Noncultured epidermal suspensions obtained from partial-thickness epidermal cuts and suction blister roofs for vitiligo treatment: A prospective comparative study.

BACKGROUND: The treatment options for vitiligo are either nonsurgical, including medical treatments and phototherapy, or surgical, including autologous transplantation methods. Noncultured epidermal suspension transplantation is indicated for the treatment of stable vitiligo not responding to either medical treatment or phototherapy. Variable results have been reported for the various techniques used for the preparation of this suspension. AIM: To compare the outcome between suction blister roof grafts and partial-thickness epidermal cuts for the preparation of noncultured epidermal suspensions for the treatment of stable vitiligo. PATIENTS AND METHODS: Forty patients with localized stable vitiligo lesions resistant to conventional therapy were included in the study. They were randomly divided into two groups for treatment with noncultured epidermal suspension grafting. The suspensions in groups I and II were obtained from suction blister roofs and partial-thickness epidermal cuts, respectively. Repigmentation grade, color match with the surrounding skin, and any side effects were compared between the groups. RESULTS: In group I, complete repigmentation was achieved in 6 cases while repigmentation was considered excellent in 8 cases; very good, 4 cases; and no response, 2 cases. In group II, complete repigmentation was achieved in 4 cases, and repigmentation was considered excellent in 16 cases. The color of the repigmented area matched the normal surrounding skin in 70% of the cases in group I and 40% of the cases in group II. CONCLUSION: Both techniques yielded comparable repigmentation results with advantages and disadvantages of both techniques.

The effect of latanoprost on vitiligo: a preliminary comparative study.

Latanoprost (LT), a prostaglandin F 2alpha (PGF2a ) analogue used in the treatment of glaucoma, was found to induce skin pigmentation in guinea pigs in addition to its known periocular and iridal pigmentation side effects. This study aims to evaluate the efficacy of topical LT in the induction of skin repigmentation in patients with vitiligo and to compare its potency with narrow band ultraviolet (UV) B (NB-UVB). The result of their combination was also assessed. This study involved 22 patients with bilateral and symmetrical vitiligo lesions, stable for the last three months, divided into three groups: group I, to evaluate LT vs. placebo; group II, to evaluate LT vs. NB-UVB; and group III, to evaluate the effect of their combination. The response to treatment was evaluated by taking photographic records of the treated lesions with follow-up photography every two weeks. After three months, assessment of the degree and extent of repigmentation was performed. Follow-up assessment was done six months after termination of the trial for the persistence of pigmentation, recurrence, or development of any side effects. LT was found to be better than placebo and comparable with the NB-UVB in inducing skin repigmentation. This effect was enhanced by the addition of NB-UVB. LT could be a promising treatment for vitiligo, especially the periocular variant. Its effect on skin repigmentation could be enhanced by NB-UVB exposure.

Expression of transforming growth factor-ß after different non-invasive facial rejuvenation modalities.

BACKGROUND: Transforming growth factor-ß (TGF-ß) is a major regulator of the synthesis of extracellular matrix (ECM) proteins in human skin as it stimulates fibroblast proliferation and collagen production. Perturbed TGF-ß expression may play a key role in the pathogenesis of skin aging. OBJECTIVES: This study was conducted to objectively evaluate the effects of different modalities of non-invasive facial rejuvenation on TGF-ß expression and to correlate its level with that of newly synthesized collagen. METHODS: A total of 36 patients with Fitzpatrick skin types III and IV were divided into six groups. Each group of six patients was subjected to a different non-invasive modality for the treatment of skin aging, including radiofrequency (RF), Nd:YAG 1320-nm laser and Er:YAG 2940-nm laser mini-peels, intense pulsed light (IPL), mesotherapy injection, and electro-optical synergy (ELOS). Skin biopsies were obtained before treatment, at the end of treatment, and at three months post-treatment. In addition, biopsies were obtained from 30 control subjects. Levels of TGF-ß were quantitatively evaluated using computerized image analysis of immunostained sections. RESULTS: The expression of TGF-ß was statistically significantly increased (P < 0.05) at the end of Nd:YAG 1320-nm and Er:YAG 2940-nm mini-peel treatments compared with baseline levels, and at three months post-treatment with RF and ELOS compared with pretreatment and end-of-treatment levels. However, no significant differences (P > 0.05) were observed in TGF-ß level in response to IPL or mesotherapy treatments in comparison with baseline. The level of TGF-ß was positively correlated (P < 0.05) to that of newly synthesized collagen at the end of Nd:YAG 1320-nm laser and Er:YAG 2940-nm laser mini-peels, as well as at three months after RF and ELOS treatments. CONCLUSIONS: Radiofrequency, ELOS, and Nd:YAG 1320-nm laser and Er:YAG 2940-nm laser mini-peels resulted in an increase in TGF-ß expression, which may mediate the effects of these modalities in enhancing dermal collagen expression through the activation of fibroblasts and thereby reverse the photoaging of skin.

