Magda Assaf - Academia.edu (original) (raw)

Papers by Magda Assaf

Zagazig university medical journal, Apr 1, 2015

The exact pathogenesis of psoriasis remains unclear. Signal transducer and activator of transcrip... more The exact pathogenesis of psoriasis remains unclear. Signal transducer and activator of transcription-3 (STAT3) is a possible important link between keratinocytes and immunocytes during psoriasis evolution. Aims: To detect the state of STAT3 activation in both lesional and non-lesional skin of patients with psoriasis and to correlate the degree of STAT3 activation with the severity of psoriasis. Methods: The study included (30) psoriasis patients and (30) age and sex matched healthy control subjects. Skin biopsy was taken from a lesional and a non-lesional site for every patient. A single biopsy site was done for every control subject. Immunohistochemical staining using anti-STAT3 antibodies was done. Statistical analysis was performed to detect the relation between the strength of STAT3 staining reaction and PASI (psoriasis area severity index) score. Results: The strength of immune-staining reaction for STAT3 is statistically higher in lesional sites than the non-lesional ones among psoriasis patients. The strength of STAT3 activation is statistically higher in patients with higher PASI scores. Moreover, the non-lesional sites demonstrated a significant STAT3 activation in comparison to the control group. Conclusion: Signal transducer and activator of transcription-3 is upregulated in lesional than non-lesional skin in psoriasis patients and the degree of its activation parallels the PASI score. The non-lesional skin in psoriasis can show STAT3 activation indicating a possible prepsoriasis state.

Syringoma is a benign, eccrine sweat gland tumor. The typical clinical appearance of syringoma is... more Syringoma is a benign, eccrine sweat gland tumor. The typical clinical appearance of syringoma is firm, skin-colored to brown papules on the lower eye lids of middle -aged women. Familial syringoma is rare, but possibly is underestimated in prevalence. Eruptive syringoma, a separate entity, presents mostly in adolescents as clusters of numerous papules on the upper half of the body. Familial eruptive syringoma is a very rare clinical variant with only few reports in world literature. Three sisters and two brothers presented to our Dermatology & Venereology department with disfiguring skin lesions asking for treatment. Their mean age was 27 years. Case 1: A 23 year old female presented with asymptomatic lesions on abdomen, axillae, and neck (fig1)

Journal of the European Academy of Dermatology and Venereology

Effect of melanocyte keratinocyte transplantation procedure, using ablative CO2 laser and followed by NB-UVB phototherapy, on the expression of E-Cadherin and matrix metalloproteinase-2 in acral vitiligo: an immunohistochemical study

Journal of the Egyptian Women's Dermatologic Society

Background Melanocyte keratinocyte transplantation procedure (MKTP) is a multi-procedural interve... more Background Melanocyte keratinocyte transplantation procedure (MKTP) is a multi-procedural intervention that could hypothetically alter the environment surrounding grafted epidermal cells, helping melanocytes’ migration and adherence to keratinocytes in their basal position. Objective To evaluate the effect of MKTP in acral vitiligo skin prepared by total ablative CO2 laser resurfacing and followed by narrow-band ultraviolet B (NB-UVB) phototherapy on matrix metalloproteinase-2 (MMP2) and E-Cadherin expression and the reflection of these changes on repigmentation. Patients and methods Acral lesions in 20 stable nonsegmental vitiligo patients were prepared by full CO2 ablation down to the papillary dermis followed by MKTP and NB-UVB sessions. Two 4 mm punch biopsies were taken: the first at baseline and the second after the onset of repigmentation or after 6 months of phototherapy if no repigmentation occurred. Immunohistochemical staining for evaluation of E-Cadherin and MMP2 expression was performed. Results Eight patients (40%) achieved repigmentation ranging from 10 to 90% with a median of 62.5%. E-Cadherin intensity was significantly increased after treatment (P<00.1). There was also a significant total increase in epidermal (P<0.001) and dermal (P<0.001) MMP2 with diffuse nuclear pattern of staining. In lesions showing repigmentations, the percentage change in dermal MMP2 was significantly higher (P=0.012), while no such difference was present in epidermal MMP2 and E-Cadherin expression. Conclusion MKTP with recipient site prepared by full CO2 laser ablation followed by NB-UVB phototherapy increased the expression of E-Cadherin and MMP2 in acral vitiliginous skin. The increase of dermal MMP2 could play a favorable role in repigmentation.

Atypisches Erythema nodosum leprosum: Diagnostische und therapeutische Aspekte

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2021

Das klassische Erythema nodosum leprosum (ENL) ist klinisch durch plötzliches Auftreten druckempf... more Das klassische Erythema nodosum leprosum (ENL) ist klinisch durch plötzliches Auftreten druckempfindlicher erythematöser Knoten, Papeln und Plaques charakterisiert. Daneben wurden verschiedene atypische Muster, wie pustulöses, bullöses, ulzeriertes, nekrotisches und Sweet‐Syndrom‐artiges ENL beschrieben. Wir geben eine Übersicht bisher dokumentierter Fälle atypischer ENL und gehen dabei auf diagnostische und therapeutische Aspekte dieser selteneren Formen ein. Dazu wurde die medizinische Literatur in der Datenbank PubMed nach allen Fällen atypischer ENL bis zum Jahr 2020 durchsucht. Die Daten von Patienten mit atypischem ENL wurden erfasst und hinsichtlich epidemiologischer, klinisch‐histologischer und therapeutischer Aspekte analysiert. Die fünf hauptsächlich beschriebenen klinischen Formen des atypischen ENL sind vesikulär‐bullöse (46 % der Patienten), ulzerös‐nekrotische (41 %), Erythema‐multiforme‐artige (28 %), Sweet‐Syndrom‐artige (11 %) und pustulöse Läsionen (9 %). Bei allen Patienten wurden die Hautveränderungen von Fieber und Allgemeinsymptomen begleitet. Die meisten Patienten wurden oral mit Steroiden und Thalidomid therapiert. Dermatologen und Pathologen sollten die klinische Variabilität des ENL kennen, um Fehldiagnosen und verzögerte Behandlungen zu vermeiden. Die frühzeitige Erkennung kann die Kontrolle der Krankheitsprogression unterstützen und die Patienten vor weiteren Komplikationen schützen.

