Evaluation and comparison of the efficacy and safety of the combination of topical phenytoin and microneedling with microneedling alone in the treatment of atrophic acne scars: A controlled blinded randomized clinical trial.

INTRODUCTION: Severe acne breakouts often lead to atrophic acne scars, which affect millions of people worldwide and can significantly affect a person's self-confidence and self-image. Given the difficulty in treating atrophic acne scars, this study aims to investigate the efficacy of topical phenytoin in the treatment of atrophic acne scars. METHOD: This split face clinical trial on 25 patients between the ages of 18 and 40 involved the application of microneedling on one side of the face, with three sessions taking place over the course of a month. On the other side, a 1% phenytoin cream was administered three times daily for 1 week following the microneedling procedure. Baseline information was collected for all patients, and follow-up assessments were conducted during the treatment sessions and 2 months after the last session. The assessments included evaluating the number and area of pores and spots, determining scar severity, assessing patient satisfaction, and recording any potential complications. RESULTS: Among patients, 20 individuals (80%) were females, and the average age of the participants was 35.96 ± 9.23. In terms of the fine pore area, despite the fine pore count, both groups showed improvement over time (p: 0.03 vs. 0.06). Also, regarding large pore count and area, and the count and area of spots, both groups showed improvement over time (p: 0.001). However, there were no significant differences between the two groups (p > 0.05). On the other hand, when it comes to acne scar grade and patients' satisfaction, the phenytoin group outperformed the control group in all follow-up sessions and this difference was found to be significant (p: 0.001). It is worth noting that no complications were observed among any of the patients. CONCLUSION: It appears that combining phenytoin cream with microneedling has a more effective therapeutic outcome in enhancing atrophic acne scars, when compared to microneedling alone, and this method can be regarded as a viable alternative in treating these types of scars.

Sonographic comparison of subcutaneous fat layer thickness in the scalp area in patients with androgenetic alopecia compared to healthy individuals: Cross-sectional.

INTRODUCTION: Androgenetic alopecia (AGA) is one of the most common alopecia among men and women worldwide. It is a nonscarring alopecia that has a characterized pattern. In female pattern AGA, the hairline is stable but general thinning occurs most notably in the frontal region. In male-pattern AGA, the hairline is receding and the thinning is most notable in the frontotemporal region. AGA has a complex pathogenesis and relation of subcutaneous fat in the scalp region and the miniaturization of terminal hair follicles is vague. In this study, subcutaneous fat in the frontal scalp an important region for AGA is compared to the occipital scalp that is spared in AGA. METHOD: Our study is a cross-sectional study that has four groups. Male patient, female patient, male control, female control. Every group has 15 individuals. All of the people in the study are those referred to Rasoul Akram's dermatology clinic. The severity of alopecia is classified by Norwood scaling for male pattern AGA and Ludwig scaling for female pattern AGA. Subcutaneous tissue in the frontal and occipital regions is measured by ultrasonography. For evaluating the effect of aging on subcutaneous fat thickness, we subdivided any group into more than 40 years old and between 20 and 40 years old and compared these two subgroups. RESULTS: The mean age of the three groups of male patient, female patient, and female control is 40 y/o and the mean age of male control is 41 y/o. The mean subcutaneous fat layer thickness in frontal region in male patients group is 6.0 mm (more than 40 y/o = 6.6 mm, between 20 and 40 y/o = 5.5 mm), in female patients group 5.1 mm (more than 40 y/o = 5.7 mm, between 20 and 40 y/o = 4.6 mm), in the male control group is 4.4 mm (more than 40 y/o = 4.7 mm, between 20 and 40 y/o = 4 mm) and in the female control group is 4.1 mm (more than 40 y/o = 4.5 mm, between 20 and 40 y/o = 3.6 mm). The mean subcutaneous fat layer thickness in the occipital region in the male patient's group is 6.4 mm (more than 40 y/o = 6.7 mm, between 20 and 40 y/o = 6 mm), in the female patient's group 6.1 mm (more than 40 y/o = 6.5 mm, between 20 and 40 y/o = 5.7 mm), in the male control group is 6.3 mm (more than 40 y/o = 6.8 mm, between 20 and 40 y/o = 5.7 mm) and in the female control group is 6.2 mm (more than 40 y/o = 6.6 mm, between 20 and 40 y/o = 5.8 mm). CONCLUSION: This study demonstrates that the subcutaneous fat layer in the frontal region in both males and females is thicker in AGA patients than healthy group and the more severe the AGA, the thicker is subcutaneous layer in the frontal region. In the male patients group, the subcutaneous fat layer in the frontal region is thicker than in the female patients group but in the male and female control groups is not so different. The subcutaneous fat layer in the occipital region is thicker in older individuals in both patients and control groups but is not different when compared to AGA patients and control individuals.

