Effect of the 1064 nm Nd: YAG Laser on the MICs of Antifungals Used in Clinical Practice for the Treatment of Fungal Nail Infections.

Introduction: The fungal nail infection (onychomycosis) involves 18%-40% of all nail disorders, which, although not fatal, can cause mechanical, aesthetic, occupational, and economic problems. Drug treatments due to prolonged treatment periods, drug interactions, adverse effects, and slow progression may associate with numerous negative outcomes. This study aimed to evaluate the long-pulsed 1064-nm Nd: YAG laser effect on fungal colonies and subsequently possible change in the minimum inhibitory concentrations (MICs) of common antifungals compared with the same non-lasered colonies as a novel way to investigate laser and antifungal interaction. Methods: Sixty onychomycosis samples consisting of saprophyte (n=20), dermatophyte (n=20), and yeast (n=20) duplicate colonies were isolated. A series was treated by a long-pulsed 1064-nm Nd: YAG laser. Afterward, the MIC (CLSI-M38-A2 and CLSI-M27-A3) of two series against common antifungals were compared. Results: After 1064-nm Nd: YAG laser irradiation in all 20 tested saprophytes, the MICs of terbinafine (P value<0.035) were changed, and in all 20 tested dermatophytes, the MICs of voriconazole (P value<0.021) were changed. Also, in all 20 tested yeasts, the MICs of caspofungin (P value<0.037) were changed. Moreover, in saprophytes, dermatophytes, and yeasts, significant changes in the MICs of itraconazole (P value<0.032), terbinafine (P value<0.025), and caspofungin (P value<0.037) were detected. Our result showed the GM MICs of the 1064-nm Nd: YAG laser in all saprophyte, dermatophyte, and yeast groups were lower than in the control group. Conclusion: The present study indicated that the long-pulsed 1064-nm Nd: YAG laser significantly changes the MICs of antifungals in onychomycosis clinical samples.

Role of Cultured Skin Fibroblasts in Regenerative Dermatology.

The skin, as the largest organ, covers the entire outer part of the body, and since this organ is directly exposed to microbial, thermal, mechanical and chemical damage, it may be destroyed by factors such as acute trauma, chronic wounds or even surgical interventions. Cell therapy is one of the most important procedures to treat skin lesions. Fibroblasts are cells that are responsible for the synthesis of collagen, elastin, and the organization of extracellular matrix (ECM) components and have many vital functions in wound healing processes. Today, cultured autologous fibroblasts are used to treat wrinkles, scars, wounds and subcutaneous atrophy. The results of many studies have shown that fibroblasts can be effective and beneficial in the treatment of skin lesions. On the other hand, skin substitutes are used as a regenerative model to improve and regenerate the skin. The use of these alternatives, restorative medicine and therapeutic cells such as fibroblasts has tremendous potential in the treatment of skin diseases and can be a new window for the treatment of diseases with no definitive treatment. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description ofthese Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Combination of epidermal keratinocyte-melanocyte cells suspension and microneedling: Safe surgical approach in vitiligo.

INTRODUCTION: Vitiligo is a skin disease that is associated with impaired skin immune systems and pigment degradation in skin melanocyte cells. Despite the significant impact of the disease on the quality of life of patients, treatment of the disease using an effective method such as the transplantation of uncultivated melanocytes was considered by researchers around the world. The goal of this research was to use microneedling to transplant epidermal keratinocyte-melanocyte cells suspension for the treatment of vitiligo patients. METHODS: In this study, 15 male and female vitiligo in face region patients aged 18-45 years were studied. In this study, melanocyte-keratinocyte cells suspension was sprayed. Patients underwent microneedling treatment after spraying the cells. Before and after transplantation, patients were biometrically examined, and the quantity of pigmentation and changes in the transplanted region were documented. Statistical software was used to examine the results. RESULTS: The color difference between the lesion area and normal skin in one, two, and six months after treatment with cell suspension was significantly reduced compared with before treatment (by 48.95%). Moreover, the amount of melanin was significantly increased 6 months after treatment compared with before treatment (129.8 ± 4.16 vs. 195.2 ± 3.54, p = 0.000). A significant decrease in skin brightness in the skin of the lesion area was observed compared with normal skin, 6 months after treatment compared with before treatment (43.7 ± 1.44 vs. 27.9 ± 1.24, p = 0.000). CONCLUSION: Epidermal keratinocyte-melanocyte cells suspension in combination with microneedling could be considered as an effective treatment of vitiligo.

