Efficacy of topical trichloroacetic acid 100% either alone or combined with topical tioconazole 28% versus systemic itraconazole in the treatment of onychomycosis.

BACKGROUND: Treatment of onychomycosis is still challenging and warrants the development of new treatment strategies. Different trials were conducted to increase the penetration and efficacy of topical antifungals aiming at finding an alternative treatment especially when systemic antifungals are contraindicated. OBJECTIVES: To evaluate the efficacy of trichloroacetic acid (TCA) 100% either alone or combined with topical tioconazole 28% versus itraconazole pulse therapy in the treatment of onychomycosis. PATIENTS/METHODS: Forty-five patients with onychomycosis were divided into three groups: group (A) treated by topical TCA 100% for 12 sessions, group (B) treated by TCA 100% for 12 sessions combined with topical tioconazole 28% for 18 weeks and group (C) treated by itraconazole (400 mg/day for 1 week/month for 4 months). RESULTS: TCA 100% combined with topical tioconazole 28% showed the highest therapeutic response; however, the difference between the groups was statistically insignificant. Mycological cure (negative culture) was reported in 66.7% of group B versus 60% of group A and 40% of group C at the 20 week. CONCLUSIONS: TCA 100% is an effective and safe treatment option for onychomycosis especially when combined with antifungals. This modality is promising in the treatment of onychomycosis especially with the increased resistance to different antifungals.

Fluid Platelet-Rich Fibrin (PRF) Versus Platelet-Rich Plasma (PRP) in the Treatment of Atrophic Acne Scars: A Comparative Study.

Platelet-rich fibrin (PRF), a second-generation platelet concentrate, was developed for the purpose of overcoming the limitations of Platelet-rich plasma (PRP). PRF can produce a higher cumulative release of growth factors than PRP. Also, this release is slow and prolonged, making it ideal for tissue regeneration and growth stimulation. This study was conducted to evaluate the efficacy of fluid PRF either alone or combined with needling versus PRP in the treatment of atrophic acne scars. A comparative study including 30 patients with atrophic acne scars who were divided into two equal groups. Group I included 15 patients in which the left side of the face was treated with intradermal injection of PRP while the right side was treated with combined needling with PRP. Group II included15 patients in which the left side of the face was treated with intradermal injection of fluid PRF while the right side was treated with combined needling with fluid PRF. All patients received four sessions with 3 weeks interval. The acne scars significantly improved in both sides of face in both groups. According to quartile grading scale and patient satisfaction; the therapeutic response was significantly higher in PRF group than PRP either alone or combined with needling. The combination with needling increases efficacy of PRF and PRP. Fluid PRF is highly effective, safe and simple procedure that can be used instead of PRP in the treatment of acne scars.

Squamous Cell Carcinoma Antigen in Psoriasis: An Immunohistochemical Study.

BACKGROUND: Squamous cell carcinoma antigens (SCCA1, SCCA2) are members of the ovalbumin serpin family that have been described as biomarkers of squamous cell carcinomas. Different studies to date have stated the involvement of SCCA in the pathogenesis of certain immunological diseases, such as asthma and atopic dermatitis. OBJECTIVE: We sought to assess the expression of SCCA2 in the skin of patients with chronic plaque psoriasis and to detect its correlation with the clinical severity of psoriasis and with the density of inflammatory infiltrates in the skin lesions. METHODS: Skin biopsies were taken from 24 patients with psoriasis vulgaris and 24 healthy controls by 5-mm punches. Tissues were stained with hematoxylin and eosin to confirm the diagnosis and to assess the grade of inflammation. The expression level of SCCA2 in the skin was assessed by immunohistochemical analysis. RESULTS: The tissue SCCA2 level was significantly higher in psoriatic patients than controls and correlated positively with the severity of psoriasis. In addition, the dermal SCCA2 expression correlated positively with the density of dermal inflammatory infiltrates. CONCLUSION: SCCA2 could be a useful marker of the clinical severity and the grade of inflammation of psoriasis.

Efficacy and safety of intralesional steroid injection in the treatment of melasma.

BACKGROUND: The etiopathogenesis of melasma is not yet completely elucidated; however, certain inflammatory cytokines are involved in its pathogenesis as interleukin (IL) 1a, IL 1b, IL6, prostaglandin (PG) D2and PGE2. Corticosteroid suppressive effect on these cytokines may explain its therapeutic effect in the treatment of melasma. AIMS: To assess the efficacy and safety of intralesional triamcinolone versus Kligman's formula in treatment of melasma. METHODS: This study included 2 groups of female patients with melasma; group1 (treatment group) included 22 patients who were treated by intralesional injection of triamcinolone acetonide at a concentration of 4 mg/mL once monthly for four sessions as a maximum and group 2 (control group), included 22 patients who were treated by Kligman's formula once daily for 3 months. All patients were evaluated by dermoscope before treatment and at each follow-up visit to record any adverse effects of treatment. RESULTS: The severity of melasma, assessed by MASI score, significantly decreased in both groups at the end of third month. There was no statistically significant difference in the therapeutic response between both groups. No side effects were reported with triamcinolone injection except for mild pain during injection, while Kligman's formula was associated with dermatitis, irritation, and burning sensation. CONCLUSIONS: Triamcinolone injection at low concentration could be an effective treatment modality of melasma.

