Therapeutic effects of topical cetirizine in the treatment of female pattern hair loss: a randomized controlled noninferiority trial.

BACKGROUND: Female pattern hair loss (FPHL) is the most prevalent form of hair loss in women. It was aimed to evaluate the therapeutic effects of topical cetirizine 1%, versus topical minoxidil 2% in patients with FPHL. RESEARCH DESIGN AND METHODS: Through a triple-blind randomized clinical trial, 60 women with FPHL were randomly divided into two groups of treatment with topical cetirizine 1% or topical minoxidil 2%. The endpoint was changing in hair loss severity as well as terminal hair density and diameter, according to trichoscopic evaluation. Intention-to-treat analysis was also performed for those who accomplished 3 months of treatment. RESULTS: Both groups showed improvement in hair diameter and density after 6 months; however, the outcome was significant only in the minoxidil group. According to per-protocol analysis, minoxidil was significantly superior to cetirizine in hair density, but not in hair diameter. According to the hair loss severity scales, FPHL was significantly improved in both the cetirizine and minoxidil groups after 6 months of therapy. The dropout rate due to adverse effects was 10.0% and 6.6% in the cetirizine and minoxidil groups, respectively. CONCLUSION: Although inferior to topical minoxidil, topical cetirizine can provide favorable therapeutic effects for FPHL, specifically when patient incompatibility with Minoxidil is observed. TRIAL REGISTRATION: The study is registered in the Iranian Registry of Clinical Trials (IRCT) with the registration code IRCT20200521047536N1.

Treatment of basal cell carcinoma with intralesional interferon alfa-2b: an open-label clinical trial.

INTRODUCTION: Basal cell carcinoma (BCC) is the most common cutaneous cancer. We report the efficacy and aesthetic outcome of intralesional IFN-α 2b injection for the treatment of BCC and compare with the surgical method. MATERIALS AND METHODS: Intralesional IFN-α 2b was injected in 58 BCC lesions from 20 patients three times a week for three weeks. Control group was retrospectively selected among patients who underwent surgical method (standard surgical excision) for BCC including 58 lesions from 24 patients. All patients were followed up for one year in terms of recurrence and cosmetic outcome. RESULTS: Two patients (four lesions) failed to complete the treatment period. After three weeks, 40 (68.96%) lesions were completely cured. Nine (15.51%) lesions achieved complete healing in less than 9 sessions. Five (8.62%) lesions were completely cured by an extra week of injection. In aggregate, complete healing was observed in 54 (93.10%) lesions. In the surgery group, complete lesion elimination was detected in 52 (89.65%) lesions (p = 0.40). After one year, cosmetic outcome was significantly more favorable in the study group compared to the surgery group (p = 0.003). Recurrence was not detected in any of the groups after one year follow-up. CONCLUSION: Intralesional IFN-α 2b injection is an appropriate treatment choice for BCC. CLINICAL TRIAL REGISTRY: We used Iranian registery of Clinical trials; The IRCT code is: 2017093017756N30.

Quality of Life, Body Image and Personality Traits Among Women Receiving Botulinum Toxin Type a for Cosmetic Purposes.

BACKGROUND: The demand for minimally invasive cosmetic procedures has rampantly increased in recent decades. The aim of this study was to evaluate the body image, personality traits and quality of life (QoL) in women consuming botulinum toxin type A for cosmetic purposes. METHODS: This case-control study was conducted on 89 participants referring to outpatient dermatology clinics in Mashhad from 2019 to 2021. All participants completed a checklist of demographic and clinical characteristics, as well as three other questionnaires, including the World-Health-Organization Quality of Life-Short Form, Big 5 Inventory-10 (BFI-10) and Yale-Brown Obsessive-Compulsive Scale modified for body dysmorphic disorder (Y-BOCS-BDD). A control group of 101 sex and age-matched people from the general population also completed the questionnaires online. RESULTS: All participants were females, and most of them in the case group were 31-50 years old (n = 68, 77.1%). Among the case group, QoL was reported higher in all domains; however, this was only significant in 'physical' (P = 0.003) and 'psychological' (P = 0.036) aspects. After considering the confounding factors, the case group was able to significantly predict increased QoL in the 'physical' (P = 0.019) and 'environmental' (P = 0.015) domains. In terms of BFI-10 scores, conscientiousness was notably higher among the case group (P < 0.001), while the control group scored slightly but significantly higher than the case group in neuroticism (P = 0.019). The control group scored significantly higher in Y-BOCS-BDD (P < 0.001). CONCLUSIONS: In clients receiving botulinum toxin injection for cosmetic purposes, QoL was higher than in the control group. No signs of body dysmorphia or pathological personality traits were found in these individuals. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluating the effect of oral clarithromycin on acute cutaneous leishmaniasis lesions compared with systemic glucantime.

