Efficacy of narrow band UVB with or without OMP in stabilization of vitiligo activity in skin photo-types (III-V): A double-blind, randomized, placebo-controlled, prospective, multicenter study.

BACKGROUND: NB-UVB has long been the vitiligo management pillar with capability of achieving the main treatment outcomes; repigmentation and stabilization. Its stabilizing effect in dark skin has been debatable. However, randomized controlled trials regarding NB-UVB ability to control disease activity are lacking. PURPOSE: To assess stabilizing effect of NB-UVB in comparison to systemic corticosteroids, the mainstay in vitiligo stabilization, in skin photo-types (III-V). METHODS: This is a multicenter, placebo-controlled, randomized, prospective study. Eighty patients with active nonsegmental vitiligo (NSV) (Vitiligo disease activity (VIDA) ≥2) were randomized to either NB-UVB and placebo (NB-placebo) or NB-UVB and dexamethasone oral mini-pulse (OMP) therapy (NB-OMP) for 6 months. Sixty four patients completed the study, 34 in the NB-OMP group and 30 in the NB-placebo group. Patients were evaluated fortnightly according to presence or absence of symptoms/signs of activity. RESULTS: In spite of earlier control of disease activity observed in the NB-OMP group, it was comparable in both groups by the end of the study period. Disease activity prior to therapy, but not extent, was found to influence control of activity in both groups. Thus, NB-UVB is a safe sole therapeutic tool in vitiligo management. Not only does it efficiently achieve repigmentation, but also it is a comparable stabilizing tool for systemic corticosteroids in spite of slightly delayed control. CONCLUSION: NB-UVB is the only well-established vitiligo therapy that can be used solely whenever corticosteroids are contraindicated or immune-suppression is unjustified. Nonetheless, its combination with corticosteroids expedites response and improves compliance.

Fractional Carbon Dioxide Laser is Effective in Amelioration of Pruritus in Primary Cutaneous Amyloidosis: A Clinical and Biochemical Study.

BACKGROUND AND OBJECTIVES: Primary cutaneous amyloidosis (PCA) is a pruritic disease characterized by amyloid deposition in the skin. Interleukin-31 (IL-31) is a pruritus-mediating cytokine. Fractional carbon dioxide (CO2 ) laser has shown efficacy in the treatment of PCA regarding the clinical appearance, histological pattern, and pruritus. The aim of this study is to assess the effect of fractional CO2 laser on pruritus associated with PCA, and analyze whether this effect is related to IL-31 and IL-31 receptor (R) expression. STUDY DESIGN/MATERIALS AND METHODS: The study included 24 patients with PCA and 24 healthy controls. Each patient received four fractional CO2 laser sessions, 4 weeks apart, using the superficial ablative mode. Skin biopsies were taken from patients before and after treatment, as well as controls, for assessment of IL-31 and IL-31R by real-time polymerase chain reaction. RESULTS: Treatment resulted in significant improvement of all clinical parameters, including pruritus (P < 0.001). Patients before treatment had significantly higher IL-31 and IL-31R than controls (P = 0.000 for both). In addition, there was a statistically significant decrease in IL-31 and IL-31R after treatment than their values before treatment (P = 0.000 for both). CONCLUSION: This study confirms the therapeutic efficacy of fractional CO2 laser in treatment of PCA. Reduction of IL-31 and its receptor seems to be one of the involved mechanisms; however, its relation to improvement of pruritus is still not clear. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Studying the effect of adding growth factors to the autologous melanocyte keratinocyte suspension in segmental vitiligo.

