Heba I. Gawdat

Autologous Platelet Rich Plasma: Topical Versus Intradermal After Fractional Ablative Carbon Dioxide Laser Treatment of Atrophic Acne Scars

BACKGROUND A proposal has recently been made regarding the potential adjuvant use of platelet‐rich plasma (PRP) with fractional carbon dioxide laser (FCL) for the correction of acne scars. OBJECTIVE To compare the efficacy and safety of two administration modes of autologous PRP (intradermal injection (ID) and topical application) after FCL with that of FCL alone in the treatment of atrophic acne scars. PATIENTS AND METHODS Thirty patients were randomly divided into two groups. Both underwent split‐face therapy. Group 1 was administered FCL followed by ID PRP on one side and FCL followed by ID saline on the other. In group 2, one cheek was treated with FCL followed by ID PRP, and the other received FCL followed by topical PRP. Each patient received 3 monthly sessions. The final assessment took place at 6 months. RESULTS Combined PRP‐ and FCL‐treated areas had a significantly better response (p = .03), fewer side effects, and shorter downtime (p = .02) than FCL‐treated areas, but there were no significant differences in ID‐ and topical PRP–treated areas in degree of response and downtime (p = .10); topically treated areas had significantly lower pain scores. CONCLUSION The current study introduces the combination of topical PRP and FCL as an effective, safe modality in the treatment of atrophic acne scars with shorter downtime than FCL alone and better tolerability than FCL combined with ID PRP.

Oral propranolol: an effective, safe treatment for infantile hemangiomas

Infantile hemangiomas (IH) are the most common childhood tumors. In 2008, Labreze reported the serendipitous effect of oral propranolol on hemangioma and since then it has overshadowed the use of other therapeutic modalities in the treatment of IH. The aim of this prospective, clinical study was to assess the efficacy and safety profile of oral propranolol at a fixed dose of 2 mgkg(-1) in the treatment of 30 patients with problematic IH. Propranolol treatment continued for a duration of 2-14 months where 60% of the patients (n=18) showed a final excellent response with complete resolution of the lesion (P<0.001). 20% (n=6) showed a good response with more than 50% reduction in the size of the IH. 16.6% showed a fair response (n=5) with less than 50% reduction in the size of the IH. Only one patient (3.3%) was resistant to treatment. Five patients (17.24%) showed evidence of rebound growth after cessation of therapy and responded well to re-treatment.We did not face any side effects related to the oral propranolol. In conclusion, propranolol therapy at a fixed dose of 2 mgkg(-1), given in three equally divided doses, is a very safe and effective regimen in the treatment of IH.

T helper 17 and Tregs: a novel proposed mechanism for NB-UVB in vitiligo.

Narrowband ultraviolet (NB‐UV)B is accepted as corner stone therapy for vitiligo. Its influence on the expression of IL‐17, IL‐ 22 and FoxP3 as markers for the Th17 and Tregs lineages has not been studied before in the context of non‐segmental vitiligo (NSV). The study included 20 active NSV patients who received 36 NB‐UVB sessions and 20 controls. Clinical evaluation Vitiligo Area Scoring Index (VASI) and determination of tissue expression of IL‐17, IL‐22 and FoxP3 by qRT‐PCR (lesional, perilesional) were carried out before and after therapy. Baseline levels of IL‐17 and IL‐22 were significantly higher in patients, whereas FoxP3 was significantly lower. After therapy, IL‐17 and IL‐22 significantly dropped, whereas FoxP3 significantly increased (lesional, perilesional). Baseline and post‐treatment VASI showed significant positive correlations with IL‐17 and IL‐22 and significant negative correlation with FoxP3 expression. Restoration of the balance between Th17 and Tregs might represent a novel pathway for the improvement that NB‐UVB exerts in vitiligo patients.

