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Background: Response to the current available treatments of melasma, dermal type, in particular, is usually gradual and can result in possible side effects. Aim and Objectives: In this study, we aim to evaluate the efficacy of the combination of plasma rich in growth factors (PRGF) and topical 4% hydroquinone (HQ) in comparison with monotherapy using topical 4% HQ alone in the treatment of dermal type of melasma. Materials and Methods: This is a single‑blinded, randomized, split‑face clinical trial on twenty female patients with dermal type of melasma. Patients were asked to apply topical 4% HQ on both sides of their face at night for 6 months. In each participant, one side of the face was randomly chosen to receive monthly intradermal injections of PRGF for 3 sessions. Efficacy of the treatment was assessed using hemi melasma area and severity index (MASI) score, physician’s global assessment (PGA), and patients’ global assessment (PtGA). Results: Both groups revealed significant improvement in hemi‑MASI score during the treatment course. Mean percentage of improvement at the end of study was 40.38 ± 6.04% and 33.42 ± 3.23% in the combination therapy and monotherapy groups, respectively (P = 0.31). PGA demonstrated excellent‑to‑marked improvement in melasma in 25% and 5% of patients in the combination therapy and monotherapy groups, respectively (P = 0.31). PtGA showed high levels of satisfaction in 15% of patients in the combination therapy group (vs. 0% in the monotherapy group) (P = 0.05). Conclusion: Differences between the two treatment groups in terms of hemi‑MASI and PGA scores were not statistically significant; however, patients demonstrated higher satisfaction with combination of PRGF and topical 4% HQ compared with topical HQ alone. Thereby, combination of PRGF and topical 4% HQ can be suggested as a safe alternative therapeutic approach and may hold promise in the development of future therapeutic options for dermal type of melasma. [ABSTRACT FROM AUTHOR]

Acne scars have negative profound impact on the quality of life of patients. Treatment of acne scars should be customized based upon characteristics of the scar, skin type, patient's preferences, and physician's experience. In this article, we comprehensively review the existing evidence for employing soft tissue augmentation in acne scars treatment. We searched PubMed, Medline, Scopus, Embase, Google scholar and Science Direct for articles that evaluated the efficacy of soft tissue augmentation via injection method for the treatment of atrophic acne scars from January 2000 until June 2021. Thirty articles were selected for final evaluation. The materials that were used for soft tissue augmentation in treatment of acne scars included hyaluronic acid-based fillers, autologous fat, polymethylmethacrylate microspheres plus bovine collagen, calcium hydroxylapatite, plasma gel, poly-L-lactic acid, collagen and silicone. Adjuvant treatments included microneedling, high-frequency ultrasound, microfocused ultrasound with visualization, radiofrequency, fractional carbon dioxide laser, erbium-doped yttrium aluminum garnet, fractional Er: glass, subcision and platelet rich plasma. Currently, soft tissue augmentation has gained popularity in treatment of acne scars. Soft tissue augmentation is a minimally invasive procedure that can provide both immediate and gradual improvement and is effective in the treatment of rolling and boxcar scars, while its efficacy is limited in icepick scars. Ideal filler in treatment of atrophic acne scars should have long-lasting effects with minimal side effects or serious complications such as nodule formation and immune system activation. [ABSTRACT FROM AUTHOR]

Key Clinical Message: In this case of disseminated cutaneous leishmaniasis in our immunosuppressive patient who was a refractor to treatment with intra‐lesion Glucantime® and systemic L‐AmB, considering the good clinical response to oral miltefosine, this drug might be the best treatment option. Diagnosis and treatment of leishmaniasis are challenging in immunosuppressed patients. Here, we report a 46‐year‐old male renal transplant recipient with disseminated cutaneous leishmaniasis presenting with multiple lesions on the face and upper extremities 15 years after transplant with a challenging course of treatment with meglumine antimoniate, liposomal amphotericin B, and miltefosine. [ABSTRACT FROM AUTHOR]