Addition of different growth factors to the medium used in autologous melanocyte-keratinocyte transplantation procedure (MKTP) was reported in the literature. The aim of the current study was comparison of response to MKTP in segmental vitiligo (SV) with and without adding growth factors to the suspension medium. Eighteen cases with SV were randomly divided into two groups. In group A: Ham F12 medium was used for suspension and in group B: 5 ng/mL recombinant basic fibroblast growth factor (bFGF) and 25 mg/500 mL 3'5' cyclic adenosine monophosphate (cAMP) were added to the medium. All cases received NB-UVB twice weekly for 24 weeks. The area of vitiligo lesions was measured before and after therapy by point-counting technique and complications were recorded. Excellent response (90%-100% repigmentation) occurred in 5/9 cases (56%) in group A and 7/9 cases (78%) in group B (with growth factors). A significant decrease in the area of treated lesions before and after therapy was found in both groups A and B (P = .0012 and .0004, respectively), however, a higher percentage of reduction in area of vitiligo was seen in group B cases (70% in group A vs 90% in group B; P value: .028). Marginal halo was seen in five cases in group A and six in group B. In conclusion addition of bFGF and cAMP to MKTP medium improved the results of the procedure. It could be considered if economically feasible.

Recipient site preparation by cryoblebbing in melanocyte keratinocyte transplantation procedure over the fingers in vitiligo: A pilot study.

Surgical treatment of vitiligo lesions over the fingers has poor outcome. In this intra-patient comparative study, 12 patients with stable non-segmental vitiligo (NSV) affecting the middle three fingers of one hand were included. Three variations were used in treatment of finger vitiligo lesions: minipuch grafting, melanocytes keratinocyte transplantation procedure (MKTP) preceded by cryoblebbing or full CO2 laser resurfacing of the recipient site. Liquid nitrogen was used to create blebs in one finger 24 hours before therapy. On the following day, the second finger was treated by minipunch grafting and the third finger was resurfaced by CO2 laser. A suspension was prepared and 0.1 mL was injected into each cryobleb. It was also applied to the resurfaced skin. All patients underwent topical PUVA therapy and were followed-up for 12 months. Ten cases with 52 lesions completed the follow-up period. About 4/18 lesions treated by cryoblebbing followed by MKTP showed ≥75% repigmentation while only 1/17 lesions treated by laser resurfacing + MKTP and 1/17 lesions treated by minipunch grafting showed 30% and 10% repigmentation, respectively. No complications occurred in MKTP treated lesions. Cryoblebbing of the recipient site seems to improve the outcome of MKTP in lesions over the fingers in stable NSV.

Effect of Different Methods of Trypsinization on Cell Viability and Clinical Outcome in Vitiligo Patients Undergoing Noncultured Epidermal Cellular Suspension.

BACKGROUND: Noncultured Epidermal Cell Suspension (NCECS) is a surgical modality used in treating stable vitiligo. Trypsinization of the epidermis may be done either at 4°C overnight (cold) or at 37°C for 30 to 50 minutes (warm). Recently, trypsinization was done at room temperature (25°C) in an in vitro trial. OBJECTIVE: To compare different trypsinization techniques in NCECS regarding cell viability and clinical outcome. METHODS: This comparative multicenter study was conducted on 20 patients with stable nonsegmental vitiligo. In each patient, 3, nonacral vitiligo lesions were randomly assigned for treatment by NCECS prepared by warm, room temperature, and cold trypsinization techniques, respectively. A perilesional biopsy was taken from each of the 3 treated lesions as an objective measure of disease stability. After transplantation, all patients received narrow-band ultraviolet B twice weekly for 6 months. Cell viability was assessed in each technique, as well as clinical outcome in all treated lesions. RESULTS: Warm and room temperature trypsinization techniques were comparable with each other. Both were significantly better than the cold technique regarding viability and repigmentation. CONCLUSION: Room temperature trypsinization can be used as a convenient substitute to warm trypsinization. Cold trypsinization is not recommended because of its poor results and poor patient satisfaction.

Persistent Pixel Stamping Marks: a novel complication of fractional CO2 laser in scar treatment.

