Evaluating the efficacy of primary excision and closure for the management of lip leukoderma and introducing the surgical site morbidity score as an effective tool for assessment of postoperative morbidity.

The lips are considered of great importance for the perception of beauty and there is still a lacuna in the attempt to successfully re-pigment resistant areas of vitiligo especially the lips. No technique evolved so far ensures 100% pigmentation with a good cosmetic appearance. To study the efficacy and cosmetic outcome following primary excision and closure in the management of lip vitiligo and assessing postoperative morbidity using the created surgical site morbidity score (SSMS). Twenty-five patients with vitiligo involving the inner margin of lower lips were posted for primary excision and closure of the vitiliginous area. Patients were followed up at 7 days and every 6 months. A SSMS including pain (P), healing time (H), and presence of complications (C) as parameters for assessment of postoperative morbidity were recorded at every follow-up visit. All patients showed healthy lip mucosa within 7 days of the procedure and no recurrence was noted at 24 months of follow up. The postoperative morbidity based on the SSMS was minimal, with a mean score of P2H8C0. Primary excision and closure technique is a safe and inexpensive modality in the management of lip vitiligo with immediate results and excellent cosmetic outcomes.

Monozygotic twins with atrophia maculosa varioliformis cutis.

Atrophia maculosa varioliformis cutis (AMVC) is a sporadic or inherited childhood disorder, signified by the occurrence of pitted scars, usually over the face. We report two cases of AMVC occurring in monozygotic twins.

Tretinoin enhances minoxidil response in androgenetic alopecia patients by upregulating follicular sulfotransferase enzymes.

Minoxidil sulfate is the active metabolite required to exert the vasodilatory and hair growing effects of minoxidil. For hair growth, sulfotransferase enzymes expressed in outer root sheath of the hair follicle sulfonate minoxidil. The large intra-subject variability in follicular sulfotransferase was found to predict minoxidil response and thus explain the low response rate to topical minoxidil in the treatment of androgenetic alopecia. A method to increase minoxidil response would be of significant clinical utility. Retinoids have been reported to increase minoxidil response. The purported mechanism of action was retinoid modulation of skin permeation to minoxidil; however, evidence to the contrary supports retinoids increase dermal thickness. In order to elucidate the effect of topical retinoids on minoxidil response, we studied the effect of topical tretinoin on follicular sulfotransferase. In this study, we demonstrate that topical tretinoin application influences the expression of follicular sulfotransferase. Of clinical significance, in our cohort, 43% of subjects initially predicted to be nonresponders to minoxidil were converted to responders following 5 days of topical tretinoin application. To the best of our knowledge, this is the first study to elucidate the interaction mechanism between topical minoxidil and retinoids and thus provides a pathway for the development of future androgenetic alopecia treatments.