Best Disease in 13 Years Old Female

Best disease is a hereditary-degenerative macular dystrophy. Described for the first time by Friedrich Best, It is due to the accumulation of lipofuscin in the macular pigment epithelium. We report a case of a 13 years old female with no medical history. Slit lamp examination revealed unremarkable findings in the anterior segment of both eyes. Posterior segment exam, at the macula, showed a well circumscribed yellow material similar to the egg yolk structure, in both eyes (Figure 1). Figure 1: Retinography with bilateral egg yolk-like image on macula. The Optical Coherence Tomography (OCT) macula revealed Pigmentary Epithelial Detachment (PED) and LE atrophic scar. The systemic examination had no remarkable findings. The patient was diagnosed Best Vitelliform macula.

Preliminary Prospective and Randomized Study of Highly Purified Polynucleotide vs Placebo in Treatment of Moderate to Severe Acne Scars

Background Managing acne scars is a challenge and therapies are divided into nonsurgical and surgical. Highly Purified Technology Polynucleotides (PN-HPT) is a compound that contains a mixture of DNA polymers of different lengths. Numerous studies have shown that PN-HPT also serves as an energy source, thus influencing cellular growth and cell vitality. Objectives The authors aimed to assess the improvement in dermal quality and acne scars after PN-HPT vs placebo according to Antera 3D and the patient responses to the patient satisfaction questionnaire after a comparison of pretreatment and posttreatment photographs at 1 and 3 months. Methods Included were women aged 30 to 50 years with grade 3 to 4 moderate-to-severe atrophic scars according to the Goodman classification; nonsmokers; and had not had active acne during the past 5 years. Ten patients (PN-HPT group) were treated with 4.0 mL of PN-HPT, and 10 patients (control) were treated with 4.0 mL of normal saline. All medical treatments were performed in a double-blinded manner; neither the injection doctor nor the patient knew if the PN-HPT or the placebo was being administered. Results Twenty women who fit the inclusion criteria were enrolled in this study. Only patients in the PN-HPT group improved significantly at 1 and 3 months after treatment compared with baseline. Conclusions This prospective and randomized study showed that PN-HPT in monotherapy was safe and effective treatment for atrophic scar acne compared with placebo. Prospective and randomized studies will be necessary to investigate the clinical effectiveness in a larger cohort of patients and for a longer follow-up. Level of Evidence: 2

Microneedle-Facilitated Intradermal Proretinal Nanoparticle Delivery

Topical retinoid treatments stimulate biological activities in the skin. The main physical barrier, which limits the efficacy of transdermal drug delivery, is the stratum corneum. Proretinal nanoparticles (PRN) have already been proven to efficiently deliver retinal into the epidermis. In the present study, two transdermal drug delivery systems, microneedles (MN) and PRN, were combined to directly target the dermis. The microchannels induced by the MN, the PRN localization in the microchannels and the skin closure kinetics were investigated by non-invasive imaging techniques, such as dermoscopy, optical coherence tomography and multiphoton tomography. Additionally, the amount of retinal in the epidermis and dermis after application in three different forms (PRN-Loaded microneedles, PRN suspension or conventional retinal solution) was compared. All imaging techniques confirmed the formation of microchannels in the skin, which were partly still detectable after 24 h. Multiphoton tomography showed the release of PRN from the MN within the microchannels. The recovered retinal concentration in the dermis was significantly higher when applied via PRN-loaded microneedles. We hypothesized that this platform of PRN-loaded microneedles can provide a rapid and efficient administration of retinal in the dermis and could be of benefit in some skin conditions such as atrophic scar or photo-aged skin.

Juvenile Xanthogranuloma

Juvenile xanthogranuloma is the most common form of non-Langerhans-cells histiocytosis or non-X histiocytosis. Most often affecting infants and young children.A case of juvenile xanthogranuloma in a 3-month-old male infant has been reported. There were multiple, discrete, firm, red-brownish, orange nodules, round and oval in shape, well-defined, 0.5–2 cm in diameter, disseminated on his scalp, face, trunk, upper and lower extremities, also genitalia and some of them with ulceration on its surface. No mucous membrane and systemic involvement. Pathology result revealed Touton giant cells that characteristic to juvenile xanthogranuloma although the other diseases might contain these cells such as Hashimoto-Pritzker disease and dermatofibroma. Within few years, the lesions could regression spontaneously and leaving a flat, atrophic scar or an area of altered pigmentation.

Evaluation of efficacy and safety of platelet rich plasma (PRP) and microneedling (radiofrequency) in the treatment of atrophic acne scars

Background: Acne Vulgaris is a self-limiting, chronic skin lesion, which may heal with squally of different types of scars (ice pitted, boxcar, rolling, and keloid). Different options used to deal with scars such as laser dermabrasion, surgical excision, and chemical peeling. This study aims to assess the safety and effectiveness of using a combination of radiofrequency (RF) microneedling and platelet-rich plasma (PRP) in managing the atrophic acne scars among a sample of Iraqi patients. Method: An interventional study conducted from January 2017 to December 2018 at a private dermatological clinic in Kalar City, Al-Sulaymmania Province, Iraq. Patients with the atrophic scar and willing to participate are adequately assessed and treated by RF and PRP. A different number of sessions of therapy used, and patients followed for three months after the last meeting. Results: Thirty-one patients were involved in the study. The majority of them (27, 87.0%) were females with a mean age of 26.41±8 years. Twenty patients (64.5%) had opened mouth (boxcar and rolling) scars, and eleven (35.5%) had ice pitted scars. Ten patients (32.25%) showed an excellent response to RF and PRP therapy with two grades improvement, fifteen patients (48.38%) showed good response with one-grade improvement and six patients (19.6%) showed poor response without improvement in grades, (all of them of ice pitted scars). There was a direct relationship between the number of sessions and the response to therapy. Three patients developed folliculitis at sits of puncturing with the isolation of staphylococcus auras bacteria, which cleared by topical and systemic antibiotics. Conclusions: Although ice pitted scars showed an inadequate response to therapy, however, the reaction of the boxcar and rolling scars to RF and PRP was excellent, indicating that combination procedure is a safe, efficient and satisfactory option for the treatment of atrophic acne scars.