Fractional CO2 laser rejuvenation of scars offers a high safety profile. Laser marks usually disappear clinically within 1 week. The authors observed occasional persistence of the laser marks on the scar surface. The purpose of this study is to report the incidence and to describe the clinical, dermoscopic, and histological features of a novel observed complication of fractional CO2 laser scar rejuvenation "Persistent Pixel Stamping Marks (PPSM)".One hundred seventy-one cases were consecutively recruited from patients assigned for fractional CO2 laser scar rejuvenation. Patients who developed the phenomenon 1 month post laser session were recorded and subjected to clinical photography, dermoscopy, and optical coherence tomography (OCT) as well as a 4-mm punch biopsy from pixelated scars. The evolution of PPSM was followed up for 6 months. PPSM developed in 16 patients (9.4%), 15 of which were post burn hypertrophic scars. PPSM was significantly related to darker skin type, darker scar color, and longer scar duration. Histopathological findings included characteristic holes in stratum corneum and superficial dermis, thick collagen bundles perpendicular to the skin surface with loss of elastic tissue, focal interface changes, and triangular focus of fibroblastic proliferation. The marks disappeared in 5 and lasted in 11 patients. Their longevity was significantly related to longer dwell times and lower densities. PPSM represent miniature scarring at the sites of the microscopic thermal zones or a sign of their delayed healing. They tend to follow fractional CO2 laser resurfacing of hyperpigmented, long-standing burn scars. Longer dwell times and lower densities make them last longer.

Is There a Relation between Vitamin D and Interleukin-17 in Vitiligo? A Cross-Sectional Study.

BACKGROUND: High interleukin (IL)-17 contributes to vitiligo pathogenesis. Vitamin D has been assessed in vitiligo, with no reports targeting its relation to IL-17. OBJECTIVE: To evaluate a possible regulatory effect of vitamin D on IL-17 and their relation to disease activity in vitiligo. METHODS: This study included 30 vitiligo patients and 40 controls evaluated for IL-17 and vitamin D serum levels by ELISA technique. RESULTS: IL-17 was significantly higher (p = 0.001) whereas vitamin D was found to be lower among the patients (p < 0.001). Multivariable regression was performed to evaluate the relationship between IL-17 and vitamin D levels with the demographic data on the patients, revealing a nonsignificant relationship (p > 0.05). A significant positive correlation was noted between vitamin D levels and disease duration. CONCLUSION: Vitamin D represents a potential player in the pathogenesis of vitiligo. Its possible regulatory relation to IL-17, together with its weight as a screening tool in vitiligo, needs further evaluation.

Low level light-minoxidil 5% combination versus either therapeutic modality alone in management of female patterned hair loss: A randomized controlled study.

BACKGROUND: Female pattern hair loss (FPHL) is the most common form of hair loss in women. Nevertheless, its management represents a real challenge. Among the FDA approved therapeutic modalities for FPHL are topical minoxidil and more recently low-level light therapy (LLLT). AIM OF WORK: Assess the efficacy and safety of LLLT in comparison to topical minoxidil 5% and to a combination of both therapies in the treatment of FPHL. PATIENTS AND METHODS: This study included 45 female patients with proven FPHL. They were randomly divided into three equal groups, where group (i) patients were instructed to apply topical minoxidil 5% twice daily, group (ii) patients received LLLT using the helmet iGrow® device for 25 minutes 3 days weekly, and group (iii) patients received a combination of both topical minoxidil 5% twice daily and LLLT for 25 minutes 3 days weekly for 4 months (study duration). Evaluation was done according to clinical, dermoscopic (folliscopic), and ultrasound bio-microscopic (UBM) parameters. Patient satisfaction and side effects were reported. RESULTS: The efficacy and safety of both topical minoxidil and LLLT were highlighted with comparable results in all parameters. The combination group (iii) occupied the top position regarding Ludwig classification and patient satisfaction. UBM and dermoscopic findings showed significant increase in the number of regrowing hair follicles at 4 months in all groups, whereas only UBM showed such significant increase at 2 months in the combination group (iii). A non-significant increase in the hair diameter was also documented in the three groups. CONCLUSION: LLLT is an effective and safe tool with comparable results to minoxidil 5% in the treatment of FPHL. Owing to the significantly better results of combination therapy, its usage is recommended to hasten hair regrowth. Lasers Surg. Med. 49:835-843, 2017. © 2017 Wiley Periodicals, Inc.

Effect of Procedural-Related Variables on Melanocyte-Keratinocyte Suspension Transplantation in Nonsegmental Stable Vitiligo: A Clinical and Immunocytochemical Study.

