A Barzilai

Tel Aviv University, Tell Afif, Tel Aviv, Israel

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Publications (165)492.55 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: Lichen planopilaris (LPP) is as a lymphocytic variant of primary cicatricial alopecia. Objective: To evaluate the demographics, clinical findings, natural history, and response to various treatments of LPP. Methods: A retrospective review of medical records of all patients with clinical and histopathological diagnosis of LPP. Results: Out of 46 patients there were 38 (82.6%) women and 8 (17.4%) men. There was no clear association of specific medical background and medications with disease onset. The most frequent complaint was itching scalp. Asymptomatic hair loss was observed in 39.2%. LPP involved the entire scalp in 39.1%, vertex in 28.3%, anterior scalp and vertex in 17.4%, fronto-temporal scalp in 6.5%, posterior and parietal scalp in 6.5%. The topical treatment that caused the highest rate of symptomatic improvement was intralesional injection of corticosteroids. The treatment that led to the highest rate of remission was hydroxychloroquine combined with topical corticosteroid application. The remission rate was 6.5% after 3 months, and 33% after 18 months. Of patients who achieved remission, 50% need continued treatment to maintain remission. No patient had any visible hair regrowth on any treatment. Conclusion: The range of empiric topical and systemic treatments used gives unsatisfactory results, in LPP patients.
    Journal of Dermatological Treatment 06/2014; · 1.50 Impact Factor
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    ABSTRACT: Psoralen plus ultraviolet (UV) A (PUVA) radiation is the preferred treatment for folliculotropic mycosis fungoides (MF) and MF refractory to narrowband (NB) UVB radiation. However, systemic PUVA has many unfavorable side effects and contraindications. Bath PUVA has been found to be a suitable alternative in patients with psoriasis, but data on MF are sparse.
    Journal of the American Academy of Dermatology 05/2014; · 4.91 Impact Factor
  • Alon Scope, Aviv Barzilai, Isaac Zilinsky
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    ABSTRACT: Lentigo maligna melanoma (LMM), a melanoma subtype that arises on sun-damaged facial skin, is difficult to diagnose clinically. Patients and physicians are reluctant to perform unnecessary facial biopsies. Reflectance confocal microscopy (RCM) is a novel technique for non-invasive skin imaging at cellular-level resolution. RCM increases the accuracy of melanoma diagnosis.
    Harefuah 05/2014; 153(5):248-52, 306.
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    ABSTRACT: Limited data are available regarding topical and systemic therapies for Leishmania tropica in children. We sought to characterize the clinical presentation and evaluate the efficacy and safety of topical and systemic treatments in pediatric patients infected with L tropica. A retrospective study was performed on 47 children with L tropica cutaneous leishmaniasis. Treatments included topical or systemic therapy with liposomal amphotericin B or pentavalent antimony. Seventy patients with L tropica cutaneous leishmaniasis were treated at our center between 2008 and 2012, of which 47 (67%) were children. The average age of the pediatric population was 8.8 years, and the face was the most common site of involvement (76%). The average number of lesions was 2.6. 24 children (51%) required systemic therapy. The patients were treated with 3 to 5 mg/kg/d of intravenous liposomal amphotericin B, and a response was observed in 83% of the patients within 3 months. This was a retrospective study. The disease burden of L tropica in children is high, and because of facial involvement and a low response to topical therapies, systemic therapy is often required. In our experience, liposomal amphotericin B treatment in children is safe and effective and is required for a considerably shorter duration than treatment with pentavalent antimony.
