Despite exhaustive research, melanocyte disappearance and the evolution of vitiligo remain enigma... more Despite exhaustive research, melanocyte disappearance and the evolution of vitiligo remain enigmatic, and although multi‐factorial, oxidative stress appears as a major player. The role of cutaneous cholinergic system in vitiligo pathogenesis has also been reported in some studies.
Journal of the Egyptian Women's Dermatologic Society, 2020
Background Depigmentation represents a final alternative for patients with widespread vitiligo, f... more Background Depigmentation represents a final alternative for patients with widespread vitiligo, failing to attain satisfactory pigmentation and having a compromised quality of life. Monobenzyl ether of hydroquinone (MBEH) is the most widely used depigmenting agent, but little is known regarding specific features of its utilization. Objective To evaluate and compare two concentrations of MBEH cream (20 and 40%) regarding their effectiveness, tolerability, and effect on patients’ quality of life. Patients and methods In a double-blind randomized study, 40 patients indicated for depigmentation were equally divided into MBEH 20 and 40% groups. Patients’ responses were assessed bimonthly over 1 year or till complete depigmentation was attained through photography, point counting, and colorimetric assessment. Baseline and final evaluations by dermatology life quality index and visual analog scale were performed. Patients were followed up for 6 months. The study was registered under number ‘PACTR201808699550182.’ Results A total of 39 patients completed the study. Significant color dilution, reduction of point counting and melanin indices, and improvement of dermatology life quality index and visual analog scale scores were obtained in both groups. The number of patients who achieved complete depigmentation and the degree of skin irritation was higher in MBEH 40% group, but no significant difference was found regarding the efficacy, adverse effects, or relapse between groups. Conclusion MBEH 20 and 40% concentrations proved to be effective in depigmentation; however, MBEH 20% is more suitable for face in terms of safety profile, whereas MBEH 40% can be employed for resistant cases as well as for hands and areas of thick skin.
Indian Journal of Dermatology, Venereology and Leprology, 2019
Background: Leukotrichia has been considered a predictor of poor outcome in vitiligo. However, st... more Background: Leukotrichia has been considered a predictor of poor outcome in vitiligo. However, studies considering the different clinical aspects of leukotrichia in vitiligo patients are few. Aim: Our aim was to conduct a detailed clinical study to provide insights into the relevance and associations of leukotrichia in non-segmental vitiligo. Methods: In this cross-sectional study, vitiligo patients attending the dermatology outpatient clinic and phototherapy unit at Cairo University Hospital over a period of 6 months (April–September 2016) were included. Family history, clinical details, the Vitiligo Global Issues Consensus Conference classification, the Dermatology Life Quality Index, Vitiligo Area and Severity Index, Vitiligo Extent Score, Vitiligo Disease Activity Score and Vellus Score were determined and these measurements were correlated to leukotrichia. Results: Out of the 101 patients studied, leukotrichia was found in 47 (46.5%) patients, with vellus hair involved in 37 (78.7%), terminal hairs in 30 (63.8%) and both in 20 (42.5%) patients. Vellus hair involvement was significantly higher in generalized bilaterally symmetrical vitiligo than in acrofacial or unclassified vitiligo. The incidence of scalp leukotrichia also was higher in generalized symmetrical vitiligo than in acrofacial vitiligo. The Vellus Score showed significant associations with Vitiligo Area and Severity Index, Vitiligo Extent Score and the Dermatology Life Quality Index. Limitations: This was a short-term study with a small sample size. Prognostic and therapeutic correlations were not studied; prospective longitudinal studies are needed for further evaluation. Conclusion: Leukotrichia was found in almost half of the studied sample and its frequency varied among the different types of vitiligo.
Journal of the Egyptian Womenʼs Dermatologic Society, 2016
Background Involvement of eccrine sweat glands in adverse cutaneous drug reactions (ACDRs) has no... more Background Involvement of eccrine sweat glands in adverse cutaneous drug reactions (ACDRs) has not received sufficient interest. Objective To examine histopathological changes in eccrine sweat glands in ACDRs. Patients and methods Forty ACDR cases were recruited. Lesional and nonlesional biopsies underwent thorough histopathological evaluation of the eccrine apparatus. Results 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. Conclusion 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.
