Effect of A. polygama APEE (Actinidia polygama ethanol extract) or APWE (Actinidia polygama water extract) on wrinkle formation in UVB-irradiated hairless mice

Background

Actinidia polygama (silver vine) is considered a medical plant which has been used in oriental medicine. It has been used for the treatment of pain, gout, rheumatoid arthritis, and inflammation. Few studies reported on the effect of Actinidia polygama (silver vine) on skin photoaging.

Objective

To evaluate the anti-photoaging effect of the ethanol and water extracts of A. polygama (APEE and APWE, respectively) in UVB-irradiated hairless mice.

Methods

SKH-1 hairless mice were exposed to UVB irradiation (30–60 mJ/cm²), following orally APEE or APWE oral administration for 10 weeks. We examined the effect on winkle improvement by a measuring Fullscope, PRIMOS, Craniometer, and Cutometer. Furthermore, we analyzed histological changes in mouse dorsal skin through hematoxylin and eosin (H&E) and Masson's trichrome (MT) staining. The expression of matrix metalloproteinase (1, 3, and 9) was analyzed by immunoblotting.

Results

Oral administration of APEE or APWE at 100 or 200 mg/kg in UVB-irradiated mice alleviated the symptoms of skin aging, such as wrinkling, epidermal hyperplasia, and water loss. In addition, the APEE or APWE oral administration increased skin elasticity by enhancing the production of type I collagen, elastin, and hyaluronic acid synthase and downregulating matrix metalloproteinase (1, 3, and 9) expression.

Conclusion

Based on results for our study, APEE or APWE could protect the UVB-mediated skin wrinkle and is new target for the developing anti-wrinkle cosmetics.     

Acyclovir skin depot characterization following in vivo iontophoretic delivery

Background/purpose: Current Herpes labialis infection treatment by oral, parenteral or topical routes is inefficient. The objective of this study was to investigate the use of iontophoresis for improved topical delivery of acyclovir (ACV) in vivo in hairless rat. Methods: Iontophoresis was performed for 10 min using a 5% ACV gel formulation. Tape stripping and skin extractions were performed at different time points following treatment for drug quantification in stratum corneum (SC) and underlying skin, respectively. Results: Fourfold more ACV was detected in the SC immediately following 10‐min iontophoresis as compared with passive delivery. Similarly, high ACV levels (29.27±3.52 μg/cm²) were achieved in the underlying skin following a single 10‐min iontophoretic treatment while no drug detected following passive delivery (P<0.05). At 24‐h post‐iontophoresis, ACV levels in the SC decreased with a corresponding increase in the underlying skin due to drug migration. After 24‐h post‐iontophoresis, drug levels gradually decreased in both skin compartments until no ACV was detected at 72‐h post‐iontophoresis. Conclusion: Iontophoretic delivery of ACV resulted in high drug levels in skin layers to form a drug depot, which persisted over 2–3 days.     

Oral itraconazole for the treatment of severe seborrhoeic dermatitis

Background:

Seborrheic dermatitis (SD) is an inflammatory skin disorder in which colonies of Malassezia furfur have been found in affected areas.

Aim:

The aim of this study was to evaluate the efficacy of itraconazole in the treatment of severe SD.

Materials and Methods:

Itraconazole was given to 30 patients of SD in a dose of 100 mg twice daily for 1 week followed by 200 mg/day for first 2 days of the following 2 months. The response was noted on day 15, 30, 60, and 90. The clinical response was graded as markedly effective, effective, or ineffective.

Results:

Clinical improvement (evaluated as markedly effective or effective) was observed in 83.3% cases.

Conclusion:

The anti-inflammatory activity of oral itraconazole suggests that it should be the first-line therapy in severe SD.     

Rheumatoid arthritis, gold therapy, contact allergy and blood cytokines

Background

During the last decade, medium-dose UVA1 phototherapy (50 J/cm²) has achieved great value within the treatment of severe atopic dermatitis (AD). The purpose of our study was to investigate to what extent UVA1 irradiation is able to modulate the status of protease activity by the use of a monoclonal antibody labeling cathepsin G.

