Effectiveness of water as the neutralising agent for glycolic acid peels in skin phototypes IV-V.

The aim of the study is to evaluate the effectiveness of water as a substitute for sodium bicarbonate plus solution in the neutralisation process of chemical peeling using a 35% glycolic acid solution. This randomised, double-blind, split-face, controlled trial was conducted in an outpatient setting. A total of 126 healthy patients with skin phototypes IV-V aged between 18 and 60 years old were recruited. Chemical peeling was performed with 35% glycolic acid solution. One side of the face was neutralised with water, and the other side of the face was neutralised with a sodium bicarbonate plus solution. The main outcome of this study was measured by the degree of erythema, pruritus and pain scores. Significant difference in the pain score immediately after the neutralisation process of the chemical peeling with glycolic acid was seen. However, there were no significant differences in the degree of erythema or the pruritus score. These results indicate that water can be used as a substitute for sodium bicarbonate plus solution in the neutralisation process of chemical peeling with 35% glycolic acid in patients with skin phototypes IV-V.

Microneedling in the treatment of atrophic scars: A systematic review of randomised controlled trials.

To date, treatment of atrophic acne scars remains a therapeutic challenge for dermatologists, yet there is no standard option on the most effective treatment. Microneedling (MN) is a minimally invasive technology that involves repetitive skin puncture using sterile microneedles to disrupt dermal collagen that connects the scar tissue. Recent studies have demonstrated the potency of MN, such as dermaroller and fractionated microneedle radiofrequency, in the treatment of atrophic scars. The objective of this review is to evaluate systematically the current literature on MN for atrophic acne scars. A systematic search of literature was performed from PubMed, Medline, Cochrane Central, and Google Scholar databases for articles published during the last 20 years. Only randomised controlled trials (RCTs) with full-text version of the manuscript available were included in our study. Nine RCTs were included in this review. All treatment modalities demonstrated consistent results that MN was efficacious in treating atrophic acne scars as a monotherapy or in combination with other treatments. Moreover, no serious adverse effects were reported in all studies after MN treatment. MN is a well-tolerated and effective therapeutic modality in treating atrophic acne scars. Further research is required to validate the efficacy of MN with a larger sample size and lengthy follow-up.

Effectiveness of Standard Therapy for Acne Vulgaris Based on Clinical Practice Guidelines in Indonesia.

Purpose: To evaluate the effectiveness of standard therapy for acne vulgaris based on Indonesian guidelines. Patients and Methods: New patients with acne vulgaris at Dr. Cipto Mangunkusumo National Central General Hospital, the national referral center in Indonesia, who met the criteria were included in this study. Patients were treated with standard therapy for acne vulgaris based on the 2017 guidelines of Dr. Cipto Mangunkusumo Hospital, depending on severity. Changes in the number of non-inflammatory, inflammatory, and total lesions and the proportion of acne severity after three months of therapy were analyzed retrospectively. Results: Among the 131 subjects, 63.4% had moderate acne; 20.6% had mild acne, and 16% had severe acne at baseline. Most patients (29 (22.2%)) received a combination of retinoic acid, benzoyl peroxide, and topical or oral antibiotics. Standard therapies reduced the median of non-inflammatory (25 (5-135) vs 8 (0-53)), inflammatory (10 (0-93) vs 2 (0-22)), and total lesions (41 (10-160) vs 10 (1-71)) at week 12 (all p < 0.001). The proportion of acne severity differed significantly after three months, with an increasing proportion of mild acne (20.6% vs 93.1%) and a decreasing percentage of moderate and severe acne (moderate = 63.6% vs 6.1%; severe, 16% vs 0.8%; p < 0.001). Conclusion: Standard therapy for acne vulgaris based on the clinical practice guidelines in Indonesia improved acne lesions and severity after 12 weeks. These results support the implementation of national guidelines for acne management in Indonesia, with the practice of improving antimicrobial stewardship.

Correlation Between Reduced IL-1ß Levels in Acne Lesions and the Decrease in Acne Inflammatory Lesions Following Topical Vitamin D Administration: A Double-Blind Randomized Controlled Trial.

