The efficacy of adding topical 5-fluorouracil to micro-needling in the treatment of vitiligo: A randomized controlled trial.

BACKGROUND AND AIM: Vitiligo is an autoimmune skin disorder characterized by circumscribed depigmented macules and patches caused by the loss of functional melanocytes. Although there is no definitive treatment for vitiligo, several treatment options have been associated with relative satisfactory outcomes. The purpose of this study was to compare the efficacy of micro-needling in conjunction with topical 5-fluorouracil (5-FU) versus topical tacrolimus ointment in treating vitiligo patches. PATIENTS AND METHODS: This study included nineteen participants, each of whom received both treatments on two randomly selected vitiligo patches of approximately the same size and location. On one patch, a combination of weekly micro-needling and topical application of 5-FU solution was used every other day, while on the other, 0.1% tacrolimus topical ointment was applied twice daily. The G-score was used to compare treatment outcomes after 3 months. RESULTS: The median duration of the disease in our population was 7 years. Six patients (32%) in the micro-needling plus topical 5-FU treated group showed a moderate to excellent response, indicating a significant improvement between both treatments (p-value = 0.019). In contrast, all other patches treated with topical tacrolimus showed poor improvement. Lower extremity and trunk responded more to treatment with micro-needling plus topical 5-FU than upper extremity and acral areas. Moreover, none of those who have had the disease for more than ten years have responded to treatment. Mild erythema, pinpoint bleeding, and irritation were detected only in the micro-needling treated group. CONCLUSION: The current study showed that using micro-needling in conjunction with 5-FU could treat vitiligo patients more efficiently than tacrolimus monotherapy. Despite showing moderate to excellent improvement in patches treated with micro-needling and 5-FU, this well-tolerated office-based modality still requires additional research.

Fractional CO2 laser is as effective as pulsed dye laser for the treatment of hypertrophic scars.

BACKGROUND: Both pulsed dye laser (PDL) and fractional CO2 laser (FCO2L) are used commonly for the treatment of hypertrophic scars. OBJECTIVE: To compare the efficacy of PDL and FCO2L on hypertrophic scars. PATIENTS AND METHODS: One part of each scar, or one of the two similar scars in 35 patients was treated with PDL and the other parts, or scars were treated with FCO2L. The parameters used for FCO2L were: power = 30 W, pulse energy = 50 mJ, density = 200 spots/cm2. The parameters used for 585 nm PDL were 9 J/cm2 with 5 mm spot size. The FCO2L side was treated for three passes to debulk the scar. The coagulated tissue was wiped out before the next pass. The PDL side was treated with two superimposed passes. The procedures were repeated every month for 4 months. RESULTS: After four sessions of laser therapy, both sides showed remarkable improvement but no meaningful difference was detected between two areas that were treated with PDL and FCO2Ls (p > .05). The mean Vancouver Scar Scale was 7.31 ± 1.93 in the beginning and 4.26 ± 1.48 for FCO2L and 4.33 ± 1.70 for PDL one months after the final session. CONCLUSIONS: Both PDL and FCO2Ls were equally effective on hypertrophic scars.

Comparing the efficacy of pulsed dye laser, Q-Switched Nd-YAG, CO2, and combined CO2 and Q-Switched Nd-YAG lasers for the treatment of cutaneous macular amyloidosis.

BACKGROUND: No topical and systemic treatment is proven to be effective on Cutaneous Macular Amyloidosis (CMA). The physical removal of the deposited protein by lasers may be a better choice. OBJECTIVE: To compare the efficacy of different lasers including Pulsed dye laser (PDL), 1064 mode of Q-Switched Nd-YAG, CO2, and combined CO2 and Q-Switched Nd:YAG lasers for the treatment of CMA. PATIENTS AND METHOD: 17 adult female patients with clinical CMA and histopathological confirmation were included in this study. Four close 1 by 1 cm2 areas were treated simultaneously with PDL, Q-Switched Nd-YAG, CO2 and combined CO2 and Nd-YAG Lasers. The energy used for 585 nm PDL were 9 J/cm2 with the spot size of 5 mm. The energy used for 1064 nm mode of Nd-YAG laser was 5 Joules/cm2, with the spot size of 4 mm, and the frequency of 10 hertz. The energies used for CO2 laser were 4 and 3.5 Micro Joules for the first and second Passes. RESULTS: No desirable result obtained after PDL therapy. The Q-Switched Nd-YAG was effective in only 3 patients. All areas treated with CO2 laser were cleared. CONCLUSION: The CO2 laser is seems to be the most effective laser treatment of CMA.

