Fractional CO2 Laser-Assisted Delivery of Botulinum Toxin-A Versus Aluminum Chloride in Treatment of Primary Palmar Hyperhidrosis.

BACKGROUND: Primary palmar hyperhidrosis (PPH) constitutes a distressing dermatologic condition that greatly affects patients' quality of life. Its management still needs to be addressed to find a suitable therapeutic modality that is readily available, cost effective, and gives patients a quite long disease-free period. OBJECTIVE: To assess the efficacy of fractional CO2 laser as a delivery method for botulinum toxin-A (BTX-A) and aluminum chloride in treating PPH. PATIENTS AND METHODS: Twenty-four subjects with PPH were treated on both hands with fractional CO2 laser followed on the right hand with topical BTX-A and on the left hand with topical aluminum chloride. Minor's starch-iodine test and Hyperhidrosis Disease Severity Scale (HDSS) were used for evaluation of treatment response and for follow-up. RESULTS: There was a significant improvement in HDSS in both groups, but there was no statistically significant difference in the therapeutic response for both modalities. There was a statistically significant longer disease-free period in the BTX-A-treated hands. CONCLUSION: Fractional CO2 laser-assisted drug delivery (LADD) represents a safe, minimally invasive procedure that enhances the delivery of BTX-A and aluminum chloride, the two most widely used agents for treating PPH, with a comparable anhidrotic response.

Intralesional bivalent human papilloma virus vaccine as a treatment for anogenital warts versus topical podophyllin resin 25%: A pilot study.

A role of human papilloma virus (HPV) vaccines as a therapy for genital warts was suggested, nevertheless; it has not been established in clinical trials and has yet to be determined. The objective of this study is to evaluate a potential benefit of intralesional injection of bivalent HPV (Cervarix) vaccine as a treatment for anogenital warts versus topical podophyllin resin 25%. Forty-four patients with anogenital warts were included in the study, 22 patients received intralesional Cervarix every 2 weeks until clearance of lesions or for a maximum of five sessions. The other 22 patients received topical podophyllin resin 25% twice weekly until complete resolution or for a maximum of 4 weeks. Follow up was done for 6 months. Dermatology life quality index (DLQI) was measured. Complete clearance of warts was achieved in 10 patients (45.5%) in Cervarix group versus six patients (27.3%) in Podophyllin group. The difference was statistically insignificant. No recurrence of warts was reported in Cervarix group while two patients (33.3%) showed recurrence in Podophyllin group. Both treatments were well tolerated. All patients reported significant improvement of their DLQI. Intralesional Cervarix is a promising modality showing higher rates of complete response, high safety, and no recurrence.

The efficacy of microneedling alone vs its combination with 5-fluorouracil solution vs 5-fluorouracil intralesional injection in the treatment of plantar warts.

Intralesional 5-fluorouracil (IL5-FU) has been used off-label for warts treatment; however, its use was limited by intense pain. Combination treatment can offer a robust therapeutic effect. Was to assess the therapeutic efficacy, safety and tolerability of microneedling vs its combination with 5-FU solution vs IL5-FU in the treatment of plantar warts. Ninety patients with plantar warts were divided randomly into three groups each containing 30 patients. Group A received (intralesional 5-FU), group B (microneedling) while group C (microneedling and 5-FU solution). All groups received treatment for a maximum of six sessions 2 weeks apart. Complete response was observed in 86.7% of the warts treated with 5-FU and microneedling (group C) vs to 76.7% and 70% in group A and B, respectively, with no statistically significant difference (P = .36). A significant increase in the number of sessions (P = .01) and pain score (P = .001) were found among group A compared to groups B and C. Patient's satisfaction was higher in group C (P = .05). No recurrence was reported in all groups. Microneedling can be used as alternative or adjuvant therapeutic modality for plantar warts treatment and significantly associated with less pain. Combination group was superior compared to the others.

Treatment of recalcitrant plantar warts with long-pulsed Nd:YAG laser versus cantharidin-podophylline resin-salicylic acid.

