Background Psoriasis is a common chronic, immune-mediated inflammatory skin disease. Despite the availability of several systemic therapeutic agents, treatment of psoriasis remains a challenge because of the associated adverse effects and/or the financial burden of these medications, given the chronicity of the disease.Objectives We aimed to compare the efficacy and safety of combined pulse azathioprine (AZA) and low-dose methotrexate (MTX) vs. a conventional dose of MTX in patients with chronic plaque psoriasis.Methods In this randomized controlled trial, 67 patients with moderate-to-severe plaque psoriasis were randomized into two groups, receiving either combined pulse AZA (300 mg weekly dose) and low-dose MTX (10 mg weekly) or conventional-dose MTX (0.3 mg kg-1 per week) for 16 weeks. Patients were assessed for treatment response using the Psoriasis Area and Severity Index (PASI) score and for the development of any adverse effects at weeks 12 and 16, and for a further 3 months after stopping treatment.Results A statistically significantly higher proportion of the patients receiving combined pulse AZA and low-dose MTX achieved >= 90% improvement in PASI and 100% improvement (PASI 100) at week 12, and PASI 100 at week 16, compared with those receiving the conventional dose of MTX as monotherapy. No serious adverse events were reported during the entire study period in the two groups.Conclusions Combination therapy using pulse AZA and low-dose MTX can be an efficacious treatment for moderate-to-severe plaque psoriasis, with a relatively good safety profile. Psoriasis is a common chronic, immune-mediated inflammatory skin disease. We aimed to compare the efficacy and safety of combined pulse azathioprine (AZA) and low-dose methotrexate (MTX) vs. a conventional dose of MTX in patients with chronic plaque psoriasis. It was found that combination therapy using pulse AZA and low-dose MTX is an efficacious treatment for moderate-to-severe plaque psoriasis, with a relatively good safety profile.

Treatment of onychomycosis includes topical and systemic agents. However, prolonged use of oral treatment could cause adverse effects and topical antifungal agents have limited penetration. To compare the clinical efficacy and the safety of fractional CO2 laser combined with topical tioconazole nail solution versus Q-switched 1064 Nd: YAG laser in the treatment of fingernail onychomycosis. This randomized comparative clinical trial was conducted on 13 patients (47 nails) with fingernail onychomycosis. Patients were randomized to receive either fractional CO2 laser combined with topical tioconazole or Q-Switched Nd: YAG 1064 nm laser every 2 weeks for 3 months followed by a 1-month follow up assessment. Onychomycosis severity index (OSI) score, Dermatology life Quality Index (DLQI) score, patient satisfaction score, dermoscopic evaluation and KOH examination were used for assessment of improvement. OSI showed improvement after treatment in both arms (from 16.17 to 10.92 in fractional CO2 arm (p = 0.026) and 23.13 to 22.43 (p = 0.92)). When comparing both groups OSI score significantly reduced in the fractional CO2 laser combined with tioconazole more than the Q-switched laser group (p = 0.002). The mean DLQI score significantly improved in both groups but no statistically significant difference between the two groups. Significant improvement in patient satisfaction score was noted in both groups. Mycological cure using KOH examination was detected in both groups (44.4

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Background/objectives The prevalence of psoriasis shows a worldwide geographic variation ranging from 0 up to 11.8%. This reflects the fact that psoriasis is a complex disease influenced by both genetic and environmental factors. The prevalence of psoriasis in children younger than 18 years of age was reported to be 0.40%; however, data about its true prevalence among children in Egypt and the Middle East region are scanty, especially among younger age groups living in rural areas. This work was performed to explore the prevalence and characteristics of psoriasis among a sample of preparatory school students in a rural community in Fayoum, Egypt. Patients and methods This cross-sectional study included 3061 preparatory school students with ages between 13 and 15 years from five rural public preparatory schools in Fayoum, Sinouris rural district. The demographic and disease-related data were collected by an assisted self-administrated questionnaire sheet. Clinical examination of all recruits was performed, and disease data for patients with psoriasis were recorded, including extent of the disease and psoriasis severity using the psoriasis area and severity index score. Results The prevalence of psoriasis was 0.1% among all of the examined students in the study, with a female-to-male ratio of 3 to 1. The most important triggering factor was changes in seasons and climate, as 50% of the patients worsened in winter. The extent and severity of psoriasis among affected children was mild. Conclusion The prevalence and genetic background of psoriasis was low with only mild forms of psoriasis identified among rural preparatory school students in Fayoum, Sinouris district.

