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   Table of Contents - Current issue
Coverpage
January-June 2020
Volume 40 | Issue 1
Page Nos. 1-67

Online since Monday, January 6, 2020

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ORIGINAL ARTICLES  

The relationship between the levels of interleukin-17 and 25-hydroxyvitamin D in vitiligo outcome p. 1
Mohamed I Metwalli, Fathia M Khattab, Manal M El Amin, Menna Allah H Abdel Aziz
DOI:10.4103/ejdv.ejdv_29_18  
Background The active form of vitamin D (1,25 hydroxyvitamin D) mediates the interaction between vitamin D and immune diseases including vitiligo, which was found to be associated with lower 25(OH)D levels. Objective To evaluate the role of vitamin D and interleukin (IL)-17 in vitiligo and its relationship with autoimmune diseases and to assess the therapeutic effect of vitamin D in patients with vitiligo. Patients and methods A total of 44 patients with vitiligo were measured for vitamin D and IL-17. Those with a low level of vitamin D took vitamin D droplet for 3 months and were then re-evaluated with Vitiligo European Task Force score before and after treatment. Results A significant negative correlation was found between vitamin D and IL-17 levels. A statistically significant increase in vitamin D level and decrease in IL-17 level was seen after treatment when compared with before treatment, accompanied by improvement of Vitiligo European Task Force scoring values after treatment. Conclusion The use of systemic vitamin D as a treatment modality for vitiligo can achieve reasonable improvement comparable to traditional modalities.
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Correlation between squamous cell carcinoma antigen 1 and 2 levels and disease severity and clinical type of atopic dermatitis p. 9
Mohamed H Khatter, Fathia M Khattab, Amal A Zidan, Mai M Al-Hakim
DOI:10.4103/ejdv.ejdv_43_17  
Background Serum levels of squamous cell carcinoma antigen (SCCA) 1 and 2 induced by type 2 cytokines such as interleukin 4 and interleukin 13 are increased in patients with atopic dermatitis (AD). Objective This study aimed to assess and correlate the severity and clinical types of AD by serum level of SCC antigen 1 and SCC antigen 2 in AD patients. Patients and methods Twenty-four AD patients (12 adults and 12 children) and 24 healthy controls were included in this study to assess the SCORAD score and to measure SCCA1 and SCCA2. Results There was a statistically significant difference between the children and adult groups in SCCA1 and SCCA2 with higher levels in adults than children maybe due to the long duration of disease, chronicity, and severity of disease and there was a positive correlation between SCCA1 and SCCA2, and severity of disease. Conclusion Serum levels of SCCA1 and SCCA2 correlate with severity of disease and clinical types and provide its role in the pathogenesis of Atopic Dermatitis. Further studies may evaluate the therapeutic effect of their blockage in the improvement of Atopic Dermatitis.
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Efficacy of dermoscopy in the diagnosis of different basal cell carcinoma subtypes p. 15
Sawsan K El-Sayed, Gamal El-Din A El-Sayed, Abeer M Kamel, Ayman A Al-Tramsy, Safaa Y Ateia
DOI:10.4103/ejdv.ejdv_26_19  
Background Basal cell carcinoma (BCC) accounts for nearly 80% of all nonmelanoma skin cancers and dermoscopy is an important, noninvasive technique that aids in the diagnosis of BCC. Objectives To evaluate the role of dermoscopy as a tool for diagnosis of BCC and prediction of its histopathological types. Patients and methods Dermoscopic features of 30 clinically diagnosed BCCs were analyzed before the histopathological findings were evaluated. Results Dermoscopy was 100% accurate in the diagnosis of BCC and types of BCC predicted by dermoscopy were identical to the results of histopathological examination, both yielding 27 nodular BCCs (90%), one superficial, one morpheaform, and one lesion of the infiltrative type, each representing 3.3% of lesions, but we did not detect any specific dermoscopic findings in the aggressive micronodular subtype. Conclusions Dermoscopy is accurate in predicting the main histopathological types, but not the aggressive subtypes of BCC, thus it should be considered a routine but not a sole investigation for BCC.
