Low-level laser therapy and narrative review of other treatment modalities in androgenetic alopecia.

Androgenetic alopecia (AGA), also termed as androgenic alopecia or common baldness, is a condition where there is androgen mediated conversion of susceptible terminal hair into vellus hair. Although it is reported more commonly in males, it also affects females but the incidence is relatively unknown. AGA tremendously affects the psychology of the patient due to its chronicity of treatment and cosmetic implications. There are numerous treatment options available for AGA but the choice of treatment has to often be tailored according to the patient's needs, affordability, and compliance. This review focusses on the various treatment options available, with special emphasis on the role of low-level laser therapy (LLLT) in the management of AGA. The literature research considered published journal articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) and reference lists of respective articles. Only articles available in English were considered for this review.

Composite hemangioendothelioma of the forehead and right eye; a case report.

BACKGROUND: Hemangioendothelioma includes several types of vascular neoplasms , as well as both benign and malignant growth. CASE PRESENTATION: This study evaluated a case of a 78-year-old female diagnosed with composite hemangioendothelioma (CHE). This patient had an 18-month history of painless inflammatory lesions and erythema on the left forehead and right upper eyelid. The clinical and pathologic characteristics of the CHE were evaluated in the present study. CONCLUSION: The evidence of the coexistence of variable components of the CHE in our study emphasized the importance of distinctive morphology and biology, and should be considered in the differential diagnosis of other vascular lesions.

Unique Presentation of Orf Virus Infection in a Thermal-Burn Patient After Receiving an Autologous Skin Graft.

We describe a burn patient who developed skin lesions on her skin-graft harvest and skin-graft recipient (burn) sites. Orf virus infection was confirmed by a combination of diagnostic assays, including molecular tests, immunohistochemical analysis, pathologic analysis, and electron microscopy. DNA sequence analysis grouped this orf virus isolate among isolates from India. Although no definitive source of infection was determined from this case, this is the first reported case of orf virus infection in a skin graft harvest. Skin graft recipients with exposures to animals may be at risk for this viral infection.

Coexistent frontal fibrosing alopecia with ophiasis pattern alopecia areata in a young female: A case report and review of the literature.

This study highlights the possibility of coexistent Frontal Fibrosing Alopecia and ophiasis pattern Alopecia Areata especially in young females which is a rare manifestation. A concomitant shared pathophysiology is suspected to underlie this association.

Revolutionizing non-melanoma skin cancer treatment: Receptor tyrosine kinase inhibitors take the stage.

BACKGROUND: Innovative treatments for non-melanoma skin cancers (NMSCs) are required to enhance patient outcomes. AIMS: This review examines the effectiveness and safety of receptor tyrosine kinase inhibitors (RTKIs). METHODS: A comprehensive review was conducted on the treatment potential of several RTKIs, namely cetuximab, erlotinib, gefitinib, panitumumab, and lapatinib. RESULTS: The findings indicate that these targeted therapies hold great promise for the treatment of NMSCs. However, it is crucial to consider relapse rates and possible adverse effects. Further research is needed to improve treatment strategies, identify patient groups that would benefit the most, and assess the long-term efficacy and safety, despite the favorable results reported in previous studies. Furthermore, it is crucial to investigate the potential benefits of integrating RTKIs with immunotherapy and other treatment modalities to enhance the overall efficacy of therapy for individuals with NMSC. CONCLUSIONS: Targeted therapies for NMSCs may be possible with the use of RTKIs. The majority of studies focused on utilizing epidermal growth factor receptor inhibitors as the primary class of RTKIs for the treatment of NMSC. Other RTKIs were only employed in experimental investigations. Research indicates that RTKIs could potentially serve as a suitable alternative for elderly patients who are unable to undergo chemotherapy and radiotherapy.

VEGF/VEGFR axis and its signaling in melanoma: Current knowledge toward therapeutic targeting agents and future perspectives.

