Topical sucralfate for treatment of mucocutaneous conditions: A systematic review on clinical evidences.

Sucralfate is an aluminum salt of sucrose octasulfate, generally considered safe in terms of adverse effects. Systemic sucralfate is FDA-approved for the treatment of duodenal ulcers. Since 1991, topical sucralfate has been used in various mucocutaneous conditions, but it is not approved by the FDA yet. In this systematic review, the online databases were searched with appropriate keywords, and the papers were screened by the authors. After screening steps, the relevant articles were selected according to the inclusions and exclusions criteria. Finally, the full texts of 18 articles were included for final evaluations. In conclusion, topical sucralfate has some clinical benefit in several mucocutaneous conditions, including mucocutaneous inflammatory conditions (e.g., post-radiotherapy reaction, diaper dermatitis, keratoconjunctivitis sicca, etc.), mucocutaneous infectious disorders (e.g., peristomal wound reaction/infection); ulcers; burns, and also pain relief.

The efficacy of energy-based devices combination therapy for melasma.

Melasma is a recalcitrant pigmentary disease with a complex pathogenesis. Monotherapy often results in unsatisfactory results with high recurrence rate. In this review article, we evaluate efficacy of energy-based devices combination therapy for melasma. We reviewed published literature since 2010 up to November 2020 regarding adjuvant therapy of energy-based devices with other treatment modalities in the treatment of melasma. After final selection, we assessed 49 articles. Energy-based devices include lasers, non-coherent lights, radiofrequency, iontophoresis, sonophoresis, microneedling, and microdermabrasion. Adjuvant therapies other than energy-based devices were lightening agents, chemical peels, platelet rich plasma (PRP) and mesotherapy. Combination of Q-switched neodymium-doped: yttrium, aluminum, and garnet (QSNY) with either intense pulsed light therapy (IPL) or pulsed-dye laser (PDL) are recommended in recalcitrant melasma in patients with light skin photo types and with dilated skin vessels (especially with PDL). Combination of fractional microneedling radiofrequency or microneedling with QSNY leads to promising results and is a safe treatment modality, especially in darker skin types. Application of topical lightening agents in combination with laser therapy leads to higher efficacy with less adverse effects (post-inflammatory hyperpigmentation) and rebound of melasma. Combination of ablative techniques with QSNY is not recommended, due to the high risk of permanent adverse effects such as guttate hypopigmentation and exacerbation of melasma.

Laser therapy in cutaneous and genital warts: A review article.

Traditional treatment modalities for wart require long-term treatment course and usually have high recurrence rates and unwanted side effects. In this review article, we evaluated different types of laser therapy in the treatment of warts. Published articles since 2000 up to July 2020 about laser therapy in genital and non-genital warts were searched and assessed. Fifty articles were selected for the final review, including 22 pulsed dye laser (PDL), 10 neodymium-yttrium-aluminum-garnet (Nd: YAG), 3 erbium-doped yttrium-aluminum-garnet (Er: YAG), 14 carbon dioxide (CO2 ) laser and one systematic review. Complete response rates were different in terms of laser type used (0%-100%, 9.1%-100%, 83.3%-100%, and 59.15%-100% for PDL, Nd: YAG, Er: YAG, and CO2 laser, respectively). There was no significant difference between conventional treatment modalities and laser therapy regarding efficacy and recurrence rate. Combination of lasers with keratolytic agents, immunomodulators and photodynamic therapy can be helpful especially in immunosuppressed patients, refractory, and recurrent lesions. PDL has the lowest occurrence of adverse effects relative to other types of lasers.

Oral manifestations of COVID-19 disease: A review article.

