Brain MRI findings in patients with bullous pemphigoid: A case-control study.

Evidence suggests that bullous pemphigoid (BP) is associated with multiple neurological disorders. We aimed to compare brain magnetic resonance (MRI) findings between BP patients and a control group. This case-control study included patients with BP referred to two dermatology clinics during a two-year period. A group of individuals attending the same clinics for cosmetic procedures were selected as controls. First, participants' general information including age, gender, education, weight and underlying disease was recorded. For BP patients, the drugs and the BP Disease Area Index (BPDAI) were recorded as well. Then, all participants underwent brain MRI without contrast. The Fazekas scale, the general cerebral atrophy (GCA) score, and the Medial Temporal lobe Atrophy (MTA) score were used to assess MRI images. Overall, 24 BP patients and 24 controls were evaluated in this study. Both groups were comparable regarding age, gender and education. However, diabetes and hypertension were more frequent in the control group. The mean BPDAI total score was 51.39 ± 68.92 in BP patients and most of them used rituximab (41.7%). None of the participants had MS or Alzheimer MRI patterns. There was no difference between groups in terms of GCA and MTA scores. Furthermore, the frequency of partially empty sella did not differ significantly between BP patients and controls (p = 0.461); nevertheless, grade-3 Fazekas was significantly higher in BP patients compared to controls (25% vs. 0%, p = 0.019). Of note, one BP patient had an epidermoid cyst and another had moderate enlargement of three ventricles. Also, new infarcts were observed in two and old infarcts in four BP patients. Although the majority of abnormal brain MRI findings were more frequent in BP patients compared to controls, only grade-3 Fazekas was significantly higher and acute infarcts were exclusively observed in BP patients.

Evaluation of Subcision for the Correction of the Prominent Nasolabial Folds.

Background. A prominent nasolabial fold (NLF) is a cosmetic problem. Currently, numerous therapeutic modalities are available for pronounced NLFs with variable efficacy. Objective. To determine the efficacy and safety of subcision using a hypodermic needle for the correction of the prominent NLFs and its effect on skin elasticity. Methods. Sixteen patients with prominent NLFs underwent subcision. The investigators' assessment of improvement and the patients' satisfaction were both recorded 1 and 6 months after the procedure. Also, we evaluate the skin elasticity of NLFs before and after the treatment using a sensitive biometrologic device with the measurement of cutaneous resonance running time (CRRT). Results. Thirteen (81.25%) patients showed a moderate improvement at 1st month and 13 (81.25%) patients had at least a mild improvement at 6th month. There was no persistent side effect lasting more than a few days. Mean CRRT at 1 and 6 months after the treatment was significantly higher compared to the baseline. Conclusion. Subcision may be considered effective for the correction of pronounced NLFs. However, further controlled studies with larger sample size are necessary to assess the efficacy of this technique in particular with use of more objective assessment of skin biometric characteristics. This trial is registered with IRCT201108097270N1 (registered on January 27, 2012).

Macrophage migration inhibitory factor gene polymorphism is not associated with pemphigus vulgaris in Iranian patients.

BACKGROUND: Promoter polymorphisms of the macrophage migration inhibitory factor gene are associated with increased production of macrophage migration inhibitory factor. Elevated levels of macrophage migration inhibitory factor have been observed in the sera of patients with pemphigus vulgaris. More than this, macrophage migration inhibitory factor promoter gene polymorphism has been found to confer increased risk of susceptibility to chronic inflammatory diseases. OBJECTIVE: We investigated whether there is an association between promoter polymorphism of the macrophage migration inhibitory factor gene and pemphigus vulgaris. METHODS: One hundred and six patients with pemphigus vulgaris, and a control panel of one hundred healthy volunteers were genotyped for a single nucleotide polymorphism identified in the 5'-flanking region at the position -173 of the gene, using polymerase chain reaction-restriction fragment length analysis. RESULTS: We found a notably high prevalence of C/C genotype in our nation but no significant difference was observed between patients and controls. CONCLUSION: The result of this study using a large and well documented trial of patients showed that macrophage migration inhibitory factor -173G-C polymorphism is not associated with pemphigus vulgaris; but as the role of macrophage migration inhibitory factor in the inflammatory process has not been delineated in detail and the prevalence of C/C genotype is notably higher in our nation, this finding merits more consideration.

Supraciliary wrinkles and botulinum toxin A.

BACKGROUND: Injection of botulinum toxin into certain areas of face that carry a high risk of ptosis (danger zone) needs caution in application. An example is the lateral forehead, particularly the lower portion. AIM: In this study, we evaluated the efficacy and safety of treating supraciliary wrinkles in the lower lateral forehead by injections of botulinum toxin at the temporal hairline, keeping a reasonable distance from danger zone. METHODS: In this randomized clinical trial, 40 women (mean age 35 years) were selected and divided into two groups, A and B. both groups were treated with botulinum toxin to treat wrinkles in the frown area, as well as frontal lines and lateral canthus lines. Group B received extra injections at each temporal line for treatment of supraciliary wrinkles. RESULTS: There was a significant difference in total wrinkle number and mean number of wrinkles between the two groups after injections (paired t-test, P < 0.01). No ptosis was seen in either group. CONCLUSIONS: Injection of botulinum toxin type A through the temporal hairline to correct supraciliary wrinkles seems to be safe and effective.

Androgenic alopecia and insulin resistance: are they really related?