Methods

In order to further elucidate the mechanisms by which medium-dose UVA1 irradiation leads to an improvement of skin status in patients with AD, biopsy specimens from 15 patients before and after treatment were analyzed immunohistochemically for proteolytic activation.

Results

Compared to lesional skin of patients with AD before UVA1 irradiation, the number of cells positive for cathepsin G within the dermal infiltrate decreased significantly after treatment. The decrease of cathepsin G⁺ cells was closely linked to a substantial clinical improvement in skin condition.

Conclusions

In summary, our findings demonstrated that medium-dose UVA1 irradiation leads to a modulation of the expression of cathepsin G in the dermal inflammatory infiltrate in patients with severe AD. Cathepsin G may attack laminin, proteoglycans, collagen I and insoluble fibronectin, to provoke proinflammatory events, to degrade the basement membrane, to destroy the tissue inhibitor of metalloproteinases and to increase the endothelial permeability. Therefore, its down-regulation by UVA1 phototherapy may induce the reduction of skin inflammation as well as improvement of the skin condition.     

A META-ANALYSIS COMPARING EFFICACY OF CONTINUOUS TERBINAFINE WITH INTERMITTENT ITRACONAZOLE FOR TOENAIL ONYCHOMYCOSIS

Background:

Toenail onychomycosis is a challenge for clinicians to treat. While both Itraconazole and terbinafine have proven to be effective against onychomycosis, very little is known about their comparative efficacy in achieving mycological and clinical cure.

Aim:

The purpose of this meta-analysis is to compare the efficacy of continuous terbinafine with intermittent itraconazole in the treatment of toenail onychomycosis.

Material and Methods:

all RCTs comparing continuous terbinafine with intermittent itraconazole were identified from PUBMED and BIDS electronic database.

Results:

analysis of total eight trials including 1181 patients state that treatment with continuous terbinafine is more likely to produce mycological and clinical cure compared to intermittent itraconazole with odds ratio 2.3(95% CI, 1.7 to 3.0 P<0.0001)

Conclusion:

though both itraconazole and terbinafine are well tolerated and highly effective drugs, continuous terbinafine is more effective than intermittent itraconazole at achieving mycological cure of toenail onychomycosis     

Protective effects of a day/night dual-antioxidant serum on skin: A randomized,regimen-controlled study in Chinese women exposed to air pollution

Background

Chronic exposure to air pollution can negatively affect skin health.

Aims

To assess the efficacy of the LUMIVIVE^® System (LVS), a skincare system consisting of individual day and night serums, in Chinese women exposed to air pollution.

Patients/Methods

In this single-center, vehicle-controlled study, eligible females (mean age, 49.02 years) were randomized 1:1 to treatment group (LVS plus basic moisturizer) or control group (basic moisturizer). Skin color, sebum content, barrier function, elasticity, and texture were measured at baseline and at each follow-up visit (days 28, 56, and 84). Air pollution parameters were collected throughout the study.

Results

Air pollution levels, including PM_2.5 and NO₂, were consistently high during the study. The treatment group showed significantly higher skin color L* (p ≤ 0.0001) and lower a* values (p ≤ 0.05) at all follow-up visits compared with the control group, indicating lower skin pigmentation and redness, respectively. Skin color L* and a* values remained unchanged over time for the control group but were significantly different at all follow-up visits compared to baseline (p ≤ 0.0001 and p ≤ 0.05, respectively) for the treatment group. There was an increasing trend for sebum content in the control group, which was not observed in the treatment group. Both groups showed improvements over time in other skin physiology parameters.

Conclusions

The current analysis demonstrates the efficacy of LVS plus basic moisturizer compared with basic moisturizer alone to reduce skin pigmentation and redness, as well as to mitigate sebum production, in Chinese women exposed to air pollution.     