Zagazig University Medical Journal, 2017

Background: Vitiligo is an acquired depigmentation of skin and mucous membranes. Many theories ex... more Background: Vitiligo is an acquired depigmentation of skin and mucous membranes. Many theories explain its pathogenesis. Keratinocyte dysfunction in vitiligo may be a possible link between the various pathological changes occurring in vitiliginous skin. Keratinocytes produce several mediators, cytokines and growth factors that support or inhibit the growth and/or melanization of surrounding melanocytes. Basic fibroblastic growth factor (bFGF) is proposed to be a paracrine mitogen for human melanocytes.Tumor necrosis factor α (TNFα), is suggested to be as an early paracrine inhibitors of melanocyte.In this study,we evaluated the keratinocyte 's TNFα and b-FGF in vitiligo patients before and after treatment with melanocyte transfer by sandpaper technique. Methods: This study was carried out on two groups, 17 vitiligo patients ,and 17 healthy persons as control. Skin biopsies were taken from the patients before and after treatment with melanocyte transfer from the lesional and perilesional skin .Skin biopsies were taken also from skin of the normal control individuals. These biopsies were prepared for histological evaluation and immunohistochemical(IHC) staining forTNFα b-FGF.Evaluation of IHC slides was done by a subjective method(i.e. eyes of an expert pathologist) and an objective method(Image analyser) before and after 3 months of treatment with melanocyte transfer by sandpaper technique. Results: There was a statistically highly significant increase of b-FGF staining in lesional and perilesional skin of the patient's group in comparison with their staining in normal control. Regarding TNFα staining of lesional and perilesional skin,there were a statistically significant increase and a statistically highly significant increase respectively with its staining in the normal control. The clinical results of the melanocyte transfer by sandpaper technique,after 3 months of follow up, were as follow,47.1%of patients showed mild improvement,35.3%of patients showed good improvement,and 17.6% of patients showed no improvement.TNFα staining of lesional and perilesional skin,evaluated subjectively, showed a statistically highly significant increase after treatment with melanocyte transfer in comparison with their staining before treatment.Regarding b-FGF staining ,subjectively evaluated,there was a statistically highly significant increase after treatment in lesional skin and a statistically highly significant decrease after treatment in perilesional skin.Using image analyser as an objective method of evaluation,there was a statistically significant increase of TNFα staining of lesional and perilesional skin after melanocyte transfer in comparison with their staining before treatment.On comparing b-FGF stainings after treatment with their corresponders before treatment by image analyser,there was a statistically significant decrease of b-FGF staining in lesional skin after treatment and there was no significant change in perilesional skin before and after treatment. Conclusion:change in the microenvironment of vitiliginous skin is evident .These changes in the cytokines,growth factors affecting the melanocytes may be a joint step in the pathogenesis of vitiligo between an intial step (supposed to be oxidative stress and apoptosis in keratinocytes) and an eventual step marked by destruction of the melanocytes.

Zagazig university medical journal, 2015

Background: Emerging evidence is implicating stem cells in the pathogenesis of different cutaneou... more Background: Emerging evidence is implicating stem cells in the pathogenesis of different cutaneous neoplasms. The immunohistochemical use of stem cell markers has facilitated stem cell identification. Aim: This study was designed to determine the expression of stem cell markers ck19 and p63 in BCC and their link to proliferation marker ki67. Subjects: Thirty patients with BCC were the subjects of this study. They were classified according to the hitopathological types into 12 patients solid circumscribed type, 3 patients solid infiltrative type, 8 patients mixed type, 3 patients superficial type, 2 patients adenoid type, one patient morpheaform type and one patient basosquamous type. Methods: The thirty paraffin-embedded BCC skin lesions were examined histopathologically to confirm the diagnosis and to determine histological type of the tumour and also, were examined immunohistchemically for CK19, p63 and Ki-67. Results: Cytokeratin 19 immunoreactivity was observed in 30% (9 of 30) ...

A Comparative Study Between the Fractional CO2 Laser and Carboxytherapy in Treatment of Striae Distensae: A Clinical and Histopathological Study

Zagazig university medical journal, 2021

Morphometric study of lymphangiogenesis in different lesions of psoriasis vulgaris with correlation to disease activity

Journal of Cosmetic Dermatology, 2021

BACKGROUND AND OBJECTIVES In the last decades, attention to the role of lymphangiogenesis in psor... more BACKGROUND AND OBJECTIVES In the last decades, attention to the role of lymphangiogenesis in psoriasis has been paid. Our study was conducted to evaluate podoplanin-stained lymphatic vessels and the level of lymphangiogenesis in papular psoriatic lesions and psoriatic plaques and ascertain if podoplanin provides any additional prognostic information. MATERIALS AND METHODS Number of lymphatic vessels and total lymphatic vessel area were morphometrically analyzed in podoplanin-stained sections, using anti-D2-40, together with the immunohistochemical study of epidermal Ki-67 in psoriasis vulgaris (n = 20) (papules = 7 and plaques = 13) and control skin specimens (n = 20). RESULTS The number of lymphatic vessels and total lymphatic vessel area were higher in psoriasis cases compared with normal skin (p = 0.01, p = 0.01 respectively). In psoriatic plaques, the number of lymphatic vessels, total lymphatic vessel area, and epidermal Ki-67 immunoreactivity were higher than in papular lesions (p = 0.002, p = 0.008, and p = 0.01, respectively). CONCLUSIONS Psoriasis vulgaris is found to be a lymphangiogenesis-dependent disease, and the lymphatic vascular network is in remodeling and expanding process. Podoplanin may be implicated in the pathogenesis of psoriasis and could be used as a prognostic biomarker for disease severity and progression.

