treated with prednisolone 1 mg/kg, which was tapered over months and azathioprine was added. When reviewed after 6 months he was afebrile, skin lesions were healed, and the power was improving. Mononeuritis multiplex and multiple skin ulcers have various etiologies. A detailed workup is essential to rule out other systemic diseases before making a diagnosis of cutaneous polyarteritis nodosa which is a benign disorder with a favorable outcome.
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A diagnostic conundrum: palmoplantar pits, lichen planus on histology lichen planus with a dermoscopic ‘Twist in the Tale’ p. 124
Tejas Vishwanath, Sunil Ghate, Geeta Shinde, Aseem Sharma, Angela Nagpal, Shikhar Chaube
DOI:10.4103/ejdv.ejdv_43_19  
A plethora of dermatologic conditions manifest as palmoplantar pits ranging from the relatively innocuous conditions like lichen planus, lichen nitidus, and keratosis punctata to more sinister ones like Cowden syndrome and Gorlin syndrome. Diagnosis generally depends on cutaneous and/or mucosal lesions. However, the occasional patient is encountered who does not manifest any other cutaneous features. In such cases, the diagnosis can only be reached by histopathology. We present two cases of isolated palmoplantar pits diagnosed as lichen planus on histopathology with intriguing dermoscopic findings in one case.
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