Long-pulsed nd: YAG laser treatment of nail psoriasis: clinical and ultrasonographic assessment.

Nail psoriasis is a chronic, inflammatory condition which is difficult to treat, linked with greater psoriasis severity, and may be associated with anxiety and significant functional impairment of the quality of life. The 1064 nm Nd: YAG laser was reported to yield satisfactory results in the treatment of nail psoriasis.The aim of the study was to assess the clinical and ultrasonographic efficacy of long-pulsed 1064 nm Nd: YAG laser in the treatment of fingernail psoriasis and compare its effect to control fingernails.This intra-patient randomized controlled trial analyzed 86 fingernails collected from 13 patients suffering from cutaneous and nail psoriasis. The nails were randomized into two groups. Group A was treated with Nd: YAG laser once monthly for three sessions while group B served as control. Assessment took place at baseline, 1 and 3 months after the last treatment session. For scoring, the 32-points target NAPSI scoring systems was used. Additionally, two blinded dermatologists' score of improvement, patients' pain assessment by visual analogue score and ultrasonographic assessment were all performed.At the end of follow up, the medians of tNAPSI score, plate definition, matrix thickness, bed thickness and bed vascularity decreased significantly in the Nd: YAG laser treated group in comparison to baseline (p = 0.001, 0.006, 0.039, < 0.001 and 0.010, respectively). While, there was a non-significant reduction in median tNAPSI score in the control group at last follow up, however, ultrasonography recorded a significant reduction in the medians of plate definition, bed thickness and vascularity (p = 0.002, 0.011 and 0.033, respectively) from the baseline. Comparison of the Nd: YAG laser and the control groups showed no significant difference from baseline regarding the medians of tNAPSI, tNAPSI percentile improvement, pits count, blinded evaluation of photographs and ultrasonographic assessments.In conclusion, Nd: YAG laser showed clinical and ultrasonographic improvement in fingernail psoriasis. Ultrasonography is a useful noninvasive tool in diagnosing and monitoring the clinical and even the subclinical changes in nail psoriasis. Nail psoriasis although difficult to treat, may show spontaneous improvement.

Efficacy of the topical cyclosporine cream assisted by fractional carbon dioxide laser vs topical clobetasol cream for the treatment of plaque psoriasis: Randomized comparative study.

BACKGROUND: In mild psoriasis, topical agents remain the mainstay of treatment. However, the available treatments are not satisfactory for a significant proportion of patients in many terms such as efficacy and safety. Because of these deficits, augmentation of therapeutic effect seems desirable. THIS STUDY AIMS: To evaluate the efficacy of topical cyclosporine cream, delivered by fractional CO2 laser vs the efficacy of topical clobetasol cream for the treatment of mild to moderate plaque psoriasis. PATIENTS AND METHODS: Twenty-two patients with chronic plaque psoriasis involving <10% BSA were included in this study. They were randomly allocated into 2 groups. In Group A, patients were instructed to apply cyclosporine cream twice daily for 5 consecutive days per week immediately after fractional carbon dioxide laser session. While in Group B, clobetasol cream was applied twice daily for 5 consecutive days per week until complete clearance or for a maximum of 10 weeks. The efficacy was objectively assisted clinically and by histopathology by using the scores and skin biopsy. RESULTS: There was a significant improvement of erythema, plaque elevation, and scaling (p < 0.001) with the use of topical cyclosporine cream delivered by the aid of fractional CO2 laser, compared to base line. However, the improvement was more significant with topical clobetasol cream. CONCLUSION: Laser-assisted delivery of topical cyclosporine can provide comparable clinical and pathological improvement to that of clobetasol in the psoriatic plaques. These findings were apparent in patients with less widespread disease. However, topical steroid showed more improvement.

The effectiveness of long Pulsed Nd:YAG Laser alone for treatment of keloids and hypertrophic scars versus its combination with bleomycin.