Background: The inflammatory process in acne vulgaris (AV) is characterized by the upregulation of specific pro-inflammatory cytokines, including interleukin (IL)-1ß, IL-6, and IL-8, within sebocytes and keratinocytes. Sebocytes have been identified as target cells for bioactive vitamin D. Experimental studies on animal models have demonstrated the potent comedolytic effects of topical vitamin D. However, further research is required to specifically evaluate the impact of vitamin D on inflammatory lesions in acne vulgaris (AV). Objective: To evaluate the effectiveness of topical vitamin D in treating acne vulgaris (AV) lesions by investigating its anti-inflammatory effects on pro-inflammatory cytokine modulation, specifically assessing the correlation between IL-1ß levels in acne lesions and the reduction in AV severity. Materials and Methods: This study is a double-blind, randomized, placebo-controlled clinical trial with a 2-arm design over an 8-week intervention period. Participants were randomly assigned to either the topical vitamin D group (cholecalciferol 50 mcg) or the topical placebo group, with each group comprising 32 subjects. All participants received concomitant treatment with topical adapalene 0.1%. Cytokine levels within acne lesions were assessed using Luminex Polystyrene Screening Assays to detect and quantify IL-1ß levels. The effectiveness of the treatment was evaluated by monitoring the reduction in the number of inflammatory lesions, while the safety of topical vitamin D was assessed by documenting and analyzing any reported side effects. Results: The study found a significant correlation between the reduction in IL-1ß levels within acne lesions and the decrease in moderate and severe inflammatory lesions in acne vulgaris (p = 0.028). The topical application of vitamin D led to a significant reduction in inflammatory AV lesions (p = 0.045). No significant topical side effects were observed in either the vitamin D or placebo groups. Conclusion: This study demonstrates that the topical administration of vitamin D in acne vulgaris (AV) lesions is effective in reducing pro-inflammatory cytokine levels within acne lesions and in decreasing the severity of AV. Trial Registration: NCT05758259. September 5, 2022.

Adipose-derived stem cell conditioned medium for hair regeneration therapy in alopecia: a review of literature.

To date, therapeutic choices for alopecia have shown limited effectiveness and safety, making the discovery of new therapeutic choices challenging. Adipose-derived stem cells conditioned-medium (ADSC-CM) contain various growth factors released by ADSCs that may support hair regrowth. This literature review aims to discover the effect and clinical impact of ADSC-CM in the treatment of alopecia. A comprehensive literature search was performed through four databases (Pubmed, ScienceDirect, Cochrane, and Scopus) in September 2021. A combination of search terms including "adipose-derived stem cells" and "alopecia" was used. Studies published in English that included ADSC-CM interventions on alopecia of all types were selected and summarized. A total of five studies were selected for review, all of which were case series. All studies showed a positive outcome for intervention. Outcomes measured in the studies include hair count or hair density, hair thickness, anagen, and telogen hair count. No adverse effects were reported from all studies. Limitations lie in the differences in intervention method, application, and length of treatment. ADSC-CM hair regeneration therapy is an effective and safe treatment for alopecia that may be combined with other types of therapy to improve outcomes.

The comparison of metabolic syndrome parameters, trichoscopic and trichoscan characteristics in androgenetic alopecia (AGA) and early-onset androgenetic alopecia (early-onset AGA).

Androgenetic alopecia (AGA), the most common cause of hair loss, is influenced by various risk factors. Metabolic syndrome constitutes a collection of risk factors elevating the risk of cardiovascular disease. The presence of early-onset AGA could serve as an indicator of the emergence of metabolic syndrome, yet to date, no research has examined these parameters in AGA. This is a cross-sectional study comparing two groups; early onset versus normal onset AGA. Forty participants were enlisted and evenly distributed into the two groups. Subsequently, participants underwent examinations utilizing trichoscopy, trichoscan, and laboratory assessments. Apart from waist circumference, BMI, and age of alopecia onset, there were no notable differences concerning sociodemographic and clinical features. In terms of hair growth parameters, the telogen hair rate stands out as the sole indicator exhibiting a significant difference between both groups, while trichoscopy data also revealed varying hair characteristics. Lastly, metabolic parameters namely triglyceride, fasting blood glucose, HbA1c and HDL differ significantly, with the normal onset group demonstrating a higher prevalence of metabolic abnormality. This suggests a potential association between AGA and metabolic syndrome. However, the exact nature of this relationship remains uncertain, necessitating further research with larger samples, specific age groups and diverse study designs.