Background Prevalence of cutaneous adverse drug reactions varies depending on genetic background, geographical location, demographic features of the patients and prescribed drugs. This study is conducted to evaluate demographic and clinical features of the patients admitted with drug reactions in dermatologic ward of Afzalipour hospital in Kerman. Methods This is a retrospective study on two-hundred and forty patients who were admitted with drug reactions in dermatology ward of Afzalipour hospital in Kerman, from 2010 to 2018. Demographic features of the patients and types of the prescribed drugs and drug reactions were recorded. Descriptive data were demonstrated by frequency and mean ±Standard deviation. Correlation between clinical patterns of cutaneous adverse drug reactions with demographic features of the patients were assessed by Fisher's exact test. Results Most of the patients were in the fourth decade of their lives (24.2%) and female to male ratio was 1.7 to 1. The most common drug reactions were maculopapular eruptions (52.8%), Stevens-Johnson syndrome/toxic epidermal necrolysis (18.7%) and fixed drug eruption (13.6%). The most culprit drugs were antibiotics (76.6%) and antiepileptic classes (14.4%). There was no correlation between age (P. value=0.432) or sex (P. value=0.65) of the patients with types of drug reactions. Conclusion In the present study, most of the patients were female and in the fourth decade of their lives. Maculopapular eruptions were the most frequent clinical pattern of cutaneous adverse drug reactions. Antibiotics (ceftriaxone) and anticonvulsants (carbamazepine, phenobarbital) were the most frequent culprit drugs for cutaneous adverse reactions. [ABSTRACT FROM AUTHOR]

Background Recognition of parameters to predict severity of drug eruptions can be helpful in early intervention in severe cases. In this study, we evaluate the role of hematological factors including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte (PLR) ratio in prediction of severity in cutaneous drug reactions. Methods This is a retrospective cross-sectional study on 46 hospitalized patients with drug eruptions and 46 healthy individuals as control group. NLR/PLR was compared between patients with drug eruptions and healthy control group by independent t test. Moreover, the values of these hematological markers were compared between serious and non-serious types of drug eruptions by independent t test. Results Serious drug eruptions constitute nearly one-fourth of total drug eruptions. The mean values of NLR in case and control groups were 3.91±2.87 and 2.30±1.62, respectively (P=0.001). The mean values of PLR in case and control groups were 155.35±90.60 and 125±45.64, respectively (P=0.045). Females with drug eruptions had significantly higher PLR compared to males (P=0.02). Furthermore, there was no significant correlation between NLR/PLR in serious and non-serious types of drug reactions. Conclusion NLR/PLR was significantly higher in patients with drug eruptions compared to control group. There was no significant correlation between NLR/PLR with either demographic features of patients or severity of drug eruption; except significantly higher PLR in female with drug eruptions compared to males. [ABSTRACT FROM AUTHOR]

Background Nowadays, role of hematologic markers including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as cost-effective and reliable tests, in recognition of chronic inflammatory and autoimmune diseases, as well as prediction of their prognosis has been elucidated. In this study we investigate role of these factors in prediction of severity of psoriasis and associated arthritis. Methods This is a retrospective cross-sectional study on thirty moderate-to-severe psoriasis patients, hospitalized in dermatology ward, and thirty aged- and sexed-matched healthy adults. NLR/PLR in psoriasis patients was compared to healthy controls. Furthermore, NLR/PLR of classic type of psoriasis was compared to other types of psoriasis (including psoriatic arthritis and erythrodermic psoriasis) by variance analysis. Correlation of demographic features with NLR/PLR was assessed via chi-square test and independent t test. Results Mean age of patients in psoriasis and control groups was 35.66±16.62 and 39.8±11.18, respectively. Psoriasis patients had significantly higher NLR/PLR compared to control groups (3.47±3.83 vs. 1.37±0.55 and 133.26±83.99 vs. 96.25±40.72, respectively). The highest and lowest NRL/PLR belonged to erythrodermic and vulgaris types, respectively. Moreover, there was no significant correlation between NLR/PLR and psoriasis patients, with or without underlying disease. Conclusion NLR/PLR can be a useful indicator for psoriasis severity and associated arthritis. It might be helpful in selection of type of treatment in psoriasis patients and employed as a prognostic factor in prediction of disease course and possible accompanied morbidities. [ABSTRACT FROM AUTHOR]

