Evaluation of the effects of carboxytherapy in the treatment of periorbital dark circles.

BACKGROUND: Dark eye circle (DEC) is one of the most common cosmetic problems. It has a great impact on the patients' quality of life. Carboxytherapy is a cosmetic technique using pure carbon dioxide for different uses in different areas of the body. The goal of this study is to evaluate the efficacy and tolerability of carboxytherapy in the cosmetic correction of DECs. METHODS: This study was conducted on 27 patients requesting the correction of DEC. The treatment was performed using a carboxy device in medical grade. The gas injection was performed intradermal after local anesthesia, with a pressure of one tenth bar and a speed of 20 cc/min, 1 cc in each upper and lower eyelid. The treatment sessions were done every 2 weeks for four sessions. RESULTS: The mean physicians' score of DECs before and after treatment was 8.7 ± 0.81 and 4.6 ± 1.1, respectively. The mean patients' score before and after treatment was 9.2 ± 0.5 versus 5.41 ± 1.37. The mean scores showed a significant reduction of skin discoloration without major side effects (p < 0.00001). CONCLUSION: Carboxytherapy seems to be an effective treatment option for dark circles around the eyes with a good safety profile and patient satisfaction.

Transplantation of autologous epidermal melanocyte-keratinocyte cells suspension for cell therapy of vitiligo: A clinical evaluation and biometric assessment.

INTRODUCTION: Among several surgical treatments, the use of transplantation of epidermal cultured melanocytes or melanocytes-keratinocytes cell suspension has gained many researchers and dermatologists' attention as a new technique for the treatment of vitiligo. The present study aimed to transplant autologous epidermal melanocytes-keratinocytes cell suspension for the treatment of vitiligo. METHODS: In this study, 15 volunteer patients aged between 18 and 45 years old were studied. The autologous melanocytes-keratinocytes cell suspension was then transplanted to the region after dermabrasion. The included patients were evaluated by VisioFace, MPA9, and Skin Scanner-DUB once before and 1, 2, and 6 months after the transplantation, while the extents of stainability and changes in the transplanted region were recorded. RESULTS: The color contrast between the lesion and normal skin significantly decreased after 1, 2, and 6 months of the melanocytes transplantation compared with the pre-procedure (13.8 ± 0.45 before vs. 12.9 ± 0.43, 12.2 ± 0.45, and 10.2 ± 0.34 at months 1, 2, and 6, p < 0.001). Furthermore, melanin index significantly increased six months after cell transplantation compared to the pretreatment (168.3 ± 4.22 vs. 130.5 ± 3.98, p < 0.001). CONCLUSION: Transplantation of melanocytes cells with dermabrasion can be effective on vitiligo improvement, so it is recommended.

COVID-19 and Dermatology in Iran.

COVID-19 infection may affect the individuals with many underlying conditions including skin diseases. This cross-sectional study was conducted to provide an overview regarding the prevalence of COVID-19 disease in the patients with several skin diseases. Overall, 703 patients with several skin diseases participated in the study and completed our online-designed questionnaire. Among the total participants, only 32(4.6%) subjects reported the COVID-19 infection. The prevalence rate was equal to 0.04%. In the patients with psoriasis, 14 out of 322 people (4.3%) developed the COVID-19. Three out of 159 patients (1.9%) with alopecia areata had been affected with the COVID-19 and 4 (5.2%) patients with vitiligo had caught the disease. Only one subject (2%) with the lichen planus, and 6 (6.8%) patients with other skin diseases had developed the COVID-19 but in the patients with GVHD (Graft Versus Host Disease), 4 (80%) out of 5 patients had caught the COVID-19 disease. The frequency of COVID-19 infection was low in the studied population however; more studies with larger sample size are needed to determine the exact prevalence of the infection in the patients with skin diseases undergoing the treatment with several systemic medications.

Immunosuppressive and immunomodulatory therapies in dermatology and coronavirus disease 2019 (COVID-19).