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Dermoscopic findings in benign racial gingival melanin hyperpigmentation and evaluation of its surgical management p. 23
Soha Abdalla Hawwam, Yasser Mohammed El-Makaky
DOI:10.4103/ejdv.ejdv_33_19  
Background Dermoscopic features of mucous membrane pigmented lesions are not the same as present in the skin. A major esthetic problem for a lot of people is gingival hyperpigmentation. Even though it is not a medical issue, a lot of methods are used in the treatment of this problem. Objective To figure out dermoscopic patterns of benign racial gingival melanin hyperpigmentation and to assess the role of dermoscopic evaluation in its management. Patients and methods A total of 20 patients were included in this study. Their age ranged from 23 to 30 years. They were selected for depigmentation procedures in the esthetic zone using a scalpel blade. Dermoscopic imaging and analysis of the patterns were done for all lesions. Clinical parameters were recorded. Recurrences of pigmentation were evaluated by clinical and dermoscopic examination at 4 weeks, 6 months, and 12 months postoperatively. Results Dermoscopic features of benign racial gingival hyperpigmentation analyzed were dotted-globular pattern, pigment network pattern, fish scale-like pattern, and a hyphal pattern. All patients showed excellent gingival wound-healing response, with no adverse complications, and no repigmentation was observed. Conclusion Dermoscopy is effective in diagnosis and evaluation of management of gingival melanin hyperpigmentation. Surgical gingival depigmentation is effective in esthetic treatment of gingival melanin hyperpigmentation.
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Relation between insulin resistance and severity of psoriasis in Egyptian patients p. 29
Noha Ezzat Mohamad, Esam Elshimi
DOI:10.4103/ejdv.ejdv_20_19  
Background Psoriasis is an immune-mediated disease of multifactorial etiology. The prevalence of insulin resistance (IR) in patients with psoriasis has been extensively studied. The prevalence varies based on many factors such as aging, genetics, diet, and sedentary lifestyle. Aim To study the association between psoriasis and IR and detection of the correlation between level of IR and the psoriasis severity. Patients and methods A total of 30 patients with psoriasis and similar number of age-matched and sex-matched controls were enrolled in this study. Patients and controls were subjected to the following measurements: systolic and diastolic blood pressure, BMI, serum triglycerides, cholesterol, low-density lipoprotein, high-density lipoprotein, fasting plasma glucose, serum insulin, and IR. Assessment of psoriasis severity was done using psoriatic area severity index score. Results A statistically significant difference regarding serum insulin, IR, fasting plasma glucose, triglyceride, low-density lipoprotein, systolic blood pressure, diastolic blood pressure, and BMI was found between patients and controls. A positive correlation between psoriasis severity and level of IR was also found. Conclusion and recommendation Patients with psoriasis had strong association with IR. The level of IR correlated with severity of psoriasis. Dermatologists and internists should give more attention toward screening and early recognition of associated metabolic disorders and IR. Correction of metabolic syndrome and IR should be initiated in this group of patients.
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Evaluation of interleukin-18 and soluble interleukin-2 receptor serum levels in patients with alopecia areata: an Egyptian study p. 34
Maha A El-Gayyar, Ahmed F State, Manal E Helmy, Eman R Amer, Lubna Y Ibrahim, Mohammad A Gaballah
DOI:10.4103/ejdv.ejdv_34_19  
Background Alopecia areata (AA) is a chronic inflammatory disorder of hair follicle cycling characterized by nonscarring hair loss. Interleukin-18 (IL-18) is a proinflammatory cytokine that was implicated in various inflammatory and autoimmune skin diseases, including AA. IL-2 initiates and develops the immune response through binding to interleukin-2 receptor (IL-2R) on T cells. Levels of soluble IL-2R (sIL-2R) may be estimated as a sign of T-cell activation in serum of patients having many disorders involving aberrant immune activation, including AA. Objective To estimate of the serum levels of IL-18 and sIL-2R as immunological factors in patients with AA and to test the correlation between these serum levels and disease severity. Patients and methods A total of 46 patients with AA and 40 age-matched and sex-matched healthy individuals as controls were included. All participants were subjected to thorough history taking, full general examination, and detailed dermatological examination for diagnosis of cases and determination of extent of the lesions. The severity of AA was graded as mild (three or less patches of alopecia with a widest diameter of 3 cm or less or the disease limited to the eyelashes and eyebrows) or severe (existence of more than three patches of alopecia or a patch >3 cm at the widest diameter or alopecia totalis or alopecia universalis). Estimation of serum levels of IL-18 and sIL-2R was done by enzyme-linked immunosorbent assay. Results Serum IL-18 was significantly higher in patients with AA compared with the controls. Serum sIL-2R was nonsignificantly increased among patients with AA than the controls. Patients with severe disease had significantly higher serum IL-18 and nonsignificantly higher serum sIL-2R compared with patients with mild disease. Conclusion AA is associated with elevation of serum IL-18 and sIL-2R, and their levels increase with the increase in the severity of the disease. The exact role of serum IL-18 and sIL-2R in AA should be investigated in future studies.
