The frequency of fatty liver in patients with alopecia areata: A case-control study.

BACKGROUND: Alopecia areata (AA) is an immune-mediated nonscarring hair loss disorder with multiple subtypes, including alopecia universalis (AU). Previous studies have shown a link between serum lipid profile and alopecia. We aimed to investigate the frequency of fatty liver in patients with AU and patchy alopecia areata (PAA) compared to a control group. METHODS: This case-control study included patients with AU and PAA referred to a dermatology clinic from September 23, 2019 to September 23, 2020. A group of individuals without hair loss disorders attending the same clinic were selected as controls. Participants' general information, including age, sex, weight, height, and waist circumference (WC), was recorded. Body mass index (BMI) was calculated for all participants. Also, hyperlipidemia and statin use were noted and liver enzymes were evaluated. For AU and PAA patients, disease duration and the Severity of Alopecia Tool (SALT) score were also recorded. Then, all subjects underwent ultrasound to assess fatty liver and its grade. RESULTS: Overall, 32 patients were included in each group. All three groups were comparable in age, sex, weight, height, BMI, WC, hyperlipidemia, abnormal liver enzymes, and statin use. Disease duration and SALT score were significantly higher in the AU than in the PAA group (p = 0.009 and p < 0.001, respectively). The frequency of fatty liver was the highest in AU patients (40.6%), followed by 34.4% in PAA patients, and 21.9% in controls (p = 0.263). This was also the case for grade-1 fatty liver, while grade-2 was more common in PAA patients, and grade-3 was only observed in one patient from the AU group (p = 0.496). CONCLUSIONS: Fatty liver was more frequent in AU and PAA patients than controls, without statistically significant differences. There might be an association between fatty liver and AA, particularly the AU subtype.

Monkeypox Disease with a Focus on the 2022 Outbreak; a Narrative Review.

Monkeypox is a zoonotic disease caused by a double-stranded DNA virus belonging to the genus Orthopoxvirus. Despite being endemic in Central and West Africa, the disease has received relatively little research attention until recent times. As the Coronavirus disease 2019 (COVID-19) pandemic continues to affect the world, the rising number of monkeypox cases in non-endemic countries has further stoked global public health concerns about another pandemic. Unlike previous outbreaks outside Africa, most patients in the present outbreak had no history of travel to the endemic regions. The overwhelming majority of patients were initially identified amongst homosexual men, who had attended large gatherings. Mutations in the coding regions of the viral genome may have resulted in fitness adaptation, enhancement of immune evasion mechanisms, and more efficient transmissibility of the 2022 monkeypox virus. Multiple factors such as diminished cross-protective herd immunity (cessation of smallpox vaccination), deforestation, civil war, refugee displacement, farming, enhanced global interconnectedness, and even climate change may facilitate the unexpected emergence of the disease. In light of the increasing number of cases reported in the present outbreak, healthcare professionals should update their knowledge about monkeypox disease, including its diagnosis, prevention, and clinical management. Herein, we provide an overview of monkeypox, with a focus on the 2022 outbreak, to serve as a primer for clinical practitioners who may encounter the disease in their practice.

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.

Elevated Serum Levels of Interleukin-15 in Pemphigus Vulgaris Patients: a Potential Therapeutic Target.

Introduction: Pemphigus vulgaris (PV) is a rare autoimmune disease that causes painful blistering. Interleukin-15 (IL-15) as a member of the immunoregulatory cytokines family is associated with the development of the chronic inflammatory or autoimmune disease. There is not much information available in the literature on the exact role IL-15 plays in PV. Objectives: The goal of this study was to evaluate the serum levels of IL-15 in patients with PV and assess the association of IL-15 with anti-desmoglein antibodies and the severity of the disease. Methods: Fifty-three individuals affected with active PV and 38 age- and gender-matched healthy controls were participated in this study. Disease severity was assessed using Autoimmune Bullous Skin Disorder Intensity Score (ABSIS). Serum levels of IL-15 (pg/mL) and anti-desmoglein antibodies (Dsg1, 3) were determined. Results: In the patient group, IL-15 serum levels were statistically higher than those in the control group (3.71 ± 1.5 vs. 0.79 ± 1.03, P < 0.001). A positive correlation was found between serum levels of IL-15 and ABSIS (r = 0.5, P = 0.04). We found no significant correlation between serum concentrations of IL-15 and antidesmoglein antibodies (Dsg1 or Dsg3). Conclusions: An increase in serum level of IL-15 in patients with PV and its relationship with disease severity suggest that this cytokine possibly contributes to the pathogenesis of the disease and targeting IL-15 will likely provide a new insight into the treatment of this disease.

