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.

Study of the in vitro and in vivo antileishmanial activities of nimodipine in susceptible BALB/c mice.

BACKGROUND & OBJECTIVES: Pentavalent antimonials are the standard treatment for cutaneous leishmaniasis (CL), however, treatment failures are frequent. Nimodipine, a calcium channel blocker is known to show promising antiprotozoal effects. Here, we investigated the antileishmanial effect of Nimodipine in both in vitro and in vivo BALB/c mice model of CL. We also compared the in vivo effect with amphotericin B and meglumine antimoniate in the experimental CL mice model. METHODS: Colorimetric alamar blue assay and J774 A.1 mouse macrophage cells were used to determine the effect of nimodipine on promastigotes and amastigotes viability, respectively. Then, the in vivo activity of nimodipine was compared to that of conventional therapies in both the early and established courses of Leishmania major infection in susceptible non-healing BALB/c mice. RESULTS: Nimodipine was highly active against promastigotes and amastigotes of L. major with IC50 values of 49.40 and 15.03 µM, respectively. In the early model, the combination therapy with meglumine antimoniate and nimodipine showed no parasites in the spleen or footpad of animals. The footpad thickness was significantly lower in mice treated with either nimodipine (1 mg/kg or 2.5 mg/kg) or amphotericin B compared to the control group in the established lesions model. However, no complete remission was observed in the footpad lesion of any of the treatment groups (nimodipine, amphotericin B, meglumine antimoniate, and combination therapy). INTERPRETATION & CONCLUSION: The effect of nimodipine was comparable to that of amphotericin B and meglumine antimoniate in early and established CL lesion models. Since nimodipine is more cost-effective than conventional therapies, our results merit further investigation in other animal models and voluntary human subjects.

The effect of platelet-rich plasma injection in the treatment of androgenetic alopecia.

BACKGROUND: Androgenetic alopecia is the most common type of hair loss in men, which is manifested by a progressive terminal hair loss in specific areas of scalp. Platelet-rich plasma (PRP) is among treatment options for androgenetic alopecia. PRP is a human platelet concentrate in a small volume of plasma containing certain cytokines. AIM: The aim of this study was to evaluate the efficacy and safety of autologous PRP in treatment of male androgenetic alopecia. METHODS: This was a clinical trial in 19 patients with grade III vertex to grade V androgenetic alopecia referring to the Clinic of Ghaem Hospital between March 2015 and March 2016. All obtained liquid PRP (5 cc) was injected at around 125 points (equals to 125 cm2 ) into the scalp, and operation was repeated in three sessions at 0, 4, and 8 weeks. We took macroscopic and dermoscopic pictures of each patient in 0, 4, and 8 weeks and 3 months after the last injection session. A dermatologist evaluated the treatment response using dermoscopy photos. RESULT: Our results showed that the trend of hair thickness and number variations during study period was significant (P < 0.001). However, there was no significant change in the hair thickness from the second injection forward. Our findings indicate the number of hair follicles during follow-up in pairwise comparison was significantly more than baseline. CONCLUSION: Findings of our study were in line with other studies in this field and showed that the use of PRP as a new and safe treatment can be effective in androgenetic alopecia.

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.

Real life management of chronic urticaria: Multicenter and cross sectional study on patients and dermatologists in Iran.

Recently, advances in understanding the etiology of urticaria and updates of diagnostic and therapeutic management guidelines have drawn attention to chronic urticaria (CU) morbidity. The present study aimed to evaluate Iranian dermatologists' practice and real life management of CU patients. A total of 35 dermatologists and 443 patients were included in the study. Number of female patients was 321 (72.5%). Mean (standard deviation) age of the study patients was 38 (13) years and the median (inter quartile range) of disease duration was 12 (6-48) months. Severity of patients' symptoms was mild for 32.1%, moderate for 38.7%, severe for 18.8%, and 10.4% of them had no evident signs or symptoms. The most common diagnostic methods were physical examination (96.6%), differential blood count (83.5%), erythrocyte sedimentation rate (77.4%), and C-reactive protein (62.8%). The number of dermatologists prescribed nonsedating antihistamines (nsAH) in regular dose and high dose mono therapy were 26 (74%) and 6 (17%), respectively. About 66% of dermatologists were familiar with British Association of Dermatologists (BAD) guideline. The most common first-line treatment for CU by Iranian dermatologists was nonsedating antihistamines in regular or high doses. The real-life management of patients with CU in Iran was in accordance with the available practice guidelines.

Expression of Th1 and Th2 Cytokine and Associated Transcription Factors in Peripheral Blood Mononuclear Cells and Correlation with Disease Severity.