Melanoma is responsible for most skin cancer-associated deaths globally. The progression of melanoma is influenced by a number of pathogenic processes. Understanding the VEGF/VEGFR axis, which includes VEGF-A, PlGF, VEGF-B, VEGF-C, and VEGF-D and their receptors, VEGFR-1, VEGFR-2, and VEGFR-3, is of great importance in melanoma due to its crucial role in angiogenesis. This axis generates multifactorial and complex cellular signaling, engaging the MAPK/ERK, PI3K/AKT, PKC, PLC-γ, and FAK signaling pathways. Melanoma cell growth and proliferation, migration and metastasis, survival, and acquired resistance to therapy are influenced by this axis. The VEGF/VEGFR axis was extensively examined for their potential as diagnostic/prognostic biomarkers in melanoma patients and results showed that VEGF overexpression can be associated with unfavorable prognosis, higher level of tumor invasion and poor response to therapy. MicroRNAs linking to the VEGF/VEGFR axis were identified and, in this review, divided into two categories according to their functions, some of them promote melanoma angiogenesis (promotive group) and some restrict melanoma angiogenesis (protective group). In addition, the approach of treating melanoma by targeting the VEGF/VEGFR axis has garnered significant interest among researchers. These agents can be divided into two main groups: anti-VEGF and VEGFR inhibitors. These therapeutic options may be a prominent step along with the modern targeting and immune therapies for better coverage of pathological processes leading to melanoma progression and therapy resistance.

The impact of blue light and digital screens on the skin.

INTRODUCTION: The skin is frequently subjected to a variety of environmental trauma and stress. It is unavoidably subjected to blue light due to the increased use of electronic equipment, including indoor lighting and digital gadgets like smartphones and laptops, which have a range of detrimental effects. The method of action and numerous harmful consequences of blue light on the skin are the main subjects of this review. MATERIALS AND METHODS: A literature search has been performed using PubMed, GoogleScholar and EmBase databases and an updated review on the topic has been presented. RESULTS: Numerous studies have shown that being exposed to blue light accelerates the aging process and produces cutaneous hyperpigmentation. It also modifies the circadian rhythm. The two main molecules that mediate cellular responses to blue light are nitric oxide (NO) and reactive oxygen species. However, the precise process is still not fully known. CONCLUSION: These negative consequences may eventually cause more general skin damage, which may hasten the aging process. At times, skin protection may be crucial for protection against blue light.

Recurrent facial microcystic adnexal carcinoma and hair transplantation on scar site.

Microcystic adnexal carcinoma (MAC) is a rare kind of cutaneous neoplasm with a very aggressive local infiltration that destructs the affected tissues. Its rate of recurrence is high and it mostly involves the face and scalp regions and most of the patients get affected in the fourth or fifth decades of their life. Here in, we report a 61-year-old woman with a right-sided eyebrow MAC lesion with recurrency. Total excisional surgery was performed. A-T Flap surgery was applied on the involved area, and after a 2-year period of follow-up, with no recurrency, hair transplantation with follicular unit transplantation method was successfully performed on the scarred area. Although microcystic adnexal carcinoma is an uncommon neoplasm; dermatologists and ophthalmologists should consider it as a differential diagnosis, due to its aggressive local infiltration. Complete surgical excision and long-term follow-up must be applied to manage the disease. Also, hair transplantation with follicular unit transplantation technique can be considered as a beneficial method for treating scars resulted from MAC excisional surgery.

Comparative effectiveness and safety of topical methimazole 5% monotherapy versus combination of Q-Switched Nd: YAG Laser and topical methimazole 5% in patients with refractory melasma.

