No abstract

The present study showed that serum level of 25(OH)D is statistically significantly lower in patients than controls, so screening for vitamin D deficiency seems of value in patients with vitiligo for the possibility of vitamin D supplementation. We also report that VDR gene polymorphisms may be a risk for the development of vitiligo in an Egyptian population.

Psoriasis, vitiligo, and mycosis fungoides (MF) are among the most frequently treated dermatological diseases by photo(chemo)therapy. The objectives are to determine which photo (chemo) therapeutic modality could achieve the best response in the treatment of psoriasis, vitiligo, and MF. The design used in this study is retrospective analytical study. The study included 745 patients' records; 293 with psoriasis, 309 with vitiligo, and 143 with early MF, treated in the Phototherapy Unit, Dermatology Department, Kasr El-Aini Hospital, Cairo University by either psoralen and ultraviolet A (PUVA), narrow band ultraviolet B (NB-UVB), psoralen and narrow band UVB (P-NBUVB), broad band UVB (BB-UVB), or broad band UVA (BetaBeta-UVA). Data were retrieved from the computer database of the unit and statistically analyzed. In psoriasis, oral and topical PUVA and NB-UVB were found to be equally effective, whereas oral PUVA had significantly better results than both UVA and BB-UVB at the end of therapy. In generalized vitiligo, PUVA and P-NBUVB had significantly better results than NB-UVB alone. In early MF, there was no statistically significant difference between the response to oral PUVA and NB-UVB. PUVA and NB-UVB are good choices in patients with psoriasis and early stage MF, whereas PUVA appears the best choice in the treatment of vitiligo.

Depigmentation emerges as a feasible solution for vitiligo universalis and refractory cases of vitiligo vulgaris that hinder patients' quality of life. A range of depigmenting modalities has previously been developed. However, each has its own limitations. Based on skin sensitivity, this study sets out to compare the efficacy and tolerability of “trichloroacetic acid (TCA) peels 25% and 50% and Qs Nd:YAG laser (1,064/532 nm)” for facial depigmentation and “cryotherapy, phenol 88% and Qs Nd:YAG (1,064/532 nm)” for extrafacial skin depigmentation. Forty vitiligo patients were examined and equally divided into facial & extrafacial groups. Regular sessions were performed. Patients' responses were assessed after 3 months or when excellent/complete depigmentation was attained through assessing “depigmentation grade”, “extent of depigmented skin”, “patient satisfaction” and “overall response”. Patients were observed for a six‐month follow‐up period. In facial depigmentation, Qs Nd:YAG showed the highest significant response followed by TCA 50% and 25%. In extrafacial depigmentation cryotherapy, phenol 88% and Qs Nd:YAG laser displayed positive outcomes without significant difference. Among the modalities tested Qs Nd:YAG yielded superior results in facial residual pigmentation in vitiligo when compared to TCA 50% and 25%, whereas in extrafacial sites Qs Nd:YAG, cryotherapy and phenol were equally effective.

Case 1 A 6‐month‐old boy presented to our clinic with a scalp lesion dating since birth (Fig. 1). The lesion was in the form of an erythematous, dome‐shaped nodule, measuring around 1.5 cm in diameter and having a slightly irregular surface. The lesion was nonitchy, nontender, and showed limited mobility. Our clinical differential diagnosis included: meningocele, hemangioma, dermoid cyst, and apocrine nevus. A computed tomography (CT) scan was performed to exclude possible intracranial connection, and the lesion was surgically excised. 1 Case 1: erythematous nodule on the occipital area of a 6‐month‐old boy. The lesion was clinically suggestive of apocrine nevus, dermoid cyst, or meningocele Histopathologic examination (Fig. 2) revealed a markedly dilated follicular cystic structure, with numerous sebaceous lobules arising from its wall. Other cystic structures containing keratin, but no hair, were also seen. There were numerous sebaceous lobules, excess fibrous tissue (showing a lamellar pattern around the cystic structures and sebaceous lobules), and excess fatty tissue, but no muscles of hair erection were found in the lesion. Clefts were seen separating the pericystic fibrous tissue from the rest of the dermis. Collections of blood vessels were detected in the lower part of the lesion. These features are characteristic and seen only in folliculo‐sebaceous cystic hamartoma. 2 large infundibular cystic structure with numerous sebaceous lobules and rudimentary follicles arising from its wall. Individual sebaceous lobules are seen surrounding the cyst. Lamellar fibrous tissue is seen around the cyst and separated from the surrounding stroma by clear clefts. Numerous blood vessels, muscle fibers, and adipose tissue are seen in the lower part (× 100) Case 2 A 55‐year‐old woman presented with two erythematous, dome‐shaped nodules on the scalp of more than 10 years' duration (Fig. 3). Each lesion measured about 1 cm in diameter, exhibited soft consistency, and showed limited mobility. Apart from the unsightly appearance, the lesions were symptomless. The clinical differential diagnosis included: intradermal nevus, apocrine nevus, nevus sebaceous, and syringocystadenoma papilliferum. 3 Case 2: skin‐colored nodules on the back of the scalp of a 55‐year‐old woman Microscopic examination (Fig. 4) revealed a mid‐dermal cystic structure lined by follicular epithelium with numerous rudimentary hair follicles and sebaceous lobules arising from its wall. There were also numerous sebaceous lobules, as well as excess fibrous and fatty tissue. Clefts were seen separating the lamellar pericystic fibrous tissue from the rest of the dermis. These features are diagnostic of folliculo‐sebaceous cystic hamartoma. 4 Infundibular cystic structure not connected to the overlying epidermis showing the same features as in Fig. 2, with a large number of isolated sebaceous lobules. There is pericystic compact lamellar fibrous tissue separated from the surrounding stroma by clear clefts (× 100)