Evaluation of the effect of combined intralesional injection of prostaglandin F2α with narrow band UVB phototherapy in treatment of resistant cases of vitiligo.

BACKGROUND: Vitiligo is a chronic cutaneous disease characterized with hypopigmented patches that leave psychological impact on the patients. There is increasing need for new treatment modalities to shorten the duration of treatment of vitiligo with the least side effects. OBJECTIVE: To explore the effect of intralesional injection of prostaglandin F2α on the outcome of narrow band ultraviolet rays B (NBUVB) for patients with stable vitiligo. PATIENTS AND METHODS: The study included 27 stable vitiligo patients with overall symmetrical lesions. For each patient, one patch was treated with NBUVB alone (control side), while another symmetrical patch was treated with combined intralesional injection of prostaglandin F2α with NBUVB therapy, weekly for 3 months. RESULTS: There was statistically significant improvement in the repigmentation in the combination group compared with NBUVB group. Side effects were minimal. CONCLUSION: Intralesional injection of prostaglandin F2α in combination with NBUVB therapy could be considered as safe and tolerable technique for treatment of vitiligo, it shortens the duration of NBUVB therapy. Longer follow up is needed.

Cinnamic acid nanoparticles modulate redox signal and inflammatory response in gamma irradiated rats suffering from acute pancreatitis.

Acute Pancreatitis (AP) is a multifactorial disease. It was characterized by severe inflammation and acinar cell destruction. Thus, the present study was initiated to evaluate the role the of Cinnamic acid nanoparticles (CA-NPs) as a modulator for the redox signaling pathway involved in the development of pancreatitis. AP in rats was induced by L-arginine and exposure to gamma radiation. The pancreatic injury was evaluated using biochemical and histological parameters. Upon the oral administration of CA-NPs, both the severity of acute pancreatitis and the serum levels of amylase and lipase were decreased. Furthermore, the malondialdehyde (MDA) levels of the pancreatic tissue were significantly reduced and the depletion of glutathione was considerably restored. The injury and apoptosis of pancreatic tissues were markedly improved by the reduction of the caspase-3 levels. Additionally, the alleviation of pancreatic oxidative damage by CA-NPs was accompanied by a down-regulation of the NLRP3, NF-κB, and ASK1/MAPK signaling pathways. Collectively, the current findings showed that CA-NPs could protect the pancreatic acinar cell from injury not only by its antioxidant, anti-inflammatory effect but also by modulation of the redox-sensitive signal transduction pathways contributed to acute pancreatitis severity. Accordingly, cinnamic acid nanoparticles have therapeutic potential for the management of acute pancreatitis.

Evaluation of PSP technique including dot peeling, subcision and intradermal injection of PRP in the treatment of atrophic post-acne scars.

BACKGROUND: Atrophic post-acne scars are common complications of acne. Many modalities are proposed, but each does not yield satisfactory clinical outcomes. To evaluate the therapeutic effect of PSP technique including dot peeling, subcision and intradermal injection of autologous platelet-rich plasma (PRP) for the treatment of atrophic post-acne scars. PATIENTS AND METHODS: Twenty patients with different types of atrophic acne scars on the face were included. All patients received PSP technique in the form of dot peeling, then after 2 weeks, subcision and intradermal PRP injection were done simultaneously. PSP technique was performed for each patient every month for 3 months. RESULTS: After 3 months of the last session, 30% of 20 patients had excellent improvement, 20% of patients had good improvement, 20% of patients had moderate improvement, and 30% of patients had mild improvement. There was statistically significant difference after treatment (p ≤ .001). Side effects were mild and tolerable and included erythema, ecchymosis, and hyperpigmentation. All types of scars showed significant improvement with no significant difference between them. CONCLUSION: PSP technique was found to be a safe and cost-effective treatment option for atrophic acne scars.

Evaluation of the efficacy of transdermal drug delivery of calcipotriol plus betamethasone versus tacrolimus in the treatment of vitiligo.

BACKGROUND: Vitiligo is a common pigmentary disorder affecting about 1% of the general population. There are numerous medical and surgical treatments. Microneedling is an evolving treatment technique for an expanding number of dermatologic conditions. It is used also to augment transdermal drug delivery through pores created in the stratum corneum. AIM: To evaluate the efficacy of microneedling with tacrolimus versus its efficacy with calcipotriol plus betamethasone in vitiligo treatment. METHODS: Twenty-five patients having vitiligo were selected and their symmetrical patches were divided into side A (right side) which received microneedling with dermapen and topical calcipotriol plus betamethasone and side B (left side) which received microneedling and topical tacrolimus. Every patient received a session every 2 weeks for a maximum 6 months (12 sessions) and follow-up for 3 months. Skin biopsies were taken before and after the treatment to evaluate the clinical results. RESULTS: On side A, 60% of the patients showed excellent improvement while 32% showed excellent response on side B. The mean percentage of improvement was significantly higher on side A than side B (P = 0.017* ). It was effective in the most resistant sites of vitiligo such as: elbows, knees, extremities, and acral area. Histopathological examination showed a significant expression of HMB45 on side A more than side B (P = 0.005* ). CONCLUSION: The combination of microneedling with calcipotriol plus betamethasone is more effective than its combination with tacrolimus. They are both effective in resistant sites. Both methods are safe, cheap, and good tolerated office techniques with minimal side effects.

