Trichloroacetic Acid 15% Peel Alone versus in Combination with Microneedling in Patients with Acanthosis Nigricans.

Background: Acanthosis nigricans is a common hyperpigmentation disorder with a profound aesthetic impact. The primary concern of most patients is the cosmetic improvement, that is way there is a continuous search for the most effective cosmetic therapeutic option. Methods: 40 acanthosis nigricans patients were included, lesions are split into equal halves; right side treated with TCA 15% peel and left side was treated with microneedling followed by TCA 15% peel, both sides were treated monthly for three months. Response to treatment was assessed by acanthosis nigricans grade improvement along with the percentage of improvement in texture and pigmentation individually. Results: There was statistically significant improvement in acanthosis nigricans grade after treatment in both sides. The combination side showed more improvement in terms of texture and pigmentation. Conclusion: Both TCA 15% alone or combined with microneedling were effective in improving acanthosis nigricans with superior results in combination modality.

Intradermal Botulinum Toxin A Injection Versus Topical 2% Glycopyrrolate for the Treatment of Primary Facial Hyperhidrosis: A Pilot Study and Review of Literature.

BACKGROUND: Facial hyperhidrosis (HH), a common problem with both cosmetic and psychological impact, interferes with quality of life. Wide range of treatment options is available for HH. Finding the most effective and yet a safe, tolerable option is the main target. OBJECTIVE: To evaluate and compare clinical efficacy, safety, and tolerability of topical 2% glycopyrrolate versus intradermal Botulinum toxin A injection in facial HH treatment. MATERIALS AND METHODS: Twenty-four patients with primary facial HH were randomly divided into 2 equal groups: Group A included patients treated by intradermal Botulinum toxin A injection and Group B included patients treated by topical glycopyrrolate gel 2%. Starch iodine test was performed before and after treatment to assess response, along with Hyperhidrosis Disease Severity Scale, Dermatology Life Quality Index (DLQI), and patient satisfaction. RESULTS: Both modalities showed complete response in 75% of cases with a longer duration of action in botulinum toxin group up to 6 months. Side effects were minor and temporary. Both Hyperhidrosis Disease Severity Scale and DLQI showed statistically significant improvement after treatment. CONCLUSION: Topical glycopyrrolate 2% showed comparable results to Botulinum toxin A in facial HH treatment with faster onset but shorter duration of action.

Recent modalities in treatment of telogen effluvium: Comparative study.

Telogen effluvium is one of the most common forms of diffuse, non-scarring hair loss for which patients present for clinical evaluation. It is usually a reactive and reversible disorder. Identifying and correcting the underlying cause is the most important component in management, yet there is always a need for therapeutic options. This study aims to evaluate the efficacy of single session botulinum toxin A injection versus multiple sessions of multivitamins mesotherapy in the treatment of telogen effluvium. A randomized clinical trial was conducted in the Dermatology, Venereology, and Andrology Department, Faculty of Medicine, Zagazig University Hospitals. Twenty-four patients with telogen effluvium were randomly divided into two groups each group included 12 patients. Group I received a single session of Botulinum toxin A injection and group II received multiple sessions of multivitamins mesotherapy injection. Both botulinum toxin A and multivitamins mesotherapy are effective in the treatment of telogen effluvium, which was reflected on the improvement of hair parameters as terminal hair and multiple follicular units. Both treatment modalities had minimal and well-tolerated side effects. Although both therapies have equivalent success rates, single session of botulinum toxin A is a better choice than multiple mesotherapy sessions.

Clinicopathological evaluation of intralesional methotrexate in different subtypes of basal cell carcinoma.

Basal cell carcinoma (BCC) is the most common malignant skin tumor. While slowly growing, it can cause major skin disfigurement. Therefore, novel cosmetically acceptable treatment options, other than surgery require investigation. The aim of the study was to evaluate efficacy and safety of intralesional methotrexate (MTX) as a convenient modality for BCC treatment clinically and pathologicaly. A total of 20 patients with BCC of any clinical variant underwent intralesional MTX injection at a maximum 1 mL of 25 mg/mL MTX per session. Histopathological assessments were performed before and 1 month after treatment. Forty percent of patients showed >50% clinical improvement after 1-4 sessions. Intralesional MTX is a suitable and safe treatment modality for BCC and may be used as an adjuvant to surgery.

