Microneedling and 5-flurouracil can enhance the efficacy of non-cultured epidermal cell suspension transplantation for resistant acral vitiligo.

Acral vitiligo is often resistant to medical and surgical treatments. Non-cultured epidermal cell suspension (NCES) transplantation is a common surgical therapeutic modality for vitiligo. 5-Flurouracil (5-FU) in combination with microneedling has been found to be useful in treating vitiligo. To evaluate the efficacy of NCES transplantation either alone or following microneedling and topical 5-FU for resistant acral vitiligo. This study included 50 patients with resistant acral vitiligo allocated into two groups; group A received only NCES transplantation, and group B received microneedling and topical 5-FU 1-2 weeks prior to NCES transplantation. All patients were monitored for 24 weeks to evaluate the repigmentation response and the immunohistochemical expression of Human Melanoma Black-45 (HMB-45). At 24 weeks, the repigmentation response was significantly higher in the combination group than in the monotherapy group (p = 0.029). Moreover, the percentage of patients with successful repigmentation of 75% or greater was significantly higher in the combination group (84%) than in the monotherapy group (40%) (p = 0.001). Furthermore, lesional skin showed a significant increase in the number of active HMB+ melanocytes in both groups but without any significant difference between the two groups. However, the color intensity of HMB-45 immunostaining was significantly higher in the combination group compared to the monotherapy group (p = 0.012). There was no significant difference between the two groups regarding the adverse effects. The repigmentation response of resistant acral vitiligo to NCES transplantation could be enhanced by prior microneedling followed by topical 5-FU.

Platelet-Rich Plasma Versus Tretinoin in Treatment of Striae Distensae: A Comparative Study.

BACKGROUND: Striae distensae (SD) are dermal scars associated with atrophy of the epidermis. OBJECTIVE: To evaluate the effect and safety of intralesional injection of platelet-rich plasma (PRP) versus topical tretinoin 0.05% in treatment of SD. METHODS: Thirty patients (27 females and 3 males) had bilateral striae distensae were enrolled in this study. In every patient, half of the selected striae were treated with PRP intralesional injection. The other half was treated by topical tretinoin. Skin biopsies were taken from both sides before and after the treatment. Digital photographs were taken at the baseline and at the end of follow-up period. Clinical improvement was evaluated by 2 blind dermatologists in addition to the patient's satisfaction rating. RESULTS: There was statistically significant improvement in the SD treated with PRP and topical tretinoin cream. The improvement was more in the SD treated with PRP injections (p = .015). Patient's satisfaction showed that the improvement was more in the PRP-treated side (p = .003). Collagen and elastic fibers in the dermis were increased in all biopsies after treatment. CONCLUSION: PRP injection and topical tretinoin are safe for the treatment of SD, but PRP is more effective and it gives better therapeutic response than tretinoin.

Sweet's syndrome: diagnostic criteria revisited.

The diagnosis of Sweet's syndrome (SS) is based on a set of criteria that requires the presence of two major and at least two minor criteria. In some cases, however, the diagnosis is not as straightforward due to the absence of certain criteria. The objective of the present study was to review the clinical, histopathological, and laboratory features of the current diagnostic criteria for SS, and to evaluate their validity in the cases reported in the literature as well as in 40 patients treated at our institution. Our comprehensive review of the current criteria for SS reveals that the two major criteria have been consistently present in all cases - including ours - since the first description of SS in 1964. With regard to the minor criteria, on the other hand, there has been marked variability between different studies, and many cases failed to fulfill the requirement of showing two minor criteria. In order to simplify the diagnosis, avoid misdiagnosis, and allow for prompt treatment, we propose two sets of revised diagnostic criteria for SS. The first set comprises constant clinical and histopathological features that must be present and are by themselves sufficient for the diagnosis of SS to be established. The second set includes variable features whose absence does not warrant ruling out SS.

Combined low-dose isotretinoin and long-pulsed nd: YAG laser in the treatment of post-acne erythema.

