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BACKGROUND Melasma is a common esthetic problem affecting the face with a lot of risk factors being incriminated. Although several treatment options are available, none of them is satisfactory. OBJECTIVE This split face prospective study aimed to compare the efficacy of microneedling with vitamin C versus with PRP in the management of mixed melasma. METHODS Ten females with bilateral mixed facial melasma were treated with six sessions of microneedling. After the needling vitamin C was applied on the right side of the face and PRP was applied on the left side. Clinical, dermoscopic, and histological assessment of the used treatments was done 1 month after the last session. RESULTS The clinical and dermoscopic clearance of melasma was proved significantly on both sides of the face but was more significant with vitamin C (P = 0.005). Reduction of epidermal melanin and dermal melanophages was more observed with vitamin C. Moreover, MART-1 stain revealed a more significant reduction in the epidermal, dermal, and the total MART-1 positive cells with vitamin C (P =0.044, 0.039, and 0.035 respectively). CONCLUSION Microneedling with vitamin C was more efficient in treating mixed melasma than with PRP.

BACKGROUND Postacne scars are still a challenge in its management. Microneedling is a popular minimally invasive technique in treatment of such scars. However, the addition of topical stem cell products after microneedling is considered a new treatment regimen for these scars. OBJECTIVE To compare efficacy of amniotic fluid-derived mesenchymal stem cell-conditioned media (AF-MSC-CM) and microneedling vs microneedling alone in management of atrophic acne scars. METHODS Ten cases with atrophic postacne scars received five sessions of microneedling, with 2-week interval on both sides of the face. Then, AF-MSC-CM was topically applied to right side of the face after microneedling. Clinical examination with histopathological and computerized histometric analysis was done 1 month after the sessions. RESULTS There was significant increase in the improvement percentage of acne scars on right side (dermaroller and AF-MSC-CM) vs left side of face (dermaroller; P

Background Pityriasis alba is a common skin condition that may be challenging to treat, especially in patients with darker skin type where the hypopigmentation may be more noticeable and represents a major cosmetic concern. Objectives This study aims to evaluate the efficacy of three cost-effective treatments of PA in comparison with placebo. Patients/methods This prospective study was conducted on 80 patients complaining from PA and divided into 4 equal groups according the received topical treatment on the target lesions twice daily for 8 weeks (Calcipotriol 0.005% cream, Tacrolimus 0.03% ointment, topical corticosteroid; Clobetasone butyrate 0.05% cream and Petrolatum as Placebo). Clinical evaluation, Physician Global Assessment, Patient's satisfaction levels as well as point counting planimetry were done for evaluation of the response. Results Significant improvement of scaling and erythema within 3 weeks after initiation of therapy and hypopigmentation by the 8th week, except for those received placebo. Tarolimus 0.03% ointment showed simple superiority over both Calcipotriol 0.005% cream and topical corticosteroid as regards repigmenation, although, the later received the highest level of patient satisfaction. Conclusion The three treatments were superior to placebo with relative superiority to Tacrolimus 0.03% due to limited side effects.

Shaimaa Mosallam,1 Maha H Ragaie,2 Noha H Moftah,2 Ahmed Hassen Elshafeey,3 Aly Ahmed Abdelbary3,4 1Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, October 6 University, Giza, Egypt; 2Department of Dermatology, STD’s and Andrology, Faculty of Medicine, Minia University, Al-Minya, Egypt; 3Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt; 4School of Life and Medical Sciences, University of Hertfordshire Hosted by Global Academic Foundation, Cairo, EgyptCorrespondence: Aly Ahmed AbdelbaryDepartment of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini, Cairo 11562, EgyptTel +201149005526Email aly.abdelbary@pharma.cu.edu.egPurpose: This manuscript aimed at encapsulating an antifungal terconazole (TCZ) into innovative novasomes for improving its penetration into the skin and clinically modulating its therapeutic efficacy.Methods: Novasomes containing free fatty acid (FFA) as a penetration enhancer were formulated using ethanol injection technique based on 24 full factorial design to explore the impact of various formulation variables on novasomes characteristics regarding entrapment efficiency percent (EE%), particle size (PS), polydispersity index (PDI), and zeta potential (ZP). The optimum formulation was chosen using Design-Expert® software and utilized for further explorations.Results: The chosen formulation (N15; including 100 mg lipid components and Span 80 to oleic acid in a ratio of 2:1 (w/w)) exhibited an EE% = 99.45 ± 0.78%, PS = 623.00 ± 2.97 nm, PDI = 0.40 ± 0.04, and ZP = − 73.85 ± 0.64 mV. N15 showed spherical vesicles with a higher deformability index (DI) (9.62 ± 0.15 g) compared to traditional niosomal formulation (0.92 ± 0.12 g). Further, N15 showed superior inhibition of Candida albicans growth relative to TCZ suspension using XTT (2,3-bis-(2-methyloxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide) reduction assay. Moreover, in vivo skin deposition tests revealed a superior TCZ deposition inside the skin from N15 in comparison to traditional niosomal formulation and TCZ suspension. Furthermore, histopathological examination for rats assured the safety of N15 for topical use. A clinical study conducted on infants suffering from napkin candidiasis proved the superiority of N15 to placebo in providing a complete cure of such fungal infections.Conclusion: Concisely, the obtained outcomes confirmed the pronounced efficacy of N15 to successfully treat skin fungal infections.Keywords: terconazole, novasomes, free fatty acid, XTT reduction assay, skin deposition, clinical study