Prevalence of Hypopigmentary Disorders in Primary School Children in Zagazig City, Sharkia Governorate, Egypt.

BACKGROUND: Epidemiologic data derived from population-based studies are very important to understand human diseases and their implications. Highlighting skin problems by identifying their incidence and prevalence is vital to direct suitable medical attention toward them. AIM: The aim of the study was to detect the prevalence and most common causes of hypopigmentation in primary school children in Zagazig City. METHODS: Cross-sectional study on 185 students selected from two schools. Data were collected by filling a questionnaire, clinical examination, and Wood's light examination to detect hypopigmented skin disorders. RESULTS: The prevalence of hypopigmentation among studied population was 45.4%; the commonest cause was pityriasis alba 58.3%, followed by pityriasis versicolor 17.9%, postinflammatory hypopigmentation 10.7%, hypopigmented nevus 9.5%, and finally 3.6% vitiligo. CONCLUSION: Hypopigmented skin disorders are important and easy to diagnosis skin diseases that need medical attention.

Efficacy of long-pulsed Nd-YAG laser in the treatment of nail psoriasis: a clinical and dermoscopic evaluation.

BACKGROUND: Nail psoriasis (NP) is frequently seen in psoriatic patients. It is difficult to treat and shows unsatisfactory response to topical preparations. Recently, different types of Lasers have been shown to be effective in some nail disorders. AIM: The aim was to evaluate the efficacy and safety of long-pulsed Nd: YAG laser 1,064 nm as a method for NP treatment. METHODS: A prospective intra-patient left-to-right, randomized, placebo-controlled study conducted on 22 patients with bilateral fingernail psoriasis, randomly assigned into right or left-side therapy with either four sessions of long-pulsed Nd:YAG laser once monthly or daily topical placebo for 4 months, followed by 3 months follow-up. Evaluation was done using NP severity index at baseline, second month, fourth month and after follow-up period. Clinical and dermoscopic photographs were taken both at baseline and at 4th month. RESULTS: There was a statistically significant improvement in both NP severity index and dermoscopic features in laser side, along with significant difference between laser and placebo side. Nail bed showed obvious improvement than nail matrix. CONCLUSION: Nd:YAG laser represents an effective and safe modality for NP treatment and dermoscopy is a useful tool for treatment efficacy assessment.

Serum YKL-40 and IL 17 in Psoriasis: Reliability as prognostic markers for disease severity and responsiveness to treatment.

YKL-40, a mammalian chitinase 3- like protein that was associated with multiple inflammatory and immune diseases. Previous studies have suggested a role for YKL-40 in psoriasis based on its significantly higher levels in the serum of psoriatic patient compared with healthy controls. The aim of this study was to determine the correlation between serum YKL-40, psoriasis severity using PASI score and serum levels of IL-17 before and after narrow-band UVB therapy. 28 patients with moderate to severe plaque psoriasis, as defined by PASI scores, were enrolled in this prospective cohort study. All cases received NB-UVB phototherapy twice weekly for 3 months. Serum YKL-40 and IL-17 levels were evaluated before and after 3 months of treatment. Clinical photographs were taken both at baseline and after 3 months. There was a statistical positive correlation between serum levels of YKL-40 and serum IL-17 levels as well as PASI score in patients with moderate to severe psoriasis before and after treatment. YKL-40 represents a reliable marker for psoriasis severity estimated by PASI and positively correlated with IL 17 as an inflammatory marker in psoriasis.

Evaluation of the additional effect of topical 5-fluorouracil to needling in the treatment of localized vitiligo.

BACKGROUND: Microneedling is a valuable tool that can be used in transdermal drug delivery in vitiligo patients to improve drug permeability and efficacy with minor side effects. AIMS: The aim of this study is to assess the effectiveness of using microneedling prior to application of topical 5-FU in treatment of localized vitiligo and to compare its results with microneedling alone. METHODS: Twenty-seven patients with localized stable vitiligo are chosen. Two patches are determined in every patient: patch A treated with needling alone and patch B treated with needling followed by topical application of 5-fluorouracil once every 2 weeks for three months. Repigmentation was accessed by grades ranging from G0; no response to G4; >75% repigmentation. Side effects were reported in every visit. RESULTS: Microneedling followed by topical application of 5-fluorouracil showed better response than needling alone with minimal side effects. CONCLUSION: Combining microneedling with topical drug application yields better results in treating localized vitiligo.

