Introduction Striae alba (SA) are a prevalent cosmetic dermatologic condition characterized by dermal collagen and elastin disruption due to mechanical stretching. Clinically, they appear as atrophic, hypopigmented linear bands that commonly affect the abdomen and are therapeutically challenging due to their refractory nature. Objective: To compare the efficacy and safety of microneedling with topical insulin versus microneedling with 20% ascorbic acid in treating SA. Patients and methods This prospective comparative study included 40 female participants with abdominal SA, divided into two equal groups: group A received microneedling with topical insulin, while group B received microneedling with topical 20% ascorbic acid. Treatments were administered monthly for four consecutive months. Clinical effectiveness was evaluated 1 month after the last session using the Manchester Scar Scale, striae width measurements, and patient satisfaction. Results Both treatments showed significant improvement ( P <0.001). Mean Manchester Scar Scale improvement was 63.74±20.21 in group A and 63.04±13.23 in group B ( P =0.898). Both groups demonstrated significant reductions in striae width after 1 month ( P <0.001). In group A, median width decreased from 1.0 mm [interquartile range (IQR) 0.65–2.0] to 0.5 mm (IQR 0.45–1.0); in group B, from 0.75 mm (IQR 0.5–1.0) to 0.3 mm (IQR 0.3–0.5). Intergroup comparisons showed no significant differences in percentage of improvement ( P =0.956), degree of improvement ( P =0.469), or patient satisfaction ( P =0.710). Conclusion Microneedling combined with either topical insulin or ascorbic acid shows comparable efficacy and favorable tolerability in treating SA, providing clinicians with two effective treatment options.
Background Neutrophil extracellular trap formation (NETosis) is a distinct mechanism of neutrophil cell death and has been increasingly implicated in the pathogenesis of systemic lupus erythematosus (SLE) and other autoimmune disorders. Objective This study was designed to evaluate serum level of antineutrophil extracellular traps antibodies (ANETA) in patients with SLE and its relation to the activity and damage of the disease. Patients and methods This case-control study enrolled 30 female patients with SLE (15 de novo and 15 on treatment), alongside 30 age- and sex-matched healthy controls (Control group). A blood sample (4 mm) was withdrawn for assessment of Neutrophil extracellular traps (NETs) complexes and ANETA levels by ELISA. Results NET levels were significantly elevated among SLE de novo group upon comparing with both SLE treatment and control groups ( P= 0.007 and 0.003, respectively). As for the ANETA levels, despite being higher among SLE de novo group, yet these differences did not reach statistical significance on comparison with SLE treatment and control groups ( P >0.05). ANETA results correlated positively with NETs reading ( P <0.001). Among SLE treatment group NETs and ANETA were positively correlated with SLE disease activity index and Systemic Lupus International Collaborating Clinics Damage Index. Conclusion The positive correlations of NETs and ANETA with SLE disease activity index and systemic lupus international collaborating clinics damage index highlight the possibility of considering NETs/ANETA as potential diagnostic and prognostic indicators in SLE, reflecting both disease activity and organ damage. However, larger longitudinal studies are needed to validate NETs/ANETA as reliable biomarkers in SLE.
Background Atrophic postacne scarring remains a challenging dermatologic condition with significant psychological and cosmetic implications. Various treatment modalities have been developed to stimulate collagen remodeling and improve skin texture, yet the optimal approach remains uncertain. Objective To compare the efficacy and safety of polydioxanone (PDO) threads, microneedling combined with autologous platelet-rich plasma (PRP), fractional carbon dioxide (CO 2 ) laser, and subcision − in the management of atrophic postacne scars. Patients and methods A randomized pilot clinical study was conducted on 24 patients (12 females and 12 males) aged 18–40 years with atrophic acne scars. Participants were randomly assigned into four equal groups ( n =6 each): group A (PDO threads), group B (PRP with microneedling), group C (fractional CO 2 laser), and group D (subcision). Clinical outcomes were assessed using the Goodman and Baron Qualitative Global Scarring Grading System before treatment, and at 1- and 3-month posttreatment. Improvement degrees, side effects, and patient satisfaction were also evaluated. Results All groups showed significant improvement in Goodman and Baron scores after 3 months ( P <0.05). After 3 months, the mean percentage of improvement was 40.0±23.98% for threads, 50.8±18.8% for PRP, 50.8±20.6% for fractional laser, and 55.8±26.3% for subcision, with no statistically significant difference among groups ( P =0.700). Conclusion All four modalities significantly improved atrophic acne scars, with fractional CO 2 laser and subcision showing the highest improvement percentages. PDO threads and PRP offered less downtime and fewer side effects.
