Efficacy and Safety of Platelet-Rich Plasma in Melasma: A Systematic Review.

Melasma is a prevalent dermatological challenge with limited therapeutic interventions. Platelet-rich plasma (PRP) has been increasingly explored for its potential benefits in various dermatological conditions. This study aimed to systematically review the efficacy and safety of PRP in the treatment of melasma. A comprehensive search in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was executed in January 2024 using PubMed, focusing on studies investigating the efficacy and safety of PRP in melasma. Criteria for inclusion were clinical trials and controlled studies examining PRP's role in melasma treatment, while exclusions covered reviews, non-English articles, and studies older than 10 years, among others. Eight studies were included, with the majority targeting female participants. The research displayed consistent positive outcomes, whether PRP was used alone or synergistically with treatments like hydroquinone and tranexamic acid. However, positive studies with the combination of PRP and other drugs will not provide the actual safety and efficacy data of PRP. The combined treatment approaches often showed enhanced results. Satisfaction rates among patients and reductions in the melasma area and severity index (MASI) scores were common findings across the studies, emphasizing the potential of PRP in melasma management. In conclusion, PRP emerges as a promising therapeutic intervention for melasma. Whether as a standalone treatment or combined with established methods, PRP presents significant potential in melasma's clinical management, warranting further expansive trials to substantiate its long-term efficacy and safety.

Spread of Terbinafine-Resistant Trichophyton mentagrophytes Type VIII (India) in Germany-"The Tip of the Iceberg?"

Chronic recalcitrant dermatophytoses, due to Trichophyton (T.) mentagrophytes Type VIII are on the rise in India and are noteworthy for their predominance. It would not be wrong to assume that travel and migration would be responsible for the spread of T. mentagrophytes Type VIII from India, with many strains resistant to terbinafine, to other parts of the world. From September 2016 until March 2020, a total of 29 strains of T. mentagrophytes Type VIII (India) were isolated. All patients were residents of Germany: 12 females, 15 males and the gender of the remaining two was not assignable. Patients originated from India (11), Pakistan (two), Bangladesh (one), Iraq (two), Bahrain (one), Libya (one) and other unspecified countries (10). At least two patients were German-born residents. Most samples (21) were collected in 2019 and 2020. All 29 T. mentagrophytes isolates were sequenced (internal transcribed spacer (ITS) and translation elongation factor 1-α gene (TEF1-α)). All were identified as genotype VIII (India) of T. mentagrophytes. In vitro resistance testing revealed 13/29 strains (45%) to be terbinafine-resistant with minimum inhibitory concentration (MIC) breakpoints ≥0.2 µg/mL. The remaining 16 strains (55%) were terbinafine-sensitive. Point mutation analysis revealed that 10/13 resistant strains exhibited Phe397Leu amino acid substitution of squalene epoxidase (SQLE), indicative for in vitro resistance to terbinafine. Two resistant strains showed combined Phe397Leu and Ala448Thr amino acid substitutions, and one strain a single Leu393Phe amino acid substitution. Out of 16 terbinafine-sensitive strains, in eight Ala448Thr, and in one Ala448Thr +, new Val444 Ile amino acid substitutions were detected. Resistance to both itraconazole and voriconazole was observed in three out of 13 analyzed strains. Treatment included topical ciclopirox olamine plus topical miconazole or sertaconazole. Oral itraconazole 200 mg twice daily for four to eight weeks was found to be adequate. Terbinafine-resistant T. mentagrophytes Type VIII are being increasingly isolated. In Germany, transmission of T. mentagrophytes Type VIII from the Indian subcontinent to Europe should be viewed as a significant public health issue.