Clin Microbiol Infect 2012; 18: E438–E445 Abstract Data are sparse on Mycobacterium tuberculosis infection among patients with cancer in Egypt. We sought to detect the presence of tuberculosis (TB) disease among patients with malignant conditions and suspected TB and to study the main risk factors. Also, we compared different diagnostic procedures and detected the antimicrobial susceptibility of M. tuberculosis isolates against rifampin and isoniazid. One hundred patients were included in this study, all of them had malignant conditions and were suspected by the clinicians of having TB. Identification of M. tuberculosis in different specimens was performed by smear microscopy, followed by Lowenstein–Jensen medium and Mycobacterium growth indicator tube (MGIT) cultures and artus® real‐time PCR. In addition, an indirect MGIT anti‐TB susceptibility test was carried out against rifampin and isoniazid. A total of 76% of studied cases were found to be TB positive. The frequencies of TB‐positive cases in the bronchogenic, haematological and solid tumour malignancy groups were 21%, 25% and 30%, respectively. Significant differences between pulmonary and extrapulmonary TB in different malignancy groups were recorded. Real‐time PCR showed the highest overall diagnostic efficiency. Multidrug‐resistance of M. tuberculosis to both rifampin and isoniazid was detected in 28.6% of examined isolates. Infection in cancer patients with TB was significantly more often recorded among elderly patients and those suffering from poverty. Pulmonary TB is more common than extrapulmonary TB in patients with malignancy. Real‐time PCR is the most accurate and rapid method for TB diagnosis. MGIT‐rifampin resistance may be used as a reliable marker for detection of multidrug‐resistant TB. Diagnosis and instituting treatment course for active or latent TB infection are crucial before starting anticancer therapy.

Background: Cutaneous warts represent a challenging condition to treat.Objective: To evaluate the safety and efficacy of intralesional injection of MMR (mumps, measles, and rubella) antigen, BCG (bacillus Calmette-Guerin) vaccine, and candida antigen for the treatment of multiple warts.Methods: A total of ninety (90) clinically confirmed adult patients complaining of recalcitrant extragenital warts of various sizes and durations were recruited in this randomized clinical trial. They were divided into three groups (A, B, and C). Each group consisted of (30) patients. Group (A) subjects received intralesional MMR injections.Group (B) subjects received intralesional BCG injection and Group (C) received intralesional candida antigen injection.Results: Full clearance of warts was observed in (73.33%, 70%, and 43.33%) in groups A, B, and C, respectively. Infrequent side effects including pain, erythema, and minimal induration were reported in all groups but did not necessitate termination of treatment. Conclusion:All the three modalities used demonstrated a simple, safe modality with low adverse events, and with no recurrence. To achieve an optimal response with an ideal immunotherapeutic agent and ideal dose, further comparative studies are warranted and on different populations and larger sample sizes.

Background Melasma is an acquired common pigmentary condition that mostly presents as pigmented macules on the face. Triple combination creams (TCC), commonly known as kligman's formula, had been regarded as the mainstay of treatment for years. Topical metformin was recently studied for its melanopenic effects and potential use in melasma. Aim of the work This study aimed to evaluate the efficacy and safety of using 30% metformin cream to that of triple combination creams (Kligman's formula) in treating melasma. Patients and Methods About 40 patients complaining of melasma were recruited for this controlled randomized trial and were divided into 2 groups. Group 1 (n = 20) subjects received 30% metformin cream whereas group 2 (n = 20) were treated with TCC for eight consecutive weeks. Pigmentation severity and improvements were assessed using the melasma area severity index (MASI) at baseline and after 8 weeks of using treatment. Results MASI score decreased dramatically from 12.18 ± 9.33 before treatment to 5.59 ± 4.61 at Week 8 with a mean decrease percentage of 55.97 ± 16.77 for group 1 (p = 0.001) and from 16.05 ± 8.73 to 7.54 ± 5.77 with a mean decrease percentage of 56.50 ± 19.44 for group 2 (p = 0.001). No significant difference was reported between the two treatment modalities regarding the reduction in melasma throughout the study period (p = 0.968). Conclusion Metformin cream is a safe, potential effective treatment for melasma, which needs to be verified by long‐term large scale studies in diffident populations.

