Application of Fractional Microneedling Radiofrequency and Autologous Platelet-Rich Plasma in Managing Facial Acne Scars.

Background: Many treatment modalities were tried to treat acne scar & still big challenge for dermatologists. Radiofrequency is a non-ionizing electromagnetic radiation used in medicine for nearly 75 years and the application of autologous Platelet-Rich Plasma has been safely used and documented in many fields of medicine. In dermatology and cosmetics they also are used in treating different conditions. Aim of Study: To evaluate the clinical efficacy of fractional microneedling radiofrequency (FMR) and autologous Platelet-Rich Plasma (PRP) a for treatment of facial acne scars. Patients and Methods: A therapeutic comparative study carried out in Dermatology Sulaimani Private Center for period from 1st of November, 2014 to end of June, 2015. Forty patients with acne scar were included, we divided these patients into 2 groups; group –A (22 patients were treated with FMR alone) & group- B (18 patients treated with both FMR & autologous PRP). Both groups were treated by 3 sessions at 4 weeks interval in between sessions. Clinical assessment of improvement was assessed by the patient himself (patient assessment) and two dermatologists by using standardized digital photography (physician assessment). Results: Most of the patients in both groups had showed a good improvement in their facial acne scar with the use of our treatment. Females were more than males with mean age of 30 years. There was a significant association between excellent improvement (by physician assessment and patients assessment) and patients acne scar treated in group- B (FMR & PRP) (p=0.02). Conclusion: Combination of FMR & autologous PRP is highly effective method for treating acne scars and it had an excellent satisfaction rate among patients.

Efficacy and safety of yellow light diode laser 577nm for treatment of melasma patients in Sulaymaniyah city

Background: Recent evidence suggests that angiogenetic factor involved in the pathogenesis of melasma. Yellow light laser which emits 577 nm may has effect on dermal vasculature and may be of benefit in the treatment of melasma

Objective: To evaluate the efficacy and safety of yellow light laser 577 nm for the treatment of melasma in Fitzpatrick skin types II-IV in both male and female patients

Methods: Thirty three patients with melasma were enrolled, from which 30 patients completed the study [5 males, 25 females], age range of [20-40] years, duration of melasma between [2-10] years. They all are either dermal or mixed according to Wood's light examination, Each patient received 2 sessions of yellow light laser 577 nm treatments to the face at 4 weeks interval. The treatment fluency ranged from 10-15 J/cm2, with the pulse duration of 100 ms for skin type II, III, and 120 ms for skin type IV. Clinical parameters included patient self assessment of changes in the pigmentations after each treatment session and 8 weeks after the last session and two investigators independently evaluated Melasma Area and Severity Index [MASI] score before each session and 8 weeks after the last session

Result: Mean MASI score decreased dramatically after treatment from 18.6 +/- 7.5 before treatment to 7.6 +/- 4.5; eight weeks after the last treatment, with a P-value < 0.001 which is statistically significant. Patient´s self assessment revealed that 14 of the patients were experienced excellent improved, 10 of the patients moderately improved, 4 of the patients mildly improved, no patients had no changes and 2 of the patients develop post inflammatory hyperpigmentation

Conclusion: The use of yellow light diode laser 577nm is an effective and safe treatment option for the demal and mixed type of melasma in both males and female patients with Fitzpatrick skin types II-IV

