Treatment of Gray Hair in Vitiligo Patients by Direct Melanocytes Transplant Using Needling Micrografting and Dermabrasion Techniques

Background: Melanocytes transplant for treatment of vitiligo is a common therapy using different surgical procedures. But there was no interest in repigmentation of grayness of hair in the treated vitiliginous area. Objective: To do melanocytes transplant from donor area into the recipient vitiliginous area with associated gray hair. Patient and Methods: This is a case interventional study was done in Department of Dermatology/Baghdad Teaching Hospital from February 2011-March 2012. Eleven patients were enrolled in this study, six males and five females with vitiligo in association of gray hair. Their ages ranged from 8 - 35 years with a mean ±SD of 20.90 ± 7.006. Melanocytes transplant in patients with vitiligo using needling micrografting technique for twelve patches and direct melanocytes transplant from normal donor area into vitiliginous recipient area by dermabrasion technique for eleven patches. Dressing was applied and patients were seen every two weeks for the first month and monthly for one year. Results: Repigmentation of the vitiliginous area was started after two weeks and was obvious at one month that progressed over time. The repigmentation of hair appeared usually after few months and was obvious after four months and the repigmentation of gray hair was quicker in patients with micrografting technique than those with dermabrasion technique. The mean rate of repigmentation was 18.3% at six months and 37.5% at twelve months in micrografting technique while the mean rate of repigmentation was 9.15% at six months and 18.55 at twelve months in dermabrasion technique. Conclusions: Direct transplant of melanocytes from normal donor area into recipient vitiliginous area with associated white hair is an effective procedure to induce repigmentation of gray hair.

Treatment of Active Acne Vulgaris by Chemical Peeling Using TCA 35%

Background: The pathogenesis of acne vulgaris is multifactorial, and therapy can be directed at many of these factors, singly or in combination. There are different modalities of treatment of active acne vulgaris but they are often long lasting which could not be accepted by many patients. Objective: To evaluate the effectiveness, long term efficacy and safety of chemical peeling using 35% TCA solution in the treatment of active acne vulgaris. Patients and Methods:This clinical, interventional, therapeutic study was done at the Department of Dermatology—Baghdad Teaching Hospital during the period from January 2012 to March 2013. Eighteen patients with active acne vulgaris were included in this study, 10 (55.6%) females and 8 (44.4%) males. Their ages ranged from 15 to 35 (21.56 ± 5.501) years. Twelve patients were associated with acne scars. History and dermatological examination were performed for all patients regarding all demographic points related to the disease. Chemical peeling with 35% TCA used one session regarding active acne vulgaris and three sessions in patients with associated scarring. Scoring for active acne vulgaris and acne scar was done for each case before and after peeling to evaluate the severity of acne lesions and scarring. All patients were with Fitzpatrick’s skin types III and IV. Patients were followed up every two weeks for 12 weeks after starting therapy and every 4 weeks for 12 weeks after stopping the treatment to watch improvement, side effects and relapse. Results: Scoring for active acne vulgaris including papules and pustules showed highly statistically significant reduction after 2 weeks of therapy (p Conclusions: Chemical peeling by TCA 35% is a cost-effective mode of therapy for active acne vulgaris and acne scar with low down time in patients with dark complexion.

Treatment of Chronic Paronychia: A Double Blind Comparative Clinical Trial Using Singly Vaseline, Nystatin and Fucidic Acid Ointment

Background: Chronic paronychia is a chronic inflammatory reaction of the proximal and lateral nail folds of multifactorial in etiology like irritant, bacterial and monilial causes. But housewife work is a major cause of chronic paronychia. Objective: To assess the efficacy and prophylactic effects of Vaseline by occlusion of nail folds in comparison with nystatin ointment and fucidic acid in treatment of housewife chronic paronychia. Patients and Methods: This double, blinded, comparative therapeutic, clinical trial is conducted at the Department of Dermatology-Baghdad Teaching Hospital from May 2010 to May 2011. Eighty female housewife patients with chronic paronychia were included in this trial. They were divided into three groups according to the following therapeutic model: Group A treated by Vaseline consisted of 40 patients;Group B and Group C treated by nystatin ointment, fucidic acid ointment respectively and each group consisted of 20 patients. All demographic points related to the disease were recorded from all patients. Invented score system was applied to assess the severity of disease and the response to therapy. Patients had used therapy twice daily on the proximal and lateral nail folds. Treatment duration was 12 weeks. Results: Group A (Vaseline): The recovery rate after 12 weeks of treatment was 26 (65%) patients, while there was no recovery in 14 (35%) patients. Group B (Nystatin ointment): The recovery rate after 12 weeks was 13 (65%) cases and there was no recovery in 7 (35%) patients. Group C (Fucidic acid ointment): The recovery rate 12 weeks of treatment was 12 (60%) patients and there was no recovery in 8 (40%) patients. The earliest signs of recovery in all groups were decreased in nail fold tenderness, redness, swelling followed by improvement in the nail shape, then decreased in the separation of proximal nail fold from nail bed followed by re-growth of cuticle. There was significant difference in clinical response before and after therapy in all groups (P ≤ 0.0001) while there was no statistical significant difference when the three groups were compared with each other (P = 0.784). Conclusions: Vaseline occlusion therapy of the nail folds in patient with chronic paronychia was enough to induce recovery from the disease and there was no statistical significant difference when compared with nystatin or fucidic acid treatment of chronic paronychia.