Dysgeusia is the first recognized oral symptom of novel coronavirus disease (COVID-19). In this review article, we described oral lesions of COVID-19 patients. We searched PubMed library and Google Scholar for published literature since December 2019 until September 2020. Finally, we selected 35 articles including case reports, case series and letters to editor. Oral manifestations included ulcer, erosion, bulla, vesicle, pustule, fissured or depapillated tongue, macule, papule, plaque, pigmentation, halitosis, whitish areas, hemorrhagic crust, necrosis, petechiae, swelling, erythema, and spontaneous bleeding. The most common sites of involvement in descending order were tongue (38%), labial mucosa (26%), and palate (22%). Suggested diagnoses of the lesions were aphthous stomatitis, herpetiform lesions, candidiasis, vasculitis, Kawasaki-like, EM-like, mucositis, drug eruption, necrotizing periodontal disease, angina bullosa-like, angular cheilitis, atypical Sweet syndrome, and Melkerson-Rosenthal syndrome. Oral lesions were symptomatic in 68% of the cases. Oral lesions were nearly equal in both genders (49% female and 51% male). Patients with older age and higher severity of COVID-19 disease had more widespread and sever oral lesions. Lack of oral hygiene, opportunistic infections, stress, immunosuppression, vasculitis, and hyper-inflammatory response secondary to COVID-19 are the most important predisposing factors for onset of oral lesions in COVID-19 patients.

The topical treatment of anthroponotic cutaneous leishmaniasis with the tincture of thioxolone plus benzoxonium chloride (Thio-Ben) along with cryotherapy: a single-blind randomized clinical trial.

A simple efficacious topical treatment for cutaneous leishmaniasis (CL) is still an unresolved challenge. This study aimed to evaluate the efficacy of the topical use of thioxolone plus benzoxonium chloride (Thio-Ben) tincture in combination with cryotherapy in comparison with intralesional meglumine antimoniate (Glucantime) along with cryotherapy in treating anthroponotic CL (ACL). The study was conducted in Leishmaniasis Center in Dadbin Health Care Clinic, Kerman, Iran. Sixty-four CL lesions were randomly assigned to receive Thio-Ben plus cryotherapy (TC) (n = 32) or Glucantime plus cryotherapy (GC) (n = 32). Thio-Ben was used topically every other day and Glucantime was used intralesionally once a week for a maximum of 3 months. In both study groups, cryotherapy was administered using liquid nitrogen once every 2 weeks. Of 64 recruited lesions, 47 lesions completed the study protocol. Twenty lesions (91%) in TC group and 23 lesions (92%) in GC group showed complete cure. TC group showed faster clinical response. Pain, hypersensitivity reaction, dizziness, and nausea were only seen in GC group. This study showed that the topical use of Thio-Ben combined with cryotherapy has a good efficacy in treating ACL with the benefit that Thio-Ben has more patient compliance and less side effects than intralesional Glucantime.

Diagnostic Value of Dermoscopic Structures in Predicting Superficial Basal Cell Carcinoma in the Skin of Color.

Background: Basal cell carcinoma (BCC) manifests different dermoscopic patterns in individuals with dark skin complexion compared to those with fair skin types. This study aimed to investigate the diagnostic utility of dermoscopy in discerning superficial BCC from other types of BCC, specifically in patients with dark skin complexion. Materials and Methods: This cross-sectional study focuses on patients diagnosed with BCC who were referred for skin biopsy between July 2020 and September 2022. Initially, the demographic characteristics of patients, clinical attributes of lesions, and pathological sub-types of BCC were documented. Subsequently, videodermoscopy was employed to capture comprehensive views and dermoscopic images of the lesions. Univariate logistic regression analysis was then utilized to assess the reliability of dermoscopic structures in distinguishing superficial BCC from other BCC types. Last, the study evaluated the sensitivity, specificity, positive predictive value, and negative predictive value of dermoscopy in the differentiation of superficial BCC from other BCC sub-types. Results: The study enrolled 49 patients diagnosed with BCC, with a mean age of 66.22 ± 10.41 years. The most prevalent pathological sub-type observed was nodular (53.1%). Dermoscopy exhibited a higher specificity compared to the naked eye in the differentiation of superficial BCC from other types (55% vs. 35%, respectively). Univariate analysis revealed a significant association between spoke-wheel structures and superficial BCC (P = 0.02, odds ratio = 7.2, 95% confidence interval = 1.35-38.32). Conclusion: Dermoscopy exhibited superior specificity compared to the naked eye in differentiating superficial BCC from other BCC types. Notably, the spoke-wheel structure demonstrated the most robust correlation with superficial BCC.

Combination of Plasma Rich in Growth Factors With Topical 4% Hydroquinone Compared With Topical 4% Hydroquinone Alone in the Treatment of Dermal Type of Melasma: A Single-Blinded Randomized Split-Face Study.