Backgrounds: Nowadays, lasers are used for treatment of vitiligo in difficult‐to‐treat areas and refractory lesions. Combination of lasers with other medical modalities can provide higher efficacy, faster response rate, and higher compliance of patients to treatment. Aim: In this article, we reviewed articles regarding safety, efficacy, and treatment protocols of combined laser with other medical modalities. Methods: We searched articles with relevant key words in Google scholar and PubMed. Inclusion criteria were articles in English language since January 2000 until March 2021that evaluate combination of laser with other topical or systemic medical treatments. Results: A total of 42 articles evaluated efficacy of lasers [excimer, carbon dioxide (CO2), erbium‐doped yttrium‐aluminum‐garnet (Er:YAG), and non‐ablative resurfacing laser] combined with topical or systemic medical treatment modalities. Effective response rate (more than 50% improvement) varied between 7.7% and 92%. Initial repigmentation observed between 4 and 13 weeks after beginning of treatment. Conclusion: Combination of laser with medical modalities leads to more rapid repigmentation, superior efficacy, and better compliance of patients with localized non‐segmental type of vitiligo compared to monotherapy. Combination of excimer laser with topical therapy might be suggested for recalcitrant vitiligo lesions in face and neck. Combination of fractional ablative resurfacing lasers with topical therapy, especially 5‐flurouracil, can be recommended particularly in recalcitrant acral and bony prominent areas. Further studies are required to achieve conclusive evidence in order to define the best stage of vitiligo for laser therapy and most effective combined treatment regimen. [ABSTRACT FROM AUTHOR]

Background: Segmental vitiligo (SV) is a distinctive variant of vitiligo that is usually resistant to traditional treatments. Therefore, surgical therapies are mainstay of treatment in this type of vitiligo. To date, there is no review article or systematic review that evaluates specifically efficacy of treatment modalities on SV. Aim: To evaluate current evidence regarding efficacy and safety of traditional and surgical treatment modalities in SV. Methods: We conducted a search in PubMed, Embase, Web of science, and Google Scholar for key words of "vitiligo" AND "segmental" AND "treatment" OR "therapy" OR "surgical treatments" OR "medical treatments" OR "laser" OR "phototherapy". Inclusion criteria were English literature that investigated efficacy of different treatments on three or more cases on SV from January 2000 until July 2021. Results: A total of thirty‐four articles were selected for detailed assessment. Different treatment modalities include medical treatment [systemic corticosteroid (SCS), topical CS (TCS), and topical calcineurin inhibitors (TCI)], phototherapy [narrow band‐ultraviolet B (NB‐UVB), psoralen and UVA (PUVA) and psoralen+solar exposure (PUVASOL)], laser/lights [helium‐neon and Excimer laser/light (EL)] and surgical treatments [punch graft (PG), follicular graft, suction blister epidermal grafting (SBEG), spilt‐thickness skin graft (STSG), and cultured/non‐cultured‐melanocytes‐keratinocytes transplantation (MKTP)]. Conclusion: There were few randomized controlled trials (RCT) evaluating the efficacy of treatments in SV. Therefore, future high quality studies are required for better assessment of various treatment modalities in SV. Results of current evidence indicate resistance of SV to traditional therapies unless in patients with short duration of vitiligo. Therefore, surgical interventions are the first‐line of treatment in refractory cases, long‐standing disease, or presence of leukotrichia in depigmented patches. [ABSTRACT FROM AUTHOR]

Background: Post‐acne erythema is described as erythema due to release of inflammatory cytokines, dilatation of microcapillaries within papillary dermis and thinning of epidermis. The erythema usually fades; however, it can persist for months. Aim: In this review, we decided to evaluate efficacy of light and laser treatments in acne‐induced erythema. Methods: We searched PUBMED, Embase, Cochrane, and Google Scholar for relevant key words. Inclusion criteria were randomized clinical trials (RCTs) that evaluated efficacy of laser or light in PAE until September 2021. Results: Twelve RCTs were selected for the final assessment. Light and laser treatments included pulsed dye laser (PDL), intense pulsed light (IPL), Q‐switched neodymium‐doped yttrium aluminum garnet (QS Nd:YAG), fractional photothermolysis, alexandrite, solid‐slate 589–1319 nm, and pro‐yellow laser. Conclusion: Light and laser treatments are effective treatment modalities in reduction of acne‐induced erythema along with active acne lesions and atrophic acne scars. [ABSTRACT FROM AUTHOR]

