Narrow band ultraviolet-B versus Goeckerman therapy for psoriasis with and without acitretin: A retrospective study.

BACKGROUND: Narrow band ultraviolet-B (NB-UVB) is now one of the most widely used modalities in the treatment of psoriasis. However, despite its high efficacy, conventional Goeckerman treatment has fallen out of favor in recent years and some institutions are now using NBUVB with coal tar as their regimen. OBJECTIVE: To evaluate the efficacy of NB-UVB, Goeckerman therapy and the effect of addition of retinoid to the treatment regimen in the treatment of psoriasis,. PATIENTS AND METHODS: A retrospective analysis of 65 patients who underwent 81 courses of treatment in our department was undertaken. The efficacy of NB-UVB and Goeckerman therapy individually, and in combination with acitretin was assessed. Data were analysed to evaluate the contribution of acitretin to these modalities. RESULTS: PASI-75 responses in the NB-UVB, retinoid+NB-UVB (re-NB), Goeckerman and retinoid+Goeckerman (re-Goeckerman) groups were achieved for 12 of 31 patients (39%), 13 of 21 patients (62%), 15 of 17 patients (88%) and 10 of 12 patients, respectively. The addition of acitretin to both modalities reduced both the number of sessions and the cumulative ultraviolet-B dose delivered. LIMITATIONS: This is a retrospective study, the patients were not randomized and the number of patients in the treatment groups were dissimilar. CONCLUSION: Goeckerman therapy is more effective than NB-UVB phototherapy. Although the addition of acitretin to both NB-UVB and Goeckerman therapy did not contribute to treatment outcomes in terms of PASI-75 responses, it enabled a reduction in UV exposures and enhanced efficacy.

Treatment of lipoid proteinosis with ablative Er:YAG laser resurfacing.

Lipoid proteinosis (LP) is a rare autosomal recessive genodermatosis characterized by deposition of amorphous hyaline material in different parts of the body, especially the skin and mucous membranes. Disfiguring lesions predominantly affect facial appearance. There is no curative therapy and treatment options are limited to symptomatic approaches. Facial disfigurement in this disease may have an huge negative effect on the patients' psychology and quality of life. With this regard, the patients may benefit very much from symptomatic treatments. Four patients with LP were treated with Er:YAG laser to ablate disfiguring lesions on the face. Patients were followed up for 14 months to 2 years. We obtained favorable clinical and aesthetic results in all cases with Er:YAG laser treatment and did not observe any recurrences during the follow-up. Depending on our observations Er-YAG laser can be accepted as an effective tool for dermal accumulations and scars of LP with precise ablation capability and favorable esthetic results.

Pulse methylprednisolone therapy for the treatment of extensive alopecia areata.

BACKGROUND: Since the mainstay of pathogenesis depends on autoimmune process, systemic steroids are widely used in the treatment of alopecia with various side effects. To avoid side effects of long-term steroid treatment, pulse methylprednisolone therapy appears to be a safe treatment option. OBJECTIVE: The aim was to determine the effect of pulse methylprednisolone therapy for the treatment of adult alopecia areata. METHODS: Demographical features of all patients were recorded before the treatment. Patients received methylprednisolone 500 mg intravenously for 3 consecutive days every month for 3 months. Patients were followed up for 3 months. Treatment responses were defined by complete regrowth (100%), significant regrowth (>50%) and minimal regrowth (<50%). RESULTS: Totally 15 patients were enrolled in this study. At the end of the study, two patients had significant regrowth and one patient had minimal regrowth in multifocal alopecia areata (n = 4); one patient had significant regrowth and one patient had minimal regrowth in alopecia universalis (n = 8); three patients had no regrowth in alopecia totalis (n = 3). CONCLUSIONS: The study suggests that pulse methylprednisolone therapy might be a therapeutic option for severe multifocal alopecia areata. However, in alopecia totalis or universalis, treatment results are unsatisfactory.

The effect of oral cyclosporine in the treatment of severe alopecia areata.