Asian Pacific journal of cancer prevention : APJCP, Jan 24, 2018

Background: Endometrial carcinomas are common gynecologic malignancies worldwide. In Egypt they r... more Background: Endometrial carcinomas are common gynecologic malignancies worldwide. In Egypt they represent 2.6 %. We evaluated the role of morphometry and MMP-9 immunohistochemical expression to differentiate atypical endometrial hyperplasia from low grade endometrial adenocarcinoma. Methods: 60 cases of endometrial lesions that included 25 cases of complex endometrial hyperplasia with atypia, 25 cases of low grade endometrioid adenocarcinoma, in addition to 10 cases of proliferative endometrium as a control group. Morphometric measurements and D-score were evaluated. MMP9 was performed using streptavidin –biotin immunoperoxidase system. Results: D score was more than 1 in 100% of cases of proliferative endometrium. In atypical hyperplasia 28 % of cases had a D-score more than 1, 44% less than 0 and 28% of cases had a D score between 0 and 1 with uncertain prognosis. All carcinoma cases had D-score less than 0. MMP9 was positive in all cases of the study but differ in its degree of e...

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2018

Background and objectives: The exact pathogenesis of psoriasis is still unclear. SLURP1 is vital ... more Background and objectives: The exact pathogenesis of psoriasis is still unclear. SLURP1 is vital for the normal differentiation of keratinocytes, and could therefore be involved in psoriasis. In this study we investigated the immunohistochemical staining reaction of SLURP1 in psoriasis vulgaris patients and its possible relation to disease pathogenesis. Patients and Methods: 20 patients with psoriasis vulgaris, 20 patients with psoriasiform dermatitis and 20 normal skin samples were studied. Psoriasis severity was measured with a combination of PASI and DLQI scores. Lesional and non-lesional sites were biopsied for each psoriasis patient. A single biopsy sample was taken for cases with psoriasiform dermatitis and for controls. All sections were immunostained for SLURP1 according to the manufacturer's protocol. Results: Significant differences were noted in SLURP1 immunostaining between lesional and non-lesional biopsies of psoriasis patients and between lesional biopsies of psoriasis patients and lesional sites of psoriasiform dermatitis. However, the differences between non-lesional biopsies of psoriasis patients and normal controls were not significant. Furthermore, the grading of SLURP1 immunostaining paralleled the degree of psoriasis severity. Conclusions: SLURP1 immunostaining is significantly increased in lesional skin of psoriasis vulgaris and not in psoriasiform dermatitis, which demonstrates the role of SLURP1 in the pathogenesis of psoriasis. SLURP1 could be used as a biological marker for psoriasis severity, and this hypothesis warrants further investigation.

International Journal of Advanced Research, 2016

Background: Triple negative breast cancer (TNBC) lacks the benefit of a specific target therapy, ... more Background: Triple negative breast cancer (TNBC) lacks the benefit of a specific target therapy, so identification and evaluation of new therapeutic agents is a high priority. Enhancer of zeste homolog 2 (EZH2) is a putative stem cell marker involved in cell cycle regulation and was linked to aggressive breast cancer. Cytokeratin 5/6 (CK5/6) is a basal cytokeratin used to define basal like breast cancer. The aim: The aim of this work is to investigate the expression of enhancer of EZH2 and CK5/6 in triple negative in comparison with non-triple negative breast cancer using immunohistochemistry. Methods: EZH2 and CK5/6 were retrospectively analyzed by immunohistochemistry in 44 paraffin-embedded specimens of breast cancer patients (20 cases of triple negative and 24 of non-triple negative breast cancer). Results: TNBC was significantly associated with higher grade (p=0.001), high tumor budding (p=0.029), syncytial growth pattern (p=0.002), lymphovascular invasion (p=.0012), geographic necrosis (p=0.003) and lymphocytic infiltrate (p=.001). EZH2 expression is significantly associated with TNBC in comparison with non-TNBC (P=0.001). CK5/6 expression was observed in 75% of cases of TNBC in comparison to 30% of non-TNBC with a statistically significant relation between CK5/6 expression and TNBC (P=0.004). Among cases of TNBC, CK5/6 expression was significantly associated with lymph node metastasis and high tumor budding. Triple negative breast cancer has distinctive but not pathognomonic morphological features. EZH2 was highly expressed in TNBC in comparison with non-TNBC and this may explain the aggressiveness of triple negative breast cancer. Basal breast cancer, identified by CK5/6 expression, showed characteristic features in the form of high tumor budding, marked lymphocytic infiltrate and higher incidence of lymph node metastasis. This finding indicates that CK5/6 positive expression in TNBC is associated with poor prognostic characteristics.

Journal of the Egyptian Womenʼs Dermatologic Society, 2016

Involvement of eccrine sweat glands in adverse cutaneous drug reactions (ACDRs) has not received ... more Involvement of eccrine sweat glands in adverse cutaneous drug reactions (ACDRs) has not received sufficient interest. To examine histopathological changes in eccrine sweat glands in ACDRs. Forty ACDR cases were recruited. Lesional and nonlesional biopsies underwent thorough histopathological evaluation of the eccrine apparatus. The eccrine apparatus was involved in 97.5% of lesional skin biopsies, secretory coils most frequently, and in 42.1% of apparently normal skin biopsies, and the difference was statistically significant (Po0.05). The most frequently encountered changes in lesional skin included acrosyringial necrosis, intraductal inflammatory cell infiltrate, and hydropic degeneration of the secretory coils. The invariable involvement of the eccrine sweat apparatus in ACDRs appears to be largely secondary to different mediators of the inflammatory process rather than events primarily and directly caused by the inciting drugs.

Generalized eruptive keratoacanthoma: proposed diagnostic criteria and therapeutic evaluation

Journal of the European Academy of Dermatology and Venereology, 2013

Generalized eruptive keratoacanthoma (GEKA) of Grzybowski is a sporadically occurring, extremely ... more Generalized eruptive keratoacanthoma (GEKA) of Grzybowski is a sporadically occurring, extremely rare variant of keratoacanthoma characterized clinically by severely pruritic, generalized eruption of numerous small follicular papules, often with a central keratotic plug, and histologically by typical features of solitary keratoacanthoma. Despite the continuous addition of new case reports, no definite diagnostic criteria have been established, and an optimum treatment is not yet determined. Herein, we review the different aspects of this rare entity, including pathogenesis, clinical and histopathological features, differential diagnosis, course and prognosis. Different therapeutic approaches and their impact on the course and prognosis of the disease are also evaluated and presented. We propose two sets of diagnostic criteria to define the disease more precisely and to avoid overlapping and confusion with other types of multiple keratoacanthoma. The first set comprises constant clin...