Background: Mesotherapy is a popular novel therapeutic modality that is defined as intradermal or subcutaneous microinjection of pharmaceutical compounds. Although this novel treatment method is used commonly in aesthetic dermatology, there is little information about details of injections, efficacy, and side effects of mesotherapy in melasma. Aim: In this review, we evaluated efficacy and safety of various types of mesotherapy in the treatment of melasma. Method: We searched Google Scholar, Medline, and PubMed for related articles with keywords "melasma" OR "chloasma" AND "mesotherapy" OR "injection." Inclusion criteria were articles that evaluated intradermal injection of lightening drugs and published dates between January 2000 and September 2021. Exclusion criteria were articles in languages other than English or non‐human studies. Results: Thirty‐three articles evaluated efficacy of mesotherapy in melasma, including 28 articles about tranexamic acid, 4 articles about vitamin C, 2 articles about glutathione, and 2 articles about triamcinolone. Conclusion: Mesotherapy is a good alternative or adjunctive choice in patients who are refractory to first‐line therapy, patients with low compliance with everyday use of topical therapy, patients with contraindication to oral tranexamic acid therapy, or who wish short downtime and fast recovery period. Further studies with large sample sizes are required to determine ideal concentrations of mesotherapy substances and intervals between sessions and to evaluate the efficacy of different substances for mesotherapy as monotherapy compared to combination therapy and other treatment modalities for melasma. [ABSTRACT FROM AUTHOR]

Background: Leishmaniasis is highly prevalent worldwide, and while conventional medicine offers numerous treatment methods for cutaneous leishmaniasis, Iranian traditional medicine suggests various remedies. We aimed to evaluate the efficacy of an herbal combination containing Indigofera argentea leaves, Pistacia atlantica resin, and Salvia hispanica seeds in patients with zoonotic cutaneous leishmaniasis. Methods: This study was conducted at the Leishmaniasis Department of Chabahar Health Center in southeastern Iran in 2021. It was a double-blinded randomized clinical trial involving 68 patients enrolled after clinical diagnosis, examination of smear samples using Giemsa staining, and PCR confirmation. The volunteers were randomly divided into intervention and control groups. Both groups received 'Glucantime ® as the primary medication weekly until complete healing or up to 12 weeks. Glucantime ® was administered intralesionally at a dosage of 0.1 cc on the wound's margin, with repeat injections at 1 cm intervals along the wound edge when necessary. In addition to the main drug, the intervention group received the herbal product topically twice daily until wound healing or for up to 4 weeks, while the control group received a placebo in the same manner. Results: 82.35% of patients in the intervention group and 20.58% in the control group achieved complete healing within four weeks. There was a significant difference between the two groups (P < 0.001). Conclusion: The herbal product demonstrated effectiveness in treating patients with zoonotic cutaneous leishmaniasis. [ABSTRACT FROM AUTHOR]

Background and Aim: Androgenetic alopecia (AGA) is the most common type of alopecia in men. Currently, minoxidil is the only topical drug which has been approved by FDA for the treatment of AGA. However, its efficacy is restricted because of its low skin penetration. Since vesicular systems such as liposomes and niosomes have higher efficacy and lower adverse effects, this study was conducted to compare the efficacy of topical niosomal minoxidil with conventional minoxidil in the treatment of AGA. Methods: This study was a randomized, controlled doubleblind clinical trial. Ninety male patients with AGA according to Hamilton criteria were enrolled into this trial. The participants applied the interversion to which they were allocated twice a day, and were evaluated monthly for 6 months by a physician and patients' self-assessments. Results: Eighty-eight patients completed the trial. Mean increased hair count in niosomal minoxidil group and conventional minoxidil group in the last visit were 28.18±11.00 and 14.22±5.23, respectively (P<0.001). Moreover, evaluation of treatment response according to the patients self-assessments were 8.7±5.03 and 3.33±2.67 in niosomal and conventional minoxidil, respectively, which revealed more satisfaction in niosomal group (P=0.001). With the exception of two cases in niosomal minoxidil group whom were withdraw due to scalp itching and erthema no other adverse effect was observed in either group. Conclusion: In the present study, application of topical niosomal minoxidil revealed an increase in the hair count in comparison with conventional minoxidil solution. Application of this new formulation for the treatment of AGA may be recommended. [ABSTRACT FROM AUTHOR]

