Search

Die Behandlung der Nagelpsoriasis ist wegen mangelnder Penetration topischer Therapeutika durch die Nagelplatte häufig unbefriedigend. Daher sind innovative Methoden zur adäquaten Verabreichung des Arzneimittels in den Nagel erforderlich. In dieser Studie vergleichen wir die Wirksamkeit der intraläsionalen Corticosteroid-Injektion mit topischer Applikation nach fraktionierter COIn der Studie wurden 36 Patienten mit Fingernagelpsoriasis in zwei Gruppen eingeteilt. Bei Gruppe A wurden die Nägel mit intraläsionalen Injektionen von Triamcinolon behandelt, in Gruppe B durch fraktionierte COBeide Modalitäten führten zu signifikanter Besserung der Psoriasis an Nagelmatrix und Nagelbett. Statistisch signifikante Unterschiede zwischen den Gruppen bestanden weder klinisch noch dermatoskopisch. Die Laserbehandlung war mit signifikant geringeren Schmerz-Scores (P = 0,03) und höherer Patientenzufriedenheit (P = 0,007) verbunden.Die fraktionierte CO

Background The treatment of warts is challenging and the development of an antiviral drug that can eradicate the human papilloma virus (HPV) is difficult. The viral origin of warts suggests that acyclovir, an antiviral drug with a proven efficacy in DNA viruses, may be a potential therapeutic option. Aim To evaluate the efficacy and safety of intralesional acyclovir in the treatment of cutaneous warts. Methods Thirty-one patients with cutaneous warts were allocated into 2 groups. Group A (19 patients) had intralesional acyclovir (70 mg/ml) injected into the warts, while group B (12 patients) received intralesional saline as control. The treatment was repeated at 2 week intervals until complete clearance or for a maximum of 5 sessions. Results Complete clearance of warts was observed in 52.6%, partial response in 36.8%, and no response in 10.5% of the patients in the acyclovir group. Partial response was reported in 16.7%, and no response in 83.3% of the patients in the control group. A high statistically significant difference was found between the treatment and control groups ( P < .01). Adverse effects included pain during injection in 89.5%, blistering in 52.6% and erythema in5.3% of the patients. No recurrence was detected during the follow-up period. Conclusion Intralesional acyclovir can be an effective and well-tolerated treatment modality for cutaneous warts.

Das klassische Erythema nodosum leprosum (ENL) ist klinisch durch plotzliches Auftreten druckempfindlicher erythematoser Knoten, Papeln und Plaques charakterisiert. Daneben wurden verschiedene atypische Muster, wie pustuloses, bulloses, ulzeriertes, nekrotisches und Sweet-Syndrom-artiges ENL beschrieben. Wir geben eine Ubersicht bisher dokumentierter Falle atypischer ENL und gehen dabei auf diagnostische und therapeutische Aspekte dieser selteneren Formen ein. Dazu wurde die medizinische Literatur in der Datenbank PubMed nach allen Fallen atypischer ENL bis zum Jahr 2020 durchsucht. Die Daten von Patienten mit atypischem ENL wurden erfasst und hinsichtlich epidemiologischer, klinisch-histologischer und therapeutischer Aspekte analysiert. Die funf hauptsachlich beschriebenen klinischen Formen des atypischen ENL sind vesikular-bullose (46 % der Patienten), ulzeros-nekrotische (41 %), Erythema-multiforme-artige (28 %), Sweet-Syndrom-artige (11 %) und pustulose Lasionen (9 %). Bei allen Patienten wurden die Hautveranderungen von Fieber und Allgemeinsymptomen begleitet. Die meisten Patienten wurden oral mit Steroiden und Thalidomid therapiert. Dermatologen und Pathologen sollten die klinische Variabilitat des ENL kennen, um Fehldiagnosen und verzogerte Behandlungen zu vermeiden. Die fruhzeitige Erkennung kann die Kontrolle der Krankheitsprogression unterstutzen und die Patienten vor weiteren Komplikationen schutzen.

