Evaluation of the effects of carboxytherapy in the treatment of periorbital dark circles.

BACKGROUND: Dark eye circle (DEC) is one of the most common cosmetic problems. It has a great impact on the patients' quality of life. Carboxytherapy is a cosmetic technique using pure carbon dioxide for different uses in different areas of the body. The goal of this study is to evaluate the efficacy and tolerability of carboxytherapy in the cosmetic correction of DECs. METHODS: This study was conducted on 27 patients requesting the correction of DEC. The treatment was performed using a carboxy device in medical grade. The gas injection was performed intradermal after local anesthesia, with a pressure of one tenth bar and a speed of 20 cc/min, 1 cc in each upper and lower eyelid. The treatment sessions were done every 2 weeks for four sessions. RESULTS: The mean physicians' score of DECs before and after treatment was 8.7 ± 0.81 and 4.6 ± 1.1, respectively. The mean patients' score before and after treatment was 9.2 ± 0.5 versus 5.41 ± 1.37. The mean scores showed a significant reduction of skin discoloration without major side effects (p < 0.00001). CONCLUSION: Carboxytherapy seems to be an effective treatment option for dark circles around the eyes with a good safety profile and patient satisfaction.

Systemic Photodynamic Therapy With Chlorine e6 as a Photosensitizer for the Treatment of Nodular BCC: A Case Report.

Introduction: Photodynamic therapy (PDT) is a demonstrated therapeutic method for basal cellcarcinoma (BCC), which is the most common human cancer. Here, we present a case report about systemic PDT with chlorine e6 as a photosensitizer (PS) for BCC treatment. Case Report: A 78-year-old man was diagnosed with a history of a 4-year nodular BCC in the nasal area. The patient was under control and treatment for hypertension and type 2 diabetes. Chlorine e6 was injected intravenously at a 0.08 mg/kg dosage in 500 cc normal saline within 20 minutes. Three hours after injection, laser irradiation was performed with a wavelength of 665 nm, a dosage of 150 J/cm2, and an irradiance value of 150 mW/cm2. His nodular BCC was completely cured without any side effects after one session of PDT with chlorine e6. Conclusion: Systemic PDT with chlorine e6 as a PS may be safe and effective in removing BCC lesions due to the data obtained in a two-month follow-up.

A Parallel Randomized Clinical Trial for Comparison of Two Methods of Maggot Therapy, Free-Range Larvae and Larval-bag, in Diabetic Ulcer (Wagner 2).

In the present study, the efficiency of two formulations of maggot therapy: free-range larvae on the wounds and larvae in a special bag (larval-bag), was compared for healing diabetic ulcers with Wagner 2 diabetic ulcer. This study was conducted as a parallel randomized clinical trial. Out of 281 patients with Wagner grade 2 diabetic ulcers referred to the wound clinic, 54 patients who met the inclusion criteria were randomly assigned to intervention groups. The disinfected larvae of Lucilia sericata were put on the wounds with 2 methods, free-range larvae and larval-bag. Follow up was done at every 48 h interval until the full appearance of granulated tissues. The main measures were wound bed preparation, removing of necrotic tissues, appearing of granulated tissues, and removing of bacterial infections in the wounds. Statistical analysis based on the Kaplan-Meier curve and the Wilcoxon (Breslow) test showed a significant reduction in wound healing time by using free-range larvae in comparison with larval-bag (P = .03). The median time to debridement was 4 days in the free-range larval group (95% confidence interval: 3-9 days) while it was 9 days in the larval-bag group (95% confidence interval: 5-16 days). Debridement rate (proportion of removed necrotic tissue surfaces) at any time in the free-ranged larvae group was 1.78 times that of the bagged larvae group (95% confidence interval 1.01-3.15, P = .036). There was no significant difference between free-range larval use and larval-bag in the acceptability of maggot therapy by patients (P = .48). It can be concluded that both of two formulations of the larval therapy (free-range larvae and larval-bag) could be recommended for cleaning out and bed preparation of diabetic ulcers. However, using free-range larvae is hardly recommended on the wounds which are eligible to use.

