YAP1 Expression in Lichen Planus and Squamous Cell Carcinoma: Role in Disease Pathogenesis and Potential Therapeutic Target.

BACKGROUND: Lichen planus (LP), especially oral type, reported a potential risk of malignant transformation to squamous cell carcinoma (SCC). Yes-Associated Protein (YAP1), a key component of the Hippo pathway, acts as a transcription cofactor regulating expression of genes involved in cell proliferation, apoptosis, and migration. Therefore, it has been implicated in carcinogenesis of a wide variety of human cancers. OBJECTIVES: To study YAP1 expression in LP and SCC in comparison to normal control (NC) specimens. PATIENTS AND METHODS: This study was conducted on 50 NC specimens, 50 LP specimens, and 50 SCC specimens. They were categorized into 2 main groups; cutaneous (25 NC, 25 LP, 25 SCC), and oral (25 NC, 25 LP, 25 SCC). All specimens were examined for YAP1 antibody expression by immunohistochemistry and YAP1 mRNA expression by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: In both cutaneous and oral groups; significant upregulation of YAP1 expressions was observed in SCC specimens followed by LP and then NC specimens in the same sequence. Its expression in SCC was found to be significantly higher in poorly and moderately differentiated types than well differentiated types. CONCLUSION: YAP1 may have a potential role in the pathogenesis of LP and oncogenesis and progression of SCC. Moreover, it could be considered as a novel therapeutic target for such cases.

Pulsed dye laser versus ablative fractional CO2 laser in treatment of old hypertrophic scars: Clinicopathological study.

There is a continuous need to find out the best treatment for old hypertrophic scars (OHSs). Thirty patients with OHSs were included. Each scar was divided into right half treated with PDL (handpiece with a 7-mm spot, pulse duration of 1.5 ms and fluence of 6 J/cm2 ) and left half treated with FrCo2 laser (15 W, spacing 800 µm, dwelling time 600 µs and stack 3) once every month for three sessions. Scars were assessed before and after treatment clinically by Vancouver Scar Scale (VSS) and histologically using hematoxylin and eosin (H&E), Masson trichrome and orcein stains. Both halves showed statistically significant improvement after treatment. However, there was no statistically significant difference in VSS between them (P = 0.176). FrCo2 laser showed more significant improvement in pliability and height (Pp = 0.017, Ph = 0,011), while, PDL showed more significant improvement in vascularity (P = 0.039) of OHSs. Both PDL and ablative FrCo2 laser were effective in the treatment of OHSs, however, FrCo2 laser was more effective in improving OHSs pliability, and height which are the main concern in OHSs.

Efficacy and safety of 1440-nm Nd:YAG laser on lower face and neck rejuvenation.

Reviewing the literatures, we did not found-to our knowledge-any study using the Nd:YAG laser with wavelength 1440 nm in assisted liposuction and rejuvenation of the head and neck region although of the higher absorption rate for fat and water. Evidence-based practice supports the benefits of laser-assisted liposuction over conventional liposuction with skin tightening in selected areas specifically the submental area and the neck. The aim of the work is to evaluate the efficacy and safety of Nd:YAG laser wavelength (WL) 1440 nm on lipolysis of submental area and skin tightening of the lower face and neck area. Fifty-seven patients with submental localized fat deposits and mild to moderate skin laxity were subjected to laser liposuction using Nd:YAG laser with WL 1440 nm (SmartLipo Triplex)® device. The efficacy of skin laxity improvement was assessed together with the whole satisfaction rate for each patient. Overall satisfaction rate was 97% of the patients. One sample test regarding skin laxity showed significant improvement (34.6%) after 6 months follow-up (0.268 SD p < 0.05) (Table 4). Complications included edema, soreness, weakness in the lower lip, and ecchymosis that resolved conservatively except one case that complained of seroma which needed aspiration and healed without infection. In conclusions, Nd:YAG laser with WL 1440 nm can be used safely and effectively for submental-assisted liposuction and lower face and neck rejuvenation. Less laser energy was needed for lipolysis and skin tightening as the fat and water have a higher absorption rate at wavelength 1440 nm.

Study the effect of erbium:YAG laser plus topical 5-flurouracil in stable vitiligo resistant to NB-UVB phototherapy.

