Clinical evaluation of efficacy of intralesional platelet-rich plasma injection versus 1064 nm long-pulsed Neodymium:YAG laser in the treatment of inflammatory acne vulgaris in adolescent and post-adolescent patients: a prospective randomized split-face comparative study.

Large numbers of local and systemic therapies are available for acne treatment. Common oral or topical retinoids, antibiotics, or keratolytics are used but sometimes are inconvenient, and side effects caused by these conventional therapies prompted a search for effective and safe treatments. This study aimed to evaluate the efficacy of intralesional platelet-rich plasma injection versus 1064 nm long-pulsed Nd:YAG laser in the treatment of moderate inflammatory acne vulgaris in both adolescents and post-adolescent patients. This split-face comparative study was carried out on thirty patients who suffered from moderate inflammatory and non-inflammatory acne vulgaris. The patients were classified into two groups: group I: adolescent (≤ 25 years) and group II: post-adolescent (< 25 years). Each group received four sessions of intralesional PRP injection on one side of the face and a long-pulsed Nd:YAG (1064 nm) laser on the other side with 2 weeks interval. Evaluation was done by blinded dermatologists using photographs and lesions counting and by patient satisfaction. Side effects were also noted. Both groups (adolescents and post-adolescent) showed a high statistically significant improvement of inflammatory as well as non-inflammatory lesions either in PRP or Nd:YAG laser-treated side with no significant difference between the two sides. The intralesional PRP injection and 1064 nm long-pulsed Nd:YAG laser are safe and effective methods for controlling inflammatory as well as non-inflammatory acne vulgaris in both adolescents and post-adolescent patients.

Optical coherence tomographic (OCT) evaluation of intraoral non-ablative erbium: YAG laser (SMOOTH mode) in rejuvenation of nasolabial folds; A prospective randomized split face comparative pilot study.

BACKGROUND: There are both few non-comparative studies investigating the efficacy of intraoral Er: YAG laser (SMOOTH mode) in rejuvenating nasolabial folds (NLFs) and lack of valid and objective wrinkles scales. In this prospective randomized split face comparative pilot study, we investigated the safety and efficacy of intraoral Er: YAG laser (SMOOTH MODE) compared with extraoral approach in rejuvenating NLFs using OCT as an objective evaluating tool. MATERIALS AND METHODS: Twenty adult women with notable NLFs were randomized in this study. The patients received 5 monthly sessions of Er: YAG laser (SMOOTH mode) using intraoral approach on one side and extraoral approach on the other side. Outcome was evaluated 2 weeks and 4 months post-treatment by Global Aesthetic Improvement Scale (GAIS), OCT, and patients' satisfaction. Side effects were also evaluated. RESULTS: Intraoral sides had significant increase in OCT evaluated dermal thickness at 4 months post-treatment (P = .03) without side effects compared with extraoral sides. Extraoral approach had significantly higher patients' satisfaction compared with intraoral approach at 2 weeks and 4 months post-treatment (P = .03, .02, respectively). Insignificant differences between both approaches were found regarding GAIS scoring, OCT evaluated epidermal thickness at 2 weeks and 4 months post-treatment, and OCT evaluated dermal thickness at 2 weeks post-treatment (P < .05). CONCLUSION: Intraoral Er: YAG laser (SMOOTH mode) is safer and more effective than extraoral approach in rejuvenating NLFs. OCT is a promising objective tool for evaluating facial wrinkles. Further studies are still needed.

Effect of narrow band-ultraviolet B on CD4(+) CD25(high) FoxP3(+) T-lymphocytes in the peripheral blood of vitiligo patients.