Background Erythroderma or exfoliative dermatitis is characterized with generalized erythema of the skin, involving approximately 90% of the body surface area. In this study, we determine prevalence of different types of erythroderma as well as clinical and laboratory features in patients admitted in dermatology ward of Afzalipour hospital, Kerman. Methods This is a retrospective cross-sectional study on patients with erythroderma during tenyear period (2010-2019). Correlation of underlying disease with demographics and clinical features of the patients was evaluated by independent t test and chi-square test. Results Prevalence of erythroderma was 12.1%. Most of the patients were in their fourth or sixth decades of life. Drug eruption, autoimmune bullous diseases and cutaneous T cell lymphoma (CTCL) were observed most commonly in females (P=0.001). The shortest and longest duration belonged to drug eruption and CTCL, respectively (P=0.001). The most common clinical symptoms and signs were pruritus (91.5%), lymphadenopathy (20.9%) and fever (20.3). The most frequent laboratory abnormality was elevated liver enzymes (83.05%). The most common causes of erythroderma were exacerbation of pre-existing dermatoses (54.2%), drug eruption (35.6%) and idiopathic (7.3%). The most prevalent causes of pre-existing skin diseases were psoriasis (35%), dermatitis (13%) and lichen planus (2.3%). Conclusion The most common causes of erythroderma were exacerbation of pre-existing dermatoses (mainly psoriasis and dermatitis), drug eruption and idiopathic. The most common causes of acute and chronic erythroderma were drug eruption and psoriasis, respectively. The most frequent clinical (other than erythema and scaling) and laboratory findings were pruritus and elevated liver enzymes, respectively. [ABSTRACT FROM AUTHOR]

Metformin is a commonly used medication in diabetic patients. It can cause different complications including cutaneous adverse reactions. Metformin-induced fixed-drug eruption (FDE) has been reported in limited cases. Due to the popularity of metformin, clinicians need to be aware of uncommon drug reactions for proper diagnosis and treatment. Herein, we report a 43-year-old man with generalized bullous lesions with a positive dechallenge-rechallenge test diagnosed as metformin-induced generalized bullous fixed-drug eruption. Metformin dosage was stopped and lesions were treated with topical clobetasol propionate and oral prednisolone and cyclosporine-A. After a 6-month follow-up, he was well without any relapsing episodes. [ABSTRACT FROM AUTHOR]

Introduction: Melasma is a chronic hyperpigmentation disorder, and its treatment poses a challenge to dermatologists due to its chronicity and resistance to conventional therapies. Oral isoniazid is used for the treatment of tuberculosis. One of us had previously showed that topical isoniazid exerts a strong depigmenting action in animal models. In this clinical trial, we assessed the therapeutic effect of topical isoniazid on melasma. Methods: Twenty female patients suffering from epidermal melasma were enrolled and divided equally into two groups. The treatment group received topical isoniazid 10%, and the control group received the cold cream vehicle as the placebo. All participants were advised to avoid sunlight and used SPF 50 sunscreen. Patients applied topical agents once daily at night for 3 months. The melanin and erythema indices were measured by colorimetric evaluations at baseline and after 4, 8, and 12 weeks of treatment. At these time points, the (mMASI) score was also determined, as was the subjective evaluation through Melasma Quality of Life Scale (MELASQOL) scores. Blood tests were performed to evaluate CBC and the liver enzymes. Results: All patients completed the 12‐week study. In the treatment group, a significant decrease in melanin index from 63.77 ± 6.27 at baseline to 55.92 ± 5.79 was recorded (p = 0.001). Very minimal clinical changes were also seen in the control group and melanin index was decreased from 62.65 ± 2.23 to 61.25 ± 2.34 (p = 0.004). Clinically significant differences were observed in the rate of changes between both groups. These findings indicate that topical isoniazid has significant depigmenting effects compared to the placebo (p = 0.001). The erythema index remained unchanged in both groups. In the treatment group, the mMASI score was 5.63 ± 3.28 at baseline and 2.13 ± 1.71 at the last follow‐up, significantly reduced compared to the control group (p = 0.002). The MELASQOL score indicated a significant improvement in the quality of life in the treatment group. Conclusion: This clinical trial shows for the first time that topical isoniazid is effective in treating melasma. Further clinical trials are necessary to confirm the efficacy and tolerability of topical isoniazid in comparison with other skin‐depigmenting compounds. [ABSTRACT FROM AUTHOR]