The pulsed dye laser is more effective and rapidly acting than intralesional meglumine antimoniate therapy for cutaneous leishmaniasis.

BACKGROUND AND OBJECTIVE: The pulsed dye laser (PDL) is not tested yet for the treatment of cutaneous leishmaniasis (CL). We compared the efficacy of 585 nm PDL with intralesional meglumine antimoniate (MA) on 17 patients with 81 lesions of CL. PATIENTS AND METHODS: Out of the 81 lesions, 42 lesions were treated with one or two passes of PDL fortnightly and 39 lesions in the same patients were treated with intralesional MA weekly. The fluence chosen for the laser was 7 Joules/cm² with 5 mm spot size. The MA treated lesions were infiltrated gently with MA to blanch the lesions completely. RESULTS: All laser treated lesions were responded well with almost 66.7% cure after the first, and more than 90% after the second treatment. One patient was recovered after third, and the last one after fourth sessions. All 39 MA treated lesions were also responded after third to eighth sessions. The mean number of the sessions required for the patients to be treated with PDL is 1.85, and the mean number of the sessions required for the patients to be treated with MA is 4.6. CONCLUSIONS: The PDL can cure many cases of CL particularly in their early stages faster than MA.

Successful treatment of isolated venous malformation with 1444-nm fiberoptic Nd-YAG laser.

UNLABELLED: Two patients with isolated venous malformations on the face were treated with fiberoptic Nd-YAG laser (Lutronic laser company, South Korea). After nerve block anesthesia, the laser tip was pushed into the lesions either through a hole made by a 16 gauge needle or directly by inserting and triggering the laser tip few millimeters away from the lesions. The laser tip was pushed from one or few directions and moved back and forth, while triggering, in a fan pattern to cover the whole lesion. The procedure was continued till complete flattening of the lesions. The parameters used were pulse rate = 30 hertz, pulse energy = 300 mJoules, power = 6.0 watt, and total energy used for the first patient was 1000 Joules and for the second patient was 800 joules. RESULTS: The lesions flattened completely after whole tissue coagulation. Moderate redness disappeared in the first 48 hours. No persistent discoloration and no sign of cutaneous burning appeared after the procedures. No antibiotic or analgesic was prescribed after the procedure. The patients were followed for more than 2 years with no recurrence and good cosmetic results. CONCLUSION: The fiberoptic Nd-YAG laser can be used as an effective procedure for venous malformations.

Recipient site preparation for epidermal graft in stable vitiligo by a special fraise.

BACKGROUND: The only approach used in the refractory lesions of stable vitiligo is the surgical supply of melanocytes. Suction Blistering Epidermal Graft is one of the most common and effective techniques. There are multiple modalities, including the motor-driven diamond fraise, for the preparation of recipient sites in suction blistering epidermal graft with different repigmentation rates and complications. OBJECTIVES: To evaluate preparation of recipient site by a motor-driven dental lab finishing carbide bur. METHODS: Sixty-one stable, depigmented lesions were selected in 14 patients (9 women and 5 men), aged 16-29 years, of which 9, 3 and 2 had localized, generalized and segmental vitiligo, respectively. Recipient site was prepared by a motor-driven dental lab finishing carbide bur. RESULT: Excellent repigmentation at the recipient site was observed in 53 out of 61 (86.9%) grafted lesions. Postinflammatory hyperpigmentation and perigraft halo were seen in 11 (18%) and 17 (27.9%) patients at the recipient site, respectively. CONCLUSION: Using a motor-driven dental lab finishing carbide bur to prepare the recipient site of suction blistering epidermal graft technique is reliable and effective, removing only the depigmented epidermis in a simple and safe manner, even on complex-shaped lesions and scar-prone sites.

