Efficacy and safety of micro-needling combined with topical 5-fluorouracil and excimer light vs. excimer light alone in treatment of non-segmental vitiligo: A comparative study.

BACKGROUND/PURPOSE: Vitiligo is one of the most challenging dermatological diseases with little improvement promises. Various modalities of treatment both medical and surgical have been used in the treatment of vitiligo. Some proved to be effective, others with controversial results and the rest were effective less. The aim of the present study was to evaluate the additional effect of topical 5-fluorouracil after micro-needling to excimer light (308 nm) in treatment of non-segmental vitiligo. METHODS: Fifty patients were included in the present study, only 33 patients continued the treatment for 6 months. Two patches were selected in every patient to be treated, one patch with micro-needling then application of 5 FU and excimer (Group A), and the other with excimer only (Group B). RESULTS: The treatment with the combination of micro-needling then application of 5 FU and excimer showed significant earlier response versus excimer alone. Also, the percentage of re-pigmentation was higher in the patches treated with the combination especially in the face and trunk. The combination of 5 FU after micro-needling and Excimer is more suitable for localized and focal vitiligo. CONCLUSION: Topical 5 FU after micro-needling is a promising, rapid, and cost-effective therapeutic strategy for treatment of non-segmental vitiligo It had limited side effects, and the best response was reported for lesions affecting face and trunk.

Systemic isotretinoin has an impact on hemoglobin, ferritin, urea, ceruloplasmin, albumin, uric acid levels, and neutrophil to lymphocyte ratio in acne patients.

BACKGROUND: Patients suffering from moderate-to-severe acne are commonly treated with systemin isotretinoin; however, a great controverse about its safety had been raised. The aim of the present study is to evaluate the effects of isotretinoin on hepatic, renal, and hematologic functions and to evaluate the potential oxidative stress in relation to isotretinoin therapy. METHODS: Fifty-three female patients, treated from moderate-severe acne with isotretinoin (0.5 mg/kg/day), were included. Blood samples were taken for measuring low density lipoprotein (LDL), triglycerides, hemoglobin, erythrocyte sedimentation rate (ESR), bilirubin, total protein, albumin, globulin, blood urea nitrogen, ferritin, uric acid, creatinine, C-reactive protein (CRP), ceruloplasmin, alanine transaminase (ALT), aspartate transaminase (AST) levels, and red blood cells (RBC), white blood cells (WBCs), and platelet counts before starting isotretinoin treatment and 6 months later. RESULTS: Isotretinoin was associated with increased levels of triglycerides, LDL, ESR, CRP, uric acid, and ferritin after 6 months of therapy (p < 0.0001), blood urea levels were significantly elevated from 3.681 ± 0.91 to 3.838 ± 0.877 (p = 0.014), ALT, AST, hemoglobin, globulin, and total proteins were significantly elevated after 6 months. Platelets, WBCs, albumin, albumin/globulin ratio, copper, ceruloplasmin, and neutrophil/lymphocyte ratio were significantly decreased after 6 months. CONCLUSION: Isotretinoin therapy could be associated with oxidative stress and hepatic, lipid, and blood abnormalities in patients with acne. Serum ferritin was elevated while serum ceruloplasmin was decreased. Isotretinoin could also affect immune regulation (decreasing neutrophil to lymphocyte ratio), isotretinoin was associated with a possible positive nitrogen balance (increasing proteins) and with elevations of blood urea nitrogen and uric acid levels.

Patterns of thyroid dysfunctions in adolescent patients suffering from severe acne during isotretinoin treatment.

Although oral isotretinoin has been widely used as a basic treatment of acne in adolescents, several studies have noted some alterations in thyroid functions during oral isotretinoin therapy. Therefore, the present study aims at evaluating the possible changes in thyroid-stimulating hormone (TSH), free thyroxin (fT4) and free triiodothyronine (fT3) levels during isotretinoin treatment and analyzing the possible factors which may contribute to such changes. In the present study, 47 patients received (0.5 mg/kg oral isotretinoin) for treatment of severe acne. TSH, fT4 and fT3 were measured at baseline, after 3 and 6 months. ANOVA tests were used for statistical analyses. The levels of fT4 and fT3 decreased significantly during isotretinoin treatment (from 0.85 ± 0.04 and 3.1 ± 0.26 at baseline to 0.81 ± 0.023 and 2.76 ± 0.2 after 6 months, respectively). The decrease was accompanied by significant elevation of TSH (0.66 ± 0.05 at baseline to 0.695 ± 0.05 after 6 months). The duration of therapy (but not the dose) has significantly affected all the hormonal changes. Previous incomplete or intermittent isotretinoin treatment had significantly influenced the changes in fT4 only, while gender affected the changes of TSH. Isotretinoin treatment can decrease fT4, fT3 and increase TSH. The pattern of these changes was affected by gender and previous isotretinoin therapy. Different doses of isotretinoin did not affect the hormonal changes, but the duration has been the major influencing factor.