BACKGROUND AND AIM: It is widely accepted that the high prevalence of leishmaniasis, demands the search for a tolerable effective treatment with the least side effects. This study aimed to evaluate the effect of treatment with clarithromycin on regression of lesions. MATERIALS AND METHODS: This study was performed on 20 patients with leishmaniasis referred to dermatology clinic in 2017-2018. They were divided into two groups of intervention (500 mg oral clarithromycin twice a day) and control (20 mg/kg/day systematic glucantime). Induration size of lesions was recorded. RESULTS: We had 20 patients with acute cutaneous leishmaniasis (CL) with 45 lesions in the control group and 49 lesions in the intervention group. In the control group, the mean number of lesions was 3 ± 2.8 and 5 ± 4.3 in each person in the control and intervention group (p=.63). The mean size of the largest diameter of lesions' induration at the beginning of the treatment was 19.81 ± 13 and 15.47 ± 15.6 mm in control and intervention group (p=.3) which changed to 1.59 and 0 respectively in three months after the treatment (p=.001). CONCLUSIONS: We concluded oral clarithromycin had therapeutic effects on acute CL similar to systematic glucantime and could be considered as a safe and effective treatment option.

A Preliminary Study on the Therapeutic Effects of Hydroxychloroquine on Generalized Vitiligo.

Vitiligo is a recalcitrant depigmentary autoimmune skin disorder. Hydroxychloroquine (HCQ) is an effective immunomodulatory drug which is widely used in treatment of autoimmune disorders. HCQ-induced pigmentation has been previously found in patients taking HCQ due to other autoimmune diseases. The present study aimed to determine whether HCQ improves re-pigmentation of generalized vitiligo. HCQ was orally administered 400 mg daily (6.5 mg/Kg of body weight) by 15 patients with generalized vitiligo (more than 10% involvement of body surface area) for three months. Patients were evaluated monthly and skin re-pigmentation was assessed using the Vitiligo Area Scoring Index (VASI). Laboratory data were obtained and repeated monthly. Fifteen patients (12 women and 3 men) with a mean age of 30.13±12.75 years were studied. After 3 months, the extent of re-pigmentation on all the body regions, including the upper extremities, hands, trunk, lower extremities, feet, and head and neck was significantly higher than the baseline (P value <0.001, 0.016, 0.029, <0.001, 0.006, 0.006, respectively). Patients with concomitant autoimmune diseases had significantly more re-pigmentation compared with others (P=0.020). No irregular laboratory data were observed during the study. HCQ could be an effective treatment for generalized vitiligo. The benefits are likely to be more evident in case of concomitant autoimmune disease. The authors recommend additional large-scale controlled studies to draw further conclusions.

A randomized clinical trial on therapeutic effects of 0.25 mg oral minoxidil tablets on treatment of female pattern hair loss.

