他克莫司软膏联合308nm准分子激光治疗儿童局限性白癜风

目的:本研究旨在评价0.03%他克莫司软膏和308 nm准分子激光治疗儿童局限性白癜风的安全性和有效性。同时研究308nm准分子激光联合外用0.03%他克莫司软膏对疗效的影响。方法:76个患者入组研究,研究采用随机单盲自身对照试验共15周。入组患者均具有两侧对称病变,进行左/右面部、躯干、手足的比较。按患者2至4个靶病变随机分为两组:A组患者外用0.03%他克莫司软膏,每天两次;B组患者外用0.03%他克莫司软膏每日两次,联合308nm准分子激光治疗,每周两次。研究期间对疗效和安全性因素进行评价。结果:76个患者完成了研究,A组91.3%和B组97.4%的皮损观察到复色。与治疗前相比,A组和B组皮损均明显改善。B组72.3%的皮损获得4级复色,与A组比较有显着性差异(P<0.05)。面颈部的复色率(复色75%以上)明显高于躯干、四肢、手足的复色率(P<0.05)。两组患者未见明显的副作用,两组之间的副作用发生率没有显著差异。结论:0.03%的他克莫司软膏和308 nm准分子激光对于治疗儿童局限性白癜风是安全、有效的,且耐受性良好。联合使用他克莫司软膏和308nm准分子激光显著提高疗效。     

Effectiveness of a 308-nm excimer laser in treatment of vitiligo: a review

Vitiligo is a relatively common acquired disorder, characterized by progressive loss of melanocytes from the epidermis and the epidermal appendages. The disease is associated with considerable morbidity because of a major impact on the quality of life. The treatment for vitiligo is generally unsatisfactory and challenging. There are a variety of therapeutic possibilities including topical corticosteroids, topical calcineurin inhibitors, as well as phototherapy with Psoralen plus UVA (PUVA), narrow-band UVB, and a 308-nm excimer laser and/or lamps. Furthermore, surgical methods encompass grafting and transplantation while depigmentation treatments and psychological support may also be considered. The objective is to assess the effect of the 380-nm excimer laser in the treatment of vitiligo based on the available studies and case series. We searched the relevant literature about vitiligo and excimer laser published between 1990 and 2012 using the MEDLINE database. We reviewed all relevant articles about 308-nm excimer laser and light sources assessing their efficacy in the management of vitiligo as well as their side effects. The value of combination treatment methods was also analyzed. The available studies provide strong evidence that the excimer laser represents the most effective approach to treat vitiligo compared to ordinary phototherapy. Excimer laser is relatively safe and effective for localized disease. UV-sensitive areas respond best as well as a short duration of the disease. More frequent treatments achieve better results. Compared to other treatment modalities, the excimer laser most likely constitutes the treatment of choice for localized vitiligo. Its efficacy can be further improved in combination with other therapies such as corticosteroids, pimecrolimus, or tacrolimus.     

308-nm Excimer Laser for the Treatment of Alopecia Areata

BACKGROUND Alopecia areata is loss of hair from localized or diffuse areas of hair-bearing area of the skin. Recently there are reports of efficacy of the 308-nm excimer radiation for this condition.
OBJECTIVE To study the effect of the 308-nm excimer laser in the treatment of alopecia areata.
MATERIALS AND METHODS Eighteen patients with 42 recalcitrant patches (including 1 adult with alopecia totalis) were enrolled in this study. The lesions were treated with the 308-nm excimer laser twice a week for a period of 12 weeks; one lesion on each patient was left as a control for comparison.
RESULTS There were 7 males and 11 females in this study. Regrowth of hair was observed in 17 (41.5%) patches. Thirteen of the 18 lesions in scalp showed a complete regrowth of hair. The extremity regions failed to show a response. Atopic diatheses had an unfavorable effect on the outcome in our patients.
CONCLUSION The 308-nm excimer laser is an effective therapeutic option for patchy alopecia areata of the scalp and for some cases with patchy alopecia areata of the beard area. It does not work for patchy alopecia areata of the extremities.     

