Pigmentation Scores Research Articles

Keloid Treatment Using Plasma Exeresis: A Pilot Trial Study

Introduction: Keloid scars and hypertrophic scars are more commonly seen after surgeries, suture placements, or other skin damages. Scars can be treated using a variety of methods, including topical compounds, surgery, and lasers. The aim of this study is to evaluate the effects of plasma exeresis on the treatment of keloid scars. Methods: This experimental study was conducted on patients with keloid scars, defined as a treatment-resistant subtype of scars with extension beyond the primary skin defect and cauliflower appearance, in different parts of the body. The patients were treated with 2-to-3-session plasma exeresis. Scars were examined based on the Vancouver scar scale (VSS) before and 5 months after the treatment. Results: A total number of 24 scars were enrolled in this study. The number of patients was 16. There was a decrease in the mean thickness of keloids from 2.20 to 0.54 (P=0.000). The mean pigmentation and pliability scores decreased from 1.54 and 2.16 to 0.375 and 0.541, respectively (P=0.001, 000). There was a significant reduction in the keloid scar vascularity score from 1.666 to 0.541 (P=0.000). There was a decrease from 0.708 to 0.00 (P=0.004) in the mean itchiness score. After the intervention, the mean pain score was 0.000, compared to 0.7500 before the intervention (P=0.003). There was a decrease in the total score from 8.958 to 2.000 (P=0.000). Conclusion: The plasma exeresis procedure is effective in destroying small keloid scars. Furthermore, results in less itching and pain, as well as no significant complications or recurrences.

Improve the dupilumab therapy evaluation with dermoscopy and high-frequency ultrasound in moderate-to-severe atopic dermatitis.

Atopic dermatitis (AD) is a chronic inflammatory disease. Monoclonal antibody dupilumab was approved to treat moderate-to-severe AD in recent years. An objective assessment of treatment response by skin imaging modality is adjuvant for clinical evaluations. This study aimed to explore the value of dermoscopy and high-frequency ultrasound (HFUS) imaging characteristics in treatment evaluation for moderate-to-severe AD patients treated with dupilumab. Moderate-to-severe AD patients refractory to conventional therapy were enrolled in the study. All patients went through at least a 16-week standardized treatment of dupilumab. Clinical scores (eczema area scoring index [EASI], SCOARD, numerical rating scale of pruritus, dermatology life quality index), dermoscopy, and HFUS examinations were conducted at 0, 2, 4, 8, 12, and 16 weeks of treatment. Erythema, scales, erosion, and pigmentation under dermoscopy were scored, and subepidermal low-echogenic band (SLEB) thickness under HFUS was measured as quantitative indexes. Descriptive analysis and mixed effect linear regression models were used for statistical analysis. Sixteen patients were enrolled in the study and their average age was 45.63±18.18 years. All clinical scores decreased with significant difference after 16-week treatment compared with baseline. All patients achieved EASI 50 (EASI score decreased by 50% or more), and 9/16 patients reached EASI 75 after 16-week treatment. Dermoscopy evaluation of erythema, scales and erosion scores were decreased, and the sign of pigmentation score was increased after treatment. For HFUS, the mean SLEB value was 0.51±0.29 mm and decreased to 0.27±0.15 mm after 16-week treatment (p<0.01). SLEB value decreased linearly with treatment time and correlated with clinical scores. However, SLEB values of two patients were 0.57 and 0.68mm at week 16, respectively, which were higher than the average, and one of the patients showed EASI 75. Dermoscopy and HFUS were able to reveal deeper inflammation response than clinical scores in AD and can be an effective method to evaluate and monitor clinical improvement during dupilumab treatment for AD patients. The preliminary value of imaging methods for predicting the treatment endpoint of dupilumab remains to be verified.

Comparison of 1064 nm Q-switched Nd:YAG laser and Jessner peeling in melasma treatment.

Melasma is an acquired hyperpigmentation disease characterized by hyperpigmented patches in sun-exposed areas that significantly impairs life quality. Topical treatments such as hydroquinone, retinoic acid, azelaic acid, chemical peels and laser treatments are among the main treatment options. In our study, we aimed to compare the effectiveness of Jessner peeling and 1064 nm Q-switched Nd:YAG laser in melasma treatment. For this purpose, Jessner peeling was applied to 20 patients and 1064 nm Q-switched Nd: YAG laser was applied to 19 patients of 39 melasma patients who applied to the cosmetology unit of Ege University department of dermatology and venereal diseases between November 2018-March 2020. Thirty seven patients completed the study. Changes in MASI, pigment and erythema scores measured by mexameter before and after treatment were compared for two groups. A statistically significant decrease in MASI scores, pigment and erythema scores was observed in both groups with no significant difference between two groups. In conclusion, in our study, it has been shown that Jessner peeling and 1064 nm Q-switched Nd:YAG laser are equally effective in treatment of melasma.

