Background In psoriasis, interleukin (IL)-36 is considered a pathogenic driver, whereas IL-38 was downregulated. Little is known about their role in metabolic syndrome (Ms) in psoriasis. Objective To evaluate a possible relation between serum IL-36 and IL-38 and Ms in psoriasis vulgaris. Patients and methods This study was designed as a case–control study. It included 80 participants, who were divided into four groups: group A included 20 psoriasis patients with Ms, group B included 20 psoriasis patients without Ms, group C included 20 controls with Ms, and group D included 20 healthy controls. Written informed consents were signed by all participants. Clinical examination and psoriasis area and severity index (PASI) evaluation were done. BMI, waist circumference, arterial blood pressure, fasting blood glucose, and lipid profile were measured. Blood samples were withdrawn, and serum IL-36 and IL-38 levels were measured using enzyme-linked immunosorbent assay. Results Serum IL-36 levels were significantly higher in group A (mean±SD=187.84±32.84 pg/ml) compared with group B (mean±SD=156.5±24.09 pg/ml) (P<0.001), or group C (mean±SD=115.18±14.69 pg/ml) (P<0.001) or group D (mean±SD=38.06±10.18 pg/ml) (P<0.001). Serum IL-38 levels were significantly lower in group A (mean±SD 57.34±19.91 pg/ml) compared with group B (mean±SD=73.9±16.13 pg/ml) (P<0.006) or group C (mean±SD=74.67±12.89 pg/ml) (P=0.002), or group D (mean±SD=212.36±17.55 pg/ml) (P<0.001). In group A, IL-36 had a 75% sensitivity and 70% specificity with a cutoff value of 166.2, whereas IL-38 had an 80% sensitivity and 65% specificity with a cutoff value of 74. There was a significant negative correlation between IL36 and IL-38 levels (r=−0.637, P<0.001). Conclusion Patients with psoriasis with Ms had significantly higher IL-36 and lower IL-38. Imbalance between IL-36 and IL-38 may be associated with underlying metabolic disturbance seen in psoriasis.

Inflammatory skin diseases are highly prevalent, yet their impacts on patients' quality of life (QoL) are not addressed. In this cross-sectional study, the Arabic version of Skindex-16 was used to evaluate the symptomatic, emotional, and functional distress of patients with inflammatory skin disorders attending several outpatient dermatology clinics in Egypt and Saudi Arabia. Patients with ≥50% of the symptoms score, ≥50% of the emotions score, and ≥33% of the functioning score were considered having poor QoL. A total of 1,310 patients aged 30 ± 13 years (70.6% from Egypt and 29.4% from Saudi Arabia) were included in this study. Of them, 1,192 patients had inflammatory skin diseases, and 118 had facial nevi, who served as controls. Patients with inflammatory skin diseases had significantly worse QoL than those with nevi. Autoimmune bullous disease group showed the highest prevalence poor symptoms (56.8%), poor emotions (75.7%), and poor functioning (83.8%) of QoL. Women with acne and psoriasis were more likely to have poor symptoms than men (16.3% vs. 4.7% and 52.7% vs. 25.3%, respectively). In conclusion, inflammatory skin diseases had profound negative effects on patients' QoL. Age, sex, education, and marital status of patients can affect their perception of QoL.

