Efficacy of Polycaprolactone Threads in Treating Atrophic Acne Scars: A Split-face Comparative Study.

Background: Polycaprolactone (PCL) threads are a novel treatment option for promoting collagen production and smoothing the skin. Objective: This study aimed to compare the efficacy and safety of threads versus microneedling with autologous platelet-rich plasma (PRP) in the treatment of atrophic acne scars. Methods: The study included 24 patients (12 females, 12 males) aged 20 to 37 years with atrophic acne scars. Each patient was treated in a split-face manner; a microneedling pen device was used to treat the right side with microneedling and PRP, whereas the left side was treated with threads. Four microneedling plus PRP sessions were used to treat the right side and a single session of threads was used on the left side. For scoring, a global scarring grading system was utilized. Patients were evaluated every three months following the conclusion of treatment. A six-month follow-up was conducted. Results: Significant clinical improvement was observed in 95.8 percent of the patients on the threads-treated side of the face and in 83.3 percent of the patients on the microneedling plus PRP side. Patient satisfaction was significantly greater in the threads group than in the microneedling+PRP group (p<0.0001). The side effects were tolerable and transient. Conclusion: Based on our results, we conclude that both threads insertion and microneedling with autologous PRP can yield satisfactory results with minor side effects (fine edema and erythema) that resolve rapidly.

Recent modalities in treatment of telogen effluvium: Comparative study.

Telogen effluvium is one of the most common forms of diffuse, non-scarring hair loss for which patients present for clinical evaluation. It is usually a reactive and reversible disorder. Identifying and correcting the underlying cause is the most important component in management, yet there is always a need for therapeutic options. This study aims to evaluate the efficacy of single session botulinum toxin A injection versus multiple sessions of multivitamins mesotherapy in the treatment of telogen effluvium. A randomized clinical trial was conducted in the Dermatology, Venereology, and Andrology Department, Faculty of Medicine, Zagazig University Hospitals. Twenty-four patients with telogen effluvium were randomly divided into two groups each group included 12 patients. Group I received a single session of Botulinum toxin A injection and group II received multiple sessions of multivitamins mesotherapy injection. Both botulinum toxin A and multivitamins mesotherapy are effective in the treatment of telogen effluvium, which was reflected on the improvement of hair parameters as terminal hair and multiple follicular units. Both treatment modalities had minimal and well-tolerated side effects. Although both therapies have equivalent success rates, single session of botulinum toxin A is a better choice than multiple mesotherapy sessions.

Keloid therapy: A neoteric comparative study.

BACKGROUND: Keloids are considered disorders of fibroproliferation characterized by accumulation of collagen fibers in hypodermis and dermis, caused by inflammation, surgery, and trauma. OBJECTIVES: The main goal of the study was to approach a better modality for the treatment of keloids by comparing the effects and the side effects of intralesional cryotherapy and intralesional injection of bleomycin. METHODS: This interventional, comparative clinical trial was conducted on 60 cases and was divided equally into the group (A), combined group who were subjected to intralesional bleomycin followed by cryotherapy in the same session, group (B) who were subjected to intralesional injection of bleomycin, and group (C) intralesional cryotherapy. All cases were subjected to clinical examination, complete history taking, dermatological examination, examination, and evaluation of scar lesion using the Vancouver scar scale. RESULTS: There was a statistically significant decrease in pliability among the combined group. Also, pliability decreased in the bleomycin group and cryotherapy, but this decrease wasn't statistically significant. Our results revealed that there was a statistically significant decrease in lesion height among all the studied groups, but the decrease was more among the combined group. CONCLUSION: Intralesional cryotherapy was effective as intralesional bleomycin. Combined therapy was a valid and more effective technique with few adverse effects than either alone for keloids as it achieved a decrease in volumes of scars or accompanied symptoms.

Incretin serum level as a biomarker of insulin resistance in acne vulgaris patients.