Primary cutaneous aggressive epidermotropic CD8+ cytotoxic T-cell lymphoma clinically simulating pyoderma gangrenosum

Clinical and Experimental Dermatology, 2009

Primary cutaneous aggressive epidermotropic CD8+ T-cell lymphoma is a rare, recently recognized d... more Primary cutaneous aggressive epidermotropic CD8+ T-cell lymphoma is a rare, recently recognized disease. We report a case presenting with a clinical resemblance to pyoderma gangrenosum (PG), and a particularly aggressive clinical course. A 19-year-old Chinese woman presented with a 1-year history of painful papular lesions on the shoulders and back, which rapidly became necrotic, progressed to enlarging ulcers and spread to involve the face, limbs and breasts. She also had an intermittent fever. Some old lesions resolved but new lesions continued to develop, with extensive ulceration and pain. Despite treatment with prednisone, the lesions continued to increase in number and size. The patient had previously been healthy. On examination, disseminated well-circumscribed ulcers, measuring 10–100 mm in diameter, some of which were deep with a purulent base and dusky-red, raised, and undermined borders, were seen on the breasts and extensor surface of limbs, along with multiple violaceous papules (Fig. 1). Histopathological examination revealed focal epidermotropism and nodular infiltration of medium to large, pleomorphic lymphoid cells in the dermis and the upper portion of the subcutaneous fat. Angiocentric infiltration was prominent, but there was no angiodestruction. Rimming of fat cells by the atypical infiltrate was not evident. Furthermore, a small number of eosinophils were also present. Immunostaining performed on paraffin wax-embedded sections showed that most of the atypical lymphocytes expressed CD3, CD8, CD43, T-cell receptor-b, and T-cell intracellular antigen 1, and were negative for CD4, CD45RO, CD20, CD30, CD5, CD56 and granzyme B. (Fig. 2a–d) In addition, some atypical cells (50%) were positive for Ki-67 (Fig. 2e). In situ hybridization for the detection of Epstein–Barr virus-encoded RNAs (EBERs) was negative. Routine laboratory studies were unremarkable. No atypical lymphocytes were found in the peripheral blood. Examination of a bone-marrow biopsy revealed involvement by T-cell lymphoma. Computed tomography revealed no lymphadenopathy or any visceral involvement. Analysis of the T-cell receptor c gene using PCR found clonal rearrangement. Based on these findings, a diagnosis of primary cutaneous epidermotropic CD8+ cytotoxic T-cell lymphoma was

Iconography : Hair loss in pityriasis versicolor lesions: A descriptive clinicopathological study

Elsevier Masson, Jun 14, 2013

Evaluation of needling/microneedling as an adjunct to phototherapy in the treatment of stable acral vitiligo: a comparative clinical and immunohistochemical study

Journal of Dermatological Treatment

OBJECTIVES To evaluate the efficacy and tolerability of needling/microneedling as an adjunct to N... more OBJECTIVES To evaluate the efficacy and tolerability of needling/microneedling as an adjunct to NB-UVB phototherapy in the treatment of stable refractory patches of acral vitiligo, based upon clinical and immunohistochemical assessment of melanocyte count and distribution in response to needling/microneedling. MATERIALS AND METHODS Twenty patients with stable acral vitiligo (≥ 2 patches) were enrolled. One of the two index patches was randomized to receive needling or microneedling in conjunction with NB-UVB. Patients received phototherapy sessions 3 times weekly, while needling was carried out on biweekly basis for 6 months. Assessment was done clinically using point counting method, VESTA, and global patients' satisfaction, and immunohistochemically by quantitative assessment of melanocyte count by Melan-A. RESULTS No statistically significant difference was observed between NB-UVB monotherapy and either of the combined therapy regimens as regards the mean percentage change in vitiligo surface area (p = 0.451), mean change in absolute melanocyte count from baseline (p = 0.589), and mean VESTA (p = 0.916). Patches subjected to adjuvant microneedling/needling were afflicted by koebnerization in 50% and 20% of cases, respectively. CONCLUSION Neither microneedling nor needling appear to confer an added therapeutic value to NB-UVB phototherapy in the treatment of stable acral vitiligo. Moreover, both carry the risk of koebnerization.

Expression of Discoidin Domain Receptor 2 in Colorectal Carcinoma: An Immunohistochemical Study

Zagazig University Medical Journal, 2021

Journal of Clinical & Experimental Dermatology Research, 2015

Comedonal Darier's disease is an extremely rare variant demonstrating unique clinical and histopa... more Comedonal Darier's disease is an extremely rare variant demonstrating unique clinical and histopathological findings; however, it is commonly misdiagnosed. Herein, we report a case of comedonal Darier's disease and discuss its different diagnostic and therapeutic challenges.

Zagazig university medical journal, 2015

Background: Primary cicatricial alopecia )PCA) is a scarring disease. Although the scarring and d... more Background: Primary cicatricial alopecia )PCA) is a scarring disease. Although the scarring and deformity may affect any part of the body, such changes have been reported to be most obvious on the face and scalp. The pathogenesis behind this scarring process is not well understood. Once lesions have scarred, recurrent disease tends to occur at the edge of the scarred lesions but not within them. The fact that inflammation in PCA generally involves the bulge area of the hair follicles raises the possibility that damage to the stem cells of the bulge region may be one process leading to the permanent loss of hair follicles. Objective : The aim of this study was to investigate the role of the epithelial hair follicle stem cells which reside in the bulge region in the scarring process in PCA. Methods : We studied the reactivity to Mouse monoclonal antibody, Keratin 15 Ab-1 (LHK15), which recognizes cytokeratin (CK 15) and preferentially immunostains epithelial hair follicle stem cells w...