他克莫司软膏联合308nm准分子激光治疗白癜风临床观察

目的:探讨外用0.1%他克莫司软膏联合308nm准分子激光治疗白癜风的疗效及安全性。方法:患者35例,以自身未治疗皮损作为空白对照,每例患者选择两处相近或对称部位的皮损,每周2次以308nm准分子激光进行治疗,共治疗16次。A组皮损同时每天早晚外用0.1%他克莫司软膏,B组单用308nm准分子激光治疗,试验结束时依据治疗前、后皮损的照片进行疗效评价。结果:试验结束时,未治疗的皮损均未出现任何改善,A组有效率为97.1%(34/35),B组为85.7%(30/35),显效率A组为74.3(&/35)、B组为48.6%(17/35),两组间显效率有显著性差(异2χ=4.884,P=0.023),但有效率差异不显著(2χ=2.917,P=0.088)。对18例患者进行随访,3个月内,A组所有治疗皮损均维持稳定或持续好转,而B组有3例皮损出现复发。结论:308nm准分子激光治疗白癜风疗效高、副作用少,联合外用0.1%他克莫司软膏可显著提高其疗效并减少复发。     

308nm准分子激光联合0.1%糠酸莫米松乳膏治疗面部白癜风疗效观察

目的:探讨308nm准分子激光联合0.1%糠酸莫米松乳膏治疗面部白癜风的疗效及安全性。方法:选取门诊面部白癜风患者180例,随机平均分为三组,共有167例完成了试验观察,A组为治疗组57例,308nm准分子激光(2次/周)联合0.1%糠酸莫米松乳膏(1次/天)治疗;B组为对照1组56例,单用308nm准分子激光治疗(2次/周);C组为对照2组54例,单用0.1%糠酸莫米松乳膏外用治疗(1次/天),疗程均为12周或至皮损完全复色,观察三组治疗方法治疗面部白癜风的疗效及不良反应。结果:A组显效率为75.43%,B组为48.21%,C组为14.81%,A组和B组及C组比较,显效率差异有统计学意义(P<0.05)。三组患者均未出现严重不良反应。结论:308nm准分子激光联合0.1%糠酸莫米松乳膏治疗面部白癜风疗效好、副作用少,显效率明显高于单独治疗。     

Optimal frequency of treatment with the 308-nm excimer laser for vitiligo on the face and neck

OBJECTIVES: This study was designed to determine the optimal treatment frequency with the 308-nm excimer laser for vitiligo and identify key clinical variable(s) associated with treatment efficacy at the optimal frequency. BACKGROUND DATA: Optimal clinical parameters for excimer laser treatment of vitiligo have not been fully determined. Data about the influence on treatment frequency of different clinical variables of vitiligo are needed to facilitate effective treatment regimens. METHODS: A total of 187 patients were treated with the 308-nm excimer laser for 20 sessions at different frequencies (0.5, 1.0, 2.0, and 3.0 per week). The repigmentation rate was graded on a six-point scale and was blindly evaluated by independent physicians. RESULTS: The final percentage of repigmentation for group 0.5 was statistically lower than those for group 1.0, 2.0, and 3.0, and percentages of final levels of repigmentation among these three groups were not statistically different. The clinical variables showed no statistical differences in the final repigmentation effect. Repigmentation occurred fastest with treatment frequencies of 2.0 and 3.0 and there was no statistically significant difference between them. The onset of repigmentation correlated with the area of vitiliginous patches treated, not with the other clinical variables. CONCLUSIONS: The 308-nm excimer laser is effective for therapy to treat vitiligo on the face and neck. The ultimate laser-induced repigmentation effect does not correlate with treatment frequency and repigmentation occurs faster with treatment frequencies of 2.0 and 3.0 than that of 1.0. It appears that the onset of repigmentation correlates with the total area of vitiliginous patches and the optimal treatment frequency. Monitored studies on a larger population with long-term follow-up would be needed to confirm and extend our findings.     

