Botulinum toxin and platelet rich plasma as innovative therapeutic modalities for keloids.

Keloids characterize a definitely challenging type of cutaneous scars for which a diversity of therapeutic modalities has been suggested. The aim of this work was to compare the therapeutic efficacy of intralesional injection of botulinum toxin type-A (BTX-A), platelet rich plasma (PRP), and triamcinolone acetonide (TAC) in keloids. A total of 60 keloids patients were enrolled and divided randomly into three equal groups. Group I treated by intralesional BTX-A injection, group II treated by intralesional PRP injection, and group III treated by intralesional TAC injection. Clinical assessment was done by Vancouver Scar Scale (VSS), Verbal Rating Scale (VRS), and dermoscopic examination. Additionally, histopathology and immunohistochemistry of connective tissue growth factor (CTGF) expression were evaluated. The results of this study revealed significant improvement of both VSS and VRS in response to all treatment modalities. There was significant improvement of VSS in BTX-A and PRP groups more than TAC group. However, no significant difference observed between BTX-A and PRP groups. Immunohistochemical examination showed significant decrease of CTGF expression after treatment in BTX-A and PRP groups more than TAC group. In conclusion, both BTX-A and PRP could yield a chance for cosmetically better outcomes in keloids treatment than conventional TAC injection.

Role of ferritin in pathogenesis of rosacea and its value in efficacy of 595 nm pulsed dye laser in treatment of different variants of rosacea: a clinical and immunohistochemical study.

BACKGROUND: Current rosacea treatment focused on symptom suppression to improve patient's quality of life, prevent progression, and sustain remission. The progress of laser therapy has brought about a paradigm shift in the world of treating erythema and telangiectasia. We appraised role of ferritin in pathogenesis of rosacea and consider its value in efficacy of 595 nm pulsed dye laser (PDL) in treatment of rosacea. MATERIALS/METHODS: 20 patients had rosacea were treated with PDL; received 4 sessions, 4 weeks apart. They were assessed before and after treatment by rosacea grading scale and skin biopsies were taken to detect changes in ferritin expression before and after treatment. RESULTS: Ferritin expression in lesional skin was positively expressed in all patients proportional to severity of rosacea that showed statistically significant reduction of ferritin expression after PDL. There was a statistically significant reduction in rosacea grading scale after PDL (p value = .005*); the highest efficacy was in phymatous then papulopustular and erythrotelangiectatic types. CONCLUSIONS: The reduction of ferritin expression after PDL opens a new era for antioxidant agents to be added as a relevant approach for the therapy of rosacea via attenuation of oxidative stress.

Microneedling (Dermapen) and Jessner's solution peeling in treatment of atrophic acne scars: a comparative randomized clinical study.

Background: Atrophic acne scarring is a permanent complication of acne vulgaris. It has a high prevalence and significant impact on the quality of life. We compared between the efficacy and safety of microneedling (dermapen) and superficial chemical peeling by Jessner's solution for treatment of atrophic acne scars. Materials/Methods: Sixty patients who had atrophic acne scars were divided randomizely into three groups. Group Ι included 20 patients and were treated with dermapen, group ΙΙ included 20 patients and were treated with Jessner's solution peeling, and group ΙΙΙ included 20 patients and were treated with dermapen and Jessner's solution. Clinical assessment of patients was done according to Goodman and Baron scarring global quantitative grading system before and after the end of treatment. Results: There was a significant clinical improvement of acne scars in group ΙIΙ than in group Ι and group ΙΙ, and boxcar scars showed the best clinical improvement in all studied groups. There was statistically negative correlation between the degree of improvement of acne scars and duration of lesions and age of patients. Conclusions: The combined technique (dermapen and Jessner's solution peeling) showed the best clinical improvement with the least number of sessions followed by the microneedling technique and lastly the jessner's solution peeling for treating atrophic acne scars.