BackgroundIntralesional immunotherapy has been effectively used in the treatment of warts; however, comparative studies between different antigens are limited.ObjectiveTo evaluate the efficacy and safety of intralesional measles, mumps, and rubella (MMR) vaccine compared with intralesional Candida antigen for the treatment of multiple common and plantar warts.MethodsSixty-eight adult patients with multiple common and plantar warts were randomly assigned into two groups, each containing 34 patients. The first group received intralesional MMR vaccine, while the second group received intralesional Candida antigen. Each treatment was injected into the largest wart at 2-week intervals until complete clearance or for a maximum of 5 sessions.ResultsThe overall therapeutic response was higher in the Candida antigen group (73.5%) compared with the MMR group (67.7%); however, the difference was not statistically significant. Complete clearance of common warts was higher in the Candida antigen group, while that of plantar warts was higher in the MMR group. Adverse effects were transient and well tolerated in both groups. No recurrence was detected during the 6-month follow-up period.ConclusionIntralesional MMR and intralesional Candida antigen showed comparable efficacy and safety in the treatment of common and plantar warts.

Hintergrund und zielsetzungen Bei Patienten mit ausgedehnter Vitiligo wurden verschiedene Methoden zur Entfernung der Restpigmentierung im Gesicht angewendet. Es gibt jedoch nach wie vor kein ideales Depigmentierungsmittel. Kurzlich wurde uber die Verwendung von Trichloressigsaure (TCA) zur Depigmentierung bei universeller Vitiligo berichtet. Unser Ziel ist die Prufung der Wirksamkeit und Sicherheit von 100 % TCA zur Depigmentierung bei therapieresistenter Gesichtspigmentierung bei Patienten mit universeller Vitiligo in Agypten. Patienten und methoden Die Studie umfasste 50 Patienten mit universeller Vitiligo und Restpigmentierung im Gesicht, die psychische Belastungen verursachte. Trichloressigsaure wurde in einer Konzentration von 100 % fokal auf die pigmentierten Stellen aufgetragen. Die Behandlung wurde alle zwei Wochen bis zur vollstandigen Depigmentierung oder in maximal funf Behandlungssitzungen wiederholt. Ergebnisse Bei 80 % der untersuchten Falle war das Ansprechen auf die TCA-Behandlung ausgezeichnet (> 90 % Depigmentierung). Bei 12 % lag ein partielles Ansprechen (50-90 % Depigmentierung) vor, und bei 8 % war das Ansprechen unzureichend ( Schlussfolgerungen Trichloressigsaure scheint eine kostengunstige und gut vertragliche Therapieoption zur Behandlung therapieresistenter Restpigmentierungen bei Patienten mit ausgedehnter Vitiligo zu sein. Die Behandlung ist mit kurzeren Ausfallzeiten und minimalen Nebenwirkungen verbunden.

Nail psoriasis has a major negative impact on physical and psychological aspects of the patient's life. Treatment is often unsatisfactory because of difficult penetration of the drug into the nail.To evaluate and compare the efficacy of laser-assisted delivery of methotrexate versus its intralesional injection in fingernail psoriasis.Twenty-eight patients with fingernail psoriasis were divided into 2 groups of 14 patients each. Group A was treated with intralesional injection of methotrexate while Group B received fractional CO2 laser followed by topical application of methotrexate. The treatment was given at a 2-week interval for 6 sessions. The improvement of nail psoriasis was assessed by clinical and dermoscopic evaluation.At the end of treatment, both laser-assisted delivery and intralesional injection of methotrexate were associated with statistically significant improvement of psoriatic signs. No statistically significant difference was found between the 2 groups regarding total nail psoriasis severity Index (p = .18), matrix score (p = .38), bed score (p = .23), and dermoscopic score (p = .78). However, the pain and subungual hematoma were significantly less in the laser group (p.001 and p = .03, respectively).Fractional CO2 laser-assisted delivery of methotrexate can be an effective and well-tolerated alternative to intralesional injection in nail psoriasis.

