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ORIGINAL ARTICLES
Chemical reconstruction of skin scars (CROSS) technique using trichloroacetic acid 50% in different types of atrophic acne scars
Yehia Farouk El Garem, Eren Emil Habib Ghabrial, Mohammed Hami Embaby
December 2013, 33(2):37-41
DOI:10.4103/1110-6530.123911  
Introduction Acne scarring is a common complication of acne, and no appropriate and effective single treatment modality has been developed yet. A new technique of focal application of high strength trichloroacetic acid (TCA) (65-100%) has been suggested. The aim of the study was to evaluate the efficacy and safety of 50% TCA in three different types of atrophic acne scars using the chemical reconstruction of skin scars technique in three sessions, each at an interval of 1 month. Materials and methods Thirty adults with a clinical diagnosis of atrophic acne scars were selected. Results Statistically significant difference was found in the total Goodman score between the atrophic acne scars before and after treatment (P < 0.0001), especially between the icepick and boxcar scars before and after treatment (P < 0.05). In addition, statistically significant difference was observed in the percentage of improvement between the three types of atrophic acne scars (P < 0.05). The best improved were the icepick type followed by the boxcar scars and then the rolling scars. Conclusion Chemical reconstruction of skin scars technique using 50% TCA is nonsurgical and safe in the treatment of atrophic acne scars, especially the icepick type followed by the boxcar scars, with minimal side effects and a short downtime.
  9,987 861 -
REVIEW ARTICLE
Immunotherapy of viral warts: myth and reality
Mohamed El-Khalawany, Dalia Shaaban, Soha Aboeldahab
January-June 2015, 35(1):1-13
DOI:10.4103/1110-6530.162451  
Immunotherapy has become one of the most important therapeutic tools for the treatment of warts. At present, immunotherapy for warts is usually limited to recalcitrant lesions that are not responding to conventional therapy. Although there are a lot of immunotherapeutic regimens, a minority seem to be really effective. Moreover, there is a lack of evidence-based data on their effectiveness. Common immunotherapeutic modalities used for the treatment of warts include contact sensitizers, imiquimod, intralesional interferon, and oral drugs such as levamisole, cimetidine, and zinc sulfate. Intralesional antigens such as MMR (measles, mumps, and rubella) vaccine, skin test antigens (mumps, Candida, and Trichophyton), BCG (bacillus Calmette-Guιrin) vaccine, and Candida antigen were reported as successful treatment modalities in various forms of warts. Moreover, intradermal injection of some vaccines such as purified protein derivatives was also reported as a successful regimen for the treatment of genital warts. Among the available options for treatment of warts, none is uniformly effective or viricidal. Moreover, in most cases their safety and efficacy has not been assessed in double-blind, controlled clinical trials, and thus the reproducibility of many of the listed treatments is difficult to evaluate and a possible placebo effect cannot be ruled out. In this report, the various forms of immunotherapy for warts are discussed and each regimen is evaluated in order to assess the efficacy of each form of treatment.
  8,423 558 1
ORIGINAL ARTICLES
Skin rejuvenation with autologous concentrated platelet-rich plasma
Nancy W Mikhael, Fatma M El-Esawy
January-June 2014, 34(1):5-9
DOI:10.4103/1110-6530.136452  
Objective The aim of this study was to assess the efficacy of autologous platelet-rich plasma (PRP) injection for facial rejuvenation. Patients and methods In a 6-month study, 20 female patients were treated with three sessions of injection with PRP every month from October 2011 to March 2012. Patients received 3 ml of PRP, activated with calcium chloride into face and neck skin. The study was evaluated by comparing the preinjection and postinjection photographs using digital camera, by final patient's satisfaction questionnaire, and by physician's impression. Results A definitive graduated score was found for each patient by adding the final result of each single parameter. Good results were observed in the skin homogeneity and emotional status of the patient without serious side effects. Conclusion PRP had an effective treatment in skin rejuvenation without serious side effects.
  4,992 734 -
Serum levels of homocysteine, vitamin B12, and folic acid in vitiligo
Hanan H Sabry, Jehan H Sabry, Hala M Hashim
January-June 2014, 34(1):65-69
DOI:10.4103/1110-6530.137315  
Background Vitiligo is an acquired depigmenting disorder. The exact etiopathogenesis of vitiligo is not fully understood. Vitamin B12 and folic acid levels are decreased in vitiligo, which are important cofactors required for the metabolism of homocysteine (Hcy). Consequently, the Hcy level increases in the circulation. Therefore, it is possible that increased Hcy plays a role in the destruction of melanocytes. Objective To determine the role of Hcy, vitamin B12, and folic acid in the pathogenesis of vitiligo. Patients and methods Thirty-five patients of both sexes with vitiligo and 35 age-matched healthy controls were included in the study. After excluding factors that may affect serum Hcy levels, blood samples from patients and controls were obtained for Hcy, vitamin B12, and folic acid determination by an enzyme immunoassay. Results The mean serum level of Hcy was significantly higher in patients with vitiligo than in the controls (17.77 ± 7.72 vs. 11.81 ± 3.41 μmol/l; P < 0.05), whereas the mean level of vitamin B12 was lower in patients with vitiligo than in the controls (208.64 ± 66.73 vs. 304.7 ± 89.9 pg/ml; P < 0.05). There was no statistically significant difference in the folic acid level in patients and controls (8.42 ± 2.06 vs. 9.39 ± 2.38 ng/ml; P > 0.05). Conclusion Elevation of serum Hcy level might be a precipitating factor for vitiligo in predisposed individuals. Hcy level may represent a new biomarker of the extent of vitiligo. Elevation in Hcy is associated with relative deficiencies of vitamin B12, suggesting that aggressive supplementation may benefit vitiligo patients.
  3,927 337 1
Significance of topical propolis in the treatment of facial acne vulgaris
Basma M Mohammad Ali, Naglaa F Ghoname, Abeer A Hodeib, Marwa A Elbadawy
January-June 2015, 35(1):29-36
DOI:10.4103/1110-6530.162468  
Background Acne is a common skin disorder affecting the pilosebaceous unit, arising commonly during adolescence and causing psychological stress. The pathogenesis of acne is attributed to multiple factors. Clinically, it is characterized by the presence of comedones, inflammatory papules, pustules, and sometimes nodules and cysts. Propolis has been attracting the attention of researchers because of its antimicrobial, antioxidant, antiviral, and antifungal properties. Objectives The aim of this study was to evaluate the clinical and bacteriological significance of topical propolis extracts in the treatment of facial acne vulgaris. Patients and methods This study included 40 patients with facial acne vulgaris. The patients were classified into two groups: group I included 20 patients who were treated with a topical solution of ethanolic extract of propolis, and group II included 20 patients who were treated with a topical solution of ethanol only and served as the control group. Patients were evaluated clinically to assess the efficacy of therapy after treatment. Bacteriological examination was carried out before and after treatment to assess the antimicrobial effect of propolis. Results There was a highly significant clinical efficacy of topical solution of ethanolic extract of propolis in the treatment of acne vulgaris. There was a highly significant bacteriological efficacy of topical solution of ethanolic extract of propolis on gram-positive aerobic (Staphylococcus epidermidis) and gram-positive anaerobic bacteria (Propionibacterium acnes). Conclusion Topical propolis is a promising, effective, well-tolerated, safe, and alternative medication for acne vulgaris. It has anti-inflammatory and antibacterial properties. Further studies are needed for its application in different skin diseases.
  2,458 235 1
Easy phytic peel as a therapeutic agent in acne vulgaris and melasma
Sahar Al-Mokadem, Ola Al-Aasser, Amani Nassar, Eman A Al-Sharkawy
June 2013, 33(1):6-11
DOI:10.7123/01.EJDV.0000430805.40547.ba   
Background

