A Systematic Review of Fibrin Glue as an Ideal Treatment for the Pilonidal Disease
Pilonidal sinus is an acquired condition caused by irritation to the hair follicles at the natal cleft, presenting with an abscess or chronic infection. It is prevalent in young adults affecting their productive lifestyle with morbidities. There are varieties of treatment options; however, there is no consensus yet for the ideal procedure. Less invasive procedures have evolved to replace the traditional surgical techniques, which cannot significantly reduce the risks of recurrence and wound complications despite extensive surgeries. We aimed to assess the effect of fibrin glue as a primary treatment after cleaning the sinus in pilonidal sinus disease. We searched for articles from PubMed®, Ovid MEDLINE®, Ovid EMBASE®, and Cochrane CENTRAL. Six studies that included 336 patients in total were analyzed. Fibrin glue treatment in these studies reported a quicker return to normal activities postoperatively, a low rate of infection, and an acceptable rate of recurrence. Thus, fibrin glue seems beneficial in the management of pilonidal disease. However, further high-quality studies are essential to support and confirm this evidence. Future research should also evaluate its cost and implications in the ambulatory service.
Platelet-rich plasma for striae distensae: What do we know about processed autologous blood contents for treating skin stretchmarks?-A systematic review
International wound journal. 2021
Striae distensae, also known as stretch marks, particularly associated with female sex, pregnancy, obesity, and/or hormonal change, are linear bands of benign dermal lesions. Although not posing any health risk, aesthetically unpleasing stretch marks can cause significant psychological distress among those affected. In abundance of therapeutic approaches, some literature sources proclaim platelet-rich plasma to be a promising treatment modality for striae distensae. We aimed to shed some light on the current literature evidence of platelet-rich plasma for treating stretch marks and performed an English literature analysis with two independent reviewers in accordance with PRISMA guidelines searching the PubMed and Web of Science databases in June 2019. Of the 12 found studies, 6 matched inclusion criteria. With no control groups in two, just two other reports used intraindividual comparisons, and all but one publication performed histopathological assessments. All studies observed clinical and subjective improvements without using validated scores or patient-reported outcome measures (PROMs). The main findings were that multiple treatments with platelet-rich plasma demonstrated increased epidermal thickness, rete ridges formation, and collagen/elastin formation, while decreasing the inflammatory cell infiltrate. The current literature evidence supporting the use of platelet-rich plasma for striae distensae is poor. We propose in this review an outline for a study protocol with intraindividual control groups, standardised scores, validated PROMs, and participant incentives to enhance the scientific power in future clinical trials.
Efficacy and Safety of Platelet-Rich Plasma in Melasma: A Systematic Review and Meta-Analysis
Dermatology and therapy. 2021
INTRODUCTION Melasma is a chronic and recurrent skin problem for which an effective therapy is currently lacking. Platelet-rich plasma (PRP) has recently emerged as a novel treatment for melasma, but to date there has been no systematic evaluation of its efficacy and safety. METHODS The Web of Science, PubMed, EMBASE, China National Knowledge Infrastructure (CNKI) and the Cochrane Library databases were searched for relevant articles using the search items "melasma," "chloasma" and "platelet-rich plasma." STATA version 15.1 software was used to analyze data. Study outcomes were calculated using standardized mean differences with 95% confidence intervals (CIs). RESULTS The database search identified ten studies involving 395 adult patients that met the inclusion criteria and were included in the meta-analysis. Analysis of pre- and post-treatment data from these studies revealed that the post-treatment modified Melasma Area and Severity Index (mMASI) score decreased by 1.18 (95% CI 0.89-1.47; p = 0.02). Subjective satisfaction evaluation of PRP treatment showed that melasma treated with the combination therapy of PRP + microneedling may have been the most efficacious treatment compared to PRP alone or in combination with intradermal injection. Adverse reactions were minor, with only a few patients reporting local congestion, temporary erythema, hyperpigmentation and discoloration. CONCLUSION These results support the efficacy and safety of PRP used in combination or alone as treatment for melasma.
