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.

Platelet-rich Plasma use for facial rejuvenation: a clinical trial and review of current literature.

BACKGROUND AND AIM OF THE WORK: Several studies have shown beneficial effects for Platelet-rich plasma (PRP). We aimed to assess the efficacy of pure PRP injection for facial rejuvenation in Iran. METHODS: 30 female consecutive participants were injected with PRP in two sessions with 3 month interval. Evaluations were performed by comparing the pre- and post-improvement measurements of skin scan, before after photography by participants, therapeutic physician and blindly by a second dermatologist. RESULTS: In 3 and 6 months follow-ups respectively,  moderate to excellent improvement in periorbital dark circles (47.8,60.9%), periorbital wrinkles (73.9%,78.3%), nasolabial fold (52.2%,56.6%) and skin rigidity (52.3%,60.9%)  reported by patients, was statistically significant only for dark circle(P value 0.031). Moderate to good improvement in periorbital dark circles (47.9%,74%), periorbital wrinkles (39.1%,43.5%)and nasolabial folds (4.3% ,13.1%)  demonstrated by therapeutic physician's evaluation , was statistically significant for dark circle (P value 0.008) and nasolabial folds (P value 0.025). Moderate to good improvement in periorbital dark circles (34.8%, 52.2%), periorbital wrinkles (26.1%, 34.8%) and nasolabial folds (4.4%, 13%)   by second dermatologist, was statistically significant for dark circle (P value 0.025). CONCLUSION: Face rejuvenation with PRP is a promising and noninvasive technique with best results observed in improving periorbital dark circles and wrinkles.

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.

The expression of serotonin transporter protein in the skin of patients with chronic spontaneous urticaria and its relation with depression and anxiety.

Studies have indicated a possible role for serotonin transporter protein (SERT) in the pathophysiology of inflammatory skin disorders. This study was aimed to determine the expression of SERT in the skin of patients with chronic spontaneous urticaria (CSU) and its relation to depression and anxiety. In this case-control study, 30 CSU patients and 30 healthy controls were evaluated with skin biopsies to evaluate the expression of the SERT protein based on histopathologic findings. Beck depression and anxiety inventories were used to investigate depression and anxiety in the case group. Data were analyzed by SPSS software. P values < 0.05 were considered significant. The case group showed significantly higher percentage of stained cells (P < 0.0001) and intensity of SERT expression (P < 0.0001) compared with the control group. The patients with uncontrolled CSU showed significantly higher percentage (P < 0.002) and intensity (P < 0.006) of SERT expression, compared with those with controlled CSU. The intensity of SERT expression in CSU patients had no significant correlation with the severity of depression, but was significantly correlated with the severity of anxiety (r = 0.555; P = 0.001). The percentage of stained cells was significantly correlated with the severities of depression (r = - 0.433; P = 0.017) and anxiety (r = 0.528; P = 0.003). The SERT expression in patients with CSU was higher compared with controls, which can demonstrate the role of serotonin in the pathogenesis of this disease. This higher SERT expression is correlated with the severity of the disease.

Comparison of therapeutic effects of conventional and liposomal form of 4% topical hydroquinone in patients with melasma.

BACKGROUND: Melasma is a common acquired hyperpigmentation disorder observed mainly in young women. Hydroquinone is the basic treatment that its effect alone and in combination with other medications has been proven. Liposomes are microscopic vesicles in which water and lipid-soluble medications can be introduced to enhance their efficacy and specificity. The aim of this study was to compare therapeutic effects of topical liposomal hydroquinone with its conventional form on melasma. METHODS: This double-blind randomized clinical trial study was conducted on 20 women. Participants were asked to apply a certain amount of topical liposomal hydroquinone on one side of the face and conventional hydroquinone on the other side for three months. Skin pigmentation severity was measured using Melasma Area and Severity Index (MASI) at each visit, separately for each side of the face every month until one month after the last treatment, the data were recorded in a questionnaire and were analyzed by SPSS 16 software, paired sample t test, and repeated measurement ANOVA. RESULTS: MASI score in both case and control groups significantly reduced (P < 0.001) but no significant difference between the case and control groups was observed at any time interval (P > 0.05). CONCLUSION: This study shows that liposomal hydroquinone has a significant therapeutic effect on melasma, but we did not observe any superiority in comparison with the conventional method. Therefore, it can be considered in the treatment protocol of this disease.

