Evaluation of Efficacy and Safety of Low-Fluence Q-Switched 1064-nm Laser in Infra-orbital Hyperpigmentation Based on Biometric Parameters.

Introduction: Dark circles and wrinkles under the eyes are common cosmetic problems, caused by various conditions, especially aging and overproduction of melanin in the epidermis or dermis of the skin. Iin addition to the application of topical lightening agents, different types of lasers, especially the Q-Switched ND:YAG laser, have been used for the treatment of cutaneous hyperpigmentation. Because of a high prevalence of idiopathic eye dark circles (EDCs) or periorbital melanosis and a poor response to available therapies, we decided to evaluate the efficacy and safety of the Fractional QS 1064 nm ND:YAG Laser through a before-after trial. Methods: 18-65-year-old patients with skin Fitzpatrick phototype of I-V and without any usage of a topical or systemic therapeutic regimen (2-4 weeks before the trial) were enrolled in the study. Each patient was treated with 6 sessions of the Fractional QS 1064 nm ND:YAG Laser at 2-week intervals and assessed for response and possible side effects or recurrences through 4 outcome measures, including Visoface-based color and erythema, melanin index and lightness (Before the fourth and sixth sessions of the therapy; also 1 week and 3 months after finishing the trial). Results: The changes of Visoface-based color and erythema, the melanin pigment amount by the Mexameter (melanin index) and the degree of lightness by the Colorimeter of patients after 6 months of intervention were statistically significant (P < 0.001). Conclusion: The fractional QS 1,064 nm ND:YAG Laser is an effective and safe therapy in EDCs since objective outcomes like the reduction of the melanin index and improving lightness and subjective ones like the reduction of darkness and erythema were confirmed.

Efficacy evaluation of Endolift-based Subcision on acne scar treatment.

BACKGROUND: People with acne scar suffer from destruction to the surface of the skin. Treating acne scars is a challenge that might need several methods. AIMS: Subsection is a method that has been informed to be a useful method in treating rolling acne scars. While Subcision is a valued procedure, its effect is mild to moderate due to its high reappearance rate, and patients' dissatisfaction with some of the side effects such as inflammation after procedure. PATIENTS/METHODS: In this pilot study, 9 rolling acne scar patients underwent Subcision with the Endolift (200-nm fiber) and followed up for 3 months. Outcomes were evaluated by 3 dermatologists (Blind). Also, the patients' satisfaction was assessed to compare with dermatologist's opinions. RESULTS: Our results indicated that Subcision with the Endolift displayed good and very good improvement in about 90% of patient with a good and very good satisfaction in the patients. Photographic data evaluation indicated 100% improvement in scar depth, topography, and total acne scar appearance. The average numbers of lesions before the treatment were 25.5 ± 12.1, and after treatment, it was reduced to 11.4 ± 2.1 (P < .05). CONCLUSION: Subcision with the Endolift seems to be a safe and effective method for acne scar treatment. It is done with a single perforation on each side (instead of several perforations), which reduces the pain and scar risk in the patients. Also, Endolift-based Subcision needs fewer surgical sessions and less recovery time with less inflammation and erythema.

Efficacy of Pumpkin Ointment in Treatment of Chronic Hand Eczema: A Randomized, Active-Controlled, Double Blind Clinical Trial.

BACKGROUND: Hand Eczema (HE) is chronic skin disease with a high prevalence in population. It has negative impact on the quality of life. Due to the public interest in herbal remedies, we attempt to assess the efficacy of pumpkin ointment in treatment of chronic HE in this research. METHODS: This study was conducted in an outpatient clinic at Imam-Khomeini Hospital in Tehran (Iran) from May 2015 to Nov 2016. We performed a double-blind trial on 60 patients with chronic HE randomized to four groups included pumpkin, betamethasone, eucerin and almond ointment (n=15 for each group) for 28 days. Patients were ordered to apply ointments twice a day. Hand Eczema Severity Index (HECSI) and Dermatology Life Quality Index (DLQI) of the patients were evaluated by a dermatologist on the 1st, 14th and 28th d after the start of treatment. RESULTS: Patients' DLQI scores in pumpkin and betamethasone group was significant and pumpkin group showed a better response in quality of life (P=0.001). Betamethasone and pumpkin ointment were effective and showed significant improvement compared with almond and eucerin and reduce HECSI scores (P=0.002 and P=0.012 respectively). Betamethasone ointment outcome on HECSI scores in comparison with topical pumpkin was significant (P<0.001). No clinically adverse effects were observed. CONCLUSION: Although pumpkin ointment showed a better response in patients' DLQI in HE but it was less effective than betamethasone in decreasing HECSI.

