BACKGROUND:Histone deacetylase 1 (HDAC1) belongs to class I histone deacetylases, which are zinc-dependent enzymes that remove the acetyl group from histones and other proteins providing epigenetic regulation of gene expression. It plays an important role in the hair follicle and epidermal homeostasis in addition to its immunomodulatory roles. Alopecia areata (AA) and acne vulgaris are common skin diseases in which epigenetic factors have been proposed. However, studies of epigenetic modifications in both diseases are quite limited.OBJECTIVE:This study aimed at elucidation of HDAC1 deregulation in AA and acne vulgaris.METHODS:A case-control study was conducted on 76 participants: 25 patients with patchy alopecia areata, 26 patients with acne vulgaris and 25 healthy controls. Blood samples were collected for the measurement of HDAC1 level by ELISA.RESULTS:A significant difference in the serum level of HDAC1 was found between the studied groups being highest in the AA group (P = 0.0001). It was significantly higher in the AA group than the acne vulgaris group (P = 0.0001).CONCLUSION:HDAC1 appears to be deregulated in patients with AA and acne vulgaris. This may suggest a potential therapeutic opportunity for HDAC inhibitors for the treatment of such diseases.

Psoriasis is an immune-mediated disease, with genetic background and triggering environmental factors; however, several gaps are still present in understanding the intertwined relationship between these elements. Epigenetic mechanisms, including microRNAs (miRNAs), play an important role in the pathogenesis of psoriasis. The relationship between interleukin (IL)-17, a key cytokine in psoriasis, and these epigenetic mechanisms still needs to be elucidated. This study aimed at assessing the expression of miRNA-155, miRNA-210, and miRNA-20b in skin and sera of psoriasis patients in relation to IL-17 levels. For 20 psoriasis patients and 20 matching controls, the expression of miRNA-155, miRNA-210, and miRNA-20b was assessed using real-time polymerase chain reaction (RT-PCR), whereas IL-17/IL-17A levels were measured using quantitative enzyme-linked immunosorbent assay (ELISA) technique. MiRNA-155 expression was significantly higher in lesional skin compared to controls (P = 0.001). MiRNA-210 expression was significantly higher in both, lesional skin (P = 0.010) and sera of patients (P = 0.001) in comparison with controls. A statistically significant positive correlation was found between serum miRNA-210 expression and serum levels of IL-17/IL-17A (P = 0.010, rs = 0.562). MiRNA-20b lesional and non-lesional expression was significantly higher than controls (P < 0.001;P = 0.018). In conclusion, the expression of miRNA-155, miRNA-210, and miRNA-20b is exaggerated in psoriasis and they may be involved in disease pathogenesis. A possible relationship between miRNA-210 and IL-17 may be suggested; however, further studies are still needed to verify this relation.

Background Angiogenin (ANG) is a member of the angiogenic process which is a contributory factor in the pathogenesis of psoriasis. In mycosis fungoides (MF), the interaction between tumour cells and their microvasculature is likely to occur during the progression of cutaneous T-cell lymphoma. Objective To estimate the tissue level of ANG in MF and psoriasis. Patients and methods This comparative study included 20 patients with chronic plaque psoriasis, 20 patients with plaque stage MF, and 10 age-matched and sex-matched healthy controls. Punch skin biopsies were taken and sent for quantitative PCR examination of ANG. Results The ANG level in psoriasis was significantly lower than that in controls, while in MF, it was significantly higher than controls, with positive correlation with disease staging. ANG was significantly higher in lesional skin of MF patients than psoriasis patients. Conclusion ANG might have a role in disease progression in cases of MF; however, it is not the main angiogenic factor in psoriasis.