COVID-19 Pandemic Impact on Severe Alopecia Areata Patients.

Introduction: The pandemic of COVID-19 has several implications for patients with chronic stress-sensitive diseases such as alopecia areata (AA). On the other hand, the vulnerability of AA patients using immunosuppressives to a more severe infection is in the shadow of ambiguity. This teledermatology study aimed to evaluate the course and outcome of AA in patients during this challenging period. Methods: Patients with AA who had previously received systemic therapy included in this study. Information about demographic data, AA history, characteristics, and treatments, hair loss progression, Corona Disease Anxiety Scale (CDAS), adherence to protective measures against the COVID-19, possible infection, and its features obtained via a telephone call. Results: A total of 57 patients participated. The majority (84.2%) of the participants had mild anxiety assessed by CDAS. Two patients (3.5%) had got infected with COVID-19. Twenty-one (36.8%) participants experienced hair loss progression. Hair loss progression correlated with drug dose reduction (OR: 46.09, 95% CI 5.48-387.14, p < 0.001) although it did not influence by the level of anxiety evaluated by the CDAS (p > 0.05). Conclusion: The anxiety perceived by severe AA patients about COVID-19 is mild; however, many experience hair loss progressions owing to their drug dose reduction.

Efficacy and safety of topical hydrogen peroxide 35% solution versus cryotherapy in the treatment of senile lentigo.

BACKGROUND: Senile lentigines (SLs) are hyperpigmented macules that predominantly affect the elderly. We aimed to compare the efficacy and safety of hydrogen peroxide35% solution with cryotherapy in the treatment of SLs. PATIENTS AND METHODS: This clinical trial included 33 patients with SLs referred to our center. Lesions of each side of the body were randomly allocated to receive 3 sessions of treatment with hydrogen peroxide or cryotherapy at a three-week interval. All patients were followed up 1 week after each round of treatment for the evaluation of side effects, the general effect of the treatment, and the general assessment of response to treatment. RESULTS: Thirty-three patients were included in this study with the mean age of 61.79 ± 4.59 years. Average and excellent effects were significantly higher with cryotherapy after the 2nd and 3rd sessions of treatment, respectively. Positive response to treatment was significantly higher with cryotherapy at all time points. Severe erythema was only observed with cryotherapy. Pigmentation was significantly more frequent with cryotherapy than with hydrogen peroxide at any time point (p < 0.001). Also, blisters were only seen with cryotherapy. Moreover, the pain score was significantly higher with cryotherapy at all time points (p < 0.001). Up to one week after the 3rd session of treatment, no recurrence of lesions occurred in any of the groups. CONCLUSIONS: Cryotherapy appears to be more efficacious for the treatment of SLs compared to hydrogen peroxide 35% solution; however, hydrogen peroxide seems to have fewer side effects.

Which laboratory/ultrasonographic parameters affect the severity of hirsutism?

