Efficacy of topical gabapentin in women with primary macular amyloidosis: A side-by-side triple-blinded randomized clinical trial.

BACKGROUND: Primary cutaneous macular amyloidosis (PCMA) is a chronic pruritic cutaneous disease characterized by heterogeneous extracellular deposition of amyloid protein in the skin. AIMS: This study aimed to evaluate the efficacy of topical 6% gabapentin cream for the treatment of patients with PCMA. MATERIALS AND METHODS: In this triple-blind clinical trial, a total of 34 patients, who were diagnosed with PCMA, treated using two different strategies of topical gabapentin as the active group and vehicle cream as the control group. RESULTS: Pruritus score reduction in both groups was statistically significant compared with the baseline value (p < 0.001). There was a significant pigmentation score reduction in intervention group compared with control group after 1 month of the study (p < 0.001). The differences of pigmentation score changes between the groups were not significant at month 2 (p = 0.52) and month 3 (p = 0.22). CONCLUSIONS: The results of this study suggest that topical gabapentin cream may be effective as a topical agent in the treatment of pruritus associated with PCMA without any significant adverse effects. It is recommended to perform similar studies with a larger sample size and longer duration in both sexes.

Systemic isotretinoin therapy and central macular and choroidal thicknesses in acne vulgaris: is there any association?

PURPOSE: To investigate the effect of oral isotretinoin therapy on central macular thickness (CMT) thickness and choroidal thickness (CT) using optical coherence tomography (OCT). METHODS: CT and CMT thickness of 43 eyes were evaluated at baseline, the third, and sixth month of isotretinoin therapy by spectral-domain OCT. For assessment of CT, OCT measurements were obtained at the fovea with six additional measurements at adjacent locations (at 500-1000 µm temporal to the fovea and 500-1000 µm nasal to the fovea). RESULTS: Forty-three eyes from 43 patients with acne vulgaris, including 33 females (76.7%), who had a mean age of 24.81 ± 6.60 years, completed the study. The mean CMT was 231.49 ± 19.52 at the baseline and significantly decreased to 229.0 ± 19.57 (p = 0.02) and 229.28 ± 18.83 after three and six months, respectively (p < 0.03). The change in the macular thicknesses measured at four quadrants and choroidal thicknesses were not statistically significant during the study (p > 0.05). CONCLUSION: The result of our study demonstrated choroidal thickness change is not significant in patients with acne vulgaris after systemic isotretinoin therapy during six months of follow-up. The decreased CMT amount was 2.2 microns; even if statistically significant, this amount is clinically insignificant.

Coexistence of mucinous nevus and multiple collagenoma with unilateral, dermatomal, and multi segmental distribution.

Connective tissue nevus is a hamartoma composed of excess amounts of one or several components of the dermis, such as collagen, elastin, and proteoglycans. This report introduces a 14-year-old girl with grouped flesh color papules and skin color nodules distributed unilaterally with a dermatomal pattern. These lesions involved more than one segment. Histopathology is the gold standard for diagnosing collagenoma and mucinous nevus. We reported the first case of mucinous nevus with multiple collagenoma that shows the specific clinical features.

A Comparative Study on the Usefulness of Fractional CO2 and Fractional Er:YAG in Acne Scars: A Split-Face Trial.

Background: Acne is a dermatologic condition with a high burden in terms of psychosocial consequences as a result of scars remaining on the skin. Its effects are severe in adolescence and finding treatments with short therapy courses, superior results, and fewer adverse effects are of high importance. Materials and Methods: We included 30 individuals with acne vulgaris scars in Al-Zahra academic training hospital from June 2018 to Jan 2019. Each individual received both fractional CO2 and fractional Er:YAG lasers on right and left sides of the face, respectively. Three sessions of laser treatment were applied to each side with one-month intervals. Results were evaluated by patients according to subjective satisfaction and physicians' assessment and photo evaluation by two blinded dermatologists. Improvement was graded by a quartile grading scale: less than 25%: mild, 25% to 50%: moderate, 51% to 75%: good, and 76% to 100%: excellent response. Assessments were obtained at baseline and one month after the last visit. Results: Based on subjective satisfaction (p < 0.05) and physicians' assessment (p < 0.01), fractional CO2 laser was significantly more effective than Erbium:YAG laser. Also, Post-treatment side effects were mild and transient in both groups. Conclusion: Laser therapies are common in the treatment of scars and each modality has special advantages and disadvantages. Choosing among them should be based on various criteria. Fractional CO2 lasers have been revealed favorable results in most reports. Large comprehensive trials could help experts in choosing among alternatives for different subgroups.

