Evaluation of Effectiveness of Diode Laser System (808 nm) versus Intense Pulse Light (IPL) in the Management of Unwanted Hair: A Split Face Comparative Study

We have evaluated and compared the effectiveness of diode laser system (808 nm) and Intense Pulse Light (IPL) system (690 - 1200 nm) by studying the change in hair density, and the time of regrowth the hair. A total of 26 have completed three months’ treatment, aged 16 - 50 years. Patients were treated by diode laser 808 nm and IPL 690 - 1200 nm devices. Pulse repetition rate for both was 1 Hz and short pulse width for diode laser and the IPL pulse width was 15 ms. The fluence was (33 - 41 and 30 - 41) J/cm2 respectively. A split face treatment method was used. The treatment was carried out on monthly bases for three months. Hair density and regrowth duration were recorded before and after each session. After the third session, the hair density was decreased by (58%) for diode laser versus (49%) for IPL p = 0.366. The time of hair regrowth was increased to (327%) for diode laser versus IPL (339%) p = 0.821. Pain appeared more during the treatment with IPL than with diode laser. Post treatment side effects such as erythema, hyper pigmentation, and burn appeared on patients treated with diode laser more than those treated with IPL. In conclusion both diode laser and IPL were effective in reduction of hair density, and prolongation of the time of hair regrowth.

Mycosis Fungoides in Iraqi Patients—Clinical, Histopathological and Immunohistochemical Study

Background: Mycosis fungoides (MF) is not an uncommon T-cell lymphoma in Iraqi population which is increasing over years. There are many diagnostic techniques to confirm the diagnosis including histopathological and immunohistochemical tests. Objectives: To evaluate all cases of MF including clinical, histopathological and immunohistochemical tests with CD markers. Patients and Methods: This clinical, histopathological, immunohistochemical outpatient based study took place in the Department of Dermatology, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq during the period from May 2012-September 2013. Twenty five patients with MF were included in the present work. History was obtained from each patient regarding all socio-demographic aspects related to the disease. Also, clinical evaluation was carried out for all patients. Incisional biopsies for ordinary histopathology and immunohistochemical tests were done. Then staging was carried out depending on TNMB classification for all patients. Results: All cases of MF were confirmed after clinical evaluation, histopathology and immunohistochemical examination. Male to female ratio was 1.5:1. The mean age of onset at presentation was 47.45 ± 16.9 years. Itching was found in 84% of cases. The patch stage was seen in 36% patients. The hypopigmentaed MF was presented in 12% cases. The lower extremities were seen in 80%. Lymph node involvement as a manifestation of the disease was seen in 44% cases. The histopathological features of MF went parallel with the clinical stage of disease. Immunohistochemical study aids in the diagnosis of patch and erythrodermic stages. The most patients presented with stage IB (36%). Conclusion: MF seems to be not uncommon problem in Iraqi population and is increasing over years. The disease was diagnosed early commonly with patch stage (stage IB) while hypopigmented MF was not a common variant when compared with neighboring countries.

A Comparative Study of Topical Azailic Acid Cream 20% and Active Lotion Containing Triethyl Citrate and Ethyl Linoleate in the Treatment of Mild to Moderate Acne Vulgaris

Background: Acne vulgaris is a common disorder affecting 79% - 95% of the adolescent population. The choice of treatment depends on the severity, patients with mild to moderate acne should receive topical therapy such as azelaic acid. Rising antibiotic drug resistance consequent to the widespread use of topical antibiotics is causing concern and effective non-antibiotic treatments are needed. Objective: To compare the efficacy and side effects of topical azelaic acid cream 20% versus active lotion containing triethyl citrate and ethyl linoleate (TCEL) in treatment of mild to moderate acne vulgaris. Patients and Methods: This single, blinded, comparative, therapeutic study was done in the Department of Dermatology-Baghdad Teaching Hospital, Baghdad, Iraq;from May 2013-July 2014. Scoring of acne was carried out and the patients were examined every 2 weeks for 10 weeks of treatment. One month after stopping drugs, patients were evaluated for drug complications and disease recurrence. Sixty patients fulfilling enrollment criteria were included in this study. Patients were divided into 2 groups: Group A (30 patients) treated twice daily with TCEL lotion and Group B (30 patients) treated twice daily with topical azelaic acid cream 20%. Results: Both topical TCEL lotion and azelaic acid cream were statistically an effective therapy for treatment of mild to moderate acne vulgaris. TCEL lotion was more effective and act earlier than azelaic acid cream starting from 4 weeks of therapy till the end of treatment (after 10 weeks) and even after 4 weeks after stopping the treatment (P-value < 0.04). No systemic side effect for both groups was noted while the following side effects were reported;burning, pruritus and erythema, all these side effects disappeared after 8 weeks from starting treatment. After one month of follow up there was no significant relapse in both groups. Conclusion: The TCEL is non-antibiotic based, it had quicker onset of action and observable improvement of both inflammatory and non-inflammatory acne lesions. Its use would reduce the risk of antibiotic resistance developing within the skin flora.