BACKGROUND: NB-UVB phototherapy is still an effective treatment in vitiligo but requires more than 1 year for its completion. Topical 5-flurouracil could improve the proliferation and migration of melanocytes. Laser-assisted dermabrasion results in stimulation of the inactive melanocytes present at the outer root sheath of the lower portion of the hair follicle, which migrates upward until they reach the surface of the skin. OBJECTIVE: To evaluate the effect of Er:YAG laser skin ablation followed by topical 5-flurouracil on the outcome of NB-UVB phototherapy as a short term technique in resistant and stable vitiligo. METHODS: The current study included 40 patients suffering from bilateral stable vitiligo resistant to NB-UVB. For each patient, one side of the body subjected to 4 months NB-UVB sessions (control side). While the other side of the body subjected to one session of Er:YAG laser ablation combined with topical 5% 5-flurouracil application under occlusion followed by NB-UVB sessions for 4 months after complete re-epithelization. Outcomes were evaluated objectively based on standard digital photographs, histopathological examination, patient satisfaction, and adverse effects. RESULTS: There was a statistically significant improvement in the repigmentation in laser side compared with control side. Histopathological examination revealed expression of prominent melanin pigmentation, with marked expression for Melan-A in laser side, whereas these findings were negative in control side. CONCLUSION: Er:YAG laser ablation, followed by 5FU application before NB-UVB phototherapy for vitiligo, is a safe and tolerable technique that improves the outcome of short-term NB-UVB therapy and is expected to increase patient compliance.

Fractional carbon dioxide laser and topical tioconazole in the treatment of fingernail onychomycosis.

Onychomycosis is a common chronic-resistant nail disease. Traditional treatment has its limitations and side effects. This study aimed to evaluate the role of fractional CO2 laser and topical tioconazole 28% nail lacquer in the treatment of fingernail onychomycosis, as sole treatment modalities and in combination. Thirty patients with culture-proven onychomycosis were included and randomly divided into three equal groups. Laser group received six fractional carbon dioxide (CO2) laser sessions at monthly intervals; topical group received topical tioconazole 28% nail lacquer twice daily for 6 months, and combined group received six fractional CO2 laser sessions at monthly intervals with topical tioconazole twice daily for 6 months. Treatment outcome was evaluated through physician's evaluation of improvement using onychomycosis severity index score (OSI), patients' satisfaction, side effect evaluation, and mycological culture (assessed after the end of treatment). At the end of treatment, both laser and combined groups showed significantly better degrees of improvement (P = 0.036, 0.024, respectively) and patient's satisfaction (P = 0.046, 0.003, respectively) in comparison with topical group. Mycological clearance in fungal cultures was significantly higher in combined group than topical group after the end of treatment (P = 0.007). Fractional CO2 laser is a safe and effective treatment modality for onychomycosis. Its efficacy approximates that of fractional CO2 laser combined with topical tioconazole 28% nail lacquer and surpasses that of topical tioconazole 28% monotherapy. It is expected to be an excellent choice for patients in whom systemic antifungals are contraindicated or who are unresponsive or intolerant to topical antifungals.

Assessment of the efficacy and safety of platelet poor plasma gel as autologous dermal filler for facial rejuvenation.

BACKGROUND: The popularity of dermal fillers has grown rapidly in the last few years for facial rejuvenation. Plasma gel is an autologous gelatinous material that is prepared from the patient's own platelet poor plasma. OBJECTIVE: To evaluate the clinical efficacy and safety of plasma gel injection as a dermal filler for facial rejuvenation. PATIENTS AND METHODS: The current study was carried out on 52 females presented with facial aging divided into two groups: Group A included 34 females with facial wrinkles, and Group B included 18 females with tear trough deformity. After taking written informed consent, they received two sessions of plasma gel injections at 2-week interval and followed up monthly for 3 months. They were assessed clinically before treatment sessions and at the end of follow-up period. RESULTS: Both studied groups showed immediate significant clinical improvement after plasma gel injection that maintained till the end of follow-up period. This finding was confirmed by significant reduction in the mean values of Wrinkle Severity Rating Scale (WSRS) in Group A and Tear Trough Rating Scale (TTRS) in group B, and significant improvement of skin homogeneity and texture in both groups. In general, the reported side effects were minimal and transient. CONCLUSION: Autologous platelet poor plasma gel injection seems to be a cost-effective, safe, well-tolerated, and minimally invasive technique producing significant aesthetic correction of facial wrinkles and tear trough deformity.

Combination of fractional carbon dioxide laser with narrow band ultraviolet B to induce repigmentation in stable vitiligo: A comparative study.