    Journal of the American Academy of Dermatology 04/2014; · 4.91 Impact Factor
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    ABSTRACT: Background Tinea pedis is a commonly encountered dermatophytic infection with a clinical prevalence of 15–25%. Limited studies have evaluated the prevalence of occult tinea pedis.Objectives The aims of this study were to evaluate the prevalence of occult tinea pedis in asymptomatic subjects with feet that appeared healthy and to identify possible related risk factors.MethodsA prospective study of 221 asymptomatic subjects with apparently normal feet was conducted. All subjects completed a questionnaire covering anamnestic details (personal and family histories of tinea pedis, preferred footwear) and were examined for foot odor and the clinical presence of tinea pedis and onychomycosis. Samples were taken from the foot for direct microscopic examination and culture.ResultsAmong the 221 patients, 31 (14.0%) were positive for occult tinea pedis. Positive cultures from both the anterior and posterior aspects of the foot were obtained in 22 patients. The most common pathogen isolated was Trichophyton rubrum. Strong correlations emerged between occult tinea pedis and characteristics such as male gender, foot odor, previous personal and family histories of tinea pedis, and clinical and mycological evidence of onychomycosis. No significant associations were found between occult tinea pedis and age or preferred footwear.Conclusions The prevalence of occult tinea pedis is similar to that of clinical tinea pedis. This may imply that patients with subclinical infection carry a risk for transmitting disease similar to that of clinical carriers. This is of great importance in the prevention and management of the disease as high-risk asymptomatic carriers can be identified.
    International journal of dermatology 04/2014; · 1.18 Impact Factor
  • Sharon Baum, Yaron Zafrir, Aviv Barzilai
    The Israel Medical Association journal: IMAJ 04/2014; 16(4):244-5. · 0.98 Impact Factor
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    ABSTRACT: Background Onchocerciasis is an infectious disease caused by the filaria Onchocerca volvulus. Very little is known regarding onchocerciasis imported from endemic to non-endemic areas.Objective To evaluate pruritic dermatitis simulating atopic dermatitis in Ethiopian immigrants in Israel.Materials and MethodsA retrospective study on 27 Ethiopian immigrants to Israel was conducted. Demographics and clinical and laboratory data were collected.ResultsOf the group of 27 patients, ten (37%) were men and 17(63%) were women. The average age at referral was 29 years. All of the patients immigrated from Kuwara, Ethiopia. Diagnosis was done by either positive snip test or immunoglobulin IgG4 serology of onchocerciasis in 14 patients. The most common presentation was a combination of lichenified onchodermatitis with atrophy and depigmentation (36%). Eosinophilia and elevated IgE levels were common. Seventeen patients were treated with a single administration of oral ivermectin 200 mcg/mg. Thirteen patients responded to the treatment.Conclusions Immigrants from endemic regions to developed countries presenting with pruritic diseases, especially those with a clinical picture suggestive of atopic dermatitis, should be and evaluated for possible onchocerciasis infection. Ivermectin, a relatively safe and low-cost treatment,should be considered even in the absence of a proven disease. Physicians should have a high index of suspicion in patients with the right residential history.This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 03/2014; · 3.76 Impact Factor
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    ABSTRACT: Blistering skin diseases are a group of autoimmune disorders that are characterised by autoantibodies against structural proteins of the epidermis or the dermal-epidermal junction and clinically by blisters and erosions on skin and/or mucous membranes.Since clinical criteria and histopathological characteristics are not sufficient for diagnosis, direct immunofluorescence microscopy of a biopsy specimen or serological tests are needed for exact diagnosis. The differentiation between the various disorders became more important sinceprognosis as well as different treatment options are nowadays available for the various diseases. Moreover, some bullous diseases may indicate the presence of an underlying malignancy. The detection of serum autoantibodies have been shown to correlate with disease activity and thus may be helpful in deciding treatment options for these patients.
    Autoimmunity reviews 01/2014; · 6.37 Impact Factor
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    ABSTRACT: Familial glucocorticoid deficiency (FGD), a rare autosomal recessive disorder of insensitivity to adrenocorticotropic hormone (ACTH), is characterized by isolated glucocorticoid deficiency and preserved mineralocorticoid production. The clinical features include generalized hyperpigmentation, hypoglycemia, failure to thrive, and recurrent infections. Here we describe the case of an infant who exhibited generalized hyperpigmentation and hypoglycemia. A high morning blood ACTH level and low blood cortisol level confirmed the diagnosis of FGD. The patient was found to be homozygous for a novel mutation in the melanocortin-2 receptor gene (635insC, I154H). Early initiation of corticosteroid treatment led to normalization of morning blood ACTH levels and the patient thrived, with subsequent fading of the hyperpigmentation.