Efficacy of Topical Timolol 0.5% in the Treatment of Acne and Rosacea: A Multicentric Study.

BACKGROUND: Acne and rosacea are common chronic inflammatory skin diseases associated with psychosocial impairment, anxiety, depression, and impaired overall quality of life. Timolol maleate is a potent nonselective ß-blocker that causes a combination of vasoconstriction and inhibition of inflammatory mediators. OBJECTIVES: We assessed the clinical efficacy and safety of topical timolol maleate 0.5% for the treatment of acne and rosacea. METHODS: A total of 116 patients (58 patients with rosacea and 58 patients with acne) were treated with topical timolol maleate 0.5% every night before bedtime for eight weeks. RESULTS: The severity of both acne and rosacea decreased relative to baseline; however, the improvement in rosacea was not statistically significant. CONCLUSION: In our study, topical timolol maleate 0.5% demonstrated effectiveness in the treatment of acne, especially in noninflammatory lesions, but seems to be more effective in erythematotelangiectatic rosacea than papulopustular rosacea lesions, with insignificant side effects. The addition of topical timolol to the standard treatment protocol for acne and rosacea is expected to be beneficial, especially by way of improving comedones of acne and resistant inflammatory erythema of both acne and rosacea.

Macrophage Migration Inhibitory Factor in Alopecia Areata and Vitiligo: A Case-Controlled Serological Study.

BACKGROUND: Alopecia areata and vitiligo vulgaris are common autoimmune diseases whose pathophysiology are not completely elucidated. Genetic susceptibility, immunological background, and stress have significant roles in their pathogenesis. Although macrophage migration inhibitory factor (MIF) is crucial for the maintenance of immune privilege in certain sites, it can upregulate different inflammatory cytokines and contribute to the pathogenesis of different autoimmune diseases. There is controversy about its role in alopecia and no adequate data about its role in vitiligo. OBJECTIVES: We sought to assess the serum level of MIF in alopecia areata and vitiligo and its relationship with different variables of both diseases. METHOD: Serum level of MIF was measured in 20 patients with vitiligo, 22 patients with alopecia areata, and 20 controls by ELISA. RESULTS: MIF was significantly higher in alopecia areata (8.477±4.1761ng/mL) and vitiligo vulgaris (3.930±2.7071ng/mL) compared to controls (0.725±0.5108 ng/mL) (P<0.01). In addition, MIF levels were positively correlated with the severity of alopecia areata and vitiligo. CONCLUSION: The MIF has an active role in the pathogenesis of alopecia areata and vitiligo and could be a target for the treatment of both diseases.

Intralesional versus intramuscular bivalent human papillomavirus vaccine in the treatment of recalcitrant common warts.

BACKGROUND: Despite the availability of different therapeutic modalities, treatment of recalcitrant common warts is still challenging. Cervarix (GlaxoSmithKline, Brentford, UK), a recombinant bivalent human papillomavirus (HPV) vaccine, has shown promising efficacy in the treatment of warts. OBJECTIVES: To evaluate the beneficial effects and tolerability of intramuscular versus intralesional bivalent HPV vaccine in the treatment of recalcitrant common warts. METHODS: The study included 44 adult patients with multiple recalcitrant common warts; 22 patients received intramuscular injection of bivalent HPV vaccine at 0, 1, and 6 months or until complete clearance of warts, and the other 22 patients received intralesional injection of 0.1 to 0.3 mL of bivalent HPV vaccine into the largest wart at 2-week intervals until complete clearance or for a maximum of 6 sessions. RESULTS: Complete clearance of warts was observed in 18 patients (81.8%) of the intralesional group and 14 patients (63.3%) of the intramuscular group; however, the difference was not statistically significant. Adverse effects were transient and insignificant, and no recurrence was reported in either group. LIMITATIONS: Small study sample and different dosing schedules. CONCLUSIONS: Bivalent HPV vaccine, particularly by intralesional injection, seems to be a potential therapeutic option for the treatment of multiple recalcitrant common warts.

Topical silymarin versus hydroquinone in the treatment of melasma: A comparative study.

BACKGROUND: Melasma is a highly prevalent hyperpigmentation disorder with a high relapsing rate and a negative impact on the psychological state of the affected patients. The exact pathogenesis of melasma is not completely elucidated; however, ultraviolet induced oxidative stress has an important role in its pathogenesis. Silymarin, antioxidant drug, reduces the harmful effects of solar ultraviolet radiation such as inflammation, immune responses, DNA damage, and pigmentation. OBJECTIVES: To assess the efficacy and safety of topical silymarin with different concentrations (0.7% and 1.4%) versus hydroquinone 4% in the treatment of melasma. METHODS: Forty-two adult female patients with melasma were assigned to three equal groups each containing 14 patients; group1 was treated by silymarin 0.7% cream, group 2 was treated by silymarin 1.4% cream and group 3 was treated by hydroquinone 4% cream. The duration of treatment was 3 months. RESULTS: MASI score was significantly reduced in all groups at the end of third month; however, there were no significant differences in the therapeutic response between the three studied groups. No side effects were recorded with silymarin, while hydroquinone was associated with significant adverse effects. CONCLUSIONS: Silymarin cream might serve as an effective and safe treatment modality for melasma.