BACKGROUND AND OBJECTIVES: Pathological scars are benign hyper-proliferative growths of dermal collagen that causes severe psychological and physical problems. This study was performed to assess and compare safety and clinical efficiency of combined pulsed Nd-YAG laser and intralesional bleomycin versus pulsed Nd-YAG laser alone to treat the hypertrophic scars and keloids. PATIENTS AND METHODS: Randomly, 40 patients with hypertrophic scars or keloids were divided into two groups A and B. Group A were handled by pulsed Nd:YAG laser and intralesional bleomycin while group B were handled by pulsed Nd:YAG laser only. Response was assessed subjectively by clinical imaging and modified Vancouver Scar Scale (mVSS). While for objective evaluation, skin biopsies were taken from volunteer patients before and after treatment, and were examined by Hematoxylin and eosin staining (H&E) and Masson trichrome staining. RESULTS: Our study demonstrated almost complete improvement in 4 (20%) patients, partial improvement in 16 (80%) patients and 0 patient with no improvement in group A. Furthermore, in group B, we demonstrated almost complete improvement in 2 (10%) patients, partial in 14 (70%) patients and no improvement in 4 (20%) patients. Modified Vancouver Scar Scale reduced from 10.15 to 3.5 in group A and from 11.05 to 4.95 in group B. Elastica Masson-Goldner staining and Hematoxylin and eosin staining showed that treatment in both groups structurally changed tissue collagen. CONCLUSION: Long-pulsed Nd-YAG laser combined with intralesional bleomycin could be a promising way for treatment of keloids or hypertrophic scars.

Automated Microneedling Versus Fractional CO2 Laser in Treatment of Traumatic Scars: A Clinical and Histochemical Study.

BACKGROUND/OBJECTIVES: Microneedling has shown satisfactory effects in scar rejuvenation. Comparisons of its results with fractional laser are limited. This study aims to compare the efficacy and safety of automated microneedling versus fractional carbon dioxide (CO2) laser in treatment of traumatic scars on clinical and histochemical bases. MATERIALS AND METHODS: Thirty patients with traumatic facial scars were randomized to treatment with 4 monthly sessions of either automated microneedling or fractional CO2 laser. Assessment of scars was performed at baseline and 3 months after the last treatment session, clinically by the modified Vancouver Scar Scale (mVSS) and histochemically by quantitative assessment of collagen and elastic fibers. RESULTS: Both groups showed improvement in mVSS, collagen, and elastin contents after treatment. Percentage improvement of collagen and elastin content was higher after treatment by a laser compared with microneedling, in case of the collagen content. Percentage increase in the collagen content after treatment was higher in atrophic scars of the laser group than those of the microneedling group. CONCLUSION: In this small study, microneedling was as safe as fractional CO2 laser for rejuvenation of traumatic scars with comparable clinical effects. Fractional CO2 laser is more powerful in stimulating neocollagenesis. Automated microneedling is effective for treatment of hypertrophic scars.

Pseudofolliculitis barbae treatment: Efficacy of topical eflornithine, long-pulsed Nd-YAG laser versus their combination.

BACKGROUND: Pseudofolliculitis barbae (PFB) is a chronic inflammatory disorder occurring mostly in regions of thick hair growth after shaving. PFB is characterized clinically by multiple painful, pruritic erythematous papules and, less commonly, pustules, nodules, or abscesses. AIM: To evaluate the efficacy of topical eflornithine cream only, long-pulsed Nd-YAG laser, versus their combination for PFB management. PATIENTS AND METHODS: Overall, 40 male patients with PFB were allocated into 3 treatment groups; Group 1 (n = 12): Treated by topical eflornithine cream twice daily for 16 weeks, Group II (n = 13): Treated by long-pulsed Nd-YAG laser for 4 sessions 4-week interval, Group III (n = 15): Treated by this combination for 16 weeks. The patients were evaluated after 16 weeks and for a further 12 weeks through serial photographs, Folliscopic evaluation, and a quartile grading system for improvement. RESULTS: After 16 weeks of treatments, the mean improvement percentages of the inflammatory papules, as well as hair density in the long-pulsed Nd-YAG laser +eflornithine cream, treated group were significantly higher compared with either eflornithine cream treated group or laser-only treated group. The same relationship was demonstrated after 12 weeks of follow-up but with lower improvements compared with 16 weeks of treatment outcome. CONCLUSIONS: Topical eflornithine cream exerts an additive effect on long-pulsed Nd-YAG laser in enhancing the rate and degree of hair reduction and inflammatory papules in PFB cases with a further follow-up improvement. This combined approach should be long-established in larger sample sizes and long-term studies.

Comparative Study Between the efficacy of Long-Pulsed Neodymium- YAG Laser and Fractional Co2 Laser in the Treatment of Striae Distensae.