BACKGROUND: Despite the numerous treatment modalities available for vitiligo, responses to treatment are still unsatisfactory. For this reason, new treatment modalities and approaches are needed. OBJECTIVE: To evaluate the efficacy and safety of fractional carbon dioxide (CO2 ) laser therapy followed by narrow band ultraviolet-B (NB-UVB) phototherapy on stable resistant vitiligo. SUBJECTS AND METHODS: Thirty-two patients with stable bilateral vitiligo were enrolled. For each patient, one side of the body was treated with NB-UVB in addition to two sessions of fractional CO2 laser performed at 2-months interval (laser side), while the other side was treated with NB-UVB alone (control side). NB-UVB was administrated twice weekly for 4 months. Outcomes were evaluated objectively based on standard digital photographs, patient satisfaction, and adverse effects. RESULTS: There was statistically significant improvement in the repigmentation in laser side compared to control side. Noticeable adverse events, such as infection, scarring, and Koebner phenomenon were not found in any patient. CONCLUSIONS: Fractional CO2 laser therapy combined with NB-UVB phototherapy could be used effectively and safely as an alternative modality for the treatment of vitiligo. It shortens the duration of NB-UVB therapy and is expected to increase patient compliance.

Study of the efficacy of carboxytherapy in alopecia.

BACKGROUND: Management of alopecia areata (AA) and androgenetic alopecia (AGA) is often challenging. The use of carboxytherapy may be a novel therapeutic option for such cases. OBJECTIVE: To evaluate the clinical efficacy and safety of carboxytherapy in alopecia areata and androgenetic alopecia. PATIENTS AND METHODS: This study was conducted on 80 patients with alopecia divided into two groups; Group I included 40 AA patients (Group IA received carboxytherapy and Group IB control received placebo), and Group II included 40 AGA patients (Group IIA received carboxytherapy and Group IIB control received placebo), and followed up monthly for 3 months. They were evaluated clinically (by assessment of Severity of Alopecia Tool (SALT) score in group I, and Sinclair scale and Norwood-Hamilton scale in group II), by dermoscopy and digital dermoscopy at each visit. RESULTS: Group IA patients showed significant clinical improvement in SALT score and dermoscopic improvement after carboxytherapy and at the end of follow-up period with significant reduction in dystrophic hair, black dots, yellow dots, and tapered hair coinciding with significant emergence of regrowing hair. Group IIA patients showed significant clinical and dermoscopic improvement after carboxytherapy with significant increase in hair density measured by digital dermoscopy. However, regression of these results was observed during the follow-up period but was still significantly better than before treatment. There were statistically significant improvements in clinical score, global assessments, dermoscopic, and digital dermoscopic findings in both group IA and group IIA received carboxytherapy in comparison with group IB and group IIB received placebo injections, respectively. CONCLUSION: Carboxytherapy seems to be a promising therapeutic option for patchy AA and could be helpful as an adjuvant therapy of AGA but more than 6 sessions are required and adjuvants are recommended for maintenance of the results.

Comparison between the efficacy and safety of platelet-rich plasma vs. microdermabrasion in the treatment of striae distensae: clinical and histopathological study.

Striae distensae is a challenging cosmetic problem for which various treatment modalities have been applied. To compare between the efficacy and tolerability of intradermal injection of autologous platelet-rich plasma (PRP) vs. microdermabrasion in the treatment of striae distensae. Sixty-eight patients with striae distensae were randomly assigned to three groups according to therapeutic modalities. Patients of group I were treated by intradermal injection of PRP alone, patients of group II were treated with microdermabrasion alone, and patients of group III were treated with combination of intradermal PRP and microdermabrasion in the same session. Each patient underwent maximum of six sessions at 2-week interval. Skin biopsies were taken from some patients at baseline, and 3 months after the last sessions stained with hematoxylin and eosin stain, Masson trichrome, orceun, and Van Gieson stains to study of histopathological changes and efficacy of treatment. There was significant clinical improvement of striae distensae in patients treated with PRP injection and patients treated with combination of PRP and microdermabrasion when compared with patients treated with microdermabrasion. However, combination of PRP and microdermabrasion in the same session showed better results in short duration. Collagen and elastic fibers were markedly increased in the dermis at the end of treatment sessions. Platelet-rich plasma alone is more effective than microdermabrasion alone in the treatment of striae distensae, but it is better to use the combination of both for more and rapid efficacy. However, each one of them is well tolerated by the patients, safe and cost effective.