Background: Response to the current available treatments of melasma, dermal type, in particular, is usually gradual and can result in possible side effects. Aim and Objectives: In this study, we aim to evaluate the efficacy of the combination of plasma rich in growth factors (PRGF) and topical 4% hydroquinone (HQ) in comparison with monotherapy using topical 4% HQ alone in the treatment of dermal type of melasma. Materials and Methods: This is a single-blinded, randomized, split-face clinical trial on twenty female patients with dermal type of melasma. Patients were asked to apply topical 4% HQ on both sides of their face at night for 6 months. In each participant, one side of the face was randomly chosen to receive monthly intradermal injections of PRGF for 3 sessions. Efficacy of the treatment was assessed using hemi melasma area and severity index (MASI) score, physician's global assessment (PGA), and patients' global assessment (PtGA). Results: Both groups revealed significant improvement in hemi-MASI score during the treatment course. Mean percentage of improvement at the end of study was 40.38 ± 6.04% and 33.42 ± 3.23% in the combination therapy and monotherapy groups, respectively (P = 0.31). PGA demonstrated excellent-to-marked improvement in melasma in 25% and 5% of patients in the combination therapy and monotherapy groups, respectively (P = 0.31). PtGA showed high levels of satisfaction in 15% of patients in the combination therapy group (vs. 0% in the monotherapy group) (P = 0.05). Conclusion: Differences between the two treatment groups in terms of hemi-MASI and PGA scores were not statistically significant; however, patients demonstrated higher satisfaction with combination of PRGF and topical 4% HQ compared with topical HQ alone. Thereby, combination of PRGF and topical 4% HQ can be suggested as a safe alternative therapeutic approach and may hold promise in the development of future therapeutic options for dermal type of melasma.

Efficacy of a Combined Herbal Product Containing Indigofera argentea, Pistacia atlantica and Salvia hispanica in Zoonotic Cutaneous Leishmaniasis Patients Treated along Glucantime ®.

Background: Leishmaniasis is highly prevalent worldwide, and while conventional medicine offers numerous treatment methods for cutaneous leishmaniasis, Iranian traditional medicine suggests various remedies. We aimed to evaluate the efficacy of an herbal combination containing Indigofera argentea leaves, Pistacia atlantica resin, and Salvia hispanica seeds in patients with zoonotic cutaneous leishmaniasis. Methods: This study was conducted at the Leishmaniasis Department of Chabahar Health Center in southeastern Iran in 2021. It was a double-blinded randomized clinical trial involving 68 patients enrolled after clinical diagnosis, examination of smear samples using Giemsa staining, and PCR confirmation. The volunteers were randomly divided into intervention and control groups. Both groups received 'Glucantime ® as the primary medication weekly until complete healing or up to 12 weeks. Glucantime ® was administered intralesionally at a dosage of 0.1 cc on the wound's margin, with repeat injections at 1 cm intervals along the wound edge when necessary. In addition to the main drug, the intervention group received the herbal product topically twice daily until wound healing or for up to 4 weeks, while the control group received a placebo in the same manner. Results: 82.35% of patients in the intervention group and 20.58% in the control group achieved complete healing within four weeks. There was a significant difference between the two groups (P < 0.001). Conclusion: The herbal product demonstrated effectiveness in treating patients with zoonotic cutaneous leishmaniasis.

Assessing effectiveness of adding niosomal atorvastatin 1% ointment to topical calcineurin inhibitor treatment in non-segmental vitiligo.