Recipient site preparation for epidermal graft in stable vitiligo by a special fraise

BACKGROUND: The only approach used in the refractory lesions of stable vitiligo is the surgical supply of melanocytes. Suction Blistering Epidermal Graft is one of the most common and effective techniques. There are multiple modalities, including the motor-driven diamond fraise, for the preparation of recipient sites in suction blistering epidermal graft with different repigmentation rates and complications. OBJECTIVES: To evaluate preparation of recipient site by a motor-driven dental lab finishing carbide bur. METHODS: Sixty-one stable, depigmented lesions were selected in 14 patients (9 women and 5men), aged 16-29 years, of which 9, 3 and 2 had localized, generalized and segmental vitiligo, respectively. Recipient site was prepared by a motor-driven dental lab finishing carbide bur. RESULT: Excellent repigmentation at the recipient site was observed in 53 out of 61 (86.9%) grafted lesions. Postinflammatory hyperpigmentation and perigraft halo were seen in 11 (18%) and 17 (27.9%) patients at the recipient site, respectively. CONCLUSION: Using a motor-driven dental lab finishing carbide bur to prepare the recipient site of suction blistering epidermal graft technique is reliable and effective, removing only the depigmented epidermis in a simple and safe manner, even on complex-shaped lesions and scar-prone sites. .

Combination of CO2 and Q-switched Nd:YAG lasers is more effective than Q-switched Nd:YAG laser alone for eyebrow tattoo removal.

BACKGROUND: The eyebrow tattoo removal using Q-switched lasers is usually prolonged. Other modalities may be required to enhance the efficacy and shorten the treatment course. OBJECTIVE: To compare the efficacy of Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser alone versus combination of Q-switched Nd:YAG and Ultrapulse CO2 lasers for eyebrow tattoo removal after a single session. PATIENTS AND METHODS: After local anesthesia, the right eyebrow of 20 patients was treated with Ultrapulse CO2 laser with the parameters of 4 J/cm(2) and 3.2 J/cm(2) for the first and the second passes. Both eyebrows were then treated with 1064-nm and 532-nm Q-switched Nd:YAG laser. The spot size and pulse duration were 3 mm and 5 nanoseconds for both wavelengths, and the fluence was 7 J/cm(2) for 1064 nm and 3 J/cm (2) for 532 nm. RESULTS: The side treated with combination of Q-switched Nd:YAG and CO2 lasers improved 75-100% in 6 of 20 patients versus only 1 of 20 in the side treated with Q-switched Nd:YAG alone. Similarly, the right side in 13 of 20 patients showed more than 50% improvement with combination therapy versus the left side (the monotherapy side), where only 6 of 20 cases showed more than 50% improvement. The Mann-Whitney test was 2.85 for the right side and 1.95 for the left side (P value = 0.007). CONCLUSION: Using Ultra pulse CO2 laser enhances the efficacy of Q-switched Nd:YAG laser in eyebrow tattoo removal.

Shallominthe active antimicrobial constituent of persian shallot in treatment of oral herpes: a double-blind randomized clinical trial.

BACKGROUND: Previous studies showed that shallomin, the active antimicrobial constituent of Persian shallot, has a wide range of antibacterial and antifungal properties. OBJECTIVES: The objective of this randomized clinical trial was to evaluate the effectiveness of topical shallomin alcoholic solution in treatment of cold sore. PATIENTS AND METHODS: A total of 60 volunteers who met the inclusion criteria were randomly allocated to two equal groups to hourly apply topical of either 0.5% shallomin alcoholic solution or placebo within the first 24 hours of developing cold sores. All the cases were reassessed at six-hour intervals. RESULTS: The cold sores were cleared within six hours among 30% of cases who received shallomin solution and the remaining of the cases in this group were cleared between 6six to 24 hours of application. In the placebo group, clearance of the sores occurred in four cases between 48 to 72 hours and the remaining of cases were cleared after 72 hours. CONCLUSIONS: The results of this study demonstrated that shallomin is a useful natural remedy in preventing the progression and treatment of cold sores and can significantly reduce the duration of ulceration.

Surgical removal of neglected soft tissue foreign bodies by needle-guided technique.

INTRODUCTION: The phenomenon of neglected foreign bodies is a significant cause of morbidity in soft tissue injuries and may present to dermatologists as delayed wound healing, localized cellulitis and inflammation, abscess formation, or foreign body sensation. Localization and removal of neglected soft tissue foreign bodies (STFBs) is complex due to possible inflammation, indurations, granulated tissue, and fibrotic scar. This paper describes a simple method for the quick localization and (surgical) removal of neglected STFBs using two 23-gauge needles without ultrasonographic or fluoroscopic guidance. MATERIALS AND METHODS: A technique based on the use of two 23-gauge needles was used in 41 neglected STFBs in order to achieve proper localization and fixation of foreign bodies during surgery. RESULTS: Surgical removal was successful in 38 of 41 neglected STFBs (ranging from 2-13mm in diameter). CONCLUSION: The cross-needle-guided technique is an office-based procedure that allows the successful surgical removal of STFBs using minimal soft tissue exploration and dissection via proper localization, fixation, and propulsion of the foreign body toward the surface of the skin.

