Fractional Carbon Dioxide Laser versus Trichloroacetic Acid 20% Peel in the Treatment of Acanthosis Nigricans: A Split Neck Comparative Study.

Background: Acanthosis nigricans (AC) is a common chronic skin disorder clinically presenting as velvety, hyperpigmented lesions that can affect any part of the body, including the face.OBJECTIVE: We sought to evaluate and compare the efficacy and safety of fractional CO2 laser and TCA 20% peel in the treatment of pseudo-acanthosis nigricans. Methods: The current study adopted an experimental, comparative split-neck design. It included a total of 20 patients with bilateral pseudo-acanthosis nigricans of the neck. Each patient was subjected to four sessions, spaced three weeks apart, involving fractional CO2 laser therapy on the right side and TCA 20% application on the left side. The evaluation of cases involved the utilization of the ANASI score and the assessment conducted by two dermatologists blinded to the treatment, both prior to and three months following the treatment. Results: Regarding Clinical improvement, 20% of the Fractional CO2 laser side had excellent improvement, and 45 percent had marked improvement. In contrast, the TCA 20% peel side had 2 percent marked improvement, 50 percent moderate improvement, and 40 percent mild improvement. In terms of response to therapy sessions, there was a statistically significant difference between the studied treatment sides (p<0.001). Regarding ANASI score differences between treated sides before and after treatment, a statistically significant reduction in ANASI score was observed, with a higher percentage of reduction in the Fractional CO2 laser side compared to the TCA 20% peel side. Limitations: The primary limitations are the small sample size and short follow-up period. Conclusion: In the treatment of pseudo-acanthosis nigricans, it appears that fractional CO2 laser and TCA 20% are promising, effective, and well-tolerated modalities. However, the Fractional CO2 laser was associated with a better response.

Intradermal injection of tranexamic acid versus platelet-rich plasma in the treatment of melasma: a split-face comparative study.

Millions of people throughout the world suffer from the acquired condition of hyperpigmentation known as melasma. Melasma is characterized by symmetrically oriented hyperpigmented macules and patches. Many treatment options are available with variable degrees of efficacy and tolerability. The aim of the work was to evaluate and compare the effectiveness and safety of intradermal tranexamic acid (TXA) versus intradermal platelet-rich plasma (PRP) in the treatment of various types of melasma. The current split-face prospective study included 40 cases with melasma. Tranexamic acid (TXA) was injected intradermally into the right side of the face by using a concentration of 4 mg/ml, while platelet-rich plasma (PRP) was injected intradermally into the left side. In both sides, a total of three sessions of treatment were provided, once every 4 weeks. Digital photographs were taken before each treatment session and 3 months after the last session. The modified melasma area severity index (mMASI) grading system and dermoscopy were used to assess the improvement in the condition. The disease severity and percentage of improvement were assessed by mMASI score before and after therapy across both sides of the face. along with determining the degree of satisfaction and side effects among the included cases. The mean mMASI score before therapy in the TXA side was 4.59 ± 2.87, while in the PRP side, the mean mMASI score before therapy was 4.72 ± 2.72 with no statistically significant difference between the two sides (p = 0.841). After 3 months of treatment, the mean mMASI score in the TXA-treated side was 2.49 ± 1.58 with a mean percentage of decrease of 45.67 ± 8.10%, while in the PRP side, the mean mMASI score after treatment was 2.17 ± 1.41 with a mean percentage of decrease of 53.66 ± 11.27%. There was a high statistically significant decrease in the mMASI score after treatment on both sides (p < 0.001); however, the percentage of score reduction in the PRP side compared to the TXA side was statistically higher. Intradermal injection with PRP revealed higher efficacy in the treatment of melasma as compared to TXA injection with no significant difference regarding the associated side effects.

Comparative study between topical application of triamcinolone acetonide after fractional carbon dioxide laser versus microneedling in the treatment of resistant alopecia areata.

Alopecia areata (AA) is a disease that affects the psychological well-being of the affected individuals. Laser-assisted drug delivery and microneedling (MN) are promising methods for the treatment of different dermatological diseases. The aim of the study was to compare the efficacy of topical application of triamcinolone acetonide after fractional carbon dioxide laser versus MN in the treatment of resistant AA from a clinical and dermoscopic perspective. Thirty patients were randomly divided into two groups of 15 patients each: the Laser group received fractional CO2 laser treatment followed by topical application of triamcinolone acetonide, and the MN group received dermapen treatment followed by topical application of triamcinolone acetonide. In our study, we found no statistically significant difference between the studied groups before and after treatment, except for black dot, which is higher in the MN group than in the laser group (46.7% vs. 13.3%). There is a statistically significant difference between the studied groups in terms of treatment response at the first follow-up, with 13.3% of the laser group seeing terminal hair regrowth compared to 0 in the MN group after 12 weeks. Regarding the degree of improvement, there was no statistically significant difference between the laser group and the MN group. The use of fractional CO2 laser and MN for transepidermal drug delivery (TED) allowed for more uniform drug distribution. There was no significant difference between the two treatment methods in terms of their high effectiveness in the treatment of resistant AA.

Topical hydrogen peroxide solution 40% in treatment of plane wart.

BACKGROUND: There are various available therapies for plane warts; however, no specific therapy has been established as entirely effective. OBJECTIVE: The aim of work was to assess the effectiveness and safety of topically hydrogen peroxide (HP) 40% solution in treating the plane warts. SUBJECTS AND METHODS: The study included 30 patients diagnosed clinically as plane warts. Topical HP 40% was applied with a single-use wood end of a cotton swab soaked with the solution to minimize filtration of effective drug to the surrounding areas. Duration of the treatment was planned to be 4 sessions for each lesion with 2-week interval and a 3-month follow-up period after treatment completion to detect any recurrence. RESULTS: Complete clearance of plane warts was observed in 27 (90%), and there was no recurrence of the lesions after a 3-month follow-up period. CONCLUSION: HP solution especially the 40% concentration may be considered a promising line of treatment for non-genital warts. It is a very effective, safe, cheap, and easy-to-use new topical treatment for non-genital warts.

Intralesional Candida antigen versus intralesional vitamin D3 in the treatment of recalcitrant multiple common warts.

BACKGROUND: There are various therapies available for recalcitrant common warts; however no specific therapy has been established as entirely effective. AIMS: To assess the efficacy and safety of intralesional Candida antigen injection of vs. intralesional vitamin D3 injection in the treatment of multiple recalcitrant common warts. PATIENTS AND METHODS: A total of 80 adult patients with multiple common warts were randomly assigned to one of three groups in this study. Thirty patients were assigned to Group I, who received a 0.3 ml intralesional injection of Candida antigen. Thirty patients were assigned to Group II, who received a 0.6-ml (60 000 IU) intralesional injection of vitamin D3. Twenty patients were in Group-III, who received 0.3 ml of normal saline as a control. Each agent was injected at the base of largest wart every 3 weeks until full clearance has been obtained, or for a maximum of four sessions. RESULTS: In the Candida antigen, vitamin D3, and saline groups, complete wart clearance was observed in 76.7 percent, 20%, and 0.0 percent, respectively. The side effects were negligible and transient, and there was no recurrence of the lesions. CONCLUSION: Intralesional injection of Candida antigen is as a safe, simple, cost-effective treatment modality for multiple recalcitrant common warts and it outperforms intralesional vitamin D3.