A 308-nm excimer laser for the treatment of scalp psoriasis

BACKGROUND AND OBJECTIVES: Scalp psoriasis is a frustrating disorder whose treatments can all too often be cumbersome and ineffective. Our objective was to test a combination device involving the 308-nm excimer laser in tandem with a hair blower for treating scalp psoriasis. STUDY DESIGN/MATERIALS AND METHODS: Adult subjects with scalp psoriasis unresponsive to class I topical steroids used in conjunction with medicated shampoos were treated with 308-nm excimer laser pulses in conjunction with a hair blower that parted the obstructing hair twice a week for up to 15 weeks. Half of the scalp served as a control. Starting doses were based on standard minimal erythema dose (MED)'s with subsequent increments of up to 20%. RESULTS: Thirteen subjects completed the study without adverse events. Two were dropped due to lack of compliance. At the end of the investigation, the difference in the mean modified PASI scores between the control and treated sites was 4.0 (<0.0001). CONCLUSIONS: The air blower device in conjunction with the 308-nm excimer laser can safely and effectively treat otherwise refractory scalp psoriasis.     

308nm准分子激光联合他卡西醇软膏治疗儿童面部白癜风疗效观察

目的:探讨308nm准分子激光联合他卡西醇软膏治疗儿童面部白癜风的疗效。方法:治疗组儿童面部白癜风患者采用Xt rac颠峰准分子激光联合他卡西醇软膏治疗,对照组仅用Xt rac颠峰准分子激光,为期3月,治疗结束后3天进行疗效评价。结果:治疗组显效率77.3%,对照组显效率52.5%,两组差异有统计学意义(χ2=5.69,P<0.05)。结论:308nm准分子激光联合他卡西醇软膏治疗儿童面部白癜风疗效好、副作用小。     

Effect of Pretreatment on the Incidence of Hyperpigmentation Following Cutaneous CO2 Laser Resurfacing

Background. Transient hyperpigmentation is the most common complication seen following cutaneous carbon dioxide (CO₂) laser resurfacing.
Objective. The purpose of this study was to determine whether the use of a topical skin lightening regimen prior to cutaneous laser resurfacing reduces the incidence of post-laser resurfacing hyperpigmentation.
Methods. One hundred consecutive CO₂ laser resurfacing patients (skin types I–III) were randomized to receive preoperative treatment with 10% glycolic acid cream twice daily (n = 25), hydroquinone 4% cream qHS and tretinoin 0.025% cream twice daily (n = 25) or no pretreatment (n = 50, control) for at least 2 weeks. Clinical and photographic assessments were performed prior to laser resurfacing and at 4 and 12 weeks following treatment.
Results. There was no significant difference in the incidence of post-CO₂ laser resurfacing hyperpigmentation between subjects who received pretreatment with either topical glycolic acid cream or combination tretinoin/hydroquinone creams and those who received no pretreatment regimen.
Conclusion. It is postulated that reepithelialization after cutaneous laser resurfacing includes follicular melanocytes that have not been affected by topical pretreatment. When instituted as a component of the skin care regimen postoperatively, topical hydroquinone, tretinoin and/or glycolic acid preparations may be helpful in reducing post-laser resurfacing hyperpigmentation.     

护理干预对他克莫司软膏联合308nm准分子激光治疗白癜风的影响

目的:探讨护理干预在他克莫司软膏联合308nm准分子激光照射治疗白癜风中的应用效果。方法:将120例白癜风患者按就诊顺序采用单双号抽签法分为治疗组60例和对照组60例;治疗组外涂他克莫司软膏联合308nm准分子激光照射同时配合适当的护理干预;对照组仅外涂他克莫司软膏联合308nm准分子激光照射,两组患者疗程均为6个月。采用统一的疗效评定标准进行疗效和安全性评价。结果:治疗组显效率为66.7%,对照组显效率为48.3%,差异具有统计学意义(χ2=4.36,P0.05);两组患者满意度比较,差异具有统计学意义(P0.05)。结论:他克莫司软膏外涂联合308nm准分子激光并配合适当的护理干预是治疗白癜风的有效方法,能显著提高疗效和患者满意度,值得推广应用。     

Treatment of Trichostasis Spinulosa in Skin Phototypes III, IV, and V With an 800-nm Pulsed Diode Laser

