Autologous Nanofat Injection Combined with Fractional CO2 Laser in the Treatment of Atrophic Acne Scars.

Background: Atrophic acne scarring is a widely prevalent condition and one of the most distressing complications of acne vulgaris. Numerous options with variable outcomes are available for the treatment of acne scarring. Laser is considered a first-line therapy for acne scars, and recently there has been a growing interest in using stem cells and their derivatives for treating acne scars. In addition, combined therapeutic modalities often achieve more satisfactory results than a single treatment. Objective: We tried to evaluate the role of nanofat and fractional CO2 laser as a combined treatment approach for atrophic acne scarring. Methods: Twenty-five patients with atrophic acne scarring were enrolled. They received a single session of intradermal nanofat injection, at different points 1 cm apart, for acne scars. Two weeks later, they were treated with three sessions of fractional CO2 laser at monthly intervals. Patients were evaluated three months after the last session using the quantitative Goodman and Baron scoring system. Pain, side effects, and patients' satisfaction were also evaluated. Results: There were two males and 23 females with a mean age of 25.96 years. Their skin type ranged between Fitzpatrick skin type III, IV, and V. Boxcar scars were the most common scar type in 13 patients (52%). After treatment, there was a significant reduction (p <0.05) in the quantitative Goodman and Baron scores. The improvement was more evident in rolling scars. Seven patients reported significant improvement, and 12 reported marked improvement. Conclusion: This study showed that combining nanofat and fractional CO2 laser is a safe and effective treatment modality for atrophic acne scars.

Picosecond Nd:YAG versus Fractional CO2 Lasers in Management of Postburn Scars.

Background: The picosecond laser was primarily designed to enhance tattoo removal. Because it has a new innovative mechanism for energy delivery, it has been modified to be used in other conditions such as skin resurfacing, which was usually treated with fractional CO2 laser. Comparing both technologies in managing postburn scars has not been widely addressed. Methods: The current prospective comparative randomized intrapatient study was done on 15 patients who presented with unsightly postburn scarring. As a split study, one-half of the affected areas were treated using the picosecond Nd: YAG laser. The other areas were treated with a fractional CO2 laser. After three treatment sessions, the results were analyzed both objectively and subjectively. Results: The assessment by the image analysis system (Antera camera) showed improvement in all the parameters in both groups. The melanin relative variation decreased from 11.65 ±â€…2.86, 15.85 ±â€…5.63 to 10.60 ±â€…1.96, 12.56 ±â€…3.98, respectively in picosecond laser sites and fractional CO2 sites. The percentage change in overall opinion decreased in in favor of the fractional CO2 laser sites, which is a statistically significant improvement. Instead, color scores revealed a greater reduction in the picosecond sites in comparison with the fractional CO2 sites, as it decreased from 7.67 ±â€…1.76, 7.73 ±â€…1.83 to 2.87 ±â€…1.06, 6 ±â€…1.2, respectively. Conclusions: When compared with fractional CO2 lasers, picosecond Nd:YAG shows comparable improvements in scars' erythema, texture, and height, with some superiority in the management of hyperpigmented scars.

Fractional CO 2 Laser Combined With Autologous Nanofat Injection Versus Fractional CO 2 Laser Combined With Platelet-Rich Plasma in the Treatment of Atrophic Acne Scars: A Split-Face Comparative Study With Optical Skin Imaging.

BACKGROUND: Atrophic acne scarring is a common problem. If left untreated, its implications can impair the quality of life. Various treatments, with differing degrees of success, are used to alleviate atrophic scars. OBJECTIVE: To assess the efficacy of nanofat versus platelet-rich plasma (PRP) as an adjuvant therapy to fractional CO 2 laser (FCL) for atrophic acne scars. METHODS: This study included 35 patients with atrophic acne scars who received 3 sessions of FCL at 1-month intervals on both sides of the face, followed by intradermal PRP injection on the left side. A single session of nanofat was injected into the right side of the face 2 weeks before the laser sessions. The evaluation was conducted 3 months after the final treatment session. RESULTS: After treatment, the right side of the face showed a significant reduction in Goodman scores and the indentation index of the Antera camera. The left side showed a significant difference in Goodman scores, yet the Antera camera showed a nonsignificant improvement. Nonetheless, the difference between the 2 sides was statistically insignificant. CONCLUSION: Atrophic acne scars improved with both modalities. As a result, cotreatment with these techniques may synergistically affect atrophic acne scars in efficacy and safety.

Evaluation of botulinum toxin type A for treating post burn hypertrophic scars and keloid in children: An intra-patient randomized controlled study.