BACKGROUND: Treatment of vitiligo is still a big challenge for dermatologists. The efficacy of statins in the treatment of vitiligo is controversial. AIM AND OBJECTIVE: We studied possible therapeutic effect of topical 1% niosomal atorvastatin ointment combined with topical 0.1% tacrolimus in treatment of non-segmental vitiligo. METHODS: This is a triple blind, pilot, randomized placebo-controlled trial (RCT) that was performed in dermatology clinic. All the patients used topical 0.1% tacrolimus cream twice daily (BD). Moreover, the intervention group participants used topical 1% niosomal atorvastatin ointment, and control group participants were prescribed placebo ointment, BD. Patients were evaluated using vitiligo area surface index (VASI) score and patients' satisfaction at baseline and after 3 months treatment. RESULTS: The mean patient satisfaction in the intervention and control groups were 5 ± 1.4 and 3.5 ± 1.9; the difference between groups was not statistically significant (p = 0.9). We found statistically significant difference in VASI score before and after treatment in both intervention and control groups (p = 0.01 and p = 0.03, respectively). However, comparison of the VASI score between groups was not statistically significant (p = 0.62). We also found no significant correlation between VASI score and other variables. CONCLUSION: The result of this study indicates that adding of niosomal atorvastatin 1% ointment to topical calcineurin inhibitor has no additional effect on non-segmental type of vitiligo. Further large studies with different combinations are recommended before any conclusive result can be concluded on efficacy of statins in vitiligo.

Topical isoniazid as a novel treatment for melasma: A randomized, double-blind, vehicle-controlled clinical trial.

INTRODUCTION: Melasma is a chronic hyperpigmentation disorder, and its treatment poses a challenge to dermatologists due to its chronicity and resistance to conventional therapies. Oral isoniazid is used for the treatment of tuberculosis. One of us had previously showed that topical isoniazid exerts a strong depigmenting action in animal models. In this clinical trial, we assessed the therapeutic effect of topical isoniazid on melasma. METHODS: Twenty female patients suffering from epidermal melasma were enrolled and divided equally into two groups. The treatment group received topical isoniazid 10%, and the control group received the cold cream vehicle as the placebo. All participants were advised to avoid sunlight and used SPF 50 sunscreen. Patients applied topical agents once daily at night for 3 months. The melanin and erythema indices were measured by colorimetric evaluations at baseline and after 4, 8, and 12 weeks of treatment. At these time points, the (mMASI) score was also determined, as was the subjective evaluation through Melasma Quality of Life Scale (MELASQOL) scores. Blood tests were performed to evaluate CBC and the liver enzymes. RESULTS: All patients completed the 12-week study. In the treatment group, a significant decrease in melanin index from 63.77 ± 6.27 at baseline to 55.92 ± 5.79 was recorded (p = 0.001). Very minimal clinical changes were also seen in the control group and melanin index was decreased from 62.65 ± 2.23 to 61.25 ± 2.34 (p = 0.004). Clinically significant differences were observed in the rate of changes between both groups. These findings indicate that topical isoniazid has significant depigmenting effects compared to the placebo (p = 0.001). The erythema index remained unchanged in both groups. In the treatment group, the mMASI score was 5.63 ± 3.28 at baseline and 2.13 ± 1.71 at the last follow-up, significantly reduced compared to the control group (p = 0.002). The MELASQOL score indicated a significant improvement in the quality of life in the treatment group. CONCLUSION: This clinical trial shows for the first time that topical isoniazid is effective in treating melasma. Further clinical trials are necessary to confirm the efficacy and tolerability of topical isoniazid in comparison with other skin-depigmenting compounds.

Disseminated cutaneous leishmaniasis in a kidney transplant recipient.

Key Clinical Message: In this case of disseminated cutaneous leishmaniasis in our immunosuppressive patient who was a refractor to treatment with intra-lesion Glucantime® and systemic L-AmB, considering the good clinical response to oral miltefosine, this drug might be the best treatment option. Abstract: Diagnosis and treatment of leishmaniasis are challenging in immunosuppressed patients. Here, we report a 46-year-old male renal transplant recipient with disseminated cutaneous leishmaniasis presenting with multiple lesions on the face and upper extremities 15 years after transplant with a challenging course of treatment with meglumine antimoniate, liposomal amphotericin B, and miltefosine.

Metformin-Induced Generalized Bullous Fixed-Drug Eruption with a Positive Dechallenge-Rechallenge Test: A Case Report and Literature Review.

Metformin is a commonly used medication in diabetic patients. It can cause different complications including cutaneous adverse reactions. Metformin-induced fixed-drug eruption (FDE) has been reported in limited cases. Due to the popularity of metformin, clinicians need to be aware of uncommon drug reactions for proper diagnosis and treatment. Herein, we report a 43-year-old man with generalized bullous lesions with a positive dechallenge-rechallenge test diagnosed as metformin-induced generalized bullous fixed-drug eruption. Metformin dosage was stopped and lesions were treated with topical clobetasol propionate and oral prednisolone and cyclosporine-A. After a 6-month follow-up, he was well without any relapsing episodes.