Post-acne erythema (PAE) is a bothering skin condition that emerges from inflammatory acne and persists after its resolution. It is characterized by telangiectasia and erythematous macules. the role of 1064-nm Nd: YAG when combined with low-dose isotretinoin in the acne erythema treatment. forty-eight PAE patients were involved in the study. They were divided into two groups; group (A) patients administering a low dose of oral isotretinoin (10 mg/day) and underwent a total of six two-week interval sessions of 1064 ND-YAG laser treatment, group (B) patients administering a low dose of oral isotretinoin (10 mg/day) only. All adverse effects experienced during the course of therapy were documented, and photos were taken before the start of the treatment and following the end of the treatment duration. Following the completion of the therapeutic intervention, a significant improvement in clinical condition was observed in both groups, with more improvement in group (A) compared to group (B) as evidenced by a notable improvement in the score on the Clinician Erythema Assessment Scale (CEAS) and also a significant decrease in the mean value of optical density of the erythema. combined 1064-nm Nd: YAG with low-dose isotretinoin may be an efficient and secure line in the PAE treatment. Also, the combined therapy had superior results when compared to low-dose isotretinoin alone.

Comparative evaluation of the efficacy of topical tacrolimus 0.03% and topical calcipotriol 0.005% mixed with betamethasone dipropionate versus topical clobetasol 0.05% in treatment of alopecia areata: A clinical and trichoscopic study.

BACKGROUND: Alopecia areata (AA) is a common non-scarring hair loss disorder that affects children and adults with a great psychological burden because of its recurrent and sometimes treatment-refractory nature. OBJECTIVE: To compare the efficacy of topical calcineurin inhibitor, topical potent steroid combined with vitamin D analogue versus topical superpotent steroid in treatment of localized AA. PATIENTS AND METHODS: Sixty subjects with chronic (>1 year) localized (SALT score < 25%) AA, confirmed clinically and dermoscopically, were randomized into three groups. Group I used topical 0.03% tacrolimus (Tarolimus®), group II used topical potent steroid combined with vitamin D analogue (Daivobet®). and group III used topical superpotent steroid (Dermovate®). All patients continued a daily therapy for three successive months and were followed up for three other months. Assessment was done using PULL test, SALT score, and dermoscopic comparison before and after therapy. RESULTS: Group II showed comparable statistical results to group III with lower values in a non-statistically significant way. Group I achieved the least improvement among all groups. CONCLUSION: Combined vitamin D analogues with potent steroid appears to be a more convenient treatment for localized AA than superpotent steroids because of less side effects and comparable efficacy. Tacrolimus needs further research or formula customization to be used as a topical therapy for AA.

Microneedling combined with botulinum toxin-A versus microneedling combined with platelet-rich plasma in treatment of atrophic acne scars: a comparative split face study.

BACKGROUND: Atrophic post-acne scarring constitutes a troublesome cosmetic concern for both patients and dermatologists. Old and new therapies as well as combinations are being introduced to achieve a satisfactory response. Microneedling has been used either alone or under different combinations for its treatment. The aim was to compare its combination with topical platelet-rich plasma versus its combination with topical Botulinum Toxin-A. METHODS: 30 subjects with different types and grades of atrophic post-acne scars completed the study. Right side of the face was treated with microneedling and platelet-rich plasma while the left side was treated microneedling and Botox. Response was assessed using two different scales. Patient satisfaction and pain were also assessed. RESULTS: Regarding response to therapy and according to the quartile grading scale, there was no statistically significant difference between the two sides where (23.4% & 13.3%) of the right and left sides, respectively, had an excellent response. Regarding the difference in the qualitative global scarring grading system before and after treatment, there was a highly statistically significant improvement on both sides with higher improvement on the right side than left side but in a non-statistically significant way. CONCLUSIONS: Both combinations present efficacious options for treating acne scars with comparable efficacy. TRIAL REGISTRATION: Registered and approved prospectively by the ethical review board of the faculty of medicine, Zagazig University.

Immunotherapeutic modalities for the treatment of recalcitrant plantar warts: a comparative study.