A split-face study to evaluate the efficacy of a dissolving microneedle-encapsulated niacinamide skin patch for the reduction of facial hyperpigmentation

Background This study aimed to evaluate the efficacy and safety of a dissolving microneedle (DMN)-encapsulated niacinamide skin patch to reduce facial hyperpigmentation.Methods A split-face study was conducted between April and June 2022 in 17 patients treated with a DMN-encapsulated niacinamide skin patch, which was applied only on the right side of the face, while the left face remained free of a pigmentation-improving agent. A topical moisturizer and physical sunscreen were applied on both sides of the face for 2 weeks. We compared both sides of the face 2 weeks after applying the skin patch using an automatic skin analysis device to investigate skin pigmentation. The melasma severity scores of both sides were evaluated before and 2 weeks after application.Results A significant difference in the epidermal pigmentation score between pre-treatment and 2 weeks after treatment was noted on the right side (P&lt;0.05), but not on the left side of the face (P&gt;0.05). A significant difference in the melanin score between pre-treatment and 2 weeks after treatment was noted on the right side (P&lt;0.05), but not on the left side (P&gt;0.05) of the face. There was no significant difference in the melasma severity score on either side of the face between pre-treatment and 2 weeks after treatment (P&gt;0.05).Conclusions The application of a DMN-encapsulated niacinamide skin patch to improve skin pigmentation may yield good outcomes and provide comfort to patients without any complications.

Cosmesis and feasibility of transvaginal natural orifice Specimen extraction (NOSE) for large organ specimen: a prospective pilot study

BackgroundThis study aimed to evaluate cosmetic outcomes and feasibility of transvaginal natural orifice specimen extraction (NOSE) in patients who underwent laparoscopic or robotic surgery for the treatment of benign or malignant diseases of the kidney, liver, stomach, adrenal gland, and bladder.MethodsThis prospective study was conducted at a tertiary hospital between March 2015 and May 2020. The main outcome was cosmetic outcomes of scars assessed using the Patient and Observer Scar Assessment Scale (POSAS) 1 and 8 weeks after surgery. The secondary outcomes were postoperative pain, operating time, and complications. Sexual function was assessed using the Female Sexual Function Index (FSFI) questionnaire 6 months after surgery in 17 patients who were sexually active at the time of surgery.ResultsA total of 38 transvaginal NOSE procedures were performed for the extraction of 33 kidneys, 2 livers, 1 stomach, 1 adrenal gland, and 1 bladder. Observers rated pigmentation and relief scores as most deviant from normal skin (2.9 ± 1.7, 3.0 ± 2.1 at postoperative 1 week; 3.6 ± 1.9, 3.5 ± 2.2 at postoperative 8 weeks, respectively), but the overall scores of each item were low. The patients’ overall satisfaction with postoperative scars was high, and the mean scores for pain and itching were low, with significant improvement from the first week to the eighth week (P = 0.014 and P = 0.006, respectively). Patients also reported low scores on vaginal assessment items, indicating better symptoms, and bleeding improved significantly between the two time points (P = 0.001). Postoperative pain was reduced from moderate during the first 24 h after surgery to mild after 24 h. The mean operative time of the transvaginal NOSE procedure was 28.3 ± 13.3 min. No postoperative complications were associated with the procedure. The mean FSFI total score was 21.2 ± 8.7 (cutoff score for dysfunction is 21), with higher scores indicating better sexual functioning.ConclusionTransvaginal NOSE seems to be a feasible procedure with promising cosmetic benefits, for patients who undergo minimally invasive surgery for large organs including the kidney, liver, stomach, adrenal gland, and bladder. A prospective randomized clinical trial is needed to provide solid evidence to support transvaginal NOSE.Trial registration:This trial is registered at ClinicalTrials.gov (NCT05113134).