OBJECTIVE: To investigate the relationship between serum Incretin and acne vulgaris (AV) and insulin resistance (IR), and to find the biological indicators of acne vulgaris with insulin resistance. METHODS: 60 patients diagnosed with acne vulgaris in the dermatology department of Zagazig University and 56 healthy people in the health examination center of this hospital were collected, respectively, as the control group; all the included people were drawn fasting blood to test serum Incretin, blood lipids, sex hormones and INS release test to explore the role of serum Incretin in acne vulgaris and insulin resistance. RESULTS: The average level of Incretin in the acne group was lower than that in the control group, and the difference was statistically significant (t = 7.189, p < 0.001). The average level of Incretin in the acne group with insulin resistance was lower than that in the acne without insulin resistance group, the difference was statistically significant (t = 22.328, p < 0.001). In the acne group, the insulin resistance index decreased with the increase of Incretin level, and the two showed a negative correlation. (R = -0.711, p < 0.001). CONCLUSIONS: Patients with acne vulgaris are prone to have insulin resistance. Insulin resistance in patients with acne vulgaris is negatively correlated with Incretin. Serum Incretin may be expected to be a biomarker for diagnosing acne vulgaris patients with insulin resistance. The severity of acne vulgaris may have no obvious correlation with insulin resistance and serum incretin.

Efficacy of botulinum toxin A injection in the treatment of androgenic alopecia: A Comparative Controlled Study.

INTRODUCTION: Scalp injection with mesotherapy (LC cell hair essence) helps in anchoring hair follicles and might have good therapeutic efficacy and lower side effects than Botox in the treatment of androgenetic alopecia (AGA). OBJECTIVE: To assess the trichoscopy and the clinical therapeutic response of LC hair essence serum injection vs. botulinum toxin (A) injection in the treatment of androgenetic alopecia. PATIENTS AND METHODS: Sixty-two AGA patients were included in the present study. Group I consisted of 31 patients who were injected with 1 ml of LC hair essence serum diluted with 0.5 ml of 0.9% normal saline once weekly for 8 weeks, and Group II involved 31 patients who were injected with 50 units of botulinum toxin A. Trichoscopic examination and photo documentation were done for every case before starting treatment (baseline) and after treatment with monthly follow-up to the patients. RESULTS: There was a significant difference between baseline trichoscopy findings and at the end of sixth month in Botox group, and the difference was highly significant in LC group; there was a statistically significant increase in the frequency of side effects (irritation and headache) among Group II compared with that of Group I. CONCLUSION: Botox can induce significant results in the treatment of AGA with mild and tolerable side effects but with high cost, while LC hair serum exhibit excellent results with fewer side effects.

Estimation of neutrophil activation marker in lichen planus patients.

BACKGROUND: Lichen planus disease is a chronic inflammatory disorder of mucosal and cutaneous tissues, and its etiology and pathogenesis are unclear. Cytokines have a significant role in the beginning, the maintenance of inflammatory and intercellular crosstalk. AIM: We assessed serum levels of neutrophil activation marker (calprotectin) in patients with cutaneous lichen planus with different subtypes and made a comparison with healthy individuals. MATERIALS AND METHOD: Peripheral blood samples of 30 cases with lichen planus were compared with 30 healthy individuals. Serum samples were prepared from LP patients, using a commercial ELISA kit, and calprotectin level was measured in each serum sample. RESULTS: The serum level of calprotectin was significantly raised in LP cases compared with control (141.34 ± 17.47 ng/ml versus 40.03 ± 1.54 ng/ml respectively; p < 0.001). No correlation was recorded among of serum of calprotectin and patients' ages, sex, disease period, and the existence or strength of pruritus. But a strong positive correlation was present between the coexistence of oral lesions and the number of locations. CONCLUSION: Calprotectin can be used as a marker of Lichen planus severity and progression. Calprotectin may play a role in the pathogenesis of LP.

Immunotherapeutic modalities for the treatment of recalcitrant plantar warts: a comparative study.

