Comparison of efficacy of platelet-rich plasma therapy with or without topical 5% minoxidil in male-type baldness: A randomized, double-blind placebo control trial.

BACKGROUND: Male-type baldness is a common chronic hair loss disorder among males. Male type baldness is characterized by stepwise miniaturization of the hair follicle, due to alteration in the hair cycle dynamics, leading to transformation of the terminal hair follicle into a vellus one. Platelet-rich plasma (PRP) seems to be a new technique which may improve hair regrowth. We planned a randomized, double-blinded placebo control trial to see the efficacy of PRP with and without topical minoxidil and to compare with placebo and standard treatment. MATERIALS AND METHODS: The study design was a randomized, double-blind placebo control trial. The sample size was calculated, and randomization was done. Patients with male type baldness were allocated into four groups; first group topical minoxidil only, the second group PRP with minoxidil, the third group normal saline (NS), and fourth group PRP only. Interventions were done monthly for 3 months and patients were followed up for the next 2 months. Effects of interventions were assessed by hair density, patient self-assessment, and clinical photography. RESULTS: A total of 80 patients were included. The maximum improvement was found in PRP with minoxidil group. Increase in hair density (in descending order) was PRP with minoxidil group, PRP-alone group, minoxidil-alone group, while a decrease in hair density was found in NS group, after 5 months. The maximum patient satisfaction was found in PRP with minoxidil group followed by (in descending order), PRP-alone group, minoxidil-alone group, and NS group. LIMITATION: Long-term follow up of patients was not done. Hair counts and hair thickness estimation were not estimated. CONCLUSION: In our study, we found PRP with topical minoxidil is more effective than PRP alone and topical minoxidil alone.

Hidradenitis Suppurativa: A Systematic Review and Meta-analysis of Therapeutic Interventions.

Hidradenitis suppurativa is a chronic inflammatory condition that affects skin regions bearing apocrine glands. Although hidradenitis suppurativa is difficult to treat and cure, the currently available treatments are directed toward managing the lesions and associated symptoms. This review presents an evidence-based outline of the available treatment options. We searched four electronic databases and extracted data from retrieved studies for qualitative or quantitative analysis. Meta-analysis was conducted using the comprehensive meta-analysis software to generate pooled standardized mean differences or risk ratios. Numerous medical treatments are available for hidradenitis suppurativa such as antibiotics, retinoids, antiandrogens, immunosuppressive and anti-inflammatory agents and radiotherapy for early lesions. Adalimumab, an anti-tumor necrosis factor antibody, was superior to placebo in reducing Sartorius score (standardized mean difference = -0.32, confidence interval [-0.46, -0.18], P < 0.0001) and pain (risk ratio = 1.42, confidence interval [1.07, 1.9], P = 0.02), when given weekly (not every other week). Combination therapies (such as antibiotics and hyperbaric oxygen therapy) have been tested, which have shown promising results that are yet to be confirmed. Based on the quality of evidence, the most recommended treatments for hidradenitis suppurativa include adalimumab and laser therapy. Surgery (either by simple excision or complete local excision followed by skin graft) is the first choice for intractable disease presenting in the late stages. However, the evidence on most of these treatments is deficient and further randomized trials are needed to establish the most efficient therapies for hidradenitis suppurativa management.

The effectiveness of adding low-level light therapy to minoxidil 5% solution in the treatment of patients with androgenetic alopecia.