INTRODUCTION: Melasma is an acquired pigmentary disorder which currently has no definitive treatment. Although topical drugs containing hydroquinone are the basis of treatments, they are usually associated with recurrence. We aimed to evaluate the effectiveness and safety of monotherapy with topical methimazole 5% versus combination of Q-Switched Nd: YAG Laser and topical methimazole 5% in patients with refractory melasma. METHODS: A total of 27 women with refractory melasma were included. We applied topical methimazole 5% (once a day) with three passes of QSNd: YAG laser (Wavelength: 1064 nm, pulse energy: 750 mJ, fluence: 1.50  J/cm2 , spot size: 4 × 4 mm, hand piece: fractional, JEISYS company) for six sessions on the right half of the face, and topical methimazole 5% (once a day) on the left half of the face, for each patient. The treatment course was 12 weeks. Evaluation of effectiveness was done with the Physician Global Assessment (PGA), Patient Global Assessment (PtGA), Physician satisfaction (PS), Patients satisfaction (PtS), and mMASI score. RESULTS: PGA, PtGA, and PtS were not significantly different between the two groups at any time (p > 0.05). PS in the laser plus methimazole group was significantly better than methimazole group at 4th, 8th, and 12th weeks (p < 0.05). The rate of PGA improvement in the combination group was significantly better than the monotherapy over time (p < 0.001). The changes of mMASI score between the two groups did not significantly differ at any time (p > 0.05). There was no significant difference in the adverse events between the two groups. CONCLUSION: Combination therapy with topical methimazole 5% and QSNY laser can be considered as an effective way to treat refractory melasma.

Comparison of the efficacy of carboxytherapy versus fractional CO2 laser therapy for the treatment of periorbital dark circles: A randomized clinical trial.

BACKGROUND: Periorbital dark circles (PDC) is one of the most common cosmetic issues in today's society. Only moderate degree of improvement has been achieved by various available treatment options. The present study aimed to compare the clinical efficacy of carboxytherapy and fractional CO2 laser therapy in the management of PDC. METHODS: In this split face study, 30 patients with bilateral PDC aged between 23 and 52 years were recruited who underwent carboxytherapy (n = 30) on PDC of one side of the face and fractional CO2 laser therapy (n = 30) on the PDC of other side. The entire treatment comprised of four sessions of each therapy with an interval of 2 weeks each time. The assessment was based on both subjective methods (patients' satisfaction and physician's judgment) and objective method (based on digital standard photographs). The degree of improvement from the patient's point of view (patient satisfaction) and physician's point of view (physician satisfaction) was assessed in different therapy sessions in comparison with the improvement after first session. RESULTS: The study included 30 patients with mean age of 38.22 ± 8.3 years. The mean disease duration was 45 ± 12.3 months. After the second therapy session, patients' satisfaction was remarkably better in the fractional CO2 laser therapy group than the carboxytherapy group, over the time. According to the physician satisfaction, the improvement rate was higher after the second and sixth weeks in the fractional CO2 laser therapy group than the carboxytherapy group; whereas in other sessions, there were no statistically significant differences. There were no significant side effects observed in either group post-treatment each time. CONCLUSION: Fractional CO2 laser therapy is a better option to treat PDC than carboxytherapy. Also, mild side effects (including erythema, pain, and discomfort) were reported in both groups; with no significant difference between the groups.

Evaluating the combined efficacy of oral isotretinoin and topical tacrolimus versus oral finasteride and topical tacrolimus in frontal fibrosing alopecia-A randomized controlled trial.

OBJECTIVE: Treatment of frontal fibrosing alopecia (FFA) is complicated and challenging. In this study, we evaluated the efficacy of combining topical tacrolimus with isotretinoin versus finasteride in patients with FFA. METHODOLOGY: Thirty-one patients with FFA were divided randomly into two groups. Therapeutic regimen of the first group (group A, n = 16) was isotretinoin and tacrolimus (Capsule isotretinoin 20 mg daily and topical tacrolimus 0.1% BD). The second group (group B, n = 15) was given finasteride and tacrolimus (Tablet finasteride 2.5 mg daily and topical tacrolimus 0.1% BD). Patients were treated and followed up periodically for 12 weeks. Evaluation of the treatment efficacy was based on Patient Global Assessment and Physician Global Assessment scales. Objective evaluation was based on improving the severity of skin lesions by viewing serial images taken from the affected areas. RESULTS: Physician Global Assessment (PGA) was significantly better in the group A as compared with the group B at 4 weeks (p = 0.038). Physician satisfaction in the group A was better than the group B at 12 weeks, but this was not statistically significant (p > 0.05). Patient Global Assessment and patient satisfaction in the group A was better than the group B at 8 and 12 weeks, but it was not statistically significant (p > 0.05). CONCLUSION: Although both therapeutic regimens were effective in the treatment of FFA, treatment with tacrolimus and isotretinoin is significantly more effective than tacrolimus and finasteride.

