Brain MRI findings in patients with bullous pemphigoid: A case-control study.

Evidence suggests that bullous pemphigoid (BP) is associated with multiple neurological disorders. We aimed to compare brain magnetic resonance (MRI) findings between BP patients and a control group. This case-control study included patients with BP referred to two dermatology clinics during a two-year period. A group of individuals attending the same clinics for cosmetic procedures were selected as controls. First, participants' general information including age, gender, education, weight and underlying disease was recorded. For BP patients, the drugs and the BP Disease Area Index (BPDAI) were recorded as well. Then, all participants underwent brain MRI without contrast. The Fazekas scale, the general cerebral atrophy (GCA) score, and the Medial Temporal lobe Atrophy (MTA) score were used to assess MRI images. Overall, 24 BP patients and 24 controls were evaluated in this study. Both groups were comparable regarding age, gender and education. However, diabetes and hypertension were more frequent in the control group. The mean BPDAI total score was 51.39 ± 68.92 in BP patients and most of them used rituximab (41.7%). None of the participants had MS or Alzheimer MRI patterns. There was no difference between groups in terms of GCA and MTA scores. Furthermore, the frequency of partially empty sella did not differ significantly between BP patients and controls (p = 0.461); nevertheless, grade-3 Fazekas was significantly higher in BP patients compared to controls (25% vs. 0%, p = 0.019). Of note, one BP patient had an epidermoid cyst and another had moderate enlargement of three ventricles. Also, new infarcts were observed in two and old infarcts in four BP patients. Although the majority of abnormal brain MRI findings were more frequent in BP patients compared to controls, only grade-3 Fazekas was significantly higher and acute infarcts were exclusively observed in BP patients.

The presence of mast cells in lichen planopilaris and discoid lupus erythematosus of the scalp: A quantitative study.

BACKGROUND: Histopathologic differentiation of lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) as two common causes of primary cicatricial alopecias remains challenging. METHOD: We performed a histopathologic study on a case series of LPP and DLE specimens to investigate the number, distribution, and morphology of mast cells as indices for differentiation of these two entities. H&E investigation and Giemsa staining for the detection of mast cells was performed. RESULT: A total of 74 cases comprising 50 cases of LPP and 24 cases of DLE were assessed. The mean mast cell count and percentage were significantly higher in LPP group (p < 0.001). Mean degranulated mast cell count and the mean intact mast cell count were also significantly higher in LPP patients (p < 0.001). Most of the specimens, 58 (78.4%), showed both perifollicular and perivascular distribution of mast cells without significant difference between two groups. The morphology of mast cells was predominantly round-oval in 85.5%, predominantly fusiform in 13.5% with more frequent fusiform morphology in DLE group. CONCLUSION: The mast cell count detected by Giemsa staining could assist pathologists in distinguishing between LPP and DLE.

Intralesional bleomycin versus intralesional triamcinolone in the treatment of keloids and hypertrophic scars.

Bleomycin is a known chemotherapeutic agent whose beneficial effects have been recently shown in the treatment of keloids and hypertrophic scars, however, it is unclear how effective it is in comparison with corticosteroids. We aimed to compare the safety and efficacy of intralesional bleomycin versus intralesional triamcinolone in the treatment of hypertrophic scars and keloids. Sixty patients were divided into two groups and treated by intralesional injection of triamcinolone (20 mg/ml) or bleomycin (1.5 mg/ml). The treatments were repeated every 3 weeks until the lesions flattened or for a maximum of six sessions. The clinical improvement was evaluated using the Japan scar workshop (JSW) scar scale (JSS) and the physician global assessment of flattening of the lesions. Side effects were also noted and recorded. 55 patients completed the study, 4 patients from the bleomycin group and 1 patient from the triamcinolone group dropped out of the study. In both groups, the total JSS scores decreased significantly after treatment compared to baseline (p < 0.001); however, the difference between groups was not statistically significant after treatment (p = 0.052). Moreover, the degree of flattening of the lesions was comparable between groups (p = 0.933). Side effects in the triamcinolone group were Hypopigmentation(55.2%), atrophy(51.7%), and telangiectasia(41.4%) and in bleomycin group included persistent pain after injection (61.5%), ulceration (69.2%), hyperpigmentation(76.9%), and secondary infection (34.6%). Intralesional bleomycin (1.5 mg/ml) is effective as triamcinolone(20 mg/ml) in the treatment of keloids and hypertrophic scars, however, bleomycin should be used carefully, due to adverse events such as pain, ulceration, and hyperpigmentation.

