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      Platelet-rich plasma versus combined fractional carbon dioxide laser with platelet-rich plasma in the treatment of vitiligo: a comparative study

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          Abstract

          Purpose

          The aim of this study was to assess the efficacy of platelet-rich plasma (PRP) vs combined fractional CO 2 (Fr: CO 2) laser with PRP in the treatment of stable nonsegmental vitiligo (NSV) lesions.

          Patients and methods

          This prospective, randomized, intrapatient, comparative controlled study was conducted between June 2014 and June 2016 at National Institute of Laser Enhanced Sciences (NILES), Cairo University, Cairo, Egypt. Thirty NSV patients were treated with PRP, Fr: CO 2 laser, and combined Fr: CO 2 laser with PRP. Intrapatient lesions were divide randomly into four groups. Each group was treated by one modality. The fourth group served as a control.

          Patients received six treatment sessions with 2-week interval for 3 months and were followed up after 3 months.

          Results

          A highly significant reduction was demonstrated through vitiligo analysis by computer-assisted grid (VACAG) in the combined Fr: CO 2 laser with PRP and in the PRP only groups than other groups. These results were confirmed by mean improvement score by physician (MISP) and by VAS with no statistical difference between them. The combined Fr: CO 2 laser with PRP group showed minimal side effects. Regardless of the modalities, better improvement was seen in the trunk than the face, extremities, and acral lesions with significant reduction in all regions. Face showed maximum response with combined Fr: CO 2 laser with PRP. Trunk showed higher response with PRP. Upper limbs showed highest response with combined Fr: CO 2 laser with PRP. Lower limbs showed the highest improvement with Fr: CO 2 laser.

          Conclusion

          According to our study, combined Fr: CO 2 laser with PRP achieved superior repigmentation than intradermal (ID) PRP. However, Fr: CO 2 alone showed poor improvement. Combined ablative Fr: CO 2 laser and PRP therapy followed by sun exposure could be used effectively and safely to treat refractory NSV.

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          Most cited references27

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          Biostatistics 102: quantitative data--parametric & non-parametric tests.

          Jim K H Chan (2003)
          Article 0 comments Cited 83 times – based on 0 reviews     Review now
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            Reliability of assessment tools in rehabilitation: an illustration of appropriate statistical analyses.

            M. Stokes, G Rankin (1998)
            To provide a practical guide to appropriate statistical analysis of a reliability study using real-time ultrasound for measuring muscle size as an example. Inter-rater and intra-rater (between-scans and between-days) reliability. Ten normal subjects (five male) aged 22-58 years. The cross-sectional area (CSA) of the anterior tibial muscle group was measured using real-time ultrasonography. Intraclass correlation coefficients (ICCs) and the 95% confidence interval (CI) for the ICCs, and Bland and Altman method for assessing agreement, which includes calculation of the mean difference between measures (d), the 95% CI for d, the standard deviation of the differences (SDdiff), the 95% limits of agreement and a reliability coefficient. Inter-rater reliability was high, ICC (3,1) was 0.92 with a 95% CI of 0.72 --> 0.98. There was reasonable agreement between measures on the Bland and Altman test, as d was -0.63 cm2, the 95% CI for d was -1.4 --> 0.14 cm2, the SDdiff was 1.08 cm2, the 95% limits of agreement -2.73 --> 1.53 cm2 and the reliability coefficient was 2.4. Between-scans repeatability was high, ICCs (1,1) were 0.94 and 0.93 with 95% CIs of 0.8 --> 0.99 and 0.75 --> 0.98, for days 1 and 2 respectively. Measures showed good agreement on the Bland and Altman test: d for day 1 was 0.15 cm2 and for day 2 it was -0.32 cm2, the 95% CIs for d were -0.51 --> 0.81 cm2 for day 1 and -0.98 --> 0.34 cm2 for day 2; SDdiff was 0.93 cm2 for both days, the 95% imits of agreement were -1.71 --> 2.01 cm2 for day 1 and -2.18 --> 1.54 cm2 for day 2; the reliability coefficient was 1.80 for day 1 and 1.88 for day 2. The between-days ICC (1,2) was 0.92 and the 95% CI 0.69 --> 0.98. The d was -0.98 cm2, the SDdiff was 1.25 cm2 with 95% limits of agreement of -3.48 --> 1.52 cm2 and the reliability coefficient 2.8. The 95% CI for d (-1.88 --> -0.08 cm2) and the distribution graph showed a bias towards a larger measurement on day 2. The ICC and Bland and Altman tests are appropriate for analysis of reliability studies of similar design to that described, but neither test alone provides sufficient information and it is recommended that both are used.
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              Effectiveness of Two Methods for Preparation of Autologous Platelet-Rich Plasma: An Experimental Study in Rabbits

