Journal of Sustainability Perspectives

Pyoderma gangrenosum (PG) may be primary or associated with various diseases including malignancies, inflammatory bowel diseases, and rheumatic disorders. However, its association with systemic lupus erythematosus (SLE) is extremely rare and only 29 cases were reported in the literature. In addition, only 10.7% of the previous cases were diagnosed simultaneously at the time of SLE diagnosis. We reported a case of 52-year-old- woman with simultaneous presentation of pyoderma gangrenosum and SLE.

Background Scalp basal cell carcinomas (sBCC) exhibit greater aggressiveness than facial BCC (fBCC), leading to a poorer prognosis. Investigating the involvement of trophoblast cell surface antigen 2 (TROP2) in sBCC could provide valuable insights into its pathogenesis and potentially uncover novel therapeutic avenues for managing challenging sBCC cases. Objective This study aimed to investigate the expression of TROP2 in sBCC versus fBCC to enhance the understanding of sBCC and elucidate the role of TROP2 in BCC progression. Methods This comparative cross-sectional study assessed TROP2 immunohistochemical expression in sBCC versus fBCC lesions. Mean expression scores, determined through ImageJ analysis based on area percentage, were compared between the two groups. Statistical analysis was conducted to evaluate the relationship between TROP2 expression and clinicopathological criteria in both sBCC and fBCC. Results The study included 40 cases of BCC, with 19 (47.5%) allocated to sBCC and 21 (52.5%) to fBCC. Scalp BCC cases demonstrated significantly lower age, larger tumor size, and a higher proportion of females than fBCC cases. TROP2 expression was significantly higher in sBCC than in fBCC. TROP2 expression positively correlated with aggressive histology in both groups. Histological type emerged as an independent factor influencing TROP2 expression at both anatomical sites, while tumor size independently affected TROP2 expression, specifically in sBCC cases. Conclusion sBCC exhibits distinctive clinicopathological features compared with fBCC. The higher TROP2 expression in sBCC may account for its documented aggressive nature compared with fBCC. Anti-TROP2 targeted therapy might have a promising role in treating challenging sBCC cases and merits further investigation.

Mycetoma is clinically diagnosed on the basis of triad as tumefaction, discharging sinuses, and grains. It may be eumycotic or actinomycetic. Cystic form of mycetoma without sinus formation is an extremely rare presentation. To the best of our knowledge, this is the first instance of cystic presentation of eumycetoma caused by Madurella mycetomatis in a 38 years old male from India.

Background The gluteal region and thigh are common donor sites used during surgical treatment of stable nonsegmental vitiligo (NSV). The outcome of transplantation could be improved if the donor site has higher melanocyte density. Aim To compare the count of melanocytes in the gluteal region and thigh, and evaluate the impact of narrow band ultraviolet B (NB-UVB) phototherapy on the quantity of melanocytes in both areas. Methods In this study, 20 stable NSV patients and five controls were included. Before and after 18 sessions of NB-UVB, two 3 mm punch biopsies were obtained from the normal skin of the thigh and gluteal region. Melan A was used for immunohistochemically labeling, and a count of melanocytes was performed on each sample. Results Before NB-UVB therapy, there was no significant difference in the number of melanocytic cells in the gluteal region and thigh in NSV patients (P=0.777) or between cases and controls. In NSV cases, the melanocytic count increased significantly in the thigh and gluteal region (P=0.002 for both), with no difference observed between the two sites (P=0.430). In the gluteal region, there was a significant positive correlation between the total cumulative joules (P=0.025, r=0.511) and the percentage change of melanocytic count and skin phototype (P=0.001, r=0.677). Conclusion In NSV patients, the melanocytic count in the normal skin of the thigh and gluteal region is similar. Following NB-UVB, this count significantly increased in both sites similarly. Both sites are equally appopriate for harvesting donor tissue for surgery in NSV cases preferably after NB-UVB phototherapy.

Background The world has suffered from the coronavirus disease 2019 (COVID-19) pandemic because of its high mortality and morbidity, resulting in the emergence of a variety of vaccines. Serum levels of vitamin D are inversely correlated with the incidence and severity of COVID-19. Hair loss is one of the most frequent complaints of COVID-19 patients. Objectives This study aims to evaluate the impact of COVID-19 vaccination on vitamin D levels in hair and serum. Patients and methods This study was conducted on 80 participants, divided into four equal groups according to the received COVID-19 vaccine. Serum and hair samples were obtained to measure vitamin D levels before and after 1 week of first and second dose of vaccinesand history of hair loss was recorded. Results Significant lower vitamin D levels in both serum and hair were recorded after the first dose (P<0.001). After the second dose, serum vitamin D has significantly increased in all groups (P<0.05), except the Pfizer group (P=0.07). Meanwhile, hair vitamin D had a nonsignificant increase in all groups (P>0.05). Hair loss was a frequent complaint after the COVID-19 vaccination, especially with the AstraZeneca vaccine, and less noted with the Pfizer vaccine. Conclusion COVID-19 vaccines harm serum and hair vitamin D with the potential increase in hair loss.

