Antidepressants and the Risk of Psoriasis Induction: A Case-Control Study.

Background: Psoriasis (PSO) is a common chronic autoimmune skin disease with a significant psycho-socio-economic burden. Some antidepressants (ADs) such as fluoxetine and bupropion can induce or exacerbate PSO. This study aimed to investigate the correlation between ADs history before PSO onset, and the risk of PSO induction, in Isfahan province, Iran. Materials and Methods: In this case-control study, 80 patients with PSO were selected by non-probability sampling method, and 80 healthy individuals were selected using simple random sampling. They were interviewed and medical information was recorded. Chi-square, Mann-Whitney, and Kruskal-Wallis tests for dichotomous or categorical data, and independent-sample t test for continuous data were used. Statistical significance was taken as P ≤ 0.05. Results: In this case-control study, a total of 160 individuals, 80 participants in each group, were included. The mean age of the total samples was 44.8 ± 16 years. Forty-three percent of the individuals were women. PSO familial history in the cases was significantly higher than the control group (OR = 11.94, P = 0.001). It was revealed that use of ADs by patients before PSO induction, was greater than the controls (OR = 2.78, P = 0.058). Conclusions: Past history of ADs in the cases before PSO onset, was higher than the controls, indicating a possible association between ADs and the risk of PSO induction. This study can be effective to pay more attention to the possible complications of ADs and PSO risk factors. Accurate knowledge of PSO risk factors will be useful for better management and morbidity reduction.

Demographic Characteristics of the Patients with Cutaneous Vasculitis Due to COVID-19 Infection.

Background: Cutaneous manifestations of coronavirus disease 2019 (COVID-19) range from mild skin rashes to severe vasculitis. In the current study, we evaluated the demographic characteristics of the patients with cutaneous vasculitis following COVID-19 infection. Materials and Methods: In the current study, we evaluated 799 hospitalised patients with COVID-19 infection for development of cutaneous vasculitis. Demographic and clinical characteristics of the patients were obtained using questionnaires and patients' records. Cutaneous vasculitis of the suspected patients were confirmed using skin biopsy and direct immunofluorescence. Results: We detected 24 hospitalised cases with cutaneous vasculitis presenting with petechia, purpura, livedoretcularis and acrocyanosis. Our data showed a significant relationship between male sex, advanced age, C-reactive protein (CRP) level and presence of comorbidities with development of cutaneous vasculitis. In addition, we found a positive association between the severity of COVID-19 infection and occurrence of cutaneous vasculitis. Conclusion: Our findings are suggestive that clinicians must be aware of cutaneous vasculitis risk as prognostic value in the patients with severe COVID-19 infection.

Pemphigus vegetans misdiagnosed as condylomata acuminata: A case report.

Pemphigus vegetans is a rare variant of pemphigus vulgaris, characterized by vegetating lesions primarily in the flexures. A 41-year-old male patient presented with pemphigus vegetans highly mimicking condylomata acuminata, which led to mistreatment. Careful analysis of clinical and laboratory findings enabled us to reach a correct diagnosis and successful treatment.

Comparison between "5% minoxidil plus 2% flutamide" solution vs. "5% minoxidil" solution in the treatment of androgenetic alopecia.

BACKGROUND: Androgenetic alopecia is defined as a patterned hair loss resulting from the effect of androgen on hair follicles and characterized by non-scarring, progressive miniaturization of the hair follicles. Minoxidil and finasteride are regarded as the first-line treatments with antiandrogens and flutamide are considered as the alternative choices. In the current study, we evaluated the efficacy of combination therapy with topical 2%flutamide plus 5% minoxidil vs. %5 minoxidil alone in the treatment of the androgenetic alopecia. MATERIAL AND METHODS: This was a randomized, double-blinded clinical trial in 40 patients with androgenetic alopecia. Patients were randomized to receive either topical minoxidil vs. topical flutamide plus minoxidil for 6 months. At the end of study, patients were compared regarding mean hair density and mean hair thickness and patient's satisfaction. Collected data were analyzed using t-test, Ki square, and Kolmogorov-Smirnov tests. RESULTS: Topical flutamide plus minoxidil solution was significantly more effective than minoxidil in terms of hair density, hair thickness, and patient's satisfaction (p < 0.05). CONCLUSION: Topical hydroalcoholic solution of flutamide plus minoxidil may be promising treatment for the androgenetic alopecia. To better evaluate the efficacy of topical flutamide, more prolonged studies with higher number of patients and use of different vehicles and different ingredients are recommended.

