Recent modalities in treatment of telogen effluvium: Comparative study.

Telogen effluvium is one of the most common forms of diffuse, non-scarring hair loss for which patients present for clinical evaluation. It is usually a reactive and reversible disorder. Identifying and correcting the underlying cause is the most important component in management, yet there is always a need for therapeutic options. This study aims to evaluate the efficacy of single session botulinum toxin A injection versus multiple sessions of multivitamins mesotherapy in the treatment of telogen effluvium. A randomized clinical trial was conducted in the Dermatology, Venereology, and Andrology Department, Faculty of Medicine, Zagazig University Hospitals. Twenty-four patients with telogen effluvium were randomly divided into two groups each group included 12 patients. Group I received a single session of Botulinum toxin A injection and group II received multiple sessions of multivitamins mesotherapy injection. Both botulinum toxin A and multivitamins mesotherapy are effective in the treatment of telogen effluvium, which was reflected on the improvement of hair parameters as terminal hair and multiple follicular units. Both treatment modalities had minimal and well-tolerated side effects. Although both therapies have equivalent success rates, single session of botulinum toxin A is a better choice than multiple mesotherapy sessions.

Voriconazole is superior to combined itraconazole/isotretinoin therapy and itraconazole monotherapy in recalcitrant dermatophytosis.

BACKGROUND: There has been an emergence of recalcitrant, recurrent, and difficult-to-treat tinea. Monotherapy with oral antifungals leads to partial clearance or high recurrence of lesions. Isotretinoin is a good adjuvant to systemic antifungals in chronic dermatophytosis. Voriconazole could be a future alternative due to its efficacy against dermatophytes and little resistance. OBJECTIVE: To evaluate the efficacy and safety of oral itraconazole, combined itraconazole/isotretinoin therapy, and voriconazole for recalcitrant tinea. PATIENTS AND METHODS: This study included 90 patients with chronic, recurrent and/or recalcitrant tinea. They were equally divided into three groups: itraconazole monotherapy, combined itraconazole/isotretinoin therapy, and voriconazole monotherapy. All patients received treatments for 6 weeks. The clinical response was classified as either a complete or incomplete clinical cure. Potassium hydroxide microscopy and culture were performed to identify mycological cure. Patients with complete cure were followed up for another 6 months to detect any recurrence. RESULTS: Complete clinical cure was observed in 53.3% of the itraconazole group, 70% of the itraconazole/isotretinoin group, and 83.3% of the voriconazole group. Mycological cure was detected in 56.7% of the itraconazole group, 83.3% of the itraconazole/isotretinoin group, and 86.7% of the voriconazole group. There was a statistically significant difference between the three groups in favour of voriconazole, then the combined group. No significant adverse effects were observed. The recurrence rate was significantly lower in the voriconazole group compared with the other two groups. CONCLUSIONS: Voriconazole could be a future alternative for the treatment of recalcitrant dermatophytosis.

Serum YKL-40 and IL 17 in Psoriasis: Reliability as prognostic markers for disease severity and responsiveness to treatment.

YKL-40, a mammalian chitinase 3- like protein that was associated with multiple inflammatory and immune diseases. Previous studies have suggested a role for YKL-40 in psoriasis based on its significantly higher levels in the serum of psoriatic patient compared with healthy controls. The aim of this study was to determine the correlation between serum YKL-40, psoriasis severity using PASI score and serum levels of IL-17 before and after narrow-band UVB therapy. 28 patients with moderate to severe plaque psoriasis, as defined by PASI scores, were enrolled in this prospective cohort study. All cases received NB-UVB phototherapy twice weekly for 3 months. Serum YKL-40 and IL-17 levels were evaluated before and after 3 months of treatment. Clinical photographs were taken both at baseline and after 3 months. There was a statistical positive correlation between serum levels of YKL-40 and serum IL-17 levels as well as PASI score in patients with moderate to severe psoriasis before and after treatment. YKL-40 represents a reliable marker for psoriasis severity estimated by PASI and positively correlated with IL 17 as an inflammatory marker in psoriasis.

