Tahra M. Leheta

Percutaneous Collagen Induction Versus Full-Concentration Trichloroacetic Acid in the Treatment of Atrophic Acne Scars

BACKGROUND Percutaneous collagen induction (PCI) promotes removal of damaged collagen and induces more collagen immediately under the epidermis. The chemical reconstruction of skin scars (CROSS) method is a focal application of full‐concentration trichloroacetic acid (TCA) to atrophic acne scars. The CROSS method has the advantage of reconstructing acne scars by increasing dermal thickening and collagen production. OBJECTIVE To compare the safety and efficacy of PCI and the 100% TCA CROSS method for the treatment of atrophic acne scars. MATERIALS AND METHODS Thirty participants were randomly equally divided into two groups; group 1 underwent four sessions (4 weeks apart) of PCI, and group 2 underwent four sessions (4 weeks apart) of 100% TCA CROSS. RESULTS Acne scarring improved in 100% of patients. Scar severity scores improved by a mean of 68.3% (p<.001) in group 1 and a mean of 75.3% (p<.001) in group 2. The difference in the degree of improvement was not statistically significant between the groups (p=.47). CONCLUSIONS PCI and 100% TCA CROSS were effective in the treatment of atrophic acne scars. The authors have indicated no significant interest with commercial supporters.

Role of the 585-nm pulsed dye laser in the treatment of acne in comparison with other topical therapeutic modalities

Abstract Background: Acne vulgaris is a disease of the pilosebaceous unit characterized by the development of inflammatory and/or non-inflammatory lesions that may progress to scars. The increase of bacterial resistance and adverse effects, the teratogenicity of retinoids and lack of response to usual therapies has led to the investigation of new therapeutic alternatives. Objective: To evaluate the role of the pulsed dye laser in the treatment of acne in comparison with other topical therapeutic modalities. Methods: We studied 45 patients with mild to moderate acne. Patients were randomly divided into three groups: group A received treatment with pulsed dye laser therapy every 2 weeks, group B received topical preparations and group C was subjected to chemical peeling using trichloroacetic acid 25%. Results: At 12 weeks of treatment, there was a significant improvement of the lesions within each group with the best results seen in group A; however, no significant difference was detected between the three treatment protocols after the treatment period. Remission in the follow-up period was significantly higher in the first group. Conclusions: Pulse dye laser therapy mainly improves the inflammatory lesions of acne with few adverse effects.

The use of sulfasalazine and pentoxifylline (low-cost antitumour necrosis factor drugs) as adjuvant therapy for the treatment of pemphigus vulgaris: a comparative study

Background  Pemphigus vulgaris (PV) represents a potentially life‐threatening autoimmune blistering disease in which IgG autoantibodies are directed against cell–cell adhesion molecules. Tumour necrosis factor (TNF)‐α has been suggested to have a possible role in the mechanism underlying acantholysis.

Acral lesions of vitiligo: why are they resistant to photochemotherapy?

Background  Acral lesions of vitiligo are usually resistant to conventional lines of treatment as well as surgical interventions.

Different therapeutic modalities for treatment of melasma.

Background  Chemical peels and topical depigmenting agents have become a popular modality in the treatment of melasma.

Deep peeling using phenol versus percutaneous collagen induction combined with trichloroacetic acid 20% in atrophic post-acne scars; a randomized controlled trial

Abstract Background: Deep peeling using phenol and percutaneous collagen induction (PCI) are used in treating acne scars. Aim: To compare deep peeling using phenol and PCI combined with trichloroacetic acid (TCA) 20% in treating atrophic acne scars. Methods: 24 patients with post-acne atrophic scars were randomly divided into two groups; group 1 was subjected to one session of deep peeling using phenol, and group 2 was subjected to four sessions of PCI combined with TCA 20%. As a secondary outcome measure, side effects were recorded and patients were asked to assess their % of improvement by a questionnaire completed 8 months after the procedure. Results: Scar severity scores improved by a mean of 75.12% (p < 0.001) in group 1 and a mean of 69.43% (p < 0.001) in group 2. Comparing the degree of improvement in different types of scars, within the same group after treatment, revealed a significant highest degree of improvement in the rolling type (p = 0.005) in group 2. Conclusion: Deep peeling using phenol and PCI with TCA 20% were effective in treating post-acne atrophic scars.

