Inflammatory Hyperpigmentation Research Articles

Treatment of Post-Inflammatory Hyperpigmentation in Skin of Colour: A Systematic Review.

Post inflammatory hyperpigmentation (PIH) affects all skin types with a heightened predilection for darker skin tones. Its course is chronic once developed and treatment is often difficult. This systematic review aims to summarize the treatment outcomes for PIH with a focus on skin of colour (SOC) individuals. A literature search was conducted using MEDLINE (from 1946), Embase (from 1974), PubMed, and Cochrane in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline. Results from 48 studies summarized 1356 SOC individuals. The mean age was 29 years (n = 1036) and 78% were female (n = 786). The ethnic prevalence was 70% Black, 27% Asian, and 3% Latin. Overall, 20% were Fitzpatrick skin type (FST) III, 40% FST IV, 34% FST V, and 6% FST VI. Most cases were precipitated by inflammatory conditions (89%) and localized to the face (83%). The most frequently reported interventions were topical retinoids (22%) and laser therapy (17%). Partial improvement was seen in 85% and 66% of participants, respectively. Laser was the only intervention that offered complete resolution in a subgroup of patients (26%); however, there were reported cases of PIH exacerbation following treatment. Chemical peels (9%) and hydroquinone (7%) were among other treatments with less effective outcomes. PIH and its persistence is a prevalent issue, significantly affecting many affected individuals with darker skin tones. Our results show a lack of robust efficacy across all treatment modalities. There is considerable room for improvement in interventions for at-risk populations.

#332 Dermatological manifestations in pediatric CKD patients

Abstract Background and Aims Chronic kidney disease (CKD), regardless of its cause, may be accompanied by various skin lesions. The most common symptom in children suffering from CKD is pruritus however other signs that may be seen are xerosis, skin hyperpigmentation, ecchymoses, acquired perforating dermatoses, nail lesions, calcinosis cutis, as well as eczematous lesions at the site of an arteriovenous fistula and skin infections. Data on different skin lesions in children with CKD is very limited; only few reports have been published discussing xerosis in pediatric patients and most studies were conducted on a small number of patients who needed renal replacement therapy . This study aimed primarily to screen the different dermatological manifestations in pediatric patients with CKD, in addition to studying the relationship of dermatological manifestations with the CKD stage, types of dialysis, various clinical and metabolic parameters. Method This was a cross sectional study, that was conducted at Pediatric Dialysis and Nephrology unit, Children's Hospital, Faculty of Medicine, Ain Shams University Hospital, Cairo, Egypt, during the period from February 2023 to August 2023, where 70 patients were enrolled in our study being divided into two groups: group 1 including CKD patients stages (2-4) and group 2 including CKD patients with stage 5 on regular hemodialysis. Detailed dermatological & nail examination were conducted. Xerosis severity was assessed using a four-point xerosis assessment scale (0, normal skin, without any xerosis; 1, mild xerosis; 2, moderately dry skin with minimal flaking; 3, severe xerosis, heavy scaling visible), whereas pruritus was assessed using a visual analogue scale (VAS) on a scale of 1 (no itch) to 10 (worst possible itch). Laboratory data were withdrawn at the time of examination to correlate with different dermatological manifestation. Results In our study, xerosis was the most frequent dermatological manifestation (78.6%) following it pruritus (62.9%) then pallor (35.7%), hyperpigmentation (20%), hypertrichosis (10 %), nail and hair abnormalities (8.5%) & post inflammatory hyperpigmentation (4.3%). The prevalence of xerosis was not affected by clinico-demographic data, CKD duration & stage, type and duration of dialysis, the only significant relation was between efficacy of dialysis (Kt/V) and incidence of xerosis, where the higher dialysis efficacy rates were associated with low incidence rates of xerosis, in which effective hemodialysis contributes to better removal of uremic toxins, & hence decrease the xerosis. Leukocytosis was noticed in xerotic & pruritic patients, where xerosis & impaired skin barrier in children with CKD pose a risk for different cutaneous infections & inflammation, and hence pruritis. Conclusion Xerosis and pruritis are not uncommon dermatological manifestations among pediatric patients with chronic kidney disease, meanwhile the age of the patients and the underlying CKD etiology had no direct effect on skin changes. The most determinant factory affecting the xerosis was the hemodialysis efficacy, where higher efficacy was associated with less xerosis, meanwhile leukocytosis was associated with higher xerosis and pruritis. Further studies are needed to detect various skin manifestations in CKD patients with different CKD stages and correlate it with the used dialysis modalities.