Leishmaniasis with Femoral Bone Involvement.

Visceral leishmaniasis is mostly subclinical, but it can become symptomatic and take acute, subacute or chronic forms. Its incubation period varies from weeks to months and can even be as long as years. Avast variety of organ involvement may be there. We report a case of osseous leishmaniasis presenting with only a long standing mild knee pain without any laboratory or organ abnormality and showed a pure bone involvement on X-ray and CTscan. Later on, it developed into a discharging sinus and the discharge showed Leishman bodies which was reconfirmed the rough bite. As the patient had reactions with amphotericin B, systemic glucantine was given which led to clinical improvement and smaller radiological lesion.

Comparison of Autoimmune Thyroid Disease in Patients With Progressive and Stable Vitiligo.

BACKGROUND AND OBJECTIVE: Activity of vitiligo has not been considered as a patient selection criteria in previous studies; we decided to compare the presence of elevated thyroid auto-antibodies in patients with progressive and stable vitiligo. METHODS: Seventy-two patients with vitiligo were examined for thyroid problems and were divided into 2 groups of stable and progressive vitiligo according to their history and physical examination. Anti-thyroid peroxidase antibodies (anti-TPO antibodies), thyroxine (T4), and thyroid stimulating hormone (TSH) levels were assessed for all patients. RESULTS: Elevated levels of anti-TPO antibodies were observed in 43.7% of the patients with stable vitiligo and in 37.5% of patients with progressive vitiligo, which was not statistically significant (P = .315). CONCLUSION: This study not only confirmed thyroid dysfunction in patients with vitiligo but also showed that there was no difference in thyroid dysfunction and anti-TPO antibody levels in the subgroups of patients with stable or progressive vitiligo.

Comparison of therapeutic effects of liposomal Tranexamic Acid and conventional Hydroquinone on melasma.

BACKGROUND: Melasma is one of the most common cosmetic disorders with skin darkening. Although several treatment modalities are available, none is satisfactorily used in management of this condition. Tranexamic acid (TA), a plasmin inhibitor, is reported to improve melasma when injected locally or used as oral and topical forms. AIM: The aim of this study was to compare therapeutic effects of liposomal tranexamic acid and conventional hydroquinone on melasma. METHODS: Thirty women with bilateral melasma were enrolled in a split-face trial lasting 12 weeks. Patients blindly applied 5% topical liposomal TA and 4% hydroquinone cream, to the designated sides of the face twice daily in addition to the assigned sunscreen in the morning. Skin pigmentation was measured using MASI (Melasma Area and Severity Index) at each visit separately for each side at the base line and every month until one month after treatment course. Data were obtained from patients file and were analyzed statistically using SPSS software, paired samples t-test, and repeated measured ANOVA. RESULTS: Twenty-three patients completed the study. The mean MASI scores significantly reduced in both treated sides (P < P = 0.001) after 12 week. A greater decrease was observed with 5% liposomal TA, although this difference was not statistically significant. Irritation occurred in three patients with hydroquinone, while no serious adverse events occurred with TA. CONCLUSION: On the basis of these results, topical liposomal TA can be used as a new, effective, safe, and promising therapeutic agent in melasma.

Bacterial contamination in cutaneous leishmaniasis: its effect on the lesions' healing course.