Oral Pulse Betamethasone, Methotrexate, and Combination Therapy to Treat Severe Alopecia Areata: A Randomized, Double-blind, Placebo-controlled, Clinical Trial.

The purpose of this study is to compare oral betamethasone pulse therapy, methotrexate therapy and a combination of the two for patients with Alopecia Areata (AA) as an autoimmune disorder. In this study, 36 patients with severe AA were selected and classified into three groups of 12: 1- Oral betamethasone therapy (3 mg, once a week) with placebo; 2- Oral methotrexate (15 mg, once a week) with placebo; and 3- A combination of methotrexate (15 mg, once a week) and betamethasone (3 mg, once a week). The Severity Alopecia Tool (SALT) was used to measure improvements in the lesions through photographs, and the patients also rated their condition on the Visual Analogue Scale (VAS). Assessments were performed, and the results were compared at baseline and then at intervals of three months for nine months. The demographics and SALT score were similar in the three groups (P > 0.05). All the groups showed improvements in SALT, VAS and photographic scores three months after beginning the treatment (P < 0.001). Betamethasone therapy (P = 0.006) and combination therapy (P < 0.001) provided greater SALT improvement than methotrexate, and combination therapy led to a greater improvement in VAS and photographic findings compared to the two other groups (P < 0.05). Oral steroid, methotrexate and combination pulse therapy were effective treatments for AA, while oral steroid pulse therapy and combination therapy were superior to methotrexate.

Heat therapy for cutaneous leishmaniasis: A literature Review.

Cutaneous leishmaniasis (CL) is endemic in many parts of the world with a high economic and health impact. Despite many treatments that have been suggested for this zoonotic infection, there is still no definite therapy for CL. Meglumine antimony compounds are considered as a standard treatment for leishmaniasis, however, these medications have a relatively high side effect profile and not always effective. Physical modalities including cryotherapy, laser, and heat therapy have also been used for this purpose. As a source of heat therapy, different methods have been used including radiofrequency, ultrasound, infrared, exothermic crystallization thermotherapy, and microwave. We reviewed all of the articles in PubMed regarding the use of heat therapy for the treatment of CL up to January 2020. According to our literature review, heat therapy using different sources showed promising results for the treatment of CL that were comparable to meglumine antimony. In addition, heat therapy has very low side effect profiles that are localized to the treatment area suggesting this method as a safe procedure for CL therapy. This study is a brief review of the literature about the effect of heat therapy on the treatment of CL. Performing randomized clinical trials to compare different methods of heat therapy and to compare it with meglumine antimony compounds is recommended.

Cutaneous leukocytoclastic vasculitis secondary to COVID-19 infection: A case report.

COVID-19 is a novel disease that mostly affects the respiratory system but as the number of cases is rising significantly around the world, more extra-respiratory manifestations are being reported among which are various dermatologic manifestations.

Comparative evaluation of Gracilaria algae 3% cream vs Clobetasol 0.05% cream in treatment of plaque type psoriasis: A randomized, split-body, triple-blinded clinical trial.

Gracilaria algae is red macro algae which has demonstrated considerable anti-inflammatory effects. Our objective was to compare the efficacy of Gracilaria algae topical cream 3% vs Clobetasol cream 0.05% in treatment of plaque-type psoriasis. Thirty adult patients with baseline modified Psoriasis Area and Severity Index (PASI) score ≤12 were randomized to receive either Clobetasol or Gracilaria algae cream on right or left-sided symmetric plaques once daily for 8 weeks and follow-up of 4 weeks. Modified PASI score, patient's satisfaction using VAS and global physician assessment score were assessed to evaluate clinical response. Thirty patients with 94 symmetrical psoriasis plaques were enrolled in this trial. The mean baseline modified PASI score of both sides was similar; however, at the end of trial, modified PASI score was reduced more on the sides treated with Gracilaria algae cream (0.80 ± 0.19% vs 0.63 ± 0.25%, P < .05). No significant difference was found regarding mean physician global assessment score between the two groups (P > .05). Patients' satisfaction was significantly higher in favor of algae cream only at week 8 of the intervention (P < .05). Gracilaria algae cream can be an effective and safe alternative of Clobetasol in the treatment of plaque type psoriasis.

Application of laser for treatment of cutaneous leishmaniasis: a review of literature.

