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Background: Urticaria affects a wide range of daily activities and social relationships. It has a severe impact on quality of life (QOL) and causes psychological problems. Objective: was to assess the impact of chronic urticaria (CU) on quality of sleep, the levels of depression, anxiety, QOL and their interaction with each other and their relation to disease related factors. Patients and methods: The study included 25 patients with CU and 25 healthy controls. Urticaria Activity Score (UAS) was used for objective evaluation of the intensity of urticaria. Patients completed a 10-cm visual analogue score (VAS) indicating the overall severity of their itching over the previous 2 weeks. The Dermatology Life Quality Index (DLQI) was used to evaluate patients' QOL. Patients were also assessed for anxiety and depression with the Hospital Anxiety and Depression Scale (HADS). Pittsburgh Sleep Quality Index (PSQI) was used for evaluation of sleep quality and sleep disturbances. Results: In our CU patients the mean of UAS7 score was 39.72 ± 2.76 and the mean of VAS score was 28 ± 1.34. The mean of DLQI score was 24.8 ± 4.37 indicating severe impact of QOL. CU patients had higher total HADS score when compared to controls; 72% of the patients had depression and 92% had anxiety. By using PSQI, CU patients had significantly longer sleep latency onset, shorter total sleep duration, lower sleep efficiency and higher PSQI scores compared to controls. Conclusion: CU highly affects the QOL of patients and is associated with higher levels of anxiety, depression and poor sleep quality.
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BACKGROUND: Striae distensae (SD) or stretch marks are common cutaneous conditions that occur because of the stretching of the dermis.OBJECTIVE To evaluate and compare the efficacy of fractional carbon dioxide (CO 2 ) laser alone versus combined fractional CO 2 laser with platelet-rich plasma (PRP) in SD treatment. METHODS AND MATERIALS: Thirty adult female patients with SD (SR and SA) were enrolled. In each patient, a split-lesion design was conducted as follows: pairs of SD on both sides of the midline were selected and allocated to groups A and B. Group A: was treated with combined fractional CO 2 laser with intradermal PRP. Group B: was treated with fractional CO 2 laser alone. Skin biopsies were taken from the lesions before and after treatment for histopathologic evaluation. RESULTS: In group A, a significant excellent improvement of the SD was achieved more than in group B ( p = .007) and the mean of improvement was significantly higher (60.33 ± 26.49) than that in group B (43.80 ± 27.43) ( p -value = .001). Group A was also associated with a more significant dermal deposition of collagen and elastic fibers. CONCLUSION: Combined fractional CO 2 laser with PRP was more effective than fractional CO 2 laser alone for the treatment of SD.
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Láseres de Gas , Plasma Rico en Plaquetas , Estrías de Distensión , Adulto , Humanos , Femenino , Estrías de Distensión/cirugía , Resultado del Tratamiento , Satisfacción del Paciente , Láseres de Gas/uso terapéuticoRESUMEN
Acne scarring usually causes cosmetic and psychological problems. Our aim of the study was to compare the efficacy of microneedling alone, intradermal injection of platelet rich plasma (PRP) alone and combined microneedling with PRP in the treatment of atrophic post-acne scars. Thirty adult patients with facial post-acne scars were randomly recruited and divided into two groups: A and B. Group A: included 15 patients; the left sides of their faces were treated with microneedling by dermapen followed by PRP while on the right side of the faces microneedling alone was performed. Group B: included 15 patients; the left sides of their faces were treated with microneedling by dermapen followed by PRP while the right sides of the faces were treated with intradermal injection of PRP. For both groups, the treatment session was repeated every 3 weeks until clearance of the atrophic acne scars or for four sessions maximally. Patients' evaluation was done pre-treatment and 3 weeks after the last session by photography, Goodman and Baron qualitative grading system and Echelle d'Evaluation Clinique des Cicatrices d'Acné (ECCA) scale. By using all of these evaluation methods, group A showed that there was better improvement on the left side but without statistical significant difference. However, group B showed that there was a significant reduction in the total number of post-acne scars on the left side compared to the right side by using photographic assessment and ECCA grading scale. Skin microneedling, PRP and combined microneedling with PRP are effective therapeutic modalities in atrophic post-acne scars treatment. However, combined microneedling with PRP gives better results and is better tolerated in all types of atrophic acne scars.