Phytic acid (myoinositol hexaphosphate) is found in almost all grains, fibers, and plants. It is a natural plant antioxidant. Easy phytic peel is a commercial product; it has a slow release, which promotes continuous penetration of the skin, and requires no external neutralization.

Aim

The aim of this study was to evaluate the effect of chemical peeling using a solution composed of phytic acid, glycolic acid, lactic acid, and mandelic acid in the treatment of acne vulgaris and melasma.

Methods

This study was carried out on 40 patients: 20 with active lesions of acne vulgaris and 20 with melasma. Both groups were treated with the aforementioned solution every week for 6 weeks.

Results

A highly significant decrease in the Global Acne Grading System scores and the Melasma Area Severity Index scores was reported after treatment (P<0.001) in case of patients with acne and melasma, respectively. However, the results of peeling were much more promising in patients with active acne compared with in those with melasma. No side effects were observed during or after treatment.

Conclusions

Peeling with this combination can be considered an effective, safe, and well-tolerated procedure in the treatment of patients affected with active acne and melasma.

  2,443 214 -
Human semen hyperviscosity: prevalence and effects on physical and biochemical semen parameters in subfertile Egyptian men
Zakaria Mahran, Mohammed El-Eraki Saleh
July-December 2014, 34(2):135-139
DOI:10.4103/1110-6530.150276  
Background Semen hyperviscosity (SHV) is a condition that can markedly impair the physical and chemical characteristics of seminal fluid, which leads to an adverse impact on sperm function. The aim of this study was to assess the prevalence of SHV in infertile Egyptian men and to evaluate its effects on physical and biochemical semen parameters, and also to identify any correlation between SHV and infections or inflammation of the genital tract. Participants and methods Semen samples were studied for 300 infertile men; of these, 225 men had normal semen viscosity and were excluded from the study. Seventy-five men with SHV were selected and included in this study. In addition, 25 fertile men with completely normal semen parameters who had recently fathered children were included as a control group. All participants underwent seminal analysis and measurement of seminal plasma fructose, ascorbic acid, calcium, and zinc, in addition to a peroxidase test and polymorphonuclear granulocyte elastase (PMN elastase). Results Our study showed that the prevalence of SHV was 25% in infertile Egyptian men. Sperm motility and sperm vitality, in addition to fructose, ascorbic acid, calcium, and zinc levels, were significantly reduced, whereas PMN elastase levels were significantly increased in samples with hyperviscosity (P < 0.05). There was a strong positive correlation between PMN elastase levels and increasing viscosity. Conclusion Our results showed that hyperviscosity seems to be the result of infection or inflammation in 75% in our cases and hyperviscosity seems not to be because of a single pathogenic factor, but rather because of several (biochemical, enzymatic, and genetic) factors that act in synergy. These factors should be studied further.
  2,167 145 -
Possible association of female-pattern hair loss with alteration in serum 25-hydroxyvitamin D levels
Hoda Moneib, Ghada Fathy, Alaa Ouda
January-June 2014, 34(1):15-20
DOI:10.4103/1110-6530.137254  
Background Female-pattern hair loss (FPHL) is the most common cause of diffuse hair loss in women. A possible role of non-androgen-dependent mechanisms was suggested. The association between serum 25-hydroxyvitamin D [25-(OH)D] and other hair 0 diseases such as male androgenetic alopecia, telogen effluvium, and alopecia areata has been indicated. Objective The aim of this study was to evaluate the association of altered serum 25-(OH)D levels in women with FPHL. Patients and methods We studied serum 25-(OH)D concentrations among 60 FPHL patients aged from 20 to 35 years in comparison with 60 healthy female controls matched for age, skin phototype, socioeconomic status, and outdoor exposure. Measurements were conducted by the radioimmunoassay technique. Results The mean serum 25-(OH)D level was significantly lower in FPHL patients (14.2 ± 7.31 ng/ml) than in controls (45.90 ± 18.83 ng/ml; P = 0.0001). There was no significant difference between patients with family history and those without family history regarding the mean vitamin D level (15.23 ± 7.56 and 13.6 ± 7.17 ng/ml, respectively; P = 0.363). A significant difference was found between the three Ludwig's degrees regarding the mean vitamin D level (12.96 ± 7.52, 14.16 ± 5.68, and 25 ± 5.35 ng/ml, respectively): between degrees I and III and between degrees II and III. Limitations This is a case-control study that supports the hypothesis of an association between vitamin D and FPHL, but does not establish a causal relationship. Conclusion Alteration in the serum 25-(OH)D level, being deficient or insufficient, might play a possible role in the pathogenesis of FPHL.