The role of cytokines and vitamin D in vitiligo pathogenesis.

Vitiligo is a pigment-related disease with a global prevalence of 0.2% to 1.8% associated with considerable burden on quality of life. The treatment is still a challenge because of relapses and/or incomplete re-pigmentation. Although the exact cause is still unclear, its pathogenesis seems to be justifiable with the autoimmune theory, supported by the results of clinical research. In this narrative review, we aimed to summarize the evidence related to cytokines and vitiligo development. This review is consisted of English articles published in PubMed and Google Scholar concerning levels of inflammatory mediators, especially interleukins, in vitiligo patients over the last 20 years. References of relevant articles were also considered for review. Crucial role of dysregulated levels of interleukins and their synergistic function to each other, in the onset or progression of the disease is evident. The theory of autoimmune vitiligo is reinforced by the results of the studies in the literature, due to the association of pathogenesis with increased secretion of pro-inflammatory mediators and reduction of anti-inflammatory mediators. Decreased vitamin D levels may have a considerable role in vitiligo development by affecting Th1- and Th17-related immune responses. Cytokines play an important role in the pathogenesis or progression of the disease. Moreover, we believe that decreased vitamin D level has a considerable role in vitiligo development by affecting Th1- and Th17-related immune responses.

Differentiation of frontal fibrosing alopecia and Lichen planopilaris on trichoscopy: A comprehensive review.

Trichoscopy in dermatology has opened up the new concept in overcoming the optical challenge faced clinically. It reveals the diagnostic details to the depth of superficial dermis, and thereby increasing the clinician's diagnostic accuracy and the level of confidence. The importance of trichoscopy in cicatricial alopecia is very evident in the current scenario for its precise diagnosis. The clinical picture in delineating lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) from each other and also from other close mimickers such as androgenetic alopecia, alopecia areata, female patterned hair loss, and other cicatricial alopecia is bewildered due to its varied presentation and co-existence with the above disease. The indecisive comparative findings on histopathology make the situation even more perplexed. In this article, we have reviewed the characteristic trichoscopy patterns that can differentiate LPP and FFA and from their close mimickers.

Pathobiology of Cutaneous Manifestations Associated with COVID-19 and Their Management.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) has been a rising concern since its declaration as a pandemic by the World Health Organization on 11 March 2020. Recently, its association with multiple underlying organs has been identified that includes cardiac, renal, gastrointestinal, nervous systems, and cutaneous manifestations. Cutaneous COVID-19 findings have been supposedly classified into the following categories: vesicular (varicella-like), papulo-vesiculsar, chilblains-like ("COVID toes") maculopapular, and urticarial morphologies. In this review, we aim to focus on the proposed pathophysiology behind the various dermatological manifestations associated with COVID-19 and their associated management. We also included prevalence and clinical features of the different COVID-19-related skin lesions in our review. A comprehensive narrative review of the literature was performed in PubMed databases. Data from case reports, observational studies, case series, and reviews till June 2022 were all screened and included in the review.

Efficacy, tolerability, and safety of montelukast versus finasteride for the treatment of moderate acne in women: A prospective, randomized, single-blinded, active-controlled trial.