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Acné Vulgar , Enfermedades del Tejido Conjuntivo , Plasma Rico en Plaquetas , Adulto , Humanos , Cicatriz/diagnóstico , Cicatriz/etiología , Cicatriz/terapia , Agujas/efectos adversos , Terapia Combinada , Acné Vulgar/complicaciones , Acné Vulgar/terapia , Atrofia/terapia , Resultado del TratamientoRESUMEN
Most therapeutic approaches for keloids remain clinically unsatisfactory. In the last years, intralesional botulinum toxin-A (IL BTX-A) was proposed for treatment of keloids. Our aim of the study was to compare the clinical efficacy of IL BTX-A and IL 5-Fluorouracil (IL 5-FU) in treatment of keloids. A total of 50 patients with keloids were included in the study, 22 patients (with 26 keloids) were treated with IL BTX-A monthly for up to 6 months and other 22 patients (with 27 keloids) were treated with IL 5-FU weekly for up to 6 weeks, while the remaining 6 patients, each having multiple keloids, were treated with both IL BTX-A for some lesions (8 keloids) and IL 5-FU for their remaining lesions (8 keloids). The clinical improvement was assessed according to flattening of the lesions. Side effects were recorded. A significantly better therapeutic response of keloids was detected after IL BTX-A than IL 5-FU (P = 0.041). IL BTX-A achieved excellent and good flattening of the lesions (58.8% and 20.6%) compared to (31.4% and 17.1%) after IL 5-FU, respectively. In BTX-A treated group, there was no statistically significant difference between the clinical response in small lesions compared to medium and large ones (P = 0.476). While in 5-FU treated group, small and medium lesions showed significantly better response than larger ones (P = 0.009). IL BTX-A caused fewer side effects than IL 5-FU, less pain, itching, no hyperpigmentation and less recurrence. Both IL BTX-A and IL 5-FU showed positive results in treatment of keloids. However, IL BTX-A showed higher clinical efficacy even in large size keloids with less side effects.
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Toxinas Botulínicas Tipo A/administración & dosificación , Fluorouracilo/administración & dosificación , Hiperpigmentación/epidemiología , Reacción en el Punto de Inyección/epidemiología , Queloide/tratamiento farmacológico , Adolescente , Adulto , Toxinas Botulínicas Tipo A/efectos adversos , Femenino , Fluorouracilo/efectos adversos , Estudios de Seguimiento , Humanos , Hiperpigmentación/inducido químicamente , Reacción en el Punto de Inyección/etiología , Inyecciones Intralesiones/efectos adversos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: The histopathological changes and immunohistochemical studies occurring in keloids in vivo after treatment by intralesional (IL) verapamil are not yet assessed. This study aimed to evaluate the efficacy and safety as well as the histological/immunohistochemical effects of intralesional verapamil on keloids. PATIENTS AND METHODS: Thirty-one patients with 43 keloids were treated with IL verapamil at 3-week intervals until reaching complete flattening of the lesion or for a maximum of 6 sessions. Keloid biopsies were obtained before and after treatment for evaluation of histopathological changes and the immunohistochemical expression of VEGF and MMP9. RESULTS: Of 43 keloids, 6 keloids (14%) and 17 (39.5%) showed excellent and good improvement, respectively, with no significant side effects except for pain at the site of injection. Histopathological and immunohistochemical evaluations were consistent with the clinical observations after treatment, and there was a statistically significant decrease in VEGF and MMP9 expressions after treatment. CONCLUSION: IL verapamil is effective in the treatment of keloids which is possibly attributed to suppression of MMP9 and VEGF. It is a simple and relatively safe treatment method for keloids.
