Tolerability and efficacy assessment of an oral collagen supplement for the improvement of biophysical and ultrasonographic parameters of skin in middle eastern consumers.

BACKGROUND: Topical skin care products often do not reach the deeper layers of the skin, and oral hydrolyzed collagen is one of the newest and most popular systemic supplementations for skin rejuvenation. However, there are limited information in case of Middle Eastern consumers OBJECTIVE: The purpose of this study was to evaluate the tolerability and efficacy of an oral collagen supplement for improvement of skin elasticity, hydration, and roughness in Middle Eastern consumers. METHODS AND MATERIALS: It was a 12-week, before-after clinical study, conducted on 20 participants (18 women and 2 men) aged 44.15 ± 5.36 years with skin type III-IV. Skin elasticity parameters (R0, R2, R5, and R7), skin hydration and friction, as well as the thickness and echo density of the dermis, were measured after six and 12 weeks daily intake of the study product, as well as 4 weeks after stopping its use (week 16). Participants' satisfaction was assessed on the basis of their answers to the standard questionnaire, and tolerability of the product was assessed by monitoring the adverse effects. RESULTS: A significant improvement was detected in R2, R5, and skin friction at week 12 (p-values 0.041, 0.012 and <0.01, respectively). At week 16, the values remained at an increased level, which indicates the persistence of the results. The increase of dermis density in week 16 was also significant (p-value = 0.03). Moderate overall satisfaction was reported with the treatment, and a few gastrointestinal complications were reported. CONCLUSION: The study demonstrated that oral collagen peptides could significantly improve the skin elasticity, roughness, and dermis echo density, and they also proved to be safe and well-tolerated.

Efficacy and safety of date palm leaf-based ointment for treatment of cutaneous warts: A pilot clinical trial.

Despite the considerably high prevalence of cutaneous warts, no optimally effective and safe treatment is available. Leaves of date palm (Phoenix dactylifera L.; Arecaceae) have long been used in Iran's folk medicine as a remedy for warts. To assess the state-of-the-art evidence on using P. dactylifera L. for warts, we conducted a systematic review using CINAHL (via EBSCO), Embase, Medline (via PubMed), ProQuest, Scopus, and Web of Science. We conducted an open-label uncontrolled pilot clinical study to evaluate the efficacy and safety of a proprietary topical date palm leaf-based ointment for the treatment of various types of nongenital warts. This study consisted of an 8-week treatment phase and a 4-week follow-up phase. The assessed outcomes included complete clearance, patient satisfaction (on Likert scale), and the occurrence of any adverse effect. The systematic review demonstrated that the effects of date palm on warts have not been scientifically studied. Thirty patients entered the study with a mean age of 29.5 years (SD = 14.04); among which 17 were female and 13 were male. The patients presented diverse types of warts: verruca vulgaris 15 (50%), plantar 9 (30%), plane 2 (7%), periungual 2 (7%), and warts at multiple sites 2 (7%). In this trial, 19 patients (63.3%) experienced complete clearance and 5 patients (16.6%) experienced partial clearance. Eight patients (26.67%) dropped out during the study. 21 (70%) patients were very satisfied (score on Likert scale = 5) while 1 (3.3%) patient with partial clearance was somewhat satisfied (score on Likert scale = 4). No adverse effect was observed. The results of this pilot study indicate that the date palm leaf-based ointment is a promising treatment whose efficacy and safety should be further investigated in a randomized controlled clinical trial.

Brightening effect of Ziziphus jujuba (jujube) fruit extract on facial skin: A randomized, double-blind, clinical study.

Ziziphus jujuba Mill. (jujube) is an invaluable medicinal plant in traditional and modern medicine. Jujube syrup is a complex of herbal extracts including Z. jujuba, Berberis vulgaris, Rhus coriaria, Prunus domestica, and Rosa damascene. The purpose of the present study was to formulate and investigate the efficacy and safety of jujube syrup on brightening of facial skin. In this randomized, double-blind, controlled clinical study, 46 participants consumed jujube syrup or placebo (23 in each group) twice a day for 8 weeks. The number of pigments, area of pigmentation, and physician's global assessment score (PGAS) were evaluated at baseline and after 8 weeks. The results showed the amounts of total phenolics and flavonoids were 81.97 ± 0.25 and 4.98 ± 1.04 mg/ml, respectively. The amounts of organic acids (gallic acid and chlorogenic acid) were quantified at 1140 ± 17.65 and 1520 ± 25.77 µg/ml, respectively. The amounts of total phenolic and flavonoids were stable under accelerated conditions. Eight weeks after treatment, the number of pigment counts reduced to 0.545 ± 0.307 compared to the placebo group. Moreover, the pigmented area and its percentages were significantly reduced to 0.556 ± 0.285 and 0.561 ± 0.288 in jujube syrup compared with placebo, respectively. Jujube syrup is efficient and safe for treating hyperpigmentation of the face.

Herbal Therapy for the Management of Seborrheic Dermatitis: A Narrative Review.

