Noncultured Trypsinized Epidermal Cell Suspension Transplantation After Cryoblebbling Versus Noncultured Nontrypsinized Epidermal Cell Graft Homogenized With Plasma Gel After Dermabrasion for Stable Vitiligo.

BACKGROUND: Vitiligo treatment is challenging, especially for resistant and stable vitiligo, which requires surgical management. Noncultured epidermal cell suspension has been modified to enhance the treatment outcomes. OBJECTIVE: Comparison of autologous noncultured trypsinized epidermal cell suspension in recipient site prepared by cryoblebbling and noncultured nontrypsinized epidermal cell graft homogenized with plasma gel in recipient site prepared by dermabrasion for stable vitiligo treatment. MATERIALS AND METHODS: Interventional comparative study on 30 patients with stable vitiligo, randomly divided into 2 equal groups. Group A: noncultured trypsinized epidermal cell suspension for recipient prepared by cryoblebbling. Group B: noncultured nontrypsinized epidermal cell graft homogenized with plasma gel for recipient prepared by dermabrasion. Afterward, both groups received 3 months of narrow-band ultraviolet B phototherapy. RESULTS: The plasma gel group showed a significantly earlier onset of repigmentation and faster healing (p = .002* and <.001*, respectively). Overall, repigmentation was higher in the plasma gel group (p = .037* at the end of the second month). Color matching and patient satisfaction were higher in the plasma gel group, without statistical significance. The cryobleb group showed more recipient site complications, and the plasma gel procedure was relatively easier and cheaper. CONCLUSION: Plasma gel modification is cost-effective, less time-consuming, does not require trypsinization, and provides rapid, satisfactory, and uniform repigmentation. Cryoblebbing and trypsinization are effective; however, there are more technical difficulties, delayed healing, and delayed onset of repigmentation.

Zinc alleviates high fat diet-induced spermatogenic dysfunction in Wistar rats: role of oxidative stress, HMGB1 and inflammasome.

Whether chronic inflammation in the genital tract induced by obesity shares in spermatogenic dysfunction is not clearly known. We aimed to study the effect of high fat diet (HFD) on spermatogenesis, seminal oxidative stress (malondialdehyde (MDA)) and inflammatory markers (high mobility group box 1 (HMGB1), nucleotide-binding oligomerization domain, leucine rich repeat and pyrin-3 domain containing (NLRP3)) in the rat testes and the role of zinc on testicular dysfunction and chronic inflammation in high fat diet (HFD) fed rat testes. This parallel group comparative experimental study included 36 male wistar rats divided into 3 groups: group A (fed on normal control diet); group B (fed on high fat diet (HFD) only); and group C (fed on HFD with zinc supplementation 3.2 mg/kg/day orally). At the end of the 12th week, sperm count, viability and motility were assessed by computer-assisted seemen analysis (CASA), seminal malondialdehyde measured by calorimetry and histopathological examination of testicular sections was done. Immunohistochemical staining was done for HMGB1 and NLRP3 evaluation. Sperm count was lowest in group B. Groups A and C showed statistically significant higher mean sperm vitality, total and progressive motility scores (p < 0.001), while no difference was found between the groups A and C (p > 0.05). Seminal malondialdehyde level was significantly highest in group B. Tubular diameter, epithelial height and Johnsen score were significantly lowest in group B. Significantly higher HMGB1 and NLRP3 levels were demonstrated in group B (p < 0.001). Obesity is associated with testicular dysfunction, testicular oxidative stress and increased testicular HMGB1 and NLRP3. We suggest a beneficial effect of zinc on testicular function in HFD-rats.

Transepidermal Delivery of Triamcinolone Acetonide or Platelet Rich Plasma Using Either Fractional Carbon Dioxide Laser or Micro-needling in Treatment of Alopecia Areata.