Background Melanocyte keratinocyte transplantation procedure (MKTP) is a multi-procedural intervention that could hypothetically alter the environment surrounding grafted epidermal cells, helping melanocytes' migration and adherence to keratinocytes in their basal position. Objective To evaluate the effect of MKTP in acral vitiligo skin prepared by total ablative CO2 laser resurfacing and followed by narrow-band ultraviolet B (NB-UVB) phototherapy on matrix metalloproteinase-2 (MMP2) and E-Cadherin expression and the reflection of these changes on repigmentation. Patients and methods Acral lesions in 20 stable nonsegmental vitiligo patients were prepared by full CO2 ablation down to the papillary dermis followed by MKTP and NB-UVB sessions. Two 4mm punch biopsies were taken: the first at baseline and the second after the onset of repigmentation or after 6 months of phototherapy if no repigmentation occurred. Immunohistochemical staining for evaluation of E-Cadherin and MMP2 expression was performed. Results Eight patients (40%) achieved repigmentation ranging from 10 to 90% with a median of 62.5%. E-Cadherin intensity was significantly increased after treatment (P<00.1). There was also a significant total increase in epidermal (P<0.001) and dermal (P<0.001) MMP2 with diffuse nuclear pattern of staining. In lesions showing repigmentations, the percentage change in dermal MMP2 was significantly higher (P=0.012), while no such difference was present in epidermal MMP2 and E-Cadherin expression. Conclusion MKTP with recipient site prepared by full CO2 laser ablation followed by NB-UVB phototherapy increased the expression of E-Cadherin and MMP2 in acral vitiliginous skin. The increase of dermal MMP2 could play a favorable role in repigmentation.

BackgroundAlthough the exact pathogenic mechanisms leading to blister formation in pemphigus vulgaris (PV) have not been fully elucidated, intracellular signaling following antibody binding has been found to be necessary for inducing cell-cell dissociation. The phosphorylated p38 mitogen-activated protein kinase (P38 MAPK) signaling pathway plays a major role in the modulation of immune-mediated inflammatory responses and therefore has been linked with several autoimmune diseases. Studies showed that activation of P38 MAPK plays a role in the acantholytic process in PV through changes in the quaternary structure and cytoskeletal rearrangements.ObjectiveTo determine the levels of p38 MAPK and its substrate [MAP kinase-activated protein kinase 2 (MAPKAPK2)] in the peripheral blood mononuclear cells of patients with PV in relation to both the clinical score and the antidesmoglein 3 antibodies.Patients and methodsThis study included 25 Egyptian patients with PV and 25 healthy controls, who were recruited from Cairo University Hospitals. Detailed history was documented, and the severity of the diseases was determined by pemphigus disease area index score in each patient. Blood samples were obtained from all participants. Then, determination of the expression of p38 MAPK and its substrate MAPKAPK2 on peripheral mononuclear cells was done using flow cytometry, with measurement of antidesmoglein 3 antibody using enzyme-linked immunosorbent assay technique.ResultsWe detected that P38 MAPK and MAPKAPK2 were upregulated in patients with PV in comparison with controls (P=0.024 and P=0.002, respectively). There was a positive correlation between the anti-Dsg3 antibodies and P38 MAPK (r=0.591, P=0.004) and between disease severity (pemphigus disease area index score) and P38 MAPK (r=0.617, P=0.002) as well.ConclusionThis study concluded that P38 MAPK and its substrate MAPKAPK2 have a role in the pathogenesis of PV. Moreover, P38 MAPK can be used as a marker for disease activity follow-up, as it was correlated with both disease severity and autoantibody level.

Background Vitiligo is a common, acquired, depigmenting disorder that results from loss of functional melanocytes in the skin and mucous membranes. It is occasionally associated with autoantibodies against the melanocyte-specific proteins such as tyrosine-related protein-1 tyrosine-related protein-2. These antibodies could induce melanocyte damage in vitro by a complement-mediated mechanism and antibody-dependent cellular cytotoxicity might play an active role in the stimulation and inappropriate expression of HLA-DR and induction of intercellular adhesion molecule-1 on melanocytes. Objective Our aim was to assess the serum levels of different immunoglobulins (Ig) in addition to C3 and C4 in vitiligo patients and to determine their correlation with different clinical aspects of the disease. Patients and methods Serum levels of IgG, IgA, and IgM as well as C3 and C4 were estimated in 24 vitiligo patients and 24 healthy controls using the Radial Immuno-Diffusion (immunoprecipitation) technique. Results Serum IgM levels were found to be significantly decreased and C3 levels were significantly increased among patients compared with the controls. No significant difference was found in the serum levels of IgA, IgG, or C4 between both groups. Also, a significant positive correlation was found between serum IgA levels and the age of the patients, as well as between C3 and C4 and a family history of vitiligo. Conclusion Changes in Ig serum levels might be a cause or an effect in the pathogenesis of vitiligo, as well as alterations in the complement system. These ffindings suggest that altered immunity is to be considered in the therapeutic management of these patients.

