Search

Oral neomycin administration impacts the gut microbiome and delays vitiligo development in mice, and topical antibiotics may likewise allow the microbiome to preserve skin health and delay depigmentation. Here, we examined the effects of 6‐week topical antibiotic treatment on vitiligo‐prone pmel‐1 mice. Bacitracin, Neosporin, or Vaseline were applied to one denuded flank, while the contralateral flank was treated with Vaseline in all mice. Ventral depigmentation was quantified weekly. We found that topical Neosporin treatment significantly reduced depigmentation and exhibited effects beyond the treated area, while Bacitracin ointment had no effect. Stool samples collected from four representative mice/group during treatment revealed that Neosporin treatment aligned with reduced abundance of the Alistipes genus in the gut, while relevant changes to the skin microbiome at end point were less apparent. Either antibiotic treatment led to reduced expression of MR1, potentially limiting mucosal‐associated invariant T‐cell activation, while Neosporin‐treated skin selectively revealed significantly reduced CD8+ T‐cell abundance. The latter finding aligned with reduced expression of multiple inflammatory markers and markedly increased regulatory T‐cell density. Our studies on favorable skin and oral antibiotic treatment share the neomycin compound, and in either case, microbial changes were most apparent in stool samples. Taken together, neomycin‐containing antibiotic applications can mediate skin Treg infiltration to limit vitiligo development. Our study highlights the therapeutic potential of short‐term antibiotic applications to limit depigmentation vitiligo. [ABSTRACT FROM AUTHOR]

Background: A variety of therapeutic approaches have been introduced for striae distensae (SD) with modest outcomes. Fractional carbon dioxide laser (FCL) and platelet-rich plasma (PRP) are effective separately in improving SD. Objective: To assess the safety and efficacy of topically applied PRP combined with FCL in the management of SD. Patients and methods: In this prospective, single-blinded, randomized, comparative intrapatient study, 24 patients with bilateral SD lesions were subjected to FCL on both sides and followed by topical application of PRP on one side only allocated by simple randomization. The sessions were performed biweekly for a total of six sessions. Overall clinical improvement was graded using the Quartile Grading Scale. Biopsies, before and after treatment, were stained with H and E, Masson's trichrome, and Orcein stains. In addition, collagen I and elastin immunohistochemical staining were performed. Results: In this study of 24 SD patients (19 females, 5 males; aged 19–39 years), topical PRP with FCL achieved moderate to excellent outcomes 3 months after the last session. Early striae rubra improved after the initial session, reaching marked excellent outcomes within a month after the second session. Manageable side effects were reported. Histological examination showed improved epidermal and dermal thickness, collagen, and elastic fiber quality after treatment, with the combined PRP and FCL side exhibiting more significant outcomes than the FCL-treated side. Conclusion: Topical PRP application post-FCL proves to be a highly effective therapeutic approach for SD, expressing superior treatment outcomes, and heightened patient satisfaction compared with the use of FCL alone. In additio, topical application is preferred over intradermal injection, offering practicality, effectiveness, and noninvasiveness. [ABSTRACT FROM AUTHOR]

Common warts are benign skin lesions caused by the human papillomavirus. Although they are usually not harmful, they can cause pain, depending on their location. While many modalities are available for treatment of warts, none is a gold standard, and many are not affordable and/or have suboptimal outcomes. Trichloroacetic acid (TCA) is a chemical tissue-destroying agent used as a highly concentrated solution for wart management. While available and efficient, it is difficult to handle as the solution spreads to tissue surrounding the wart causing pain and burning. Hence, we developed a new polymer-based gel of high TCA content (100% w/v). Gels were formed successfully as hydroxyethyl cellulose (HEC) and chitosan were used to impart viscosity and bioadhesion. Formulae of different concentrations were tested for their physical properties, and the optimal formulation was selected for clinical evaluation. A combination of 3% HEC and 2% chitosan provided optimal viscosity and limited water content and have acceptable stability. The efficacy and safety of the biweekly application of TCA gel were evaluated in 30 patients. The clinical study revealed gel's efficacy and tolerability; half of the patients showed a complete cure, and 90% showed improvement within 6 weeks. Only 10–12% of the patients reported side effects. In summary, transforming TCA solution into a gel enabled its application and handling in a practical manner by physicians and patients alike, while maintaining its efficacy as a tissue-destroying agent. Moreover, it is economic and easy to apply, rendering it a promising formulation for similar conditions requiring controlled tissue ablation. [ABSTRACT FROM AUTHOR]

