Effect of Cedar (Ziziphus spina-christi) topical solution in mild to moderate acne vulgaris: a randomized clinical study.

BACKGROUND: Acne is the most prevalent skin disease in the world and antibiotics as its standard treatments have limited and also adverse effects. Cedar (Ziziphus spina-christi) has medicinal properties like antibacterial activity and is used topically for treatment of some kinds of skin problems in Persian medicine. The aim of this study was to evaluation the efficacy of topical cedar solution of acne vulgaris. METHODS: Eighty patients aged between 15-45 years with mild to moderate acne vulgaris were conducted in this randomized, double blind trial. The participants were allocated to receive the topical cedar solution plus clindamycin 1% or topical placebo plus 1% clindamycin solution for six weeks. Patients were evaluated at the beginning of the study, second, sixth and eighth weeks after intervention for the acne severity index (ASI) and total acne lesions counting (TLC). Data was analyzed by SPSS software with Mann-Whitney U test. RESULTS: From 105 subjects 68 people completed the study (33 persons in cedar group and 35 persons in placebo group). The mean and standard deviation of the age was 26.1 ± 7.5 years and 22 subjects (32.4%) were male. TLC and ASI in the sixth and eighth weeks in cedar group were significantly less than in placebo group (p < 0.001). Topical cedar solution had no serious side effects. CONCLUSION: The topical cedar solution plus clindamycin 1% was more effective and safe than placebo plus 1% clindamycin for the treatment of acne vulgaris.

Autologous whole fat injection stimulates hair growth in resistant Androgenetic Alopecia: Report of nine cases.

BACKGROUND: The changes in morphology of hair follicle and aberrant cycling of hair follicle are the main reasons of the most common forms of hair loss (alopecia). However, existing alopecia treatments do not specifically target these processes. AIMS: Autologous whole fat injection suggests a paradigm shift that may offer alternative therapies that can be used to prevent hair loss. This study aimed to present clinical cases for the treatment of androgenetic alopecia by autologous whole fat injection in the scalp. METHODS: Nine patients with androgenetic alopecia (7 women and 2 men) were enrolled to our study. After lipoaspiration, autologous whole fat was injected into the patient's scalp. Hair regeneration was evaluated by three clinical tests: the pull test, hair quality, and hair density. RESULTS: For all patients, before and after treatment, the number (density) and diameter of hair were calculated using trichograms. The pull test was also performed. The pictures were obtained before after treatment. CONCLUSION: Our results showed that whole fat injection enormously can increase the level of hair growth.

Sambucus ebulus extract stimulates cellular responses in cutaneous leishmaniasis.

This is the first study aiming to determine the therapeutic effects of the Sambucus ebulus aquatic extract as an antileishmanial herbal drug and evaluate the immune responses in Leishmania major major infected BALB/c mice. The antileishmanial activity of S ebulus aquatic extract was evaluated using MTT test as well as parasite rescue and transformation assay. Footpad swelling and parasite load of infected mice were measured by several techniques. The immune responses were evaluated by measuring the levels of IFN-γ, IL-4, nitric oxide and arginase. The results indicated that S. ebulus can significantly decrease L. major promastigotes and amastigotes viability, but it was not toxic to macrophages. The lesion size, parasite burden and the level of ARG decreased in the treated infected mice, while the IFN-γ-to-IL-4 ratio and the level of NO increased significantly. Altogether, the S. ebulus extract is an effective compound for killing Leishmania parasite without excessive toxicity to the host cells and can cure the CL by switching the host immune responses towards Th1 response. Thus, it may be a perfect therapeutic option for CL treatment.

The effectiveness of adding low-level light therapy to minoxidil 5% solution in the treatment of patients with androgenetic alopecia.