Introduction: Stretch marks, or striae distensae (SD), are the lesions of the dermis caused by its linear atrophy at the sites of stretching. They occur in more than 70% of pregnant women and adolescents as a result of cutaneous stretching. This study aimed at evaluating and comparing the clinical and histological efficacy of the fractional CO2 laser versus the long pulsed (LP) Nd: YAG laser in the treatment of striae alba. Methods: Thirty female subjects having bilateral symmetrical stretch marks were managed by the LP Nd: YAG laser on the right side and the fractional CO2 laser on the left side. The laser treatment course consisted of 3 sessions with an interval of 3 weeks. The patient satisfaction score and the Global Aesthetic Improvement Scale (GAIS) were employed in the study in order to assess the improvement 3 months after therapy. Punch biopsies measuring 4 mm were extracted from one lesion on each side at baseline and after the last treatment session by 3 months to evaluate the thickness of both collagen and epidermis Results: Clinical improvement was more significant in the lesions treated by the LP Nd:YAG laser than those treated with the fractional CO2 laser. The patient satisfaction score and the GAIS were higher with a statistically significant value in the side treated by the LP Nd:YAG laser. Collagen and epidermal thickness increased more in the LP Nd: YAG laser-treated lesions in comparison to their thickness in the fractional CO2 laser-managed lesions, but this difference did not have a statistical significance. Conclusion: The clinical efficacy of the LP Nd-YAG laser exceeded that of the fractional CO2 laser in the treatment of striae alba without severe side effects in spite of the insignificant histological difference between the two lasers.

Nanovesicular Photodynamic Clinical Treatment of Resistant Plantar Warts.

BACKGROUND: Photodynamic therapy which involves the use of photosensitizer molecule activated by a light source was proven very promising for the treatment of dermatological diseases, especially the resistant ones such as recalcitrant Plantar Warts (PW). OBJECTIVE: However, its efficacy is hindered by the poor permeation of the photosensitizer molecule required to initiate skin photo-induced effects. METHODS: In this manuscript, the efficiency of the nano-vesicular system (transfersomes) as a potential topical drug delivery system for the photosensitizer methylene blue (MB) was investigated following clinical Photodynamic Therapy (PDT) in patients suffering from PW. RESULTS: Results revealed that MB transfersomal gel displayed a higher complete healing percentage for the lesions compared to the free MB gel (86.67% versus 53.57%) achieved at a lower number of treatment sessions (2.2 versus 4.14). Patients reported no signs of pain or inflammation, with no recurrence of the lesions during the follow up period of 8 months. CONCLUSION: PDT using transfersomal MB is an effective and safe therapeutic modality for the treatment of PW.

The Effect of the Fractional Carbon Dioxide Laser on Improving Minoxidil Delivery for the Treatment of Androgenetic Alopecia.

Introduction: Recently, laser treatment for hair loss has become very popular. Laser-assisted drug delivery (LAD) is an evolving technology with potentially broad clinical applications. This work aims at inspecting the effect of the fractional carbon dioxide laser (CO2 ) on improving the delivery of minoxidil in patients with androgenetic alopecia and detecting the role of the fractional CO2 laser in its treatment. Methods: We enrolled 45 Egyptians with male androgenetic alopecia (MAGA); clinical grading was assessed based on Norwood-Hamilton classification. The patients were divided into 3 groups: the first group (combined group) received the fractional CO2 laser session followed by topical application of minoxidil and also in between sessions; the second group received fractional CO2 laser sessions only and 6 sessions with 2-week intervals were performed; the third group applied topical minoxidil only for 3 months. Global photographs and dermoscopic assessments were performed before treatment and 3 months after the treatment. Results: Several dermoscopic findings were detected, including peripilar sign, hair diversity, yellow spot, white dots, and arborizing red lines. The number of double hair units significantly increased after the treatment in the combined group. The mean number of hair after the treatment in the 3 groups significantly increased, mostly in the combined group. The hair thickness (thin & thick) significantly increased after the treatment in the combined group and the fractional group; however, in the minoxidil group, only thin hair thickness increased. In all the 3 groups, there was a significant improvement in hair count and thickness. Conclusion: The ablative fractional CO2 laser alone or combined with minoxidil may serve as an additional treatment for MAGA.

Effect of Topical 5-Fluorouracil Alone versus Its Combination with Erbium:YAG (2940 nm) Laser in Treatment of Vitiligo.

