الفهرس 
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Abstract
Amyloidosis is a disease caused by the misfolding of amyloid proteins. Accumulation of these insoluble fibrillar proteins in tissues can disrupt the function of body organs and called systemic amyloidosis. Primary cutaneous amyloidosis (PCA) develops when amyloid deposits in the skin The three main variants are lichen, macular, and nodular amyloidosis. Macular amyloidosis: mild to severely itchy, small, gray-brown macules may blend together to produce hyperpigmented patches appears on the upper back less commonly on the chest or extremities. Itching is present in 70–90% of primary cutaneous amyloidosis (PCA) patients. The intensity of which can be severe impairing the quality of life of patients. In addition, amyloid deposition leads to pruritus with subsequent scratching which leads to more amyloid deposition forming a viscous circle.The exact pathogenesis of PCA is unclear, and is considered to be multifactorial, involving both genetic and environmental factors .Various treatments have been tried for primary cutaneous amyloidosis with variable results, including topical agents, systemic treatments or other modalities as: dermabrasion, phototherapy, electrodessication have also been tried to treat primary cutaneous amyloidosis with conflicting results. LASER therapy for primary cutaneous amyloidosis is a promising treatment modality, and clinical improvement has been achieved by different types of LASERs.Tranexamic acid is a synthetic lysine derivative, anti- fibrinolytic. It can inhibit plasminogen activation by blocking lysine-binding sites on the plasminogen molecule .It inhibits plasmin activity in keratinocyte by preventing binding of plasminogen to keratinocyte, leading to less free Arachidonic acid (AA) and diminished ability to produce Prostaglandins (PGs) and subsequently reduces melanogenesis in melanocytes. So TA stops the keratinocytes activate melanocytes pathway Tranexamic acid is a synthetic lysine derivative, anti- fibrinolytic. It can inhibit plasminogen activation by blocking lysine-binding sites on the plasminogen molecule . It inhibits plasmin activity in keratinocyte by preventing binding of plasminogen to keratinocyte, leading to less free Arachidonic acid (AA) and diminished ability to produce Prostaglandins (PGs) and subsequently reduce melanogenesis in melanocytes. So TA stops the keratinocytes activate melanocytes pathway.The Aim of this study: The aim of this study is to evaluate the efficacy and side effects of using fractional co2 LASER in the treatment of primary cutaneous amyloidosis either alone or with assisted drug delivery of tranexamic acid clinically and by dermoscope.Materials and methods: Lesions were allocated into 2 groups according to used therapeutic modalities.group A: right side lesions treated with CO2fractional LASER combined with intradermal injection of tranexamic acid.group B: left side lesions treated with CO2fractional LASER only.Four sessions were done for each patient with 4 weeks interval. LASER treatment were performed using fractional co2 LASER (DEKA SmartXide DOT) with parameters (power 12 W. spacing 800 Mm, dwell times 600 Mm, and stacking3) after applying topical anesthesia (lidocaine 1%) 30 minutes before the session.Then tranexamic acid was applied to the right side of the lesion by intradermal injection.Dermoscopic evaluation&Histopathological examination of skin biopsiesstained with hematoxylin and eosin (H&E) and congo red stain then examined under polarized lightbefore treatment and after 1month of treatment were done Results: The current revealed that:•there were highly statistically significant reductions in pigmentation, lichenfication, itching and rippling between before and after treatment in group A•there were highly statistically significant reductions in pigmentation, lichenfication, itching and rippling between before and after treatment in group B.•there is statistically significant higher patient satisfaction among lesions treated with LASER & tranxemic acid ( group A) than lesions treated with LASER only ( group B) as 60% of group A lesions show excellent improvement versus 45% of group B lesions.•comparison of degree of pigmentation improvement in the treated areas. Statistically significant differences was recorded between both groups (A and B) in terms of the degree of pigmentation improvement (P=0.03). group A lesions show 65% marked improvement versus 40% among group B, on the other hand moderate improvement is detected among 25% of group A versus 45% group B which means that most of group A lesions shown marked improvement while group B lesionts mostly shown moderate improvement .Also group A had a better improvement regarding itching score than group B with significant difference. Regarding rippling and lichenification there was no significant difference between both groups A&B, in our study there were no differences in both groups A&B lesions before treatment regarding pigmentation score, lichenification, rippling and itching score in all patients.•The percentage of hup and spoke, pigmented structure with central hup, pigmented structure with bizarre pattern, leaf venation like pigmented structure, pre follicular depigmented halo, white to brown isolated hup, white intersecting lines and white non adherent structure were 75, 45, 45, 85, 80, 20, 60 and 80 respectively.Conclusion: Fractional co2 LASER has main role in treatment of macular cutaneous amyloidosis but combined treatment by fractional LASER and tranexamic acid is more effective with more preferable results. Keywords: fractional co2 laser, tranexamic acid , primary cutaneous amyloidosis .