Background Depigmented macules and patches characterize vitiligo, an acquired autoimmune skin condition that has several lines of treatment. A new treatment for vitiligo, photodynamic therapy (PDT), has mixed results. Objective To evaluate the efficacy and safety of PDT using liquid crystal-loaded methylene blue and intense pulsed light in the treatment of vitiligo. Patients and methods This prospective, randomized study was conducted in 40 patients with multiple vitiligo lesions. For each patient, three vitiligo lesions were treated: Treatment area A was exposed to PDT alone (for six sessions at 2 weeks intervals), treatment area B was exposed to PDT and topical daily steroids (mometasone furoate cream) and treatment area C was exposed to only topical steroids (mometasone furoate cream) daily. There were two methods used to evaluate the repigmentation: a mean improvement score by physician carried out by three blinded dermatologists, and patients’ satisfaction. Results Improvement and its percentage were significantly higher in treatment area B compared with areas A and C, and were significantly higher in treatment area C compared with area A ( P <0.05). The only side effect was tolerable pain only during the procedure and was minimal to mild in 80% of patients. It did not require analgesics or discontinuation of sessions. Conclusion In Vitiligo, the combination of PDT and topical steroid was a safe and effective treatment for vitiligo. Combination therapy was more effective than PDT alone or steroids alone. Topical steroids were more effective than PDT alone.
Artificial intelligence (AI) is increasingly influencing dermatology, with expanding applications in lesion classification, teledermatology, workflow optimization, and patient education. This review summarizes current applications, limitations, and practical considerations for clinicians, emphasizing AI’s role as a supportive tool rather than a replacement for clinical judgment. While promising, AI adoption requires careful evaluation of evidence, attention to equity, workflow integration, and ongoing monitoring to ensure safety and effectiveness.
Background High-mobility group box 1 (HMGB1) may play an important role in autoimmune and inflammatory disorders. Objective To estimate serum levels of HMGB1 in alopecia areata (AA), vitiligo and oral lichen planus (OLP) patients compared with those in normal control subjects. Patients and methods This case-control study consisted of 80 age-matched and sex-matched participants divided into four groups as follows: group I (AA group): 20 AA patients, group II: 20 vitiligo patients, group III: 13 OLP patients, and group IV: 27 healthy controls. Disease severity was assessed based on the severity of Alopecia Tool, Vitiligo Area Scoring Index, and Reticulation Erythema and Ulceration scores. Disease activity/stability was considered for every patient. Serum HMGB1 levels were assessed using a human (HMGB1) ELISA kit for all study participants. Results The levels of serum HMGB1 in groups I, II, and III were significantly higher than those in group IV ( P <0.001). A positive correlation was found between serum HMGB1 levels and severity of Alopecia Tool, Vitiligo Area Scoring Index, and Reticulation, Erythema, and Ulceration severity scores. Serum HMGB1 levels were higher in active AA patients than in stable AA patients; however, no association was found with vitiligo or OLP stability. Conclusion We concluded that serum HMGB1 may serve as a biomarker for AA, vitiligo, and OLP.
Background Azathioprine (AZA) is a commonly used steroid-sparing agent to treat various inflammatory conditions, including immunobullous diseases. Objective To evaluate thiopurine S-methyltransferase (TPMT) enzyme level by enzyme-linked immunosorbent assay and TPMT genotype by PCR, and to assess the correlation between TPMT enzyme level and genotype with AZA-related toxicity in Egyptian patients with immunobullous diseases. Patients and methods This was a prospective observational cohort study that included 69 patients with immunobullous diseases. Serum TPMT enzyme level was assessed using enzyme-linked immunosorbent assay for phenotyping, while common inactivating alleles (TPMT*2, TPMT*3 A, and TPMT*3C) were identified through allele-specific-PCR and PCR-restriction fragment length polymorphism genotyping. After initiating AZA therapy, patients were followed for adverse drug reactions, with evaluations conducted at baseline, 1 month, and 3 months. Results Of the 56 patients who completed the study, 28.6% developed AZA-related toxicity. Incidence of cytopenias increased from 4.5% at 1 month to 7.1% at 3 months, while hepatotoxicity rose from 16.4 to 23.2% over the same period. TPMT testing revealed that 72.5% had normal enzyme levels, 24.6% had low levels, and 2.8% had high levels, with only wild-type TPMT*2, TPMT*3A, and TPMT*3C variants identified. Conclusion TPMT enzyme level and genotyping were not reliable predictors of AZA-related toxicity. Emphasizing the importance of close clinical and laboratory monitoring of patients after initiation of AZA.