Comparison of effectiveness of interventions in reducing mortality in patients of toxic epidermal necrolysis: A network meta-analysis
Indian journal of dermatology, venereology and leprology. 2021;:1-17
BACKGROUND Limited evidence is available about effectiveness and choice of immunomodulating treatment modalities for toxic epidermal necrolysis (TEN). AIMS To compare the effectiveness of interventions to reduce mortality in patients of toxic epidermal necrolysis through network meta-analysis. METHODS Studies were retrieved using PubMed, Google Scholar and Cochrane Database of Systematic Reviews from inception to September 18, 2018. Only English language articles were considered. Observational and randomized controlled studies having ≥ 5 TEN patients in each intervention arm were included. Two investigators independently extracted study characteristics, intervention details and mortality data. Bayesian network meta-analysis was performed using the Markov chain Monte Carlo (MCMC) approach through the random effect model. The ranking analysis was done to provide a hierarchy of interventions. The consistency between direct and indirect evidence was assessed through node spit analysis. The primary outcome was to compare the mortality [Odds ratio OR (95% credibility interval CrI)] among all treatment modalities of TEN. RESULTS Twenty-four studies satisfying the selection criteria were included. The network analysis showed improved survival with cyclosporine as compared to supportive care [OR- 0.19 (95% CrI: 0.05, 0.59)] and intravenous immunoglobulin [OR- 0.21 (95% CrI: 0.05, 0.76)]. The hierarchy of treatments based on "surface under the cumulative ranking curves" (SUCRA) value were cyclosporine (0.93), steroid+intravenous immunoglobulin (0.76), etanercept (0.59), steroids (0.46), intravenous immunoglobulin (0.40), supportive care (0.34) and thalidomide (0.02). No inconsistencies between direct and indirect estimates were observed for any of the treatment pairs. LIMITATIONS Evidence is mainly based on retrospective studies. CONCLUSION The use of cyclosporine can reduce mortality in TEN patients. Other promising immunomodulators could be steroid+intravenous immunoglobulin combination and etanercept.
Fractional Carbon Dioxide Laser versus Fractional Carbon Dioxide Laser with Autologous Intralesional Platelet-rich Plasma in the Treatment of Stable, Non-segmental Vitiligo: A Randomized Comparative Study
Journal of cutaneous and aesthetic surgery. 2021;14(1):55-63
BACKGROUND The treatment of vitiligo is often challenging and requires a multi-modality approach. Fractional carbon dioxide (FCO(2)) laser has been studied as an adjuvant therapy in cases of vitiligo. Autologous platelet-rich plasma (PRP) is rich in growth factors, which may contribute to the growth of melanocytes, and thus help in the repigmentation of vitiligo patches. We aimed to study the combination of these two modalities for the treatment of vitiligo. AIMS AND OBJECTIVE The aim of this study was to compare the efficacy and safety of FCO(2) laser with PRP and FCO(2) laser alone as an adjuvant therapy in stable non-segmental vitiligo (NSV) patients. SETTINGS AND DESIGN A prospective, randomized, comparative, open-label interventional study was carried out for a period of 18 months from December 2017 to June 2019, at a tertiary care hospital. MATERIALS AND METHODS Seventy patients with stable, NSV were assessed for eligibility; 66 patients were randomized equally into two groups. Group A received treatment with FCO(2) laser with intralesional PRP, whereas Group B was treated with FCO(2) laser alone. Patients in both the groups were treated with one therapy session and were followed up monthly for a period of 3 months. All the patients received topical psoralen with ultraviolet A (UVA) PUVA-sol treatment. Baseline and monthly assessments were done by VITILIGO AREA SEVERITY INDEX and standardized photographs. RESULTS VASI score reduction was significantly more in the Group A with (mean ± standard deviation [SD]) 9.5 ± 0.22, 5.8 ± 1.12, and 3.6 ± 1.81 as compared to Group B 11.9 ± 2.83, 9.9 ± 3.11, and 8.9 ± 3.46 at each subsequent follow-up visits, respectively. Side effects such as burning sensation, erythema, and crusting were seen less frequently and lasted for a short period in Group A in comparison to those in Group B. CONCLUSION Combination of FCO(2) laser and autologous intralesional PRP has a synergetic effect in treating patients with vitiligo as an adjuvant therapy with minimal adverse effects.
