Efficacy and Tolerability of a Hyaluronic Acid-Based Extracellular Matrix for Labia Majora Rejuvenation and Augmentation: A Pilot Study.

A new injectable solution containing low-molecular-weight hyaluronic acid (HA) and a specific amino acid mixture was formulated with proper aesthetic performance for the main signs of facial skin photoaging. The present study aimed to investigate its new application for rejuvenating and augmenting labia majora using clinical and biometric assessments. Three sessions of intradermal injections were performed using 3 ml of test extracellular matrix (ECM) for 10 eligible post-menopause female subjects (age 53.6 ± 7.93 years). The effectiveness of the intervention was assessed by an independent physician using before-and-after pictures based on the physician's global assessment score. Objective biophysical skin assessments, including skin hydration, skin erythema, and melanin index, as well as elasticity parameters including firmness (R0), gross elasticity (R2), and net elasticity (R5), were also performed before the first injection and then on the 2nd and 12th weeks after the last session. Patients' satisfaction and all reported or observed adverse events were documented. At week 12, all the subjects reported an aesthetic improvement of 25% or more in rejuvenation and sagging of the labia major area. A statistically significant improvement was also detected in R0 and R5 at week 12 (p-values 0.005 and 0.022, respectively). Patient satisfaction surveys revealed a median score of 8 at both follow-up visits. The results showed a new indication of the tested HA ECM for providing a beneficial, durable, rejuvenating effect on the labia majora with a good safety profile.

The Efficacy of IPL in Periorbital Skin Rejuvenation: An Open-Label Study.

Introduction: Intense pulsed light (IPL) is one of the effective methods used to treat the signs of facial aging. However, its efficacy in improving the appearance of periorbital wrinkles has always been evaluated in the context of whole-face rejuvenation and not studied in its own right. Therefore, in this study, we sought to examine the effectiveness and side effects of IPL in periorbital skin rejuvenation. Methods: In this uncontrolled, open-label clinical trial, 38 patients referred to the Behrooz professional skin clinic for signs of periorbital skin aging were recruited. The patients underwent three treatment sessions with IPL at one-month intervals and were evaluated for treatment side effects after each session. Six months after the final IPL session, patients were examined to assess the level of symptom improvement. The patients were photographed at each treatment session and on the 6-month follow-up visit. Before and after treatment, the patient images were evaluated by two dermatologists unaffiliated with the study to determine the extent of improvement in the appearance of wrinkles and skin texture. Results: Six months' post-treatment, excellent improvement was observed in 3 patients (9.1%), considerable improvement in 7 patients (21.2%), moderate improvement in 9 patients (27.3%), mild improvement in 9 patients (27.3%), and finally little or no improvement in 5 patients (15.1%). A comparison of improvement scores based on the Fitzpatrick skin phenotype did not show significant differences (P=0.674). Four patients (12.1%) were dissatisfied with the treatment, whilst 17 patients (51.5%) reported moderate to considerable satisfaction with IPL rejuvenation. Conclusion: During facial rejuvenation, IPL can be used to improve periorbital skin aging.

Comparison of the effects of 665 nm low level diode Laser Hat versus and a combination of 665 nm and 808nm low level diode Laser Scanner of hair growth in androgenic alopecia.

BACKGROUND: This study aimed to evaluate the effectiveness of a combined set of low level diode laser scanner (665 nm and 808nm) on hair growth, and assessment of safety and effectiveness of a new laser scanner on hair growth treatment procedure in androgenic alopecia. METHODS: 90 patients (18 to 70 years) with androgenic alopecia were randomized into three groups. The first group (n=30) received 655 nm red light using laser hat, the second group (n=30) received 655 nm red laser plus 808 nm infrared laser using a laser scanner of hair growth device (with the patent number: 77733) and the third group (n=30) received no laser as the control group. RESULTS: Patients in laser scanner group had better results and showed a higher increase in terminal hair density compared with laser hat group (mean of 9.61 versus 9.16 per cm2). We found significant decrease in terminal hair density from baseline in control group (mean -1.8 per cm2, p<0.0001). CONCLUSION: Results showed a statistically significant improvement in the laser scanner of the hair growth group compared with laser hat and the control group. The study showed that treatment with new laser devise had a promising result without any observable adverse effects.

