Split-face comparative study between intradermal tranexamic acid injection alone versus intradermal tranexamic acid injection combined with Q-switched Nd:YAG laser in melasma treatment: dermoscopic and clinical evaluation.

Melasma is a chronic, dark brown-pigmented patches and macules commonly on the face. Many treatment modalities for melasma have been used as hydroquinone, laser treatment, and recently tranexamic acid. Dermoscopy is used to diagnose and follow up the treatment of melasma and to detect underlying invisible vessels and their change with treatment. Melasma treatment evaluation by using combined Q-switched Nd:YAG laser with intradermal tranexamic acid injection versus tranexamic acid intradermal injection alone. This study was conducted on 40 female patients aged 35-45 years. It was a split-face study; for 12 weeks, the right side of the face was treated with low fluence Q-switched Nd:YAG laser combined with intradermal injection of tranexamic acid, while the left side was treated with an injection of tranexamic acid intradermal alone. The patients were clinically evaluated by using the modified melasma area and severity index (mMASI) score, and underwent dermoscopic evaluation before treatment, at the end of the treatment (12 weeks), and at (24 weeks) as follow-up. The efficacy, adverse effects, and recurrence after treatment were reported. There was a statistically significant decrease in mMASI score with combination treatment than with intradermal injection of tranexamic acid alone after treatment at 12 weeks and at the end of follow-up at 24 weeks. Combination of an injection of tranexamic acid intradermal and low fluence Q-switched Nd:YAG laser is an effective and safe treatment for melasma with minimal side effects more than the intradermal tranexamic acid injection alone.

Efficacy and Safety of tranexamic acid versus vitamin c after microneedling in treatment of melasma: Clinical and Dermoscopic study.

BACKGROUND: Melasma is a common acquired symmetrically distributed hyperpigmented macules of sun-exposed skin. Skin microneedling acts as a transdermal delivery system that facilitates the penetration of lightening agents to deeper layers of skin. OBJECTIVE: Clinical and dermoscopic evaluation of the efficacy and safety of topical tranexamic acid versus topical vitamin C after microneedling for melasma treatment. PATIENTS AND METHODS: Twenty patients with facial melasma were enrolled in a split-face prospective, randomized uncontrolled study. The right side of the face was treated with topical tranexamic acid after dermapen microneedling, while the left side of the face was treated with topical vitamin C after dermapen microneedling. Sessions were done every 2 weeks for 6 sessions. The Hemi-MASI score and dermoscopic examination before and after treatment were done. RESULTS: Hemi-MASI score was reduced after treatment on both sides of the face, besides improvement of the pigmented lesions showed by dermoscopy on both sides and improvement of the vascular component on the tranexamic acid treated side. CONCLUSION: Topical tranexamic acid or vitamin C application after dermapen microneedling was an effective and safe technique in melasma treatment with minimal side effects, and vascular component improvement by tranexamic acid.

A dermoscopic study of cutaneous myiasis: other findings.

BACKGROUND: Myiasis is a cutaneous infestation by the larvae of dipterous flies. It can be furuncular/nodular, papular, or pustular. Diagnosis of cutaneous myiasis depends mainly on clinical examination especially for the nodular form. The latter two forms can present diagnostic difficulties. Dermoscopy has been reported to be helpful. This report illustrates some of the dermoscopic features of this condition. METHODS: The history, clinical findings, and dermoscopic findings of 15 affected individuals were documented. RESULTS: Dermoscopy in all patients showed the posterior end of larvae (creamy-white bodies and respiratory spiracles resembling birds' legs with digitated feet). Larval motility and bubbles were noticed in 15 and 10 of patients, respectively. Skin surrounding the larvae showed hypopigmentation in 11 patients and an increase in dilated capillaries in 13. CONCLUSIONS: Dermoscopy can facilitate the diagnosis of myiasis particularly of the papular and pustular forms.

Evaluation of adding platelet-rich plasma to combined medical therapy in androgenetic alopecia.