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Queloide , Glucocorticoides/uso terapéutico , Humanos , Inyecciones Intralesiones , Queloide/tratamiento farmacológico , Queloide/patología , Dolor , Resultado del Tratamiento , Verapamilo/uso terapéuticoRESUMEN
BACKGROUND: Vitiligo is a chronic depigmentary skin disorder, characterised clinically by the development of white macules and or patches caused by loss of epidermal melanocytes. S100B is a dual function protein released from epidermal melanocytes in response to injury. It considered a possible marker of disease activity in both malignant melanoma and vitiligo. AIM OF THE STUDY: To estimate the serum level of S100B level in vitiligo patients and correlate its level with disease activity and various disease parameters. PATIENTS AND METHODS: Sixty vitiligo patients and 60 healthy volunteers as controls were included in the study. Vitiligo Area Severity Index (VASI) and Vitiligo Disease Activity (VIDA) scores were estimated for each patient. Quantitative assessment of S100B level using ELISA technique was done for all participants. RESULTS: S100B level was significantly correlated with the presence of vitiligo (P = 0.01), while it showed no correlation with the disease activity using VASI or VIDA scores. As regards the receiver operating characteristic (ROC) curve analysis of S100B for diagnosis and discrimination of vitiligo, serum S100B showed area under the curve (AUC) of 0.781 with 73.3% sensitivity and 80% specificity. CONCLUSION: The serum level of S100B was related to the presence of vitiligo, but its level did not show any relation to the disease activity using either VASI and VIDA scores or various disease parameters.
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Subunidad beta de la Proteína de Unión al Calcio S100/sangre , Vitíligo/sangre , Adolescente , Adulto , Biomarcadores/sangre , Estudios de Casos y Controles , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Vitíligo/diagnóstico , Adulto JovenRESUMEN
Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and overlap SJS/TEN are life-threatening diseases that are most frequently caused by drugs. Much debate remains about the role of systemic corticosteroids (SCs) in their treatment. Our aim to determine the incidence, causative drugs, the role and side effects of SCs in severe cutaneous adverse reactions (SCARs), in Assiut University Hospital (AUH). Patients This study was conducted in Department of Dermatology at AUH, from 2012 to 2017. All patients with SJS, overlap SJS/TEN and TEN admitted during this period were included in the study. Eighty-three patients with SCARs were included in this study. The most common type was SJS (67.5%). The incidence ranged from 1.7% in 2012 to 7.7% in 2017. Carbamazepine, valproic acid, lamotrigine, diclofenac sodium, and flucloxacillin-amoxicillin were the most common causative drugs. The most common side effects of SCs were peptic ulcer (55.5%) and hypertension (51.8%). The mortality rate in patients treated with SCs was 100% in TEN, 33.3% in overlap SJS/TEN and 16.3% in SJS. The patients of SCARs must be aware of the causative drugs and must never be re-administered. SCs in treatment of SCARs may increase the complications and the mortality rate.
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Preparaciones Farmacéuticas , Síndrome de Stevens-Johnson , Egipto/epidemiología , Hospitales , Humanos , Incidencia , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/epidemiología , Síndrome de Stevens-Johnson/etiologíaRESUMEN
Wound healing could be categorized as a chronic disorder which needs a prompt and effective medication. Nowadays, vascular problems and wound-healing progression studies relay on the role of metformin; however, the exact mechanisms for its beneficial effects are still not completely understood. The aim of the present work was to study the potential of metformin hydrochloride, MET-HCL hydrogel in wound healing after topical administration. MET-HCL hydrogel was formulated using different hydrogel bases then characterised for its drug content and pH, homogeneity, viscosity, spreadability, and in vitro release. Furthermore, the wound-healing activity was evaluated in rats. Clinical study was also performed in patients showing lower limbs traumatic wounds and cutaneous ulcers. In addition, histopathology and immunohistochemical studies were also investigated. Results showed that MET-HCL hydrogels have a high drug content, and they are homogenous and spreadable with minimum sheer stress and showed null irritation. Furthermore, carbopol showed the optimum gel base for the highest MET-HCL release. Wound healing activity in rats showed a significant (p < 0.05) increase in the percentage wound contraction from the day-7 compared with plain hydrogel. Clinical study revealed a complete healing of traumatic wounds and cutaneous ulcers after 21 and 30 days, respectively. Moreover, histopathology investigation showed a complete restoration of connective tissue matrix and re-epithelization of the induced wound. In addition, immunohistochemistry showed a significant expression of transforming growth factor-ß1 (TGF-ß1). In conclusion, MET-HCL hydrogel is a promising formulation for topical treatment of wounds with effective and faster healing activity.
