Systemic isotretinoin therapy and central macular and choroidal thicknesses in acne vulgaris: is there any association?

PURPOSE: To investigate the effect of oral isotretinoin therapy on central macular thickness (CMT) thickness and choroidal thickness (CT) using optical coherence tomography (OCT). METHODS: CT and CMT thickness of 43 eyes were evaluated at baseline, the third, and sixth month of isotretinoin therapy by spectral-domain OCT. For assessment of CT, OCT measurements were obtained at the fovea with six additional measurements at adjacent locations (at 500-1000 µm temporal to the fovea and 500-1000 µm nasal to the fovea). RESULTS: Forty-three eyes from 43 patients with acne vulgaris, including 33 females (76.7%), who had a mean age of 24.81 ± 6.60 years, completed the study. The mean CMT was 231.49 ± 19.52 at the baseline and significantly decreased to 229.0 ± 19.57 (p = 0.02) and 229.28 ± 18.83 after three and six months, respectively (p < 0.03). The change in the macular thicknesses measured at four quadrants and choroidal thicknesses were not statistically significant during the study (p > 0.05). CONCLUSION: The result of our study demonstrated choroidal thickness change is not significant in patients with acne vulgaris after systemic isotretinoin therapy during six months of follow-up. The decreased CMT amount was 2.2 microns; even if statistically significant, this amount is clinically insignificant.

Skin and metabolic syndrome: A review of the possible associations.

Metabolic syndrome (MeTS) is a well-known health-related problem with several end-organ damages and the resulted side effects such as rising in the blood glucose and lipid and blood pressure. Although MeTS might show several skin symptoms such as acanthosis nigricans, skin tags, acne, and androgenic alopecia, it could also be implicated in the pathophysiology of numerous dermatologic disorders. Furthermore, some dermatologic drugs might be implicated in the incidence or exacerbation of MeTS. Consequently, MeTS and skin problem could interfere closely with each other and each one could predispose the patient to the other one and vice versa. Remembering these close relationships help us to have better therapeutic choices regarding each inflammatory skin conditions. Moreover, some of the skin symptoms should be followed cautiously to define the underlying MeTS.

Evaluation of combination therapy with peeling added to minimal invasive blepharoplasty in lower eyelid rejuvenation.

INTRODUCTION: Aging is an inevitable process in life that can pose unsatisfactory changes in appearance. Recently, rejuvenation surgeries have opened an exciting new window toward people who are vulnerable according to their facial appearance. Periocular plastic microsurgeries are among the most common aesthetic surgeries with various outcomes. The current study was aimed to compare outcomes of blepharoplasty with and without peeling regarding lower eyelid rejuvenation. METHODS: This is a randomized clinical trial study conducted on 30-patients referred for inferior lid rejuvenation in 2017-18. Patients were randomly divided into two 15-member subgroups of microinvasive blepharoplasty with and without peeling. Peeling for the group underwent blepharopeeling was performed all over the inferior periocular region using Phenol 89%. Then, skin and underlying muscle were incised superficially, and underlying fat tissue was excised. The other group underwent blepharoplasty without peeling. Patients were followed daily for 2 months to assess complications, patients' and physicians' satisfaction. RESULTS: Two assessed groups were not statistically different regarding age and gender distribution (P-value = .417 and .666, respectively). Considering patients' opinion, symmetry, scar formation, skin laxity, swelling, and total satisfaction score were not different between two groups (P-value > .05) while physicians presented similar outcomes except for better scar formation status of peeling add-on therapy (P-value = .042). Rate of adverse effects was significantly higher among those under blepharoplasty plus peeling treatment (P-value < .05). CONCLUSION: Outcomes of blepharoplasty alone versus blepharoplasty plus peeling were not significantly different regarding both patients' and physicians' assessments in general while fewer complications due to blepharoplasty without peeling were presented.

The effectiveness of adapalene 0.1% with intense pulsed light versus benzoyl peroxide 5% with intense pulsed light in the treatment of acne vulgaris: A comparative study.

