An Unusual Case of Pemphigus Vulgaris

<b><i>Introduction:</i></b> Pemphigus is a potential life-threatening skin disorder belonging to the group of the autoimmune bullous diseases affecting the skin and mucosa. The most common subtypes are pemphigus foliaceus (PF) and pemphigus vulgaris. <b><i>Case Presentation:</i></b> We present the case of a young woman with scalp manifestations diagnosed as seborrhiasis who came to our office where a more careful history and clinical examination directed us toward another diagnostic suspicion. The histological examination confirmed our suspicion of pemphigus and therefore we believe it is important to report our experience to avoid misdiagnosis. <b><i>Discussion/Conclusion:</i></b> Our case may be useful in the literature to identify cases of PF with atypical manifestations that may mimic other diseases.

A Comparative Study of Efficacy of Miniature Punch Grafting and Platelet Rich Plasma Therapy in Treatment of Focal Stable Vitiligo in 50 Cases

Introduction: Vitiligo, a depigmented skin disorder is characterized by selective loss of melanocytes, which in turn leads to pigment dilution in the affected areas of the skin. The characteristic lesion is a totally amelanotic, non scaly, chalky white macule with distinct margins. If the disease is not progressing for the past one year it is described as stable vitiligo. There are various treatment options available for the treatment of focal stable vitiligo. It can be safely treated with miniature punch grafting as well as platelet rich plasma therapy. Aims and Objectives: Aim of this study is to compare efficacy of miniature punch grafting and platelet rich plasma therapy and to evaluate the outcome of treatment of focal stable vitiligo. Materials and Methods: Total 50 patients were selected and divided into two groups. One group was treated with miniature punch grafting while the other group underwent platelet rich plasma therapy. Pre-treatment and post treatment assessment was done by VASI (Vitiligo area scoring index) score. Result: A total of 25 patients were selected for grafting. Perigraft pigmentation was evident from 3rd week of grafting steadily increasing up to the end point of record i.e 6months. 17 patients showed good response, 4 patients showed average response while 4 patients showed poor or no response at all. Out of the 25 patients taken for platelet rich plasma therapy, 7 patients showed good response, 7 patients showed average response while 11 patients showed poor or no response at all. Conclusion: Miniature punch grafting showed better response as compared to platelet rich plasma therapy but both the therapies have their pros and shortcomings. Keywords: Vitiligo, miniature punch grafting, platelet rich plasma, VASI.

Management of Acne in Unani System of Medicine: A Case Report

Introduction: Acne is a common skin disorder of pilosebaceous gland. It caused due to excessive production of sebum, hyperkeratinisation and proliferation of Propionibacterium acnes bacteria. Case presentation: This case report is of 38 years of female having severe problem of acne. She has no family history and her menstrual order was normal. Previously she had taken modern medicine orally and topically but did not relieve. Conclusion: The treatment with Majoon Ushbah orally and multicomponent powdered formulation applied topically proved to be effective. There was significant (p<0.05) reduction of Global Acne Grading Score (GAGS) nearly 81% as compared to baseline. VAS (Visual Analogue Scale)) indicated changes in appearance and symptoms at the end of study. There was significant improvement in DQLI (Dermatology Quality of Life Index). The tested drug proved to be effective in management of acne

Discovery of small-molecule modulators of melanogenesis by docking-based virtual screening

Background: Vitiligo is a relatively common depigmenting skin disorder. UV light stimulation is often used to obtain repigmentation. Wnt signaling regulates melanocyte differentiation, and expression of TYR is upregulated in narrow-band UVB-treated epidermis. Manipulation of these two pathways by drugs could serve as one of the therapeutic approaches for durable repigmentation. Methods and results: CD9 was identified as a novel TYR activator by virtual screening and bioactivity assay. CD9 activated the Wnt signaling pathway through triggering translocation of β-catenin from cytoplasm to nucleus. Conclusion: The pathogenesis of vitiligo is complicated and varies with each individual, so combination therapy may be much more suitable for treatment of vitiligo. CD9 could synergize with other anti-inflammatory compounds or autoimmune suppressors to shorten repigmentation time and improve efficacy.

Melasma Clinical Features, Diagnosis, Epidemiology and Etiology: An Update Review

Melasma is one of the commonest dermatological challenges that facing dermatologists in the whole world. Most of the previously published articles regarding melasma usually focused on its management and the newly discovered drugs; however, the understanding of the suspected etiology and the pathogenesis is very critical to treat this skin disorder in a correct manner. Therefore, this review is an attempt to do a comprehensive updating on the present understanding of the melasma epidemiology, etiology, its role in pregnant, post-menopausal women, and in males, besides its clinical features and diagnosis through searching in many scientific databases including EMBASE, Cochrane Library, PubMed, Pubmed Central (PMC), Medline, Web of Science, and Scopus. This review approaches recognizing the pathogenesis that can provide ideas to solve the therapeutic problems which connect to melasma. Therefore, this article is entirely established on previously performed studies so that no new studies on animal or human subjects were conducted by the author.