BACKGROUND: It is widely believed that an imbalance between activated CD8(+) T cells and regulatory T cells (Tregs) exists in patients with vitiligo. Although there is evidence that narrow band ultraviolet (NB-UVB) irradiation can induce Tregs' number and activity, but up to our knowledge, none of the published studies involved the possible effect of NB-UVB on Tregs in vitiligo. OBJECTIVE: To evaluate the effect of NB-UVB on circulating CD4(+) CD25(high) FoxP3(+) regulatory T cells (FoxP3(+) Tregs) in vitiligo. METHODS: This prospective analytic study included 20 patients with active non-segmental vitiligo and 20 healthy controls. The patients were exposed to NB-UVB therapy three times per week for 30 sessions. Blood sampling before and after NB-UVB phototherapy was done to evaluate circulating CD4(+) CD25(high) Tregs and Foxp3(+) Tregs. RESULTS: The CD4(+) CD25(high) Tregs% and FoxP3(+) Tregs% were significantly higher in vitiligo patients compared with controls. NB-UVB therapy decreased both of them in patients, but they did not reach those of controls. Each of circulating CD4(+) CD25(high) Tregs% and FoxP3(+) Tregs% didn't correlate with either extent or activity of vitiligo before or after NB-UVB. CONCLUSION: Tregs functional defect is probably having an impact on NSV. NB-UVB may improve the function of Tregs. Understanding the mechanisms through which NB-UVB exert its effect on reducing the number of circulating Tregs would help open up the paths for future therapeutic options.

Evaluation of serum and tissue levels of cold-inducible RNA-binding protein in non-segmental Vitiligo.

Damage-associated molecular patterns (DAMPs) play a role in the pathogenesis of vitiligo. It has been established that the cold-inducible RNA-binding protein (CIRP), a member of the family of cold-shock proteins that respond to stress, is a DAMP molecule that promotes inflammation. The objective was to evaluate the serum and tissue CIRP expression in non-segmental vitiligo (NSV) patients. A sample of 40 participants, 20 NSV patients and 20 control groups of age- and sex-matched healthy individuals were included in this case-control study where the enzyme-linked immunosorbent assay was used in detecting the serum and tissue CIRP levels in participants. The serum and tissue CIRP levels significantly increased in NSV patients compared with the healthy controls, (165.35 ± 24.42, 226.29 ± 24.00 versus 59.81 ± 12.10, 105.86 ± 11.27 pg/ml, respectively) (P < 0.01). Serum and tissue CIRP are significantly correlated with each other (r = 0.641, P = 0.002). Except for a statistically significant positive correlation between CIRP tissue level and VASI (r = 0.539, P = 0.014), the CIRP Serum and tissue did not show any statistically significant correlations with different clinical parameters in patients. ROC curve shows that the cut-off point for serum and tissue CIRP level to differentiate between patients and controls was 86.5, 124.3 pg/ml, respectively, with 100.0% sensitivity, 100.0% specificity and 1.000 AUC for each of them. It is concluded that CIRP may have a crucial role in the pathogenesis of NSV and could be used as a marker for vitiligo and its extent with the need for further large-scale study.

Multipass low fluence, high-frequency 755-nm alexandrite laser versus high fluence, low-frequency 1064-nm long-pulsed Nd: YAG laser in axillary hair reduction of dark skin phototypes: an intra-individual randomized comparative study.

BACKGROUND: Laser hair removal has become popular means of achieving hair reduction with improved quality of life. OBJECTIVE: This study aimed to assess the safety and efficacy of Multipass low fluence, high-frequency 755-nm Alexandrite laser versus the high fluence, low-frequency 1064-nm long-pulsed Nd: YAG laser on axillary hair reduction in women with dark skin phototypes. PATIENTS AND METHODS: This study was carried out on 30 adult women [skin type, IV-VI)] who seek axillary hair reduction. These subjects were adjusted to receive 5 laser sessions with a 1-month interval. One side received high fluence, low-frequency 1064-nm laser where the other side received multipass low fluence, high-frequency 755 nm laser. The follow-up was done using photographs, folliscope, patients' visual analog pain scale. RESULTS: The mean percentage of hair density reduction showed significant improvement in both treated sides being higher in the Alex treated side with corresponding significant decreases in the mean hair thickness. CONCLUSION: Multipass low fluence, high-frequency 755-nm Alex laser practice was verified to be safe and effective for hair removal in dark skin phototypes compared to the high fluence, low frequency 1064-nm long-pulsed Nd:YAG laser.

Fractional versus full ablative CO2 laser in recipient site of non-cultured melanocytes and keratinocyte transplantation in treatment of vitiligo.

