Sodium Phenylbutyrate and Tauroursodeoxycholic Acid: A Story of Hope Turned to Disappointment in Amyotrophic Lateral Sclerosis Treatment.

The absence of a definitive cure for amyotrophic lateral sclerosis (ALS) emphasizes the crucial need to explore new and improved treatment approaches for this fatal, progressive, and disabling neurodegenerative disorder. As at the end of 2023, five treatments - riluzole, edaravone, dextromethorphan hydrobromide + quinidine sulfate (DHQ), tofersen, and sodium phenylbutyrate-tauroursodeoxycholic acid (PB-TUDCA) - were FDA approved for the treatment of patients with ALS. Among them PB-TUDCA has been shown to impact DNA processing impairments, mitochondria dysfunction, endoplasmic reticulum stress, oxidative stress, and pathologic folded protein agglomeration defects, which have been associated with ALS pathophysiology. The Phase 2 CENTAUR trial demonstrated significant impact of PB-TUDCA on the ALS Functional Rating Scale-Revised (ALSFRS-R) risk of death, hospitalization, and the need for tracheostomy or permanent assisted ventilation in patients with ALS based on post hoc analyses. More recently, contrasting with the CENTAUR trial results, results from the Phase 3 PHOENIX trial (NCT05021536) showed no change in ALSFRS-R total score at 48 weeks. Consequently, the sponsor company initiated the process with the US FDA and Health Canada to voluntarily withdraw the marketing authorizations for PB-TUDCA. In the present article, we review ALS pathophysiology, with a focus on PB-TUDCA's proposed mechanisms of action and recent clinical trial results and discuss the implications of conflicting trial data for ALS and other neurological disorders.

Diagnostic Value of Dermoscopic Structures in Predicting Superficial Basal Cell Carcinoma in the Skin of Color.

Background: Basal cell carcinoma (BCC) manifests different dermoscopic patterns in individuals with dark skin complexion compared to those with fair skin types. This study aimed to investigate the diagnostic utility of dermoscopy in discerning superficial BCC from other types of BCC, specifically in patients with dark skin complexion. Materials and Methods: This cross-sectional study focuses on patients diagnosed with BCC who were referred for skin biopsy between July 2020 and September 2022. Initially, the demographic characteristics of patients, clinical attributes of lesions, and pathological sub-types of BCC were documented. Subsequently, videodermoscopy was employed to capture comprehensive views and dermoscopic images of the lesions. Univariate logistic regression analysis was then utilized to assess the reliability of dermoscopic structures in distinguishing superficial BCC from other BCC types. Last, the study evaluated the sensitivity, specificity, positive predictive value, and negative predictive value of dermoscopy in the differentiation of superficial BCC from other BCC sub-types. Results: The study enrolled 49 patients diagnosed with BCC, with a mean age of 66.22 ± 10.41 years. The most prevalent pathological sub-type observed was nodular (53.1%). Dermoscopy exhibited a higher specificity compared to the naked eye in the differentiation of superficial BCC from other types (55% vs. 35%, respectively). Univariate analysis revealed a significant association between spoke-wheel structures and superficial BCC (P = 0.02, odds ratio = 7.2, 95% confidence interval = 1.35-38.32). Conclusion: Dermoscopy exhibited superior specificity compared to the naked eye in differentiating superficial BCC from other BCC types. Notably, the spoke-wheel structure demonstrated the most robust correlation with superficial BCC.

Enhancing Precision and Efficiency in Fabricating Complete Arch Screw-Retained Implant Prosthesis: A Clinical Case Report Utilizing the Nexus iOS Scan Gauge System.

Achieving an accurate fit in a complete arch screw-retained implant prosthesis is paramount, regardless of whether analog or digital impressions are employed. In the context of complete arch implant prostheses, using intraoral scanners has sparked significant debate. However, recent advancements in scanner technology, specialized scan gauges meticulously calibrated for precise recording, and the implementation of appropriate scanning techniques have substantially improved the precision and accuracy of digital records. The Nexus iOS scan gauge system represents a pioneering approach, seamlessly integrating these optimization strategies into a purely digital workflow to fabricate complete arch screw-retained implant prostheses in edentulous patients. This case report elucidates the fabrication process of a complete arch screw-retained implant prosthesis that exhibited remarkable fitting accuracy and streamlined the treatment process to a mere 3 appointments. The patient reported high satisfaction with the efficient timeline, aesthetic appeal, and functional performance of the prosthesis. A distinctive advantage of this technique is the notable reduction in treatment steps compared to traditional procedures.

