Conventional methods of treatment for vitiligo are often unsatisfactory to the patients and time consuming, new treatment modalities are needed. This study was conducted to evaluate the efficacy and safety of fractional carbon dioxide (CO2) laser therapy followed by narrow band ultraviolet‐B (NB‐UVB) phototherapy, topical tacrolimus or topical calcipotriol on stable nonsegmental vitiligo. Thirty patients with stable nonsegmental vitiligo were evaluated. All patients were subjected to three sessions of fractional CO2 laser 1 month apart. Patients were divided into three groups (each group 10 patients). Group (A) treated with tacrolimus ointment twice daily for 3 months, group (B) treated with calcipotriol ointment twice daily for 3 months, and group (C) treated with NB‐UVB twice weekly for 3 months. Outcomes were evaluated by calculating vitiligo area scoring index (VASI) score change, percentage of repigmentation, patient satisfaction, and adverse effects. There was a statistical significant decrease in VASI score after treatment in the three groups. The VASI change and % of regimentation was higher in group (C) treated by laser and NB‐UVB and this was significantly higher than group (B) treated with laser and calcipotriol. Otherwise, there was no statistical significant difference between other treatment groups. In concluion, NB‐UVB phototherapy, topical tacrolimus, or topical calcipotriol in combination with fractional CO2 laser could be used effectively and safely as an alternative modality for treatment of vitiligo. The combination of fractional CO2 laser and NB‐UVB was found to be more effective.

Melasma is a disfiguring dermatologic condition and its treatment is still considered a challenge. To evaluate the efficacy and safety of microdermabrasion (MDA) combined with glycolic acid 70% (GA70%) peel versus GA70% alone in treating melasma in dark-skinned patients. This study included 30 female patients (skin type IV and V) with melasma. After cleansing the face, 3 passes of MDA were done on one side of the face. Then, GA70% was applied to the whole face in 1-2 uniform passes.Melasma area and severity index (MASI), modified MASI and hemi-MASI scores were used to assess the outcome. A significant decline of the mean MASI, mMASI and both hemi-MASI scores following treatment (p value = 0.000 for each). Furthermore, the hemi-MASI score on the MDA/GA70% treated side showed significantly greater decrease than the hemi-MASI score on GA70% treated side (p value = 0.041). MDA enhanced the improvement of GA70% peel effectively and safely.

Pemphigus is a group of immune‐mediated blistering diseases of skin and mucus membrane caused by destruction of the intercellular junction (desmosomes) by autoantibodies. Pemphigus vulgaris (PV) is considered the most common type of all pemphigus family. Various cytokines play a major role in pemphigus pathogenesis. Interleukin‐33 (IL‐33) role has been studied in various autoimmune diseases as; psoriasis and rheumatoid arthritis, yet it has not been studied in Egyptian patients with PV. The study aimed to evaluate the possible role of IL‐33 in PV by assessing its level in the serum using ELISA and to detect its correlation with activity score using Pemphigus Disease Area Index (PDAI). Forty‐four patients with PV and 36 age and sex‐matched healthy controls were enrolled in the study. After full history taking and complete dermatological examination, the severity score was calculated using PDAI, then serum samples were taken from each patient and control subjects and subjected to quantitative measurement of serum IL‐33 using ELISA. Serum level of IL‐33 is significantly raised in PV patients compared to control subjects (P‐value = .007). The level of IL‐33 was found to be strongly correlated with the activity of the disease measured by PDAI. IL‐33 might have a role in PV pathogenesis as shown by its rising level in PV patients. In addition, serum level of IL‐33 is strongly correlated with the activity of PV. Thus, we suspect that IL‐33 can be used as marker for monitoring PV severity and measuring treatment efficacy.

Background Therapies for postacne scarring act through modulation of elastin and collagen, and collagen III might therefore represent a biomarker of treatment effectiveness. Patients and methods Patients (n = 70) with postacne scars and individuals without scars (n = 56) were included in this case‐control study. Patients were treated with Dermaroller microneedling, trichloroacetic acid chemical reconstruction, punch excision, or scar subcision. Scar severity was graded immediately before and after treatment with a photographic quartile scale and the ECCA scale. Serum levels of collagen III were measured in control individuals and in patients, before treatment, 1 month after the first treatment session, and 4 months after the final session. Results Circulating levels of collagen III were significantly higher in patients with postacne scarring (24.1 ± 12.5) before treatment than in control individuals (2.6 ± 0.8). Circulating levels of collagen in patients were significantly lower 4 months posttreatment (14.3 ± 8.1) than at baseline. The mean percentage change in serum collagen III was positively correlated with both the mean percentage improvement by photographic evaluation (r = .530, P < .000) and the mean percentage change in the ECCA scale (r = .632, P < .000). Conclusion Circulating collagen III is a biomarker for improvement of postacne scarring following different therapies.