Background Acne is a chronic condition with inflammatory and non-inflammatory elements and scarring sequelae. Both adolescent and adult onsets have psychosocial impact and can greatly impair the quality of life. Several scales were developed to classify the acne severity, and variable algorithms are currently implemented for treatment; no consensus was reached on grading or treatment Objective A group of Egyptian dermatologists held this consensus meeting to identify a grading system that is accepted by the majority as well as the most appropriate treatment for each stage. Results Consensus was reached on several choices for each of the acne type and each of severity type as well as on maintenance protocols. Conclusion Acne management varies according to several factors in the practice of Egyptian dermatologists.

Background Hepatitis C virus (HCV) infection has a high prevalence in Egypt. The sexual function of female patients with chronic HCV has not been adequately studied in Egypt, where discussion of sexual desires and function is considered unacceptable by many. Objective This study aims to assess sexual function in females with chronic HCV and clarifies its correlation with medical parameters. Patients and methods Participants of this study were 120 female patients with chronic HCV and 120 healthy female controls. The Arabic-validated version of the Female Sexual Function Index (FSFI) was used to assess the sexual function of the patients and controls. Results There was a significant decrease in all domains of the FSFI score (desire, excitement, lubrication, orgasm, satisfaction, and pain) in female patients with chronic HCV versus the control candidates. We found a significant correlation between FSFI domains and hemoglobin level, leucocytic and platelet counts. However, the correlation between FSFI domains and serum HCV RNA, alanine transaminase was statistically nonsignificant. Conclusion Being a worker, having HCV+ve partner, having an old aged partner, the presence of financial stress, and duration greater than 2 years since HCV diagnosis, all were associated with a significant increase in female sexual dysfunction in chronic hepatitis C patients.

Lepra reactions or ‘reactions’ in leprosy are immunological phenomena with distinct immunopathogenesis resulting in characteristic clinical manifestations and often are precursors of neuritis and disability. The reactions seen in leprosy are type 1, type 2, or erythema nodosum leprosum reaction and Lucio phenomenon. When undiagnosed or with a delay in intervention, these acute events affecting nerves and other organs can cause irreversible deformities and disabilities. Much research is ongoing to identify definitive biomarkers to predict and diagnose leprosy reactions early, to arrest the immunopathogenesis, prevent the morbidity/disabilities associated with reactions, and improve quality of life. After a brief introduction to leprosy and its reactions, we discuss the advances in identifying biomarkers for leprosy reactions. The serological, histopathological, and genetic markers have been covered in respect of all the three lepra reactions. We have strived to correlate the findings with respect to biomarkers for reactions with clinical features, pathogenesis, and immune histopathology of reactions for a better understanding.

Background Hyperhidrosis (HH) is a condition characterized by excessive sweating caused by overstimulation of cholinergic receptors on eccrine glands. Primary hyperhidrosis (PH) is idiopathic, bilaterally symmetric, and affects various parts of the body. Botulinum neurotoxin-A (BTX-A) has a role in the nonsurgical management of HH. Dermapen was introduced for transdermal drug delivery. Objective To evaluate the clinical efficacy of Dermapen assisted delivery of BTX-A versus its intradermal injection in the treatment of primary palmar HH. Patients and methods A prospective intrapatient comparative study, conducted on 20 patients with bilateral palmar HH categorized into two groups, group A: left palm was treated by intradermal injection of BTX-A, group B: right palm was treated by Dermapen combined with topically applied BTX-A. Results Both groups had significant improvement after treatment. However, group A showed significantly better grades regarding hyperhidrosis disease severity scale, dermatology life quality index, and patient satisfaction. Conclusion Both methods were effective and tolerable. Intradermal injection intervention was better regarding hyperhidrosis disease severity scale, dermatology life quality index, patients satisfaction, and long-term follow-up.