Blunt Blade Subcision: An Evolution in the Treatment of Atrophic Acne Scars.

BACKGROUND: Subcision is the mainstay of atrophic acne scar treatment but the efficacy and safety of the procedure is controversial. OBJECTIVE: To improve the efficacy of the subcision procedure, a blunt subcision blade was designed and evaluated. METHODS: Eighteen patients with bilateral atrophic acne scars considered eligible for subcision were enrolled. Before subcision, a tumescent solution was injected subdermally to anesthetize the treatment area and aid the dissection of the dermal-subcutaneous tissue. Patients underwent treatment using the blunt subcision blade, a long metal blade with gradually narrowing edges, and a rounded blunt tip. Early postoperative complications, overall aesthetic improvement and persistent discoloration, or lumpiness were assessed 7 days after subcision and at a 6-month follow-up visit. RESULTS: Moderate to marked improvement of atrophic scars was observed in 15 cases (83.3%). Mild to moderate tenderness, periorbital ecchymoses, and swelling were reported by some patients, but resolved completely within 1 week after the procedure. No cases of persistent discoloration or lumpiness were observed at the final visit. CONCLUSION: The blunt blade subcision procedure is suggested as an effective method for the treatment of atrophic acne scars.

Evaluation of safety and efficacy of 980-nm diode laser-assisted lipolysis versus traditional liposuction for submental rejuvenation: A randomized clinical trial.

BACKGROUND: Submental fat accumulation and skin laxity is a frequent concern of cosmetic patients. OBJECTIVE: The aim of this randomized prospective controlled clinical trial was to compare the efficacy and safety of laser-assisted lipolysis and liposuction in the submental rejuvenation. MATERIAL AND METHODS: Thirty-six female adults were enrolled in this clinical trial and were categorized into two groups: group 1 underwent 980-nm diode laser with the power of 6-8 W and group 2 underwent traditional liposuction. Patients were evaluated with ultrasonography 2 weeks and 2 months after the procedures. RESULTS: Ultrasonographic evaluation reported the significant reduction of fat thickness in each group compared with the baseline (p value < 0.001). At the 2 weeks and 2 months follow-up visit, fat thickness reduction was significantly higher in the lipolysis group (p value < 0.05). Overall patients' satisfaction in lipolysis group was higher than liposuction with 11 (61%) of lipolysis patients being very satisfied in contrast to 10 (55.5%) of liposuction patients reporting "dissatisfied or neutral" results. CONCLUSION: Laser-assisted lipolysis using 980-nm diode is approved to be safe and effective for skin tightening and rejuvenation of the submental area and seems to be a better option than traditional techniques for treatment of this cosmetic problem.

Nasal alar necrosis following hyaluronic Acid injection into nasolabial folds: a case report.

Injection of synthetic fillers for soft tissue augmentation is increasing over the last decade. One of the most common materials used is hyaluronic acid (HA) that is safe and temporary filler for soft tissue augmentation. We present a case of 54-year-old female who experienced vascular occlusion and nasal alar necrosis following HA injection to the nasolabial folds. She suffered from pain, necrosis, infection, and alar loss that finally required a reconstructive surgery for cosmetic appearance of the nose. The case highlights the importance of proper injection technique by an anesthesiologist, as well as the need for immediate recognition and treatment of vascular occlusion.

Herbal Extracts Induce Dermal Papilla Cell Proliferation of Human Hair Follicles.