PURPOSE: To compare the efficacy of topical 5-FU as monotherapy to combined therapy of topical 5-FU and Er:YAG (2940 nm) laser in the treatment of non-segmental vitiligo (NSV). METHODS: This is a prospective randomized comparative study. Thirty patients diagnosed with NSV were recruited from the dermatology outpatient clinics of the Medical Research Centre of Excellence, the National Research Centre and the National Institute of Laser Enhanced Sciences. Our study group was divided into two subgroups, Group 1 was subjected to ablative Er:YAG and 5-FU cream and Group 2 applied topical 5-FU cream. Three treatment sessions were repeated every 4 to 6 weeks and patients were followed up to 9 months. Repigmentation was assessed by digital photography and subsequent computer based image analysis. RESULTS: Repigmentation of Group 1 patients ranged from 0 to 70% (mean 12±7%) whilst in Group 2 this ranged from 0 to 5% (mean 1.4±0.8%). In Group 1 repigmentation was mild in 22/30 (73.3%) and moderate to severe in 3/30 (10%) starting after 3 months and persisted or increased during the period of follow up to 9 months. Groups 1 and 2 were subdivided into A and B, vitiligo involving non-resistant and resistant areas respectively. Group 1A showed more repigmentation (mean 13.8±8.5%) than Group 1B (mean 9.8±4.5%) and Group 2A showed more repigmentation (mean 1.5±1%) than Group 2B (mean 1.3±0.5%). CONCLUSION: The combination of Er:YAG with 5-FU is safe and effective in treating and improving outcome in vitiligo especially of non-resistant areas. Computer based image analysis of vitiliginous lesions and assessing post-therapy response is an easy, quick, and reliable method.

Optical coherence tomographic (OCT) evaluation of intraoral non-ablative erbium: YAG laser (SMOOTH mode) in rejuvenation of nasolabial folds; A prospective randomized split face comparative pilot study.

BACKGROUND: There are both few non-comparative studies investigating the efficacy of intraoral Er: YAG laser (SMOOTH mode) in rejuvenating nasolabial folds (NLFs) and lack of valid and objective wrinkles scales. In this prospective randomized split face comparative pilot study, we investigated the safety and efficacy of intraoral Er: YAG laser (SMOOTH MODE) compared with extraoral approach in rejuvenating NLFs using OCT as an objective evaluating tool. MATERIALS AND METHODS: Twenty adult women with notable NLFs were randomized in this study. The patients received 5 monthly sessions of Er: YAG laser (SMOOTH mode) using intraoral approach on one side and extraoral approach on the other side. Outcome was evaluated 2 weeks and 4 months post-treatment by Global Aesthetic Improvement Scale (GAIS), OCT, and patients' satisfaction. Side effects were also evaluated. RESULTS: Intraoral sides had significant increase in OCT evaluated dermal thickness at 4 months post-treatment (P = .03) without side effects compared with extraoral sides. Extraoral approach had significantly higher patients' satisfaction compared with intraoral approach at 2 weeks and 4 months post-treatment (P = .03, .02, respectively). Insignificant differences between both approaches were found regarding GAIS scoring, OCT evaluated epidermal thickness at 2 weeks and 4 months post-treatment, and OCT evaluated dermal thickness at 2 weeks post-treatment (P < .05). CONCLUSION: Intraoral Er: YAG laser (SMOOTH mode) is safer and more effective than extraoral approach in rejuvenating NLFs. OCT is a promising objective tool for evaluating facial wrinkles. Further studies are still needed.

Evaluation of Topical Capislow Extract and Long Pulsed Nd-YAG Laser in the Treatment of Idiopathic Hirsutism.

Introduction: Hirsutism is a condition that affects 10% of women worldwide. In many cultures, hirsutism is regarded as loss of femininity and can be psychologically traumatizing to the suffering females. The aim of the present study was to evaluate how topical capislow would affect or enhance the efficacy of laser hair removal. Methods: A randomized, monoblinded, placebo controlled split face study of combined topical capislow and long pulsed Nd-YAG laser on one side of the face versus long pulsed Nd-YAG laser alone on the opposite side of the face. Laser sessions were done at 4 weeks interval for maximum seven sessions. Topical capislow and placebo were applied once daily from the day of the first laser session to the day of the last laser session. Patients were evaluated both subjectively and objectively in each laser session and for six months after the last laser session. Results: Both treatment modalities were well tolerated and accepted with significantly better results in combined capislow and laser group versus laser alone. Conclusion: Topical capislow can represent a safe and effective synergistic method for laser with faster results but this is a temporary effect retained only to the time of its application.