Background Uncertainty surrounds the exact etiology of hypertrophic scars and keloids. It is generally accepted, nevertheless, that they are caused by reticular dermal chronic inflammation, which typically begins shortly after wounding. Prolonged inflammation increases myofibroblast differentiation and fibroblast proliferation. Objective To measure prolargin’s tissue expression and serum level in individuals with keloids and hypertrophic scars to determine how these factors are related to the disease. Patients and methods This was a case–control study on 90 patients who were classified into three equal groups. Group I: patients with hypertrophic scars. Group II: patients with keloids. Group III: healthy individuals, age-matched and sex-matched, as controls. Blood samples and tissue biopsies were taken to assess serum and tissue levels of prolargin using the enzyme-linked immunosorbent assay technique. Results Serum and tissue prolargin were significantly lower in groups I and II than in group III (P<0.001). Multinomial logistic regression was done for serum prolargin to predict hypertrophic scars and keloids. Group III was used as a reference category. Serum prolargin was a significant predictor for hypertrophic scars (odds ratio=0.933, 95% confidence interval= 0.902–0.965, P<0.001) and keloids (odds ratio=0.946, 95% confidence interval=0.919–0.974, P<0.001). Conclusion The current study sheds light on prolargin’s possible role in hypertrophic scars and keloid pathogenesis. The results open up the possibility of investigating prolargin’s intricate pathologic role and its potential as a marker for diagnosis and prognosis for these difficult fibroproliferative skin disorders.

Aim To investigate the possible association of Toll-like receptor (TLR4) +896 A/G and CD14 −159C/T single nucleotide polymorphisms (SNPs) with the development of atopic dermatitis (AD) in a sample of Egyptian AD cases and to evaluate their correlation with total serum immunoglobulin E (IgE) level and disease severity. Patients and methods This work comprises 100 AD cases in addition to 100 patients similar in age and sex as controls. TLR4 +896 A>G rs 4986790 and CD14–159 C>T rs 2569190 polymorphisms were determined using polymerase chain reaction-restriction fragment length polymorphism. Results TLR4 +896 A/G genotyping, showed a statistically significant higher frequency of AG genotype (30%), AG+GG genotype (33%), and G allele (36%) in AD patients versus controls (2%) (P<0.001), with high risk to develop AD (OR =21.9, 24.1, and 21.7), respectively. CD14–159 C>T rs 2569190 genotyping, showed a higher frequency of CT, TT, and combined CT+TT genotypes in the control group (57%, 27%, 84%), versus AD patients (39%, 20%, 59%), respectively. Also, the T allele showed a statistically significant higher frequency in controls (55.5%) compared with AD patients (39.5%), (P<0.001, 0.002, <0.001, and 0.001), respectively. Still, they are not associated with the clinical features, serum IgE level, and SCORAD in all studied AD patients. Conclusion TLR4 (+896 A>G) rs 4986790 AG, combined AG+GG genotype, in addition to G allelomorph may be considered risky, while CD14 −159 C>T rs 2569190 (CT), (CT+TT) genotype and T allelomorph may be considered safeguarding elements against development of AD in Egyptian cases. Still, neither is associated with the clinical features, serum IgE level, or disease severity.

Background Metabolic syndrome (MetS) is more common comorbidity in psoriasis and a risk factor for cardiovascular disease. Interleukin 38 (IL-38) is an anti-inflammatory cytokine that has a vital role in MetS. Aim This research aimed to identify the possible relationship between plasma IL-38 levels in psoriatic cases and MetS development. Methods This case-control study included 88 adults aged greater than 18 years, divided into four groups of 22: group (1) cases with psoriasis vulgaris only, group (2) cases with psoriasis vulgaris and MetS, group (3) cases with MetS only, and group (4) healthy control subjects. All participants were subjected to full history taking, clinical assessment, laboratory investigation (fasting blood sugar, fasting triglyceride level, high-density lipoprotein), and plasma levels of IL-38 using ELISA kits. Results IL-38 levels were significantly decreased in each of the diseased patients (psoriasis, MetS, or both) than in controls. patients with psoriasis and MetS had the lowest level of IL-38 than those with psoriasis only or MetS only. There was a highly significant difference in the IL-38 levels among the groups (P<0.0001). In patients with psoriasis there was a significantly negative correlation between the PASI score and IL-38 levels. Conclusion The decreased serum level of IL-38 among psoriatic patients with MetS is more than patients with either disease alone due to its role in the pathogenesis of both conditions. Much decrease in its level in psoriatic patients can be an indicator of development of metabolic abnormalities. This opens a new scope in the treatment of both conditions using IL-38.

Becker nevus also known as pigmented hairy epidermal nevus, is a cutaneous hamartoma localized on upper extremities and trunk. It is characterized by a unilateral, hyperpigmented patch with irregular border and hypertrichosis. In most cases, the lesions are more common in males than in females and appear in late childhood or adolescence. The etiology of Becker nevus remains uncertain but it is thought that there is a relationship between androgen metabolism and Becker nevus. There have been rare reports of cases with atypical location such as the face and lower extremities. Here we report a case of a young boy with Becker nevus localized on the left cheek with asymmetrical growth of beard hair. Becker nevus must be kept in mind in the differential diagnosis of hyperpigmented lesions with hypertrichosis which are located on the face.