The innovative application of autologous biofillers in aesthetic dermatology.

INTRODUCTION: Tissue engineering is a revolutionized biotechnology that utilizes biomaterials in regenerative medicine. Nowadays, there is a trend in employing autologous-based materials in aesthetic medicine. In this review, we discuss safety and efficacy of autologous-based fillers in the fields of aesthetic dermatology, and describe the details of preparation and injection methods based on current literature. EVIDENCE ACQUSITION: PubMed, Scopus, Web of science, Embase and Google scholar were searched for studies which evaluated efficacy of autologous-based filler in the field of aesthetic dermatology from January 2000 until August 2022. Nineteen articles including five randomized clinical trials, ten prospective and four retrospective studies were selected for this review. EVIDENCE SYNTHESIS: Most of the studies evaluated use of biofillers in rejuvenation (twelve articles) and the remaining were in atrophic scars (six articles) and striae distensae (one article). Adjuvant treatments included liquid platelet rich growth factor (PRGF), autologous cultured fibroblast, adipose tissue micrograft, microneedling, fractional carbon dioxide laser and subcision. Application of biofillers is a safe alternative therapeutic option for soft tissue augmentation. CONCLUSIONS: Application of biofillers is especially recommended in patients who seek low-cost rejuvenation methods and those with a past history of granulomatous reactions to the other fillers. It provides the advantage of immediate filling effects with long-lasting efficacy.

Treatment protocols and efficacy of light and laser treatments in post-acne erythema.

BACKGROUND: Post-acne erythema is described as erythema due to release of inflammatory cytokines, dilatation of microcapillaries within papillary dermis and thinning of epidermis. The erythema usually fades; however, it can persist for months. AIM: In this review, we decided to evaluate efficacy of light and laser treatments in acne-induced erythema. METHODS: We searched PUBMED, Embase, Cochrane, and Google Scholar for relevant key words. Inclusion criteria were randomized clinical trials (RCTs) that evaluated efficacy of laser or light in PAE until September 2021. RESULTS: Twelve RCTs were selected for the final assessment. Light and laser treatments included pulsed dye laser (PDL), intense pulsed light (IPL), Q-switched neodymium-doped yttrium aluminum garnet (QS Nd:YAG), fractional photothermolysis, alexandrite, solid-slate 589-1319 nm, and pro-yellow laser. CONCLUSION: Light and laser treatments are effective treatment modalities in reduction of acne-induced erythema along with active acne lesions and atrophic acne scars.

Safety and efficacy of mesotherapy in the treatment of melasma: A review article.

BACKGROUND: Mesotherapy is a popular novel therapeutic modality that is defined as intradermal or subcutaneous microinjection of pharmaceutical compounds. Although this novel treatment method is used commonly in aesthetic dermatology, there is little information about details of injections, efficacy, and side effects of mesotherapy in melasma. AIM: In this review, we evaluated efficacy and safety of various types of mesotherapy in the treatment of melasma. METHOD: We searched Google Scholar, Medline, and PubMed for related articles with keywords "melasma" OR "chloasma" AND "mesotherapy" OR "injection." Inclusion criteria were articles that evaluated intradermal injection of lightening drugs and published dates between January 2000 and September 2021. Exclusion criteria were articles in languages other than English or non-human studies. RESULTS: Thirty-three articles evaluated efficacy of mesotherapy in melasma, including 28 articles about tranexamic acid, 4 articles about vitamin C, 2 articles about glutathione, and 2 articles about triamcinolone. CONCLUSION: Mesotherapy is a good alternative or adjunctive choice in patients who are refractory to first-line therapy, patients with low compliance with everyday use of topical therapy, patients with contraindication to oral tranexamic acid therapy, or who wish short downtime and fast recovery period. Further studies with large sample sizes are required to determine ideal concentrations of mesotherapy substances and intervals between sessions and to evaluate the efficacy of different substances for mesotherapy as monotherapy compared to combination therapy and other treatment modalities for melasma.