BACKGROUND: Plantar warts are sometimes resistant or they tend to recur after every possible destructive therapy. Immunotherapy has been used as a promising alternative therapeutic option in such recalcitrant cases. AIM: To evaluate and compare the efficacy and safety of the intralesional injection of vitamin D3, zinc sulfate 2%, and Candida antigen in the treatment of recalcitrant plantar warts. PATIENTS AND METHODS: The study included 152 adult patients with single or multiple recalcitrant plantar warts. They were equally subdivided into four groups (38 patients in each): 2% zinc sulfate, vitamin D3, Candida antigen, and normal saline respectively. Injections were done at 3-week intervals until complete resolution or for a maximum of 4 sessions. RESULTS: Complete response was achieved in 20 patients (52.7%) of the zinc sulfate group, 34 patients (89.5%) of the intralesional vitamin D3 group, 25 patients (65.7%) of the intralesional Candida antigen group and 8 patients (21.2%) of the saline group. The difference between the groups was statistically significant in favor of vitamin D3 (p = .037). CONCLUSIONS: Recalcitrant plantar warts were best treated with vitamin D3 that also has the advantages of better response on distant warts, minimal side effects, and low rate of wart recurrence.

The SARS-COV2 (COVID-19) Pandemic: What Clinicians should Know

In late 2019, a novel coronavirus, now designated SARS-CoV-2, emerged and was identified as the cause of an outbreak of acute respiratory illness in Wuhan, a city in China, named as COVID-19. Since then the waves of the virus exponentially hit many countries around the globe with high rates of spread associated with variable degrees of morbidity and mortality. The WHO announced the pandemic state of the infection in March 2020 and by June 1st 2020 more than 6 million individuals and more than 370 thousands case fatalities were documented worldwide. In this article, we discussed many aspects regarding this emerged infection based on the available evidence aiming to help clinician to improve not only their knowledge but also their practices toward this infection.

The SARS-COV2 (COVID-19) Pandemic: What Clinicians should Know

In late 2019, a novel coronavirus, now designated SARS-CoV-2, emerged and was identified as the cause of an outbreak of acute respiratory illness in Wuhan, a city in China, named as COVID-19. Since then the waves of the virus exponentially hit many countries around the globe with high rates of spread associated with variable degrees of morbidity and mortality. The WHO announced the pandemic state of the infection in March 2020 and by June 1st 2020 more than 6 million individuals and more than 370 thousands case fatalities were documented worldwide. In this article, we discussed many aspects regarding this emerged infection based on the available evidence aiming to help clinician to improve not only their knowledge but also their practices toward this infection.

Botulinum toxin type-A versus 5-fluorouracil in the treatment of plaque psoriasis: Comparative study.

BACKGROUND: Long-term remission and total clearance in Psoriasis can only be achieved in a few patients. AIM: To compare the efficacy and safety of intradermal Botulinum toxin (BTX) in the treatment of plaque psoriasis. SUBJECTS AND METHODS: A comparative study conducted in thirty-five patients with chronic plaque psoriasis was treated by split-body therapy. The patients were either treated with intradermal BTX or with intralesional 5-fluorouracil (5-FU) to each of 2 bilaterally symmetrical psoriatic plaque lesions. The outcomes were assessed using the following criteria: the sum of erythema, scaling, and induration scores and the clearing percentage of the target plaque lesion assessed by 2 blinded observers. RESULTS: At the end of the study, the response rate was 85% on the BTX treatment side and 90% on the 5-FU side. There was no significant difference between both sides regarding a clinical response or side effects. The recurrence rate was 15% on both sides. CONCLUSIONS: Botulinum toxin was a novel, safe, single injection, and effective therapy for plaque-type psoriasis. More studies are required to further prove the efficacy of BTX in the treatment of plaque psoriasis.

308-nm excimer laser: a hopeful and optional therapy for pityriasis versicolor.

