A comparative study on the effect of alcohol-based hand sanitizers in spray and gel formulation on the skin: A prospective, randomised, crossover trial.

BACKGROUND: Many formulations of Alcohol-based hand rubs (ABHRs), such as liquid, gel, and spray have been developed and used for preventing infections. This study aimed to compare skin irritation from using ABHRs in gel and spray formulations. METHOD: This was a prospective, randomised, crossover trial conducted to investigate the effect of skin irritation caused by ABHRs in gel compared to spray formulation after 21 days of using each formulation. Clinical outcomes were assessed using subjective Larson's skin assessment score and Frosch and Kligman observer skin assessment score, as well as bioengineering measures: transepidermal water loss (TEWL) and skin capacitance on days 3, 7, 14, and 21. RESULTS: Among 38 participants, both formulations showed no significant change in clinical scores and skin capacitance during the study. However, TEWL increased significantly from baseline on day 3 (p = 0.029) for the spray formulation and on day 21 (p = 0.019) for the gel formulation, with no statistically significant difference between the formulations (p = 0.46). CONCLUSION: Our research supports the safety of gel and spray ABHRs for regular use, with the only potential issue being mild skin irritation. For those with sensitive skin, the gel formulation is preferable.

The efficacy of a transdermal hydrogel patch containing betamethasone dipropionate for treatment of chronic hand eczema: A single-blind, randomized and controlled trial.

BACKGROUND: Topical corticosteroids under occlusion have been used to enhance the treatment of eczema. However, no study has investigated the efficacy of a steroid-containing transdermal patch for the treatment of chronic hand eczema. METHODS: We conducted a randomized, controlled, assessor-blinded trial to determine the efficacy of a transdermal patch containing betamethasone dipropionate compared to topical betamethasone dipropionate ointment in the treatment of mild to moderate chronic hand eczema. The patients were included and assigned to receive either the transdermal patch once daily at night or the ointment twice daily for a period of 8 weeks. The outcomes were assessed using the Hand Eczema Severity Index (HECSI), Physical Global Assessment (PGA) score, self-reported compliance, level of patient satisfaction, quality of life, and side effects. RESULTS: Fifty-six patients completed this study. At 8 weeks, there was a significant reduction in the HECSI scores in both the transdermal patch and topical ointment groups compared to those measured at baseline (14.61 to 1.86, p < 0.001; 18.46 to 3.43, p < 0.001, respectively) without a statistically significant difference between the two groups. Similarly, the two groups did not show any significant difference in the PGA scores, quality of life and side effects. However, the transdermal patch group reported better compliance and a higher level of patient satisfaction than the topical ointment group. CONCLUSION: The transdermal corticosteroid patch has proven to be a safe and effective treatment, comparable to topical corticosteroids, after 8 weeks of use. Its sustained-release properties, along with once-daily use, can improve patient satisfaction and promote greater adherence to the treatment. TRIAL REGISTRATION: This study was registered with the Thai Clinical Trials Registry (www. CLINICALTRIALS: in.th) under registration number TCTR20220413003.

Efficacy and Safety of Detachable Microneedle Patch Containing Triamcinolone Acetonide in the Treatment of Inflammatory Acne.

Background: Detachable microneedles (DMNs) are dissolvable microneedles that detach from the base during administration. The use of DMNs-containing steroids for acne has never been investigated. Methods: Thirty-five patients with facial inflammatory acne were evaluated for acne treatment efficacy and safety of DMNs and DMNs containing triamcinolone acetonide (TA) via a 28-day randomized, double-blind, controlled trial. Four inflammatory acne lesions were selected from each participant and randomly treated with a single application of 700 µm DMNs containing 262.02 ± 15.62 µg TA (700DMNTA), 1000 µm DMNs containing 160.00 ± 34.92 µg TA (1000DMNTA), 700 µm DMN without TA (700DMN), and a control. Efficacy was measured by assessing physical grading, diameter, volume, erythema index, and melanin index. Safety was evaluated by assessing reports of adverse effects from patients and physicians. Results: All three treatment groups achieved resolution of inflammatory acne significantly faster than the control group, with median times for resolution of 4.6, 5.25, 6.7, and 8.1 days in the 1000DMNTA, 700DMNTA, 700DMN, and control, respectively. When compared to the control group, the diameters and post-acne erythema of inflammatory acne were significantly reduced in the treatment groups. The 1000DMNTA decreased acne size and erythema more than other treatments. DMNTA also tended to decrease acne size and erythema more than DMN with no TA, but there was no statistically significant difference. All participants preferred DMN over conventional intralesional steroid injection due to less pain and self-application. No adverse effect was observed. Conclusion: DMNTA is a safe, effective alternative treatment for inflammatory acne and significantly reduces post-acne erythema.