BACKGROUND: Melanocyte-keratinocyte transplant procedure (MKTP) or non-cultured epidermal cell suspension transplantation is a very popular surgical modality for treating stable vitiligo. The recipient-site preparation is one potential determinant in the repigmentation outcomes. AIM: To assess the efficacy of fractional CO2 (FCO2 ) laser in recipient-site preparation before MKTP and comparing it to the frequently used full surface laser ablation. METHODS: This randomized comparative trial included 19 patients with 40 stable vitiligo lesions. In each patient, the treated sites were randomly categorized into two groups according to the recipient-site ablation (either fractional or full ablative CO2 laser). Assessment of repigmentation was performed six months after the procedure. RESULTS: Both modalities achieved successful repigmentation of a median of 80% and 77.5% for fractional and full ablation groups, respectively, with a non-statistically significant difference between them. The median of VASI change percent was -73% and -71% with fractional and full surface ablation, respectively. CONCLUSIONS: FCO2 laser ablation is effective for recipient-site preparation before cell suspension transplantation as well as the full ablative CO2 laser.

Different platelet-rich plasma preparation protocols in Female pattern hair loss: Does it affect the outcome? A pilot study.

BACKGROUND: Platelet-rich plasma (PRP) injection is a promising modality for hair regeneration in female pattern hair loss (FPHL). A standard protocol on best methods for PRP preparation has not been established. OBJECTIVES: To optimize standard PRP preparation protocols and evaluate its clinical efficacy in FPHL. METHODS: Comparative study enrolled 40 female patients with FPHL divided randomly into 4 equal groups. Each group received 3 sessions of monthly intradermal injection of PRP prepared by different methods regarding number of spins, centrifugation speeds, type of the centrifuge, and the size of PRP tube. Patients were evaluated by trichoscan before and 1 month after the 3rd session for number of terminal, vellus hair, and average hair width. RESULTS: A statistically significant increase in platelet count in PRP prepared by combination of digital centrifuge, large-sized sodium citrate tube, and low centrifugation speed (900 rpm). All patients showed statistically significant increase in percentage of terminal hair and average width of hair after treatment as assessed by trichoscan, without statistically significant difference between studied groups. CONCLUSIONS: Digital centrifuge, large-sized sodium citrate tubes, and a single spin with low centrifugation speed (900 rpm) were ideal for PRP preparation. PRP is an effective and safe modality in FPHL therapy.

Clinical, trichoscopic, and folliscopic identification of the impact of metabolic syndrome on the response to intradermal dutasteride 0.02% injection in patients with female pattern hair loss: a prospective cohort study.

BACKGROUND: No studies investigating the impact of metabolic syndrome (MetS) in treatment response of female pattern hair loss (FPHL). OBJECTIVE: In this prospective cohort study, we studied the impact of MetS in response to intradermal dutasteride 0.02% injection in patients with FPHL. METHODS: Fifty-one adult participants with FPHL were classified into study cohorts: with MetS and comparison cohorts without MetS. Both groups underwent clinical, trichoschopic, and digital folliscopic evaluation. Treatment was scheduled over a period of 3 months as four weekly sessions, followed by another four bimonthly sessions. Response was evaluated by digital folliscopy, investigator's, and patient's self assessments at 1 and 3 months post-treatment. Side effects were evaluated. RESULTS: In participants with MetS, there was a significant reduction of the mean percentage of terminal hair with significant increase of the mean percentage of vellus hair (p = .003, .006, respectively) compared with participants without MetS at 1 month after treatment. These significant differences persisted at 3 months after treatment; for terminal and vellus hair (p = .000) with significant reduction in the mean hair thickness (p = .002) compared with participants without MetS. CONCLUSIONS: MetS negatively impacted FPHL in terms of response to intradermal injection of dutasteride 0.02% and severity. Further studies are still needed.

Clinical characteristics of pediatric hidradenitis suppurativa: a cross-sectional multicenter study of 140 patients.