BACKGROUND: Pityriasis Versicolor (PV) is known as a superficial fungal infection. It is suggested that resistant strains to azoles may be developed and hence, the treatment would be difficult. This study aimed to evaluate the efficacy of excimer laser (308 nm) as an alternative therapy for PV. MATERIALS AND METHODS: This is a prospective intra-patient left-to-right, randomized, placebo-controlled study conducted on 26 patients with bilateral lesions which are not responding to the PV standard treatment. Patients were randomly assigned to right or left-side therapy for a duration of 8 weeks with either excimer laser (308 nm three times weekly) or topical placebo. Clinical assessment and mycological evaluation were performed before the initiation of treatment and at the fourth and eighth week of therapy. RESULTS: A decrease in the mean clinical score of cases was recorded from 7.1 at the baseline evaluation to 1.56 after 4 weeks and to 1.96 after 8 weeks of treatment. At week 4, there was a statistically significant reduction in the clinical scores compared with pretreatment scores and with the placebo group (p < .001). CONCLUSION: 308-nm excimer laser can be considered as a hopeful and optional therapy for PV.

Monofilament threads in treatment of female hair loss.

BACKGROUND: Recently, thread treatment has been commonly used in Korean medicine for cosmetic reasons such as decreasing skin wrinkles. It was noted that an inserted thread caused constant stimulation, followed by assistance for connective tissue regeneration. However, its role in hair development has not yet been revealed. OBJECTIVE: To perform a pilot study on the effect of monofilament threads scalp injections in women with female androgenetic alopecia. MATERIALS AND METHODS: This double-blind, multicenter, placebo-controlled study compared the effect of monofilament threads with that of saline as placebo. The endpoints were hair count and hair mass index (HMI), along with patient-opinion survey responses. RESULTS: HMI or hair count has statistically significantly differed between the study and placebo groups. However, 73.3% of the treatment subjects (vs. 0% of the placebo subjects) experienced substantial improvement in hair loss, rate of hair loss, hair thickness, and ease of managing/styling hair, and 76.8% (vs. 18.4% of the placebo group) reported that their hair felt coarser or heavier after the treatment. CONCLUSION: Monofilament threads demonstrate highly statistically significant improvement in HMI or hair count in women female pattern hair loss. The patient survey results suggest a therapeutic advantage of monofilament threads as perceived by patients and according to hair count or HMI.

Evaluation of Botulinum Toxin A as an Optional Treatment for Atopic Dermatitis.

OBJECTIVE: Botulinum toxin (BTX) A has different biological activities, including anti-inflammatory and antipruritic behavior. Studies on humans and animals have shown that BTX is efficient in treating itch caused by histamine, lichen simplex chronicus, psoriasis, rosacea, allergic rhinitis, and scar avoidance. OBJECTIVE: This study sought to assess the impact of BTX-A in patients with atopic dermatitis using scores of SCORAD and to identify parameters linked to greater improvements. METHODS: This was a prospective, intrapatient, left-to-right, randomized, placebo-controlled study of BTX-A for the treatment of atopic dermatitis. The study included 26 patients with atopic dermatitis (12 males and 14 females) with an average age of 37.8 years. Responses to therapy were assessed using SCORAD, Dermatology Quality of Life Index (DLQI), and the worldwide clinical reaction score evaluation. RESULTS: Mean SCORAD values dropped from 50.5 to 11 points (p<0.001); meanwhile, 64.1 percent of patients reported an excellent response, including 78.9 percent of patients with severe AD. The DLQI score fell by 10.15 points (43.5%) in patients treated with BTX-A. A statistically significant reduction in SCORAD and DLQI scores occurred relative to in the placebo group (p<0.001). CONCLUSION: Based on the results of this study, BTX-A appears to be a safe and effective therapy for atopic dermatitis of all grades (mild, moderate, and severe). However, BTX-A appears to be best suited for patients with severe atopic dermatitis.

Assessment of neopterin level and severity in lichen planus patients treated with narrow-band ultraviolet B.