BACKGROUND AND OBJECTIVES Several modalities have been used to clear residual facial pigmentation in patients with extensive vitiligo; however, the ideal depigmenting agent does not yet exist. The use of trichloroacetic acid (TCA) for depigmentation in universal vitiligo has been recently reported. We aim to evaluate the efficacy and safety of TCA 100 % as a depigmenting therapy for recalcitrant facial pigmentation in Egyptian patients with universal vitiligo. PATIENTS AND METHODS The study included 50 patients with universal vitiligo who had residual spotted pigmentation on the face causing psychological distress. TCA was focally applied to cover the pigmented patches at 100 % concentration. The treatment was repeated every two weeks until complete depigmentation or for a maximum of five treatment sessions. RESULTS Excellent response to TCA treatment (> 90 % depigmentation) was reported in 80 % of the studied cases, partial response (50-90 % depigmentation) in 12 % and poor response (

BACKGROUND Treatment of warts in diabetic patients with ablative modalities poses a significant risk owing to increased possibility of secondary infection, slow healing, and recurrence. Intralesional immunotherapy has gained popularity in the treatment of warts due to its proven efficacy and good tolerability compared with destructive methods. AIM To evaluate the intralesional Candida antigen injection for the treatment of multiple warts in diabetic patients. PATIENTS/METHODS Fifty diabetic patients with multiple genital/nongenital warts were divided into two groups. The first group (30 patients) received intralesional Candida antigen, and the second group (20 patients) had intralesional saline as control. The treatments were injected into the largest wart every 2 weeks until complete clearance of warts or for a maximum of five sessions. RESULTS Complete clearance of warts was observed in 80% of the diabetic patients in the Candida antigen group compared with 15% in the control group (P

Background Despite the recent advances in the treatment of vitiligo, results are still largely unsatisfactory and many patients show either weak or no response to treatment. Few clinical trials have investigated the use of trichloroacetic acid (TCA) to induce repigmentation in stable vitiligo. Objective To evaluate the efficacy and safety of TCA, in different concentrations, for the treatment of stable localized vitiligo. Methods The study included 100 patients with acral/nonacral stable vitiligo. Trichloroacetic acid was applied, as a monotherapy, to the vitiliginous patches at different concentrations according to the treated site every 2 weeks until complete repigmentation or for a maximum of 6 treatment sessions. Follow-up was done every month for 6 months to detect any recurrence. Results Eyelid vitiligo showed the highest response to TCA treatment (excellent response in 80% of cases), followed by the face, trunk, and extremities. Lower response rates were noticed in the hands and feet vitiligo. Adverse effects were transient and insignificant in few patients. Conclusion Trichloroacetic acid seems to be a potential, cost-effective, well-tolerated therapeutic option for the treatment of vitiligo in the adults and pediatric populations.

Candida antigen injection is one of the most widely used intralesional immunotherapy in the treatment of warts. It acts through the induction of systemic immune response. The pattern of cytokines production may play an integral role in its mechanism of action.To investigate the possible relation between serum levels of IL17 and MIF, and the clinical response to intralesional Candida antigen in multiple common warts.A total of 90 patients with multiple common warts were divided into 2 groups. Sixty patients received intralesional Candida antigen injection into the largest wart, controlled against thirty patients who had intralesional saline, as placebo. The injection was done at a 2-week interval for 5 doses. Blood samples were obtained from both groups, and serum levels of IL17A and MIF were estimated at baseline and 2 weeks after the last session using ELISA kits.Complete clearance of warts was statistically higher in the Candida antigen group (40% of the patients) compared to the saline group (p 0.05). The serum levels of IL17 had significantly declined from baseline, while the level of MIF had risen after intralesional Candida antigen injection, but not in the saline group. At a cutoff level of 316 pg/ml, IL17 had a sensitivity of 83.3% to predict therapeutic response.IL17A and MIF may have possible roles in the mechanism of action of Candida antigen in the treatment of common warts. At a certain level, serum IL17A may be a potential predictor of response to treatment.