BACKGROUND: Androgenic alopecia is known to be androgen-dependent. Insulin is found in hair follicles and may play a role in the regulation of androgen metabolism and the hair-growth cycle. OBJECTIVES: To compare the insulin resistance between people with androgenic alopecia and a control group. METHODS: A case-control study was conducted with 97 cases in the patient and 87 in the control group. Serum fasting insulin level, fasting blood glucose, serum total cholesterol, triglyceride and high-density lipoprotein (HDL) were all measured in both groups. RESULTS: There was no difference in serum fasting insulin level, fasting blood glucose, serum total cholesterol, triglyceride, HDL and insulin resistance between the two groups (P > 0.05). CONCLUSION: Despite previous reports suggesting a link, our study found no significant relationship between insulin resistance and androgenic alopecia. Further studies are warranted.

Biophysical characteristics of skin in diabetes: a controlled study.

BACKGROUND: Cutaneous complications are common in diabetes. Previous assays suggest that hyperglycemia and decreased insulin signal are involved in the impairment of skin function. The aim of this study was to evaluate the biophysical characteristics of skin in patients with diabetes mellitus and compares them with healthy non-diabetic controls. OBJECTIVE: To measure biophysical characteristic of skin including transepidermal water loss (TEWL), water content, sebum and skin elasticity in patients with diabetes mellitus and compare them with healthy non-diabetic controls. METHODS: This case-control study was conducted on 38 patients with diabetes and 40 age- and sex-matched healthy people. The biophysical properties of skin including stratum corneum (SC) hydration, sebum content, TEWL and skin elasticity were measured and compared between the two groups at three different locations of the body. RESULTS: The measurement of SC hydration and TEWL showed no significant difference between diabetics and controls. The skin surface lipids on the forehead but not other sites were significantly lower in the diabetics than in the controls. Acoustic wave propagation speed, a measurement related to skin elasticity, was significantly lower in forearm and forehead of diabetics. CONCLUSION: Diabetes affects some functional properties of epidermis and dermis that may responsible for many cutaneous manifestations of diabetes. These results suggest that patients with diabetes mellitus tend to show a normal hydration state of the SC together with decreased sebaceous gland activity and impaired skin elasticity, without any impairment of the SC barrier function.

Subcision in acne scar with and without subdermal implant: a clinical trial.

BACKGROUND: Subcision is a procedure that has been reported to be beneficial in treatment of acne scars. OBJECTIVE: This stady aims to assess the efficacy of subcision in the treatment of rolling acne scars and evaluate a novel subdermal filler 'absorbable plain catgut suture' with subcision. METHODS: Twenty-two patients with rolling acne scars underwent subcision, 20 of whom completed treatment and follow-up period. One side of the face underwent subcision and another side subcision with subdermal implant. The patients and investigators' assessment of improvement were both recorded. RESULTS: Subcision showed mild improvement in about 60% of patient and moderate improvement in about 40% of them. The rate of response showed no significant difference with the use of subdermal implant. The side-effects of local oedema, bruising and infection were all transient. CONCLUSIONS: Subcision seems to be a safe method to correct the rolling acne scars with long-term improvement. However, the subdermal implant led to no significant superior results.

Efficacy and safety of cryotherapy vs. trichloroacetic acid in the treatment of solar lentigo.

BACKGROUND: Solar lentigines are common sun-induced benign melanocytic proliferation that presents a significant cosmetic worrying for many middle-aged and elderly patients. Although the newer photoselective lasers have become the mainstay of treatment, cryotherapy and trichloroacetic acid (TCA) solution are inexpensive alternatives in the treatment of solar lentigines. The purpose of this study was to assess the efficacy of cryotherapy compared with TCA 33% on solar lentigines of the back of the hands (SLBH) in patients presenting to dermatologic clinic of our hospital. METHODS: Each hand of 25 women with SLBH was treated randomly with either cryotherapy or TCA 33% solution. Photographs of the hands were taken prior to and 2 months following the treatment. The response and side- effect rate were compared. RESULTS: Cryotherapy was more likely to produce substantial lightening of the solar lentigines than TCA 33% solution (P = 0.025) but more painful and took more time to heal. Post-inflammatory hyperpigmentation (PIH) was almost equal in two types of treatment (P > 0.05). Statistically, the better results were seen in fairer Fitzpatrick's skin types (P = 0.00). CONCLUSION: Cryotherapy shows better results than TCA 33% solution in the treatment of SLBH particularly in lower Fitzpatrick skin types. PIH is the major complication of each type of treatments particularly in darker Fitzpatrick skin types. Generally, the major criterion for treatment of SLBH with cryotherapy or TCA is Fitzpatrick's skin type of patients.

The lipid profile in psoriasis: a controlled study.

BACKGROUND: Psoriasis is an inflammatory dermatosis that is characterized with hyperproliferation of keratinocytes and inflammatory infiltration in the epidermis and dermis. The high prevalence of atherosclerosis has been reported in psoriatic patients. High serum lipid level has been suggested in the pathogenesis of this phenomenon. In this study, our purpose was to compare the lipid profile in psoriatic patients with non-affected persons. METHODS: This study was designed and conducted as a case-control assay with 50 cases in the patient and control groups, respectively. The lipid profile, including serum level of triglyceride, cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL), were assessed in both groups. RESULTS: The patient and control groups each consisted of 50 cases (39 male and 11 female). The serum triglyceride, cholesterol, and LDL was significantly higher in psoriatic patients (P < 0.05) but not for HDL (P = 0.29). CONCLUSION: This study, like previous assays, shows that high serum lipid level is significantly more common in psoriasis. This fact may be responsible for higher prevalence of cardiovascular accident in psoriatic patients. It may be useful to do early screening and treatment of hyperlipidaemia in psoriasis to prevent the atherosclerosis and its complications.