Global clinicoepidemiological pattern of childhood vitiligo: a systematic review and meta-analysis.

BACKGROUND: Childhood vitiligo differs from adult vitiligo in many aspects. To the best of the authors' knowledge, there is no systematic review of different clinicoepidemiological patterns of vitiligo in children. This study aimed to review the characteristics of vitiligo among the paediatric population. METHODS: In June 2022, a comprehensive search was conducted using MeSh-based keywords on online databases including PubMed, Scopus and Web of Sciences. The papers were assessed, and the eligible articles were selected. The selection of articles followed three distinct steps. The extracted clinicoepidemiological data were then imported into the STATA software for meta-analysis. RESULTS: The meta-analysis of 17 studies with 4365 subjects yielded 2475 women (estimated=56.8%, 95% CI 54.45 to 59.22). The female-to-male ratio was determined to be 1.3:1. Meta-regression demonstrated a significant relationship between continents and gender (p=0.03). The most prevalent types of non-segmental vitiligo were vulgaris (42.49%), focal (27.21%) and acrofacial (17.8%). The pooled ratio of non-segmental to segmental was 4.6:1. The highest and lowest ratios were found in Africa with one study (estimated=11.56%, 95% CI -0.98 to 24.10) and America with two studies (estimated=3.02%, 95% CI 1.54 to 4.50), respectively. Using meta-regression, the relationship between continents and vitiligo type was found to be insignificant (p=0.47). Positive family history was recorded in 657 patients (estimated = 16.88%, 95% CI 13.37 to 20.39). Positive family history varied by country of study from 13.91% (Asia with 11 studies) to 27.01% (Europe with two studies) (p=0.11). Kobner phenomena and leukotrichia were noted in 687 (25.47%) and 461 (18.52%) patients, respectively. CONCLUSION: The review indicated that childhood vitiligo is more prevalent in women. Non-segmental forms of childhood vitiligo were the most common, including vulgaris, focal and acrofacial. The clinicoepidemiological pattern of childhood vitiligo is variable in different geographic areas.

Managing the deluge of newly discovered plant viruses and viroids: an optimized scientific and regulatory framework for their characterization and risk analysis.

The advances in high-throughput sequencing (HTS) technologies and bioinformatic tools have provided new opportunities for virus and viroid discovery and diagnostics. Hence, new sequences of viral origin are being discovered and published at a previously unseen rate. Therefore, a collective effort was undertaken to write and propose a framework for prioritizing the biological characterization steps needed after discovering a new plant virus to evaluate its impact at different levels. Even though the proposed approach was widely used, a revision of these guidelines was prepared to consider virus discovery and characterization trends and integrate novel approaches and tools recently published or under development. This updated framework is more adapted to the current rate of virus discovery and provides an improved prioritization for filling knowledge and data gaps. It consists of four distinct steps adapted to include a multi-stakeholder feedback loop. Key improvements include better prioritization and organization of the various steps, earlier data sharing among researchers and involved stakeholders, public database screening, and exploitation of genomic information to predict biological properties.

The innovative application of autologous biofillers in aesthetic dermatology.