Efficacy of anti-sebum moisturizing cream containing 2% l-carnitine and 5% epigallocatechin gallate in seborrhea: A randomized clinical trial.

BACKGROUND: Seborrhea leads to facial greasiness and unpleasant feeling. People with seborrhea also have trouble with selecting moisturizers. l-Carnitine and epigallocatechin gallate (EGCG) are reported anti-sebum properties. However, neither efficacy comparison nor the combination effect of the two topical anti-sebum agents was studied. Moisturizing cream with these agents is supposed to provide skin with an optimal water-oil balance. AIMS: To compare the efficacy of moisturizer containing 2% l-carnitine or 5% EGCG alone on sebum controlling, and the synergistic effect of these two agents. METHODS: Three study creams were formulated by adding three kinds of anti-sebum agents which were 2% l-carnitine, 5% EGCG, and 2% l-carnitine plus 5% EGCG in moisturizing cream base of dimethicone and glycerin. A randomized clinical trial was conducted. Ninety subjects, divided into three groups, applied the cream for 4 weeks. Sebum level, skin capacitance, and transepidermal water loss (TEWL) were evaluated at Weeks 0, 1, 2, and 4. Life qualities and subjective outcomes were assessed before and after treatment. RESULTS: The mean sebum reduction from baseline was statistically significant in all treatment groups (p < 0.01). The median time to oil control was longer in l-carnitine group. The combine group had significantly greater anti-sebum efficacy than l-carnitine group (p = 0.009). All three groups had significant improvement of other objective parameters and subjective outcomes. CONCLUSIONS: The anti-sebum moisturizing cream exhibited beneficial effect on the sebum reduction with improve skin hydration in people with seborrhea and made users satisfied. The EGCG group and the combine group show the greater anti-sebum effect than the l-carnitine group.

Comparison of the onset, depth, and duration of cutaneous anesthesia between topical 10% lidocaine and EMLA creams: a randomized, intraindividual, comparative trial.

BACKGROUND: The eutectic mixture of local anesthetics (EMLA) is an effective cutaneous anesthetic, although its application is time consuming and poses a risk of methemoglobinemia. Currently, the efficacy of topical 10% lidocaine cream is unclear. OBJECTIVE: To compare the onset, anesthesia depth, and duration of topical 10% lidocaine and EMLA cream. METHODS: The randomized, split-body, comparative trial performed on 40 participants who received a topical 10% lidocaine cream or EMLA on forearms for 15-150 min. Pain was stimulated using a 21-gauge needle insertion and evaluated with the Verbal Pain Score. Adverse effects were recorded. RESULTS: EMLA conferred significantly better efficacy than 10% lidocaine (p < .001). For acceptable pain at 4-mm depth, the minimal application times were 40.88 and 45.38 min of EMLA and 10% lidocaine creams, respectively. With 60/120-min application, the maximal needle-insertion depths with acceptable pain were 6.61/9.47 mm (EMLA) and 6.01/8.94 mm (10% lidocaine). EMLA's anesthetic effect showed an early increase after removal which was sustained for 60-90 min. Both creams caused adverse effects, with EMLA showing higher proportions, although the differences were statistically insignificant. CONCLUSION: The efficacy of EMLA was superior to 10% lidocaine cream, especially regarding anesthesia onset and duration.