  1,948 180 -
Oral manifestations of patients with leprosy: A disease, actually infectious but not always, still a stigma in society
Anand B Babu, A Ravikiran, Y Samatha, Abhishek S Nayyar, Mohammed Arif, Krishnaveni Buduru
January-June 2015, 35(1):37-44
DOI:10.4103/1110-6530.162479  
Context Leprosy is a chronic granulomatous infectious disease process in humans primarily involving the skin, peripheral nerves, and nasal mucosa but capable of affecting any tissue or organ. The leprae bacilli were first observed by Hansen in 1868. Although this was the first bacterial human pathogen to be described, it continues to remain one of the least understood. Aims The aim of the study was to evaluate oral and facial manifestations in patients affected with leprosy. Materials and methods The present study was performed with an aim of reviewing oral and facial manifestations in patients suffering from leprosy. For this, 150 patients suffering from lepromatous and tuberculoid forms of leprosy were included in the study. The study was approved by the ethical committee appointed by SIBAR Institute of Dental Sciences, Guntur. Permission was also taken from asylum management and the district leprosy officer to conduct the study. All study samples were patients diagnosed with Hansen's disease by a leprologist using a bacteriological index. Results In the present study, oral and facial manifestations were observed more frequently in the lepromatous type of leprosy than in the tuberculoid form. Also, these manifestations were less pronounced in group I than in group II and were more in groups III and IV based on increased exposure to the disease process. Statistical analysis was performed using the c2 -test and P values were also found to be significant. Conclusion Present day diagnostic protocols for early detection and treatment are effective in controlling the disease and in preventing further progression with severe orofacial manifestations. A dentist should be able to recognize these manifestations and treat them under the supervision of a leprologist. Protective care must be taken in treating the disease, although it should not be held as a nightmare as was considered previously.
  1,904 158 -
Risks for metabolic syndrome and cardiovascular diseases in both male and female patients with androgenetic alopecia
Naglaa Agamia
July-December 2015, 35(2):49-55
DOI:10.4103/1110-6530.178459  
Background Androgenetic alopecia (AGA) is a nonscarring progressive miniaturization of the hair follicle with a usually characteristic pattern of distribution in genetically predisposed men and women. Although several previous studies have investigated the association of metabolic syndrome (MS) and cardiovascular risks with AGA, the results have been inconsistent. Aim We attempted to evaluate the possible association between MS and cardiovascular risks with AGA in both male and female patients. This may help to detect whether AGA can be considered as a clue for underlying serious systemic diseases. Patients and methods A total of 50 patients (38 male and 12 female) and 50 normal sex-matched and age-matched controls were included. Anthropometric measures, blood pressure, fasting glucose, high-density lipoprotein cholesterol, triglycerides, testosterone, sex hormone binding globulin, and serum insulin levels were evaluated. Acute phase reactants (C-reactive protein, fibrinogen, and erythrocyte sedimentation rate) were measured for all participants. The presence of MS, insulin resistance, and cardiovascular risk factors were evaluated. Results There were statistically significant differences with regard to the mean values of waist circumference, BMI, systolic blood pressure, fasting blood sugar, fibrinogen, and Homeostasis Model Assessment of Insulin Resistance in both male and female patients. In contrast, triglycerides, cholesterol, MS, erythrocyte sedimentation rate, and sex hormone binding globulin were significantly elevated in male patients only in relation to their sex-matched controls. Conclusion Patients of both sexes with AGA are more susceptible to have cardiovascular diseases in future compared with people who do not have AGA.
  535 1,419 -
Evaluation of reactive oxygen species (ROS) and DNA integrity assessment in cases of idiopathic male infertility
Hassan A Khodair, Tarek Omran
December 2013, 33(2):51-55
DOI:10.4103/1110-6530.123932  