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.

Evaluation of the effects of adding an adipose tissue-derived stromal vascular fraction to platelet-rich plasma injection in the treatment of androgenetic alopecia: A randomized clinical trial.

BACKGROUND: Stromal vascular fraction (SVF) cells derived from adipose tissue and platelet-rich plasma (PRP) are among novel treatments for androgenetic alopecia (AGA). We aimed to investigate the effect of adding SVF to PRP and compare it to administering PRP injection alone. METHODS: Eighteen patients were randomly divided into two groups of nine. The PRP group was treated with PRP at all three visits at 1-month intervals, while the SVF-PRP group received an SVF injection on the first visit and a PRP injection on the second and third visits. Each group was evaluated at baseline and 20 weeks after the therapy's initiation. RESULTS: Changes in mean hair diameter and hair count compared to baseline were significant in both groups. The PRP group experienced a greater increase in mean hair count than the SVF-PRP group, and the SVF-PRP group had a marginally greater increase in hair diameter than the PRP group. These differences were not statistically significant compared to each other. The patient and physician assessment scores exceeded the mean (on a scale from 0: poor to 3: excellent) in both groups. CONCLUSION: Adding one SVF injection to two PRP treatment sessions versus three PRP injections alone had no significant difference in evaluated variables. If additional research demonstrates the same results, we suggest that multiple SVF injection sessions may be required to produce a statistically significant difference compared to PRP injection alone. Moreover, considering lower cost and greater accessibility of PRP, it can be used before SVF in the treatment of AGA.

A systematic review of the comparison between needling (RF-needling, meso-needling, and micro-needling) and ablative fractional lasers (CO2, erbium YAG) in the treatment of atrophic and hypertrophic scars.

The aim of this study is to compare needling (RF-needling, meso-needling, micro-needling) and ablative fractional lasers (CO2, erbium-YAG) in the treatment of atrophic and hypertrophic scars in a systematic review. The database was searched, and 10 articles were selected that were relevant in terms of content, topic, and purpose and met the inclusion criteria. Of all the articles reviewed in this study, there were 2 randomized split-face trials (20%), 1 controlled nonrandomized trial (10%), 1 controlled randomized phase III clinical trial (10%), 1 prospective trial (10%), 1 prospective nonrandomized open-label trial (10%), and 1 randomized comparative trial (10%), with the type of study not reported in 3 articles. We used Endnote X8 to review the articles and extract data. After review, the studies were analyzed and categorized. No statistically significant difference was found between the two methods, laser and micro-needling, in the treatment of atrophic and hypertrophic scars in 60% of the articles studied, and both showed significant improvement (70% or more improvement to complete response). Significant improvement was noted in 20% of the studies reviewed for the laser and micro-needling treatment methods. The results of this study show that needling and ablative fractional lasers are tolerable and safe procedures with no significant difference in the treatment of skin scars in sixty percent of the studies.

Comparison of the efficacy and safety of intralesional injection of tranexamic acid and the topical application of Kligman combination drug in the treatment of macular amyloidosis.

Macular amyloidosis (MA) is a common form of cutaneous amyloidosis that manifests as dark spots consisting of brown pigments with a rippled pattern on the skin, and the treatment of this condition is highly challenging. The aim of this study was to compare the efficacy and safety of intralesional injection of tranexamic acid (TXA) and topical application of Kligman combination drug in the treatment of macular amyloidosis. In this double-blind clinical trial, a total of 43 patients, who were diagnosed with MA, were treated with two different methods of intralesional injection of tranexamic acid and topical application of Kligman combination drug. Both therapeutic methods were effective in improving MA and significantly reduced hyperpigmentation of the treated areas, but tranexamic acid was significantly more effective than the Kligman combination drug. Significantly, greater improvements were observed in the group of patients treated with tranexamic acid. In the tranexamic acid treatment group, ΔE was reduced from 11.39 in the first session to 8.53 in the third session, and in the Kligman treatment group, it was reduced from 8.79 in the first session to 6.32 in the third session (p < 0.05). In addition, the pruritus score in patients treated with topical tranexamic acid injection was lower compared to the patients treated with the topical application of the Kligman combination drug. The results of this study demonstrated the significant positive effects of both treatment methods, but in terms of reducing melanin content, intralesional injection of tranexamic acid was a more effective method. Both treatments considered safe for MA. In tranexamic acid group, patients logically experienced a tolerable pain during injection but they significantly had significantly lower local pruritic discomfort during study. So, based on the positive findings of this study we suggest to use tranexamic acid in combination with other effective therapeutic methods for treatment of MA especially use of its topically applied form in combination with non-aggressive needling that results in better drug delivery without the experience of injection pain. Selection of the best administration route of tranexamic acid for hyperpigmented lesions depends on the each patient characteristic and their previous theraputic results that may vary case by case.