BACKGROUND: Androgenetic alopecia is the commonest type of alopecia affecting over half of men and women. Low-level light therapy is a new technique for stimulating hair growth in both genders. AIMS: To overcome the shortcomings of previous epidemiological studies and a lack of controlled clinical trials on the subject, this study compared the effectiveness of adding low-level light therapy to minoxidil topical solution in the treatment of androgenetic alopecia in patients presenting to two skin clinics in Isfahan, Iran during 2014-2015. MATERIALS AND METHODS: This clinical trial included 50 patients aged 17-45 presenting to Khorshid and Alzahra educational centers and skin diseases research center for androgenetic alopecia during 2014-2015. The patients were randomly divided into a control and a case group. The case group received topical minoxidil 5% solution plus low-level light therapy twice per day. The control group was given the same topical solution and a laser comb system that was turned off to act as a placebo. Changes in patients' hair density and diameter and its overall regrowth as well as their satisfaction with the treatment were assessed at months 0 (baseline), 3, 6, 9 and 12. RESULTS: The percentage of recovery from androgenetic alopecia and the patients' satisfaction with their treatment were significantly higher in the case group compared to the control group. The patients' mean hair density and diameter were found to be higher in the case group after the intervention compared to the control group. LIMITATIONS: The study limitations included patient compliance, small sample size, patient insight due to novelty of the method and clinical judgement. CONCLUSION: As a new method of treatment, low-level light therapy can help improve the percentage of recovery from androgenetic alopecia and increase patients' satisfaction with their treatment.

Effect of low-level laser therapy on the healing process of donor site in patients with grade 3 burn ulcer after skin graft surgery (a randomized clinical trial).

Skin graft is a standard therapeutic technique in patients with deep ulcers, but managing donor site after grafting is very important. Although several modern dressings are available to enhance the comfort of donor site, using techniques that accelerate wound healing may enhance patient satisfaction. Low-level laser therapy (LLLT) has been used in several medical fields, including healing of diabetic, surgical, and pressure ulcers, but there is not any report of using this method for healing of donor site in burn patients. The protocols and informed consent were reviewed according to Medical Ethics Board of Shahid Beheshti University of Medical Sciences (IR.SBMU.REC.1394.363) and Iranian Registry of Clinical Trials (IRCT2016020226069N2). Eighteen donor sites in 11 patients with grade 3 burn ulcer were selected. Donor areas were divided into 2 parts, for laser irradiation and control randomly. Laser area was irradiated by a red, 655-nm laser light, 150 mW, 2 J/cm2, on days 0 (immediately after surgery), 3, 5, and 7. Dressing and other therapeutic care for both sites were the same. The patients and the person who analyzed the results were blinded. The size of donor site reduced in both groups during the 7-day study period (P < 0.01) and this reduction was significantly greater in the laser group (P = 0.01). In the present study, for the first time, we evaluate the effects of LLLT on the healing process of donor site in burn patients. The results showed that local irradiation of red laser accelerates wound healing process significantly.

Efficacy of Intense-pulsed Light Therapy with Topical Benzoyl Peroxide 5% versus Benzoyl Peroxide 5% Alone in Mild-to-moderate Acne Vulgaris: A Randomized Controlled Trial.

OBJECTIVE: Acne vulgaris is a disease of pilosebaceous unit with multifactorial pathogenesis and threats patients' social functioning. There is a growing research to find faster, more effective, and easy to use treatments. The aim of this study is to evaluate the efficacy of benzoyl peroxide 5% (BP) with and without concomitant intense-pulsed light (IPL) therapy in mild-to-moderate acne vulgaris. METHODS: In this controlled trial, 58 eligible patients with mild-to-moderate acne and Fitzpatrick skin phototype III and IV were randomly allocated to two groups. All patients were asked to use a thin layer of BP every night. The IPL therapy was administered at the end of first, 2nd, and 3rd months. Acne Global Severity Scale (AGSS), Acne Severity Index (ASI), and total lesion counting (TLC) along with patient satisfaction were recorded. Patients were also examined 1 month after the final therapeutic visit. FINDINGS: The IPL group showed greater reduction in AGSS (P < 0.001) and TLC (P = 0.005) than the control group. However, the difference in ASI was not significant (P = 0.12). Patients in IPL groups were more satisfied than control group (P < 0.001). CONCLUSION: Adding IPL to BP can result better response to BP alone. In acne treatment, combination therapy such as IPL and other topical agents should be kept in mind.

Effects of low level laser therapy on the prognosis of split-thickness skin graft in type 3 burn of diabetic patients: a case series.

