RESUMEN
BACKGROUND: Acne scar is a distressing psychosocial problem, and it has a negative effect on the quality of life. Although variety of approaches are available, demand of less invasive and more effective ways for their treatment is needed. OBJECTIVE: This study aimed to assess and compare the clinical safety, efficacy, and tolerability of fractional carbon dioxide (FCO2) laser versus fractional microneedling radio frequency (MNRF) in the management of acne scars. MATERIALS AND METHODS: This study was a prospective, observational, nonrandomized, open-labeled study of total 50 patients selected according to Goodman and Baron global qualitative acne scar grading, and they were divided into two groups of 25 each, having Fitzpatrick skin type III-V. A total of four sessions were given for both the groups at an interval of 2 months. The assessment was done by the treating physician as well as by the blinded physician. Both the subjective and the objective assessment was done at the last follow up given at second month of the fourth session. RESULTS: The mean score of 25 patients in each group of FCO2 and fractional MNRF, decreased from 29.24 to 10.7 (i.e., 63.41%) and from 33.24 to 13.04 (i.e., 60.72%), respectively, as calculated by Goodman and Baron quantitative grading assessed by the treating physician (P = 0.0001). Grade 4 (>75%) improvement was shown by four patients and Grade 3 improvement (51%-75%) was shown by 14 patients among FCO2 group, and similarly Grade 4 (>75%) improvement was shown by three patients and Grade 3 improvement (51%-75%) was shown by 12 patients among MNRF group, as observed by a blinded physician (P = 0.689). CONCLUSION: Both modalities are equally effective in the treatment of acne scars; however, fractional MNRF having lesser down time and Post inflammatory hyperpigmentation (PIH) among darker skin shades, with good patient satisfaction score, makes it an efficient and safer treatment option as compared to FCO2.
RESUMEN
INTRODUCTION: Leprosy is a disease primarily affecting skin and nerve. Nail involvement, although indirect, is observed in several patients. This is a study to determine the pattern of nail changes in leprosy. METHODS: It was an observational study involving 125 patients. Apart from cutaneous and neurological examination, nails were examined. Diagnosis was confirmed by previous records in already diagnosed cases, while by slit skin smear and histopathologically in new cases. Patients were grouped as per Ridley-Jopling classification and further subdivided as per age, sex, and duration and reaction status. Nail changes in these groups were summarized and compared. RESULTS: Overall prevalence of nail changes was 80% with 66.6% in TT patients, 79.4% in BT patients 50% in BB patients, 83.7% in BL patients and 84.3% in LL patients. Longitudinal melanonychia and longitudinal ridges were frequent finger nail changes with longitudinal melanonychia being more common among tuberculoid pole and longitudinal ridges among lepromatous pole. Brachyonychia, subungual hyperkeratosis and brown black pigmentation were frequent finger nail changes, with onychorrhexis being commonest among TT patients, subungual hyperkeratosis among BT patients, while brachyonychia among BL and LL patients. Anonychia and rudimentary nails were not found in tuberculoid pole. Beau's lines, terry nails, pterygium, pincer nail, and onychorrhexis were significantly more frequent in ENL patients. Onychomadesis, which is not reported yet in leprosy, was found in one patient after severe ENL. CONCLUSION: Various changes in leprosy are due to multiple causes like neuropathic, traumatic, vascular, osseous, infections and drugs reflecting extensive systemic morbidity caused by Mycobacterium leprae.