Background Studies suggest that reactive oxygen species (ROS) attack the integrity of DNA in the sperm nucleus by causing base modifications, DNA strand breaks, and chromatin cross-linking. Sperm DNA damage analysis may reveal hidden sperm DNA abnormalities in infertile men with normal standard semen analysis values who were diagnosed with idiopathic infertility. Aim of the work We explored the levels of ROS and their correlation with sperm DNA damage in patients with idiopathic male infertility. Patients and methods A total of 93 men were included in this study. Among them, 68 presented to our Andrology outpatient clinic with idiopathic infertility and were selected, and 25 were healthy fertile men, who were assigned to the control group. Both groups were subjected to the following laboratory investigations: semen analysis including peroxidase test, measurement of ROS levels by chemiluminescence assay, and sperm DNA damage assessment by terminal deoxyribonucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL). Results There were no significant differences in the semen parameters between idiopathic infertile men and controls. However, ROS and sperm DNA damage levels were significantly higher in idiopathic infertile men compared with controls ( P ͳ 0.001). In addition, the results showed a strong positive correlation between ROS levels and the percentage of sperm DNA damage ( P ͳ 0.001). Conclusion Traditional semen analysis does not reveal seminal defects at the molecular level that might be induced by ROS. Therefore, our results suggest that standard semen analysis should be coupled with measurement of ROS and assessment of DNA integrity in cases of idiopathic male infertility as even sperms with normal morphology and motility may harbor DNA damage.
  1,734 212 1
Prevalence of cutaneous manifestations in chronic renal failure patients on regular hemodialysis: a hospital-based study
Eman M Sanad, Neveen E Sorour, Wael M Saudi, Afaf M Elmasry
January-June 2014, 34(1):27-35
DOI:10.4103/1110-6530.137278  
Background Chronic renal failure (CRF) presents with an array of cutaneous manifestations. Newer changes are being described since the advent of hemodialysis (HD), which prolongs life expectancy, providing time for these changes to manifest. Objective The aim of this study was to estimate the prevalence and pattern of cutaneous manifestations among patients with CRF on regular HD. Patients and methods This case-series study included 100 patients with CRF on regular HD. They were subjected to a full assessment of history, and general and dermatological examinations of the skin, hair, nails, and oral mucosa. Results All patients included in this study had at least one cutaneous manifestation attributed to CRF. The most prevalent finding was xerosis (72%), followed by pruritus (52%) and hyperpigmentation (44%), whereas purpura (2%) and bullous dermatosis (1%) were the least detected. Oral changes included xerostomia (46%), macroglossia with teeth markings (43%), fissured tongue (17%), ulcerative stomatitis (11%), and angular cheilitis (6%). The most common nail changes were absent lunula (61%), half and half nail (41%), and koilonychia (29%). Hair changes included sparse scalp hair (48%), sparse body hair (41%), and brittle and lusterless hair (39%). Hypertension and diabetes mellitus were the most common causes of CRF (53 and 18%, respectively). Conclusion Every CRF patient on HD had at least one cutaneous manifestation, which may appear before or after HD. The most common cutaneous manifestations were xerosis, pruritus, hyperpigmentation, xerostomia, macroglossia, absent lunula, half and half nail, sparse scalp hair, and sparse body hair.
  1,670 186 -
Androgenetic alopecia as an early marker for hypertension
Fatma M El-Esawy, Sherine H Abd El-Rahman
December 2013, 33(2):63-66
DOI:10.4103/1110-6530.123946  
Background and objectives The relationship between androgenetic alopecia (AGA) and cardiovascular diseases has been studied by some authors in the past, although the results of epidemiological studies have been variable. The objective of this study was to determine the prevalence of hypertension and aldosterone level in male patients with AGA. Patients and methods Sixty men were enrolled in this case-control study, 30 with a diagnosis of AGA and 30 control participants who consulted for other skin conditions. They were recruited from the outpatient clinic of the Dermatology and Andrology of Benha University Hospital. Data were collected included, age, AGA score with Ebling score (I-V), serum aldosterone and serum testosterone level, blood pressure or history of hypertension, smoking, family history of AGA, and treatment. Results Patients with AGA showed significantly higher aldosterone levels and blood pressure values (P < 0.05) versus controls. However, there was no statistically significant difference between patients and controls in the serum testosterone level. Conclusion Blood pressure screening of patients with AGA will enable earlier diagnosis of an unknown hypertension and initiation of appropriate treatment. Moreover, determination of aldosterone levels can enable early detection of individuals at risk and initiation of preventive treatment before cardiovascular disease becomes established.
  1,673 173 2
Study of oxidative stress in different clinical severities of acne vulgaris
Yehia F El Garem, Rana AM Ahmed, Magdy A Ragab, Abla A AbouZeid
January-June 2014, 34(1):53-57
DOI:10.4103/1110-6530.137313  