BACKGROUND:There is a reported relation between hyperhomocysteinemia and lichen planus (LP). An increase in homocysteine (Hcy) and the risk of cardiovascular disease (CVD) in patients with methylenetetrahydrofolate reductase (MTHFR) mutation has been described.OBJECTIVE:To detect MTHFR (C677T) gene polymorphism, and to find its association with CVD risk, Hcy and folic acid levels in patients with LP.METHODS:This hospital-based case-control study included 110 patients with LP: 70 with cutaneous LP (CLP) and 40 with oral LP (OLP). A total of 120 age- and sex-matched healthy subjects were used as controls. Three millilitre venous blood sample was taken for detection of MTHFR gene polymorphism by PCR-RFLP technique and for measurement of the lipid profile. Hcy and folic acid were measured by ELISA. Hypertension was evaluated.RESULTS:There were significantly higher prevalence of hypertension with higher Hcy, triglycerides and cholesterol levels and lower folic acid and HDL levels among patients' groups. Hypertension with higher Hcy and cholesterol levels together with lower folic acid and HDL levels have been found in OLP when compared to CLP. Patients showed a significant higher percentage of the MTHFR 677 TT genotype (P=.003) and of the MTHFR 677 T allele (P=.042) compared to controls. Moreover, there was a higher prevalence of MTHFR 677 T allele in patients with CLP.CONCLUSION:MTHFR 677 gene polymorphism may be a risk factor for the development of the LP, and to predispose these patients to higher risk of CVD.

Chronic inflammation with lichen planus (LP) has been suggested as a component of the metabolic syndrome (MetS). LP is assumed to be related closely to dyslipidemia. Plasma osteopontin (OPN) has been reported to be a potential clinical marker for the prediction of atherosclerosis. Selenium (Se), an essential trace element, involved in the defense against oxidative stress, has been hypothesized to prevent cardiovascular disease (CVD). Se compounds are effective in the downregulation of OPN expression. Moreover, an inverse relation has been detected between the levels of plasma OPN and plasma Se in patients with psoriasis. To determine the possible role of OPN and Se in the pathogenesis of LP and their relation to the metabolic status in patients. Thirty patients with LP and 30 controls were included. Participants were assessed for the presence of MetS and/or its components. In all participants, plasma and tissue OPN levels were assessed using an enzyme-linked immunosorbant assay, plasma Se levels were assessed by flame atomic absorption spectrophometry, and high-sensitivity C-reactive protein levels were assessed using a solid-phase enzyme-linked immunosorbant assay. Patients with LP showed a significant association with MetS parameters than the controls. Plasma and tissue OPN were significantly higher in LP patients than those in the control group. Plasma Se levels were significantly lower in patients than those in the control group. In patients, plasma OPN levels were associated positively with the presence of diabetes mellitus, dyslipidemia, and MetS. The presence of LP in patients was associated strongly with MetS parameters, most probably because of long-standing inflammation. OPN may be a critical regulator of chronic inflammation in patients with LP and may explain its association with components of the MetS such as diabetes mellitus and dyslipidemia.