Employing microbotox technique for facial rejuvenation and face-lift.

BACKGROUND: Microbotox technique, intradermal injection of microdroplets of botulinum toxin, is a favorable rejuvenation approach in subjects who prefer more natural appearance. AIM: To determine the best injection techniques (dosage, concentration, as well as number and location of injection points), efficacy and side effects of this innovative technique for facial rejuvenation. METHODS: We conducted a search in Pubmed, Embase, Web of Science, and Google Scholar databases from conception until October 2021 with keywords "microbotox" OR "mesobotox" OR "intradermal injection" AND "botulinum toxin" AND "rejuvenation" AND "wrinkle" AND "face-lift." RESULTS: Twenty articles were included in this review article. Different types of formulation including onabotulinum toxin A (OBA), abobotulinum toxin A (ABO), and incobotulinum toxin A (IBA) were used. The most used concentrations were 10-20 u/cc of OBA. Number of injection points varied from 4 (forehead and periorbital areas) to 999 (entire face) with 2 mm to 2 cm apart. Adjuvant treatment modalities were cross-linked hyaluronic acid, intense pulsed laser, and Fraxel laser. Most studies reported the initial results appeared after 5-14 days of procedure, lasting for nearly 3-6 months. CONCLUSION: Microbotox is an efficient and attractive method for facial rejuvenation, mid-lower face-lifting, and fine wrinkles reduction in forehead, periocular, and cheek regions, especially in younger-aged subjects. Furthermore, it is a suitable treatment for neck rejuvenation and recontouring of lower mandibular border, particularly in older subjects with marked skin laxity.

Treatment protocols and efficacy of combined laser with medical treatment modalities in vitiligo.

BACKGROUNDS: Nowadays, lasers are used for treatment of vitiligo in difficult-to-treat areas and refractory lesions. Combination of lasers with other medical modalities can provide higher efficacy, faster response rate, and higher compliance of patients to treatment. AIM: In this article, we reviewed articles regarding safety, efficacy, and treatment protocols of combined laser with other medical modalities. METHODS: We searched articles with relevant key words in Google scholar and PubMed. Inclusion criteria were articles in English language since January 2000 until March 2021that evaluate combination of laser with other topical or systemic medical treatments. RESULTS: A total of 42 articles evaluated efficacy of lasers [excimer, carbon dioxide (CO2 ), erbium-doped yttrium-aluminum-garnet (Er:YAG), and non-ablative resurfacing laser] combined with topical or systemic medical treatment modalities. Effective response rate (more than 50% improvement) varied between 7.7% and 92%. Initial repigmentation observed between 4 and 13 weeks after beginning of treatment. CONCLUSION: Combination of laser with medical modalities leads to more rapid repigmentation, superior efficacy, and better compliance of patients with localized non-segmental type of vitiligo compared to monotherapy. Combination of excimer laser with topical therapy might be suggested for recalcitrant vitiligo lesions in face and neck. Combination of fractional ablative resurfacing lasers with topical therapy, especially 5-flurouracil, can be recommended particularly in recalcitrant acral and bony prominent areas. Further studies are required to achieve conclusive evidence in order to define the best stage of vitiligo for laser therapy and most effective combined treatment regimen.

Employing hyaluronic acid-based mesotherapy for facial rejuvenation.

BACKGROUND: Mesotherapy is a method of treatment in which biocompatible substances are injected in small aliquots into different levels of skin. This technique can be used for facial rejuvenation. AIM: To comprehensively evaluate efficacy of different hyaluronic acid (HA) materials for skin rejuvenation, and discuss longevity of these products, potential adverse effects, and different injection techniques. MATERIAL AND METHODS: We searched Pubmed, Scopus, Web of science, Google Scholar, Embase, Cochrane Library, and Science direct until April of 2022. Thirty-four articles were selected including 23 articles about non-cross-linked HA and 11 articles about cross-linked HA. RESULTS: Eleven and five different non-cross-linked HA and cross-linked HA materials were utilized, respectively. Treatment sessions for non-cross-linked HA were between 1 and 6 at weekly-to-bimonthly interval, and for cross-linked HA were 1-3 at 4-36 weeks apart. In most of the studies, serial micropuncture technique with 23-32 gauge needles was used for injection. Other injection techniques were Nappage (picotage), depot and micro-linear. CONCLUSION: Mesotherapy with HA-based fillers is a favorable method for restoring youthful appearance, rejuvenation, and revitalization of skin. Proper selection and precise placement of HA in desired level of dermis is an essential key to optimize improvement and minimize side effects including skin irregularities and Tyndall effect. Adjuvant therapy with additional rejuvenation procedures to enhance esthetic results is required especially in elderly individuals with severe photodamaged skin. Moreover, preservation of esthetic results requires maintenance therapy every few months.

