Necrotizing leukocytoclastic small vessel vasculitis associated with letrozole: A case report.

INTRODUCTION: Letrozole is an aromatase inhibitor that used to treat breast cancers. Letrozole-associated skin vasculitis is a rare side effect of this medication, in this study we report a case of necrotizing type of Small vessel cutaneous vasculitis associated with letrozole consumption. CASE PRESENTATION: A 45-year-old woman was referred to the dermatology clinic with painful necrotic annular lesions on the lower limbs. Her past medical history showed evidence of breast cancer and taking letrozole. Five months after the start of letrozole, the patient's signs and symptoms had appeared. Physical examination revealed annular plaques with erythematous margin and multiple necrotic centers that were painful to touch. The histopathology showed extravasated red blood cells and leukocytoclasis as well as neutrophils surrounding and infiltrating the wall of blood vessels in superficial and mid dermis. We discontinued letrozole, then prescribed topical clobetasol, systemic prednisolone, and colchicine; the lesions began to heal after 1 month from the start of treatment, and did not recur after discontinuing the treatment. DISCUSSION: Pathogenesis of vasculitis caused by aromatase inhibitors is not fully elucidated, but estrogen depletion and idiosyncratic drug reaction has been proposed. Cutaneous leukocytoclastic small vessel vasculitis (CLSVV) resulting from aromatase inhibitors is relatively rare so it is recommended to consider drug-induced CLSVV in other patients treated with aromatase inhibitors.

Fractional erbium:YAG laser (2940 nm) plus topical hydroquinone compared to intradermal tranexamic acid plus topical hydroquinone for the treatment of refractory melasma: a randomized controlled trial.

OBJECTIVES: Melasma is a chronic acquired condition characterized by grayish-brown macules and patches with a distinct border on the face. Although various treatments methods have been suggested for treating melasma, none has been completely successful. The aim of the study was to compare the efficiency of erbium: yttrium-aluminum-garnet (Er:YAG) laser and 4% hydroquinone (HQ) with the effects of intradermal tranexamic acid (TA) and 4% HQ for the treatment of refractory melasma. METHODS: The study included 31 female patients with refractory melasma. The left or right side of the patient's face was chosen randomly to receive laser therapy with topical HQ on the one side (i.e. the laser side) and intradermal injection of TA plus topical HQ on the other side (i.e. the mesotherapy side). Digital photography was performed at baseline, at the end of the treatment, and three months after the treatment as follow-up. Two independent dermatologists evaluated the modified Melasma Area and Severity Index (mMASI) score according to the pictures. Overall, 27 patients completed the study and went through the clinical evaluation. RESULTS: Treatment using HQ in combination with either Er:YAG laser therapy or intradermal injection of TA significantly improved the hemi-mMASI and resulted in higher patient satisfaction. While the improvement was not significantly different between the two regiments after the treatment and upon follow up and both were equally efficient in the treatment of refractory melasma (p = 1.308), recurrence rate was higher after treatment with Er:YAG laser than TA (12% vs 34%). CONCLUSION: This study confirmed the comparable efficacy of TA plus topical HQ versus Er:YAG laser plus topical HQ for the treatment of refractory melasma. Both groups improved significantly and no subject left the treatment because of adverse effects. TRIAL REGISTRATION NUMBER: IRCT20191011045057N1.

The simultaneous occurrence of lichen planopilaris and alopecia areata: A report of two cases and literature review.

Although the coexistence of alopecia areata and lichen planopilaris is rare, if alopecic patches appear abruptly, this possible association should be kept in mind.

The effects of Anethum graveolens essence on scopolamine-induced memory impairment in mice.

Since Anethum graveolens (Dill) has phytoestrogenic compounds and it is proven that estrogens exert beneficial effects on cognition; the aim of this study was to understand if this plant can improve memory performance. Male Balb/c mice weighing 25-30 g were used in this study and memory was assessed by the novel object recognition task. In this method, the difference in the exploration time between a familiar object and a novel object is taken as an index of memory performance (recognition index, RI). Scopolamine significantly reduced memory index (RI = -15.5% ± 3.0). Dill essence (100 mg/kg, ip) prevented the harmful effects of scopolamine on memory (RI = 40% ± 5.5), thus RI did not differ with control animals (RI = 50% ± 5.8). In addition, 17-ß estradiol also prevented memory impairment in animals (0.2 mg/kg, ip; RI = 35.8% ± 6.5). Nevertheless, the beneficial effects of dill essence were antagonized by prior injection of tamoxifen (1 mg/kg, ip; RI = -30% ± 7.8). Although phytoesrogens are not steroids, the beneficial effect of dill on memory, at least in part, may have been achieved by estrogenic receptors present in the brain. Thus dill essence could be promising in improving memory and cognition, mainly in postmenopausal women.