Treatment Indications of Carbon Solution-Assisted Nd: YAG Laser According to Patient Satisfaction: A Retrospective Study.

Carbon solution-assisted Nd:YAG lasers were previously used in enlarged pores; hair removal; acne and acne scars; and facial rejuvenation. The aim of this study is to determine the patient satisfaction for different treatment indications of carbon solution-assisted 1064 nm Nd:YAG lasers. This is a retrospective study that included the patients who were treated with carbon solution-assisted 1064 nm Nd:YAG laser with any indication in a private dermatology practice. A pre-prepared carbon solution was applied 30 minutes before the laser treatment with the following parameters: a spot size of 8mm, fluence of 1.3 J/cm2 and a frequency of 8Hz. Patient satisfaction was assessed with GAIS. A total of 272 patients were included; of these 70 patients had acne lesions, 135 patients had melasma, 27 patients had post-inflammatory hyperpigmentation, 17 patients had ephelides and 23 patients had solar lentigines. The mean patient satisfaction for solar lentigo patients (4.35/5) was greater than for that of acne patients (4.26/5) which was greater than that of ephelide patients (3.94/5) which was greater than that of melasma patients (3.67/5) which was greater than that of post inflammatory hyperpigmentation patients (2.30/5) CONCLUSIONS: This study revealed that carbon solution-assisted 1064 nm Nd:YAG laser therapy is effective in the treatment of solar lentigo, acne vulgaris, ephelides and melasma. However, it fails to provide therapeutic efficacy in post inflammatory hyperpigmentation.

Exploring clinical effects and usage patterns of a daily face cleanser enriched with glycolic acid, aloe vera, and vitamin-E for acne management: a post-hoc analysis

Background: Face cleansers are recommended as adjuncts to acne therapy to counteract the acne related manifestation like acne spots and post inflammatory hyperpigmentation (PIH). This complementary study was designed to assess the clinical impact and tolerability of glycolic acid, aloe vera and vitamin-E based face cleanser for daily use in acne patients prescribed with clindamycin, tretinoin, adapalene and benzoyl peroxide for management of acne in real-world scenario. Methods: We conducted a retrospective review at 193 centres, focusing on individuals having acne with oily and mix skin types who used face cleanser twice a day. Total 619 cases (D age: 28.94±7.92 years) of acne were further analysed over a 4-week study period to study improvement in post-inflammatory hyperpigmentation, acne spot reduction and enhance skin radiance and glow using subjective assessment questionnaires. Results: The face cleanser, when used regularly with standard of care, significantly reduced acne (43.58%), acne spots (44.85%), and PIH (46.06%) with statistical significance (p<0.01). Patients with oily and mix skin type, 337 (54.44%) and 264 (42.65%) rated improvement on acne spots, PIH, radiance, and glow to be good to excellent, respectively. No patients experienced serious adverse events (AEs) or cleanser-related adverse event. Conclusions: The facial cleanser demonstrated effectiveness and tolerance in treating acne patients who were prescribed with anti-bacterial and anti-inflammatory agents. In 4-week long treatment period, the facial cleanser enhanced skin radiance and also demonstrated its worth as a beneficial inclusion in everyday skincare regimens.

