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Mogawer RM, Fawzy MM, Mourad A, Ahmed H, Nasr M, Nour ZA, Hafez V. Topical sodium valproate-loaded nanospanlastics versus conventional topical steroid therapy in alopecia areata: a randomized controlled study. Arch Dermatol Res 2024; 316:64. [PMID: 38170256 PMCID: PMC10764371 DOI: 10.1007/s00403-023-02785-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/17/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND A myriad of therapeutic modalities for alopecia areata are available; however, none is of high level of evidence, creating an immense need for the evaluation of other treatment modalities, of which topical sodium valproate is of potential role via proposed decrease in beta-catenin breakdown, despite its well-known side effect of hair fall as an oral therapy. OBJECTIVE Evaluating the efficacy and the safety of sodium valproate (SV)-loaded nanospanlastics, in comparison to topical corticosteroids, this is the currently available gold standard topical treatment for patchy AA. METHODOLOGY A total of 66 patients with patchy AA were randomly assigned to receive either topical mometasone furoate lotion or topical SV applied twice daily to all patches except a control patch, which was left untreated. Clinical, trichoscopic and biochemical assessments of beta-catenin tissue levels and Axin-2 gene expression were carried out at baseline and after 3 months. RESULTS Both therapeutic modalities were comparable. Potential efficacy was highlighted by significant improvement in the representative patch, the largest treated patch, to the control patch, the smallest untreated patch in both steroid and valproate groups (p = 0.027, 0.003 respectively). Both beta-catenin levels and Axin-2 gene expression were reduced after treatment, pointing to the inhibitory effect of dominating uncontrolled inflammatory milieu. Baseline beta-catenin was found to significantly negatively correlate with improvement in the representative patch in patients with baseline level above 0.42 ng/ml (p = - 0.042). CONCLUSION Both topical SV and steroids are of comparable modest efficacy. Thus, further evaluation of SV is due in combination with intralesional steroids and other anti-inflammatory treatment modalities, together with developing individualized approaches based on baseline beta-catenin level. CLINICALTRIALS GOV IDENTIFIER NCT05017454, https://clinicaltrials.gov/ct2/show/NCT05017454 .
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Affiliation(s)
- Rania M Mogawer
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Marwa Mohamed Fawzy
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Mourad
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba Ahmed
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maha Nasr
- Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Zeinab Ahmed Nour
- Biochemistry Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Vanessa Hafez
- Dermatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
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El-Komy MHM, Mashaly H, Sayed KS, Hafez V, El-Mesidy MS, Said ER, Amer MA, AlOrbani AM, Saadi DG, El-Kalioby M, Eid RO, Azzazi Y, El Sayed H, Samir N, Salem MR, El Desouky ED, Zaher HAEM, Rasheed H. Clinical and epidemiologic features of psoriasis patients in an Egyptian medical center. JAAD Int 2020; 1:81-90. [PMID: 34409325 PMCID: PMC8362248 DOI: 10.1016/j.jdin.2020.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 02/01/2023] Open
Abstract
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.
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Affiliation(s)
- Mohamed Hussein Medhat El-Komy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Heba Mashaly
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khadiga S Sayed
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Vanessa Hafez
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa S El-Mesidy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman R Said
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa A Amer
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Aya M AlOrbani
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina G Saadi
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona El-Kalioby
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Reem O Eid
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yousra Azzazi
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hagar El Sayed
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nesrin Samir
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marwa R Salem
- Department of Public Health and Community, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman D El Desouky
- Department of Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hesham Abd El-Moaty Zaher
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hoda Rasheed
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Kasr Al-Ainy Psoriasis Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
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Youssef R, Hafez V, Elkholy Y, Mourad A. Glycerol 85% efficacy on atopic skin and its microbiome: a randomized controlled trial with clinical and bacteriological evaluation. J DERMATOL TREAT 2020; 32:730-736. [PMID: 31869257 DOI: 10.1080/09546634.2019.1708246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Treating atopic dermatitis (AD) is still a challenge. The staphylococcal skin load is known to aggravate AD. Narrow band ultraviolet B (NB-UVB) and glycerol in low concentration (20-40%) are established therapies for AD. NB-UVB has proven antimicrobial actions, while high concentration glycerol (85-100%) showed similar effects in vitro but has not been clinically tested.Objective: To evaluate the efficacy and tolerability of concentrated glycerol 85% compared to NB-UVB in patients with AD, as assessed by clinical improvement and reduction of staphylococcal colonization of the skin.Methods: 30 patients with mild to moderate AD were randomized into either NB-UVB or glycerol 85% group. Patients were treated for one month and followed for an additional month. Swabs were taken from the skin and nose to be cultured on mannitol-salt agar for Staphylococci and quantified to determine Colony Forming Units.Results: Both groups showed statistically insignificant microbial changes and statistically significant clinical improvement after treatment. The results were comparable between both groups.Conclusions: Concentrated glycerol 85% is a cheap effective readily accessible alternative for phototherapy in patients with mild-moderate AD who cannot access the facility. Reduction of staphylococcal skin load seems to be involved, but its role is minimal.