BACKGROUND: Acne is a chronic inflammatory skin disease which involves the pilosebaceous unit. Tissue inflammation isone of the crucial mechanisms, amongst others. Of the various cytokines, leukotriene B4 (LT-B4) is the most potentleucocyte chemotactic mediator. Montelukast is an antagonist of the LT-B4 receptor. Finasteride is an antiandrogen whichspecifically inhibits the 5α-reductase enzyme. AIMS: This study aimed at comparing the efficacy, tolerability and safety of montelukast versus finasteride in the treatmentof moderate acne in women. PATIENTS/METHOD: This randomized, single-blinded, prospective trial over 12 weeks recruited 65 female subjects with moderate acne vulgaris (Global Acne Grading System Scale) for evaluation. One group (n = 30) received oral montelukast (10 mg PO daily), while the second group (n = 25) received oral finasteride (2.5 mg PO daily) in combination with topical clindamycin 2% solution. Lesion count and acne severity were evaluated at time intervals of 0 (baseline), 4, 8, and 12 weeks. Adverse effects of the drugs were noted. RESULTS: Both lesion count and severity of acne decreased significantly after treatment in both the groups as compared to the baseline. The acne severity score reached from 33.93 in time zero to 20.6 in the 12th week and 35.71 at baseline to 16.43 at the end of treatment in the Montelukast and Finasteride groups, respectively. Side effects were noted in 3 patients and 2 patients in the monteleukast and finasteride group, respectively, which were transient and non-serious in nature proving the satisfactory tolerability and safety of these two drugs. CONCLUSION: The results of this study show that both montelukast and finasteride have good efficacy in the treatment of acne. Finasteride has more efficacy than montelukast for treating moderate acne in normo-androgenic women.

Evaluation of the glycemic effect of methotrexate in psoriatic arthritis patients with metabolic syndrome: A pilot study.

Methotrexate (MTX) is a systemic immunosuppressant drug used for the treatment of psoriasis and psoriatic arthritis. Previous studies demonstrated a potential association between psoriasis and diabetes mellitus, obesity, atherosclerosis, hypertension, eventuating into metabolic syndrome. This study aimed at exploring the glycemic effects of MTX in psoriatic arthritis (PsA) patients. In this prospective cross-sectional study, 27 patients with PsA were evaluated. The status of PsA and presence of accompanying metabolic syndrome was determined by standard criteria and indices. Blood indicators including HbA1c, erythrocyte sedimentation rate, fasting blood sugar, total cholesterol, high-density lipoprotein, triglycerides, and C-reactive protein were examined before and 12 weeks after MTX therapy. There were no significant changes between HbA1c levels before and after MTX therapy in both genders (men: P=0.131, women: P=0.803). In addition, HbA1c levels in PsA patients with metabolic syndrome were not different before and after treatment (P=0.250). Finally, HbA1c levels did not change in PsA patients without metabolic syndrome before and after therapy (P=0.506). MTX in PsA patients does not appear to have hyperglycaemic effects in the short-term and can be safely used in patients with metabolic syndrome and diabetes.

Association among Thyroid Dysfunction, Asthma, Allergic Rhinitis and Eczema in Children with Alopecia Areata.

BACKGROUND: Alopecia areata is a non-scarring hair loss, which typically starts quickly. Atopy is one of the possible predisposing risk factors for this condition. AIM: This study aimed to evaluate the prevalence of thyroid disease, atopic dermatitis and allergic diseases in children with alopecia areata and compare the results with healthy individuals. METHODS: This case-control study was conducted on 50 patients with alopecia areata, diagnosed by a dermatologist, and 150 healthy individuals as the control group. Participants filled the questionnaires, and necessary tests were performed. RESULTS: In this study, the mean age of the participants was 2.55 ± 14.26 and 3.19 ± 11.92 in the case and control groups, respectively. Prevalence of asthma was 22% in the case group and 12.5% in control group (P = 0.109). Also, allergic rhinitis and eczema were observed in 20% and 22% of the subjects of the case group, whereas they were reported to be 8% and 10% in the control group (PV = 0.03 and 0.175, respectively). Moreover, 28% and 8% of the participants in the case and control groups had a family history of atopy and allergic disorders, respectively (P = 0.046). A significant difference was observed between the two groups regarding gender, type of delivery and contact with animals. CONCLUSIONS: According to the results of this study, a significant association was observed between the prevalence of alopecia areata and atopic conditions, such as allergic rhinitis and history of atopic dermatitis.