Clinical evaluation of the efficacy of trichloroacetic acid 70% after microneedling vs intradermal injection of 5-fluorouracil in the treatment of nonsegmental vitiligo; A prospective comparative study.

Vitiligo is a skin disorder commonly acquired. Although different therapies are used, they are refractory to therapy in many cases. Trauma has been reported to cause hyperpigmentation by the pigment incontinence, which results in the build-up of melanophages in the upper dermis after basal cell layer destruction. To detect the effectiveness of trichloroacetic acid (TCA) 70% in the treatment of nonsegmental vitiligo after skin microneedling by dermapen or intradermal injection of 5-fluorouracil. PATIENTS AND METHODS: A prospective comparative study was enrolled with 32 patients with vitiligo who were assigned to two equal groups. Each containing 16 patients; group 1 was treated by microneedling followed by TCA 70%, group 2 was treated by intradermal 5-FU injection. This was done every 2 weeks for 2 months. RESULTS: According to the Physician's Global Assessment, there was no significant (P < .05) difference in the therapeutic response between the two studied groups. CONCLUSIONS: Both microneedling plus TCA 70% and 5-FU intradermal injection are a simple means of treating vitiligo with cosmetically accepted repigmentation of all age groups, as well as a relatively safe alternative or additive method that can be used before (or in combination with) any of the well-known and widely approved method for stable nonsegmented vitiligo treatment.

Tranexamic Acid for Melasma Treatment: A Split-Face Study.

BACKGROUND: Melasma is an acquired hyperpigmented skin disorder. Tranexamic acid (TXA) prevents ultraviolet radiation induced pigmentation in melasma through interfering with the plasminogen-plasmin pathway. OBJECTIVE: This study was conducted to evaluate the therapeutic effect and safety of TXA by intradermal injection versus TXA with microneedling for melasma treatment. METHODS: Fifty-six female patients with bilateral symmetrical melasma were recruited in a split-face study. All patients received an intradermal injection of TXA on one side of the face, and the other side received TXA with microneedling for 6 sessions at 2 weeks intervals. Clinical efficacy was assessed using a modified Melasma Area Severity Index (mMASI) score at the baseline and after treatment. Global photographs underwent blinded review by 2 dermatologists. Patient self-assessment and satisfaction were recorded. RESULTS: After the treatment, the mMASI score was significantly reduced compared with the baseline in both treated sides (p < .001). No significant difference between both treated sides (p > .05). Patient satisfaction was higher in the microneedling-treated side than the intradermal-injected side (p < .001). No significant adverse effects were observed in both treated sides. CONCLUSION: Intradermal injection and microneedling of TXA could be safe and effective in melasma treatment. Microneedling of TXA was significantly more satisfying to the patients.

Bacillus Calmette-Guerin, polysaccharide nucleic acid in the treatment of cutaneous and oral lichen planus.

The aim of this study was to evaluate the safety and efficacy of Bacillus Calmette-Guerin, polysaccharide nucleic acid (BCG-PSN) therapy in the treatment of oral and cutaneous LP. Twenty-four LP patients were included in this study and classified randomly into; Oral LP group (OLP), 11 patients and Cutaneous LP group (CLP), 13 patients. All patients received intradermal injections of BCG-PSN, twice weekly for three weeks. Patients with complete response were followed up for 3 months. The assessment in OLP was based on the reduction in the treated area, (Reticulation/Erythema/Ulceration) REU scoring system and numerical rating scale (NRS). CLP evaluated by the response to treatment as (complete, partial and no response) and visual analogue scale (VAS). There were highly significant differences in the diminution of lesion areas (p < .006), NRS scores (p < .001), REU score (p < .011), and VAS (p < .001) after treatment. The majority of patients achieved complete response after 3-week management. The BCG-PNS is safe and effective in the treatment of oral and cutaneous LP.

Successful treatment of acne keloidalis nuchae with erbium:YAG laser: a comparative study.