Introduction: Trans-epidermal drug delivery, using "laser-assisted drug delivery", or micro-needling, are new treatment modalities, that can improve drug penetration into skin in treatment of alopecia areata patients. Objectives: To evaluate the use of fractional carbon dioxide laser versus micro-needling in trans-epidermal delivery of triamcinolone acetonide and platelet rich plasma in alopecia areata treatment. Methods: Interventional comparative study carried out on 60 patients, randomly divided into four equal groups. Group I: Fractional Carbon dioxide laser and triamcinolone acetonide. Group II: micro-needling with Dermapen and triamcinolone acetonide. Group III: fractional carbon dioxide laser and platelet-rich plasma. Group IV: micro-needling with Dermapen and platelet-rich plasma. Patients were evaluated clinically, using Severity of Alopecia Tool score and hair regrowth scale, and dermoscopically. Results: In all treatment groups, there was improvement in the Regrowth scale, with statistical significance between the different groups at fourth (P = 0.001) and last (P = 0.008) visits, with highest, most significant changes in Pen-Steroid group. Comparing Regrowth scale at last visit, results were in favor of Dermapen, compared to Carbon dioxide laser for trans-epidermal drug delivery (P = 0.023); and in favor of triamcinolone acetonide, compared to platelet-rich plasma as topical medication (P = 0.015). Dermoscopic signs of improvement included decrease in black dots, and appearance of Upright regrowing hairs (P < 0.001). Conclusions: Micro-needling and fractional carbon dioxide laser are effective tools for trans-epidermal drug delivery for Alopecia areata treatment. Micro-needling for delivery of Triamcinolone acetonide showed best treatment outcomes. Dermoscopy is highly beneficial in evaluating treatment response in alopecia areata.

Schistosoma mansoni egg-derived extracellular vesicles: A promising vaccine candidate against murine schistosomiasis.

Extracellular vesicles (EVs) are protein-loaded nano-scaled particles that are extracellularly released by eukaryotes and prokaryotes. Parasite's EVs manipulate the immune system, making them probable next-generation vaccines. Schistosomal EVs carry different proteins of promising immunizing potentials. For evaluating the immune-protective role of Schistosoma mansoni (S. mansoni) egg-derived EVs against murine schistosomiasis, EVs were isolated from cultured S. mansoni eggs by progressive sequential cooling ultra-centrifugation technique. Isolated EVs were structurally identified using transmission electron microscope and their protein was quantified by Lowry's technique. Experimental mice were subcutaneously immunized with three doses of 20 µg EVs (with or without alum adjuvant); every two weeks, then were challenged with S. mansoni cercariae two weeks after the last immunizing dose. Six weeks post infection, mice were sacrificed for vaccine candidate assessment. EVs protective efficacy was evaluated through parasitological, histopathological, and immunological parameters. Results showed significant reduction of tegumentally deranged adult worms, hepatic and intestinal egg counts reduction by 46.58%, 93.14% and 93.17% respectively, accompanied by remarkable amelioration of sizes, numbers and histopathology of hepatic granulomata mediated by high interferon gamma (IFN γ) and antibody level. Using sera from vaccinated mice, the molecular weight of EVs' protein components targeted by the antibody produced was recognized by western immunoblot. Results revealed two bands of ~ 14 KDa and ~ 21 KDa, proving that EVs are able to stimulate specific antibodies response. In conclusion, the present study highlighted the role of S. mansoni-egg derived EVs as a potential vaccine candidate against murine schistosomiasis mansoni.

Low-power Fractional Carbon Dioxide Laser Followed by Jessner's Peel versus Jessner's Peel Alone for the Treatment of Melasma.

BACKGROUND: A number of treatments have been used to treat melasma, with varying degrees of success and side effects. OBJECTIVE: We sought to compare the efficacy of a single session of low-power fractional CO2 (10,600 nm) laser followed by Jessner's solution peeling against that of Jessner's solution peeling alone for the treatment of melasma by way of a prospective cohort comparative study performed at Alexandria Main University Hospital in Alexandria, Egypt. This study included 40 Egyptian female patients diagnosed with melasma. Group A received a single session of low-power fractional CO2 laser followed by Jessner's solution peeling for up to six sessions, while Group B received up to six sessions of Jessner's solution peeling alone. Responses were evaluated using the modified Melasma Area and Severity Index (mMASI) score. RESULTS: There was a statistically significant (p≤0.001) difference between mMASI score between before and after treatment in both groups. There was no intergroup significant difference in mMASI score improvements. CONCLUSION: Both low-power fractional CO2 laser combined with Jessner's solution and Jessner's solution peeling alone were safe and effective for the treatment of melasma in patients with different skin types, especially in dark skin types (Fitzpatrick Skin Types III and IV).

Fractional Carbon Dioxide Laser Versus Carboxytherapy in Treatment of Striae Distensae.