BACKGROUND. : Trichostasis spinulosa (TS) is a common follicular disorder that results from the retention of multiple vellus hairs within pilosebaceous follicles. A variety of treatment modalities have been used with variable but largely transient success. OBJECTIVES. : To determine whether a pulsed diode laser irradiation would provide a therapeutic response to TS for a prolonged period. METHODS. : Thirteen subjects with untreated TS and skin phototypes III, IV, and V were treated with a 800-nm pulsed diode laser at fluences ranging from 24 to 40 J/cm2 (mean, 36 J/cm2) and a 12- to 20-ms (mean 18 ms) pulse width. Two treatments were delivered at 4-week intervals. Evaluation of improvement was performed at 4 and 20 weeks after the last treatment by a blinded assessment of clinical photographs. RESULTS. : Complete clearing of the lesions was achieved for a period of 8 to 12 weeks. A decrease in dark-plug appearance of greater than 50% was noted in half of the subjects 20 weeks after the second treatment. No pigmentary changes and scarring occurred in any subjects. CONCLUSION. : Pulsed diode laser proved to be a safe and long-term effective treatment for TS in dark-skinned individuals.     

A Retrospective Study of 3,000 Indian Patients with Vitiligo Treated with Phototherapy or Topical Monotherapy

BACKGROUND: Vitiligo-affected individuals, especially patients with darker skin tones, can suffer from negative psychosocial impacts due to unpredictable development of the condition and perceived cosmetic concerns. However, given that spontaneous repigmentation can be gained in vitiligo, many patients ask for treatment due to these cosmetic concerns. In the literature, only a few studies have been documented focusing on the outcome of various treatment modalities for vitiligo. OBJECTIVE: This article highlights the retrospective response of various treatment modalities in Indian patients with vitiligo. METHODS: A retrospective chart review was performed from July 2017 to August 2018 at our private dermatology clinic. A total of 3,000 patients were enrolled in this observational study. Patient characteristics and details of phototherapy (psoralen and ultraviolet A, narrow-band ultraviolet B, excimer laser) were noted as per a predefined format. The clinical response was evaluated as a marked response, defined as repigmentation in more than 75% of the initial lesional area. RESULTS: Of those included in this retrospective analysis, 1,996 patients received phototherapy and 1,004 patients were treated with topical monotherapy. Patients treated with phototherapy only and those treated with a combination of phototherapy and topical agents showed significantly higher clinical response rates relative to patients treated with topical monotherapy only (marked response rate: 47.8% vs. 8.7%; P<0.001 and 23.4% vs. 8.7%; P<0.001). Disease subtype predominately affected the treatment response. CONCLUSION: In Indian patients with vitiligo, phototherapy appears to be an effective treatment option for both focal and vitiligo vulgaris. Due to its reliability and minimal side effects, it can be considered a preferable treatment modality for vitiligo.     

308nm准分子激光联合0.1%他克莫司乳膏治疗白癜风的临床体会

目的:比较应用0.1%他克莫司软膏联合308nm准分子激光与单用308nm准分子激光治疗白癜风的效果。方法:64例白癜风患者,每个部位选择1～2处皮损将自身皮损分为A、B两组,分别108处皮损,A组予308nm准分子激光治疗,2次/周,共30次;B组在激光治疗的基础上外用0.1%他克莫司乳膏,2次/天。治疗过程中记录疗效及不良反应。结果:两组分别108处皮损,所有患者完成了治疗。总有效率:A组65.74%(71/108),B组89.81%(97/108),(χ2=18.10,P<0.05);其中面颈部有效率:A组88.10%(38/42),B组92.86%(39/42)(χ2=0.26,P>0.05);躯干部有效率:A组53.84%(28/52),B组94.23%(49/52)(χ2=22.06,P<0.05);四肢有效率A组50.00%(5/10),B组80.00%(8/10);手足有效率:A组0(0/4),B组25.00%(1/4);平均治疗次数:A组21.8次、B组19.4次,平均出现色素次数:A组7次、B组5.5次。结论:308nm准分子激光联合他克莫司乳膏治疗白癜风起效快、疗效好,副作用少;面颈部单用308nm准分子激光亦可获良效。     

Feline penile erection induced by topical glans penis application of combination alprostadil and SEPA (Topiglan)