Stem Cells as a Therapeutic Choice in Dermatological Disorders.

Stem cells are known for their extraordinary properties, mainly their potency, self-renewal, and clonality. In recent years, we have witnessed notable advancements in the field of cell therapy. Due to its remarkable properties and versatility, this cutting-edge therapy has now become a potentially promising cure for many diseases. Stem cell-based therapies have been utilized to treat various dermatological conditions, for instance, autoimmune skin disorders, atopic dermatitis, skin aging, wound healing, scar treatment, and many others. This article aims to serve as an overview of cell-based therapy's current application in dermatology field.

Trichoscopy Features of Indonesian Males with Androgenetic Alopecia in Association with Disease Severity.

Introduction: Androgenetic alopecia (AGA) is a progressive loss of terminal hairs in a specific pattern distribution related to androgen. The dermoscopy of hair and scalp, known as trichoscopy, is a noninvasive method for diagnosing alopecia and other hair and scalp disorders. Objective: This study aims to report the correlation between the severity of males with AGA based on Hamilton-Norwood's scale with the clinical characteristics found in trichoscopy. Materials and Methods: This study included 40 patients aged 25-58 years who visited the dermatology outpatient clinic in a tertiary health facility in Indonesia. Clinical diagnosis was determined through history taking, physical examination, and trichoscopy. Based on Hamilton-Norwood's criteria, patients were divided into two groups: early and late stage. Parameters examined in trichoscopy include yellow dots, white dots, peripilar sign, vellus hair, hair diameter diversity, single-hair follicles, and empty follicles. The Chi-square test and Fisher's exact test were used to analyze the statistical significance between the groups. Results: All participants presented with hair diameter diversity, vellus hair, and empty follicles (100%). None of the study participants had yellow dots. White dots and single-hair follicles were seen in 32 (80%) and 30 cases (75%), respectively. In the late-stage group, these features were more prevalent. Peripilar sign was found in 25 participants (62.50%), and it was more common in the early-stage group. No significant association was found between disease severity and trichoscopy features. Conclusion: The most common trichoscopy findings in particular order were hair diameter diversity, vellus hair, and empty follicles, followed by white dots, single-hair follicles, and peripilar signs. No significant association between alopecia severity and trichoscopy parameters was observed. Studies with a larger number of participants, including a control group, should be conducted to yield more significant results.

Combination of adipose-derived stem cell conditioned media and minoxidil for hair regrowth in male androgenetic alopecia: a randomized, double-blind clinical trial.

INTRODUCTION: Treatments for AGA have yet to produce satisfactory outcomes and may cause intolerable side effects. Recent studies have reported that adipose tissue-derived stem cell conditioned media (ADSC-CM) could induce hair growth and regeneration. OBJECTIVE: To investigate the efficacy of ADSC-CM combined with minoxidil for hair regeneration therapy in male AGA. METHODS: This study lasted for 6 weeks. Subjects were divided into two groups: concentrated and non-concentrated ADSC-CM. Scalp was divided vertically in half before intradermal injection was administered from the frontal region of the scalp toward the vertex with a 30G needle, spaced about 1 cm apart. Treatment side received 2 ml of ADSC-CM; the other side was given 2 ml of NaCl 0.9% as placebo. Patients applied 5% minoxidil twice daily post-injection. Improvements were assessed using photographs and trichoscan every 2 weeks. RESULTS: Hair count, hair density, and mean thickness increased significantly on both sides after 6 weeks, while vellus rate decreased proportionally with the increase of terminal rate. No statistically significant differences between treatment groups were found. Minimum side effects were reported, and subjects were satisfied with the results. CONCLUSION: Combination of ADSC-CM and minoxidil could be a potential agent for hair regrowth. Follow-up research with extensive populations, longer duration, and different study design may be required to confirm the exact mechanisms of ADSC-CM on hair growth. TRIAL REGISTRATION: Clinicaltrials.gov, NCT05296863. Registered 25 March 2022-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05296863 .

A Comparative Study on Adipose-Derived Mesenchymal Stem Cells Secretome Delivery Using Microneedling and Fractional CO2 Laser for Facial Skin Rejuvenation.