Comparison of efficacy, safety and satisfaction of latanoprost versus minoxidil, betamethasone and in combination in patients with alopecia areata: A blinded multiple group randomized controlled trial.

Alopecia areata (AA), a polygenic and chronic autoimmune disease and there is no definitive cure. We aimed to evaluate latanoprost effects in patients with AA. In this controlled randomized double-blind clinical trial, we enrolled patients with AA randomly assigned to six groups of 18; Group 1 received latanoprost eye drops; group 2 minoxidil 5% solution; group 3 latanoprost eye drops and minoxidil 5% solution; group 4 betamethasone and minoxidil 5% solution; group 5 betamethasone solution and latanoprost eye drops; group 6 (the control group) betamethasone solution. The alopecia severity in patients before and after treatment was assessed by severity of alopecia tool (SALT). One hundred and eight patients, 50% male (mean age: 32.6 ± 10.4) were studied. The overall SALT score decreased in all. After 2 weeks, patients receiving betamethason-minoxidil and betamethason-latanoprost showed more decline in their SALT than other groups. In final, there was statistically significant difference among betamethasone-latanoprost group with minoxidil, betamethasone-minoxidil and betamethasone groups. Regrowth was higher in latanoprost and betamethasone-latanoprost groups than minoxidil. Topical latanoprost added to therapeutic efficacy of topical betamethason and minoxidil in treating patchy AA, suggesting it being beneficial and safe adjuvant therapy and add to efficacy of topical treatments without any adverse effects.

Efficacy and safety of topical timolol 0.5% plus saline 0.9% versus each one alone in acne scar trichloroacetic acid-CROSS therapy: A blinded randomized controlled trial.

Trichloroacetic acid-CROSS (TCA-CROSS) or chemical reconstruction of scars is an approved method in the treatment of ICE-PICK scars. Timolol is a blocker of beta-adrenergic receptors that speeds up the healing of skin wounds. In this study, for the first time, the TCA-CROSS technique was combined with the use of saline injection and topical timolol to increase the effectiveness of treatment, and reduce the number of treatment sessions and complications, and thus improve the aesthetic result. In this parallel-group split-face randomized controlled assessor and analyst-blinded study, 45 patients with atrophic acne scars were randomly divided into 3 equal groups. TCA-CROSS treatment was performed on all facial scars of patients. In group 1, before TCA-CROSS, saline was injected under the scars on one side of the face, in group 2, after TCA-CROSS, 0.5% timolol eye drops were applied on the scars on one side, and in group 3, saline was injected before TCA-CROSS. After that, timolol eye drops were applied on the scars of the same side. In all groups, the choice of control side was random. The number of scars and patient and physician satisfaction were the main variables evaluating the effectiveness of the treatment. TCA-CROSS improved scars in both control and treatment sides of all 3 groups. Although the number of scars decreased on the treatment side of groups 2 and 3, the decrease was not statistically significant. In the saline + TCA group, the number of scars on the treatment side was slightly more than on the control side. In the group of patients who used timolol, the severity and duration of scar hyperpigmentation were significantly lower (group 2 p = 0.016, group 3 p = 0.002). No permanent complication was observed in the patients. Patients' satisfaction in groups 2 and 3 was higher in the treatment side than the control side. The combination of saline injection followed by TCA-CROSS is not recommended. Application of 0.5% timolol after TCA-CROSS caused a slight decrease in scar severity and a significant reduction of post-inflammatory hyperpigmentation (PIH) duration. So, the topical timolol makes a better result of TCA-CROSS for acne scar treatment.

Rare clinical features of the Ellis van Creveld syndrome: A case report and literature review.