Clinical application effect of sequential nursing on the management of new skin on face and neck after deep burns

Objective: To explore the clinical application effect of sequential nursing on the management of new skin on face and neck after deep burns. Methods: The retrospective case-control research approach was used. From January to December 2019, 109 patients who met the inclusion criteria were admitted to the First Affiliated Hospital of Army Medical University (the Third Military Medical University) within 1 week after deep burn wound healing on the face and neck. Fifty-five patients who were admitted to the hospital from January to June and received comprehensive treatment and conventional nursing were included in conventional nursing group (27 males and 28 females, aged 21-65 (40±17) years), and fifty-four patients who were admitted to the hospital from July to December and received comprehensive treatment and sequential nursing were included in sequential nursing group (29 males and 25 females, aged 18-57 (37±11) years). The scores of pigmentation, vascularity, pliability, and thickness in Vancouver scar scale (VSS), the total score of VSS, the score of itch's impact on sleep in the four-item itch questionnaire (FIIQ), and the total score of FIIQ of patients were counted in the two groups before the first treatment (hereinafter referred to as treatment) and 3 months, 6 months, and 1 year after treatment. The treatment effective rate and the score of patients' satisfaction with the treatment effect in one year after treatment and the occurrence of adverse reaction during the treatment were counted. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, and chi-square test. Results: The scores of pigmentation, vascularity, pliability, and thickness in VSS and the total VSS score of patients between the two groups before treatment were close (P>0.05). The pliability score in VSS and total VSS score after 3 months of treatment, the score of vascularity in VSS and total VSS score after 6 months of treatment, and the scores of pigmentation, vascularity, pliability, and thickness in VSS and total VSS score of patients after 1 year of treatment in sequential nursing group were significantly lower than those in conventional nursing group (with Z values of -2.51, -3.37, -2.05, -3.28, -3.12, -5.86, -4.63, -5.56, -6.76, respectively, P<0.05 or P<0.01). The score of itch's impact on sleep in FIIQ after 3 months of treatment of patients in sequential nursing group was significantly lower than that in conventional nursing group (Z=-4.17, P<0.01), and the total scores of FIIQ after 3 months, 6 months, and 1 year of treatment of patients in sequential nursing group were significantly lower than those in conventional nursing group (with Z values of -6.56, -5.53, -5.84, respectively, P<0.01). After 1 year of treatment, the treatment effective rate of patients in sequential nursing group was 96.3% (52/54), which was significantly higher than 81.8% (45/55) in conventional nursing group (χ2=5.83, P<0.05), and the score of patients' satisfaction with the treatment effect in sequential nursing group was significantly higher than that in conventional nursing group (Z=-4.49, P<0.01). During the treatment period, there was no adverse reaction in patients in sequential nursing group, but there were 3 patients with pruritus and peripheral erythema on the wound in conventional nursing group, which were improved after dressing changes. Conclusions: Sequential nursing can effectively improve the prevention and management of new skin scars in patients after deep burns on the face and neck, improve the itching, the efficiency of treatment, and the satisfaction of patients with the treatment effect.

Virulence, phenotype and genotype characteristics of invasive group B Streptococcus isolates obtained from Swedish pregnant women and neonates

Group B streptococci (GBS) are bacteria that can cause preterm birth and invasive neonatal disease. Heterogeneous expression of virulence factors enables GBS to exist as both commensal bacteria and to become highly invasive. A molecular epidemiological study comparing GBS bacterial traits, genotype and host characteristics may indicate whether it is possible to predict the risk of perinatal invasive GBS disease and more accurately target intrapartum antibiotic prophylaxis. A total of 229 invasive GBS isolates from Swedish pregnant women or neonates were assessed for virulence and phenotypic traits: hemolysis zone, hemolytic pigment (Granada agar), Streptococcus B Carrot Broth (SBCB) assay, CAMP factor, and hyaluronidase activity. Genes regulating hemolytic pigment synthesis (covR/covS, abx1, stk1, stp1) were sequenced. Of the virulence factors and phenotypes assessed, a Granada pigment or SBCB score ≥ 2 captured more than 90% of EOD isolates with excellent inter-rater reliability. High enzyme activity of hyaluronidase was observed in 16% (36/229) of the invasive GBS isolates and notably, in one case of stillbirth. Hyaluronidase activity was also significantly higher in GBS isolates obtained from pregnant/postpartum individuals versus the stillbirth or neonatal invasive isolates (p < 0.001). Sequencing analysis found that abx1 (g.T106I), stk1 (g.T211N), stp1 (g.K469R) and covS (g.V343M) variants were present significantly more often in the higher (Granada pigment score ≥ 2) versus lower pigmented isolates (p < 0.001, each variant). Among the 203 higher Granada pigment scoring isolates, 22 (10.8%) isolates had 3 of the four sequence variants and 10 (4.9%) had 2 of the four sequence variants. Although heterogeneity in GBS virulence factor expression was observed, the vast majority were more highly pigmented and contained several common sequence variants in genes regulating pigment synthesis. High activity of hyaluronidase may increase risk for stillbirth and invasive disease in pregnant or postpartum individuals. Our findings suggest that testing for GBS pigmentation and hyaluronidase may, albeit imperfectly, identify pregnant people at risk for invasive disease and represent a step towards a personalized medical approach for the administration of intrapartum antibiotic prophylaxis.