Topical care in pemphigus wounds: A systematic review of the literature.

Pemphigus is a group of autoimmune blistering diseases. Given the ulcerative nature of the diseases, the full healing of ulcers and erosions might be challenging. The aim of this study was to determine various topical wound care options for pemphigus patients, the advantage of each alternative, and to compare their efficacy, safety, and feasibility. In accordance with PRISMA guideline, we performed a systematic search in PubMed/Medline, web of science, and Scopus databases for articles published from inception until February 2, 2022. Out of 703 initially retrieved articles, 11 full texts were included. Our findings were divided into the following categories: silver-containing dressings, paraffin-embedded tulle nets, topical insulin, EPIFIBROIN 0039, platelet gel, and Biobrane®. The most commonly used topical care in pemphigus patients was silver-containing dressings in six studies. All of the included studies reported acceptable outcomes without any severe adverse effects. Due to the few available studies in this field, a definite suggestion cannot be made. We recommend larger randomized controlled studies to identify the best topical care modality in pemphigus patients.

The efficacy of polycaprolactone filler injection on enlarged facial pores.

Facial pores, visible topographic change of skin representing enlarged openings of pilosebaceous follicles, are common aesthetic concern. The aim of this study was to examine the efficacy of polycaprolactone (PCL) filler on enlarged facial pores and skin texture improvement. A total of seven participants with enlarged facial pores were included in the study and underwent deep dermal injection of PCL based filler (Ellanse M, Sinclair Pharma; London, United Kingdom). Skin quality measurements including skin evenness, red areas, UV spots, wrinkles and pore numbers evaluated with an automated aesthetic camera (FotoFinder®, Teach Screen Systems software GmbH; Bad Birnbach, Germany) before and 3 months after the injection session. Adverse events during procedure were monitored and recorded. Subjects were asked to report any injection related side effects. The average size of enlarged pores was 33.51 ± 41 before treatment and 20.51 ± 35 after treatment. The difference was statistically significant (P < 0.05). The skin evenness, red areas, UV spots, and wrinkles showed no significant improvement after filler injection. No serious adverse events were reported at follow-up visit. The PCL based filler seems to be notably effective in improvement of enlarged facial pores especially in moderate to severe cases. However, further structured studies with larger sample size and control group could be more beneficial to elucidate the possible efficacy of PCL filler injection on the skin quality characteristics.

A review of reported infectious events following rituximab therapy in pemphigus patients.

Pemphigus is a rare autoimmune blistering condition that used to be fatal before the introduction of corticosteroid (CS) and immunosuppressive agents. Rituximab is a monoclonal anti-CD-20 antibody that induces the pathologic B-cells apoptosis with significant efficacy in the treatment of pemphigus. The application of rituximab can lead to infectious events. We aim to review the reported infectious events in pemphigus patients who previously received rituximab and classify them based on the causative agents. A thorough search of PubMed was conducted using the keywords "rituximab," "pemphigus," "infection," "viral disease," "viral infection," "complication," "efficacy" and their combinations also applying their equivalent Mesh terms and including the references cited in each study. All studies that mentioned at least one infectious event were included. A total of 77 infectious events in 68 patients were reported in the literature out of which the most reported causative agent was viral but the most fatal one found to be bacterial. Although rituximab therapy has shown promising results in controlling pemphigus patients mainly the refractory cases, given possible fatal outcomes, we believe the medical profile of the patients before initiating the therapy warrants careful examination to search for any risk factors or predisposing conditions.

Laser treatment of benign melanocytic lesion: a review.

Treatment of pigmented lesions is one of the major challenges of laser and cosmetic practitioners. The most common pigmented lesions that are treated by lasers are melanocytic nevi, ephelides, solar lentigines, and café au lait macules. Melanin absorbs different wavelengths (500-1100 nm); thereby, treatment of various pigmented lesions requires the application of lasers with different wavelengths. Choosing the most appropriate type of laser depends on various factors such as the chromophore and the location of a specific lesion in the skin. In this paper, we aim to review the most efficient laser treatment protocols for each pigmented skin lesion and compare their efficacy in each part based on the previous studies.

