Background Use of localized microinjection of tranexamic acid (TA) has been studied for the treatment of melasma and was proved to be effective, but transdermal delivery of this agent has not been well studied. The use of Dermaroller may increase the effective delivery of active ingredients in topical mesolightening mixture and TA. Aim The aim of this split-face study was to compare the safety and efficacy of transdermal delivery of TA versus topical mesolightening mixture using the Dermaroller in the treatment of melasma. Patients and methods This split-face study was carried out on 15 patients having melasma. For each patient, the following was done after taking an informed consent: history taking, dermatological examination, Wood’s light examination, Melanin Area and Severity Index (MASI) score calculation, photography, physician’s global assessment by independent investigators, patient’s global evaluation, eight sessions of transdermal delivery of TA and topical mesolightening mixture, with a session every week (mixture of kojic acid 3%, TA 0.01%, azelaic acid 4% (19,20), L-ascorbic acid 1 g, and water for injection), and recording of the adverse effects every session. This was followed by 3 months of follow-up. Results The initial (pre-4) reduction of MASI (after the first four sessions) on the left side (TA treated) was significantly higher than that on the right side. Similarly, the later (four to eight sessions) (upon comparing the second set with the first set of sessions) and overall reduction was higher on the left side compared with that on the right side; however, these differences were not statistically significant in terms of MASI. Conclusion TA and topical mesolightening mixture are individually effective in the treatment of melasma. TA is superior to mesolightening, as well as cost-effective in the treatment of melasma.

Background The active form of vitamin D (1,25 hydroxyvitamin D) mediates the interaction between vitamin D and immune diseases including vitiligo, which was found to be associated with lower 25(OH)D levels.Objective To evaluate the role of vitamin D and interleukin (IL)-17 in vitiligo and its relationship with autoimmune diseases and to assess the therapeutic effect of vitamin D in patients with vitiligo.Patients and methods A total of 44 patients with vitiligo were measured for vitamin D and IL-17. Those with a low level of vitamin D took vitamin D droplet for 3 months and were then re-evaluated with Vitiligo European Task Force score before and after treatment.Results A significant negative correlation was found between vitamin D and IL-17 levels. A statistically significant increase in vitamin D level and decrease in IL-17 level was seen after treatment when compared with before treatment, accompanied by improvement of Vitiligo European Task Force scoring values after treatment.Conclusion The use of systemic vitamin D as a treatment modality for vitiligo can achieve reasonable improvement comparable to traditional modalities.

Background Dermoscopic features of mucous membrane pigmented lesions are not the same as present in the skin. A major esthetic problem for a lot of people is gingival hyperpigmentation. Even though it is not a medical issue, a lot of methods are used in the treatment of this problem.Objective To figure out dermoscopic patterns of benign racial gingival melanin hyperpigmentation and to assess the role of dermoscopic evaluation in its management.Patients and methods A total of 20 patients were included in this study. Their age ranged from 23 to 30 years. They were selected for depigmentation procedures in the esthetic zone using a scalpel blade. Dermoscopic imaging and analysis of the patterns were done for all lesions. Clinical parameters were recorded. Recurrences of pigmentation were evaluated by clinical and dermoscopic examination at 4 weeks, 6 months, and 12 months postoperatively.Results Dermoscopic features of benign racial gingival hyperpigmentation analyzed were dotted-globular pattern, pigment network pattern, fish scale-like pattern, and a hyphal pattern. All patients showed excellent gingival wound-healing response, with no adverse complications, and no repigmentation was observed.Conclusion Dermoscopy is effective in diagnosis and evaluation of management of gingival melanin hyperpigmentation. Surgical gingival depigmentation is effective in esthetic treatment of gingival melanin hyperpigmentation.

Background Demonstration of intercellular deposition of immunoglobulin (Ig)G on the cell surface of keratinocytes by direct immunofluorescence (DIF) of the skin is the gold standard in diagnosis of pemphigus. In the past few years, the intercellular deposition of IgG in the outer root sheath has shown to be useful. Objective The aim was to compare the DIF of hair (plucked anagen and telogen and telogen obtained by combing) with that of skin for diagnosis of patients with pemphigus vulgaris (PV) and those with pemphigus foliaceus (PF). Materials and methods A total of 30 patients [24 with PV and six with PF] with active disease were included. Clinical evaluation (ABASIS score), histopathological examination, and DIF of skin and hair were done. Presence of intercellular deposits of IgG and or C3 in skin and outer root sheath of the hair was considered positive. Results DIF of skin was positive in all patients for IgG and in 25 patients for C3 and also DIF in anagen hair was positive in all patients, whereas in telogen hair, it was positive in 23 patients (17 with PV for both IgG and C3, and six with PF for IgG, and four of them for C3). All patients showed a positive relation between clinical, histopathological, DIF skin, and DIF of anagen hair in both PV and PF. Regarding telogen hair, the same findings was found in all six (100%) patients with PF, but in PV, only 17 (70.83%) patients showed these positive relations, whereas the other seven (29.2%) had positive DIF of both skin and anagen hair only. The sensitivity of hair DIF was 100% for anagen hair and 76.67% for telogen hair in patients with pemphigus. Conclusion Anagen and telogen hair DIF is a simple, noninvasive, and cost-effective procedure and can be used as an additional procedure for diagnosis in patients with PV and PF.

