Scabies among primary schoolchildren in Egypt: sociomedical environmental study in Kafr El-Sheikh administrative area

BACKGROUND/OBJECTIVES

Scabies is a major global public health issue that might affect people from all socioeconomic levels. The primary contributing factors in contracting scabies seem to be poverty and overcrowded living conditions. Scabies often spreads among schoolchildren quite rapidly, owing to their close contact and overcrowding within the schools. However, limited information is available about its risk factors and the socioeconomic correlates among schoolchildren in Egypt. This study aimed to assess the prevalence of scabies and its risk factors among primary schoolchildren in Kafr El-Sheikh administrative area, Egypt.

METHODS

This cross-sectional descriptive study was performed on primary schoolchildren in urban and rural areas of Kafr El-Sheikh administrative area. A predesigned questionnaire was used for data collection from the randomly selected 2,104 children, and clinical dermatological examination was done for them.

RESULTS

Out of 2,104 children studied, there were 92 cases of scabies with a prevalence of 4.4%. The prevalence of scabies infestation in male students was 3.9%, while it was 4.8% in females, with no statistical significance. The results showed significant variations in the risk of scabies infestation by factors such as residence, paternal education and occupation, maternal education, sleeping with others, having animals at home, dealing with animals outside the house, type of building for living, family history of itchy rash, and sharing clothes with others.

CONCLUSION

In our community, scabies is still an important health problem affecting schoolchildren, especially in rural areas. It is characterized by a complex web of causation, particularly poor living conditions and low level of parents' education.

Combined intralesional triamcinolone acetonide and platelet rich plasma versus intralesional triamcinolone acetonide alone in treatment of keloids

Background: Keloids are benign fibro-proliferative growths occurring after skin injury or spontaneously. Intralesional triamcinolone acetonide (TA) is their first-line therapy, but commonly associated with side effects or recurrence. Platelet rich plasma (PRP) is an autologous blood-derived product with promising results in improving wound healing with lower keloid occurrence.Objective: To compare the efficacy of combined intralesional TA and PRP versus TA alone in keloids treatment.Methods: Forty patients with keloids were divided randomly into two equal groups (A and B). Both groups received intralesional TA (20 mg/ml) for four sessions, 3 weeks apart. Group A patients received additional intralesional PRP 1 week after TA injections. Evaluation was done after 3 months of follow up by Vancouver scar scale (VSS) and verbal rating scale (VRS) for pain and itching.Results: Both groups showed significant improvement in all parameters of VSS and VRS in comparison with baseline. Significantly better improvement in height, pigmentation, and pliability and overall VSS was detected in patients of group A. A significantly higher incidence of post-TA atrophy and hypopigmentation was observed in group B.Conclusion: Combining intralesional PRP with TA could yield cosmetically better outcomes in keloid treatment with lower incidence of TA-induced side effects especially atrophy and hypopigmentation.

Use of transcutaneous electrical nerve stimulation for chronic pruritus

Pruritus is a distressing symptom in many dermatological as well as systemic conditions, and it is sometimes very chronic and relapsing. Transcutaneous electrical nerve stimulation (TENS) is an inexpensive form of analgesia that could also ameliorate itching. This study aimed to evaluate TENS efficacy in patients with pruritus due to some types of chronic eczema, and in patients with chronic hepatic disease. Ten patients with atopic dermatitis (AD), 20 patients with lichen simplex chronicus (LSC), and 16 patients with chronic liver disease having chronic distressing pruritus received three sessions of TENS weekly for 12 sessions, and the effect on the visual analogue scale (VAS) scores was recorded after 2 weeks of therapy, at treatment end, and after an additional month for follow up. There was a statistically significant decline in the mean VAS score for studied groups at weeks 2 and 4 of therapy compared to baseline, but the improvement was more significant in patients with AD, and LSC (p < 0.001 for both) than in those with chronic liver disease (p < 0.01) who also showed an early re-elevation of VAS score on follow up. TENS therapy holds promise as a palliative, alternative, safe and inexpensive treatment for patients with some chronic pruritic conditions.