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Metformina/farmacología , Úlcera Cutánea/tratamiento farmacológico , Cicatrización de Heridas/efectos de los fármacos , Administración Tópica , Animales , Femenino , Humanos , Hidrogeles , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/farmacocinética , Hipoglucemiantes/farmacología , Masculino , Metformina/administración & dosificación , Metformina/farmacocinética , Estudios Prospectivos , Ratas , Ratas WistarRESUMEN
BACKGROUND: The efficacy of intralesional (IL) cryosurgery in the treatment of cutaneous warts has not been previously studied. OBJECTIVE: To compare the efficacy and safety of IL cryosurgery versus electrosurgery in multiple extragenital warts and investigate their effect on serum interleukin (IL)-12 and interferon-gamma (IFN-γ). MATERIALS AND METHODS: Thirty-one patients were included; 18 received IL cryosurgery, and 13 had electrosurgery. Treatment was performed for the largest or few (2-3) small warts (target) until cleared, leaving the remaining (distant) warts untreated. Clinical response of the target and distant warts and adverse effects were evaluated. Serum IL-12 and IFN-γ levels were assessed before and after treatment. RESULTS: All patients had complete clearing of the treated wart in both groups. IL cryosurgery was well tolerated; infection, ulceration, and recurrence occurred only with electrosurgery. Complete/near-complete resolution of the distant untreated warts was seen in 33.3% versus none of patients in the IL cryosurgery and electrosurgery groups, respectively (p = .003). Furthermore, IL-12 and IFN-γ levels showed a tendency to increase after IL cryosurgery, and their increase correlated with distant wart response. CONCLUSION: Intralesional cryosurgery is effective not only in clearing treated warts but also resolving untreated warts and possibly enhances human papillomavirus-directed immune response.
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Criocirugía/métodos , Interferón gamma/sangre , Interleucina-12/sangre , Verrugas/sangre , Verrugas/cirugía , Adolescente , Adulto , Criocirugía/efectos adversos , Electrocirugia/efectos adversos , Femenino , Humanos , Masculino , Dolor Postoperatorio/etiología , Verrugas/inmunología , Adulto JovenRESUMEN
Intralesional (IL) vitamin D3 is an emerging treatment for cutaneous warts. However, its effectiveness and exact mechanism is not fully evaluated. We aimed to compare the efficacy and safety of IL purified protein derivative (PPD) and IL vitamin D3 in multiple warts and to investigate their systemic effect clinically and immunologically. Forty-five patients with multiple extragenital warts were treated with IL-PPD (22 patients) or IL vitamin D3 injection (23 patients) for a maximum of three sessions at 3 week intervals. Decrease in size and number of warts and adverse effects were evaluated. Serum interleukin-12 (IL-12) and interferon-gamma (IFN-γ) levels were measured before and 3 weeks after the last session. Higher clearance rates for all warts were observed with IL-PPD compared to IL vitamin D (59.1% vs. 21.7% complete clearance, p < .001). Significant increase was found in both serum IL-12 and IFN-γ after PPD treatment (p = .034 and p = .04, respectively), but only IFN-γ after vitamin D3 treatment (p = 0.02). Both IL vitamin D3 and PPD showed positive results in treatment of multiple warts. However, PPD showed higher clinical efficacy and more increase in both IL-12 and IFN-γ levels.
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Colecalciferol/administración & dosificación , Dermatosis del Pie/tratamiento farmacológico , Inmunidad Celular , Células TH1/inmunología , Verrugas/tratamiento farmacológico , Adulto , Biomarcadores/sangre , Relación Dosis-Respuesta a Droga , Ensayo de Inmunoadsorción Enzimática , Femenino , Estudios de Seguimiento , Dermatosis del Pie/sangre , Dermatosis del Pie/inmunología , Humanos , Inyecciones Intralesiones , Interferón gamma/sangre , Interleucina-12/sangre , Masculino , Estudios Prospectivos , Resultado del Tratamiento , Vitaminas/administración & dosificación , Verrugas/sangre , Verrugas/inmunologíaRESUMEN
BACKGROUND: The new modified Melasma Area and Severity Index (mMASI) score, the recently used outcome measure for melasma, has not been tested to determine its sensitivity to change in melasma. OBJECTIVE: To determine the reliability, validity, and sensitivity to change overtime of the mMASI score in assessment of the severity of melasma. METHODS: Pearson correlation, Cronbach alpha, and intraclass correlation coefficient were calculated to assess the reliability of the mMASI score. Validity of the mMASI scale was carried out using Spearman correlation between mMASI total score (before and after treatment), clinical data, and patient's responses. RESULTS: The mMASI score showed excellent reliability and good validity for assessment of the severity of melasma. The authors also determined that the mMASI score demonstrated sensitivity to change over time. CONCLUSION: An excellent degree of agreement between the mMSAI and MASI scores was revealed. The mMASI score is reliable, valid, and responsive to change in the assessment of severity of melasma. Moreover, the mMASI score was found to be easier to learn and perform and simpler in calculation compared with the MASI score. Overall, the mMASI score can effectively replace the MASI score.