Background: Trichoscopy is a simple, noninvasive procedure practiced in the diagnosis of a multitude of scalp and hair disorders. Hair shaft abnormalities usually represent a diagnostic challenge to dermatologists. Objectives: The aim of the study was to determine the practicality, versatility, and value of using the handheld dermoscope in the assessment of hair shaft abnormalities and the diagnosis of different hair/scalp disorders. Methods: Eight hundred and seven patients of both sexes, aged from 1 to 76 years, with complaints pertaining to scalp and hair, were the subjects of the study. All patients were examined by the handheld dermoscope, and 400 were additionally examined by the folliscope, digital dermoscope, or their hairs mounted for light microscopy. Results: Based on trichoscopic findings, more than half the patients demonstrated thinned terminal hairs and a predominance of single-haired scalp pilosebaceous units (57% and 55.5%, respectively). Over a quarter of the patients showed hair diameter heterogeneity, upright regrowing hairs, and increased vellus hairs (37%, 31%, and 25%, respectively). Other trichoscopic findings included scalp scaling (19%), hair weathering (12%), thinned wavy hairs (10.5%), brush-like hair fractures (9%), exclamation mark hairs (9%), and longitudinal cleavage (trichoptilosis) (8%). The clinical diagnostic spectrum was topped by the following diagnoses in order of frequency: female pattern hair loss, telogen effluvium, traction alopecia, and trichotillomania. Trichodynia appeared to be significantly associated with numerous hair shaft abnormalities. Conclusion: Most hair shaft abnormalities can be reliably diagnosed with high accuracy using a handheld dermoscope in an office setting. Skillful knowledge of dermoscopy is an important aid in the diagnosis of hair and scalp disorders.

Trichoscopy is a simple noninvasive tool that is used in calculating different hair parameters and the diagnosis of different hair/scalp diseases at variable magnifications.

Background Acral lesions of vitiligo are most likely recalcitrant to the known lines of treatment. Ablative fractional CO2 has shown efficacy in treatment of vitiligo in combination with other modalities. Methods Thirty non-segmental vitiligo patients with acral lesion were included in the study. Each patient was subjected to fractional Carbon Dioxide Laser Treatment followed by application of 5 fluorouracil (5FU) cream for five consecutive days. Evaluation was done 3 weeks from the start of treatment and 12 weeks after the last treatment session using VESTA score, evaluation of patients' photos by blinded investigation in addition to patients' satisfaction scores. Results Patients showed significant improvement of Vitiligo extent score for a target area (VESTA) score and developed considerable degree of repigmentation as assessed by blinded investigators. Conclusion The combination of fractional ablative CO2 and 5FU is an effective and safe procedure for the treatment of acral vitiligo with promising results offering patients a new therapeutic window.

Background Emerging evidence now suggests an association between Mycosis fungoides (MF) and metabolic risk factors.Objective To investigate a possible association between MF and metabolic syndrome (MetS).Patients and methods This study was designed as an observational, case-control study. It included thirty MF patients and 39 controls who were assessed for body mass index (BMI), waist circumference, blood pressure, fasting blood glucose, triglycerides (TG), total cholesterol, high and low density lipoproteins, serum leptin level and insulin resistance.Results Our results revealed that serum leptin level (P=0.029), TG (P=0.004), cholesterol (P=0.001) and LDL (P=0.019), waist circumference in males (P<0.003), hypertension (P=0.039) and frequency of metabolic syndrome (P=0.042), are statistically significantly higher in MF patients than controls.Conclusion Our results indicate that patients with MF may be at higher risk for metabolic syndrome. Concurrently, screening for metabolic syndrome is recommended for all MF cases for early detection of cardiovascular risk.

Background: Nonsegmental vitiligo is defined as being “often symmetrical”, however, no work has tackled the point as to how valid it is to depend upon the concept of symmetricity in generalized nonsegmental vitiligo. Aims: To investigate vitiligo symmetry, taking into account sites of predilection, the clinical characteristics of patients were studied. Methods: This multicentric study included 712 nonsegmental vitiligo patients with 2876 examined lesions. Three models were drawn for each patient. Sagittal, transverse and frontal planes were drawn to divide the body into right/left, upper/lower and anterior/posterior halves respectively. Patients were examined by Wood’s light and analyzed for symmetry. Results: Bilateral involvement was present in 78% (P < 0.001). Studying the similarity of clinical involvement in the upper and lower body parts revealed that such similarity was present in 38%, with a significant positive association in some areas. Studying clinical similarity in the anteroposterior distribution pattern revealed a significant positive association in 11%. Limitations: Relatively low number of patients. Conclusions: We found significant bilateral symmetry in the lesions of 78% of vitiligo patients. Our work could aid in drawing the anticipated vitiligo map in patients with active disease, helping in increasing our understanding of the clinical behaviour of this disease.