The objective of this study was to evaluate the efficacy of topically applied prostaglandin E1 (PGE(1))+5% SEPA (soft enhancement of percutaneous absorption) on the glans penis in a feline erection model. Erectile response after glans penis administration of PGE(1)+5% SEPA cream (Topiglan, MacroChem Co., Lexington, MA, USA) was compared to the erectile response after intracavernosal administration of the triple-drug combination (1.65 mg papaverine, 25 microg phentolamine, and 0.5 microg PGE(1)). The placebo cream and increasing concentrations (0.25%, 2.5 mg/ml; 0.5%, 5 mg/ml; and 1%, 10 mg/ml) of PGE(1)+5% SEPA were applied in a total volume of 0.1 ml via a plastic needle-less syringe. The control triple-drug combination was administrated intracavernosally via a 30-gauge needle at the completion of each experiment to serve as a control reference. With each application of placebo, PGE(1)+SEPA, and the triple-drug combination, changes in intracavernosal pressure and systemic blood pressure were continuously monitored. Topical application of PGE(1)+SEPA induced increases in intracavernosal pressure in a dose-dependent manner, with minimal effects on systemic blood pressure. The increases obtained with 1% PGE(1) Topiglan cream were similar to the intracavernosal pressure values elicited by the standard intracavernosal triple-drug combination. These data demonstrate that topical glans penis application of PGE(1)+SEPA can induce an erectile response in cats with minimal systemic adverse effects. Oral pharmacological agents are the first-line treatment for male ED. Studies investigating the effectiveness of noninvasive modalities such as topical therapy should continue, because these agents have the potential to avoid the systemic effects commonly seen with oral therapies. Additionally, topical therapy may also benefit patients who are unresponsive to oral agents or have explicit contraindications. Topical PGE(1) application to the glans penis may become an important treatment option in selected patients suffering from erectile dysfunction.     

Rapid response of facial vitiligo to 308nm excimer laser and topical calcipotriene

Objective: Vitiligo is a common depigmenting condition that carries a high psychosocial morbidity. Many of the current topical and light therapies aid in repigmentation but require extensive treatment periods and carry unwanted side effects. The excimer laser is a newer treatment option that can induce repigmentation in an abbreviated time frame without global exposure to radiation. This case series provides further evidence to support the use of excimer laser in treating vitiligo especially of the face. Design: Patients with extensive facial depigmentation were treated with excimer laser twice weekly and calcipotriene daily until they developed significant repigmentation. Setting: Evaluation and treatment was performed at the Veterans Affairs outpatient dermatology clinic in Tampa, Florida. Participants: Three patients with Fitzpatrick skin types IV to VI were selected. These patients had failed a variety of topical treatments including steroids and calcipotriene, but were light naïve prior to beginning the study. Measurements: The primary outcome measure employed was percent repigmentation by visual estimation. The average dose of radiation, number of treatments, and weeks of therapy were also recorded. Results: All three patients experienced greater than 75 percent repigmentation of their facial vitiligo over a treatment course from 10 to 20 weeks. Conclusion: The excimer laser is a viable treatment for vitiligo and may yield results more expeditiously than other commonly utilized therapies. The rapid response may be correlated with skin type, but a more extensive study needs to be undertaken to further evaluate this correlation.Vitiligo is believed to be an autoimmune disease that results in the destruction of melanocytes leading to depigmentation. The disease affects approximately one percent of the population worldwide. Studies have demonstrated that the disfiguring nature of vitiligo causes high psychosocial morbidity.^1–3 This is especially pronounced in populations with darker skin tone, likely due to the marked contrast.^1,4A variety of treatment regimens are currently employed to repigment the skin. However, many of these require a prolonged treatment course and may yield minimal results. Therapies such as topical steroids rarely achieve more than 50- to 75-percent repigmentation and are cumbersome, requiring multiple daily applications. Further, topical steroids may require a year or more to note significant improvement.^5,6 Less than 50 percent of patients achieve greater than 75-percent repigmentation after 10 months of therapy.⁷ Other topical therapies including tacrolimus and calcipotriene yield similar results to topical steroids.Patients with extensive depigmentation may prefer treatment with light therapy due to the large surface area affected. Light therapies include oral or topical psoralens plus ultraviolet A radiation (PUVA), narrowband ultraviolet B radiation (NB-UVB), and excimer laser.PUVA has long been a mainstay of treatment for vitiligo, but over the last decade NB-UVB has been increasing in use due to decreased incidence of phototoxic side effects.^8,9 However, with both therapies, treatment may take many months, a year, or longer to achieve results.^8–10 PUVA achieved a partial response in 60 percent of patients after a mean of 84.2 treatments.¹¹ Patients treated with NB-UVB experienced a partial response at four weeks, but mean repigmentation was still less than 50 percent by 12 weeks.¹² There is some evidence that light treatments used in combination with topical agents improve outcomes.¹³The 308nm excimer laser is a newer treatment option that can yield impressive results in an abbreviated timeframe.¹⁰ Nicolaidou et al¹⁰ reviewed the use of excimer laser and demonstrated that 15 to 50 percent of patients achieved greater than 75-percent repigmentation. Notably, excimer laser treatment periods were 15 weeks or less in the overwhelming majority of the studies analyzed.¹⁰ Additionally, there has been some evidence that excimer laser treatment causes faster, more complete repigmentation in patients with higher Fitzpatrick skin types.^13,14This case series examines three male patients with Fitzpatrick skin types IV to VI and their results after undergoing combination treatment utilizing excimer laser with calcipotriene.     