    Pediatric Dermatology 11/2013; · 1.04 Impact Factor
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    ABSTRACT: Localized scleroderma (LS) comprises a spectrum of sclerotic autoimmune diseases primarily affecting the dermis. Various treatment modalities have been recommended for the management of LS, but only a few studies exist regarding the efficacy of bath PUVA photochemotherapy in the treatment of LS. To evaluate the efficacy of bath PUVA photochemotherapy in the management of LS in a retrospective study. Twenty-eight patients (23 women and five men) with a diagnosis of LS, confirmed by histology, were included in the study. Patients were treated with a thrice-weekly regimen of bath immersion in 0.2 mg/1 water solution of 8-methoxypsoralen, followed by irradiation with UVA. Eleven patients (39%) showed complete remission (complete softening of the sclerotic plaques with or without postinflammatory hyper- or hypopigmentation) after a mean of 71 treatments (range 33-170) and a mean cumulative dose of 115 J/cm(2) (range 11-232). Partial softening and regression of the sclerotic plaques was observed in 14 patients (50%). Three patients (10.7%) showed no effect, and in none of the patients was worsening noted during treatment. In our experience, bath PUVA photochemotherapy is an effective and well-tolerated treatment option for LS and should be considered as one of the first-line treatment modalities.
    Photodermatology Photoimmunology and Photomedicine 10/2013; 29(5):247-52. · 1.52 Impact Factor
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    ABSTRACT: Biopsy specimens from 23 early stage and 19 tumor-stage mycosis fungoides (MF) patients were evaluated for miR-155 expression by real-time qualitative PCR and compared with 15 biopsy specimens from patients with T-cell-rich inflammatory skin diseases. Significant upregulation of miR-155 was found in MF tumors compared with both early-stage MF lesions and controls. There was no difference in miR-155 expression between early-stage and inflammatory dermatoses. Using laser capture microdissection, it was found that miR-155 was significantly higher in the lymphoma cells in tumor stage compared with the intraepidermal lymphocytes in early stage. In contrast, there was no difference in miR-155 expression between the intraepidermal lymphocytes and the dermal lymphocytes in early-stage MF. These findings suggest that although miR-155 expression cannot serve to discriminate early-stage MF from inflammatory dermatoses; however, it is involved in the switch from the indolent early stage into the aggressive tumor stage of the disease.
    Experimental Dermatology 06/2013; 22(6):431-433. · 3.58 Impact Factor
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    ABSTRACT: Abstract Background: Pemphigus vulgaris follows a chronic relapsing course where the mainstay of therapy has been oral corticosteroids and second-line immunosuppressive and immunomodulating therapies. Successful responses have been reported with Rituximab, a chimeric monoclonal anti-CD20 antibody targeting B lymphocytes, although its use in recalcitrant pemphigus is still being studied. Methods: A retrospective analysis is presented of 18 patients with cutaneous and mucous membrane involvement after disease relapse following steroid and other adjuvant therapies who were treated with Rituximab (4 intravenous infusions of 375 mg/m2 once weekly for 4 consecutive weeks). Results: At 3 months follow-up 44% of cases achieved complete disease remission with a further 44% showing partial remission. Further follow-up showed 5/8 partial responders achieving a complete response with 4 cases experiencing disease relapse (72% response at 9 months). There were no adverse drug-related events and its use resulted in a significant reduction in steroid dosage during follow-up. Conclusion: Rituximab is beneficial in the management of refractory PV, resulting in clinical remission and a steroid sparing effect. Further study needs to examine Rituximab dosage and scheduling as well as its place within the treatment algorithm.