Background: Platelet-rich concentrates have emerged as adjuncts in chronic wound management, with healing potential influenced by underlying etiology. Objective: To evaluate whether ulcer etiology (diabetic neuropathic vs. venous ulcers) influences healing outcomes following treatment with platelet-rich concentrates (platelet-rich plasma and platelet-rich fibrin) in chronic nonhealing ulcers, using secondary analysis of a randomized clinical trial. Patients and methods: In this prospective stratified randomized controlled study, 36 patients were stratified by ulcer etiology (18 diabetic foot ulcers, 18 venous leg ulcers, randomized in a 1 : 1 : 1 ratio within each stratum to receive platelet-rich plasma, platelet-rich fibrin, or conventional therapy. ImageJ was used to assess and measure the ulcer before and after the reduction in wound area over a period of 8 weeks. Results: No statistically significant differences were observed between diabetic neuropathic and venous ulcers in surface area reduction (week 4: P =0.436; week 8: P =0.246), healing rate (week 4: P =0.74; week 8: P =0.55), or time to complete healing ( P =0.5592), despite numerically greater improvements in the diabetic group. Conclusion: Healing outcomes following treatment with platelet-rich concentrates were comparable between diabetic neuropathic and venous ulcers. Although diabetic ulcers showed numerically greater improvement in some parameters, and venous ulcers had a higher complete-healing rate, these differences were not statistically significant. While baseline demographic differences between groups may have influenced healing patterns, they did not result in statistically significant differences in overall outcomes.
Background Vitiligo is considered as a depigmenting skin disorder. Various proteins and inhibitors have been implicated to play an important role in the pathogenesis of vitiligo. Elafin is a skin-derived anti-leukoproteinase that is elastase-specific protease inhibitor expressed mainly in epithelial cells. It is expressed in lung and displaying anti-inflammatory and antibacterial properties. Objective To measure and compare the concentration level of elafin in both serum and tissue of vitiligo patients with healthy controls. Also, to detect the association of elafin with other descriptive; clinical and precipitating factors. Patients and methods In this control study, 30 patients with nonsegmental vitiligo and 30 apparently healthy volunteers as controls were involved in the study. For evaluating the level of elafin in serum, 3 ml blood samples were collected from patients and controls. While for assessment of the concentration level of elafin in tissue, 4 mm punch skin biopsies were obtained from lesional areas of patients, while control samples were collected from anatomically matched sites in healthy volunteers. Both serum and skin biopsy were assessed by enzyme-linked immunosorbent assay. Results The concentration level of elafin was significantly elevated in vitiligo patients compared to healthy controls for both serum (64.81±40.95, 36.29±5.61) and tissue (7736.61±4230.13, 406.25±82.83), respectively with P value=0.0001 each. Results revealed that patients with sudden onset had higher levels of elafin in serum than patients with gradual onset ( P =0.037). Also, patients with progressive disease had higher levels than stationary vitiligo patients group but with no significance difference between the two groups. There was a positive correlation between elafin concentration in serum and tissue ( r =0.452, P =0.012). Conclusion The elevated levels of elafin in vitiligo patients suggest its role as a host protective response in disease pathogenesis and support its promise as a biomarker and a possible therapeutic target.
Condyloma acuminata, chiefly linked to low-risk human papillomavirus (LR-HPV), demonstrates a more severe clinical course – characterized by extensive lesions, recurrence, and treatment resistance–in HIV individuals. This group also shows increased high-risk HPV (HR-HPV) infection and coinfection prevalence, elevating oncogenic risk. This review aimed to compare HPV subtype profiles between HIV-positive and HIV-negative patients to guide clinical strategies. A systematic review and meta-analysis was conducted, querying PubMed, ScienceDirect, Cochrane/CENTRAL, and Google Scholar for literature published from 2015 to 2025. Six studies involving 703 participants were included. Data were synthesized using a random-effects model in RevMan 5.4.1 to generate pooled odds ratios with 95% confidence intervals. Methodological quality was evaluated via ROBINS-I and SIGN tools. Results demonstrated that HIV status was a significant determinant of HPV genotype distribution. Individuals living with HIV had substantially higher frequencies of HR-HPV infections (e.g. genotypes 16, 18, 52, 59) compared with HIV-negative individuals, in whom LR-HPV types predominated (pooled odds ratio: 5.25; 95% confidence interval: 3.10–8.88; P <0.001). In summary, these findings confirm a distinct HR-HPV predominance in individuals living with HIV, underscoring the imperative for enhanced, tailored screening, and preventive oncology measures in this high-risk group.