BACKGROUND: Consequently, the management of post burn hypertrophic scars and keloid in children are a great challenge for the physicians, parents, and children themselves. PURPOSE OF THE STUDY: To assess the efficacy and safety of treating hypertrophic and keloid scars with botulinum toxins injections. PATIENTS AND METHODS: This is a randomized intra-patient comparative study was conducted on 15 children with post burn hypertrophic and keloid scars. Children were randomized to receive Intralesional injection of botulinum toxins on one part of the hypertrophic scar/keloid where the other part was left as a control. The assessment of clinical improvement was measured by the Vancouver scar scale (VSS) and by skin analysis camera system. Sessions were performed every month for 6 months. RESULTS: Clinical and statistical dramatic improvement in the vascularity, pliability, and height of the lesions which have been injected with neuronox. Evaluation of the lesions by the Antera camera has proven marked changes in the vascularity and height. There was no correlations between Vancouver score improvement and variables such as the age, sex, skin type, and duration and lesion type. CONCLUSIONS: The botulinum toxins proved its efficacy and safety in treatment of hypertrophic scars and keloid in children. It improved the associated itching and pain. Moreover it improves the pliability, erythema, and thickness of the scars.

A split face comparative study between intradermal tranexamic acid and Erbium-YAG laser in treatment of melasma.

BACKGROUND: Although there are different treatment modalities of melasma, it remains a challenging problem. Erbium-YAG laser proved its efficacy in melasma improvement with minimal downtime. Tranexamic acid (TA) is a new promising treatment of melasma. OBJECTIVE: The first objective is to compare between the efficacy of intradermal injection of TA and Erbium-YAG laser in the treatment of melasma. The second objective is to use the dermoscope as an objective evaluation method. PATIENTS AND METHODS: A split face study was conducted on 28 patients. One side of the face received intradermal TA injection. The other side was treated with laser. Melasma Area and Severity Index (MASI) and the dermoscope were used for evaluation of treatment. RESULTS: The MASI scores showed a significant decrease in TA treated side. The dermoscope assessment showed no significant difference in both treatment modalities. CONCLUSION: A promising results were obtained by both intradermal TA and Erbium:YAG laser; however, the TA yields a higher patient satisfaction because of its high efficiency and low cost.

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.

Pulsed-dye Laser Versus Intralesional Steroid in the Management of Nail Psoriasis: A Randomized, Intra-patient, Comparative, Controlled Study.

BACKGROUND: Intralesional injection of corticosteroid (ILIS) and pulsed-dye laser (PDL) have been used in nail psoriasis treatment with variable outcomes. OBJECTIVE: We sought to compare the efficacy of ILIS to PDL for the treatment of psoriatic fingernails using a dermoscope in the assessment and follow-up. METHODS: This study included 30 patients with bilateral nail psoriasis. The fingernails of one hand were treated with PDL, whereas ILIS was used to treat the fingernails of the other hand. One psoriatic nail was left alone as a control. Every patient received four treatment sessions once every month. Efficacy was recorded clinically using the Nail Psoriasis Severity Index (NAPSI) and by a dermoscope before treatment (baseline) and at eight, 24, and 36 weeks after treatment. RESULTS: The assessment by NAPSI revealed improvements of 22.24% and 24.11% occurred in the laser group and the intralesional steroid group, respectively. Also, the dermoscopic assessments revealed an improvement of 18.33% in the laser group versus that of 21.69% in the ILES. No significant difference was found between the two groups. CONCLUSION: Both PDL and ILIS are considered safe treatments for nail psoriasis, yielding nearly equal results. The dermoscope is a reliable tool for the diagnosis and follow-up of nail psoriasis treatment.

Novel bergamot oil nanospanlastics combined with PUVB therapy as a clinically translatable approach for vitiligo treatment.

The impact of nanomedicine has grown in the current decade; however, only very few clinical translational attempts have been realized. Therefore in the present study, we hypothesized that bergamot oil, a psoralen-containing oil, would produce an optimized melanogenic effect in the clinical treatment of vitiligo when loaded within an elastic nanocarrier (spanlastics) and combined with PUVB for activation of psoralens. Spanlastics were prepared and characterized for particle size, physical stability, in vitro release, thermal behavior, deformability, morphology, and in vitro photostability. The efficacy of the selected formula was tested histopathologically on rat skin and clinically translated in patients suffering from vitiligo. Results revealed that the spanlastics were of reasonable nanosize, deformable, and provided sustained release of bergamot oil. The incorporation of bergamot oil within spanlastics improved its photostability and its photodynamic activity. Spanlastics exhibited promising clinical results in terms of extent and onset of repigmentation in vitiligo patients. Therefore, it can be concluded that spanlastics can be introduced as a promising nanotreatment modality for vitiligo.

