Microneedling and 5-flurouracil can enhance the efficacy of non-cultured epidermal cell suspension transplantation for resistant acral vitiligo.

Acral vitiligo is often resistant to medical and surgical treatments. Non-cultured epidermal cell suspension (NCES) transplantation is a common surgical therapeutic modality for vitiligo. 5-Flurouracil (5-FU) in combination with microneedling has been found to be useful in treating vitiligo. To evaluate the efficacy of NCES transplantation either alone or following microneedling and topical 5-FU for resistant acral vitiligo. This study included 50 patients with resistant acral vitiligo allocated into two groups; group A received only NCES transplantation, and group B received microneedling and topical 5-FU 1-2 weeks prior to NCES transplantation. All patients were monitored for 24 weeks to evaluate the repigmentation response and the immunohistochemical expression of Human Melanoma Black-45 (HMB-45). At 24 weeks, the repigmentation response was significantly higher in the combination group than in the monotherapy group (p = 0.029). Moreover, the percentage of patients with successful repigmentation of 75% or greater was significantly higher in the combination group (84%) than in the monotherapy group (40%) (p = 0.001). Furthermore, lesional skin showed a significant increase in the number of active HMB+ melanocytes in both groups but without any significant difference between the two groups. However, the color intensity of HMB-45 immunostaining was significantly higher in the combination group compared to the monotherapy group (p = 0.012). There was no significant difference between the two groups regarding the adverse effects. The repigmentation response of resistant acral vitiligo to NCES transplantation could be enhanced by prior microneedling followed by topical 5-FU.

Combined low-dose isotretinoin and long-pulsed nd: YAG laser in the treatment of post-acne erythema.

Post-acne erythema (PAE) is a bothering skin condition that emerges from inflammatory acne and persists after its resolution. It is characterized by telangiectasia and erythematous macules. the role of 1064-nm Nd: YAG when combined with low-dose isotretinoin in the acne erythema treatment. forty-eight PAE patients were involved in the study. They were divided into two groups; group (A) patients administering a low dose of oral isotretinoin (10 mg/day) and underwent a total of six two-week interval sessions of 1064 ND-YAG laser treatment, group (B) patients administering a low dose of oral isotretinoin (10 mg/day) only. All adverse effects experienced during the course of therapy were documented, and photos were taken before the start of the treatment and following the end of the treatment duration. Following the completion of the therapeutic intervention, a significant improvement in clinical condition was observed in both groups, with more improvement in group (A) compared to group (B) as evidenced by a notable improvement in the score on the Clinician Erythema Assessment Scale (CEAS) and also a significant decrease in the mean value of optical density of the erythema. combined 1064-nm Nd: YAG with low-dose isotretinoin may be an efficient and secure line in the PAE treatment. Also, the combined therapy had superior results when compared to low-dose isotretinoin alone.

Intralesional bivalent and quadrivalent human papillomavirus vaccines didn't significantly enhance the response of multiple anogenital warts when co-administered with intralesional Candida antigen immunotherapy. A randomized controlled trial.

Treatment of anogenital warts (AGWs) is challenging. Candida antigen immunotherapy has been proven to be a safe and relatively effective therapeutic modality; nevertheless, some patients may experience a partial or no response. Combining Candida antigen with other immunotherapies has been proposed to improve the cure rate. Immunotherapy with human papillomavirus (HPV) vaccines has been tried with conflicting outcomes. This study aimed to  assess the efficacy and safety of intralesional Candida antigen, either alone or in combination with intralesional bivalent or quadrivalent HPV vaccines, for treating multiple AGWs. Eighty patients with multiple AGWs were included and randomly assigned to four equal groups: group A treated with intralesional Candida antigen only; group B treated with intralesional bivalent HPV vaccine (Cervarix) and Candida; group C treated with intralesional quadrivalent HPV vaccine (Gardasil) and Candida; and group D (control) treated with intralesional saline. Complete clearance of lesions was detected in 40%, 20%, and 60% of patients in Candida monotherapy, Cervarix/Candida, and Gardasil/Candida groups, respectively, whereas 40%, 60%, and 20% of patients in the three groups, respectively, showed partial response. Only 10% of the control group had a partial response. Therapeutic outcomes were significantly better in the three treatment groups compared to the control group, with no statistically significant difference between the Candida monotherapy group and the combination groups, but the response was significantly better in the Gardasil/Candida group than in the Cervarix/Candida group. No statistically significant difference was found between the studied groups regarding the development of side effects. Moreover, no recurrence was detected in any of the groups throughout the 3-month follow-up period.  Based on our results, combining intralesional HPV vaccines with Candida antigen immunotherapy may have no significant benefit for treating multiple AGWs. Candida antigen may be recommended as a relatively effective and inexpensive therapeutic modality. The combination of Gardasil and Candida was also effective but very expensive. The results of the Cervarix/Candida combination were unsatisfactory.  This clinical trial was registered and approved prospectively by the ethical review board at Faculty of Medicine, Zagazig University.

Non-cultured epidermal cells suspended in either platelet-rich plasma or ringer lactate for stable vitiligo: A prospective comparative study.

BACKGROUND: Noncultured epidermal cell suspension (NCES) transplantation is a commonly used surgical treatment for resistant stable vitiligo. The combination of platelet-rich plasma (PRP) with different therapeutic modalities for vitiligo yielded higher repigmentation response, probably due to platelet-derived growth factors. AIM: To evaluate the efficacy of PRP-suspended NCES compared to NCES suspended in Ringer's lactate (RL) solution in the treatment of stable vitiligo. PATIENTS AND METHODS: A prospective comparative study was conducted on 40 patients with stable vitiligo. They were divided into two equal groups: group A (treated with RL-suspended NCES) and group B (treated with PRP-suspended NCES). All patients were followed-up for 6 months for assessment of their therapeutic response regarding clinical outcomes and immunohistochemical expression of HMB-45 in lesional skin. RESULTS: Patients treated with PRP-suspended NCES showed a significantly higher repigmentation response compared to those treated with RL-suspended NCES at 1, 3, and 6 months after treatment (p = 0.015, 0.023, 0.029, respectively). The expression of HMB-45 significantly increased in both groups after therapy, but without a significant difference between the two groups. CONCLUSION: The repigmentation response of NCES can be enhanced by suspending the melanocytes in autologous PRP.