The New Era of Biologics in Atopic Dermatitis: A Review

Atopic dermatitis (AD) is a prevalent inflammatory skin disorder affecting all ages and ethnic groups. The age-dependent varying appearance and extent of pruritic lesions are accompanied by distinct individual suffering, highlighting the importance of effective treatment options. Over the past years, systemic drugs have considerably extended therapeutic approaches of patients with moderate to severe AD, in particular, new biologics, most notably dupilumab has appeared as major breakthrough. In addition to monoclonal blockade of IL-4 and IL-13 pathway, more cytokines have been found to play a substantial role in AD pathogenesis, presenting potential targets for new therapy options.

Equine vitiligo-like depigmentation in grey horses is related to genes involved in immune response and tumor metastasis

Background In horses, the autoimmune disease vitiligo is characterized by the loss of melanocytes and results in patchy depigmentation of the skin around the eyes, muzzle and the perianal region. Vitiligo-like depigmentation occurs predominantly in horses displaying the grey coat colour and is observed at a prevalence level of 26.0–67.0% in grey horses compared with only 0.8–3.5% in non-grey horses. While the polygenetic background of this complex disease is well documented in humans, the underlying candidate genes for this skin disorder in horses remain unknown. In this study we aim to perform a genome-wide association study (GWAS) for identifying putative candidate loci for vitiligo-like depigmentation in horses. Methods In the current study, we performed a GWAS analysis using high-density 670 k single nucleotide polymorphism (SNP) data from 152 Lipizzan and 104 Noriker horses, which were phenotyped for vitiligo-like depigmentation by visual inspection. After quality control 376,219 SNPs remained for analyses, the genome-wide Bonferroni corrected significance level was p < 1.33e-7. Results We identified seven candidate genes on four chromosomes (ECA1, ECA13, ECA17, ECA20) putatively involved in vitiligo pathogenesis in grey horses. The highlighted genes PHF11, SETDB2, CARHSP1 and LITAFD, are associated with the innate immune system, while the genes RCBTB1, LITAFD, NUBPL, PTP4A1, play a role in tumor suppression and metastasis. The antagonistic pathogenesis of vitiligo in relation to cancer specific enhanced cell motility and/or metastasis on typical melanoma predilection sites underlines a plausible involvement of RCBTB1, LITAFD, NUBPL, and PTP4A1. Conclusions The proposed candidate genes for equine vitiligo-like depigmentation, indicate an antagonistic relation between vitiligo and tumor metastasis in a horse population with higher incidence of melanoma. Further replication and expression studies should lead to a better understanding of this skin disorder in horses.

Antibiotic and novel compounds manipulation in vitro collagen matrix cells changes extracellular matrix non-complete cell division of fibroblast cells as new dermology technology

Fibroblasts are several cells that are essential for human skin function and regulation process, the underfeed cells are a further issue of skin disorder the current study was based on isolated novel antibiotics compounds comparison of (Chloramphenicol IV) with the changes of Extracellular matrix (RC), inflammatory cells (SC) and non-complete cell division (ICD) effects on fibroblasts cell changes with the cell wall in structural and morphological changes. The new antibiotic compounds were measured and characters in (FTIR) methods with their functional group's analysis of bioactive compounds from Adhatoda vasica and Calotropis procera plants and their effective inhibition concentrations (I C50) extract's against tyrosinase conditions with their activity in vitro enzymatic process, both extracts have higher enzymatic inhibition assay was assessed. The fibroblast cells were compared with Chloramphenicol IV antibiotics with extracted compounds the cell wall was indiscretion and complete shape and structural changes were measured. The higher values of Diphenolase (22.5 μg/mL) was noted in Adhatoda vasica while an IC50 value of Monophenolase was 19.16 μg/mL, which is helpful in the treatment of fibroblast cell disorders, were higher in collagenase inhibition assay, elastase inhibition assay, hyaluronidase inhibition assay, tyrosinase inhibition assay process. It was concluded that novel antibiotics compounds from species could act an as effective role in fibroblast were used in future medicines as sources of locations and creams to control various skin diseases and skin disorder management's processes.

The Neuronal Theory in the Pathogenesis of Vitiligo: Past and Present

Vitiligo is a common skin disorder with an estimated prevalence of 1-2% of the world population. It is characterised by well demarcated milky white patches of depigmentation which have the tendency to enlarge and spread peripherally. The pathogenesis is not fully understood, a process leads and end in the loss of functional melanocytes from the epidermis. There are many proposed theories and hypotheses, none of which can fully explain its pathogenesis. However, lately it is believed that an overlap between some of these theories can present better understanding. This is to include the two long standing theories i.e., the autoimmune and the neuronal. The latter been proposed in 1959, initially based on clinical observations and studies, including animal, physiological, biochemical, embryonic, structural and electron microscopy. In 1994 new evidence emerged linking the neuronal theory to autoimmune mechanisms by demonstration of changes in Neuropeptides in particular Neuropeptide Y (NPY), in the skin at the active edge of vitiligo skin. This review paper highlights all evidence supportive of the neuronal theory in the pathogenesis of vitiligo past and present.