Diabetic dermopathy as marker for early detection of myocardial infarction

There are many cutaneous signs in diabetes mellitus [DM] which is the most common endocrine disorder among the general population. Diabetic Dermopathy [DD] or Shin Spots are the most common cutaneous signs of diabetes. Although they occur individually in people who do not have diabetes, if four or more are present the specificity is high for microvascular disease in other tissues. This study was done to evaluate frequency of diabetic dermopathy among diabetic patients and use this obvious subtle clinical sign as marker for early detection of atherosclerotic changes in diabetic patients including myocardial infarction. This study was done at diabetic center in Sulaimani intensive care unit[IUC] in teaching hospital of Suliamani during the period from November 2008 to June 2009. A total of 384 patients with Diabetes mellitus were included in this descriptive case series hospital-based study. All patients were diagnosed by specialist diabetician as a case of DM depending on classic diagnostic criteria of DM. All patients were thoroughly assessed regarding the age, sex, skin color, duration of diabetes mellitus and treatment regime. Careful skin examinations has been performed for diabetic dermopathy, diabetic wet gangrene of foot. Diagnosis of myocardial infarction was done either by electrocardiographic changes or by plasma biochemical marker. Eighty four [21.9%] case with DD were reported in our study; fifty four [64.3%] case of them were females while the remaining 30 [35.7%] cases were male. Diabetic patients with myocardial infarction were 44[11.5%] cases, 36 cases as acute MI. while the other eight cases were old cases of MI. Of these 44 cases 16[36.4%] had DD while 28[63.6%] had no DD. There was a statistically significant association between the myocardial infarction and the frequency of diabetic dermopathy and we should use this obvious subtle clinical sign as marker for early detection of atherosclerotic changes in diabetic patients including myocardial infarction. Wet gangrene of the foot is also considered a marker of bad glycemic control.

Herpes simplex labialis virus is a risk factor for vitiligo [post- herpes simplex labialis vitiligo]

Herpes simplex labialis is a common disease and is the major cause of erythema multiforme. Recently post-herpes labialis leukoderma had been noticed on the lips of Iraqi patients. The aim of the present work is to assess this new pigmentary problem. A total of 24 patients with post-herpes labialis leukoderma were included in this study. Full history and a thorough physical examination were done for all patients. Fourteen females [58.37%] and 10 males [41.67%] were studied. Their ages ranged between 7-53 years. Koebner phenomenon was positive in 17 [70.83%] patients. Family history of vitiligo in close relatives was positive in 13 [54.17%] of patients. The findings of the present work are in favor that this type of leukoderma is a variant of vitiligo that may be induced by herpes-simplex labialis.

frequency of some deramatoses related to increase solar radiation exposure in Sulaimania city

Various skin disorders are related to increase solar radiation exposure. These diseases mainly increase in spring and summer months among general population due to an increase to sun light exposure and an increase intensity of uhravaiolet radiation [UVR]. This study was done to evaluate different skin diseases related to study the frequency of the skin diseases related to increase exposure to UV light in Sulaimania city. This is a selective prospective study; the data collected during the period of the January 2006 to September 2007 in Dermatology Department in Consulting Clinic in Sulaimania city, 391 cases were collected in both sexes whose ages ranged between 5 and 73 years with a mean age of 39 years. Full history and thorough physical examination was done for all patients. Three hundred ninety one patients were included in this study; they were 190 [4 8.6%] males and 201 [51.4%] females, there ages ranged between 5-73 years with a mean age of 39 years. Sunburn 116 [29.7%] patients was the commonest condition seen, acne like eruption 84 [21 .4%] patients, drug photosensitivity: 74 [18.9%] patients, Polymorphous light eruption: 32 [8.1%] patients, Chronic actinic dermatitis: 24 [6.1%] patients, Lichenoid dermatitis: 21 [5.3%] patients, Actinic prurigo like polymorphic light eruption 18 [4.6%] patients, Lichen planus actinicus: 15 [3.9%] patients, Solar urticaria: 5 [1.2%] patients, Porokeratoses: 2 [0.6%] patients, The number of the eases variable during the months from no cases in January and February to the highest numbers during the summer months with a top [149] patients, in August. To best of our knowledge this is first study done about UVR exposure in Sulaimania city. There are various dermatoses related to increase UVR exposure, as the UV index increases, the number of eases increases. The highest number of eases occurs in summer [especially in July and August], because in summer the UV index reaches its higher levels and the outdoor activities increase with inadequate protective measures in Sulaimania without regular used of sunscreen. We recommend strict use of sunscreen for males and females especially summer times and avoid going out in specific times of the day especially in summer. We recommend future studies about tumors, photo aging, DNA repair-defective disorders and dermatoses aggravated by solar exposure like porphyria, SLE, pellagra, rosacea