Background: Melasma is a cosmetically disfiguring disorder of facial pigmentation. Objectives: We evaluated the value of platelet-rich plasma (PRP) in the treatment of melasma using two different delivery techniques: microneedling using dermapen versus microinjections using mesoneedles. Patients and methods: Twenty-three adult Egyptian melasma patients were enrolled. Wood's light was used to determine the histological type of melasma. Autologous PRP was delivered into the lesional melasma skins through microneedling with dermapen on the right side of the face and intradermal microinjections using mesoneedles on the left side of the face (for each patient). The treatment was done regularly (three sessions, each month). The response to PRP therapy was measured using melasma area and severity index (MASI) and modified melasma area and severity index (mMASI) that were calculated before and after three treatment sessions. Hemi-MASI was used to compare the effectiveness of the two delivery techniques. Results: Following PRP treatment, MASI and mMASI scores decreased significantly from 11.86 ± 5.25 to 6.96 ± 4.82, and from 5.71 ± 2.56 to 2.90 ± 2.05, respectively (p < .000,). A statistically significant decrease was noted in the hemi-MASI score on each side of the face following PRP treatment (p < .000), but there was no significant difference in comparing both sides. Conclusions: Our study provides the first indication about the value of PRP as a useful and new therapeutic option in melasma. Moreover, our study was the first to compare PRP delivery through microneedling versus microinjections.

Introduction: Non-Hodgkin lymphomas of the oral and maxillofacial regions are uncommon malignancies. They usually have progressive course and dismal outcome. Areas covered: This review provides an update about the clinicopathologic, immunophenotypic, and molecular features of these lymphomas. Some relevant case reports are presented. Expert commentary: The lymphomas of the oral and maxillofacial regions involve the tongue, gingiva, hard palate, maxilla, mandible, Waldeyer’s ring, palatine, and lingual tonsils. They include diffuse large B-cell lymphoma (DLBCL), T-cell lymphoma, Burkitt lymphoma (BL), natural killer/T-cell lymphoma (NKTCL), marginal zone lymphoma, plasmablastic lymphoma (PBL), mantle cell lymphoma, and lymphoblastic lymphoma. They are more common in males than in females. They commonly present as mass lesions covered by an intact or ulcerated mucosa. Some lymphomas are associated with viral infections (Epstein–Barr virus or HIV) and specific genetic alterations. Each subtype has its specific clinicopathologic features and the most common subtypes include DLBCL, BL, NKTCL, and PBL. DLBCL is the most common oral lymphoma. BL is a rapidly proliferating mature B cell neoplasm almost always presenting in extranodal sites. Nasal-type NKTCL presents as a locally destructive, midfacial necrotizing lesion. PBL is a rare, highly aggressive disease that is commonly associated with immunodeficiency conditions.

Background: Melasma is a common acquired facial hyperpigmented skin disorder. Platelet-rich plasma (PRP) is autologous plasma containing higher than normal platelets concentrations. Recently, PRP has been used as a therapeutic modality in melasma with significant clinical improvement, possibly due to its abundant contents of growth factors such as TGF-β. The latter represents a natural multifunctional polypeptide that negatively regulates melanocyte differentiation and therefore reduces skin hyperpigmentation. To date, the expression pattern of TGF-β protein in skin of melasma patients following PRP injection is unknown. Here we hypothesize that “injection of PRP in the lesional skin of melasma patients is associated with alterations of TGF-β protein expression”. Patients and Methods: The study included 20 adult patients with melasma. Autologous PRP was delivered into the lesional skin either through microneedling or as intradermal microinjections. TGF-β protein expression was immunohistochemically examined in the perilesional and lesional skins before and after PRP treatment and in the healthy skins of nine volunteers (control group). Results: TGF-β protein was expressed within the epidermis, dermal adnexal structures, vascular endothelium, nerves and arrector pili muscle fibers of the healthy skins (control group), perilesional and lesional skins of melasma patients before and after treatment with PRP. Before treatment with PRP, the expression ofTGF-β protein in the lesional (1.26 ± 0.41) and perilesional (1.68 ± 0.51) skins of melasma patients were significantly lower than that in the healthy skins (2.26 ± 0.37, p value<.05). After treatment with PRP, the expression of TGF-β protein was significantly increased in the lesional (2.15 ± 0.44) skin of melasma patients. Conclusions: Our study provides the first indication about increased TGF-β protein expression in skin of melasma patients after PRP treatment. The alterations of TGF-β protein in skin of melasma patients not only support its roles in the development of this condition but also have some therapeutic ramifications.

Background: Vitiligo is an idiopathic skin disease characterized by white areas on the skin due to loss of the functional melanocytes, with possible involvement of oxidative stress. Glutathione peroxidase (GPx) is an antioxidant enzyme that protects cells against oxidative damage. Aim: To examine serum GPx levels in patients with vitiligo and to relate the findings to the clinical features. Patients and Methods: The study group included 60 patients with vitiligo and 30 matching healthy controls. GPx activity was evaluated using enzyme-linked immunosorbent assay. Results: We found a significant decrease in serum GPx activity level in the patients with vitiligo compared to the healthy controls (0.29 ± 0.14 versus 0.47 ± 0.13, p < .001). The levels were significantly low in skin phenotypes III and IV ( p < .001). Higher levels were also observed with increasing age (≥ 14 years), prolonged disease duration (≥ 3 years), and generalized and extensive vitiligo (<50%). However, these variations were statistically insignificant. Conclusions: Low levels of serum GPx activity, indicative of a disturbed oxidant-antioxidant system, may contribute to the development of vitiligo.

Background: Striae distensae (SD) are common skin conditions. Objectives: This study was done to test the hypothesis that ‘the use of microneedling (MN) before platelet-rich plasma (PRP) application will allow for deeper penetration and therefore, augment its efficacy in the treatment of SD.’ Patients and methods: Forty patients with SD were divided into (i) Group I, the patients were treated with MN only, and (ii) Group II, the patients were treated with combined MN-PRP. The clinical improvement was evaluated by two dermatologists. Skin biopsies were obtained before and after therapy to examine immunohistological changes. Results: As compared to the use of MN alone, therapy with combined MN-PRP was associated with: (i) a marked to the excellent improvement of the skin lesions of SD, (ii) a more significant deposition of collagen and elastic fibers, (iii) increased proliferative activity in the epidermis, and (iv) a decreased caspase-3 protein expression values in the epidermis. Conclusions: This study proved that the combined MN-PRP is more effective than MN alone for the treatment of the lesions of SD. The underlying molecular mechanisms are open for future studies.