Clinical effects of pulsed dye laser dynamically combined with triamcinolone acetonide in the treatment of keloids

Objective: To explore the clinical effects of pulsed dye laser (PDL) dynamically combined with triamcinolone acetonide (TAC) in the treatment of keloids. Methods: A retrospectively observational study was conducted. From April 2015 to October 2020, 34 keloid patients (46 keloids) who met the inclusion criteria were admitted to Huaihe Hospital of Henan University. The patients were divided into TAC group and dynamic treatment group according to their treatment methods. There were 18 patients (26 keloids) in TAC group, including 8 males and 10 females, aged (30±12) years, who were treated with TAC injection alone. There were 16 patients (20 keloids) in dynamic treatment group, including 6 males and 10 females, aged (26±11) years, who were treated with TAC injection, PDL, or PDL combined with TAC injection according to the Vancouver scar scale (VSS) score before each treatment. Before the first treatment (hereinafter referred to as before treatment) and 12 months after the first treatment (hereinafter referred to as after treatment), the keloids were assessed by VSS, patient and observer scar assessment scale (POSAS), and the effect of keloids on the quality of life of patients was evaluated with dermatology life quality index (DLQI) scale. Twelve months after treatment, the curative effect of keloid was evaluated according to the VSS score and the effective rate was calculated. The first effective time and the cumulative times of TAC injection at the first effective time, the number of follow-up and the occurrence of adverse reactions of keloids within 12 months after treatment were recorded, and the incidence of adverse reactions was calculated. Data were statistically analyzed with paired sample t test, independent sample t test, Wilcoxon rank-sum test, Mann-Whitney U test, chi-square test, and Fisher's exact probability test. Results: The total VSS scores of patients' keloids in TAC group and dynamic treatment group 12 months after treatment were significantly lower than those before treatment (with t values of 7.53 and 8.09, respectively, P<0.01), and the total scores of pigmentation and vascularity in VSS and POSAS, the total POSAS score, and the DLQI scale score were significantly lower than those before treatment (with Z values of -3.71, -4.04, -4.21, -4.11, -3.76, -3.73, -3.92, and -3.93, respectively, P<0.01). The total scores of pigmentation and vascularity in VSS and POSAS of patients' keloids in dynamic treatment group 12 months after treatment were significantly lower than those in TAC group (with Z values of -2.03 and -2.12, respectively, P<0.05). Twelve months after treatment, the effective rate of patients' keloids in dynamic treatment group was significantly higher than that in TAC group (χ2=3.88, P<0.05). The first effective time of patients' keloids in dynamic treatment group was 5.5 (2.0, 6.0) months, which was significantly shorter than 6.0 (2.3, 10.3) months in TAC group (χ2=4.02, P<0.05). The cumulative times of TAC injection at the first effective time of patients' keloids in dynamic treatment group was 3.2±1.7, which was significantly less than 4.2±1.8 in TAC group (t=2.09, P<0.05). The number of follow-up of patients' keloids within 12 months after treatment in dynamic treatment group was significantly more than that in TAC group (t=-2.94, P<0.01), and the total incidence of adverse reactions was lower than that in TAC group but without statistically significant difference (P>0.05). Conclusions: Compared with TAC injection alone, PDL dynamically combined with TAC in the treatment of keloid can shorten the effective time, reduce the number of TAC injection, and improve the patient's compliance and clinical efficacy.

Identifying Gingival Pigmentation Patterns and Skin Color and Its Co-relation With Serum Ferritin Levels in Thalassemic Patients

Background: Patients with β-thalassemia major (β-TM), a genetic issue due to hemoglobin (Hb) synthesis disorder, require life-long erythrocyte transfusion. The purpose of this study is to evaluate and compare gingival pigmentation and skin color with serum ferritin levels of patients with β-TM, using the Dummett's oral pigmentation index (DOPI) and Fitzpatrick skin scale, respectively.Methods: A total of 100 patients were monitored at a thalassemia care center. Each patient's gingival pigmentation and skin color were matched with DOPI and the skin scale under natural light. Serum ferritin levels, the interval of blood transfusions, and iron chelation medications were studied. A gingival pigmentation score and skin color type were compared with the serum ferritin.Results: A significant correlation was found between age, serum ferritin, pigmentation score, and skin color, which means as serum ferritin level increases, gingival pigmentation score increases, and skin color darkens.Conclusion: This study evaluated the correlation between gingival pigmentation and skin color with serum ferritin levels and established gingival pigmentation as a sign of iron deposition in β-TM patients. This is the simplest and least invasive method for evaluating serum ferritin level parameters in β-TM patients.