Idiopathic orbital inflammatory syndrome, formerly known as orbital pseudotumor, is a rare benign condition with myriad clinical presentations including periorbital edema, pain, conjunctival chemosis, diplopia, extraocular muscle restriction, and decreased vision. It is a relatively lesser known clinical entity from a dermatological perspective and may present as recurrent periorbital edema as a sole manifestation as in this case, and thus can potentially be mistaken for angioedema. The objective of this case report is to emphasize on the wide range of clinical manifestations and the need for awareness of this entity and thus avoiding its misdiagnosis.

Background Serum levels of squamous cell carcinoma antigen (SCCA) 1 and 2 induced by type 2 cytokines such as interleukin 4 and interleukin 13 are increased in patients with atopic dermatitis (AD).Objective This study aimed to assess and correlate the severity and clinical types of AD by serum level of SCC antigen 1 and SCC antigen 2 in AD patients.Patients and methods Twenty-four AD patients (12 adults and 12 children) and 24 healthy controls were included in this study to assess the SCORAD score and to measure SCCA1 and SCCA2.Results There was a statistically significant difference between the children and adult groups in SCCA1 and SCCA2 with higher levels in adults than children maybe due to the long duration of disease, chronicity, and severity of disease and there was a positive correlation between SCCA1 and SCCA2, and severity of disease.Conclusion Serum levels of SCCA1 and SCCA2 correlate with severity of disease and clinical types and provide its role in the pathogenesis of Atopic Dermatitis. Further studies may evaluate the therapeutic effect of their blockage in the improvement of Atopic Dermatitis.

Juvenile systemic lupus erythematosus is a rare multisystemic autoimmune disorder characterized by several clinical and immunological features. In the present case, a 13-year-old female presented with diffuse nonscarring hair loss at the frontal and vertex of the scalp. The hairs were dry, fragile, and easily detached. She had patches of erythema on the palmar aspects of both hands. She had no other cutaneous, nail, or mucous membrane manifestations. Erythrocyte sedimentation rates were elevated. The titer of antinuclear antibody was positive, and anti-double strand DNA antibody was positive. Otherwise, all laboratory and radiological investigations were normal.

Background Vitiligo is a common skin disease that has been reported to affect ∼1% of the population worldwide. Many patients with vitiligo feel distressed and stigmatized by their condition. Objective The aim was to assess the effect of vitiligo on the patients’ quality of life and to ascertain comorbidity of depression and anxiety associated with the disease using Hamilton rating scale for anxiety and depression. Patients and methods One hundred patients with vitiligo and 50 control participants were subjected to clinical examination with assessment of vitiligo severity by vitiligo area scoring index (VASI) in addition to their assessment by dermatology life quality index (DLQI), Hamilton depression rating scale, and Hamilton anxiety rating scale. Results In this study, there was a significantly higher DLQI score among the study group compared with controls (P Conclusion Vitiligo has a negative effect on patient’s psychological status in terms of anxiety and depression, especially in female patients, patients with increased body surface involvement, and those with lesions on exposed parts of the body.

Background Alopecia areata (AA) is a chronic inflammatory disorder of hair follicle cycling characterized by nonscarring hair loss. Interleukin-18 (IL-18) is a proinflammatory cytokine that was implicated in various inflammatory and autoimmune skin diseases, including AA. IL-2 initiates and develops the immune response through binding to interleukin-2 receptor (IL-2R) on T cells. Levels of soluble IL-2R (sIL-2R) may be estimated as a sign of T-cell activation in serum of patients having many disorders involving aberrant immune activation, including AA.Objective To estimate of the serum levels of IL-18 and sIL-2R as immunological factors in patients with AA and to test the correlation between these serum levels and disease severity.Patients and methods A total of 46 patients with AA and 40 age-matched and sex-matched healthy individuals as controls were included. All participants were subjected to thorough history taking, full general examination, and detailed dermatological examination for diagnosis of cases and determination of extent of the lesions. The severity of AA was graded as mild (three or less patches of alopecia with a widest diameter of 3 cm or less or the disease limited to the eyelashes and eyebrows) or severe (existence of more than three patches of alopecia or a patch >3 cm at the widest diameter or alopecia totalis or alopecia universalis). Estimation of serum levels of IL-18 and sIL-2R was done by enzyme-linked immunosorbent assay.Results Serum IL-18 was significantly higher in patients with AA compared with the controls. Serum sIL-2R was nonsignificantly increased among patients with AA than the controls. Patients with severe disease had significantly higher serum IL-18 and nonsignificantly higher serum sIL-2R compared with patients with mild disease.Conclusion AA is associated with elevation of serum IL-18 and sIL-2R, and their levels increase with the increase in the severity of the disease. The exact role of serum IL-18 and sIL-2R in AA should be investigated in future studies.