Expression of p53 protein after nonablative rejuvenation: the other side of the coin.

BACKGROUND: Disturbance of p53 expression may play an important role in the pathogenesis of ultraviolet (UV) light-induced skin cancer as well as photoaging. OBJECTIVES: To objectively evaluate the potential effect of nonablative facial rejuvenation on p53 expression. PARTICIPANTS AND METHODS: Thirty patients with Fitzpatrick skin type III to IV were divided into five groups. Each group underwent a different nonablative modality: radiofrequency (RF), intense pulsed light (IPL), electro-optical synergy (ELOS) (combined RF and IPL), 1,320-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, and 2,940-nm erbium-doped (Er):YAG laser minipeel. Skin biopsies were obtained before treatment, by the end of treatment, and 3 months after treatment. Biopsies were also taken from 30 controls. Quantitative evaluation of p53 was performed using computer image analysis for immunostained tissues. RESULTS: P53 expression was statistically significantly greater at the end of IPL (p = .02) and ELOS (p = .02) treatments than before treatment but was statistically insignificantly lower (p > .05) 3 months after treatment than at the end of treatment. No significant differences (p > .05) were observed in p53 level after RF, 1,320-nm Nd:YAG, and 2,940-nm Er:YAG mini-peel treatments from baseline. CONCLUSIONS: The increase in epidermal p53 expression after IPL treatment could increase the risk of skin neoplasia by intense pulsed light-induced DNA damage which may lead to dysregulation of apoptosis and initiation of skin cancer.

Efficacy of mesotherapy in facial rejuvenation: a histological and immunohistochemical evaluation.

BACKGROUND: Mesotherapy, commonly known as "biorejuvenation" or "biorevitalization", is a technique used to rejuvenate the skin by means of a transdermal injection of a multivitamin solution and natural plant extracts that are thought to improve the signs of skin aging. OBJECTIVES: This prospective study aimed to evaluate the clinical effect of mesotherapy applied to periorbital wrinkles and to quantitatively evaluate histological changes in the skin occurring in response to the same treatment. METHODS: Six volunteers with Fitzpatrick skin types III or IV and Glogau class I-III wrinkles were subjected to a three-month course of mesotherapy injections in the periocular area (six sessions administered at two-week intervals). Standard photographs and skin biopsies were obtained from the treatment area at baseline, at the end of treatment, and at three months post-treatment. Quantitative evaluation of collagen types I, III, and VII, newly synthesized collagen, total elastin, and tropoelastin was performed using a computerized morphometric analysis. RESULTS: The clinical evaluation of volunteers at baseline, end of treatment, and three months post-treatment revealed no significant differences. Histological and immunostaining analysis of collagen types I, III, and VII, newly synthesized collagen, total elastin, and tropoelastin showed no statistically significant changes (P > 0.05) after mesotherapy injection. CONCLUSIONS: The present study indicates that mesotherapy for skin rejuvenation does not result in statistically significant histological changes or clinical improvement.

Multiple minimally invasive Erbium: Yttrium Aluminum Garnet laser mini-peels for skin rejuvenation: an objective assessment.

BACKGROUND: As the demand for minimally invasive rejuvenation is increasing, micropeel resurfacing using Erbium:Yttrium Aluminum Garnet (Er:YAG) laser 2940 nm has been reported for the treatment of photoaged skin without ablation of the epidermis. However, little is known about the efficacy and underlying histologic changes associated with this type of treatment. AIMS: The aims of this study are to evaluate the clinical effect and objectively quantify the histological changes in response to multiple sessions of Er:YAG laser 2940 nm mini-peels. PATIENTS AND METHODS: Six female volunteers of Fitzpatrick skin type III-IV and Glogau's class I-III wrinkles were subjected to six microresurfacing peels at 2-week intervals using Er:YAG 2940 nm laser at subablative fluences of 2-3 J/cm(2) to treat periorbital rhytides. Quantitative evaluation of collagen types I, III, and VII, newly synthesized collagen, total elastin, and tropoelastin was performed by histochemistry and immunohistochemistry coupled with computerized morphometric analysis at base line, end of treatment, and 3 months post-treatment. RESULTS: Compared to the base line, evaluation of volunteers revealed obvious clinical improvement in response to Er:YAG mini-peels. Collagen types I, III, and VII, as well as newly synthesized collagen, together with tropoelastin showed a statistically significant increase in response to treatment, while the mean level of total elastin was significantly decreased in response to treatment. However, this was followed by regression of improvement at 3 months post-treatment but was still better than baseline. CONCLUSIONS: This study revealed that multiple Er:YAG mini-peels is a promising treatment option for photoaging as it reverses the signs of photoaged skin with little downtime and side effects. However, to maintain the short-term improvement achieved after treatment, continued Er:YAG 2940 nm laser mini-peels is required.