BackgroundInvolvement of eccrine sweat glands in adverse cutaneous drug reactions (ACDRs) has not received sufficient interest. ObjectiveTo examine histopathological changes in eccrine sweat glands in ACDRs. Patients and methodsForty ACDR cases were recruited. Lesional and nonlesional biopsies underwent thorough histopathological evaluation of the eccrine apparatus. ResultsThe eccrine apparatus was involved in 97.5% of lesional skin biopsies, secretory coils most frequently, and in 42.1% of apparently normal skin biopsies, and the difference was statistically significant (P<0.05). The most frequently encountered changes in lesional skin included acrosyringial necrosis, intraductal inflammatory cell infiltrate, and hydropic degeneration of the secretory coils. ConclusionThe invariable involvement of the eccrine sweat apparatus in ACDRs appears to be largely secondary to different mediators of the inflammatory process rather than events primarily and directly caused by the inciting drugs.

Patients with dystrophic epidermolysis bullosa (DEB) have mutations in type VII collagen gene. Type VII collagen is synthesized by keratinocytes and fibroblasts. Based on the ability of bone marrow non-hematopoeitic stem cells (NHBMSC) to develop into fibroblasts, we decided to investigate the use of NHBMSC in the treatment of recessive DEB (RDEB). This study included fourteen patients with RDEB; the first seven of them were given cyclosporine after the infusion of NHBMSC. As cyclosporine has been used for the treatment of RDEB we decided not to use cyclosporine for the second group of seven patients. Skin biopsies from the lesions were studied by electron microscopy before and after treatment. The number of new blisters decreased significantly after treatment in both groups (p=0.003 and 0.004 respectively) and the rate of healing of new blisters became significantly faster after treatment in both groups (p<0.001) with no significant difference between the two groups. Electron microscopic examination revealed increased number of anchoring fibrils after treatment in both groups. No major side effects were reported during the 1-year follow-up period. Our findings highlight the efficacy as well as the safety of NHBMSC in the treatment of RDEB.

Background: Histone deactylases (HDAC) have a role in the pathogenesis of mycosis fungoides (MF) through their actions on different apoptosis pathways. Objective: To assess the possible role played by HDAC-2 in MF by estimating the tissue expression of HDAC2 mRNA in different stages of MF. Methods: This study included 28 MF patients and 30 controls. The HDAC-2 levels were detected by real-time polymerase chain reaction (PCR). Correlations of HDAC-2 levels with clinical presentation and different stages of MF were analyzed. Results: Mean HDAC-2 level was significantly higher in patients (P < .001) than in controls. HDAC-2 highest mean value was significantly detected in patients with stage IIb, and the lowest mean value was detected in patients with stage Ia (P < .001). Conclusion: Up-regulation of tissue HDAC-2 in MF patients might develop a new approach in the understanding of the pathogenesis of MF. Histone deactylases are important targets for molecular cancer therapeutics.

Background: Although almost all patients with T1DM eventually develop one or more skin manifestations, data on cutaneous manifestations of type 1 diabetes mellitus (T1DM) are scarce. They can be the first presenting sign, or even precede the diagnosis or develop from the long-term effects of diabetes. Objective: To detect the prevalence and spectrum of skin manifestations in children and adolescents with T1DM attending the DEMPU clinic, Cairo University and to investigate the effect of the disease duration on these dermatoses. Subjects and methods:Two hundred twenty-five children and adolescents with T1DM were examined for dermatological problems. Of them, 152 patients who had cutaneous manifestations with T1DM were included in this case-control study, 152 age and sex matched non diabetic patients were included as control group. A detailed dermatological examination was carried out by the dermatology team. Results: The overall prevalence of dermatologic manifestations was 67.56% (152 T1DM patients; 74 males and 78 females). The mean age of the patients was 8.38±3.79years and the mean diabetes duration was 2.80±2.86years. Cutaneous adverse effects related to insulin injections were the most common manifestation representing 28.9%, followed by cutaneous infections (bacterial, fungal and viral infections) in 25%, allergic skin diseases in 19.1% and pruritus in 15.1% of patients with T1DM. Conclusion: Broad spectrums of dermatoses are common (67.56%) in Egyptian patients with T1DM. Early referral to the dermatologist helps to detect skin complications of diabetes in these children and is essential for both prevention and management of these conditions.