    Journal of Dermatological Treatment 03/2013; · 1.50 Impact Factor
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    ABSTRACT: Autoimmune bullous skin disorders are characterized by a severe and potentially lethal course and may require aggressive long-term treatment with systemic corticosteroids and other immunosuppressive drugs, which can lead to serious adverse events. Recently, anti-CD20 antibody, Rituximab, was reported to be beneficial as an adjuvant therapy in these diseases. Herein, we present 2 case reports of patients suffering from resistant rare diseases from the aforementioned spectrum: linear IgA dermatosis and Pemphigoid gestationis. The patients were successfully treated with Rituximab (Mabthera). This is one of the first reports of this kind of treatment for these rare life-threatening diseases. These case reports emphasize the role of Rituximab as a crisis therapy in autoimmune blistering diseases.
    Harefuah 10/2012; 151(10):562-5, 606.
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    ABSTRACT: BACKGROUND: New World cutaneous leishmaniasis is mostly acquired in the Amazon Basin of Bolivia where L viannia (V) braziliensis is endemic. Treatment with systemic pentavalent antimonial compounds has been shown to be effective in achieving clinical cure in only 75% of cases. OBJECTIVE: We sought to assess the efficacy and safety of liposomal amphotericin B (L-AmB) treatment for primary infection of cutaneous L (V) braziliensis. METHODS: A prospective observational evaluation was performed for cutaneous leishmaniasis due to L (V) braziliensis which was treated with L-AmB, 3 mg/kg, for 5 consecutive days, and a sixth dose on day 10. This therapy regimen was compared with the treatment regimen of sodium stibogluconate (SSG) 20 mg/kg for 3 weeks. RESULTS: Our study was divided into two groups; 34 patients received L-AmB and 34 received SSG treatment. Almost all patients were infected in Bolivia. In the L-AmB group, 29 patients (85%) had complete cure compared with 70% in the SSG group (P = not significant), 4 other patients were slow healers, and only one patient needed additional treatment with SSG. No relapses were seen during a mean 29-month follow-up period. Failure rate was 3% in the L-AmB versus 29% in the SSG group (P = .006). Treatment was interrupted in 65% of patients taking SSG because of adverse events, whereas all patients receiving L-AmB completed treatment. LIMITATIONS: This was a non-blinded comparative study. CONCLUSIONS: Comparison of L-Amb to SSG treatment for L (V) braziliensis shows that the former is effective, better tolerated, and more cost effective. L-AmB should therefore be considered as the first-line treatment option for cutaneous L (V) braziliensis infection.
    Journal of the American Academy of Dermatology 08/2012; · 4.91 Impact Factor
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    ABSTRACT: Metastatic melanoma is a devastating disease with limited therapeutic options. MicroRNAs (miRNAs) are small non coding RNA molecules with important roles in post-transcriptional gene expression regulation, whose aberrant expression has been implicated in cancer. We show that the expression of miRNAs from a large cluster on human chromosome 14q32 is significantly down-regulated in melanoma cell lines, benign nevi and melanoma samples relative to normal melanocytes. This miRNA cluster resides within a parentally imprinted chromosomal region known to be important in development and differentiation. In some melanoma cell lines, a chromosomal deletion or loss-of-heterozygosity was observed in the cis-acting regulatory region of this cluster. In several cell lines we were able to re-express two maternally-induced genes and several miRNAs from the cluster with a combination of de-methylating agents and histone de-acetylase inhibitors, suggesting that epigenetic modifications take part in their silencing. Stable over-expression of mir-376a and mir-376c, two miRNAs from this cluster that could be re-expressed following epigenetic manipulation, led to modest growth retardation and to a significant decrease in migration in-vitro. Bioinformatic analysis predicted that both miRNAs could potentially target the 3'UTR of IGF1R. Indeed, stable expression of mir-376a and mir-376c in melanoma cells led to a decrease in IGF1R mRNA and protein, and a luciferase reporter assay indicated that the 3'UTR of IGF1R is a target of both mir-376a and mir-376c. Our work is the first to show that the large miRNA cluster on chromosome 14q32 is silenced in melanoma. Our results suggest that down-regulation of mir-376a and mir-376c may contribute to IGF1R over-expression and to aberrant negative regulation of this signaling pathway in melanoma, thus promoting tumorigenesis and metastasis.