Background Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are non-melanoma skin cancer (NMSC). microRNAs (miRNAs) are short single-stranded post-transcriptional regulatory RNAs that are known to play significant roles in cell development, differentiation, and cancer development. miR-205 has been found to be dysregulated in some tumors in humans. Objective To assess the tissue expression of miR-205 3p and 5p, as oncogenes, in BCC and SCC. Patients and Methods This case-control study included 21 patients with BCC, 21 patients with SCC and 21 healthy controls. Tissue expressions of miR-205 3p and 5p were evaluated using Real Time PCR technique. Results Tissue expressions of miR-205 3p and 5p were significantly higher in BCC and SCC compared to controls with a significantly higher expression of miR-205 3p than the 5p arm in both BCC and SCC. Moreover, the expressions of both arms were significantly higher in SCC compared to BCC. Conclusion miR-205 3p and 5p seemed to have an oncogenic effect in BCC and SCC with the 3p arm contributing more to this oncogenic effect. This oncogenic effect could be through miR-205 3p and 5p targeting and inhibiting tumor suppressor proteins in skin cells.

Background and Objectives To investigate the therapeutic efficacy and safety of growth factors combined with fractional carbon dioxide (CO2) laser in comparison with fractional CO2 alone in a sample of patients with facial mature burn scars. Study Design/Materials and Methods Fifteen Egyptian patients with bilateral facial burn scars were treated with six sessions of fractional CO2 laser at 6-week intervals. Following each laser session, a topical growth factors cocktail was applied to one side of the face in a split-face manner. Clinical evaluation by Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (PSOS), and photography before and 2 months after the last laser session was done. Three millimeter punch biopsies were obtained from each side of the face pre- and 1-month posttreatment to measure the mean area percent of collagen. Results Posttreatment, both VSS and PSOS scores decreased on both sides of the face being more significant on the growth factors treated side, showing more scar pliability and shorter downtime (P = 0.001). A significant difference in the mean area percent of collagen was also noted on both sides. Conclusion Adding topical growth factors to fractional CO2 laser treatments is effective and safe with better results as regards scar pliability and shorter downtime than fractional CO2 laser alone. Lasers Surg. Med. (c) 2020 Wiley Periodicals, Inc.

BACKGROUND:Identification of epidemiologic and phenotypic variations of psoriasis among different ethnic groups can further our understanding of this perplexing disease, aiming at better management of patients worldwide. OBJECTIVE:To provide a descriptive analysis of psoriasis patients registered at Kasr Al-Ainy Psoriasis Unit Disease Registry. METHODS:This retrospective single-center registry study included patient records between November 2015 and November 2018 (2534 patients). Sociodemographic and phenotypic data were analyzed. RESULTS:The mean age of the registered patients was 39.3 years and 56.3% were men. Stress was the main precipitating factor (48.3%), whereas the most common symptom reported was itching (82.4%). The median body mass index was 27.5, and the median percentage of body surface area involved was 10.0. The mean Psoriasis Area Severity Index score was 8.7, and the mean Psoriasis Disability Index score was 13.0. Both parameters correlated positively, and both showed significantly higher means in smokers. LIMITATIONS:Despite that the study was performed at a highly specialized tertiary care center with a high flow of patients, this was still a single-center registry. CONCLUSIONS:This work shows that the characteristics of Egyptian patients with psoriasis are comparable to those of other studied ethnic groups, with minor differences.

In this paper we restrict the design probabilities of Mahmood, Singh and Horn (1998) unrelated question randomized response model. Besides its simplicity, the resulted restricted model has two advantages over Mahmood et al. (1998) model with other design probabilities. First, the restricted model requires selecting only one simple random sample and not two which reduces the cost of survey. Second, the efficiency of the estimator of the proportion pi(s), of the population bearing a sensitive characteristic is increased. In addition, efficiency comparisons showed that this estimator can be easily adjusted to be more efficient than other competitors that were developed after 1998. A simulation study is performed to determine the minimum sample size required for the estimator to lie inside the unit interval. Moreover, the restricted model is extended to stratified random sampling and the resulting estimator is shown to be more efficient than the Kim and Elam (2007) and Singh and Tarray (2016) estimators.