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Background: Acral vitiligo is usually more resistant to medical management due to minimal density of hair follicles and greater chance of repeated friction or trauma. Objective: To determine efficacy and safety of adding topical platelet rich plasma (PRP) to automated micro needling and narrow band ultra violet B (NB- UVB) in treatment of resistant acral vitiligo and to assess the best treated sites with this combination therapy. Patients and methods: Forty-two patients with stable acral vitiligo were recruited. lesions at the hand were classified according to their sites into (Dorsum, periungual, knuckles and inversed knuckles)while lesions at the feet were classified into (Dorsum, lateral side and medial side of the feet). One side was treated with automated micro needling and topical PRP (group A) and the other side with automated micro needling only (group B) twice monthly for 3 months. Both sides received NB-UVB phototherapy twice weekly. Results: One month after the last session, in both groups A and B, a statistically significant better percent of pigmentation was noticed at the dorsum of the hands 38.95 ± 39.81 and 42.11 ± 33.51 respectively followed by inverted knuckles 28.42 ± 37.01 and 25.53 ± 37.19 respectively , while no significant difference was noted in comparing both groups A and B either at the hands or the feet lesions, regarding the percent of regimentation, the percent of change in VASI, change in number of the lesions and color match. Conclusion: Adding PRP to NB-UVB and micro needling has no significant advantage in treating patients with resistant acral vitiligo. The response to treatment is better in area with hair follicles as the dorsum of the hand and inverted knuckles, while areas over bony prominences (knuckles) and devoid of hair follicles (periungual) are resistant to this combination therapy.

Alopecia areata (AA) is a common cause of hair loss with no available universally successful treatment. Thus, new innovative treatments are urgently needed. This research aimed to evaluate the effectiveness of fractional carbon dioxide laser (FCL) alone or combined with triamcinolone acetonide (TA) solution, platelet-rich plasma (PRP), or vitamin D3 solution in treating AA. Sixty-four AA patients with 185 lesions were recruited and divided into four treatment groups. All patients received FCL either alone (group A, n = 19) or followed by topical TA (group B, n = 16) or PRP (group C, n = 15), or vitamin D3 solution (group D, n = 14). The response was assessed using Alopecia Areata Severity Index (AASI), MacDonald Hull and Norris grading, and trichoscopy. Histopathological features and immunohistochemical decorin expression were studied. All groups showed significant improvement in AASI compared to the baseline, with insignificant differences between them. Post-treatment, trichoscopic features of disease activity significantly decreased in all groups. Compared to control biopsies, both anagen follicles and decorin expression were significantly decreased in all pretreatment specimens. After treatment, all groups showed significantly increased anagen follicles and decorin expression compared to the baseline. Accordingly, FCL is an effective treatment for AA alone or combined with TA, PRP, or vitamin D3 solution. In AA, Decorin expression was downregulated, while enhanced expression following successful treatment occurred. This suggests the role of decorin in AA pathogenesis. However, further research is still recommended to clarify the exact role of decorin in AA pathogenesis and to investigate the therapeutic benefits of decorin-based therapy.

Immunotherapy represents a promising therapeutic option for treatment of warts. Different concentrations of Candida antigen (1/100 and 1/1000) and zinc sulfate 2% were not previously compared regarding their efficacy in treatment of cutaneous warts. The present study compared the safety and efficacy of intralesional candida antigen versus intralesional 2% zinc sulfate for treatment of cutaneous warts. This prospective controlled clinical trial included one hundred and five patients presented with common, plantar, and plane warts. Patients were divided randomly into three groups, each group included 35 patients. Group 1 were treated with intralesional candida antigen (Ag) 1/100, Group 2 were treated with intralesional candida Ag 1/1000, and Group 3 were treated with intralesional zinc sulfate 2%. This study found that target warts of group 1 displayed higher rate of complete clearance compared to group 2 and group 3 (94.3%, 77.1, 74.2%), respectively. The present study concluded that intralesional immunotherapy with Candida antigen was more effective than Intralesional 2% zinc sulfate in treatment of cutaneous warts and less painful. Clinical trial registration number is (Clinical Trials.gov Identifier: NCT03158168).