Paradoxical and bimodal immune-mediated dermatological side effects of TNF-α inhibitors: A comprehensive review.

INTRODUCTION: Due to the increasing prevalence of immune-mediated diseases such as psoriasis, lichen planus, rheumatoid arthritis and inflammatory bowel disease, dermatologists have turned to new biologic drugs known as DMARDs (disease-modifying anti-rheumatic drugs) in recent years. AREAS COVERED: In this study, we evaluate the immune-mediated dermatological side effects of DMARDS by reviewing and analyzing previous peer-reviewed research on the effects of TNF-α inhibitors in the treatment of skin diseases, as well as adverse effects of these drugs and some of the main causes of these effects. EXPERT OPINION: DMARDs are very effective in improving control of the above diseases. TNF-α inhibitors are an important group of DMARDs that are widely used. The paradoxical adverse events (PAEs) associated with the use of TNF-α inhibitors are divided into three categories: true paradoxical, borderline paradoxical, and non-paradoxical. True PAEs include conditions for which TNF-α inhibitors are approved for treatment. Borderline PAEs are considered to occur with this class of drugs for which there is no definite approval but for which there is sufficient evidence. Although these events are rare, early recognition of the accused drug and appropriate decision-making may prevent progression of complications and irreversible side effects.

Evaluation of the efficacy of mesenchymal stem cells derived conditioned medium in the treatment of striae distensae: a double blind randomized clinical trial.

BACKGROUND: Striae distensae is a disfiguring atrophic skin condition that impairs the body's aesthetic image. Despite the variety of conducted studies, there is controversy regarding the best modalities. Human mesenchymal stem cells are considered a rich source for scar treatment. Skin needling is among the most efficient and safe aesthetic and therapeutic devices. This study aimed to evaluate the efficacy of the combination of needling and intradermal injection of mesenchymal stem cells compared to skin needling alone for treating striae distensae. METHOD: This study was a randomized, double-blind clinical trial involving 10 women aged 18-60. Each striae lesion was divided into two parts, with one side receiving needling and intradermal injection of conditioned medium, while the other side received needling and intradermal injection of normal saline. This treatment was administered in three sessions with three-week intervals. Patients were evaluated before the first intervention and three months after the final session. Three months after the completion of the intervention, patients' lesions were evaluated using biometric criteria, physician evaluation, and patient self-assessment. RESULTS: The results demonstrated a significant improvement in dermal and complete thickness and skin density in patients treated with microneedling. All skin ultrasound parameters improved significantly in patients receiving the combination of needling and conditioned medium. When comparing the two groups, significantly higher physician and patient satisfaction was observed in the combination group. However, the comparison of biometric indices improvement wasn't significant between these groups. CONCLUSION: The combination of human mesenchymal stem cells with microneedling could be considered a novel effective option for stretch marks.

Effectiveness, safety, and patient satisfaction of carboxytherapy as an adjunctive treatment for periorbital hyperpigmentation.

INTRODUCTION: Dark under-eye circles or periorbital hyperpigmentation constitute a prevalent and challenging cosmetic problem with diverse etiologies and types. While modifying exacerbating habits can provide partial relief for the pigmentary and vascular factors associated with this condition, and despite the abundance of available treatment options, there is currently a lack of gold-standard evidence-based treatments proposed for curing this disorder. OBJECTIVES: This study aimed to assess the safety and effectiveness of carboxytherapy in treating periorbital hyperpigmentation. MATERIAL AND METHODS: In this 4-week single-arm clinical trial, 20 eligible Iranian patients with symmetric periorbital hyperpigmentation received weekly intradermal carboxytherapy. The treatment involved administering 10-20 mL of CO2 at a rate of 20 mL/min and a temperature of 15°C for a duration ranging from a few seconds to 1 min. Follow-up assessments were conducted 1 month after the final session. The primary outcome was defined as the changes in ΔE or the variations in pigmentation observed between the orbital and extra-orbital skin before and after the trial. RESULTS: The patients reported satisfaction with the statistically significant reduction in hyperpigmentation achieved through carboxytherapy in the lateral (p = 0.002), middle (p = 0.001), and medial (p = 0.001) regions of the periorbital area. The total response rate of the patients was estimated at 20%. Patient satisfaction exceeded ΔE changes, with no significant linear relationship (p = 0.084). CONCLUSION: Carboxytherapy can be proposed as an effective and safe treatment for periorbital hyperpigmentation.

Efficacy of Endolift laser for arm and under abdomen fat reduction.