BACKGROUND: The number of people suffering from balding or hair thinning is increasing, despite the advances in various medical therapies. Therefore, it is highly important to develop new therapies to inhibit balding and increase hair proliferation. OBJECTIVE: We investigated the effects of herbal extracts commonly used for improving balding in traditional medicine to identify potential agents for hair proliferation. METHODS: The expression levels of 5α-reductase isoforms (type I and II) were analyzed using quantitative real-time reverse transcription polymerase chain reaction in the human follicular dermal papilla cells (DPCs). The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenylteterazolium bromide and bromodeoxyuridine tests were used to evaluate the cell proliferation effect of herbal extracts in DPCs. The expression levels of extracellular signal-regulated kinase (ERK), Akt, cyclin D1, cyclin-dependent kinase 4 (Cdk4), B-cell lymphoma (Bcl-2) and Bcl-2-associated X protein (Bax) were measured using western blot analysis. RESULTS: The 5α-reductase isoform mRNAs and proteins were detected in the cultured DPCs, and the expression level of 5α-R2 in DPCs in the presence of the herbal extracts was gradually decreased. Herbal extracts were found to significantly increase the proliferation of human DPCs at concentrations ranging from 1.5% to 4.5%. These results show that the herbal extracts tested affected the protein expressions of ERK, Akt, cyclin D1, Cdk4, Bcl-2, and Bax in DPCs. CONCLUSION: These results suggest that herbal extracts exert positive effects on hair proliferation via ERK, Akt, cyclin D1, and Cdk4 signaling in DPCs; they also suggest that herbal extracts could be a great alternative therapy for increasing hair proliferation.

Effect of Arnebia euchroma ointment on post-laser wound healing in rats.

INTRODUCTION: Arnebia euchroma ointment has been used in Iranian Traditional Medicine for burn wound healing. The aim of this study is to evaluate wound healing efficacy of A. euchroma ointment on wounds induced after fractional CO2 laser in rats. MATERIAL AND METHODS: In this study, after anesthetizing two bilateral burn wounds were induced on dorsal skin of the rat using fractional ablative CO2 laser. After applying laser, A. euchroma ointment, petrolatum, and silver sulfadiazine cream were used topically on wounds twice daily for 10 days. Digital photographs were captured from the wound surfaces every day. At the end of the study, two blinded dermatologists observed the photograph of 3rd, 5th, 7th, and 9th days after laser injury and assessed erythema, crusting/scabbing, epithelial confluence, and general wound appearance to determine the efficacy of wound healing. These wound-healing parameters were assessed using the 5-point scales. RESULTS: This study showed significantly less erythema and crusting (P = 0.024 and P = 0.004, respectively) on 9th day and higher epithelial confluence and general wound appearance scores on 7th (P = 0.037 and p = 0.016, respectively) and 9th days (P = 0.008 and P = 0.016, respectively) in A. euchroma ointment compared with other groups. CONCLUSION: This study showed A. euchroma ointment has good healing effects on post-laser wounds in rats.

Multifocal epithelial hyperplasia: report of 3 cases.

Multifocal epithelial hyperplasia (MEH) is a rare disorder characterized by multiple painless discrete and soft flattened papules on the oral mucosa. It is caused by human papilloma virus 13 and 32. The frequency of this disease varies widely from one geographic region to another. Generally it is very rare in Asia. Herein we report 3 Iranian cases with oral lesions, which showed clinical and histopathological characteristics of MEH disease. Two of them were siblings and HPV13 was detected in one of the patients.

Low-power fractional CO2 laser versus low-fluence Q-switch 1,064 nm Nd:YAG laser for treatment of melasma: a randomized, controlled, split-face study.