Background and Objectives To compare the efficacy and safety of intradermal injection of tranexamic acid (TXA) versus Q switched (QS) KTP (532 nm) in the treatment of facial ephelides. Study Design/Materials and Methods A randomized comparative split-face study included a total of 30 female patients with bilateral facial ephelides. One cheek was treated by intra-dermal TXA injections and the other was treated by QS-KTP (532 nm). Patient assessment was performed by photography, pigmentation area, severity index and spectrophotometry at baseline, 1 week after treatment, and 2 months after treatment. Results A significant difference was found between both sides regarding the percentage change of pigmentation area, severity score (PSI) and melanin index (MI) after treatment and during follow up, favoring laser (P = 0.001). PSI decreased after treatment by 66.5% and 15.4% (laser and TXA sides respectively), further decrease after follow-up was 69.4% with laser and 26.1% with TXA. MI improved by 3.7% after KTP laser to 7.7% after follow-up and by 2.4% after TXA injections to 6.5% after follow-up. Four patients developed post-inflammatory hyperpigmentation following QS-KTP. Conclusion QS-KTP laser is superior to intradermal TXA injection in the treatment of facial ephelides. Lasers Surg. Med. (c) 2020 Wiley Periodicals LLC

Melasma is a hard-to-manage disorder with considerable relapsing behavior. Dermoscopy emerged to help in comprehensive evaluation of pigmentary disorders and melasma. The aim of the study was to evaluate the potential role of dermoscopy in assessing melasma and monitoring the efficacy of 1064-nm low-fluence Q-switched neodymium:yttrium-aluminum-garnet (QS Nd:YAG) laser. A total of 31 patients with facial melasma were included. A total of five laser sessions were performed with 2-week intervals. Patients were evaluated at baseline and 2 weeks after the last session (at the 10th week) by using digital photography, modified melasma area and severity index (mMASI), and colorimetry, as well as dermoscopic score for pigment and vascular elements. Adverse effects were reported. Postlaser sessions, mMASI scores as well as the colorimetric melanin and erythema indices had showed significant improvement. The "dermoscopic score of pigmentary and vascular elements" displayed significant change and confirmed the improvement. Side effects were tolerable. mMASI, colorimetry, and dermoscopy had ascertained the efficacy of low-fluence 1064-nm QS Nd:YAG laser in melasma; however, dermoscopy is superior to other assessments as it can help in the diagnosis of melasma besides the follow-up assessment and can precisely detect the detailed changes in response to treatment.

Background Trichoscopy is a useful tool for diagnosis and follow-up of alopecia areata (AA) patients. Both platelet-rich plasma (PRP) and intralesional corticosteroids (ILCs) are important treatment modalities of patchy AA. Aim Trichoscopic diagnosis of AA and monitoring the treatment response to PRP versus ILCs in patchy AA treatment. Patients/Methods This comparative study included 31 patients with patchy AA, divided into two groups: (group A) received ILCs while (group B) received PRP once monthly for 3 months. Evaluation was done by Severity of Alopecia Tool (SALT) score, Alopecia Areata Symptom Impact Scale (AASIS), photography, and dermoscopy. Results There was a significant improvement in trichoscopic findings in both groups with regard to the number of follicular units per opening, black dots, broken hairs, and dystrophic changes. Final SALT score showed significant lower levels in both groups compared to baseline levels (P= .025 &P= .008). Final AASIS showed significant decrease in group B (P= .006) not in group A (P= .062). Conclusion Trichoscopy can help in the diagnosis, evaluation of the efficacy and safety of both modalities and might give a clue for treatment response. Both ILCs and PRP were effective in patchy AA treatment.