Background Acne vulgaris is a multifactorial disease, but recent studies have focused on the role of oxygen free radicals and antioxidant enzymes. Malondialdehyde (MDA) is the end product of lipid peroxidation and is a good marker of free radical-mediated damage and oxidative stress. Superoxide dismutase (SOD) represents the major cellular defense against superoxide anions. Objective The objective of this study was to study the role of oxidative stress in acne vulgaris and to detect a possible link with the different clinical severities. Patients and methods Fifty patients with acne vulgaris and 20 healthy controls were included in this study. The severity of the disease was assessed using the Global Acne Grading System. The levels of SOD in erythrocytes and MDA in plasma were measured using a spectrophotometer. Results Although higher SOD levels and mean values were present in patients, there was no statistically significant difference compared with the controls. MDA levels showed a significant difference between patients and controls (P < 0.05), with MDA being higher in patients, indicating a condition of oxidative stress that had resulted from a high level of lipid peroxidation in acne patients. Comparison of SOD levels in patients showed that patients with severe acne had the lowest levels in comparison with patients with mild and moderate acne (P < 0.001). SOD levels were the highest in patients with mild acne. In terms of MDA levels, patients with severe acne showed the highest plasma MDA levels compared with those with mild and moderate (P < 0.05) acne, suggesting an increase in reactive oxygen species production overwhelming the antioxidant capacity. The lowest MDA levels were observed in mild acne. Conclusion Oxidative stress may play a role in the etiopathogenesis of acne and⁄or the progression of the disease. Coadministration of antioxidant drugs with various lines of treatment of acne might be helpful, especially for those with inflammatory lesions.
  1,566 246 -
Estimation of nitric oxide level in psoriatic patients and its correlation with disease severity
Amany Mahmoud, Rabie Abo-Elmaged, Hanaa Fahmy, Hesham Nada
December 2013, 33(2):71-75
DOI:10.4103/1110-6530.123952  
Background Psoriasis is a genetically determined inflammatory and proliferative disease of the skin. There is now increased evidence for the role of nitric oxide in some diseases, including psoriasis. Nitric oxide is a potent regulator of keratinocyte growth and differentiation and stimulates angiogenesis. Aim This study aimed to detect serum nitric oxide level in active psoriasis patients, to correlate these levels with severity of the disease scored with psoriasis area and severity index, and compare them with those in normal individuals. Patients and methods Twenty-five patients with active psoriasis and 25 age-matched and sex-matched controls were recruited after their written consent was obtained. Patients on local or systemic treatment or with coexisting inflammatory skin disease were excluded. Serum nitric oxide levels were assessed using the Griess method. Results The mean serum nitric oxide levels (95.96 ± 12.7 μmol/l) were significantly higher in active psoriasis patients than that in the healthy controls (27.1 ± 6.85 μmol/l). Conclusion The significantly elevated serum levels of nitric oxide and their positive correlation with the severity of psoriasis may suggest the possible role of this mediator in the etiopathogenesis of the disease, and suggest a potential future therapy for the disease.
  1,546 159 -
Skin manifestations in Egyptian diabetic patients: a case series study
Eman M Sanad, Mona M ElFangary, Neveen E Sorour, Noha M ElNemisy
December 2013, 33(2):56-62
DOI:10.4103/1110-6530.123941  
Background Skin manifestations in diabetes mellitus (DM) are quite common. Skin changes can manifest in the prediabetic stage, in the acute metabolic situation and in the late diabetic degenerative stage. Objective To study the prevalence and the pattern of cutaneous manifestations among diabetic patients to aid in better management of diabetic skin diseases. Patients and methods One hundred patients with DM having at least one skin manifestation were selected and subjected to a detailed dermatological and systemic examination, and the findings were recorded. Blood samples were obtained for random blood glucose level. Results The most prevalent findings were cutaneous infections (40%), followed by pruritus (11%), local reactions at the site of insulin injection (8%), vitiligo (8%), diabetic dermopathy (7%), periungual telangectasia (6%), and xanthelasma (5%). The prevalence of skin manifestations was higher as the duration of diabetes increased and was more in type II than in type I diabetic patients. Conclusion The early detection of skin manifestations in DM is of prime importance to be able to avoid and/or properly manage the complications and prevent disability.
  1,527 174 1
Testicular function in male patients with lepromatous leprosy
Faten A Abd-Elkawi, Seham A Bahgat, Abeer M Kamel, Asmaa S Farag, Omima M Ashor
January-June 2014, 34(1):41-45
DOI:10.4103/1110-6530.137307  