BACKGROUND: Acne vulgaris (AV) is one of the most common skin diseases with major psychological impacts. Hence, selecting the best treatment modality is so important; there are different ways to treat AV such as topical and systemic agents, laser, and also photodynamic therapy. In this study, we tried to assess the difference between the efficacy of combination therapy with intense pulsed light (IPL) and benzoyl peroxide (BPO) in comparison with IPL and adapalene (AD) in the treatment of the mild to moderate AV. MATERIALS AND METHODS: Thirty Iranian females in reproductive age with mild to moderate acne were enrolled in this study. The left and right side of the patients were randomized to receive either AD 0.1% or BPO 5% every other day plus three sessions of monthly apart IPL in the treatment of AV. Different parameters of AV such as acne severity index (ASI), total acne lesions counting (TLC), and Acne Global Severity Scale (AGSS) were measured before, during, and after the treatments. RESULTS: There was a significant difference regarding AGSS, TLC, and ASI before and after treatment with AD plus IPL (P < 0.001). Furthermore, there was a significant difference regarding AGSS, TLC, and ASI before and after treatment with BP plus IPL (P < 0.001). However, no significant difference regarding AGSS, TLC, and ASI were observed between the 2 groups after treatment (P > 0.05). No significant side effects were observed in both groups. CONCLUSION: Our study shows that there was not any significant difference between combining IPL with either AD or BPO so we can use either one of these combinations to achieve similar efficacy.

Target Site Insensitivity Detection in Deltamethrin Resistant Culex pipiens Complex in Iran.

BACKGROUND: Some mosquito species which belong to the Culex. pipiens complex are primary vectors for West Nile virus, Sindbis, Dirofilaria immitis, and many arboviruses. Knockdown resistance (kdr) mutations in the voltage-gated sodium channel (VGSC) gene of Cx. pipiens that is inherited, is one of the important threats for the efficacy of pyrethroids insecticides. Knockdown resistance (kdr) mutation, L1014F, is a well-defined mechanism of resistance to pyrethroids and DDT in many insect species. The aim of study was to determine the mechanisms of Insecticide resistance in this species. METHODS: Specimens of Cx. pipiens, the major vector of West Nile virus, were obtained in Tehran, Iran by collecting larvae from polluted wastewater in Qarchak of Tehran. In 2016 Insecticide susceptibility tests were performed according to WHO methods with deltamethrin 0.05%. We focused on determination of this point mutation in the VGSC gene of Cx. pipiens by Real-time PCR. RESULTS: Our results revealed high levels of resistance to deltamethrin 0.05%. The lethal times i.e. LT50 and LT90 for deltamethrin were 2.1530 and 8.5117 h respectively. The result of Real-time PCR confirmed the presence of resistant genotype in all the members of tested population. This study is the first report on kdr genotyping of Cx. pipiens from Tehran and our results on the VGSC gene in position L1014F confirmed the TTA to TTT nucleotide change. CONCLUSION: This finding will provide a clue for management of insecticide resistance in mosquito which are vectors of arboviruses and decision for replacement of novel approach for vector control.

Role of Fatty Acids Intake in Generalized Vitiligo.

BACKGROUND: Previous studies indicated the effect of fat on autoimmune diseases. The present study was aimed to investigate the association between fat intake and vitiligo. METHODS: This case-control study was conducted in the Skin and Leishmania Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Intakes of fatty acids were examined for their relation to risk of vitiligo among 100 cases and 110 controls. We included patients who suffered from generalized or localized vitiligo for <5 years that was approved by a dermatologist via the Vitiligo European Task Force criteria and the vitiligo area scoring index. Fat intake was assessed through individual interviews by a standardized food frequency questionnaire. RESULTS: Vitiligo group consumed more saturated fatty acid (SFA) and less eicosapentaenoic acid and docosahexaenoic acid than control group, while other fatty acids were not significantly different among two groups (P > 0.05). Crude analysis showed that total fat (odds ratio [OR] = 3.33, 95% confidence interval [CI]: 1.46-7.58) and SFA (OR = 2.22, 95% CI: 1.04-4.90) intakes were associated with an increased risk of vitiligo (for highest quartile vs. lowest quartile). Results demonstrated a decrease in the risk of vitiligo for those within the highest quartile of monounsaturated fatty acids intake (OR = 0.41, 95% CI: 0.18-0.92). However, this relationship disappeared after adjustment for confounders as energy, age, sex, and body mass index, except for total fat (OR = 2.84, 95% CI: 1.63-5.44). Crude and adjusted analyses for polyunsaturated fatty acids and cholesterol intake were not statistically significant. CONCLUSIONS: Total-fat content of the diet had more impressive role than the specific subclasses of fats on the incidence risk of vitiligo. High-fat diet escalated the vitiligo risk. Regarding the role of fats on skin autoimmune diseases especially vitiligo, future studies are crucial.