A pilot study of combined oral minocycline and narrowband UVB phototherapy in vitiligo: A randomized, double-blind, placebo-controlled trial.

Narrowband ultraviolet B (NBUVB) phototherapy is an effective therapeutic option for generalized vitiligo. Previous reports showed the potential benefit of minocycline to stop disease progression in vitiligo. Meanwhile, minocycline has antioxidative, anti-inflammatory, and immunomodulating properties. There is no clinical study combining oral minocycline and NBUVB for treating generalized vitiligo. This study aims to compare the efficacy and safety of the combination treatment of NBUVB plus oral minocycline with NBUVB alone in generalized vitiligo. A randomized, double-blinded, placebo-controlled pilot study was conducted. Patients were randomly treated with either combined oral minocycline 100 mg per day plus NBUVB phototherapy or placebo plus NBUVB. All patients recieved NBUVB two times per week, for 12 weeks. The outcomes were assessed using Vitiligo Area Scoring Index score (VASI) percent change, quartile grading scale (QGS) of repigmentation, and Vitiligo Disease Activity Index (VIDA) score. Fourteen generalized vitiligo patients were included, and seven cases were assigned in each group. At week 12, the mean VASI score was decreased by 28.87% (24.15) in the minocycline group compared to 27.26% (7.98) in placebo group (p = 0.886). No significant difference was observed between both treatment modalities in QGS of repigmentation and mean VIDA score change. Two of the seven patients (29%) receiving minocycline developed hyperpigmentation, dark-brown and muddy brown discoloration, which was only confined to some vitiliginous patches. In conclusion, combination therapy with oral minocycline does not enhance the efficacy of NBUVB in generalized vitiligo. Due to the high incidence of drug-induced skin hyperpigmentation, minocycline plus NBUVB should be avoided.

Efficacy of probiotic-derived lotion from Lactobacillus paracasei MSMC 39-1 in mild to moderate acne vulgaris, randomized controlled trial.

BACKGROUND: Probiotics provide benefits for reducing acne. Previous studies showed an anti-inflammatory effect of Lactobacillus paracasei. However, the clinical evidence of topical probiotic lotion and acne treatment is still lacking. OBJECTIVE: To evaluate the efficacy and safety of probiotic-derived lotion compared with 2.5% benzoyl peroxide in the treatment of mild-to-moderate acne vulgaris. METHODS: Topical probiotic-derived lotion was formulated from cell-free supernatant of L. paracasei MSMC 39-1. In vitro study showed the ability of the supernatant to inhibit both antibiotic-resistance and-susceptibility strains of C. acnes and inhibit tumor necrosis factor-α. The patients with mild-to-moderate acne vulgaris on the face were randomized to receive topical probiotic-derived lotion or 2.5% benzoyl peroxide. Acne lesion counts, erythema index, and side effects were assessed after 2 and 4 weeks of treatment. RESULTS: One hundred and four acne vulgaris patients were enrolled. After four weeks of treatment, the inflammatory acne lesion counts and erythema index significantly decreased compared with the baseline in both the probiotic-derived lotion group and 2.5% benzoyl peroxide group (p < 0.001 in both groups) without statistically significant difference between the two groups (p > 0.05). However, the comedones were not affected in both groups. Four patients (7.69%) treated with probiotic-derived lotion and 14 patients (26.92%) treated with 2.5% benzoyl peroxide reported treatment-associated side effects. CONCLUSION: Probiotic-derived lotion is safe and effective for treating mild to moderate acne vulgaris, a comparable outcome with 2.5% benzoyl peroxide. It could be an alternative treatment of acne with more minor side effects.

Minimum Contact Time of 1.25%, 2.5%, 5%, and 10% Benzoyl Peroxide for a Bactericidal Effect Against Cutibacterium acnes.