Cutaneous leishmaniasis (CL) is a major health problem in developing countries with high economic and health impact. Despite suggested treatment for CL, there is still no definite therapy for this infection, and many of these treatments are associated with serious local and systemic side effects. In the current paper, use of different laser types including continuous and fractional CO2, argon, PDL, erbium glass, and Nd:YAG have been reviewed. Based on our review, given the high reported efficacy and low side-effect profile, use of laser can be considered as a good alternative to standard treatment of cutaneous leishmaniasis (CL). Performing more studies using different types of lasers is recommended to evaluate the efficacy of this method for treatment of CL.

Evaluation of combination therapy with peeling added to minimal invasive blepharoplasty in lower eyelid rejuvenation.

INTRODUCTION: Aging is an inevitable process in life that can pose unsatisfactory changes in appearance. Recently, rejuvenation surgeries have opened an exciting new window toward people who are vulnerable according to their facial appearance. Periocular plastic microsurgeries are among the most common aesthetic surgeries with various outcomes. The current study was aimed to compare outcomes of blepharoplasty with and without peeling regarding lower eyelid rejuvenation. METHODS: This is a randomized clinical trial study conducted on 30-patients referred for inferior lid rejuvenation in 2017-18. Patients were randomly divided into two 15-member subgroups of microinvasive blepharoplasty with and without peeling. Peeling for the group underwent blepharopeeling was performed all over the inferior periocular region using Phenol 89%. Then, skin and underlying muscle were incised superficially, and underlying fat tissue was excised. The other group underwent blepharoplasty without peeling. Patients were followed daily for 2 months to assess complications, patients' and physicians' satisfaction. RESULTS: Two assessed groups were not statistically different regarding age and gender distribution (P-value = .417 and .666, respectively). Considering patients' opinion, symmetry, scar formation, skin laxity, swelling, and total satisfaction score were not different between two groups (P-value > .05) while physicians presented similar outcomes except for better scar formation status of peeling add-on therapy (P-value = .042). Rate of adverse effects was significantly higher among those under blepharoplasty plus peeling treatment (P-value < .05). CONCLUSION: Outcomes of blepharoplasty alone versus blepharoplasty plus peeling were not significantly different regarding both patients' and physicians' assessments in general while fewer complications due to blepharoplasty without peeling were presented.

Combination of continuous wave CO2 laser and topical application of trichloroacetic acid 50% vs CO2 laser alone the treatment of cutaneous leishmaniasis (A case series of 6 patients).

BACKGROUND: Cutaneous leishmaniasis (CL) is an endemic disease of Iran and despite self-healing nature of this disease and many suggested treatments, scar is usually inevitable results of the affection with this cutaneous infection. CO2 laser in CL has a specific thermolysis effect on infected tissues and application of trichloroacetic acid (TCA) 50% solution for treatment of leishmaniasis scars showed promising results. AIM: To evaluate CO2 laser plus TCA 50% versus CO2 laser alone for treatment of CL. PATIENTS/METHODS: In the current report, we present 6 cases of noduloulcerative CL that were treated successfully by the combination of the continuous wave CO2 laser plus topical application of TCA 50%. RESULTS: Five patients improved after 3 weeks of starting treatment, and 1 patient needed to repeat treatment. The scars were flat and good. CONCLUSIONS: The CO2 laser plus topical TCA 50% may be more effective in treatment of the cutaneous leishmaniasis and results in shorter healing time.

The effectiveness of adapalene 0.1% with intense pulsed light versus benzoyl peroxide 5% with intense pulsed light in the treatment of acne vulgaris: A comparative study.

BACKGROUND: Acne vulgaris (AV) is one of the most common skin diseases with major psychological impacts. Hence, selecting the best treatment modality is so important; there are different ways to treat AV such as topical and systemic agents, laser, and also photodynamic therapy. In this study, we tried to assess the difference between the efficacy of combination therapy with intense pulsed light (IPL) and benzoyl peroxide (BPO) in comparison with IPL and adapalene (AD) in the treatment of the mild to moderate AV. MATERIALS AND METHODS: Thirty Iranian females in reproductive age with mild to moderate acne were enrolled in this study. The left and right side of the patients were randomized to receive either AD 0.1% or BPO 5% every other day plus three sessions of monthly apart IPL in the treatment of AV. Different parameters of AV such as acne severity index (ASI), total acne lesions counting (TLC), and Acne Global Severity Scale (AGSS) were measured before, during, and after the treatments. RESULTS: There was a significant difference regarding AGSS, TLC, and ASI before and after treatment with AD plus IPL (P < 0.001). Furthermore, there was a significant difference regarding AGSS, TLC, and ASI before and after treatment with BP plus IPL (P < 0.001). However, no significant difference regarding AGSS, TLC, and ASI were observed between the 2 groups after treatment (P > 0.05). No significant side effects were observed in both groups. CONCLUSION: Our study shows that there was not any significant difference between combining IPL with either AD or BPO so we can use either one of these combinations to achieve similar efficacy.