Proteus Syndrome with Arteriovenous Malformation.

Proteus syndrome is a rare sporadic disorder that appears with localized macrosomia, congenital lipomatosis, and slow flow vascular malformations, connective tissue nevus, and epidermal nevus. There are usually some manifestations at birth. The vascular abnormalities that have been reported in Proteus syndrome are capillary and slow flow venous malformation. We report a case of a 10-year-old boy with confirmed Proteus syndrome characterized by high flow vascular malformation (arteriovenous [AV] malformation) unlike the usual vascular malformations seen in this syndrome. This case adds a new perspective to the established clinical findings of the Proteus syndrome.

Quality of life in patients with primary axillary hyperhidrosis before and after treatment with fractionated microneedle radiofrequency.

BACKGROUND: Primary axillary hyperhidrosis (PAH) is a common condition with a great impact on the patient's quality of life (QOL). It is associated with serious social, emotional, and occupational distress. The aim of this study was to investigate the QOL in patients with PAH before and after treatment with fractionated microneedle radiofrequency (FMR). MATERIALS AND METHODS: We evaluated 25 patients with severe PAH. Each patient had three sessions of FMR treatment using a novel applicator at 3-week intervals. The study was based on Dermatology Life Quality Index (DLQI) Questionnaires. Patients were evaluated at baseline and 3 months after the last session. RESULTS: Our patients included 32% males and 68% females. The mean ± standard deviation (SD) age of subjects was 30.2 ± 6.27 years. The mean ± SD of the DLQI before and after treatment was 12.96 ± 5.93, and 4.29 ± 2.21, respectively. There was a statistically significant difference between the before and after intervention (P < 0.001). No major, permanent adverse effects were shown. CONCLUSION: Treatment with FMR can improve the DLQI of patients with PAH.

The relationship between quality of life and coping strategies in polycystic ovary syndrome patients.

BACKGROUND: There are many factors that affect the quality of life, for example, stress and the coping strategies. Polycystic ovary syndrome is a common hormonal disorder leading to menstrual disorders, hirsutism, acne, obesity, infertility and abortion. In such cases, the patients suffer from a variety of stresses and face problems in their coping strategies with life's problems which can affect the quality of life and cause psychological distress and low the quality of life. The quality of life is a descriptive term which points to health and emotional, social and physical promotion of individuals as well as their ability to perform daily living tasks. The purpose of this study was to investigate the relationship between quality of life and coping strategies in patients with polycystic ovary syndrome. MATERIALS AND METHODS: To perform this study, randomly 200 women who had inclusion criteria and were referred to Ali Shariati Hospital in Isfahan were selected and responded DLQI questionnaire and Carver coping strategies and form of demographic characteristics. RESULTS: The mean score of quality of life in the patients was 4.14 ± 5.57. It was shown that acne has no effective role on quality of life and coping strategies in contrast in hirsute and non-hirsute patients; there was a significant difference in quality of life P value < 0.001). Also there is a significant relationship between the quality of life and coping strategies (problem solving, cognitive, emotional and social support) (P < 0.05) and quality of life has the highest correlation with emotional strategies (r = 0.46). CONCLUSION: According to results of this study, patients with PCOS are at risk pcychologicla disorders that may be led to decrease of quality of life. Thus this patients need to support by oppositions strategies. Also not only physical treatment but also psychological surveillance especially social support must be done for them.