Background: Acne keloidalis nuchae (AKN) is a chronic inflammatory disease involving hair follicles of the neck. It is a form of keloidal scarring alopecia that is often refractory to medical or surgical management. Objective: To evaluate the efficacy of Er:YAG laser in the treatment of AKN as compared to long pulsed Nd:YAG laser. Patients and Methods: This study was conducted on 30 male patients with AKN. Their ages ranged from 19 to 47 years with a mean age of 36.87 ± 7.8 years. Patients were divided randomly into two groups of 15 patients, each receiving six sessions of either Er:YAG or long-pulsed Nd:YAG laser therapy. Results: A statistically significant decrease in the number of papules was detected at the end of therapy in both groups, with a mean of 91.8% improvement in the Er:YAG group versus 88% in the Nd:YAG group. A significant decrease in plaques count was detected only in the Er: YAG group while a significant decrease in plaques size and consistency was recorded in both groups. Conclusion: The Er: YAG laser proved to be a potentially effective and safe modality both in the early and late AKN lesions.

Treatment of striae distensae with needling therapy versus CO2 fractional laser.

BACKGROUND AND OBJECTIVES: Striae are atrophic dermal scars with overlying epidermal atrophy causing cosmetic concern. This study assesses and compares the efficacy and safety of needling therapy versus CO2 fractional laser in treatment of striae. METHODS: Twenty Egyptian female patients with striae in the abdomen and lower limbs were involved in the study. The patients were treated with needling therapy and CO2 laser every 1 month for 3 sessions. Follow-up by digital photography and skin biopsy was conducted at baseline and 6 months after treatment. Clinical improvement was assessed by comparing photographs and patient's satisfaction before and after treatment. RESULTS: Nine of 10 (90%) needle-treated patients showed improvement. Among them, 3 (30%) had good, 4 (40%) had fair, and 2 (20%) had poor improvements; however, 1 (10%) did not show any improvement after the treatment. In CO2-laser treated patients, 5 of 10 (50%) of the patients showed clinical improvement; 1 (10%) were good, 3 (30%) were fair, and 1 (10%) were poor; however, 5 (50%) did not show improvement. CONCLUSION: The results support the use of microneedle therapy over CO2 lasers for striae treatment.

Intralesional combined digoxin and furosemide versus intralesional 5-flurouracil for the treatment of recalcitrant plantar warts: a prospective, randomized study.

There are many therapeutic modalities for plantar warts, however treating it remains challenging. Intralesional injection of 5-fluorouarcil and combined digoxin and furosemide were observed to be effective and safe, however no comparison study between them was done. Our study was conducted to evaluate the efficacy of both therapies in the treatment of plantar warts. 90 adult patients with multiple recalcitrant plantar warts were included in our study. They were randomly allocated to one of three groups; combined digoxin and furosemide, 5-fluorouarcil, or normal saline group. Fortnightly injections were done into all studied warts till complete clearance or up to 5 sessions. Warts were evaluated clinically and dermoscopically. Clinical response was reported in 24 patients (80%) of the combined digoxin and furosemide group with 40% complete response and in 24 patients (80%) of the 5-fluorouarcil group with 33.3% complete response. No statistically significant difference was observed between the two groups concerning efficacy and safety. Intralesional injection of 5-fluorouarcil and combined digoxin and furosemide are nearly equivalent in efficacy and safety for plantar wart treatment. Dermoscopy helps to take the truthful judgment about complete clearance of warts.

Efficacy of Polycaprolactone Threads in Treating Atrophic Acne Scars: A Split-face Comparative Study.

Background: Polycaprolactone (PCL) threads are a novel treatment option for promoting collagen production and smoothing the skin. Objective: This study aimed to compare the efficacy and safety of threads versus microneedling with autologous platelet-rich plasma (PRP) in the treatment of atrophic acne scars. Methods: The study included 24 patients (12 females, 12 males) aged 20 to 37 years with atrophic acne scars. Each patient was treated in a split-face manner; a microneedling pen device was used to treat the right side with microneedling and PRP, whereas the left side was treated with threads. Four microneedling plus PRP sessions were used to treat the right side and a single session of threads was used on the left side. For scoring, a global scarring grading system was utilized. Patients were evaluated every three months following the conclusion of treatment. A six-month follow-up was conducted. Results: Significant clinical improvement was observed in 95.8 percent of the patients on the threads-treated side of the face and in 83.3 percent of the patients on the microneedling plus PRP side. Patient satisfaction was significantly greater in the threads group than in the microneedling+PRP group (p<0.0001). The side effects were tolerable and transient. Conclusion: Based on our results, we conclude that both threads insertion and microneedling with autologous PRP can yield satisfactory results with minor side effects (fine edema and erythema) that resolve rapidly.