Platelet-rich Plasma for Androgenetic Alopecia Treatment: A Randomized Placebo-controlled Pilot Study
Acta Derm Venereol. 2020
Platelet-rich plasma injections have been presented as an effective treatment for androgenetic alopecia; however, reliable study data concerning this therapy are lacking. The current randomized, placebo-controlled pilot study explored this novel therapy in 30 healthy male subjects with androgenetic alopecia. Five platelet-rich plasma treatments, at intervals of 4-6 weeks, and 2 follow-up examinations were performed. Twenty subjects were injected intracutaneously with platelet-rich plasma and 10 with physiological saline. Treatment efficacy was assessed by changes in hair number and diameter, measured with the TrichoScan system. A secondary objective was to assess clinical improvement, which was evaluated by an independent reviewer using patient photographs and a 5-point Likert scale. In addition, subject satisfaction was assessed by survey. No improvements were seen over the course of the trial, using TrichoScan measurements or visual assessment. In conclusion, treatment with platelet-rich plasma as a monotherapy does not improve hair growth in men with androgenetic alopecia.
Systematic Review of Platelet-Rich Plasma Use in Androgenetic Alopecia Compared with Minoxidil((R)), Finasteride((R)), and Adult Stem Cell-Based Therapy
Int J Mol Sci. 2020;21(8)
The number of articles evaluating platelet-rich plasma (PRP) efficacy in androgenic alopecia (AGA) have exponentially increased during the last decade. A systematic review on this field was performed by assessing in the selected studies the local injections of PRP compared to any control for AGA. The protocol was developed in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) guidelines. A multistep search of the PubMed, MEDLINE, Embase, PreMEDLINE, Ebase, CINAHL, PsycINFO, Clinicaltrials.gov, Scopus database, and Cochrane databases was performed to identify studies on hair loss treatment with platelet-rich plasma. Of the 163 articles initially identified, 123 articles focusing on AGA were selected and, consequently, only 12 clinical trials were analyzed. The studies included had to match predetermined criteria according to the PICOS (patients, intervention, comparator, outcomes, and study design) approach. In total, 84% of the studies reported a positive effect of PRP for AGA treatment. Among them, 50% of the studies demonstrated a statistically significant improvement using objective measures and 34% of the studies showed hair density and hair thickness improvement, although no p values or statistical analysis was described. In total, 17% of the studies reported greater improvement in lower-grade AGA, while 8% noted increased improvement in higher-grade AGA. Only 17% of the studies reported that PRP was not effective in treating AGA. The information analyzed highlights the positive effects of PRP on AGA, without major side effects and thus it be may considered as a safe and effective alternative procedure to treat hair loss compared with Minoxidil((R)) and Finasteride((R)).
Platelet-rich plasma in alopecia areata: intradermal injection versus topical application with transepidermal delivery via either fractional carbon dioxide laser or microneedling
Acta dermatovenerologica Alpina, Pannonica, et Adriatica. 2020;29(4):169-173
INTRODUCTION Alopecia areata (AA) is a common cause of non-scarring alopecia with variable response to treatment. Platelet-rich plasma (PRP) stimulates proliferation and differentiation of stem cells in the hair-follicle bulge via multiple mechanisms. Although beneficial, pain during injection in addition to unequal delivery and coverage is a major drawback of intralesional PRP in alopecia, particularly for extensive lesions and in patients with a low pain threshold. This study evaluates intradermal injection of PRP versus its topical use with enhanced transepidermal delivery through either fractional CO2 laser (FCL) or microneedling in treatment of AA. METHODS Sixty AA patients were randomized into three equal groups to receive monthly sessions of either PRP intradermal injection, FCL followed by topical PRP, or microneedling followed by topical PRP for 3 consecutive months. Assessment was done through the Severity of Alopecia Tool (SALT) score and patient satisfaction at the end of sessions (2 weeks after the last session) and after 3 additional months of follow-up. RESULTS Patients in all groups showed satisfactory results of PRP treatment, with statistically insignificant differences in the degree of improvement among patients of the three groups studied according to the two assessment parameters. Intralesional PRP injection was associated with significantly higher pain scores. CONCLUSIONS PRP is potentially effective and safe for treatment of AA. FCL and microneedling could facilitate topical PRP delivery and considerably decrease pain associated with intradermal injection while preserving PRP efficacy. These methods could be helpful for extensive lesions and in children.