INTRODUCTION: Dandruff and Seborrheic Dermatitis (SD) are similar skin conditions with different degrees ofseverity. Since the current therapies cannot remove dandruff efficiently, herbal extracts with better effectiveness and fewer side effects are used in the pharmaceutical and cosmetic industries. Due to the adverse effects of chemical drugs, the use of natural products and traditional medicine has significantly increased over the past few decades. Therefore, in this review, we reported the herbs used as anti-dandruff agents in traditional medicine worldwide. METHODS: The review was conducted on the literature available on the medicinal utility of certain plants as anti-dandruff agents using PubMed and Google Scholar and the following search terms: Dandruff and plants or medicinal plant and dandruff treatment, and essential oil and dandruff. RESULTS: Since the current therapies cannotefficiently remove dandruff, herbal extracts with better effectiveness and fewer side effects are used in the pharmaceutical and cosmetic industries. Nowadays, there are numerous different types of herbal antidandruff shampoos. They are effective and safe without the side effects of chemical agents. Recently, herbal medicine has attracted a great deal of scientific attention. Clinical evidence on the therapeutic effects of herbal products has resulted in the study of far more herbs for their therapeutic roles. CONCLUSION: Herbal therapy plays a significant role in the development of favorable therapeutics, either alone or in combination with conventional antibiotics. However, the major challenges in this regard include finding compounds with satisfactorily lower MICs, low toxicity, and high bioavailability for effective and safe use in humans and animals.

Preparation and evaluation of anti-wrinkle cream containing saffron extract and avocado oil.

BACKGROUND: Recently, many compounds or extracts from natural sources are used for reducing facial aging and wrinkles. OBJECTIVE: This study investigates the preparation and evaluation of the safety and efficacy of saffron extract and avocado oil used for anti-wrinkle topical cream. METHODS AND MATERIALS: Oil in water cream was prepared containing avocado oil and the saffron extract. Accelerated stability tests were carried out due to 6 months accordingly through the International Council for Harmonization (ICH) guideline. For clinical studies, topical cream was applied by twenty healthy volunteers daily, for 12 weeks. Improvement in wrinkle grading by a Global Aesthetic Improvement Scale (GIAS), depth and volume of the nasolabial fold, thickness, and density of dermis, and determination of the skin biophysical parameters were evaluated at the baseline, 6th and 12th week. RESULT: During the period of storage, the formulation showed no variation in physicochemical properties. The clinical evaluation showed at least one-grade improvement in GIAS in 30% and 45% of participants, after 6 and 12 weeks, respectively. Subjects were "moderately satisfied" with the treatment. In addition, the area and volume of nasolabial folds were significantly reduced. Moreover, net elasticity (R5) and gross elasticity (R2) showed a significant increase after 12 weeks of treatment. There was no report of allergic reactions, and no changes in skin hydration occurred during the treatment. CONCLUSION: The results of this study showed that saffron extract and avocado oil anti-wrinkle topical cream is an efficient and safe treatment for facial skin rejuvenation.

Combination of Fractional Radiofrequency and Thermo-Contraction Systems for Facial Skin Rejuvenation: A Clinical and Histological Study.

BACKGROUND: Radiofrequency energy systems are popular options in the treatment of skin laxity and wrinkles. Fractional radiofrequency devices (FRFs) have increased the efficacy and safety. The thermo-contraction (TC) system is also a novel technology that can promote a marked lifting effect. OBJECTIVES: This trial was done to assess the safety and efficacy of a combination treatment using the FRF system and TC for facial skin rejuvenation. METHODS: Fifteen female volunteers (mean age, 47.07 ± 8.83 years) received 3 FRF and 6 TC bipolar treatments in 3 weeks. Assessment methods included wrinkle grading by independent investigator using Glogau wrinkle scoring, objective measurement of depth, area, and volume of right nasolabial fold (using the VisioFace CSI software), thickness and echo-density of the dermis (using high-frequency ultrasound), and measurement of the skin biophysical parameters before and 3 months after last treatment. Histological assessment was also performed on 5 volunteer participants. RESULTS: The clinical evaluation showed a significant improvement in Glogau wrinkle scoring after 3 months (P value, 0.041). The area and volume of nasolabial folds were also significantly reduced (P values, 0.026 and 0.031, respectively). Skin ultrasound showed a significant increase in echo-density of the dermis, which was confirmed by histological findings of an increase in dermal collagen content. Adverse reactions were all transient and mild in severity, and subjects were "moderately satisfied" with the treatment (Likert scale, 3.6 out of 5). CONCLUSIONS: The results of this trial showed that a combination therapy by FRF and TC bipolar systems is efficient and safe for facial skin rejuvenation.

Comparison of clinical efficacy and safety of thermotherapy versus cryotherapy in treatment of skin warts: A randomized controlled trial.