Incretin serum level as a biomarker of insulin resistance in acne vulgaris patients.

OBJECTIVE: To investigate the relationship between serum Incretin and acne vulgaris (AV) and insulin resistance (IR), and to find the biological indicators of acne vulgaris with insulin resistance. METHODS: 60 patients diagnosed with acne vulgaris in the dermatology department of Zagazig University and 56 healthy people in the health examination center of this hospital were collected, respectively, as the control group; all the included people were drawn fasting blood to test serum Incretin, blood lipids, sex hormones and INS release test to explore the role of serum Incretin in acne vulgaris and insulin resistance. RESULTS: The average level of Incretin in the acne group was lower than that in the control group, and the difference was statistically significant (t = 7.189, p < 0.001). The average level of Incretin in the acne group with insulin resistance was lower than that in the acne without insulin resistance group, the difference was statistically significant (t = 22.328, p < 0.001). In the acne group, the insulin resistance index decreased with the increase of Incretin level, and the two showed a negative correlation. (R = -0.711, p < 0.001). CONCLUSIONS: Patients with acne vulgaris are prone to have insulin resistance. Insulin resistance in patients with acne vulgaris is negatively correlated with Incretin. Serum Incretin may be expected to be a biomarker for diagnosing acne vulgaris patients with insulin resistance. The severity of acne vulgaris may have no obvious correlation with insulin resistance and serum incretin.

Immunotherapeutic modalities for the treatment of recalcitrant plantar warts: a comparative study.

BACKGROUND: Plantar warts are sometimes resistant or they tend to recur after every possible destructive therapy. Immunotherapy has been used as a promising alternative therapeutic option in such recalcitrant cases. AIM: To evaluate and compare the efficacy and safety of the intralesional injection of vitamin D3, zinc sulfate 2%, and Candida antigen in the treatment of recalcitrant plantar warts. PATIENTS AND METHODS: The study included 152 adult patients with single or multiple recalcitrant plantar warts. They were equally subdivided into four groups (38 patients in each): 2% zinc sulfate, vitamin D3, Candida antigen, and normal saline respectively. Injections were done at 3-week intervals until complete resolution or for a maximum of 4 sessions. RESULTS: Complete response was achieved in 20 patients (52.7%) of the zinc sulfate group, 34 patients (89.5%) of the intralesional vitamin D3 group, 25 patients (65.7%) of the intralesional Candida antigen group and 8 patients (21.2%) of the saline group. The difference between the groups was statistically significant in favor of vitamin D3 (p = .037). CONCLUSIONS: Recalcitrant plantar warts were best treated with vitamin D3 that also has the advantages of better response on distant warts, minimal side effects, and low rate of wart recurrence.

Keloid therapy: A neoteric comparative study.

BACKGROUND: Keloids are considered disorders of fibroproliferation characterized by accumulation of collagen fibers in hypodermis and dermis, caused by inflammation, surgery, and trauma. OBJECTIVES: The main goal of the study was to approach a better modality for the treatment of keloids by comparing the effects and the side effects of intralesional cryotherapy and intralesional injection of bleomycin. METHODS: This interventional, comparative clinical trial was conducted on 60 cases and was divided equally into the group (A), combined group who were subjected to intralesional bleomycin followed by cryotherapy in the same session, group (B) who were subjected to intralesional injection of bleomycin, and group (C) intralesional cryotherapy. All cases were subjected to clinical examination, complete history taking, dermatological examination, examination, and evaluation of scar lesion using the Vancouver scar scale. RESULTS: There was a statistically significant decrease in pliability among the combined group. Also, pliability decreased in the bleomycin group and cryotherapy, but this decrease wasn't statistically significant. Our results revealed that there was a statistically significant decrease in lesion height among all the studied groups, but the decrease was more among the combined group. CONCLUSION: Intralesional cryotherapy was effective as intralesional bleomycin. Combined therapy was a valid and more effective technique with few adverse effects than either alone for keloids as it achieved a decrease in volumes of scars or accompanied symptoms.

