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.

Efficacy and safety of tranexamic acid 5% cream vs hydroquinone 4% cream in treating melasma: A split-face comparative clinical, histopathological, and antera 3D camera study.

Various tranexamic acid (TA) formulations have been evaluated for treating melasma, yet the effectiveness of this therapy has not been efficiently comparatively analyzed. To assess and compare the therapeutic efficacy and safety of TA 5% vs hydroquinone (HQ) 4% creams in treating melasma. 100 melasma female patients were treated with daily application of TA 5% cream on right-sided facial lesions and HQ 4% cream on left-sided lesions for 12 weeks. Photographic documentation using digital and Antera 3D camera, Wood's light examination, calculation of Hemi Melasma Area and Severity Index (Hemi MASI), Melasma quality of life (MELASQOL) scores and area% of melanin through histopathological examination was done before and after treatment. Both TA 5% and HQ 4% creams yielded significant improvement of all melasma lesions after 12 weeks of treatment, with no significant difference in treatment response regarding Hemi MASI, MELASQOL scores and Antera average level of melanin (P > .05); however, significant reduction in area % of melanin was recorded with TA 5% than HQ 4% creams (P = .000). TA appears to be a promising therapeutic option in treating melasma with fewer adverse effects, same or even better results in comparison to HQ cream.

Comparative study between fractional carbon dioxide laser vs intralesional steroid injection in treatment of alopecia areata.

Few studies have reported Fractional Carbon Dioxide (FCO2) laser use in treating alopecia areata (AA), yet, effectiveness of this therapy has not been comparatively analyzed. To assess efficacy and safety of FCO2 laser in comparison to traditional intralesional corticosteroids injection (ILCs) in treatment of AA. This study included 20 patients with at least two patches of AA. Patients were subjected to history taking, general, dermatological and folliscopic examination. One patch was treated by FCO2 laser every 2 weeks for 3 to 6 sessions, while the other treated with intradermal injection of Triamcinolone Acetonide monthly for three sessions maximally. Evaluation of treatment response was done by physician clinical assessment using Mean Improvement Score (MISP), patient satisfaction and folliscopic examination measuring hair density (hair/cm2 ) before each session, 1 month and 3 months after end of sessions. The obtained data were tabulated and statistically analyzed. There was a highly significant improvement with FCO2 laser rather than ILCs 3 months after last session according to MISP, patient satisfaction and hair density without serious side effects or relapse. FCO2 laser could be a better therapeutic alternative for treating AA in comparison to traditional ILCs.

Assessment of serum interleukin-19 in acne vulgaris patients of different clinical severities.

BACKGROUND: Acne vulgaris (AV) is a common chronic inflammatory disorder of the pilosebaceous unit among adolescents and young adults. Inflammation does have a central role in formation of both inflammatory and noninflammatory acne lesions with production of proinflammatory cytokines. AIMS: To measure serum levels of interleukin 19 (IL-19) in acne vulgaris patients with different severities, and compare it with healthy controls, to evaluate its role in pathogenesis of acne vulgaris and correlate it with acne severity. MATERIALS AND METHODS: This study included 120 subjects, aged 18-30 years, divided into four groups, 30 in each; mild, moderate, and severe AV patients groups according to acne severity as well as apparently healthy controls group of matched age and sex with no previous history of acne or active acne. Each patient was subjected to history taking, general and dermatological examination with assessment of acne severity. Serum IL-19 levels of both patients and controls were also measured using quantitative enzyme-linked immunosorbent assay (ELISA). RESULTS: Results revealed significant difference in serum IL-19 levels between acne patients and controls, being higher in the former group (P value is < 0.001). Moreover, the rise in serum IL-19 levels was significantly proportional to the increased acne severity (P value < 0.001). CONCLUSION: IL-19 is related to the etiopathological inflammatory process of acne vulgaris and correlates with acne severity. It could be proposed as a prognostic inflammatory marker for acne vulgaris.

Epidemiological and biochemical factors (serum ferritin and vitamin D) associated with premature hair graying in Egyptian population.

BACKGROUND: The etiology of premature hair graying (PHG) remains incompletely understood with limited treatment options, although has profound impacts on patient's quality of life. AIMS: To assess demographic and clinical profiles of Egyptian PHG patients and explore association of various epidemiological risk factors and serum vitamin D and ferritin levels with PHG. PATIENTS AND METHODS: Three hundred PHG patients and equal number of controls, aged <30 years, were included. Assessment of epidemiological and clinical characteristics, biometric data and stress perception using perceived stress scale (PSS-10) was done, with measurement of serum vitamin D and ferritin levels for all subjects. PHG was graded into mild, moderate, and severe if <10, 10-100, and >100 gray hairs, respectively. Statistical significance for various compared parameters was done employing suitable tests, with P-value ≤ .05 considered significant. RESULTS: Results reported significant positive relation of PHG with family history, sedentary life style, and stress (P = .001, .029, and .001, respectively), while no significant relation with smoking, body mass index, or frequent hair dyes use (>3 per year) (P = .425, .5, and .65, respectively). No significant difference was found in mean vitamin D between patients and controls (23.79 ± 13.01 ng/mL vs 24.85 ± 13.19 ng/mL, P = .701), while low serum ferritin (<20 ng/mL) was significantly associated with PHG (14.7 % patients vs 2.7% controls, P = .017). CONCLUSION: PHG in Egyptian population is significantly associated with positive family history, stress, sedentary life style, and low serum ferritin level, while role of vitamin D deficiency should be further evaluated.