Epidemiological Study of Patients Infected with Scabies in Aden, Yemen

Background: Scabies is a highly contagious skin disease. Objectives: To determine the occurrence of scabies among Yemeni patients and to identify the complication and treatment. Materials and methods: This retrospective study was conducted at two private clinics in Aden, Yemen. We reviewed all medical files of the patients who diagnosed with scabies and treated in our clinics during the period January 2020 to December 2021. The collected data were processed by the statistical software package SPSS version 22 and statistical analysis was done by estimating rates, means and standard deviations. Chi-square test was used and p-value < 0.05 was considered as statistically significant. Results: The study patients were (59.8%) males and (40.2%) females. The mean age of all patients was 21.6 ± 16.8 years. The patients of the age ≤ 10 years were predominant (31.8%) followed by patients of the age group 11-20 years old with (21.5%). The affected students represented the higher number and percentage (34.6%). The second infected groups were the workers with (14.9%) and housewives with (14.7%) (p = 0.000). The poor level of personal hygiene was predominant with (66.8%). Impetigo complication represented (9.2%) followed by post inflammatory hyperpigmentation in (6.3%) patients, scabiophobia in (2.7%) patients and ecthyma in (1.6%) patients. 44% patients were treated with benzyl benzoate lotion and 32.1% with permethrin lotion and oral antibiotic. Conclusion: The occurrence of scabies in the age group ≤ 10 years were predominant. Impetigo was the first complication. Most of the patients treated with benzyl benzoate lotion and permethrin lotion with oral antibiotic. Further studies are needed to determine the incidence and prevalence of scabies in Aden governorate. Keywords: Epidemiological study, scabies, Aden, Yemen.

Role of carbon dioxide laser in treatment of xanthelasma palpebrarum

Background:Xanthelasma palpebrarum (XP) is the commonest form of xanthomas which develop over eye lids. Carbon dioxide (CO2) LASERs are considered the ideal therapy for xanthelasma. Objectives:The aim of this work was to evaluate the efficacy and safety of CO2 LASER in the therapy of XP. Methods: The current work was carried out on 15 cases presented with XP to be treated by CO2 LASER. For all cases, assessment of the degree of clinical improvement, cases' content and side effects were done. Results: Regarding assessment of the degree of clinical improvement, 11 xanthelasma cases (173-3%) showed excellent improvement, and 4 cases (26.7%) showed very good improvement. Regarding cases’ content, 8 cases (53.3%) were very contented, 4 cases (26.7%) were contented, 2 cases (13.3%) were slightly contented, and one case (6.7%) was uncontented. Regarding side effects, all the 15 cases (100%) showed pain, erythema and superficial crustation, 9 cases (60%) showed edema and 5 cases (33.3%) showed scarring, 6 cases (40.0%) post inflammatory hyperpigmentation and no cases showed recurrence of the lesions during the follow up period. Conclusions: Carbon dioxide LASER is an excellent modality in the therapy of xanthelasma but its side effects must considered.

New Butyroside D from Argan Press Cake Possess Anti-Melanogenesis Effect via MITF Downregulation in B16F10 and HEM Cells.

Hyperpigmentation is a skin condition where patches of skin become darker in color due to excess melanin production upon UV exposure leading to melasma, which are lentigines or post inflammatory hyperpigmentation that psychologically affecting a great number of people. The present study investigates the anti-melanogenic effect of Butyroside D and the underling mechanism. After the confirmation of the non-cytotoxic effect of Butyroside D on B16F10 cells, we proceeded with analyzing the impact of the treatment at low and high concentration (i.e., 0.2 μM and 2 μM) using gene profiling analysis and examined the differentiation in gene expression. Our results identify cyclic adenosine monophosphate (cAMP), Wnt/β-catenin and Mitogen-Activated Protein Kinase (MAPK) signaling pathways to be downregulated upon treatment with Butyroside D. These pathways were targeted to further validate the effect of Butyroside D on membrane receptors melanocortin 1 receptor (MC1R) and receptor tyrosine kinase (c-Kit), related microphthalmia-associated transcription factor (MITF) and consequently tyrosinase (TYR), and tyrosine-related protein-1 (TYRP-1) that were all shown to be downregulated and, therefore, leading to the repression of melanin biosynthesis. Finally, the anti-melanogenic effect of Butyroside D was confirmed on human epidermal melanocytes (HEM) cells by inhibiting the activation of cAMP pathway generally mediated through α-melanocyte-stimulating hormone (α-MSH) and MC1R. Overall, this study suggests the potential applicability of this purified compound for the prevention of hyperpigmentation conditions.