BACKGROUND: Androgenetic alopecia is the commonest type of alopecia affecting over half of men and women. Low-level light therapy is a new technique for stimulating hair growth in both genders. AIMS: To overcome the shortcomings of previous epidemiological studies and a lack of controlled clinical trials on the subject, this study compared the effectiveness of adding low-level light therapy to minoxidil topical solution in the treatment of androgenetic alopecia in patients presenting to two skin clinics in Isfahan, Iran during 2014-2015. MATERIALS AND METHODS: This clinical trial included 50 patients aged 17-45 presenting to Khorshid and Alzahra educational centers and skin diseases research center for androgenetic alopecia during 2014-2015. The patients were randomly divided into a control and a case group. The case group received topical minoxidil 5% solution plus low-level light therapy twice per day. The control group was given the same topical solution and a laser comb system that was turned off to act as a placebo. Changes in patients' hair density and diameter and its overall regrowth as well as their satisfaction with the treatment were assessed at months 0 (baseline), 3, 6, 9 and 12. RESULTS: The percentage of recovery from androgenetic alopecia and the patients' satisfaction with their treatment were significantly higher in the case group compared to the control group. The patients' mean hair density and diameter were found to be higher in the case group after the intervention compared to the control group. LIMITATIONS: The study limitations included patient compliance, small sample size, patient insight due to novelty of the method and clinical judgement. CONCLUSION: As a new method of treatment, low-level light therapy can help improve the percentage of recovery from androgenetic alopecia and increase patients' satisfaction with their treatment.

Retrospective study on the characteristics and treatment of late-onset vitiligo.

BACKGROUND: Late-onset vitiligo, defined as being aged 50 years and above at the point of clinical onset, remains poorly characterized till now. AIM: This study aims to describe the clinical characteristics and treatment response of patients with late-onset vitiligo. METHODS: We retrospectively reviewed the case records of all patients diagnosed with late-onset vitiligo, from January 1, 2010 to December 31, 2014. Information obtained included patient demographics, characteristics of vitiligo and treatment responses. RESULTS: Of the 3128 patients diagnosed with vitiligo over the 5-year period, 461 (14.7%) had late-onset disease. The study had more females (n = 260, 56.4%) than males, with an average onset age of 59.4 ± 7.4 years. Majority of patients were Chinese (n = 308, 66.8%) and 45 (9.8%) patients had an associated autoimmune disease. Focal vitiligo, defined as the localized presence of depigmented patches, was most common (n = 209, 45.3%). Treatment response was evaluated in 359 patients, of which 216 received monotherapy (topical creams: n = 210, 97.2%; phototherapy: n = 6, 2.8%) and 143 received both modalities. Fifty six (15.6%) patients received oral steroids. Patients who were treated with both topical creams and phototherapy yielded better clinical responses compared to those on monotherapy (P < 0.001) with 56.6% (n = 81) of them achieving good epidermal repigmentation, defined as >50% return of pigmentation compared to baseline (vs. n = 66, 30.6% in the monotherapy group). The choice of phototherapy (targeted, narrowband ultraviolet B or psoralen + ultraviolet A) did not significantly affect clinical response (P = 0.774). LIMITATIONS: This study is limited by its retrospective nature, the nonstandardized documentation resulting in the inability to determine disease progression and associated metabolic comorbidities and also by the gradual loss to follow-up of patients. CONCLUSION: Late-onset vitiligo is not uncommon and tends to be of the focal vitiligo subtype. Nonsegmented vitiligo is more prevalent than segmental vitiligo. Combination therapy with topical medications and phototherapy is superior to monotherapy.

Decompressive surgery for treating nerve damage in leprosy.

