Intense pulsed light versus cryotherapy in the treatment of hypertrophic scars: A clinical and histopathological study.

BACKGROUND: Different therapeutic modalities have been tried for hypertrophic scar treatment. To our knowledge, intense pulsed light (IPL) has not been previously evaluated in comparison with cryotherapy as a stand-alone treatment for hypertrophic scars. OBJECTIVE: We aimed to evaluate the efficacy of IPL as a monotherapy for hypertrophic scar treatment as compared with cryotherapy both clinically and histopathologically. METHODS: This study included 28 patients with hypertrophic scars. Patients were divided randomly and equally into two groups; group I patients received cryotherapy while group II patients received IPL. All patients received treatments for a total of six sessions or until resolution of the lesion whichever was nearer. The outcome was evaluated clinically and histopathologically. RESULTS: Scar height showed a significant decrease and scar color and pliability showed a significant improvement in group I. No significant changes were detected in group II except in scar pliability. Vancouver scar scale (VSS) mean decreased by -53.7% in group I versus -11.5% decrease in group II. Histopathologically, group I showed a significantly increased epidermal thickness and decreased dermal and collagen bundle thickness, while group II showed insignificant histopathological changes. Group I exhibited a statistically significant clinical and histopathological improvement compared to group II, yet with more complications. CONCLUSION: Cryotherapy is more effective than IPL in the treatment of hypertrophic scars both on clinical and histopathological level yet with more complications.

Comparison between single- versus double-spin prepared platelet-rich plasma injection in treatment of female pattern hair loss: clinical effect and relation to vascular endothelial growth factor.

Platelet-rich plasma (PRP) provides a treatment option for female pattern hair loss (FPHL). However, the most suitable preparation method is not yet clear. The primary aim is to compare between the efficacy of single- versus double-spin PRP preparation injection in the treatment of FPHL, while the secondary aim is to assess the relationship between vascular endothelial growth factor (VEGF) concentrations in different prepared PRP preparations (pre- and post-activation) and the obtained treatment results. 15 female patients with FPHL were subjected to intradermal injection of double-spin prepared PRP into the right (Rt) half of the scalp and single-spin prepared PRP into the left (Lt) half of the scalp, three sessions, 3 weeks apart. Evaluation of treatment response was done through comparing patients' photographs, patients' satisfaction and trichoscopic assessment (measurement of terminal hair density) before and after treatment. In addition, VEGF concentration was measured in different PRP samples before and after activation with calcium gluconate. Results showed clinical improvement in both sides of scalp 6 weeks after last PRP session. Meanwhile, Rt median terminal hair density measured by trichoscan following treatment was significantly higher compared to Lt median terminal hair density. Furthermore, VEGF concentration did not differ significantly in single- versus double-spin prepared PRP, or upon calcium activation. PRP is effective in treatment of FPHL. Double-spin method could yield better results than single-spin method. Adding calcium gluconate prior to PRP injection is of no value.

Evaluation of macrophage migration inhibitory factor (MIF) levels in serum and lesional skin of patients with alopecia areata.

BACKGROUND: Alopecia areata (AA) is a non-scarring hair loss condition, the pathogenesis of which is not fully understood. Genetic predisposition, autoimmunity, and stress may each play a role. Macrophage migration inhibitory factor (MIF) is a cytokine that plays a role in the regulation of macrophage function. It also initiates inflammation and immune response by regulating a number of proinflammatory cytokines. OBJECTIVES: This study was designed to study serum and lesional skin biopsy MIF levels in AA patients and to assess their associations with disease severity. METHODS: This study included 30 patients with AA and 15 age- and sex-matched healthy control subjects. Quantitative measurements of MIF concentrations in sera and skin samples were obtained in both patients and control subjects. Associations with disease severity (assessed using the Severity of Alopecia Tool) were evaluated. RESULTS: Mean ± standard deviation (SD) MIF levels in serum and skin were significantly higher in AA patients (45.03 ± 26.98 ng/ml and 73.83 ± 29.81 ng/ml, respectively) than in controls (7.73 ± 1.62 ng/ml and 0.40 ± 1.12 ng/ml, respectively) (P < 0.01). Mean ± SD serum and skin MIF levels were also found to be higher in severe AA (69.93 ± 11.51 ng/ml and 100.80 ± 13.77 ng/ml, respectively) than in mild AA (20.13 ± 6.84 ng/ml and 46.87 ± 9.65 ng/ml, respectively) (P < 0.01). CONCLUSIONS: The finding that MIF is increased in serum and lesional skin of AA patients indicates its possible involvement in the pathogenesis of the disease.

Assessment of serum vascular endothelial growth factor and nail fold capillaroscopy changes in systemic lupus erythematosus with and without cutaneous manifestations.

Angiogenesis and microvascular endothelial injury play a role in the pathogenesis of systemic lupus erythematosus (SLE). Vascular endothelial growth factor (VEGF), a key regulator of angiogenesis, and nail fold capillaroscopy (NFC) have been investigated in few studies in SLE with no reports targeting SLE with cutaneous manifestations. To evaluate NFC changes and VEGF serum level in relation to disease activity in SLE patients with versus without cutaneous manifestations. Thirty SLE patients (15 with cutaneous manifestations [group I], 15 without [group II]) and 15 healthy controls were evaluated for VEGF serum levels, NFC changes and were related to disease activity. VEGF serum levels were significantly higher in patients than controls (median and interquartile range [IQR]: 2110.77, 471.09-4714.30 vs. 60.00, 14-366, respectively, P < 0.0001). VEGF cut-off value to predict SLE patients was more than 293 and to detect moderate and severe SLE activity was more than 422 pg/mL and more than 3800 pg/mL, respectively. Serum VEGF levels increased with increased disease activity (P < 0.05). It was significantly higher in group I than group II (median and IQR: 2624.74, 1801.39-4141.70 vs. 862.50, 180-2426.95, respectively, P < 0.05). Mean serum VEGF was significantly higher with NFC score 3 than 1 (P = 0.008). NFC score and SLE activity were significantly associated in patients (P < 0.05). Serum VEGF is significantly elevated in SLE patients with cutaneous manifestations and its cut-off values to detect different activity grades of SLE are identified. Abnormalities in NFC reflect the extent of microvascular involvement in SLE.