INTRODUCTION: Tissue engineering is a revolutionized biotechnology that utilizes biomaterials in regenerative medicine. Nowadays, there is a trend in employing autologous-based materials in aesthetic medicine. In this review, we discuss safety and efficacy of autologous-based fillers in the fields of aesthetic dermatology, and describe the details of preparation and injection methods based on current literature. EVIDENCE ACQUSITION: PubMed, Scopus, Web of science, Embase and Google scholar were searched for studies which evaluated efficacy of autologous-based filler in the field of aesthetic dermatology from January 2000 until August 2022. Nineteen articles including five randomized clinical trials, ten prospective and four retrospective studies were selected for this review. EVIDENCE SYNTHESIS: Most of the studies evaluated use of biofillers in rejuvenation (twelve articles) and the remaining were in atrophic scars (six articles) and striae distensae (one article). Adjuvant treatments included liquid platelet rich growth factor (PRGF), autologous cultured fibroblast, adipose tissue micrograft, microneedling, fractional carbon dioxide laser and subcision. Application of biofillers is a safe alternative therapeutic option for soft tissue augmentation. CONCLUSIONS: Application of biofillers is especially recommended in patients who seek low-cost rejuvenation methods and those with a past history of granulomatous reactions to the other fillers. It provides the advantage of immediate filling effects with long-lasting efficacy.

Strains in the implant collars supporting a cantilevered cross-arch bar prosthesis. An in vitro study.

PURPOSE: To examine the strains in the collar area of implants supporting a cantilevered cross-arch bar prosthesis during vertical load application. MATERIALS AND METHODS: A milled cross-arch metal framework supported by four implants in a trapezoidal design was supported in polymethylmethacrylate. T-strain gage rosettes were attached to the crestal areas of the implants with two grids, one recording circumference strain of the crestal area of the implant and the second recording vertical strain, torquing strains of the implant. The framework was subject to vertical loading from an MTS 810 mechanical system. Loading sites were directly on anterior and posterior implants, and on a cantilever at 7.5, 15, 22.5, and 30 mm (0.5, 1.0, 1.5, and 2.0 of the anterior-posterior spread) distal from the posterior implant on the right side. The anterior-posterior (A-P) spread from anterior to posterior implants was 15 mm. Sites were loaded individually with 50 and 100 N. The data from the rosettes were transferred to a desktop computer and processed using StrainSmart 5000 software. RESULTS: Means and standard deviations were calculated for the 10 trials at each of the loading sites. Two-way ANOVAs were done separately for each dependent variable, the vertical grid, and the circumferential grid. The independent variables were the load magnitude and the load site. Tukey's test was used to compare groups post hoc. When directly loading the implants, loading the anterior implant resulted initially in compression followed by increasing tensile strain with 100 N loads. Loading the implant adjacent to cantilever (the posterior implant) resulted in greater strain at the collar than that observed with anterior implant with minimal bending strains. When loading the cantilever, anterior implant showed increasing bending strain at greater cantilever length, whereas the circumferential strains were greater for the supporting implant adjacent to the cantilever, particularly at 100 N loads, p ≤ 0.001. CONCLUSIONS: Limiting cantilever lengths to A-P spread ratios of 0.5 are preferred. Ratios greater than 1.0 should be avoided as flexing of the collar may occur. The dimensions of the implant, particularly wall thickness, adjacent to the cantilever should be carefully considered when planning the cantilevered implant-supported prosthesis.

The Expanding Menagerie of Prunus-Infecting Luteoviruses.

Members of the genus Luteovirus are responsible for economically destructive plant diseases worldwide. Over the past few years, three luteoviruses infecting Prunus trees have been characterized. However, the biological properties, prevalence, and genetic diversity of those viruses have not yet been studied. High-throughput sequencing of samples of various wild, cultivated, and ornamental Prunus species enabled the identification of four novel species in the genus Luteovirus for which we obtained complete or nearly complete genomes. Additionally, we identified another new putative species recovered from Sequence Read Archive data. Furthermore, we conducted a survey on peach-infecting luteoviruses in eight European countries. Analyses of 350 leaf samples collected from germplasm, production orchards, and private gardens showed that peach-associated luteovirus (PaLV), nectarine stem pitting-associated virus (NSPaV), and a novel luteovirus, peach-associated luteovirus 2 (PaLV2), are present in all countries; the most prevalent virus was NSPaV, followed by PaLV. The genetic diversity of these viruses was also analyzed. Moreover, the biological indexing on GF305 peach indicator plants demonstrated that PaLV and PaLV2, like NSPaV, are transmitted by graft at relatively low rates. No clear viral symptoms have been observed in either graft-inoculated GF305 indicators or different peach tree varieties observed in an orchard. The data generated during this study provide a broader overview of the genetic diversity, geographical distribution, and prevalence of peach-infecting luteoviruses and suggest that these viruses are likely asymptomatic in peach under most circumstances.