INDUCTION OF PSORIASIFORM CHANGES IN GUINEA PIG SKIN BY PROPRANOLOL

Background. The ability of β-adrenergic blocking agents to induce psoriasis as an adverse effect prompted us to use such an agent to induce psoriasis in guinea pigs. Methods. Thirty female albino guinea pigs were divided into four groups. Group 1 received propranolol, 0.1 mg/day, dissolved in 2 mL of normal saline, orally by gavage for 30 days. Group 2 was given the same treatment, but in addition intradermal injections of propranolol with Freund's complete adjuvant, injected at weekly intervals. Group 3 (five animals) received 2 mL saline, and group 4 additional injections of adjuvant without propranolol. Groups 3 and 4 served as normal controls. Results. All animals of group 2 (which received propranolol orally and in addition intradermal injections of adjuvant) developed psoriasiform epidermal hyperplasia with acanthosis. Parakeratosis, papillomatosis, and formation of microabscesses, all characteristic signs of psoriasis, have not been seen in any of the skin samples of this group. Skin samples from group 1 animals receiving propranolol orally showed normal epidermis and dermis. They showed exactly the same histologic picture as the control groups 3 and 4. Conclusions. Beta-blockers given orally for 30 days do not cause any significant skin changes in guinea pigs. When given with a weekly intradermal injection of Freund's complete adjuvant, they cause psoriasiform epidermal hyperplasia. Although the overall histologic appearance of the skin of group 2 resembled psoriasis, it lacked important histologic features characteristic of this disease. It seems, therefore, that the model, per se, does not fulfill the initial expectations as an experimental model for psoriasis; however, this model has potential in the study of adverse drug reactions. Perhaps by introducing modifications to the experimental protocol, we may succeed also in developing a better model for experimental psoriasis.     

Cutaneous effects compared between higher fluence with fewer treatments and lower fluence with more treatments in a combined IR laser/radio frequency system

Background and aims: A combined infrared (IR) laser/radio frequency (RF) system has recently been reported to create rejuvenation‐related cutaneous effects, but was associated with high levels of pain and some complications. The present study was designed to evaluate the cutaneous effects of the same system with a lower fluence and more treatments. Methods: Twenty patients were randomly assigned into two groups of 10 individuals each: Group A was treated at 50 J/cm² / 100 J/cm³ (laser/RF), respectively, two passes, three treatment sessions 30 days apart; Group B at 30 J/cm² / 50 J/cm³, three passes, five treatment sessions 15 days apart. Objective comparisons were made at the same time points with a computer program based on the clinical photography. Results: Group A noted more improvement in wrinkles than Group B at the first assessment, but both groups showed slight and progressive deterioration at the 2‐ and 6‐month assessments. Improved skin appearance was maintained throughout in both groups. The authors recognize that the comparatively small number of subjects possibly limits the statistical power of the study. Conclusions: Lower fluences and more treatment sessions with the combined 900 nm laser/RF system were complication‐free, produced improvements in the overall skin condition and less pain during sessions, suggesting that this combination may produce better patient compliance. Further treatment sessions may improve the results with implications in skin rejuvenation.     

A Randomized, Placebo-Controlled Trial of Topical Retinol in the Treatment of Cellulite

Background

Cellulite occurs to varying degrees on the thighs and buttocks of many otherwise healthy women. Among the many purported treatments for cellulite, only a handful have been tested in clinical trials.

Objective

The aim of this study was to critically explore the reputed effect of topical retinol in the treatment of cellulite.

Materials and Methods

The study compared the effect of topical retinol to a placebo formulation in a left-right randomized trial in order to eliminate the massage-effect. The study was conducted in 15 women aged from 26 to 44 years who had requested liposuction to improve mild to moderate cellulite.

Results

After 6-months of treatment, skin elasticity was increased by 10.7% while viscosity was decreased by 15.8% at the retinol-treated site. Such an effect on the tensile properties of skin was more prominent where the mattress phenomenon was the only evidence of cellulite. The lumpy-bumpy appearance of the skin showed either little response or was not responsive to the treatment. Although gross microanatomical differences were not disclosed between the comparative sites at completion of the study, evidence for a shift in the phenotype of connective tissue cells was obtained. The main retinol-related change consisted of a 2- to 5-fold increase in the number of factor XIIIa⁺ dendrocytes both in the dermis and fibrous strands of the hypodermis.

Conclusions

We hypothesize that the functional and phenotypic changes seen in this study were linked and represent the result of a direct or indirect modulating effect of retinol on cellulite. Such features ultimately improve the resting tensions inside the skin which should in turn smooth the skin surface.     

Can St John's wort (hypericin) ingestion enhance the erythemal response during high‐dose ultraviolet A1 therapy?