Background Leprosy is a chronic granulomatous infectious disease affecting mainly the skin and peripheral nerves. Testicular affection with leprosy occurs mainly in the lepromatous type. Objective The aim of the study was to investigate testicular function and potential infertility in male patients with lepromatous leprosy. Patients and methods This study included 40 patients and 40 healthy, age-matched and sex-matched controls. All participants were subjected to careful history taking, dermatological and genital examination, complete blood count, liver and renal function tests, complete urine analysis, assessment of follicular stimulating hormone (FSH), luteinizing hormone (LH), testosterone levels, and semen analysis. Results There was statistically significant difference between patients and controls regarding history, sexual examination, hormonal profile, and sperm count, with high mean FSH and LH hormonal levels among patients and high mean testosterone levels and sperm count among controls. There was statistically significant difference between patients with history of erythema nodosum leprosum and patients without history of erythema nodosum leprosum regarding sexual examination, hormonal profile, and sperm count. There was strong positive correlation between disease duration and hormonal levels of FSH and LH and strong negative correlation between disease duration and hormonal levels of testosterone and sperm count. Conclusion Lepromatous leprosy causes a pattern of primary testicular failure.
  1,514 143 1
Combined cryotherapy and topical 5-fluorouracil for treatment of basal cell carcinoma
Nevien A Samy, Ahmed Sadek
July-December 2014, 34(2):98-101
DOI:10.4103/1110-6530.150259  
Background Cryotherapy (Cryo) and topical 5-fluorouracil (5FU) are both considered as successful noninvasive therapeutic options for basal cell carcinoma (BCC). Objective The aim of the study was to investigate the efficacy of combined Cryo and topical 5FU (Cryo+5FU) in patients suffering from BCC. Design This was a prospective clinical trial with a 6-month follow-up. Duration The study was carried out during a period of 11 months from March 2012 to February 2013. Patients and methods Fifteen patients complaining of BCC were included. Intervention Intervention included combined weekly regimen of Cryo followed after 3 days by twice daily 5FU application for four successive days for a maximum of 6 weeks. Main outcome measures Assessments of clinical improvement by examination, dermatological photography, and skin biopsy were the main outcome. Results All 15 patients achieved complete response with minimal side effects, good cosmetic outcome, and relatively shorter duration of treatment. Conclusion Combined Cryo+5FU offers a new effective modality for treatment of BCC.
  1,445 137 -
REVIEW ARTICLE
Advancements in photodermatology - 2013: Part II. Clinical research
Medhat El-Mofty, Wedad Z Mostafa, Rehab A Hegazy
July-December 2014, 34(2):81-85
DOI:10.4103/1110-6530.150251  
Photochemotherapy is considered a key tool for dermatologists in treating numerous, diverse conditions. Accordingly, there is a continuous effort to evaluate the well-settled indications, seek new ones for these lines of treatment, singly or in combination, aiming at better results and fewer side effects. The limitations and risks that photochemotherapy bears and the proper management plans are other fields of interest. In this article we will discuss some of the important clinical research studies in the domain of photochemotherapy published during the past year in an attempt to emphasize the up-to-date recommendations, widen our therapeutic scope, and expand our forthcoming research plans as dermatologists and researchers.
  729 843 -
ORIGINAL ARTICLES
Expression of interleukin-17 mRNA in vitiligo patients
Ahmed M Habeb, Al Hassan M Al Hefnawy, Shereen B Elsayed, Amira Abd El-rahman Abo Bkr, Alhasan M Elhefnawy
December 2013, 33(2):67-70
DOI:10.4103/1110-6530.123951  
Background Vitiligo is a specific type of idiopathic acquired or inherited leukoderma which is characterized by patterned/circumscribed hypomelanosis of the skin and hair, with complete absence of melanocytes. The aetiology of vitiligo is unknown, several hypotheses have been proposed to explain its pathogenesis and a convergence theory was proposed which assumes that all hypotheses are not mutually exclusive. In vivo, immunohistochemical studies of perilesional area of active lesions in generalized vitiligo mainly detects predominant CD8+ and to lesser extent CD4+ T cells in the infiltrate, which express activation molecules such as the skin homing receptor; CLA antigen and the IL-17. IL17 mRNA is up-regulated in the blood of vitiligo patients therefore, it has been suggested as a crucial regulator of vitiligo. Aim of work In this study, we focused primarily on the regulatory pathways and role of IL-17 in vitiligo by determination of the level of expression of IL17 mRNA by Real-time RT-PCR.
  1,314 160 1
Comparative study of the 80% trichloroacetic acid multiple puncture technique versus botulinum toxin type A in the treatment of keloid scars
Noha Ghonaim
June 2013, 33(1):22-27
DOI:10.7123/01.EJDV.0000431207.04926.59   
Background