BACKGROUND AND OBJECTIVES: Hirsutism is associated with other androgen-dependent signs/symptoms. This study was designed with the aim of a comprehensive investigation of laboratory and ultrasonographic findings in hirsute women and their probable association with the "severity" of the disease. PATIENTS AND METHODS: This cross-sectional study included 123 hirsute women. Comprehensive medical history of each patient was recorded, and a broad physical examination was performed by a single dermatologist. Ferriman-Gallwey score was used to evaluate the hirsutism severity. Pelvic ultrasonography was done by a single radiologist for each patient, and serum levels of the follicular stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH ratio, prolactin, thyroid-stimulating hormone, total testosterone, dehydroepiandrosterone sulfate, 17-alpha-hydroxyprogesterone, and cortisol were measured. The association of hirsutism severity and these paraclinical parameters was investigated. RESULTS: A statistically significant association was observed between polycystic ovary disease (PCOD) and the severity of hirsutism. A past medical history of PCOD was found to cause more severe forms of hirsutism in the involved patients as well. The presence of hormonal abnormalities was also significantly associated with the severity of hirsutism. CONCLUSIONS: More than half of the hirsute patients have endocrine abnormalities and/or PCOD. These two disorders are associated with the severity of hirsutism.

Efficacy and safety of fractional CO2 laser and tranexamic acid versus microneedling and tranexamic acid in the treatment of infraorbital hyperpigmentation.

OBJECTIVE: To compare the efficacy and safety of microneedling and fractional CO2 laser in combination with tranexamic acid (TA) in the treatment of infra-orbital hyperpigmentation. PATIENTS AND METHODS: This split-face clinical trial performed on 30 volunteers. The patients were randomly assigned to treat with fractional CO2 laser and microneedling, both combined with TA topically. Three monthly treatment sessions were performed. Two blinded dermatologists evaluated the response after each treatment session and one and three months after the last session. We also asked patients to evaluate their overall satisfaction at the final follow up. Adverse effects have also been documented. RESULTS: Both methods showed significant improvement in all sessions comparing with the baseline state (p value <.05). There were no significant differences between two methods on the days 30, 90, and 150. But the laser showed significantly higher improvement on day 60. The patients' satisfaction did not reveal any significant difference between the two sides. Adverse events were temporary with no significant difference between both sides except for erythema that lasts longer with microneedling. CONCLUSIONS: Both fractional CO2 laser and microneedling in combination with topical TA seem to be effective modalities in the treatment of infraorbital hyperpigmentation with no significant side effects.

Photodynamic therapy of vitiligo: A pilot study.

BACKGROUND: Vitiligo is an acquired autoimmune skin disorder with depigmented macules and patches. There are several possible treatments for vitiligo, none of which could be considered as a definitive cure. Photodynamic therapy (PDT) is a novel treatment with controversial outcomes in vitiligo patients. MATERIALS & METHODS: A total of 10 patches (5 patches on the trunk, 3 on the extremities, and 2 on the neck) were selected and received microderm abrasion. Then the lesion was covered with 5- aminolevulinic acid (ALA) for one hour. Afterwards, it received red light with a dose of 120 J/cm2.This cycle was repeated monthly for 5 sessions. Another vitiligo patch was considered as a control and received topical mometasone twice a day during the study. The therapeutic results were compared by a blind dermatologist. RESULTS: The median of repigmentation score, which was determined by a blind dermatologist, was 0.5 in the PDT group and 1 in the steroid group, which did not show any statistically significant difference. CONCLUSION: The results of this study demonstrated that PDT does not have any additional therapeutic effect in comparison with topical corticosteroids as the traditional treatment of vitiligo.

Clinical Diagnosis has a High Negative Predictive Value in Evaluation of Malignant Skin Lesions.

BACKGROUND: The increasing incidence of skin cancers in fair-skinned population and its relatively good response to treatment make its accurate diagnosis of great importance. We evaluated the accuracy of clinical diagnosis of malignant skin lesions by comparing the clinical diagnosis with histological diagnosis as the gold standard. MATERIALS AND METHODS: In this retrospective study, we assessed all the pathology reports from specimens sent to a university hospital laboratory in 3 consecutive years from March 2008 to March 2010. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios were calculated for clinical diagnosis of malignant skin lesions stratified by their histological subtype. RESULTS: A total 4,123 specimen were evaluated. The sensitivity and specificity for clinical diagnosis of malignancy were 90.48% and 82.85%, respectively, whereas the negative predictive value was shown to be 99.06%. The positive and negative likelihood ratios were 5.23 and 0.11, respectively. CONCLUSION: Pathological assessment of skin lesions remains the cornerstone of skin cancer diagnosis. The high NPV and the relatively low PPV indicate that clinical diagnosis is more efficient in ruling out malignancies rather than diagnosing them.