Background St John's wort (SJW) is widely used as a treatment for depression. A phototoxic reaction, due to its content of hypericin, can occur in animals and in cell culture, and has been reported in humans. Hypericin displays absorption within the ultraviolet (UV) A1 spectrum and there may therefore be a potential for phototoxicity if taken during high‐dose UVA1 therapy. Objectives To assess the phototoxicity risk of SJW ingestion. Methods Eleven adult volunteers of skin types I and II were exposed to a geometric dose series of UVA1 irradiation from a high‐output source (Dermalight Ultra 1; Dr Hönle, Martinsreid, Germany; irradiance 70–77 mW cm^?2) on the photoprotected lower back skin at eight 1·5‐cm² test areas. Irradiation was carried out at baseline and after 10 days of SJW extract 1020 mg (equivalent to 3000 µg of hypericin) daily. Four, 8, 24 and 48 h after each exposure, the minimal erythema dose (MED) and the presence or absence of pigmentation were recorded visually and erythema was assessed objectively with an erythema meter. Results The median MED and D_0·025, an objective measure of MED, were lower at all time‐points after SJW ingestion. The visual erythemal peak (lowest median MED), which was seen at 8 h postirradiation, was lower after SJW (median 14 J cm^?2, range 10–56) than at baseline (median 20 J cm^?2, range 14–56) (P = 0·047). Similarly, the median D_0·025 at 8 h postirradiation was lower after SJW (median 22·0 J cm^?2, range 15·2–53·9) than at baseline (median 33·7 J cm^?2, range 22·9–136·0) (P = 0·014). The MED and D_0·025 were also significantly different at the 48‐h and 4‐h time‐points, respectively. Significance was not reached at the 24‐h time‐point. Median intensity of postirradiation erythema increased at all time‐points after ingestion of SJW. Despite these differences, the maximum slope of the dose–response curve was not increased after SJW ingestion. Conclusions These data suggest that SJW extract has the potential to lower the erythemal threshold to UVA1 irradiation in a significant proportion of individuals and highlight the importance of ascertaining a full drug history, including herbal remedies, before initiating UVA1 phototherapy.     

Topical Lactiplantibacillus plantarum LB244R® ointment alleviates skin aging: An exploratory trial

Background

The skin is of vital importance for health and well-being. As people age, the skin undergoes visual and morphological changes such as wrinkling, loss of elasticity, increased pigmentation, and decreased cell turnover. This is not only visually unappealing to many but can also pose health issues.

Aim

In this study, a probiotic ointment (PO) containing live lactic acid bacteria (LAB) (Lactiplantibacillus plantarum LB244R®) was investigated for its ability to alleviate symptoms of skin aging in an exploratory clinical trial.

Methods

The PO was applied twice daily for 56 days by 21 subjects. Anti-aging efficacy was evaluated by skin ultrasonography, skin biomechanical properties, skin hydration, and clinical evaluations at day 0, 28, and 56.

Results

Sub-epidermal low echogenic band thickness decreased (0.261 ± 0.069 mm to 0.247 ± 0.055 mm) after 56 days. Dermal density increased (324.689 ± 57.506 pixel/mm² to 367.831 ± 75.790 pixel/mm²). Skin hydration increased (34.1 ± 6.9 to 51.3 ± 10.0 AU). Additionally, skin firmness increased, as shown by decreasing values (0.264 ± 0.038 to 0.228 ± 0.037 mm). Skin elasticity increased (0.578 ± 0.045 to 0.618 ± 0.044). Trans-epidermal water loss decreased (9.1 ± 2.0 g/h/m² to 8.5 ± 1.3). All clinical evaluations, Crow's feet, spot score, smoothness score, and complexion radiance, were improved.

Conclusion

The PO improved all measured parameters with statistical significance after 56 days of application, clearly demonstrating the potential of the PO as an anti-aging agent and reaffirming the potential of topical probiotic LAB. Future studies need to elucidate the mode of action of anti-aging effects by probiotics, but at present time, this study paves the way for the use of probiotic LAB topically to alleviate aging of the skin.     

