VEGF seems to play an important role in the pathogenesis of keloids and may be a useful guide in the evaluation of keloid therapeutics. Modulation of its production may provide a valuable treatment for keloids.

BACKGROUNDNail psoriasis has a major negative impact on physical and psychological aspects of the patient's life. Treatment is often unsatisfactory because of difficult penetration of the drug into the nail.OBJECTIVETo evaluate and compare the efficacy of laser-assisted delivery of methotrexate versus its intralesional injection in fingernail psoriasis.MATERIALS AND METHODSTwenty-eight patients with fingernail psoriasis were divided into 2 groups of 14 patients each. Group A was treated with intralesional injection of methotrexate while Group B received fractional CO2 laser followed by topical application of methotrexate. The treatment was given at a 2-week interval for 6 sessions. The improvement of nail psoriasis was assessed by clinical and dermoscopic evaluation.RESULTSAt the end of treatment, both laser-assisted delivery and intralesional injection of methotrexate were associated with statistically significant improvement of psoriatic signs. No statistically significant difference was found between the 2 groups regarding total nail psoriasis severity Index (p = .18), matrix score (p = .38), bed score (p = .23), and dermoscopic score (p = .78). However, the pain and subungual hematoma were significantly less in the laser group (p < .001 and p = .03, respectively).CONCLUSIONFractional CO2 laser-assisted delivery of methotrexate can be an effective and well-tolerated alternative to intralesional injection in nail psoriasis.

Acanthosis nigricans is a common pigmentary disorder characterized by hyperpigmented and hyperkeratotic velvety skin lesions that presents mainly on the flexural sites, for example, the neck, the axillae, and groin. 1 The pathogenesis is mostly attributed to increased insulin resistance and hyperinsulinemia that result in stimulation of insulin growth factor 1 (IGF-1) receptors on keratinocytes and fibroblasts, leading to cellular proliferation. The dark color of AN is mostly due to hyperkeratosis rather than an increase in melanocytes. 2 It can be simply classified into four types: benign, malignant, drug-induced, and syndromic/pseudo-acanthosis nigricans. The term pseudo-acanthosis nigricans was referred to obese individuals who have AN with no underlying endocrinopathies. In these cases, the etiology was attributed to obesity, excessive local friction, and sweat. 3 The goal of therapy in AN is to correct the underlying disorder and treatment of AN lesions through cosmetic correction of the pigmentation. 4 Several topical and systemic agents have been used in the treatment of AN, for example, tretinoin, salicylic acid,

Background and objectives: The treatment of nail psoriasis is often unsatisfactory due to poor penetration of topical therapeutics through the nail plate. The development of innovative methods that provide adequate delivery of the drug into the nail is warranted. In this study, we aim to compare the efficacy of intralesional corticosteroid injection versus its topical application after fractional CO 2 laser in the treatment of fingernail psoriasis. Patients and Methods:The study included 36 patients with fingernail psoriasis divided into two groups. The nails in group A were treated with intralesional injection of triamcinolone acetonide while the nails in group B received fractional CO 2 laser therapy followed by topical application of the drug for six sessions. The evaluation was performed using NAPSI and dermatoscopic scores.Results: Both modalities yielded a significant improvement of the nail matrix and bed psoriatic signs. No statistically significant difference was found between the two groups by both clinical and dermatoscopic assessment. The laser treatment was associated with significantly lower pain scores (P = 0.03) and higher patient satisfaction (P = 0.007). Conclusions:Fractional CO 2 laser-assisted delivery of topical corticosteroids can be a potentially effective and well-tolerated therapeutic modality in the treatment of nail psoriasis with comparable efficacy to intralesional injection.

The term dilated facial pores refers to the visible openings on the surface of the skin that correspond to the dilated openings of pilosebaceous follicles. Large facial pores represent a common aesthetic complaint in both men and women with negative psychological impact. 1 They have been discussed in literature as sequelae of chronological aging and photoaging due to the defect in the collagen and elastin dermal framework. However, an increasing number of young patients are presenting at dermatology clinics with the complaint of dilated pores without signs of skin aging. 2 Other potential causative factors include sex, ethnic, and genetic predisposition, follicular size, and seborrhea. The association between increased sebum output and wide pores has been well established, and acne patients often complain of wide facial pores. 3 The treatment of dilated pores is difficult due to the multifactorial nature of its pathogenesis, and most current treatment options intend to address the associated factors. 4 A variety of treatment modalities have been tried, for example, topical and oral retinoids, chemical peels, microbotox, and energy-based devices. 4,5 The treatment