Pulsed dye laser alone versus its combination with topical ivermectin 1% in treatment of Rosacea: a randomized comparative study.

BACKGROUND: While the etiology of rosacea is multifactorial, it is not surprising that treatment has been controversial. Pulsed dye laser (PDL) has been successfully used to treat vascular components of rosacea. Ivermectin 1% cream is an emerging treatment of rosacea. OBJECTIVE: To provide a comprehensive clinical and dermatoscopic comparative study between the efficacy and safety of pulsed dye laser alone versus its combination with topical ivermectin 1% in the treatment of rosacea. MATERIALS AND METHODS: Thirty Patients were randomly divided into two groups. Group A (n = 15) treated with 585 nm PDL, and group B (n = 15) treated with 585 nm PDL and topical ivermectin 1% cream. All patients received four laser treatments with a 4-week interval. The efficacy of treatment was assessed by photographs and dermoscopic photomicrographs at baseline and 3 months after the final treatment. The patient's level of satisfaction was also recorded. RESULTS: At the 3-month follow-up, group B induced better clinical improvement than group A. However, this difference was not significant. No serious adverse events were observed in either treatment group. CONCLUSION: This study supports the efficacy of PDL treatment for patients with rosacea. PDL could be more effective when combined with ivermectin 1% cream.

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.

Topical 5 fluorouracil cream vs combined 5 fluorouracil and fractional erbium YAG laser for treatment of severe hypertrophic scars.

BACKGROUND: Topical 5 fluorouracil (5-FU) has been reported as one of the standard treatments for hypertrophic scars (HTS). Ablative fractional laser was found to have promising results in the delivery of topical drugs into the skin by creating vertical channels through which the drugs can penetrate the skin. So far there have been no comparative studies performed to compare both modalities in the same patient and same anatomical region, especially in severe HTS. OBJECTIVE: The aim of this study was to compare the effectiveness of topical 5-FU and combined topical 5-FU and laser in treating severe HTS. PATIENTS AND METHODS: Twenty-four severe HTS lesions were treated by 5-FU monotherapy and 5-FU combined with ablative fractional erbium YAG laser. Each lesion was divided into two parts. One part was treated with topical 5-FU twice weekly for 8 months. The other part was treated with combined topical 5-FU and ablative fractional erbium YAG laser once per month for 8 months. The scars' improvement was evaluated by Vancouver scar scale (VSS) and skin analysis camera. RESULTS: The assessment by VSS showed a significant reduction in the mean height, pliability, and vascularity of the lesions which were treated with combined approaches compared to 5-FU monotherapy. Pain and ulceration occurred at a higher rate in the combination therapy group. CONCLUSION: Treatment of severe HTS with combined 5-FU and ablative fractional erbium YAG laser is more effective than 5-FU alone.

Platelet-rich plasma versus combined fractional carbon dioxide laser with platelet-rich plasma in the treatment of vitiligo: a comparative study.

PURPOSE: The aim of this study was to assess the efficacy of platelet-rich plasma (PRP) vs combined fractional CO2 (Fr: CO2) laser with PRP in the treatment of stable nonsegmental vitiligo (NSV) lesions. PATIENTS AND METHODS: This prospective, randomized, intrapatient, comparative controlled study was conducted between June 2014 and June 2016 at National Institute of Laser Enhanced Sciences (NILES), Cairo University, Cairo, Egypt. Thirty NSV patients were treated with PRP, Fr: CO2 laser, and combined Fr: CO2 laser with PRP. Intrapatient lesions were divide randomly into four groups. Each group was treated by one modality. The fourth group served as a control.Patients received six treatment sessions with 2-week interval for 3 months and were followed up after 3 months. RESULTS: A highly significant reduction was demonstrated through vitiligo analysis by computer-assisted grid (VACAG) in the combined Fr: CO2 laser with PRP and in the PRP only groups than other groups. These results were confirmed by mean improvement score by physician (MISP) and by VAS with no statistical difference between them. The combined Fr: CO2 laser with PRP group showed minimal side effects. Regardless of the modalities, better improvement was seen in the trunk than the face, extremities, and acral lesions with significant reduction in all regions. Face showed maximum response with combined Fr: CO2 laser with PRP. Trunk showed higher response with PRP. Upper limbs showed highest response with combined Fr: CO2 laser with PRP. Lower limbs showed the highest improvement with Fr: CO2 laser. CONCLUSION: According to our study, combined Fr: CO2 laser with PRP achieved superior repigmentation than intradermal (ID) PRP. However, Fr: CO2 alone showed poor improvement. Combined ablative Fr: CO2 laser and PRP therapy followed by sun exposure could be used effectively and safely to treat refractory NSV.

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.

Fractional Erbium-Doped Yttrium Aluminum Garnet Laser Versus Microneedling in Treatment of Atrophic Acne Scars: A Randomized Split-Face Clinical Study.

