Intralesional immunotherapy with tuberculin purified protein derivative (PPD) in recalcitrant wart: A randomized, placebo-controlled, double-blind clinical trial including an extra group of candidates for cryotherapy.

BACKGROUND: Due to paucity of randomized clinical trials, intralesional immunotherapy has not been yet accepted as a standard therapeutic method. OBJECTIVE: To examine the efficacy and safety of intralesional immunotherapy with tuberculin purified protein derivative (PPD) for treating recalcitrant wart. METHODS: In this randomized, placebo-controlled, double-blind clinical trial, a total of 69 patients with recalcitrant warts received either intralesional PPD antigen (n = 35) or intralesional saline (n = 34) for six times at 2-week intervals. A third group of candidates for cryotherapy (n = 33) was also included. The decrease in lesion size (good: complete response, intermediate: 50-99% improvement, poor: <50% improvement), adverse effects and recurrence within 6-month follow-up were documented. RESULTS: At the final session, good, intermediate and poor responses were observed in 77.1%, 22.9% and 0% of the PPD patients; 0%, 14.7% and 85.3% of the placebo patients and 18.2%, 33.3% and 48.5% of the cryotherapy patients, respectively (PPD versus placebo: p < 0.001; PPD versus cryotherapy: p < 0.001). No significant complication was seen in the PPD group. The recurrence rate was 8.6%, 5.9% and 24.2% in the PPD, placebo and cryotherapy groups, respectively (p > 0.05). CONCLUSION: Intralesional immunotherapy with PPD antigen is highly effective and safe for treating recalcitrant warts. CLINICAL TRIAL REGISTRATION: IRCT201407089844N3 in the Iranian Registry of Clinical Trials (IRCT).

Immunohistochemical study of cyclooxygenase-2 in skin tumors.

INTRODUCTION: Anti-cancerous effects of cyclooxygenase-2 (COX-2) inhibitors have been reported in different cancers. High expression of COX-2 has been demonstrated in various neoplasms such as colorectal, gastric, esophageal, breast, non-small cell lung cancers, and pre-neoplastic lesions such as colorectal adenomas and Barrett's esophagus. GOAL: The purpose of this study was to investigate percentage of positive COX-2 expression in skin tumors, including pre-malignant and malignant tumors. METHODS: This is an analytic cross-sectional study that includes 62 skin tumor samples, among which 49 samples were malignant and 13 were pre-malignant. After study for determination of pathologic kind of tumors, samples underwent immunohistochemical study for COX-2 expression. The DakoCytomation EnVision+System-HRP is a two-step extremely sensitive IHC staining technique which we used in this study. RESULTS: Among the skin tumors, a considerable number of COX-2 expression were found in squamous cell carcinomas (SCC) (16 of 17; 94%), basal cell carcinomas (BCC) (28 of 32; 87.5%), Bowen's disease (BD) (8 of 9; 89%), and actinic keratosis (AK) (4 of 4; 100%). CONCLUSION: COX-2 expression was positive in skin tumors including malignant and pre-malignant skin lesions. This study strongly suggests that COX-2 can be one of the molecular targets in treating various skin tumors.

Topical 4% nicotinamide vs. 1% clindamycin in moderate inflammatory acne vulgaris.

Nicotinamide and clindamycin gels are two popular topical medications for acne vulgaris. This study aimed to compare efficacy of the topical 4% nicotinamide and 1% clindamycin gels in these patients. In this randomized, double-blind clinical trial, patients with moderate inflammatory facial acne vulgaris were randomly allocated to receive either topical 4% nicotinamide (n = 40) or 1% clindamycin gels (n = 40) twice daily. In each group, they were further categorized in two subgroups with oily and non-oily types of facial skin. The Cook's acne grade was determined at baseline and at weeks 4 and 8 post treatment. Acne grade decreased from an average of 5.93 ± 0.83 at baseline to 4.03 ± 1.33 at week 4 and 2.08 ± 1.59 at week 8 in nicotinamide receivers, and from an average of 5.70 ± 0.94 at baseline to 3.85 ± 1.66 at week 4 and 2.03 ± 1.53 at week 8 in the clindamycin group (within-group P < 0.001, between-group P > 0.05). Comparing with each other, nicotinamide and clindamycin gels were significantly more efficacious in oily and non-oily skin types, respectively. No major side effect was encountered by any patient. Skin type is a significant factor in choosing between topical nicotinamide and clindamycin in patients with acne vulgaris.

Immunohistochemical evaluation of p53 and Ki67 expression in skin epithelial tumors.

BACKGROUND AND AIMS: The cellular mechanisms responsible for initiating or limiting the tumors including skin types are of great importance. The p53 is a tumor-inhibiting gene which is believed to be defective in many malignant situations. Ki67 is a non-histonic protein which is mainly interfere with the proliferation and has many controlling effects during the cell cycle. Because of their importance in skin tumor cell growth, this study aimed at evaluating the p53 and Ki67 expression in skin epithelial tumors by immunohistochemical method. MATERIALS AND METHODS: In a descriptive setting, 50 biopsy samples (30 basal cell carcinomas (BCCs), 10 squamous cell carcinomas (SCCs), 8 keratoacanthomas (KAs), and 2 trichoepitheliomas (TEs)) were immunohistochemically evaluated for p53 and Ki67 expression during a 14-month period. The incidence and expression rate of these two variables were separately reported in each group of samples. RESULTS: The expression rate of p53 was 67.77% for the BCCs, 50.20% for the SCCs, and null for the KAs. For both TEs, it was 50%. The expression rate of Ki67 was 57.33% for the BCCs, 47.70% for the SCCs, 37.5% for the KAs, and 0.0% for TEs. The incidence of P53+ cells was 100% and 90% in the BCC and SCC samples, respectively. The both TEs were positive in this regard. The incidence of Ki67+ cells was 100% for the BCC, SCC, and KA samples. The both TEs were negative in this regard. CONCLUSION: This study showed that the incidence rate of p53- and Ki67-positive cells is very high in skin malignant epithelial tumors. The expression rate of these two variables is comparable with reports in the literature. Further studies with large sample size are recommended to be carried out for KA and TE samples.