Pregabalin administration and withdrawal affect testicular structure and functions in rats.

The aim of this prospective experimental study was to investigate the effects of pregabalin (PG) administration and withdrawal on testicular structures and functions in rats. A total of 24 male Wistar rats were divided into two groups (n = 12 each): a control group received normal saline, and PG-treated group received 62 mg kg-1  day-1 PG for 2 months. Half the animals of each group were sacrificed for the collection of blood and testicular samples. The remaining animals were bred for another 2 months without treatment before collection of blood and testicular samples. PG administration decreased testosterone and increased luteinising hormone (LH) and follicle-stimulating hormone (FSH) levels versus controls. PG withdrawal led to a decrease in both FSH and LH and an increase in testosterone levels versus saline withdrawal. Compared to controls, PG administration caused degeneration of seminiferous tubules and decreased the number of spermatogenic but increased the number of Leydig cells. After PG withdrawal, these cells showed a rebound reverse. Reduced glutathione levels increased with PG administration while PG withdrawal increased malondialdehyde levels. Conclusion: PG administration affected testicular morphometry, gonadotrophic and sex hormones; however, there was a rebound reversal in all these parameters and a significant oxidative stress in PG withdrawal.

Successful treatment of facial vascular skin diseases with a 577-nm pro-yellow laser.

BACKGROUND: Treatment of vascular skin diseases is one of the most important indications of the laser. AIMS: To evaluate the effectiveness of 577-nm pro-yellow laser in the treatment of some vascular skin diseases. PATIENTS/METHODS: Ninety-five patients with vascular skin diseases were included in this prospective monocentric study. They were classified into: port-wine stain birthmarks (n = 37), papulopustular rosacea (n = 20), facial telangiectasia (n = 16), and facial erythema (n = 22). All participants received a monthly session of 577-nm pro-yellow laser. Follow-up was done by comparing the photographs before and at every follow-up visit. RESULTS: At the final visit, there was a significant improvement (>50%) occurred in 24/37 (64.82%), 12/20 (60%), 10/16 (62.5%), and 19/22 (86.3%) cases and poor response occurred in 6/37 (16.2%), 2/20 (10%), 2/16 (12.5%), and 0/22 cases after a mean number of sessions 7.76 ± 2.28, 3.1 ± 1.8, 3.63 ± 1.12, and 1.8 ± 0.85 in port-wine stain, rosacea-, facial telangiectasia-, and facial erythema-treated groups, respectively. Transient irritation and erythema during the session were the only complications reported in the study. CONCLUSION: Facial port-wine stains, rosacea, telangiectasia, and erythema can be successfully treated with a single pass of 577-nm pro-yellow laser with a minimal side effect. Facial erythema showed the highest degree of success with the least number of sessions, while more sessions needed for the treatment of port-wine stain.

Intense Pulsed light Versus 1,064 Long-Pulsed Neodymium: Yttrium-Aluminum- Garnet Laser in the Treatment of Facial Acne Vulgaris.

INTRODUCTION: Laser and light-based procedures provide a good and safe modality for treatment of active acne lesions when used properly. AIM: To compare the clinical efficacy of intense pulsed light (IPL) versus 1,064 long-pulsed Neodymium:Yttrium-Aluminum- Garnet (Nd: YAG) in treatment of facial acne vulgaris. MATERIALS AND METHODS: Seventy four patients recruited between June 2013 and August 2014 was enrolled in this controlled, single-blind, split-face clinical trial. All participants received 3 sessions of IPL on the right side of the face and 1,064-nm Nd:YAG on the left side of the face at 4-weeks intervals. Final assessment was made by comparison of the changes in the count of inflammatory acne lesions (inflammatory papules, pustules, nodules and cyst) and non-inflammatory acne lesions (Comedones) and the acne severity score between both therapies, based on standardized photography. RESULTS: At the final visit, the inflammatory acne lesions were reduced on the IPL and 1,064-nm Nd:YAG treated sides by 67.1% and 70.2% respectively (p<0.05 for each), while non inflammatory acne lesions were reduced by 18.3% and 19.3% respectively (p>0.05 for each). For both therapies, there was significant difference in the improvement on inflammatory acne lesions in comparison to non-inflammatory lesions (p<0.05 for each). There was no significant difference in the efficacy of the two therapies in reducing the percentage of both types of acne lesions count from baseline to the end of the study (p>0.05 for each). CONCLUSION: Both IPL and 1,064-nm Nd:YAG laser are effective in treatment of inflammatory facial acne vulgaris. There is no significant difference between the effects of both therapies on facial acne lesions.

