Evaluation of the additional effect of topical 5-fluorouracil to needling in the treatment of localized vitiligo.

BACKGROUND: Microneedling is a valuable tool that can be used in transdermal drug delivery in vitiligo patients to improve drug permeability and efficacy with minor side effects. AIMS: The aim of this study is to assess the effectiveness of using microneedling prior to application of topical 5-FU in treatment of localized vitiligo and to compare its results with microneedling alone. METHODS: Twenty-seven patients with localized stable vitiligo are chosen. Two patches are determined in every patient: patch A treated with needling alone and patch B treated with needling followed by topical application of 5-fluorouracil once every 2 weeks for three months. Repigmentation was accessed by grades ranging from G0; no response to G4; >75% repigmentation. Side effects were reported in every visit. RESULTS: Microneedling followed by topical application of 5-fluorouracil showed better response than needling alone with minimal side effects. CONCLUSION: Combining microneedling with topical drug application yields better results in treating localized vitiligo.

Cowden's syndrome: a clinical, immunological, and histopathological study.

BACKGROUND: Cowden's syndrome is a rare, autosomal dominant condition characterized by hamartomas of the gastrointestinal tract and cancer of the breast and thyroid. This study describes the clinical, immunological, and histopathological status of four Cowden's syndrome cases from two different families. METHODS: Biopsies were taken from different skin, mucous membrane, and intestinal lesions in all patients. Blood samples from patients and their parents were also examined. RESULTS: Two brothers in the first family had more flexural distribution of papular and warty skin lesions as well as other manifestations of the syndrome, including recurrent pyogenic and fungal infections. Flow cytometric study revealed decreased total T and B-cell percentages and abnormal helper: suppressor ratios in these patients. The other two patients from the second family showed the classical picture of the syndrome and normal immunological parameters. Histopathologically, most skin lesions of the face showed trichilemmomas, and all oral and some of the other skin lesions showed benign fibromas with giant cells (Cowden's fibroma). Examination of intestinal biopsies revealed hamartomatous and hyperplastic polyps. CONCLUSIONS: Some cases of Cowden's syndrome may be associated with prominent flexural skin lesions, recurrent pyogenic and fungal skin infections, decreased total T and B-cell counts, and an abnormal helper:suppressor ratio.