Assessment of various intralesional injections in keloid: comparative analysis.

 : In reaction to skin injury in genetically predisposed persons, the keloid is formed and marked by benignant overgrowth of dermic collagen. Intralesional triamcinolone was used in the treatment of keloids with varying results. AIM: Intralesional triamcinolone is a gold standard in treating the keloids in comparison with its effectiveness versus intralesional 5-fluorouracil intralesional verapamil and intralesional platelet-rich plasma. PATIENTS AND METHODS: Several 160 cases were categorized into four groups of each group-containing 40 cases. Group-A (control) treated with intralesional triamcinolone and Group-B intralesional verapamil, Group-C intralesional 5-fluorouracil, and Group-D intralesional platelet-rich plasma. Patients were assessed for clinical response based on a decrease in the patient and observer scar assessment scale (POSAS) at baseline and the end of treatment. RESULTS: The mean base-line POSAS score was 91 ± 10.98 SD check-in Group-A, 90 ± 10.85 in Group-B, 89 ± 10.06 in Group-C, and 92 ± 10.84 in Group-D. POSAS score after 24 weeks 36 ± 12.74 in Group-A, 29 ± 10.91 in Group-B, 39 ± 13.74 in Group-C, 36 ± 12.74 in Group-D. Statistically, a significant difference was observed between groups. CONCLUSION: Intralesional verapamil reported to be the most effective therapy and platelet-rich plasma was effective as intralesional triamcinolone acetonide with no serious side effects and 5-fluorouracil was less effective in treating the keloids.

Estimation of neutrophil activation marker in lichen planus patients.

BACKGROUND: Lichen planus disease is a chronic inflammatory disorder of mucosal and cutaneous tissues, and its etiology and pathogenesis are unclear. Cytokines have a significant role in the beginning, the maintenance of inflammatory and intercellular crosstalk. AIM: We assessed serum levels of neutrophil activation marker (calprotectin) in patients with cutaneous lichen planus with different subtypes and made a comparison with healthy individuals. MATERIALS AND METHOD: Peripheral blood samples of 30 cases with lichen planus were compared with 30 healthy individuals. Serum samples were prepared from LP patients, using a commercial ELISA kit, and calprotectin level was measured in each serum sample. RESULTS: The serum level of calprotectin was significantly raised in LP cases compared with control (141.34 ± 17.47 ng/ml versus 40.03 ± 1.54 ng/ml respectively; p < 0.001). No correlation was recorded among of serum of calprotectin and patients' ages, sex, disease period, and the existence or strength of pruritus. But a strong positive correlation was present between the coexistence of oral lesions and the number of locations. CONCLUSION: Calprotectin can be used as a marker of Lichen planus severity and progression. Calprotectin may play a role in the pathogenesis of LP.

Itraconazole versus propranolol: therapeutic and pharmacologic effect on serum angiopoietin-2 in patients with infantile hemangioma.

BACKGROUND: The initial recommendation propranolol usage in managing infantile hemangioma was in 2008 followed by various researches assessing the dosage, efficacy, and other parameters. Itraconazole is a world-wide tolerated antifungal but only a few studies have focused on its assessment in the treatment of infantile hemangiomas (IH). OBJECTIVE: This study aimed to investigate the newly proposed antifungal drug ICZ and characterize different aspects of its usage as an antiangiogenic drug. METHODS: This was an interventional clinical trial to assess the efficacy of ICZ versus propranolol in the treatment of infantile hemangioma with studying the change in serum angiopoietin 2 (Ang2). A total of 36 pediatric patients were divided into two equal groups: firstly treated with oral itraconazole and secondly treated by oral propranolol. RESULTS: Response to treatment was observed using a modified IH score. In itraconazole-treated infants, good response was observed in 44.4% of the patients. This was slightly higher than the propranolol group which showed 22.2% with good response. We observed a decrease in serum ang2 level after usage of ICZ and propranolol and the change in serum Ang2 level before and after treatment in each group was statistically significant (p < .001). CONCLUSION: Oral itraconazole can be an equivalent option for oral propranolol while safer and shorter treatment periods.