The Molecular Characterization of a New Prunus-Infecting Cheravirus and Complete Genome Sequence of Stocky Prune Virus.

As part of a virome characterization of Prunus species, a novel cheravirus was discovered in two wild species, Prunus brigantina and P. mahaleb, and in an apricot (P. armeniaca) accession. The sequence of the two genomic RNAs was completed for two isolates. The Pro-Pol conserved region showed 86% amino acid (aa) identity with the corresponding region of trillium govanianum cheravirus (TgCV), a tentative Cheravirus member, whereas the combined coat proteins (CPs) shared only 40% aa identity with TgCV CPs, well below the species demarcation threshold for the genus. This suggests that the new virus should be considered a new species for which the name alpine wild prunus virus (AWPV) is proposed. In parallel, the complete genome sequence of stocky prune virus (StPV), a poorly known cheravirus for which only partial sequences were available, was determined. A phylogenetic analysis showed that AWPV, TgCV and StPV form a distinct cluster, away from other cheraviruses.

VirHunter: A Deep Learning-Based Method for Detection of Novel RNA Viruses in Plant Sequencing Data.

High-throughput sequencing has provided the capacity of broad virus detection for both known and unknown viruses in a variety of hosts and habitats. It has been successfully applied for novel virus discovery in many agricultural crops, leading to the current drive to apply this technology routinely for plant health diagnostics. For this, efficient and precise methods for sequencing-based virus detection and discovery are essential. However, both existing alignment-based methods relying on reference databases and even more recent machine learning approaches are not efficient enough in detecting unknown viruses in RNAseq datasets of plant viromes. We present VirHunter, a deep learning convolutional neural network approach, to detect novel and known viruses in assemblies of sequencing datasets. While our method is generally applicable to a variety of viruses, here, we trained and evaluated it specifically for RNA viruses by reinforcing the coding sequences' content in the training dataset. Trained on the NCBI plant viruses data for three different host species (peach, grapevine, and sugar beet), VirHunter outperformed the state-of-the-art method, DeepVirFinder, for the detection of novel viruses, both in the synthetic leave-out setting and on the 12 newly acquired RNAseq datasets. Compared with the traditional tBLASTx approach, VirHunter has consistently exhibited better results in the majority of leave-out experiments. In conclusion, we have shown that VirHunter can be used to streamline the analyses of plant HTS-acquired viromes and is particularly well suited for the detection of novel viral contigs, in RNAseq datasets.

Viral aetiology of acute central nervous system infections in children, Iran.

Introduction. Viral infections are increasingly an important cause of central nervous system (CNS) complications.Hypothesis/Gap Statement. There is no comprehensive insight about CNS infections due to viral agents among Iranian children.Aim. This study aimed to investigate the viral aetiology, clinical and epidemiological profile of children with acute infections of the CNS.Methodology. A prospective study was conducted on children at the referral hospital in Isfahan, Iran, from June 2019 to June 2020. A multiplex PCR assay was used to detect the viral causative agent in cerebrospinal fluid and throat/rectal swab samples.Results. Among 103 patients with eligible criteria, a confirmed or probable viral aetiology was detected in 41 (39.8 %) patients, including enteroviruses - 56.1 %, herpes simplex virus 1/2 (HSV-1/2) - 31.7 %, Epstein-Barr virus - 17.1 %, varicella-zoster virus (VZV) - 9.7 %, influenza A virus (H1N1) -4.9 % and mumps - 2.4 %. There was a higher proportion of PCR-positive samples in infants than in other age groups. Encephalitis and meningoencephalitis were diagnosed in 68.3 % (28/41) and 22 % (9/41) PCR-positive cases, respectively.Conclusion. The findings of this research provide insights into the clinical and viral aetiological patterns of acute CNS infections in Iran, and the importance of molecular methods to identify CNS viruses. HSV and VZV were identified as important causes of encephalitis in young children.

Employing hyaluronic acid-based mesotherapy for facial rejuvenation.