Do combined alternating sessions of 1540 nm nonablative fractional laser and percutaneous collagen induction with trichloroacetic acid 20% show better results than each individual modality in the treatment of atrophic acne scars? A randomized controlled trial.

Background: There have been no well-controlled studies evaluating the efficacy of combining 1540 nm nonablative fractional laser with percutaneous collagen induction (PCI) and trichloroacetic acid (TCA) 20% in the treatment of atrophic acne scars. Objective: We hypothesized that combined alternating sessions of both modalities would show better results than each individual modality. Methods and materials: Thirty-nine patients with post acne atrophic scars were included in this study. Patients were randomly equally divided into three groups; group 1 was subjected to six sessions of PCI combined with TCA 20% in the same session, group 2 was subjected to six sessions of 1540 nm fractional laser and group 3 was subjected to combined alternating sessions of the previously mentioned two modalities. Results: Scar severity scores improved by a mean of 59.79% (95% CI 47.38–72.21) (p < 0.001) in group 1, a mean of 61.83% (95% CI 54.09–69.56) (p < 0.001) in group 2 and a mean of 78.27% (95% CI 74.39–82.15) (p < 0.001) in group 3. The difference in the degree of improvement was statistically significant when comparing the three groups using ANOVA test (p = 0.004). Conclusion: The current work recommends combining 1540 nm nonablative fractional laser in alternation with PCI and TCA 20% in the treatment of atrophic acne scars.

Comparative evaluation of long pulse Alexandrite laser and intense pulsed light systems for pseudofolliculitis barbae treatment with one year of follow up.

Background: Existing remedies for controlling pseudofolliculitis barbae (PFB) are sometimes helpful; however the positive effects are often short lived. The only definitive cure for PFB is permanent removal of the hair follicle. Aims: Our aim was to compare the efficacy of the Alexandrite laser with the intense pulsed light system in the treatment of PFB and to follow up the recurrence. Methods: Twenty male patients seeking laser hair removal for the treatment of PFB were enrolled in this study. One half of the face was treated with the long-pulse Alexandrite laser and the other half was treated with the IPL system randomly. The treatment outcome and any complications were observed and followed up for one year. Results: All patients exhibited a statistically significant decrease in the numbers of papules. Our results showed that the Alexandrite-treated side needed seven sessions to reach about 80% improvement, while the IPL-treated side needed 10-12 sessions to reach about 50% improvement. During the one year follow up period, the Alexandrite-treated side showed recurrence in very minimal areas, while the IPL-treated side showed recurrence in bigger areas. Conclusions: Our results showed that both systems might improve PFB but Alexandrite laser was more effective at reducing PFB than IPL.

Non-ablative 1540 fractional laser: How far could it help injection lipolysis and dermal fillers in lower-face rejuvenation? a randomized controlled trial

Abstract Background: Rejuvenation of the lower face can be challenging and no single modality can accomplish all its complex events. Patients and methods: This 18-month study included 24 female patients with a primary complaint of lower-face aging signs. They were randomly allocated to either Group A, who received injection lipolysis and hyaluronic acid dermal filler, or Group B who in addition received non-ablative 1540 fractional laser. The improvement evaluation score used was the global aesthetic improvement scale (GAIS). Patients satisfaction level was also recorded. Both were repeated at Months 6, 13 and 18. Results: At all evaluations, laser group showed higher degree of improvement. Interestingly, at short-term evaluation (6 month), there was no significant difference between both groups (P > 0.05). However, the laser group improvement in comparison to the other group became significant in the long-term evaluations (13 and 18 months) (P < 0.05). Conclusion: This study further documents the importance of combination therapy in facial rejuvenation, offering a treatment protocol combining injection lipolysis and hyaluronic acid as an effective, safe, short-term therapeutic option in lower-face rejuvenation. The addition of 1540 non-ablative fractional laser to the protocol offers a higher efficacy with longer-term effects and no adverse events.