Retinoids and active vitamin D3 analogues regulate the proliferation and differentiation of keratinocytes. Retinoids are the main stay in the treatment of acne vulgaris through their comedolytic and anti‐inflammatory effects. However, the effect of calcipotriol on the different forms of acne lesions has not been reported. This split face prospective study aimed to detect the efficacy of topical calcipotriol in the treatment of acne lesions in comparison with that of adapalene. Forty patients with acne vulgaris were treated with topical calcipotriol (0.005%) cream and 0.1% adapalene gel on the right and left sides of the face respectively. Clinical and histological assessment of the used treatments was done 2 months after the start of treatment. Two months after treatment, there was significant reduction of all acne lesions with significant decrease of physician global assessment and patient global assessment scores (p = 0.0001) on both sides of the face with no significant difference between both sides. Histologically, there was significant decrease in the density of inflammatory infiltrate, which was more significant on the right side (p < 0.0001). Topical calcipotriol can serve a significant role in the treatment of acne vulgaris, through its anti‐inflammatory effect which was comparable to that of adapalene. [ABSTRACT FROM AUTHOR]

Pityriasis alba is a common skin condition that may be challenging to treat, especially in patients with darker skin type where the hypopigmentation may be more noticeable and represents a major cosmetic concern. This study aims to evaluate the efficacy of three cost-effective treatments of PA in comparison with placebo. This prospective study was conducted on 80 patients complaining from PA and divided into 4 equal groups according the received topical treatment on the target lesions twice daily for 8 weeks (Calcipotriol 0.005% cream, Tacrolimus 0.03% ointment, topical corticosteroid; Clobetasone butyrate 0.05% cream and Petrolatum as Placebo). Clinical evaluation, Physician Global Assessment, Patient's satisfaction levels as well as point counting planimetry were done for evaluation of the response. Significant improvement of scaling and erythema within 3 weeks after initiation of therapy and hypopigmentation by the 8th week, except for those received placebo. Tarolimus 0.03% ointment showed simple superiority over both Calcipotriol 0.005% cream and topical corticosteroid as regards repigmenation, although, the later received the highest level of patient satisfaction. The three treatments were superior to placebo with relative superiority to Tacrolimus 0.03% due to limited side effects. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa (HS) rarely affects pediatric patients. The literature on pediatric HS patients is scarce. This is a cross-sectional study based on case note review or interviews and clinical examination of 140 pediatric patients undergoing secondary or tertiary level care. Patients were predominantly female (75.5%, n = 105) with a median age of 16. 39% reported 1st-degree relative with HS. Median BMI percentile was 88, and 11% were smokers (n = 15). Median modified Sartorius score was 8.5. Notable comorbidities found were acne (32.8%, n = 45), hirsutism (19.3%, n = 27), and pilonidal cysts (16.4%, n = 23). Resorcinol (n = 27) and clindamycin (n = 25) were the most frequently used topical treatments. Patients were treated with tetracycline (n = 32), or oral clindamycin and rifampicin in combination (n = 29). Surgical excision was performed in 18 patients, deroofing in five and incision in seven patients. Obesity seemed to be prominent in the pediatric population and correlated to parent BMI, suggesting a potential for preventive measures for the family. Disease management appeared to be similar to that of adult HS, bearing in mind that the younger the patient, the milder the disease in majority of cases. [ABSTRACT FROM AUTHOR]