    Molecular Cancer 07/2012; 11:44. · 5.13 Impact Factor
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    ABSTRACT: Unlike T-cell neoplasms, B-cell lymphoproliferative disorders have a limited clinical spectrum of skin involvement. Cutaneous B-cell neoplasms mimicking rosacea or rhinophyma are rare. We described 12 patients with B-cell lymphoproliferative neoplasms presenting with a facial eruption clinically mimicking rosacea or rhinophyma. Eleven patients were women; ages ranged from 36 to 81 years. The clinical presentation included small papules on the nose and cheeks and around the eyes mimicking granulomatous rosacea; nodules on the nose, cheeks, chin, or forehead mimicking phymatous rosacea; or a combination of both. Three patients had preexisting erythematotelangiectatic rosacea and 1 had rhinophyma. Based on a clinicopathologic correlation and B-cell clonality analysis, the diagnosis was primary cutaneous follicular center B-cell lymphoma in 4 cases, primary cutaneous marginal zone lymphoma in 6, and skin involvement of chronic lymphocytic leukemia in 2. All patients had an indolent course as expected for their disease. Cutaneous involvement of B-cell neoplasms may mimic granulomatous rosacea or rhinophyma. This unusual clinical presentation is more common in women and appears in the setting of preexisting rosacea or as a new eruption. Proliferative B-cell disorders should be added to the differential diagnosis of symmetric papular or papulonodular eruptions of the face.
    Archives of dermatology 04/2012; 148(7):824-31. · 4.76 Impact Factor
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    ABSTRACT: Pemphigus vulgaris (PV) is a severe autoimmune blistering disease caused by anti-epithelial antibodies, leading to disruption of cell-cell adhesion. Although the disease is exceedingly rare worldwide, it is known to be relatively prevalent in Jewish populations. The low prevalence of the disease represents a significant obstacle to a genome-wide approach to the mapping of susceptibility genes. We reasoned that the study of a genetically homogeneous cohort characterized by a high prevalence of PV may help exposing associated signals while reducing spurious results due to population sub-structure. We performed a genome-wide association study using 300K single-nucleotide polymorphisms (SNPs) in a case-control study of 100 PV patients of Jewish descent and 397 matched control individuals, followed by replication of significantly associated SNPs in three additional cohorts of Jewish, Egyptian, and German origin. In addition to the major histocompatibility complex locus, a genomic segment on 8q11.23 that spans the ST18 gene was also found to be significantly associated with PV. This association was confirmed in the Jewish and Egyptian replication sets but not in the German sample, suggesting that ST18-associated variants may predispose to PV in a population-specific manner. ST18 regulates apoptosis and inflammation, two processes of direct relevance to the pathogenesis of PV. Further supporting the relevance of ST18 to PV, we found this gene to be overexpressed in the skin of PV patients as compared with healthy individuals.
    Journal of Investigative Dermatology 03/2012; 132(7):1798-805. · 6.19 Impact Factor
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    ABSTRACT: Morphea and other scleroderma-like skin conditions are occasionally linked with exposure to chemical compounds such as silicone. We treated a 56-year-old woman with generalized severe skin induration accompanied with systemic symptoms and peripheral eosinophilia, which appeared 2.5 years after breast silicone implantation and abdominal liposuction. Blood test results and histopathological examination of her skin suggested the diagnosis of morphea overlapping with eosinophilic fasciitis. Her skin disease was presumed to be an autoimmune reaction to silicone implantation. While the removal of the implants did not improve her illness, treatment with 1 mg/kg prednisone and PUVA bath was initiated, with some improvement. This patient illustrates an example of ASIA (Autoimmune Syndrome Induced by Adjuvants), as her disease appeared following exposure to an adjuvant stimulus, with 'typical', although not well-defined, autoimmune manifestations.