Background Acne vulgaris is a multifactorial inflammatory disease. Resistin gene is believed to play a role in inflammatory diseases by triggering the release of some cytokines. Objective The aim was to investigate resistin gene polymorphisms in patients with acne and the relation between the gene polymorphisms and serum lipid levels in Egyptian patients with acne. Patients and methods A total of 50 Egyptian patients with acne vulgaris and 50 healthy controls were enrolled in this case–control study. Global acne grading system was used to assess the severity of acne. PCR-RFLP technique was used to detect polymorphisms of RETN +299G>A and RETN −420C>G, and the serum lipids are measured in all patients and controls. Results RETN gene polymorphisms at −420C>G genotype distribution showed a significant difference between patients and control groups in CG and GG genotypes. Participants carrying G allele were significantly more likely to develop acne vulgaris. There was a significant difference between patients and control groups in the frequency of distribution of GA and AA genotypes in RETN gene polymorphisms at +299G>A. There were significant positive correlations between both RETN gene polymorphisms and acne severity, total cholesterol, and low-density lipoprotein. Conclusion RETN gene polymorphisms at −420C>G and +299G>A are significantly associated with serum lipids and severity of acne vulgaris in Egyptian populations. Thus, RETN may play a central role in acne pathogenesis through its dual effects on both lipid metabolism and inflammation.

BACKGROUND The use of stem cells derived growth factors is representing a novel treatment modality in facial rejuvenation. Nowadays, skin needling is considered a very famous treatment of skin aging. However, the addition of such derived products, augments its therapeutic efficacy in the management and delay of skin aging. OBJECTIVE Comparing the effect of amniotic fluid mesenchymal stem cell derived conditioned media (AF-MSC-CM) combined with skin needling versus the needling alone in the management of facial aging. METHODS Both sides of the face of ten volunteers, suffering from facial aging, were treated with five sessions of skin needling, 2 weeks apart. After skin microneedling, AF-MSC-CM was added topically to the right side only. Clinical, histological, and morphometrical assessment of the treated skin was done at 1 month after the last session. RESULTS The percentage of improvement of aged skin increased significantly on the combined treated side (AF-MSC-CM and dermaroller [DR]), when compared with the other side (DR only) (P

Acne vulgaris is a common inflammatory skin disorder. It affects the pilosebaceous units followed by an overgrowth by Propionibacterium acne bacteria. Dapsone is a sulfone antibiotic with an anti-inflammatory effect, which is considered to be accountable for its effectiveness in the treatment of acne vulgaris. The present study aims to prepare and evaluate the effectiveness of dapsone niosomes for topical application with an objective to control and prolong the release of the drug with improved skin penetration as a novel formulation for healing of mild to moderate acne vulgaris. Niosomes were formulated by thin film hydration method using different ratios of surfactants (various spans 20, 40, 60 and 80) and cholesterol and were investigated with respect to its shape, size, entrapment efficiency, Fourier transform infrared spectroscopy (FTIR) and in vitro release. Fifteen patients with mild to moderate acne vulgaris were selected and treated with dapsone niosomes as a single topical treatment for their acne lesions. Clinical assessment was done before and after 2 and 8 weeks of treatment. Niosomes containing span 60 showed a higher percentage of drug release after 24 h and greater entrapment efficiency as compared to other formulations. The clinical improvement was noticeable after 2 weeks of treatment with highly significant improvement of acne lesions after 8 weeks of treatment (P < 0.001). Dapsone niosomes is a promising topical formulation for safe, tolerable and effective drug delivery system with minimal side effects apart from mild erythema and post-inflammatory hyperpigmentation. Key words: Dapsone, acne vulgaris, niosomes, topical, clinical application.