Application of a collagen matrix dressing on a neuropathic diabetic foot ulcer: a randomised control trial.

OBJECTIVE: Diabetic foot ulcers (DFU) are often hard-to-heal, despite standard care. With such a complicated healing process, any advanced wound care to aid healing is recommended. Chitosan/collagen composite hydrogel materials have the potential to promote the regenerative process. In this study, the efficacy of a new collagen matrix dressing including chitosan/collagen hydrogel was compared with a standard dressing of saline-moistened gauze for wound healing in patients with a hard-to-heal neuropathic DFU. METHOD: This is an open labelled, randomised clinical trial. After conventional therapy consisting of debridement, infection control and offloading, patients were randomly allocated to receive either a collagen matrix dressing (the study group, receiving Tebaderm manufacturer) or a saline-moistened gauze dressing (control group) for wound care. The reduction in DFU size and the number of patients with complete healing were measured throughout the treatment and in follow-up. RESULTS: A total of 61 patients with a neuropathic DFU were recruited. Average percentage reduction in DFU size at four weeks was greater in the study group compared with the control group (54.5% versus 38.8%, respectively). Rate of complete healing rate at 20-weeks' follow-up was significantly better in the study group than the control group (60% versus 35.5%, respectively). CONCLUSION: The collagen matrix dressing used in this study accelerated the healing process of patients with a hard-to-heal DFU. Further research may suggest the used of this dressing to shorten the length of time to achieve complete healing.

Treatment of striae distensae using fractional ablative CO2 laser in skin types II-IV: a retrospective case series study.

Striae distensae (SD) are atrophic dermal scars often found on abdomen, breasts, thighs, and hips of pregnant women. The strias' self-healing without any intervention is a poor possibility. Till now, several lasers and light sources have been used for treatment of SD. However, there are no integrated therapeutic approaches determined for treatment of SD yet. So, in this study, the therapeutic effect of fractional ablative CO2 laser in women with pregnancy was assessed. Twenty-four ethic Iranian women aged between 20 and 42 years with various severity of pregnancy SD enrolled in retrospective case series study. Participants with skin types II-IV were treated in four sessions with a one-month interval by fractional ablative CO2 laser. The severity of striae was determined by Daveys scoring. Clinical improvement was assessed by comparing pretreatment and posttreatment clinical photographs based on global improvement scoring. The evaluation of clinical results showed that fractional ablative CO2 laser was an effective treatment. Twenty of 24 (83.3%) patients showed improvement. Clinical improvement was affected by striae severity (P = 0.03). Also, there were no statistical differences between clinical improvements with skin types, striae scar severity, number of pregnancy, and striae location.

Simulated Microgravity Condition Alters the Gene Expression of some ECM and Adhesion Molecules in Adipose Derived Stem Cells.

Adipose- derived stem cells (ADSCs) are widely used for tissue engineering and regenerative medicine. The beneficial effects of ADSCs on wound healing have already been reported. Remodeling of extracellular matrix (ECM) is the most important physiological event during wound healing. ECM is sensitive to mechanical stresses and the expression of its components can be therefore influenced. The aim of this study was to investigate the effect of simulated microgravity on gene expression of some ECM and adhesion molecules in human ADSCs. After isolation and characterization of ADSCs, cells were exposed to simulated microgravity for 1, 3 and 7 days. Real-time PCR, fluorescence immunocytochemistry, and MTT assay were performed to evaluate the alterations of integrin subunit beta 1 (ITGB1), collagen type 3 (ColIII), matrix metalloproteinase-1 (MMP1), CD44, fibrillin (FBN1), vimentin (VIM) genes, and ColIII protein levels as well as cells viability. Microgravity simulation increased the expression of ITGB1, ColIII, MMP1, and CD44 and declined the expression of FBN1 and VIM genes. ColIII protein levels also increased. There were no significant changes in the viability of cells cultured in microgravity. Since the high expression of ECM components is known as one of the fibroblast markers, our data suggest that pretreatment of ADSCs by simulated microgravity may increase their differentiation capacity towards fibroblastic cells. Microgravity had not adversely affected the viability of ADSCs, and it is likely to be used alone or in combination with biochemical inducers for cell manipulation.