COVID-19 infection may affect the individuals with many underlying conditions including skin diseases. This cross-sectional study was conducted to provide an overview regarding the prevalence of COVID-19 disease in the patients with several skin diseases. Overall, 703 patients with several skin diseases participated in the study and completed our online-designed questionnaire. Among the total participants, only 32(4.6%) subjects reported the COVID-19 infection. The prevalence rate was equal to 0.04%. In the patients with psoriasis, 14 out of 322 people (4.3%) developed the COVID-19. Three out of 159 patients (1.9%) with alopecia areata had been affected with the COVID-19 and 4 (5.2%) patients with vitiligo had caught the disease. Only one subject (2%) with the lichen planus, and 6 (6.8%) patients with other skin diseases had developed the COVID-19 but in the patients with GVHD (Graft Versus Host Disease), 4 (80%) out of 5 patients had caught the COVID-19 disease. The frequency of COVID-19 infection was low in the studied population however; more studies with larger sample size are needed to determine the exact prevalence of the infection in the patients with skin diseases undergoing the treatment with several systemic medications.

In vivo Skin Penetration, Radical Protection, and Structural Changes after Topical Application of a Herbal Oil Cream Compared to Topical Calcipotriol in Mild to Moderate Psoriasis.

BACKGROUND: The chronicity of psoriasis often requires continuous topical treatment. MATERIALS AND METHODS: Here, the radical protection of a cream containing various herbal oils was evaluated in vivo by electron paramagnetic resonance (EPR) spectroscopy and its skin penetration by Raman microscopy in intact and barrier-disturbed skin. Changes in skin barrier properties were evaluated after 4 weeks of daily topical application using in vivo laser scanning microscopy (LSM) and transepidermal water loss in 26 healthy volunteers. A randomized, controlled, double-blind, three-arm parallel clinical study evaluated the efficacy of the herbal oil cream compared to a 0.05% calcipotriol-containing cream and to a vehicle cream, in 135 patients with mild to moderate plaque psoriasis with the change in Psoriasis Area and Severity Index (PASI) from baseline to week 12 as the primary endpoint. RESULTS: EPR spectroscopy disclosed a significantly higher radical formation in untreated than skin treated with the herbal oil cream (p ≤ 0.05). LSM measurements indicated a protective skin barrier effect in treated compared to untreated skin. In the clinical trial, the topical application of herbal oils showed a significant reduction of the PASI score compared to topical calcipotriol at week 12 (p = 0.016). The mean reduction in PASI was 49% for the herbal oil cream, 38% for calcipotriol, and 55% for the vehicle cream. The percentage of patients, who reached PASI 50 and 75 at any time point, was 55.9% and 29.4% for the herbal oil cream, 47.4% and 15.8% for calcipotriol, and 23 (60.5%) and 13 (34.2%) for the vehicle, respectively (p > 0.05). The vehicle, originally designed as a placebo, contained a main ingredient of the herbal oil cream and therefore showed corresponding results. CONCLUSION: The herbal oil cream demonstrated effectiveness in the treatment of mild to moderate plaque psoriasis.

Clinical, biometric, and ultrasound assessment of the effects of the autologous fibroblast cells transplantation on nasolabial fold wrinkles.