Ellis van Creveld syndrome (EVC) is a rare autosomal recessive disorder also called chondroectodermal dysplasia. This study reports on a 40-year-old woman from Iran with a syndromic appearance consisting of a coarse face, conical anterior teeth, dental agenesis and permanent teeth at birth, several small extralabial, nonmidline frenula with a high-arched palate, and a large maxillary labial frenulum. The patient had cyanosis on her lips since childhood and a history of adenoid tonsillectomy surgery. She also had androgenic alopecia, an elongated trunk with excessive lordosis and pectus excavatum, polycystic ovarian syndrome, and a history of two periods in a month. She also had multiple fibrocystic cysts in her breasts, lower extremity deformity, dysplastic genu valgum, and short limb dwarfism; she had undergone left knee surgery four times and had severe osteoporosis in some of her bones and some hyperpigmented patches on the dorsal of the left hand. Her hands and feet were also wide and markedly deformed with hypoplastic fingernails and toenails, and she had bimanual hexadactyly on the ulnar side of the hands. She also had a history of severe hypotension and cyanosis during surgery and suffered from congenital heart failure and had undergone open heart surgery for correcting her atrial heart defect. In this study pectus excavatum, Phrygian cap gallbladder, liver hemangioma, polycystic ovarian disease, and breast fibrocystic cysts was reported for first time in this case of EVC syndrome. This case was reported and all articles regarding common, uncommon, rare, and extremely rare presentations of this syndrome were reviewed.

Systematic review of low-dose isotretinoin for treatment of acne vulgaris: Focus on indication, dosage, regimen, efficacy, safety, satisfaction, and follow up, based on clinical studies.

Oral isotretinoin is the most effective treatment for moderate to severe acne and its side effects are mostly dose-dependent. Low dose isotretinoin (0.5 mg/kg/day for 1 week every 4 weeks for 6-months) could be effective and even in its end result, comparable with high or optimal doses. In this systematic review, we aimed to sum up the results of clinical trials regarding indications, dosage, prescription protocol, effectiveness, side effects, patient satisfaction, recurrence rate, and follow-up period of low dose isotretinoin in treatment of acne. Cochrane, Google Scholar, Science Direct, PubMed, and Medline were searched. A total of 460 articles were searched electronically and 382 articles were excluded. About 4 were non-English and 2, before 1980. The full text of 72 articles was reviewed. Finally 15 documents met the inclusion criteria for entering this systematic review. The standard dose of isotretinoin is 0.5-1 mg/kg/day for 4 months with a total dose of 120-140 mg/kg/day. Daily doses between 0.1 and 0.3 mg/kg can be recommended for more than 6 months due to the occurrence of fewer side effects and more economical concerns. For greater effectiveness, it could be combined with other medications.

Systematic review of platelet-rich plasma in treating alopecia: Focusing on efficacy, safety, and therapeutic durability.

Considering the different forms, alopecia could be a very common condition with particular therapeutic concerns; thus, recent therapies still require further assessments. Aim of this systematic review was to evaluate efficacy, safety, and therapeutic durability of platelet rich plasma (PRP) in treating various forms of alopecia. A total of 64 articles were found through a systematic search, and eight original articles were included in the study, based on inclusion/exclusion criteria. In most studies (62.5%) patients' conditions had improved by receiving PRP therapy; these cases experienced an increase in growth and thickness of hair. Simultaneous use of PRP and Minoxidil demonstrated the highest rate of improvement and satisfaction. The highest efficacy in patients with alopecia areata was 76% and the lowest efficacy was 31.7% and in patients with androgenetic alopecia the highest efficacy was 42.75% and the lowest reported efficacy was 25.55%. The main side effect was pain due to PRP injection, which disappeared after ending the treatment and only one article reported more serious side effects. Recurrence after treatment was also reported in only one article. PRP is a safe and easy method for treating hair loss and has limited adverse effects. Optimization of this method depends on dosage, number of sessions and their intervals, and injection techniques. According to the results, the use of PRP due to its relatively high efficiency, low and tolerable side effects, and low recurrence rate can be a good method for the treatment of alopecia and hair loss.

Varicella-Zoster Scar Treatments: A Tertiary Review.