BACKGROUND: Mesotherapy is a method of treatment in which biocompatible substances are injected in small aliquots into different levels of skin. This technique can be used for facial rejuvenation. AIM: To comprehensively evaluate efficacy of different hyaluronic acid (HA) materials for skin rejuvenation, and discuss longevity of these products, potential adverse effects, and different injection techniques. MATERIAL AND METHODS: We searched Pubmed, Scopus, Web of science, Google Scholar, Embase, Cochrane Library, and Science direct until April of 2022. Thirty-four articles were selected including 23 articles about non-cross-linked HA and 11 articles about cross-linked HA. RESULTS: Eleven and five different non-cross-linked HA and cross-linked HA materials were utilized, respectively. Treatment sessions for non-cross-linked HA were between 1 and 6 at weekly-to-bimonthly interval, and for cross-linked HA were 1-3 at 4-36 weeks apart. In most of the studies, serial micropuncture technique with 23-32 gauge needles was used for injection. Other injection techniques were Nappage (picotage), depot and micro-linear. CONCLUSION: Mesotherapy with HA-based fillers is a favorable method for restoring youthful appearance, rejuvenation, and revitalization of skin. Proper selection and precise placement of HA in desired level of dermis is an essential key to optimize improvement and minimize side effects including skin irregularities and Tyndall effect. Adjuvant therapy with additional rejuvenation procedures to enhance esthetic results is required especially in elderly individuals with severe photodamaged skin. Moreover, preservation of esthetic results requires maintenance therapy every few months.

Attachment of human periodontal ligament fibroblasts to root dentin conditioned with different endodontic irrigants: An experimental study.

Background. Periradicular surgery is the last treatment option for teeth with persistent periradicular endodontic lesions. This study aimed to assess the adhesion of fibroblasts to root dentin conditioned with ethylenediaminetetraacetic acid (EDTA), MTAD, and QMix. Methods. Twelve dentin discs were fabricated of 6 human single-rooted teeth. Fibroblasts were isolated from the periodontal ligament (PDL) of a premolar tooth. The teeth were healthy and freshly extracted from the socket. The samples were divided into four groups for surface conditioning with (I) EDTA, (II) MTAD, (III) QMix, and the control group. Fibroblasts were cultured on conditioned dentin discs at 37°C, 95% air, and 5% CO2 for 4 hours and then rinsed with PBS three times to eliminate unattached cells from the surface. The mean counts of attached cells were calculated using a Neubauer chamber. Also, the attachment of fibroblasts was evaluated using scanning electron microscopy (SEM). Results. The mean counts of fibroblasts attached to root dentin in EDTA, QMix, MTAD, and control groups were 303±46, 243±41, 213±33, and 347±38, respectively. No significant difference was noted in the number of fibroblasts attached between MTAD, EDTA, and QMix and the control group (P>0.05). Under SEM, the fibroblasts were flat and spindle-shaped, with cytoplasmic processes covering the untreated dentin surface. In the experimental groups, the cells were rounder with fewer processes. All the three groups showed weaker adhesion to dentin compared to the control (untreated dentin) group. Conclusion. Under the limitations of this study, it was concluded that treating the dentin surface with EDTA, MTAD, or QMIX might not be an effective way to improve the adhesion of human PDL fibroblasts.

COVID-19-associated pityriasis rosea in children: Case report and literature review.

Skin lesions are one of the Coronavirus disease 2019 (COVID-19) symptoms. Pityriasis rosea (PR) is a mucocutaneous manifestation that can occur following virus infections. Most of the PR lesions after COVID-19 infection were reported in adults. Herein, we report a child with PR lesions, and a literature review on 5 other case reports in children.

Comparison of Pregabalin and Ketotifen in treatment of uremic pruritus in hemodialysis patients.

