Treatment of nevus of Ota by Q switched Nd : YAG laser: a histologic and histometric study Moetaz El-Domyati, Wael Hosam, Ghada Nasef, Rasha T.A Abdel-Aziz, Yousra Raouf Journal of the Egyptian Women�s Dermatologic Society 2019 16(3):147-154 Background Nevus of Ota is a dermal hamartoma that presents as bluish/slate gray pigmentation along first or second branch of trigeminal nerve. Patients search for treatment early in life due to psychological trauma and cosmetic disfigurement. The establishment of high power, short pulse Q switched (QS) lasers has provided a tool for substantial therapeutic advances in the management of dermal pigmented lesions. Objectives The aim of the present study was to correlate the clinical efficacy of QS Nd : YAG laser with histological, as well as histometric findings through studying the quantitative changes of dermal melanocyte surface area in nevus of Ota patients after treatment. Patients and methods Twelve patients with nevus of Ota were subjected to multiple treatment sessions with 1064 nm QS Nd : YAG laser at 2 months interval accomplished over a period of 2 years. Skin types treated included phototypes III and IV. All patients were photographed before, after each session and at the end of treatment. Skin biopsies were taken from all patients before treatment and after six sessions to perform histological and histometric analysis. Results Excellent improvement was noticed in four (33.3%) patients, good improvement in five (41.6%) patients, and one (8.3%) patient showed fair response. While, poor response was seen only in two (16.7%) patients. Hematoxylin and eosin and Fontana-Masson stained sections showed significant decrease in the number of elongated spindle-shaped dermal melanocytes throughout the dermis. Meanwhile, histometric study revealed significantly decreased dermal melanocyte surface area after treatment. Conclusion QS Nd : YAG laser is an effective and easy-to-perform treatment in cases of nevus of Ota in Egyptian patients with minimal side effects. Histological and histometric findings correlated with the clinical improvement attained.

Histopathologic spectrum of vulvar lesions in South India with an emphasis on morphological classification of vulvar squamous cell carcinoma: a retrospective study of 8 years Gayatri Ravikumar, Rajalakshmi Tirumalae, Julian Crasta Journal of the Egyptian Women�s Dermatologic Society 2019 16(3):155-163 Background Vulvar diseases comprise inflammatory and neoplastic conditions. Comprehensive data in Indian population is lacking. Vulva is also prone to HPV related lesions and the prevalence of HPV related vulvar squamous cell carcinoma (SCC) in the study population is not known. Objectives The primary aim of this study was to describe the range of vulvar lesions over a period of 8 years in South Indian population. Additionally the vulvar squamous neoplasias were subclassified into morphological types in an attempt to differentiate the HPV and non HPV associated lesions, which helps in triaging cases for HPV testing. Methods The vulvar lesions from database were categorised as inflammatory, cysts, non-neoplastic proliferations and neoplasms. The inflammatory lesions were classified as lichenoid and acanthotic patterns. The squamous neoplasias were morphologically categorised into HPV and non HPV associated types. Results There were 204 biopsies from 192 adults and 10 children. Epithelial ones were commoner than mesenchymal (48 vs.18). Benign adnexal neoplasms included hidradenoma papilliferum, syringoma , apocrine adenoma. The commonest malignancy was squamous cell carcinoma (SCC) (n=21) of which 17 were classified as HPV associated and 4 non-HPV associated. SCC subtypes were warty (n=3), basaloid (n=5), mixed (n=1) and arising from differentiated VIN(n=8). One case of basal cell carcinoma was reported. There were 15 cases of VIN [5 LSIL and 10 HSIL {3 warty, 5 basaloid,2 mixed}], one extramammary Paget’s disease. Vascular neoplasms were the commonest mesenchymal lesions. There was one case each of leiomyosarcoma and angiosarcoma. Among non-neoplastic proliferations, fibroepithelial polyps were the commonest (n=9). Lichenoid inflammatory lesions (n=75) was more common than acanthotic (n=4). Conclusion The study highlights the importance of histopathologic typing of SCC and VIN, which helps in triaging cases for HPV testing in resource limited setting.

