Efficacy and safety of chitosan-based bio-compatible dressing versus nanosilver (ActicoatTM ) dressing in treatment of recalcitrant diabetic wounds: A randomized clinical trial.

Chitosan has a biocompatible, biodegradable, and nontoxic nature. The effectiveness of Nano-chitosan films in the field of wound healing has been confirmed previously. The aim of this study was to compare the clinical efficacy and safety of two dressings (chitosan and nanosilver dressings) in the treatment of refractory diabetic wounds. A total of 25 eligible patients with chronic diabetic wound were included and randomly assigned to receive chitosan (13 patients) or nanosilver (12 cases) dressing. The dressings were applied on the wounds based on their protocols and patients were visited and examined by an experienced dermatologist every week. The clinical assessments and healing rates were recorded using diabetic-foot-infection (DFI) score at the 2nd, 4th, and 6th weeks during treatment. The study endpoint, safety and tolerability profile were also documented. The patterns of change in total 10-item-DFI wound scores did not differ significantly over time between the two groups. In both groups, the total 10-item-DFI wound score reduced continuously through the course of study. The mean percentage reduction of this score from baseline was 78.1% and 74.1% in the chitosan and nanosilver dressing groups, respectively. Both dressings were well tolerated and there were no adverse events. The relatively small sample size in both groups was the main limitation of the study. Our findings confirmed that chitosan may be safely and effectively used for the treatment of diabetic wounds just like the nanosilver (ActicoatTM ) dressing. Further studies are recommended with more volunteers and a longer follow-up period.

Cutaneous adverse events related to COVID-19 vaccines: A cross-sectional questionnaire-based study of 867 patients.

Considering the emergency approval of the Food and Drug Administration for widespread use of coronavirus disease 2019 (COVID-19) vaccines, evaluating potential vaccine-related adverse effects is critical as it will allow physicians to diagnose and manage these complications properly. In this descriptive cross-sectional questionnaire-based study, we evaluated the possible side effects of the COVID-19 vaccine from June 1, 2021 to June 21, 2021. The Iranian population is generally vaccinated with AstraZeneca, Sputnik V, Sinopharm, and Bharat vaccines. The continuous and categorical variables were described and data analyzed by the SPSS software version 25. Cutaneous reactions occurred in 30% of individuals vaccinated against COVID-19. The most common cutaneous complications were focal injection site reaction, exanthematous rash, and urticaria. There were infrequent cutaneous adverse events that included vesicular eruption, pernio-like lesions, angioedema, erythema multiforme-like eruption, and zoster. Acquainting physicians with COVID-19 vaccine-related cutaneous complications will assist them in detection and management. In addition, introducing these complications to individuals might improve acceptance of vaccine-related adverse effects in the general population.

Losartan treatment improves recessive dystrophic epidermolysis bullosa: A case series.

Recessive dystrophic epidermolysis bullosa (RDEB) manifests with blistering and erosions of the skin and mucous membranes due to mutations in COL7A1. The repetitive wound healing processes lead to extensive cutaneous scarring. The scarring is driven by inflammatory processes, particularly the TGF-ß signaling pathways, resulting in excess synthesis and deposition of the extracellular matrix, especially collagen. There is currently no effective or specific treatment for RDEB. Losartan, an angiotensin II type 1 receptor antagonist, is an inhibitor of TGF-ß activity. Previous preclinical studies with hypomorphic Col7a1 mice recapitulating features of RDEB have suggested that losartan may improve the clinical features of RDEB. In this case series, we assessed the effects of losartan on the clinical and histopathologic features in seven patients with RDEB; three females and four males; aged 18.1 ± 9.1 years. The diagnosis was based on characteristic clinical features and the presence of biallelic loss-of-function mutations in COL7A1. Daily oral administration of losartan (0.7 mg/kg) for six weeks resulted in subjective improvement of the clinical features, as judged by the treating physicians and the patients, and the severity of the disease objectively improved based on Birmingham Epidermolysis Bullosa Severity (BEBS) score (30.1 ± 12.8 versus 23.3 ± 10.4, before and after treatment, p = 0.018), accompanied by improvement of quality of life, as determined by the EB-QoL questionnaire (24.0 ± 8.1 versus 17.7 ± 5.5, p = 0.018). Histopathology of the selected lesions revealed after treatment increased number of mast cells, and enhanced microvasculature in the mid and lower dermis. The width of collagen bundles in dermis was suggested to be decreased in four samples and changed from dense to loose in appearance. In summary, this case series reports beneficial effects of losartan on RDEB as a potentially novel treatment.

Androgenetic alopecia and COVID-19: A review of the hypothetical role of androgens.