Topical colloidal indocyanine green-mediated photodynamic therapy for treatment of basal cell carcinoma.

Indocyanine green (ICG) is a near-IR fluorescent dye with a great potential for application as photosensitizer in topical photodynamic therapy (PDT) of skin diseases. Despite its merits, its use has been hampered by its high degradation rate. Therefore, in the current article, ICG was encapsulated in a vesicular colloidal nanocarrier (transfersomes), with the aim of enhancing its therapeutic efficacy. Transfersomes were characterized for their entrapment efficiency, particle size, zeta potential, morphology, in vitro release and histopathological effect on mice skin. A pilot clinical study was conducted to test its therapeutic potential for PDT of basal cell carcinoma (BCC). Transfersomal ICG displayed particle size (∼125 nm) and a negative zeta potential (∼-31 mV). Transfersomes were also able to sustain the release of ICG >2 h. Upon incorporation of transfersomal ICG in gel form, it was found to maintain the normal histology of mice skin post-irradiation with diode laser 820 nm. Moreover, ICG transfersomal PDT achieved 80% clearance rate for BCC patients with minimal pain reported during treatment. The previous findings suggest that transfersomal nanoencapsulated ICG is a promising treatment modality for BCC.

Comparison of pulsed dye laser versus combined pulsed dye laser and Nd:YAG laser in the treatment of inflammatory acne vulgaris.

BACKGROUND: Both pulsed dye laser and combined 585/1064-nm (sequential dual-wavelength PDL and Nd:YAG) laser improves inflammatory skin disorders including acne vulgaris. OBJECTIVE: To compare the efficacy of 585-nm pulsed dye laser versus sequential dual-wavelength PDL and Nd:YAG in treatment of acne vulgaris. PATIENTS AND METHOD: Thirty patients with acne vulgaris were treated by PDL alone on half of the face while contra lateral half was treated by combined 585/1064 nm laser. RESULTS: The study showed that inflammatory acne lesions count was significantly reduced by 82.5% (p 0.0001) on PDL sides and by 83.5% (p 0.00001) on combined 585/1064-nm side after 8 weeks, while reduction of non-inflammatory acne lesions was observed at 8 weeks by 58.4% and 71.5% respectively. However, difference between the two modalities was not statistically significant. CONCLUSION: PDL and combined PDL/Nd:YAG laser treatment were found to be an effective, safe and well-tolerated treatment option for inflammatory and non-inflammatory acne vulgaris.

Comparative study between excimer light and topical antioxidant versus excimer light alone for treatment of vitiligo.

BACKGROUND: Vitiligo is an acquired idiopathic cutaneous disease characterized by pearly white patches of variable shapes and sizes. Various medical and surgical therapeutic options have been proposed to achieve repigmentation; phototherapy is one of the most efficient options. Topical therapies have been a mainstay of vitiligo treatment, with or without phototherapy. AIM OF THE WORK: To compare the efficacy of combined topical antioxidant hydrogel and excimer light versus excimer light alone in treating vitiligo. PATIENTS AND METHODS: Thirty patients were included in this comparative, prospective, randomized study. For each patient, at least 2-4 vitiliginous macules were randomly selected and treated while an untreated vitiliginous macule served as control. Lesions were divided into two groups: Group A received combination therapy of daily topical antioxidant plus excimer light, while Group B received only excimer light. Lesions were treated twice a week for a maximum of 24 sessions. Initial fluencies were adjusted individually according to the minimal erythema dose in vitiliginous skin. Efficacy based on repigmentation percentages were blindly evaluated by two independent physicians. RESULTS: Group A lesions showed significant efficacy than group B (p < 0.001), specially on treating UV-sensitive lesions with no side effects. CONCLUSION: Topical antioxidant and excimer light represents a valuable, effective therapy for localized vitiligo.

Functionalized formazans: A review on recent progress in their pharmacological activities.