BACKGROUND: Treatment for recalcitrant plantar warts remains a continuing challenge as the options for treatment have differing levels of success. long-pulsed Nd:YAG laser is considered a good treatment modality in resistant plantar warts. On the other hand, high cure rates have been reported with a topical proprietary formulation consisting of 1% cantharidin, 5% podophyllotoxin, 30% salicylic acid. AIM: To compare the efficacy of 1% cantharidin, 20% podophylline resin and 30% salicylic acid (CPS) versus long-pulsed Nd:YAG laser in the treatment of recalcitrant plantar warts. METHODS: This study included 30 patients with single or multiple recalcitrant plantar warts; patients were assigned to two groups: the first group included 15 patients with 71 recalcitrant plantar warts who were treated by long-pulsed Nd:YAG laser (group I) and the second group included 15 patients with 78 recalcitrant plantar warts who received CPS (group II). The diagnosis of plantar warts was made by clinical examination. RESULTS: Fourteen patients (93%) were completely cleared of their warts with topical CPS, while 11 patients (73%) showed complete clearance with long-pulsed Nd:YAG laser with statistically significant difference between the two groups. CONCLUSION: Topical CPS is safe and efficacious and represents a promising therapeutic modality than long-pulsed Nd:YAG laser in the treatment of recalcitrant plantar warts.

Microneedling combined with botulinum toxin-A versus microneedling combined with platelet-rich plasma in treatment of atrophic acne scars: a comparative split face study.

BACKGROUND: Atrophic post-acne scarring constitutes a troublesome cosmetic concern for both patients and dermatologists. Old and new therapies as well as combinations are being introduced to achieve a satisfactory response. Microneedling has been used either alone or under different combinations for its treatment. The aim was to compare its combination with topical platelet-rich plasma versus its combination with topical Botulinum Toxin-A. METHODS: 30 subjects with different types and grades of atrophic post-acne scars completed the study. Right side of the face was treated with microneedling and platelet-rich plasma while the left side was treated microneedling and Botox. Response was assessed using two different scales. Patient satisfaction and pain were also assessed. RESULTS: Regarding response to therapy and according to the quartile grading scale, there was no statistically significant difference between the two sides where (23.4% & 13.3%) of the right and left sides, respectively, had an excellent response. Regarding the difference in the qualitative global scarring grading system before and after treatment, there was a highly statistically significant improvement on both sides with higher improvement on the right side than left side but in a non-statistically significant way. CONCLUSIONS: Both combinations present efficacious options for treating acne scars with comparable efficacy. TRIAL REGISTRATION: Registered and approved prospectively by the ethical review board of the faculty of medicine, Zagazig University.

Therapeutic Effect of Microneedling with Platelet-rich Plasma Versus Microneedling with Tranexamic Acid for Melasma.

BACKGROUND: Melasma is a chronic acquired focal pigment disorder showing symmetrical hyperpigmentation or hypermelanosis of photoexposed areas on the face. Tranexamic acid (TXA) is a treatment for melasma. The regression of melasma after platelet-rich-plasma (PRP) treatment is an interesting finding. OBJECTIVE: We investigated the effect of microneedling followed by PRP versus microneedling followed by tranexamic acid in the treatment of patients with melasma. METHODS: The study included 26 patients with melasma divided into two groups of 13 patients each. Group 1 was treated with microneedling and PRP, and Group 2 was treated with microneedling and tranexamic acid. RESULTS: The response to treatment was assessed using the Melasma Area and Severity Index scoring system before and after treatment. At the start of the study and at the first session, there were no statistically significant differences (p>0.05). At the second and third treatment sessions, there were statistically significant differences (p<0.05). There were no statistically significant differences between the two groups regarding side effects of pain, erythema and postinflammatory hyperpigmentation. CONCLUSION: Microneedling with PRP offers better results than microneedling with TXA in treating melasma.

Efficacy and safety of a new 10% topical minoxidil versus 5% topical minoxidil and placebo in the treatment of male androgenetic alopecia: a trichoscopic evaluation.

INTRODUCTION: Androgenetic alopecia is a stressful condition for males. Minoxidil 2% and 5% have been FDA approved for treatment of this condition. In literature, all studies have compared minoxidil 5% with 2%. Although other concentrations (2% to 12.5%) are available nowadays, we believe our study is the first to compare 10% versus 5% topical minoxidil in treatment of AGA. OBJECTIVE: To compare the efficacy and safety of 5% topical minoxidil with 10% topical minoxidil and placebo in AGA treatment. MATERIALS AND METHODS: 36-weeks, double-blinded, placebo-controlled, randomized trial. A total of 90 men with AGA. First group have applied 5% minoxidil solution, second group applied 10% minoxidil solution; or third placebo group. Efficacy was evaluated clinically and trichoscopically. RESULTS: After 36 weeks of therapy; 5% topical minoxidil (0.47 ± 0.26) (0.59 ± 0.64) was significantly superior to 10% topical minoxidil (0.05 ± 0.13) (0.45 ± 0.74) and placebo (0.01 ± 0.05) (-0.03 ± 0.08) in terms of change from baseline in total vertex and frontal hair mean count respectively. Pull test change to negative in minoxidil 5%: (37%) patients after 6 month treatment, Minoxidil 10% group (37.5%) patients changed and in placebo group all patients after 6 month were the same (0%) change. No reported sexual dysfunction in all three groups. CONCLUSION: Five percent of topical minoxidil was moderately superior to 10% topical minoxidil and placebo in increasing hair regrowth opposite to the expected, the irritation was marked for 10% topical minoxidil. Psychosocial stress after 10% usage were worsen by the shedding, irritation compared to their high expectation in comparison to 5% usage.