BACKGROUND: Psoriasis is a T cell-mediated autoimmune disease in patients with elevated levels of proinflammatory cytokines belonging mainly to the Th1 pathway. We investigated whether treatment of psoriasis patients with methotrexate (MTX), along with micronutrients, modulated mRNA expression of Th1 and Th2 components and whether expression of these components correlated with psoriasis severity. METHODS: Thirty plaque-type psoriasis patients with Psoriasis Area and Severity Index (PASI) scores greater than 10 were recruited; these were 15 non-micronutrients taking- (NMT) patients treated with MTX daily (0.2-0.3 mg/kg/week), and 15 micronutrients taking- (MT) patients treated with MTX plus a micronutrient supplement daily, for 12 weeks. Blood samples were collected immediately before treatment (baseline) and after 12 weeks of treatment. Taqman quantitative real-time polymerase chain reaction (qPCR) was applied to analyze the expression of the Th1 components T-bet, interleukin-12 (IL-12), and interferon-gamma (IFN-Υ), and the Th2 components GATA-3 and interleukin-4 (IL-4). Disease severity was measured using the PASI scoring system. RESULTS: Significant clinical improvement in the MT group coincided with significant down-regulation of Th1 and up-regulation of Th2 markers (P<0.05). With respect to the PASI-75, (defined as a 75% or greater reduction in the PASI score) cut-off point, expression of IFN-γ in the MT group with PASI scores above 75 was significantly less than that of patients in the NMT group (P=0.05). Also, GATA3 and IL-4 mRNA expression in the MT group with PASI scores greater than above 75 was significantly greater than that of patients in the NMT group (P=0.05 and 0.04, respectively). CONCLUSION: Based on significant attenuation of the PASI score, which correlated with upregulation of Th2 pathway markers in the MT group, we recommend administration of micronutrients combined with MTX for psoriasis patients. Our results contribute to a better understanding of methotrexate immunepathogenesis mechanisms and their correlations to clinical responses in psoriasis.

Investigation of dietary supplements prevalence as complementary therapy: Comparison between hospitalized psoriasis patients and non-psoriasis patients, correlation with disease severity and quality of life.

OBJECTIVES: Psoriasis patients are often displeased with traditional medical treatments and they may self-prescribe dietary supplements as an alternative or complementary treatments. We aimed to investigate the prevalence of self-medication of dietary supplements among psoriasis and non-psoriasis cases and its impact on disease severity and quality of life. DESIGN AND SETTING: This case-control study evaluated 252 records of psoriasis patients and 245 non-psoriasis cases. Dietary supplementation over last 30days and characteristics, including age, age at onset of disease, co-morbidities, smoking and education were recorded. Psoriasis area and severity index (PASI) and dermatology quality of life index (DLQI) were calculated. P value less than 0.05 was considered as significant level. RESULTS: This study consisted 138 psoriasis (females; 54) and 138 non-psoriasis cases (females; 50), aged between 21 and 91 years. Among psoriasis patients, 72% reported using at least one of dietary supplements, which was different from non-psoriasis cases (25.36%, P=0.01). Multivitamin/mineral supplements (MVM) were the most frequent used dietary supplements (26.81%) and the most common reasons for the consumption of these supplements were to maintain and improve health. The consumption of folic acid (21.73%), omega-3 fatty acids or fish oil (10.14%), herbs (12.31%) and vitamin E (1.44%) had the most frequencies after MVM. No significant differences in PASI and DLQI were found among patients with consumption of different supplements (P>0.05). There was non-significant and negative correlation between education and use of supplements (P=0.21, r=-0.02). CONCLUSIONS: Self-medicating of MVM over last 30days was prevalent among studied psoriasis patients. They took dietary supplements in order to improve and maintain their health.

Evaluation of psoriasis severity and inflammatory responses under concomitant treatment with methotrexate plus micronutrients for psoriasis vulgaris: a randomized double blind trial.

INTRODUCTION: We evaluated the effectiveness of concomitant treatment with methotrexate (MTX) plus micronutrients in comparison with monotherapy with MTX only in psoriasis patients. Plasma levels of interleukin-1 beta (IL-1ß) and tumor necrosis factor alpha (TNF-α) were also measured and their association with clinical severity was evaluated. METHODS: Thirty psoriasis patients 20 to 50 years old with a PASI score > 10 were divided randomly into two groups. Both groups were given oral methotrexate (0.2-0.3 mg/kg/week) for 12 weeks. In addition, Group B received one tablet of micronutrient supplement daily. Disease severity was calculated using the psoriasis area and severity index (PASI) score before and after 12 weeks. Levels of IL-1ß and TNF-α were measured using enzyme-linked immunosorbent assay (ELISA). RESULTS: We found that 13 (86.6%) patients in Group B and 8 (53.3%) patients in Group A attained a mild PASI score (≤ 10% body involvement). IL-1ß and TNF-α levels were significantly decreased in favor of Group B (p < 0.05). There was a significant correlation between changes in both IL-1ß and TNF-α levels and PASI score after the study (p < 0.05). CONCLUSION: The results obtained were positive, and therefore double-blind randomized trials with a larger sample size are highly suggested to confirm or reject these results.