The treatment of nail psoriasis is often unsatisfactory due to poor penetration of topical therapeutics through the nail plate. The development of innovative methods that provide adequate delivery of the drug into the nail is warranted. In this study, we aim to compare the efficacy of intralesional corticosteroid injection versus its topical application after fractional COThe study included 36 patients with fingernail psoriasis divided into two groups. The nails in group A were treated with intralesional injection of triamcinolone acetonide while the nails in group B received fractional COBoth modalities yielded a significant improvement of the nail matrix and bed psoriatic signs. No statistically significant difference was found between the two groups by both clinical and dermatoscopic assessment. The laser treatment was associated with significantly lower pain scores (P = 0.03) and higher patient satisfaction (P = 0.007).Fractional CO

H syndrome is a rare autosomal recessive disorder with clinical features comprising: hyperpigmentation, hypertrichosis, hearing loss, heart anomalies, low height, hypogonadism and hepatosplenomegaly. H syndrome results from loss-of-function mutations in SLC29A3 which leads to abnormal proliferation and function of histiocytes. Herein, we discuss the considerable phenotypic heterogeneity detected in a consanguineous Egyptian family comprising of four affected siblings, two of which are monozygotic twin and the possible therapeutics. The phenotypic variability may be attributed to the role of histiocytes in the tissue response to injury. Such variable expressivity of H syndrome renders the diagnosis challenging and delays the management. The different treatment approaches used for this rare entity are reviewed.

Background The treatment of dilated facial pores is difficult, and the ideal modality is not established yet. Different ablative and nonablative lasers have been used in the treatment of dilated pores with variable outcomes. Aim To evaluate and compare the efficacy of fractional CO2 laser versus carbon-assisted Q-switched Nd: YAG laser in dilated facial pores. Methods The study included 80 patients with dilated pores divided into two groups each containing 40 patients. Group (A) had fractional CO2 laser treatment, and group (B) received Q-switched Nd: YAG laser treatment after the application of a carbon solution on the face. The treatment was repeated monthly for a total of 3 sessions. Objective and subjective assessments of the clinical outcome were performed. Results Both modalities significantly improved the dilated pores; however, the clinical response was statistically higher and the improvement was maintained for a longer duration of time in the factional laser group compared with the carbon-assisted Q-switched Nd: YAG laser group (p = 0.01). The downtime was significantly lower in the Q-switched Nd: YAG laser group, and the patients' satisfaction rates were comparable in both groups. Conclusion The two laser systems appear to be effective, safe, and well-tolerated in the treatment of dilated pores. The fractional CO2 laser was associated with a significantly higher and more prolonged clinical response.

BACKGROUND Treatment of acanthosis nigricans (AN) is challenging, and new modalities are being explored continuously to increase the therapeutic efficacy. AIM To evaluate the efficacy and safety of fractional CO2 laser compared to trichloroacetic acid (TCA) peel in the treatment of pseudo-acanthosis nigricans (pseudo-AN). METHODS The study included 40 patients with pseudo-AN on the neck and axilla allocated into two groups each containing 20 patients. Group (A) was treated with TCA 20% peel applied on the pigmented area while group (B) received fractional CO2 laser. Both treatments were performed till complete clearance or for a maximum of four treatment sessions. Patients with excellent response were further followed up for 6 months after the end of treatment. RESULTS Both modalities were effective in the treatment of pseudo-AN; however, the therapeutic response was significantly higher in the fractional CO2 laser group compared to the TCA peel group (p