Zagazig university medical journal, Apr 1, 2015

The exact pathogenesis of psoriasis remains unclear. Signal transducer and activator of transcrip... more The exact pathogenesis of psoriasis remains unclear. Signal transducer and activator of transcription-3 (STAT3) is a possible important link between keratinocytes and immunocytes during psoriasis evolution. Aims: To detect the state of STAT3 activation in both lesional and non-lesional skin of patients with psoriasis and to correlate the degree of STAT3 activation with the severity of psoriasis. Methods: The study included (30) psoriasis patients and (30) age and sex matched healthy control subjects. Skin biopsy was taken from a lesional and a non-lesional site for every patient. A single biopsy site was done for every control subject. Immunohistochemical staining using anti-STAT3 antibodies was done. Statistical analysis was performed to detect the relation between the strength of STAT3 staining reaction and PASI (psoriasis area severity index) score. Results: The strength of immune-staining reaction for STAT3 is statistically higher in lesional sites than the non-lesional ones among psoriasis patients. The strength of STAT3 activation is statistically higher in patients with higher PASI scores. Moreover, the non-lesional sites demonstrated a significant STAT3 activation in comparison to the control group. Conclusion: Signal transducer and activator of transcription-3 is upregulated in lesional than non-lesional skin in psoriasis patients and the degree of its activation parallels the PASI score. The non-lesional skin in psoriasis can show STAT3 activation indicating a possible prepsoriasis state.

Syringoma is a benign, eccrine sweat gland tumor. The typical clinical appearance of syringoma is... more Syringoma is a benign, eccrine sweat gland tumor. The typical clinical appearance of syringoma is firm, skin-colored to brown papules on the lower eye lids of middle -aged women. Familial syringoma is rare, but possibly is underestimated in prevalence. Eruptive syringoma, a separate entity, presents mostly in adolescents as clusters of numerous papules on the upper half of the body. Familial eruptive syringoma is a very rare clinical variant with only few reports in world literature. Three sisters and two brothers presented to our Dermatology & Venereology department with disfiguring skin lesions asking for treatment. Their mean age was 27 years. Case 1: A 23 year old female presented with asymptomatic lesions on abdomen, axillae, and neck (fig1)

Journal of the European Academy of Dermatology and Venereology

Effect of melanocyte keratinocyte transplantation procedure, using ablative CO2 laser and followed by NB-UVB phototherapy, on the expression of E-Cadherin and matrix metalloproteinase-2 in acral vitiligo: an immunohistochemical study

Journal of the Egyptian Women's Dermatologic Society

Background Melanocyte keratinocyte transplantation procedure (MKTP) is a multi-procedural interve... more Background Melanocyte keratinocyte transplantation procedure (MKTP) is a multi-procedural intervention that could hypothetically alter the environment surrounding grafted epidermal cells, helping melanocytes’ migration and adherence to keratinocytes in their basal position. Objective To evaluate the effect of MKTP in acral vitiligo skin prepared by total ablative CO2 laser resurfacing and followed by narrow-band ultraviolet B (NB-UVB) phototherapy on matrix metalloproteinase-2 (MMP2) and E-Cadherin expression and the reflection of these changes on repigmentation. Patients and methods Acral lesions in 20 stable nonsegmental vitiligo patients were prepared by full CO2 ablation down to the papillary dermis followed by MKTP and NB-UVB sessions. Two 4 mm punch biopsies were taken: the first at baseline and the second after the onset of repigmentation or after 6 months of phototherapy if no repigmentation occurred. Immunohistochemical staining for evaluation of E-Cadherin and MMP2 expression was performed. Results Eight patients (40%) achieved repigmentation ranging from 10 to 90% with a median of 62.5%. E-Cadherin intensity was significantly increased after treatment (P<00.1). There was also a significant total increase in epidermal (P<0.001) and dermal (P<0.001) MMP2 with diffuse nuclear pattern of staining. In lesions showing repigmentations, the percentage change in dermal MMP2 was significantly higher (P=0.012), while no such difference was present in epidermal MMP2 and E-Cadherin expression. Conclusion MKTP with recipient site prepared by full CO2 laser ablation followed by NB-UVB phototherapy increased the expression of E-Cadherin and MMP2 in acral vitiliginous skin. The increase of dermal MMP2 could play a favorable role in repigmentation.

Atypisches Erythema nodosum leprosum: Diagnostische und therapeutische Aspekte

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2021

Das klassische Erythema nodosum leprosum (ENL) ist klinisch durch plötzliches Auftreten druckempf... more Das klassische Erythema nodosum leprosum (ENL) ist klinisch durch plötzliches Auftreten druckempfindlicher erythematöser Knoten, Papeln und Plaques charakterisiert. Daneben wurden verschiedene atypische Muster, wie pustulöses, bullöses, ulzeriertes, nekrotisches und Sweet‐Syndrom‐artiges ENL beschrieben. Wir geben eine Übersicht bisher dokumentierter Fälle atypischer ENL und gehen dabei auf diagnostische und therapeutische Aspekte dieser selteneren Formen ein. Dazu wurde die medizinische Literatur in der Datenbank PubMed nach allen Fällen atypischer ENL bis zum Jahr 2020 durchsucht. Die Daten von Patienten mit atypischem ENL wurden erfasst und hinsichtlich epidemiologischer, klinisch‐histologischer und therapeutischer Aspekte analysiert. Die fünf hauptsächlich beschriebenen klinischen Formen des atypischen ENL sind vesikulär‐bullöse (46 % der Patienten), ulzerös‐nekrotische (41 %), Erythema‐multiforme‐artige (28 %), Sweet‐Syndrom‐artige (11 %) und pustulöse Läsionen (9 %). Bei allen Patienten wurden die Hautveränderungen von Fieber und Allgemeinsymptomen begleitet. Die meisten Patienten wurden oral mit Steroiden und Thalidomid therapiert. Dermatologen und Pathologen sollten die klinische Variabilität des ENL kennen, um Fehldiagnosen und verzögerte Behandlungen zu vermeiden. Die frühzeitige Erkennung kann die Kontrolle der Krankheitsprogression unterstützen und die Patienten vor weiteren Komplikationen schützen.