Background: Treatment of vitiligo is still a big challenge for dermatologists. The efficacy of statins in the treatment of vitiligo is controversial. Aim and Objective: We studied possible therapeutic effect of topical 1% niosomal atorvastatin ointment combined with topical 0.1% tacrolimus in treatment of non‐segmental vitiligo. Methods: This is a triple blind, pilot, randomized placebo‐controlled trial (RCT) that was performed in dermatology clinic. All the patients used topical 0.1% tacrolimus cream twice daily (BD). Moreover, the intervention group participants used topical 1% niosomal atorvastatin ointment, and control group participants were prescribed placebo ointment, BD. Patients were evaluated using vitiligo area surface index (VASI) score and patients' satisfaction at baseline and after 3 months treatment. Results: The mean patient satisfaction in the intervention and control groups were 5 ± 1.4 and 3.5 ± 1.9; the difference between groups was not statistically significant (p = 0.9). We found statistically significant difference in VASI score before and after treatment in both intervention and control groups (p = 0.01 and p = 0.03, respectively). However, comparison of the VASI score between groups was not statistically significant (p = 0.62). We also found no significant correlation between VASI score and other variables. Conclusion: The result of this study indicates that adding of niosomal atorvastatin 1% ointment to topical calcineurin inhibitor has no additional effect on non‐segmental type of vitiligo. Further large studies with different combinations are recommended before any conclusive result can be concluded on efficacy of statins in vitiligo. [ABSTRACT FROM AUTHOR]

Dysgeusia is the first recognized oral symptom of novel coronavirus disease (COVID‐19). In this review article, we described oral lesions of COVID‐19 patients. We searched PubMed library and Google Scholar for published literature since December 2019 until September 2020. Finally, we selected 35 articles including case reports, case series and letters to editor. Oral manifestations included ulcer, erosion, bulla, vesicle, pustule, fissured or depapillated tongue, macule, papule, plaque, pigmentation, halitosis, whitish areas, hemorrhagic crust, necrosis, petechiae, swelling, erythema, and spontaneous bleeding. The most common sites of involvement in descending order were tongue (38%), labial mucosa (26%), and palate (22%). Suggested diagnoses of the lesions were aphthous stomatitis, herpetiform lesions, candidiasis, vasculitis, Kawasaki‐like, EM‐like, mucositis, drug eruption, necrotizing periodontal disease, angina bullosa‐like, angular cheilitis, atypical Sweet syndrome, and Melkerson‐Rosenthal syndrome. Oral lesions were symptomatic in 68% of the cases. Oral lesions were nearly equal in both genders (49% female and 51% male). Patients with older age and higher severity of COVID‐19 disease had more widespread and sever oral lesions. Lack of oral hygiene, opportunistic infections, stress, immunosuppression, vasculitis, and hyper‐inflammatory response secondary to COVID‐19 are the most important predisposing factors for onset of oral lesions in COVID‐19 patients. [ABSTRACT FROM AUTHOR]

Background Autoimmune bullous diseases (AIBDs) are a group of chronic blistering diseases that affect mucocutaneous membranes. These diseases are common worldwide and affect males and females of all races. Treatment options include corticosteroids, rituximab, and topical agents. We evaluated the epidemiology of AIBD in Kerman, Iran, over a five-year period. Methods This retrospective study was conducted on 100 patients diagnosed with an AIBD between 2015-2020. All patients were included in this study by census method. Factors like age, sex, disease type, and age at diagnosis were evaluated. Data analyses were performed using SPSS version 26. Results One hundred patients participated in this study, and the male-to-female ratio was 1:1.08. The mean age of participants was 51.99±19.52 years, and the mean age at diagnosis was 49.19±8.31. Out of 100 patients, 82 suffered from pemphigus disease (70 pemphigus vulgaris; 12 pemphigus foliaceus), 17 had bullous pemphigoid, and one patient had pemphigus gestationis. Conclusion In many countries, pemphigus is the most common AIBD. Although AIBDs are uncommon, the diagnosed cases increase with age. [ABSTRACT FROM AUTHOR]