Intralesional immunotherapy has been effectively used in the treatment of warts; however, comparative studies between different antigens are limited.To evaluate the efficacy and safety of intralesional measles, mumps, and rubella (MMR) vaccine compared with intralesionalSixty-eight adult patients with multiple common and plantar warts were randomly assigned into two groups, each containing 34 patients. The first group received intralesional MMR vaccine, while the second group received intralesionalThe overall therapeutic response was higher in theIntralesional MMR and intralesional

Background Intralesional immunotherapy using different types of antigens is considered an effective and safe treatment option for different types of warts. However, there are few studies that illustrate the use of these antigens in the treatment of periungual warts as a distinct type of warts. Objective To evaluate the efficacy and safety of three antigens: measles, mumps, rubella (MMR) vaccine, Candida antigen, and purified protein derivative (PPD) in the treatment of periungual warts. Methods The study included 150 patients who were randomly assigned to 3 groups with 50 patients in each. Each agent was injected intralesionally at a dose of 0.1 mL into the largest wart at 2-week intervals until complete clearance or for a maximum of 5 sessions. Results Complete clearance of warts was observed in 70%, 80%, and 74% in PPD, Candida antigen, and MMR vaccine groups, respectively. There was no statistically significant difference regarding the therapeutic response between the 3 studied groups. Adverse effects were transient and insignificant in the 3 groups. No recurrence of the lesions was reported in any of the studied groups. Conclusions Intralesional antigen immunotherapy seems to be an effective therapeutic option for the treatment of periungual warts.

BACKGROUND Topical antifungals are the most commonly used therapy in white piedra of the scalp. However, persistence and relapse of infection still pose a significant challenge. Systemic antifungals have been recommended to enhance the therapeutic response. AIMS To compare the efficacy of topical antifungal alone versus combined topical and oral antifungals in the treatment of white piedra of the scalp. METHODS Sixty patients with white piedra of the scalp were divided into 3 groups, each containing 20 patients. Group A received topical clotrimazole, group B received combined topical clotrimazole and oral itraconazole, and group C received combined topical clotrimazole and oral terbinafine. The treatment was continued until clearance of infection was confirmed by dermoscopic and mycological examination. Positive responders were followed up for 3 months after treatment. RESULTS All the patients achieved complete clearance of infection. The median treatment time in group B was significantly shorter than group A (P

Classic erythema nodosum leprosum (ENL) is characterized clinically by abrupt eruption of tender erythematous nodules, papules and plaques. Variable atypical patterns have been described, for example pustular, bullous, ulcerative, necrotic and Sweet's syndrome-like ENL. We aim to review previously reported cases of atypical ENL addressing the diagnostic and therapeutic aspects of these uncommon presentations. A search of medical literature for all cases of atypical ENL was conducted in the PubMed database till 2020. Data of patients with atypical ENL were collected and analyzed to describe the epidemiological, clinico-histological and therapeutic features. The major five clinically described presentations of atypical ENL include vesiculo-bullous lesions (46 % of patients), ulcero-necrotic lesions (41 %), erythema multiforme-like lesions (28 %), Sweet's syndrome-like lesions (11 %) and pustules (9 %). The skin lesions were accompanied by fever and constitutional symptoms in all patients. Oral steroids and thalidomide were the main lines of therapy in most of the reported patients. Dermatologists and pathologists should keep in mind the clinical variability of ENL to avoid misdiagnosis and delayed management. Early recognition can help control disease progression and save the patients from further complications.

Background The prevalence of anogenital warts is increasing in adults as well as in pediatric population. The treatment of anogenital warts is challenging, particularly in children as most conventional modalities are painful and associated with high recurrence rates. Objectives To evaluate the efficacy and safety of intralesional immunotherapy for the treatment of anogenital warts in pediatric patients. Methods Forty child presenting with multiple anogenital warts were randomly assigned into 3 groups. The first group (15 patients) received intralesional MMR vaccine, the second group (15 patients) received intralesional Candida antigen and the third group (10 patients) received intralesional saline as a control. Each modality was injected into the largest wart at 2-week intervals until complete clearance or for a maximum of 5 sessions. Results Highly significant difference was found between the therapeutic response of anogenital warts to both MMR vaccine and Candida antigen compared to intralesional saline (p = .005). No significant difference was observed between MMR vaccine and Candida antigen groups (p = .885). Side effects were mild and no recurrence was detected in the 6 month follow-up period. Conclusions Intralesional immunotherapy is a promising effective and well-tolerated treatment modality for multiple anogenital warts in children.