BACKGROUND: Plantar warts are sometimes resistant or they tend to recur after every possible destructive therapy. Immunotherapy has been used as a promising alternative therapeutic option in such recalcitrant cases. AIM: To evaluate and compare the efficacy and safety of the intralesional injection of vitamin D3, zinc sulfate 2%, and Candida antigen in the treatment of recalcitrant plantar warts. PATIENTS AND METHODS: The study included 152 adult patients with single or multiple recalcitrant plantar warts. They were equally subdivided into four groups (38 patients in each): 2% zinc sulfate, vitamin D3, Candida antigen, and normal saline respectively. Injections were done at 3-week intervals until complete resolution or for a maximum of 4 sessions. RESULTS: Complete response was achieved in 20 patients (52.7%) of the zinc sulfate group, 34 patients (89.5%) of the intralesional vitamin D3 group, 25 patients (65.7%) of the intralesional Candida antigen group and 8 patients (21.2%) of the saline group. The difference between the groups was statistically significant in favor of vitamin D3 (p = .037). CONCLUSIONS: Recalcitrant plantar warts were best treated with vitamin D3 that also has the advantages of better response on distant warts, minimal side effects, and low rate of wart recurrence.

Assessment of various intralesional injections in keloid: comparative analysis.

 : In reaction to skin injury in genetically predisposed persons, the keloid is formed and marked by benignant overgrowth of dermic collagen. Intralesional triamcinolone was used in the treatment of keloids with varying results. AIM: Intralesional triamcinolone is a gold standard in treating the keloids in comparison with its effectiveness versus intralesional 5-fluorouracil intralesional verapamil and intralesional platelet-rich plasma. PATIENTS AND METHODS: Several 160 cases were categorized into four groups of each group-containing 40 cases. Group-A (control) treated with intralesional triamcinolone and Group-B intralesional verapamil, Group-C intralesional 5-fluorouracil, and Group-D intralesional platelet-rich plasma. Patients were assessed for clinical response based on a decrease in the patient and observer scar assessment scale (POSAS) at baseline and the end of treatment. RESULTS: The mean base-line POSAS score was 91 ± 10.98 SD check-in Group-A, 90 ± 10.85 in Group-B, 89 ± 10.06 in Group-C, and 92 ± 10.84 in Group-D. POSAS score after 24 weeks 36 ± 12.74 in Group-A, 29 ± 10.91 in Group-B, 39 ± 13.74 in Group-C, 36 ± 12.74 in Group-D. Statistically, a significant difference was observed between groups. CONCLUSION: Intralesional verapamil reported to be the most effective therapy and platelet-rich plasma was effective as intralesional triamcinolone acetonide with no serious side effects and 5-fluorouracil was less effective in treating the keloids.

Intralesional cryotherapy versus cryotherapy spray for the treatment of recalcitrant plantar warts: a prospective, randomized study.

BACKGROUND: Recalcitrant plantar warts are representing a therapeutic challenge. Intralesional cryotherapy (ILC) has emerged as a promising therapeutic option in recalcitrant plantar warts treatment. OBJECTIVE: To compare the clinical efficacy, safety and tolerability of (ILC) versus Cryotherapy spray (Cryo-sp) for treatment of recalcitrant plantar warts. METHODS: One hundred-thirty patients with recalcitrant plantar warts were assigned equally to two groups. Group A received ILC and group B treated with Cryo-SP. Both groups received one session at 2 weeks intervals until complete clearance or for a maximum of 5 sessions. The main outcome was complete clearance of warts guided by dermoscopy. Follow-up was carried out for 6 months after the treatment. RESULTS: Complete clearance occurred in 80.3% in group A compared to 50.8% in group B with a highly significant difference between both groups (p < .001). The clearance rate was faster in group A (1.5 ± 0.40) than group B (4 ± 1.3) (p < .001). The adverse effects were mild in group A than group B (p < .001). The recurrence rate was 2% in group A versus 23.3% in group B (p < .007).patients satisfaction was higher in ILC (p < .001). CONCLUSION: Intralesional cryotherapy is more effective, requiring few sessions with a low recurrence rate than cryo-sp.