BACKGROUND: Androgenetic alopecia (AGA) is a common hair loss disorder. OBJECTIVES: To evaluate the therapeutic effects of platelet-rich plasma (PRP) in androgenetic alopecia. METHODS: This study was done on 126 AGA patients, 42 patients survived as control group who received medical treatment, only other 84 patients were subdivided into two groups, and they received PRP sessions as co-adjuvant therapy using different methods administration. Patients were evaluated clinically, by dermoscopy and by digital dermoscopy to measure hair density and diameters before and after treatment. RESULTS: PRP-treated patients showed statistically significant increase in hair density and diameter measurements than control group. These results increased by using microneedling as a method of PRP administration. CONCLUSION: In AGA, the addition of "PRP with microneedling" to the combined medical treatment increases its efficacy and shortens the time needed for optimum improvement. STUDY DESIGN: Single-blinded randomized controlled study.

Efficacy of topical vs combined oral and topical antifungals in white piedra of the scalp.

BACKGROUND: Topical antifungals are the most commonly used therapy in white piedra of the scalp. However, persistence and relapse of infection still pose a significant challenge. Systemic antifungals have been recommended to enhance the therapeutic response. AIMS: To compare the efficacy of topical antifungal alone versus combined topical and oral antifungals in the treatment of white piedra of the scalp. METHODS: Sixty patients with white piedra of the scalp were divided into 3 groups, each containing 20 patients. Group A received topical clotrimazole, group B received combined topical clotrimazole and oral itraconazole, and group C received combined topical clotrimazole and oral terbinafine. The treatment was continued until clearance of infection was confirmed by dermoscopic and mycological examination. Positive responders were followed up for 3 months after treatment. RESULTS: All the patients achieved complete clearance of infection. The median treatment time in group B was significantly shorter than group A (P < .001) and group C (P < .001), respectively. In addition, the median treatment time in group C was significantly shorter than group A (P = .002). No recurrence of infection was noted during follow-up period. CONCLUSION: The three modalities were effective in the treatment of white piedra of the scalp. The most rapid response was observed with the combined use of topical and oral azoles.

Microbotox for the treatment of wide facial pores: A promising therapeutic approach.

BACKGROUND: Microbotox is the injection of multiple microdroplets of diluted onabotulinum toxin A into the upper dermis. It has been previously used in one study only to decrease pore size and to improve skin texture. AIMS: To evaluate the efficacy and safety of microbotox in the treatment of wide facial pores. METHODS: Thirty-five patients with wide facial pores received a single session of microbotox. Objective measurements regarding improvement of pore size (0-4 scale) were recorded by two-blinded dermatologists. The improvements were confirmed by dermoscopic examination. Patient satisfaction was measured by Likert satisfaction scale (1-5 scale). Follow-up of the patients was done for 1 year. RESULTS: After a single treatment session, the total average of improvement was 87.2%. The average improvement of pore size was 3.7 (0-4 scale). The average patient satisfaction after the end of therapy was 4.7. Dermoscopic evaluation confirmed the reduction in the size and number of pores. There were no serious or long-term side effects. CONCLUSIONS: A single treatment session of microbotox appears to be safe and effective for the reduction of facial pore size. Improvement of skin texture and oiliness was also observed.

Study the effect of erbium:YAG laser plus topical 5-flurouracil in stable vitiligo resistant to NB-UVB phototherapy.