BACKGROUND: Ablative fractional erbium-doped yttrium aluminum garnet (Er:YAG) laser and microneedling have been popularized in recent years and their effectiveness and side effects individually reported. No previous study, however, has directly compared the efficacy and safety between the 2 different treatments. OBJECTIVE: To compare the efficacy and safety of the ablative fractional Er:YAG laser and microneedling for the treatment of atrophic acne scars. MATERIALS AND METHODS: Thirty patients with atrophic acne scars were randomly treated in a split-face manner with a fractional Er:YAG laser on one side and microneedling on the other side. All patients received 5 treatments with a 1-month interval. Objective and subjective assessments were obtained at baseline and at 3 months after the final treatment. RESULTS: At the 3-month follow-up, both treatment modalities induced noticeable clinical and histological improvement, with significantly better results in fractional Er:YAG laser versus microneedling (70% vs 30%), respectively (p < .001). Fractional Er:YAG laser sides had significantly lower pain scores. Total downtime was significantly shorter in microneedling sides. CONCLUSION: Both treatment modalities are effective and safe in the treatment of atrophic acne scars, with significantly higher scar response to the fractional Er:YAG laser treatment.

Comparison of the effectiveness of two fluences using long-pulsed Nd:YAG laser in the treatment of striae distensae. Histological and morphometric evaluation.

Striae distensae are common undesirable skin lesions of significant aesthetic concern. To compare the efficacy of two fluences (75 and 100 J/cm2) of long-pulsed Nd:YAG laser in the treatment of striae. Forty-five patients (Fitzpatrick skin types III-V) aged between 11 and 36 years with striae (23 patients with rubra type and 22 with alba type) were enrolled in the study. Each stria was divided into three equal sections, whereby the outer sections were treated with long-pulsed 1064 nm Nd:YAG laser, at a fluence of 75 or 100 J/cm2, and fixed laser settings of 5 mm spot size and 15 ms pulse duration. The middle section was an untreated control. All subjects received four treatments at 3 weeks interval. Three 2-mm punch biopsies were taken from six subjects, all of the same stria, one before treatment and the other two from the outer sections, 3 months after the last session. Paraffin-embedded skin sections were subjected to histological and quantitative morphometric studies for collagen and elastic fibres. Results were assessed clinically through photographic evaluation and were considered satisfactory for both doctors and patients. A significant improvement in appearance of striae alba using 100 J/cm2 was found while striae rubra improved more with 75 J/cm2. Histologically, collagen and elastin fibres increased in posttreatment samples. A satisfactory improvement in striae distensae lesions was seen through clinical and histological evaluation. Thus, long-pulsed Nd:YAG laser is a safe and effective module of laser treatment for these common skin lesions.

Efficacy of pulsed dye laser versus intense pulsed light in the treatment of striae distensae.

BACKGROUND: Pulsed dye laser (PDL) and intense pulsed light (IPL) have been used to treat striae distensae. OBJECTIVE: To compare the difference between the treatment efficacy of PDL and IPL on striae distensae. MATERIALS AND METHODS: Twenty patients with age ranging from 15 to 42 years were included in this study. All patients were treated on one side of their bodies with PDL and on the other side with IPL for 5 sessions with a 4-week interval between the sessions. Skin biopsies were stained with hematoxylin and eosin, Masson trichrome, orcein, Alcian blue, and anticollagen I α1. RESULTS: After both PDL and IPL, striae width was decreased and skin texture was improved in a highly significant manner. Collagen expression was increased in a highly significant manner after PDL and IPL. However, PDL induced the expression of collagen I in a highly significant manner compared with IPL, where p values were <.001 and .193, respectively. Striae rubra gave a superior response with either PDL or IPL compared with striae alba, which was evaluated clinically by the width, color, and texture, although the histological changes could not verify this consequence. CONCLUSION: Both PDL and IPL can enhance the clinical picture of striae through collagen stimulation.

Pulsed dye laser versus Nd:YAG laser in the treatment of plantar warts: a comparative study.

Plantar warts are common viral infection that are usually challenging in treatment. Conventional treatment methods are usually invasive, have low efficacy, and need long recovery periods. In this study, we compared pulsed dye laser (PDL) and neodymium yttrium aluminum garnet (Nd:YAG) lasers in the treatment of recalcitrant plantar warts. The study included 46 patients with multiple plantar warts. In each patient, lesions were divided into two groups: one treated with Nd:YAG (spot size, 7 mm; energy, 100 J/cm(2); and pulse duration, 20 ms) and the other with PDL (spot size, 7 mm; energy, 8 J/cm(2); and pulse duration, 0.5 ms). Laser sessions were applied every 2 weeks with maximum of six sessions. The study included 63% males and 37% females with a mean age of 29.6 ± 7.34 years. The cure rate was 73.9% with PDL with no significant difference (p = 0.87) from Nd:YAG (78.3%). The number of sessions required was more in PDL (mean, 5.05 ± 0.2) compared with Nd:YAG (mean, 4.65 ± 0.5) but without significant difference. Complications were significantly higher with Nd:YAG (43.5%) compared with PDL (8.7%). Hematoma was the most common complication recorded by Nd:YAG (28.3 %), and it was significantly higher (p = 0.002) than PDL (2.2%). Relapse was recorded in 8.7% with Nd:YAG compared with 13% in PDL with no significant difference (p = 0.74). Our results suggested that PDL and Nd:YAG lasers are effective in the treatment of resistant plantar warts. PDL is safer and less painful but needs more sessions, while Nd:YAG is more painful and shows more complications.