This review provides an up to date information about the diverse pharmaceutical activities of formazans. The bibliography includes 97 references which have been published during the period from 1980 to 2013. The covered biological activities of the title compounds include antioxidant, anticonvulsant, therapeutic, anthelmintic, anti-tubercular, antiviral, anti-inflammatory, anticancer, anti-HIV, antimicrobial, antiparkinsonian, cardiovascular and antiproliferative activities.

Effect of methylene blue-mediated photodynamic therapy for treatment of basal cell carcinoma.

Photodynamic therapy (PDT) is regarded as a treatment option for basal cell carcinoma (BCC). The aim of this study is to investigate the efficacy of methylene blue (MB)-based PDT in patients suffering from nodular or ulcerative BCCs. This study is a prospective clinical trial with a 6-months follow-up. The study setting is at the Dermatology Clinic at NILES, Cairo University, Egypt. Seventeen patients complaining of nodular BCC (nBCC) and three patients complaining of ulcerative BCC (uBCC) were taken as samples. Methylene blue, the photosensitizer, was prepared in two different formulas: liposomal-loaded MB (LMB) was prepared and formulated in hydrogel (MB 0.2%) to be used topically alone for treating BCCs <2 cm in diameter or to be combined with intralesional injection (ILI) of free MB 2% aqueous solution for treating BCCs ≥2 cm in diameter. A session was performed every 2 weeks until complete response (CR) of the lesion or for a maximum of six sessions. Clinical assessments of clinical improvement, dermatological photography, monthly follow-up visits for 6 months, and skin biopsy after 3 months of follow-up to confirm the response, recurrence, or both in cases in which the clinical evaluation was ambiguous. Seventeen patients of the 20 completed the study, 11 patients achieved CR with very good cosmetic outcome, photosensitizer tolerance, and minimal reported side effects. MB is a cheap promising alternative photosensitizer for PDT of nBCC.

Topical liposomal Rose Bengal for photodynamic white hair removal: randomized, controlled, double-blind study.

BACKGROUND: Blond and white hair removal by laser is a complicated task with weak satisfactory results due to the deficiency in laser-absorbing chromophore. OBJECTIVE: To investigate if repetitive sessions of photodynamic therapy (PDT) using external application of liposomal Rose bengal (RB) photosensitizer followed by intense pulsed light (IPL) exposure enables removal of gray and white hair. MATERIALS AND METHODS: Rose bengal loaded in liposomes (LRB) was constructed, prepared in hydrogel, and was studied for some pharmaceutical properties. Penetration and selective hair follicle damage in mice skin were studied. Topical gel containing LRB was used for treating fifteen adult females who were complaining of facial white terminal hair. Unwanted facial hair was treated for three sessions at intervals of 4-6 weeks using intense pulsed light (IPL). At each session, the treatment area was pre-treated with topical LRB gel, while a control group of another 15 patients applied placebo gel before IPL treatment. Evaluations included hair regrowth, which was measured 4 weeks after each treatment session and at 6 months follow-up by counting the number of terminal hair compared with baseline pretreatment values. Treatment outcomes and complications if any were also reported. RESULTS: Average hair regrowth in the LRB group was 56% after 3 treatment cycles. After six-months follow up, average terminal hair count compared with baseline pretreatment showed 40% reduction and no recorded side effects. A significant difference (P<0.05) was seen compared with the control group; the clinical results were promising. CONCLUSIONS: Photodynamic hair removal using rose bengal-encapsulated liposomal gel in combination with IPL treatment showed significant efficacy in the treatment of white hair compared with a control group.

Liposomal methylene blue hydrogel for selective photodynamic therapy of acne vulgaris.