Background Viral warts are known for their persistence and recurrence, causing frustration to patients and treating physicians. Researchers recently proposed the hypothesis that intralesional vitamin D3 would be an effective treatment option for warts. Objective To assess the efficacy of intralesional injection of vitamin D3 in the treatment of cutaneous warts by clinical and dermoscopic evaluation. Patients and methods Sixty-two patients with single or multiple warts were randomized into two groups, groups I and II, who were treated with intralesional vitamin D3 and normal saline, respectively. Injections were performed every 2 weeks for a maximum of four sessions. All patients were followed up for 6 months. Results Complete cure was reported in 56.25% of patients treated by intralesional vitamin D3. No serious adverse effects or allergic reactions were reported. None of the healed wart recurred by the end of follow-up period. Conclusion Vitamin D3 is an effective and safe treatment option in treating cutaneous warts. The use of dermoscopy adds a great value in evaluating treatment response and in decreasing the incidence of recurrence.

Re-pigmentation and stabilization are the two ultimate goals of any re-pigmenting plan designed for vitiligo management. Furthermore, whether the improvement of some vitiligo lesions could be considered a guarantee for a similar response and/or stabilization of the rest of the lesions or not, remains to be clarified. To evaluate the behavior of non-segmental vitiligo (NSV), while on narrow band-ultraviolet B (NB-UVB) phototherapy. 25 patients with stable generalized NSV were included and received NB-UVB twice weekly. For the sake of ensuring accuracy of follow up, up to four lesions were randomly chosen in each patient and regularly measured using the point counting technique. The over-all point counting technique of all included patients showed a significant reduction (18.5 ± 8.4 cm2 to 8.2± 3.1 cm2) after 6 months of therapy (p

Background Melasma is an acquired disorder of symmetrical hypermelanosis that involves sun-exposed areas of the skin. Although multiple therapeutic modalities have previously been tried, successful, truly effective treatment options for this condition have been few and quite elusive. Objectives To compare the therapeutic efficacy of topical tranexamic acid (TXA) with microneedling versus microneedling alone in the treatment of melasma and to evaluate the changes that occur clinically, histologically, and immunohistochemically. Patients and methods This study was conducted on 42 patients with melasma, randomly divided into two groups. In group I, each patient was subjected to a series of six sessions of skin microneedling and TXA application, whereas in group II, six sessions of microneedling alone were performed, with 2-week interval. Results Clinically, the mean melasma area and severity index (MASI) score was significantly decreased in both groups with statistically significant higher reduction scores in group I compared with group II. Histopathologically, epidermal hyperpigmentation and dermal melanophages were significantly reduced after treatment with more obvious reduction in group I. The number of melanoma antigen recognized by T cells-1-positive cells showed significant reduction in both groups; this reduction was statistically higher in group I than group II. Conclusions Although microneedling alone produced significant lightening effect, topical TXA combined with microneedling achieved more satisfactory results.

Background and aims Vitiligo is an acquired pigmentary disorder of skin and hair. Active melanocytes in hair follicles can be detected by DOPA and immunohistochemical staining, while amelanotic melanocytes can only be detected by the latter. None of the studies on hair melanocytes in vitiligo discussed the effect of disease duration on these melanocytes. Here, we study the presence of melanotic and amelanotic melanocytes in vitiligo hair follicles and statistically correlating their presence with the disease duration. Methods This study was conducted on 30 patients with vitiligo and 10 normal volunteers. Three biopsies were taken from each patient: two from black and white hairs from vitiliginous areas and the third from apparently normal skin of the same patients. Sections were stained by DOPA reaction and NKI/beteb then examined for the presence of melanocytes. The presence of melanocytes and the disease duration were correlated statistically using the t-test. Results Active melanocytes were detected in black hairs of 6.7% of vitiligo patients and in 100% of apparently normal skin of the same patients and controls. On examining black hairs of the 28 vitiligo patients with negative DOPA reaction, 19 of them (67.9%) showed positive NKI/beteb stain. Disease duration was inversely correlated with the melanocytes’ presence within hair follicles. Melanocytes were absent from 100% of white hairs. Conclusions The melanotic melanocytes were the first target of the disease process followed by the amelanotic melanocytes. Since the disappearance of the latter was inversely correlated with the disease duration, early treatment in vitiligo is advised. Conflicts of interest None declared.