Topical minoxidil solution is recommended treatment for female pattern hair loss. However, some complications, such as skin allergies, have prevented some patients from completely receiving this treatment. This study intends to evaluate the therapeutic and side effects of oral minoxidil 0.25 mg tablets treatment on FPHL and compare it with conventional treatment of 2% topical minoxidil. This study is a triple-blind randomized clinical trial in which 72 women with FPHL were treated as two separate groups. Group 1 was treated with oral minoxidil 0.25 mg tablets and topical placebo solution, while topical minoxidil solutions and oral placebo tablets were used to treat group 2 patients. In the oral minoxidil group, the average hair diameter and hair density after the 9-month treatment reached from 0.044 mm and 102 per cm2 to 0.048 mm and 115 per cm2 , respectively. In the topical minoxidil group, the average hair diameter and hair density from initial values of 0.044 mm and 107 per cm2 increased to 0.047 mm and 113 per cm2 . In both groups, the changes of hair diameter and hair density were significant compared to initial values (p < 0.001), while the trend of changes was not statically different between the two groups (p = 0.077, p = 0.674 for hair diameter and hair density, respectively) and side effects were trivial. In conclusion, oral minoxidil is an effective and new treatment for FPHL, even with a minimal dose, which can be used as an alternative treatment, especially for patients with poor compliance against topical minoxidil.

Evaluation of High-Efficiency Image Coding algorithm for dermatology images in teledermatology.

BACKGROUND: Currently, teledermatology assumes a progressively greater role in the modern healthcare system, especially in consultation, diagnosis, or examining lesions and skin cancers. One of the major challenges facing teledermatology systems is determining the optimal image compression method to efficiently reduce the space needed for electronic storage and data transmission. OBJECTIVE: To the objective and subjective assessment of HEIC compression method on dermatological color images and benchmarking the performance of High-Efficiency Image Coding (HEIC) with different algorithms to a feasibility study of the method for teledermatology. METHODS: Twenty-five clinical and five skin histopathology images were taken in department of dermatology, Imam Reza Hospital, Mashhad, Iran. For each image, a set of 24 compressed images with different compression rates, which is composed of eight JPEG, eight JPEG2000, and eight HEIC images, has been prepared. Compressed and original images were shown simultaneously to three dermatologists and one dermatopathologist with different experiences. Each dermatologist scored quality and suitability of compressed images for diagnostic, as well as educational/scientific purposes. An objective evaluation was performed by calculating the mean "distance" of pixel colors and peak signal-to-noise ratio (PSNR). RESULTS: All compression rates for HEIC were objectively better than JPEG and JPEG2000, particularly at PSNR. Moreover, mean "color distance" per pixel for compressed images using HEIC was lower than others. The subjective image quality assessment also confirms the results of objective evaluation. In both educational and clinical diagnostic applications, HEIC compressed images have the highest score. CONCLUSION: In consideration of objective and subjective evaluation, the HEIC algorithm represents an optimal performance in dermatology images compression compared with JPEG and JPEG2000.

The effect of oral miltefosine in treatment of antimoniate resistant anthroponotic cutaneous leishmaniasis: An uncontrolled clinical trial.

BACKGROUND: Recent circumstantial evidence suggests increasing number of Iranian patients with cutaneous leishmaniasis (CL) who are unresponsive to meglumine antimoniate (MA), the first line of treatment in Iran. Oral meltifosine was previously reported to be effective in visceral leishmaniasis as well CL. The current study is designed to determine efficacy and safety of oral miltefosine for the treatment of anthroponotic cutaneous leishmaniasis (ACL) cases who were refractory to MA in Iran. METHODOLOGY/PRINCIPAL FINDINGS: Miltefosine was orally administered for 27 patients with MA resistant ACL with approved L.tropica infection, at a dosage of ∼2.5 mg/kg daily for 28 days. Patients were evaluated on day 14 and 28, as well as 3, 6 and 12 month post treatment follow up sessions. Laboratory data were performed and repeated at each visit. Data were analyzed using SPSS version 17. Twenty-seven patients including 16 men (59.25%) and 11 women (40.74%) with mean age of 28.56 ± 4.8 (range 3-54 years old) were enrolled. Total number of lesions were 42 (1-4 in each patient). Most of lesions were on face (76.19%). Mean lesions' induration size was 2.38 ± 0.73 cm at the base-line which significantly decreased to1.31 ± 0.58 cm and 0.61 ±0.49 cm after 14 and 28 days of therapy, respectively (p value <0.05). At 12-months follow-up post treatment, 22 patients had definite/partial cure (81.48%) including 17 definitely cured patients, corresponding to a cure rate of 68% on per protocol analysis, and 62.96% according to intention to treat analysis. Recurrence of lesion was only occurred in one patient (3.70%). Nausea was the most subjective complication during the therapy (33.33%). CONCLUSION: Oral miltefosine could be an effective alternative for the treatment of MA-resistant ACL.