Combined 5-Fluorouracil and Er:YAG Laser Treatment in a Case of Recurrent Giant Keratoacanthoma of the Lower Leg

Background. Keratoacanthomas are fast-growing squamous tumors, which usually show spontaneous regression. The development of giant variants with an aggressive behavior has been described. Although surgical excision remains the treatment of choice for very large keratoacanthomas, other therapeutic options including laser surgery and topical chemotherapy may be superior in special situations.
Objective. The objective was to evaluate the efficacy of Er:YAG laser surgery combined with topical 5-fluorouracil treatment in a case of recurrent giant keratoacanthoma.
Methods. A 64-year-old woman presented for evaluation and treatment of recurrent tumors in her face and extremities. Despite repeated invasive surgical removal of these lesions, recurrence of fast-growing giant keratoacanthomas developed in the pretibial region of her left lower leg. Owing to recurrence after conventional surgery and the tumor size, a novel treatment method using ablative Er:YAG laser combined with topical 5-fluorouracil was performed.
Results. After four treatments with excellent patient compliance, histologic analysis of punch biopsies revealed tumor-free ulcerations. Complete epithelization was obtained after 9 weeks. Six months after the treatment, no recurrence was observed.
Conclusion. The combined use of ablative Er:YAG laser and topical 5-fluorouracil chemotherapy may be considered as an effective treatment option in cases of giant keratoacanthoma when conventional surgery is not indicated.     

A Randomized, Double-Blind, Pharmacokinetic Study of Oral Maribavir with Tacrolimus in Stable Renal Transplant Recipients

Maribavir is being developed as a novel agent for the prevention or treatment of cytomegalovirus infections after stem cell and organ transplantation. This was a randomized, double-blind, placebo-controlled study designed to evaluate the potential pharmacokinetic interaction of concomitant administration of maribavir and tacrolimus. Twenty-five adult renal transplant recipients with stable renal function and stable dosing regimens of tacrolimus were randomized (20 maribavir 400 mg p.o. q12 h: 5 placebo). Tacrolimus whole blood concentration profiles were determined before and after 7 days of co-administration with maribavir. When co-administered with maribavir, tacrolimus mean C_max increased 38%, tacrolimus trough concentrations (12 h post-dose) increased 57% and tacrolimus AUC_(0-τ) increased 51%. Apparent oral clearance of tacrolimus decreased 34% and T_max was delayed by 0.5 h. There were no serious adverse events and no subject prematurely discontinued treatment. Because of the limited 7-day dosing course, the adverse event profile could not be adequately assessed. However, as seen with other maribavir studies, dysgeusia was common (90% of maribavir subjects and 20% of placebo subjects). In conclusion, co-administration of maribavir 400 mg twice daily increases exposure to tacrolimus. Routine therapeutic drug monitoring of tacrolimus blood concentrations should be included both at initiation and completion of maribavir treatment.     