Intralesional pentoxifylline, triamcinolone acetonide, and their combination for treatment of keloid scars

BACKGROUND

Keloids are common fibroproliferative tumors, and their treatment still represents a dilemma. Intralesional triamcinolone acetonide (TAC) injection is effective, but frequently associated with side effects. Pentoxifyllin (PTX) is a vasodilator, anti-inflammatory, and antifibrotic agent. Its intralesional injection in keloids has not been evaluated yet.

AIMS

Evaluating the efficacy and safety of intralesional PTX versus intralesional TAC and their combination for treatment of keloids.

PATIENTS/METHODS

Thirty patients with keloids were divided into three equal groups and treated by intralesional injection of TAC, PTX, or their combination (admixed in 1:1 ratio). Injections were repeated every 3 weeks until lesional flattening or for maximum of 5 sessions. The evaluation was done using the Vancouver Scar Scale and the Verbal Rating Scale for pain and itching.

RESULTS

A significant improvement in VSS was detected in all groups. Significantly better improvements in keloid height, pliability, pain, and itching were detected in the TAC and combination groups than in the PTX group. There was a significantly higher incidence of side effects (atrophy, hypopigmentation, telangiectasia, and precipitation of TAC) in the TAC group than in the combination group, while no side effects were reported in the PTX group. A statistically significant reduction in the number of treatment sessions (required to achieve best results) was detected in patients in the combination group.

CONCLUSIONS

Intralesional injection of PTX is a potentially helpful, safe, and well-tolerated therapeutic tool for keloids, but with lower efficacy than intralesional TAC when used solely. Combining PTX and TAC produces significantly better results for keloid treatment and lowers the risk of TAC-induced side effects.

Prospective study on prevalence of dermatological changes in patients under hemodialysis in hemodialysis units in Tanta University hospitals, Egypt

Introduction

Chronic hemodialysis patients experience frequent and varied mucocutaneous manifestations in addition to hair and nail disorders. The aim of this study was to evaluate the prevalence of dermatological changes among patients with end-stage renal disease under hemodialysis in a hemodialysis unit in Tanta University hospitals over a period of 6 months, and to evaluate the relations of these dermatological disorders with the duration of hemodialysis as well as with different laboratory parameters in these patients.

Patients and methods

Ninety-three patients with end-stage renal disease on regular hemodialysis (56 males and 37 females) were selected and included in this cross-sectional, descriptive, analytic study. Their ages ranged from 18–80 years. All patients underwent thorough general and dermatological examinations. Laboratory investigations (complete blood counts, renal and liver function tests, serum parathormone levels, serum electrolytes, alkaline phosphatase, random blood sugar, and Hepatitis C virus (HCV) antibodies) were evaluated.

Results

This study revealed that most patients had nonspecific skin changes, including xerosis, pruritus, pallor, ecchymosis, hyperpigmentation, and follicular hyperkeratosis. Nail and hair changes were commonly found, especially half and half nail, koilonychia, subungal hyperkeratosis, melanonychia, onychomycosis, and brittle and lusterless hair. Mucous membrane changes detected were pallor, xerostomia, macroglossia, bleeding gums, aphthous stomatitis, and yellow sclera. There was a significant positive correlation between the presence of pruritus and serum parathormone level. There was a significant negative correlation between the presence of mucous membrane changes and hemoglobin level.

Conclusion

Nonspecific mucocutaneous manifestations are common in patients on hemodialysis, particularly xerosis, dyspigmentation, and pruritus. Early and prompt recognition and treatment of dermatological conditions in patients on dialysis may improve their quality of life.

Efficacy and Safety of Topical Tranexamic Acid Alone or in Combination with Either Fractional Carbon Dioxide Laser or Microneedling for the Treatment of Melasma

INTRODUCTION

Tranexamic acid (TXA) is a promising treatment modality for melasma. Microneedling (MN) and fractional carbon dioxide (CO2) laser were reported to enhance TXA transepidermal delivery.

OBJECTIVES

To compare efficacy and safety of topical TXA alone or in combination with either fractional CO2 laser or MN for treatment of melasma.