BACKGROUND: Noninvasive laser for body fat contouring is a quickly growing field in the cosmetic dermatology. Surgical options carry disadvantages, such as the usage of anesthetics, swelling, pain and long time for recovery, so there is a growing public request for the techniques with fewer side effects and shorter recovery periods. Several new noninvasive body contouring ways have been advanced such as, cryolipolysis radiofrequency energy, suction-massage, high-frequency focused ultrasound, and laser therapy. Noninvasive laser improves the body's appearance by the elimination of excess adipose tissue, specifically in areas in which fat perseveres in spite of diet and exercise. METHODS: In this study the efficacy of Endolift laser was evaluated for reduction of excess fat in the arms and under abdomen. Ten patients with excess fat in the arms and under abdomen were enrolled in this study. The patients were treated by Endolift laser in the arms and under abdomen areas. The outcomes were evaluated by two blinded board certified dermatologists and by patients' satisfaction. The circumference of each arm and under abdomen was measured using a flexible tape measure. RESULTS: The results showed reduction in the fat and circumference of arms and under abdomen after treatment. The treatment was considered as effective methods with high patient satisfaction. Also no severe adverse effects were reported. CONCLUSION: Endolift laser can be a good alternative to surgical body fat contouring due to its efficacy, safety, minimal recovery time, low cost. Also Endolift laser does not require general anesthetics.

Oral propranolol and topical timolol in the treatment of post-burn pyogenic granuloma: Two cases and a review of the literature.

Two cases of pyogenic granulomas in burned skin were presented, a 17-month-old boy and a 7-year-old girl, being given oral propranolol and topical timolol. Both cases showed lesions improvement with no adverse effects, suggesting that beta-blocker therapy may have a positive impact on the treatment of pyogenic granuloma after burns.

Efficacy, safety, tolerability, and satisfaction of N-acetylcysteine and pentoxifylline in lichen planopilaris patients under treatment with topical clobetasol: A triple arm blinded randomized controlled trial.

Lichen planoplaris (LPP) is one of the most common causes of inflammatory cicatricial alopecias. There is no definitive cure for the disease and most of the available therapeutic options can potentially lead to serious complications following their use for extended durations. In this study, we aimed to evaluate the efficacy, safety and tolerability of N-acetylcysteine (NAC) and pentoxyfillin (PTX), as adjunctive therapies, in the management of LPP. In a randomized, assessor- and analyst-blinded controlled trial, patients with proven LPP were randomly assigned to three groups of 10. Group I (the control group) received clobetasol 0.05%lotion; Group II, a combination of clobetasol 0.05% lotion and oral PTX; Group III, a combination of clobetasol lotion 0.05% and oral NAC. Lichen planopilaris activity index (LPPAI), the possible side effects, tolerability and patients satisfaction were assessed before and two and four months after the initiation of the treatments. Thirty patients, 96.7% women, with a mean age of 46.8 ± 13.3 years old, were included in the study. Four months into the treatments, the overall LPPAI and the severity and/or frequency of most of its determinants significantly decreased in all groups. In a comparison among the groups, patients who received either of the combination therapies showed more decline in their LPPAI than those receiving only clobetasol. The decline was more noticeable and statistically significant only in the NAC group. Three patients in the PTX group developed complications that were not statistically significant when compared with the other groups. There were no substantial differences in the tolerability of the treatments among the study arms. The use of oral NAC and PTX added to the therapeutic efficacy of topical clobetasol in the treatment of LPP, suggesting that they might be beneficial and safe adjuvant therapies and add to the efficacy of topical treatment without any noticeable impact on the adverse effects experienced by patients.

Endolift laser an effective method for the lower eye bag treatment: a case series study.

Numerous individuals suffer from the lower eye bag. Lower eye bag treatment is a challenge that might require new methods. Depending on the cause, there are different treatment approaches to reduce puffiness under the eyes. In this pilot study, 9 patients with lower eye bags received Endolift therapy (200-300-nm fiber) and were followed up for 6 months. The patients were evaluated according to biometric characteristics. Additionally, outcomes were evaluated by three blinded dermatologists, and patients' satisfaction was assessed. The obtained biometric results showed that Endolift laser treatment could increase both the dermis and epidermis of the skin and skin elasticity in this area. Furthermore, the results indicated that Endolift therapy showed good and very good improvement in about 90% of patients. Photographic data evaluation indicated a 90% improvement in the appearance of eye bags (P < 0.05). Endolift laser seems to be a safe and effective method for lower eye bag treatment. It is a noninvasive treatment with satisfactory results with minimal downtime and side effects. Endolift therapy significantly reduces the appearance of eye bags and wrinkles and increases skin elasticity under the eyes; therefore, it is an effective method for lower eye bag treatment. The method is pain-free, bloodless, and without the need for stitches. Endolift therapy allows the patient to avoid surgery.

Acne scar treatment using combination therapy: Subcision and human autologous fibroblast injection.