Chickenpox is a highly communicable disease caused by Varicella Zoster Virus. Varicella rash commonly evolves into permanent depressed scars, documented in up to 18% of post varicella patients, leaving life-long cosmetic issues for patients. Although there is a lot of reviews on depressed scars, the viral etiology and the unique scar morphology of post varicella scar discriminate it from other depressed scars. Therefore it is required to assess the efficacy of scar removal modalities on these scars, specifically. Yet, despite the prevalence, there is no comprehensive review on chickenpox scars' treatment, particularly. This review provides an overview and categorization of efficacy and adverse events of various methods used in the treatment of post varicella skin scars. A comprehensive literature search was performed on major databases, including all papers related to post varicella scar treatment until 2020. The results were categorized into topical treatment with tretinoin, systemic medical treatments with topiramate and isotretinoin, non-invasive procedures including chemical peelings, micro-needling and laser, invasive procedures including dermal grafting and subcision-suction method, and combination therapies. According to literature, chemical peeling with trichloroacetic acid was the most frequently used method in the treatment of chickenpox scar, revealing moderate to excellent response in patients. However, there is insufficient evidence to accurately compare the efficacy of other modalities on these scars specifically.

Real life management of chronic urticaria: Multicenter and cross sectional study on patients and dermatologists in Iran.

Recently, advances in understanding the etiology of urticaria and updates of diagnostic and therapeutic management guidelines have drawn attention to chronic urticaria (CU) morbidity. The present study aimed to evaluate Iranian dermatologists' practice and real life management of CU patients. A total of 35 dermatologists and 443 patients were included in the study. Number of female patients was 321 (72.5%). Mean (standard deviation) age of the study patients was 38 (13) years and the median (inter quartile range) of disease duration was 12 (6-48) months. Severity of patients' symptoms was mild for 32.1%, moderate for 38.7%, severe for 18.8%, and 10.4% of them had no evident signs or symptoms. The most common diagnostic methods were physical examination (96.6%), differential blood count (83.5%), erythrocyte sedimentation rate (77.4%), and C-reactive protein (62.8%). The number of dermatologists prescribed nonsedating antihistamines (nsAH) in regular dose and high dose mono therapy were 26 (74%) and 6 (17%), respectively. About 66% of dermatologists were familiar with British Association of Dermatologists (BAD) guideline. The most common first-line treatment for CU by Iranian dermatologists was nonsedating antihistamines in regular or high doses. The real-life management of patients with CU in Iran was in accordance with the available practice guidelines.

The effect of GGC and CAG repeat polymorphisms on the androgen receptor gene in response to finasteride therapy in men with androgenetic alopecia.

BACKGROUND: It should be assessed whether the polymorphisms on androgen receptor gene can affect therapeutic response to androgenetic alopecia (AGA) medications. We aimed to find a link between polymorphisms on the androgen receptor gene (including the number of triple sequences of cytosine, adenine, and guanine [CAG] and guanine-guanine-cytosine [GGC]) and response to treatment with finasteride in male patients. MATERIALS AND METHODS: This case-control study was performed on 25 consecutive male patients with hereditary AGA and 25 sex-matched healthy individuals without AGA. The complete sequence of the gene was extracted from the NCBI database. To replicate the samples, real-time polymerase chain reaction technique was used for the pointed gene and the results were confirmed by the sequencing technique. RESULTS: The mean number of CAG sequences in two groups with and without baldness, was 23.16 ± 0.47 and 23.04 ± 0.67. For GGC sequencing with and without baldness, mean count was 22.22 ± 1.45 and 19.92 ± 81.2, respectively, which was significantly higher in the group with baldness. There was no association between number of CAG sequence and improvement in hair loss or the level of patients' satisfaction, but lower number of GGC sequences was associated with higher rate of stopping hair loss, more new hair growth, higher level of satisfaction, and more clinical response to finasteride and clinical improvement in AGA patients. CONCLUSION: Counting of GGC sequence in the gene encoding the androgen receptor is associated with an increase in odds of baldness and a decrease in the response rate to finasteride in AGA patients.

Platelet-rich plasma as a new and successful treatment for lichen planopilaris: A controlled blinded randomized clinical trial.