Evaluation of Different Concentrations of Imatinib on the Viability of Leishmania major: An In Vitro Study.

BACKGROUND: Leishmaniasis is an infectious disease caused by an intracellular parasite of Leishmania and is transmitted through the female sandflies bite and may lead to severe skin lesions. Although drugs such as antimony compounds are available, their side effects such as toxicity, low efficacy, and emergence of resistance have raised the importance of effective replacement. Imatinib, as an inhibitor of tyrosine kinase (TK) of Leishmania, stops abnormal function of TK such as Bcr-Abl through assembling into transmembrane pores in a sterol-dependent manner. Hence, the evaluation of killing effects of different concentrations of imatinib against Leishmania major amastigotes and promastigotes in vitro were the objectives of the present study. MATERIALS AND METHODS: The killing effects of different concentrations of imatinib (25, 50, and 100 µg) and 25 µg amphotericin B (as positive control) were evaluated against RPMI 1640-cultured promastigotes and the amastigote/macrophage model by MTS cell proliferation assay kit (ab197010) and Giemsa staining method during 24, 48, and 72 h. RESULTS: The results showed anti-Leishmania effect of imatinib in concentration and time-dependent manner. The lowest number of live promastigotes and amastigotes were obtained due to treat with 100 µg/ml imatinib at 72 h. Furthermore, 100 µg concentration of imatinib had the same effect as 25 µg amphotericin B on both L. major promastigotes and amastigotes (P < 0.001). CONCLUSION: The anti-Leishmania effect of imatinib was confirmed by MTS and direct microscopy. Further study is recommended for evaluating possible therapeutic effects of imatinib on leishmaniasis in vivo.

Prolotherapy: Potential for the Treatment of Chronic Wounds?

Significance: Chronic skin ulcers, including venous, diabetic, and pressure ulcers, constitute a major health care burden, affecting 2-6 million people in the United States alone, with projected increases in incidence owing to the aging population and rising epidemic of diabetes. The ulcers are often accompanied by pain. Standard of care fails to heal ∼50% of diabetic foot ulcers and 25% of venous leg ulcers. Even advanced therapies do not heal >60%. Thus there is an unmet need for novel therapies that promote healing and also address the concomitant pain issue. Recent Advances: Prolotherapy involves injection of small amounts of an irritant material to the site of degenerated or painful joints, ligaments, and tendons. Multiple irritants are reported to be efficacious, but the focus here is on dextrose prolotherapy. In vitro and in vivo studies support translation to clinical use. Concentrations as low as 5% dextrose have resulted in production of growth factors that have critical roles in repair. Numerous clinical trials report pro-reparative effects of dextrose prolotherapy in joint diseases, tendon, and ligament damage, and for painful musculoskeletal issues. However, most of the studies have limitations that result in low-quality evidence. Critical Issues: The preclinical data support a role for dextrose prolotherapy in promoting tissue repair that is required for healing chronic wounds and ameliorating the associated pain. Critical issues include provision of evidence of efficacy in human chronic wounds. Another potential obstacle is limitation of reimbursement by third-party payers for a therapy with as yet limited evidence. Future Directions: Preclinical studies in models of chronic wounds would support clinical translation. As dextrose prolotherapy has some mechanistic similarities to already approved honey therapies, it may have a shortened pathway for clinical translation. The gold standard for widespread adoption would be a well-designed clinical trial.

Successful Treatment of Facial Acne Fulminans: Antimicrobial Agents and Oral Prednisolone as Promising Regimes.

Acne fulminans (AF), also known as acne maligna, is a rare painful ulcerative form of acne with an abrupt onset and systemic symptoms. Its incidence appears to be decreasing, possibly because of earlier and better treatment of acne. This report highlights a case on a necrotizing facial wound due to AF that was successfully treated with oral prednisolone and antimicrobial medication.