BACKGROUND: Neopterin is a cellular immunity biochemical marker. Serum and saliva neopterin levels have been reported to increase in lichen Planus. Nonetheless, analysis has not yet been made for the direct link between narrow band ultraviolet B and severity of Lichen planus. AIM: We aimed to assess serum neopterin levels in patients who receive narrow band ultraviolet B therapy treatment with lichen planus, paired with the severity of the disease. PATIENTS AND METHODS: The study consisted of 35 lichen planus patients and 30 healthy individuals. A 35 patient group received narrow band ultraviolet B therapy. An enzyme-related immunosorbent assay procedure was used in serum neopterin analysis before and post-therapy. RESULTS: The correlation between the level and severity of the patient group was statistically significant (P = .001). In patients with severe disease, serum neopterin levels were significantly increased. Also, in the severe lichen planus group, the serum neopterin level was statistically higher than that of the mild or moderate groups (P = .001).Also, a significant decrease was seen following therapy according to serum neopterin level. CONCLUSION: Serum neopterin levels are a useful marker for the assessment of the severity and effectiveness of narrow band ultraviolet therapy. Thus, our findings may provide a new approach with the management of disease and follow-up strategies in patients with lichen planus.

Clinical evaluation of the efficacy of trichloroacetic acid 70% after microneedling vs intradermal injection of 5-fluorouracil in the treatment of nonsegmental vitiligo; A prospective comparative study.

Vitiligo is a skin disorder commonly acquired. Although different therapies are used, they are refractory to therapy in many cases. Trauma has been reported to cause hyperpigmentation by the pigment incontinence, which results in the build-up of melanophages in the upper dermis after basal cell layer destruction. To detect the effectiveness of trichloroacetic acid (TCA) 70% in the treatment of nonsegmental vitiligo after skin microneedling by dermapen or intradermal injection of 5-fluorouracil. PATIENTS AND METHODS: A prospective comparative study was enrolled with 32 patients with vitiligo who were assigned to two equal groups. Each containing 16 patients; group 1 was treated by microneedling followed by TCA 70%, group 2 was treated by intradermal 5-FU injection. This was done every 2 weeks for 2 months. RESULTS: According to the Physician's Global Assessment, there was no significant (P < .05) difference in the therapeutic response between the two studied groups. CONCLUSIONS: Both microneedling plus TCA 70% and 5-FU intradermal injection are a simple means of treating vitiligo with cosmetically accepted repigmentation of all age groups, as well as a relatively safe alternative or additive method that can be used before (or in combination with) any of the well-known and widely approved method for stable nonsegmented vitiligo treatment.

Correlation between serum IL 37 levels with keloid severity.

BACKGROUND: Keloids are dermal fibroproliferative disorders that characterized by over deposition of components of the extracellular matrix. Interleukin 37 (IL-37) is known by its ability to inhibit the proliferation of keloid fibroblasts by inhibiting extracellular matrix production induced by transforming growth factor ß (TGF-ß). Thus, Il-37 is suggested to be used as an early preventive treatment for keloids. AIMS: This study aimed to evaluate the correlation between serum levels of IL37 level and the keloid severity. PATIENTS/METHODS: This is a cross-sectional analytic study involving thirty-two patients diagnosed clinically as having Keloid. An assessment of keloid severity was conducted by using Vancouver Scar Scale (VSS). Blood samples were collected from every patient to measure and assess the serum levels of IL37. RESULTS: A negative correlation was found between IL37 level and the keloid severity (P = .0001; r = -.737). Also, there was a nonsignificant correlation between IL37 levels in patient with keloid and age, gender, duration of lesions, and family history. CONCLUSION: Lower level of plasma IL 37 could be an indicator of the severity of Keloids.

Evaluation of combined excimer laser and platelet-rich plasma for the treatment of nonsegmental vitiligo: A prospective comparative study.

BACKGROUND: Excimer laser therapy of vitiligo generally takes months to years to achieve excellent outcomes. Platelet-rich plasma is an autologous preparation with a focus on various growth factors that can help with vitiligo repigmentation. OBJECTIVES: To assess the additive effect of PRP in the therapy of vitiligo on the results of the excimer laser. PATIENTS AND METHODS: A comparative study included 52 patients (8 males and 44 females) in two groups with stable (no new lesion for 6 months), nonsegmental and symmetrical vitiligo. Group I (26 patients): The patient was treated by intradermal PRP injection and the excimer laser, while group II (26 patients) was treated with the excimer laser only. The PRP injection was repeated every 3 weeks for 4 months and excimer laser two times a week and for 16 weeks till complete response. VAS for patient's satisfaction assessment, safety assessment for complications, and follow-up for 3 months was done. Clinical (repigmentation response) and histopathological assessment was done. RESULTS: There was a higher statistically significant treatment response in group I compared with group II. In addition, a statistically significant correlation between the treatment response and the lesion site in group I (P < .000). A significant difference in VAS between both groups (P < .000). Few the side effects were reported. CONCLUSION: The combination of PRP and excimer laser phototherapy is an efficient vitiligo treatment as PRP increases the excimer laser impact and also improves the result.