Interleukin-17 levels in patients with psoriasis with or without metabolic syndrome Hanan Morsy, Ashraf Hasaballa, Sara Awad Journal of the Egyptian Women�s Dermatologic Society 2019 16(3):164-169 Background Psoriasis is a chronic immune-mediated hyperproliferative disease frequently associated with systemic comorbidities including metabolic syndrome (MS). Interleukin-17 (IL-17) has been identified as a central player in psoriasis-associated inflammation. Objective To investigate serum IL-17 levels in relation to metabolic disturbances in patients with psoriasis. Patients and methods Serum IL-17 levels were measured in 55 patients with psoriasis (26 having MS) and 50 healthy controls using the enzyme-linked immunosorbent assay method. Results IL-17 levels were higher in patients with psoriasis than controls (P=0.03), and in patients with psoriasis and MS than those without MS (P=0.043). IL-17 was particularly increased in the presence of dyslipidemia and obesity (P<0.001 and P=0.041, respectively). Conclusion Proinflammatory IL-17 expression in patients with psoriasis seems to be enhanced in the presence of MS and is particularly related to obesity and dyslipidemia.

Role of carboxytherapy in localized lipolysis: a clinical and radiological study Azza G.A Farag, Alaa H Maraee, Ashraf A Zytoon, Wafaa A Shehata, Shahlaa Abd El Reheim Essa Journal of the Egyptian Women�s Dermatologic Society 2019 16(3):170-178 Background Localized obesity is a result of accumulation of adipose tissue present in small quantities in specific area. It is an important issue to search for novel noninvasive fat elimination modalities which help in body contouring. Objective To estimate the efficacy as well as safety of subcutaneous injection of CO2 in management of localized fat deposits. Patients and methods This interventional study was conducted on 34 females)22–45years old) having localized fat deposits in abdomen, chin, arm, and thigh. For all history and clinical examination including circumferential tape measurements were done. Digital photographic registration and ultrasound measurements of subcutaneous fat thickness, as well as circumferences of the treated areas before and after eight carboxytherapy sessions (once/week) were performed. Results There were observed improvement in carboxytherapy treated areas (abdomen, chin, arm, and thigh) in all studied subjects indicated by significant decrease in circumferences of abdomen (P<0.0001), arms (P=0.0003), and thighs (P<0.0001), and ultrasound fat thickness measurements in abdomen (P≤0.0001), chin (P=0.012), arms (P=0.0004), and thighs (P<0.0001). This improvement was achieved in arm (P=0.0004) and chin (P=0.012) better than abdomen and thighs. Half of our patients (17, 50%) recorded an excellent degree of satisfaction, the highest satisfaction rate was among patients who had lipolysis in the chin region (P=0.027). Pain (mild and moderate) and ecchymosis were the only observed adverse effects. Conclusion Carboxytherapy may be an effective method that could be used in the management of localized obesity, without remarkable adverse effects. Treatment of localized obesity by CO2 sessions once weekly for 8 weeks has a significantly better outcome in arms and chin than in abdomen and thighs.

Carbon dioxide laser-assisted dermabrasion versus mechanical dermabrasion in the treatment of stable vitiligo Mahmoud Abdel Sabour Makki, Wael Saudi, Hatem Hasan Journal of the Egyptian Women�s Dermatologic Society 2019 16(3):179-183 Background Vitiligo still remains a challenging disease to treat. Although various treatment modalities have been mentioned in the literature, few studies have been performed to evaluate the efficacy and safety of dermabrasion in the treatment of stable vitiligo. Objective To compare the efficacy of mechanical dermabrasion versus carbon dioxide (CO2) laser-assisted dermabrasion in the treatment of stable vitiligo. Patients and methods A total of 22 patients with stable vitiligo were included in this comparative study. Two patches in the same site from each patient were selected; the lower patches were treated by mechanical dermabrasion whereas the upper patches were treated by CO2 laser-assisted dermabrasion. Immediately after the dermabrasion, 5-fluorouracil was topically applied daily for 2 weeks followed by twice weekly sessions of excimer light. The outcome was assessed at 3 months postoperatively. Results A total of 22 patients, comprising 13 women and nine men, were included in the study. There was no significant difference in the percentage of improvement between the two procedures (P>0.05). Adverse effects reported were postinflammatory hyperpigmentation in 11 (50%) patients and scar in six (27.3%) patients after mechanical dermabrasion, whereas postinflammatory hyperpigmentation after CO2-assisted dermabrasion was reported in two (9.1%) patients and scar in a single patch (4.5%). Conclusion CO2 laser-assisted dermabrasion is as effective as mechanical dermabrasion, with less adverse effect in the treatment of stable vitiligo.