Background: Mesotherapy is a method of treatment in which biocompatible substances are injected in small aliquots into different levels of skin. This technique can be used for facial rejuvenation. Aim: To comprehensively evaluate efficacy of different hyaluronic acid (HA) materials for skin rejuvenation, and discuss longevity of these products, potential adverse effects, and different injection techniques. Material and Methods: We searched Pubmed, Scopus, Web of science, Google Scholar, Embase, Cochrane Library, and Science direct until April of 2022. Thirty‐four articles were selected including 23 articles about non‐cross‐linked HA and 11 articles about cross‐linked HA. Results: Eleven and five different non‐cross‐linked HA and cross‐linked HA materials were utilized, respectively. Treatment sessions for non‐cross‐linked HA were between 1 and 6 at weekly‐to‐bimonthly interval, and for cross‐linked HA were 1–3 at 4–36 weeks apart. In most of the studies, serial micropuncture technique with 23–32 gauge needles was used for injection. Other injection techniques were Nappage (picotage), depot and micro‐linear. Conclusion: Mesotherapy with HA‐based fillers is a favorable method for restoring youthful appearance, rejuvenation, and revitalization of skin. Proper selection and precise placement of HA in desired level of dermis is an essential key to optimize improvement and minimize side effects including skin irregularities and Tyndall effect. Adjuvant therapy with additional rejuvenation procedures to enhance esthetic results is required especially in elderly individuals with severe photodamaged skin. Moreover, preservation of esthetic results requires maintenance therapy every few months. [ABSTRACT FROM AUTHOR]

Background: Microbotox technique, intradermal injection of microdroplets of botulinum toxin, is a favorable rejuvenation approach in subjects who prefer more natural appearance. Aim: To determine the best injection techniques (dosage, concentration, as well as number and location of injection points), efficacy and side effects of this innovative technique for facial rejuvenation. Methods: We conducted a search in Pubmed, Embase, Web of Science, and Google Scholar databases from conception until October 2021 with keywords "microbotox" OR "mesobotox" OR "intradermal injection" AND "botulinum toxin" AND "rejuvenation" AND "wrinkle" AND "face‐lift." Results: Twenty articles were included in this review article. Different types of formulation including onabotulinum toxin A (OBA), abobotulinum toxin A (ABO), and incobotulinum toxin A (IBA) were used. The most used concentrations were 10–20 u/cc of OBA. Number of injection points varied from 4 (forehead and periorbital areas) to 999 (entire face) with 2 mm to 2 cm apart. Adjuvant treatment modalities were cross‐linked hyaluronic acid, intense pulsed laser, and Fraxel laser. Most studies reported the initial results appeared after 5–14 days of procedure, lasting for nearly 3–6 months. Conclusion: Microbotox is an efficient and attractive method for facial rejuvenation, mid‐lower face‐lifting, and fine wrinkles reduction in forehead, periocular, and cheek regions, especially in younger‐aged subjects. Furthermore, it is a suitable treatment for neck rejuvenation and recontouring of lower mandibular border, particularly in older subjects with marked skin laxity. [ABSTRACT FROM AUTHOR]

Introduction: The overall effects of Carboxytherapy, defined as the administration of carbon dioxide, have been studied for many years. It has been suggested that by improving oxygenation, interacting with the tissue perfusion regulators, and disrupting the adipose cell membranes, the method can lead to notable improvements in different esthetic and pathological conditions. Therefore, we aimed to systematically review the available studies evaluating the potential benefits of carboxytherapy in dermatological conditions and how it objectively stands against scientific scrutiny. Methods: We searched the PubMed, Scopus, Embase, and Web of Science databases, including the studies exploring the method's efficacy in managing any dermatological condition. Results: A total 27 of studies were identified (with a pooled sample of over 700 cases), most of which were clinical trials. Facial wrinkles, periorbital hyperpigmentation, skin laxity deficiency, scars, striae distensae, localized lipolysis and cellulite, alopecia, chronic diabetic wounds, and psoriatic plaques comprised the package of the dermatological conditions that were studied. Except for a few studies, the method mainly demonstrated significant improvements on all of the mentioned conditions. The inter‐ and post‐operational adverse events were mild and transient, including erythema, pain, crepitus, and ecchymoses. Discussion: Carboxytherapy can provide those practicing in the field with sustainably favorable results. However, the numbers of cases on whom the fat‐reducing capabilities of the method were studied and experienced varying degrees of recurrence caught our eye. In addition, we observed a notable disparity between the outcome measures utilized in the studies. The modest sample size in each condition also added to the injury, as the conditions on which the method was evaluated are pretty common in the general population. Therefore, for a definite conclusion, more randomized controlled trials with the shortcomings mentioned well addressed need to be conducted. [ABSTRACT FROM AUTHOR]