Fractional CO2 laser versus combined platelet-rich plasma and fractional CO2 laser in treatment of acne scars: Image analysis system evaluation.

BACKGROUND: Fractional CO2 laser and platelet-rich plasma (PRP) treatments have been used in the treatment of acne scars. However, an objective method of assessment has been lacking. OBJECTIVE: To evaluate the efficacy of CO2 laser versus the combination of PRP and fractional CO2 laser in treatment of acne scar. PATIENTS AND METHODS: Thirty patients with atrophic acne scar lesions were included in this study. Patients were randomized to receive fractional CO2 laser therapy to one side of the face while the other side of the face was treated with fractional CO2 laser followed by intradermal PRP injection. Follow-up using the skin analysis camera system and photography was done for three months. RESULTS: A dramatic improvement was observed in the scar depth on both sides of the face. However, the combined fractional CO2 laser and PRP showed more significant improvement. Improvements in the scar appearance and skin texture were reported by the patients. Although 70% of our patients were of a dark skin type, no hyperpigmentation was reported. CONCLUSION: The combined use of fractional CO2 laser and PRP achieved better results. It reduced the downtime of the fractional CO2 laser. The use of the skin analysis camera provided an objective assessment of the results.

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.

The effect of autologous activated platelet-rich plasma injection on female pattern hair loss: A randomized placebo-controlled study.

BACKGROUND: Hair is an essential part of a woman's appearance and attractiveness. This is reflected in the predominantly psychological morbidity that can be associated with female pattern hair loss. Platelet-rich plasma(PRP) has been used in numerous fields of medicine. Recently, PRP has received growing attention as a potential therapeutic tool for hair loss. OBJECTIVE: To evaluate the efficacy and safety of autologous platelet-rich plasma in the treatment of female pattern hair loss. MATERIALS AND METHODS: Thirty female patients with female pattern hair loss were randomly assigned to receive autologous PRP injection into a selected area, and another area was injected with normal saline as a placebo. Sessions were performed weekly for a maximum total of four sessions. Patients were followed up 6 months after the end of last session. The outcome was assessed both subjectively and objectively. RESULTS: There was a statistical significant difference between PRP and placebo areas (P<.005) regarding both hair density and hair thickness as measured by a folliscope. The hair pull test became negative in PRP-injected areas in 25 patients (83%) with average number of three hairs. Global pictures showed a significant improvement in hair volume and quality together with a high overall patient satisfaction in PRP-injected sites, and these results were maintained during the 6-month follow- up. CONCLUSION: Platelet-rich plasma injections can be regarded as an alternative for the treatment of female pattern hair loss with minimal morbidity and a low cost-to-benefit ratio.

A study of the treatment of cutaneous fungal infection in animal model using photoactivated composite of methylene blue and gold nanoparticle.

BACKGROUND: Onychomycosis is a widespread public health problem, in which T. rubrum and T. mentagrophytes is the commenest causative organisms. Current medical therapy has many drawbacks and side effects. Methylene blue (m.b) photodynamic therapy (pdt) proved efficacy but with lengthy sessions. OBJECTIVES: Optimizing methylene blue photodynamic therapy by combination of methylene blue photosensitizer and gold nanoparticles (aunps) in a composite as gold nanoparticles are efficient delivery systems and efficient enhancers of photosensitizers for antifungal photodynamic therapy. MATERIALS AND METHODS: Eighty newzealand rabbit (Oryctolagus cuniculus) were used and categorized in eight equal groups as follows; healthy and infection control, composite photodynamic therapy and five comparative groups. Photodynamic therapy was initiated at day three to five post inoculation, for four sessions forty eight hours apart. Each group divided and light exposure at two fluencies; 80J and 100J. All groups were investigated macroscopically and microscopically (histopathology and scanning electron microscope) also flowcytometry assessment for cell death and X-ray analysis for gold nanoparticles accumulation in brain and liver tissues were determined. RESULTS: Recovery from infection approaching 96% in gold nanoparticles+light group, around 40% in methylene blue photodynamic therapy and 34% in composite photodynamic therapy. The observed findings confirmed by apparent decrease of apoptosis, however small amounts of gold nanoparticles detected in brain and liver. CONCLUSION: Light stimulated gold nanoparticles is a promising tool in treatment of onychomycosis.