MULTIFOCAL FIXED DRUG ERUPTION IN AN ATOPIC PATIENT

<h3>Introduction</h3> Fixed Drug Eruption (FDE) is a cutaneous reaction that usually occurs in the same locations with re-exposure of certain drugs. Acute episodes present with violaceous plaques following with post-inflammatory hyperpigmentation. This case highlights the challenge of diagnosing FDE when lesions are multifocal and do not recur in the exact same location. <h3>Case Description</h3> A 58 year old woman with a past medical history of aspirin exacerbated respiratory disease, multiple nasal polypectomies, atopic dermatitis, chronic urticaria, allergic rhinitis, and moderate persistent asthma on dupilumab presented to clinic for evaluation of skin hyperpigmentation. Possible triggers she recalled included NSAID use or pseudoephedrine use. Symptoms included hyperpigmentation following recurring episodes of erythematous, pruritic plaques since 2017 located on her face, chest, and groin. The plaques usually resolved after days to weeks. To treat her skin hyperpigmentation, the patient had tried sunscreen, hydroquinone, and tretinoin creams with no improvement. Physical examination showed skin hyperpigmentation on her forehead, cheeks, nose, periorbital area, chest, and hands with well demarcated violaceous patches. <h3>Discussion</h3> The patient's symptoms are likely associated with a multifocal FDE with post inflammatory hyperpigmentation. This patient's use of NSAIDs or pseudoephedrine are potential triggers. The patient had never had a biopsy during the presence of active lesions and could not report a medication history that clearly correlated with symptoms, which makes diagnosis difficult.

Advances in Pigmentation Management: A Multipronged Approach.

Key cellular players regulating human skin pigmentation include melanocytes in the epidermis that synthesize melanin, neighboring keratinocytes that receive and distribute melanin in the upper layers, and fibroblasts in the dermis that affect overlying melanocytes and keratinocytes. In addition, endocrine factors from the blood supply (endothelial cells) and inflammation-related factors play a role. Thus, new strategies for affecting pigmentation need to consider these multiple cell lines to adequately cover various causes and disease processes associated with hyperpigmentation. Pathophysiologic mechanisms and cellular pathways involved in melanogenesis were thoroughly reviewed with particular emphasis on the cellular interplay involved in the process. A complex system of interlinking and independent pathways was defined and described demonstrating differing pathways for altered pigmentary disorders - melasma associated with endothelial cell interactions; post inflammatory hyperpigmentation associated with keratinocyte inflammatory mediators (PGE2 in particular); and photodamage involving all 4 cell types. In vitro validation studies were then undertaken to define differing cell group gene expression profiles with selected peptides and other active agents. Melanocytic production of pigment was then tested with these agents to identify key potential players capable of limiting pigmentation. Hexapeptide-12 and lactoferrin (melanocytes), Hexapeptide-11 (in keratinocytes), and phosphatidylserine (endothelial cells) were identified as major inhibitors of melanogenesis based on their gene expression profiles. This was confirmed by secondary melanin production tests performed on melanocytic lines. Additional active agents were also identified as inhibitors of melanocytic production of melanin, and together, these constituents formed the basis for a novel formulation for use in pigmentary disorders. A comprehensive scientific narrative of the various facets relating to pigmentation has been presented including differing pathways affecting varied cell lines that effect pigment production. Based on this concept, actives were tested using gene expression studies as well as in vitro melanogenic model testing in different cell lines. Using this novel multi-faceted approach, we have selected and validated a series of active agents to be used in a formulation targeting the complex problem of hyperpigmentation. J Drugs Dermatol. 2022;21(11):1206-1220. doi:10.36849/JDD.7013.