Robotic search for optimal cell culture in regenerative medicine.

Induced differentiation is one of the most experience- and skill-dependent experimental processes in regenerative medicine, and establishing optimal conditions often takes years. We developed a robotic AI system with a batch Bayesian optimization algorithm that autonomously induces the differentiation of induced pluripotent stem cell-derived retinal pigment epithelial (iPSC-RPE) cells. From 200 million possible parameter combinations, the system performed cell culture in 143 different conditions in 111 days, resulting in 88% better iPSC-RPE production than that obtained by the pre-optimized culture in terms of the pigmentation scores. Our work demonstrates that the use of autonomous robotic AI systems drastically accelerates systematic and unbiased exploration of experimental search space, suggesting immense use in medicine and research.

Necroptosis-associated classification combined with tumor microenvironment characteristic analysis of cutaneous melanoma

Necroptosis is a mode of programmed cell death that overcomes apoptotic resistance. The accurate prognosis of cutaneous melanoma is complicated to predict due to tumor heterogeneity. Necroptosis contributes to the regulation of oncogenesis and cancer immunity. We comprehensively investigated different necroptosis patterns by the non-negative matrix factorization (NMF) clustering analysis and explored the relationships among necroptosis patterns, infiltered immune cells, and tumor microenvironment (TME) scores. Two different necroptosis patterns were identified, and the two clusters could predict prognosis and immune landscape. A four-gene signature was successfully constructed and validated its predictive capability of overall survival (OS) in cutaneous melanoma patients. The prognostic value of the signature was further enhanced by incorporating other independent prognostic factors such as age and clinicopathological stages in a nomogram-based prediction model. Patients with lower risk scores tended to have better OS, higher TME score, immune checkpoints, immunophenoscore (IPS), and lower Tumor Immune Dysfunction and Exclusion (TIDE), which indicated better responses to immunotherapy. In addition, the pigmentation score of the high-risk group was visibly higher than those of the low-risk group. In conclusion, the necroptosis-related signature indicated favorable predictive performance in cutaneous melanoma patients, which provides guidance for immunotherapy and provide novel insights into precision medicine.

Development and validation of the interpretability analysis system based on deep learning model for smart image follow-up of nail pigmentation.

BackgroundNail pigmentation can be a clinical manifestation of malignant melanoma and a variety of benign diseases. Nail matrix biopsy for pathologic examination, the gold standard for diagnosis of subungual melanoma, is a painful procedure and may result in nail damage. Therefore, there is a great need for non-invasive methods and long-term follow-up for nail pigmentation. The objective of this study is to establish an intelligent precursor system to provide convenient monitoring for nail pigmentation, early warning subungual melanoma, and reduce nail biopsies to the minimum necessary.MethodsDermoscopic images of nail lesions were obtained from outpatients between 2019 and 2020. The images were divided into the training set and the test set using k-fold cross validation at a ratio of 10:1. The deep learning model is developed based on the Pytorch framework. The model structure is optimized using the image segmentation model U-Net. An image segmentation module analyzed the contours of the whole nail plate and pigmented area according to the boundary features of the input images and a rule calculation module used the output information of the segmentation model to automatically analyze specific indicators referring to the “ABCDEF” rule. The model’s results were compared with those of clinical experts.ResultsFrom 550 dermoscopic images of nail lesions obtained, 500 were selected randomly as the training set, and the remaining 50 as the test set. Our image segmentation module realized automatic segmentation of the pigmented area and the whole nail plate with dice coefficient to be 0.8711 and 0.9652, respectively. Five qualitative indicators were selected in the interpretability analysis system and the models showed a certain degree of consistency with the evaluation by clinical experts, i.e., R2 for area ratio vs. breadth score was 0.8179 (P<0.001), for mean pixel value vs. pigment score was 0.7149 (P<0.001), for evenness vs. pigment score was 0.5247 (P<0.001).ConclusionsThe proposed system made accurate segmentation of the nail plate and pigmented area and achieved medically interpretable index analysis. It is potentially a primer of an intelligent follow-up system that will enable convenient and spatially unaffected management and monitoring of nail pigmentation. It may provide clinicians with understandable auxiliary information for diagnosis.

