Evaluation of platelet-rich plasma on hair regrowth and lesional T-cell cytokine expression in alopecia areata: A randomized observer-blinded, placebo-controlled, split-head pilot study.

BACKGROUND: Platelet-rich plasma has shown some promise in the treatment of alopecia areata. OBJECTIVE: To evaluate the effect of platelet-rich plasma on hair regrowth and lesional T-cell cytokine expression in alopecia areata. METHODS: This was a randomized, placebo-controlled, split-head study involving 27 patients with alopecia areata (Severity of Alopecia Tool score ≥25%). Alopecia patches on either side of the scalp were randomized to receive 3 intradermal injections of platelet-rich plasma or normal saline at monthly intervals and evaluated 3 months after the last session. Lesional T-cell cytokine messenger RNA expression was compared pre- and posttreatment in the platelet-rich plasma-treated sites. RESULTS: The mean Severity of Alopecia Tool score did not change significantly compared with baseline with either platelet-rich plasma or placebo injections at any visit; however, the mean percentage reduction in the score in the platelet-rich plasma arm was more than in the placebo arm (9.05% ± 36.48% vs 4.99% ± 33.88%; P = .049) at final assessment. The mean interferon gamma (P = .001) and interleukin 17 cytokine (P = .009) messenger RNA expression decreased, whereas the mean interleukin 10 (P = .049) and FOXP3 (P = .011) messenger RNA expression increased significantly after platelet-rich plasma treatment. LIMITATIONS: Small sample size and a relatively short follow-up. CONCLUSION: Platelet-rich plasma was found to have limited efficacy in alopecia areata. However, it may play a role in restoring immune balance in the alopecic patches.

Photo-patch and patch tests in patients with dermatitis over the photo-exposed areas: A study of 101 cases from a tertiary care centre in India.

BACKGROUND: Many patients with dermatitis over photo-exposed body areas are positive to many contact allergens and have a pre-existing allergic contact dermatitis. METHODS: This study included patients who presented to a tertiary centre in India with dermatitis on photo-exposed body areas suspected of chronic actinic dermatitis. Their detailed histories were recorded and cutaneous and systemic examinations were performed. Patch testing was done in all the patients and photo-patch testing was carried out in 86 patients. RESULTS: Altogether 101 patients were included (69 males, 32 females). The most common presentation was lichenified hyperpigmented plaques on the photo-exposed sites. Photosensitivity was recorded in 64 (63%) patients and summer exacerbation in 52 (52%). Exposure to the Parthenium hysterophorus weed was recorded in 70 (69%) patients, 27 (26.7%) had a history of hair dye application and 20 (20%) had a history of atopy. Photo-patch test was positive in 11 (12.8%) patients and patch testing was positive in 71 (70%). Parthenium hysterophorus was the most common allergen implicated and was positive in three (4%) photo-patch and 52 (52%) patch tests. Other positive photo-patch test allergens were perfume mix, balsam of Peru, thiuram mix, Compositae mix and promethazine hydrochloride. Other common patch test allergens were parthenolide, colophony, fragrance mix and p-phenylenediamine (PPD) base. CONCLUSION: In the Indian population parthenium and perfume mix are the most common photoallergens in patients with dermatitis over photo-exposed areas, while parthenium, colophony, fragrance mix and PPD are the common positive allergens.

Comparison of patch test contact sensitivity to acetone and aqueous extracts of Parthenium hysterophorus in patients with airborne contact dermatitis.

Our aim was to compare the degree of patch test positivity to acetone and aqueous extracts of Parthenium hysterophorus in patients with airborne contact dermatitis. We performed patch testing with the Indian standard series (which includes aqueous extracts of parthenium, xanthium and chrysanthemum), and with 1 : 100 and 1 : 200 dilutions of an acetone extract of parthenium in 72 patients with airborne contact dermatitis. All patients showed contact sensitivity to the 1 : 100 dilution and 67 patients had positive allergic reactions to the 1 : 200 dilution of the acetone extract, whereas only 45 patients showed a positive reaction to the aqueous extract of P. hysterophorus. Our results confirm that parthenium allergens are more soluble in acetone than in water, and that the acetone extract is significantly better in detecting contact sensitivity to parthenium in patients with suspected plant dermatitis. Hence, the acetone extract is recommended for routine patch testing.

Hydroxyurea as an alternative therapy for psoriasis.

BACKGROUND: Methotrexate is the drug of choice in extensive psoriasis in developing countries. In patients who can not take methotrexate either due to intolerance or concomitant liver disease, there is an urgent need for an alternative affordable and accessible drug. AIMS: To evaluate the therapeutic efficacy and safety of hydroxyurea as an alternative in the management of patients with extensive psoriasis. METHODS: A prospective study was carried out over 16 months on 34 patients with chronic plaque psoriasis (>20% body surface area involvement), erythrodermic or generalized pustular psoriasis who were partially responsive or non-responsive to the conventional topical and systemic modalities of therapy. Besides doing a baseline hemogram, liver and renal function tests, and urine analysis, these tests were frequently repeated during the course of therapy. Hydroxyurea was started at 1 g daily and increased to 1.5 g, if required. The therapeutic response was evaluated by a global assessment made by the patient and physician and regular PASI scoring. RESULTS: Good to excellent response was observed in 25 (73.5%) patients, less than 50% response in 7 (20.6%) patients, while 2 (5.9%) patients were lost to follow up. The mean PASI score was reduced by 76% at 10-12 weeks. Therapy was discontinued in 3 patients due to leukopenia that recovered on discontinuation of hydroxyurea. Patients were followed up to 1 year and relapse was observed in 5 patients. The duration of remission varied from 6 months to 1 year. CONCLUSION: Hydroxyurea is an effective and reasonably safe second line agent for psoriasis.