BACKGROUND: Melanocyte-keratinocyte suspension (M-K susp) is gaining popularity for vitiligo treatment. Few studies have addressed procedure-related variables. OBJECTIVE: To assess the effect of different M-K susp procedure-related variables on the clinical outcome in stable vitiligo. METHODS: This prospective multicenter comparative study included 40 cases with nonsegmental stable vitiligo. Donor site was either a skin graft in noncultured epidermal cell suspension (NCECS) or hair follicle units in outer root sheath hair follicle suspension (ORSHFS). Recipient site was prepared by either cryoblebbing or CO2 laser resurfacing. Cell counts and viability were recorded in the cell suspensions. Tissue melanocytes and keratinocytes were examined by melan-A and cytokeratin, respectively. Assessment of repigmentation was performed 18 months after the procedure. RESULTS: Thirty-seven subjects completed the study. Cell count was significantly lower in the ORSHFS compared with NCECS with no significant difference in the repigmentation outcome. On comparing techniques of recipient site preparation, homogenicity was better in the CO2 group. Elbows and knees responded better to CO2 resurfacing, whereas distal fingers responded better to combination of cryoblebbing with NCECS. CONCLUSION: Using different techniques in M-K susp produces comparable results. However, the distal fingers showed better results using combination of donor NCECS and recipient cryoblebs.

Propranolol versus captopril in the treatment of infantile hemangioma (IH): A randomized controlled trial.

BACKGROUND: Renin-angiotensin system components have been demonstrated in the biology of infantile hemangioma (IH). Captopril, an angiotensin-converting enzyme inhibitor, is proposed as a therapeutic alternative to oral propranolol. OBJECTIVES: We sought to compare the benefit of propranolol and captopril in the treatment of IH, and to assess angiotensin-converting enzyme gene polymorphism in patients with IH and in control subjects. METHODS: Thirty patients with IH and 35 healthy control subjects were enrolled in this study. Patients were randomly assigned to treatment with either propranolol or captopril. Assessment was done clinically and by measurement of serum vascular endothelial growth factor and angiotensin II in patients and control subjects. Angiotensin-converting enzyme gene polymorphism was also studied. RESULTS: Clinical improvement was significantly better and faster in the patients treated with propranolol. Both groups showed reduced vascular endothelial growth factor and angiotensin II levels posttreatment, with a significantly higher percentage reduction in the propranolol-treated group. Cardiac side effects were reported only in the captopril-treated group. Baseline vascular endothelial growth factor level was significantly higher, and baseline angiotensin II level was significantly lower, in patients than control subjects. LIMITATIONS: We studied a relatively small number of patients and control subjects. CONCLUSION: Propranolol shows greater benefit than captopril in the treatment of IH.

Bimatoprost versus Mometasone Furoate in the Treatment of Scalp Alopecia Areata: A Pilot Study.

BACKGROUND: Alopecia areata (AA) is an immune-mediated disease that targets anagen hair follicles. Despite various therapeutic options, there is no cure for AA. Prostaglandin analogues have been recognized as being capable of inducing hypertrichosis. OBJECTIVE: To compare the efficacy and safety of bimatoprost to those of corticosteroid in the treatment of scalp AA. METHODS: Thirty adult patients with patchy AA (S1) were included. Two AA patches were randomly assigned to treatment either by mometasone furoate 0.1% cream once daily (area A) or bimatoprost 0.03% solution twice daily (area B) for 3 months. Patients were assessed using the Severity of Alopecia Tool (SALT) scoring system for hair re-growth. RESULTS: All responding AA patches showed significant reduction in their SALT score after therapy. Area B demonstrated significantly better results regarding rapidity of response in weeks, percentage of hair re-growth and side effects compared to area A. CONCLUSION: Bimatoprost solution represents a therapeutic option for scalp AA.

Efficacy of different modes of fractional CO2 laser in the treatment of primary cutaneous amyloidosis: A randomized clinical trial.