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Skin disorders among elderly patients: clinicodemographic characteristics of 808 Egyptian patients p. 38
Mohammed Abu El-Hamd, Wafaa M Abd-Elmaged, Nesreen A Mohammed
DOI:10.4103/ejdv.ejdv_22_19  
Background Geriatric health care has increased rapidly worldwide. The frequency of skin diseases is rising among elderly patients. Objectives This study aimed to evaluate demographic features and pattern and frequency of skin disorders among elderly patients attending dermatology clinics. Patients and methods This was a cross-sectional clinical hospital-based study that included all patients aged more than or equal to 60 years old who attended the Outpatient Clinics of Dermatology, Sohag University, Upper Egypt. All the patients were subjected to a detailed medical history and complete general and dermatological examination. Results This study included 808 elderly patients, with a mean age of 70.21±7.51 years. A total of 434 (53.7%) patients were females and 374 (46.3%) were males. Among the patients, 264 (32.7%) were living in urban areas. Overall, 188 (23.3%) patients were smokers. Among patients, 268 (33.1%) had low education levels and 450 (53.2%) patients had a previous history of manual work. The most common comorbidities were diabetes mellitus, seen in 270 (33.41%) patients, and hypertension, seen in 64 (7.92%) patients. Of 808 elderly patients, 188 (23.7%) had infectious skin diseases, 162 (20%) had allergic and eczematous diseases, 98 (12.1%) had senile pruritus, 78 (9.7) had xerosis, 48 (5.9%) had papulosquamous diseases, 32 (4%) had cutaneous tumors, 30 (3.7%) had vesiculobullous diseases, 28 (3.5%) had pigmentary skin diseases, and 18 (2.3%) had vascular disorders. Conclusion Skin diseases are common among elderly patients. Infectious skin diseases, allergic and eczematous diseases, senile pruritus, and xerosis are the most common skin diseases among elderly patients.
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Tranexamic acid versus topical mesolightening mixture using the dermaroller in the treatment of melisma p. 45
Adel A.S. Aly, Rania E.A. AbdElMaksoud, Inas Ismail
DOI:10.4103/ejdv.ejdv_36_19  
Background Use of localized microinjection of tranexamic acid (TA) has been studied for the treatment of melasma and was proved to be effective, but transdermal delivery of this agent has not been well studied. The use of Dermaroller may increase the effective delivery of active ingredients in topical mesolightening mixture and TA. Aim The aim of this split-face study was to compare the safety and efficacy of transdermal delivery of TA versus topical mesolightening mixture using the Dermaroller in the treatment of melasma. Patients and methods This split-face study was carried out on 15 patients having melasma. For each patient, the following was done after taking an informed consent: history taking, dermatological examination, Wood’s light examination, Melanin Area and Severity Index (MASI) score calculation, photography, physician’s global assessment by independent investigators, patient’s global evaluation, eight sessions of transdermal delivery of TA and topical mesolightening mixture, with a session every week (mixture of kojic acid 3%, TA 0.01%, azelaic acid 4% (19,20), L-ascorbic acid 1 g, and water for injection), and recording of the adverse effects every session. This was followed by 3 months of follow-up. Results The initial (pre-4) reduction of MASI (after the first four sessions) on the left side (TA treated) was significantly higher than that on the right side. Similarly, the later (four to eight sessions) (upon comparing the second set with the first set of sessions) and overall reduction was higher on the left side compared with that on the right side; however, these differences were not statistically significant in terms of MASI. Conclusion TA and topical mesolightening mixture are individually effective in the treatment of melasma. TA is superior to mesolightening, as well as cost-effective in the treatment of melasma.