Phototherapy has been the mainstay of vitiligo therapy for several decades. A variety of waveleng... more Phototherapy has been the mainstay of vitiligo therapy for several decades. A variety of wavelengths and modalities are available, but NBUVB remains the safest and most commonly utilized treatment. Acting on multiple steps in vitiligo pathogenesis, NBUVB is one of the few therapies that can effectively induce stabilization and stimulate repigmentation. Achievement of optimal results involves using a combination of appropriate treatment protocols, careful patient selection, and patient education to set expectations. Individual patient characteristics, including disease activity, vitiligo phenotype, lesion location, and skin phototype should all be considered, along with combination therapies
Journal of the Egyptian Womenʼs Dermatologic Society, 2016
Phototherapy is a unique tool in the hands of dermatologists that has proved its efficacy, excell... more Phototherapy is a unique tool in the hands of dermatologists that has proved its efficacy, excellent safety profile, and cost-effectiveness along the decades. In this respect, it still stands its ground regardless of the development of newer medications in this rapidly evolving field. Furthermore, it remains a focus of attraction among scientists who will never cease in their attempts to obtain a clearer understanding of its mechanisms of action. Newer protocols aiming for higher efficacy, faster results, and wider safety margin will continue to be suggested and evaluated. In the coming review we will highlight 'what is new in phototherapy' by tackling some of the most important studies published during the past year of 2014.
The Egyptian journal of psychiatry: official journal of the Egyptian Psychiatric Association
Psycho-demographic Profiles in Patients with Chronic Dermatoses: Impact on Time Lag for Seeking H... more Psycho-demographic Profiles in Patients with Chronic Dermatoses: Impact on Time Lag for Seeking Health Services Samir M. Abolmagd*M.D., Mona I. El Lawindi** M.D., Naglaa N. El Mongy***M.D., & Wedad M. Zoheir***M.D. *Psychiatry, **Public Health, & ***Dermatology Departments, Faculty of Medicine - Cairo University. Abstract: Background: Revolutionary changes have recently occurred in the way we think about chronic diseases, how we consider what causes them; how we measure their depth and intensity, how we treat them, and, most important how we seek to prevent their occurrence in the first place. It has become increasingly obvious that successful research, prevention, and control efforts require collaborative relationships among various disciplines that collectively embody the necesssary expertise to understand all the dimensions of the problems facing them. Objective: to model the psycho-demographic and behavioral combination associated with chronic dermatoses and their impact on time...
... Correspondence: Wedad Z. Mostafa MD,. *Correspondence: Address correspondence to: Wedad Z. Mo... more ... Correspondence: Wedad Z. Mostafa MD,. *Correspondence: Address correspondence to: Wedad Z. Mostafa, MD, PO Box 1883, Alkhobar 31952, Saudi Arabia. Othman Abdel Aziz, MD, Al-Khobar Government Hospital, referred this case. Publication History. ...
Granulomas in the diaper area developed in four patients; two male infants following surgery for ... more Granulomas in the diaper area developed in four patients; two male infants following surgery for Hirschsprung's disease and two female children with urinary (and/or fecal) incontinence. The use of the term 'Diaper area granuloma of incontinence' is suggested to describe these lesions seen in the elderly, as well as in incontinent infants and children.
Egyptian Journal of Dermatology and Venerology, 2014
Photochemotherapy is considered a key tool for dermatologists in treating numerous, diverse condi... more Photochemotherapy is considered a key tool for dermatologists in treating numerous, diverse conditions. Accordingly, there is a continuous effort to evaluate the well-settled indications, seek new ones for these lines of treatment, singly or in combination, aiming at better results and fewer side effects. The limitations and risks that photochemotherapy bears and the proper management plans are other fields of interest. In this article we will discuss some of the important clinical research studies in the domain of photochemotherapy published during the past year in an attempt to emphasize the up-to-date recommendations, widen our therapeutic scope, and expand our forthcoming research plans as dermatologists and researchers.
Egyptian Journal of Dermatology and Venerology, 2014
Photodermatology is the study of the interaction between light, visible and ultraviolet, and the ... more Photodermatology is the study of the interaction between light, visible and ultraviolet, and the skin. It is one of the major areas of interest for research. The endless pursuit for profound understanding of its mechanisms of action, the real players involved in delivering its therapeutic effects, and those responsible for its deleterious implications deem ′photodermatology′ a constantly developing territory. In the coming review, we will discuss some of the important preclinical and laboratory research studies in the domain of photodermatology published during the past year attempting to highlight the latest achievements and findings.