BACKGROUND: Primary cutaneous amyloidosis (PCA) comprises three main forms: macular, lichen, and nodular amyloidosis. The current available treatments are quite disappointing. OBJECTIVES: Assess and compare the clinical and histological changes induced by different modes of Fractional CO2 laser in treatment of PCA. PATIENTS AND METHODS: Twenty five patients with PCA (16 macular and 9 lichen amyloidosis) were treated by fractional CO2 using; superficial ablation (area A) and deep rejuvenation (area B). Each patient received 4 sessions with 4 weeks intervals. Skin biopsies were obtained from all patients at baseline and one month after the last session. Patients were assessed clinically and histologically (Congo red staining, polarized light). Patients were followed-up for 3 months after treatment. RESULTS: Both modes yielded significant reduction of pigmentation, thickness, itching, and amyloid deposits (P-value < 0.001). However, the percentage of reduction of pigmentation was significantly higher in area A (P-value = 0.003). Pain was significantly higher in area B. Significant reduction in dermal amyloid deposits denotes their trans-epidermal elimination induced by fractional photothermolysis. CONCLUSION: Both superficial and deep modes of fractional CO2 laser showed comparable efficacy in treatment of PCA. Superficial mode being better tolerated by patients, is recommended as a valid therapeutic option.

T helper 17 and Tregs: a novel proposed mechanism for NB-UVB in vitiligo.

Narrowband ultraviolet (NB-UV)B is accepted as corner stone therapy for vitiligo. Its influence on the expression of IL-17, IL- 22 and FoxP3 as markers for the Th17 and Tregs lineages has not been studied before in the context of non-segmental vitiligo (NSV). The study included 20 active NSV patients who received 36 NB-UVB sessions and 20 controls. Clinical evaluation Vitiligo Area Scoring Index (VASI) and determination of tissue expression of IL-17, IL-22 and FoxP3 by qRT-PCR (lesional, perilesional) were carried out before and after therapy. Baseline levels of IL-17 and IL-22 were significantly higher in patients, whereas FoxP3 was significantly lower. After therapy, IL-17 and IL-22 significantly dropped, whereas FoxP3 significantly increased (lesional, perilesional). Baseline and post-treatment VASI showed significant positive correlations with IL-17 and IL-22 and significant negative correlation with FoxP3 expression. Restoration of the balance between Th17 and Tregs might represent a novel pathway for the improvement that NB-UVB exerts in vitiligo patients.

Autologous platelet rich plasma: topical versus intradermal after fractional ablative carbon dioxide laser treatment of atrophic acne scars.

BACKGROUND: A proposal has recently been made regarding the potential adjuvant use of platelet-rich plasma (PRP) with fractional carbon dioxide laser (FCL) for the correction of acne scars. OBJECTIVE: To compare the efficacy and safety of two administration modes of autologous PRP (intradermal injection (ID) and topical application) after FCL with that of FCL alone in the treatment of atrophic acne scars. PATIENTS AND METHODS: Thirty patients were randomly divided into two groups. Both underwent split-face therapy. Group 1 was administered FCL followed by ID PRP on one side and FCL followed by ID saline on the other. In group 2, one cheek was treated with FCL followed by ID PRP, and the other received FCL followed by topical PRP. Each patient received 3 monthly sessions. The final assessment took place at 6 months. RESULTS: Combined PRP- and FCL-treated areas had a significantly better response (p = .03), fewer side effects, and shorter downtime (p = .02) than FCL-treated areas, but there were no significant differences in ID- and topical PRP-treated areas in degree of response and downtime (p = .10); topically treated areas had significantly lower pain scores. CONCLUSION: The current study introduces the combination of topical PRP and FCL as an effective, safe modality in the treatment of atrophic acne scars with shorter downtime than FCL alone and better tolerability than FCL combined with ID PRP.

Fractional CO2 laser is an effective therapeutic modality for xanthelasma palpebrarum: a randomized clinical trial.