Clinical Skin Aging Score and Risk of Degenerative Cardiovascular Diseases.

BACKGROUND: Skin aging can be a contributing factor in the prediction, follow-up, and early diagnosis of some disorders related to the aging process, including degenerative cardiovascular diseases. OBJECTIVE: We sought to explore the association between a clinical skin aging score and risk of degenerative heart diseases. METHODS: This study included two groups; a case group consisting of 44 patients older than 30 years who were admitted to the cardiology department with degenerative heart disease and 44 age- and sex-matched healthy individuals to act as a control group. The skin aging score was calculated for all subjects. RESULTS: Regarding intrinsic skin aging parameters, there were highly significant differences between the two groups in uneven pigmentation, reduced fat tissue, benign skin tumors, fine wrinkles, and lax skin appearance. Concerning extrinsic skin aging parameters, there were significant differences between the two groups regarding pigment changes, changes in skin phenotype, yellowness, pseudoscars, cutis rhomboidalis nuchae, telangectasia, coarse wrinkles, and dryness. CONCLUSION: Our study suggests that any individual with intrinsic skin aging score greater than eight points or total score of more than 15 points is at high risk for degenerative cardiovascular disease and should undergo periodic follow-up.

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.

Skin aging parameters: A window to heart block.

BACKGROUND: Skin acts as a mirror to the internal state of the body. HYPOTHESIS: We tried to find the relation between skin aging parameters and the incidence of degenerative AV block. METHODS: This study included 97 patients divided into 2 groups; group D comprised 49 patients with advanced-degree AV block, and group C comprised the 48 matched control group. All were subjected to full history taking, thorough clinical examination, calculation of intrinsic skin aging score, and resting 12-lead surface electrocardiography (ECG). ECG for all patients assessed left ventricular end-systolic diameter, left ventricular end-diastolic diameter, ejection fraction, left atrium (LA) diameter, aortic root diameter, mitral annular calcification, aortic sclerosis. Coronary angiography was also performed when indicated for patients in group D. RESULTS: Patients in group D had a higher percentages of uneven pigmentation, fine skin wrinkles, lax appearance, seborrheic keratosis, total score > 7 (38 [77.55%] vs 10 [20.83%]), mitral annular calcification score of 33 (67.34%) vs 5 (10.41%), aortic sclerosis score of 21 (42.85%) vs 4 (8.33%), and mean LA diameter of 39.98 ± 5.52 vs 36.21 ± 3 mm (P < 0.001). Total score > 6 is the best cutoff value to predict advanced-degree heart block with 89.79% sensitivity and 64.58% specificity. Seborrheic keratosis was the strongest independent predictor. CONCLUSIONS: Any population with a total intrinsic skin aging score of >6 is at high risk for developing advanced-degree AV block and should undergo periodic ECG follow-up for early detection of any conduction disturbance in the early asymptomatic stages to minimize sudden cardiac death.

Role of Osteopontin in Psoriasis: An Immunohistochemical Study.

BACKGROUND: Osteopontin (OPN) has been postulated to have a role in several T-helper (Th) 1 and Th 17-mediated diseases including psoriasis (PS), through multiple mechanisms sharing in the onset and worsening of PS, OPN shares in induction of keratinocyte proliferation through inhibiting keratinocyte apoptosis, OPN acts as a proinflammatory agent that participates in the upregulation of Th cell lineages, among which are the Th 1 and Th 17 cells. AIMS AND OBJECTIVES: The aim of this study was to explore the possible role of OPN in the pathogenesis of PS. MATERIALS AND METHODS: This case-control study was carried out on 18 patients of chronic plaque PS (mean age 37.61 ± 14.48) and a control group of 18 apparently healthy volunteers (mean age 41.11 ± 11.02 years). Severity of PS was assessed using the PS area and severity index score. Two skin biopsies were taken from psoriatic patients. The first was taken from the lesional skin and the other from a counter apparently healthy site. RESULTS: Our results showed statistically significant differences in the expression of OPN, between lesional and nonlesional skin as well as between nonlesional skin and control group (P ≤ 0.001). In addition, there was a significant difference in the expression of OPN, between control and lesional group. CONCLUSIONS: OPN involvement in PS enlarges the list of cytokines able to stimulate the inflammatory response in this disease, anti-OPN antibodies, may eventually become a useful therapeutic approach in PS.