Introduction Melasma is a chronic relapsing pigmentary disorder that poses a significant therapeutic challenge, prompting growing interest in regenerative treatment modalities such as platelet-rich plasma (PRP) and amniotic membrane-derived products. Objective To compare the efficacy and safety of microneedling with irradiated human amniotic gel (HAG) versus microneedling with PRP in melasma. Patients and methods In this split-face comparative interventional study thirty female participants with melasma were included. The right hemiface received microneedling combined with PRP, while the left side received microneedling combined with HAG. Participants received three treatment sessions spaced 4 weeks apart. Therapeutic effect was determined using the modified Melasma Area and Severity Index (mMASI), Wood’s lamp examination, and patient satisfaction scores. Results A highly significant reduction in mMASI scores was observed after treatment in both modalities ( P <0.001). Nevertheless, the side treated with PRP demonstrated significantly greater improvement compared with the HAG-treated side with higher reduction in mMASI scores and better patient satisfaction ( P <0.001). Both interventions were well tolerated, with only mild and transient adverse effects reported. No significant association was found between treatment response (regarding percentage of improvement of mMASI scores) with either age, disease duration, or baseline mMASI score ( P >0.05). Conclusion Microneedling combined with either irradiated HAG or PRP is safe and effective in melasma, with PRP showing superior clinical efficacy and patient satisfaction.
Syringocystadenoma papilliferum is a rare benign hamartomatous adnexal tumor of apocrine or eccrine sweat glands. Most patients present a solitary lesion involving the head and neck region. Lesions arising outside this region are exceedingly rare. We report a case of syringocystadenoma papilliferum presenting as a nodular lesion located on the middle of the posterior aspect of the right arm of a 23-year-old male. This case highlights an unusual anatomical location of this rare entity. No associated nevus sebaceous was identified, despite its well-documented association with this tumor.
Microneedling radiofrequency (MRF) has emerged as a novel technique in cosmetic and aesthetic dermatology, combining the benefits of microneedling with radiofrequency (RF). This procedure utilizes fine needles to create controlled micro-injuries in the dermis, stimulating collagen and elastin production. Concurrently, RF energy is delivered through these needles, heating the deeper skin layers to promote further collagen remodeling and tightening effects. The synergy between these two modalities not only improves skin texture and tone but also effectively addresses concerns such as acne scars, wrinkles, and skin laxity. In addition, the treatment is suitable for various skin types and conditions, including acne vulgaris, hyperhidrosis, striae distensae, cellulite, androgenic alopecia, melasma, and rosacea. A series of 3-5 sessions with 2-4 weeks interval is recommended to achieve optimal results. As MRF continues to gain interest in aesthetic practices, its integration with other treatments, such as platelet-rich plasma, stem cell products, and its derivatives, further enhances outcomes. Overall, MRF represents an innovation in cosmetic dermatology and aesthetics that can provide quite promising therapeutic results for various cases of cosmetic and aesthetic dermatology. However, further research is still needed to assess its effectiveness. This literature review aims to increase understanding of the application of MRF in cosmetic dermatology and aesthetics.
Background Telogen effluvium (TE), a form of nonscarring alopecia, has emerged as a common postinfection sequela of coronavirus disease 2019 (COVID-19). Increasing evidence suggests that oxidative stress and impaired antioxidant defense may play key roles in its pathogenesis. Objective To evaluate serum levels of soluble receptor for advanced glycation end products (sRAGE) and heme oxygenase-1 (HO-1) as markers of oxidative and antioxidative status, respectively, in post-COVID-19 patients with TE and to explore their association with TE severity and hair clinical characteristics. Patients and methods This comparative cross-sectional study included 90 participants divided equally into three groups: post-COVID-19 patients with TE (group A), post-COVID-19 patients without hair loss (group B), and healthy controls (group C). All underwent clinical and trichoscopic evaluation. Serum sRAGE and HO-1 levels were measured using ELISA. Results Group A exhibited significantly higher sRAGE levels (655.9 +/- 449.2 ng/l) than group B (347.0 +/- 41.8 ng/l) and group C (55.6 +/- 32.6 ng/l; P<0.001). Conversely, HO-1 was lowest in group A (0.58 +/- 0.54 ng/l) compared with group B (1.37 +/- 1.51 ng/l) and group C (6.47 +/- 3.36 ng/l; P<0.001). sRAGE levels correlated positively with TE severity (P<0.001), while HO-1 levels showed a negative correlation. Both markers were independent predictors of TE in multivariate analysis. Conclusion An imbalance between oxidative stress and antioxidant defense, reflected by elevated sRAGE and reduced HO-1, is strongly associated with post-COVID-19 TE. These biomarkers may aid in early diagnosis and monitoring of post-COVID-19 TE.