Effect of Simulated Microgravity Conditions on Differentiation of Adipose Derived Stem Cells towards Fibroblasts Using Connective Tissue Growth Factor.

Background: Mesenchymal stem cells (MSCs) are multipotent cells able to differentiating into a variety of mesenchymal tissues including osteoblasts, adipocytes and several other tissues. Objectives: Differentiation of MSCs into fibroblast cells in vitro is an attractive strategy to achieve fibroblast cell and use them for purposes such as regeneration medicine. The goal of this study was investigate the simulated microgravity effect on differentiation of Adipose Derived Stem Cells (ADSCs) to fibroblasts. Materials and Methods: To fibroblast differentiation 100 ng.mL-1 of connective tissue growth factor (CTGF), and for simulation microgravity, 2D clinostat was used. After isolation the human ADSCs from adipose, cells were passaged, and at passages 3 they were used for characterization and subsequent steps. After 7 days of CTGF and simulated microgravity treatment, proliferation, and differentiation were analyzed collectively by MTT assay, quantitative PCR analyses, and Immunocytochemistry staining. Results: MTT assay revealed that CTGF stimulate the proliferation but simulated microgravity didn't have statistically significant effect on cell proliferation. In RNA level the expression of these genes are investigated: collagen type I (COLI), elastin (ELA), collagen type III (ColIII), Matrix Metalloproteinases I(MMP1), Fibronectin 1 (FN1), CD44, Fibroblast Specific protein (FSP-1), Integrin Subunit Beta 1 (ITGB1), Vimentin (VIM) and Fibrillin (FBN). We found that expression of ELN, FN1, FSP1, COL1A1, ITGB1, MMP1 and COL3A1 in both condition, and VIM and FBN1 just in differentiation medium in normal gravity increased. In protein level the expression of COL III and ELN in simulated microgravity increased. Conclusions: These findings collectively demonstrate that the simulated microgravity condition alters the marker fibroblast gene expression in fibroblast differentiation process.

The Effect of One Session Low Level Laser Therapy of Extracted Follicular Units on the Outcome of Hair Transplantation.

INTRODUCTION: Photobiostimulation with low level laser (LLL) has been used in medicine for a long time and its effects have been shown in many diseases. Some studies have evaluated the effect of LLL on androgenic alopecia. One of the most important limitations of the use of LLL in the treatment of alopecia is the requirement for multiple sessions, which is hardly accepted by patients. This study was conducted to evaluate the effect of the irradiation of extracted follicular hair units by LLL on the outcome of hair transplantation. METHODS: We enrolled 10 patients with androgenic alopecia and after screening tests for infections and other diseases, we extracted hair follicular units. The hair units were divided in two groups. One group was irradiated by LLL 20 minutes before transplantation (660 nm, 80 Hz, 100 mW) and the other one was used as control. The containing plates were labeled as A and B and sent to the operation room. The surgeon was unaware of the therapy assigned to the plates and transplanted them randomly on the right or left side of the head. One hundred follicular units on each sides of the scalp were transplanted symmetrically. The follicles on both sides were evaluated at 3 and 6 months of transplantation for hair growth rate by another physician, blinded to the treatment assigned to each side. RESULTS: Ten patient with androgenic alopecia and mean (SD) age of 31.5 (6.6) years (range 25-45 years) completed the study. All patients had 100% hair growth at 3 and 6 months follow-up except one who had hair growth of 20% at three months of transplantation, which changed to 100% at sixth months. There was no significant difference between the groups regarding hair growth (P > 0.8). CONCLUSION: One session of LLL irradiation has no significant effect on the outcome of transplanted hair follicles. Studies with larger sample size are needed to draw a definite conclusion.