Propranolol and infantile hemangiomas: Different routes of administration, a randomized clinical trial

UNLABELLED Oral propranolol has become the treatment of choice of infantile hemangiomas (IH)s. However, the safety of systemic propranolol is questioned. Topical therapy with 1% propranolol has been reported to be safe and effective. Intralesional (IL) administration may possibly allow safe delivery of higher drug dosages. AIM To assess the efficacy and safety of two locally administered routes of propranolol (topical and IL), in comparison with its systemic oral use in the treatment of IHs. PATIENTS AND METHODS 45 patients with IHs were randomly divided into 3 groups, A, B and C (n = 15 in each), receiving oral propranolol, 2 mg/kg/day, topical propranolol 1% ointment twice daily, IL propranolol, 1 mg of propranolol hydrochloride in 1 ml of injection once weekly, respectively. Follow up was done for 6 months after treatment was stopped. RESULTS Excellent response was achieved in 9 patients in group A (60%), 3 in group B (20%) and 2 in group C (13.3%), (P value : 0.04). As regards safety, all 3 modalities proved safe with no major side effects apart from 1 patient in group A and 3 in group C who dropped out due to pain or inconvenience of therapy. CONCLUSIONS Further work is needed to establish clear guidelines and reach best formulations. Nevertheless, in properly selected patients with IHs, we recommend the usage of oral propranolol. Topically administered propranolol could be considered in patients at risk of potential side effects from oral administration. As IL application did not offer any more benefits, it could not be recommended.

Immunomodulatory impression of anti and pro-inflammatory cytokines in relation to humoral immunity in human scabies

The chief manifestations of scabies are mediated through hypersensitivity-like reactions and immune responses which are so far not well understood and remain poorly characterized. The aim of this study is to investigate the role of inflammatory cytokines in relation to humoral immunity in patients with scabies. Serum levels of total IgE, specific IgG, IL-10, IL-6, INF-γ, and TNF-α were investigated in a cross-sectional study including 37 patients with manifestations suggestive of scabies and serologically positive for anti-Sarcoptes IgG, in addition to 20 healthy controls. The median value of total IgE was 209 (range, 17–1219 IU/mL), reflecting its wide range within cases. IL-10 showed significant higher levels (287 ± 139) in cases than in controls (17.4 ± 11.32). A positive correlation was reported between total IgE and severity of manifestations (r = 0.429, P <0.005). A significant positive correlation was observed between total IgE and both IgG and IL-6. On the contrary, a negative correlation was recorded between IL-6 and TNF-α which makes us suggested anti-inflammatory rather than pro-inflammatory effect of IL-6. Moreover, a negative correlation was noticed between the anti-inflammatory cytokine IL-10 and severity of manifestations, specific IgG, total IgE, and INF-γ. Therefore, the current study theorized a regulatory role of IL-10 in inflammatory responses of scabietic patients suggesting further future analysis of its therapeutic potential.

Pentoxifylline (anti-tumor necrosis factor drug): effective adjuvant therapy in the control of ocular cicatricial pemphigoid.

Purpose The detection of tumor necrosis factor-α (TNF-α) in conjunctiva affected by ocular cicatricial pemphigoid (OCP) may indicate that this cytokine plays an important role in its pathogenesis. The purpose of this randomized, controlled, comparative, blinded study was to evaluate the effectiveness of adding pentoxifylline as an anti- TNF-α drug to the well-documented therapy of steroids and cyclophosphamide in controlling OCP. Methods Thirty patients with different grades of OCP were included. They were randomly divided into 2 equal groups. Group A patients received pulse steroid and cyclophosphamide therapy; in addition, group B patients received intravenous pentoxifylline. Patients were evaluated before and after therapy clinically, histopathologically, and serologically (serum level of TNF-α). Twenty controls were included to compare their serum TNF-α level with that measured in patients with OCP. Results Group B patients showed a more significant improvement in their clinical and histopathologic evaluation. The serum TNF-α was significantly higher in OCP cases prior to therapy compared to the control group (p=0.0001). Following therapy, serum TNF-α showed a more significant reduction in group B patients (77.4±26.1 to 19.2±15.6) compared to group A patients (50.3±14.3 to 36.2±18.3). Conclusions The significantly increased level of serum TNF-α in OCP as compared to controls proves that TNF-α has an important role in the pathogenesis of this disease. The study illustrates that the addition of pentoxifylline to pulse steroid cyclophosphamide therapy is an effective, safe, and economical method in controlling OCP through directly reducing TNF-α levels, with long periods of remission as detected in our 18-month follow-up period.