Comparing the efficacy of Emu oil with clotrimazole and hydrocortisone in the treatment of seborrheic dermatitis: A clinical trial.

BACKGROUND: Seborrheic dermatitis (SD) is a common, chronic inflammatory disease. Inflammatory reaction and oxidative stress are thought to be effective in the pathogenesis of SD. Based on anti-inflammatory and anti-oxidant properties of emu oil, this study was designed to evaluate effects of emu oil on patients suffering from SD, and to compare it with routine treatments of SD with topical steroids and antifungal agents. MATERIALS AND METHODS: This clinical trial was conducted on126 patients who were randomly allocated to 2 groups: 62 in the clotrimazole vs. emu oil (group-1) and 64 in the hydrocortisone vs. emu oil (group-2). The right side of the face in both groups was treated with topical emu oil. The left side was treated with topical clotrimazole in the first group and with topical hydrocortisone in the second group. One month after the treatment, pre and post treatment symptom severity scores of pruritus, erythema and scales were compared. RESULTS: All 3 medications significantly improved pruritus, erythema and scales (P < 0. 01). However, topical clotrimazole and hydrocortisone were significantly more effective than emu oil in improving scales (P < 0.01), and hydrocortisone was significantly more effective than emu oil in reducing pruritus (P < 0. 01). Comparing with topical clotrimazole, emu oil resulted in significantly more improvement of erythema (p:0.01). CONCLUSION: Emu oil is a potentially useful agent that significantly improves itching, erythema and scales associated with SD; however, it was less effective than hydrocortisone and clotrimazole which are routinely prescribed to treat SD.

Comparative study between Ribavirin and Ribavirin plus Intravenous Immunoglobulin against Crimean Congo hemorrhagic fever.

BACKGROUND: Crimean Congo hemorrhagic fever (CCHF) has high morbidity and mortality. Therefore the treatment effect of Ribavirin with and without intravenous Immunoglobulin (IVIG) in viral Crimean Congo hemorrhagic fever was evaluated. MATERIALS AND METHODS: In a clinical trial study, 40 patients with confirmatory positive serology test, 12 (30%) received Ribavirin and IVIG (case group) and 28 (70%) received only ribavirin as standards therapy (control group). The patients were followed and compared by defervescence and other clinical symptoms, and laboratory results such as white blood cell count (WBC), platelets; liver function test (LFT) and duration of hospitalization and mortality rate after eight weeks. RESULTS: The mean (SD) period for defervescence and stopping bleedings was five (0.6) days in case group and five (0.5) days in control group with no significant differences (P = 0.27). The mean period for return of WBC to normal was three (0.6) days in case group and five (0.8) days in control group (P = 0.002). The mean period for return of LFT to normal was three (0.9) days in case group and seven (0.5) days in control group which showed a meaningful difference (P = 0.001) Normalization of platelets was returned within four (0.8) days in case group compared to 6 (0.6) days in control group. Mortality was observed in three cases of each group. CONCLUSION: Considering our results, using IVIG in viral hemorrhagic fever (VHF) may need further evaluations.

Bowenoid transformation in seborrheic keratosis: A retrospective analysis of 429 patients.

BACKGROUND: Seborrheic keratosis is a common, benign skin tumor. Numerous reports have shown its possibility of malignant transformation. This study was designed to demonstrate the occurrence of concomitant seborrheic keratosis and skin cancers. MATERIALS AND METHODS: Data was retrospectively reviewed from all patients with a diagnosis of seborrheic keratosis in pathology department of Alzahra Hospital and a private pathology laboratory in Isfahan, Iran over a 4-year period. We classified all demographic data and associated dysplasia or Bowen's disease and analyzed them by student-t or chi-square tests. RESULTS: From all 429 specimens, 5 (1.2%) were found to be associated with Bowen's disease and one (0.2%) with mild dysplasia in squamous epithelium. All cases arose within the clinically, atypical seborrheic keratosis. More men were affected with lesions alone and with malignancy (230/423 (54.4%) and 5/6 (83.3%), respectively) compared to women. The average age of patients suffering from lesions with and without associated malignancy was 57 and 54 years, respectively. The common site of lesion alone was head and neck but lesions with malignancy involved lower extremities. The two lesions were significantly different in site of occurrence (p < 0.001). CONCLUSION: Generally, although the association between seborrheic keratosis and skin malignancy appears to be accidental, it must always be in mind. Therefore, histopathologic examination of all seborrheic keratosis should be considered, especially when seborrheic keratosis has atypical clinical manifestations.