Background: The efficacy of adipose-derived mesenchymal stem cells (ADMSCs) secretome for skin aging has been established, yet no studies hitherto directly investigated the best administration method for such purpose. Purpose: We aimed to compare microneedling (MN) versus fractional CO2 laser (FL) as methods of delivery for ADMSCs secretome in the treatment of aging skin. Patients and Methods: A single-blind, randomized split-face clinical trial was conducted on 30 Indonesian women (aged 35-59 years old) with signs of facial cutaneous senescence. Their initial aging status was assessed by dermoscopy photoaging scale (DPAS) and Janus-III measurement system. In the second and fourth weeks, all participants were treated with both MN and FL, followed by the application of a four-fold concentrated ADMSC secretome. The assignment of which side of the face received MN or FL was done by computer-based randomization. Skin parameters were reevaluated on the fourth and sixth weeks, along with patient satisfaction, level of comfort, preference for administration techniques, and also adverse events experienced during the study. Appropriate statistical analyses were subsequently performed at a significance level of 0.05. Results: Significant improvements in total DPAS and wrinkles were found in the MN and FL groups at the end of the trial. In contrast, no statistical differences in all parameters were observed between groups in the fourth and sixth weeks. FL scored higher than MN for satisfaction and preference, but lower in terms of comfort. Pain, burning sensation, and itch were the side effects experienced by subjects upon treatment. Two patients had prolonged reddish skin succeeding FL treatment, which relieved with moisturizer application. Conclusion: Both MN and FL yielded comparable results for improving several skin aging features. However, subjective preference for ADMSCs secretome administration method may differ when considering satisfaction, comfort, and possible adverse events.

Expert consensus on holistic skin care routine: Focus on acne, rosacea, atopic dermatitis, and sensitive skin syndrome.

BACKGROUND: Treatment, cleansing, moisturizing, and photoprotection are four major components of holistic skin care for dermatological conditions. While treatment (T) is recognized as a key component in the management of dermatological conditions, there is a lack of practical guidance on the adjunctive role of cleansing, moisturizing, and photoprotection ("CMP"). Limited patient knowledge, confusion over product selection, and lack of guidance on how to choose and use CMP skin care products (in conjunction with pharmacological therapy) are the main barriers to establishing a holistic skin care routine for dermatological conditions. AIMS: This study aimed to review current clinical evidence, identify gaps, and provide practical guidance on conceptualization and implementation of CMP routine in the management of sensitive skin due to underlying acne, atopic dermatitis, or rosacea, including conditions with idiopathic causes referred to as idiopathic sensitive skin syndrome. METHODS: An expert panel comprising of 10 dermatologists from Australia, China, Hong Kong, Taiwan, India, Indonesia, Philippines, Singapore, South Korea, and Thailand convened to develop consensus statements on holistic skin care in acne, rosacea, atopic dermatitis, and idiopathic sensitive skin syndrome using the Delphi approach. RESULTS: Consensus was defined as ≥80% of panel rating statement as ≥8 or median rating of ≥8. The final statements were collated to develop consensus recommendations on holistic skin care. CONCLUSION: A dermatologist-guided holistic skin care routine is essential to improve patient confidence and reduce confusion over product selection. The consensus recommendations presented here highlight the importance of cleansing, moisturization, and photoprotection in holistic skin care and how it can be utilized as a communication tool for physicians and patients to achieve overall better patient compliance, satisfaction, and treatment outcomes.

Topical tretinoin for treating photoaging: A systematic review of randomized controlled trials.

