Efficacy of 15% azelaic acid in psoriasis vulgaris: a randomized, controlled clinical trial.

BACKGROUND: Psoriasis is a common disorder affecting 1-3 percent of the general global population. Many therapeutic modalities have been suggested for treatment of this condition, but still there is no definite treatment for this disease. The objective in this study was to evaluate the efficacy of topical azelaic acid gel versus placebo in the treatment of psoriasis vulgaris. PATIENTS, MATERIALS AND METHODS: This study was a single-blinded randomized clinical trial. Overall, 31 patients were selected and the left or right sided lesions of the patients were randomized to receive either 15% azelaic acid or gel twice daily for a one-month period. Two symmetrical lesions with almost similar severity in every patient were selected and considered as index lesions to evaluate lesion response to treatment. The severity of erythema, scaling, hyperkeratosis and pruritus of the index lesions were scored in range of 0-3 for each lesion by the investigator at the baseline and follow up visits. The percent of involvement of each side of body was also measured using rule of nines. The collected data were analyzed using statistical tests including Mann-Whitney and ANOVA tests. RESULTS: There was no significant difference between the two groups before treatment (P > 0.05). After treatment, however, except pruritus, there was significant difference between the two groups (P < 0.05). There was no significant difference regarding total psoriasis score between the two groups before treatment (P > 0.05). After treatment, however, there was significant difference between the two groups (P < 0.05) in favor of more efficacy for azelaic acid. There was no significant difference regarding percent of body involvement between the two groups before treatment (P > 0.05). After treatment, however, there was a significant difference between the two groups (P < 0.05) in favor of more efficacy on the part of azelaic acid gel. DISCUSSION: The results of our study showed that 15% azelaic acid gel was effective in reduction of purities, scaling and hyperkeratosis of psoriasis plaques. This treatment was also effective in reduction of skin involvement with psoriasis. It is recommended that a longer study be performed that can better evaluate the efficacy of this treatment against plaque-type psoriasis.

The safety of diclofenac for the management and treatment of actinic keratoses.

BACKGROUND: Actinic keratoses (AKs), defined as carcinoma in situ of squamous carcinoma, is usually induced by excessive sun exposure. The efficacy of 3% diclofenac in 2.5% hyaluronic acid gel for treatment of AKs has been documented in a few studies. OBJECTIVE: Is diclofenac safe and effective for the management and treatment of AKs? METHOD: All the papers that were cited in Medline and ISI Web of Science are included in this study. RESULTS/CONCLUSION: The use of diclofenac is associated with a few side effects, which include pruritus, rashes, dry skin, and scaling. These side effects are usually minimal and tolerable; therefore, this topical medication is suggested as the first line of treatment for AKs.

The efficacy of 5% topical tea tree oil gel in mild to moderate acne vulgaris: a randomized, double-blind placebo-controlled study.

BACKGROUND: Finding an effective treatment for acne that is well tolerated by the patients is a challenge. One study has suggested the efficacy of tea tree oil in treatment of the acne vulgaris. AIM: To determine the efficacy of tea tree oil in mild to moderate acne vulgaris. METHODS: This was a randomized double-blind clinical trial performed in 60 patients with mild to moderate acne vulgaris. They were randomly divided into two groups and were treated with tea tree oil gel (n=30) or placebo (n=30). They were followed every 15 days for a period of 45 days. Response to treatment was evaluated by the total acne lesions counting (TLC) and acne severity index (ASI). The data was analyzed statistically using t-test and by SPSS program. RESULTS: There were no significant differences regarding demographic characteristics between the two groups. There was a significant difference between tea tree oil gel and placebo in the improvement of the TLC and also regarding improvement of the ASI. In terms of TLC and ASI, tea tree oil gel was 3.55 times and 5.75 times more effective than placebo respectively. Side-effects with both groups were relatively similar and tolerable. CONCLUSION: Topical 5% tea tree oil is an effective treatment for mild to moderate acne vulgaris.

The efficacy of 1% metronidazole gel in facial seborrheic dermatitis: a double blind study.

BACKGROUND: Seborrheic dermatitis is a common, chronic inflammatory disease of the skin, characterized by erythematous plaques that are covered with yellow, greasy, scales and may or may not be associated with itching. Although a few studies have suggested use of topical metronidazole for the treatment of seborrheic dermatitis, there is no general consensus about it. AIMS: To evaluate the efficacy of 1% metronidazole gel and its vehicle alone, in the treatment of seborrheic dermatitis. METHODS: This was a double-blind, prospective, clinical trial. Fifty six patients with seborrheic dermatitis were randomly allocated to either apply 1% metronidazole gel or placebo to their facial lesions, twice daily for 8 weeks. All the patients were evaluated and scored every 2 weeks for 8 weeks. The results were analyzed statistically. RESULTS: A total of 56 patients entered this study and 53 patients completed the treatment course. There was no significant difference in terms of demographic data and lesions severity score. There were statistically significant differences in the reduction of mean severity scores between the 2 groups at the second, fourth, sixth and eighth weeks of treatment (p<0.05). Metronidazole gel significantly decreased mean of seborrheic dermatitis severity score from the 2nd visit (p<0.001). CONCLUSION: Metronidazole gel is an effective treatment for facial seborrheic dermatitis.

Carbon dioxide laser for the treatment of lupoid cutaneous leishmaniasis (LCL): a case series of 24 patients.

We report the use of a carbon dioxide laser to vaporize local cutaneous leishmaniasis. We used CO2 laser for the treatment of 24 patients with lupoid cutaneous leishmaniasis in Isfahan. We identified 24 patients with lupoid cutaneous leishmaniasis (LCL) for evaluation. All of the patients had clinical signs of LCL and had the lesion for more than 1 year. LCL diagnosis was confirmed by both direct smear and biopsy. The efficacy of laser was determined on the basis of cure and lack of relapse after 1 year. Treatment was performed using a CO2 laser (Lasersonic LS500 machine). The maximum power was 100 Watts and the pulse width was 0.5-5 seconds. There were 21 patients, 13 females and 8 males, who were treated and followed for 1 year. Mean duration of the lesions was 4.1+/- 3.9 years. The treatment was well tolerated and complications were minimal, and included pain, xerosis, and mild erythema. Of these patients, 19 were disease free (90.47 % efficacy based on clinic and laboratory). Only 2 patients were treatment failures (9.5 %). Our results indicate that CO2 laser radiation is highly effective for treatment of lupoid cutaneous leishmaniasis.