Efficacy of the combination of Q-switched Nd:YAG laser and microneedling for melasma.

BACKGROUND: Melasma is a common, multifactorial, and recurring disease which is not easy to treat. AIMS: The purpose of this study is to evaluate the efficacy of microneedling in combination with Q-switched neodymium-doped yttrium aluminum garnet laser (QsNd-YAG laser) for treatment of melasma. PATIENTS/METHODS: Fifteen female patients with epidermal or mixed-type melasma on the face were included in the study. Patients were first treated with QsNd-YAG laser, and then with microneedling containing mesotherapy products of biomimetic peptides, at the same session. Modified Melasma Area Severity Index (mMASI) scores were calculated before the first session and again 2 weeks after the last session. The same treatment protocol was repeated every 2 weeks for five sessions within period of 3 months of therapy. The evaluation was performed according to the before and after photographs taken from three angles including 90-degree front and 45 degrees from left and right with the VISIA device. RESULTS: Of the 15 patients included in the study, the mean mMASI scores before and after treatment were 9.2 ± 5.7 (3.8-23.1) and 3.6 ± 4.0 (0.6-16.8), respectively. mMASI scores were significantly reduced after completion of the protocol. Six (40%) patients had "very good response," 4 (26.7%) patients had "good response," and 5 (33.3%) patients were "unresponsive." Six (40%) patients were followed up for 1 year, and only 1 patient had a recurrence (6.7%). CONCLUSIONS: In addition to the use of photoprotective measures, multimodality treatment including QsNd-YAG laser and microneedling with mesotherapy products containing biomimetic peptides is effective to treat melasma and they work synergistically.

Evaluation of a Handheld Dermatoscope in Clinical Diagnosis of Primary Cicatricial Alopecias.

INTRODUCTION: Clinical diagnosis of primary cicatricial alopecias presents difficulties. Studies regarding their trichoscopic features are scarce and mostly not comprehensive. The aim of this study is to evaluate the potential benefit of a handheld dermatoscope in clinical diagnosis of primary cicatricial alopecias. METHODS: In all, 69 patients with primary cicatricial alopecias were included in this prospective study. Preliminary diagnoses were established clinically, and confirmed by scalp biopsy in all cases. Trichoscopic examination was performed using a polarized-light handheld dermatoscope with tenfold magnification. The images were taken using a digital camera with threefold optical zoom. RESULTS: The following findings were significantly more common, or noted only, in particular types of primary cicatricial alopecias: "target" pattern blue-grey dots, perifollicular scaling, perifollicular cast in lichen planopilaris (n = 27); short vellus hairs, tufted hairs, crust formation, yellowish tubular scaling, pustule, red dots in folliculitis decalvans (n = 17); large keratotic yellow dots in discoid lupus erythematosus (n = 7); yellow dots, yellow dots with "three-dimensional" structure, black dots in dissecting cellulitis of the scalp (n = 6). Absence of vellus hairs was observed in patients with lichen planopilaris, frontal fibrosing alopecia, and discoid lupus erythematosus without a significant difference between the groups. Short vellus hairs were detected in all types, including frontal fibrosing alopecia (n = 7). CONCLUSION: We suggest that a polarized-light handheld dermatoscope is useful for revealing several typical trichoscopic features of primary cicatricial alopecias that guide clinical diagnosis. As a novel observation, our data indicate that absence of vellus hairs is not an identifying feature for frontal fibrosing alopecia.

Definition of videodermoscopic features of demodicosis.

BACKGROUND: Diagnosis of demodicosis is usually confirmed by standardized skin surface biopsy. The skin of the patients with demodicosis is usually very sensitive. There is a need for new noninvasive tests. Videodermoscopic findings of demodicosis have not been validated yet. Our aim was to provide a noninvasive and easy method for diagnosis of demodicosis by using videodermoscopy. MATERIALS AND METHODS: This study included 26 patients with demodicosis which were confirmed with microscopy and responded well to anti-Demodex therapy Twenty-six age- and sex-matched individuals without demodicosis constituted the control group. Dermatologic evaluation included clinical observation along with microscopy. All photographs of the clinical and dermoscopic findings were taken with videodermoscope. RESULTS: Demodex tails representing "Demodex mites" were a common feature in all patients. Gray dots were described as the second major videodermoscopic finding. Epidermal scale and red dots were also observed with higher prevalence than the other videodermoscopic features. We defined a new finding as follicular annular pigmentation corresponding to the facial pigmentation with demodicosis by videodermoscopy. CONCLUSIONS: We concluded that it seems possible to confirm the clinical diagnosis of demodicosis by videodermoscopy, with similar results to handheld dermoscopy. Demodex tails should be considered as a sign of demodicosis, whereas detection of gray dots, epidermal scale, and red dots may raise the suspicion of demodicosis.

Clinical evaluation of alopecias using a handheld dermatoscope.

BACKGROUND: There are numerous reports of the value of videodermatoscopy in the clinical evaluation of alopecia. Studies performed with a handheld dermatoscope are scarce and limited to a few disease entities. OBJECTIVE: The aim of this study was to evaluate the potential benefit of a handheld dermatoscope in the clinical diagnosis of alopecia. METHODS: In all, 144 patients with alopecia and 144 age- and sex-matched control subjects were enrolled in the study. Diagnoses were established clinically, and confirmed by scalp biopsy in doubtful cases. Dermatoscopic examination was performed by a polarized-light handheld dermatoscope with a 10-fold magnification. The images were obtained by a digital camera with a 3-fold optical zoom. RESULTS: The dermatoscopic patterns of circular hairs, dirty dots, epidermal scale, and pustules showed no statistically significant difference between patients and control subjects. The following features were significantly more common, or observed solely, in particular types of alopecia: hair diameter diversity, peripilar sign, and empty follicles in androgenetic alopecia; yellow dots, black dots, tapering hairs, and broken hairs in alopecia areata; absence of follicular openings, tufted hairs, white dots, follicular hyperkeratosis, pili torti, red dots, honeycomb pigment pattern, pink-white appearance, crusts, and pustules in primary cicatricial alopecias. LIMITATIONS: Evaluation of all primary cicatricial alopecias in the same cluster. CONCLUSIONS: We suggest that a polarized-light handheld dermatoscope attached to a digital camera provides a practical and useful aid for the clinical diagnosis of alopecias.