Overview on Post-Inflammatory Hyperpigmentation

Post inflammatory hyperpigmentation (PIH) can affect people of all skin colours, but it is more common in people of colour, such as African Americans, Hispanics/Latinos, Asians, Native Americans, Pacific Islanders, and those of Middle Eastern descent. There is no distinction between men and women. In darker-skinned acne sufferers, the prevalence of PIH might reach 65 percent. Many studies have demonstrated that topical retinoids, especially in darker skin types, can be beneficial in treating PIH associated with acne. However, Hydroquinone is still a go-to treatment for melasma and hyperpigmentation, and it's commonly referred to as the "gold standard." triple combination fixed treatment has also become a common intervention, with evidence showing that the combination is more successful than hydroquinone monotherapy. In this review article we will be looking at PIH etiology, epidemiology, different treatment options as well as the effectiveness of each medication.

26415 Regulation of postinflammatory hyperpigmentation by niacinamide through potential modulation of the protease inhibitor, SERPINB3

Among various cutaneous disorders, acne is often accompanied by post inflammatory hyperpigmentation (PIH). Such increases in pigmentation are controlled not only by secreted factors from keratinocytes, but also from dermal fibroblasts which respond to inflammatory stimuli from the epidermis. Niacinamide is a cosmetic ingredient with proven clinical efficacy against acne-associated PIH. In this study we evaluated the role of Serpin Family B Member 3 (SERPINB3), an endogenous protease inhibitor reported to be upregulated in acne lesions as a potential regulator of the PIH response and its modulation by niacinamide.

A COMPARATIVE STUDY OF THE EFFICACY AND SAFETY OF 12 % GLYCOLIC ACID CREAM AND 10% AZELAIC ACID CREAM IN THE TREATMENT OF POST ACNE HYPERPIGMENTATION.

Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit that is associated with significant psychosocial repercussions. Post inflammatory hyperpigmentation is a most common complication seen after post acne. Therapeutic goal of treatment include promoting degradation of melanosomes and inhibiting their formation. Patient treated with Azelaic acid / Glycolic acid experienced of significant greater reduction in number of inflammatory lesions. This study focuses on the comparison of efficacy of 12% Glycolic acid and 10% Azelaic acid in treating post acne hyperpigmentation.

Comparative Study between Topical Latanoprost versus Topical 5- Fluorouracil after Dermabrasion for Treatment of Non-Segmental Stable Vitiligo

Background: Latanoprost [LT], a prostaglandin F2-alpha [PGF2α] analogue used in the treatment of glaucoma. It induces skin pigmentation in guinea pigs. The rationale of trying 5-fluorouracil [5‐FU] in vitiligo treatment may come from the first report of hyperpigmentation induced by 5‐FU as a side effect in the skin tumors and psoriasis treatment The Aim of the work: Comparison between the efficacy of topical latanoprost versus topical 5-fluorouracil after skin dermabrasion in induction of skin repigmentation in stable non-segmental vitiligo. Patients and Methods: This study included thirty Egyptian patients, 18-60 years old, with stable non-segmental vitiligo. They were divided into: group [A] patients subjected to 5 fluorouracil after dermabrasion and group [B] patients subjected to latanoprost after dermabrasion then followed up every two weeks for three months. Result: There was no statistically significant difference between both groups regarding total response to treatment and degree of repigmentation. However, there was higher response to treatment in group A than group B. In both groups patients were satisfied with the degree of improvement. As regard complication there were minimal complications only one case of koebnerization and two cases of post inflammatory hyperpigmentation Conclusion: 5- fluorouracil 5% was associated with better improvement than latanoprost. However, the difference did not reach statistical significance. Patients reported high satisfaction with the two treatment modalities.