Purpose: Benzoyl peroxide (BPO) is an effective acne treatment and has been used as a cleanser and short contact therapy. However, data on the minimum contact time of BPO needed to kill Cutibacterium acnes are lacking. Thus, the aim of this study was to determine the minimum contact time of commonly used BPO concentrations for bactericidal effects on C. acnes. Materials and Methods: An in vitro experimental study of clinically isolated C. acnes was performed to determine the minimal inhibitory concentration (MIC) of BPO using the broth microdilution method. Subsequently, the minimum contact times of various concentrations of BPO were evaluated, and their bactericidal effects were assessed by the plate count method. Results: The median MIC of BPO was 9375 µg/mL, which did not significantly differ between antibiotic-resistant and nonresistant C. acnes. The minimum contact time of BPO with C. acnes was significantly different among the BPO concentrations. For bactericidal activity against all isolates, 1.25%, 2.5%, 5%, and 10% BPO required 60 min, 15 min, 30 sec, and 30 sec, respectively. Conclusion: BPO demonstrated bactericidal activity against both antibiotic-resistant and antibiotic-susceptible C. acnes. The in vitro contact time needed to kill C. acnes was almost immediate with 5% or more BPO, but ≤ 2.5% BPO required longer contact times for bactericidal effects.

Association Between Diet and Acne Severity: A Cross-sectional Study in Thai Adolescents and Adults.

The association between diet and acne is of growing concern. Every country has its own food culture; however, only a few studies have surveyed the influence of Asian cuisine on acne. This study investigated the association between acne severity and diet/lifestyle factors in 2,467 Thai adolescents and adults. Data were collected via a validated semi-quantitative food frequency questionnaire. In Thai adolescents and adults, the prevalence of mild acne was 52%, moderate acne 22%, and severe acne 8%. No acne was found in 18% of participants. The dietary factors associated with increased severity of acne were consumption of chocolate >100 g/week (adjusted odds ratio (aOR) 1.29; 95% CI 1.07-1.56), oily and fried food >3 times/week (aOR 1.84; 95% CI 1.07-3.16) and white rice (aOR 1.80; 95% CI 1.24-2.63). Conversely, the factors associated with decreased severity of acne were consumption of sugar-free milk-free tea (aOR 0.61; 95% CI 0.43-0.87) and vegetables (aOR 0.74; 95% CI 0.62-0.89).

Comparison of Normal Saline Injection with Pneumatic Injector to Subcision for the Treatment of Atrophic Acne Scars.

BACKGROUND: Acne scarring is a concerning consequence of acne with a prevalence of 11 to 14 percent after acne resolution. Needle subcision is usually used by clinicians to treat acne scars due to its safety and simplicity. Recently, normal saline injection with a pneumatic injector has shown compatible outcomes in treating acne scars. OBJECTIVE: This study compared the effectiveness of acne scar treatment with a pneumatic injector and that of hypodermic needle subcision. METHODS: Twenty patients with moderate to severe atrophic acne scars were voluntarily enrolled. All consecutive patients were randomly selected and treated with normal saline injection by using a pneumatic injector on one side of the face during three sessions, separated by a four-week interval. The other side of the face was treated with needle subcision at the end of the first week of the protocol. Subjective assessments were performed by self-evaluation and two blinded dermatologists. For objective assessment, the depth and volume of acne scars were estimated by an ultraviolet A light video camera and Vernier calipers at baseline and four, eight, and 12 weeks. Pain score and adverse reactions were also noted at each visit. RESULTS: Eighteen patients with Fitzpatrick Skin Type III or IV completed the study. Differences in the resolution in diameter and the volume of boxcar and rolling acne scars over 12 weeks of follow-up between the pneumatic injection and needle subcision groups were statistically significantly improved relative to at baseline; however, there was no statistically significant difference in the efficacy between the two modalities. Satisfaction with each modality was not statistically different. No serious adverse effects occurred. Minor reactions such as minor hematoma and subcutaneous emphysema resolved within two weeks. CONCLUSIONS: The efficacy of normal saline injection with a pneumatic injector is not statistically different from that of needle subcision in treating boxcar and rolling acne scars; however, less side effects were recorded. Given this advantage, the use of pneumatic injectors should be considered for treating acne scars.