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Foreplay importance from the point of view of a sample of Egyptian women p. 53
Ihab Younis, Menha A Ibrahim, Doaa M El-Habbaq, Raghad K Farag
DOI:10.4103/ejdv.ejdv_19_19  
Background Human beings engage in sexual intercourse not only for reproductive reasons but also for pleasure. So, it becomes important to study the effects of foreplay in facilitating sexual arousal as a means to increase the pleasurable aspects of sexual intercourse. Aim To evaluate the importance of foreplay in a sample of Egyptian women and to assess sexual practices affected by foreplay. Patients and methods The study was carried out on 200 married women with regular sexual practice using self-report questionnaires. The number of usable questionnaires was 200. Privacy was guaranteed for all the participants. Results Most of the participants initiated foreplay in less than half of sexual encounters (44%). The most cited purpose for coitus was to obtain pleasure for both partners (54%). Overall, 33% of participants thought that their sexual life was unsatisfactory. Participants reporting that their husbands were interested in foreplay during love making comprised 72% of the whole sample. Half of the couples do foreplay almost every time of sexual intercourse (50%), and 51% reported that they play an active role in foreplay. Caressing is preferred by most of the participants (33%) followed by kissing (25%). Most of the participants could not obtain orgasm during foreplay (53%). Most of the participants reported that their husbands stimulate their clitoris during foreplay (64%), and 37% of them liked that their husbands stimulate their genitalia orally. Conclusion This study has the potential to provide alternate ways through which the sexual experience can be enjoyed. Foreplay has a very important role in sexual life, as it strongly affects sexual desire, arousal, and orgasm. Ignorance of the importance of its role may have a negative effect on sexual activity and the overall sexual satisfaction.
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CASE REPORTS Top

Idiopathic orbital inflammatory syndrome: a dermatological perspective p. 59
Priyanka Sharma, Jasleen Kaur, Rakesh Kumar Bansal, Gurvinder P Thami
DOI:10.4103/ejdv.ejdv_40_18  
Idiopathic orbital inflammatory syndrome, formerly known as orbital pseudotumor, is a rare benign condition with myriad clinical presentations including periorbital edema, pain, conjunctival chemosis, diplopia, extraocular muscle restriction, and decreased vision. It is a relatively lesser known clinical entity from a dermatological perspective and may present as recurrent periorbital edema as a sole manifestation as in this case, and thus can potentially be mistaken for angioedema. The objective of this case report is to emphasize on the wide range of clinical manifestations and the need for awareness of this entity and thus avoiding its misdiagnosis.
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Treatment of a wide wound area with extensive necrosis by modern dressing in a 1-month-old infant p. 62
Robabeh Ahmadli, Abolfazl Mohammadbeigi, Narges Farshadpour
DOI:10.4103/ejdv.ejdv_42_19  
The current report aimed to introduce the history of wound treatment in a 1-month-old infant that was taken care by modern dressing with Aquasel tender wet plus and Colactive R plus collagen. The patient was admitted to the hospital with seizure, but after complete physical examination, it was revealed that her left thigh had experienced burning, and an extensive necrosis had occurred at the child’s skin. Injury debridement was conducted owing to vastness of the area of injury, and according to consultation with the children plastic surgeon, skin graft of patient was recommended. However, modern dressing with Aquasel tender wet plus and Colactive R plus collagen was used for treatment besides the combination dressing of Aquasel Ag+, foam Aquasel, and colactive collagen. Finally, the patient was treated with modern dressing and healed completely after 45 days.
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LETTER TO THE EDITOR Top

Woolly hair: a rare disorder p. 66
Jyoti Budhwar, Chetna Singla
DOI:10.4103/ejdv.ejdv_24_19  
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