Serum Vitamin D3 Level in Patients with Female Pattern Hair Loss.

BACKGROUND: Female pattern hair loss (FPHL) is the most common cause of alopecia in women, characterized by diffuse nonscarring hair loss in frontal, central, and parietal areas of the scalp. Pathophysiology of FPHL is still not well known, and it is probably a multifactorial genetic trait. FPHL is also observed in women without increased androgen levels, which raises the likelihood of androgen-independent mechanisms and explains the lack of response to antiandrogen treatments in some patients. Vitamin D is a factor that has recently been considered in dealing with these patients. The purpose of this study was to evaluate the serum levels of Vitamin D in patients with FPHL and compare it with healthy controls. METHODS: In this case-control study, 45 women with FPHL were evaluated as well as the same number of healthy women matched for age, hours spent under sunlight per day, and body mass index. Serum 25(OH) D3 level was measured using ELISA. RESULTS: 60% of FPHL patients were in 15-30 years old age group with the mean standard deviation (SD) age of 29.11 (7.30) years. In the majority of patients (66.7%), severity of hair loss was Ludwig I. Mean (SD) serum Vitamin D3 level in patient and control group was 13.45 (8.40) and 17.16 (8.96), respectively. T-test showed a significant difference between the two groups in terms of Vitamin D3 serum levels (P = 0.04). CONCLUSIONS: This study indicated the correlation between the incidence of FPHL and decreased serum levels of Vitamin D3. It is recommended to evaluate serum Vitamin D3 levels as well as other hormone assays in these patients.

Efficacy of fractional CO2 laser in treatment of atrophic scar of cutaneous leishmaniasis.

Cutaneous leishmaniasis is an endemic disease in Iran. Unfortunately, it can lead to unsightly atrophic scars with limited treatment options. Fractional CO2 laser is accepted for treatment of atrophic acne scars and recently has been used to treat cutaneous leishmaniasis, so we planned to use fractional CO2 laser on leishmaniasis scar. We conducted this study on 60 leishmaniasis scars on the face of 40 patients. The lesions were treated by a fractional CO2 laser with beam size of 120 µm, with energy of 50-90 mJ, and 50-100 spots/cm(2) density with two passes in three monthly sessions. Evaluation was done in the first and second months after the first treatment and 3 and 6 months after the last treatment. Digital photography was performed at each visit. Assessment of improvement rate by patient and physician was rated separately as follows: no improvement (0%), mild (<25%), moderate (25-50%), good (51-75%), and excellent (76-100%). Based on patients' opinion, in the first and second follow-up, 48.3 and 90% of them reported moderate to excellent healing, respectively (p < 0.001). In 3 and 6 months follow-up after the end of the experiment, most of the patients (88.3 and 95%, respectively) reported moderate to excellent healing of scars. Based on two observers' opinion, healing in the first follow-up in most of the patients (65%) was mild to moderate and 33% were reported as having no healing. In the second follow-up, only 5% of the patients were reported with no healing and 60% were reported as having moderate healing (p < 0.001). In 3 and 6 months follow-up, most of the patients (95 and 96.6%) were reported as having moderate to excellent healing (p = <0.001). Our results underlined the high efficacy of fractional CO2 laser for leishmaniasis scar. No significant adverse effects were noted.

Frequency of Borrelia in Morphea Lesion by Polymerase Chain Reaction in Northeast of Iran.

BACKGROUND: The etiology of morphea is still unknown. Borrelia spp. as a causative agent of morphea has been discussed since 1985, but the relationship remains uncertain. OBJECTIVES: We aimed to find the frequency of Borrelia in morphea lesions by polymerase chain reaction (PCR) in northeast of Iran. PATIENTS AND METHODS: Sixty six patients with morphea were prospectively included in the present study. For each patient, formalin-fixed, paraffin-embedded tissue blocks of skin lesion biopsies were examined for Borrelia spp. DNA using PCR. RESULTS: No Borrelia DNA was detected by PCR in skin lesions of patients with morphea. CONCLUSIONS: The result of this study showed no relationship between Borrelia infection and morphea lesions and in other word indicated that morphea, at least in Iran, is not caused by Borrelia spp.