A cream containing linoleic acid, 5% dexpanthenol and ceramide in the treatment of atopic dermatitis.

BACKGROUND: Nowadays, moisturizers contain non-steroidal anti-inflammatory agents that help for treatment of atopic dermatitis (AD). Defensil® (black currant seed oil, sunflower oil, and balloon vine), a new anti-inflammatory, obtained from plant extracts, remain had a few studies for AD. OBJECTIVE: To compare the effectiveness of moisturizer containing 3% Defensil®, 5% dexpanthenol and ceramide (LDC) with 5% urea cream in childhood AD treatment. METHODS: Thirty-eight patients with diagnosis of atopic dermatitis by UK working party's criteria were recruited in randomized, controlled, double-blinded 4-week study. The patients were received with twice-daily application of LDC cream on one side of the body and 5% urea cream on the opposite side. The clinical severity was assessed by modified scoring of atopic dermatitis (SCORAD). Median time to remission was analyzed by survival analysis. RESULTS: Thirty-seven out of 38 patients accomplished the protocol. The clinical SCORAD significantly improved from baseline in both groups (p < 0.001) after 2 and 4 weeks. Furthermore, the LDC group significantly reduced severity of disease better than the 5% urea group (P = 0.043). The mean difference SCORAD scores were -13.83 (±1.83) and -13.04 (±3.22) respectively. Stratum corneum hydration (SCH) was enhanced from baseline in both groups (p < 0.001) but no statistically significant difference between both groups. Median time to remission had no statistically significant difference (P = 0.697). CONCLUSIONS: The effectiveness of LDC cream is better than 5% urea cream for improving clinical atopic dermatitis. It was suggested that moisturizer containing LDC could be used for the treatment of mild-to-moderate childhood atopic dermatitis.

Efficacy and safety of a novel water-soluble herbal patch for acne vulgaris treatment: A randomized, assessor-blinds controlled, intra-individual split-face comparative study.

Acne vulgaris is a chronic inflammatory skin disease. Antibiotics, particularly clindamycin and erythromycin, are used for the treatment of acne vulgaris. However, emerging antibiotic-resistant strains have been an important problem. This study aims to evaluate the efficiency and safety of a novel water-soluble herbal acne patch (WHAP) compared with the hydrocolloid acne patch (HAP) in mild to moderate inflammatory acne patients. The randomized, assessor-blind controlled, intra-individual split-face study was performed on 49 acne patients. The clinical outcomes were evaluated on day 2, 4, 7, 9, and 11 of treatment. It was shown that the median time to resolution of the inflammatory acne treated with WHAP was shorter than HAP with a statistically significant difference (WHAP was 4 days, whereas HAP was 6 days) (P value <.001). Moreover, WHAP had a more significant decrease in the rate of inflammatory diameter, erythema scores (by clinical and colorimetry), and a more increase in the rate of lightness scores (by colorimetry) than HAP (P value <.05). No adverse effects were reported in both groups. It is safe to use WHAP as an alternative treatment for inflammatory acne.

Comparison between the use of intense pulsed light and Q-switched neodymium-doped yttrium aluminum garnet laser for the treatment of axillary hyperpigmentation.

BACKGROUND: Axillary hyperpigmentation (AH) is a condition in which axillary skin is darker than the adjacent areas. To date, there is no standard treatment for AH. The Q-switched neodymium-doped yttrium aluminum garnet 1064-nm(QS) laser and intense pulsed light (IPL) are two effective modalities for the treatment of pigmentary disorders; however, the efficacy and safety levels of both treatments for AH have not yet been compared in a controlled study. AIMS: To evaluate and compare the efficacy and safety of the QS laser and IPL in the treatment of AH. METHODS: A randomized, split-side study was conducted on 22 subjects; all subjects received a total of five split-side treatments every 2 weeks. The efficacy was determined using the melanin index (MI), color chart level using the Pantone SkinTone™ Guide, improvement grading scale (IGS), and patient satisfaction scores at weeks 2, 4, 6, 8, and 10. RESULTS: The results showed that there was no significant difference in MI, color chart level, IGS, and patient satisfaction scores between the two treatments. Both treatments significantly improved AH after three sessions. However, the pain score was lower for IPL treatment. The adverse effects were transient and were found after IPL treatment in one participant (4.45%) who developed hyperpigmentation and another participant (4.45%) who developed erythema. CONCLUSIONS: Intense pulsed light therapy is safe and effective for the treatment of AH, with no significant difference in the outcome compared with QS laser treatment.