The efficacy of topical minoxidil 2% versus topical botanically derived inhibitors of 5 alpha reductase in treatment of female pattern hair loss by trichoscopy Fairouz K Badran, Rania E Abd El Maksoud, Mona M Ibrahim Moawad Journal of the Egyptian Women�s Dermatologic Society 2019 16(3):184-192 Background Female pattern hair loss (FPHL) is a distressing common problem. Minoxidil is the only FDA approved medical treatment for FPHL. However, the off-label botanically derived 5-alpha reductase inhibitors (5αRIs) are commonly used despite insufficient studies. Objective To determine the effectiveness of topical botanically 5αRIs in treating FPHL, by comparing its results with topical minoxidil 2%. Patients and methods This study included 40 females with FPHL. Group 1 received topical minoxidil 2% and group 2 received topical botanically 5αRIs. Patients were clinically assessed via Savin scale; to compare between weeks 0 and 36. Change in hair diameter and count in the target site were trichoscopically assessed at weeks 0, 16, and 36. Side effects of both drugs were recorded. Results Minoxidil was effective in all disease stages, while 5αRIs were effective in early disease onset and moderate cases. Both drugs produced a significant rise in hair count and diameter, however; minoxidil had the superiority regarding the mean increase of hair diameter. Side effects of minoxidil were more troublesome. Conclusion Minoxidil is recommended as a first line of therapy for patients with FPHL who want a treatment with affordable price and could tolerate its side effects. Furthermore, it is advised to shift to topical botanical 5αRIs as a second line therapy, in cases that were nontolerant to minoxidil due to its fewer side effects. Likewise, the use of trichoscopy for therapeutic follow up is strongly recommended.

A pilot study on serum lactoferrin in patients with mild versus severe acne in correlation with disease duration Manal A Sharara, Heba M Diab, Abd El Rahman M Reda Journal of the Egyptian Women�s Dermatologic Society 2019 16(3):193-197 Background Acne vulgaris (AV) is a chronic inflammatory disease of the pilosebaceous units. Lactoferrin (LF) is an iron-binding glycoprotein, which is known to have a role in decreasing inflammation and microbial infection. A few studies have reported that many of the patients with acne had acceptable therapeutic response to LF supplementation. However, no studies have directly assessed serum LF level in patients with acne. Objective To evaluate serum LF level in patients with severe versus mild acne in comparison with healthy controls. Patients and methods Serum LF was assessed using enzyme-linked immunosorbent assay in 40 AV patients comprising two subgroups; 20 mild and 20 severe cases, versus 20 healthy controls. Levels were correlated with disease duration. Results Mean serum LF levels were significantly higher in patients with AV than in healthy controls (P<0.001), and in patients with severe disease than with mild AV. Serum LF level was inversely correlated with disease duration. Conclusion Serum LF is directly related to acne severity, being elevated in severe rather than mild cases. Therefore, it could be of prognostic value. Serum LF level is higher in acute stages rather than chronic cases, denoting its possible role as a compensatory acute-phase reactant, to overcome the detrimental effects of acute inflammation.

Diclofenac sodium-induced livedoid dermatitis (Nicolau syndrome) in an obese patient Galal El Anany, Noha Nagui, Hanan Nada, Iman Sany, Ahmad Nada, Omar El Ghanam Journal of the Egyptian Women�s Dermatologic Society 2019 16(3):198-200 Livedoid dermatitis (Nicolau syndrome) is an uncommon and avoidable side effect of intramuscular injection. In this case report we present a 60-year-old female who developed a unilateral painful ulcer around the site of injection. Serial photography taken by the patient was pathognomonic.

What is your diagnosis? Mohamed H.M El-Komy Journal of the Egyptian Women�s Dermatologic Society 2019 16(3):201-202