Journal of the Egyptian Womenʼs Dermatologic Society, 2014
Background Many factors contribute to periorbital darkening, including melanin deposition and ski... more Background Many factors contribute to periorbital darkening, including melanin deposition and skin redundancy. Therapeutic options are still limited and usually unsatisfactory. Dermoscopy allows the identification of different colors and structures not seen by naked-eye examination. Objective To assess patients with periorbital darkening by dermoscopy. Patients and methods In this descriptive study, 35 patients complaining of periorbital darkening were included. Clinical and dermoscopic evaluation was performed. Both pigmentary and vascular components were assessed. Clinical and dermoscopic photographs were evaluated, graded, and results were statistically analyzed. Results Clinically, pigmentation was mild, moderate, and marked. Textural changes and periorbital edema were observed. Dermoscopically, three patterns were described: pseudonetwork, blotchy, and multicomponent. Erythema and telangiectasia were documented. The degree of pigmentation correlated positively with patient age, skin type, and presence of anemia. Limitations Small number of patients and no controls were the limitations. Conclusion Dermoscopic evaluation of periorbital darkening/melanosis appears valuable, particularly in the determination of the degree and pattern of pigmentation as well as the extent of vascular involvement, which in turn would reflect on the choice of therapy.
1) Erythemogenic and pigmentogenic effects of different UV waves Suh et al.1 investigated and com... more 1) Erythemogenic and pigmentogenic effects of different UV waves Suh et al.1 investigated and compared the biological effects, namely erythema and pigmentation, induced by UVA1, broad band-UVA (BB-UVA), narrow band-UVB (nB-UVB) and broad band-UVB (BB-UVB) on the skin of 10 volunteers over a period of six months. Two minimal erythema doses of UVA were found to produce far more prolonged erythema and pigmentation than UVB. Both BB-UVA and UVA1 showed similar intensity and duration of skin reaction. For UVB, erythema and pigmentation produced by nB-UVB were milder in intensity and shorter in time course than those by BB-UVB.
Photodermatology, Photoimmunology and Photomedicine, 2004
Ultraviolet A (UVA) phototherapy proved to be an efficient line of treatment of scleroderma. The ... more Ultraviolet A (UVA) phototherapy proved to be an efficient line of treatment of scleroderma. The mechanism through which it acts is still not clear. To detect the mechanism of action of UVA phototherapy in morphea through measuring its effect on the levels of different parameters related to collagen metabolism. Twenty-one cases of morphea were treated with low-dose broad-band UVA for 20 sessions. Twelve cases received 20 J/cm(2)/session with a cumulative dose of 400 J/cm(2) and nine cases received 10 J/cm(2)/session with a cumulative dose of 200 J/cm(2). The response was assessed clinically every week. Two skin biopsies were taken from the lesional skin of each patient before starting and after the end of therapy. Paraffin sections were examined for quantitative polymerase chain reaction measurement of collagen I, collagen III, collagenase, transforming growth factor-beta (TGF-beta) and interferon gamma (IFNgamma). Eighteen patients reported remarkable softening of the skin lesions, with variable degrees ranging from moderate in 57.1% of them good in 19% to very good response in 9.5%. After treatment, all the studied parameters revealed statistically significant changes. There was a significant decrease in collagen I, collagen III and TGF-beta and a significant increase in collagenase (MMP-1) and IFNgamma. The relative change was found to be greatest in collagenase, followed by IFNgamma then TGF-beta and finally collagen I. The changes in collagen I, collagenase, IFNgamma and TGF-beta were found to increase gradually with the degree of clinical response. In all the parameters studied the relative change was significantly higher in cases treated with 20 J/cm(2)/session in contrast to those treated with 10 J/cm(2)/session although no statistically significant difference could be detected in the clinical response to those doses. The efficacy of low-dose UVA phototherapy in the treatment of localized scleroderma is mainly obtained by the increased production of MMP-1 and IFNgamma, and to a lesser extent by decreasing TGF-beta and collagen production. Concerning the use of 10 or 20 J/cm(2)/session those effects are dose dependent, but the clinical response does not significantly differ.