Zagazig University Medical Journal, 2017

Background: Vitiligo is an acquired depigmentation of skin and mucous membranes. Many theories ex... more Background: Vitiligo is an acquired depigmentation of skin and mucous membranes. Many theories explain its pathogenesis. Keratinocyte dysfunction in vitiligo may be a possible link between the various pathological changes occurring in vitiliginous skin. Keratinocytes produce several mediators, cytokines and growth factors that support or inhibit the growth and/or melanization of surrounding melanocytes. Basic fibroblastic growth factor (bFGF) is proposed to be a paracrine mitogen for human melanocytes.Tumor necrosis factor α (TNFα), is suggested to be as an early paracrine inhibitors of melanocyte.In this study,we evaluated the keratinocyte 's TNFα and b-FGF in vitiligo patients before and after treatment with melanocyte transfer by sandpaper technique. Methods: This study was carried out on two groups, 17 vitiligo patients ,and 17 healthy persons as control. Skin biopsies were taken from the patients before and after treatment with melanocyte transfer from the lesional and perilesional skin .Skin biopsies were taken also from skin of the normal control individuals. These biopsies were prepared for histological evaluation and immunohistochemical(IHC) staining forTNFα b-FGF.Evaluation of IHC slides was done by a subjective method(i.e. eyes of an expert pathologist) and an objective method(Image analyser) before and after 3 months of treatment with melanocyte transfer by sandpaper technique. Results: There was a statistically highly significant increase of b-FGF staining in lesional and perilesional skin of the patient's group in comparison with their staining in normal control. Regarding TNFα staining of lesional and perilesional skin,there were a statistically significant increase and a statistically highly significant increase respectively with its staining in the normal control. The clinical results of the melanocyte transfer by sandpaper technique,after 3 months of follow up, were as follow,47.1%of patients showed mild improvement,35.3%of patients showed good improvement,and 17.6% of patients showed no improvement.TNFα staining of lesional and perilesional skin,evaluated subjectively, showed a statistically highly significant increase after treatment with melanocyte transfer in comparison with their staining before treatment.Regarding b-FGF staining ,subjectively evaluated,there was a statistically highly significant increase after treatment in lesional skin and a statistically highly significant decrease after treatment in perilesional skin.Using image analyser as an objective method of evaluation,there was a statistically significant increase of TNFα staining of lesional and perilesional skin after melanocyte transfer in comparison with their staining before treatment.On comparing b-FGF stainings after treatment with their corresponders before treatment by image analyser,there was a statistically significant decrease of b-FGF staining in lesional skin after treatment and there was no significant change in perilesional skin before and after treatment. Conclusion:change in the microenvironment of vitiliginous skin is evident .These changes in the cytokines,growth factors affecting the melanocytes may be a joint step in the pathogenesis of vitiligo between an intial step (supposed to be oxidative stress and apoptosis in keratinocytes) and an eventual step marked by destruction of the melanocytes.

Zagazig university medical journal, 2015

Background: Emerging evidence is implicating stem cells in the pathogenesis of different cutaneou... more Background: Emerging evidence is implicating stem cells in the pathogenesis of different cutaneous neoplasms. The immunohistochemical use of stem cell markers has facilitated stem cell identification. Aim: This study was designed to determine the expression of stem cell markers ck19 and p63 in BCC and their link to proliferation marker ki67. Subjects: Thirty patients with BCC were the subjects of this study. They were classified according to the hitopathological types into 12 patients solid circumscribed type, 3 patients solid infiltrative type, 8 patients mixed type, 3 patients superficial type, 2 patients adenoid type, one patient morpheaform type and one patient basosquamous type. Methods: The thirty paraffin-embedded BCC skin lesions were examined histopathologically to confirm the diagnosis and to determine histological type of the tumour and also, were examined immunohistchemically for CK19, p63 and Ki-67. Results: Cytokeratin 19 immunoreactivity was observed in 30% (9 of 30) ...

A Comparative Study Between the Fractional CO2 Laser and Carboxytherapy in Treatment of Striae Distensae: A Clinical and Histopathological Study

Zagazig university medical journal, 2021

Morphometric study of lymphangiogenesis in different lesions of psoriasis vulgaris with correlation to disease activity

Journal of Cosmetic Dermatology, 2021

BACKGROUND AND OBJECTIVES In the last decades, attention to the role of lymphangiogenesis in psor... more BACKGROUND AND OBJECTIVES In the last decades, attention to the role of lymphangiogenesis in psoriasis has been paid. Our study was conducted to evaluate podoplanin-stained lymphatic vessels and the level of lymphangiogenesis in papular psoriatic lesions and psoriatic plaques and ascertain if podoplanin provides any additional prognostic information. MATERIALS AND METHODS Number of lymphatic vessels and total lymphatic vessel area were morphometrically analyzed in podoplanin-stained sections, using anti-D2-40, together with the immunohistochemical study of epidermal Ki-67 in psoriasis vulgaris (n = 20) (papules = 7 and plaques = 13) and control skin specimens (n = 20). RESULTS The number of lymphatic vessels and total lymphatic vessel area were higher in psoriasis cases compared with normal skin (p = 0.01, p = 0.01 respectively). In psoriatic plaques, the number of lymphatic vessels, total lymphatic vessel area, and epidermal Ki-67 immunoreactivity were higher than in papular lesions (p = 0.002, p = 0.008, and p = 0.01, respectively). CONCLUSIONS Psoriasis vulgaris is found to be a lymphangiogenesis-dependent disease, and the lymphatic vascular network is in remodeling and expanding process. Podoplanin may be implicated in the pathogenesis of psoriasis and could be used as a prognostic biomarker for disease severity and progression.