Aging, an inevitable and continuous process in one's lifetime, has all along been a focus of interest, especially for women, yet photoaging treatment to slow the process remains challenging. Recent studies have demonstrated the potency of topical tretinoin in the treatment of photoaging. Tretinoin, a metabolite of retinoids, shows prominent efficacy to regulate proliferation and differentiation of epidermal cells and induce new collagen formation. Objective: This review aims to study the current evidence on topical tretinoin for photoaging treatment. Methods: A systematic search of the literature was performed from Medline, Cochrane Central, Embase, and PubMed databases for published articles in the past 20 years. Only randomized controlled trials investigating tretinoin for photoaging treatment were included in our review. Results: A total of 180 studies were initially examined, of which 7 randomized controlled trials were included in this review. Four studies included only women as their participants, while the rest demonstrated women as their majority subjects. All studies that indicated topical tretinoin were safe and well tolerated in all patients. Topical tretinoin dosage varied from 0.025% to 5% while duration of treatment ranged from 3 months up to 24 months. With regard to efficacy, all studies consistently reported that topical tretinoin was efficacious in improving clinical appearance of photoaging in terms of wrinkling, mottled hyperpigmentation, sallowness, and lentigines as early as 1 month and lasted after 24 months. Limitations: Different tretinoin formulas used, different outcome parameters, and limited recent studies on topical tretinoin cause lack of uniformity in the evidences. Conclusion: Topical tretinoin is a safe and effective therapeutic modality for long-term treatment of photoaging. Further research is required to compare dose-ranging topical tretinoin to other agents to provide the best treatment strategy for photoaged skin.

Hair disorder in dr. Cipto Mangunkusumo cosmetic dermatology and venereology outpatient clinic of Jakarta, Indonesia: A socio-demographic and clinical evaluation.

Hair disorder has a significant impact on sociopsychology. In Indonesia, there are currently few and out-of-date studies on hair disorders. Our study aimed to provide an update on the epidemiology of hair loss, which is common in Indonesia. This is a retrospective study of hair disorder cases seen at Dr. Cipto Mangunkusumo's Cosmetic Dermatology Outpatient Clinic at the National Central General Hospital from January 2017 to December 2019. Each patient's age, gender, family history, education, occupation, body mass index (BMI), comorbidities, and diagnosis were recorded. Hair disorders were found to be more prevalent in males (54.6 percent) with a mean age of 26.41 ± 12.8 years old and the highest age group of 18-39 years old (59.4 percent) among the 64 patients who were eligible for the study. There were 32 cases (50.0%) of alopecia areata (AA), 20 cases (31.2%) of alopecia androgenetic (AGA), 9 cases (14.0%) of telogen effluvium (TE), 2 cases of cicatricial alopecia (CA) due to lupus erythematosus (DLE), and 1 case of trichotillomania (TTM). Female patients had significantly more TE cases. Cases of AGA in the study, mainly early-onset AGA (mean age 29.45 ± 10.29 years old, 39.5% in 18-39 years old) showed a significant positive familial history. At dr Cipto Mangunkusumo National General Hospital Jakarta, the most common types of hair disorders were AA, AGA, and TE, with each disease having a unique socio-demographic and clinical profile.

Acne Lesion Extraction versus Oral Doxycycline for Moderate Acne Vulgaris: A Randomized Clinical Trial.

CLINICAL TRIAL ID: NCT04206631. BACKGROUND: Acne vulgaris is a polymorphic skin condition comprising inflamed and noninflamed lesions. In addition to topical retinoids, systemic antibiotics play a role as a main therapy for acne with inflamed papules and cysts. However, due to the increasing tendency for bacterial resistance, alternatives to antibiotics are needed. OBJECTIVE: The aim of this study was to evaluate the effectiveness of acne lesion extraction compared to oral doxycycline for moderate acne vulgaris and to explore the impact of both treatments on Hypoxia-inducible factor (HIF)-1 alpha. METHODS: This randomized clinical trial was conducted in two teaching hospitals in 2016. Subjects with moderate acne vulgaris (N=140) were divided into two groups. Each subject in both groups received 0.05% tretinoin cream, applied to the entire face each night, and 2.5% benzoyl peroxide gel, applied to the acne lesions in the morning and afternoon. One group was also treated with oral doxycycline 100mg once daily and the other was treated with acne lesion extraction performed on all facial lesions every two weeks; the patients were evaluated via patient-reported self-assessment and lesion counts every two weeks for six weeks. HIF-1 alpha expression of the biopsied lessions was examined via immunohistochemistry. RESULTS: 128 subjects completed the study. Among these 128 subjects there was a prominent decrease in inflamed lesions at Week 6 in the lesion extraction group compared to the oral doxycycline group (p<0.05). HIF-1 alpha expression of the biopsied lesions was found in 7 of 9 samples taken from the oral doxycycline group, while 3 of 4 samples in the lesion extraction group were found negative. CONCLUSION: According to our results, acne lesion extraction appeared to be more effective than oral doxycycline in treating this sample of patients with moderate acne vulgaris. Additionally, HIF-1 alpha expression appeared to be decreased after acne lesion extraction.