Despite exhaustive research, melanocyte disappearance and the evolution of vitiligo remain enigma... more Despite exhaustive research, melanocyte disappearance and the evolution of vitiligo remain enigmatic, and although multi‐factorial, oxidative stress appears as a major player. The role of cutaneous cholinergic system in vitiligo pathogenesis has also been reported in some studies.
Journal of the Egyptian Women's Dermatologic Society, 2020
Background Depigmentation represents a final alternative for patients with widespread vitiligo, f... more Background Depigmentation represents a final alternative for patients with widespread vitiligo, failing to attain satisfactory pigmentation and having a compromised quality of life. Monobenzyl ether of hydroquinone (MBEH) is the most widely used depigmenting agent, but little is known regarding specific features of its utilization. Objective To evaluate and compare two concentrations of MBEH cream (20 and 40%) regarding their effectiveness, tolerability, and effect on patients’ quality of life. Patients and methods In a double-blind randomized study, 40 patients indicated for depigmentation were equally divided into MBEH 20 and 40% groups. Patients’ responses were assessed bimonthly over 1 year or till complete depigmentation was attained through photography, point counting, and colorimetric assessment. Baseline and final evaluations by dermatology life quality index and visual analog scale were performed. Patients were followed up for 6 months. The study was registered under number ‘PACTR201808699550182.’ Results A total of 39 patients completed the study. Significant color dilution, reduction of point counting and melanin indices, and improvement of dermatology life quality index and visual analog scale scores were obtained in both groups. The number of patients who achieved complete depigmentation and the degree of skin irritation was higher in MBEH 40% group, but no significant difference was found regarding the efficacy, adverse effects, or relapse between groups. Conclusion MBEH 20 and 40% concentrations proved to be effective in depigmentation; however, MBEH 20% is more suitable for face in terms of safety profile, whereas MBEH 40% can be employed for resistant cases as well as for hands and areas of thick skin.
Indian Journal of Dermatology, Venereology and Leprology, 2019
Background: Leukotrichia has been considered a predictor of poor outcome in vitiligo. However, st... more Background: Leukotrichia has been considered a predictor of poor outcome in vitiligo. However, studies considering the different clinical aspects of leukotrichia in vitiligo patients are few. Aim: Our aim was to conduct a detailed clinical study to provide insights into the relevance and associations of leukotrichia in non-segmental vitiligo. Methods: In this cross-sectional study, vitiligo patients attending the dermatology outpatient clinic and phototherapy unit at Cairo University Hospital over a period of 6 months (April–September 2016) were included. Family history, clinical details, the Vitiligo Global Issues Consensus Conference classification, the Dermatology Life Quality Index, Vitiligo Area and Severity Index, Vitiligo Extent Score, Vitiligo Disease Activity Score and Vellus Score were determined and these measurements were correlated to leukotrichia. Results: Out of the 101 patients studied, leukotrichia was found in 47 (46.5%) patients, with vellus hair involved in 37 (78.7%), terminal hairs in 30 (63.8%) and both in 20 (42.5%) patients. Vellus hair involvement was significantly higher in generalized bilaterally symmetrical vitiligo than in acrofacial or unclassified vitiligo. The incidence of scalp leukotrichia also was higher in generalized symmetrical vitiligo than in acrofacial vitiligo. The Vellus Score showed significant associations with Vitiligo Area and Severity Index, Vitiligo Extent Score and the Dermatology Life Quality Index. Limitations: This was a short-term study with a small sample size. Prognostic and therapeutic correlations were not studied; prospective longitudinal studies are needed for further evaluation. Conclusion: Leukotrichia was found in almost half of the studied sample and its frequency varied among the different types of vitiligo.
Journal of the Egyptian Womenʼs Dermatologic Society, 2016
Background Involvement of eccrine sweat glands in adverse cutaneous drug reactions (ACDRs) has no... more Background Involvement of eccrine sweat glands in adverse cutaneous drug reactions (ACDRs) has not received sufficient interest. Objective To examine histopathological changes in eccrine sweat glands in ACDRs. Patients and methods Forty ACDR cases were recruited. Lesional and nonlesional biopsies underwent thorough histopathological evaluation of the eccrine apparatus. Results 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. Conclusion 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.