BACKGROUND: NB-UVB phototherapy is still an effective treatment in vitiligo but requires more than 1 year for its completion. Topical 5-flurouracil could improve the proliferation and migration of melanocytes. Laser-assisted dermabrasion results in stimulation of the inactive melanocytes present at the outer root sheath of the lower portion of the hair follicle, which migrates upward until they reach the surface of the skin. OBJECTIVE: To evaluate the effect of Er:YAG laser skin ablation followed by topical 5-flurouracil on the outcome of NB-UVB phototherapy as a short term technique in resistant and stable vitiligo. METHODS: The current study included 40 patients suffering from bilateral stable vitiligo resistant to NB-UVB. For each patient, one side of the body subjected to 4 months NB-UVB sessions (control side). While the other side of the body subjected to one session of Er:YAG laser ablation combined with topical 5% 5-flurouracil application under occlusion followed by NB-UVB sessions for 4 months after complete re-epithelization. Outcomes were evaluated objectively based on standard digital photographs, histopathological examination, patient satisfaction, and adverse effects. RESULTS: There was a statistically significant improvement in the repigmentation in laser side compared with control side. Histopathological examination revealed expression of prominent melanin pigmentation, with marked expression for Melan-A in laser side, whereas these findings were negative in control side. CONCLUSION: Er:YAG laser ablation, followed by 5FU application before NB-UVB phototherapy for vitiligo, is a safe and tolerable technique that improves the outcome of short-term NB-UVB therapy and is expected to increase patient compliance.

Fluconazole-loaded solid lipid nanoparticles topical gel for treatment of pityriasis versicolor: formulation and clinical study.

Solid lipid nanoparticles (SLNs) are very potential formulations for topical delivery of antifungal drugs. Hence, the purpose of this research was to formulate the well-known antifungal agent Fluconazole (FLZ)-loaded SLNs topical gel to improve its efficiency for treatment of Pityriasis Versicolor (PV). FLZ-SLNs were prepared by modified high shear homogenization and ultrasonication method using different concentration of solid lipid (Compritol 888 ATO, Precirol ATO5) and surfactant (Cremophor RH40, Poloxamer 407). The physicochemical properties and the in vitro release study for all FLZ-SLNs were investigated. Furthermore, the optimized FLZ-SLN formula was incorporated into gel using Carpobol 934. A randomized controlled clinical trial (RCT) of potential batches was carried out on 30 well diagnosed PV patients comparing to market product Candistan® 1% cream. Follow up was done for 4 weeks by clinical and KOH examinations. The results showed that FlZ-SLNs were almost spherical shape having colloidal sizes with no aggregation. The drug entrapment efficiency ranged from 55.49% to 83.04%. The zeta potential values lie between -21 and -33 mV presenting good stability. FLZ showed prolonged in vitro release from SLNs dispersion and its Carbapol gel following Higuchi order equation. Clinical studies registered significant improvement (p < .05) in therapeutic response (1.4-fold; healing%, 4-fold; complete eradication) in terms of clinical cure and mycological cure rate from PV against marketed cream. Findings of the study suggest that the developed FLZ loaded SLNs topical gels have superior significant fast therapeutic index in treatment of PV over commercially available Candistan® cream.

Stem cell therapy as a novel therapeutic intervention for resistant cases of alopecia areata and androgenetic alopecia.

BACKGROUND: Management of alopecia areata (AA) and androgenetic alopecia (AGA) is often challenging as patients may be resistant to currently available modalities of treatment. The use of stem cells may be a novel option for resistant cases. OBJECTIVE: To evaluate the safety and efficacy of the use of autologous bone marrow derived mononuclear cells (including stem cells) as compared to follicular stems cells for the management of resistant cases of AA and AGA. METHODS: This study included 40 patients (20 AA patients and 20 AGA patients), all patients were treated with a single session of intradermal injection of autologous stem cells (SCs) therapy. They were divided into four groups according to the applied modality [either autologous bone marrow derived mononuclear cells (bone marrow mononuclear cells [BMMCs] or autologous follicular stem cells [FSC]). RESULTS: Six months after stem cell therapy (SCT) injection, there was a significant improvement, confirmed by immunostaining and digital dermoscopy. The mean improvement in all groups was "very good". There was no significant difference between both methods in either type of alopecia. No serious adverse events were reported. CONCLUSION: Autologous BMMCs and FSC seem to be a safe tolerable and effective treatment for the management of both resistant AA and AGA.