Hidradenitis suppurativa (HS) rarely affects pediatric patients. The literature on pediatric HS patients is scarce. This is a cross-sectional study based on case note review or interviews and clinical examination of 140 pediatric patients undergoing secondary or tertiary level care. Patients were predominantly female (75.5%, n = 105) with a median age of 16. 39% reported 1st-degree relative with HS. Median BMI percentile was 88, and 11% were smokers (n = 15). Median modified Sartorius score was 8.5. Notable comorbidities found were acne (32.8%, n = 45), hirsutism (19.3%, n = 27), and pilonidal cysts (16.4%, n = 23). Resorcinol (n = 27) and clindamycin (n = 25) were the most frequently used topical treatments. Patients were treated with tetracycline (n = 32), or oral clindamycin and rifampicin in combination (n = 29). Surgical excision was performed in 18 patients, deroofing in five and incision in seven patients. Obesity seemed to be prominent in the pediatric population and correlated to parent BMI, suggesting a potential for preventive measures for the family. Disease management appeared to be similar to that of adult HS, bearing in mind that the younger the patient, the milder the disease in majority of cases.

Syringes versus Chinese cups in harvesting suction-induced blister graft: a randomized split-body study.

BACKGROUND: Suction blister grafting (SBG) is a technique where the pigmented epidermis is harvested from the donor site by induction of a blister using different suction methods as syringes, Chinese cups, suction device, etc. However, pain, time consumption, incomplete blister formation, and failure of blister development are the main limitations. OBJECTIVE: To compare between cups and syringes of similar diameter in inducing suction blisters. PATIENTS AND METHODS: In 30 patients with stable nonsegmental vitiligo, 2-cm-diameter (20 ml) syringe was applied on the anterolateral aspect of one thigh and a 2-cm-diameter cup on the corresponding site of the other thigh where right and left sides were chosen randomly. Patients were observed untill complete blister development or for a maximum of 3 hours. Suction blister induction time (SBIT) and the blister diameter were recorded for each patient. Pain during the process of induction was evaluated. RESULTS: Incomplete blister development was noted in 9 out of 30 (30%) with 2 cm syringes and 6 out of 30 (20%) with the similar diameter cups with no significant difference (P = 0.49). No significant difference was found between SBIT induced by the 2 cm syringes and the similar size cups (101.17 ± 68.14 minutes, 98 ± 56.84 minutes, respectively) (P = 0.85). Meanwhile, blister diameter induced by either syringe or cup was not significantly different (P = 0.37). Anesthesia was for short duration with xylocaine, and pain was intolerable in both sides in the first seven patients. A combination of xylocaine and bupivacaine was used with prolonged loss of pain in 17 of the remaining 23 patients and tolerable pain in six patients similarly in both sides. CONCLUSION: According to present results, the differences in SIBT, diameter of blisters, and number of complete blister formation induced by either syringes or cups of similar size were not significant. Therefore, whatever the available and feasible technique for the surgeon will be the ideal choice. A combination of xylocaine and bupivacaine is recommended to overcome the accompanying pain of the procedure.

Intense pulsed light versus photodynamic therapy using liposomal methylene blue gel for the treatment of truncal acne vulgaris: a comparative randomized split body study.

Acne vulgaris is an extremely common skin condition. It often leads to negative psychological consequences. Photodynamic therapy (PDT) using intense pulsed light has been introduced for effective treatment of acne. The objective was to study the effect of PDT in truncal acne vulgaris using liposomal methylene blue (LMB) versus IPL alone. Thirty-five patients with varying degrees of acne were treated with topical 0.1 % LMB hydrogel applied on the randomly selected one side of the back, and after 60 min the entire back was exposed to IPL. The procedure was done once weekly for three sessions and patients were re-evaluated 1 month after the third session by two independent dermatologists. Acne severity was graded using the Burton scale. Patient satisfaction using Cardiff Acne Disability Index (CADI) was recorded before and after treatment. On LMB-pretreated side, inflammatory acne lesion counts were significantly decreased by 56.40 % compared with 34.06 % on IPL alone. Marked improvement was seen on LMB-pretreated side in 11.5 % of patients compared with 2.8 % on IPL alone. There was a correlation between CADI score and overall improvement. Our study concluded that LMB-IPL is more effective than IPL alone, safe with tolerable pain in the treatment of acne vulgaris on the back. LMB-IPL is more effective than IPL alone, safe with tolerable pain in the treatment of acne vulgaris on the back.

ULBP3: a marker for alopecia areata incognita.