Efficacy and safety of traditional and surgical treatment modalities in segmental vitiligo: A review article.

BACKGROUND: Segmental vitiligo (SV) is a distinctive variant of vitiligo that is usually resistant to traditional treatments. Therefore, surgical therapies are mainstay of treatment in this type of vitiligo. To date, there is no review article or systematic review that evaluates specifically efficacy of treatment modalities on SV. AIM: To evaluate current evidence regarding efficacy and safety of traditional and surgical treatment modalities in SV. METHODS: We conducted a search in PubMed, Embase, Web of science, and Google Scholar for key words of "vitiligo" AND "segmental" AND "treatment" OR "therapy" OR "surgical treatments" OR "medical treatments" OR "laser" OR "phototherapy". Inclusion criteria were English literature that investigated efficacy of different treatments on three or more cases on SV from January 2000 until July 2021. RESULTS: A total of thirty-four articles were selected for detailed assessment. Different treatment modalities include medical treatment [systemic corticosteroid (SCS), topical CS (TCS), and topical calcineurin inhibitors (TCI)], phototherapy [narrow band-ultraviolet B (NB-UVB), psoralen and UVA (PUVA) and psoralen+solar exposure (PUVASOL)], laser/lights [helium-neon and Excimer laser/light (EL)] and surgical treatments [punch graft (PG), follicular graft, suction blister epidermal grafting (SBEG), spilt-thickness skin graft (STSG), and cultured/non-cultured-melanocytes-keratinocytes transplantation (MKTP)]. CONCLUSION: There were few randomized controlled trials (RCT) evaluating the efficacy of treatments in SV. Therefore, future high quality studies are required for better assessment of various treatment modalities in SV. Results of current evidence indicate resistance of SV to traditional therapies unless in patients with short duration of vitiligo. Therefore, surgical interventions are the first-line of treatment in refractory cases, long-standing disease, or presence of leukotrichia in depigmented patches.

Carboxytherapy in dermatology: A systematic review.

INTRODUCTION: The overall effects of Carboxytherapy, defined as the administration of carbon dioxide, have been studied for many years. It has been suggested that by improving oxygenation, interacting with the tissue perfusion regulators, and disrupting the adipose cell membranes, the method can lead to notable improvements in different esthetic and pathological conditions. Therefore, we aimed to systematically review the available studies evaluating the potential benefits of carboxytherapy in dermatological conditions and how it objectively stands against scientific scrutiny. METHODS: We searched the PubMed, Scopus, Embase, and Web of Science databases, including the studies exploring the method's efficacy in managing any dermatological condition. RESULTS: A total 27 of studies were identified (with a pooled sample of over 700 cases), most of which were clinical trials. Facial wrinkles, periorbital hyperpigmentation, skin laxity deficiency, scars, striae distensae, localized lipolysis and cellulite, alopecia, chronic diabetic wounds, and psoriatic plaques comprised the package of the dermatological conditions that were studied. Except for a few studies, the method mainly demonstrated significant improvements on all of the mentioned conditions. The inter- and post-operational adverse events were mild and transient, including erythema, pain, crepitus, and ecchymoses. DISCUSSION: Carboxytherapy can provide those practicing in the field with sustainably favorable results. However, the numbers of cases on whom the fat-reducing capabilities of the method were studied and experienced varying degrees of recurrence caught our eye. In addition, we observed a notable disparity between the outcome measures utilized in the studies. The modest sample size in each condition also added to the injury, as the conditions on which the method was evaluated are pretty common in the general population. Therefore, for a definite conclusion, more randomized controlled trials with the shortcomings mentioned well addressed need to be conducted.