Keloid is one of the most challenging clinical problems encountered in wound healing. Although there are numerous treatment modalities, none of them have shown excellent therapeutic results.

Aim

The aim of the study was to evaluate the efficacies of 80% trichloroacetic acid (TCA) and botulinum toxin type A in the treatment of patients with keloid scars.

Methods

Thirty keloid patients were divided into two groups (each consisting of 15 patients). In group A, keloid scars were punctured using a punch instrument previously dipped in 80% TCA, whereas in group B keloid scars were injected intralesionally with botulinum toxin type A (2.5 U/cm3;). All patients underwent three to five therapeutic sessions 1 month apart, and follow-up for 1 year. The therapeutic response was determined according to the scores on the Vancouver scar scale and a self-assessment scale for pain and pruritus.

Results

In group A, the mean scores on the Vancouver scar scale before and after treatment were 9.73±1.33 and 4.94±2.44, respectively, with a total improvement of 49%. In group B, the mean scores on the Vancouver scar scale before and after treatment were 9.05±1.34 and 4.68±2.67, respectively, with a total improvement of 48%. Comparison between mean values obtained on the Vancouver scar scale in groups A and B after treatment showed a statistically nonsignificant difference. Group B showed better improvement as per the self-assessment score. Most common side effects were reported in group A and were in the form of hyperpigmentation (33.3%), hypopigmentation (6.7%), and mixed pigmentation (6.7%). Relapses occurred in 26.7% of patients in group A, whereas no relapses occurred in group B.

Conclusions

The 80% TCA multiple puncture technique is better than botulinum toxin type A in the treatment against keloids.