Evaluating the efficacy of microneedling technique in treating striae alba lesions.

Striae alba, as an unsettling skin complication, has the potential to threaten the physical appearance and psychological health of individuals. So far, dermatologists' endeavors have been futile in finding an ideal treatment. This study evaluated microneedling as a novel treatment modality for striae alba scars. Microneedling was implemented in 1-3 sessions in 2-week intervals among patients with striae alba lesions. The lesions were photographed before and 3 months after the treatment, while all side effects were recorded. Two non-involved dermatologists and a patient self-report based on a visual analog score scale were utilized to evaluate the clinical improvement of striae scars. The complication rate among the 32 patients was 25%, which consisted of seven (21.9%) cases of post-inflammatory hyperpigmentation and one case (3.1%) of skin infection. The average improvement score among the patients in our study based on their self-report was 5.3 ± 1.3. (Range 4-8), while based on physician evaluation was 5.6 ± 1.2 (range 3.5-8). There was a significant association between lower age and higher self-report scores. Also, the improvement of lesions was more significant in skin type 3 compared to 2, based on physician assessment. In this study, MN was effective in ameliorating SA scars and was observed to induce better clinical satisfaction in younger patients and breast lesions. The studies concerning the use of MN in treating SA have yielded much attention lately, and they have denoted the relatively low cost of MN, its capability to be utilized over vast treatment areas, and its safety in that regard. Further research regarding the comparison of MN's efficacy in solo use versus implementing it as an adjuvant modality should be carried out.

Comparison between "5% minoxidil plus 2% flutamide" solution vs. "5% minoxidil" solution in the treatment of androgenetic alopecia.

BACKGROUND: Androgenetic alopecia is defined as a patterned hair loss resulting from the effect of androgen on hair follicles and characterized by non-scarring, progressive miniaturization of the hair follicles. Minoxidil and finasteride are regarded as the first-line treatments with antiandrogens and flutamide are considered as the alternative choices. In the current study, we evaluated the efficacy of combination therapy with topical 2%flutamide plus 5% minoxidil vs. %5 minoxidil alone in the treatment of the androgenetic alopecia. MATERIAL AND METHODS: This was a randomized, double-blinded clinical trial in 40 patients with androgenetic alopecia. Patients were randomized to receive either topical minoxidil vs. topical flutamide plus minoxidil for 6 months. At the end of study, patients were compared regarding mean hair density and mean hair thickness and patient's satisfaction. Collected data were analyzed using t-test, Ki square, and Kolmogorov-Smirnov tests. RESULTS: Topical flutamide plus minoxidil solution was significantly more effective than minoxidil in terms of hair density, hair thickness, and patient's satisfaction (p < 0.05). CONCLUSION: Topical hydroalcoholic solution of flutamide plus minoxidil may be promising treatment for the androgenetic alopecia. To better evaluate the efficacy of topical flutamide, more prolonged studies with higher number of patients and use of different vehicles and different ingredients are recommended.

Clinical and Epidemiological Features of Patients with Drug-Induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Iran: Different Points of Children from Adults.