Evaluation the efficacy of trichloroacetic acid (TCA) 33% in treatment of oral retinoid-induced cheilitis compared with placebo (Vaseline): a randomized pilot study.

BACKGROUND: Oral Isotretinoin (13-cis-retinoic acid) is a gold standardtreatment for severe forms of acne with cheilitis as a most frequent complication. We designed this novel study to investigate the therapeutic effect of trichloroacetic acid (TCA) 33% as compared with placebo to treat cheilitis. METHODS: In this pilot study, 90 acne vulgaris patients between 18 and 50 years, who referred dermatologic clinic with cheilitis, were assigned to either case (TCA) or control (Vaseline) group using permuted-block randomization from 2013 to 2015 with data analysis in 2016. Patients had follow-up visits after 2 and 6 weeks, at which their lesions were photographed. Two blinded expert dermatologists recorded physician International global score for each image. RESULTS: Ninety eligible patients were randomly allocated into two groups. This included 45 patients in each group. At the end of follow-up, 44 patients in the intervention group and 37 patients in control group completed the final assessment. Compared to the control group, the TCA group had a greater reduction in the mean ICGS value from baseline to Week 6 (mean difference 2.59 points, p < .0001). CONCLUSIONS: TCA can be considered as a good strategy in improvement of cheilitis to isotretinoin therapy.

Rejuvenation of facial skin and improvement in the dermal architecture by transplantation of autologous stromal vascular fraction: a clinical study.

Introduction: The rejuvenation characteristics of fat tissue grafting has been established for many years. Recently it has been shown that stromal vascular fraction (SVF) of fat tissue contributes to its rejuvenation properties. As the SVF is a minimal processed cell population (based on FDA guidance), therefore it is a suitable cell therapy for skin rejuvenation. This clinical trial was aimed to evaluate the ultrastructural improvement of aging skin in the facial nasolabial region after transplantation of autologous SVF. Methods: Our study was conducted in 16 patients aged between 38 and 56 years old that were interested in face lifting at first. All of the cases underwent the lipoaspiration procedure from the abdomen for sampling of fat tissue. Quickly, the SVF was harvested from 100 mL of harvested fat tissue and then transplanted at dose of 2.0×107 nucleated cells in each nasolabial fold. The changes in the skin were evaluated using Visioface scanner, skin-scanner DUB, Visioline, and Cutometer with multi probe adopter. Results: By administration of autologous SVF, the elasticity and density of skin were improved significantly. There were no changes in the epidermis density in scanner results, but we noticed a significant increase in the dermis density and also its thickness with enrichment in the vascular bed of the hypodermis. The score of Visioface scanner showed slight changes in wrinkle scores. The endothelial cells and mesenchymal progenitors from the SVF were found to chang the architecture of the skin slightly, but there was not obvious phenotypic changes in the nasolabial grooves. Conclusion: The current clinical trial showed the modification of dermis region and its microvascular bed, but no changes in the density of the epidermis. Our data represent the rejuvenation process of facial skin by improving the dermal architecture.

Skin manifestations in sulfur mustard exposed victims with ophthalmologic complications: Association between early and late phase.