Therapeutic effect of microneedling and autologous platelet-rich plasma in the treatment of atrophic scars: A randomized study.

BACKGROUND: New treatments and techniques were being added over the last few years to treat atrophic scars with variable results and adverse effects. AIM OF THE WORK: The aim of this study was to evaluate and compare the therapeutic efficacy and safety of microneedling, autologous platelet-rich plasma, and combination of both procedures in the treatment of atrophic scars. PATIENTS AND METHODS: This study included 90 patients with atrophic scars and were classified randomly into three groups: I: 28 patients treated with microneedling, one session every 4 weeks; II: 34 patients treated with intradermal injection of platelet-rich plasma, one session every 2 weeks; and III: 28 patients treated with alternative sessions of each microneedling and platelet-rich plasma, 2 weeks between each session, for a maximum of six sessions. RESULTS: There was a statistically significant improvement in the appearance of atrophic scars, with reduction in the scores associated with the clinical evaluation scale for atrophic scarring in all groups, but the improvement was more obvious in group III. CONCLUSIONS: Although a single treatment may give good results, combination between skin needling and platelet-rich plasma is more effective, safe with less number of sessions in all types of atrophic scars.

Assessment of the efficacy and safety of single platelet-rich plasma injection on different types and grades of facial wrinkles.

BACKGROUND: Platelet-rich plasma (PRP) is considered as a growing modality for tissue regeneration and a developing research area for clinicians and researchers. PRP injection treatment provides supraphysiological concentrations of growth factors that may help in accelerated tissue remodeling and regeneration. AIM OF THE STUDY: To evaluate the efficacy and safety of single autologous PRP intradermal injection for treatment of facial wrinkles and for facial rejuvenation. PATIENTS AND METHODS: A total of 20 subjects with different types of facial wrinkles were included in this study. All subjects received single PRP intradermal injection and were clinically assessed before and after treatment for a period of 8 weeks using Wrinkle Severity Rating Scale (WSRS), Skin Homogeneity and Texture (SHnT) Scale, Physician Assessment Scale, and Subject Satisfaction Scale. RESULTS: The mean value of WSRS reduced from 2.90 ± 0.91 before treatment to 2.10 ± 0.79 after 8 weeks of treatment. The most significant results were with younger subjects that have mild and moderate wrinkles of the nasolabial folds (NLFs). Fourteen of seventeen subjects with NLFs showed more than 25% improvement in their appearance. Side effects of PRP treatment were minimal to mild and with excellent tolerability. CONCLUSION: Single PRP intradermal injection is well tolerated and capable of rejuvenating the face and producing a significant correction of wrinkles especially the NLFs.

The effect of platelet-rich plasma on the outcome of short-term narrowband-ultraviolet B phototherapy in the treatment of vitiligo: a pilot study.

BACKGROUND: Narrowband - ultraviolet B (NB-UVB) is an emerging, effective, and safe therapy for vitiligo, but the treatment course often requires a long duration of time which may carry a potential risk for various side effects and patients' noncompliance. OBJECTIVE: To explore the effect of platelet-rich plasma (PRP) injection on the outcome of short-term NB-UVB therapy for the patients with stable vitiligo. PATIENTS AND METHODS: The study included 60 stable vitiligo patients with overall symmetrical lesions. For each patient, the left side of the body was treated with NB-UVB alone (control side) while the right side was treated with NB-UVB therapy in addition to intradermal injection of PRP, every 2 weeks for 4 months. RESULTS: There was statistically highly significant improvement in the repigmentation in the combination group(PRP plus NB-UVB) compared with NB-UVB group. CONCLUSION: Intradermal PRP injection in combination with NB-UVB could be considered as a simple, safe, tolerable, and cheap technique for treatment of vitiligo. It shortens the duration of NB-UVB therapy and is expected to increase patient compliance. Longer follow-up is needed.

Evaluation of the efficacy and safety of combinations of hydroquinone, glycolic acid, and hyaluronic acid in the treatment of melasma.