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.

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.

Evaluation between Association of Psoriasis and Vitiligo.

BACKGROUND: Although the occurrence of psoriasis and vitiligo is reported in a few studies, no proper relationship has been found between these two diseases. OBJECTIVE: The aim of this study was to identify the frequency of the coincidence of these two diseases. METHOD: A descriptive and cross-sectional study was conducted on 6,200 patients referred to dermatology clinics from September 2004 to June 2005. RESULTS: Among these patients, 219 and 154 patients suffered from psoriasis (3.53%) and vitiligo (2.48%), respectively, and 12 patients (0.19%) had psoriasis and vitiligo simultaneously. The coincidence in the psoriasis group was 5.48% and in the vitiligo group was 7.79%, so the coincidence of both diseases was greater than the incidence of each alone. This association was significant (p = .004). CONCLUSION: Coincidence of these two diseases was seen, but more studies should be done to find common genetic and immunologic factors.

Comparison of lesion improvement in lupoid leishmaniasis patients with two treatment approaches: trichloroacetic Acid and intralesional meglumine antimoniate.

BACKGROUND: There are several therapies for treating lupoid leishmaniasis. We compared the effectiveness of intralesional meglumine antimoniate (MA) and topical application of trichloroacetic acid (TCA) 50% solution. METHODS: This study was a randomized clinical trial comprising 60 lupoid leishmaniasis patients. The first group received intralesional MA once a week, and the second group was treated once weekly with TCA 50% topical solution. The results were recorded once after 8 weeks and then 3 months after the termination of treatment. RESULTS: The total clearance rates after treatment and after the 3-month follow-up were, respectively, 48.1% and 40% in the first group and 44.4% and 36.6% in the second group. There was no significant difference between the two treatment groups (p=.25 and p=.26). In both groups, the most common side effect was scarring. CONCLUSION: Having almost the same efficacies, TCA as a topical approach could be as effective as MA in the lupoid leishmaniasis treatment plan.

Dermoscopic features of cutaneous leishmaniasis.

BACKGROUND: Previous studies have demonstrated that dermoscopy improves accuracy in diagnosing pigmented and non-pigmented tumors. Recently, there has been increasing evidence that dermoscopy can also be useful in the diagnosis of some skin infections. OBJECTIVE: We sought to describe the dermoscopic features of cutaneous leishmaniasis. METHOD: Dermoscopic examination (using the Derm Lite FOTO, 3Gen) of 144 CL lesions in 82 patients was performed. This study was conducted in the Imam Reza and Ghaem hospitals (Mashhad, Iran) from October 2010 to September 2011. RESULTS: We observed the following dermoscopic features: generalized erythema (81.9%), white starbursts (60.4%), yellow hue (43.8%), yellow teardrop-like structures (41.7%), central ulcers (59%), hyperkeratosis (33.3%), and milia-like cysts (4.9%). We also observed vascular structures, including dotted vessels (61.1%), hairpin vessels (37.5%), linear irregular vessels (30.6%), comma-shaped vessels (29.9%), glomerular vessels (22.9%), arborizing telangiectasia (10.4%), and corkscrew vessels (4.2%). LIMITATIONS: Biopsy and pathologic evaluation were not performed due to ethical considerations. CONCLUSION: Important vascular patterns seen in melanocytic and non-melanocytic tumors were frequently observed in this infection. Dermoscopy may be a promising tool to predict the clinical course in cases of cutaneous leishmaniasis.

Study of the Association between Human T-cell Lymphotropic Virus Type 1 Infection and Lichen Planus.

OBJECTIVE(S): Lichen Planus is a common disease with unknown etiology which affects the skin and mucosa. Recent studies have focused on the possible role of the virus in the pathogenesis of Lichen Planus. The purpose of this study was to determine the association between the human T-cell lymphotropic virus type 1 and Lichen Planus. MATERIALS AND METHODS: This case control study was conducted on a total of 200 patients. The case group consisted of 100 patients with a confirmed histopathological diagnosis of lichen planus disease, and the control group consisted of 100 healthy blood donors without any signs or symptoms of skin diseases, and who were similar in age and sex to the case group. Blood samples of both participants in the case and control groups were examined for the presence of anti -HTLV-I antibodies using the ELISA method. The polymerase chain reaction for human T-cell lymphotropic virus type 1 was conducted in cases in which the findings for antihuman T-cell lymphotropic virus type 1 antibody test was positive, and statistical analysis was conducted on the obtain results. RESULTS: One case in the case group was infected with human T-cell lymphotropic virus type 1; however, no infection was observed in the control group. The difference was not statistically significant (P = 1). CONCLUSION: Based on the obtained results, no association was observed between the human T-cell lymphotropic virus type 1 infection and Lichen Planus.

