EFFICACY OF 3O% SALICYLIC ACID AND JESSNER SOLUTION CHEMICAL PEELING IN PATIENTS WITH EPIDERMAL MELASMA

Background; Melasma has a significant impact on appearance, causing psychosocial and emotional distress, and reducing the quality of life of the affected patients. In this context, it has a negative impact on the quality of life of patients, affecting their psychological and emotional well-being, which often motivates them to search for a dermatologist. Objective; To compare mean MASI score of in patients with epidermal melasma treated with 30 % salicylic acid versus Jessner solution chemical peeling. Material and methods; A total of 396 patients were taken in our study. Patients was randomly allocated in to two groups by lottery method. Group A, having 198 patients, were treated with 30 % salicylic acid while group B, having 198 patients, with Jessner solution chemical peeling in patients. After two weeks of priming, which was comprised of nightly application of 0.05% tretinoin and daytime sunscreen with a sun protection factor of 60, treatment according to the group was started. Night-time use of moisturizer was applied in all patients and asked for follow up visits after 2 weeks till 12 weeks to document final outcome. Baseline and post-treatment MASI scores was calculated and patients were followed weekly till 12 weeks from the beginning of therapy to document efficacy. Results; Of these 396 study cases, 126 (31.8 %) were male patients while 270 (68.2 %) were female patients. Mean age of our study cases was 27.20 ± 5.08 years.  Mean body mass index of our study cases was 24.82 ± 2.51 kg/m2 and obesity was present in 28 (7.1 %) of our study cases. Fitzpatrick Skin type III was noted in 270 (68.2%) and skin type III was noted in 126 (31.8%) of our study cases. Mean disease duration was 10.62 ± 5.92 months and 293 (74 %) had duration of illness up to 1 year. Mean post treatment MASI score in our study was noted to 9.31 ±2.93 while mean MASI in group A was 7.59 ± 3.02 while in group B mean MASI was 11.03 ± 1.48 (p = 0.000). Conclusion; Our study results have indicated that 30 % salicylic acid is more effective in treatment of epidermal melasma as compared with Jessner solution as there was significant reduction of mean MASI score in our patients and it provides rapid and sustained clinical improvement in the treatment of melasma. The results of this study support use of 30 % salicylic acid among targeted population which had significant impact on the improvement of quality of life of these patients and relieved them from psychological stress of this disease. Proper management of melasma helps improve productivity of the patients as it hits main working force of the society, hence plays important role in the national productivity and health economy. Keywords; Melasma, Salicylic acid, Jessner Solution, MASI.

Safety, immunogenicity, and reactogenicity of BNT162b2 and mRNA-1273 COVID-19 vaccines given as fourth-dose boosters following two doses of ChAdOx1 nCoV-19 or BNT162b2 and a third dose of BNT162b2 (COV-BOOST): a multicentre, blinded, phase 2, randomised trial

Background Some high-income countries have deployed fourth doses of COVID-19 vaccines, but the clinical need, effectiveness, timing, and dose of a fourth dose remain uncertain. We aimed to investigate the safety, reactogenicity, and immunogenicity of fourth-dose boosters against COVID-19.Methods The COV-BOOST trial is a multicentre, blinded, phase 2, randomised controlled trial of seven COVID-19 vaccines given as third-dose boosters at 18 sites in the UK. This sub-study enrolled participants who had received BNT162b2 (Pfizer-BioNTech) as their third dose in COV-BOOST and randomly assigned them (1:1) to receive a fourth dose of either BNT162b2 (30 µg in 0·30 mL; full dose) or mRNA-1273 (Moderna; 50 µg in 0·25 mL; half dose) via intramuscular injection into the upper arm. The computer-generated randomisation list was created by the study statisticians with random block sizes of two or four. Participants and all study staff not delivering the vaccines were masked to treatment allocation. The coprimary outcomes were safety and reactogenicity, and immunogenicity (antispike protein IgG titres by ELISA and cellular immune response by ELISpot). We compared immunogenicity at 28 days after the third dose versus 14 days after the fourth dose and at day 0 versus day 14 relative to the fourth dose. Safety and reactogenicity were assessed in the per-protocol population, which comprised all participants who received a fourth-dose booster regardless of their SARS-CoV-2 serostatus. Immunogenicity was primarily analysed in a modified intention-to-treat population comprising seronegative participants who had received a fourth-dose booster and had available endpoint data. This trial is registered with ISRCTN, 73765130, and is ongoing.Findings Between Jan 11 and Jan 25, 2022, 166 participants were screened, randomly assigned, and received either full-dose BNT162b2 (n=83) or half-dose mRNA-1273 (n=83) as a fourth dose. The median age of these participants was 70·1 years (IQR 51·6–77·5) and 86 (52%) of 166 participants were female and 80 (48%) were male. The median interval between the third and fourth doses was 208·5 days (IQR 203·3–214·8). Pain was the most common local solicited adverse event and fatigue was the most common systemic solicited adverse event after BNT162b2 or mRNA-1273 booster doses. None of three serious adverse events reported after a fourth dose with BNT162b2 were related to the study vaccine. In the BNT162b2 group, geometric mean anti-spike protein IgG concentration at day 28 after the third dose was 23 325 ELISA laboratory units (ELU)/mL (95% CI 20 030–27 162), which increased to 37 460 ELU/mL (31 996–43 857) at day 14 after the fourth dose, representing a significant fold change (geometric mean 1·59, 95% CI 1·41–1·78). There was a significant increase in geometric mean anti-spike protein IgG concentration from 28 days after the third dose (25 317 ELU/mL, 95% CI 20 996–30 528) to 14 days after a fourth dose of mRNA-1273 (54 936 ELU/mL, 46 826–64 452), with a geometric mean fold change of 2·19 (1·90–2·52). The fold changes in anti-spike protein IgG titres from before (day 0) to after (day 14) the fourth dose were 12·19 (95% CI 10·37–14·32) and 15·90 (12·92–19·58) in the BNT162b2 and mRNA-1273 groups, respectively. T-cell responses were also boosted after the fourth dose (eg, the fold changes for the wild-type variant from before to after the fourth dose were 7·32 [95% CI 3·24–16·54] in the BNT162b2 group and 6·22 [3·90–9·92] in the mRNA-1273 group).Interpretation Fourth-dose COVID-19 mRNA booster vaccines are well tolerated and boost cellular and humoral immunity. Peak responses after the fourth dose were similar to, and possibly better than, peak responses after the third dose