BACKGROUND: Feeling beautiful and staying young have always been important to the people. Therefore, an extensive body of research has focused on the efforts made to remove the skin problems, especially wrinkles. Fibroblast cells of the skin are the various autologous cells currently used in repairing several wounds, scars, and skin aging. Thus, the present study was conducted to assess the efficacy of the transplantation of the fibroblast cells in eliminating the facial wrinkles using the biometric assessment and to optimize the application of this technique in this treatment. METHODS: The present study was conducted on 22 male and female patients aged between 35 and 60 years old. Samples were collected from the retro-auricular region, and the fibroblast cells were isolated and cultured. Subjects received three injections with autologous fibroblasts at 2-week intervals. The patients were followed up for 6 months, and structural changes in their wrinkles were assessed by the sonography and the VisioFace software, cutometer, tewameter, and colorimeter. RESULTS: The results obtained using the VisioFace software showed the significant phenotypic changes in the patients after the nasolabial injections (81.42 ± 23.97 vs. 60.91 ± 21.91, p = 0.0001). The results showed a significant increase in the total skin density (13.73 ± 6.30 vs. 26.27 ± 7.93, p = 0.0001), dermis density (11.28 ± 5.21 vs. 31.88 ± 7.96, p = 0.0001), epidermis density (27.68 ± 23.15 vs. 49.21 ± 45.68, p = 0.046), and dermis thickness (798.09 ± 133.51 µm vs. 905.59 ± 240.67 µm, p = 0.036) compared to pre-treatment. CONCLUSION: The findings of the study revealed that the injection of autologous fibroblasts can be effective in restoring the aging skin, especially in the nasolabial region, and can be used as a safe rejuvenating strategy.

Study of efficacy of microneedling and mesoneedling in the treatment of epidermal melasma: A pilot trial.

BACKGROUND: Melasma is a difficult to treat pigmentation disorder. However, some successes have been attained by microneedling. The aim of the present study was to evaluate the efficacy of microneedling using meso-depigmentation solution (mesoneedling) in comparison with standard microneedling, over a 4-month treatment period. METHODS: As a part of this pilot study, 20 patients received microneedling on one side and mesoneedling on another side of their face. Treatment was repeated on a monthly basis for 4 months. Treatment efficacy was defined through Dermacatch® colorimetry, modified Melasma Area and Severity (mMASI) score determination, Investigator's Global Assessment (IGA), and patient questionnaires, whereby all assessments were conducted at the baseline, as well after 2 and 4 months of treatment. RESULTS: Before treatments, mean difference between pigmented and normal skin calculated by Dermacatch® was 43.7 ± 20.12 and 44.6 ± 20.72 in microneedling sides and mesoneedling sides, respectively. After two and four sessions, these values declined to 34.5 ± 16.26 and 28.05 ± 13.79 on the side subjected to microneedling, while 29.75 ± 15.07 and 20.45 ± 10.58 were measured on the mesoneedling side. Statistically significant differences have been observed between microneedling and mesoneedling treatments at both time points (P = .0001, P = .0001). The mMASI scores obtained upon treatment completion were significantly lower on both the microneedling and the mesoneedling side. The IGA and patients' self-assessment scores further confirmed that both treatments were effective in treating melasma, without producing any notable side-effects or complications. CONCLUSION: In sum, both microneedling and mesoneedling are effective in decreasing melanin content in the epidermal melasma lesions.

Significant therapeutic response to cysteamine cream in a melasma patient resistant to Kligman's formula.

L-Cysteamine is a biological antioxidant produced during the coenzyme A metabolism cycle and is naturally present in all mammalian cells. The efficacy of topical cysteamine for the treatment of melasma has been recently shown in two double-blind, randomized, and placebo-controlled clinical trials. Herein, we report a 44-year-old patient with melasma resistant to Kligman's formula (Pigmanorm cream), who was successfully treated with topical cysteamine as a new depigmenting agent. Skin colorimetric measurements, MASI score determination, and standard photographies after 2 and 4 months of once daily application of cysteamine cream showed a marked improvement of the hyperpigmented lesions. Telangiectasia and perilesional hypopigmentation improved rapidly after the discontinuation of Kligman's formula and starting the treatment with topical cysteamine. After 4 months, the therapeutic results were maintained through a biweekly application regimen of cysteamine cream. The use of cysteamine cream was well tolerated and did not induce any side effects during the 3-year follow-up of the patient. Cysteamine is a natural molecule with an excellent safety profile and known antimutagenic, antimelanoma, and anticarcinogenic effects. Considering the high efficacy of cysteamine cream, it is possible that it could replace mutagenic and carcinogenic depigmenting agents such as hydroquinone in near future.