A new morphometric technique for assessment of melanization in skin of guinea pigs.

BACKGROUND: The degree of melanization is an important finding in many skin disorders. An objective measurement of melanin density is needed to achieve an accurate evaluation. OBJECTIVES: The present work aims at translating the subjective increase of melanin particles after narrow band ultraviolet-B (NB-UVB) irradiation into objective numerical values ready for statistical analysis. MATERIALS AND METHODS: This study had involved 18 guinea pigs that were exposed to biweekly sessions of NB-UVB radiation for 4 weeks to induce skin pigmentation. Two skin biopsies were obtained from each animal; the first before treatment and the second at the end of the study, using 5 mm punch and stained with hematoxylin and eosin and Masson-Fontana (MF) stains. Surface area of both the epidermis (ESA) and the melanin particles (MPSA) were measured in µm(2) using a software supplied with Olympus light microscope. The MPSA/ESA percentage was calculated for each biopsy. The results before and after NB-UVB exposure were compared and statistically analyzed. RESULTS: In the MF-stained sections, the mean ± SD of the MPSA/ESA percentage were 0.24 µm(2) ± 0.09 and 6.21 µm(2) ± 2.45 at the start of the study and at its end, respectively, with a highly significant difference (P < 0.001). CONCLUSION: This technique offers a new methodology for an accurate numerical evaluation of epidermal melanization.

Intense pulsed light photorejuvenation: a histological and immunohistochemical evaluation.

BACKGROUND: The use of intense pulsed light (IPL) for facial rejuvenation had been the topic of many studies. However, few of them discussed quantitative changes in extracellular matrix proteins after IPL therapy. OBJECTIVE: To objectively quantify the histological changes in extracellular matrix proteins after IPL treatment for facial wrinkles. METHODS: Biopsy specimens were obtained from the periocular area of six volunteers of Fitzpatrick skin type III-IV and Glogau's class I-III wrinkles. They were subjected to three months of IPL treatment (six sessions at two-week intervals). Using histological and immunostaining analysis coupled with computerized morphometric analysis, quantitative evaluation of collagen types I, III and VII, newly synthesized collagen, total elastin and tropoelastin was performed for skin biopsies at baseline, end of treatment, and three months post-treatment. RESULTS: Clinical assessment of volunteers did not show clinically noticeable improvement in facial wrinkles after IPL treatment. Furthermore, quantitative evaluation of extracellular matrix proteins showed no statistically significant changes (P>0.05) in response to IPL treatment CONCLUSION: Although 50 percent of volunteers showed mild improvement in skin texture at the end of IPL treatment, none of them reported improvement in skin tightening or wrinkles. No statistically significant histological changes were observed three months post IPL treatment.

Effects of the Nd:YAG 1320-nm laser on skin rejuvenation: clinical and histological correlations.

The neodymium:yttrium-aluminum-garnet (Nd:YAG) laser is a popular non-ablative treatment used for skin rejuvenation. The purpose of this prospective study was to evaluate the clinical effects, coupled with a quantitative assessment, of the histological changes in response to Nd:YAG 1320-nm laser treatment of periocular wrinkles. Six volunteers with Fitzpatrick skin types III and IV and Glogau class I-II wrinkles were subjected to 3 months of Nd:YAG 1320-nm treatment in the periocular area (six sessions at 2-week intervals). Volunteers were photographed, and skin biopsies were obtained at baseline as well as 3 and 6 months after the start of treatments. Quantitative evaluation of total elastin, newly synthesized tropoelastin, collagen types I, III and VII, and newly synthesized collagen was performed using a computerized morphometric analysis. A noticeable clinical and histological improvement was observed after Nd:YAG 1320-nm treatment. Collagen types I, III and VII, as well as newly synthesized collagen, together with tropoelastin showed a statistically significant increase in response to treatment, while the mean level of total elastin was significantly decreased after treatment. Our data suggest that Nd:YAG 1320 nm is an effective treatment for skin rejuvenation as it stimulates the repair processes, and reverses the clinical, as well as the histopathological, signs of skin aging.

Radiofrequency facial rejuvenation: evidence-based effect.