Childhood vitiligo in Egypt: Clinico-epidemiologic Profile of 483 patients.

BACKGROUND: Childhood vitiligo is commonly encountered. Pattern and distribution of childhood vitiligo were not clearly described in past. AIMS: To study clinical characteristics of vitiligo among Egyptian children in relation to epidemiological data and compare them with those of adolescents and adults. PATIENTS AND METHODS: Recruited clinically diagnosed vitiligo patients were categorized into three groups: I (children): <12 years old (yo), II (adolescents): 12-18 yo, and III (adults): 18-30 yo. Patients were subjected to history taking, general and dermatological examination to determine skin phototype, type, presentation, and distribution of vitiligo, percentage of body area involved using vitiligo extent score (VES), associated mucosal involvement, presence of leukotrichia, koebnerization, and halo nevi. RESULTS: A total of 483 vitiligo patients were included: 220 children, 123 adolescents, and 140 adults. The most common form of vitiligo was nonsegmental vitiligo (NSV). Segmental and active vitiligo were more common in children than in adolescents and adults. The most common site of distribution of NSV in children was the face (periocular) vs arms and forearms in adults followed by thighs and legs in both. The mean age of onset of vitiligo in children was 6.18 (SD 2.93) yo, while mean duration of disease was 2.12 (SD 2.21) y. Face was the most common site of onset of vitiligo in children and adolescents vs arms and forearms in adults. CONCLUSIONS: Childhood vitiligo differs from adult onset vitiligo regarding several features as type, site of onset, distribution, extent, and activity of disease.

Comparison between single- versus double-spin prepared platelet-rich plasma injection in treatment of female pattern hair loss: clinical effect and relation to vascular endothelial growth factor.

Platelet-rich plasma (PRP) provides a treatment option for female pattern hair loss (FPHL). However, the most suitable preparation method is not yet clear. The primary aim is to compare between the efficacy of single- versus double-spin PRP preparation injection in the treatment of FPHL, while the secondary aim is to assess the relationship between vascular endothelial growth factor (VEGF) concentrations in different prepared PRP preparations (pre- and post-activation) and the obtained treatment results. 15 female patients with FPHL were subjected to intradermal injection of double-spin prepared PRP into the right (Rt) half of the scalp and single-spin prepared PRP into the left (Lt) half of the scalp, three sessions, 3 weeks apart. Evaluation of treatment response was done through comparing patients' photographs, patients' satisfaction and trichoscopic assessment (measurement of terminal hair density) before and after treatment. In addition, VEGF concentration was measured in different PRP samples before and after activation with calcium gluconate. Results showed clinical improvement in both sides of scalp 6 weeks after last PRP session. Meanwhile, Rt median terminal hair density measured by trichoscan following treatment was significantly higher compared to Lt median terminal hair density. Furthermore, VEGF concentration did not differ significantly in single- versus double-spin prepared PRP, or upon calcium activation. PRP is effective in treatment of FPHL. Double-spin method could yield better results than single-spin method. Adding calcium gluconate prior to PRP injection is of no value.

Efficacy and safety of homologous autoinoculation in treatment of multiple recalcitrant warts of different types.

BACKGROUND: Homologous autoinoculation is a novel minimally invasive procedure that treats warts by stimulating specific immune response. AIM: To evaluate the efficacy and safety of autoinoculation in treatment of multiple recalcitrant warts of different types in relation to patient's age, gender, type, number, size, and duration of warts. PATIENTS AND METHODS: Two hundred patients with multiple recalcitrant warts of different types were treated with one autoinoculation session. Each patient was subjected to history taking, general and dermatological examination, and photographic documentation before and after treatment. Patients were followed up after 1 week, 2, 12, and 16 weeks to assess possible side effects, treatment response, and recurrence rate, respectively. Evaluation of treatment response was done through physician assessment according to change in size or number of warts or both. RESULTS: After 12 weeks of procedure, 66% of patients showed complete clearance, 26% showed moderate clearance, and 4% showed mild clearance while only 1.5% of patients showed treatment failure, with negligible side effects and no recurrence. There was negative correlation between treatment response and wart duration (P < .001). CONCLUSION: Autoinoculation is effective in treating multiple recalcitrant warts irrespective of their type, number or size, with minimal complications and no recurrence. The longer wart duration is, the less treatment response will be achieved.