BACKGROUND: Acne scar treatment is a problem for both the dermatologist and the dermatologic surgeon. Many therapies have been advanced to improve acne scars over the past years. Nevertheless, they were often related to adverse side effects like hyperpigmentation. These combination therapy using subcision and autologous fibroblast injection can provide a better technique for the acne scar treatment. MATERIAL AND METHODS: In this study, we describe nine patients with the age of 25 to 48 and rolling acne scars (moderate to severe) that were treated with combination therapy using subcision (cannula, 18 gauge) and autologous fibroblast injection. Finally, before and 6 months after the final injection, the patients' biometric characteristics were evaluated by Visioface 1000D and Mexameter and a skin ultrasound imaging system. RESULTS: The results show a significant improvement in the acne scars in the patients. The Visioface results showed that the size and number of skin pores and spots were reduced after combination therapy. Also, the results of skin ultrasonography exhibited denser skin layers both in the epidermis and dermis. CONCLUSION: In summary, the combination therapy of autologous fibroblast injection and subcision can be considered as a new alternative, safe, and useful method for acne scar treatment.

Effect of Endolift laser on upper eyelid and eyebrow ptosis treatment.

Drooping of the upper eyelid and eyebrow (ptosis) is common among people and cause the patients dissatisfaction. Various methods have been developed to treatment of the upper eyelid and eyebrow ptosis. However, the current methods focus on surgery to improve the disorder. But patients are worried about the risks of the procedure, and seeking for a non-invasive alternative method. Therefore, non-invasive methods with consistent efficient improvement are needed, especially for middle-aged patients. This study was conducted of 9 patients who underwent the upper eyelid and eyebrow ptosis. Endolift laser method was used to treat the patients' upper eyelid and eyebrow ptosis. The biometric assessment was used to evaluate the efficiency of the technique. Also the results were evaluated by 3 board-certified dermatologists (blind). Additionally, patients' satisfaction was evaluated at the end of the treatment. The biometric results showed that Endolift laser can increase the thickness, density, and elasticity of the skin in the eyelid area. The patient's satisfaction results showed excellent improvement in the 90% of patients. The results by the dermatologist displayed improvement in about 90% of patient. Endolift laser has been proved efficient and consistent for upper eyelid and eyebrow ptosis rejuvenation and treatment.

Revisión del papel de las plantas medicinales en el tratamiento del acné / A review on the role of medicinal plants in treatment of acne

Antecedentes: el acné vulgar es un trastorno cutáneo muy común que puede presentarse con lesiones inflamatorias y no inflamatorias principalmente en la cara, pero también puede ocurrir en la parte superior de los brazos, el tronco y la espalda. El tratamiento del acné es de gran importancia y el acné vulgar y, por lo tanto, la bacteria que causa el acné, P. acnes, se han estudiado intensamente y se han propuesto varias soluciones. Sin embargo, poca investigación se ha centrado en el uso de plantas medicinales para el tratamiento de esta enfermedad de la piel. Sin embargo, hay una serie de plantas medicinales que se utilizan tradicionalmente para tratar el acné, y esto proporciona el ímpetu para que los científicos exploren sus propiedades medicinales. Objetivo: Este trabajo tuvo como objetivo revisar los enfoques de tratamiento a base de plantas medicinales para el acné. Metodología: Se realizaron búsquedas en las bases de datos científicas en línea autorizadas, incluidas Pubmed, MEDLINE, Link of Springer, Online Library of Wiley, Science Direct of Elsevier, Cambridge Core y Cochrane, y se recopilaron, combinaron y analizaron los datos útiles asociados con el objetivo del presente estudio. luego categorizado en términos de plantas medicinales, acné, acné vulgar, hierbas. Conclusión: Actualmente existe un fuerte enfoque en las plantas medicinales a nivel de investigación y, por lo tanto, existe una fuerte motivación para el uso de estos ingredientes en productos para el cuidado cosmético que deben probarse como seguros y efectivos con la ayuda de la investigación clínica

Background: Acne Vulgaris is a very common skin disorder which can present with inflammatory and non-inflammatory lesions chiefly on the face but can also occur on the upper arms, trunk, and back. Treatment of acne is of a high importance and acne vulgaris and thus the acne-causing bacterium, P. acnes, have been intensively studied and several solutions have been proposed. Nevertheless, little research has focused on the use of medicinal plants for the treatment of this skin disease. However, there are a number of medicinal plants used traditionally to treat acne, and this provides the impetus for scientists to explore their medicinal properties. Objective: This work aimed to review medicinal plants-based treatment approaches for acne. Methodology: The authoritative online scientific databases including Pubmed, MEDLINE, Link of Springer, Online Library of Wiley, Science Direct of Elsevier, Cambridge Core, and Cochrane were searched and the useful data associated with the objective of present study were gathered, combined, and then categorized in terms of medicinal plants, acne, Acne Vulgaris, herbs. Conclusion: There is currently a strong focus on medicinal plants at a research level and therefore strong motivation exists for the use of these ingredients in cosmetic care products that need to be proven safe and effective with the aid of clinical research.