Generalized eruptive keratoacanthoma: a diagnostic and therapeutic challenge.

BACKGROUND: Generalized eruptive keratoacanthoma (GEKA) is an extremely rare variant of keratoacanthoma that poses significant diagnostic and therapeutic challenges. PATIENTS: The study included three patients presenting with highly pruritic, generalized eruption of numerous small skin and flesh-colored follicular papules. They were mainly distributed on the face, neck, and trunk. Few larger nodules were also present. Mask-like facies, mucosal involvement, and ectropion were evident in two patients. Family history was irrelevant, and general examination was unremarkable. RESULTS: Histopathological examination revealed typical features of keratoacanthoma, particularly in the larger lesions. Routine laboratory tests were normal, and ultrasonography and computed tomography revealed no evidence of malignancy. Based on the clinicopathological correlation, the diagnosis of our cases was GEKA of Grzybowski. Acitretin 1 mg/kg per day and methotrexate 15 mg/week for three months were associated with mild or no response. Cyclophosphamide pulse therapy 1 g/month for six months was associated with complete clearance of the lesions in the first two patients, while the third was lost to follow-up after failure of acitretin therapy. CONCLUSION: Because of the extreme rarity of reported cases, the common absence of classic large lesions of keratoacanthoma, the atypical histological presentations in some cases, and absence of a uniformly effective therapeutic approach, we believe that GEKA still represents a diagnostic and therapeutic challenge. Cyclophosphamide pulse therapy is a promising alternative to oral retinoids.

Cognitive functions and cognitive styles in young euthymic patients with bipolar I disorder.

BACKGROUND: Recent evidences suggest that bipolar disorder patients do not return to premorbid functioning levels during the inter-episode periods. Cognitive deficits may impair patients working and functioning status and may also have negative impact on other aspects of thinking. OBJECTIVES: To assess the prevalence of cognitive dysfunction in patients with bipolar disorder in euthymic state and to explore any evident cognitive style problems. METHOD: Case-control naturalistic study 60 patients with bipolar I disorder in euthymic state according to DSM-IV were recruited and subdivided into two groups each contains of 30 patients; (Group BPM) euthymic patients with recent manic episode, and Group BPD euthymic patients with recent depressive episode. Both groups were further compared with control group (Group C) consisted of 30 frequency matched healthy volunteers. Groups were subjected to the following: 1-clinical psychiatric examination, 2-Hamilton Depression Scale (HAMD-17) and Bech-Rafaelsen Melancholia Scale (MES) for patients' group (BPD), 3-Young Mania Rating Scale (YMRS) and Bech-Rafaelsen Mania Scale (MAS) for patients' group (BPM), 4-assessment of euthymic state of mood included both MAS and MES, 5-MMSE, MTS and CDT were performed to assess cognitive functions, 6-cognitive styles evaluation included Fear of Failure, Hopelessness Scale, (the Social Dysfunction and Aggression Scale SDAS-9 and Arabic Anger Scale. RESULTS: Definite cognitive function impairment and different patterns of cognitive style were detected in case groups. MMSE, MTS and CDT scores were statistically significant. Fear of Failure Scale Scores were higher in BPM; 16 (53.33%) reported severe intensity compared to 16 (53.33%) of BPD Group reporting moderate intensity and 30 (100%) of the control group reporting only mild intensity of fear of failure with statistically significant differences. Although patients were in euthymic state; Hopelessness Scale discriminated between those with affective disorders and controls and other scores for hostility SADS-9 and Arabic Anger Scale. Moreover, measures of cognitive styles showed differences among patients of the case groups who joined psychotherapy program in their management (28) compared to those who did not (32). LIMITATION: Cognitive impact of psychotropic drugs could not be eliminated since the current study is naturalistic study. CONCLUSIONS: Those with BAD in euthymic state suffer from cognitive dysfunction and some aspects of cognitive styles that may negatively interfere with their performance. Psychotherapeutic programs should consider these findings in their approaches for better impact on patients' quality of life and overall treatment outcome.