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Affiliation(s)
- Randa Youssef
- Dermatology Department, Cairo University, Cairo, Egypt
| | - Vanessa Hafez
- Dermatology Department, Cairo University, Cairo, Egypt
| | - Yasmine Elkholy
- Medical Microbiology and Immunology Department, Cairo University, Cairo, Egypt
| | - Ahmed Mourad
- Dermatology Department, Cairo University, Cairo, Egypt
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El-Mofty M, Rasheed H, El-Eishy N, Hegazy RA, Hafez V, Shaker O, El-Samanoudy SI. A clinical and immunological study of phototoxic regimen of ultraviolet A for treatment of alopecia areata: a randomized controlled clinical trial. J DERMATOL TREAT 2019; 30:582-587. [DOI: 10.1080/09546634.2018.1543847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Medhat El-Mofty
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hoda Rasheed
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nermin El-Eishy
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab A. Hegazy
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Vanessa Hafez
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Olfat Shaker
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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El-Komy M, Hafez V, Hay RA, Mehaney D, Hafez I. Toenail concentrations of zinc, selenium and nickel in patients with chronic recurrent warts: A pilot two-group comparative study. Indian J Dermatol Venereol Leprol 2018; 85:51-55. [PMID: 30226475 DOI: 10.4103/ijdvl.ijdvl_861_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Normal immune functioning requires sufficient levels of trace elements including zinc and selenium, while elements such as nickel can be immunotoxic. Aim To assess long-term abnormalities in zinc, selenium and nickel levels in patients with chronic recurrent warts. Methods Toenail samples were taken from 28 patients with chronic recurrent warts and 30 apparently healthy matching controls were analysed. Toenail concentrations of zinc, selenium and nickel were measured using inductively-coupled plasma-optical emission spectroscopy. Results Selenium levels were significantly higher in patients than in controls (P = 0.03). Levels of trace elements did not correlate with the number or duration of warts. Toenail nickel levels in all subjects were higher than globally reported values. Limitations A small sample size and the absence of regional reference ranges for concentrations of trace elements in toenails. Conclusion Zinc does not seem to be involved in the chronicity of warts, and it is unclear if selenium has a protective role against warts. Our finding of high concentrations of nickel in both patients and controls raises concerns about environmental exposure.
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Affiliation(s)
- Mohamed El-Komy
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Vanessa Hafez
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rania Abdel Hay
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina Mehaney
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Iman Hafez
- Egyptian Health Insurance Organization, Egypt
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Abstract
BACKGROUND Acne scarring is a frequent complication of acne and resulting scars may negatively impact on an affected person's psychosocial and physical well-being. Although a wide range of interventions have been proposed, there is a lack of high-quality evidence on treatments for acne scars to better inform patients and their healthcare providers about the most effective and safe methods of managing this condition. This review aimed to examine treatments for atrophic and hypertrophic acne scars, but we have concentrated on facial atrophic scarring. OBJECTIVES To assess the effects of interventions for treating acne scars. SEARCH METHODS We searched the following databases up to November 2015: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (2015, Issue 10), MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We also searched five trials registers, and checked the reference lists of included studies and relevant reviews for further references to randomised controlled trials. SELECTION CRITERIA We include randomised controlled trials (RCTs) which allocated participants (whether split-face or parallel arms) to any active intervention (or a combination) for treating acne scars. We excluded studies dealing only or mostly with keloid scars. DATA COLLECTION AND ANALYSIS Three review authors independently extracted data from each of the studies included in this review and evaluated the risks of bias. We resolved disagreements by discussion and arbitration supported by a method expert as required. Our primary outcomes were participant-reported scar improvement and any adverse effects serious enough to cause participants to withdraw from the study. MAIN RESULTS We included 24 trials with 789 adult participants aged 18 years or older. Twenty trials enrolled men and women, three trials enrolled only women and one trial enrolled only men. We judged eight studies to be at low risk of bias for both sequence generation and allocation concealment. With regard to blinding we judged 17 studies to be at high risk of performance bias, because the participants and dermatologists were not blinded to the treatments administered or