Successful removal of polyacrylamide hydrogel by pulsed fiberoptic 1444-nm Nd-YAG laser.

BACKGROUND: Tissue augmentation by polyacrylamide gel (PAAG) may lead to displacement or complications several years later and necessitate its removal. OBJECTIVE: To use a fiberoptic 1444-nm neodymium-doped yttrium aluminum garnet (Nd-YAG) laser for removing polyacrylamide hydrogel augmentations. METHODS: Five patients with frontal and cheek augmentations were referred for gel removal. After nerve block anesthesia, a 600-µm optical fiber tip with a metallic cannula was inserted into a hole created by a 16-gauge needle, and the laser was triggered. The cannula was moved in a fan pattern in the augmented area and was then removed. The tissue was squeezed from its outermost region toward the hole to extrude the gel. The laser system used was a 1444-nm fiberoptic Nd-YAG, obtained from Lutronic lasers, South Korea. The parameters used were: pulse rate = 30, pulse energy = 150 J, power = 4.5 W, and total energy = 400-1200 J. RESULTS: The heat of the laser tip liquefies the gel and by coagulating the surrounding tissues, it produces multiple patent canals. These two factors facilitate gel removal by squeezing the tissues. No temporary or permanent complication, such as hematoma, burning, or fibrosis, was detected. CONCLUSION: The 1444-nm Nd-YAG laser is a safe and efficient method for removing subcutaneous polyacrylamide hydrogel.

Weekly vs. daily administration of oral methotrexate (MTX) for generalized plaque psoriasis: a randomized controlled clinical trial.

UNLABELLED: Methotrexate (MTX) treatment for psoriasis is most often administered weekly, because the drug has been considered more hepatotoxic when taken daily. However, some patients may tolerate smaller, more frequent doses better. OBJECTIVE: To study the efficacy and toxicity of daily vs. weekly MTX. PATIENTS AND METHODS: In a randomized controlled trial, 101 patients with generalized plaque psoriasis received oral MTX 2.5 mg daily for weeks, 4 weeks and monthly for a total of 4 months. Changes in PASI scores were classified into three categories: >75% improvement was considered significant; 25-75% moderate; and <25% poor. RESULTS: Sixty Group 1 patients and 81 Group 2 patients showed a significant response (P-value 0.001); 19 patients in Group 1 and 14 in Group 2 responded moderately; 22 patients in Group 1 and six patients from Group 2 responded poorly. Forty-five patients in Group 1 and 33 in Group 2 developed transient increases in liver enzymes (P-value 0.11). Nausea, headache, fatigue, and gastrointestinal upset were noted in four Group 1 patients and 30 Group 2 patients (P-value 0.0001). CONCLUSION: Nausea, vomiting, headache, and fatigue were significantly less common side effects in our patients who received MTX daily, but liver enzyme abnormalities were less common, and clinical efficacy was greater in the patients who received MTX weekly.

Botulinum toxin type-A (BT-A) for the treatment of multiple eccrine hydrocystomas.

BACKGROUND: The treatment of multiple eccrine hydrocystomas is challenging. Surgical excision is impractical. The outcomes of CO(2) and pulsed-dye laser therapy are not well studied. Botulinum toxin-A (BT-A) can block the secretions of the sweat glands and prevent dilatation of the cysts. OBJECTIVE: To study the efficacy of BT-A on eccrine hydrocystoma. METHODS: Eighteen patients with multiple facial eccrine hydrocystomas were treated by BT-A. The 500 IU vial of BT-A (Dysport; Ipsen Ltd, UK) was dissolved in 7.5 cc of normal saline to prepare a solution, 0.1 cc of which contains 6 IU of BT-A. Then, 0.1-0.2 ml of diluted BT-A was injected intradermally around the lesions using an insulin syringe with a 30-gauge needle. A second BT-A injection session was carried out 3-4 weeks later for four partially responsive patients. RESULTS: Thirteen patients showed significant flattening of the lesions after the first session. The remaining partially responsive four patients showed considerable flattening after the second boosting session, performed 3-4 weeks later. The side effects were temporary and minimal. The duration of effect for the BT-A injection was 5-7 months. CONCLUSION: Intradermal BT-A injection can be considered as a relatively safe and cost-effective treatment for multiple eccrine hydrocystomas.