              Maria J H Nagata, Michel R. Messora, Flávia Furlaneto … (2010)
              Objectives: The purpose of this study was to compare the quantity and quality of platelets in platelet-rich plasma (PRP) samples prepared using either the single- or the double-centrifugation protocol. Methods: Ten adult white New Zealand rabbits were used. Ten ml of blood were drawn from each animal via cardiac puncture. Each blood sample was divided into two equal parts for PRP preparation: 5 ml of blood were centrifuged according to a single-centrifugation protocol (Group I), and 5 ml were centrifuged according to a double-centrifugation protocol (Group II). Manual platelet counts were performed on the whole blood and PRP samples of each group. Smears were also done on all samples in order to see the morphology of the platelets. The data obtained in the manual platelet count were submitted to statistical analysis (repeated measures ANOVA, Tukey, P<.05). Results: The average whole blood platelet count was 446,389/μl. The PRP samples in Group II presented an average platelet amount significantly higher than that of Group I (1,986,875 ± 685,020/μl and 781,875 ± 217,693/μl, respectively). The PRP smears from Group II were the only one to present platelets with altered morphology (75% of the smears). A few lymphocytes with increased cytoplasm were observed in the PRP smears of both Groups I (25% of the smears) and II (62.5% of the smears). Conclusions: Within the limits of this study, it can be concluded that the double-centrifugation protocol resulted in higher platelet concentrations than did the single-centrifugation protocol. However, the double-centrifugation protocol caused alterations in platelet morphology and was more sensitive to small processing errors.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Cosmet Investig Dermatol
                Journal ID (iso-abbrev): Clin Cosmet Investig Dermatol
                Journal ID (publisher-id): Clinical, Cosmetic and Investigational Dermatology
                Title: Clinical, Cosmetic and Investigational Dermatology
                Publisher: Dove Medical Press
                ISSN (Electronic): 1178-7015
                Publication date Collection: 2018
                Publication date (Electronic): 08 November 2018
                Volume: 11
                Pages: 551-559
                Affiliations
                [1 ]Faculty of Medicine, Dermatology Department, Helwan University Cairo, Helwan, Egypt
                [2 ]Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt, ashrafbadawi@ 123456hotmail.com
                [3 ]Department of Allergology and Dermatology, Szeged University, Hungary, ashrafbadawi@ 123456hotmail.com
                Author notes
                Correspondence: Ashraf Badawi, Dermatology, Laser Institute, Cairo University, Dermatology and Laser applications, Szeged 2147 Mayflower Blvd., Oakville, ON L6H4E6, Email ashrafbadawi@ 123456hotmail.com
                Article
                Publisher ID: ccid-11-551
                DOI: 10.2147/CCID.S178817
                PMC ID: 6231433
                PubMed ID: 30510437
                SO-VID: 3f2e0b5d-a3e4-4534-818d-17a25f06f6de
                Copyright © © 2018 Kadry et al. This work is published and licensed by Dove Medical Press Limited
                License:

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Dermatology
                Keywords: platelet-rich plasma,fractional carbon dioxide laser,melanoblasts,stem cells,nonsegmental vitiligo,refractory vitiligo,vitiligo,undifferentiated stem cell
                Data availability:
                ScienceOpen disciplines: Dermatology
                Keywords: platelet-rich plasma, fractional carbon dioxide laser, melanoblasts, stem cells, nonsegmental vitiligo, refractory vitiligo, vitiligo, undifferentiated stem cell

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