Development and Validation of a Novel Survival Model for Cutaneous Melanoma Based on Necroptosis-Related Genes.

BackgroundNecroptosis is crucial for organismal development and pathogenesis. To date, the role of necroptosis in skin cutaneous melanoma (SKCM) is yet unveiled. In addition, the part of melanin pigmentation was largely neglected in the bioinformatic analysis. In this study, we aimed to construct a novel prognostic model based on necroptosis-related genes and analysis the pigmentation phenotype of patients to provide clinically actionable information for SKCM patients.MethodsWe downloaded the SKCM data from the TCGA and GEO databases in this study and identified the differently expressed and prognostic necroptosis-related genes. Patients’ pigmentation phenotype was evaluated by the GSVA method. Then, using Lasso and Cox regression analysis, a novel prognostic model was constructed based on the intersected genes. The risk score was calculated and the patients were divided into two groups. The survival differences between the two groups were compared using Kaplan-Meier analysis. The ROC analysis was performed and the area under curves was calculated to evaluate the prediction performances of the model. Then, the GO, KEGG and GSEA analyses were performed to elucidate the underlying mechanisms. Differences in the tumor microenvironment, patients’ response to immune checkpoint inhibitors (ICIs) and pigmentation phenotype were analyzed. In order to validate the mRNA expression levels of the selected genes, quantitative real-time PCR (qRT-PCR) was performed.ResultsAltogether, a novel prognostic model based on four genes (BOK, CD14, CYLD and FASLG) was constructed, and patients were classified into high and low-risk groups based on the median risk score. Low-risk group patients showed better survival status. The model showed high accuracy in the training and the validation cohort. Pathway and functional enrichment analysis indicated that immune-related pathways were differently activated in the two groups. In addition, immune cells infiltration patterns and sensitivity of ICIs showed a significant difference between patients from two risk groups. The pigmentation score was positively related to the risk score in pigmentation phenotype analysis.ConclusionIn conclusion, this study established a novel prognostic model based on necroptosis-related genes and revealed the possible connections between necroptosis and melanin pigmentation. It is expected to provide a reference for clinical treatment.

Is dentin biomodification with collagen cross-linking agents effective for improving dentin adhesion? A systematic review and meta-analysis.

ObjectivesThe aim of this investigation was to evaluate the effectiveness of collagen cross-linking agents (CCLAs) used in combination with the adhesive technique in restorative procedures.Materials and MethodsIn this systematic review, the authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. An electronic search was performed using PubMed, Scopus, Web of Science, Cochrane Library, LILACS, and DOSS, up to October 2020. The gray literature was also researched. Only randomized clinical trials were selected.ResultsThe selection process yielded 3 studies from the 838 retrieved. The addition of CCLAs in the retention of restorations increased the number of events. The postoperative sensitivity scores and marginal adaptation scores showed no significant difference between the CCLA and control groups, and the marginal pigmentation scores showed a significant increase in the CCLA group. There were no caries events in any group throughout the evaluation period.ConclusionsThis systematic review showed that there is no clinical efficacy to justify the use of CCLAs in the protocols performed.

Evaluating the Effect of Low Power Diode Laser 806 nm on the Healing of Unilateral Cleft Lip Scar: An Open-Label Comparative Study.

To investigate the effect of laser bio-modulation irradiation therapy on the scar after surgical correction of unilateral cleft lip. a comparative, open-label study. we conducted the study in a university based tertiary hospital that recruited early wound healers of unilateral cleft lip correction. Eighty patients were divided into two groups: In study's group, patients undergo laser bio-modulation irradiation (n = 60); in the control group, patients were followed-up without intervention (n = 20). In the study's group, patients underwent low-power diode Laser with wavelength of 806 nm and power of 100 mw. The change in the scar of cleft lip patients, which was assessed by clinical examination and ultrasound. The median pigmentation score was significantly lower in the laser group (median = 1; IQR = 1-2) than the control group (median 2; IQR 1-3), with p-value of <0.001. Likewise, the median height score was significantly lower in the laser group (median = 1; IQR = 1-1) than the control group (median 1.5; IQR 1.5-2), with p-value of 0.001. The median pliability score was significantly lower in the laser group (median = 1; IQR = 1-1) than the control group (median 2.5; IQR 1-3), with p-value of <0.001. Finally, the median vascularity score was significantly lower in the laser group (median = 1; IQR = 1-1) than the control group (median 1.5; IQR 1-2), with p-value of <0.001. laser bio-modulation irradiation therapy demonstrates a potential efficacy in managing the hypertrophic scars after surgical repair of unilateral cleft lip.