A comparison of the efficacy of silicone gel containing onion extract and aloe vera to silicone gel sheets to prevent postoperative hypertrophic scars and keloids.

BACKGROUND: Hypertrophic scars and keloids are postsurgery problems. Some studies showed that onion extract and aloe vera might be beneficial for postoperative scars. However, few of the randomized clinical trials were investigated. AIMS: To compare the efficacy of silicone gel containing onion extract and aloe vera (SGOA) to silicone gel sheets (SGS) to prevent postoperative hypertrophic scars and keloids. METHODS: The prospective randomized assessor-blind controlled trial was conducted with 40 patients who had undergone surgery. The patients were divided into two groups: one treated with SGOA, the other with SGS. The patients were evaluated after 1, 2, and 3 months. The objective assessment was to determine the incidences of scarring, erythema, and melanin values using Mexameter, and pliability through Cutometer. The subjective assessment consisted of the patient and observer scar assessment scale (POSAS) and patient satisfaction. RESULTS: After the 12-week follow-up, there was no statistically significant difference in the scarring incidence rate of both groups. There were no statistical differences in the POSAS score, erythema, and melanin value between both groups. Using objective assessment, pliability in the SGOA group was statistically significantly higher compared to the SGS group. Pain and itchiness significantly decreased in both groups. No adverse effects were reported in either group. CONCLUSION: Silicone gel containing onion extract and aloe vera is effective as SGS for postoperative scar prevention.

The comparative study of efficacy between 1064-nm long-pulsed Nd:YAG laser and 595-nm pulsed dye laser for the treatment of acne vulgaris.

BACKGROUND: The popularity of laser therapy in acne treatment has been increasing recently due to its safety, effectiveness, and convenience. Both 595-nm pulsed dye laser (PDL) and 1064-nm long-pulsed neodymium:yttrium-aluminum-garnet laser (Nd:YAG) have been successful in treating inflammatory acne lesions. However, clinical data from controlled comparative studies are still lacking. AIMS: To compare the clinical efficacy of 1064-nm Nd:YAG with 595-nm PDL for the treatment of acne vulgaris. METHODS: Thirty-four participants with mild to moderate facial acne were enrolled and then randomized to receive three, 2-week interval treatments with 1064-nm Nd:YAG on one side of the face and 595-nm PDL on the other side. Clinical assessments including acne lesion counts, acne erythema grading, and erythema index were performed at baseline, 2nd, 4th, and 8th week. Participants' satisfaction, preference, and adverse effects were recorded. RESULTS: As compared with baseline, the significant reduction of mean inflammatory acne lesion counts, acne erythema grading, and erythema index was demonstrated on 595-nm PDL-treated sides and 1064-nm Nd:YAG-treated sides. However, there were no significant differences between both sides. The participants were satisfied with both laser treatments, but the participants preferred 1064-nm Nd:YAG over 595-nm PDL treatment. The adverse effects were less on 1064 nm Nd: YAG-treated sides. CONCLUSIONS: 1064-nm Nd:YAG and 595-nm PDL treatments are equally effective in reducing inflammatory acne lesions and acne erythema in mild to moderate facial acne vulgaris.

Efficacy and tolerability of 20% aluminum sesquichlorohydrate vs 20% aluminum chloride for the treatment of axillary hyperhidrosis: A randomized controlled trial.