Abstract: Background: The introduction of minimally invasive procedures has increased acceptance due to their efficacy, safety, and relatively long‐lasting and natural results. At least two different and unrelated modalities are employed to consider a combination treatment. Objectives: This study aims to evaluate and compare the use and effectiveness of combined microneedling with platelet‐rich plasma (PRP) or trichloroacetic acid (TCA) peeling for facial rejuvenation. Patients/methods: Twenty‐four volunteers with photoaging were randomly divided into three equal groups according to performed procedure on each side of the face (microneedling by dermaroller alone or combined with PRP or TCA 15% peeling). They had received one session every 2 weeks for six sessions of treatment. Photography and punch biopsies were performed before and after 3 months of treatment for clinical, histometrical, and histological evaluation. Results: Combined treatment of dermaroller and PRP or dermaroller and TCA showed significant improvement when compared with dermaroller alone. Significant increase in epidermal thickness was apparent in studied groups, especially after combined treatment with TCA. Organized collagen bundles with newly formed collagen formation and markedly decreased abnormal elastic fibers were noticed in the three studied groups. However, improvement of dermal structures was better demonstrated after combined treatment of Dermaroller and PRP than Dermaroller and TCA 15%. Conclusions: Most volunteers showed significant clinical improvement after treatment supported by the histometrical and histochemical evaluation; however, the combined use of dermaroller with PRP is apparently more beneficial for facial rejuvenation. [ABSTRACT FROM AUTHOR]

Summary: Background: Minimally invasive procedures provide effective, safe, relatively long‐lasting, and natural results without large damage to the skin. A combination treatment is considered an approach that includes at least 2 different and unrelated modalities. Objectives: This study aims to evaluate the use and effectiveness of some combined minimally invasive procedures for management of acne scarring. Patients/methods: Twenty‐four volunteers with postacne atrophic scars were randomly divided into 3 equal groups according to performed procedure on each side of the face (microneedling by dermaroller alone or combined with platelet‐rich plasma [PRP] or trichloroacetic acid [TCA] 15% peeling) and received 6 bi‐weekly sessions of treatment. Photography and punch biopsies were taken before and after 3 months of treatment for clinical, histological, and histometrical evaluation. Results: Combined treatment of dermaroller and PRP or dermaroller and TCA 15% showed significant improvement when compared with dermaroller alone (P = .015 and .011 respectively). Epidermal thickness showed statistically significant increase in studied groups, mainly after dermaroller and TCA 15%. Moreover, the 3 studied groups showed more organized collagen bundles and newly formed collagen formation and markedly decreased abnormal elastic fibers. Conclusions: Based on the clinical, histometrical, and histochemical assessment, inspite that most volunteers showed significant improvement after treatment, however, the combined use of dermaroller and TCA 15% was more effective in postacne atrophic scars than the use of dermaroller and PRP or dermaroller only. [ABSTRACT FROM AUTHOR]

Background Microdermabrasion is a nonchemical superficial resurfacing procedure that removes the stratum corneum. Because it is a somewhat subtle procedure, it may be difficult to demonstrate its cosmetic benefit. Objectives To assess the efficacy of microdermabrasion in treatment of melasma, postacne scarring, striae distensae, and photoaging by a series of microdermabrasion sittings through clinical, histometric, and histopathologic analysis. Patients and Methods The study was conducted on 38 patients constituting four groups (melasma, acne scars, striae destinsae, and photoaging), each patient was subjected to a series of 8 microdermabrasion treatments performed at 1-week interval. Punch biopsies, at base line, 1 week after the 4th and the 8th session, were obtained from each subject for histometric and histopathologic analysis. Results Clinically, the improvement in melasma, acne scars, and striae distensae groups was mainly mild to moderate, while in photoaging group was mainly mild. Histometric analysis of epidermal thickness showed insignificant changes in all groups. Histopathologically, decreased melanization and regular distribution of melanosomes in the epidermis were noted in melasma group while increased density of collagen fibers with more regular arrangement in collagen bundles was detected in all candidates of acne scars, striae distensae, and photoaging groups. Meanwhile, Orcein stain did not show any significant changes in elastic fibers. Conclusions Microdermabrasion is an easy and safe technique. In this study, most cases showed mild to moderate improvement. Decreased melanization with regular distribution of melanosomes and increased collagen density with regular arrangement of collagen bundles were the most common observed histologic changes. [ABSTRACT FROM AUTHOR]