BACKGROUND: Photodynamic therapy (PDT) has been proposed as a treatment option for acne vulgaris. The authors have proposed in this work a liposomal delivery for methylene blue (MB) for selective acne treatment. OBJECTIVES: To evaluate the efficacy and tolerability of liposomes loaded methylene blue (LMB) based photodynamic therapy in patients with mild-to-moderate acne vulgaris in a randomized, controlled and investigator blinded study. MATERIALS AND METHODS: Liposomes loaded methylene blue (LMB) was prepared and studied for different pharmaceutical properties and formulated in hydrogel (MB 0.1%). Permeability and selective sebaceous gland targeting in mice skin was studied. Gel containing LMB was used for treating 13 patients complaining of mild-moderate acne vulgaris once a week for two weeks. Efficacy evaluation included changes in lesions counts, clinical assessments of clinical improvement by patients and evaluating dermatologists. Pain and local adverse effects were also evaluated. RESULTS: The mechanism of the drug released from liposomes (both in pH = 5.5 and in pH = 7.2) was following zero order kinetics with significant increase in the drug released in pH = 5.5. Drug released from free methylene blue (FMB) gel was significantly higher (P < 0.05) with Higuichi's diffusion model than LMB gel, which followed zero order kinetics. Free MB gel showed superficial destruction in the mice hair shaft while LMB showed complete destruction of pilosebaceous unit. After only two sessions, there was a 83.3% reduction in the number of inflammatory acne lesions and a 63.6% reduction in the number of non-inflammatory acne lesions. At 12 weeks, 90% of patients had a moderate-to-marked improvement of their acne in the treated areas. Most patients had no pain; also no serious adverse side effects were recorded. All the patients had no edema. Slight transient hyperpigmentation was seen only in three patients. CONCLUSION: Liposomal MB hydrogel selectively delivered MB to sebaceous gland and was effective in photodynamic treatment of mild-to-moderate acne vulgaris.

Methylene blue mediated photodynamic therapy for resistant plaque psoriasis.

Topical treatment of resistant psoriatic plaque stage lesions may be difficult and the systemic therapies seem inappropriate. Therefore, a topical 0.1% methylene blue (MB) hydrogel was prepared and evaluated for percent drug content, drug uniformity, pH, rheological and organoleptic characters such as feel tackiness, grittiness sensation, and transparency in addition to release kinetics study in vitro. The efficiency of the photodynamic therapy (PDT) of MB photo-activated using 565 mW Light emitting diode (LED) 670 nm was evaluated in patients with resistant plaque psoriasis. The gel was evaluated in single blinded study. The patients were subjected to repeated sessions of irradiation, skin biopsies from each patient in the beginning and at the end of the sessions were taken for histopathological studies. Results showed the hydrogel was transparent nongritty and the drug uniformly dispersed with pH=7.2 and viscosity value=25.04 Pa. The drug content was found to be 99.4 +/- 0.15 %. Drug release was following zero order kinetics with rate constant K=0.348 +/- 0.01 and T(1/2) = 0.95 +/- 0.5 hours. Sixteen patients experienced complete clearance of their treated lesions. Skin appeared normal in color, texture, and pliability with no complications indicating the lack of skin sensitivity. Histopathological examinations showed nearly normal epidermis at the end of all sessions. The authors concluded that the prepared hydrogel was safe, stable, and very effective. The results are encouraging to accept MB as a photosensitizer for PDT and as a safe and effective method for treatment of selected cases of resistant localized psoriasis

Non-excision treatment of multiple cutaneous neurofibromas by laser photocoagulation.

Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder characterized by skin tumours derived from peripheral nerves. It is a clinically diagnosed disorder of a mainly cosmetic concern. There are different excision modalities for treatment of cutaneous neurofibromas; however, none is considered to be universally accepted treatment. This study was conducted to evaluate a non-excision treatment of multiple cutaneous neurofibromas, using surface and interstitial approaches of neodymium:yttrium aluminum garnet (Nd:YAG) laser (1,064 nm) photocoagulation, depending upon the size and location of the lesions. Twelve patients with multiple cutaneous neurofibromas were included. Surface laser photocoagulation by long-pulsed Nd:YAG laser has been used for treatment of flat lesions, while interstitial laser photocoagulation by continuous wave (CW) Nd:YAG laser has been used for treatment of bulkier lesions. After 14 months of follow up, both approaches of laser photocoagulation have shown different success rates, as denoted by the regression of the lesions, an overall acceptable cosmetic outcome, and, generally, patients' satisfaction. Within the limitations of the present study, laser photocoagulation has proven to be a promising technique that may be an alternative or additive modality for treatment of multiple cutaneous neurofibromas. It is a minimally invasive, office-based technique that could be used safely and effectively, with a limited rate of complications. Surface laser photocoagulation has proven to be an effective tool for treatment of flat lesions, especially those located in exposed areas, with a favourable cosmetic result, while interstitial laser photocoagulation could be reserved for bulkier lesions, especially those located in non-exposed areas. However, further studies are necessary to refine the procedure, and to confirm the present encouraging findings, especially over a longer period of follow up, as well as to evaluate laser parameters for optimization of the technique.