This study evaluated the efficacy and tolerability of topical aluminum sesquichlorohydrate (AS) when compared to aluminum chloride (AC) as a treatment for primary axillary hyperhidrosis (PAH). Twenty subjects were included in this randomized, controlled, split-side 8-week study. All participants applied 20% AS and 20% AC lotions in their axillae (one treatment per axilla) every night for 2 weeks; next, the application was reduced to three times a week for 4 weeks. The assessment was performed using the sweating intensity visual scale (SIVS), hyperhidrosis disease severity score (HDSS), patient satisfaction score, and the appearance of adverse effects on weeks 0, 1, 2, 4, 6, and 8. Both AS as well as AC application showed positive results, significantly differing from the baseline, as assessed using SIVS, HDSS, and patient satisfaction score at every follow-up visit; however, no significant difference was observed between the AS and AC groups at any follow-up visit. The mean time of response was 1.14 weeks for both treatments. A side effect was observed in one subject (5%), who reported itching on the AC axilla. The therapeutic effects persisted even after reducing the frequency of application and lasted for at least 2 weeks after cessation of use. In conclusion, topical 20% AS demonstrated similar efficacy to topical 20% AC in the treatment of PAH, with a high safety profile.

Comparison of the effectiveness of fractional 1550-nm erbium fiber laser and 0.05% tretinoin cream in the treatment of acanthosis nigricans: a prospective, randomized, controlled trial.

Acanthosis nigricans is a common dermatological problem. There are currently limited clinical trials to determine the efficacy and safety of laser treatments. To compare the efficacy of fractional 1550-nm erbium fiber laser versus 0.05% tretinoin cream for the treatment of acanthosis nigricans at neck, a randomized, controlled, assessor-blinded study was conducted in 18 subjects with acanthosis nigricans at the neck. All patients were treated with both fractional 1550-nm erbium fiber laser and 0.05% tretinoin cream on each side of the neck. The laser side was treated with three treatment sessions, with a 4-week interval of 1550-nm fractional erbium laser. Another side was treated with 0.05% tretinoin cream daily at bedtime for 12 weeks. We evaluated at baseline, with a 4-week interval until 4 weeks after the last treatment. The efficacy was assessed by skin color ratio, melanin index, average roughness, photographic evaluation, patients' satisfaction, and the adverse effects. At the study endpoint, week 12, the mean Visiometer-average roughness showed greater reduction in laser-treated side (24.65%) than tretinoin side (22.94%) (p = 0.004). Laser-treated side also showed greater percentage of skin color ratio reduction, melanin index reduction, and better mean of photographic-based evaluation percentage change from the baseline than tretinoin side with no significant different (p = 0.331, p = 0.116, p = 0.327, respectively). The study showed one post-inflammatory hyperpigmentation in tretinoin side. Regarding to the average roughness, fractional 1550-nm erbium fiber laser was superior to 0.05% tretinoin cream for treatment of neck-acanthosis nigricans with less side effect. Fractional 1550-nm erbium fiber laser could be considered as an alternative treatment for acanthosis nigricans.

Low-fluence Q-switched Nd:YAG 1064-nm laser versus Q-switched Nd:YAG 532-nm laser in the treatment of hyperpigmented lips: a prospective, randomized, controlled, evaluator-blinded trial.

Lip hyperpigmentation is an esthetic problem. Clinical data from controlled comparative studies is insufficient to support the efficacy of laser treatments for hyperpigmented lips. This study is aimed to compare the efficacy of low-fluence Q-switched Nd:YAG 1064-nm laser (LFQS 1064-nm) versus Q-switched Nd:YAG 532-nm laser (QS 532-nm) for the treatment of hyperpigmented lips. A randomized, controlled, evaluator-blinded study was conducted in thirty subjects. They were randomized into 2 groups. The first group was treated with five treatment sessions with a 2-week interval of LFQS 1064-nm laser while the second group was treated with a single session of QS 532-nm laser. The evaluation was conducted at baseline, 2 weeks of each post treatment, and 4 weeks after the last treatment session. The efficacy was assessed by melanin index, Methuen colored plate, photographic evaluation, pain score, patient's satisfaction, and patient's Dermatology Life Quality Index. The adverse effects were also recorded. All patients attained throughout the study protocol. The most frequent fluence applied was 2.4 J/cm2 (2.2-2.5 J/cm2) and 2.0 J/cm2 (1.7-2.4 J/cm2) in the LFQS 1064-nm group and QS 532-nm group, respectively. The results of the QS 532-nm group showed greater percentage of melanin index reduction and better average mean of photographic evaluation percentage changes from the baseline than the LFQS 1064-nm group (p < 0.001 and p < 0.001, respectively). The adverse effects were less likely to occur in the LFQS 1064-nm group. Few cases of scale, hypopigmentation, bleb formation, postinflammatory hyperpigmentation, and labial edema occurred only in the QS 532-nm group.