Background Data have been accumulating in the past few years that identify vitiligo as a disorder with systemic implications. Results and methods In this hospital-based, cross-sectional, case-control study, 50 patients with non-segmental vitiligo and 50 age- and sex-matched controls underwent analysis of serum lipid profile, oxidative stress biomarkers and carotid duplex. Hydrogen peroxide (H2O2) and malondialdehyde (MDA) were significantly higher in patients than controls (p-value < .001, <.001, respectively); on the other hand, total antioxidant capacity (TAC) was significantly lower in patients than controls (p-value = .001). A significantly higher percentage of patients had hypercholesterolemia and borderline high, high or very high levels of LDL-C, compared to controls (p-value = .001 and .001, respectively). Atherosclerotic plaques and increased common carotid intima media thickness were significantly detected in patients versus controls. Discussion Results of the present study suggest that a subset of patients with vitiligo are at a higher risk of developing dyslipidemia and atherosclerosis, which might increase their future risk for the development of cardiovascular disease. Confirmation of these findings would subsequently influence investigative and the treatment strategies in the management plan of vitiligo patients in the near future. Significance Vitiligo patients might be at a higher risk of developing dyslipidemia and atherosclerosis, which might increase their risk for the development of cardiovascular disease necessitating prophylactic measures to improve prognosis. Our results might influence the investigative and treatment strategies in the management plan of vitiligo patients in the near future.

Background: Janus kinases (JAKs) are a family of non-receptor protein tyrosine kinases that are expressed in a variety of tissues. Several JAK-controlled cytokine receptor pathways are incriminated in the initiation and progression of psoriasis. Genetic polymorphisms influencing JAK expression would be anticipated to have a great impact on disease activity. Objective: The aim of the study was to evaluate the association between JAK1 rs310241 and JAK3 rs3008 polymorphisms and the risk of developing psoriasis. Methods: Blood samples of 150 patients and 120 controls were screened for nucleotide polymorphisms in JAK1 rs310241 and JAK3 rs3008 genes by using polymerase chain reaction (PCR)-restriction fragment length polymorphism technique. Results: The GG genotype of the JAK1 rs310241 and JAK3 rs3008 genes was significantly associated with an increase in psoriasis risk (p = 0.000, OR = 7.7, 95% CI = 2.8–21.5; p = 0.003, OR = 3.3, 95% CI = 1.5–6.9, respectively). The G allele of both genes was also associated with psoriasis susceptibility (p = 0.000, OR = 2.0, 95% CI = 1.4–2.8; p = 0.002, OR = 1.7, 95% CI = 1.2–2.4, respectively). Conclusion: The results indicate a possible association between JAK1 rs310241 and JAK3 rs3008 gene polymorphisms and susceptibility to psoriasis. These findings validate the importance of these molecules in psoriasis and may enable the identification of the individuals most susceptible to the disease.

BACKGROUND:Alopecia areata (AA) is, an organ-specific autoimmune disease, characterized by an aberrant expression of cytokines of the T helper 1 type. Tumour necrosis factor-like weak inducer of apoptosis (TWEAK) is a multifactorial cytokine that exerts a role in the pathogenesis of inflammatory and autoimmune diseases, especially in cutaneous diseases.AIM:To estimate the serum level of TWEAK in AA and to correlate it with different parameters.METHODS:This case-control study enrolled 40 patients with AA and 50 clinically healthy volunteers matched for age and sex. A blood sample (5 mL) was extracted from each participant for analysis of serum TWEAK levels by ELISA.RESULTS:Levels of TWEAK were significantly higher in patients with AA (mean ± SD 213.7 ± 59.2 pg/mL, range 109.1-341.6 pg/mL) than in controls (95.97 ± 13.28 pg/mL, range 80.1-152.3 pg/mL) (P < 0.001). A significant positive correlation was found between serum TWEAK level and the Severity of Alopecia Tool (SALT) score (r = 0.56, P < 0.001).CONCLUSION:To our knowledge, this study highlights for the first time a possible link between higher serum TWEAK level and AA. Serum TWEAK level appears to reflect AA disease severity.

Psoriasis is a chronic multisystem inflammatory disease affecting primarily the skin and joints but also involves several comorbidities. The disease affects between 0.2 and 4% of the population worldwide. The Kasr Al-Ainy Psoriasis Unit developed a protocol of therapy for psoriasis. Part I discussed the topical and systemic therapies. This part discusses the biological therapy. Biological therapies for psoriasis are agents that can specifically target an immune mediator and block specific molecular steps important in the pathogenesis of psoriasis. Despite the cost, the use of biological therapies in psoriasis is sometimes necessary. However, the adequate choice of biologic in the proper indication is mandatory for cost–benefit balance for the patient. Physicians using biological therapies should be familiar with complications. The protocol offers regional physicians a practical algorithm for choice of biological therapies in psoriasis and a full workup before therapy and during follow-up. Authors highlight the safety and efficacy data of biologic therapies available in the Egyptian market, with special focus on particular situations (hepatitis, tuberculosis, and demyelinating disorders).