BACKGROUND: Different epidemiologic aspects of drug-induced Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in children are scarce. AIM: To compare the clinical and epidemiological features of patients with drug-induced SJS and TEN in children and adults. METHOD: This retrospective study was conducted at two academic referral centers (Isfahan, Iran) over 5 years. SJS and TEN were clinically diagnosed and confirmed by skin biopsy as needed. RESULTS: One hundred one patients (31 children and 70 adults) with a female to male ratio of 1.1 : 1 was identified in the present study. SJS was more commonly diagnosed in both pediatric and adult patients. The most frequent reason for drug administration identified was the infection (45.2%) and seizure (45.2%) in children and infection (34.3%) and psychiatry disorder (27.1%) in adults (P = 0.001). The most common culprit drugs in the pediatric were phenobarbital (9/31), cotrimoxazole (4/31), and amoxicillin (4/31); however, in the adult group, the most common drugs were carbamazepine (11/70) and lamotrigine (9/70). Fever was significantly more common in adults (44.3%) compared to pediatric patients (22.6%) (P = 0.03). Multiple logistic regression models showed that pediatric patients had significantly lower odds of hospitalization (OR [odds ratio]: 0.14; 95% CI 0.02, 0.67). In addition, patients with SCORTEN 1 had significantly higher odds of hospitalization (OR: 6.3; 95% CI: 1.68, 23.79) compared to patients with SCORTEN 0. CONCLUSIONS: The present study showed several differences between the pediatric and adult patients with SJS and TEN, including the reason for drug administration, culprit drugs, length of hospital stay, presence of fever, and final diagnosis of disease.

Comparison of systemic and topical isotretinoin in the treatment of facial lichen planopilaris: A randomized controlled trial.

BACKGROUND: Facial papules reflecting the lichenoid inflammation of facial vellus hair follicles can occur in the backgrounds of frontal fibrosing alopecia, lichen planopilaris (LPP), or even alone. In the present study, we aimed to compare systemic and topical isotretinoin in the treatment of facial LPP. METHOD: In a prospective randomized trial, 26 patients with facial LPP were randomly allocated to receive either 20 mg/day oral isotretinoin or isotretinoin 0.05% gel every night for 6 months. Global Aesthetic Improvement Scale (GAIS) and patient's satisfaction questionnaire were used at 1, 3, and 6 months after treatment to evaluate the outcomes. RESULTS: In both oral and topical isotretinoin groups, facial papules were significantly improved at all follow-up visits, resulting in statistically significant improvements (p = 0.005 and p = 0.007, respectively, for oral and topical groups) in GAIS score mean difference from month 1 to month 6. Overall levels of patient satisfaction were high in both groups, and no significant difference was observed between two groups (p = 0.107). However, the mean GAIS score at 3 and 6 months after treatment showed significantly greater improvements in oral isotretinoin group compared to topical group (1.85 ± 0.62 vs. 1.03 ± 0.49 at month 3, p = 0.004; 2.45 ± 54 vs. 1.59 ± 0.62 at month 6, p = 0.008). Overall, patients could well tolerate the treatments; however, topical therapy was associated with fewer side effects. DISCUSSION: Both oral and topical isotretinoin were found to be effective in improving facial papules; however, oral isotretinoin was significantly more efficacious. Considering safety profile of topical isotretinoin, it can be administrated as maintenance therapy for patients with facial LPP.

Efficacy and Safety of Topical Timolol for the Treatment of Facial Angiofibroma in Children with Tuberous Sclerosis Complex.

Objective: This study aimed to assess the efficacy and safety of topical timolol in treating facial angiofibromas (FAs) in pediatric patients with tuberous sclerosis complex (TSC). Methods: A prospective clinical trial was conducted involving 15 children diagnosed with TSC and presenting with FAs. The participants were administered topical timolol gel 0.5% twice daily. Prior to the intervention, the severity of FAs in each patient was evaluated using the FA severity index (FASI), which assessed erythema, size, and extent of lesions. Clinical response was assessed at weeks 2 and 4 during the intervention period as well as 1 month after discontinuation of treatment. Findings: Four weeks after discontinuing topical timolol 0.5%, statistically significant reductions were observed in the mean FASI score, erythema, size, and extent of lesions (P < 0.0001, P < 0.0001, P = 0.012, P = 0.008, respectively). FASI scores at 4 and 12 weeks postintervention, as well as 4 weeks after treatment cessation, demonstrated a significant decrease compared to baseline (P < 0.001). Erythema and extension scores also exhibited a significant decrease 1 month after treatment cessation compared to baseline (P < 0.05), while the mean size of lesions before and after the intervention did not show a statistically significant difference (P = 0.004). Conclusion: Topical timolol 0.5% represents a cost-effective and readily available treatment option for pediatric patients with FAs associated with tuberous sclerosis.

