Treatment of keloids (K) and hypertrophic scars (HTS) is challenging. A few case reports reported good results in HTS treated by fractional CO2 laser. The aim of the present study was the assessment of the clinical response as well as histological changes in K and HTS treated by fractional CO2 laser and the role of matrix metalloproteinase 9 (MMP9) in the response. A randomized half of the scar was treated by fractional CO2 laser in 30 patients (18 K, 12 HTS) for a total of four sessions 6 weeks apart. Vancouver scar score (VSS) was done before and 1, 3, and 6 months after the last laser session by a blinded observer. Biopsies taken from normal skin, untreated scar, and treated scar tissue 1 and 3 months after the laser sessions were stained by HX & E for histological changes and Masson trichrome for collagen fiber arrangement. Immunohistochemical staining for MMP9 was done in before and 1 month after samples. Quantitative morphometric analysis was done for collagen and MMP9 by image analyzer. Nineteen patients completed the 6-month follow-up period (12 K, 7 HTS). VSS score was significantly lower in the treated compared to untreated areas after 3 and 6 months in both K and HTS but was mainly due to improved pliability of the scar. Histologically, dense inflammatory infiltrate and increased vascularity was apparent 1 month after laser sessions and disappeared at 3 months. Thinner better organized collagen bundle could be seen in 3 months after samples. MMP9 was significantly increased in after treatment samples but without significant correlation with VSS. Fractional CO2 resurfacing is safe but affects mainly pliability of K and HTS with collagen remodeling apparent 3 months after therapy. MMP9 may play a role in mechanism of action of CO2 laser in K and HTS.

Background: Identification of epidemiologic and phenotypic variations of psoriasis among different ethnic groups can further our understanding of this perplexing disease, aiming at better management of patients worldwide. Objective: To provide a descriptive analysis of psoriasis patients registered at Kasr Al-Ainy Psoriasis Unit Disease Registry. Methods: This retrospective single-center registry study included patient records between November 2015 and November 2018 (2534 patients). Sociodemographic and phenotypic data were analyzed. Results: The mean age of the registered patients was 39.3 years and 56.3% were men. Stress was the main precipitating factor (48.3%), whereas the most common symptom reported was itching (82.4%). The median body mass index was 27.5, and the median percentage of body surface area involved was 10.0. The mean Psoriasis Area Severity Index score was 8.7, and the mean Psoriasis Disability Index score was 13.0. Both parameters correlated positively, and both showed significantly higher means in smokers. Limitations: Despite that the study was performed at a highly specialized tertiary care center with a high flow of patients, this was still a single-center registry. Conclusions: This work shows that the characteristics of Egyptian patients with psoriasis are comparable to those of other studied ethnic groups, with minor differences.

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Alopecia areata (AA) is an autoimmune disease resulting in nonscarring hair loss. Topical, intralesional, and systemic agents are available. 1 Intralesional corticosteroids (ILCs) may be used in patients above 10 years of age with <50% scalp involvement. 2 Other previously tried modalities with success include topical immunomodulators 3 and chemical peeling using phenol and lactic acid. 4,5 Trichloroacetic acid (TCA) is a chemical peeling agent that precipitates epidermal proteins and destructs the upper dermis. 6 TCA 35% was tried with successful results in treating patchy alopecia areata. The proposed mechanism of action was through stimulating growth factors and cytokines during the wound-healing process. 7 The aim of the current work was to compare clinically and trichoscopically the efficacy of this peeling agent for the treatment of patchy alopecia areata with ILCs.

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Background Psoriasis is associated with several comorbidities and different psychological disorders including anxiety and depression. Psoriasis may also affect sleep quality and consequently the quality of life. The use of immunosuppressants used in the treatment of psoriasis were also reported to increase insomnia, so the purpose of the study is to assess the quality of sleep and degree of insomnia in patients with psoriasis not on any systemic or immunosuppressive therapy compared to controls and to examine the relation between sleep quality, insomnia with depressive, and anxiety symptoms. One hundred psoriasis cases, not receiving immunosuppressive therapy, and 80 apparently healthy subjects were recruited as controls. We assessed quality of sleep, insomnia and screened for anxiety and depressive symptoms among psoriasis patients and healthy controls; any patient on immunosuppressant therapy was excluded. Results Quality of sleep using Pittsburgh Sleep Quality Index, insomnia using Insomnia Severity Index, depression using Beck Depression Inventory, and anxiety using Taylor Anxiety Manifest Scale were statistically significant higher among psoriasis patients than healthy controls all with p value p < 0.001. Depressive symptoms were significantly positively correlated with Pittsburgh Sleep Quality Index (PSQI) global score (p = 0.045) and subjective sleep quality subscale (p = 0.005). Also, BDI scores was significantly positively correlated with insomnia scores as measured by ISI (p = 0.026). Anxiety symptoms were significantly positively correlated with global score of PSQI (p = 0.004) and its subscale (subjective sleep quality, sleep latency, sleep disturbance, use of medications and daytime dysfunction) and insomnia (p = 0.001). Conclusions Abnormal sleep quality and insomnia were detected in patients with psoriasis not using any immunosuppressive or systemic therapy, and this could be due to the psoriasis disease itself or due to the associated anxiety and depression associated with psoriasis. Screening for psychiatric symptoms specially that of depression, anxiety, and sleep among patients with psoriasis is of utmost importance for better quality of life. Thus, collaboration between dermatologists and psychiatrists may show better life quality for these cases and better treatment outcomes.