Carboxytherapy for treatment of localized chronic plaque psoriasis: Clinical and histopathologic evaluation

An overview of the role of carboxytherapy in dermatology

BACKGROUND

Carboxytherapy is defined as intradermal and/or subcutaneous microinjections of sterile purified carbon dioxide into different parts of the body for therapeutic aims. The vasodilatation effect and intradermal collagen reorganization associated with carboxytherapy have advantages for aesthetic dermatology and cosmetology.

OBJECTIVE

In the current article, we have reviewed some of the most important indications of this modality in dermatology and aesthetic dermatology.

METHOD

Our review is a narrative one which has gathered some of the most important indications of carboxytherapy in dermatology and cosmetology.

RESULTS

Carboxytherapy has successfully been applied for some dermatologic and cosmetic conditions among which skin aging, cellulite, localized fat deposits, striae distensae, infraorbital hyperpigmentation, scar, lymphedema, androgenetic alopecia, alopecia areata, psoriasis, morphea, and vitiligo are the most important.

CONCLUSION

Carboxytherapy can be considered as a safe, minimally-invasive modality used for rejuvenation, restoration, and recondition of the skin.

Intralesional combined furosemide and digoxin in cutaneous warts treatment: A randomized controlled clinical trial

Although being a benign lesion, Warts can affect the quality of life by causing discomfort, disfigurement, and social embarrassment besides the tendency to spread. Cutaneous wart treatment faces many challenges as the development of an antiviral drug that can eradicate the human papilloma virus (HPV) is difficult. This clinical study aimed to assess the efficacy and safety of intralesional combined furosemide and digoxin in the treatment of multiple cutaneous warts. This double blinded randomized clinical trial included 80 adult patients with multiple cutaneous warts (≥2 warts) who were randomized into two groups, Group I (40 patients) treated with intralesional combined furosemide and digoxin and Group II (40 patients) who were treated with intralesional normal saline solution as a control group, weekly till improvement or for maximum five sessions. Clinical and dermoscopic evaluation at baseline, every session, and monthly for 6 months after the last session to detect any recurrence was performed. Complete wart clearance was observed in 92.5% of patients in the intralesional combined furosemide and digoxin group (Group I) compared with 10.0% in saline group (Group II), with highly statistically significant difference (P-value = 0.000). Pain during injection in 95.0% and 45.0% of patients in Group I and Group II respectively, treatment group was superior compared to control group. Intralesional injection of combined furosemide and digoxin can be a safe and effective treatment option in multiple cutaneous warts with minimal side effects in this study.

Combination of carboxytherapy with narrowband-ultraviolet B in the treatment of recalcitrant areas of vitiligo: A randomized clinical trial

Carboxytherapy has been used in the treatment of autoimmune skin diseases such as psoriasis and morphea. Carboxytherapy has antioxidant effects, and leads to better tissue oxygenation, and release of growth factors. In this article, we decided to evaluate efficacy of combined carboxytherapy and narrowband-ultraviolet B (NB-UVB) compared to NB-UVB alone in the treatment of vitiligo. This is a prospective, split-body double-blind comparative study performed in patients with generalized stable vitiligo in acral areas and extremities referred to dermatology clinic of Afzalipour hospital in Kerman University of Medical Sciences. NB-UVB was performed three times a week in non-consecutive days for 4 months. In each patient, one lesion was randomly treated with carboxytherapy (weekly sessions for total of 16 sessions). Efficacy of treatment was evaluated by percentage of repigmentation of the lesions. Chi-square test and analysis of variance test (ANOVA) were used to compare efficacy of treatment based on demographic features of the patients and clinical features of the lesions, respectively. Twenty-eight patients with mean age of 32.35 ± 7.37 years old completed the study. At the end of the treatment, 37% of the patients in combination therapy group demonstrated more than 75% improvement compared to 0% in the monotherapy group (p = 0.001). There was no significant difference between either demographic features of the patients (age, sex, and skin phototypes) or duration of disease with efficacy of the treatment in both groups. Combination of carboxytherapy with NB-UVB leads to higher percentage of repigmentation and patients' satisfaction compared to monotherapy with NB-UVB.

Botulinum toxin type-A versus 5-fluorouracil in the treatment of plaque psoriasis: Comparative study

BACKGROUND

Long-term remission and total clearance in Psoriasis can only be achieved in a few patients.

AIM

To compare the efficacy and safety of intradermal Botulinum toxin (BTX) in the treatment of plaque psoriasis.

SUBJECTS AND METHODS

A comparative study conducted in thirty-five patients with chronic plaque psoriasis was treated by split-body therapy. The patients were either treated with intradermal BTX or with intralesional 5-fluorouracil (5-FU) to each of 2 bilaterally symmetrical psoriatic plaque lesions. The outcomes were assessed using the following criteria: the sum of erythema, scaling, and induration scores and the clearing percentage of the target plaque lesion assessed by 2 blinded observers.

RESULTS

At the end of the study, the response rate was 85% on the BTX treatment side and 90% on the 5-FU side. There was no significant difference between both sides regarding a clinical response or side effects. The recurrence rate was 15% on both sides.

CONCLUSIONS

Botulinum toxin was a novel, safe, single injection, and effective therapy for plaque-type psoriasis. More studies are required to further prove the efficacy of BTX in the treatment of plaque psoriasis.