Evaluating the efficacy and safety of vascular IPL for treatment of acute cutaneous leishmaniasis: a randomized controlled trial.

Treatment of cutaneous leishmaniasis (CL) continues to be a health concern, and alternative therapies with fewer side effects are substantially needed. This study aimed to determine the efficacy of intense pulsed light (IPL) with wavelength spectrum affecting vascular lesions on acute cutaneous leishmaniasis. In this randomized clinical trial study, 30 patients with acute CL were enrolled. Baseline clinical and demographic data were recorded in the checklist after obtaining written informed consent. Patients were randomly allocated to receive either IPL fortnightly (intervention group) or intralesional meglumine antimoniate (MA) weekly (control group) over 10 weeks. Patients were assessed every 2 weeks to determine the size of induration and improvement rate of lesions. Follow-up visits were arranged at 3rd and 6th months. Overall, 15 patients (21 lesions) in the intervention group and 15 patients (22 lesions) in the control group were studied. The size of lesions in the control group was significantly higher at the baseline (P = 0.014) and the second week (P = 0.034), and significantly lower in the eighth week (P = 0.009), compared with the intervention group. The size of lesions in the control group changed during the study (P < 0.001), whereas changes were not significant in the intervention group. The trend of changes in size of lesions was faster in the control group (P < 0.001). More patients in the control group had higher improvement rate at the sixth (P = 0.005) and tenth (P < 0.001) weeks. At the end of study, the cure rate was 35% (7 out of 20 lesions) in intervention group and 81.8% (18 out of 22 lesions) in the control group. Complete response happened earlier in the control group (P < 0.001). None of the lesions that were cured before the tenth week relapsed after 6 months. The frequency of blistering was significantly higher in intervention group (P = 0.001). Our results indicated that IPL with wavelength spectrum affecting vascular lesions was inferior to intralesional MA in treatment of CL. However, it can be considered as a second-line option, especially in patients with limitations for use of MA. Trial registry:  https://www.irct.ir/trial/34246 IRCT20140414017271N5.

Immunomodulatory effects of topical diphencyprone for the treatment of acute urban cutaneous leishmaniasis.

BACKGROUND AND OBJECTIVE: Efficacious and safe treatments are lacking for cutaneous leishmaniasis (CL). This study investigates the efficacy of adding diphencyprone immunotherapy to conventional meglumine antimoniate (MA) treatment for acute urban CL. METHODS: This randomized controlled pilot study included 46 patients with acute CL. They were randomly allocated to receive either combination of diphencyprone immunotherapy with intralesional MA (intervention; N = 23) or intralesional MA alone (control; N = 23) weekly. The size and duration of lesions were measured at the baseline and after that at 4th, 8th, 12th, and 24th weeks. Data were analyzed in SPSS and p < .05 was considered significant. RESULTS: The groups showed no significant difference in duration of lesions, but number of injections was significantly higher in the control group compared with the intervention group (p < .001). Size and induration of lesions was significantly reduced in both groups during the course of study (p < .001). The intervention group showed significantly lower induration of lesions in 4th, 8th, and 12th week compared with controls (p < .05). CONCLUSION: Combination of diphencyprone with MA resulted in earlier resolution of acute CL lesions with a relatively acceptable rate of adverse effects, compared with intralesional MA alone.

Evaluation of desmoglein 1 and 3 autoantibodies in pemphigus vulgaris: correlation with disease severity.