Bimatoprost versus Mometasone Furoate in the Treatment of Scalp Alopecia Areata: A Pilot Study.

Background: Alopecia areata (AA) is an immune-mediated disease that targets anagen hair follicles. Despite various therapeutic options, there is no cure for AA. Prostaglandin analogues have been recognized as being capable of inducing hypertrichosis. Objective: To compare the efficacy and safety of bimatoprost to those of corticosteroid in the treatment of scalp AA. Methods: Thirty adult patients with patchy AA (S1) were included. Two AA patches were randomly assigned to treatment either by mometasone furoate 0.1% cream once daily (area A) or bimatoprost 0.03% solution twice daily (area B) for 3 months. Patients were assessed using the Severity of Alopecia Tool (SALT) scoring system for hair re-growth. Results: All responding AA patches showed significant reduction in their SALT score after therapy. Area B demonstrated significantly better results regarding rapidity of response in weeks, percentage of hair re-growth and side effects compared to area A. Conclusion: Bimatoprost solution represents a therapeutic option for scalp AA.

Analysis of oxidative stress status, catalase and catechol-O-methyltransferase polymorphisms in Egyptian vitiligo patients.

Vitiligo is the most common depigmentation disorder of the skin. Oxidative stress is implicated as one of the probable events involved in vitiligo pathogenesis possibly contributing to melanocyte destruction. Evidence indicates that certain genes including those involved in oxidative stress and melanin synthesis are crucial for development of vitiligo. This study evaluates the oxidative stress status, the role of catalase (CAT) and catechol-O-Methyltransferase (COMT) gene polymorphisms in the etiology of generalized vitiligo in Egyptians. Total antioxidant capacity (TAC) and malondialdehyde (MDA) levels as well as CAT exon 9 T/C and COMT 158 G/A polymorphisms were determined in 89 patients and 90 age and sex-matched controls. Our results showed significantly lower TAC along with higher MDA levels in vitiligo patients compared with controls. Meanwhile, genotype and allele distributions of CAT and COMT polymorphisms in cases were not significantly different from those of controls. Moreover, we found no association between both polymorphisms and vitiligo susceptibility. In conclusion, the enhanced oxidative stress with the lack of association between CAT and COMT polymorphisms and susceptibility to vitiligo in our patients suggest that mutations in other genes related to the oxidative pathway might contribute to the etiology of generalized vitiligo in Egyptian population.

Propranolol versus captopril in the treatment of infantile hemangioma (IH): A randomized controlled trial

BACKGROUND Renin-angiotensin system components have been demonstrated in the biology of infantile hemangioma (IH). Captopril, an angiotensin-converting enzyme inhibitor, is proposed as a therapeutic alternative to oral propranolol. OBJECTIVES We sought to compare the benefit of propranolol and captopril in the treatment of IH, and to assess angiotensin-converting enzyme gene polymorphism in patients with IH and in control subjects. METHODS Thirty patients with IH and 35 healthy control subjects were enrolled in this study. Patients were randomly assigned to treatment with either propranolol or captopril. Assessment was done clinically and by measurement of serum vascular endothelial growth factor and angiotensin II in patients and control subjects. Angiotensin-converting enzyme gene polymorphism was also studied. RESULTS Clinical improvement was significantly better and faster in the patients treated with propranolol. Both groups showed reduced vascular endothelial growth factor and angiotensin II levels posttreatment, with a significantly higher percentage reduction in the propranolol-treated group. Cardiac side effects were reported only in the captopril-treated group. Baseline vascular endothelial growth factor level was significantly higher, and baseline angiotensin II level was significantly lower, in patients than control subjects. LIMITATIONS We studied a relatively small number of patients and control subjects. CONCLUSION Propranolol shows greater benefit than captopril in the treatment of IH.

Autologous platelet-rich plasma versus readymade growth factors in skin rejuvenation: A split face study

The escalating urge for a youthful‐looking skin instigates continuous innovations with minimally invasive procedures. Readymade growth factors and autologous platelet‐rich plasma (PRP) represent such therapeutic interventions.