Background Linear immunoglobulin A disease ( LAD), also known as linear Ig A bullous dermatosis, is an autoimmune disorder characterized by subepidermal bullae caused by Ig A autoantibodies directed against several antigens located in the basement membrane zone of the skin. Laminin 5 (laminin-332) is considered a key component of the lamina lucida/lamina densa interface, which provides stable attachment of the epidermis to the dermis. Meanwhile, collagen IV is a major component of the lamina densa. Laminin 5 and collagen IV bind to the cell membrane and induce cytoskeletal rearrangements, which contribute to the basement membrane's final mat-like structure. The study aimed to evaluate the immunohistochemical staining of laminin 5 and collagen IV and to identify the site of blister formation in formalin-fixed, paraffin-embedded skin biopsies from adults with LAD. Methods Skin biopsies from 20 adult patients with LAD were subjected to routine hematoxylin-eosin as well as immunohistochemical staining of collagen IV and laminin 5. Results Linear staining was positive on the floor of the blister for laminin 5 in 65% and collagen IV in 90% of biopsies denoting that the site of separation in most cases of LAD is above the lamina densa. Conclusions The use of laminin 5 and collagen IV immunohistochemistry can be considered as an adjuvant diagnostic tool and may aid in the identification of the site of blister formation in routine skin biopsies in adults with LAD. [ABSTRACT FROM AUTHOR]

Background The nail unit is an important part of cosmetic appearance of an individual. Older people are at an increased risk of nail alterations, including normal age-related changes and disorders that more commonly affect this specific population. Objectives To identify and evaluate the age-related nail changes and disorders in Egyptian elderly people both clinically and histopathologically. Patients/Methods A total of 400 adult subjects, not complaining from any dermatological disease, were included in the present study; half of them were elderly of 60 years and above (elderly group). Meanwhile, the other half served as a control group with younger ages. Full history taking, general and local examinations as well as nail biopsies were performed from selected cases with age-related nail changes and disorders. Results Nail changes were significantly ( P < 0.05) more common in old age group (88%) compared to control subjects (39%). The commonest age-related nail changes noticed were pale, dull, opaque, and lusterless nails (73%); brittle nails (67.5%); decreased lunula visibility (49%); and onychorrhexis (45.5%). They showed highly significant increase ( P < 0.001) when compared with control group. Conclusions The prevalence of nail changes and disorders has increased among elderly patients although they are frequently overlooked by health care providers. Dermatologist should be aware about various nail changes related to aging and those associated with other dermatoses or systemic diseases. Histopathologic picture can enhance the accuracy of clinical diagnosis of various nail changes and disorders. [ABSTRACT FROM AUTHOR]

Background Wrinkles are associated with cutaneous aging especially on sun-exposed skin. Despite they are considered a major topic in cosmetic dermatology, very few reports have studied the specific histological and immunohistochemical changes characteristic for wrinkles. Aim The study aims to evaluate the histological and immunohistochemical changes of static forehead wrinkles in relation to surrounding photoaged skin. Methods Biopsy specimens were obtained from the forehead wrinkles of 20 volunteers of Glogau's class III–IV wrinkles. Using histological and immunostaining methods coupled with computerized morphometric analysis, measurement of epidermal thickness and quantitative evaluation of total elastin and tropoelastin as well as collagen types I, III, and VII were performed for skin biopsies. Results In the wrinkle site, there was statistically significant lower epidermal thickness (P = 0.001), elastin (P < 0.001), tropoelastin (P < 0.001), and collagen VII (P < 0.001) than the surrounding photoaged skin. Meanwhile, there was no significant difference between the wrinkle site and adjacent photoaged skin regarding collagen type I (P = 0.07) or III (P = 0.07). Conclusion This study detected some histological and immunohistochemical differences in the wrinkle site when compared to adjacent photoaged skin. This may help in understanding the pathophysiology of facial wrinkling as well as its ideal way of management. [ABSTRACT FROM AUTHOR]