BACKGROUND: Various laser treatments are currently available for melasma but their use remains challenging because of potential side effects. OBJECTIVE: The aim of this randomized controlled study was to compare the efficacy and safety of low-fluence Q-switch 1,064 nm Nd:YAG and low-power fractional CO2 laser using a split-face design. MATERIALS AND METHODS: A total of 40 female patients with symmetric melasma were enrolled to the study and each side of their face was randomly allocated to either low-fluence Q-switch 1,064 nm Nd:YAG or low-power fractional CO2 laser. They were treated every 3 weeks for five consecutive sessions and followed for 2 months after the last treatment session. Response to treatment was assessed using the Melanin Index (MI) score, modified Melasma Area and Severity Index (mMASI) score, and a subjective self-assessment method. RESULTS: At the 2-month follow-up visit, both sides of the face had statistically significant reductions in the MI and mMASI scores compared with the first visit (p < 0.001). The differences between the mean MI and mMASI scores at baseline and at 2-month follow-up were compared between the two treatments and results showed that the reduction of MI and mMASI score in the fractional CO2 laser-treated side was significantly more than on the Q-switch 1,064 nm Nd:YAG laser-treated side (p < 0.001). There were no significant adverse effects with either of the laser treatments. CONCLUSION: The present study shows that low-power fractional CO2 laser is safe and effective and can be considered as a valuable approach in the treatment of melasma.

Comparing the Healing Effects of Arnebia euchroma Ointment With Petrolatum on the Ulcers Caused by Fractional CO2 Laser: A Single-Blinded Clinical Trial.

BACKGROUND: Arnebia euchroma ointment (AEO) has been used in Iranian traditional medicine for burn wound healing. OBJECTIVES: The aim of this study is to evaluate wound healing efficacy of AEO in burn wounds after fractional Co2 laser. PATIENTS AND METHODS: This split-face, single-blinded, single-center clinical study was performed in Shohada-e-Tajrish Hospital, Tehran, Iran. A total of 26 subjects with facial acne scar, who were to receive fractional CO2 laser resurfacing were recruited. After laser procedure, AEO was applied to one side of the face and petrolatum on the other side for wound healing. Digital photographs were taken from acne scar area before resurfacing and on each of the assessment sessions. Three researchers, who were unaware of the applied medications, assessed these digital photographs for erythema, edema, epithelial confluence, crusting/scabbing, and general wound appearance. Subject's irritations such as dryness and itching were evaluated on the second, fifth, and seventh days. RESULTS: Our study indicated higher epithelial confluence and general wound appearance scores (P = 0.045 for both) and less erythema and edema on fifth day in petrolatum (P = 0.009 and P = 0.034, respectively). The results showed less crusting and erythema (P = 0.016 and P = 0.035, respectively) and higher general wound appearance scores in petrolatum on the second day (P = 0.035 and P = 0.001, respectively). Dryness was the most common subjective complaint in both groups; however, it was more severe in AEO, especially on the second day (P = 0.023). CONCLUSIONS: Despite the healing effects of AEO in burn wounds, petrolatum was more effective than AEO in post-laser wound.

Combination of herbal extracts and platelet-rich plasma induced dermal papilla cell proliferation: involvement of ERK and Akt pathways.

BACKGROUND AND AIMS: Recently, platelet-rich plasma (PRP) has attracted attention in various medical fields, including plastic surgery, treatment for problematic wounds, and dermatology. Specifically, PRP has been tested during hair transplantation to reduce swelling and pain and to increase hair density. We examined the effects of PRP and herbal extracts combination in order to identify potential stimulants of hair growth. METHODS: PRP was prepared using the double-spin method and applied to dermal papilla cells (DPCs). MTT viability test and BrdU cell proliferation assay were used to study the effect of herbal extracts and PRP on proliferation of DPCs. To understand the mechanisms of herbal extracts and PRP involved in the regulation of hair growth, we evaluated signaling pathways and measured the expressions of ERK and Akt, by Western blot. RESULTS: Combination of herbal extracts and PRP was found to induce significant proliferation of human DPCs at concentrations ranging from 1.5% to 4.5%. The present study shows that herbal extracts and PRP affect the expressions of extracellular signal-regulated kinase (ERK) and Akt in DPCs. CONCLUSION: In this study, we have shown that combination of herbal extracts and PRP plays an active role in promoting the proliferation of human dermal papilla (DP) cells via the regulation of ERK and Akt proteins, and this may be applicable to the future development of herbal extracts and PRP combination therapeutics to enhance hair growth.