Fractional erbium:YAG laser (2940 nm) plus topical hydroquinone compared to intradermal tranexamic acid plus topical hydroquinone for the treatment of refractory melasma: a randomized controlled trial.

OBJECTIVES: Melasma is a chronic acquired condition characterized by grayish-brown macules and patches with a distinct border on the face. Although various treatments methods have been suggested for treating melasma, none has been completely successful. The aim of the study was to compare the efficiency of erbium: yttrium-aluminum-garnet (Er:YAG) laser and 4% hydroquinone (HQ) with the effects of intradermal tranexamic acid (TA) and 4% HQ for the treatment of refractory melasma. METHODS: The study included 31 female patients with refractory melasma. The left or right side of the patient's face was chosen randomly to receive laser therapy with topical HQ on the one side (i.e. the laser side) and intradermal injection of TA plus topical HQ on the other side (i.e. the mesotherapy side). Digital photography was performed at baseline, at the end of the treatment, and three months after the treatment as follow-up. Two independent dermatologists evaluated the modified Melasma Area and Severity Index (mMASI) score according to the pictures. Overall, 27 patients completed the study and went through the clinical evaluation. RESULTS: Treatment using HQ in combination with either Er:YAG laser therapy or intradermal injection of TA significantly improved the hemi-mMASI and resulted in higher patient satisfaction. While the improvement was not significantly different between the two regiments after the treatment and upon follow up and both were equally efficient in the treatment of refractory melasma (p = 1.308), recurrence rate was higher after treatment with Er:YAG laser than TA (12% vs 34%). CONCLUSION: This study confirmed the comparable efficacy of TA plus topical HQ versus Er:YAG laser plus topical HQ for the treatment of refractory melasma. Both groups improved significantly and no subject left the treatment because of adverse effects. TRIAL REGISTRATION NUMBER: IRCT20191011045057N1.

Interventions for bullous pemphigoid: An updated systematic review of randomized clinical trials.

Background: Bullous pemphigoid (BP) is a widely recognized autoimmune blistering disease (AIBD) linked with a high incidence of morbidity and mortality. The aim of this study was to evaluate the available findings of randomized clinical trial studies to update interventions for Bullous pemphigoid. Methods: This article provides an updated overview of interventions for BP. A literature search was performed using Cochrane Central Register of Clinical Trials, MEDLINE, Scopus, and Web of Science from August 2010 to December 2020. All randomized clinical trials (RCTs) were done on adults and investigated the effectiveness of administered topical or systemic medications versus placebos or controls included in the current systematic review. Three RCTs comprising 363 patients were included in the systematic review. One of the eligible studies was placebo-controlled. All of the included studies used various interventions including, methylprednisolone plus azathioprine versus methylprednisolone plus dapsone, doxycycline versus prednisolone, and intravenous immunoglobulin (IVIG). Results: Following their potentials in disease control, no difference was observed between dapsone and azathioprine; although, dapsone had a higher corticosteroid-sparing potential. The evaluation of the effect of doxycycline in short-term blister control in comparison to corticosteroids showed that the medication was not inferior to prednisolone, although it had a higher long-term safety. Conclusion: Therapeutic outcome of IVIG for steroid-resistant patients was satisfactory. Moreover, the effectiveness and reliability of various immunosuppressive drugs and tetracyclines are investigated by blinded RCTs for the treatment of BP.

Platelet-rich plasma versus carboxytherapy for the treatment of periocular hyperpigmentation; which approach is superior?