Evaluation of cicatricial alopecia in Iran.

Cicatricle alopecia represents a diverse group of diseases characterized by a lack of follicular ostia and irreversible alopecia. This study aimed at evaluating cicatricial alopecia in Iranian patients. One hundred patients with cicatricial alopecia were studied. Patients disease was pathologically proven. All epidemiologic and clinicopathologic data were obtained through questionnaires. The results were analyzed by means of descriptive statistical methods. One hundred patients were consisted of 52 (52%) males and 48 (48%) females. 30 patients (24 males and 6 females) suffered from folliculate decalvans, 25 cases (10 males and 15 females) from DLE, 18 patients (6 males and 11 females) from brocq pseudopelade, 14 patients (4 males and 10 females) from lichen planopilaris, 8 patients (4 males and 4 females) from morphea and 5 cases (4 males and 1 female) from folliculate colloidalis. Early stage diagnosis by biopsy and proper treatment will reduce further progression and especially alleviate psychosocial disturbances.

Efficacy of 2% metronidazole gel in moderate acne vulgaris.

BACKGROUND: Acne vulgaris is an inflammatory disease of the pilosebaceous units. Various systemic and topical options are available for its treatment. AIMS: This study aimed to evaluate the efficacy of 2% metronidazole gel in acne vulgaris. MATERIALS AND METHODS: Double-blind, randomized, placebo-controlled, split-face clinical trial. Seventy young adults with moderate acne vulgaris received 2% metronidazole gel on the right side of their face and placebo on the left side of their face twice daily for 8 weeks. The number of inflamed and noninflamed facial lesions and side effects of treatment were documented on weeks 1, 2, 4, and 8. The patients' overall satisfaction was recorded at the end of the study. For statistical analysis we used the repeated-measures analysis, the chi-square test, Fisher's exact test, and the independent-samples t-test as appropriate. RESULTS: Counts of inflamed and noninflamed facial lesions were comparable between the two sides at baseline. The number of the lesions was significantly lower on the metronidazole-treated side at all follow-up visits. Erythema and oily face decreased by 85.7% and 87.1%, respectively, on the metronidazole-treated side. Mild burning sensation and dryness on the metronidazole-treated side was reported by 3.4% and 22.9% of the patients, respectively. Eighty-eight percent of the patients were satisfied with the results of treatment on the metronidazole-treated side. CONCLUSIONS: Metronidazole gel (2%) is an effective, safe, and well-tolerated topical medication for moderate acne vulgaris.

Topical steroids versus PUVA therapy in moderate plaque psoriasis: a clinical trial along with cost analysis.

BACKGROUND: Psoriasis is a common chronic disease. It is estimated that between US$1.6 billion and US$3.2 billion is spent per year to treat psoriasis. OBJECTIVE: To compare psoralen plus UV-A (PUVA) therapy with topical steroids in moderate plaque psoriasis. METHODS: In this randomized, clinical trial with cost analysis, 88 patients with moderate plaque psoriasis were recruited in two equal groups to receive either PUVA therapy or topical steroids. The induction phase was applied for 4 months and the patients were followed-up for another 3 months, while the maintenance therapy continued. Outcome, direct cost (related to medications, phototherapy, laboratory tests, and medical consultation), indirect cost (related to transportation and other extra expenditures) and total cost (direct plus indirect costs) were compared between the two groups. RESULTS: The outcome was equally satisfactory in both groups. The indirect cost was significantly higher in the PUVA group, while the direct and total costs as well as the patients' satisfaction rate were comparable. Recurrence was significantly more frequent in the topical group. CONCLUSION: Although both PUVA therapy and topical steroids are equally efficient and cost-effective in moderate plaque psoriasis, the recurrence rate is higher in the latter group.

Comparison of therapeutic effects of oral doxycycline and azithromycin in patients with moderate acne vulgaris: What is the role of age?

BACKGROUND: Acne vulgaris is the most common dermatological disorder in adolescence and young adults. In past decades, systemic antibiotics have had the main role in the treatment of acne patients with inflammatory papules and cysts. They are sometimes associated with side effects, contributing to reduced compliance. OBJECTIVE: This study aimed at comparing the efficacy and safety of oral azithromycin and doxycycline in the treatment of moderate acne vulgaris, considering the age of patients as an influencing parameter. METHODS: In a randomized, double-blind, clinical trial, 100 patients with moderate acne vulgaris who attended the outpatient dermatology clinic were evaluated during a 15-month period. They were randomized into two equal groups: A and D. Patients in group A received oral azithromycin (500 mg daily, 4 consecutive days per month for 3 consecutive months) and patients in group D took doxycycline (100 mg daily for 3 consecutive months). The number and types of lesions (all over the body) were determined at baseline and at the end of each month for 90 days afterwards. Michaelson's acne severity score was also determined at baseline and at the end of the third month after initiating treatment. Patients were followed up for another 3 months after discontinuation of treatment to determine the recurrence rate. RESULTS: Both antibiotics were comparably effective in the treatment of moderate acne vulgaris. There was no significant side effect in the A group and the complications were minor in the D group. Doxycycline was significantly more effective in patients older than 18 years. CONCLUSION: Azithromycin is at least as effective as doxycycline in the treatment of moderate acne vulgaris; however, in patients older than 18 years doxycycline is better.