Significant populations in burn centers are diabetic burn patients. Healing process in these patients is more difficult due to diabetes complications. The gold standard treatment for patients with grade 3 burn ulcer is split-thickness skin grafting (STSG), but in the diabetic patients, the rate of graft failure and amputation is high due to impaired tissue perfusion. The technique of low level laser therapy (LLLT) improves tissue perfusion and fibroblast proliferation, increases collagen synthesis, and accelerates wound healing. The purpose of this case report is introducing a new therapeutic method for accelerating healing with better prognosis in these patients. The protocols and informed consent were reviewed according to the Medical Ethics, Board of Shahid Beheshti Medical Sciences (IR.SBMU.RAM.REC.13940.363). Diabetic type 2 patients with 13 grade 3 burn ulcers, candidate for amputation, were enrolled in the study. We used a 650-nm red laser light, 2 J/Cm for the bed of the ulcer and an 810-nm infrared laser light 6 J/Cm(2) for the margins along with intravenous laser therapy with a 660-nm red light, before and after STSG for treating grade 3 burn ulcers in 13 diabetic ulcers. The results of this study showed complete healing in the last 8 weeks for all patients who were candidates for amputation. In this case series, we present 13 cases of diabetic ulcer with type 3 burn wound, candidate for amputation, who healed completely using LLLT and STSG. This is the first time that these two techniques are combined for treatment of burn ulcer in diabetic patients. Using LLLT with STSG might be a promising treatment for burn victims especially diabetic patients.

Complementary Therapies for Idiopathic Hirsutism: Topical Licorice as Promising Option.

Hirsutism is one of the most prevalent health problems in women. The aim of the study was to compare the effect of 755 nm alexandrite hair removal laser with that of alexandrite laser plus topical licorice on the improvement of idiopathic hirsutism. A double-blind, randomized placebo-controlled study was performed on 90 female subjects. The patients were divided into two groups: alexandrite laser plus 15% licorice gel (group A) and placebo (group B). Each subject received one of both products over one side of the face, twice daily for 24 weeks on the hirsute locations. Each group underwent five sessions of alexandrite laser at 6-week intervals. To minimize the effects of confounding variables, the test was performed on two separate zones of patients' skin. The mean ± SD numbers of terminal hairs in group A were 7.05 ± 4.55 for zone 1 and 6.06 ± 3.70 for zone 2. In group B, they were 3.18 ± 1.75 for zone 1 and 2.49 ± 1.63 for zone 2. The difference in the mean number of terminal hairs was statistically significant between the two groups (p < 0.001), and there were no serious adverse reactions. The treatment of idiopathic hirsutism with 755 nm alexandrite laser plus topical licorice is more effective than alexandrite laser only.

The Effects of Adiantum capillus-veneris on Wound Healing: An Experimental In Vitro Evaluation.

BACKGROUND: A lot of remedies, mostly plant based, were mentioned in the Persian old pharmacopoeias for promoting of burn and wound healing and tissue repairing. The efficacy of most of these old remedies is unexplored till now. Adiantum capillus-veneris from Adiantaceae family is one of them that was used to treating of some kinds of chronic wounds. METHODS: Methanol extract was fractionated to four different partitions that is, hexane, ethyl acetate, n-butanol, and aqueous. The potential of A. capillus-veneris fractions in wound healing or prevention of chronic wounds were evaluated through angiogenesis and fibroblast proliferation, in addition to in vitro tests for protection against damage to fibroblasts by oxygen free radicals. RESULTS: The aqueous part of A. capillus-veneris promoted significant angiogenesis (P < 0.05) through both capillary-like tubular formations and proliferation of endothelial cells in vitro. In addition, in the tests for protection against damage to fibroblasts by oxygen free radicals, aqueous and butanol fractions showed significant protective effects in the concentrations 50, and 500 µg/ml (P < 0.05) in comparison with a control group. In the toxicity testing, it showed weak irritation in the Hen's egg test chorioallantoic membrane (CAM) bioassay at the vascular level on the CAM of the chicken and no significant cytotoxicity in the MTT assays on normal human dermal fibroblasts. CONCLUSIONS: Angiogenic effects and protective effects against oxygen free radicals suggested aqueous partition of A. capillus-veneris local application for prevention of late-radiation-induced injuries after radiation therapy and healing of external wounds similar to bedsores and burns.