Background Fractional photothermolysis is a modern resurfacing technique, in which microscopic zones of thermal injury are created, stimulating turnover of both epidermis and dermis. Fractional laser rejuvenation has been developed to overcome the drawbacks of traditional ablative laser. Objectives To objectively evaluate the effectiveness of multiple sessions of fractional Er: YAG laser rejuvenation for aging upper face clinically, histologically and immunohistochemically. Patients/Methods Ten volunteers asking for facial rejuvenation were subjected to multiple sessions (3-5) of fractional Er: YAG laser. Clinical evaluation with both histopathological and immunohistochemical assessment for skin biopsies was carried out before, after 1 month and 6 months of laser resurfacing. Histometry for epidermal thickness and quantitative assessment for neocollagen formation, collagen I, III, and VII, elastin and tropoelastin were carried out for all skin biopsies. Results Comparing before, after 1 month and 6 months of fractional Er: YAG laser resurfacing resulted in improved clinical appearance with increased epidermal thickness ( P < 0.001). Dermal collagen showed increased neocollagen formation ( P = 0.006), with increased concentration of collagen types I ( P < 0.001), III ( P < 0.001), and VII ( P = 0.001). Dermal elastic tissue studies revealed decreased elastin, while tropoelastin concentration increased after laser resurfacing ( P < 0.001). An increase in collagen (I and III) and tropoelastin level and decreased elastin content was encountered with increasing the number of sessions, yet it was not significant. Conclusions Multiple sessions are effective in rejuvenation of the aging face with high safety, short downtime, and no adverse effects. They stimulated formation of new collagen (type I, III, and VII) up to 6 months after treatment with better improvement in skin texture and fine wrinkles. The variable number of fractional Er: YAG laser sessions (3-5) showed no significant difference as regards efficacy. [ABSTRACT FROM AUTHOR]

Background The histopathologic changes characteristic of psoriasis might be related to suppressed apoptosis. One of the actions of psoralen ultraviolet A ( PUVA) in psoriasis could be exerted through induction of apoptosis of keratinocytes and lymphocytes; however, its exact molecular mechanism is still confusing. Aim In this study, we evaluated the expression of pro-apoptotic ( P53, Fas and Bax) and anti-apoptotic ( Bcl-2) proteins correlating it with apoptotic index ( AI) and epidermal thickness in psoriatic skin before and after PUVA therapy. Methods Lesional and non-lesional skin biopsy specimens were obtained from 10 patients with generalized plaque psoriasis before and after 8 weeks of PUVA therapy. Histometric measurements of epidermal thickness as well as P53, Fas, Bax and Bcl-2 expressions were evaluated using immunoperoxidase technique and apoptotic cells were detected by terminal deoxynucleotide transferase ( TdT) mediated deoxyuridine triphosphate nick end labeling ( TUNEL) method. Results After PUVA therapy, the epidermal thickness of psoriatic skin was significantly decreased ( P < 0.001) and keratinocytes of psoriatic skin showed significant increased expression of P53 ( P < 0.001), Fas ( P < 0.001) and Bcl-2 ( P < 0.001) with no significant change in Bax expression ( P > 0.05). Apart from significant decrease of Bcl-2 expression ( P = 0.01), no significant difference in all previous markers were encountered in lymphocytes ( P53, Fas and Bax; P > 0.05) after PUVA therapy. The AI was significantly increased ( P = 0.008) after PUVA therapy especially in lymphocytes ( P = 0.002). Conclusion The present study suggests that one of the actions of PUVA therapy in psoriasis might be exerted through induction of apoptosis especially of lymphocytes by suppression of Bcl-2 expression and of keratinocytes through P53 and Fas pathways leading to healing of psoriasis. [ABSTRACT FROM AUTHOR]