Effectiveness of combined use of targeted pressure energy,radiofrequency, and high-intensity focused electromagnetic fields to improve skin quality and appearance of fat and muscle tissue in different body parts

Background

Inevitable signs of aging are especially noticeable in middle to elder age when stretch marks, loose skin, cellulite, and body-contour changes naturally appear.

Aims

To verify efficacy of high-intensity focused electromagnetic field (HIFEM), radiofrequency (RF), and Targeted Pressure Energy (TPE) combination treatment to address unfavorable changes in skin, fat, and muscle tissue.

Methods

The device simultaneously emitting monopolar RF and TPE energies was consecutively combined with simultaneous HIFEM+RF procedure in 32 subjects (21–64 years, 17.4–33.5 kg/m²) for treatment of thighs (N = 15; back, inner, or front), buttocks/saddlebags (N = 7), abdomen (N = 8), and upper arms (N = 2). All patients underwent four weekly, combined treatments of 30-min HIFEM+RF procedure followed by 15–30 min RF+TPE, depending on treatment area. Circumferential measurements, digital photographs, subject satisfaction, and comfort questionnaires were assessed up to 3-months post-treatment.

Results

Majority of participants found treatments comfortable, no adverse events occurred. Subjects showed substantial improvement in all treated areas from 1-month follow-up. Combination of HIFEM+RF, monopolar RF, and TPE resulted in significant circumference decrease. Generally, more pronounced results were seen at 3 months when subjects showed −5.2 cm on abdomen, −3.0 cm on thighs, and −5.5 cm on saddlebags, respectively. Ninety-four percent of subjects were satisfied with treatment results, most noticed improvement in cellulite, skin laxity, and muscle definition.

Conclusions

Results showed high patient satisfaction and efficacy in improving body contour and skin quality. Combining simultaneous HIFEM+RF procedure with simultaneous monopolar RF+TPE treatments considerably enhanced body contour and skin tissue. The procedure proved versatile and may effectively treat multiple body parts.     

Effects of kestose on gut mucosal immunity in an atopic dermatitis mouse model

Background

Atopic dermatitis (AD) is recently increasing among populations, but the underlying mechanisms remain controversial. Interactions between the gut microbiota and mucosal immunity are considered to be a crucial etiology. Fructooligosaccharide (FOS), prebiotics have been reported as activators of the gut microbiota.

Evaluation of tissue thermal effects from 1064/1320-nm laser-assisted lipolysis and its clinical implications

Liposuction is a standard for removing fat. Recently developed, laser lipolysis can be used to simultaneously remove unwanted fat and tighten skin. Laser lipolysis is accomplished with single or multiple sequential wavelengths. Development of an optimal method requires detailed understanding of tissue heating for the wavelengths employed. This study systematically evaluates tissue heating for superficial and deep laser lipolysis using three approaches, and correlates temperature rise with histology changes, defining appropriate system parameters. Two individuals scheduled for abdominoplasty had laser testing on healthy abdominal skin scheduled for excision. Each treatment was applied to 3×3 cm squares with various laser parameters. Treatment was conducted in the fatty layer for lipolysis and subdermally for skin tightening. Individual squares were treated with SmartLipo (Cynosure, Inc. Westford, MA, USA) using 1064 nm, 1320 nm, or MultiPlex (1064 nm/1320 nm) with laser doses of 8.3 to 333 J/cm². Exposures were applied at 3–5 mm or ～20 mm depth below the skin surface. Skin temperatures at the surface and at depths of 5 mm to 37 mm were recorded immediately post-treatment for each exposure. Treated tissue was excised and evaluated for thermal injury using H&E and transmission polarization microscopy. Histology was correlated to tissue temperature to determine appropriate treatment limits. Superficial treatment with surface temperatures exceeding 47°C (50°C and 55°C at 5 mm depth) typically caused epidermal and dermal injury, with blistering above 58°C. Below this threshold, focal collagen change and dermal inflammatory response were found in many samples without epidermal injury. These acute thermal effects may link to skin tightening during the healing process. Deep treatments, at up to 133 J/cm², exhibited minimal temperature rise and induced thermal effects in vessels and ligaments. Higher laser doses were associated with a significant temperature increase. In conclusion, superficial subdermal heating (within approximately 5 mm of the surface) during laser lipolysis should limit skin surface temperature to 42°C. The laser dose per surface temperature rise in treatments are 4.5 J/cm²/°C for 1320 nm, 6 J/cm²/°C for MultiPlex and 7.5 J/cm²/°C for 1064 nm. Clinical studies should be performed to validate these results.     

