The Comparison between Microneedling and Fractional CO2 Laser for Amniotic Membrane Stem Cell-Conditioned Medium and Vitamin C in Photoaging Treatment.

Context: Photoaging correlates with ultraviolet radiation (UVR). In addition to direct and indirect DNA damage, UVR leads to a breakdown of collagen, resulting in enlarged pores, visible wrinkles, also uneven skin tones and pigmentations. Amniotic membrane stem cell (AMSC) can be a useful modality in cell regeneration. Vitamin C has been known as an agent of depigmentation, antioxidants, and collagen synthesis. A topical combination of amniotic membrane stem cell-conditioned medium (AMSC-CM) and vitamin C is expected to improve photoaging. Fractional CO2 laser and microneedling served as transdermal drug delivery. Aims: To compare between microneedling and fractional CO2 laser for the administration of AMSC-CM and vitamin C in photoaging treatment. Methods and Material: Sixty Indonesian women with photoaged skins participated in this experimental analytic, controlled, matching research and were divided into two groups. Thirty women received fractional CO2 laser, and others received microneedling. All participants received a topical combination of AMSC-CM and vitamin C. Three treatment sessions were repeated at a four-week interval for fractional CO2 laser and a two-week interval for microneedling. We evaluated the progression and side effects using a skin analyzer on weeks 0, 4, and 8 for the microneedling group and for the fractional CO2 laser group on weeks 0, 4, and 12. Results: Assessment of wrinkles, UV spots, skin tone, and pore revealed a statistically significant effect of a topical combination of AMSC-CM and vitamin C after fractional CO2 laser (p < 0.05). Conclusions: Combination of AMSC-CM and vitamin c using fractional CO2 laser can improve photoaging and is better compared to microneedling.

Unusual presentation of secondary syphilis mimicking erythema multiforme in HIV positive patient: a case report.

Secondary syphilis is known as "The Great Imitator". It can mimic numerous diseases clinically and histologically, including erythema multiforme (EM). Coinfection with HIV often makes its manifestations more atypical leading to delays in diagnosis and therapy. A 34-year-old male-sex-male patient who had received coronavirus disease 2019 (COVID-19) vaccine 1 week earlier presented with complaints of slightly pruritic scaly erythematous targetoid plaques and erythematous macules on the trunk and extremities for 6 weeks. Histopathology examination showed basal cell vacuolar degeneration of the epidermis and lymphocytic infiltrates along the dermal-epidermal junction and superficial dermis, consistent with EM. Upon further investigation, syphilis and HIV serology were reactive (VDRL 1: 128, TPHA 1: 40960, CD4+ 461 cells/µl). Lesions improved significantly after a single dose of 2,4-million units of benzathine penicillin intramuscular injection. Secondary syphilis presenting as erythema multiforme (EM)-like eruptions is very rare. Physicians should be aware of this unusual presentation to prevent complications.

A single dose of benzathine penicillin G as an effective treatment for malignant syphilis in an HIV-positive patient: a case report.

Malignant syphilis (MS) is a rare, atypical manifestation of secondary syphilis. Ulcerative lesions should be suspected as MS when found with supporting microscopic morphology, a high syphilis serology titer test, a Jarisch-Herxheimer reaction (JHR), and rapid disease resolution. To date, there is no specific recommendation for treatment for MS. A 24-year-old HIV-positive MSM patient with a CD4 count of 470 cells/µl presented with a chief complaint of necrotic, ulcerative lesions and oyster shell-like surface plaques on his face, trunk, groin, and extremities. The patient also developed various typical presentations of secondary syphilis. Dark-field microscopy revealed spirochetes. Histopathological examination showed spongiotic dermatitis with many neutrophil cells in the dermis, together with endarteritis and fibrin micro-thrombus in the blood vessels. The patient had a high venereal disease research laboratory (VDRL) titer of 1:512. There was rapid disease resolution following a single injection of 2,400,000-unit benzathine penicillin G (BPG); together with anti-retroviral therapy, this was supportive treatment for MS. JHR was not observed in this study and many other reports. This case showed that ulcerative lesions with an oyster shell-like surface presenting in HIV-positive patients along with supporting microscopic morphology, high VDRL titer, and a dramatic improvement after antibiotic treatment is highly suggestive of MS. JHR may no longer be a characteristic of MS. A single dose of 2,400,000-unit BPG is sufficient for MS treatment.

The Efficacy of Amniotic Membrane Stem Cell (AMSC) Metabolite Product and Vitamin E for Wrinkles, Spots, and Pores in Photoaging.

BACKGROUND: It is expected that a combination of amniotic membrane stem cell metabolite product (AMSC-MP) and vitamin E after fractional CO2 laser as laser-assisted drug delivery (LADD) will provide better effects in photoaging treatment as the combination reaches the target. This promises an option for photoaging therapy in the future. MATERIALS AND METHODS: Sixty women with photoaged skins were involved in this experimental study. They were then divided into two groups. The treatment group received a topical combination of AMSC-MP and vitamin E, and the control group received AMSC-MP alone after fractional CO2 laser. The treatment was repeated three times. RESULT: The Janus assessment results showed a significant difference in pores in the third observation, and the average pore improvements in the treatment group were better than the control group. Wrinkle, UV spot, and polar spot did not show any significant difference. CONCLUSION: A combination of the amniotic membrane stem cell metabolite product (AMSC-MP) and vitamin E after fractional CO2 laser as LADD only improves pores in photoaged skins.