Introduction: Keloids are benign fibro-proliferative scarring extending outside the initial wound. Different modalities of treatment as intralesional corticosteroid injection, fractional CO₂ laser and others can be used either as mono or combined therapies.
Objectives: To assess the role of fractional CO2 laser versus fractional CO2 laser accompanied with either triamcinolone acetonide or trichloroacetic acid 20% in keloid treatment clinically and radiologically.
Methods: The current study was conducted on 45 Egyptian participants with keloid scar at different sites of the body. They were classified into three groups treated by fractional CO2 laser only (group I), fractional CO2 laser followed by triamcinolone acetonide (group II) or trichloroacetic acid application (group III) respectively. Evaluation of the keloid was done with Vancouver Scar Scale (VSS) and Color Doppler Ultrasound (CDU) before and after treatment. Four sessions, one month apart were applied for the patients. They were followed up for 8 weeks after the last session.
Results: After treatment, there was high statistically significant reduction in Vancouver Scar Scale among the three groups (P value ≤ 0.001), reduction was more in group II then I then III. Also, high statistically significant reduction in keloid scar thickness assessed by Doppler was recorded (P value ≤0.001 in group II and P value ≤0.01 in group I & III).
Conclusion: Combined therapy is favorable in treatment of keloids. Trichloroacetic acid is a promising modality in treating keloid; hence it can be tried in different combinations. Color Doppler Ultrasound is a promising method of keloids pre- and post-treatment assessment.
Striae Distensae (SD) are quite common complaint in dermatology practice. They are linear lesions of variable length and width according to the site and the causative condition. Several treatment modalities have been tried. To achieve satisfactory results, a combination therapy is often needed. To evaluate the efficacy and safety of fractional CO 2 laser versus carboxytherapy in the treatment of Striae Distensae clinically and radiologically. Thirty Egyptian patients with striae distensae, received a split body therapy: the left side was treated by fractional CO 2 laser and the right side was treated by carboxytherapy in the same session. Six sessions were done with 4 weeks apart. Clinical evaluation by measurement of the width of widest striae on both sides, global aesthetic improvement scale (GAIS), and Likert satisfaction scale. Radiological evaluation by measurement of cutaneous thickness of widest striae on both sides by ultrasonography. There was a highly statistically significant decrease in the median width of the widest striae distensae on both sides after the last session (P < 0.01). Regarding GAIS, satisfaction scale and ultrasound, there was highly statistically significant improvement on laser side than carboxytherapy side (P < 0.01) after last session. Both fractional CO 2 laser and carboxytherapy may be considered as safe and effective lines of treatment for striae distensae, but fractional CO 2 laser showed excellent improvement clinically, radiologically when compared with carboxytherapy which made it a promising module in treatment of striae distensae.
Cardiovascular diseases are common in children with chronic kidney disease (CKD). According to studies, monocytes play a role in atherosclerotic vascular disorders. CD36 promotes the binding of oxidised low-density lipoprotein (oxLDL) on monocytes, however its role in atherosclerosis is unclear. We aimed to assess the frequency of monocyte subsets in CKD children, and to determine CD36 differential expression on monocyte subsets and its association with the risk of atherosclerotic incidents in those patients. This case-control study included 40 children with CKD and 40 apparently healthy children as controls. We investigated the frequency of total monocyte and monocyte subsets using CD14/CD16. Also, we assessed CD36 differential expression on circulating subsets using flow cytometry. In addition to Doppler ultrasound assessment of the intimal medial thickness (IMT) and peak systolic velocity (PSV) of the main arteries, with routine laboratory investigations of both groups. There was a significant increase in median values of total circulating monocyte percentage in patients than controls (P=0.001). Also, there was a significant increase in the percentage of classical monocyte (CD14high/CD16-) and non-classical monocytes subset (CD14low/CD16+) in patients when compared to controls (P=0.027) and (P=0.001), respectively. There was a significant decrease in the median values of CD36 Mean fluorescence intensity (MFI) expressed on classical, non-classical and intermediate monocytes in patients than the control group (P=0.001), (P=0.001) and (P=0.002), respectively. CD36 MFI expressed on classical, non-classical and intermediate monocytes negatively correlated with cholesterol, triglyceride, systolic, diastolic blood pressure and the IMT of the femoral artery. In conclusion, the increase in the frequency of monocytes, particularly the classical and nonclassical subsets, may be a key component in atherosclerosis pathogenesis in children on hemodialysis. Low CD36 expression on monocyte subsets may be involved in the pathogenesis of atherosclerosis in children on hemodialysis.
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