Background: Granulocyte-macrophage colony-stimulating factor (GM-CSF) is believed to play an important role in the development of acne vulgaris. Aim of the Work:To investigate the presence of GM-CSF 3928C/T and GM-CSF 3606 T/C promoter gene polymorphisms in Egyptian acne patients. Methods:To examine whether GM-CSF single nucleotide polymorphisms (SNPs) are associated with susceptibility to acne vulgaris (AV), we investigated the genotype and allele frequencies of the SNP 3928C/T and 3606T⁄C of the GM-CSF gene in 100Egyptian acne patients (29 with mild acne, 38 with moderate acne, and 33 with severe acne) and 100 controls, using a PCR restriction fragment length polymorphism (RFLP) method.Results: There was a highly significant difference in genotype and allele frequencies of the 3928C/T group between patients with acne vulgaris and controls for the SNP site. Regarding the 3606 T/C subgroup only a marginal significant difference was found between cases and controls in TC pattern (p = 0.039); with the TC genotype appearing more in cases (53% of patients) than controls (35% of healthy controls). Conclusion:We report a novel GM-CSF 3928C/T promoter gene polymorphism contributing to the pathogenesis of acne in Egyptian population.

Alopecia areata (AA) is an autoimmune disease that results in non-scarring hair loss.Topical minoxidil 5% gel and methotrexate (MTX) 1% gel are important modalities used in the treatment of many dermatological diseases. We aimed to evaluate the efficacy of MTX 1% gel versus topical minoxidil 5% gel in the treatment of localized AA both clinically and dermoscopically. A total of 50 patients were randomly divided into two groups of 25 each; the first was treated with topical minoxidil 5% gel and the second was with MTX 1% gel. Dermoscopic and photographic pictures were used to follow up at baseline, 3, 6, and 12 weeks. By comparing the two therapies, we noticed that minoxidil has a statistically significant higher frequency of broken hair and black dots after 6 weeks than MTX. After 12 weeks, dermoscopic revealed that the minoxidil group had a lower frequency of vellus hair than the MTX group. Clinically after 6 weeks, minoxidil showed significantly more excellent improvement than MTX (16% vs. 0%), after 12 weeks, minoxidil and MTX showed excellent improvement (52% and 36%), respectively. There was no significant difference in side effects (erythema and itching) between the MTX and minoxidil groups. Both topical MTX 1% gel and topical minoxidil 5% gel had high efficacy in treating localized AA, with no significant differences between them as evaluated by clinical and dermoscopic examination.

Tinea capitis (TC) is the most common dermatophyte infection in children. Fungal culture; although a gold standard of diagnosis, requires time for the final results which can favor horizontal transmission. Trichoscopy helps in rapid diagnosis and could work as a monitoring tool during antifungal therapy. The objective of this study is to provide a clinico‐trichoscopic evaluation and follow‐up of children presenting with TC during treatment with either griseofulvin or terbinafine. One hundred and twenty children clinically diagnosed with TC confirmed by potassium hydroxide microscopy, were divided into two groups and given either oral ultramicrosize griseofulvin (60, Group A) or terbinafine (60, Group B). Following initiation of the antifungal therapy, trichoscopic features within Groups A and B were noted at 0, 2, 4, 6, and 8 weeks. However, variation in the baseline trichoscopic features between the two groups was not statistically significant (p = 0.855). A significant reduction of corkscrew and broken hairs as well as perifollicular scales, scalp erythema, and crust was significantly observed from 2 weeks onward irrespective of the antifungal drug prescribed. Despite the paucity of data evaluating trichoscopic features in patients with TC, this tool can serve as a rapid diagnostic and monitoring tool during antifungal treatment. Trichoscopic signs of TC resolution occur before clinical improvement and can guide for treatment adjustment during the course of therapy.

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