Cross-sectional study of quality of life impairment of adult female acne patients

The effect of acne vulgaris on the quality of life of adult females is not readily documented nor the factors that impair quality of life in these adult females. The aim of this study was to document quality of life impairment and the factors that affect this quality of life in adult female acne patients. The study was a prospective cross sectional study of 56 adult female acne patients aged 25 years and above. Socio-demographic data, clinical examination were documented with a study proforma. Quality of life was assessed using Cardiff Acne Disability Index (CADI). Data was analysed using SPSS version 22. Mean of independent groups were compared using Students ‘t’ test while Chi squared test was used to compare categorical variables. For all statistical tests, P value &lt;0.05 was adjudged to be significant. The mean age of the participants was 33.4± 8.2 and mean CADI was 6.6±3.8, minimum CADI was 2 and maximum was 15. Quality of life impairment was mild, moderate and severe in 35.7%, 37.5% and 26.8% respectively. The items affected in the CADI index were questions about “Perception of how bad pimples were,” “Feelings about appearance of skin,” and “Aggression, frustration and embarrassment.” Factors associated with quality of life impairment were age, post inflammatory hyperpigmentation, presence of scarring. Quality of life is impaired by acne in adult females. This impairment is made worse by age, presence of scarring and post-inflammatory hyperpigmentation and not marital status, level of education and a family history of acne.

Transdermal Absorption of Methimazole- a Cat’s Tale

Introduction: In modern civilization different kinds of animals live with us as pets. These pets have different diseases and are on medications. Close contact with animals can cause medication adverse reactions or may worsen pre-existing conditions in humans. Here we present an interesting case of hypothyroidism worsened by transdermal absorption of methimazole administered for feline hyperthyroidism. Case History: 66-year-old Caucasian female with past medical history of postoperative hypothyroidism s/p total thyroidectomy secondary to multinodular goiter due to Hashimoto’s thyroiditis with a 0.2 cm papillofollicular microcarcinoma and 0.7 cm follicular adenoma presented for follow up. She complained of weight gain, lethargy and dry skin for the past 4 months. She was on a stable dose of levothyroxine 112 mcg daily for the past year. She took her pill correctly and did not miss any doses. Her other medical problems were impaired fasting glucose, osteopenia and B12 deficiency. Her repeat thyroid function tests showed TSH 11.2 mc IU/ l (0.4 -4) (TSH - 0.538 mc IU/ L 6 months back), T4 - 6.8 mcg/ dl (4.5 - 12) (T4 8.9 6 months back). She had a measurable serum thyroglobulin of 0.4 ng/ml with antithyroglobulin antibody 11 IU/ml (<115) consistent with some residual thyroid tissue despite her history of a “total thyroidectomy”. Due to recent worsening of her symptoms with elevated TSH on background of previous stable levothyroxine requirement, further detailed history was taken. She reported that her cat was suffering from hyperthyroidism, treated with methimazole 10 mg daily. The patient used to cut the pill in half with bare hands and fed it to her pet. She also used to handle wet methimazole that her cat coughed up. Her levothyroxine dose was continued at 112 mcg daily. The patient was advised to use gloves before feeding and wash her hands after feeding her cat. Her symptoms resolved after she took precautions and TSH normalized to 1.170 mc IU/ l with T4 7.6 two months later. Conclusion: Absorption of methimazole by transdermal administration has been shown in cats1. A study by Kasraee et al showed safety of a 5% topical methimazole application for treatment of post inflammatory hyperpigmentation in humans with no change in thyroid function tests2. Our case contradicts this study and indicates that methimazole might be absorbed transdermally in humans. To conclude, more studies are needed to study the effect of transdermal administration of methimazole in humans.