The coronavirus disease 2019 (COVID-19) has become the most emerging health issue globally. A prompt investigation regarding disease management and treatment is crucial for decreasing the burden of the disease. Many explorations and hypotheses have been posed, but the definite treatment has not been determined for COVID-19. Recent studies described a substantial prevalence of COVID-19 and also a higher rate of morbidity and mortality in men afflicted with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The gender-related discordance in COVID-19 infection may be due to hormonal differences, socioeconomic factors, genetic susceptibility, gender-related comorbidities, and habits like alcohol consumption. On the other hand, several studies proposed that androgens could improve the immune system and have a protective role in COVID-19, and decreased levels of androgens might be associated with unsatisfactory outcomes. In the field of dermatology, androgenetic alopecia (AGA) is correlated with a hyperandrogenic state and may be related to COVID-19 severity. Furthermore, recent research has assessed the plausible association of AGA and COVID-19. In this review, we investigate all evidence on AGA and its relationship with COVID-19, including the possible role of androgens in COVID-19 severity and outcomes as well as candidate androgen-related drugs for the treatment of COVID-19.

Clinicopathological characteristics of cutaneous complications following COVID-19 vaccination: A case series.

INTRODUCTION: Several vaccine-related cutaneous adverse events occurred following the widespread use of vaccines to prevent coronavirus disease 2019 (COVID-19). This case series reports 25 patients with de novo or accentuated dermatologic conditions after receiving the Sinopharm, Sputnik V, AstraZeneca, or BIV1-CovIran vaccine in Iran. METHODS AND RESULTS: Twenty-five eligible patients with a mean age of 46.80 years were investigated. The cutaneous adverse events included pityriasis rosea, zoster, viral exanthema, urticaria, bullous pemphigoid, pemphigus vulgaris, and acute generalized exanthematous pustulosis. The manifestations appeared 14.45 ± 6.98 and 20.79 ± 22.18 days following injection of the first and second doses of COVID-19 vaccines, respectively. All patients experienced new cases of cutaneous disease other than two who developed flare-ups of lichen planus and psoriasis. CONCLUSION: Several cutaneous reactions, ranging from allergic events to skin diseases, have been reported following the injection of COVID-19 vaccines. Focal injection-site reactions are the most common cutaneous adverse events; however, de-novo skin diseases and a flare-up of preexisting cutaneous disorders have also been described. Although many cases of COVID-19 vaccine-related cutaneous diseases have been published, our zoster/lichen planus and AGEP cases after vaccination are interesting. A more detailed understanding of cutaneous adverse events following COVID-19 vaccination will facilitate better diagnosis and management.

Iranian psoriasis registry: Research protocol and preliminary results of a pilot study.

BACKGROUND: Psoriasis as a common cutaneous inflammatory disease affect many aspects of patients' life. Disease registries render it possible to collect valuable data regarding a disease prevalence and burden as well as long-term observations concerning possible therapeutic regimens. METHODS: This registry was designed for the ongoing systematic data collection on patients with psoriasis at two referral dermatology centers in Iran. The pilot phase of the registry was used to identify possible obstacles in the application and execution of systematic registration. RESULTS: A total of 281 patients were registered with the mean age of 42.02 years. The disease duration was 12.06 ± 10.90 years with the variety of clinical presentations. There was no significant difference between males and females in the age of disease onset (p = 0.53). Notably, 167 patients had children. Among them, 13 had children with psoriasis. The gender of the affected parent did not affect the possibility of psoriasis transmission to the child, and no significant difference was seen between the two sexes (P = 0.569). Regarding treatment, 99.4% of patients (n = 280) had used topical agents, 52.3% (n = 147) biologics, and 60.9% (n = 171) nonbiologic medications. CONCLUSION: Clinical trials report the efficacy and safety data regarding limited study populations in a restricted time window, and the results may differ from the general population. This highlights the importance of registry-based studies for collecting and analyzing longitudinal information. In terms of long-term disease complications such as malignancies, cardiovascular events, and serious adverse events, registry-based studies will help clinicians better recognize and manage each disease.

Perceived impact of COVID-19 pandemic on body dysmorphic disorder and anxiety among population seeking cosmetic procedures.

INTRODUCTION: COVID-19-related anxiety and preventative actions like the widespread shutdown of beauty-related services emerged as a stressful condition for BDD patients seeking expert opinions. MATERIAL AND METHODS: We conducted a cross-sectional investigation to assess anxiety symptoms (by CDAS) and BDD (via BDD-YBOCS questionnaire) in patients referred to the esthetic clinic. RESULTS: A total of 120 individuals (106 females and 14 males; mean age: 45.53 ± 11.84) were evaluated. 13.3% of subjects were diagnosed with BDD; 79.2%, 17.5%, and 3.3% of them perceived none or mild, moderate, and severe symptoms of anxiety, respectively. CONCLUSION: Anxiety was not connected with BDD in our investigation. Further evaluation of other psychiatric disorders associated with anxiety and BDD was recommended.