Efficacy of cysteamine cream in the treatment of epidermal melasma, evaluating by Dermacatch as a new measurement method: a randomized double blind placebo controlled study.

BACKGROUND: Melasma is a difficult-to-treat hyperpigmentary disorder. Very few studies have been performed regarding the efficacy of cysteamine in the treatment of melasma. OBJECTIVE: To determine the efficacy of cysteamine cream in the treatment of patients with epidermal melasma using Dermacatch® as a more accurate skin colorimetric measurement tool. METHODS: Participating patients (n = 40) received either placebo (n = 20) or cysteamine cream (n = 20) in a double-blind placebo controlled study. Cysteamine cream or placebo was applied on the lesions once a day at bedtime throughout the four-month study period. Treatment efficacy was determined through Dermacatch® and Mexameter® skin colorimetry, MASI scores, Investigator Global Assessments (IGAs), and patient questionnaires, all performed at baseline, 2-month, and 4-month examinations. RESULTS: Prior to the start of the protocol, the mean difference between pigmented and normal skin was calculated for cysteamine and placebo groups using both Dermacatch® (72.3 ± 27.8 and 52.9 ± 16.4, respectively) and Mexameter® (93.6 ± 42.6 and 65.4 ± 22.6, respectively). At 2 months, the mean differences were 38.1 ± 15.3 (Dermacatch®) and 49.9 ± 19 (Mexameter®) in the cysteamine group and 64.9 ± 25.3 (Dermacatch®) and 68 ± 26.2 (Mexameter®) in the placebo group. At 4 months, the mean differences were 23.8 ± 12.9 (Dermacatch®) and 35.5 ± 16.1 (Mexameter®) in the cysteamine group, and 50 ± 18 (Dermacatch®) and 51.2 ± 16.8 (Mexameter®) in the placebo group. Statistically significant differences were found between the cysteamine and placebo group outcomes at both time points (p = .01, p = .02). At the end of the treatment period, MASI scores were significantly lower in the cysteamine group versus placebo (8.03 ± 5.2 vs. 12.2 ± 7.4, p = .04). IGA scores and patient viewpoints indicated significant efficacy of cysteamine cream versus placebo. CONCLUSION: Cysteamine cream showed significant efficacy in decreasing melanin content of the lesions, as established by Dermacatch® as a new measuring method.

Antidepressant effects of citalopram on treatment of alopecia areata in patients with major depressive disorder.

OBJECTIVE: The authors sought to determine whether antidepressant therapy could enhance the efficacy of dermatological treatment in alopecia areata patients who suffer from major depressive disorder. METHODS: Sixty patients were enrolled in the study. Thirty patients with alopecia who were diagnosed with major depressive disorder received 20 mg/day citalopram and 5 mg/mL triamcinolone injection every 4 weeks, up to six injections, and 30 patients received only triamcinolone injection each month for 6 months using a simple random method. RESULTS: The mean diameter of the alopecic patches in the triamcinolone injection only group as against the combined treatment group (psychiatric [citalopram] plus dermatologic treatment) before treatment was 2.7 ± 0.7 (mean ± SD) and 2.5 ± 1.8, respectively, with no statistically significant differences (Mann-Whitney, p = 0.08). After 6 months of therapy, the mean diameter of patches reached 1.6 ± 1 and 0.54 ± 0.97 in the triamcinolone injection only group and the combined treatment groups, respectively (Mann-Whitney, p < 0.0001). DISCUSSION: The results of this study showed that antidepressant treatment might help in improving alopecia areata in patients with major depressive disorder.

A randomized double blind, vehicle controlled bilateral comparison study of the efficacy and safety of finasteride 0.5% solution in combination with intense pulsed light in the treatment of facial hirsutism.