BACKGROUND: Multiple therapies involving ablative and nonablative techniques have been developed for rejuvenation of photodamaged skin. Monopolar radiofrequency (RF) is emerging as a gentler, nonablative skin-tightening device that delivers uniform heat to the dermis at a controlled depth. OBJECTIVE: We evaluated the clinical effects and objectively quantified the histologic changes of the nonablative RF device in the treatment of photoaging. METHODS: Six individuals of Fitzpatrick skin type III to IV and Glogau class I to II wrinkles were subjected to 3 months of treatment (6 sessions at 2-week intervals). Standard photographs and skin biopsy specimens were obtained at baseline, and at 3 and 6 months after the start of treatment. We performed quantitative evaluation of total elastin, collagen types I and III, and newly synthesized collagen using computerized histometric and immunohistochemical techniques. Blinded photographs were independently scored for wrinkle improvement. RESULTS: RF produced noticeable clinical results, with high satisfaction and corresponding facial skin improvement. Compared with the baseline, there was a statistically significant increase in the mean of collagen types I and III, and newly synthesized collagen, while the mean of total elastin was significantly decreased, at the end of treatment and 3 months posttreatment. LIMITATIONS: A limitation of this study is the small number of patients, yet the results show a significant improvement. CONCLUSIONS: Although the results may not be as impressive as those obtained by ablative treatments, RF is a promising treatment option for photoaging with fewer side effects and downtime.

The spectrum of fungal infections with a special reference to dermatophytoses in the capital area of Kuwait during 2000-2005: a retrospective analysis.

BACKGROUND: Fungal infections constitute a major health problem all over the world. Signs and symptoms induced by various dermatophytic infections are difficult to distinguish clinically from each other. So, characterization by in vitro culture is required for appropriate diagnosis and treatment as well as to study the epidemiological characteristics in a region. OBJECTIVES: The present retrospective work was aimed to study the spectrum of fungal infections of the skin, nails and hairs in the Capital area of Kuwait over a span of 5 years and to compare the results with those reported earlier from this region and other parts of the world. PATIENTS/MATERIALS: The study was conducted on 2,730 patients referred from dermatology outpatients to mycology laboratory suspected to have fungal infection over a 5-year period. Identification of dermatophyte isolates obtained was done by conventional microscopic examination in all patients, whereas culture techniques were performed for 1,593 of them. RESULTS: Among 2,730 patients, 1,437 were men and 1,293 were women with a men to women ratio of 1.1:1. The age ranged from 3 months to 70 years (mean age 28.5 years). The clinical diagnosis of these patients was as follows: onychomycosis; tinea corporis; tinea capitis; tinea pedis; tinea cruris; tinea manum and tinea versicolor. Potassium hydroxide (KOH) examination showed positive results in 39% of all cases, whereas positive cultures were obtained in 29% of cultured specimens. Among dermatophytes, six species were isolated: Trichophyton mentagrophytes (39%), Microsporum canis (16%), Trichophyton rubrum (10%), Epidermophyton floccosum (6.2%), Trichophyton violaceum (2.4%) and Trichophyton verrucosum (0.4%). Trichophyton mentagrophytes was isolated from all body sites. Candida and Aspergillus niger were isolated on cycloheximide-free cultures in cases with onychomycosis. CONCLUSIONS: Cutaneous fungal infections including dermatophytes remain prevalent in this part of the world. The most common isolate was T. mentagrophytes followed by Candida species. The least isolate was T. verrucosum. Species identification in relation to factors such as time, place and population is warranted in order to implement treatment regimens and to propose potential control measures.

Electro-optical Synergy Technique: A New and Effective Nonablative Approach to Skin Aging.

OBJECTIVES: Electro-optical synergy technology is one of the most recently described methods for nonablative skin rejuvenation. The aim of this study is to evaluate the effects of electro-optical synergy on connective tissue composition by histological and immunohistochemical techniques coupled with computerized morphometric analysis. DESIGN: A prospective clinical study. PARTICIPANTS: Six volunteers with Fitzpatrick skin types 3 to 4 and Glogau class I to II wrinkles were subjected to three months (6 sessions at 2-week intervals) of electro-optical synergy treatment. MEASUREMENTS: Standard photographs and skin biopsies were obtained at baseline as well as three and six months after the start of treatment. The authors performed quantitative evaluation of total elastin, tropoelastin, collagen types I, III, and VII, and newly synthesized collagen. RESULTS: Noticeable clinical and histological improvement was observed after electro-optical synergy treatment. A statistically significant increase in the means of collagen types I, III, and VII, as well as newly synthesized collagen, together with increased levels of tropoelastin, were detected, while the mean level of total elastin was significantly decreased at the end of treatment and three months post-treatment. CONCLUSION: Electro-optical synergy is an effective treatment for contouring facial skin laxity. This modality stimulates the repair processes and reverses the clinical, as well as the histopathological, signs of aging with the advantage of being a relatively risk-free procedure with minimal patient recovery time.