BACKGROUND: The colonization of aerobic and anaerobic microbial agents on cutaneous leishmaniasis (CL) lesions, especially acute erosive ulcerative ones, has been mentioned in previous studies showing controversial results on the healing course of lesions with the use of antibiotics. AIMS: The purpose of this study was to evaluate the prevalence of secondary bacterial infections in CL lesions and the effect of its elimination on the lesions' improvement rate. MATERIALS AND METHODS: This cross-sectional clinical trial was performed on 84 acute CL patients. The required skin samples were taken. Cultivation for bacteria was conducted. Patients with positive culture results were divided into two groups. Both groups received standard anti-leishmania treatment, whereas only one group was treated with cephalexin 40-50 mg/kg/day for 10 days. The improvement rate was evaluated in the following visits based on changes in the lesions' induration size. RESULTS: Among the 84 studied patients, 22.6% had a negative culture result whereas the result was positive in 77.4%. The most common pathogenic germs were Staphylococcus aureus (52.3%) and Staphylococcus epidermidis (9.5%); 34/5% of the positive lesions received antibiotic treatment. Finally, among the lesions with a 75-100% improvement rate, no significant difference was observed between the antibiotic-treated and -untreated groups (36.1% vs. 63.9%, respectively, P = 0.403). CONCLUSIONS: The most common pathogen was S. aureus and, as a primary outcome, the simultaneous treatment for microbial agents did not have any considerable effect on the improvement rate of CL lesions.

Survey of bullous pemphigoid disease in northern Iran.

BACKGROUND: Bullous pemphigoid is an autoimmune subepidermal blistering skin and mucous membrane disease that usually occurs in elderly people. This study was done to determine clinical features, paraclinical findings, incidence of mucosal lesions, prognosis, course of the disease, and mortality rate of patients with bullous pemphigoid. METHOD: Retrospective descriptive study that reviews the existing files of 122 patients with bullous pemphigoid referred to dermatology clinics of Ghaem and Imam Reza hospitals in Mashhad, Iran, from 1995 to 2010. RESULT: The majority of patients were aged between 60 and 79 years, and 53% of them were women. The major prodromal lesions were erythematous and urticarial (36.8%) and eczematous lesions (32.7%); 84.3% of patients complained of pruritus, and mucosal lesions were observed in 31.1% of patients (all in the oral mucosa). The most frequent concurrent diseases with pemphigoid were hypertension and diabetes mellitus. CONCLUSION: Clinical features, paraclinical findings, incidence of mucosal lesions, prognosis, course of the disease, and mortality rate of bullous pemphigoid in the Khorasan region were approximately similar to results from other regions.

Antileishmanial Activity of Liposomal Clarithromycin against Leishmania Major Promastigotes.

OBJECTIVES: Cutaneous leishmaniasis is a common parasitic disease which is endemic in some parts of the world. In vitro and in vivo studies have shown azithromycin efficacy on some Leishmania species. Because of structural similarity between clarithromycin and azithromycin and efficacy of clarithromycin against intracellular organisms and due to the absence of previous studies in this respect, we decided to evaluate the efficacy of clarithromycin against promastigotes of L. major in vitro. MATERIALS AND METHOD: First, liposomal and non- liposomal clarithromycin were prepared, then both forms of the drug were incubated with promastigotes for 24 hr in NNN culture media without red phenol in the presence of 5% FCS with different concentrations as follows: 20, 40, 80, 100, 200 and 500 µg/ml. RESULTS: According to the results, clarithromycin in both liposomal and non- liposomal forms has in vitro activity against the promastigotes of L. major. The concentration of drug that killed 50% of parasites (ED 50) was 169 and 253.6 µg/ml for liposomal and non- liposomal forms, respectively which shows that lower concentrations of liposomal drug are required to have the same effect as non- liposomal drug and the liposomal form of the drug is more effective than non- liposomal form. CONCLUSION: Clarithromycin in both liposomal and non- liposomal forms has in vitro activity against the promastigotes of L. major.