BackgroundMany factors contribute to periorbital darkening, including melanin deposition and skin redundancy. Therapeutic options are still limited and usually unsatisfactory. Dermoscopy allows the identification of different colors and structures not seen by naked-eye examination. ObjectiveTo assess patients with periorbital darkening by dermoscopy. Patients and methodsIn this descriptive study, 35 patients complaining of periorbital darkening were included. Clinical and dermoscopic evaluation was performed. Both pigmentary and vascular components were assessed. Clinical and dermoscopic photographs were evaluated, graded, and results were statistically analyzed. ResultsClinically, pigmentation was mild, moderate, and marked. Textural changes and periorbital edema were observed. Dermoscopically, three patterns were described: pseudonetwork, blotchy, and multicomponent. Erythema and telangiectasia were documented. The degree of pigmentation correlated positively with patient age, skin type, and presence of anemia. LimitationsSmall number of patients and no controls were the limitations. ConclusionDermoscopic evaluation of periorbital darkening/melanosis appears valuable, particularly in the determination of the degree and pattern of pigmentation as well as the extent of vascular involvement, which in turn would reflect on the choice of therapy.

BackgroundVitiligo is an acquired depigmenting disorder characterized by the selective destruction of melanocytes. Cyclooxygenases (COXs) are key enzymes in the conversion of arachidonic acid into prostaglandins. COX-2 expression plays a major role in prostaglandin E2 (PGE2) production. PGE2 plays an important role in tyrosinase activation and melanogenesis. ObjectiveTo determine the possible role of COX-2 and PGE2 in the pathogenesis of vitiligo. Patients and methodsThis analytic cross-sectional study included 22 vitiligo patients and 20 controls. Two skin biopsies were obtained from depigmented lesions and clinically normal skin from patients and one skin biopsy from the controls. COX-2 gene expression was semiquantified in skin biopsies using a reverse transcriptase-PCR and the PGE2 level was determined by an enzyme-linked immunosorbent assay. Blood samples were withdrawn from patients and controls to assess the plasma levels of PGE2 and COX-2 using the enzyme-linked immunosorbent assay technique and COX-2 activity using the Cyclooxygenase Enzyme Immunometric Assay Kit. ResultsThe expression of COX-2 mRNA was significantly decreased in lesional and nonlesional skin of patients compared with the controls (P<0.001). In addition, the level of PGE2 was significantly decreased in lesional and nonlesional skin of patients compared with the controls (P<0.001, P=0.003, respectively). The plasma levels and activity of COX-2 and the levels of PGE2 were significantly elevated in patients compared with the controls (P<0.001). ConclusionCOX-2 and PGE2 could contribute toward the development of vitiligo through their immunomodulatory role or locally through their role in melanogenesis.

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.

BackgroundHealthcare-associated infection (HCAI) is a growing problem in healthcare today. Thus, surveillance of HCAI is an important aspect of modern infection control. ObjectiveTo identify the incidence, etiology, and outcome of HCAI in the dermatology wards at Cairo University Hospital. Patients and methodsIn a cross-sectional study, over a period of 3 months, 180 patients were surveyed for HCAI and its risk factors according to the criteria set by the Centers for Disease Control and Prevention. Samples were obtained from skin lesions upon admission and after 72 h. Whenever infection was suspected, samples were obtained from the corresponding site or body fluids and submitted for microbiological evaluation. ResultsTen patients out of 180 (5.6%) inpatients developed HCAI: four cases with urinary tract infection, three cases with skin and soft tissue infection, two cases with conjunctivitis, and one with respiratory tract infection. The intravenous cannula was the only medical device used during the study period. Methicillin-resistant Staphylococcus aureus was obtained in 50% of cultures. The nurse-to-patient ratio was 1: 8, the median length of stay of patients who developed HCAI was 40 days. The HCAI mortality was one out of 10 patients, with a 10% rate. This was a 45-year-old male patient with pemphigus vulgaris; methicillin-resistant Staphylococcus aureus growth was only obtained from the conjunctival mucosal surface. ConclusionThe present study documents for the first time, to our knowledge, the status of HCAI in an Egyptian University Hospital dermatology inpatient. Prolonged length of stay, progressive disease course, empirical use of antibiotics, and a low nurse-to-patient ratio were the main causes for the development of HCAI. The incidence of HCAI in the dermatology wards (5.6%) appears to be within the reported international levels; however, this value could be reduced by addressing the predisposing factors.

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.