Successful Treatment of Multiple Common Warts With Intralesional Ozone.

BACKGROUND: Although there are multiple treatments for warts, wart management remains a challenge. Ozone therapy is an emerging treatment for infectious and noninfectious dermatological diseases. OBJECTIVE: To assess intralesional ozone gas safety and efficacy in multiple warts management. MATERIALS AND METHODS: Seventy-four adult patients with multiple common warts were included in this study. They were randomly assigned into 2 groups: first group comprised 44 patients treated with intralesional ozone gas, and the second group comprised 30 patients who received intralesional saline injection. In both groups, warts in all patients were directly injected weekly until complete clearance occurred or for a maximum of 10 treatment sessions. The subjects were followed for 6 months to record any recurrences. RESULTS: In the ozone group, 25 patients (56.8%) had a complete response with an excellent cosmetic outcome, 15 patients (34.1%) showed a partial response, and 4 patients (9.1%) had no response. More subjects responded to ozone than to saline (p < .001). Ozone therapy was associated with mild side effects, including pain at time of injection, numbness, and fatigue. CONCLUSION: Intralesional ozone is effective and safe for the treatment of multiple warts.

Evaluation of combined treatment with long-pulsed neodymium-doped yttrium aluminum garnet laser and potassium hydroxide for the treatment of recalcitrant wart: a prospective comparative study.

Background: Lasers have been used for verruca treatment in recent years with successful results in some types. In addition, peeling processes have been used to enhance penetration in some studies.Objectives: This study aimed to evaluate combined treatment with LP Nd:YAG laser and KoH for the treatment of recalcitrant wart.Methods: This study included 132 lesions from 38 patients. Long-pulsed (LP) Nd:YAG laser was applied to 66 lesions with daily 10% KOH application at night, and the remaining 66 lesions underwent LP Nd:YAG laser therapy only.Results: Both groups showed statistically significant regressions in the size of the lesions at the end of the fifth session compared with those present at the onset of therapy (p < .05). Also, complete clearance of the lesions was noticed after 2.2 sessions in the combined therapy group, and after 3.1 sessions in the LP Nd:YAG laser group (p < .05).Conclusions: Although the difference in clearance rate between the combined therapy group and the LP Nd:YAG laser group could not be detected after the fifth session, adding KOH to LP Nd:YAG laser can decrease the number of treatment sessions to a large extent.

Combination of pulsed dye laser and verapamil in comparison with verapamil alone in the treatment of keloid.

Background and objective: Many modalities of treatment have been advocated for Keloid ,but the success rates of these have been variable. The present study is an attempt to evaluate and compare the efficacy of a combination of pulsed dye laser (PDL) and intralesional verapamil against intralesional verapamil alone in the treatment of keloids.Methods: 40 Patients with keloids were divided into two groups randomly of 20 each receiving four sessions of therapy. Group A intralesional verapamil alone 2.5mg/ml. Group B received a combination of PDL and intralesional verapamil alone 2.5mg/ml. Pretreatment measurements and photographs were taken.Results: Statistically significant improvement was seen in the height and length of the lesions. Overall appearance criteria of modified MQS showed an improvement of more than 50% in 43.3% of the lesions by the end of four sessions. The improvement of these parameters in the verampil only group was significantly lower than the improvement seen in the PDL+ intralesional verapamil group.Conclusion: Combination therapy with PDL+ intralesional verapamil was superior in efficacy when compared to intralesional verapamil alone, in the treatment of keloids.

Serum elafin as a potential inflammatory marker in psoriasis.

BACKGROUND: Psoriasis is a distressing chronic skin disease. Its exact pathogenesis is still unclear, as many factors interplay in its occurrence. AIM: The aim of the study is to estimate elafin levels in the serum of both cases and controls and to correlate the levels with psoriasis severity and other markers of inflammation. SUBJECTS AND METHODS: Twenty-six psoriatic cases along with 26 healthy controls were assigned in this case-control study. Psoriasis severity was determined by Psoriasis Area and Severity Index score. Elafin levels were measured by ELISA in serum of both cases and controls. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured in the cases. RESULTS: Elafin levels show highly statistical significance difference (P < 0.001) between cases and controls. There is a statistical significant correlation between elafin levels and both psoriasis severity and inflammation markers as CRP and ESR. CONCLUSION: Elafin represents a mirror for psoriasis severity and inflammatory state.