METHODS

Thirty females with facial melasma were divided randomly into 3 equal groups after excluding pregnant and lactating women and those using oral contraceptives or other hormonal therapy. Patients of group A were treated with fractional CO2 laser and those of group B were treated with MN (4 sessions, 3 weeks apart for both) with immediate topical application of TXA 5% solution after sessions and daily application of 5% TXA cream for both groups. Patients of group C were treated by topical daily application of TXA 5% cream. Evaluation was done by modified melasma area and severity index scores (mMASI), patient satisfaction and dermoscopy.

RESULTS

Statistically significant improvement of mMASI was reported in all studied groups with a significantly better improvement in patients of groups A and B than those of group C, meanwhile the difference between groups A and B was statistically insignificant.

CONCLUSIONS

Topical TXA is a safe and fairly effective treatment modality for facial melasma. Combining TXA with either fractional CO2 laser or MN yielded significantly better improvement than when used alone. Fractional CO2 laser carries the risk of post-inflammatory hyperpigmentation in patients with skin types III and IV and requires meticulous patient selection.

Immunohistochemical expression of AQP-3 in vitiligo: a new potential guide for disease activity

BACKGROUND

Vitiligo is a depigmenting skin disorder, with disappearance of functioning epidermal melanocytes. Aquaporin-3 (AQP-3) is an aquaglyceroporin expressed in epidermal keratinocytes, where it shares in regulating their proliferation and differentiation, and so it might affect melanocytes indirectly. So far, little is known regarding its possible role in vitiligo. This work aimed to study the changes in immunohistochemical expression of AQP-3 protein in vitiligo to detect its possible role in disease pathogenesis.

METHODS

Skin biopsies were taken from lesional skin of 30 vitiligo patients in addition to 20 normal controls. Epidermal immunohistochemical expression of AQP-3 was assessed as: +3 = strong expression, +2 = moderate, +1= weak and 0= negative expression.

RESULTS

AQP-3 was significantly less expressed in vitiligo epidermis than control (P<0.001) with an inverse correlation with Vitiligo Index of Disease Activity (r =-0.505, P=0.004).

CONCLUSIONS

Reduced epidermal AQP-3 may have a role in impaired melanocyte survival in vitiligo, and might be a potential negative biological marker for vitiligo activity. Larger trials should further elucidate the effect of changes in epidermal AQP-3 expression in development of vitiligo, and that might pave the road for discovering new therapeutic modalities for the disease.

Serum interleukin-33 (IL-33) in children with active systemic lupus erythematosus: A cross-sectional study

Interleukin-33 (IL-33) is a member of the IL-1 cytokine family and is associated with the development of different autoimmune diseases as systemic lupus erythematosus (SLE). So, the purpose of this cross-sectional study was to measure the serum IL-33 in children with SLE (c-SLE) in relation to their SLE disease activity index. This study was conducted upon 50 c-SLE patients in comparison to 50 normal matched children as a control group. Disease activity was assessed according to SLE Disease Activity Index (SLEDAI-2K). Serum IL-33 was measured by an Enzyme-linked immunosorbent assay (ELISA). Serum IL-33 was significantly higher in c-SLE patients (median: 157.47, IQR:64.49-237.57ng/l) than controls (median: 10.9, IQR: 10.04-12.51ng/L) (P= 0.001) and negatively correlated with serum C3 and C4 levels. Serum IL-33 levels were significantly higher in high disease activity status (HDAS) patients (SLEDAI-2K ≥ 10) (298.47 ± 78.84ng/l) than lupus low disease activity status (LLDAS) patients (SLEDAI-2K < 10) (112.18 ± 16.23ng/l) (P= 0.001). The receiver operating characteristic (ROC) curve analysis revealed that the best cutoff of serum IL-33 level to predict the disease activity was ≥141.3 ng/l with a sensitivity of 93%, a specificity of 90% and accuracy 97%. We concluded that serum IL-33 was higher in c-SLE patients and positively related to the disease activity index so could be used as a disease activity marker.