BACKGROUND: Leprosy causes nerve damage which may result in nerve function impairment and disability. Decompressive surgery is used for treating nerve damage, although the effect is uncertain. This is an update of a review first published in 2009 and previously updated in 2010. OBJECTIVES: To assess the effects of decompressive surgery on nerve damage in leprosy. SEARCH METHODS: We searched the Cochrane Neuromuscular Disease Group Specialized Register (15 October 2012), CENTRAL (2012, Issue 9 in The Cochrane Library), MEDLINE (January 1966 to October 2012), EMBASE (January 1980 to October 2012), AMED (January 1985 to October 2012), CINAHL Plus (January 1937 to October 2012) and LILACS (from January 1982 to October 2012). We checked reference lists of the studies identified, the Current Controlled Trials Register (www.controlled-trials.com) (1 November 2012), conference proceedings and contacted trial authors. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs of decompressive surgery for nerve damage in leprosy. DATA COLLECTION AND ANALYSIS: The primary outcome was improvement in sensory and motor nerve function after one year. Secondary outcomes were improvement in nerve function after two years, change in nerve pain and tenderness, and adverse events. Two authors independently extracted data and assessed trial quality. We contacted trial authors for additional information. We collected adverse effects information from the trials and non-randomised studies. MAIN RESULTS: We included two RCTs involving 88 participants. The trials were at high risk of bias. The trials examined the added benefit of surgery over prednisolone for treatment of nerve damage of less than six months duration. After two years' follow-up there was only very low quality evidence of no significant difference in nerve function improvement between participants treated with surgery plus prednisolone or with prednisolone alone. Adverse effects of decompressive surgery were not adequately described. AUTHORS' CONCLUSIONS: Decompressive surgery is used for treating nerve damage in leprosy but the available evidence from RCTs is of very low quality and does not show a significant added benefit of surgery over steroid treatment alone. Well-designed RCTs are needed to establish the effectiveness of the combination of surgery and medical treatment compared to medical treatment alone.

Comparative efficacy of narrow-band ultraviolet B phototherapy alone and its combination with topical 8-methoxypsoralen in psoriasis.

BACKGROUND: Very few studies using the combination of topical 8-methoxypsoralen (8-MOP) and narrow-band ultraviolet B (NBUVB) have been performed, especially in Indian patients. A combination of oral psoralen with NBUVB has been shown to have a superior efficacy as compared with NBUVB alone in psoriasis. AIMS: Comparison of the efficacy of topical psoralen NBUVB (combination) versus NBUVB alone in psoriasis. METHODS: Thirty patients with plaque psoriasis were taken up for the study and NBUVB phototherapy was given twice weekly. The target lesions on one side were treated with 0.1% topical 8-MOP 15 min before the irradiation. The treatment period was 12 weeks or 24 exposures. RESULTS: The number of treatment sessions and cumulative NBUVB doses were lower in the combination therapy as compared with NBUVB monotherapy, although the differences were not statistically significant. CONCLUSION: To conclude, topical 8-MOP enhances the therapeutic effects of NBUVB therapy without increasing the incidence of adverse effects.

Topical placental extract: does it increase the efficacy of narrowband UVB therapy in vitiligo?

BACKGROUND: Narrowband UVB therapy is presently one of the most effective therapies for generalized vitiligo. Many topical agents have been used in combination with narrowband UVB therapy to increase its efficacy in causing repigmentation in vitiligo. Placental extract is used topically usually in combination with sun exposure to cause repigmentation of vitiligo lesions. AIMS: The present study aims to study whether the efficacy of narrowband UVB therapy would be enhanced by addition of topical placental extract to the treatment regimen. METHODS: Ninety patients with vitiligo having more or less bilaterally symmetrical lesions on the face, trunk or limbs and receiving narrowband UVB therapy were enrolled for the study and instructed to apply topical placental extract (placentrex) lotion on their vitiligo lesions on the right side of the body. The other side of the body received narrowband UVB therapy alone and served as the control side. The extent of repigmentation achieved was assessed by VASI scoring and compared between the symmetrical lesions present on the two sides at monthly intervals and at the end of study period. RESULTS: Seventy-eight patients with 218 symmetrically distributed lesions, excluding those present on the hands or feet, were evaluated for study results at the end of treatment period. The time to onset of repigmentation as well as the mean NB-UVB dosage required was the same on the two sides. The mean repigmentation achieved was 63% (VASI score of 3.69) on the right (placental extract) sided lesions in comparison with 62% (VASI score of 3.60) on the left (control) sided lesions. Greater than 90% repigmentation was achieved in 70 symmetrical lesions in 24 patients. Of these 70 lesions, 39 were located on the right side of the body while 31 belonged to the left side of the body. CONCLUSIONS: Addition of the topical placental extract was seen to have a modest but a statistically insignificant effect on the efficacy of NB-UVB therapy in causing repigmentation in vitiligo.