CONTEXT: Sulfur mustard (SM) was used during the Iraq-Iran war (1980-1988). Exposed veterans continue to suffer from its ocular, skin, and respiratory complications. OBJECTIVE: We aimed to evaluate associations between early (at the time of acute exposure) and decades later skin manifestations in individuals with severe ophthalmologic complications secondary to sulfur mustard exposure. MATERIALS AND METHODS: One hundred forty-nine veterans with severe ocular injuries were evaluated for acute and chronic skin complications. Logistic regression models were used to examine the associations between early and late skin manifestations. RESULTS: Late skin complaints were observed in nearly all survivors who had early skin lesions (131 out of 137; 95.62%). Seven out of 12 patients (58.33%) who did not have early skin lesions ultimately developed late skin complications. There was a significant relationship between the presence of lesions at the time of exposure and developing late skin complaints (two-sided Fisher's exact test, OR = 15.59, p < 0.001). There was an association between having at least one early skin lesion and occurrence of late skin complications. Survivors with blisters at the time of chemical exposure were more likely to complain of itching (95% CI: 3.63-25.97, p < 0.001), burning (OR = 11.16; 95% CI: 2.97-41.89, p < 0.001), pigmentation changes (OR = 10.17; 95% CI: 2.54-40.75, p = 0.001), dryness (OR = 6.71, 95% CI: 1.22-37.01, p = 0.03) or cherry angioma (OR = 2.59; 95% CI:1.21-5.55, p = 0.01) during the late phase. Using multivariate logistic models, early blisters remained significantly associated with latent skin complaints. Of note, the genitalia and great flexure areas were the most involved anatomical sites for both early and late skin lesions in SM exposed survivors. CONCLUSION: According to this study, the presence of blisters at the time of exposure to SM is the most important predictor of developing dermatologic complications decades later in patients with severe ophthalmologic complications from sulfur mustard exposure.

Pulsed dye laser in treatment of steroid-induced atrophy.

BACKGROUND: One of the important and distressing cutaneous side effects of steroid therapy is skin atrophy, which has no definite and effective treatment. To the best of our knowledge, laser therapy for steroid-induced atrophic scars has not been investigated to date. OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of pulsed dye laser in the treatment of steroid-induced atrophic scars. METHODS: In this pilot study, 15 patients with at least one atrophic patch were treated with the 585-nm pulsed dye laser at 4-week interval sessions until achieving complete improvement or until patient were lost to follow-up. Clinical outcome was assessed via standard photographic method before each treatment session and after the final visit. An independent dermatologist evaluated the photographs. RESULT: All of the patients (13 females and two males) with 25-59 years of age experienced some degree of improvement, except one patient who withdrew from the treatment after three sessions. The treatment was well tolerated. CONCLUSION: The results of our study indicated that pulsed dye laser therapy could be employed as a new method in the treatment of steroid-induced atrophic scars. Pulsed dye laser might affect the lesions through inducing collagen deposition and production of more superficial dermal elastin as well as less unidirectional collagen in clusters.

Hereditary hypotrichosis simplex of the scalp.

Hereditary hypotrichosis simplex of the scalp is a genetic disorder, characterized by sparse or absent scalp hair without structural defects, in the absence of other ectodermal or systemic abnormalities. Structural hair defects may be presented with a genetic disorder affecting hair growth or part of a congenital syndrome or may indicate underlying metabolic disorders, or may be associated with other diseases. We describe a 26-years-old Persian girl suffering from hypotrichosis simplex of the scalp with trichorrhexis nodosa who had no ectodermal defects and systemic disease.

Leech therapy for linear incisional skin-wound healing in rats.

BACKGROUND: The aim of this study was to investigate the effects of leech therapy (LT), in comparison with topical phenytoin (PHT), on incisional skin-wound healing in animal models. METHODS: This experimental study included 15 male rats (5 animals in 3 groups) with approximately equal body weights (350 ± 10 g). Skin wounds with lengths of 20 mm and depths of 0.5 mm were made on the dorsolateral region of rats 4 cm from the spine. The first group (PHT group) was treated daily with topical PHT (1%) while the second group (LT group) received LT at the beginning of the experiment. The control group received neither the drug nor the therapy. Wound healing was evaluated every day, and the study was continued until the wound had completely healed. Changes in the areas and the appearances of the skin wounds and histological differences (at the end of the experiment) were used to investigate the differences in wound healing among the groups. RESULTS: The process of wound healing was significantly faster in the group treated with LT (p < 0.05) than in the group treated with the PHT. CONCLUSION: The study results showed that LT improved incisional skin-wound healing in rats.

Considerable variation among Iranian dermatologists in the dosing and monitoring of methotrexate for treating psoriasis.