Background: Hepatitis-C virus (HCV) infection is considered a major worldwide public health problem with a global prevalence. Maintenance of skin homeostasis requires a delicate balance between proliferation, differentiation, and apoptosis. Meanwhile, it is unclear if there is an altered keratinocyte proliferation/apoptosis balance in advanced liver disease with HCV infection. Aim: This work aimed to evaluate the epidermal thickness and changes in the expression of apoptosis regulatory markers as well as apoptotic index in skin samples of advanced HCV liver patients compared to normal controls. Materials and Methods: Twenty biopsies were taken from apparently normal skin of advanced HCV liver disease patients, as well as five healthy control subjects. These specimens were used for histometric epidermal measurement, immunohistochemical staining of apoptosis regulatory proteins (Bax, Fas, p53, Caspase-3, Bcl-2, Bcl-xL) as well as the TUNEL technique for detection of apoptotic cells. Results: The mean epidermal thickness was significantly lower than the control group (P=0.000). There were significant overexpression of pro-apoptotic markers (Bax, Fas, P53, and Caspase-3) in patients (P=0.03, 0.03, 0.003, 0.003 respectively), with increased apoptotic index in HCV liver patients (P=0.002) when compared to normal controls. On the other hand, no statistically significant difference were encountered in the expression of antiapoptotic markers (Bcl-2, Bcl-xL) in HCV patients when compared to normal controls (P=0.5, 0.9, respectively). Conclusion: These findings suggest that an alteration in the proliferation/apoptosis balance is present in the skin of HCV liver patients. [ABSTRACT FROM AUTHOR]

Androgenetic alopecia (AGA) is a common androgen-induced progressive disorder; the pathways of which are regulated by local genetic codes and hormonal control. Meanwhile, it is unclear whether an altered proliferation or increased apoptosis could contribute to its pathogenesis. To evaluate the role of some apoptosis regulatory markers and follicular proliferation in the pathogenesis of AGA. Thirty biopsies were taken from the frontal (bald) area and occipital (hair-bearing) area of 15 male patients with AGA, as well as five specimens from the frontal area of five age-matched controls. The biopsies were stained with apoptosis regulatory markers (Bcl-2, p53, Bax & Fas) and PCNA (proliferating cell nuclear antigen), as well as TUNEL (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling) staining for the detection of DNA fragmentation in apoptotic cells. Bcl-2 expression was localized to epidermal basal layer and follicular dermal papilla with highly significant correlation with PCNA expression ( P < 0.001). Perifollicular lymphocytic infiltrate of the bald area showed significant expression of Bcl-2. However, pro-apoptotic Bax and Fas were expressed in the epidermis and not in the hair follicles which does not show any apoptotic keratinocytes by TUNEL staining. The low proliferation rate in the bald area of patients, together with persistent perifollicular inflammatory infiltrate as evidenced by the anti-apoptotic Bcl-2 expression in dermal lymphocytes, would result in follicular miniaturization and fibrosis. [ABSTRACT FROM AUTHOR]

Background Androgenetic alopecia is a common cosmetic hair disorder, resulting from interplay of genetic, endocrine, and aging factors leading to a patterned follicular miniaturization. Microinflammation seems to be a potential active player in this process. Aims To study the histopathological and ultrastructural changes occurring in male androgenetic alopecia (AGA). Patients/methods Fifty-five subjects were included in this study (40 with AGA and 15 as normal age-matched controls). Skin biopsies from frontal bald area and occipital hairy area were subjected to histopathological examination, immunohistochemical staining for collagen I and ultrastructural study. Results The frontal bald area of patients showed highly significant increase in telogen hairs and decrease in anagen/telogen ratio and terminal/vellus hair ratio ( P < 0.001). Perifollicular inflammation was almost a constant feature in early cases and showed a significant inverse correlation with perifollicular fibrosis ( P = 0.048), which was more marked with thickening of the follicular sheath in advanced cases. Conclusion Follicular microinflammation plays an integral role in the pathogenesis of AGA in early cases. Over time, thickening of perifollicular sheath takes place due to increased deposition of collagen, resulting in marked perifollicular fibrosis, and sometimes ends by complete destruction of the affected follicles in advanced cases. [ABSTRACT FROM AUTHOR]