Paradoxical hypertrichosis and terminal hair change after intense pulsed light hair removal therapy.

BACKGROUND: Although complications such as blister formation, erosion, and post-inflammatory hypo- and hyperpigmentation are well-known side effects of intense pulsed light (IPL) photoepilation, little is known about the paradoxical hypertrichosis after therapy. OBJECTIVE: To report the paradoxically increased hair density and coarseness after IPL photoepilation. METHODS: Within a period of 23 months, a total of 991 hirsute female patients were treated with IPL for photoepilation. The IPL system used was the Vasculight-SR, a multifunctional laser and IPL system (Lumenis Inc., Santa Clara, CA, USA). The cut-off filters frequently used were 695, 755 and 645 nm. RESULTS: Paradoxical hypertrichosis and terminal hair change were detected after a few sessions of IPL therapy among 51 out of 991 patients. Our serial digital photographs, schematic diagrams, and hair counts before and after treatment confirmed the patients' claims. The other more commonly seen complications were epidermal burning with blisters, erosion, and crust formation followed by post-inflammatory hypo- and/or hyperpigmentation. CONCLUSION: Paradoxical hypertrichosis and terminal hair change is a common complication of IPL photoepilation.

Burning, paradoxical hypertrichosis, leukotrichia and folliculitis are four major complications of intense pulsed light hair removal therapy.

BACKGROUND: Lasers and intense pulsed light (IPL) are now used worldwide for prolonged photo-epilation. OBJECTIVE: To study the side effects of IPL hair removal therapy among 2541 female hirsute patients as the largest series reported so far in the literature. METHODS: The first series of 1000 patients were treated by the Lumina IPL system. (Lynton Lasers, UK). The second series of 1541 patients were treated by Vasculight-SR, a multi-functional laser and IPL system (Lumenis, Inc., USA). The fluences used for Lumina varied between 16 and 30 J/cm2. The parameters used for Vasculight-SR were as follows: fluences ranged from 33 to 42 J/cm2; pulse duration was 3-5 ms, and pulse delay was 20-80 ms. The pulse mode was either double or triple. The parameters were chosen according to the patients' Fitzpatrick skin types and tolerance. The cut-off filters frequently used were 695, 755, 645 and 615 nm in descending order of their frequencies. Patients were treated every 4-6 weeks and for eight sessions or more. All patients were followed for up to 20 months. RESULTS: Series 1 - burning and its sequelae presented as post-inflammatory hyperpigmentation (PIH), post-inflammatory hypopigmentation (PIHPO), bulla and erosion, and finally scar formation in 75, 10, 64 and one case, respectively. Leukotrichia, folliculitis, and paradoxical hypertrichosis were recorded in 40, 35, and 12 more cases, respectively. Series 2 - PIH and PIHPO were recorded in 28 and four patients. Erosion and crust formation were recorded in 28 patients. Paradoxical effect, leukotrichia and acne formation were seen in 79, 27 and 19 cases, respectively. CONCLUSION: Burning and its sequellae, leukotrichia, paradoxical hypertrichosis and folliculitis are four major side effects of IPL hair removal therapy in our study.

Isolated eyebrow and eyelash trichotillomania mimicking alopecia areata.

BACKGROUND: Isolated Trichotillomania (TM) of the eyebrows and eyelashes is occasionally seen and may be mistaken for alopecia areata (AA). OBJECTIVE: The clinical study of the patients with isolated eyebrows and eyelashes alopecia suggesting of TM. PATIENTS AND METHOD: Seven children and young adult patients who referred with recalcitrant eyebrows and eyelashes alopecia were diagnosed as TM based on the clinical criteria for TM. The hair specifications for TM were include: hairs are broken at different levels, they may be tufted, tortuous and some hair fibers may be abnormally longer than others. The hair follicles may be prominent. The patients and their parents studied for psychopathology using a semistructured interview based on the Diagnostic Statistical manual of Psychiatric disorders (DSM-1V) and maudsley inventory. RESULTS: Our clinical study, interview with the patients and their parents and the clinical criteria used to differentiate TM from AA all support the clinical diagnosis of TM. The patients and their parents mainly suffered from obsessive-compulsive disorders (OCD) and obsessive-compulsive spectrum disorders (OCSDs). CONCLUSION: TM as a hair pulling habit in patients with underlying psychopathology can be considered in cases with isolated eyebrows and eyelashes alopecia when the hair are broken at different levels. And they may be malaligned, nonuniform, tortuous, and tufted.