This study aims to compare the efficiency of Pregabalin and Ketotifen in treatment of uremic pruritus in hemodialysis (HD) patients. Thirty HD patients were randomly divided into two groups: A (Pregabalin 50 mg three times a day) and B (Ketotifen 1 mg twice a day). Efficacy of treatment and quality of life were weekly evaluated by visual analogue scale (VAS) and Itchy Quality of life, respectively. There was no significant difference between the two groups regarding demographic features, laboratory data, quality of life, and VAS before treatment. In the second week of treatment, the pruritus intensity was significantly lower in the Pregabalin group than the Ketotifen group (p = 0.026). The mean of life quality was significantly lower in Ketotifen than Pregabalin group in weeks 1, 2, and 4 (p = 0.001, p = 0.001, and p = 0.036, respectively). There was no significant difference between the two groups regarding the side effects of drugs. This study showed that a higher dose of Pregabalin could be a more effective treatment than Ketotifen without additive side effects in improving the quality of life in dialysis patients.

Efficacy and safety of traditional and surgical treatment modalities in segmental vitiligo: A review article.

BACKGROUND: Segmental vitiligo (SV) is a distinctive variant of vitiligo that is usually resistant to traditional treatments. Therefore, surgical therapies are mainstay of treatment in this type of vitiligo. To date, there is no review article or systematic review that evaluates specifically efficacy of treatment modalities on SV. AIM: To evaluate current evidence regarding efficacy and safety of traditional and surgical treatment modalities in SV. METHODS: We conducted a search in PubMed, Embase, Web of science, and Google Scholar for key words of "vitiligo" AND "segmental" AND "treatment" OR "therapy" OR "surgical treatments" OR "medical treatments" OR "laser" OR "phototherapy". Inclusion criteria were English literature that investigated efficacy of different treatments on three or more cases on SV from January 2000 until July 2021. RESULTS: A total of thirty-four articles were selected for detailed assessment. Different treatment modalities include medical treatment [systemic corticosteroid (SCS), topical CS (TCS), and topical calcineurin inhibitors (TCI)], phototherapy [narrow band-ultraviolet B (NB-UVB), psoralen and UVA (PUVA) and psoralen+solar exposure (PUVASOL)], laser/lights [helium-neon and Excimer laser/light (EL)] and surgical treatments [punch graft (PG), follicular graft, suction blister epidermal grafting (SBEG), spilt-thickness skin graft (STSG), and cultured/non-cultured-melanocytes-keratinocytes transplantation (MKTP)]. CONCLUSION: There were few randomized controlled trials (RCT) evaluating the efficacy of treatments in SV. Therefore, future high quality studies are required for better assessment of various treatment modalities in SV. Results of current evidence indicate resistance of SV to traditional therapies unless in patients with short duration of vitiligo. Therefore, surgical interventions are the first-line of treatment in refractory cases, long-standing disease, or presence of leukotrichia in depigmented patches.

Treatment protocols and efficacy of light and laser treatments in post-acne erythema.

BACKGROUND: Post-acne erythema is described as erythema due to release of inflammatory cytokines, dilatation of microcapillaries within papillary dermis and thinning of epidermis. The erythema usually fades; however, it can persist for months. AIM: In this review, we decided to evaluate efficacy of light and laser treatments in acne-induced erythema. METHODS: We searched PUBMED, Embase, Cochrane, and Google Scholar for relevant key words. Inclusion criteria were randomized clinical trials (RCTs) that evaluated efficacy of laser or light in PAE until September 2021. RESULTS: Twelve RCTs were selected for the final assessment. Light and laser treatments included pulsed dye laser (PDL), intense pulsed light (IPL), Q-switched neodymium-doped yttrium aluminum garnet (QS Nd:YAG), fractional photothermolysis, alexandrite, solid-slate 589-1319 nm, and pro-yellow laser. CONCLUSION: Light and laser treatments are effective treatment modalities in reduction of acne-induced erythema along with active acne lesions and atrophic acne scars.

Employing microbotox technique for facial rejuvenation and face-lift.