Hepatitis C virus infection could be a risk factor for adult-onset vitiligo in Egyptian patients: A cross-sectional study.

BACKGROUND: Vitiligo is a common skin disorder resulting from the destruction of melanocytes. Hepatitis C virus (HCV) infection has been linked to a variety of extrahepatic manifestations, including skin diseases. AIM: To measure the prevalence of HCV-seroreactivity among vitiligo patients. METHODS: This cross-sectional study included 108 vitiligo patients. Serum anti-HCV antibodies were detected by chemiluminescence immunoassay. RESULTS: Eighteen patients (16.7%) out of 108 were HCV-reactive; all of them had adult-onset vitiligo. They represented approximately 34.6% of the total patients with adult-onset vitiligo (52 patients). On the contrary, all patients with childhood-onset vitiligo were HCV-non-reactive. Moreover, adult-onset vitiligo was significantly associated with HCV-seroreactivity (p < .001). Also, there was a significant difference between HCV-reactive and HCV-non-reactive vitiligo patients regarding the age of patients and their ages at the onset of vitiligo (p < .001). CONCLUSIONS: HCV may be the triggering factor for adult-onset vitiligo, particularly in regions with a high prevalence of HCV. Therefore, patients with adult-onset vitiligo, rather than childhood-onset disease, should be screened for associated HCV infection in HCV-endemic regions.

Efficacy of botulinum toxin A injection in the treatment of androgenic alopecia: A Comparative Controlled Study.

INTRODUCTION: Scalp injection with mesotherapy (LC cell hair essence) helps in anchoring hair follicles and might have good therapeutic efficacy and lower side effects than Botox in the treatment of androgenetic alopecia (AGA). OBJECTIVE: To assess the trichoscopy and the clinical therapeutic response of LC hair essence serum injection vs. botulinum toxin (A) injection in the treatment of androgenetic alopecia. PATIENTS AND METHODS: Sixty-two AGA patients were included in the present study. Group I consisted of 31 patients who were injected with 1 ml of LC hair essence serum diluted with 0.5 ml of 0.9% normal saline once weekly for 8 weeks, and Group II involved 31 patients who were injected with 50 units of botulinum toxin A. Trichoscopic examination and photo documentation were done for every case before starting treatment (baseline) and after treatment with monthly follow-up to the patients. RESULTS: There was a significant difference between baseline trichoscopy findings and at the end of sixth month in Botox group, and the difference was highly significant in LC group; there was a statistically significant increase in the frequency of side effects (irritation and headache) among Group II compared with that of Group I. CONCLUSION: Botox can induce significant results in the treatment of AGA with mild and tolerable side effects but with high cost, while LC hair serum exhibit excellent results with fewer side effects.

Monofilament threads in treatment of female hair loss.

BACKGROUND: Recently, thread treatment has been commonly used in Korean medicine for cosmetic reasons such as decreasing skin wrinkles. It was noted that an inserted thread caused constant stimulation, followed by assistance for connective tissue regeneration. However, its role in hair development has not yet been revealed. OBJECTIVE: To perform a pilot study on the effect of monofilament threads scalp injections in women with female androgenetic alopecia. MATERIALS AND METHODS: This double-blind, multicenter, placebo-controlled study compared the effect of monofilament threads with that of saline as placebo. The endpoints were hair count and hair mass index (HMI), along with patient-opinion survey responses. RESULTS: HMI or hair count has statistically significantly differed between the study and placebo groups. However, 73.3% of the treatment subjects (vs. 0% of the placebo subjects) experienced substantial improvement in hair loss, rate of hair loss, hair thickness, and ease of managing/styling hair, and 76.8% (vs. 18.4% of the placebo group) reported that their hair felt coarser or heavier after the treatment. CONCLUSION: Monofilament threads demonstrate highly statistically significant improvement in HMI or hair count in women female pattern hair loss. The patient survey results suggest a therapeutic advantage of monofilament threads as perceived by patients and according to hair count or HMI.