Changes in radioactivity in rat organs after 3H-8-MOP medication followed by UVA and “sunlight”

Summary The radioactivity was measured in serum, liver, skin, lens, and eye in pigmented rats given 1 mg ³H-8-MOP/kg in solution orally. Half an hour after medication the rats were illuminated with UVA 10 J/cm² for 30 min. Compared to the animals kept in the dark the concentration of radioactivity increased and remained higher for the next 136 h. Exposure to sunlight for 7 h, starting 1 h after medication with 0.6 mg ³H-8-MOP/kg raised the radioactivity level by about 20%. Sunlight did not alter the relative distribution of radioactivity of ³H-8-MOP, lipid- and water-soluble metabolites, ³H₂O or the insoluble rest, compared to the same fractions from animals kept in the dark. It is concluded that the general distribution of higher radioactivity in irradiated animals might be caused by a higher intestinal absorption.     

Preliminary studies on the relationship among peel force,quantitative measures of skin damage and subjective discomfort

Background/aims: The ability to anticipate skin damage and subject/patient discomfort due to the removal of adhesive materials without human testing is currently limited. While standardized laboratory methods have been developed, their ability to model and predict the interaction with relevant living substrate is imperfect. The aim of this study was to assess the adhesion of various materials as a function of time using the abdomen as the body site, and determine if a relationship existed with skin damage and subject discomfort. Methods: Strips of six different materials used in medical devices and known to have different adhesive properties in the laboratory setting were tested in this study. The strips were adhered to the abdomens of normal volunteer subjects for varying periods of time. Peel force was measured under conditions developed to lessen the influence of skin elasticity. Disturbance of the skin barrier was assessed by measuring transepidermal water loss; erythema by reflectance L^*a^*b^* measurements; skin cells removal by quantitation of dyed cells adhering to the test strips; and discomfort using subject self‐assessment. Results: When measured at times from 30 min to 72 h after application, the peel force was highest for materials at 30 min. The peel force for one of the six materials, designated F, was clearly higher than the others at time points from 30 min to 48 h after application. Interestingly, this material caused less disruption to the skin barrier and was reported to cause less discomfort. Conclusions: In this system, there was not a correspondence between adhesion as measured by peel force and skin damage or self‐report of discomfort. Further investigations will be required to establish the predictive value of other biophysical measurements and discomfort.     

Scalded Skin of Rat Treated by Using Fibrin Glue Combined with Allogeneic Bone Marrow Mesenchymal Stem Cells

Background

It is difficult to achieve satisfactory results with the traditional treatment of large-area skin defects and deep burns.

Objective

To test the treatment effect of an active dressing film made of a mixture of fibrin glue and bone marrow mesenchymal stem cells (BMSCs) for repairing burn wounds on the skin of rats.

Methods

Two scald wounds were made on the back of each rat. A total of 30 scald wounds were randomly divided into 3 groups, with 10 wounds in each group. In the experimental treatment group, the scald wounds were covered with the fibrin glue and BMSC mixture. The wounds of the experimental control group were covered with fibrin glue only. No intervention was administered to the blank control group. Thirty days after treatment, pathological sections were cut from the scalded local tissues of all rats from the 3 groups and observed with a microscope.

Results

The speed of scald wound healing in the experimental treatment group was faster than the other 2 groups. In the experimental treatment group, histopathological analysis revealed that the sebaceous glands showed obviously proliferous at the edge of the new tissue and gradually extended to the deep dermal layer of the new tissue.

Conclusion

BMSCs may have an active role in promoting skin tissue repair and generating skin appendages. Allogeneic BMSCs mixed with fibrin glue can contribute to the quick formation of a film-like gel over the scald wounds, which might be of significance for emergency treatment and skin-grafting operations.     