Asian Pacific journal of cancer prevention : APJCP, Jan 24, 2018

Background: Endometrial carcinomas are common gynecologic malignancies worldwide. In Egypt they r... more Background: Endometrial carcinomas are common gynecologic malignancies worldwide. In Egypt they represent 2.6 %. We evaluated the role of morphometry and MMP-9 immunohistochemical expression to differentiate atypical endometrial hyperplasia from low grade endometrial adenocarcinoma. Methods: 60 cases of endometrial lesions that included 25 cases of complex endometrial hyperplasia with atypia, 25 cases of low grade endometrioid adenocarcinoma, in addition to 10 cases of proliferative endometrium as a control group. Morphometric measurements and D-score were evaluated. MMP9 was performed using streptavidin –biotin immunoperoxidase system. Results: D score was more than 1 in 100% of cases of proliferative endometrium. In atypical hyperplasia 28 % of cases had a D-score more than 1, 44% less than 0 and 28% of cases had a D score between 0 and 1 with uncertain prognosis. All carcinoma cases had D-score less than 0. MMP9 was positive in all cases of the study but differ in its degree of e...

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2018

Background and objectives: The exact pathogenesis of psoriasis is still unclear. SLURP1 is vital ... more Background and objectives: The exact pathogenesis of psoriasis is still unclear. SLURP1 is vital for the normal differentiation of keratinocytes, and could therefore be involved in psoriasis. In this study we investigated the immunohistochemical staining reaction of SLURP1 in psoriasis vulgaris patients and its possible relation to disease pathogenesis. Patients and Methods: 20 patients with psoriasis vulgaris, 20 patients with psoriasiform dermatitis and 20 normal skin samples were studied. Psoriasis severity was measured with a combination of PASI and DLQI scores. Lesional and non-lesional sites were biopsied for each psoriasis patient. A single biopsy sample was taken for cases with psoriasiform dermatitis and for controls. All sections were immunostained for SLURP1 according to the manufacturer's protocol. Results: Significant differences were noted in SLURP1 immunostaining between lesional and non-lesional biopsies of psoriasis patients and between lesional biopsies of psoriasis patients and lesional sites of psoriasiform dermatitis. However, the differences between non-lesional biopsies of psoriasis patients and normal controls were not significant. Furthermore, the grading of SLURP1 immunostaining paralleled the degree of psoriasis severity. Conclusions: SLURP1 immunostaining is significantly increased in lesional skin of psoriasis vulgaris and not in psoriasiform dermatitis, which demonstrates the role of SLURP1 in the pathogenesis of psoriasis. SLURP1 could be used as a biological marker for psoriasis severity, and this hypothesis warrants further investigation.

International Journal of Advanced Research, 2016

Background: Triple negative breast cancer (TNBC) lacks the benefit of a specific target therapy, ... more Background: Triple negative breast cancer (TNBC) lacks the benefit of a specific target therapy, so identification and evaluation of new therapeutic agents is a high priority. Enhancer of zeste homolog 2 (EZH2) is a putative stem cell marker involved in cell cycle regulation and was linked to aggressive breast cancer. Cytokeratin 5/6 (CK5/6) is a basal cytokeratin used to define basal like breast cancer. The aim: The aim of this work is to investigate the expression of enhancer of EZH2 and CK5/6 in triple negative in comparison with non-triple negative breast cancer using immunohistochemistry. Methods: EZH2 and CK5/6 were retrospectively analyzed by immunohistochemistry in 44 paraffin-embedded specimens of breast cancer patients (20 cases of triple negative and 24 of non-triple negative breast cancer). Results: TNBC was significantly associated with higher grade (p=0.001), high tumor budding (p=0.029), syncytial growth pattern (p=0.002), lymphovascular invasion (p=.0012), geographic necrosis (p=0.003) and lymphocytic infiltrate (p=.001). EZH2 expression is significantly associated with TNBC in comparison with non-TNBC (P=0.001). CK5/6 expression was observed in 75% of cases of TNBC in comparison to 30% of non-TNBC with a statistically significant relation between CK5/6 expression and TNBC (P=0.004). Among cases of TNBC, CK5/6 expression was significantly associated with lymph node metastasis and high tumor budding. Triple negative breast cancer has distinctive but not pathognomonic morphological features. EZH2 was highly expressed in TNBC in comparison with non-TNBC and this may explain the aggressiveness of triple negative breast cancer. Basal breast cancer, identified by CK5/6 expression, showed characteristic features in the form of high tumor budding, marked lymphocytic infiltrate and higher incidence of lymph node metastasis. This finding indicates that CK5/6 positive expression in TNBC is associated with poor prognostic characteristics.

Journal of the Egyptian Womenʼs Dermatologic Society, 2016

Involvement of eccrine sweat glands in adverse cutaneous drug reactions (ACDRs) has not received ... more Involvement of eccrine sweat glands in adverse cutaneous drug reactions (ACDRs) has not received sufficient interest. To examine histopathological changes in eccrine sweat glands in ACDRs. Forty ACDR cases were recruited. Lesional and nonlesional biopsies underwent thorough histopathological evaluation of the eccrine apparatus. The eccrine apparatus was involved in 97.5% of lesional skin biopsies, secretory coils most frequently, and in 42.1% of apparently normal skin biopsies, and the difference was statistically significant (Po0.05). The most frequently encountered changes in lesional skin included acrosyringial necrosis, intraductal inflammatory cell infiltrate, and hydropic degeneration of the secretory coils. The invariable involvement of the eccrine sweat apparatus in ACDRs appears to be largely secondary to different mediators of the inflammatory process rather than events primarily and directly caused by the inciting drugs.

Generalized eruptive keratoacanthoma: proposed diagnostic criteria and therapeutic evaluation

Journal of the European Academy of Dermatology and Venereology, 2013

Generalized eruptive keratoacanthoma (GEKA) of Grzybowski is a sporadically occurring, extremely ... more Generalized eruptive keratoacanthoma (GEKA) of Grzybowski is a sporadically occurring, extremely rare variant of keratoacanthoma characterized clinically by severely pruritic, generalized eruption of numerous small follicular papules, often with a central keratotic plug, and histologically by typical features of solitary keratoacanthoma. Despite the continuous addition of new case reports, no definite diagnostic criteria have been established, and an optimum treatment is not yet determined. Herein, we review the different aspects of this rare entity, including pathogenesis, clinical and histopathological features, differential diagnosis, course and prognosis. Different therapeutic approaches and their impact on the course and prognosis of the disease are also evaluated and presented. We propose two sets of diagnostic criteria to define the disease more precisely and to avoid overlapping and confusion with other types of multiple keratoacanthoma. The first set comprises constant clin...