Papulopustular and Ocular Rosacea with an Alleged Coincidence of Cutaneous Lupus Erythematosus: A Case Report.

Rosacea is a chronic inflammatory skin disease characterized by central facial erythema with or without ocular involvement. It is often difficult to distinguish rosacea from other malar rashes, one of which is acute cutaneous lupus erythematosus (CLE), particularly when there is an increase in antinuclear antibody (ANA) level. We report the case of a 16-year old woman with facial erythematous plaque accompanied by papules and pustules, reddened eyes, and swollen eyelids since the last one year. Dermoscopic examination revealed telangiectasia, and skin scraping examination with 20% potassium hydroxide identified the presence of Demodex folliculorum. Further ocular examination also revealed blepharitis, dysfunction of Meibomian gland, cicatrix, and corneal neovascularization. The ANA titer was positive (1:320), while the anti-dsDNA was negative. The patient was treated according to standard treatment for rosacea. The patient showed a satisfactory response following 2 weeks of therapy. Signs of recurring red patches with papules, pustules, telangiectasia, and identification of D. folliculorum on skin scraping examination led to the diagnosis of papulopustular rosacea. A positive ANA test may also be present in other diseases, e.g. acute CLE. Therefore, the diagnosis of rosacea remains a challenge. Thorough observation and examination must be done in order to yield an accurate diagnosis of rosacea.

A comparative study of melasma severity after hyperthyroid therapy in hyperthyroid subjects with melasma.

INTRODUCTION: Melasma, and its variant chloasma, is an acquired and chronic disorder of hyperpigmentation, characterized by symmetrical hypermelanoses of the face. The exact pathogenesis of melasma remains unclear. Several hormones are thought to play a role, including thyroid hormones. The study's objectives are to determine the proportion of melasma cases in hyperthyroid patients and to compare the severity of melasma before and after medications of hyperthyroid therapy. METHODS: A quasi-experimental (pre-post intervention) study was conducted in Jakarta from August 2019 to February 2020. Twenty-three patients either newly diagnosed with hyperthyroidism or that had undergone hyperthyroid therapy for a maximum of 3 months and also had melasma were recruited. The severity of melasma was scored with the modified Melasma Area and Severity Index (mMASI), and dermoscopy of the lesions was performed. The evaluation was performed after 3 months of hyperthyroid therapy. RESULTS: Among the 69 hyperthyroid patients, 45 (65%) had melasma. The mean difference in the mMASI score was 0.49 (p > 0.05). Dermoscopy features did not show any differences between the start and end of the study. CONCLUSIONS: There is no significant improvement of melasma severity in hyperthyroid patients after 3 months of hyperthyroid therapy.

Evaluating Oral Glutathione Plus Ascorbic Acid, Alpha-lipoic Acid, and Zinc Aspartate as a Skin-lightening Agent: An Indonesian Multicenter, Randomized, Controlled Trial.

CLINICALTRIALSGOV IDENTIFIER: NCT04105504. BACKGROUND: For Asians, especially women with darker skin tones (Fitzpatrick Skin Types IV and V), clear, bright skin is considered highly desirable, and various topical, oral, or injection-based cosmetic skin-lightening agents with different mechanisms of action are widely available across Asia. OBJECTIVE: We sought to investigate the efficacy and safety of an oral glutathione supplement comprising L-glutathione (fermentation), ascorbic acid, alpha-lipoic acid, and zinc (as zinc aspartate) as a skin-lightening agent. METHODS: This randomized, double-blind, controlled clinical trial was carried out at three teaching hospital-based dermatovenereology clinics in Indonesia. Participants were randomized to receive either the glutathione supplement or placebo capsules and were evaluated every four weeks over a 12-week study period. Total reduction in spot ultraviolet, spot polarization, and skin tone were measured and recorded using a Janus Facial Analysis System® (PIE Co., Ltd, Suwon-si, Gyeonggi-do, Korea). RESULTS: Eighty-three participants, aged between 33 and 50 years, completed the study. Reductions in spot ultraviolet in certain subgroups, spot polarization, and skin tone were greater in the glutathione supplement group than in the placebo group, but the difference was not statistically significant. Both the glutathione supplement and placebo groups experienced only mild side effects in the first four weeks. CONCLUSION: The oral glutathione supplement was slightly beneficial for skin lightening in particular subgroups, but the results were not statistically significant. Mild and temporary side effects were reported. Further research is required to more fully evaluate the efficacy of this glutathione supplement as a skin-lightening agent.

