BCL-2 and Bax Expression in Skin Flaps Treated with Finasteride or Azelaic Acid.

Despite all modern surgical techniques, skin flap that is considered as the main method in most reconstructive surgeries puts the skin tissue at danger of necrosis and apoptosis derived from ischemia. Therefore, finding a treatment for decreasing the apoptosis derived from flap ischemia will be useful in clinic. In present study, we evaluated the effect of azelaic acid 20% and finasteride on expression of BCL-2 and bax proteins after the skin flap surgery. For this purpose, 21 rats were entered in three groups including control, azelaic acid 20% and finasteride, all experienced skin flap surgery and then flap tissue was assessed for determining the expression of proteins in 5 slices prepared from each rat that were graded between - to +++ scales. Both azelaic acid and finasteride increased the expression of BCL-2 protein (p < 0.05) and decrease the expression of bax protein (p < 0.05). These results suggested an antiapoptotic role for finasteride and azelaic acid in preserving the flap after the ischemia reperfusion insult.

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.

Pigmented Bowen's disease of the finger mimicking malignant melanoma.

Pigmented Bowen's disease is an uncommon in situ squamous cell carcinoma of the skin, which has been rarely reported on the finger. Herein, we report an unusual case of pigmented Bowen's disease of the pulp of the fourth finger in a 20-year-old white woman, which was clinically presented as a superficial, spreading malignant melanoma. Physical examination revealed a solitary hyperpigmented patch, measuring 1 cm in its greatest diameter. The lesion had an irregular, but well-defined margin, and was homogeneously brown with a smooth surface. There was no nodularity or induration in the lesion or in its surrounding skin. A skin biopsy was obtained with the clinical suspicion of malignant melanoma. Histological examination was compatible with the diagnosis of pigmented Bowen's disease. Surgical treatment was then considered and the patient underwent complete excision of the lesion. In spite of its rarity, Bowen's disease should be considered in the differential diagnosis of pigmented lesions, particularly malignant melanoma.

Imiquimod in combination with meglumine antimoniate for cutaneous leishmaniasis: a randomized assessor-blind controlled trial.

OBJECTIVE: To determine the efficacy and safety of imiquimod in combination with meglumine antimoniate in treating cutaneous leishmaniasis. DESIGN: Prospective, randomized, assessor-blind, parallel-design, placebo-controlled trial. SETTING: Two primary care health clinics. PATIENTS: One hundred nineteen patients (59 patients in the imiquimod group and 60 in the placebo group) were included in the study. INTERVENTIONS: Patients were randomly assigned to receive a combined 4-week course of imiquimod or placebo with meglumine antimoniate treatment (20 mg/kg of pentavalent antimony daily for 2 weeks) in an endemic area of Leishmania tropica. MAIN OUTCOME MEASURES: The primary end point was clinical cure, defined as more than 75% reduction in the size of lesions compared with baseline at week 8. RESULTS: At the end of the 4-week treatment period, clinical cure was similar in both groups (11 patients [18.6%] in the imiquimod-treated group vs 18 patients [30.0%] in the placebo group) (P = .15). Four weeks after the end of treatment, 26 patients (44.1%) and 29 patients (48.3%) in the imiquimod-treated and placebo groups, respectively, were cured (P = .64). Pruritus and burning sensation were reported by 3 patients treated with imiquimod and by no patients treated with placebo. CONCLUSION: This study showed no beneficial effect of combining a 4-week course of treatment with 5% imiquimod cream and a standard course of treatment with meglumine antimoniate in patients with cutaneous leishmaniasis in an endemic area of L tropica. TRIAL REGISTRATION: isrctn.org Identifier:ISRCTN77659407 and Cochrane Skin Group Identifier: CSG Trial No. 32.