INTRODUCTION: Lichen planopilaris (LPP) is one of the most common causes of scarring hair loss caused by immune-mediated inflammation resulting in atrophy and scaling. The key to preventing this irreversible hair loss is diagnosing and starting treatment at the earliest possible stage. As there is no definite cure for LPP, the therapy could be challenging. In the study, we conducted a single-blinded randomized clinical trial to evaluate the therapeutic effects, safety, and tolerability of platelet-rich plasma versus topical clobetasol in the treatment of LPP. METHOD: A randomized single-blinded controlled clinical trial was conducted in 24 LPP patients referring to our dermatology clinic between August 2022 and March 2023. Patients in the control group were treated with topical clobetasol 0.05% applied at night, and patients in the case group, in addition to topical clobetasol, received three sessions of PRP injection monthly. Both groups were assessed 1, 2, and 6 months after the start of the study by the Lichen Planopilaris Activity Index (LPPAI), physician and patient satisfaction, tolerability, and recording adverse effects. RESULTS: The average age in the clobetasol and PRP groups was 43.75 ± 13.51 and 42.75 ± 9.67, respectively (p = 0.83). In terms of gender, all 12 cases (100%) in the clobetasol group and 9 cases (75%) in the PRP group were female (p = 0.21). Both PRP and topical clobetasol effectively reduced LPPAI in the first 2 months; however, after 6 months, the LPPAI significantly increased in the clobetasol group (p = 0.001). There were no significant differences in LPPAI between the two groups at the beginning of the study and after 1 month. However, the mean LPPAI score in the clobetasol group was significantly higher than in the PRP group at 2 and 6 months after the start of the study (p = 0.01). Patient satisfaction with treatment increased in both groups during follow-up sessions, but at the end of the follow-up period, it was significantly higher in the PRP group (p = 0.03). Finally, the study did not have any serious adverse effects, and the pain experienced during PRP injection was tolerable for the patients. Overall, treatment tolerability was excellent in both groups. CONCLUSION: Given the different efficacy profiles, PRP could be considered a new and effective choice for the treatment of LPP.

A systematic review of clinical trials using single or combination therapy of oral or topical finasteride for women in reproductive age and postmenopausal women with hormonal and nonhormonal androgenetic alopecia.

Female pattern hair loss (FPHL) is a hereditary form of hair loss in women and the most common patterned progressive hair loss in female patients with androgenetic alopecia (AGA). One of the best methods for treating hair loss in women is the finasteride treatment. This systematic review includes a summary of the pharmacology of finasteride and the effect of the drug on women, especially those in the menopausal age group, and is aimed at elucidating methods of preventing systematic side effects. A search of all published literature from 1999 to 2020 has been conducted with the use of PubMed/MEDLINE, Embase, PsycINFO, TRIP Cochrane, as well as Cochrane Skin databases. A total of 380 articles were found, of which 260 articles were removed and 87 review studies were excluded. Lastly, full texts of 33 original articles were reviewed and 14 articles that met the inclusion criteria were selected. Ten out of the 14 articles reported a high rate of alopecia recovery in women taking finasteride. Based on the results, it can be stated that 5 mg of oral finasteride per day could be an effective and safe treatment in normoandrogenic women with FPHL, especially when used in combination with other drugs, such as topical estradiol and minoxidil. We also found that topical finasteride is more effective than other topical formulas for treating hair loss.

Comparison of efficacy and safety of tranexamic acid mesotherapy versus oral tranexamic acid in patients with melasma undergoing Q-switched fractional 1064-nm Nd:YAG laser: A blinded RCT and follow-up.

BACKGROUND: Melasma is a common hyperpigmentation disorder. This study aimed to compare the efficacy of Nd-Yag fractional 1064 plus microinjection of tranexamic acid versus Nd-Yag fractional 1064 plus oral tranexamic acid in patients with melasma. MATERIALS AND METHODS: This is a prospective, randomized study with a sample size of 40 patients, 20 in each treatment arm, which was done six times with 2-week intervals. Twenty patients were administered localized microinjections (4 mg/ml) of tranexamic acid and Q-switched 1064 laser every 2 weeks in one arm, while in the other arm, 20 were given oral tranexamic acid 250 mg three times a day and Q-switched 1064 laser every 2 weeks per visit. RESULTS: Twenty-one patients with mean SD 40.52+-4.95 y/o were treated with oral tranexamic acid, and 20 patients with 43.3+-5.87 y/o treated with microinjection of tranexamic acid were analyzed. There was no statistically significant difference between the two groups in terms of demographic and clinical characteristics at the baseline (p > 0.05). The patients MASI score and ∆E decrease over the study period in both treatments significantly (p < 0.001). However, patient's MASI score (p = 0.99) and ∆E (p = 0.53) did not differ significant between the two group over the time. Satisfaction (p = 0.41) and complication during the study period (p = 0.09) were not significantly different between the two group. CONCLUSION: The combination treatment method can be a viable option for Middle Eastern patients having melasma disorder, and tranexamic acid appears to be an effective and safe treatment for melasma, irrespective of its route of administration. Tranexamic acid can increase the permeability locally by non-invasive methods such as microneedling which is less painful than microinjection and can also increase patient satisfaction. Although the oral method is more tolerable for the patient, it may have systemic side effects, and its combination with Q-switch laser increases its effect regardless of the type of prescription. Therefore, it is recommended to use of this drug topically (cream or lotion) by non-invasive methods like microneedling to reduce pain and laser treatment in future studies.