The Effectiveness of a 5% Retinoic Acid Peel Combined with Microdermabrasion for Facial Photoaging: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

Background. Tretinoin has been shown to improve photoaged skin. This study was designed to evaluate the efficacy and tolerability of a 5% retinoic acid peel combined with microdermabrasion for facial photoaging. Materials and Methods. Forty-five patients, aged 35-70, affected by moderate-to-severe photodamage were enrolled in this trial. All patients received 3 sessions of full facial microdermabrasion and 3 sessions of either 5% retinoic acid peel or placebo after the microdermabrasion. Efficacy was measured using the Glogau scale. Patients were assessed at 2 weeks and 1, 2, and 6 months after treatment initiation. Results. The mean ± SD age of participants was 49.55 ± 11.61 years, and the majorities (73.3%) were female. Between 1 month and 2 months, participants reported slight but statistically significant improvements for all parameters (P < 0.001). In terms of adverse effects, there were statistically significant differences reported between the 5% retinoic acid peel groups and the control group (P < 0.001). The majority of adverse effects reported in the study were described as mild and transient. Conclusion. This study demonstrated that 5% retinoic acid peel cream combined with microdermabrasion was safe and effective in the treatment of photoaging in the Iranian population. This trial is registered with IRCT2015121112782N8.

Efficacy of Intense-pulsed Light Therapy with Topical Benzoyl Peroxide 5% versus Benzoyl Peroxide 5% Alone in Mild-to-moderate Acne Vulgaris: A Randomized Controlled Trial.

OBJECTIVE: Acne vulgaris is a disease of pilosebaceous unit with multifactorial pathogenesis and threats patients' social functioning. There is a growing research to find faster, more effective, and easy to use treatments. The aim of this study is to evaluate the efficacy of benzoyl peroxide 5% (BP) with and without concomitant intense-pulsed light (IPL) therapy in mild-to-moderate acne vulgaris. METHODS: In this controlled trial, 58 eligible patients with mild-to-moderate acne and Fitzpatrick skin phototype III and IV were randomly allocated to two groups. All patients were asked to use a thin layer of BP every night. The IPL therapy was administered at the end of first, 2nd, and 3rd months. Acne Global Severity Scale (AGSS), Acne Severity Index (ASI), and total lesion counting (TLC) along with patient satisfaction were recorded. Patients were also examined 1 month after the final therapeutic visit. FINDINGS: The IPL group showed greater reduction in AGSS (P < 0.001) and TLC (P = 0.005) than the control group. However, the difference in ASI was not significant (P = 0.12). Patients in IPL groups were more satisfied than control group (P < 0.001). CONCLUSION: Adding IPL to BP can result better response to BP alone. In acne treatment, combination therapy such as IPL and other topical agents should be kept in mind.

The comparison between modified kligman formulation versus kligman formulation and intense pulsed light in the treatment of the post-burn hyperpigmentation.

BACKGROUND: Post inflammatory hyperpigmentation (PIH) is a common problem occurs following many dermatologic diseases and medical interventions. Different modalities including topical agents, lasers and intense pulsed light (IPL) are suggested for treatment of the post-burn PIH. In the current study, we evaluated the efficacy of IPL plus modified Kligman cream (MODIFIED KLIGMAN CREAM) versus MODIFIED KLIGMAN CREAM alone in the treatment of the post-burn PIH. MATERIALS AND METHODS: This was a randomized, non-blinded clinical trial. A total of 53 patches of post-burn PIP in 14 patients were randomized to receive either two sessions of IPL plus modified Kligman formula or kligman formula for 2 months. The patients were recommended to apply MODIFIED KLIGMAN CREAM cream for 12 h at night. RESULTS: According to our results, the patients in the MODIFIED KLIGMAN CREAM + IPL group had higher satisfaction as compared with MODIFIED KLIGMAN CREAM alone (P = 0.000) (Mann-Whitney test). In addition, according to physician evaluation, the patients in the MODIFIED KLIGMAN CREAM + IPL group had higher satisfaction as compared with MODIFIED KLIGMAN CREAM alone (P = 0.000) (Mann-Whitney test). No side effects except a little irritation, erythema and exfoliation due to MODIFIED KLIGMAN CREAM cream were seen in the patients. CONCLUSIONS: The results of our study showed the better efficacy and faster response of the IPL plus modified Kligman formula versus modified Kligman formula in the treatment of the post-burn PIH. To better determine the efficacy of IPL in treatment of the post-burn PIP, more extensive studies as randomized, double-blinded clinical trial are recommended.

Multiple Giant Pilar Cyst Distributed Over the Body Since Childhood.

Trichilemmal cyst or pilar cyst is defined as a cyst containing keratin and its breakdown products. It is usually situated on the scalp with a wall resembling external hair root sheath. In this case report we present a 55-year-old man with multiple giant pilar cysts that were distributed over the whole body since childhood. One of the cyst on the chest was transformed to squamous cell carcinoma (SCC).