Microneedling With and Without Vitamin C versus Fractional CO2LASER in Treating Abdominal Striae Distensae Alba: A ComparativeClinical and Histopathological Study

AbstractBackground: Striae distensae, a common skin condition,represent linear dermal scars accompanied by epidermalatrophy.Aim of Study: The aim of this prospective self controlledcomparative study is to evaluate and compare between micro-needling only, microneedling with topical vitamin C 15%application and fractional CO2 LASER in treatment of ab-dominal striae distensae alba.Patients and Methods: This prospective self-controlledcomparative study included 30 patients with abdominal striaedistensae alba (five patients skipped the study). Samplingmethod equation and program: MedCalc® version 12.3.0.0 (Ostend, Belgium)was used for calculation of sample size,statistical calculator based on 95% confidence interval andpower of the study was 80% with a error 5%. Type of samplingwas simple random sampling.All patients were from the Dermatology Outpatient Clinic,Ain-Shams University Hospitals in the period from December2016 till July 2017.This study was approved by the Research Ethical Com-mittee of Faculty of Medicine Ain Shams University. Allpatients signed an informing written consent with full infor-mation about the description of the procedure of treatment,possible side effects and photo documentation.Results: Microneedling in combination with vitamin C isan effective, safe and low-cost therapy treatment modalityfor abdominal striae distensae alba Addition of topical vitamin C increases the treatment outcome. It is easy to perform with no observable side effects or serious complications and results in great patient satisfaction with high induction of both collagen and elastin and increase in epidermal thickness and rete ridges.Although fractional CO2 LASER has been proven to play a role in collagen and elastin induction but the presence of complications as post inflammatory hyperpigmentation leads to decrease in patient satisfaction.

Cutaneous Post Inflammatory Hyperpigmentation from Morsicatio Buccarum

Post Inflammatory hyperpigmentation (PIH) is a pigmentary phenomenon which commonly follows disease or injury. Examples include thermal or caustic burns, infections, or inflammatory disorders affecting the skin such as acne, atopic dermatitis, or rash. PIH can occur in anyone but is more common in Fitzpatrick types III-VI individuals, where the color tends to be more intense and persist for a longer period than in Fitzpatrick types I and II individuals. We present a unique case of PIH on the skin as a result of frequent biting of the inner buccal mucosa.

Nonmelasma facial melanosis: a prospective, clinical, histopathological and immunohistochemical study

Background: Paucity of literature and non consensus on clinicohistopathological features amongst the nonmelasma facial melanosis for example lichen planus pigmentosus (LPP), pigmented contact dermatitis (PCD), macular amyloidosis, acanthosis nigricans, pigmented demarcation line, post inflammatory hyperpigmentation, etc., make them difficult to diagnose and equally challenging to treat. Materials and Methods: It was a prospective, uncontrolled study, conducted at tertiary hospital at eastern India in 100 patients presenting with facial hyperpigmentation who agreed to undergo 3 mm skin biopsy during Jan 2014 to Jun 2015. Cases of melasma were excluded by clinical, Woods lamp examination and if required dermoscopy. Details of history, physical examination, histopathological examination, and Immunohistochemical studies were recorded. Melan A was used as melanocytic differentiation marker while CD4, CD8 were used as inflammatory markers. Mean ± SD, chi-square test or Fisher’s exact test, degree of agreement by Cohen’s Kappa were calculated. P-value was considered significant if ≤0.05. Results: 44 males and 56 females (56%) (M: F=1:1.24) with mean age of 45.98 years and median duration of illness of 28 months (5 months-13 years) were studied. Out of 43 confirmed cases of PCD, 16 had associated hypothyroidism (chi square 6.11, P-value 0.0134). Maximum patients belonged PCD (n = 47) followed by LPP (n = 27). Maximum concordance of clinical and histopathological diagnosis was present in PCD and LPP (Cohen kappa more than 0.9). Epidermal atrophy and band like inflammatory infiltrate were statistically significant features in LPP (P