CONTEXT: Alopecia areata (AA) is a common non-scarring hair loss condition with an unpredictable and relapsing disease course. T-cell mediated autoimmune process is mainstay of the pathogenesis of AA, therefore immunosuppressive therapies are widely used in the treatment of AA. OBJECTIVE: The aim of the study was to evaluate efficacy of oral cyclosporine therapy and reveal effects of prognostic factors in the treatment of severe AA. MATERIALS AND METHODS: We evaluated case histories of patients who were admitted to our department between December 2004 and September 2011 for the treatment of severe AA. A total of 25 patients were included in the study. Patients' data that included sex, age, alopecia type, alopecia duration, family history, atopic history, previous treatments, treatment dosage, treatment duration, adverse events and clinical response were retrieved from patients' records. Twelve patients had multifocal AA, nine patients had alopecia universalis and four patients had alopecia totalis. Patients were treated with 2.5-6 mg/kg/d doses of oral cyclosporine for 2-12 months. RESULTS: The mean age of patients was 21.92 ± 3.56 (range: 19-34) years. All patients were male. The mean duration of disease was 8.3 ± 6.48 (range: 0.5-21) years. Four patients had positive family history and three patients had atopy history. Three of 25 (16%) patients discontinued treatment due to adverse events. Of remaining 22 patients, significant hair growth was observed in 10 (45.4%) patients; five patients with multifocal AA, three patients with alopecia universalis and two patients with alopecia totalis. In addition to this, six of nine patients with less than four years disease duration showed significant hair growth. But in patients with more than four years disease duration, only 4 of 13 patients showed significant hair growth. CONCLUSION: This study indicates that oral cyclosporine treatment may be a beneficial treatment option for severe AA. In addition to this, disease duration is an important prognostic factor that influences efficacy of oral cyclosporine treatment.

Targeted photochemotherapy in alopecia areata.

BACKGROUND/PURPOSE: Alopecia areata (AA) is a common cause of localized non-scarring alopecia. Usage of targeted UVA after the topical application of 8-methoxypsoralen (8-MOP) is one of the rising treatment modalities for AA. Our aim was to assess the efficacy and safety of topical 8-MOP plus targeted UVA phototherapy in the treatment of patchy AA. METHODS: Seven patchy AA patients were treated by topical 8-MOP application to the lesions followed by UVA irradiation 3 times a week, with 15 to 24 sessions in total. At the end of the treatment all patients were evaluated for response on a four-point scale (0 = no hair, 1 = white vellus hair, 2 = regrowth cosmetically acceptable for the patient, 3 = complete hair growth). RESULTS: The mean cumulative UVA dose was from 7.5 to 39.6 J/cm(2) . For all 7 patients, average response score was calculated as 2, which means cosmetically acceptable regrowth. CONCLUSION: Targeted UVA phototherapy combined with topical 8-MOP may be an effective and safe alternative treatment protocol for patchy AA, which should be kept in mind in order to choose the best for the patient, especially for patients incompatible with other treatments that are systemic and invasive.

An open, randomized, comparative study of oral finasteride and 5% topical minoxidil in male androgenetic alopecia.

BACKGROUND AND AIM: Androgenetic alopecia (AGA) is undoubtedly the most common form of hair loss in males. It is a condition which may cause cosmetic and psychosocial problems in androgen-dependent cases. In this open, randomized and comparative study we evaluated the efficacy of oral finasteride and 5% topical minoxidil treatment for 12 months in 65 male patients with mild to severe AGA. METHODS: We randomly assigned 40 (61.53%) patients to receive 1 mg/day oral finasteride for 12 months, and 25 (38.47%) patients applied 5% topical minoxidil solution twice daily for 12 months. RESULTS: There were no significant differences between the 2 groups considering age, age of onset of hair loss, family history and type of hair loss (p > 0.05). In the clinical evaluation at the endpoint of treatment, the clinical cure rates (i.e. increased intensity of hair) were 80% (32/40) for the oral finasteride group and 52% (13/25) for the 5% topical minoxidil group. Encountered side effects were all mild, and there was no need to stop the treatment. In the group given oral finasteride, side effects were noted in 7 patients: 6 patients suffered from loss of libido, and 1 patient had an increase in other body hairs; irritation of the scalp was seen in 1 patient in the group administered 5% minoxidil. These adverse events disappeared as soon as the treatment was stopped. The laboratory data on both drug groups did not show any statistically or clinically significant intragroup changes from baseline values to the endpoint (p > 0.05), except the level of serum total testosterone which was increased, and free testosterone and serum prostate-specific antigen in the finasteride group which were statistically decreased from baseline values to the endpoint (p < 0.05). CONCLUSION: In this comparative study of systemic finasteride and topical minoxidil, it was concluded that both drugs were effective and safe in the treatment of mild to severe AGA, although oral finasteride treatment was more effective (p < 0.05). Adverse events were not considered important either, and these side effects disappeared as soon as the treatment was stopped.