    Lupus 02/2012; 21(2):136-9. · 2.78 Impact Factor
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    ABSTRACT: Background  'Erysipelas-like' erythema (ELE) is a well recognized, although uncommon, manifestation of familial Mediterranean fever (FMF), which is frequently mistaken for infectious erysipelas, especially when forming the initial disease presentation. Aim  To clinically and genetically characterize ELE as the first manifestation of FMF. Methods  FMF patients with ELE as the first disease presentation (study group), were compared with FMF patients with ELE, appearing during the disease course (control group I), and to those FMF patients who never had ELE (control group II). Results  Patients of the study group were comparable to patients without ELE with respect to all demographic, clinical and genetic features studied, and yet differed from patients with ELE appearing later in the disease course in disease severity score (1.7 ± 0.4 vs. 2.4 ± 0.6, P = 0.01), length of diagnosis delay (7.2 ± 6.4 vs. 2.3 ± 3.3 years, P=0.037), age of FMF onset (24.8 ± 19.9 vs. 5.6 ± 5.7 years of age, P=0.014) and rate of homozygosity to the M694V mutation (14.3% vs. 68.7% respectively). ELE traits in the study and control groups were alike. Conclusions  FMF with ELE as the first disease manifestation form an uncommon subgroup, clinically and genetically diverging from the rest of the FMF-ELE patients.
    Journal of the European Academy of Dermatology and Venereology 01/2012; · 2.69 Impact Factor
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    ABSTRACT: Pemphigus vulgaris (PV) is a chronic, autoimmune blistering disease. Most patients require long term therapy with systemic steroids as a first line of treatment. Immunosuppressive agents such as methotrexate (MTX) are administrated as second line therapy. Only a few reports have assessed MTX efficacy, with contradictory results. The aim of this study was to evaluate MTX as an adjuvant therapy in patients with PV. A retrospective study of 30 PV patients treated with MTX as an adjuvant therapy. Disease severity score and prednisone dosage served as assessing measures. All patients were treated with 15 mg MTX per week. Of the 25 patients defined as severe or moderate disease at the beginning of treatment, 21 (84%) improved and downgraded their severity status at 6 months of treatment. In 21 patients (76.6%) we were able to reduce the prednisone dose. There was a significant improvement in the severity score (p=0.00001) and in prednisone dose (p=0.0001). Four patients (13%) suffered from mild side effects. MTX treatment is safe and beneficial as a steroid-sparing agent in PV.
    European journal of dermatology: EJD 01/2012; 22(1):83-7. · 1.95 Impact Factor

Publication Stats

2k Citations
492.55 Total Impact Points


  • 1987–2014
    • Tel Aviv University
      • • Department of Dermatology
      • • Department of Neurobiology
      • • Faculty of Life Sciences
      Tell Afif, Tel Aviv, Israel
    • Sheba Medical Center
      • • Department of Dermatology
      • • Department of Pathology
      Gan, Tel Aviv, Israel
  • 2011
    • Weizmann Institute of Science
      • Department of Immunology
      Tell Afif, Tel Aviv, Israel
  • 1997–2007
    • Rabin Medical Center
      Tell Afif, Tel Aviv, Israel
  • 1998–2004
    • Schneider Children's Medical Center of Israel
      Petah Tikva, Central District, Israel
    • Hebrew University of Jerusalem
      • Hadassah Medical School
      Jerusalem, Jerusalem District, Israel
  • 2000
    • Kaplan Medical Center
      Kefar Yavne, Central District, Israel
    • Ben-Gurion University of the Negev
      • Faculty of Health Sciences
      Beersheba, Southern District, Israel
  • 1999
    • Assaf Harofeh Medical Center
      Ayun Kara, Central District, Israel