Periorbital hyperpigmentation (POH) is a common aesthetic condition causing people referring to dermatology clinics. Although the therapeutic approach is steeply dependent to the etiology of POH, the gold standard approach of treatment is still a question. The current study is designed to compare the use of carboxytherapy versus platelet-rich plasma (PRP) for the treatment of POH. In the current clinical trial, number of 21 patients with POH underwent carboxytherapy in one side of the face and PRP therapy on the other side. SPSS software version 22 was used with independent T-test, Chi-square, and ANOVA for analytics. Carboxytherapy was performed by intradermal injection of 5 cc carbon-dioxide gas once weekly for 6 weeks. The PRP treatment was performed by intradermal injection of PRP in periorbital space using an insulin syringe every 2 weeks for three times. The periorbital darkness was assessed using visual analogue scale preoperatively and within 8 weeks postoperatively by the patients and the dermatologists. Automatic assessments of skin vascularity and pigmentation were assessed using a digital camera. The patients represented significant darkness improvement postoperatively for both of the approaches (p value: 0.84, p value: 0.87), while the comparison of the two groups revealed insignificant postoperative changes by dermatologists assessments (p value = 0.59, p value: 0.61), the patients' assessments (p value = 0.85), the digital camera skin vascularity and pigmentation assessments (p value > 0.05). Conclusion: Although insignificant changes following both of the approaches were found, it may have occurred due to the technique, quality of material, or inadequate treatment sessions due to the type of Iranian skin; therefore, more evaluations considering particular entities such as vascularity for longer duration of follow-up and new design are strongly recommended.

Microneedling in androgenetic alopecia; comparing two different depths of microneedles.

BACKGROUND: Microneedling has shown to have positive therapeutic effects in treatment of androgenetic alopecia (AGA); however, the best microneedling protocol is still controversial. AIMS: Investigating effect of microneedling with 2 different depths of penetration on promoting hair growth in patients with AGA. METHODS: Sixty patients, in the age of 18-45 years old with moderate and severe AGA, were allocated into 3 groups of control: treatment with minoxidil 5% lotion; group A: treatment with minoxidil 5% lotion and biweekly microneedling with a depth of 1.2 mm and group B: treatment with minoxidil 5% lotion and biweekly microneedling with a depth of 0.6 mm during 12 weeks. Efficacy parameters including change of hair count and hair thickness from baseline and assessment of hair growth by patient and investigator were evaluated. RESULTS: Compared with the baseline, a significant increase in hair count and hair thickness was observed in all three groups after completion of the treatment course (P < .05). The mean rise in hair count (P = .017) and hair thickness (P = .007) was significantly greater in group B compared with control group. Investigator's evaluation of hair regrowth was significantly greater in group A (P = .04) and group B (P = .007) compared with control group. CONCLUSION: Microneedling with a depth of 0.6 mm in combination with minoxidil is more effective than minoxidil monotherapy in patients with AGA in terms of hair count and hair thickness. This depth of penetration tended to be more beneficial than depth of 1.2 mm.

An experience of slow-Mohs micrographic surgery for the treatment of Dermatofibrosarcoma protuberans: A long-term cohort study.

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a rare dermal mesenchymal tumor known as a low-grade, slow-growing malignancy. The local invasion and high rate of recurrence following surgical treatment are the main concerns to plan the best surgical approach of treatment. AIMS: In the current study, it is aimed to provide an experience of slow-Mohs surgery for the treatment of patients with DSFP. PATIENTS/METHODS: Number of 25 patients with the diagnosis of DFSP through histological and immunostaining study was included. The slow-Mohs was performed by excision of the tumor with margins accounting for 1-2 cm from both the tumor margins and three-dimensional thickness. The obtained tissue margins were horizontally, and if any of the specimens was not margin-free, the procedure was repeated. The patients' opinion about the procedure was assessed using Patient-Observer Scar Assessment Scale (POSAS). RESULTS: Number of 25 patients were included and followed for a median of 46.9 months. The median of the area of excision was 35.56 cm2 , and the median clinical excision margins were 19 mm (tumor excision margins + thickness of the three-dimensional excision). The surgery was performed once for 16 (64%), and postoperative skin closure within 5-7 days after the procedure was performed for 19 (76%) patients. None of the patients represented any recurrence. The patients' overall opinion and satisfaction POSAS score accounted for 2.3 ± 1.65 and 1.6 ± 0.59, respectively. CONCLUSION: The findings of the current study are in favor of slow-Mohs surgery for the management of DFSP, while more extensive studies are strongly recommended for generalization of this procedure.