Effect of Polarized Light on Post Burn Hypertrophic Scars

Background. Hypertrophic scar (HTS) formation after burn remains a major issue for burned patients and is considered a huge problem for clinicians because the hypertrophic scar is painful, reddish, elevated, pruritic, and aesthetically unacceptable. Purpose. To study the effect of polarized light therapy (PLT) on post burn HTS. Materials and Methods. Thirty patients complaining of HTS formation after thermal burn with ages ranged from 20 to 40 years shared in this study and were randomly distributed into two matching groups in number (15 patients for each group). Group A (Study group): received 10 min. PLT 3 sessions/week plus silicone gel sheet (SGS) kept for 12 hours/day, medical treatment such as (hydration creams and antihistamine drugs), and routine physical therapy (splinting, massage therapy, stretching exercises, and strengthening exercises) for 2 months. Group B (Control group): received SGS kept for 12 hours/day, medical treatment such as (hydration creams and antihistamine drugs), and routine physical therapy (splinting, massage therapy, stretching exercises, and strengthening exercises) for 2 months. Methods of evaluation included Vancouver scar scale (VSS) to measure four parameters of hypertrophic scar (height, vascularity, pigmentation, and pliability) and photographic method to allow for visual assessment of the scars. Results. Comparison between post-treatment and pre-treatment in the study group showed a significant decrease in height, vascularity, pigmentation, and pliability scores (p &gt; 0.01). There was a significant decrease in height and pliability scores of the study group in comparison with that of the control group (p &lt; 0.01), while there was no significant difference in vascularity and pigmentation between groups (p &gt; 0.05). Conclusion. PLT is an effective, easy to apply, and non-invasive treatment modality in post burn HTS.

EFFICACY OF INTRALESIONAL VERAPAMIL HYDROCHLORIDE VERSUS INTRALESIONAL TRIAMCINOLONE ACETONIDE IN HYPERTROPHIC SCARS AND KELOIDS

Background: Keloids and hypertrophic scars are dermal fibro-proliferative disorders lead to disfigurement, pain and pruritus. Their management is still challenging as there is no universally accepted treatment regimen. Corticosteroid injections, most commonly triamcinolone acetonide, continue to play a major role in the management of keloids. Verapamil is a phenylalkylamine calcium channel blocker antiarrhythmic agent that has antifibrotic effect. Objective: To compare efficacy of intralesional verapamil hydrochloride and triamcinolone acetonide in hypertrophic scars and keloids. Patients and methods: Forty Egyptian patients with keloids or hypertrophic scars were divided into two equal groups. The patients were recruited from the Dermatology outpatient clinics of Al-Zahraa University Hospital during the period from May 2016 to May 2017. Informed written consents were obtained from all patients. Group A: Intralesional Verapamil Hydrochloride. Group B: Intralesional Triamcinolone Acetonide. The efficacy of treatment was evaluated by Digital photography and Vancouver scar scale before and after treatment. Two- fine millimeter punch biopsies were taken from 5 patients of the verapamil group before and after treatment to demonstrate the histopathological changes induced by verapamil. Results: Both drugs improved total Vancouver scar scale, vascularity score and pliability score of keloid or hypertrophic scar nearly equally with no statistical significant difference. Both drugs improved height of keloid or hypertrophic scar significantly, but triamcinolone showed better improvement. Verapamil highly improved pigmentation score of keloids and hypertrophic scars, but triamcinolone showed non- significant improvement. Side effects were reported in 4 patients of triamcinolone group with no side effects in verapamil group. The histopathological examination after treatment with verapamil injection showed marked reduction of collagen deposition and alteration of the fibroblast shape (from elongated to spherical), and these changes are similar to histopathological changes which occur after corticosteroids injection. Conclusion: Verapamil was among the several therapeutic modalities, have an option for keloids and hypertrophic scars with an extremely low cost and fewer adverse effects.

Changes of trabecular meshwork pigmentation in patients with pigment dispersion syndrome: A 15-year study.