Ivermectin Increases Random-Pattern Skin Flap Survival in Rats: The Novel Role of GABAergic System.

BACKGROUND: Ivermectin (IVM) was first used as an antiparasitic agent; however, the role of this drug evolved into a broad spectrum. Many mechanisms have been proposed, including interaction with the GABAergic system. Considering the presence of GABA receptor in the skin tissue and its role in ischemia-reperfusion I/R injury, we aimed to evaluate the effect of IVM through GABA receptors on random-pattern skin flap survival. METHODS: Sixty Wistar male rats were used. Multiple doses of IVM (0.01, 0.05, 0.2, and 0.5 mg/kg) were injected intraperitoneally before the surgery. Baclofen (selective GABAB agonist) and bicuculline (selective GABAA antagonist) were administered in combination with IVM to assess the role of the GABAergic system. Histopathological evaluations, immunohistochemical staining, quantitative assessment of IL-1ß and TNFα, and the expression of GABAA α1 subunit and GABAB R1 receptors were evaluated in the skin tissue. RESULTS: IVM 0.05 mg/kg could significantly increase flap survival compared with the control group (P < 0.001). Subeffective dose of baclofen (0.1 mg/kg) had synergistic effect with the subeffective dose of IVM (0.01 mg/kg) (P < 0.001), whereas bicuculline 1 mg/kg reversed the effect of IVM (0.05 mg/kg) (P < 0.001). IVM 0.05 mg/kg could also decrease the IL-1ß and TNFα levels and increase the expression of GABAA α1 subunit and GABAB R1 receptors in the flap tissue compared with the control group. CONCLUSIONS: IVM could improve skin flap survival, probably mediated by the GABAergic pathway. Both GABAA and GABAB receptors are involved in this process. This finding may repurpose the use of old drug, "Ivermectin."

Efficacy and safety of cryotherapy, electrodesiccation, CO2 laser, and Er:YAG laser in the treatment of seborrheic keratosis.

Seborrheic keratosis (SK) is a common benign skin epidermal lesion. Different treatment modalities have been proposed for this lesion. This study aimed to compare the efficacy and safety of electrodesiccation, cryotherapy, CO2 laser, and Er:YAG laser in the treatment of SK. The study was carried out on 30 patients each with four similar facial SKs. Each lesion was assigned to be treated with cryotherapy, electrodesiccation, CO2 laser, and Er:YAG laser in a random fashion. Therapeutic results were evaluated 8 weeks after the interventions through clinical and dermatoscopic assessment. Treatment improvement criteria for each lesion included the texture of the lesion, severity of the pigmentation, and an overall assessment of the healing. The severity of burning, pain, erythema, and the duration of the erythema after the procedures were documented. A survey of the patients' satisfaction with the treatments was also performed. In the assessment of overall lesion healing by two dermatologists, the improvement rate was significantly higher in the CO2, Er:YAG lasers and electrodesiccation group compared to the cryotherapy (p < 0.001). However, the CO2 and Er:YAG laser and the electrodesiccation groups showed no significant difference (p > 0.05). Moreover, no significant difference was observed in posttreatment pigmentation and texture between the groups (p > 0.05). The pain and burning severity after the interventions were negligible in all four groups. Prolonged erythema was not observed in any of the cases; however, the duration of erythema in the Er:YAG laser group was significantly longer (p < 0.001). Patient satisfaction in the cryotherapy group was significantly lower than the other three groups (p < 0.001). The efficacy of treatment and patient satisfaction rate is highly comparable between electrodesiccation, CO2 laser, and Er:YAG laser but significantly higher than cryotherapy.

Evaluation of serum level of sex hormones in women with frontal fibrosing alopecia in comparison to healthy controls.