BACKGROUND: Microbotox technique, intradermal injection of microdroplets of botulinum toxin, is a favorable rejuvenation approach in subjects who prefer more natural appearance. AIM: To determine the best injection techniques (dosage, concentration, as well as number and location of injection points), efficacy and side effects of this innovative technique for facial rejuvenation. METHODS: We conducted a search in Pubmed, Embase, Web of Science, and Google Scholar databases from conception until October 2021 with keywords "microbotox" OR "mesobotox" OR "intradermal injection" AND "botulinum toxin" AND "rejuvenation" AND "wrinkle" AND "face-lift." RESULTS: Twenty articles were included in this review article. Different types of formulation including onabotulinum toxin A (OBA), abobotulinum toxin A (ABO), and incobotulinum toxin A (IBA) were used. The most used concentrations were 10-20 u/cc of OBA. Number of injection points varied from 4 (forehead and periorbital areas) to 999 (entire face) with 2 mm to 2 cm apart. Adjuvant treatment modalities were cross-linked hyaluronic acid, intense pulsed laser, and Fraxel laser. Most studies reported the initial results appeared after 5-14 days of procedure, lasting for nearly 3-6 months. CONCLUSION: Microbotox is an efficient and attractive method for facial rejuvenation, mid-lower face-lifting, and fine wrinkles reduction in forehead, periocular, and cheek regions, especially in younger-aged subjects. Furthermore, it is a suitable treatment for neck rejuvenation and recontouring of lower mandibular border, particularly in older subjects with marked skin laxity.

Safety and efficacy of mesotherapy in the treatment of melasma: A review article.

BACKGROUND: Mesotherapy is a popular novel therapeutic modality that is defined as intradermal or subcutaneous microinjection of pharmaceutical compounds. Although this novel treatment method is used commonly in aesthetic dermatology, there is little information about details of injections, efficacy, and side effects of mesotherapy in melasma. AIM: In this review, we evaluated efficacy and safety of various types of mesotherapy in the treatment of melasma. METHOD: We searched Google Scholar, Medline, and PubMed for related articles with keywords "melasma" OR "chloasma" AND "mesotherapy" OR "injection." Inclusion criteria were articles that evaluated intradermal injection of lightening drugs and published dates between January 2000 and September 2021. Exclusion criteria were articles in languages other than English or non-human studies. RESULTS: Thirty-three articles evaluated efficacy of mesotherapy in melasma, including 28 articles about tranexamic acid, 4 articles about vitamin C, 2 articles about glutathione, and 2 articles about triamcinolone. CONCLUSION: Mesotherapy is a good alternative or adjunctive choice in patients who are refractory to first-line therapy, patients with low compliance with everyday use of topical therapy, patients with contraindication to oral tranexamic acid therapy, or who wish short downtime and fast recovery period. Further studies with large sample sizes are required to determine ideal concentrations of mesotherapy substances and intervals between sessions and to evaluate the efficacy of different substances for mesotherapy as monotherapy compared to combination therapy and other treatment modalities for melasma.

Treatment protocols and efficacy of combined laser with medical treatment modalities in vitiligo.

BACKGROUNDS: Nowadays, lasers are used for treatment of vitiligo in difficult-to-treat areas and refractory lesions. Combination of lasers with other medical modalities can provide higher efficacy, faster response rate, and higher compliance of patients to treatment. AIM: In this article, we reviewed articles regarding safety, efficacy, and treatment protocols of combined laser with other medical modalities. METHODS: We searched articles with relevant key words in Google scholar and PubMed. Inclusion criteria were articles in English language since January 2000 until March 2021that evaluate combination of laser with other topical or systemic medical treatments. RESULTS: A total of 42 articles evaluated efficacy of lasers [excimer, carbon dioxide (CO2 ), erbium-doped yttrium-aluminum-garnet (Er:YAG), and non-ablative resurfacing laser] combined with topical or systemic medical treatment modalities. Effective response rate (more than 50% improvement) varied between 7.7% and 92%. Initial repigmentation observed between 4 and 13 weeks after beginning of treatment. CONCLUSION: Combination of laser with medical modalities leads to more rapid repigmentation, superior efficacy, and better compliance of patients with localized non-segmental type of vitiligo compared to monotherapy. Combination of excimer laser with topical therapy might be suggested for recalcitrant vitiligo lesions in face and neck. Combination of fractional ablative resurfacing lasers with topical therapy, especially 5-flurouracil, can be recommended particularly in recalcitrant acral and bony prominent areas. Further studies are required to achieve conclusive evidence in order to define the best stage of vitiligo for laser therapy and most effective combined treatment regimen.