To report the changes of trabecular meshwork (TM) pigmentation and clinical outcomes of patients with pigment dispersion syndrome (PDS) after resolution of reverse pupillary block.Twenty one eyes of 11 PDS patients were followed up periodically for 15 years after resolution of reverse pupillary block with either Nd: YAG laser peripheral iridotomy (LPI) or trabeculectomy. Visual acuity (VA), best-corrected visual acuity (BCVA), slit lamp examination, intraocular pressure (IOP), Humphrey visual field analysis (VFA), gonioscopy and stereoscopic funduscopy were performed on admission and every 6 months postoperatively. TM pigmentation was quantitatively evaluated and graded every 5 years after the treatment, in which the circumference of anterior chamber angle was divided into 4 quadrants: superior, inferior, nasal and temporal. Postoperative IOP, VA, BCVA, VFA, TM pigmentation and adjunctive anti-glaucoma medications were main outcome measurements and compared with baseline.Eleven patients (9 males, 2 females) were identified as PDS according to the diagnostic criteria, with average age of 38.25 ± 6.93 years (range, 31–55 years) at initial diagnosis. The mean IOP level was 33.1 ± 9.8 mmHg (range, 22–56 mmHg) at diagnosis. Ten PDS eyes received LPI, and the other eleven eyes underwent uneventful trabeculectomy. The median TM pigmentation score of the 21 PDS eyes was 16 (interquartile range [IQR], 15–16) on admission, which changed to 14 (IQR, 13–15), 13 (IQR, 12–14), 12(IQR, 10.5–12) at 5-, 10-, 15-year follow-up visits respectively. The decrease rate of TM pigmentation was 37% in inferior quadrant, while in nasal, temporal, and superior quadrant the reduction rate was 28%, 23%, and 18%, respectively, at the last follow-up visit. Majority of these enrolled eyes (19/21) had stable VA and BCVA with average endpoint IOP of 15.1 ± 3.4 mmHg.TM pigmentation in PDS patients attenuates with time after reverse pupillary block was resolved, in which the inferior quadrant seems faster than the other quadrants.

Outdoor sunscreen testing with high-intensity solar exposure in a Chinese and Caucasian population.

BackgroundCurrently, sunscreens' sun protection factor (SPF) and ultraviolet (UV) A protection are tested separately under indoor conditions, without considering external conditions that may affect performance. Studies are often conducted in Caucasian individuals; other racial groups may respond differently.MethodsAn outdoor, double‐blind, intra‐individual study was performed in 63 healthy Chinese and Caucasian volunteers in Singapore. Subjects underwent one outdoor sun exposure lasting 2‐3 hours. ISO reference products P3 (SPF 15), P5 (SPF 30), and P8 (SPF 50+) applied at 2 mg/cm2 were compared against each other and against an untreated exposed area (positive control) and an unexposed area (negative control). Endpoints were investigator global assessment (IGA) of erythema at 24 hours, IGA of pigmentation at 1 week, and colorimetry (a*, L*, and ITA) at 24 hours and 1 week.ResultsClinical erythema and pigmentation scores were statistically significantly different among the three sunscreens, with the highest SPF product providing the highest protection, confirming the discriminatory capacity of the model used. Colorimetric assessment correlated well with clinical evaluation.ConclusionThis study confirmed the feasibility of ranking sunscreens (at 2 mg/cm2) based on clinical effects of high‐intensity outdoor solar radiation. Larger studies are needed to look at differences in erythema and pigmentation reactions between Chinese and Caucasian individuals, which could be relevant for photoprotection.

A split-face study evaluating the efficacy of a topical antioxidant cream containing tocotrienol after 1064-nm picosecond Nd:YAG laser treatment for environment-induced skin pigmentation

Background This study aimed to evaluate the efficacy and safety of a topical antioxidant cream containing tocotrienol after 1064-nm picosecond neodymium-doped yttrium aluminum garnet (Nd:YAG) laser treatment for environment-induced skin pigmentation.Methods A split-face study was conducted between December 2020 and March 2021 in 26 patients (25 women and one man) who were treated with a 1064-nm picosecond Nd:YAG laser. On the right side of the face, an antioxidant cream containing tocotrienol was applied after picosecond laser treatment, and on the left side, only picosecond laser treatment was performed. We compared the right and left sides of the face at 4 weeks after laser treatment using an automatic skin analysis device to investigate skin pigmentation. The melasma severity scores of the two sides were evaluated before and 4 weeks after picosecond laser treatment.Results The skin pigmentation score showed a significant difference between pretreatment and 4 weeks after picosecond laser treatment on both sides of the face (P&lt;0.001), and there was a significant difference in skin pigmentation score improvement between the right and left sides (P&lt;0.001). The melasma severity score showed a significant difference on the right side between pretreatment and 4 weeks after laser treatment (P&lt;0.001), but there was no significant change on the left side (P&gt;0.05).Conclusions Our results show that, for the treatment of environment-induced skin pigmentation, the application of a tocotrienol-containing antioxidant cream after 1064-nm picosecond laser treatment can provide good results without any complications.