BACKGROUND:No effective treatment has been found for epidermolysis bullosa dystrophica (EBD). OBJECTIVE:To evaluate the efficacy and safety mycophenolate mofetil (MMF) in treating EBD. METHODS:This randomized controlled double-blinded study included 35 patients with severe generalized EBD. Patients were randomly divided into two groups: group I (18 patients) received cyclosporine therapy (5 mg/kg/day) and group II (17 patients) received MMF therapy (500-1500 mg/day). Clinical assessment was made weekly for 3 months from the start of the treatment. Patients were assessed by measuring the extent of the disease, the % of improvement, assessing the number of new blister formation and the time of complete healing of new blisters. Side effects were recorded when detected. RESULTS:The % of improvement in the disease extent was statistically significantly higher (p = 0.009) in group I (mean ± SD: 59.21 ± 22.676) than in group II (mean ± SD: 44.03 ± 25.71). As regards the number of new blisters and the rate of healing of blisters, there was no statistically significant difference between both groups (p = 0.693 and 0.404, respectively). No serious side effects were reported. CONCLUSION:MMF seems to be a good therapeutic option for the long-term treatment of EBD, it can be a good alternative for patients who cannot tolerate cyclosporine.

Journal of the Egyptian Women’s Dermatologic Society 2012, 9:151–155 Background Vitiligo is believed to result from progressive autoimmune-mediated loss of melanocytes. Although a number of studies suggest the involvement of several autoimmune influencing cytokines in the pathogenesis of vitiligo, these reports are still limited and contradictory. Objective To examine the degree of expression of transforming growth factor b1 (TGF-b1) in both the serum and the tissue of vitiligo patients and their relation to disease development, progression, and severity. Patients and methods In this case control study, 20 vitiligo patients and 10 age-matched and sex-matched controls were recruited. TGF-b1 levels were detected in serum and lesional as well as nonlesional specimens of cases and controls. The relations of TGF-b1 levels with disease parameters including disease extent, type, and vitiligo disease activity score were analyzed statistically. Results Serum and tissue levels of TGF-b1 were significantly lower in patients than the controls (P = 0.001 and Po0.001, respectively). There was no significant difference between the TGF-b1 levels between the lesional and the nonlesional skin of patients (P = 0.634). Conclusion Downregulation of serum and tissue TGF-b1 may result in the loss of peripheral tolerance mediated by T regulatory cells and should be further investigated as a prerequisite for disease initiation in susceptible individuals.

BACKGROUND:Skin tags (STs), are papillomas commonly found in the neck and in the axillae of middle-aged and elderly people. Metabolic syndrome (MS) is a complex of interrelated risk factors for cardiovascular disease and diabetes. Epidemiologic studies of different ethnic populations have indicated that hyperleptinaemia and leptin resistance are strongly associated with MS.AIM:To study the possible relation of skin tags and leptin levels to MS guided by the International Diabetes Federation (IDF) diagnostic criteria.METHODS:This study included 80 participants, 40 ST patients and 40 apparently healthy controls. Age, sex, waist circumference (WC), body mass index (BMI), smoking status, fasting glucose level, insulin level and insulin resistance were estimated as well as cholesterol, triglycerides, HDL, criteria of MS, and leptin levels.RESULTS:The univariate analysis showed that WC, BMI, fasting glucose, insulin levels, insulin resistance, cholesterol, triglycerides, HDL, and leptin levels were significantly higher in ST patients compared to controls (P<0.001). The multivariate analysis between MS components and ST showed that only high triglyceride levels (OR 1.205/95% CI 1.044-1.391/P=0.011) and low HDL levels (OR 0.554/95% CI 0.384-0.800/P=0.002) were significantly associated with ST. Multivariate linear regression analysis of the predictors of high plasma leptin levels, showed that high triglyceride levels (OR 0.287/95% CI 0.410-3.56/P=0.014), and low HDL levels (OR -0.404/95% CI -8.7 to -2.08/P=0.002) 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.