Narrow-Band Ultraviolet B versus Oral Minocycline in Treatment of Unstable Vitiligo: A Prospective Comparative Trial.

Background. We have compared NB-UVB and oral minocycline in stabilizing vitiligo for the first time. Subjects and Methods. 42 patients were divided equally into two groups: the NB-UVB and minocycline groups. Phototherapy was administered twice a week on nonconsecutive days. In the minocycline group, patients were advised to take minocycline 100 mg once daily. The treatment period was 3 months. Vitiligo disease activity (VIDA) score was noted every 4 weeks for 12 months. Digital photographs were taken at baseline and monthly intervals. Results. Before the therapy, disease activity was present in 100% of the patients, which was reduced to 23.8% and 66.1% by the end of therapy in the NB-UVB and minocycline groups retrospectively (P < 0.05). 16 of the 21 (76/1%) patients with unstable disease in the NB-UVB group achieved stability, whereas this was the case for only 7 of the 21 (33.3%) in the minocycline group (P < 0.001). The diameter changes were statistically significant at the end of treatment in the NB-UVB group compared to the minocycline group (P = 0.031). Side effects in both groups were mild. Conclusion. NB-UVB was statistically more advantageous than oral minocycline in unstable vitiligo in terms of efficacy and the resulting stability.

Treatment of acute cutaneous leishmaniasis with intralesional injection of meglumine antimoniate: comparison of conventional technique with mesotherapy gun.

BACKGROUND: The gold standard treatment of Old World leishmaniasis, a common tropical parasitic infestation, is intralesional meglumine antimoniate injection. Mesotherapy is a new minimally invasive method of administration of variable substances to the skin. OBJECTIVE: Comparison of the efficacy and adverse effects of treatment of leishmaniasis with intralesional injection of meglumine antimoniate using conventional method and mesotherapy method. PATIENTS AND METHODS: Eighty-five patients with proven leishmaniasis were recruited and randomly treated by one of the two methods, either by conventional injection or by mesotherapy administration weekly. Lesion characteristics were evaluated at every treatment session as well as 1 week, 1 month and 3 months after cessation of treatment. RESULTS: The improvement in lesions was similar in both groups, while it was noted sooner in mesotherapy group with less amount of drug usage (P = 0.005 and 0.016 respectively). Also, patients treated with mesotherapy experienced less pain severity (P = 0.005). CONCLUSION: Mesotherapy is a safe and effective method of meglumine antimoniate injection for the treatment of cutaneous leishmaniasis and is less painful.

Effect of topical honey application along with intralesional injection of glucantime in the treatment of cutaneous leishmaniasis.

BACKGROUND: Leishmaniasis is an endemic disease in Iran. Although many treatments have been suggested for this disease, there hasn't been an effective and safe treatment yet. Regarding the healing effect of honey in the chronic ulcers and its reported therapeutic effect in cutaneous leishmaniasis, we performed a study to better evaluate the efficacy of honey in cutaneous leishmaniasis and its final scar. METHODS: In a prospective clinical trial, 100 patients with confirmed cutaneous leishmaniasis were selected and randomized into 2 groups. Group A were treated with topical honey twice daily along with intralesional injection of glucantime once weekly until complete healing of the ulcer or for maximum of 6 weeks. Group B were treated with intralesional injection of glucantime alone until complete healing of the ulcer or for a maximum of 6 weeks, too. The patients were followed for 4 months. The collected data were analyzed statistically using statistical tests including Chi-square, Mann Whitney and Kaplan-Mayer tests. RESULTS: In this study, 45 patients that had cutaneous leishmaniasis were treated with intralesional glucantime alone and 45 patients were treated with topical honey and glucantime. Ten patients left out the study. In the glucantime alone treated group, 32 patients (71.1%) had complete cure whereas in the group treated with both glucantime & topical honey, 23 patients (51.1%) achieved complete cure. This difference was significant statistically (p = 0.04). CONCLUSION: Further studies to better clarify the efficacy of honey in cutaneous leishmaniasis is needed. We suggest that in another study, the efficacy of honey with standardized level of antibacterial activity is evaluated against cutaneous leishmaniasis.