Background Keloid is a benign well‐demarcated overgrowth of fibrotic tissue which extends beyond the original boundaries of a defect. The treatment of keloids is a particular challenge to dermatologists. Intralesional corticosteroid injection has been considered the first‐line treatment for keloids. Vitamin D plays an important role in cell proliferation and differentiation as it slows the progression of tissue fibrosis by keloid fibroblasts and inhibits collagen synthesis in dermal fibrosis. Objectives To evaluate the efficacy of intralesional injection of vitamin D in the treatment of keloids, both clinically and ultrasonically. Methods Forty Egyptian patients with keloid scars were injected weekly with intralesional vitamin D with dose of 0.2 ml (200,000 IU) per 1 cm lesion. The keloid scars were evaluated with Vancouver Scar Scale (VSS) and by a high‐resolution ultrasound using B mode before and after treatment, the patients received 3 to 4 sessions. Results There was statistically highly significant reduction in VSS after treatment with intralesional vitamin D injection (p value≤0.001). There was also statistically highly significant improvement in ultrasonic keloid scar thickness after treatment (P value ≤0.001). Conclusions Intralesional vitamin D is an effective and safe method in treatment of keloid scars. Ultrasound is a useful method in assessing the improvement of keloids after treatment.

Acanthosis nigricans (AN) is a skin disorder with a wide prevalence, depending on the concomitant disorder and other elements such as age, race, and Fitzpatrick skin type. This prevalence is 25% in general researches while more than 60% in overweight-specific researches. 1 The AN diagnosis depends on the presence of symmetrical dark brown hyperpigmentation, thickening in the affected area varies between 1 mm and 1 cm, and a velvety texture can occur especially in the flexural skin fold area. 2 The AN dermatological issue indicates the presence of systemic problems: metabolic disorder (mostly), endocrine syndrome, malignancy, medication side effects, and genetic factor, it resembles the apex of an iceberg, that leads the physicians to search for what of these disorders lies beneath. 3 The treatment aims to treat the underlying causes; however, the cosmetic resolution of the cutaneous lesion has an impact on the quality of

Background: Alopecia areata (AA) is a common, non-scarring type of hair loss, affecting approximately 2.1% of the population. Many modalities of treatment are recommended like steroid injection, topical Immunotherapy, and several systemic therapies, but none of them can prevent or alter the course of the disease with variable degrees of improvement. Objective: To evaluate efficacy and safety of superficial cryotherapy versus intralesional corticosteroid injection in the treatment of alopecia areata. Patients and Methods: Thirty patients aged 14-58 years, with localized multiple patchy alopecia areata (at least two patches), were enrolled in this study. In each patient, one patch was treated by superficial cryotherapy via liquid nitrogen spray. This involved two treatment cycles/sessions, each lasting 3-5 seconds. The other patch was treated with intralesional steroid injection (triamcinolone acetonide 5 mg/ml, 0.1ml /cm 2 . Sessions were repeated every three weeks up to three months. The target lesions were evaluated clinically using SALT score and by 2 blinded dermatologists and dermoscopically at baseline, every session, and the end of the study (one month after the last session). Results: At the end of the study, the clinical response (number of the patients with hair growth > 20%) to superficial cryotherapy was about 83.3% (25 patients out of 30 patients). While in the steroid group the clinical response was about 80% (24 patients out of 30 patients). There was a statistically significant reduction in SALT score and dermoscopic parameters at the end of the study in both groups with no significant difference between them. There was a significant clinico-dermoscopic relation between hair regrowth and dermoscopic findings. Conclusion: Superficial cryotherapy is an effective and safe therapeutic modality for AA with advantages of simplicity and noninvasiveness.

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.

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Introduction: Alopecia areata (AA) is a challenging disease with variable treatment outcomes. Hair follicles express vitamin D receptors. Therefore, vitamin D3 may be promising for AA treatment through immunomodulatory mechanisms. The efficacy of bimatoprost in scalp AA treatment was reported by few studies. Objective: To evaluate the efficacy and safety of microneedling (MN) with topical vitamin D3 versus MN with bimatoprost in comparison with MN alone in the treatment of localized AA. Patients and Methods: Seventy-five patients with localized AA were divided into three groups. The first group: 25 patients were treated with MN alone. The second group: 25 patients treated with MN combined with topical vitamin D3. The third group: 25 patients treated with MN combined with bimatoprost solution. The response was evaluated clinically and dermoscopically.Results: At the end of the study, all groups showed a statistically significant decrease in the SALT score compared to the baseline. The clinical response (regrowth scale): vitamin D and bimatoprost groups showed a statistically significant higher regrowth scale compared to MN alone group (p-value = 0.000). After treatment, hair regrowth was significantly higher in MN combined with bimatoprost than in MN combined with topical vitamin D3. However, after 3 months of follow-up, there was no statistically significant difference between both groups. Side effects were mild and transient in all groups. Conclusion:Topical vitamin D3 and bimatoprost combined with MN are safe and effective therapeutic options for localized AA.

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.