The effect of thermotherapy in the treatment of skin warts in comparison to cryotherapy, as the standard conventional method, has remained uncertain. This study aimed to assess the clinical efficacy and safety of thermotherapy and cryotherapy in removing skin warts. This randomized controlled trial was conducted on 52 patients aged 18 years and over with ≤ 10 skin warts. The participants were randomly assigned into two groups to receive cryotherapy (every 2 to 3 weeks up to six sessions if required) or thermotherapy (one session). The patients in both groups were followed every 2 to 3 weeks for the first three months, and then three months after the last treatment session. The clearance rate was 79.2% in the thermotherapy group and 58.3% in the cryotherapy group with no significant difference (p = 0.212). The rate of scarring in the thermotherapy group was 20% (p = .018). A higher clearance rate was achieved in the thermotherapy group. However, this result was not statistically significant. There were some minimal post-treatment complications. Patients needed only one session of thermotherapy. Due to the risk of scarring, we suggest thermotherapy only as a suitable treatment method for palmoplantar warts.

Randomized controlled trial using vitamins E and D supplementation in atopic dermatitis.

BACKGROUND: Atopic dermatitis is a chronically relapsing, highly pruritic and inflammatory skin disease. This study was done to assess the effects of vitamins D and E supplementation on the clinical manifestation of atopic dermatitis. METHODS: Forty-five atopic dermatitis patients were included in a randomized, double-blind, placebo-controlled trial. They were randomly divided into four groups and treated for 60 days: group P (n = 11), vitamins D and E placebos; group D (n = 12), 1600 IU vitamin D(3) plus vitamin E placebo; group E (n = 11), 600 IU synthetic all-rac-α-tocopherol plus vitamin D placebo; and group DE (n = 11), 1600 IU vitamin D(3) plus 600 IU synthetic all-rac-α-tocopherol. Serum 25(OH) vitamin D and plasma α-tocopherol were determined before and after the trial. The clinical improvement was evaluated with SCORing Atopic Dermatitis (SCORAD). Data were analyzed by analysis of variance (ANOVA) and Kruskal-Wallis tests. RESULTS: SCORAD was reduced after 60 days in groups D, E and DE by 34.8%, 35.7% and 64.3%, respectively (p = 0.004). Objective SCORAD also showed significant improvement. There was a positive correlation between SCORAD and intensity, objective, subjective and extent (p < 0.001). We found a significant negative association between plasma α-tocopherol and SCORAD, intensity, objective and extent (p = 0.02). CONCLUSION: This study supports the contributing and beneficial effects of vitamins D and E in the treatment of atopic dermatitis.

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.

Unwanted facial hair removal with laser treatment improves quality of life of patients.

BACKGROUND: Unwanted facial hair can have adverse psychological effects on women and reduce their quality of life. OBJECTIVE: To assess the effects of unwanted facial hair removal with laser on improving quality of life. METHODS: In this study, 70 patients treated for unwanted facial hair by laser were assessed by Dermatology Life Quality Index (DLQI) questionnaire on admission and 3 months later after three sessions of laser treatment. RESULTS: The DLQI score before treatment was 9.42 +/- 5.99, which was reduced to 3.12 +/- 3.40 after laser treatment (p <0.05). CONCLUSION: Unwanted facial hair removal with laser can improve the quality of life of patients.

Comparison of long-pulsed alexandrite and Nd:YAG lasers, individually and in combination, for leg hair reduction: an assessor-blinded, randomized trial with 18 months of follow-up.

OBJECTIVE: To compare the long-term effectiveness and safety of long-pulsed Nd:YAG and alexandrite lasers, individually and in combination, in long-term leg hair reduction. DESIGN: Randomized, single-center, within-participant, investigator-blinded, active-controlled clinical trial. SETTING: Private skin laser center. PARTICIPANTS: Twenty individuals aged 16 to 50 years with skin phototypes III and IV. INTERVENTIONS: The medial and lateral sides of each participant's legs were randomly assigned to receive 1 of the following laser treatments: (1) long-pulsed 1064-nm Nd:YAG laser (12-mm spot size); (2) long-pulsed 755-nm alexandrite laser (12-mm spot size); (3) long-pulsed 755-nm alexandrite laser (18-mm spot size); and (4) a combination of long-pulsed 1064-nm Nd:YAG laser and long-pulsed 755-nm alexandrite laser (treatments 1 and 2). Identified areas were treated for a total of 4 sessions at 8-week intervals. MAIN OUTCOME MEASURES: Hair reduction from baseline based on hair counting with digital photography by 2 blinded assessors, 8 and 18 months after the last treatment session. RESULTS: Fifteen participants completed the trial. The mean (SD) hair reduction 18 months after the last treatment, as measured by the assessors from digital photographs, were 75.9% (19.0%) for the 12-mm spot size alexandrite laser, 84.3% (12.4%) for the 18-mm spot size alexandrite laser, 73.6% (11.4%) for the Nd:YAG laser, and 77.8% (15.9%) for the combination therapy (analysis of variance, P > .05). The incidence of adverse effects (hyperpigmentation) and pain severity were significantly greater in areas that received combination therapy (P = .001). CONCLUSIONS: After 18 months of follow-up, alexandrite and Nd:YAG lasers were efficacious for leg hair removal. Combination therapy did not have any additional benefit and caused more adverse effects.