Antidepressant effects of citalopram on treatment of alopecia areata in patients with major depressive disorder.

OBJECTIVE: The authors sought to determine whether antidepressant therapy could enhance the efficacy of dermatological treatment in alopecia areata patients who suffer from major depressive disorder. METHODS: Sixty patients were enrolled in the study. Thirty patients with alopecia who were diagnosed with major depressive disorder received 20 mg/day citalopram and 5 mg/mL triamcinolone injection every 4 weeks, up to six injections, and 30 patients received only triamcinolone injection each month for 6 months using a simple random method. RESULTS: The mean diameter of the alopecic patches in the triamcinolone injection only group as against the combined treatment group (psychiatric [citalopram] plus dermatologic treatment) before treatment was 2.7 ± 0.7 (mean ± SD) and 2.5 ± 1.8, respectively, with no statistically significant differences (Mann-Whitney, p = 0.08). After 6 months of therapy, the mean diameter of patches reached 1.6 ± 1 and 0.54 ± 0.97 in the triamcinolone injection only group and the combined treatment groups, respectively (Mann-Whitney, p < 0.0001). DISCUSSION: The results of this study showed that antidepressant treatment might help in improving alopecia areata in patients with major depressive disorder.

Loss of expression of TGF-ßs and their receptors in chronic skin lesions induced by sulfur mustard as compared with chronic contact dermatitis patients.

BACKGROUND: Sulfur mustard (SM) is a blister-forming agent that has been used as a chemical weapon. Sulfur mustard can cause damage in various organs, especially the skin, respiratory system, and eyes. Generally, the multiple complications of mustard gas result from its alkalizing potency; it reacts with cellular components like DNA, RNA, proteins, and lipid membranes.TGF-ß is a multi-functional cytokine with multiple biological effects ranging from cell differentiation and growth inhibition to extracellular matrix stimulation, immunosuppression, and immunomodulation. TGF-ß has 3 isoforms (TGF-ß 1, 2, 3) and its signaling is mediated by its receptors: R1, R2 and intracellular Smads molecules.TGF-ß has been shown to have anti-inflammatory effects. TGF-ßs and their receptors also have an important role in modulation of skin inflammation, proliferation of epidermal cells, and wound healing, and they have been implicated in different types of skin inflammatory disorders. METHODS: Seventeen exposed SM individuals (48.47 ± 9.3 years), 17 chronic dermatitis patients (46.52 ± 14.6 years), and 5 normal controls (44.00 ± 14.6 years) were enrolled in this study.Evaluation of TGF-ßs and their receptors expressions was performed by semiquantitative RT-PCR. Only TGF1 was analyzed immunohistochemically. RESULTS: Our results showed significant decreases in the expression percentages of TGF-ß 1, 2 and R1, R2 in chemical victims in comparison with chronic dermatitis and normal subjects and significant decreases in the intensity of R1 and R2 expressions in chemical victims in comparison with chronic dermatitis and normal controls. (P value < 0.05) CONCLUSIONS: TGF-ßs and their receptors appear to have a noticeable role in chronic inflammatory skin lesions caused by sulfur mustard.

Comparative study of skin sebum and elasticity level in patients with sulfur mustard-induced dermatitis and healthy controls.

BACKGROUND: Sulfur mustard (SM) - a chemical agent - has both acute and chronic effects on skin. Xerosis, which is deemed to be due to the damage of hydrolipidic barrier of the skin, is the most common complaint of veterans exposed to the chemical. This study was designed to evaluate skin sebum and elasticity in veterans with a history of SM contact. METHODS: Three hundred and ten subjects were enrolled in this study and were divided into four groups: SM-exposed patients with current skin lesions (n=87); SM-exposed patients without skin lesions (n=71); patients with dermatitis (n=78); and normal controls (n=74). The skin sebum and elasticity were measured in four areas (forehead, suprasternal, palm and back of the hands) using a Sebumeter and a Reviscometer. RESULTS: Skin sebum was higher in participants who presented with dermatitis and had history of contact with SM than others; the difference was only statistically significant on the forehead. There was no significant difference in the skin elasticity between the four groups. CONCLUSION: While SM may increase skin sebum in long term, there is no evidence that it has a substantial effect on skin elasticity.