A comparative study on the effectiveness of herbal extracts vs 2.5% benzoyl peroxide in the treatment of mild to moderate acne vulgaris.

BACKGROUND: Although there is a standard guideline for the treatment of acne, it is still a common skin disease, and suboptimal medication adherence is a major reason for treatment failure. Herbal extracts are an interesting alternative medicine because they consist of a variety of active ingredients. Moreover, herbal extracts may have improved therapeutic efficacy because of the combination of various herbs. OBJECTIVES: To evaluate the effectiveness of herbal extracts for the treatment of mild to moderate acne vulgaris. METHODS: A total of 77 patients were randomized to receive either an herbal extract or 2.5% benzoyl peroxide, which were applied for a period of 12 weeks. Acne lesion counts, adherence, porphyrin counts, the Dermatology Life Quality Index, satisfaction and side effects were assessed. RESULT: At the 12-week point, the acne lesion counts decreased, with statistically significant differences from the baseline values in both groups and for all types of acne (P-value < 0.001). The adherence rate was significantly higher in the patients using the herbal extract than in the patients using 2.5% benzoyl peroxide (P-value = 0.002). There was no statistically significant difference in terms of porphyrin counts, spot scores, the Dermatology Life Quality Index or satisfaction with efficacy between the groups; however, satisfaction with drug administration was significantly higher in the patients using the herbal extract (P-value = 0.001). CONCLUSION: Herbal extracts could be beneficial for anti-acne pharmaceutical preparations and may be used as an alternative medicine for patients with mild to moderate acne vulgaris who do not adhere to benzoyl peroxide treatment.

Nitrogen plasma skin regeneration for the treatment of mild-to-moderate periorbital wrinkles: A prospective, randomized, controlled evaluator-blinded trial.

BACKGROUND: Nitrogen plasma skin regeneration is a novel device that produces heat to the skin, resulting in the production of new collagen. Because of lower energy with safer skin damage and lesser adverse effects who have high Fitzpatrick's skin type especially Thais, this technique is very interesting for clinical application for skin esthetic treatment. However, this treatment has yet been empirically studied as the treatment for mild-to-moderate periorbital wrinkles. OBJECTIVES: This study aimed to evaluate clinical efficacy of nitrogen plasma for the treatment of mild-to-moderate periorbital wrinkles. METHODS: Eighteen volunteers were enrolled. Each volunteer was randomized to receive nitrogen plasma treatment on one side of periorbital wrinkles with three sessions at a three-week interval and compared with contralateral side without treatment. Photographic examination, skin wrinkle (SEw) score, melanin index, patients' satisfaction score, side effect, and pain score were reported. RESULTS: At over fourteen weeks, all volunteers completed the study. Treatment with nitrogen plasma group had significantly better improvement for periorbital wrinkles score by Lemperle scale, skin wrinkle (SEw) score by Visioscan® VC 98, and the melanin index by Mexameter® than the control groups (P = 0.004, P < 0.001, P < 0.001, respectively). This study also showed significantly greater satisfaction score to favor the nitrogen plasma treatment group than the control group (P < 0.001). The short-term adverse effects included erythema, scaling, temporary hyperpigmentation, pruritus, and dryness. CONCLUSION: Nitrogen plasma skin regeneration is effective and safe for the treatment of mild-to-moderate periorbital wrinkles and darkening.