Pulsed Dye Laser in the Treatment of Localized Scleroderma and Its Effects on CD34+ and Factor XIIIa+ Cells: An Immunohistochemical Study

Background

Localized scleroderma (morphea) is characterized by hardening and thickening of the dermis due to excessive collagen deposition. A decreased number of CD34+ cells and an increased number of Factor XIIIa+ cells are seen in the affected skin. The flashlamp pulsed dye laser (FLPDL) has been used in the treatment of localized morphea with promising results.

Objective

The purpose of this study was to evaluate the therapeutic effectiveness of the pulsed dye laser in localized scleroderma and to assess its effect on CD34+ cells, Factor XIIIa+ cells, and blood vessels.

Study Design

Thirty patients with plaque morphea were treated with a FLPDL (585 nm wavelength, 450 μs pulse duration). Fluence ranged from 7.5 to 8.5 J/cm². Sessions were performed biweekly for a maximum of 6 months. Clinical, histopathologic, and immunohistochemical assessments were performed.

Results

Patients showed varying degrees of improvement of indurated skin. There was no worsening or further improvement at the treated sites during the follow-up assessments at 3, 6, and 12 months. An increased number of CD34+ cells were found in both the upper and the lower dermis, and a decreased number of Factor XIIIa+ cells were found in the lower dermis.

Conclusion

The FLPDL is effective in the treatment of morphea, as confirmed by the changes in the pathologic tissue and levels of CD34+ and Factor XIIIa+ cells.     

Efficacy of Ultraviolet A1 Phototherapy in Recalcitrant Skin Diseases

Background

Ultraviolet (UV) radiation has been used for decades to treat a variety of skin diseases. UVA1 was used initially as an effective treatment for acute exacerbated atopic dermatitis. Since then, UVA1 has been attempted for recalcitrant skin diseases.

Objective

This study examined the efficacy of UVA1 phototherapy in three recalcitrant skin diseases.

Methods

This retrospective study reviewed the efficacy and follow-up of 26 patients with atopic dermatitis (AD), mycosis fungoides (MF) and localized scleroderma (LS). SUPUVASUN 3000 (Mutzhas Co., Munich, Germany) and SELLAMED 3000 (Sellas Medizinische Gerate GmbH, Gevelsberg, Germany) were the UVA1 equipment used. Irradiation was performed in accordance with the disease. Low-dose (20 J/cm²), medium-dose (65 J/cm²) and high-dose regimens (100 J/cm²) of UVA1 therapy were employed. The frequency of the therapy ranged from 3 to 5 times weekly. The therapeutic effectiveness was assessed according to the clinical examination before and after the last treatment.

Results

In patients with AD, complete and partial remission was achieved in four (80%) and one (20%) patient, respectively. In patients with MF, complete and partial remission was observed in thirteen (86.7%) and two (13.3%) patients, respectively. In patients with LS, complete and partial remission was observed in three (50%) and three (50%) patients, respectively.

Conclusion

UVA1 phototherapy is an effective treatment modality for acute exacerbated AD, MF and LS.     

Single-dose fluconazole versus itraconazole in pityriasis versicolor

BACKGROUND: The new antifungal triazoles itraconazole and fluconazole have revolutionized the treatment of pityriasis versicolor. Both drugs have shown promising results in different dose schedules. OBJECTIVE: To compare the efficacy and safety of single oral dose treatment with fluconazole versus itraconazole in patients with pityriasis versicolor. METHODS: A total of 40 patients with pityriasis versicolor were allocated randomly to group A and group B. A single dose of fluconazole (400 mg) or itraconazole (400 mg) was given orally to group A or group B patients, respectively. Patients were assessed mycologically by KOH and culture. Culture was done from lesional and perilesional skin to quantify growth and to observe the effect of these drugs and the persistence/reappearance of the fungus in relation to relapse at 2 and 8 weeks. Relapse was defined as reappearance or worsening of clinical signs and symptoms or positive KOH/culture after initial improvement. RESULTS: Thirteen (65%) patients in the fluconazole group and 4 (20%) patients in the itraconazole group became culture negative at the end of 8 weeks. Relapse was found to be higher in the itraconazole group compared to the fluconazole group (60 vs. 35%). A direct correlation was found between the relapse rate and positivity of perilesional skin for Malassezia furfur. CONCLUSION: In the same dosing, fluconazole was found to be more effective than itraconazole; however, both drugs were found to be safe.