Skin hydration and transepidermal water loss in patients with a history of sulfur mustard contact: a case-control study.

BACKGROUND: Skin lesions are among the most common complications of contact with sulfur mustard. OBJECTIVE: This study was aimed to measure skin water content and transepidermal water loss (TEWL) in patients with a history of sulfur mustard contact. METHODS: Three hundred ten male participants were included in this study: 87 (28.1%) sulfur mustard-exposed patients with current skin lesions (group 1), 71 (22.9%) sulfur mustard-exposed patients without skin lesions (group 2), 78 (25.2%) patients with dermatitis (group 3) and 74 (23.8%) normal controls (group 4) The water content and TEWL of skin was measured at four different locations of the body: forehead, suprasternal, palm and dorsum of hand. Nonparametric statistical tests (Kruskal-Wallis) were used to compare the four groups, and P < 0.05 was considered statistically significant. RESULTS: The mean age of participants were 44.0 +/- 6.7, 41.9 +/- 5.9, 43.8 +/- 9.3 and 44.8 +/- 8.9 years in groups 1 to 4, respectively (P = 0.146). Xerosis, post-lesional hyperpigmentation and lichenification were significantly more common in either sulfur mustard-exposed participants or non-exposed participants with dermatitis (P < 0.05). Skin hydration was higher in subjects with sulfur mustard contact than in non-injured participants (P < 0.05) in the dorsum and palm of hands and forehead. TEWL was significantly higher in participants only in suprasternal area and dorsum of hand. CONCLUSION: Contact with sulfur mustard agent can alter biophysical properties of the skin--especially the function of stratum corneum as a barrier to water loss-several years after exposure.

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.

Cetirizine, doxepine, and hydroxyzine in the treatment of pruritus due to sulfur mustard: a randomized clinical trial.

A 4-week randomized, double-blind safety and efficacy study was conducted to compare the safety and efficacy of cetirizine, doxepine, and hydroxyzine 5 in the treatment of chronic pruritus due to sulfur mustard. Patients were treated in the Dermatology Clinic of Baqiyatallah Hospital. The study population consisted of 75 patients with chronic pruritus due to sulfur mustard exposure. Patients were given either cetirizine 10 mg, doxepine 10 mg, or hydroxyzine 25 mg/day, for 4 weeks. A calculated pruritic score for each patient was taken before and 1 month after treatment. Mean before-treatment pruritic scores were 38.2 +/- 4.8, 37.2 +/- 4.9, and 37.3 +/- 5.1 in the cetirizine, doxepine, and hydroxyzine groups, respectively. After treatment, the mean pruritic scores were 24.8 +/- 3.1, 17.8 +/- 2.5, and 16.7 +/- 2.3 in the cetirizine, doxepine, and hydroxyzine groups, respectively. In addition, 65%, 75%, and 80% of patients in the cetirizine, doxepine, and hydroxyzine groups were downgraded in the severity of pruritus (P 1/4 0.465). Sedation effects were reported in 6, 14, and 18 patients in the cetirizine, doxepine, and hydroxyzine groups, respectively. Hydroxyzine 25 mg/day has equal results compared to doxepine 10 mg once daily; but greater than cetirizine 10 mg once a day in controlling the symptoms of patients with chronic pruritus.

Incidence of lung, eye, and skin lesions as late complications in 34,000 Iranians with wartime exposure to mustard agent.

Approximately 34,000 Iranians known to have sustained mustard agent exposure during the Iran-Iraq war of 1980-1988 and survived over a decade afterwards were screened for distribution of the most commonly occurring medical problems. In order of greatest incidence, these include lesions of the lungs (42.5%), eyes (39.3%), and skin (24.5%). Within each subpopulation, patients were ranked according to severity of lesions. Twenty-three percent to 37% of patients exhibited at least mild coverage, with 1.5% to 4.5% classed as moderate, and a much smaller population (0.023-1.0%) of the 34,000 patients exhibiting extensive (severe) lesional coverage. These results provide a comprehensive overview of the medical problem most common among mustard victims and could serve as a predictor of the likely impact of these weapons on health status of populations exposed to them during ongoing military conflicts.