A comparative study of combined microneedling and narrowband ultraviolet B phototherapy versus their combination with topical latanoprost in the treatment of vitiligo.

Regardless of the continuous discovery of innovative modalities for the treatment of vitiligo, none of them ensure excellent therapeutic outcome. Microneedling had been suggested either singly or concomitantly with other therapeutic modalities for vitiligo with encouraging results. Latanoprost, a prostaglandin F2-alpha (PGF2α), and their analogues are recently recommended for vitiligo treatment. This study was designed to assess the therapeutic efficacy of microneedling in combination with NB-UVB phototherapy versus their combination with latanoprost in vitiligo. It was conducted on 50 patients presented with stable bilateral localized nonsegmental vitiligo. In every patient; two bilateral, nearly symmetrical lesions were selected and treated by microneedling (12 sessions at 2-week interval) followed by topical application of latanoprost 0.005% solution on one side, and topical saline (as placebo) on the other side. In addition, all patients received concomitant NB-UVB phototherapy (three sessions/week) for 6 months. Significant clinical improvement of vitiligo lesions with significant increase in the degree of repigmentation were reported in response to both treatment regimens. Latanoprost in combination with microneedling and NB-UVB provides more significant therapeutic outcomes than combined microneedling and NB-UVB. In conclusion, topical latanoprost 0.005% enhances the therapeutic efficacy of combined microneedling and NB-UVB phototherapy in localized stable nonsegmental vitiligo.

Study the effect of erbium:YAG laser plus topical 5-flurouracil in stable vitiligo resistant to NB-UVB phototherapy.

BACKGROUND: NB-UVB phototherapy is still an effective treatment in vitiligo but requires more than 1 year for its completion. Topical 5-flurouracil could improve the proliferation and migration of melanocytes. Laser-assisted dermabrasion results in stimulation of the inactive melanocytes present at the outer root sheath of the lower portion of the hair follicle, which migrates upward until they reach the surface of the skin. OBJECTIVE: To evaluate the effect of Er:YAG laser skin ablation followed by topical 5-flurouracil on the outcome of NB-UVB phototherapy as a short term technique in resistant and stable vitiligo. METHODS: The current study included 40 patients suffering from bilateral stable vitiligo resistant to NB-UVB. For each patient, one side of the body subjected to 4 months NB-UVB sessions (control side). While the other side of the body subjected to one session of Er:YAG laser ablation combined with topical 5% 5-flurouracil application under occlusion followed by NB-UVB sessions for 4 months after complete re-epithelization. Outcomes were evaluated objectively based on standard digital photographs, histopathological examination, patient satisfaction, and adverse effects. RESULTS: There was a statistically significant improvement in the repigmentation in laser side compared with control side. Histopathological examination revealed expression of prominent melanin pigmentation, with marked expression for Melan-A in laser side, whereas these findings were negative in control side. CONCLUSION: Er:YAG laser ablation, followed by 5FU application before NB-UVB phototherapy for vitiligo, is a safe and tolerable technique that improves the outcome of short-term NB-UVB therapy and is expected to increase patient compliance.

Assessment of the efficacy and safety of platelet poor plasma gel as autologous dermal filler for facial rejuvenation.

BACKGROUND: The popularity of dermal fillers has grown rapidly in the last few years for facial rejuvenation. Plasma gel is an autologous gelatinous material that is prepared from the patient's own platelet poor plasma. OBJECTIVE: To evaluate the clinical efficacy and safety of plasma gel injection as a dermal filler for facial rejuvenation. PATIENTS AND METHODS: The current study was carried out on 52 females presented with facial aging divided into two groups: Group A included 34 females with facial wrinkles, and Group B included 18 females with tear trough deformity. After taking written informed consent, they received two sessions of plasma gel injections at 2-week interval and followed up monthly for 3 months. They were assessed clinically before treatment sessions and at the end of follow-up period. RESULTS: Both studied groups showed immediate significant clinical improvement after plasma gel injection that maintained till the end of follow-up period. This finding was confirmed by significant reduction in the mean values of Wrinkle Severity Rating Scale (WSRS) in Group A and Tear Trough Rating Scale (TTRS) in group B, and significant improvement of skin homogeneity and texture in both groups. In general, the reported side effects were minimal and transient. CONCLUSION: Autologous platelet poor plasma gel injection seems to be a cost-effective, safe, well-tolerated, and minimally invasive technique producing significant aesthetic correction of facial wrinkles and tear trough deformity.

Combination of fractional carbon dioxide laser with narrow band ultraviolet B to induce repigmentation in stable vitiligo: A comparative study.

BACKGROUND: Despite the numerous treatment modalities available for vitiligo, responses to treatment are still unsatisfactory. For this reason, new treatment modalities and approaches are needed. OBJECTIVE: To evaluate the efficacy and safety of fractional carbon dioxide (CO2 ) laser therapy followed by narrow band ultraviolet-B (NB-UVB) phototherapy on stable resistant vitiligo. SUBJECTS AND METHODS: Thirty-two patients with stable bilateral vitiligo were enrolled. For each patient, one side of the body was treated with NB-UVB in addition to two sessions of fractional CO2 laser performed at 2-months interval (laser side), while the other side was treated with NB-UVB alone (control side). NB-UVB was administrated twice weekly for 4 months. Outcomes were evaluated objectively based on standard digital photographs, patient satisfaction, and adverse effects. RESULTS: There was statistically significant improvement in the repigmentation in laser side compared to control side. Noticeable adverse events, such as infection, scarring, and Koebner phenomenon were not found in any patient. CONCLUSIONS: Fractional CO2 laser therapy combined with NB-UVB phototherapy could be used effectively and safely as an alternative modality for the treatment of vitiligo. It shortens the duration of NB-UVB therapy and is expected to increase patient compliance.

Study of the efficacy of carboxytherapy in alopecia.

BACKGROUND: Management of alopecia areata (AA) and androgenetic alopecia (AGA) is often challenging. The use of carboxytherapy may be a novel therapeutic option for such cases. OBJECTIVE: To evaluate the clinical efficacy and safety of carboxytherapy in alopecia areata and androgenetic alopecia. PATIENTS AND METHODS: This study was conducted on 80 patients with alopecia divided into two groups; Group I included 40 AA patients (Group IA received carboxytherapy and Group IB control received placebo), and Group II included 40 AGA patients (Group IIA received carboxytherapy and Group IIB control received placebo), and followed up monthly for 3 months. They were evaluated clinically (by assessment of Severity of Alopecia Tool (SALT) score in group I, and Sinclair scale and Norwood-Hamilton scale in group II), by dermoscopy and digital dermoscopy at each visit. RESULTS: Group IA patients showed significant clinical improvement in SALT score and dermoscopic improvement after carboxytherapy and at the end of follow-up period with significant reduction in dystrophic hair, black dots, yellow dots, and tapered hair coinciding with significant emergence of regrowing hair. Group IIA patients showed significant clinical and dermoscopic improvement after carboxytherapy with significant increase in hair density measured by digital dermoscopy. However, regression of these results was observed during the follow-up period but was still significantly better than before treatment. There were statistically significant improvements in clinical score, global assessments, dermoscopic, and digital dermoscopic findings in both group IA and group IIA received carboxytherapy in comparison with group IB and group IIB received placebo injections, respectively. CONCLUSION: Carboxytherapy seems to be a promising therapeutic option for patchy AA and could be helpful as an adjuvant therapy of AGA but more than 6 sessions are required and adjuvants are recommended for maintenance of the results.