The pathogenesis of frontal fibrosing alopecia (FFA) is still unknown while hormonal factors have been postulated to play a role. There is scarce evidence with divergent results on the role of sex hormones in FFA. To evaluate the possible association between sex hormone levels and FFA, this study included 30 female cases of FFA and 34 healthy controls. Serum free testosterone, dehydroepiandrosterone sulfate (DHEAS), Luteinizing hormone (LH), follicle-stimulating hormone (FSH), 17-OH progesterone, androstenedione, and prolactin levels were measured in all subjects. Median and interquartile ranges of DHEAS and androstenedione were 79.26 (52.91-195.50) and 1.41 (0.90-2.29) in patients and 152.34 (81.72-218.63) and 2.31 (1.54-2.84) in healthy controls, respectively. The serum levels of DHEAS and androstenedione were significantly lower in FFA patients in comparison with healthy controls (P-value = .038 and .012, respectively). There were no significant differences in serum levels of free testosterone, LH, FSH, 17-OH progesterone, and prolactin between the FFA group and the control group The lower serum levels of DHEAS and androstenedione in FFA patients compared to controls is supporting a new growing concept of the low androgen level theory in the pathogenesis FFA, while the exact mechanism, clinical significance, and also the potential therapeutic effects of these hormones in FFA remain to be determined in future studies.

Efficacy and safety of long pulse Nd:YAG laser versus fractional erbium:YAG laser in the treatment of facial skin wrinkles.

Fractional lasers such erbium:YAG (Er:YAG) are among popular options for facial rejuvenation. Lasers with infrared wavelength ranges such as long pulse Nd:YAG have been used in nonablative rejuvenation of skin with variable outcomes. In this study, we plan to compare safety and efficacy of fractional Er:YAG and long pulse Nd:YAG for facial rejuvenation applying objective and subjective measurements. Twenty-five patients with Glogau photo aging scale of II to IV were recruited in this randomized face-split double-blind controlled trial. Individuals received three monthly treatments on two sides of the face; one side was treated by fractional Er:YAG laser and the other side by long pulse Nd:YAG laser. Outcomes were evaluated by two blinded dermatologists, patient satisfaction reports and objective measurements of cutaneous resonance running time (CRRT). Both modalities significantly improved periorbital wrinkling, nasolabial folds, dyschromia and skin laxity, and sagging of jowls (p value < 0.05), with no noticeable difference between two lasers. Mean CRRT values decreased significantly after treatment with both lasers. The downtime was significantly lower for the Nd:YAG-treated side. Fractional Er:YAG laser and long pulse Nd:YAG has comparable effects in facial rejuvenation but little to no downtime of the latter makes it popular for many patients. ClinicalTrials.gov Identifier: IRCT2015120320468N3.

Atypical Cutaneous Mucinosis Treated with Intravenous Immunoglobulin and Corticosteroid.

FA 25-year-old man presented with a 12-month history of progressive skin lesions involving the face, upper areas of the trunk, arms, and natal cleft. There was moderate pruritus, disfiguring lesions of the face, and mild arthralgia. No therapy had been applied before the referral to our clinic. On physical examination, there were skin-colored nodules on the face (Figure 1A), along with multiple firm subcutaneous nodules and tumors with a fairly symmetrical distribution on the extensor surface of the hands and forearms (Figure 2A). Dense papular lesions were found on the upper part of the back (Figure 3A). There was also a waxy infiltrated plaque in the natal cleft area (Figure 4A).

The role of Toll-like receptors (TLRs) in stroke.

Toll-like receptors (TLRs) recognizing the exogenous pathogen-associated molecular patterns (PAMPs) are part of the innate immune system that plays a role in various challenging interactions between the neurons and the immune system. Stroke as a major injury to the central nervous system (CNS) is one of the hot points of such cross-talk. The various roles of the different types of TLRs in stroke can be classified into three major categories: (1) the hazardous effect of TLRs with a focus on the part in poststroke neurodegeneration, (2) the beneficial effect of those types of TLRs that exert a neuroprotective effect following an ischemic insult, and (3) the role of TLRs in immunomodulation on one hand and the possible autoimmunity as a consequence of neuronal injury due to an ischemic attack on the other hand. However, the mentioned functions of TLRs, similar to many other parts of the immune system, might overlap in many aspects. The current review article, including both experimental and clinical studies, is an attempt to bring together the studies that have investigated the roles of TLRs in stroke while referring to the apparent controversies in this field, with pointing out the new ideas for further considerations.