Intralesional immunotherapy by different antigens has shown promising efficacy and safety in the treatment of warts. However, the use of these antigens for the treatment of plane warts has been investigated in two studies only. To evaluate the efficacy and safety of three antigens; Measles Mumps, Rubella vaccine (MMR), Candida antigen, and purified protein derivative (PPD) in the treatment of multiple plane warts. The study included 120 patients who were randomly assigned to three groups, 40 patients in each group. Each agent was injected intralesionally at a dose of 0.1 mL into the largest wart at 2-week intervals until complete clearance or for a maximum of five sessions. Complete clearance of warts was observed in 55% of the PPD group, in 70% of the Candida antigen group, and in 62.5% of the MMR group. No statistically significant difference in the therapeutic response was found between the three groups. Intralesional antigen immunotherapy seems to be a promising well-tolerated and effective therapeutic option for the treatment of multiple plane warts, with relatively higher efficacy of Candida antigen.

Background The burden of human papillomavirus (HPV) infection and HPV-associated diseases is consistently growing worldwide. Several combination therapies are being tested nowadays for the treatment of recalcitrant warts, with promising results. Aims To evaluate the potential therapeutic role of combined bivalent HPV vaccine (Cervarix) and Candida antigen versus candida antigen alone in the treatment of multiple recalcitrant warts. Patients/methods Forty patients with recalcitrant warts were enrolled into this study. They were divided into two groups (A and B), each including 20 patients. Patients in the group (A) received intralesional Candida antigen injection alone for five sessions at 2-week intervals. Patients in the group B received combined treatment of bivalent recombinant HPV vaccine and intralesional Candida antigen. Candida antigen was administered as in the group A, while Cervarix vaccine was given intramuscularly at 0, 1, and 6 months as scheduled. Follow-up was made monthly for 6 months to detect any possible recurrence. Results Eight patients (40%) in the group (A) showed complete clearance of warts after intralesional Candida antigen injection alone, while 14 patients (70%) in the group (B) showed complete regression of warts after the combined therapy. No significant side effects were reported in both groups, and no recurrence was detected. Conclusion Bivalent human papillomavirus vaccine combined with Candida antigen is a promising, effective, and safe modality for the treatment of multiple recalcitrant warts.

Background Lichen myxedematosus (LM) is a rare, chronic idiopathic disorder characterized clinically by waxy, closely set papules and histopathologically by diffuse dermal mucin deposition and fibroblast proliferation. The most recent classification of LM was proposed in 2001; however, it seems to be complex, confusing, and imprecise. Herein, we present seven cases of LM to evaluate the validity of the current classification, to propose new diagnostic criteria and classification, and to suggest a clinically relevant severity grading system for this rare disorder. Materials and methods The study included seven patients with different presentations and severities of LM. All patients were subjected to thorough dermatological and systemic examination, routine laboratory tests, evaluation of thyroid function, protein electrophoresis, and detailed investigations to detect systemic involvement. Results The current classification does not meet the requirements of proper diagnosis of different presentations of LM. Subtyping of the studied patients differs greatly according to the old classification and the newly proposed one. New diagnostic criteria, classification, and grading are consequently suggested. Conclusions We propose two sets of diagnostic criteria to define the disease more precisely and to avoid confusion associated with the other classification. The first set comprises constant clinical and histopathological features that are always present in every case, and the second set includes associated features that were variably reported in some patients. LM is then subclassified according to the presence or absence of systemic manifestations into a systemic severe form (scleromyxedema) and a non-disabling, pure cutaneous form.