BACKGROUND: Methotrexate (MTX) is a risky medication requiring careful attention to dosing and monitoring. Dosing and monitoring practices are not well characterized. AIMS: The aim of this study was to assess variation in the dosing and monitoring of methotrexate among Iranian dermatologists. METHODS: A questionnaire was administered to forty experts in psoriasis concerning the use of MTX. RESULTS: Among the 39 responding dermatologists (15 women, 24 men), 54% saw fewer than 10 psoriatic patients per week, 23% 10-20 patients, and 23% more than 20 patients. About half of the dermatologists treat their patients with an initial MTX dose of <7.5 mg/week (range 5-17.5 mg/week), an average dose of <10 mg/week (range 5-25 mg/week), and a maximum dose of <20 mg/week (range 7.550 ­ mg/week) with 71.8% prescribing the medication orally and 28.2% intramuscularly. Subcutaneous injection was preferred by none of the dermatologists as a usual route of administration. Nearly 5% of the dermatologists believe that liver biopsy should be performed prior to treatment with MTX in all patients, and another 5% consider this procedure prior to treatment only in patients with risk factors. About 44 and 33% of the dermatologists do the liver biopsy after 1.0-1.5 g and 3.54 g total cumulative doses, respectively. CONCLUSION: After more than a half century, there are still noticeable controversies on the manner of using MTX in treating psoriasis among Iranian dermatologists. A national guideline may help standardize treatment practices.

The Safety and Efficacy of the 1540nm Non-Ablative Fractional XD Probe of Star Lux 500 Device in the Treatment of Striae Alba: Before-After Study.

INTRODUCTION: Striae distensae (SD) are a frequent skin condition for which treatment remains a challenge. The 1540-nm non-ablative fractional laser (Star Lux 500) has been shown to improve atrophic scars by increasing the amount of dermal collagen. To assess the safety and efficacy of the Star Lux 500 laser in the treatment of mature hypopigmented striae in Persian people (Striae Alba). METHODS: Ten women aged 26-50 years with SD and Fitzpatrick skin types III-V were enrolled in the study. The exclusion criteria were a history of keloids, photosensitivity and collagen, elastin disorders as well as history of other striae treatment within one year. The lesions were treated with non-ablative fractional laser 1540nm, and a total of four treatments were given at 4-week intervals. Clinical standard photographs were taken before each treatment. Also, patients were followed up at 3 months after the last treatment. Clinical improvement was assessed by comparing baseline and post-treatment photographs by two independent blinded physicians using grading scale. Treatment efficacy analysis was performed via the comparison between the images taken before and after each treatment session. RESULTS: There was a clinically appreciable improvement in striae ranging from 1 to 24%. A significant improvement in striae between the 16-week treatment and the 4-week treatment was identified (P<0.0001). Three months after the final treatment, patients showed noticeable improvement in the striae, compared with baseline (P<0.048). Mild post inflammatory hyperpigmentation was observed in one patient after the 8-week treatment and mild to moderate acne occurred in another patient after 4 weeks of treatment. CONCLUSION: Therapy with Star lux 500 laser had clinically and statistically striae improvement with no adverse events. This may be a safe and an effective treatment modality for Striae Alba lesions.

Pemphigus foliaceus.

Pemphigus foliaceus is an autoimmune blistering disease, which affects the skin but rarely affects the mucosae. There are two variants of pemphigus foliaceus : endemic and sporadic. Erythroderma due to pemphigus foliaceus is unusual and its occurrence in a child is very rare. We describe a case of erythrodermic pemphigus foliaceus in a 12- year- old boy.

Unilateral colloid milium: a rare presentation.

We report a case of a 31-year-old man with asymptomatic papules on one side of his face that had been present for 31 months. On physical examination, he had clusters of 1 to 4 mm skin colored translucent and dome-shaped, papules forming a plaque with a size of 4 x 3 cm on his left mandibular angle. Histopathology revealed atrophy of the epidermis with extensive deposition of pale eosinophilic homogenous deposits containing artifactual fissures that were PAS positive, diastase resistant, and Congo red negative. The final diagnosis was unilateral colloid milium.