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Assessment of fractional CO 2 laser in stable scars
Abdel Aziz I El Taweel, Sherine H Abd El-Rahman
January-June 2014, 34(1):74-80
DOI:10.4103/1110-6530.137317  
Background A variety of modalities have been used and, depending on the scar type, treatment may be invasive and/or conservative. Objective The aim of this study is to assess the safety and efficacy of treating stable nonhypertrophic scars using a fractional carbon dioxide (CO 2 ) laser. Patients and methods This is a prospective study of 25 patients (skin types III-IV, aged 6-37 years) with stable nonhypertrophic scars who underwent at least three sessions with a fractional CO 2 laser at 1-month interval. Side effects as well as improvements in texture, atrophy, and overall satisfaction with appearance were graded on a quartile scale by the patients and investigators after each treatment and 4 weeks after the final treatment. Before-after scores were compared using the Student t-test, with significance assigned to P values less than 0.05. Results All patients showed clinical improvement. There was no significant difference between the assessment of the investigator and the two blinded dermatologists. In terms of patient satisfaction, 32% of patients were not satisfied to slightly satisfied, whereas 68% were satisfied and 20% were very satisfied to extremely satisfied. Side effects were minimal and transient. Conclusion Fractional CO 2 laser treatment represents a safe, well-tolerated, effective, and promising treatment modality for nonhypertrophic traumatic and postinflammatory scars, with minimal downtime and fewer side effects.
  1,220 148 -
Epidemiological study of leprosy in Egypt: 2005-2009
Ahmed Amer, Ali Mansour
January-June 2014, 34(1):70-73
DOI:10.4103/1110-6530.137316  
Background Leprosy is considered a major public health problem because of its capacity to cause permanent disabilities, with the social consequences of discrimination and stigma. In 1991, the World Health Assembly adopted a resolution to eliminate leprosy by the year 2000. Egypt has achieved the WHO goal as early as 1994; however, there are still focal points, especially in Upper Egypt, which have failed to achieve the WHO goal and are reporting higher figures than the national one. Objective The aim of the study was to assess the epidemiological trend of leprosy in Egypt from 2005 to 2009. Materials and methods This is a descriptive study of the National Leprosy Control program registry in Egypt from 2005 until the end of 2009. An analysis of the cases on the basis of the prevalence rate of leprosy, new case detection rates, active case detection among contacts, type of leprosy, and grade of disability was carried out. Results The prevalence rate in the study period is less than one case per 10 000 populations at the national level; however, there were certain foci showing prevalence rate more than one case per 10 000 populations. The disease affected men more than women. Male patients (93.14%) are more common than female patients (6.86%). Multibacillary cases were more common than paucibacillary cases. Grade 2 disability showed an increase from 2005 till 2008 and a decrease in 2009. Conclusion Although Egypt has achieved the WHO goal of leprosy elimination since 1994, yet, the presence of certain foci with prevalence rate more than one case per 10 000 populations reflects the need for more efforts for early case detection.
  1,205 121 1
Assessment of serum leptin, atherogenic lipids, glucose level, insulin resistance and metabolic syndrome in patients with skin tags
Naglaa F Agamia, Salwa H Gomaa
January-June 2014, 34(1):58-64
DOI:10.4103/1110-6530.137314  
Background Skin tags (STs) are papillomas commonly found on the neck and on the axillae of middle-aged and elderly people. Metabolic syndrome is a complex of interrelated risk factors for cardiovascular disease and diabetes. Epidemiologic studies on different ethnic populations have indicated that hyperleptinaemia and leptin resistance are strongly associated with metabolic syndrome. Aim The aim of the study was to investigate the relationship between serum leptin, homoeostasis model assessment of insulin resistance (HOMA-IR) and atherogenic lipid in patients with STs and to compare them with the levels in healthy controls. Patients This study included 90 participants, 60 ST patients and 30 apparently healthy age-matched and sex-matched controls. Fasting glucose level, insulin level and insulin resistance were estimated in addition to cholesterol, triglycerides, high-density lipoprotein, leptin and HOMA-IR levels. Results The univariate analysis showed that waist circumference, BMI, fasting glucose, insulin levels, insulin resistance, cholesterol, triglycerides, HDL, leptin and HOMA-IR levels were significantly higher in ST patients compared with controls (P < 0.001). The multivariate analysis between metabolic syndrome components and ST showed that only high triglyceride levels and low HDL levels were significantly associated with ST. Multivariate linear regression analysis of the predictors of high plasma leptin levels showed that high triglyceride levels and low HDL levels were significant predictors. Conclusion The results of this study suggested that the presence of both ST and hyperleptinaemia in patients with STs may be associated with high levels of triglycerides and low levels of HDL, and this could suggest that changing the life style of patients with ST may have a beneficial role.
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Quality of life in erectile dysfunction patients and their partners responding to tadalafil versus sildenafil citrate
Attia A Attia, Faisal A Hassan, Mohamed I Kamel, Mohammed R Ayoub
June 2013, 33(1):32-36
DOI:10.7123/01.EJDV.0000431583.00793.33   
Background

Erectile dysfunction (ED) is considered the most common sexual problem in men, with a direct impact on the life of the patient and their partners. Quality of life (QOL) has become a useful variable to assess the overall impact of diseases and medical treatments from the patient’s point of view.

Aim

The aim of this study was to estimate the QOL in ED patients responding to tadalafil versus sildenafil citrate as well as that of their partners and also to find out the type of treatment associated with the best QOL among these patients.

Methods

The present study was carried out over a period of 2 months and involved 60 diagnosed ED patients and their partners who were divided into two groups. Group A comprised 30 male patients who responded to tadalafil (20 mg) on demand therapy as well as their partners. Group B comprised 30 male patients who responded to sildenafil citrate (50 mg) on demand therapy as well as their partners. All patients included in the study were subjected to a thorough medical history taking, physical and genital examination, and QOL assessment using the WHO QOL BREF questionnaire before administration of tadalafil or sildenafil as a treatment for their condition; they were then reassessed after 2 months.

Results

The present study showed that ED has a negative impact on all domains of QOL.

Conclusions

Treatment with tadalafil or sildenafil improves QOL for both the patients and their partners in different domains of QOL.

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