A novel treatment strategy for eyebrow transplantation in an ectodermal dysplasia patient.

BACKGROUND: Ectodermal dysplasia (ED) is a hereditary syndrome which affects the ectodermal layer and thus appendages originating from this layer like hair, teeth, and sweet glands. The hairs of the scalp and eyebrows are sparse and broken and sometimes absent in ED patients. We reported a case of ED who underwent successful hair transplantation for her eyebrows. CASE REPORT: A 17-year-old female with previously known Ed referred to our clinic because of absent lateral eyebrow hairs. She also had hypodontia (she lacked incisor teeth) and hypohydrosis. We designed a hair transplantation procedure for the lateral third of her eyebrows with follicular unit transplantation (FUT) method. We selected the occipital part of the scalp as the donor. After 6 months and 2 years follow-up, the patient was quite satisfied with her appearance. CONCLUSIONS: The facial appearance of ED patients could be corrected well enough by hair transplantation methods.

Psychological evaluation in hemodialysis patients.

INTRODUCTION: End stage renal disease has a high burden of disease affecting patient's quality of life and this may dramatically shorten their life expectancy. These patients may be faced with serious stressors which are related to the disease and its treatment. Considering psychosocial problems in hemodialysis patients, we designed this study to evaluate depression, anxiety, social support and to determine temperament, character and correlation between these factors in hemodialysis patients. METHODS: This was a multicenter cross-sectional study which was done on 218 hemodialysis patients in Isfahan during April-July 2011. Depression, anxiety, social support, temperament and character were evaluated in patients using Hospital Anxiety and Depression Scale (HADS), Persian version of Multidimensional Scale of Perceived Social Support (MSPSS-P) and Temperament and Character Inventory (TCI) questionnaires. RESULTS: 138 (63.3%) subjects were male. Mean age was 58.18 +/- 14.3 years. 95 (43.6%) participants had depression and 94 (43.1%) had anxiety. Family support had the highest score between social support subscales. Family support was significantly correlated with self-directedness (p = 0.012), cooperativeness (p = 0.03), self-transcendence (p = 0.018), reward dependence and friends support (p = 0.036) and cooperativeness and others support (p = 0.049). CONCLUSION: Physicians should be aware of depression and anxiety in hemodialysis patients. Our results showed that patients had a supportive relation with their family and it could be because of Iranian culture and religious believes. In terms of temperament and character, patients were tolerant, supportive, humble and sociable.

Increased insulin sensitivity by metformin enhances intense-pulsed-light-assisted hair removal in patients with polycystic ovary syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is an insulin-resistant state with hirsutism as a common manifestation. OBJECTIVE: We hypothesized that treatment with metformin would improve the cosmetic effects of intense pulsed light (IPL) therapy for hair removal in PCOS patients. METHODS: In a prospective randomized controlled trial, 70 PCOS patients randomly received metformin (1,500 mg daily) + IPL therapy or IPL therapy alone for 5 IPL sessions during a 6-month period, followed by an additional 6 months of observation. Hirsutism score, homeostasis model assessment for insulin resistance (HOMA-IR), free androgen index (FAI) and patient satisfaction were evaluated at every visit. RESULTS: Fifty-two patients finished the study. Hirsutism was significantly better controlled in the metformin group (p = 0.009). Patient satisfaction was significantly better in the metformin group at the end of the observation period (52.9 vs. 34.1%, p = 0.019). HOMA-IR and FAI scores improved after metformin + IPL treatment (p < 0.05). CONCLUSION: Adding metformin to IPL in women with PCOS results in a significant improvement in insulin sensitivity and hirsutism.