Alopecia areata incognita (AAI) is a type of diffuse hair fall with no confirmatory diagnostic test. The UL16 binding protein-3 (ULBP3) is ligands for natural-killer group 2, member D (NKG2D) receptor. It is a key regulator of both innate and adaptive immune responses. In the normal hair follicle, ULBP3 is turned off. However, different studies reported its high level in alopecia areata (AA). Therefore, this study was done to evaluate ULBP3 in AAI in comparison with telogen effluvium (TE), female pattern hair loss (FPHL), and normal hair. Biopsy specimens from 36 females suffering from AAI, 15 with FPHL, nine with TE, and ten healthy female controls were subjected to the immunogenetic detection of ULBP3 levels by real-time polymerase chain reaction (PCR). A high statistically significant increase in ULBP3 level in AAI patient group compared with FPHL, TE, and normal hair was detected. ULBP3 levels were positively correlated with the age and duration of the disease. Accordingly, ULBP3 may act as a confirmatory test for AAI. ULBP3 may be implicated in the disease pathogenesis, progression, and chronicity, and AAI may be a subtype of AA.

Skin diseases in patients with primary psychiatric conditions: a hospital based study.

BACKGROUND: Although the relationship between skin diseases in patients with primary psychiatric conditions is important for patient management, studies on this issue are limited. OBJECTIVE: To detect the frequency and type of cutaneous disorders among patients with primary psychiatric conditions. SUBJECTS AND METHODS: This analytic cross-sectional study was conducted on a total of 400 subjects - 200 patients with primary psychiatric disorders and 200 age and sex matched individuals free from primary psychiatric disorders. Patients included in the study were diagnosed according to The Diagnostic and Statistical Manual of Mental Disorders (DMS IV) Criteria. A specially designed questionnaire including socio-demographic data, medical history, family history and dermatological examination was applied. The data were statistically analyzed. RESULTS: There was a significant statistical increase in the prevalence of skin diseases in general and infectious skin diseases in particular in psychiatric patients compared with non-psychiatric patients (71.5% versus 22%, P<0.001) and (48% versus 11%, P<0.001), respectively. Parasitic infestations (42.7%) were the most common infectious skin diseases in psychiatric patients (P<0.001). Infectious skin diseases in psychiatric patients were seen most in patients diagnosed with schizophrenia (83.6%) and least in obsessive compulsive disorders (30%)(P<0.001). Psychogenic skin disorders were found in 8.4% of psychiatric patients with skin diseases; delusional parasitosis was the most common (50%). CONCLUSION: Health education of psychiatric patients and/or of their caregiver and periodic monthly inspection of psychiatric patients are highly indicated for the prevention and control of infectious skin diseases in primary psychiatric patients.

Morphometry and epidermal fas expression of unexposed aged versus young skin.

BACKGROUND: Identifying the molecular mechanisms of intrinsic aging is critical in developing modalities for reversal of cutaneous aging. OBJECTIVE: The objective was to evaluate the expression of epidermal Fas, epidermal thickness, collagen, and elastic fibers degeneration in unexposed skin of aged individuals compared with young ones. MATERIALS AND METHODS: Skin biopsies were taken from normal skin of the back of 22 old subjects (age range: 48-75 years) and 15 young subjects (age range: 18-28 years). Skin sections were stained with hematoxylin and eosin, Masson trichrome, orcein. Epidermal thickness was measured with image analyzer and scoring was done for collagen and elastic fiber degeneration. Fas immunostaining was done. Quantitative and qualitative data were compared statistically between the old and young subjects. RESULTS: A statistically significant decreased epidermal thickness was found in old compared with young skin (P<0.05). A statistically significant number of patients showed decreased epidermal thickness, density, and fragmentation of both collagen and elastic fibers in old compared with young skin (P<0.001). Epidermal Fas expression was detected in 19 of 22 old subjects (86.4%) compared with 2 of 15 young subjects (13.3%) (P<0.001). There was no statistically significant correlation between age of old subjects and each of epidermal thickness, collagen, and elastic fiber degeneration. CONCLUSION: The decreased epidermal thickness and morphological alteration of collagen and elastic fibers are not correlated with aging and Fas-mediated apoptosis could be involved in thinning of the epidermis in unexposed aged skin.