Photodynamic antibacterial enhanced effect of methylene blue-gold nanoparticles conjugate on Staphylococcal aureus isolated from impetigo lesions in vitro study.

BACKGROUND: Staphylococcal aureus is the most common organism which has been encountered in impetigo infection. Gold nanoparticles can be used as a tool to deliver antimicrobials or to enhance photodynamic destruction of bacteria. OBJECTIVE: To evaluate the photodynamic effect of methylene blue gold nanoparticles (MB-gold nanoparticles conjugate) on S. aureus which were isolated from impetigo lesions. PATIENT AND METHODS: Twenty children were diagnosed clinically as impetigo, and aged from 3 to 5 years of both sexes were recruited in the study. Two bacteriological samples were collected from each patient, identified and cultured. Samples of S. aureus of a concentration of 10(-1)ml were divided into four groups. S. aureus was treated by MB-gold nanoparticles conjugate, gold nanoparticles, MB, and the fourth group served as a control group. Diode laser (660 nm) was used for photoactivation. The bacterial growth inhibition was determined by two methods: the percentage of reduction of viable bacteria count and the optical density (O.D) of bacterial growth. RESULTS: The highest significant inhibitory effect on S. aureus was obtained with MB-gold nanoparticles conjugate when irradiated by diode laser 660 nm (P < 0.0001). The percentage of viable bacteria was 3%. The photoactivated gold nanoparticles showed a significant inhibitory effect on bacterial growth (P < 0.05). A non-significant inhibitory effect was elicited in other groups. CONCLUSION: The photoactivated MB-gold nanoparticles conjugate showed the maximum inhibitory effect on S. aureus activity. The gold nanoparticles proved efficacy as a drug delivery system. It enhanced the photodynamic antibacterial effect of methylene blue.

Novel treatment of nail psoriasis using the intense pulsed light: a one-year follow-up study.

BACKGROUND: Pulsed dye laser has been used successfully in the treatment of nail psoriasis. Intense pulsed light (IPL) has been used in the treatment of plaque psoriasis using a 550-nm filter. OBJECTIVE: To study the efficacy of IPL in the treatment of nail psoriasis. PATIENTS AND METHODS: Twenty patients with finger and toe nail psoriasis were treated by IPL. Sessions were performed every 2 weeks for a maximum of 6 months. The Nail Psoriasis Severity Index (NAPSI) score was calculated at baseline and 1 month after the last treatment session. Follow-up was performed at 1, 6, and 12 months. RESULTS: Patients received a mean of 8.63 ± 3.6 IPL sessions. After treatment, there was significant improvement in the nail bed and matrix (p < .0001), and in the NAPSI (p < .0001). Nail bed showed improvement by 71.2%, whereas the nail matrix improvement was only 32.2%. The total NAPSI was 82.4%. Patient follow-up revealed relapse in 3 patients after 6 months. CONCLUSION: Intense pulsed light is a promising effective modality of treatment of nail psoriasis, which is easy to use, safe, and provide a long period of remission. This was confirmed by the elicited clinical improvement, NAPSI, and patient satisfaction.

Pulsed dye laser in the treatment of localized scleroderma and its effects on CD34+ and factor XIIIa+ cells: an immunohistochemical study.

BACKGROUND: Localized scleroderma (morphea) is characterized by hardening and thickening of the dermis due to excessive collagen deposition. A decreased number of CD34+ cells and an increased number of Factor XIIIa+ cells are seen in the affected skin. The flashlamp pulsed dye laser (FLPDL) has been used in the treatment of localized morphea with promising results. OBJECTIVE: The purpose of this study was to evaluate the therapeutic effectiveness of the pulsed dye laser in localized scleroderma and to assess its effect on CD34+ cells, Factor XIIIa+ cells, and blood vessels. STUDY DESIGN: Thirty patients with plaque morphea were treated with a FLPDL (585 nm wavelength, 450 µs pulse duration). Fluence ranged from 7.5 to 8.5 J/cm(2). Sessions were performed biweekly for a maximum of 6 months. Clinical, histopathologic, and immunohistochemical assessments were performed. RESULTS: Patients showed varying degrees of improvement of indurated skin. There was no worsening or further improvement at the treated sites during the follow-up assessments at 3, 6, and 12 months. An increased number of CD34+ cells were found in both the upper and the lower dermis, and a decreased number of Factor XIIIa+ cells were found in the lower dermis. CONCLUSION: The FLPDL is effective in the treatment of morphea, as confirmed by the changes in the pathologic tissue and levels of CD34+ and Factor XIIIa+ cells.