BACKGROUND: Pemphigus is an autoimmune blistering disease of the skin and mucous membranes caused by autoantibodies against desmoglein 1 (Dsg1) and desmoglein 3 (Dsg3). Pemphigus vulgaris (PV) is the most common form of pemphigus. The aim of this study was to assess the correlation between the levels of anti-desmoglein 1 and 3 autoantibodies and the severity of PV disease. MATERIAL AND METHODS: Nineteen newly diagnosed patients with pemphigus vulgaris were enrolled in this study. The titers of Dsg in subjects by using enzyme-linked immunosorbent assay (ELISA) were done at diagnosis time-point, 4th and 8th weeks after the initiation of treatment, and the correlation of antibodies with the oral and skin disease severity was evaluated. RESULTS: The severity of cutaneous lesions was significantly correlated with anti-Dsg1 titer in all visits and the severity of mucosal lesions was correlated with the titer of Dsg3 in the third visit (<0.001, 0.001, 0.016 and 0.015 P value, respectively). CONCLUSIONS: Anti-Dsg-1 autoantibodies titers seem to be more useful in showing the extent of the disease and activity in pemphigus with mucocutaneous lesions. Key words:Pemphigus vulgaris, Desmoglein (Dsg), Enzyme-linked immunosorbent assay (ELISA).

Disseminated phaeohyphomycosis caused by Cyphellophora ludoviensis: A novel case report from Iran.

Disseminated phaeohyphomycosis is a rare and unusual infection that can be caused by dematiaceous fungi. Cyphellophora is an uncommon aetiological agent of cutaneous and systemic fungal infections. This study describes a case of disseminated phaeohyphomycosis caused by C. ludoviensis in Iran. The molecular identification of the isolates was established by DNA sequencing of the internal transcribed spacer (ITS) region of rDNA. The patient was successfully treated with an 8-month course of systemic voriconazole.

Nutritional Intake and Chronicity Associated with the Old World Cutaneous Leishmaniasis: Role of Vitamin A.

BACKGROUND: Old world cutaneous leishmaniasis (CL) is known as a self-healing cutaneous parasitic infection. Host immunity has a fundamental role in the course of this infection. This study was designed to investigate the relationship between nutritional status and vitamin A intake with the clinical course of CL. METHODS: Overall, 250 patients with CL attending a dermatology clinic in Imam Reza Hospital Mashhad, Iran, were enrolled from Apr 2011 to Aug 2012. For data gathering, a semi-quantitative 302-item food frequency questionnaire was utilized. They received routine treatment protocols for leishmaniasis and 1 year of follow-up. RESULTS: As for the 149 patients who completed the study, a deficiency of macro and micronutrients, particularly vitamin A, was significantly related to a chronic clinical disease course. CONCLUSION: Imbalanced or insufficient nutritional intake including vitamin A deficiency, may influence the clinical course of CL.

The effect of UV radiation in the presence of TiO2-NPs on Leishmania major promastigotes.

BACKGROUND: Cutaneous leishmaniasis is a parasitic disease, which is difficult to treat due to high drug resistance and adverse side effects. Photodynamic therapy by ultraviolet radiation using materials with high photocatalytic features like titanium dioxide nanoparticles (TiO2-NPs) is an emerging treatment for this disease. In this study, TiO2-NPs with ultraviolet (UV) radiation were administered as photodynamic therapy against Leishmania Major (LM) promastigotes. METHODS: Two forms of TiO2 viz. including Anatase and Rutile were administered in two UV ranges< UVA and UVB for different time periods (30 and 60 min). Finally, 24 and 48 h after incubation, the MTS test was performed and cell survival percentage was calculated. RESULTS: The mean size of Anatase and Rutile-NPs is approximately 32.5 and 50.9 nm respectively by DLS and FE-SEM, and crystal phase is emphasized by XRD. The combined treatment of LM with TiO2-NPs and UV has significant effects on LM promastigotes, which vary depending on NP and UV types. The synergistic effect was anticipated in the groups irradiated by UV-B in the presence of Rutile NPs. CONCLUSION: The combined treatment with UV- radiation and TiO2-NPs can be effective in killing the promastigotes of Leishmania major. The proper concentration of NPs and the type of UV-radiation must be taken into consideration. The results suggest improved treatment methods, after proper in vivo studies.

Psoralen and narrowband UVB combination provides higher efficacy in treating vitiligo compared with narrowband UVB alone: A randomised clinical trial.