Phototherapy has been the mainstay of vitiligo therapy for several decades. A variety of waveleng... more Phototherapy has been the mainstay of vitiligo therapy for several decades. A variety of wavelengths and modalities are available, but NBUVB remains the safest and most commonly utilized treatment. Acting on multiple steps in vitiligo pathogenesis, NBUVB is one of the few therapies that can effectively induce stabilization and stimulate repigmentation. Achievement of optimal results involves using a combination of appropriate treatment protocols, careful patient selection, and patient education to set expectations. Individual patient characteristics, including disease activity, vitiligo phenotype, lesion location, and skin phototype should all be considered, along with combination therapies
Journal of the Egyptian Womenʼs Dermatologic Society, 2016
Phototherapy is a unique tool in the hands of dermatologists that has proved its efficacy, excell... more Phototherapy is a unique tool in the hands of dermatologists that has proved its efficacy, excellent safety profile, and cost-effectiveness along the decades. In this respect, it still stands its ground regardless of the development of newer medications in this rapidly evolving field. Furthermore, it remains a focus of attraction among scientists who will never cease in their attempts to obtain a clearer understanding of its mechanisms of action. Newer protocols aiming for higher efficacy, faster results, and wider safety margin will continue to be suggested and evaluated. In the coming review we will highlight 'what is new in phototherapy' by tackling some of the most important studies published during the past year of 2014.
The Egyptian journal of psychiatry: official journal of the Egyptian Psychiatric Association
Psycho-demographic Profiles in Patients with Chronic Dermatoses: Impact on Time Lag for Seeking H... more Psycho-demographic Profiles in Patients with Chronic Dermatoses: Impact on Time Lag for Seeking Health Services Samir M. Abolmagd*M.D., Mona I. El Lawindi** M.D., Naglaa N. El Mongy***M.D., & Wedad M. Zoheir***M.D. *Psychiatry, **Public Health, & ***Dermatology Departments, Faculty of Medicine - Cairo University. Abstract: Background: Revolutionary changes have recently occurred in the way we think about chronic diseases, how we consider what causes them; how we measure their depth and intensity, how we treat them, and, most important how we seek to prevent their occurrence in the first place. It has become increasingly obvious that successful research, prevention, and control efforts require collaborative relationships among various disciplines that collectively embody the necesssary expertise to understand all the dimensions of the problems facing them. Objective: to model the psycho-demographic and behavioral combination associated with chronic dermatoses and their impact on time...
... Correspondence: Wedad Z. Mostafa MD,. *Correspondence: Address correspondence to: Wedad Z. Mo... more ... Correspondence: Wedad Z. Mostafa MD,. *Correspondence: Address correspondence to: Wedad Z. Mostafa, MD, PO Box 1883, Alkhobar 31952, Saudi Arabia. Othman Abdel Aziz, MD, Al-Khobar Government Hospital, referred this case. Publication History. ...
Granulomas in the diaper area developed in four patients; two male infants following surgery for ... more Granulomas in the diaper area developed in four patients; two male infants following surgery for Hirschsprung's disease and two female children with urinary (and/or fecal) incontinence. The use of the term 'Diaper area granuloma of incontinence' is suggested to describe these lesions seen in the elderly, as well as in incontinent infants and children.
Egyptian Journal of Dermatology and Venerology, 2014
Photochemotherapy is considered a key tool for dermatologists in treating numerous, diverse condi... more Photochemotherapy is considered a key tool for dermatologists in treating numerous, diverse conditions. Accordingly, there is a continuous effort to evaluate the well-settled indications, seek new ones for these lines of treatment, singly or in combination, aiming at better results and fewer side effects. The limitations and risks that photochemotherapy bears and the proper management plans are other fields of interest. In this article we will discuss some of the important clinical research studies in the domain of photochemotherapy published during the past year in an attempt to emphasize the up-to-date recommendations, widen our therapeutic scope, and expand our forthcoming research plans as dermatologists and researchers.
Egyptian Journal of Dermatology and Venerology, 2014
Photodermatology is the study of the interaction between light, visible and ultraviolet, and the ... more Photodermatology is the study of the interaction between light, visible and ultraviolet, and the skin. It is one of the major areas of interest for research. The endless pursuit for profound understanding of its mechanisms of action, the real players involved in delivering its therapeutic effects, and those responsible for its deleterious implications deem ′photodermatology′ a constantly developing territory. In the coming review, we will discuss some of the important preclinical and laboratory research studies in the domain of photodermatology published during the past year attempting to highlight the latest achievements and findings.