Non-Pharmacological Treatments of Psoriasis in Persian Medicine a Narrative Review.

Psoriasis is a chronic disease that has no definitive cure. In this review study, the main sources of Persian Medicine (PM) such as the Canon of Medicine (by Avicenna) and Al-Havi (by Rhazes) were assessed to identify non-pharmacological treatments for psoriasis. Several treatments that are recommended for this disease include nutritional advice, lifestyle modifications, and manipulation therapy such as wet cupping (Hijamah), leech therapy, and phlebotomy (Fasd). These recommendations may help to prevent recurrence and be useful in improving psoriasis. The efficacy of PM recommendations to improve psoriasis should be evaluated in future studies.

Systematic review of clinical studies assessing the needling for treatment of melasma: Focusing on efficacy, safety, and recurrence rate.

BACKGROUND AND OBJECTIVE: Melasma is common, chronic and treatment-challenging cosmetic concern and the aim of this study was to systematically evaluate clinical studies assessing the treatment of melasma through needling while focusing on efficiency, safety, and recurrence. METHOD: After e-search a total of 54 articles were reviewed and 12 published articles (February 2011-September 2020) in terms of content, topic, and purpose, were finalized. Articles were open pilot trials, case reports, case series, retrospective studies, quasi-experimental trials, randomized clinical trials, and split face comparative studies. RESULTS: The highest decrease in MASI score was 85.71% and allocated to microneedling method following only 3 sessions with an interval of 30 days. On the other hand, the lowest decrease in this score was 3.7% and allocated to microneedling treatment and its use for vitamin C delivery at the end of the fourth week of treatment. No side effects were reported in included studies, and the various needling methods used were safe. Recurrence after treatment was reported in none of these articles, and only one of them reported a 4% recurrence in the second phase of treatment, but no recurrence was reported in the last phase of that study. CONCLUSION: Non-aggressive microneedling with topical depigmenting agents was more effective than topical depigmenting agents alone, so that the mean MASI score was significantly higher than those who used lightening serum alone. So needling can be suggested as an effective and safe method with low recurrence rate for the treatment of melasma.

The investigation of the efficacy and safety of stromal vascular fraction in the treatment of nanofat-treated acne scar: a randomized blinded controlled clinical trial.

BACKGROUND: Acne is the most common skin disorder which is known as a chronic inflammatory disease with psychological burden and reduced quality of life. Adipose tissue-derived stromal vascular fraction (SVF) is recognized as a source of regenerative cells and improves the quality of skin by increasing collagen content. To date, a few studies have been performed on the therapeutic role of SVF in the treatment of acne scars. METHODS: This randomized, single-blinded clinical trial was performed on 7 patients with acne scars. In all patients, the initial grade of acne (volume, area and depth) was evaluated and ultrasound of the relevant scar was performed to evaluate neocollagenesis. As a spilt face study, for treating the scars, we used nanofat subcutaneously on one side of the face (control group) and combination of nanofat subcutaneously and SVF intradermally on the opposite side (intervention group). The patients were evaluated for severity of acne by visioface after one month, also for thickness of epidermis and dermis by ultrasound after one month and three months. RESULTS: All of the apparent findings of scars improved in two groups after one month, but these changes were significant just for the group treated with SVF (p value < 0.05). Epidermal, dermal and complete thicknesses during the first month in both control and intervention groups were significantly increased (p value < 0.05) but between the first and third months, there was no significant difference in the variables (p value > 0.05). The findings showed that dermal and complete thicknesses of the skin in the first month were different between two groups significantly (p value: 0.042 and 0.040, respectively). CONCLUSION: The use of SVF in the treatment of patients with acne scars accelerates the improvement of volume, area and depth of the scar by increasing collagen content and the dermal thickness, so it can be used as a potentially effective treatment for these patients.