Surgical excision and immediate postoperative radiotherapy versus cryotherapy and intralesional steroids in the management of keloids: a prospective clinical trial

To compare the efficacy and tolerability of surgical excision and radiotherapy with those of cryotherapy and intralesional steroid treatment of keloids. Twenty-six patients with a total of 76 keloids were enrolled in this study. Nineteen patients with 44 keloids underwent surgical excision combined with immediate 12-Gy irradiation [group A] while the remaining 9 patients with 32 keloids received multiple sessions of intralesional steroid treatment after cryotherapy which continued until flattening of lesion[s] occurred [group B]. Two patients were included in both treatment groups. All patients were followed up at regular intervals for at least 1 year. In both treatment groups, keloids responded well without any major side effect. While patients of group A were all satisfied, those of group B [with a mean number of treatment sessions of 5.84 +/- 2.51] experienced more side effects, a more prolonged course, a higher recurrence rate and less satisfaction. This study showed that surgery plus immediate postoperative irradiation was an effective and relatively safe choice for treatment of keloids. Although cryotherapy combined with intralesional steroids was associated with more side effects and higher relapse rates, it could be a good choice for small and newly formed keloids

Lack of association between ctla-4 A49G polymorphism and vitiligo

Vitiligo is an acquired skin disorder that selectively destroys melanocytes in epidermis with an unknown etiology. To investigate the exon 1 A49G polymorphism of cytotoxic T lymphocyte antigen-4 [ctla-4] gene in vitiligo patients. The A49G polymorphism was detected by Po-lymerase Chain Reaction-Restriction Fragment Length Polymorphism [PCR-RFLP] method in 101 patients and 208 normal healthy age/ethnicity matched individuals. The frequencies of heterozygote genotypes in patients and controls were found to be 42 [41.6%] of 101 and 85 [40.9%] of 208, respectively. The frequencies of homozygote A and G genotypes were 49 [48.5%] and 10 [9.9%] in 101 patients, whereas, these frequencies in 208 control individuals were 103 [49.5%] and 20 [9.6%], respectively. There was no significant difference between the genotype [P = 0.98] and allele [P = 0.86] frequencies of A49G polymorphism in patients and normal healthy individuals. Our results indicate that in contrast to several immune mediated disorders, there is no asso-ciation between ctla-4 A49G gene polymorphism and vitiligo

Efficacy of topical immunotherapy of extensive and/or chronic alopecia areata with diphencyprone

Highly variable results of topical immunotherapy with diphencyprone [DPC] in the treatment of alopecia areata have been reported so far. The purpose of this study was to evaluate the efficacy and tolerability of DPC in the treatment of severe and chronic alopecia areata. Twenty-eight patients [16 female and 12 male, 10-35 years old, mean age 25 years] with chronic and/or extensive alopecia areata were enrolled in an open-label clinical trial. After sensitization with 2% DPC, progressively higher concentrations beginning at 0.001% were applied weekly for 6 months to one side of the scalp. The maximum concentration of DPC was 2%.Twenty-seven of 28 patients completed therapy. The overall response rate was 81.5% [22 cases]. Complete response [90% -100% terminal hair re-growth] was obtained in 22.2% [6 cases] and partial response [10%-90% terminal hair re-growth] in 59.3% [16 cases], and 18.5% [5 cases] showed no regrowth. In all patients an eczematous reaction consisting of erythema, itching, and scaling at the site of application was observed. Other observed side effects included occipital lymphadenopathy in 40.7% [11 cases], severe eczema /blister formation in 40.7% [11 cases], hyperpigmentation in 18.5% [5 cases]. Notably, partial recurrence was observed in 66.7% [18 cases] of these patients after 6 to 12 months of follow up. Topical DPC treatment for alopecia areata is an effective therapy with a relatively high relapse rate