A Comprehensive Review of Cutaneous Manifestations Associated with COVID-19.

The novel coronavirus (SARS-CoV-2), the cause of coronavirus 2019 disease (COVID-19) pandemic, is associated with some cutaneous manifestations. Although the cutaneous presentations of COVID-19 are infrequent, it is of great importance for all clinicians to be aware of these manifestations, as it may contribute to sooner and better diagnosis and management of the disease, even in asymptomatic or paucisymptomatic patients. The reported cutaneous manifestations of COVID-19 are various, dispersed, and sometimes confusing. In this article, all reported cases to date were collected and classified under 6 major groups: maculopapular rash, urticaria, chilblain, vesicular lesions, livedo reticularis, and petechiae. Different characteristics of each group were discussed in detail as well.

A Comparison of The Effects of Clobetasol 0.05% and Photodynamic Therapy Using Aminolevulinic Acid With Red Light in the Treatment of Severe Nail Psoriasis.

Introduction: The treatment of nail psoriasis is often difficult and unsatisfactory due to therapy resistance. This study aimed to compare the efficacy of clobetasol 0.05% ointment and photodynamic therapy (PDT) using aminolevulinic acid (ALA) and red light in the treatment of severe nail psoriasis. Methods: This open-trial study included 69 nails of 8 patients with severe nail psoriasis. Thirty-four nails were treated with clobetasol 0.05% ointment and 35 nails were treated with ALA-PDT. ALAPDT treatment was performed every 3 weeks for 5 cycles; the nails were treated with clobetasol under occlusion every day during the study. All the patients were followed up after 24 weeks. The severity of nail involvement was measured by the Nail Psoriasis Severity Index (NAPSI) scores at the baseline and during the treatment. Results: There were no significant differences in the NAPSI scores between the treatment groups in the baseline and weeks 3, 6 and 9 (all P>0.05), although significant differences were found in weeks 12, 15 and 24 (follow-up) (P<0.001). A significant time-effect improvement was found in all the nailmatrix, nail-bed and total NAPSI scores in both treatment groups (all P<0.001). The patients did not report intense pain and discomfort during irradiation. Conclusion: Clobetasol 0.05% ointment seems to be effective in treating nail psoriasis after a treatment period of 15 weeks. However, the efficacy of ALA-PDT at a 24-week follow-up was greater than that of clobetasol.

Methylprednisolone pulse therapy plus adjuvant therapy for pemphigus vulgaris: an analysis of 10 years' experience on 312 patients.

Steroid pulse therapy has shown satisfactory efficacy and safety in treating pemphigus vulgaris (PV). However, there is a paucity of data about the efficacy and safety of methylprednisolone, despite its frequent administration. The aim of this study is to evaluate the efficacy and safety of steroid pulse therapy in treating PV. In this 10-year retrospective cohort study, 312 patients with PV, who had received methylprednisolone pulse therapy, were included. Data of pulse therapy sessions, adjuvant medications, dosages, remission rates, complications, and mortalities were collected from all patients. A total of 276 patients out of 312 underwent the final follow-up at least 6 months after the last session of pulse therapy. Complete remission off therapy was achieved in 83 patients (30%), and 152 patients (55%) had complete remission on therapy. About 29 (10.5%) patients had lesions of pemphigus at the time of the study follow-up, and 26.8% of remained patients were on the minimal therapy. Methylprednisolone pulse therapy could be considered as an option for proper control of PV in severe cases. It might lead to shorter periods of hospitalization and reduce the need to take long-term high-dose oral steroid therapy.