Comparative study of topical 80% trichloroacetic acid with 35% trichloroacetic acid in the treatment of the common wart.

BACKGROUND: Common warts caused by the human papillomavirus (HPV) are considered to be the most common infectious skin disease. No individual treatment for common warts is effective as monotherapy in eradicating the lesions. The aim of this study is to evaluate the clinical efficacy of a 35% and an 80% trichloroacetic acid (TCA) solution in the treatment of the common wart. METHODS: In this single-blinded clinical trial, 62 eligible patients with common warts referred to the dermatology clinic of Ghaem Hospital in Mashhad, Iran. Patients were randomly divided into two groups, each treated with a TCA solution (group A, TCA 80%; group B, TCA 35%) once per week until complete clearance of the lesions or for a maximum duration of six weeks. Seven patients were excluded from the final analysis (one patient in group A and six patients in group B) for various reasons, including irregular follow-up, using physical tools such as razor blades to remove the lesion, and failure to complete treatment; and 55 patients were included in the final analysis. RESULTS: Improvement to treatment responses was classified as: no change (no changes in the number of warts), mild (clearing of less than 25% of warts), moderate (clearing of 25% to 75% of warts), and good (clearing of more than 75% of warts). At the end of follow-up, the clinical improvement of group A (n=30) was: 10 patients (33.3%) with a mild response, 6 patients (20%) with a moderate response, and 14 patients (46.7%) with a good response. In group B (n=25), 16 patients (64%) showed a mild response, 6 patients (24%) a moderate response, and 3 patients (12%) a good response. There was a statistically significant difference in improvement between the two treatment groups (P=.017). Improvement was greater with a higher concentration of TCA solution. CONCLUSION: This study showed that a different concentration of TCA solution was an effective form of treatment for common warts. Trichloroacetic acid 80% is more effective, but this solution must be used only with careful consideration by a physician.

Efficacy of suction blister epidermal graft without phototherapy for locally stable and resistant vitiligo.

INTRODUCTION: Surgical methods for treatment of vitiligo include punch grafts, blister grafts, follicular grafts and cultured melanocyte grafts. The aim of this study was to determine the efficacy of suction blister grafts for treatment of vitiligo, without the use of phototherapy. MATERIALS AND METHODS: This clinical trial study was conducted on 10 patients with vitiligo that was resistant to usual treatments and with limited involvement in the affected sites. We used cryotherapy and a manual suction device for blistering at the recipient and donor sites, respectively. The blister was separated and fixed with sutures and a dressing to the recipient site. Repigmentation of lesions was evaluated monthly for 6 months after treatment. Repigmentation rates higher than 90%, between 71%-90%, from 51%-70%, and less than 50% were graded as complete, good, moderate, and poor, respectively. RESULTS: Ten patients (five females with a mean age of 23.2±3.96 years and five males with a mean age of 30.60±4.15 years) were enrolled in the study. Reponses to treatment after a 6-month follow-up were 'complete,' 'good,' and 'moderate' in 7 (70%), 1 (10%), and 2 (20%) patients, respectively. CONCLUSION: With this technique, patients with restricted sites of involvement, that did not respond to the usual treatments showed very good repigmentation without any additional phototherapy over a 6-month follow-up; moreover, there were no side effects such as scarring.

Comparison of oral zinc sulfate with systemic meglumine antimoniate in the treatment of cutaneous leishmaniasis.

The purpose of this study was to investigate comparison between oral zinc sulfate and meglumine antimoniate in the treatment of cutaneous leishmaniasis (CL). So 100 patients with CL were included and randomly divided into two groups. The first group was treated with oral zinc sulfate (10 mg/kg/day during 45 days period), and the second group was treated with systemic meglumine antimoniate (20 mg/kg/day intramuscularly for 20 days). Acceptable cure after completing 45 days of followup occurred in 30.2% of lesions in first group, while this was 35.5% for the second group. There is not any significant difference between the two treatment groups (P = 0.42). Serious side effects resulting in treatment discounting occurred in only meglumine antimoniate group. Although cure rate of systemic meglumine antimoniate group was better the treatment with zinc sulfate is much easier, cheaper, more convenient in consumption, safer, and nearly close cure percentage to systemic meglumine antimoniate injections without serious side effect.