Intralesional injection of Candida albicans antigen versus measles, mumps, and rubella vaccine for treatment of plantar warts

INTRODUCTION

Many therapeutic modalities have been used for management of plantar warts; however, no optimal treatment with high efficacy and no or low recurrence has been explored to date. Intralesional immunotherapy has shown promising results in the treatment of different types of warts.Here we compare the efficacy of Candida albicans-specific antigen versus measles, mumps, and rubella (MMR) vaccine for treatment of plantar warts by intralesional injection.

METHODS

Sixty patients with refractory or recurrent plantar warts were randomly divided into two equal groups. Group A was treated with C. albicans antigen and Group B with MMR vaccine. Both groups were injected intralesionally in a single wart every 3 weeks until complete clearance of the wart or for a maximum of five sessions. The patients were followed up for an additional 2 months.

RESULTS

C. albicans antigen yielded a statistically significant higher cure rate (80,0%) than MMR vaccine (26.7%) in the treatment of plantar warts through a mean of 3.98 sessions versus 4.24 sessions, respectively (p = 0.002), and both modalities were well tolerated, with no remarkable side effects and no recurrence in cured patients during follow-up.

CONCLUSIONS

Intralesional C. albicans antigen injection is an easy and effective treatment tool for plantar warts, even resistant and recalcitrant ones, with no post-procedural downtime and only transient occasional side effects. MMR vaccine is thought to be less effective.

Evaluation of diagnostic accuracy of dermoscopy in some common hypopigmented skin diseases

BACKGROUND

Diagnosis of cutaneous hypopigmentation can sometimes be challenging. Dermoscopy may play a role in identifying hypo or-depigmented dermatoses. The aim was to investigate which dermoscopic criteria represent potent indicators for the diagnosis of vitiligo, nevus depigmentosus, pityriasis alba, hypopigmented pityriasis versicolor, idiopathic guttate hypomelanosis, hypopigmented mycosis fungoides (MF), lichen sclerosus et atrophicus and ash leaf hypopigmented macules of tuberous sclerosis, and evaluate their diagnostic accuracy. 168 individuals diagnosed with one of these hypopigmented disorders were evaluated for the presence or absence of predetermined dermoscopic criteria. Evaluation of dermatoscopic characteristics in each condition and analysis for sensitivity and specificity of dermatoscopic diagnosis in these hypopigmented lesions was performed. The starburst pattern, micro-koebnerization, and trichrome pattern were unique to vitiligo diagnosis. Vitiligo had higher comet-tail appearance, perifollicular pigmentation, and perilesional hyperpigmentation than other hypopigmented illnesses. Other hypopigmented lesions had greater incidence of amoeboid pattern, faint or diminished pigment network, islands of pigmentation, ill-defined boundaries, pseudopods, and widespread scaling than vitiligo. Finally, perifollicular scaling, comedo-like openings, blue-gray specks, and fibrotic regions excluded vitiligo. Dermoscopy can help identify common hypopigmented skin lesions and reduce the need for skin biopsy. Nevus depigmentosus, pityriasis alba and idiopathic guttate hypomelanosis were the top three hypopigmented dermatoses that could be diagnosed by dermoscopy with 100% sensitivity. Vitiligo was in the second rank (94.7%), followed by lichen sclerosis et atrophicus (93.3%) then hypopigmented MF at 81.2% sensitivity. Dermoscopy sensitivity was lowest in pityriasis versicolor and ash leaf macules of tuberous sclerosis (52.6% and 46.7%, respectively).

Pulsed-dye laser versus intralesional Candida albicans antigen injection in treatment of genital warts

INTRODUCTION

Genital warts are a troublesome therapeutic issue. Pulsed-dye laser (PDL) is a non-ablative therapeutic tool for viral warts. Intralesional Candida albicans (C. albicans) immunotherapy has yielded promising results in treatment of various types of warts. We aimed to evaluate the effectiveness of PDL versus C. albicans immunotherapy for treatment of genital warts.