Focal high-concentration trichloroacetic acid peeling for treatment of atrophic facial chickenpox scar: an open-label study.

BACKGROUND: Despite their prevalence, there is a paucity of information in the medical literature on the treatment of atrophic chickenpox scars. OBJECTIVE: To evaluate the efficacy and safety of using the chemical reconstruction of skin scar technique for the treatment of atrophic facial chickenpox scars. METHODS AND MATERIALS: One hundred patients (mean age 23 years; Fitzpatrick skin types II-IV) were treated with focal chemical peeling with 70% trichloroacetic acid (TCA) for a maximum of six sessions. Improvement rate, frequency of adverse events and patient satisfaction were assessed. RESULTS: Five hundred thirty-three peeling sessions in 100 consecutive patients were performed. Final assessment at 12-week follow-up visit after the last treatment revealed improvement in 95% of patients: mild improvement in 12 cases, moderate improvement in 42 cases, and marked improvement in 41 cases. The appearance of scars did not change in five patients. Seventy-nine patients expressed moderate to high satisfaction with the results. Post-treatment side effects were mild and transient, resolving gradually within the study period. CONCLUSION: Focal peeling with high-concentration TCA appears to be a safe and effective alternative in the treatment of atrophic facial chickenpox scars.

Uric Acid: a new antioxidant in patients with pemphigus vulgaris.

BACKGROUND: Increased reactive oxygen species (ROS) and lipid peroxidation are seen in many dermatologic disorders, for example, atopic dermatitis, psoriasis, vitiligo, acne vulgaris, pemphigus vulgaris (PV), lichen planus, and alopecia areata. ROS has an important role in the inflammation process. In PV, increased production of ROS leads to decline of antioxidants in plasma and red blood cells which results in oxidative stress. We aimed to evaluate the level of these antioxidants in PV patients and compare it to the controls. MATERIALS AND METHODS: Among patients attending the dermatology clinics, 30 patients with PV, who had never been on treatment, were enrolled to the study. The control group consisted of 30 age- and sex-matched healthy non-smoker individuals. Venous blood was collected from the subjects for the evaluation of plasma levels of glutathione peroxidase, vitamin C, selenium, bilirubin, and uric acid. RESULTS: Age mean and standard deviation of the patients (40.83, 12.74) was comparable to the controls (41.96, 13.08). Mean level of uric acid was significantly lower in PV patients compared to the controls (P = 0.006). Other antioxidants were not different between the two groups. Uric acid of the patients with mucosal involvement was significantly lower than patients with mucocutaneous involvement (P = 0.049). LIMITATIONS: The blood level of other antioxidants (e.g. malondialdehyde) was not evaluated. CONCLUSIONS: Uric acid as an antioxidant in our study had similar changes to previous studies in the field of other diseases but selenium, bilirubin, and glutathione peroxidase did not differ between patients and controls.

Darier disease associated with HIV infection: a case report.

AIDS is characterized with immune dysregulation and depletion of CD4+ T cells and increased vulnerability to different pathological conditions, including many dermatoses. The present report describes features of Darier disease (DD) in an HIV-positive patient. The subject of this report was a 45-year old Ghanaian man referred to the dermatology unit of the Iranian Red Crescent Society in Accra, Ghana. He presented with numerous follicular keratotic red-brown papules on the scalp, face, retroauricular regions, ears, sternum, upper trunk, hands, axilla, and inguinal regions. The lesions first appeared on the dorsal surface of the hands and face and subsequently appeared on the other parts of the body including the outline of the scalp. This is the first report of DD in the setting of HIV infection. Significant features of this case associated with HIV in comparison with non-HIV cases are negative family history of DD, late onset, and wide distribution of the disease without abnormality on the nails and mucous membranes beginning a few years after involvement with HIV virus.