The effectiveness of adapalene 0.1% with intense pulsed light versus benzoyl peroxide 5% with intense pulsed light in the treatment of acne vulgaris: A comparative study.

BACKGROUND: Acne vulgaris (AV) is one of the most common skin diseases with major psychological impacts. Hence, selecting the best treatment modality is so important; there are different ways to treat AV such as topical and systemic agents, laser, and also photodynamic therapy. In this study, we tried to assess the difference between the efficacy of combination therapy with intense pulsed light (IPL) and benzoyl peroxide (BPO) in comparison with IPL and adapalene (AD) in the treatment of the mild to moderate AV. MATERIALS AND METHODS: Thirty Iranian females in reproductive age with mild to moderate acne were enrolled in this study. The left and right side of the patients were randomized to receive either AD 0.1% or BPO 5% every other day plus three sessions of monthly apart IPL in the treatment of AV. Different parameters of AV such as acne severity index (ASI), total acne lesions counting (TLC), and Acne Global Severity Scale (AGSS) were measured before, during, and after the treatments. RESULTS: There was a significant difference regarding AGSS, TLC, and ASI before and after treatment with AD plus IPL (P < 0.001). Furthermore, there was a significant difference regarding AGSS, TLC, and ASI before and after treatment with BP plus IPL (P < 0.001). However, no significant difference regarding AGSS, TLC, and ASI were observed between the 2 groups after treatment (P > 0.05). No significant side effects were observed in both groups. CONCLUSION: Our study shows that there was not any significant difference between combining IPL with either AD or BPO so we can use either one of these combinations to achieve similar efficacy.

Comparison of two methods of subcision Nokor and blunt blade in acne scars treatment.

CONTEXT: Subcision is a simple surgical method that can be effective in treatment of acne scars. AIMS: This study was conducted to evaluate and compare the two methods of Nokor needle and blunt blade (BB) subcision in treatment of acne scars. SETTINGS AND DESIGN: This clinical trial study was conducted on 28 patients with acne scars. PATIENTS AND METHODS: One side of the face was treated with BB subcision method, and the other side was treated with Nokor needle method. Followed up period was 6 months after treatment. STATISTICAL ANALYSIS USED: Data were analyzed by Statistical Package for the Social Sciences (version 20) software using independent sample t test, Mann-Whitney test, Friedman test, and Fisher's exact test. RESULTS: In follow-up period, the improvement of acne scars was comparable in both groups (P > 0.05). Complications were lower in BB method than another method (P < 0.05). The patient satisfaction was higher in BB method (P < 0.05). CONCLUSIONS: Both of modalities offered similar improvement, but the complication rate was lower and the patient satisfaction was also higher in the BB method than another method.

Comparison between the efficacy of intralesional rituximab versus intralesional triamcinolone in the treatment refractory Pemphigus Vulgaris lesions: A randomized clinical trial.

BACKGROUND: Pemphigus Vulgaris (PV) is a vesiculobullous autoimmune disorder characterized by production of autoantibody against cellular adhesion molecules. The treatment of PV is based on the use of systemic corticosteroid along with immunosuppressive therapy, but sometimes there are limited resistant lesions not responding to conventional systemic therapy. This double-blind, randomized clinical trial was designed to evaluate the efficacy of intralesional rituximab versus triamcinolone in treatment of the refractory scalp and mucosal pemphigus lesions. METHODS: 2 refractory lesions of PV were selected in 21 patients, and they were randomly assigned to two groups to be treated with either intralesional triamcinolone or rituximab for 2 times at one-month interval. All of the patients were under treatment with prednisolone and azathioprine. Patients were visited at the baseline, 1 and 6 months after treatment, and all information including demographic characteristics of the patients, Pemphigus Vulgaris Lesion Severity Score (PVLSS), Epithelialization Index (EI) and patient's satisfaction (using Visual Analogue Scale (VAS)) were obtained. The collected data were analyzed using SPSS software (ver18). RESULTS: The results showed that, both rituximab and triamcinolone were effective in treatment of the refractory PV lesions (p < 0.05). However, there was no significant difference between the effect of intralesional rituximab and triamcinolone (p > 0.05). In addition, no side effect was observed in both groups. CONCLUSION: Regarding the results of the present study, the use of intralesional rituximab can be suggested for treatment of the resistant PV lesions as an alternative to intralesional triamcinolone or using more aggressive systemic therapy.