Effectiveness and safety of topical tacrolimus in treatment of vitiligo.

Vitiligo is one of the most primitive well-known dermatoid disorders with different suggested therapies. Therefore, this study investigated the efficiency and safety of topical tacrolimus in treatment of patients with vitiligo. This study was a clinical randomized designed study pre- post-test method, has been conducted on thirty cases with vitiligo who have referred to polyclinic and dermatology clinic. Participant's evaluated and demographic information recorded in designed checklist. In the next stage, the disease activity scored by vitiligo index disease activity system. Photography and depigmentation percent has recorded before treatment and further in 4th, 8th, 12th, 16th, 20th, and 24th weeks. Finally, gathered data compared through SPSS-20 software. The final sample comprised 30 persons including: 12 men (40%) and 18 women (60%). The average of patient's age in this study was 26/13 ± 18/20 (2-76-year-old). Eleven persons was ≤15 years old and rest was older than 15. Sixty-six lesions have funded in patients that maximum has accrued on face and neck (37/87%) and trunk (21/21%). In addition, minimum of lesions is related to genitalia (9/09%). In the in 4th, 8th, 12th, 16th weeks, improvement in face and neck had increased significantly, into the past weeks. In the 20th and 24th weeks, the improvement has increased although it was not significant enhancement. Also about trunk, in the 4th week the improvement does not have significant increasing in compare to the past week. In the eighth, 12th, 16th, 20th, and 24th weeks the improvement has been increased significantly in compare to the past weeks. Although in the case of limbs and genitalia, the improvement was lower. There was no significant difference between male and females and age. Although the improvement was, slow in older persons. Study results, has presented applying topical tacrolimus in vitiligo, particularly in face and neck, could be effective and does not seen any specified adverse effects during consumption of tacrolimus, it could be effective in decreasing effects in use of corticosteroid.

Should variation of serum lipid levels be considered a risk factor for the development of basal cell carcinoma?

BACKGROUND: Basal cell carcinoma (BCC) is the most common cutaneous neoplasm in human beings. Ultraviolet radiation is one of the most important predisposing factors for BCC. Although some recent investigations have shown a high serum level of phospholipids in actinic keratosis and BCC, this subject is still debated and needs approval. This study aimed to evaluate the association between serum lipid level and development of cutaneous BCC. MATERIALS AND METHODS: In this case-control study, lipid profile including triglyceride (TG), Cholesterol (CHOL), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) were measured in 30 patients with BCC and 30 healthy controls. Data were analyzed by descriptive statistical tests including t tests and Chi square test. RESULTS: This study shows that the mean age of the case and control groups were 63.93 ± 12.09 and 61.57 ± 21.1 years (mean ± SD), respectively. The average amount of triglyceride, cholesterol, HDL and LDL in the BCC patients were 139.73 ± 69.11 mg/dl, 179.20 ± 43.42 mg/dl, 39.40 ± 9.30 mg/dl and 110.70 ± 34.13 mg/dl, respectively, whereas these amounts in the control group were 141.83 ± 80.41 mg/dl, 173.60 ± 96.32 mg/dl, 36.97 ± 6.35 mg/dl, 110.70 ± 34.13 mg/dl and 104.87 ± 30.85 mg/dl, respectively. No significant difference was found in the lipid profile of the case and control groups (P > 0.05%). CONCLUSION: This study shows that the serum lipid levels in patients with BCC has no significant difference in comparison with the control group and, therefore, relevance between BCC and serum lipid level is not proven. Further studies with a larger sample size are necessary for evaluating this subject.