Febrile ulceronecrotic Mucha-Habermann disease (FUMHD) is a rare, potentially fatal, severe variant of pityriasis lichenoides et varioliformis acuta (PLEVA). Lesions of FUMHD usually start with erythematous papules and plaques that rapidly progress to form large, often coalescing necrotic ulcers with hemorrhagic crusts. The skin findings are typically accompanied by systemic symptoms including high fever, abdominal pain, diarrhea, arthritis, pulmonary involvement, central nervous system symptoms, and sepsis. These systemic manifestations can lead eventually to serious complications or even a fatal outcome.1, 2, 3 Fatal cases were confined to adults (9 deaths of about 70 reported cases). On the contrary, children with FUMHD tend to have a more favorable outcome than adults, and no deaths have so far been reported in children.2, 3 Here we report the first case, to our knowledge, of a child with FUMHD complicated by sepsis that resulted in multiple organ failure and death.

Febrile ulceronecrotic Mucha-Habermann disease (FUMHD) is a rare severe variant of pityriasis lichenoides et varioliformis acuta characterized clinically by aggressive ulceronecrotic skin lesions associated with high fever and histologically by features typical of pityriasis lichenoides et varioliformis acuta. Despite the continuous addition of new case reports, no definite diagnostic criteria have been established, and an optimum treatment is still waiting. Herein, we review the different aspects of this rare entity, including pathogenesis, clinical and histopathological features, differential diagnosis, course, prognosis, and outcome. Different diagnostic and therapeutic challenges associated with FUMHD are also evaluated and discussed. We propose two sets of diagnostic criteria to define the disease more precisely and to avoid missing cases. The first comprises constant clinical and histopathological features that are always present in every case, the combination of which is necessary for diagnosis. The second set includes variable features that may be present in some cases and to which any emerging finding could be added. Although different therapeutic options have been used, there is no optimum therapy for FUMHD, and the disease still represents a therapeutic challenge.

Haberland syndrome is characterized by diverse malformations affecting the ecto-mesodermal tissues (the central nervous system, the eye, and the skin). The most prominent anomalies include a hairless fatty tissue nevus of the scalp (nevus psiloliparus) and ocular choristomas.1 In addition, several central nervous system (CNS) anomalies have been described, including cranial and spinal lipomas, partial or complete hemisphere atrophy, and intracranial cysts that can lead eventually to mental retardation and/or seizures.2 We present a case of Haberland syndrome that met the revised diagnostic criteria proposed by Moog in 20092 and can be considered a definite case of Haberland syndrome despite the absence of a fatty nevus. In addition, we demonstrate that the histopathologic findings of vascular hyperplasia are a prominent feature of all involved sites.

Platelet-rich plasma (PRP) is an autologous preparation of platelets in concentrated plasma that may be beneficial in the treatment of atrophic acne scars by promoting collagen deposition. Skin needling is a technique that uses a sterile dermaroller to puncture the skin and release growth factors. The combination of skin needling and PRP could enhance the efficacy of both modalities. Chemical reconstruction of skin scars technique consists of focal application of high concentration of trichloroacetic acid (TCA) on the acne scars to stimulate collagen production.To evaluate the efficacy and safety of intradermal injection of PRP, 100% focal TCA, and combined skin needling plus topical PRP in the treatment of atrophic acne scars.Forty-five patients with atrophic acne scars were randomly assigned to 3 equal groups; Group A received intradermal injection of PRP, Group B received chemical reconstruction of skin scars technique with TCA 100%, and Group C was treated by combined skin needling and PRP. Each patient underwent 3 sessions at 2-week interval.All the patients completed the study. The 3 groups showed statistically highly significant improvement in the degree of acne scars after treatment (p.001). No major adverse effects were observed in the studied groups.This is the first study to use intradermal injection of PRP alone for the treatment of atrophic acne scars. The 3 modalities showed a promising efficacy and safety in the treatment of atrophic acne scars.