received; however, we judged all 24 trials to be at a low risk of detection bias for outcome assessment. We evaluated 14 comparisons of seven interventions and four combinations of interventions. Nine studies provided no usable data on our outcomes and did not contribute further to this review's results.For our outcome 'Participant-reported scar improvement' in one study fractional laser was more effective in producing scar improvement than non-fractional non-ablative laser at week 24 (risk ratio (RR) 4.00, 95% confidence interval (CI) 1.25 to 12.84; n = 64; very low-quality evidence); fractional laser showed comparable scar improvement to fractional radiofrequency in one study at week eight (RR 0.78, 95% CI 0.36 to 1.68; n = 40; very low-quality evidence) and was comparable to combined chemical peeling with skin needling in a different study at week 48 (RR 1.00, 95% CI 0.60 to 1.67; n = 26; very low-quality evidence). In a further study chemical peeling showed comparable scar improvement to combined chemical peeling with skin needling at week 32 (RR 1.24, 95% CI 0.87 to 1.75; n = 20; very low-quality evidence). Chemical peeling in one study showed comparable scar improvement to skin needling at week four (RR 1.13, 95% CI 0.69 to 1.83; n = 27; very low-quality evidence). In another study, injectable fillers provided better scar improvement compared to placebo at week 24 (RR 1.84, 95% CI 1.31 to 2.59; n = 147 moderate-quality evidence).For our outcome 'Serious adverse effects' in one study chemical peeling was not tolerable in 7/43 (16%) participants (RR 5.45, 95% CI 0.33 to 90.14; n = 58; very low-quality evidence).For our secondary outcome 'Participant-reported short-term adverse events', all participants reported pain in the following studies: in one study comparing fractional laser to non-fractional non-ablative laser (RR 1.00, 95% CI 0.94 to 1.06; n = 64; very low-quality evidence); in another study comparing fractional laser to combined peeling plus needling (RR 1.00, 95% CI 0.86 to 1.16; n = 25; very low-quality evidence); in a study comparing chemical peeling plus needling to chemical peeling (RR 1.00, 95% CI 0.83 to 1.20; n = 20; very low-quality evidence); in a study comparing chemical peeling to skin needling (RR 1.00, 95% CI 0.87 to 1.15; n = 27; very low-quality evidence); and also in a study comparing injectable filler and placebo (RR 1.03, 95% CI 0.10 to 11.10; n = 147; low-quality evidence).For our outcome 'Investigator-assessed short-term adverse events', fractional laser (6/32) was associated with a reduced risk of hyperpigmentation than non-fractional non-ablative laser (10/32) in one study (RR 0.60, 95% CI 0.25 to 1.45; n = 64; very low-quality evidence); chemical peeling was associated with increased risk of hyperpigmentation (6/12) compared to skin needling (0/15) in one study (RR 16.00, 95% CI 0.99 to 258.36; n = 27; low-quality evidence). There was no difference in the reported adverse events with injectable filler (17/97) compared to placebo (13/50) (RR 0.67, 95% CI 0.36 to 1.27; n = 147; low-quality evidence). AUTHORS' CONCLUSIONS There is a lack of high-quality evidence about the effects of different interventions for treating acne scars because of poor methodology, underpowered studies, lack of standardised improvement assessments, and different baseline variables.There is moderate-quality evidence that injectable filler might be effective for treating atrophic acne scars; however, no studies have assessed long-term effects, the longest follow-up being 48 weeks in one study only. Other studies included active comparators, but in the absence of studies that establish efficacy compared to placebo or sham interventions, it is possible that finding no evidence of difference between two active treatments could mean that neither approach works. The results of this review do not provide support for the first-line use of any intervention in the treatment of acne scars.Although our aim was to identify important gaps for further primary research, it might be that placebo and or sham trials are needed to establish whether any of the active treatments produce meaningful patient benefits over the long term.
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Affiliation(s)
- Rania Abdel Hay
- Faculty of Medicine, Cairo UniversityDepartment of Dermatology13th Abrag OthmanKournish el MaadiCairoEgypt11431
| | | | - Hesham Zaher
- Faculty of Medicine, Cairo UniversityDepartment of Dermatology13th Abrag OthmanKournish el MaadiCairoEgypt11431
| | - Vanessa Hafez
- Cairo UniversityDepartment of Dermatology, Faculty of MedicineKasr El Aini Hospital Medical School15 Nasser Street from Fatma Roshdi St.Haram, GuizaCairoEgypt
| | - Ching‐Chi Chi
- Chang Gung Memorial HospitalDepartment of Dermatology and Centre for Evidence‐Based Medicine6, Sec West, Chia‐Pu RoadPuzihChiayiTaiwan61363
- Chang Gung UniversityCollege of MedicineTaoyuanTaiwan
| | - Sandra Dimitri
- Ain Shams UniversityDepartment of Obstetrics and Gynaecology, Faculty of MedicineRamsees street, AbbaseyaCairoEgypt11566
| | - Ashraf F Nabhan
- Ain Shams UniversityDepartment of Obstetrics and Gynaecology, Faculty of MedicineRamsees street, AbbaseyaCairoEgypt11566
| | - Alison M Layton
- Harrogate and District NHS Foundation TrustDepartment of DermatologyHarrogateUK
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