A systematic review of the histopathologic survey on skin biopsies in patients with Corona Virus Disease 2019 (COVID-19) who developed virus or drug-related mucocutaneous manifestations.

The mucocutaneous manifestations of Corona Virus Disease 2019 (COVID-19) logically may reflect systemic visceral involvements. These findings are visible and easy to approach like biopsies for exact histopathologic evaluations. This systematic review was conducted to collect the mucocutaneous histopathologic data of COVID-19 patients for future investigations and interpretations. The COVID-19 dermatology resource of the Centre of Evidence-Based Dermatology (CEBD) at the University of Nottingham, PubMed, Scopus, Google Scholar and Medscape was searched for relevant English articles published by June 3, 2020. This review included 31 articles, involving 459 patients. The common primary virus-related mucocutaneous manifestations are easy to approach in the course of COVID-19. The authors of this study supposed dermatopathological findings as the predictors of the nature of potential systemic involvements and outcomes of COVID-19. Scrutinizing these findings can help with adopting more effective therapeutic and management strategies; nevertheless, this review found the severity and time of onset of symptoms not to be associated with the laboratory and histopathological findings. Deterioration of clinical conditions and laboratory tests was also not related to the histopathological findings. It is recommended that meta-analyses be conducted in the future to detail on these data for having more comprehensive and better conclusion.

Mucoromycosis and Wegner's Granulomatosis: A Case Report.

Wegener's granulomatosis is a rare vasculitis affecting the upper and lower respiratory tracts and kidneys. The cornerstone of treatment in these patients is immunosuppressive therapy, which may predispose the patient to super-infections such as fungal diseases per se. However, the fungal infection mimics the clinical manifestations of Wegener's diseases would lead to neglected course of the infection and subsequent morbidity and mortality especially if unusual organs are involved. Here we report a 21-yr-old female patient referred to a hospital, Tehran, Iran in 2013 with a neglected skin mucormycosis and the course of the disease and outcome with Wegener's granulomatosis.

Pachydermodactyly with Broder Hand Span and Long Fingers: A Case Report.

Pachydermodactyly is a rare and benign disease that may be idiopathic, genetic, acquired as a response to repetitive trauma, or associated with several other acquired conditions often pushing the health caregiver to do a bunch of costly lab tests and diagnostic workups to rule out other entities. All health care givers must be aware about this disease for reassure the patients and cut unnecessary costs. Moreover, there seems to be an issue of association with certain occupations. A good example might be computer keyboards causing special damages to certain organs like eyes and musculoskeletal system. We have observed deleterious effects of excess work with computer keyboards on fingers in the form of Pachydermodactyly in our case. A 27-yr-old man presented with wider hand span and longer fingers to Dermatology Clinic of Rasoul-E-Akram Hospital in June 2015, especially the ring finger in our case, considered a big symptom who depressed due to their fingers appearance as a rare disease. We gave him an emollient to make his hand smoother. The patient improved both clinically and psychologically on a simple emollient. This disease with its deleterious psychological effects and a simple way of management should be appreciated more by the health care system.

Serum iron level, ferritin and total iron binding capacity level among nonpregnant women with and without melasma.

BACKGROUND: Melasma is a common acquired disorder characterized by symmetric, hyperpigmented patches with an irregular outline, occurring most commonly on the face. It is most prevalent among young to middle-aged women. Although iron overload affects skin pigmentation, effect of iron deficiency on skin is not clear. So, we evaluated serum iron level, ferritin and total iron binding capacity (TIBC) level among nonpregnant women with and without melasma. MATERIALS AND METHODS: A cross-sectional case study was conducted in 2012 at university dermatologic department on 33 nonpregnant women with melasma (case) and 33 nonpregnant women without melasma (control). Serum iron level, TIBC and ferritin in the two groups was measured and compared. RESULTS: Serum iron level was lower in the case group (85 ± 11) in comparison with control group (102 ± 9), but the difference was not significant (P: 0.9). Mean TIBC and Ferritin were higher in the case group (TIBC: 329.4 ± 29, ferritin: 6 ± 18) than the control group (TIBC: 329.3 ± 29, ferritin: 33 ± 6) without significant difference. CONCLUSION: Although the serum iron level was lower in nonpregnant women with mealsma, it was not significant compared with those without melasma.