EVALUATION OF INTRADERMAL TRANXEMIC ACID INJECTION IN TREATMENT OF MELASMA

Background: Melasma is an acquired skin disorder characterized by light to dark brown macules and patches occurring in the sun-exposed areas of the face. The major etiological factors include genetic influences, pregnancy, sex hormones, exposure to ultraviolet rays (UVR) radiation and cosmetics. The treatment of melasma remains a challenge. Numerous treatment options as topical agents, systemic depigmenting therapy, chemical peeling and laser have been included in melasma treatment. No single therapy has proven to be of benefit to all patients, combination of modalities can achieve more control especially in difficult cases. Objective: To evaluate the efficacy of intradermal tranexamic acid injection in treatment of melasma. Patients and Methods: Sixty Egyptian patients presented with melasma were enrolled into our study and divided into 2 equal groups: group A with intradermal injection of tranexamic acid, and group B were injected with intradermal saline. The patients were recruited from the Dermatology Outpatient Clinic of Al-Azhar University Hospitals during the period from August 2019 to October 2019. Results: All patients were females. The mean age was 41.87 ± 7.79 years, and the median of duration of melasma among the patients were 7 years. Gravidity and pregnancy (96.7%) were the most common precipitating factors while family history was positive in 46.7%. According to the efficacy of the therapy in melasma patients, intradermal injection of tranexamic acid showed that the percentage of change of mMASI score after treatment was 58.123%. Response to therapy in melasma, showed very good response in 18.3%, moderate response in 13.3%%, good response in 16.7%%, no response in 51.7%. As regard the side effects, tranexamic acid side effects were mild burning and transient edema at the site of injection in whole 60 patients. Five patients showed post inflammatory hyperpigmentation (8.3%). Conclusion: Intradermal tranexamic acid is safe, well tolerated and effective therapy in the treatment of melasma. Tranexamic acid solution is available therapy, not expensive and easy to be prepared and applied. Tranexamic acid is preferred in dark skin phototypes than as it is more safe and less liable to cause PIH. Tranexamic acid prevents the rapid relapse of melasma after stoppage of treatment.

A Prospective, Nonrandomized, Open-label Study, Comparing the Efficacy, Safety, and Tolerability of Fractional CO2 Laser versus Fractional Microneedling Radio Frequency in Acne Scars.

Background:Acne scar is a distressing psychosocial problem, and it has a negative effect on the quality of life. Although variety of approaches are available, demand of less invasive and more effective ways for their treatment is needed.Objective:This study aimed to assess and compare the clinical safety, efficacy, and tolerability of fractional carbon dioxide (FCO2) laser versus fractional microneedling radio frequency (MNRF) in the management of acne scars.Materials and Methods:This study was a prospective, observational, nonrandomized, open-labeled study of total 50 patients selected according to Goodman and Baron global qualitative acne scar grading, and they were divided into two groups of 25 each, having Fitzpatrick skin type III–V. A total of four sessions were given for both the groups at an interval of 2 months. The assessment was done by the treating physician as well as by the blinded physician. Both the subjective and the objective assessment was done at the last follow up given at second month of the fourth session.Results:The mean score of 25 patients in each group of FCO2 and fractional MNRF, decreased from 29.24 to 10.7 (i.e., 63.41%) and from 33.24 to 13.04 (i.e., 60.72%), respectively, as calculated by Goodman and Baron quantitative grading assessed by the treating physician (P = 0.0001). Grade 4 (>75%) improvement was shown by four patients and Grade 3 improvement (51%–75%) was shown by 14 patients among FCO2 group, and similarly Grade 4 (>75%) improvement was shown by three patients and Grade 3 improvement (51%–75%) was shown by 12 patients among MNRF group, as observed by a blinded physician (P = 0.689).Conclusion:Both modalities are equally effective in the treatment of acne scars; however, fractional MNRF having lesser down time and Post inflammatory hyperpigmentation (PIH) among darker skin shades, with good patient satisfaction score, makes it an efficient and safer treatment option as compared to FCO2.