Journal of the Egyptian Womenʼs Dermatologic Society, 2014
Background Many factors contribute to periorbital darkening, including melanin deposition and ski... more Background Many factors contribute to periorbital darkening, including melanin deposition and skin redundancy. Therapeutic options are still limited and usually unsatisfactory. Dermoscopy allows the identification of different colors and structures not seen by naked-eye examination. Objective To assess patients with periorbital darkening by dermoscopy. Patients and methods In this descriptive study, 35 patients complaining of periorbital darkening were included. Clinical and dermoscopic evaluation was performed. Both pigmentary and vascular components were assessed. Clinical and dermoscopic photographs were evaluated, graded, and results were statistically analyzed. Results Clinically, pigmentation was mild, moderate, and marked. Textural changes and periorbital edema were observed. Dermoscopically, three patterns were described: pseudonetwork, blotchy, and multicomponent. Erythema and telangiectasia were documented. The degree of pigmentation correlated positively with patient age, skin type, and presence of anemia. Limitations Small number of patients and no controls were the limitations. Conclusion Dermoscopic evaluation of periorbital darkening/melanosis appears valuable, particularly in the determination of the degree and pattern of pigmentation as well as the extent of vascular involvement, which in turn would reflect on the choice of therapy.
1) Erythemogenic and pigmentogenic effects of different UV waves Suh et al.1 investigated and com... more 1) Erythemogenic and pigmentogenic effects of different UV waves Suh et al.1 investigated and compared the biological effects, namely erythema and pigmentation, induced by UVA1, broad band-UVA (BB-UVA), narrow band-UVB (nB-UVB) and broad band-UVB (BB-UVB) on the skin of 10 volunteers over a period of six months. Two minimal erythema doses of UVA were found to produce far more prolonged erythema and pigmentation than UVB. Both BB-UVA and UVA1 showed similar intensity and duration of skin reaction. For UVB, erythema and pigmentation produced by nB-UVB were milder in intensity and shorter in time course than those by BB-UVB.
Photodermatology, Photoimmunology and Photomedicine, 2004
Ultraviolet A (UVA) phototherapy proved to be an efficient line of treatment of scleroderma. The ... more Ultraviolet A (UVA) phototherapy proved to be an efficient line of treatment of scleroderma. The mechanism through which it acts is still not clear. To detect the mechanism of action of UVA phototherapy in morphea through measuring its effect on the levels of different parameters related to collagen metabolism. Twenty-one cases of morphea were treated with low-dose broad-band UVA for 20 sessions. Twelve cases received 20 J/cm(2)/session with a cumulative dose of 400 J/cm(2) and nine cases received 10 J/cm(2)/session with a cumulative dose of 200 J/cm(2). The response was assessed clinically every week. Two skin biopsies were taken from the lesional skin of each patient before starting and after the end of therapy. Paraffin sections were examined for quantitative polymerase chain reaction measurement of collagen I, collagen III, collagenase, transforming growth factor-beta (TGF-beta) and interferon gamma (IFNgamma). Eighteen patients reported remarkable softening of the skin lesions, with variable degrees ranging from moderate in 57.1% of them good in 19% to very good response in 9.5%. After treatment, all the studied parameters revealed statistically significant changes. There was a significant decrease in collagen I, collagen III and TGF-beta and a significant increase in collagenase (MMP-1) and IFNgamma. The relative change was found to be greatest in collagenase, followed by IFNgamma then TGF-beta and finally collagen I. The changes in collagen I, collagenase, IFNgamma and TGF-beta were found to increase gradually with the degree of clinical response. In all the parameters studied the relative change was significantly higher in cases treated with 20 J/cm(2)/session in contrast to those treated with 10 J/cm(2)/session although no statistically significant difference could be detected in the clinical response to those doses. The efficacy of low-dose UVA phototherapy in the treatment of localized scleroderma is mainly obtained by the increased production of MMP-1 and IFNgamma, and to a lesser extent by decreasing TGF-beta and collagen production. Concerning the use of 10 or 20 J/cm(2)/session those effects are dose dependent, but the clinical response does not significantly differ.
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