OBJECTIVE: We sought to determine whether topical finasteride can enhance the efficacy of intense pulsed light hair removal. MATERIALS AND METHODS: An intense pulsed light (IPL) treatment with radiofrequency (RF) was performed every four weeks, resulting in up to three sessions, and again at the end of the study - 6 months after the start of the experiment. Each patient also applied either finasteride or placebo solution twice daily to each side of the chin in a double-blinded manner. RESULTS: A total of 77 patients were included in the study. Mean hair density before treatment in finasteride side of the patient's chin was 19.7 ± 11.7 and in placebo side was 19.1 ± 11.3. After three sessions of IPL + RF treatment, combined with twice daily application of finasteride and placebo solutions, at the end of 6-month period mean hair density of 8 ± 6.3 and 9 ± 5.6 was achieved in finasteride and placebo side respectively. Statistically significant difference was found between finasteride and placebo solution. CONCLUSIONS: We have demonstrated that the addition of finasteride solution to IPL + RF hair removal may result in a more reduction of unwanted facial hair in women when the combination is used for up to 6 months.

The evaluation of the clinical effect of topical St Johns wort (Hypericum perforatum L.) in plaque type psoriasis vulgaris: a pilot study.

In this case series, ten patients with plaque-type psoriasis were treated with Hypericum perforatum ointment. The hypericum ointment was applied to one side of each patient's body and the vehicle to the opposite side twice daily for 4 weeks in a single blinded manner. Modified psoriasis area severity index (PASI) scores were significantly lowered where the formulated ointment had been applied. In determining PASI scores, three factors, erythema, scaling and thickness, were evaluated; all were significantly lower where the formulated ointment had been applied (P = 0.01, P = 0.004, P = 0.04). Hypericum perforatum ointment applied twice daily may be effective in reducing PASI scores in mild plaque-type psoriasis, however, further larger studies need be conducted to achieve a more conclusive result.

Comparative study of therapeutic effects of 20% azelaic acid and hydroquinone 4% cream in the treatment of melasma.

BACKGROUND: Melasma is an irregular brown or grayish-brown symmetric facial hypermelanosis, often affecting women, especially those living in areas with intense ultraviolet radiation. OBJECTIVE: Comparison of therapeutic effects of 20% azelaic acid and 4% hydroquinone cream in the treatment of melasma. METHODS: Twenty-nine women with melasma were recruited. Fifteen patients were treated with 4% hydroquinone cream and 14 patients were treated with azelaic acid cream for 2 months. The cream was applied twice daily. A broad-spectrum sunscreen was used concomitantly by both groups. The Melasma Area Severity Index (MASI) scores were determined prior to treatment and at each follow-up. RESULTS: The mean MASI score before treatment was 7.2 ± 3.2 in the hydroquinone group and 7.6 ± 3.5 in the azelaic acid group, with no significant difference between them (t-test, CI 95% = -2.9 to 2.2). One month after treatment, the mean MASI score reached 6.7 ± 3.4 with hydroquinone and 6.3 ± 3.4 with azelaic acid with no significant difference between them (t-test, CI 95% = -2.2 to 3). After 2 months' treatment, the MASI score was 6.2 ± 3.6 with hydroquinone and 3.8 ± 2.8 with azelaic acid, a significant statistical difference (t-test, CI 95% = 0.03-4.9). CONCLUSIONS: In conclusion, this study suggests that 20% azelaic acid cream applied twice daily may be more effective than hydroquinone 4% in reducing mild melasma. However, because this was an open trial, it is suggested that further studies involving large groups of patients be conducted to achieve a more conclusive result.

Letter: Generalized lichen nitidus successfully treated with pimecrolimus 1 percent cream.

An eight-year-old child presented with generalized popular eruptions of two years duration. The diagnosis was lichen nitidus with pathologic confirmation. The lesions were successfully reduced and flattened by pimecrolimus 1 percent cream for 8 weeks.