BACKGROUND: Xanthelasma palpebrarum (XP) is a common cosmetic concern. Although there is a wide range of therapeutic modalities for XP, there is no general consensus on the optimal treatment for such condition. OBJECTIVE: Compare the efficacy and safety of super pulsed (SP) and fractional CO2 lasers in the treatment of XP. PATIENTS AND METHODS: This prospective randomized comparative clinical study included 20 adult patients with bilateral and symmetrical XP lesions. Xanthelasma palpebrarum lesions were randomly assigned to treatment by either single session of ablative SP CO2 laser or 3 to 5 sessions of ablative fractional CO2 laser with monthly intervals. All patients were assessed using digital photography and optical coherence tomography images. RESULTS: Xanthelasma palpebrarum lesions on both sides were successfully removed with significant improvement in size, color, and thickness. Although lesions treated by SP CO2 laser showed significantly better improvement regarding color and thickness of the lesions, downtime and patient satisfaction were significantly better for lesions treated with fractional CO2 laser. Scarring and recurrence were significantly higher in lesions treated by SP CO2 laser. CONCLUSION: Ablative fractional CO2 laser is an effective and safe therapeutic option for XP with significantly shorter downtime and higher patient satisfaction compared with SP CO2 laser.

Evaluation of needling/microneedling as an adjunct to phototherapy in the treatment of stable acral vitiligo: a comparative clinical and immunohistochemical study.

OBJECTIVES: To evaluate the efficacy and tolerability of needling/microneedling as an adjunct to NB-UVB phototherapy in the treatment of stable refractory patches of acral vitiligo, based upon clinical and immunohistochemical assessment of melanocyte count and distribution in response to needling/microneedling. MATERIALS AND METHODS: Twenty patients with stable acral vitiligo (≥2 patches) were enrolled. One of the two index patches was randomized to receive needling or microneedling in conjunction with NB-UVB. Patients received phototherapy sessions 3 times weekly, while needling was carried out on biweekly basis for 6 months. Assessment was done clinically using point counting method, VESTA, and global patients' satisfaction, and immunohistochemically by quantitative assessment of melanocyte count by Melan-A. RESULTS: No statistically significant difference was observed between NB-UVB monotherapy and either of the combined therapy regimens as regards the mean percentage change in vitiligo surface area (p = .451), mean change in absolute melanocyte count from baseline (p = .589), and mean VESTA (p = .916). Patches subjected to adjuvant microneedling/needling were afflicted by koebnerization in 50% and 20% of cases, respectively. CONCLUSION: Neither microneedling nor needling appear to confer an added therapeutic value to NB-UVB phototherapy in the treatment of stable acral vitiligo. Moreover, both carry the risk of koebnerization.

Autologous platelet-rich plasma 'fluid' versus 'gel' form in combination with fractional CO2 laser in the treatment of atrophic acne scars: a split-face randomized clinical trial.

BACKGROUND: The treatment of atrophic acne scars represents a therapeutic challenge. Recently, plasma gel has been introduced among treatment modalities. OBJECTIVE: To compare the efficacy of platelet-rich-plasma 'fluid' versus 'gel' form combined with fractional CO2 laser in the treatment of atrophic acne scars. METHODS: Twenty-seven patients with atrophic acne scars were included. Treatment with fractional CO2 laser plus plasma fluid/gel was randomly assigned to the right/left sides of the face. Clinical and Optical Coherence Tomography (OCT) assessments were scheduled at baseline, one month, and three months after the last session. RESULTS: There was a significant improvement in clinical assessment scores at third-month follow-up on the plasma gel- and plasma fluid-treated sides compared to those at the first-month follow-up (p < .001). Scar depth decreased significantly at third-month follow-up when compared to baseline on both plasma gel- and plasma fluid-treated sides (p < .001). The numerical pain score was significantly lower on the plasma fluid-treated side compared to the plasma gel-treated side (p = .004). CONCLUSION: The use of platelet-rich plasma in combination with fractional CO2 laser, both in fluid and gel form, produced significant results in the treatment of atrophic acne scars. Patients reported an immediate more noticeable effect with plasma gel. However, the fluid injection was less painful.

Dermoscopy aids in differentiating primary cutaneous amyloidosis and post-inflammatory hyperpigmentation: A clinico-dermoscopic-histopathaological study.