Efficacy of mesotherapy with tranexamic acid and ascorbic acid with and without glutathione in treatment of melasma: A split face comparative trial.

INTRODUCTION: Melasma is a prevalent annoying skin hyperpigmentation disorder that commonly involves reproductive-aged females. Variety of treatments with controversial results has been recommended. The aim of the current study was to evaluate combination therapy of tranexamic acid (TA) and vitamin C with and without glutathione with mesotherapy technique for treatment of melasma. METHODS AND MATERIALS: This is a randomized clinical trial study conducted on 30 patients referred to Dermatology Clinics. Patients were examined under wood lamp in order of melasma type (epidermal, dermal, or mixed) determination. Then, patients underwent melasma therapy using Cocktail A (TA 4 mg/mL; vitamin C 3% and glutathione 2%) on their right half of the face and Cocktail B (TA 4 mg/mL and vitamin C 3%) on their left half of the face, with mesotherapy technique. This procedure was done for six times with 2-week intervals. Patients' modified Melasma Area and Severity Scoring (mMASI) was assessed at initiation and end of the study. RESULTS: According to mMASI score changes 12 weeks after intervention, both cocktails had significant efficacy in reduction of mMASI score in each side. Mean of mMASI in left side had decrease of 1.82 ± 0.88 (P-value < 0.001) and in right side had decrease of 3.046 ± 1.25 (P-value < 0.001) from base line. Comparison between two groups 12 weeks after treatment showed significantly more reduction (1.28 ± 0.64) of mMASI score with cocktail A than B (P-value < 0.001). Erythema, edema, and ecchymosis was not significantly different among two cocktails (P-value > 0.05). CONCLUSION: Use of combination mesotherapy in treatment of melasma was accompanied with appropriate outcomes regardless of type of agents but treatment with glutathione containing cocktail A presented superior results compared with cocktail of TA and vitamin C but not glutathione.

The effectiveness of adding low-level light therapy to minoxidil 5% solution in the treatment of patients with androgenetic alopecia.

BACKGROUND: Androgenetic alopecia is the commonest type of alopecia affecting over half of men and women. Low-level light therapy is a new technique for stimulating hair growth in both genders. AIMS: To overcome the shortcomings of previous epidemiological studies and a lack of controlled clinical trials on the subject, this study compared the effectiveness of adding low-level light therapy to minoxidil topical solution in the treatment of androgenetic alopecia in patients presenting to two skin clinics in Isfahan, Iran during 2014-2015. MATERIALS AND METHODS: This clinical trial included 50 patients aged 17-45 presenting to Khorshid and Alzahra educational centers and skin diseases research center for androgenetic alopecia during 2014-2015. The patients were randomly divided into a control and a case group. The case group received topical minoxidil 5% solution plus low-level light therapy twice per day. The control group was given the same topical solution and a laser comb system that was turned off to act as a placebo. Changes in patients' hair density and diameter and its overall regrowth as well as their satisfaction with the treatment were assessed at months 0 (baseline), 3, 6, 9 and 12. RESULTS: The percentage of recovery from androgenetic alopecia and the patients' satisfaction with their treatment were significantly higher in the case group compared to the control group. The patients' mean hair density and diameter were found to be higher in the case group after the intervention compared to the control group. LIMITATIONS: The study limitations included patient compliance, small sample size, patient insight due to novelty of the method and clinical judgement. CONCLUSION: As a new method of treatment, low-level light therapy can help improve the percentage of recovery from androgenetic alopecia and increase patients' satisfaction with their treatment.