Primary cutaneous aggressive epidermotropic CD8+ cytotoxic T-cell lymphoma clinically simulating pyoderma gangrenosum

Clinical and Experimental Dermatology, 2009

Primary cutaneous aggressive epidermotropic CD8+ T-cell lymphoma is a rare, recently recognized d... more Primary cutaneous aggressive epidermotropic CD8+ T-cell lymphoma is a rare, recently recognized disease. We report a case presenting with a clinical resemblance to pyoderma gangrenosum (PG), and a particularly aggressive clinical course. A 19-year-old Chinese woman presented with a 1-year history of painful papular lesions on the shoulders and back, which rapidly became necrotic, progressed to enlarging ulcers and spread to involve the face, limbs and breasts. She also had an intermittent fever. Some old lesions resolved but new lesions continued to develop, with extensive ulceration and pain. Despite treatment with prednisone, the lesions continued to increase in number and size. The patient had previously been healthy. On examination, disseminated well-circumscribed ulcers, measuring 10–100 mm in diameter, some of which were deep with a purulent base and dusky-red, raised, and undermined borders, were seen on the breasts and extensor surface of limbs, along with multiple violaceous papules (Fig. 1). Histopathological examination revealed focal epidermotropism and nodular infiltration of medium to large, pleomorphic lymphoid cells in the dermis and the upper portion of the subcutaneous fat. Angiocentric infiltration was prominent, but there was no angiodestruction. Rimming of fat cells by the atypical infiltrate was not evident. Furthermore, a small number of eosinophils were also present. Immunostaining performed on paraffin wax-embedded sections showed that most of the atypical lymphocytes expressed CD3, CD8, CD43, T-cell receptor-b, and T-cell intracellular antigen 1, and were negative for CD4, CD45RO, CD20, CD30, CD5, CD56 and granzyme B. (Fig. 2a–d) In addition, some atypical cells (50%) were positive for Ki-67 (Fig. 2e). In situ hybridization for the detection of Epstein–Barr virus-encoded RNAs (EBERs) was negative. Routine laboratory studies were unremarkable. No atypical lymphocytes were found in the peripheral blood. Examination of a bone-marrow biopsy revealed involvement by T-cell lymphoma. Computed tomography revealed no lymphadenopathy or any visceral involvement. Analysis of the T-cell receptor c gene using PCR found clonal rearrangement. Based on these findings, a diagnosis of primary cutaneous epidermotropic CD8+ cytotoxic T-cell lymphoma was

Iconography : Hair loss in pityriasis versicolor lesions: A descriptive clinicopathological study

Elsevier Masson, Jun 14, 2013

Evaluation of needling/microneedling as an adjunct to phototherapy in the treatment of stable acral vitiligo: a comparative clinical and immunohistochemical study

Journal of Dermatological Treatment

OBJECTIVES To evaluate the efficacy and tolerability of needling/microneedling as an adjunct to N... more OBJECTIVES To evaluate the efficacy and tolerability of needling/microneedling as an adjunct to NB-UVB phototherapy in the treatment of stable refractory patches of acral vitiligo, based upon clinical and immunohistochemical assessment of melanocyte count and distribution in response to needling/microneedling. MATERIALS AND METHODS Twenty patients with stable acral vitiligo (≥ 2 patches) were enrolled. One of the two index patches was randomized to receive needling or microneedling in conjunction with NB-UVB. Patients received phototherapy sessions 3 times weekly, while needling was carried out on biweekly basis for 6 months. Assessment was done clinically using point counting method, VESTA, and global patients' satisfaction, and immunohistochemically by quantitative assessment of melanocyte count by Melan-A. RESULTS No statistically significant difference was observed between NB-UVB monotherapy and either of the combined therapy regimens as regards the mean percentage change in vitiligo surface area (p = 0.451), mean change in absolute melanocyte count from baseline (p = 0.589), and mean VESTA (p = 0.916). Patches subjected to adjuvant microneedling/needling were afflicted by koebnerization in 50% and 20% of cases, respectively. CONCLUSION Neither microneedling nor needling appear to confer an added therapeutic value to NB-UVB phototherapy in the treatment of stable acral vitiligo. Moreover, both carry the risk of koebnerization.

Expression of Discoidin Domain Receptor 2 in Colorectal Carcinoma: An Immunohistochemical Study

Zagazig University Medical Journal, 2021

Journal of Clinical & Experimental Dermatology Research, 2015

Comedonal Darier's disease is an extremely rare variant demonstrating unique clinical and histopa... more Comedonal Darier's disease is an extremely rare variant demonstrating unique clinical and histopathological findings; however, it is commonly misdiagnosed. Herein, we report a case of comedonal Darier's disease and discuss its different diagnostic and therapeutic challenges.

Zagazig university medical journal, 2015

Background: Primary cicatricial alopecia )PCA) is a scarring disease. Although the scarring and d... more Background: Primary cicatricial alopecia )PCA) is a scarring disease. Although the scarring and deformity may affect any part of the body, such changes have been reported to be most obvious on the face and scalp. The pathogenesis behind this scarring process is not well understood. Once lesions have scarred, recurrent disease tends to occur at the edge of the scarred lesions but not within them. The fact that inflammation in PCA generally involves the bulge area of the hair follicles raises the possibility that damage to the stem cells of the bulge region may be one process leading to the permanent loss of hair follicles. Objective : The aim of this study was to investigate the role of the epithelial hair follicle stem cells which reside in the bulge region in the scarring process in PCA. Methods : We studied the reactivity to Mouse monoclonal antibody, Keratin 15 Ab-1 (LHK15), which recognizes cytokeratin (CK 15) and preferentially immunostains epithelial hair follicle stem cells w...