Hearing status in patients with vitiligo.

Background: Vitiligo is an acquired disorder characterized by depigmented macules and patches that result from a progressive loss of functional melanocytes. During embryogenesis, precursor cells of melanocytes (melanoblasts) migrate not only to the epidermis and hair follicles but also to the leptomeninges, uveal tract of the eye, and inner ear. Thus, it has been proposed that these organs may be involved in vitiligo, as well. Objective: This study was designed to evaluate the frequency and characteristics of hearing loss by means of audiometry and  distortion  product otoaucostic emission (DPOAE) in patients with vitiligo. Methods: Fifty-three patients with vitiligo and 52 age- and sex-matched healthy subjects were enrolled in this case-control study. After a complete otological examination, comprehensive audiological evaluations including pure tone audiometry (PTA) and DPOAE were performed for all participants and the results were compared between the two groups. Results: Neither PTA nor DPOAE showed significant difference between the two groups in any of the evaluated frequencies (0.75-8 KHz). Furthermore, in patient group, there was no association between PTA/DPOAE and age, gender, duration of the disease, presence of halo nevus, type of vitiligo, extent of involvement, and positive family history of vitiligo. Conclusion: Vitiligo patients have normal hearing status.

The effect of platelet rich plasma on hair regrowth in patients with alopecia areata totalis: A clinical pilot study.

Autologous rich plasma (PRP) is blood plasma with enhanced concentration of platelets and is enriched with several growth factors which stimulate tissue regeneration. The current study aimed to investigate the effect of PRP on hair regrowth in patients with alopecia areata (AA) totalis. Ten subjects (28.9 ± 6.28 years; five males and five females) with clinically diagnosed AA totalis for at least 3 years who had not received any treatment within 3 months prior to the study were recruited. Blood sample was collected in thrombocyte harvesting tubes. The PRP was separated via centrifugation. The patients' scalp was divided sagittally into two approximately equal parts. In each patient, 4 mL of PRP was injected intradermally into the left or right side of the scalp; in each point, 0.1 mL of PRP was injected. Each patient was followed up monthly for 4 months. No hair regrowth was seen in eight patients and in two patients only <10% hair regrowth was observed. Totally, no significant effect was found for PRP on hair regrowth (p > .05). There was no side effect during treatment. Single dermal PRP injection did not prove to have any effect on hair regrowth in these patients.

Evaluation of Therapeutic Efficacy and Safety of Tranexamic Acid Local Infiltration in Combination with Topical 4% Hydroquinone Cream Compared to Topical 4% Hydroquinone Cream Alone in Patients with Melasma: A Split-Face Study.

INTRODUCTION: Melasma is an acquired pigmentary disorder characterized by hyperpigmented macules and/or patches affecting sun-exposed skin. Tranexamic acid (TA) can reduce melanin content of epidermis. Thus, we conducted this study to evaluate the efficacy and safety of tranexamic acid local infiltration in combination with topical 4% hydroquinone cream compared to topical 4% hydroquinone cream alone in patients with melasma. MATERIAL AND METHODS: This study was a prospective assessor- and analyst-blind, randomized split-face clinical trial which was performed on patients with bilateral malar epidermal melasma. A total of 55 patients were enrolled, and each side of their face was randomly allocated to either TA+HQ or HQ alone treatment. The MASI score was applied as an objective measurement to compare two treatment groups. The patient's satisfaction of melasma treatment was evaluated using a four-scale grading, as well. RESULTS: The mean of MASI score in week 16 decreased in both groups significantly (p < 0.01). The therapeutic outcomes were significantly better in TA+HQ group than HQ group (p=0.001). Patients satisfaction with treatment was significantly higher in the TA + HQ group. The difference between the two groups regarding side effect occurrence was not statistically significant. CONCLUSION: Addition of tranexamic acid injections to conventional hydroquinone therapy can increase the efficacy of topical treatment. This trial is registered with IRCT2015110324865N1.