BACKGROUND/OBJECTIVES: Side effects of current treatments and the need for a safe treatment with higher efficiency necessitate seeking new treatment options for vitiligo. Few studies have investigated the combination of psoralen with narrowband ultraviolet B (NBUVB). In this study, we compared the efficacy and safety of psoralen and NBUVB combination (P-NBUVB) with NBUVB alone in treatment of vitiligo. METHODS: This randomised clinical trial was carried out during 2015-2017 in dermatology clinics of Ghaem and Imam Reza hospitals, Mashhad, Iran on 40 vitiligo patients with 5-60% body involvement. The patients were randomly divided into two groups of NBUVB alone and P-NBUVB. Both groups underwent 60 phototherapy sessions (three sessions per week), and the repigmentation rate was measured using vitiligo area severity index (VASI) score. SPSS v. 16 software and appropriate statistical tests were used to analyse the data. P < 0.05 was considered statistically significant. RESULTS: The mean age of patients was 33.9 ± 11.3 years. Twenty patients (50%) were females. The P-NBUVB group showed greater VASI improvement in lower extremities (P = 0.003) and overall (P = 0.026) compared with NBUVB group. Moreover, the treatment response appeared sooner in P-NUVB group. CONCLUSION: Based on our results, we can conclude that adding psoralen to NBUVB phototherapy can result in increased efficacy. However, more studies are needed to evaluate the long-term effects and side effects of this treatment.

Investigation of the relationship between atopy and psoriasis.

INTRODUCTION: The relationship between allergic and autoimmune diseases is an important issue, which has recently attracted the researchers' interest. AIM: To determine the relationship between atopy and psoriasis. MATERIAL AND METHODS: This case-control study was conducted on 102 patients referred to the Ghaem Hospital, Mashhad, Iran, in 2016. The participants were assigned into two groups: experimental and control groups, including the patients suffering from psoriasis and those with no history of cutaneous or other systemic diseases, respectively. Both groups filled in the ISAAC questionnaire and had skin prick tests. In addition, the serum levels of immunoglobulin E (IgE) and blood eosinophil cell count were measured. The data were analysed using the regression test through SPSS version 16. RESULTS: According to the results of the ISAAC questionnaire, there was a significant difference between the control and experimental groups in terms of asthma (p = 0.04). The mean serum concentrations of IgE and eosinophil cell count were not significantly different between the experimental (153.93 IU/ml and 187.77 cells/µl, respectively) and control groups (152.19 IU/ml and 187.68 cells/µl, respectively) (p = 0.057 and p = 0.886, respectively). In addition, there was an indirect correlation between the eosinophil cell count and psoriasis severity (p = 0.032, r = -0.297). Furthermore, the comparison of the skin prick test results revealed no significant difference between the two groups regarding the number of positive and negative cases (p = 0.436). CONCLUSIONS: The findings suggested that atopy was not common in the patients with psoriasis and supported the concept that atopy protects against such autoimmune diseases such as psoriasis.

Fractional CO2 laser treatment for post-surgical lip scars in cleft lip and palate patients.

Post-surgical scars of cleft lip patients can lead to abnormal lip activity, which causes deficient maxillary growth. The aim of the present study was to assess the effect of laser therapy on the appearance and electrical activity of the upper lip in cleft lip and palate patients. Twelve patients with cleft lip and palate participated in this study. All patients had surgically repaired the cleft lip at the age of about 3-6 months. The lip scars underwent five fractional CO2 laser treatment sessions with a 4-week interval. Improvement of the quality of the skin texture was recorded according to quartile grading scale based on photographs taken before and 1 month after treatment. Patients' satisfaction survey was also recorded using Patient Scar Assessment Questionnaire (PSAQ) before and after laser therapy. Moreover, the EMG activity of the upper lip muscle was measured before and after treatment. According to dermatologists, the improvement of scar appearance ranged from 0.5 to 3, with a mean of 1.29 ± 0.86. Mean scores of the scar appearance (p < 0.001), symptoms (p = 0.003), and scar consciousness (p < 0.001) subscales of the PSAQ questionnaire had significantly increased after treatment. The EMG recording of the upper lip had decreased significantly after laser treatment at rest (p = 0.009) and maximum lip compression (p = 0.007). The fractional CO2 laser is an effective method for treating old scars of the cleft lip with a significant change in the opinion of patients about their scar appearance. Also, the therapy can help to reduce the EMG activity of the upper lip at rest.