Acne Vulgaris Mimicking Cutaneous Lupus Erythematosus in an Adolescent: Report of a Rare Case.

Acne vulgaris is a chronic and self-limiting disorder of the pilosebaceous unit which is primarily seen in adolescents. Acne vulgaris presents as polymorphic lesions, consisting of comedones, papules, pustules, cysts, nodules, scarring, and dyspigmentation. Acneiform presentation of cutaneous lupus erythematosus (CLE) is extremely rare. The presentation of CLE is notoriously diverse and often mimics a broad range of unrelated skin disorders. We present a case by referring to American College of Rheumatology (ACR) criteria for systemic lupus erythematosus (SLE); our patient's conditions did not meet any of the clinical criteria of the Systemic Lupus International Collaborating Clinics (SLICC) for SLE. Subsequent to thorough history-taking, physical examination, and laboratory evaluations, the diagnosis of acne vulgaris was established, and a diagnosis of CLE was excluded. As acneiform presentation of CLE is rare, we here present a case which resembled both acne vulgaris and CLE. We describe our experience in establishing the diagnosis of severe acne vulgaris accompanied by scars in a 12-year-old boy with a malar rash and scars on his frontal and malar area who had initially been misdiagnosed as having CLE. This unusual case highlights the broad spectrum of adolescent acne and the importance of clinical identification of the disease so that unnecessary workups might be avoided.

Combination treatment with light emitting diode and wound dressings in a patient with a venous leg ulcer: a case report.

Leg ulcers are a problem often found in the adult population, with a prevalence of 1 to 2% in the population. Vascular disease is the most common cause. Venous disorders that occur in the lower limbs are the main cause of lower leg ulcers compared to other vascular disorders. Emerging wounds can cause pain, thereby interfering with quality of life. These conditions often persist for a long time, and they can be a health problem that leads to an economic burden as a result of a long period of wound care. Several therapeutic methods that can be chosen for wound healing purposes include light-emitting diodes (LED) and wound dressings. LED can have physiological effects such as anti-inflammatory resolution, neoangiogenesis, fibroblast and epithelial proliferation, and collagen synthesis and deposition. Furthermore, wound dressings provide an optimal condition for wound healing by creating a moist and clean environment for the wound. We present the case of a 47-year-old man with a venous leg ulcer that was treated with LED and wound dressings. After the patient underwent the eighteenth LED session, combined with wound dressings, the size, depth, and pain of the venous leg ulcer decreased.

The diagnostic conundrum of Riehl melanosis and other facial pigmentary disorders: a case report with overlapping clinical, dermoscopic, and histopathological features.

Riehl melanosis (RM) is a form of pigmented contact dermatitis that often poses a diagnostic challenge due to overlaps in its clinical, dermoscopic, and histopathological features with other pigmentary disorders. This report highlights significant findings and the proper approach for diagnosis. We present the case of a 47-year-old female with progressive facial hyperpigmentation (irregular, blotchy, grayish patches on the forehead, cheeks, and around the mouth) that acknowledged applying a lightening product before her complaint. Dermoscopy revealed brownish-gray dots and pseudonetwork pigmentation. The histopathological findings were comprised of hypergranulosis, interface dermatitis, and pigment incontinence. The patient's history and clinical, dermoscopic, and histopathological examination results showed features consistent with-but not exclusive to-RM, such that it was not possible to rule out lichen planus pigmentosus (LPP) and ashy dermatosis (AD). We finally diagnosed the patient with RM and treated her with medications consisting of alpha hydroxy acid, tretinoin, hydroquinone, and sunscreen. Patch testing might help because higher positivity rates were found in RM patients compared to LPP and AD. However, positive patch testing favors RM, and, regardless of diagnosis, provides a basis for substance avoidance in the treatment plan.