Combined microneedling with topical vitamin D3 or bimatoprost versus microneedling alone in the treatment of alopecia areata: A comparative randomized trial.

INTRODUCTION: Alopecia areata (AA) is a challenging disease with variable treatment outcomes. Hair follicles express vitamin D receptors. Therefore, vitamin D3 may be promising for AA treatment through immunomodulatory mechanisms. The efficacy of bimatoprost in scalp AA treatment was reported by few studies. OBJECTIVE: To evaluate the efficacy and safety of microneedling (MN) with topical vitamin D3 versus MN with bimatoprost in comparison with MN alone in the treatment of localized AA. PATIENTS AND METHODS: Seventy-five patients with localized AA were divided into three groups. The first group: 25 patients were treated with MN alone. The second group: 25 patients treated with MN combined with topical vitamin D3. The third group: 25 patients treated with MN combined with bimatoprost solution. The response was evaluated clinically and dermoscopically. RESULTS: At the end of the study, all groups showed a statistically significant decrease in the SALT score compared to the baseline. The clinical response (regrowth scale): vitamin D and bimatoprost groups showed a statistically significant higher regrowth scale compared to MN alone group (p-value = 0.000). After treatment, hair regrowth was significantly higher in MN combined with bimatoprost than in MN combined with topical vitamin D3. However, after 3 months of follow-up, there was no statistically significant difference between both groups. Side effects were mild and transient in all groups. CONCLUSION: Topical vitamin D3 and bimatoprost combined with MN are safe and effective therapeutic options for localized AA.

Split body comparative clinical and radiological study of fractional CO2 laser versus carboxytherapy in treatment of striae distensae.

Striae Distensae (SD) are quite common complaint in dermatology practice. They are linear lesions of variable length and width according to the site and the causative condition. Several treatment modalities have been tried. To achieve satisfactory results, a combination therapy is often needed. To evaluate the efficacy and safety of fractional CO2 laser versus carboxytherapy in the treatment of Striae Distensae clinically and radiologically. Thirty Egyptian patients with striae distensae, received a split body therapy: the left side was treated by fractional CO2 laser and the right side was treated by carboxytherapy in the same session. Six sessions were done with 4 weeks apart. Clinical evaluation by measurement of the width of widest striae on both sides, global aesthetic improvement scale (GAIS), and Likert satisfaction scale. Radiological evaluation by measurement of cutaneous thickness of widest striae on both sides by ultrasonography. There was a highly statistically significant decrease in the median width of the widest striae distensae on both sides after the last session (P < 0.01). Regarding GAIS, satisfaction scale and ultrasound, there was highly statistically significant improvement on laser side than carboxytherapy side (P < 0.01) after last session. Both fractional CO2 laser and carboxytherapy may be considered as safe and effective lines of treatment for striae distensae, but fractional CO2 laser showed excellent improvement clinically, radiologically when compared with carboxytherapy which made it a promising module in treatment of striae distensae.

Role of vitamin D in treatment of keloid.

BACKGROUND: Keloid is a benign well-demarcated overgrowth of fibrotic tissue which extends beyond the original boundaries of a defect. The treatment of keloids is a particular challenge to dermatologists. Intralesional corticosteroid injection has been considered the first-line treatment for keloids. Vitamin D plays an important role in cell proliferation and differentiation as it slows the progression of tissue fibrosis by keloid fibroblasts and inhibits collagen synthesis in dermal fibrosis. OBJECTIVES: To evaluate the efficacy of intralesional injection of vitamin D in the treatment of keloids, both clinically and ultrasonically. METHODS: Forty Egyptian patients with keloid scars were injected weekly with intralesional vitamin D with dose of 0.2 ml (200,000 IU) per 1 cm lesion. The keloid scars were evaluated with Vancouver Scar Scale (VSS) and by a high-resolution ultrasound using B mode before and after treatment, the patients received 3 to 4 sessions. RESULTS: There was statistically highly significant reduction in VSS after treatment with intralesional vitamin D injection (p value≤0.001). There was also statistically highly significant improvement in ultrasonic keloid scar thickness after treatment (P value ≤0.001). CONCLUSIONS: Intralesional vitamin D is an effective and safe method in treatment of keloid scars. Ultrasound is a useful method in assessing the improvement of keloids after treatment.

Comparative study between fractional carbon dioxide laser versus retinoic acid chemical peel in the treatment of acanthosis nigricans.

BACKGROUND: Acanthosis nigricans (AN) is a common dermatological issue with several therapeutic modalities to treat. Despite retinoid is the first drug of choice in the treatment, the fractional-ablative carbon dioxide (CO2 ) laser has revealed as a promising procedure for the management of neck-AN, outstanding to its ability for superficial ablation of the skin surface, with trans-epidermal melanin elimination. OBJECTIVES: To decide whether fractional-ablative CO2 laser or retinoic acid (5%) peel is the more effective and safe choice for AN treatment. METHODS: In this study, twenty Egyptian cases with neck-AN were enrolled, where each case was exposed to four sessions with 2 weeks apart of both fractional CO2  laser on the right half of the neck and retinoic acid peel on the left half of the neck. Cases were assessed by a scoring system: Acanthosis Nigricans Area and Severity Index (ANASI) score, two blinded dermatologists, and dermoscopically before and one month after treatment. RESULTS: We found a highly statistically significant improvement among both treated groups regarding (ANASI) score and dermatologist's assessments. Bedside, the degree of sulci cutis, cristae cutis, brown-to-dark brown dots, and milia-like cysts, dermoscopic sign improvement was evident in both treated groups. However, fractional CO2 laser shows the superior result to retinoic acid peel in the treatment. CONCLUSION: Fractional CO2 laser and retinoic acid peel are considered effective modalities for neck-AN treatment. However, fractional CO2 laser was more effective.