BACKGROUND: Primary cutaneous amyloidosis (PCA) and post-inflammatory hyperpigmentation (PIH) are common causes of cutaneous hyperpigmentation that are usually diagnosed clinically. However, their presentations are sometimes atypical, and their differentiation is difficult. Dermoscopy is a valuable diagnostic tool for pigmented diseases that might aid in their diagnosis. OBJECTIVE: To describe the characteristic dermoscopic features of PCA and PIH together with histopathological correlation, and to differentiate between these conditions in a non-invasive way. METHODS: Fifty-two patients with PCA (n = 26) and PIH (n = 26) were enrolled. A detailed history, skin examination, dermoscopic examination using handheld and video dermoscopy, and histopathological evaluation were performed. RESULTS: A statistically significant difference could be detected between PCA and PIH in terms of the duration of the disease (p = 0.027), symmetry (p = 0.044), rippling (p < 0.001), and back affection (p = 0.048). On dermoscopic examination, central hubs were seen more in the PCA group (p < 0.001) with different patterns of peripheral pigmentation. Histopathologically, the number of melanophages per high-power field was significantly higher in the PCA group (p = 0.013). CONCLUSION: The results of this study shed the light on the potential of dermoscopy as a non-invasive diagnostic tool in differentiating between doubtful cases of PCA and PIH.

Comparison of the efficacy of Fractional Radiofrequency Microneedling alone and in combination with platelet-rich plasma in neck rejuvenation: a clinical and optical coherence tomography study.

BACKGROUND: Esthetic improvement of the neck and cervicomental angle remains one of the most challenging aspects of rejuvenation. Fractional radiofrequency microneedling demonstrated significant skin tightening and lifting of lower third of the face. AIM OF WORK: To evaluate and compare fractional radiofrequency microneedling alone and in combination with autologous platelet-rich plasma (PRP) in neck rejuvenation. METHODS: 20 patients with mild to moderate neck laxity were randomized to receive 3 sessions of either fractional radiofrequency microneedling +PRP (group A) or fractional radiofrequency microneedling monotherapy (group B). Evaluation was done using optical coherence tomography to detect dermis thickness, measurement of cervicomental angle, a score done by two investigators blinded to used modality (GAIS) and patient satisfaction score. RESULTS: Both Groups showed a statistically significant improvement in all parameters. Comparing the two groups, the mean dermal thickness after treatment was higher in group A compared with B but was found statistically insignificant. More favorable results were reported in group A according to GAIS. Other parameters showed comparable results. CONCLUSION: Fractional microneedle radiofrequency with insulated microneedles offers a safe and effective modality for mild to moderate neck laxity when used alone or in combination with PRP. It remains questionable whether combining fr-RF microneedling with PRP provides more favorable results in terms of efficacy and side effects.

Differentiating active from stable vitiligo: The role of dermoscopic findings and their relation to CXCL10.

BACKGROUND: Distinguishing vitiligo activity/stability status is pivotal in the management of patients with vitiligo. CXCL10 is a chemokine released in the tissues and sera of patients with vitiligo and an indicator of disease activity. AIM: This study aimed to assess the role of dermoscopy in detecting active and stable vitiligo by comparing the dermoscopic signs in vitiligo with Vitiligo Disease Activity Score (VIDA), clinical activity, and CXCL10 activity. METHODS: Ninety-seven patients with vitiligo were enrolled in this cross-sectional study. Vitiligo activity/stability was assessed using VIDA scores, clinical examination, dermoscopy, and serum CXCL10 levels measured by enzyme-linked immunosorbent assay technique. Dermoscopic scores were calculated using BPLeFoSK score. RESULTS: The dermoscopic score was concordant with the VIDA score in 83.5% of patients (n = 81), clinical assessment in 97.9% (n = 95), and serum CXCL10 level in 70.1% (n = 68). Dermoscopic signs of ill-defined border, satellite lesions, and micro-Koebner and starburst appearance were more common in active vitiligo, while a well-defined border was more common in stable lesions. CONCLUSION: Dermoscopic examination is a practical, reliable, noninvasive, semi-objective tool in the assessment of vitiligo activity/stability that helps reach an informed decision on the disease status to choose the appropriate therapeutic modality.