Treatment of carpal tunnel syndrome by low-level laser versus open carpal tunnel release.

Carpal tunnel syndrome (CTS) is an entrapment neuropathy of the median nerve at the wrist. It is one of the most common peripheral nerve disorders. The cause of idiopathic CTS remains unclear. The diagnosis of CTS is still mainly clinical. Open carpal tunnel release is the standard treatment. The present study was conducted to evaluate the effectiveness of low level laser treatment (LLLT) for CTS in comparison to the standard open carpal tunnel release surgery. Out of 54 patients, 60 symptomatic hands complaining of CTS were divided into two equal groups. Group A, was subjected to LLLT by Helium Neon (He-Ne) laser (632.8 nm), whereas group B was treated by the open approach for carpal tunnel release. The patients were evaluated clinically and by nerve conduction studies (NCSs) about 6 months after the treatment. LLLT showed overall significant results but at a lower level in relation to surgery. LLLT showed significant outcomes in all parameters of subjective complaints (p < or = 0.01) except for muscle weakness. Moreover, LLLT showed significant results in all parameters of objective findings (p < or = 0.01) except for thenar atrophy. However, NCSs expressed the same statistical significance (p < or = 0.01) after the treatment by both modalities. LLLT has proven to be an effective and noninvasive treatment modality for CTS especially for early and mild-to-moderate cases when pain is the main presenting symptom. However, surgery could be preserved for advanced and chronic cases. Refinement of laser tools and introduction of other wavelengths could make LLLT for CTS treatment a field for further investigations.

Treatment of genital warts in males by pulsed dye laser.

OBJECTIVE: To determine the safety and efficacy of the flashlamp-pumped pulsed dye laser for the treatment of uncomplicated genital warts in adult males. METHODS: This was a prospective observational study set in the outpatient clinics of the Department of Andrology and Sexually Transmitted Diseases, National Institute of Laser Enhanced Sciences, the Dermatology Clinic, Cairo University, and the Department of Dermatology and Venereology, Suez Canal University. A total of 174 adult male patients with 550 uncomplicated anogenital warts were included. Selective photothermolysis and photocoagulation of the lesions with the flashlamp-pumped pulsed dye laser was carried out. A pulsed dye laser (wavelength 585 nm, 450 s pulse duration; Cynosure, USA) was used with the following settings: spot size 5-7 mm; fluence 9-10 J/cm2. RESULTS: Complete resolution of treated warts was achieved in 96% of lesions. Side effects were limited, transient and infrequent. Lesion recurrence rate was 5%. CONCLUSION: The pulsed dye laser has been found to be safe, effective and satisfactory for the treatment of anogenital warts in males. It could be used to selectively destroy warts without damaging the surrounding skin.

Study of solar photosensitization processes on dermatophytic fungi.

The antifungal activity of solar simulator was evaluated in presence of haematoporphyrin derivative (HPD), methylene blue (MB) and toluidine blue O (TBO) as photosensitizers. Seven dermatophytes were used as test fungi. The solar simulator at fluence rate 400 W/m2 for 30 minutes induced marked inhibition for spore germination of the photosensitized fungi. The rate of inhibition varied according to the fungal species and concentration of the photosensitizer. There was an increase in percentage inhibition of spore germination as the concentration of HPD or MB increased. Complete inhibition for spore germination of Trichophyton. verrucosum, T. mentagrophytes, and Miccrosporum canis was induced when these species were pretreated with 10(-3) M of HPD or MB before irradiation. Epidermophyton floccosum, T. rubrum, M. gypseum and T. violaceum were less sensitive to irradiation when pretreated with HPD or MB. On contrary, the maximum reduction in percentage spore germination was induced at the lowest concentration (10(-7) M) of TBO. The tested dermatophytes were mostly capable of producing different enzymes (keratinase, phosphatases, amylase, lipase). The separate application of radiation or photosensitizer was ineffective or exerted slight inhibition on enzyme production. However, the activity of the enzymes was drastically inhibited when the fungi were irradiated after their treatment with photosensitizer. T. verrucosum and T. mentagrophytes were the most sensitive. In a trail to apply a control measure against dermatomycosis using solar simulator radiation, the results revealed that the radiation was successful in curing the MB-photosensitized guinea pigs, artificially infected with T. verrucosum, T. mentagrophytes or M. canis. The percentage of recovery reached 100% in some treatments.