Double-Blinded, Placebo-Controlled Trial of Green Tea Extracts in the Clinical and Histologic Appearance of Photoaging Skin

Background. Green tea extracts have gained popularity as ingredients in topical skin care preparations to treat aging skin. Green tea polyphenolic compounds have significant antioxidant and anti-inflammatory activities, and studies suggest that these extracts help mediate ultraviolet radiation damage.
Objective. To evaluate the effects of a combination regimen of topical and oral green tea supplementation on the clinical and histologic characteristics of photoaging.
Methods. Forty women with moderate photoaging were randomized to either a combination regimen of 10% green tea cream and 300 mg twice-daily green tea oral supplementation or a placebo regimen for 8 weeks.
Results. No significant differences in clinical grading were found between the green tea–treated and placebo groups, other than higher subjective scores of irritation in the green tea–treated group. Histologic grading of skin biopsies did show significant improvement in the elastic tissue content of treated specimens (p<.05).
Conclusion. Participants treated with a combination regimen of topical and oral green tea showed histologic improvement in elastic tissue content. Green tea polyphenols have been postulated to protect human skin from the cutaneous signs of photoaging, but clinically significant changes could not be detected. Longer supplementation may be required for clinically observable improvements.
THIS STUDY WAS SUPPORTED BY NU SKIN INTERNATIONAL, INC. DR. KIMBALL HAS SERVED AS A CONSULTANT TO NU SKIN AND HAS RECEIVED HONORARIA FOR SPEAKING.     

Methimazole in the Treatment of Melasma: A Clinical and Dermascopic Study

BACKGROUND: Melasma is a chronic hypermelanotic disorder that is challenging to treat; no single effective therapeutic agent for it has been discovered. Methimazole, an oral antithyroid drug, has a skin depigmenting effect when used topically. OBJECTIVE: We sought to evaluate the efficacy and safety of methimazole, applied during microneedling sessions and additional topical use in between sessions, for the treatment of melasma. METHODS: This split-face study included 30 Egyptian patients with melasma, each of whom received 12 microneedling sessions once per week for 12 weeks followed by topical methimazole on the right side of face and placebo on the left side. In between the sessions, topical methimazole 5% cream was applied twice per day on the right side and placebo on the left side. Assessments were performed using the Hemi-melasma Area and Severity Index (hemi-MASI) percentage of improvement, patient satisfaction, dermoscopy, and thyroid-stimulating hormone (TSH) serum levels. RESULTS: There were significant clinical and dermoscopic improvements; hemi-MASI scores on the methimazole-treated right sides were decreased (p<0.001). The percent of hemi-MASI score improvement was significantly associated with the malar pattern (p=0.031) and epidermal type (p=0.04) of melasma. About 70 percent of our studied patients reported being satisfied with their treatment response (7% excellent, 33% good, 30% fair). No significant local or systemic side effects were observed. Pre- and posttreatment serum TSH levels were within the normal range in all treated cases. CONCLUSIONS: Methimazole has the potential to be a safe and promising therapeutic agent for the treatment of melasma via dermapen-delivered microneedling sessions with topical use in between sessions.     

Treatment of Inverse Psoriasis with the 308 nm Excimer Laser

BACKGROUND: The treatment of inverse psoriasis can be both challenging and frustrating. Conventional topical and systemic treatments can be limited in terms of efficacy, acceptability and safety. The 308 nm excimer laser has been shown to be effective in the treatment of psoriatic plaques. METHODS: A patient with chronic inverse psoriasis was treated with 308 nm excimer laser using a 3.5 cm spot, a dosage of 2 minimal erythema doses and a pulse width of 30 ns. RESULTS: Complete clearance of the psoriatic lesions was obtained after 3 weeks of treatment. Remission duration was at least 6 months. CONCLUSION: The 308 nm excimer laser is safe and effective for the treatment of inverse psoriasis. Treatments are well tolerated with minimal side effects.