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Melanosis/terapia , Índice de Severidad de la Enfermedad , Femenino , Humanos , Reproducibilidad de los Resultados , Factores de Tiempo , Resultado del TratamientoRESUMEN
Vitiligo is a chronic disorder of depigmentation that has different treatment modalities, but patients' nonadherence is common. This study aimed to assess the influence of patients' medication beliefs on patients' adherence to topical, oral medications, and phototherapy in vitiligo. Between September 2015 and February 2016, 260 patients with vitiligo were asked to fill in the Beliefs about Medicines Questionnaire (BMQ) to assess their beliefs about therapy for vitiligo. Their adherence to the therapy was examined using the 8-item Morisky Medication Adherence Scale (MMAS-8). RESULTS: The MMAS-8 scale and BMQ had good internal consistency (Cronbach's α = 0.78 and 0.66, respectively). Using Morisky's recommended cutoff point, 71% of patients were categorized as low or nonadherent to the scheduled therapy. Patients who perceived specific necessity of dermatological medicines significantly adhered to their therapy (OR 1.23; 95% CI 1.09, 1.38; p = 0.001) whereas patients who had specific concerns about the adverse effects exhibited significant low adherence (OR 0.65; 95% CI 0.56, 0.76; p < 0.001). CONCLUSION: Positive beliefs about the necessity of medications in vitiligo do not necessarily reflect high adherence. Patients' adherence behavior is a multidimensional and dynamic process. The prolonged course of treatment, its cost, and unsatisfactory outcomes influenced the patients' adherence.
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Fármacos Dermatológicos/uso terapéutico , Conocimientos, Actitudes y Práctica en Salud , Cumplimiento de la Medicación , Percepción , Vitíligo/tratamiento farmacológico , Adolescente , Adulto , Anciano , Distribución de Chi-Cuadrado , Estudios Transversales , Fármacos Dermatológicos/efectos adversos , Fármacos Dermatológicos/economía , Costos de los Medicamentos , Egipto , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Medición de Riesgo , Factores de Riesgo , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , Vitíligo/diagnóstico , Vitíligo/economía , Vitíligo/psicología , Adulto JovenRESUMEN
BACKGROUND: Melasma is a common disorder of facial hyperpigmentation that is often resistant to treatment. OBJECTIVE: To evaluate the efficacy of trichloroacetic acid (TCA) peeling in comparison with double frequency Q-switched neodymium-doped:yttrium aluminum garnet (QS-Nd:YAG) laser in the treatment of melasma. PATIENTS AND METHODS: Sixty-five adult Egyptian female patients with melasma were enrolled in this study. Wood light was used for determination of the histological type of melasma. The patients were divided into 4 groups according to treatment modalities: peeling with different concentrations of TCA and double frequency QS-Nd:YAG laser. Trichloroacetic acid peeling was performed every 2 weeks up to 8 sessions, whereas laser treatment was performed every month up to 6 sessions. Melasma area and severity index (MASI) score was used before and after treatment for evaluation. RESULTS: Improvement percentage of MASI score was significantly higher among patients treated with TCA 25% (p < .001). Epidermal type of melasma was significantly improved compared with the dermal type (p = .0029). Q-switched neodymium-doped:yttrium aluminum garnet laser showed the highest incidence of postinflammatory hyperpigmentation (53.3%). CONCLUSION: Trichloroacetic acid peeling is effective in the treatment of melasma, TCA 25% was the most effective concentration. Q-switched neodymium-doped:yttrium aluminum garnet laser is not recommended in the treatment of melasma because it was associated with the highest incidence of complications.