Primary cutaneous actinomycosis caused by Actinomyces bovis in a patient with common variable immunodeficiency.

Actinomycosis is a chronic, suppurative granulomatous disease caused by the genus Actinomyces. This report is an interesting case of primary cutaneous actinomycosis (PCA) in a patient with common variable immunodeficiency (CVI) affecting the fingernails. The patient was successfully treated with penicillin G, cefazolin and metronidazole as well as surgical debridement of the infected tissues. In a 4-year follow-up period, no recurrence was observed. Primary cutaneous actinomycosis is a rare disease and the diagnosis needs a high index of clinical suspicion with attention to the history of skin implantation of the organism.

Could azathioprine be considered as a therapeutic alternative in the treatment of alopecia areata? A pilot study.

Alopecia areata is an autoimmune disease resulting in partial or total nonscarring hair loss and the treatment of severe alopecia areata is difficult. The aim of this study was to evaluate the efficacy and safety of azathioprine as a systemic monotherapy for moderate to severe alopecia areata. A total of 20 patients [14 men (70%) and six women (30%)] with minimum 6 months history of alopecia areata were included. The extent of scalp hair regrowth during and after the completion of the 6 months treatment was evaluated by the Severity of Alopecia Tool (the SALT score). The daily drug intake was calculated as 2 mg/kg of body weight. Mean duration of current episode of scalp hair loss was 26.4 (26.4 ± 17) months. Mean regrowth percentage was 52.3% (52.3 ± 38.4). Mean hair loss percentage before treatment was 72.7% (72.7 ± 28.3) compared with 33.5% (33.5 ± 30.7) after 6 months of azathioprine treatment. This showed a highly significant statistical difference (Paired t-test, CI 95% =21.5-54.1). Mean hair loss score (S(0) -S(5) ) before treatment was 3.9 (3.9 ± 1.6) and after 6 months of azathioprine treatment was 1.8 (1.8 ± 1.3). Assessment showed significant difference from baseline score (sign test, P < 0.0001). No significant statistical difference was observed with respect to gender before and after azathioprine treatment. Treatment with azathioprine as a systemic monotherapy clinically produces relevant improvement in moderate-to-severe alopecia areata. Generally azathioprine is a low-cost and well-tolerated drug and with controlled studies on larger number of patients, long-term efficacy and safety of this treatment should be investigated.

Pimecrolimus 1 percent cream and pulsed dye laser in treatment of a patient with reticular erythematous mucinosis syndrome.

We report on the efficacy of twice daily application of pimecrolimus 1 percent cream in a 48-year-old woman with reticular erythematous mucinosis (REM) syndrome and compare its results with pulsed dye laser (PDL) on the other side of her chest and back. The patient was previously treated by hydroxychloroquine but only a fair response was observed. After application of 5 months of pimecrolimus, the lesions completely resolved and the result was comparable with the other side of her body treated by pulsed dye laser PDL. Topical pimecrolimus and pulsed dye laser appear to be effective and safe treatments for REM.

Pimecrolimus 1 percent cream in the treatment of psoriasis in a child.

Psoriasis is a chronic inflammatory skin disorder of multifactorial etiology. Because of the potential side effects of repeated topical application of potent corticosteroids, equally-effective, safer therapeutic options are required, especially in the treatment of children. We report on the efficacy of twice daily application of pimecrolimus 1 percent cream in a girl who suffered from psoriasis involving the eyelids and anogenital region. After 20 days of application of pimecrolimus cream the plaques completely resolved. No significant side effects have been observed. Topical pimecrolimus appears to be an effective and safe treatment for children with psoriasis. Our case observations provide further evidence for the beneficial effects of topical pimecrolimus in the treatment of psoriasis. Vehicle-controlled studies on a larger number of patients are now needed to investigate long-term efficacy and safety of topical pimecrolimus in the treatments of a variety of types of psoriasis in children.