Xanthoma disseminatum with tumor-like lesion on face.

Xanthoma disseminatum (XD) is a rare benign mucocutaneous xanthomatosis that is classified as a benign non-Langerhans cell histiocytosis. We report a 62-year-old man who presented with widespread yellow-brown papulonodular and tumoral lesions on face, flexors, and trunk. Histopathological features of the cutaneous lesions were typical of XD.

Hypertrichosis Is Not so Prevalent in Becker's Nevus: Analysis of 47 Cases.

Becker's nevus is a relatively common cutaneous hamartoma, but is often overlooked or misdiagnosed. This nevus usually begins during the second decade of life as a circumscribed, hyperpigmented patch with irregular outline that gradually enlarges with associated hypertrichosis, developing several years later. The purpose of this study was to determine the prevalence of lesional hypertrichosis associated with Becker's nevus. Methods. 47 patients who had sharply demarcated brown patch with or without coarse hair, presence or enlargement of the lesion at the time of puberty, and compatible Wood's light examination were enrolled. Patients who had axillary freckling, previous skin inflammation, and gray pigmentation of the lesions were excluded. Results. In summary, the mean age of onset was 11.89 (range 0-19). The most commonly involved site was the arm (34%), followed by shoulder (23.4%), chest, face, flank, buttock, and leg. Lesional hypertrichosis was found in only 8 (17%) of the 47 patients. In 29 cases (61.7%) the lesions were in the right side of the body. Conclusion. Hypertrichosis was not so frequent among patients with Becker's nevus. There was a higher preponderance of the lesions on the right side.

Comparison of Red and Infrared Low-level Laser Therapy in the Treatment of Acne Vulgaris.

BACKGROUND/PURPOSE: Acne vulgaris is a very prevalent skin disorder and remains a main problem in practice. Recently, phototherapy with various light spectrums for acne has been used. There are some evidences that low-level laser therapy (LLLT) has beneficial effect in the treatment of acne lesions. In this study, two different wavelengths of LLLT (630 and 890 nm) were evaluated in treatment of acne vulgaris. MATERIALS AND METHODS: This study was a single-blind randomized clinical trial. Patients with mild to moderate acne vulgaris and age above 18 years and included were treated with red LLLT (630 nm) and infrared LLLT (890 nm) on the right and left sides of the face respectively, twice in a week for 12 sessions, and clinically assessed at baseline and weeks 2, 4, 6, and 8. RESULTS: Twenty-eight patients were participated in this study. Ten weeks after treatment acne lesion were significantly decreased in the side treated by 630 nm LLLT (27.7±12.7 to 6.3±1.9) (P<0.001), but this decrease was not significant in the site treated by 890 nm LLLT (26.9±12.4 to 22.2±8.5) (P>0.05). CONCLUSION: Red wavelength is safe and effective to be used to treat acne vulgaris by LLLT compared to infrared wavelength.

A new surgical technique for the correction of pincer-nail deformity: combination of splint and nail bed cutting.

BACKGROUND: Pincer nail is a kind of nail deformity characterized by a transverse overcurvature of the nail that increases along the longitudinal axis. Many conservative and surgical treatment modalities have been reported. PURPOSE: Widening the nail bed and use of aspiration tube splint in pincer nail surgery. MATERIALS AND METHODS: Pincer nail was treated by surgery with splinting in 11 patients. In this procedure, the nail bed is enlarged in a transverse direction using incisions on the nail bed. RESULTS The postoperative follow-up ranged from 12 to 19 months (mean 15 months). Excellent results were obtained in all patients. No further complications were reported. CONCLUSIONS: The splint can prevent contracture of the nail matrix and nail bed. Widening and flattening the nail bed using an aspiration tube splint provided a longstanding effective treatment of pincer nail deformity and pain relief. The authors have indicated no significant interest with commercial supporters.