A Comparative Study of Therapeutic Response to Intralesional Injections of Platelet-Rich Plasma Versus Triamcinolone Acetonide in Alopecia Areata
Indian dermatology online journal. 2020;11(6):920-924
BACKGROUND Alopecia areata (AA) is a chronic nonscarring alopecia that involves hair follicles and is characterized by patchy areas of hair loss without any signs of clinical inflammation. Platelet-ri-ch plasma (PRP) has a high platelet concentration. Anti-inflammatory effect of PRP may be of great help in AA. AIMS AND OBJECTIVES Study was conducted to compare the outcome of treatment and side effects of intralesional PRP versus triamcinolone in AA. MATERIALS AND METHODS 40 patients with alopecia areata were allocated into 2 groups and treated with triamcinolone and PRP injections. The response was analyzed by SALT score (severity of alopecia tool score) and hair regrowth grade (HRG) scale. Inferential statistical tools such as t-test, Mann-Whitney U test, and Chi-square test were used. RESULTS 16 patients in each group completed the study. While comparing the decrease in SALT score at different intervals of time, there was a significant difference in SALT score reduction during the second review between PRP group and triamcinolone group (P = 0.028). After the first and final review, results did not show any statistically significant difference between the two groups. While comparing the hair regrowth scale between treatments, there was no statistical significance. 12.5% patients in PRP group reported excellent response after final review (HRG scale 4), compared to none in triamcinolone group. CONCLUSIONS Platelet-rich plasma is a safe, effective, steroid sparing, and suitable alternative in AA. Only side effect noted was pain during injections in both the groups.
Efficacy, Safety, and Immunomodulatory Effect of the Intramuscular Administration of Autologous Total Immunoglobulin G for Atopic Dermatitis: A Randomized Clinical Trial
Allergy, asthma & immunology research. 2020;12(6):949-963
PURPOSE The management of patients with atopic dermatitis (AD) is often difficult. We hypothesized that repeated intramuscular administration of autologous total immunoglobulin G (IgG) could induce clinical improvement in patients with AD through immune modulation. This clinical trial was conducted to evaluate the efficacy, safety, and immunomodulatory effect of the intramuscular administration of autologous total IgG in patients with AD. METHODS In this randomized, double-blind, placebo-controlled trial, 51 adolescent and adult patients with moderate-to-severe AD were randomized to receive 8 weekly intramuscular administrations of autologous total IgG 50 mg (n = 26) or saline (n = 25) over a 7-week period and were followed up to week 16. Changes in the clinical severity score (Eczema Area and Severity Index), affected body surface area, patient-reported Dermatology Life Quality Index (DLQI) score, laboratory biomarkers, and incidence of adverse events from baseline to week 16 were assessed. RESULTS The intramuscular administration of autologous total IgG, compared with saline, decreased the clinical severity score (-64.8% vs. -20.3%, P < 0.001), reduced the affected body surface area (-53.9% vs. -19.1%, P < 0.001), improved the DLQI score (-35.4% vs. -14.4%, P = 0.015), increased serum interleukin-10 and interferon-γ levels (P = 0.011 and P = 0.003, respectively), and reduced the incidence of AD exacerbation (11.5% vs. 48.0%, P = 0.004) from baseline to week 16. No serious adverse events were observed. CONCLUSIONS The intramuscular administration of autologous total IgG provided clinical improvements and a systemic immunomodulatory effect in adolescent and adult patients with moderate-to-severe AD without significant side effects. TRIAL REGISTRATION Clinical Research Information Service Identifier: KCT0001597.