A Split-Face Study to Evaluate Efficacy of Autologous Injectable Platelet-Rich Fibrin With Microneedling Against Microneedling With Normal Saline (Placebo Control) in Atrophic Acne Scars.

BACKGROUND: Acne scars cause significant psychosocial stress. Despite a wide armamentarium, there is a constant search for an effective modality. Autologous injectable platelet-rich fibrin (i-PRF) is a promising novel option in the management of atrophic scars. OBJECTIVE: To compare efficacy of autologous i-PRF with microneedling against microneedling alone in atrophic acne scars. MATERIALS AND METHODS: A split-face prospective interventional study was conducted on 40 patients with atrophic acne scars. Autologous i-PRF and normal saline were injected into each scar on right (study) and left (control) sides, respectively, followed by microneedling on both sides. Four sessions were performed at monthly intervals with follow-up at 2 months. For assessment, Goodman and Baron (GB) scale, physician subjective score, and patient satisfaction scores were used. RESULTS: Mean baseline GB grade on each side was 3.45. At 24 weeks, mean GB grade was significantly reduced on the study side (1.47, SD 0.56) than control side (3.33, SD 0.53). Mean patient satisfaction score was significantly higher on the right side (5.95) compared with the left side (5.35). Rolling scars responded the best followed by boxcar and ice-pick scars. CONCLUSION: Autologous i-PRF and microneedling act synergistically to improve acne scars.

Combination of autologous platelet rich plasma and hydroquinone 4% is more effective than hydroquinone alone in treatment of melasma: A split-face comparative study.

Melasma is a common acquired circumscribed hyper-pigmentary disorder involving sun-exposed areas, particularly face. The high frequency of recurrence renders the management more challenging. Autologous platelet rich plasma (PRP) has promising potential in the treatment of melasma. This study evaluates the efficacy of combination of autologous PRP and Hydroquinone and compares it with the gold standard molecule 4% Hydroquinone. Thirty patients with melasma were enrolled in this split-face study conducted between 2018 and 2020. All the patients were prescribed Hydroquinone cream 4% to be applied on the affected area at night. Microneedling was performed once a month (total four sessions) on both sides of face, followed by application of autologous platelet rich plasma on right side and normal saline as control on left side of affected area. Modified Melasma Area and Severity Index (MASI) score, Patient satisfaction score and Physician's Global Assessment score were calculated at baseline and after each session and improvement was assessed. Improvement in mean modified MASI score was significant on both sides of face. Mean percentage improvement in modified MASI score on study side and control side was 82% and 69% respectively. The difference between the two sides was statistically significant in terms of modified MASI, patient satisfaction and physician global assessment scores. Adverse effects were mild and transient. Autologous platelet rich plasma is an effective and safe therapy for treatment of melasma. Combination of autologous PRP and 4% Hydroquinone showed greater improvement than hydroquinone alone.

Lepromatous leprosy as a presenting feature of HIV.

Various bacterial, mycobacterial and fungal opportunistic infections occur frequently in immunocompromised individuals, however, leprosy in retroviral disease is a relatively rare association. Hereby, we report a case of lepromatous leprosy that presented with clinical features mimicking other opportunistic infections and subsequently led to the diagnosis of HIV. The myriad challenges associated with the diagnosis and management of HIV-leprosy coinfection are also discussed. Thus, although uncommon, atypical cutaneous lesions in HIV-seropositive patients warrant investigation for leprosy.

Systemic lupus erythematosus in HIV: An insight into clinical implications and management.

Although HIV infection can mimic the manifestations of various autoimmune disorders, the coexistence of HIV and systemic lupus erythematosus (SLE) has been rarely reported. The exact impact of HIV on SLE and vice versa is unclear. We report an HIV-seropositive female on highly active antiretroviral therapy presenting with features of SLE. Herein, an attempt has been made to discuss the various complex clinical and therapeutic implications along with the influence on disease course and prognosis.

Platelet-Rich Plasma Augments Subcision in Atrophic Acne Scars: A Split-Face Comparative Study.