A case of severe psoriatic erythroderma with COVID-19.

COVID-19 caused by the SARS-CoV-2, became pandemic very quickly. Management of severe dermatologic disorders in patients who require systemic immunosuppressive treatment is a major concern in COVID-19 pandemic era. Here, we report a 45-year-old homeless addicted male with second flare of psoriatic erythroderma and positive PCR test for COVID 19. His first attack occurred two months earlier, when he was screened for SARS-CoV-2 before admission which all evaluations showed nagative results. The patient was treated and relatively controlled with cyclosporine and therefore he was discharged. During this interval, he not only discontinued his medication, but also became SARS-CoV-2 positive. It seems that both factors participated in flare of his erythroderma.

Soluble biomarkers for diagnosis, monitoring, and therapeutic response assessment in psoriasis.

BACKGROUND: Psoriasis is an inflammatory disease associated with multiple comorbidities. Biomarkers for the assessment of psoriasis, its associated comorbidities, and the therapeutic response are not well characterized. A number of possible biomarkers for the diagnosis and monitoring of psoriasis have been proposed. PURPOSE: To assess potential biomarkers for diagnosis of psoriasis, its associated comorbidities and response to treatment. METHODS: We investigated medical databases from 2000 to 2021 and assessed relevant research. In this review, we evaluated the important biomarkers to help predict potential risk of psoriasis and disease activity (Beta-defensin-2, VEGF, Lipocalin-2, and YKL-40) and its possible inflammatory-related comorbidities like cardiovascular diseases (hs-CRP, GlycA, Psoriasin, IL-18, NT-proBNP, and Adipokines). In addition, we described the potential biomarkers for psoriatic arthritis (CXCL10, S100A8 and S100A9, and MicroRNA) and related manifestations such as enthesitis. Finally, we discussed novel markers for monitoring the response to specific treatments (HLA-C 06, PLC, TARC, NLR, and PLR) as well as potentially useful biomarkers for evaluation of therapy-associated adverse events (liver fibrosis-related markers). CONCLUSION: A wide range of genetic, tissue, and serum markers have been investigated in psoriasis; however, most of them are not used in routine clinical practice; and thorough physical examination along with the appropriate application of clinical scoring systems like Psoriasis Area and Severity Index score are still of particular importance.

Androgenetic alopecia and COVID-19: Is there a clinical connection?

BACKGROUND: During the coronavirus disease 2019 (COVID-19) outbreak, multiple studies showed higher rates of severe infection in adults and specifically in male patients, which may be related to differences in androgen receptor (AR) expression. Androgenetic alopecia (AGA) is one of the AR expression manifestations. AIM: To explore AGA severity as a possible risk factor for COVID-19 severity in hospitalized patients. METHODS: A total of 164 subjects (116 men and 48 females) with confirmed COVID-19 in need of hospitalization were included in this study. An experienced dermatologist examined the correlation of clinical signs of COVID-19 severity with AGA types. For evaluation of the association between categorical variables and comparison of the mean age in three groups of COVID-19 patients, the Fisher's exact test and the analysis of variance were used. RESULTS: Our cross-sectional study included 116 male patients (70.7%) with a median age of 65.5 (age range: 22-97) years. Among them, 13.8% required intubation, 15.5% needed intensive care unit (ICU) care, and 70.7% required inward hospitalization. The Hamilton-Norwood Scale (HNS) was as follows: HNS I 14.7%, HNS II 12.1%, HNS III 20.7%, HNS IV 19.8%, HNS IV 29.8%, HNS V 17.2%, HNS VI 13.8%, and HNS VII 1.7%. Also, 29.3% of the patients were female, possessing a median age of 72 (age range: 23-98) years. In this group, 8.3% required intubation, 6.3% required ICU care, and 85.4% needed inpatient ward admission care. The Ludwig Scale (LS) was as follows: LS I 52.1%, LS II 35.4%, and LS III 12.5%. CONCLUSION: The severity of AGA type did not correlate with the severity of COVID-19 among hospitalized patients. Our results were in contrast with other research that suggested AGA severity as a marker of unfavorable outcomes of COVID-19.

Depigmentation of the vulvar area: Is it an alarming sign?

A 34-year-old female patient presented with recurrent bilateral hypopigmented macules on the labia majora. The lesions were treated with topical steroids, which led to mild improvement, but erosive plaques developed after discontinuing the treatment. Histopathological findings were compatible with extramammary Paget disease (EMPD), which was treated with radical vulvectomy with no recurrence in the next months of follow-up.