BACKGROUND AND OBJECTIVES: The aim of this study was to compare the efficacy and safety of fractional carbon dioxide (CO2 ) laser versus carboxytherapy in treatment of striae distensae. STUDY DESIGN/MATERIALS AND METHODS: This study was conducted on forty female patients with striae distensae on the abdomen. Patients were selected and divided randomly into two matched groups; group I was treated with fractional CO2 laser resurfacing and group II with carboxytherapy. Assessment and evaluation of the results were done by comparing photographs and the Global Aesthetic Improvement Scale (GAIS). RESULTS: Pregnancy, obesity, and long-term steroid use were the most common causes of striae in both groups. Both groups showed a statistically significant improvement in both the width and length of striae with no statistically significant difference between them. Patients' satisfaction was comparable in both groups. Pain and post-inflammatory hyperpigmentation were the two most common side effects in group I while bruising at the injection site was the most common in group II. CONCLUSIONS: Both modalities could be effective in management of striae distensae. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.

Long-Pulsed Nd:YAG (1,064 nm) Laser Versus Q-Switched Nd:YAG (1,064 nm) Laser for Treatment of Onychomycosis.

BACKGROUND AND OBJECTIVES: To compare the efficacy of the long-pulsed Nd:YAG (1,064 nm) laser versus the Q-Switched Nd:YAG (1,064 nm) laser in treatment of onychomycosis. STUDY DESIGN/MATERIALS AND METHODS: This is a prospective cohort study. It was carried out on 20 patients with clinical and mycological evidence of onychomycosis who were randomly assigned into two groups; group I: included 10 patients treated with biweekly sessions of long-pulsed Nd:YAG (1064 nm) laser and group II; included 10 patients treated with monthly sessions of Q-Switched Nd:YAG (1064 nm) laser. The assessment was done using proximal nail measurement and microscopic examination using 10-20% potassium hydroxide solution and culture on Sabouraud's dextrose agar. All patients were followed up for 6 months after the last treatment session. RESULTS: Fungal isolates in the present study were grouped into yeast in 50%, non-dermatophyte moulds in 10%, while dermatophyte infection was detected in 40%. Each group showed a statistically significant improvement in proximal nail plate measurements with no statistically significant difference between both groups. Mycological cure was only achieved in 40% of group I and 30% of group II. Patient satisfaction was higher in group II. CONCLUSIONS: Both long-pulsed Nd:YAG (1064 nm) and Q-Switched Nd:YAG (1064 nm) laser systems can be used as a safe and effective modality in the treatment of onychomycosis, particularly in patients who refuse or have a contraindication to oral antifungal treatment. Lasers Surg. Med. 00:00-00, 2019. © 2019 Wiley Periodicals, Inc.

White and yellow dots as new trichoscopic signs of severe female androgenetic alopecia in dark skin phototypes.

BACKGROUND: Androgenetic alopecia or female pattern hair loss is the condition that most commonly leads to hair loss in adult females. The trichoscope is used for the early diagnosis of the disease. The study aims at finding a possible association between trichoscopic signs and disease severity in dark-skinned females. METHODS: This was an observational study involving trichoscopic examination of 129 females with different hair disorders. RESULTS: Clinical and trichoscopic examination revealed 79 patients with androgenetic alopecia. All patients showed hair shaft diameter diversity. The predominance of one hair per follicle was found in 97.4% (77/79), peripilar brown halo in 32.9% (26/79), peripilar white halo in 10.1% (8/79), and honeycomb-like scalp pigmentation in 17.7% (14/79) of patients, yellow dots in 15.2% (12/79), white dots in 20.3% (16/79), and hidden hair in 7.6% (6/79). Yellow dots and white dots were positively correlated with the advanced Ludwig and Sinclair staging of hair loss. Peripilar sign, honeycomb pigmentation, and white dots were associated significantly with darker skin types. The other 50 patients were diagnosed with the following: normal healthy controls (10/50), telogen effluvium (25/50), alopecia areata (4/50), fibrosing alopecia in pattern distribution (4/50), folliculitis decalvans (2/50), discoid lupus erythematosus (1/50), lichen planopilaris (2/50), frontal fibrosing alopecia (1/50), and end-stage cicatricial alopecia (1/50). CONCLUSIONS: The yellow dot and white dot signs are suggested as new dermoscopic findings in advanced androgenetic alopecia. Peripilar sign, honeycomb pigmentation, and white dots are characteristic signs of female androgenetic alopecia in ethnic groups of darker skin.