BACKGROUND: Various treatments are currently available for melasma. However, results are often disappointing. OBJECTIVES: 1 To assess the efficacy and safety of combinations of hydroquinone, glycolic acid, and hyaluronic acid in the treatment of melasma after topical application. 2 To evaluate the dermoscopy as a tool in diagnosis and follow-up of melasma treatment. PATIENTS AND METHODS: One hundred patients with mild, moderate-to-severe melasma were divided into five groups. Group I (twenty patients were treated with cream formula containing 4% hydroquinone), group II (twenty patients were treated with cream formula containing 4% hydroquinone + 10% glycolic acid), group III (twenty patients were treated with cream formula containing 4% hydroquinone + 0.01% hyaluronic acid), group IV (twenty patients were treated with cream formula containing 4% hydroquinone + 10% glycolic acid + 0.01% hyaluronic acid), and group V (twenty patients were treated with placebo cream). All patients were subjected to dermoscopic examination and digital photographs before and after treatment. The response and side effects were evaluated. RESULTS: Groups I, III, and IV showed highly significant changes in modified Melasma Area and Severity Index (mMASI) score after using the treatment. Group II showed significant change in mMASI score after using the treatment. The side effects were more reported in group II, followed by group IV, followed by group I, followed by group III. There was highly significant difference between the dermoscopic color findings before and after treatment. Vascularization was another dermoscopic finding. CONCLUSION: A cream formula containing 4% hydroquinone + 10% glycolic acid + 0.01% hyaluronic acid was very effective in treatment of melasma with tolerable side effects. Dermoscope is a valuable noninvasive tool in the diagnosis and follow-up of melasma treatment.

Immunohistochemical expression of cathepsin L in atopic dermatitis and lichen planus.

BACKGROUND: Cathepsin L is a member of papain superfamily. It seems to promote T-cell survival, selection maturation in the thymus and enhance the antigen presentation. Cathepsin L plays an important role in tumor necrosis factors (TNF-α) induced cell death. Also it degrades the tight junction between cornedesomses in the epidermis. Elevated expression of cathepsin L has been found in many inflammatory and neoplastic diseases. OBJECTIVE: The aim of this study was to determine immunohistochemical expression of cathepsin L in atopic dermatitis (AD) and lichen planus (LP) patients in order to evaluate its role in the pathogenesis of both diseases. MATERIALS AND METHODS: This study included 15 patients with AD (Group I), 15 patients with LP (Group II), in addition to 10 healthy skin specimens served as controls (Group III). Punch biopsies were taken from lesional skin of the patients and controls for immunohistochemical detection of cathepsin L expression. RESULTS: Highly significant increase was found in cathepsin L expression in AD and LP patients compared to controls [P = 0.001]. CONCLUSION: Cathepsin L could be implicated as an important protease in the pathogenesis of AD and LP. It could be a useful marker for assessing AD severity.

Autologus bone marrow stem cells in atrophic acne scars: A pilot study.

BACKGROUND: Acne scar is a very distressing and difficult problem for physicians and patients. Management of cutaneous scarring from acne can be challenging and confusing. The available modalities may be effective, having considerable morbidity and long downtime. Besides, they may not have the same efficacy in different skin types or acne scar types. OBJECTIVE: To evaluate the short-term safety and efficacy of autologous bone marrow (BM) stem cells (SCs) in treating atrophic acne scars. METHODS: Fourteen patients with moderate to severe atrophic acne scars were included. All patients were subjected to single session of autologous BMSCs therapy. Each patient received 5 µg/kg/day granulocyte colony-stimulating factor (G-CSF) as a single subcutaneous dose for 2 successive days before BM aspiration. The SC-containing solution was injected under each scar intradermally. The scars of the patients were clinically assessed both qualitatively and quantitatively before and after 6 months. The patients were given a preformed questionnaire Cardiff acne disability index (CADI) before and after treatment. RESULTS: After 6 months of the injection, there was significant improvement in the qualitative grading, quantitative grading and CADI scores. All types of scars showed significant improvement. No significant adverse effects were reported in any patient. CONCLUSION: Autologous BMSCs seem to be a safe and effective treatment option for the management of all types of atrophic facial acne scars.

A proliferation-inducing ligand in atopic dermatitis and vitiligo.

BACKGROUND: A proliferation-inducing ligand (APRIL) is a tumor necrosis factor (TNF) superfamily member ligand that stimulates B cells in vitro and in vivo. It also plays an important role in T cell activation and survival. OBJECTIVES: This study was conducted to evaluate serum levels of APRIL in patients with atopic dermatitis (AD) and vitiligo and their correlation with disease activity. METHODS: A total of 100 subjects were included; these comprised 40 AD patients, 40 vitiligo patients, and 20 control subjects. Serum APRIL levels were measured and their relationships with the severity of AD and activity of vitiligo evaluated according to scores on the SCORAD (SCORing of Atopic Dermatitis) and VIDA (Vitiligo Disease Activity) indices, respectively. RESULTS: The serum level of APRIL was significantly higher in AD patients than in the control group. Serum APRIL in patients with severe AD showed a statistically significant difference with serum APRIL in patients with either mild or moderate AD. Serum APRIL was significantly higher in vitiligo patients than in the control group. Differences in serum APRIL among patients with different VIDA scores were significant only between patients with VIDA scores of +1 and +4. Statistically significant positive correlations emerged between serum APRIL and activity of AD (r = 0.939) and vitiligo (r = 0.740). CONCLUSIONS: APRIL may play a role in the pathogeneses of AD and vitiligo and could be used as an objective marker for the assessment of AD severity and vitiligo activity. Further studies are required to clarify the precise mechanism of APRIL in the pathogeneses of AD and vitiligo and to test the possible use of APRIL inhibitors as novel modalities of therapy.