Efficacy of 1064 Q switched Nd:YAG laser in the treatment of oral lichen planus.

Background: The erosive-atrophic form of oral lichen planus (OLP) is usually presented with severe pain and burning sensation that is usually refractory to traditional treatment. Topical corticosteroid is considered the first line despite their adverse effects. Therefore, new therapeutic approaches are required.Aim: This study aimed to examine the effectiveness of Nd:YAG laser in the treatment of long-standing erosive-atrophic OLP.Patients and methods: Twenty-four patients diagnosed with OLP were included in this study. A total of 59 lesions was assessed as regards to the degree of pain by visual analog scale and clinical scores by Thongprasom sign scoring system before and after treatment. All patients were treated by Nd:YAG laser therapy with (1064 nm 0.5 W, 30 s, 1.2 J/cm2) three times weekly and for 1 month. Treatment efficacy index was determined after the end of therapy.Results: A significant pain reduction was detected after Nd:YAG laser treatment (p < .0001). In addition to that, complete resolution was achieved in about 37.3% of the lesions and improvement in clinical signs was found in 59.3% of the lesions. By the end of therapy, about 30.5% showed score 1 while 11.9% of them were scored 3. Also, 8.5% of the lesion was scored 2, 6.8% were scored 4 and 5.1% were scored 5. Actually, all of the participating patients showed some degree of improvement and most of them achieved moderate recovery.Conclusion: The results of this study can indicate that Nd:YAG laser is an effective modality that can be used safely in the management of erosive-atrophic OLP.

Combination of pulsed dye laser and verapamil in comparison with verapamil alone in the treatment of keloid.

Background and objective: Many modalities of treatment have been advocated for Keloid ,but the success rates of these have been variable. The present study is an attempt to evaluate and compare the efficacy of a combination of pulsed dye laser (PDL) and intralesional verapamil against intralesional verapamil alone in the treatment of keloids.Methods: 40 Patients with keloids were divided into two groups randomly of 20 each receiving four sessions of therapy. Group A intralesional verapamil alone 2.5mg/ml. Group B received a combination of PDL and intralesional verapamil alone 2.5mg/ml. Pretreatment measurements and photographs were taken.Results: Statistically significant improvement was seen in the height and length of the lesions. Overall appearance criteria of modified MQS showed an improvement of more than 50% in 43.3% of the lesions by the end of four sessions. The improvement of these parameters in the verampil only group was significantly lower than the improvement seen in the PDL+ intralesional verapamil group.Conclusion: Combination therapy with PDL+ intralesional verapamil was superior in efficacy when compared to intralesional verapamil alone, in the treatment of keloids.

Combined therapy of plantar warts with topical bleomycin and microneedling: a comparative controlled study .

Background: The aim of this study was to assess the efficacy of combination between microneedling with dermapen and topical bleomycin in the treatment of plantar warts in comparison with intralesional bleomycin and intralesional saline (placebo).Methods: Fifty-four patients were assigned into three groups, each containing 18 patients. The first group treated by micro-needling phenotype with topical bleomycin at 2 weeks interval, the second group received intralesional bleomycin at 3 weeks interval and the control group was intralesional saline for a maximum of four weeks.Results: Complete clearance of warts in 16 patients in the micro-needling group (88.9%) versus 15 patients (83.3%) in the intralesional bleomycin group versus one patient (5.6%) in the control group .Conclusions: Microneedling assisted topical bleomycin spraying seems to be a promising effective and noninvasive therapeutic modality for recalcitrant plantar warts that facilitates delivery and absorption of bleomycin into the lesion .