The Immunogenetics of Lichen Planus.

Lichen planus (LP) is a multifaceted autoimmune disease affecting the skin, nails, hair, and mucous membranes, with several clinical subgroups. Cell-mediated immunity plays a key role in its progression. This chapter reviews the known genetic associations of lichen planus including HLA as well as non-HLA genes.

Transplantation of autologous fat, stromal vascular fraction (SVF) cell, and platelet-rich plasma (PRP) for cell therapy of atrophic acne scars: Clinical evaluation and biometric assessment.

BACKGROUND: Scarring is an unfortunate result of acne because it causes the psychological and cosmetic problems for the patients. Unfortunately, no single treatment is suitable, and using multiple methods may have a better result. The autologous fat and stromal vascular fraction (SVF) cells and their secretory factors can enhance the angiogenesis, collagen synthesis, and migration of fibroblasts, therefore regenerate hurt tissues. Moreover, other treatments for acne scarring, such as platelet-rich plasma (PRP), induce the increase in scare. AIMS: This study aimed to verify the effectiveness of transplantation of autologous fat, SVF cells, and PRP as cell therapy techniques on atrophic acne scars. PATIENTS/METHODS: This study included 9 adult patients with atrophic acne scars on face. All patients received the transplantation of autologous fat, stromal vascular fraction (SVF) cells, and PRP. The treatment outcome was measured by biometric assessment (VisioFace 1000 D, Colorimeter, multi-probe adapter Cutometer, Tewameter, Mexameter, and skin ultrasound imaging system), and also, the satisfaction of patients was evaluated. The patients were followed 6 months after the treatment. RESULTS: There was a significant improvement in the skin pores, spots, skin lightness and melanin content of skin, skin elasticity, and TEWL (transepidermal water loss) after 6 months of the treatment. Furthermore, denser skin layers were observed both in the epidermis and in the dermis. Moreover, 66.6% of patients showed good satisfaction after the treatment. CONCLUSION: In brief, the transplantation of autologous fat, SVF cells, and PRP is an effective cell therapy for atrophic acne scars.

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.

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.

Comparison of carboxy therapy and fractional Q-switched ND:YAG laser on periorbital dark circles treatment: a clinical trial.

Treatment of the periorbital dark circles (PDCs) is a current challenge, with most treatment methods failing to yield promising results. The effectiveness of two common methods for periorbital dark circle treatment was compared in 28 patients with PDC. The patients were randomly divided into two groups of equal numbers: the first group received carboxy therapy, and the second group fractional 10,64 nm Q-switched Nd:YAG laser. In the carboxy therapy group, the treatment was performed six times, with 1-week intervals between sessions. In the group treated by Nd:YAG laser, the treatment was conducted in four sessions, with 1-month intervals between sessions. The results were evaluated through biometric evaluation, scoring on the visual analog scale (VAS) by both physicians and patients, and patients' satisfaction. Side effects of the treatments were also evaluated. The results showed that both carboxy therapy and Nd:YAG laser are effective in the treatment of periorbital dark circles, but carboxy therapy is significantly more effective. An increase in the skin lightness and a decrease in the melanin content of the periorbital skin was observed in the group receiving carboxy therapy, and these changes were more pronounced in this group compared to the group of Nd:YAG laser. In addition, side effects, such as erythema and post-inflammatory hyperpigmentation, were less in carboxy therapy than in Nd:YAG laser. Furthermore, the procedure was less expensive and easier to perform compared to Nd:YAG laser. Carboxy therapy is significantly more effective than Nd:YAG laser in PDC treatment.Trial registration: IRCT20080901001159N24.