Podophyllin (10%) Ointment: A New Therapeutic Modality for Psoriasis

Background: There are many topical therapies for the treatment of plaque psoriasis like steroid, dithranol, tar and vitamin D analogues, but none of them is ideal. Most recently, in a pilot study, podophyllin 5% ointment on every other day regimen was as effective as clobetasole 0.05% ointment twice daily. Objective: To reassess the efficacy of a higher concentration of podophyllin (10%) in the treatment of mild psoriasis in comparison with clobetasole using a different regimen. Patients and Methods: This is therapeutic, comparative, placebo-controlled study conducted at the Department of Dermatology-Baghdad Teaching Hospital, during the period of January 2011 - October 2012. Eighty-seven patients with mild plaque-type psoriasis were divided into three groups: Group A (30) patients were treated with podophyllin 10% ointment;Group B (30) patients were treated with clobetasol propionate 0.05% ointment and Group C (27) patients were treated with Vaseline as a placebo control group. All patients were treated on every other day. The efficacy was evaluated every 2 weeks for 8 weeks using PASI score and the local and systemic side effects were recorded. The relapse was recorded after cessation of therapy in those patients who achieved good response during another 8 weeks follow-up period. Results: The patients were 60 (68.9%) males and 27 (31.1%) females (male: female ratio, 2.2:1). Their ages ranged from 18 - 62 (36.4 ± 10) years. Their disease duration ranged from 0.1 - 40 (7.8 ± 8.5) years. Their baseline PASI score ranged from 1.6 - 9.6 (4.4 ± 5.85). At the end of 8th week of therapy, Group A patients had achieved much higher reduction in PASI score (77.4 ± 14.1) than Group B patients (60.4 ± 27.8), P value = 0.004, and both of them were with statistically and significantly higher PASI reduction than patients in Group C (28 ± 23.4), P value = <0.001. The total relapse rate during 8 weeks follow-up was much lower among Group A treated patients, 20% versus 66.6% in Group B (P-value = 0.002), while the relapse rate was 100% in the Group C patients. Regarding side effects: 3 (10%) patients developed erythema, burning, pain, blistering and hypopigmentationin Group A. No side effects were reported in Groups B nor C patients with no statistically significant difference among the three groups (P = 0.052). Conclusion: Podophyllin 10% ointment was more effective than clobetasole 0.05% ointment on every other day treatment regimen at the end of 8 weeks treatment with no side effects and a much lower relapse rate in treatment of mild plaque-type psoriasis.

Direct Melanocytes Transplant from Normal Donor Area into Vitiliginous Recipient Area by Dermabrasion Technique

Background: Vitiligo is an autoimmune pigmentory disorder, that affects all age group that is treated by many medical treatments but some of them might need surgical therapy. Objective: To evaluate the dermabrasion technique in the treatment of vitiligo by direct transfer of melanocytes from the dermabraded normal donor area to the vitiliginous recipient area. Patients and Methods: This is a case interventional study was done in Department of Dermatology/Baghdad Teaching Hospital from February 2011-March 2012. Nine Patients with vitiligo were enrolled in this study with different clinical types of vitiligo including 5 segmental, 2 generalized and 2 localized. The donor and recipient areas were anesthetized at the same time with xylocain alone. Dermabrasion of recipient area was done first by manual abrader and left for few minutes until the oozing was stopped. Then the donor area was similarly dermabraded and the dermabraded tissue including the epidermis and superficial epidermis was immediately transferred into the recipient area and dressing was applied. Removal of the dressing was done after 10 - 14 days from the operative time. Follow up was done every 2 weeks in the first month then monthly for six months to record the result of implantation and repigmentation. Results: The re-pigmentation started one month after the operation as small macules and this increased gradually over time: the mean rate of re-pigmentation was 13% at 2 months, 27.8% at 4 months and 36.78% at 6 months. In addition, sun light exposure was applied to enhance re-pigmentation. The pigmentation was diffuse and not follicular in shape. Conclusion: Direct transfer of melanocytes from normal donor area into vitiliginous recipient area by dermabrasion technique was easy, rapid and non-costly and gave 36.78% mean rate of pigmentation at 6 months follow up and without complications.

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.