METHODS

Forty adult patients with genital warts were divided into two equal groups; the first was treated using PDL and the second using intralesional C. albicans antigen injection. Treatments were performed at 3-week intervals until complete lesion resolution or for a maximum of three sessions.

RESULTS

PDL yielded higher complete clearance rates (95%) than C. albicans antigen (50%; p = 0.001), which in turn had the advantage of treating distant and internal genital warts. Apart from pain during the session in PDL, both modalities were well tolerated with no recurrence in cured patients during the 16-week follow-up period.

CONCLUSIONS

PDL and C. albicans antigen injection are safe and effective treatment alternatives for genital warts. PDL yielded better frequencies of clearance, but C. albicans antigen has additional advantages, including a single injection site and treating distant and internal mucosal uninjected warts, which are usually difficult to treat.

Topical Oxybutynin 3% Gel Versus Aluminum Chloride 15% Lotion in Treatment of Primary Focal Hyperhidrosis

INTRODUCTION

Hyperhidrosis is excessive sweating beyond thermoregulatory needs. It is a potentially disabling condition with challenging management. Aluminum chloride is the established topical treatment; however, response remains unsatisfactory. Oxybutynin is an anticholinergic drug that stands as a therapeutic chance for hyperhidrosis.

OBJECTIVES

comparing the efficacy of topical oxybutynin 3% gel versus aluminum chloride 15% lotion in treatment of primary focal hyperhidrosis.

METHODS

Forty patients with hyperhidrosis were randomly distributed into 2 equal groups treated by either topical oxybutynin 3% gel or topical aluminum chloride 15% lotion once daily night application for 4 weeks (both groups). Evaluation was done at 2 and 4 weeks of treatment and after 1 month of the end of treatment for follow up by Minor iodine starch test, hyperhidrosis disease severity scale (HDSS) and dermatology life quality index (DLQI).

RESULTS

Both treatment modalities were effective with insignificant differences between patients of both groups regarding improvement in Minor iodine starch test and HDSS after 2 weeks of treatment (P = 0.561, 0.33 respectively). Oxybutynin 3% gel yielded significantly better improvement of Minor's test, HDSS and patient's quality of life at the end of 4 weeks of treatment with lower recurrence rate than aluminum chloride 15% lotion at 1 month follow up. Minimal adverse effects were noted in both studied groups.

CONCLUSIONS

Oxybutynin 3% gel could be considered as a promising treatment modality for hyperhidrosis with higher efficacy than aluminum chloride 15% lotion and lower recurrence rate.

Platelet-rich plasma in alopecia areata: intradermal injection versus topical application with transepidermal delivery via either fractional carbon dioxide laser or microneedling

INTRODUCTION

Alopecia areata (AA) is a common cause of non-scarring alopecia with variable response to treatment. Platelet-rich plasma (PRP) stimulates proliferation and differentiation of stem cells in the hair-follicle bulge via multiple mechanisms. Although beneficial, pain during injection in addition to unequal delivery and coverage is a major drawback of intralesional PRP in alopecia, particularly for extensive lesions and in patients with a low pain threshold. This study evaluates intradermal injection of PRP versus its topical use with enhanced transepidermal delivery through either fractional CO2 laser (FCL) or microneedling in treatment of AA.

METHODS

Sixty AA patients were randomized into three equal groups to receive monthly sessions of either PRP intradermal injection, FCL followed by topical PRP, or microneedling followed by topical PRP for 3 consecutive months. Assessment was done through the Severity of Alopecia Tool (SALT) score and patient satisfaction at the end of sessions (2 weeks after the last session) and after 3 additional months of follow-up.

RESULTS

Patients in all groups showed satisfactory results of PRP treatment, with statistically insignificant differences in the degree of improvement among patients of the three groups studied according to the two assessment parameters. Intralesional PRP injection was associated with significantly higher pain scores.

CONCLUSIONS

PRP is potentially effective and safe for treatment of AA. FCL and microneedling could facilitate topical PRP delivery and considerably decrease pain associated with intradermal injection while preserving PRP efficacy. These methods could be helpful for extensive lesions and in children.