Non-cultured epidermal cells suspended in either platelet-rich plasma or ringer lactate for stable vitiligo: A prospective comparative study.

BACKGROUND: Noncultured epidermal cell suspension (NCES) transplantation is a commonly used surgical treatment for resistant stable vitiligo. The combination of platelet-rich plasma (PRP) with different therapeutic modalities for vitiligo yielded higher repigmentation response, probably due to platelet-derived growth factors. AIM: To evaluate the efficacy of PRP-suspended NCES compared to NCES suspended in Ringer's lactate (RL) solution in the treatment of stable vitiligo. PATIENTS AND METHODS: A prospective comparative study was conducted on 40 patients with stable vitiligo. They were divided into two equal groups: group A (treated with RL-suspended NCES) and group B (treated with PRP-suspended NCES). All patients were followed-up for 6 months for assessment of their therapeutic response regarding clinical outcomes and immunohistochemical expression of HMB-45 in lesional skin. RESULTS: Patients treated with PRP-suspended NCES showed a significantly higher repigmentation response compared to those treated with RL-suspended NCES at 1, 3, and 6 months after treatment (p = 0.015, 0.023, 0.029, respectively). The expression of HMB-45 significantly increased in both groups after therapy, but without a significant difference between the two groups. CONCLUSION: The repigmentation response of NCES can be enhanced by suspending the melanocytes in autologous PRP.

The potential role of insulin-like growth factor 1 in acne vulgaris and its correlation with the clinical response before and after treatment with metformin.

BACKGROUND: Acne vulgaris (AV) is a complex and multifactorial inflammatory disease affecting the pilosebaceous follicles. Optimum treatment of AV is important to reduce the disease severity and recurrence. AIM: To evaluate the role of metformin in the treatment of acne vulgaris by reducing the level of insulin-like growth factor 1. METHODS: Fifty patients with AV were included in the study. Their ages ranged from 16 to 30 years, and they had different grades of the disease. IGF-1 levels were measured in all patients before and after the treatment with metformin. RESULTS: After 4 months of therapy, there was a clinical improvement detected by an improvement in the global acne grading system (GAGS) score and also a significant decrease in IGF-level. CONCLUSION: IGF-1 may have an important role in the pathogenesis of acne; also we can presume that oral metformin is an effective and safe line in the treatment of AV.

Plasma gelsolin levels in patients with psoriatic arthritis: a possible novel marker.

BACKGROUND: Psoriatic arthritis (PsA) is an inflammatory disorder affecting the joints of psoriatic patients. Gelsolin regulated the actin assembly and disassembly. Reduction in plasma gelsolin levels was detected in tissue damages, including trauma, sepsis, and chronic inflammatory disorders. OBJECTIVES: The study aims to investigate the potential role of gelsolin in PsA and to determine the association between gelsolin and the disease activity. METHODS: Plasma gelsolin levels were measured in 76 PsA patients in comparison with 40 patients having psoriasis only and 40 age- and sex -matched healthy controls. RESULTS: Plasma gelsolin levels were decreased in PsA patients compared to controls and psoriasis-only patients (p Ë‚ 0.0001). The optimal cutoff point of gelsolin was 172.5 mg/L. Gelsolin showed 92.1% sensitivity and 95% specificity in detecting PsA. But, it had 92.1% sensitivity and 80% specificity in differentiating between psoriasis and PsA. Plasma gelsolin showed a significant negative correlation with inflammatory markers as C-reactive protein and erythrocyte sedimentation rate (p < 0.0001 and p = 0.039; respectively). A significant negative correlation between plasma gelsolin and PsA activity was detected (p < 0.0001). The PsA activity was defined by the Disease Activity for Psoriatic Arthritis Score and the Composite Psoriatic Disease Activity Index. CONCLUSIONS: The plasma gelsolin levels were decreased in PsA patients, suggesting that gelsolin may be implicated in the chronic joint inflammation process. Plasma gelsolin seems to be a useful predictive biomarker for diagnosing PsA and monitoring the disease activity.Key Points• This study introduces an unprecedented focus within which the relationship between the levels of plasma gelsolin and PsA is investigated• The study examines the potential role of gelsolin in PsA, and detects the association between gelsolin and the arthritis activity.• There were decreased plasma gelsolin levels in PsA patients. So, gelsolin can constitute a role in the chronic joint inflammation process.• Gelsolin may be a useful biomarker for diagnosing of PsA and monitoring the disease activity.