The Clinical Effectiveness of Intralesional Injection of 2% Zinc Sulfate Solution in the Treatment of Common Warts.

Objective. To investigate the clinical efficacy and safety of intralesional injection of 2% zinc sulfate solution in the treatment of common warts. Patients and Methods. One hundred and twenty patients (78 females and 42 males) aged 5-55 years with 225 common warts participated in this prospective monocentric randomized study. All lesions were treated with intralesional injection of 2% zinc sulfate. Results. From 225 warts injected, 135 warts (60%) cured from the first session, 51 warts (22.67%) cured from the second session, and 12 warts (5.33%) cured from the third session. There is no significant relation between improvement and patient's ages, duration, or number of warts (P > 0.05). All patients complained from pain during injection, and all treated lesions showed redness, tenderness, and swelling in the first 3 days after injection. Late complications were postinflammatory hyperpigmentation in 90 patients (75%), scaring in 9 patients (7.5%), and ulceration in 3 patients (2.5%). Recurrence occurred in 3 lesions (1.33%). Conclusion. The clinical data indicate that intralesional injection of 2% zinc sulfate is an effective maneuver in the treatment of common warts; however, its associated complications limit its use.

Trichoscopic changes in hair during treatment of hirsutism with 1064-nm neodymium:yttrium-aluminum-garnet laser.

BACKGROUND: Laser hair removal has become an accepted form of long-term hair reduction and is now one of the most common dermatologic procedures. Trichoscan is a validated method of assessing hair length, thickness, and density and growth rate using dermoscopy. OBJECTIVE: The study aimed to evaluate the trichoscopic changes during treatment of hirsutism with 1064-nm neodymium:yttrium-aluminum-garnet laser. METHODS: Seventy patients with idiopathic facial hirsutism referring to the laser centers of Al-Azhar University hospital (Asyut and Cairo) between December 2012 and October 2014 were enrolled in this open-label, multicentric study. All participants received six sessions of 1064-nm Nd:YAG laser at 4-week intervals. Mean hair density/cm(2) , percentage of terminal/vellus hair ratio, and hair thickness (mm) were assessed at baseline and 1 month after each session for six sessions using trichoscan. RESULTS: Seventy female patients completed the study protocol. At the final visit, mean hair density, terminal/vellus hair ratio, and hair thickness were significantly decreased from baseline (73.7 + 20.6, 72.5 + 14.7, 0.095 + 0.02, respectively) to (19.4 + 5.6, 21.3 + 5.2, 0.02 ± 0.007, respectively) (P < 0.05 for each). CONCLUSION: One thousand and sixty-four-nm Nd:YAG laser is an effective and safe method in the reduction of unwanted facial hair. Trichoscan is an easy and more accurate method in monitoring the treatment of hair disorders.

Hungry for nothing: should dental patients fast prior to conscious sedation?

OBJECTIVE: This research explores the attitudes of medical professionals towards fasting patients prior to the use of conscious sedation. MATERIALS AND METHODS: Questionnaires were completed by a total of 113 dentists, anaesthetists and dental nurses in order to identify current practices and opinions concerning the employment of pre-operative fasting in the context of conscious sedation in dentistry. RESULTS: Seventy-eight (69%) respondents did not recommend fasting, compared with 35 (31%) who did. Those who did not recommend fasting were able to state significantly more adverse effects (P<0.01) of fasting when compared to the 35 (31%) who advocated fasting. Significantly more anaesthetists (80%) than dentists (14%) advised fasting patients (P<0.001). Thirty-two of 39 (82%) respondents mentioned the risk of aspiration to be the main reason for recommending that patients be fasted. CONCLUSION: Medical professionals in dentistry provide a wide range of conflicting views on the employment of fasting prior to conscious sedation reflecting the lack of homogeneity in literature surrounding this topic.