BACKGROUND: Acne has a prevalence of 90% among adolescents. Facial scarring affects 75% of patients. Autologous platelet-rich plasma (PRP) is a novel treatment option for acne scar management and can be used as an adjuvant to acne scar revision procedures. Owing to its remodeling properties, PRP when used as an adjuvant reduces the total number of sittings. OBJECTIVE: To compare efficacy of autologous PRP and subcision against subcision alone in acne scars. METHODOLOGY: It was an experimental analytical study conducted over a period of 2 years. Forty patients successfully completed the trial. It was a split-face study in which the right side of the face was the study side where autologous PRP was injected into each scar after performing subcision. The left side of the face was the control side where only subcision was performed. Digital photographs were taken at every sitting. Analysis was performed using the Wilcoxon signed-rank test and Mann-Whitney tests in SPSS software. RESULTS: Platelet-rich plasma and subcision showed greater improvement (32.08%) in postacne scars as compared to subcision alone (8.33%). Rolling acne scars responded greatest (39.27%) followed by box-type scars (33.88%). CONCLUSION: Platelet-rich plasma and subcision act synergistically to improve the appearance of acne scars.

Circulating cytokine profiles in leprosy patients.

BACKGROUND: Leprosy is a chronic infectious disease caused by Mycobacterium leprae which is an obligate intracellular pathogen. It is characterised by a broad spectrum of clinical forms dictated by the patient's immune response to the organism. The tuberculoid pole has good cell mediated immunity to M. leprae, with few lesions and bacilli while the lepromatous pole has poor immunity coupled with extensive involvement and greater bacillary load. METHODS: We studied serum levels of interferon gamma and interleukin 6 in 100 patients of untreated leprosy, compared them with 30 age and sex matched normal healthy controls and co-related them with different parts of the spectrum and reactional episodes. The purpose of this study was to delineate the role of cytokines and their clinical implications in the leprosy spectrum and during reactional episodes. RESULTS: We observed that mean cytokine levels were significantly higher in the patient group as compared to the controls. In the non reactional patient group, pure neuritic leprosy patients showed highest levels of INFgamma which were directly proportional to the extent of nerve involvement. Lepromatous leprosy patients had the highest levels of IL6. Bacteriological index demonstrated a negative and positive corelation with INFgamma and IL 6 levels respectively. Type I and Type II reactional patients had higher levels of INFgamma and IL 6 respectively as compared to nonreactional patients. CONCLUSIONS: Our results suggest that pure neuritic leprosy and borderline tuberculoid patients in type I reaction are at greatest risk for nerve and tissue damage. Thus cytokines have the potential to play a significant role in classification, prognosis and treatment of leprosy.

Disseminated cutaneous rhinosporidiomas in an immunocompetent male.

Rhinosporidiosis is a chronic recurrent infective granulomatous disease of man and animals. It is endemic in India and Sri Lanka. Rhinosporidiosis is a chronic disease commonly involving the nose and nasopharynx. Cutaneous lesions, although rare, can occur due to autoinoculation or due to hematogenous spread. However, disseminated cutaneous lesions presenting as tumor-like swellings are rare. We report here a 48-year-old immunocompetent patient who had disseminated painless cutaneous tumor-like swellings over both the upper limbs, abdomen, left buttock and calf since 10 months, gradually increasing in size. On inquiring, the patient gave history of excisions and electrocauterization of subglottic and nasal polyps. Histopathological examination of these lesions was suggestive of rhinosporidiosis. The general and systemic examinations of the patient did not reveal any abnormality.

A study of serum nitric oxide levels in psoriasis.

BACKGROUND: M any inter and intracellular mediators have been implicated in the pathogenesis of psoriasis. Nitric oxide has been shown to play an important role in many diseases. Previous studies have demonstrated raised levels of nitric oxide in psoriatic plaques which may be attributed to its effect on keratinocytes, on local cGMP levels or its ability to induce angiogenesis. AIMS: To detect serum nitric oxide (NO) levels in patients with active psoriasis, to correlate these levels with severity of disease and compare them with those in normal individuals. METHODS: Thirty six patients with active psoriasis were selected after written consent. All patients on topical or systemic treatment for fifteen days prior to the study were excluded. Disease severity was assessed by PASI score and serum nitric oxide levels were detected by Greiss method and compared with age and sex matched controls. Statistical analysis of all data was done by unpaired t test. RESULTS: Out of 36 patients, 30 had chronic plaque psoriasis (mean NO 157.5), 4 had erythroderma (mean NO 120.2) and 2 had generalized pustular psoriasis (mean NO 144.3). The mean NO level in the psoriatic group was 157.7 with SD 50.4 while in the control group it was 32.8 with SD 4.03. The difference was statistically significant (t=13.8, P < 0.001). In the chronic plaque group, as the duration of disease increased, the NO levels increased significantly. CONCLUSIONS: Nitric oxide levels were significantly increased in patients with psoriasis and these levels showed a positive correlation with severity and duration in the chronic plaque type group.