Evaluation of platelet-rich plasma vs intralesional steroid in treatment of alopecia areata.

BACKGROUND: Alopecia areata (AA) is nonscarring patchy area of hair loss. Platelets rich plasma (PRP) promotes development of new hair follicles. Dermoscopy is a diagnostic tool that helps in evaluation of skin microstructures which are not visible to naked eye. AIM: To evaluate safety and efficacy of (PRP) vs intralesional corticosteroid (ILCs) in treatment of AA. PATIENTS AND METHODS: This study was conducted on 80 patients of both sexes who had AA. Patients were classified into Group I treated by ILCs and group II treated by (PRP). Results were assessed by dermoscopic evaluation and by hair re-growth score (RGS) at (baseline), 2, 4, 6, 8, and 12 weeks. Patients were followed up for 6 months. RESULTS: There was greater hair re-growth after treatment in both groups. In group I, (26) patients (65%) showed improvement >70% compared to 29 patients (72.5%) in group II. There was significant re-growth of pigmented hair and decrease in dystrophic hair (P < 0.001) by dermoscopic evaluation in both groups. The difference between both groups was insignificant (P = 0.57). At follow-up, two (5%) patients in group II had relapse compared to 10 (25%) patients in group I. CONCLUSION: Platelets rich plasma is safe and promising therapeutic option in AA.

Lichen myxedematosus: diagnostic criteria, classification, and severity grading.

BACKGROUND: Lichen myxedematosus (LM) is a rare, chronic idiopathic disorder characterized clinically by waxy, closely set papules and histopathologically by diffuse dermal mucin deposition and fibroblast proliferation. The most recent classification of LM was proposed in 2001; however, it seems to be complex, confusing, and imprecise. Herein, we present seven cases of LM to evaluate the validity of the current classification, to propose new diagnostic criteria and classification, and to suggest a clinically relevant severity grading system for this rare disorder. MATERIALS AND METHODS: The study included seven patients with different presentations and severities of LM. All patients were subjected to thorough dermatological and systemic examination, routine laboratory tests, evaluation of thyroid function, protein electrophoresis, and detailed investigations to detect systemic involvement. RESULTS: The current classification does not meet the requirements of proper diagnosis of different presentations of LM. Subtyping of the studied patients differs greatly according to the old classification and the newly proposed one. New diagnostic criteria, classification, and grading are consequently suggested. CONCLUSIONS: We propose two sets of diagnostic criteria to define the disease more precisely and to avoid confusion associated with the other classification. The first set comprises constant clinical and histopathological features that are always present in every case, and the second set includes associated features that were variably reported in some patients. LM is then subclassified according to the presence or absence of systemic manifestations into a systemic severe form (scleromyxedema) and a non-disabling, pure cutaneous form.

Classical Kaposi sarcoma: case reports with unusual presentation on the penis and scrotum.

BACKGROUND: Kaposi sarcoma (KS) is the most common vascular neoplasm. Any skin area could be involved, including the genitalia. Traditionally, classic KS lesions have a general distribution, often involving skin of the feet and legs, and to a lesser extent, that of the hands, arms, and trunk. KS limited to the external genitalia is extremely rare in HIV seronegative individuals. METHODS: We report six patients of classic KS with generalized dermal KS lesions. RESULTS: Two of them presenting with unusual KS lesions on the penis and scrotum beside the other dermal lesions. Patients were HIV negative and human herpes virus eight positive. Histological examination showed classical KS. CONCLUSIONS: Primary KS of the penis and scrotum is rare but could occur in HIV-negative patients.