Treatment of Acne Vulgaris with 5-Alpha Avocuta Cream 2% in Comparison with Tretinion Cream 0.025% (Single Blind Comparative Study)

Background: Acne vulgaris is a common skin disease. Its pathogenesis is multifactorial, and therapy can now be directed at many of these factors. Among these factors are androgen hormones which play an important role in the pathogenesis of acne. Accordingly,many antiandrogens have been developed to treat acne by systemic and topical ways. Five-Alpha Avocuta 2% cream is a new topical 5-alpha reductase inhibitor extracted from the tropical fruit “avocado”. Objectives: To evaluate the effectiveness and safety of 5-Alpha Avocuta cream and compare it to tretinoin 0.025% cream, in the treatment of acne vulgaris. Patients& Methods: This single blinded comparative study was done in Department of Dermatology– Baghdad Teaching Hospital - from July 2009 through October 2010. All demographic points related to the disease were obtained from each patient to evaluate severity of acne. Sixty-eight patients with acne were divided into two groups and instructed to apply the drugs for three months. Group A uses 5-Alpha avocuta 2% (Teen-derm K) cream and Group B uses tretinoin (Acretin) 0.025% cream. Severe acne was excluded from the study. The clinical improvement was evaluated by counting the number of inflammatory lesions before and after treatment and compare between them by paired t-test. Results: Fifty-eight patients completed the study, their age ranged from 12 - 30 years with a mean of 18.21 ± 4.64 years. In Group A there was a significant reduction of the mean number of papules from 29.7 before treatment to 15.5 after treatment (p < 0.0001), while the mean number of pustules decreased from 4.9 to 0.6 (p = 0.019). In Group B the mean number of papules was reduced from 28.5 to 14.9 (p < 0.0001), while the mean number of pustules dropped from 5.3 before treatment to 0.7 after treatment (p = 0.009). The mean difference of papules after 14 weeks in Group A was 15.55 ± 6.95 while in Group B, the mean difference was 14.86 ± 6.99. This result was statistically not significant (p = 0.708, t-test). The difference in the mean percentage of reduction of inflammatory lesions at week 14 between the two groups was not statistically significant (P-value = 0.999).The side effect was negligible in Group A and not required stopping the drug while in Group B treatment stopped in 2 patients. Conclusions: Five Alpha avocuta was an effective mode of therapy in treatment of acne vulgaris, and it was comparable to tretinoin, with little side effects.

Treatment of Localized Vitiligo with 1% Pimecrolimus Cream versus 0.05% Clobetasol Propionate Cream—Single, Blinded, Comparative Therapeutic Trial

Background: Calcineurin inhibitors like tacrolimus and pimecrolimus are new modality of treatment of localized vitiligo. Objective: To compare the effectiveness and side effects of 1% pimecrolimus cream in comparison with 0.05% clobetasol propionate cream as a treatment of localized type of vitiligo. Patients and Methods: Fifty two patients with localized vitiligo were included in this single, blind, comparative therapeutic trial. Full history and examination for each patient was done. Wood’s light was used when needed to confirm the diagnosis. Thirty (57.7%) were females and 22 (42.3%) males, female to male ratio of 1.36:1. Their ages ranged between 3 - 40 (13.15 ± 7.9) years, while disease duration ranged from 6 - 84 (29.62 ± 20.56) months. Total numbers of lesions were 114 lesions with a mean of 2.2 lesions per patient. The surface area of the lesions ranged between 1 - 31 (7.15 ± 6.98) cm2. Vitiliginous patches were most commonly located on face 48 (42.1%) lesions, and lower limbs 35 (30.7%) lesions. Patients were divided in to two groups according to the type of therapeutic modality.?Group?A?consisted of 25 patients (52 lesions) receiving 1% pimecrolimus cream and?Group?B?27 patients (62 lesions) treated with 0.05% clobetasol propionate cream, both used twice daily. The amount of cream per area was applied according to rule of fingertip unit. Measuring the surface area of the lesions and calculating the reduction rate were done every month till the end of the 6th?month. Then patients were asked to stop the use of medication to be re-evaluated again after 3 months without any treatment and to record any local or systemic side effects. Results: After 6 months of treatment there was 79.67% reduction in the surface area of lesions in?Group?A, while inGroup?B?there was 82.59% reduction in the surface area with no statistically significant difference between the two groups. The reduction rate was early as there was statistically significant reduction for both groups after one month of treatment (p value < 0.01). The reduction rates for facial lesions were more than other parts of the body. There was no significant relapse after 3 months of stopping treatment for both groups. Side effects were minimal and tolerable. Conclusions: Topical 1% pimecrolimus is as effective as clobetasol propionate in treatment of localized vitiligo affecting less than 5% of the body surface area but pimecrolimus was more preferred as the side effects of topical steroid could be avoided.

Infliximab Therapy in Iraqi Patients with Moderate to Severe Psoriasis

Background: Tumor necrosis factor alpha (TNF-α) is a proinflammatory cytokine which plays a critical role in the pathogenesis of psoriasis. Infliximab is an anti-TNF-α drug widely used for the treatment of psoriasis. Objectives: To assess the efficacy and safety of infliximab in Iraqi patients with moderate-to-severe psoriasis. Patients and Methods: In this therapeutic, single-center study, a total of 23 patients with moderate-to-severe psoriasis resistant to conventional treatments were enrolled to receive infusions of infliximab 5 mg/kg at weeks 0, 2, and 6, then every 8 weeks for at least 22 weeks. Psoriasis Area and Severity Index(PASI), Body Surface Area (BSA) and Dermatology Life Quality Index (DLQI) were calculated at each visit to assess the response to treatment and all side effects were recorded. Results: PASI score was reduced from a mean ± SD of 17.41 ± 8.53 before treatment to 2.44 ± 2.68 after 22 weeks. At week 22, 84% of patients achieved PASI 75, 42% achieved PASI 90 and 28% achieved complete clearance. BSA and DLQI score were reduced from a mean ± SD of 35.69 ± 22.44 and 20.04 ± 4.68 before treatment to 3.52 ± 4.94 and 3.87 ± 5.60 after 22 weeks, respectively. Pruritus, boils, infusion reactions were recorded and relapse during treatment was found in 3 patients. Conclusion: Infliximab monotherapy is highly effective in the treatment of moderate-to-severe psoriasis, with rapid onset of action and relatively low side effects.