Sucralfate is an aluminum salt of sucrose octasulfate, generally considered safe in terms of adverse effects. Systemic sucralfate is FDA‐approved for the treatment of duodenal ulcers. Since 1991, topical sucralfate has been used in various mucocutaneous conditions, but it is not approved by the FDA yet. In this systematic review, the online databases were searched with appropriate keywords, and the papers were screened by the authors. After screening steps, the relevant articles were selected according to the inclusions and exclusions criteria. Finally, the full texts of 18 articles were included for final evaluations. In conclusion, topical sucralfate has some clinical benefit in several mucocutaneous conditions, including mucocutaneous inflammatory conditions (e.g., post‐radiotherapy reaction, diaper dermatitis, keratoconjunctivitis sicca, etc.), mucocutaneous infectious disorders (e.g., peristomal wound reaction/infection); ulcers; burns, and also pain relief. [ABSTRACT FROM AUTHOR]

BACKGROUND: Numerous factors such as nutrition and diet can affect the quality of sleep of people, especially employees. The aim of this study was to investigate the relationship between university employees' sleep quality and their dietary quality scores (HEI, DII and DASH score). MATERIALS AND METHODS: This cross-sectional study was performed on 211 employees with a mean age of 38.75±11.31. Nutritional status of individuals was determined through the Food Frequency Questionnaire (FFQ) and to assess sleep quality, the Pittsburgh Sleep Quality Index (PSQI) was used. The quality of sleep decreases with increasing Pittsburgh index score. The calculated dietary quality scores include DASH Index, Healthy Nutrition Index (HEI) and Diet Inflammation Index (DII). RESULTS: The results of this study after adjusting for confounding showed a significant positive relationship between DASH diet score and sleep duration (p <0.001). There was a significant negative relationship between HEI score and total score of PSQI (P = 0.003). Also, HEI score had a significant positive relationship with sleep duration in the unmodified and modified models (p <0.001), and a significant negative relationship was seen in unadjusted and modified model between DII score and sleep duration (p <0.001). CONCLUSION: It can be concluded that with increasing the diet quality in employees, the sleep quality also increases. This was the first study in south of Iran that examined the quality of sleep and diet of employees and the result of this study can affect the general health and improve the quality of foods consumed by employees. [ABSTRACT FROM AUTHOR]

Introduction: Melasma remains a recurrent, chronic, therapeutically challenging, and psychologically burdening condition. Several different modalities and approaches have been utilized, and some with notable success to experimentally manage the condition. Cysteamines, with their depigmentation properties, have only recently been intensely studied. One such formulation is the topical 5% cysteamine hydrochloride, the structure of which is notably more stable and with a less foul odor than its prior counterparts. We, therefore, aimed to assess the efficacy of the mentioned formulation in the treatment of melasma. Methods: The PubMed, SCOPUS, ISI Web of Science, and Embase, Cochrane, and Proquest databases were thoroughly searched for English studies evaluating the effects of the topical agent mentioned. Results: Eight studies (five RCTs, two case reports, and one case series) were included after three rounds of screening, most of which were carried out in Iran. Statistical significance was noted when assessing decreased melanin content and satisfaction rates. Conclusions: It appears that the cysteamine cream could be comparably efficient in treating melasma while accompanied only by minor and transient adverse events. However, current evidence is limited by insufficient sample size, long‐term follow‐up, and only to epidermal melasma, highlighting the need for appropriately designed randomized controlled clinical trials to draw a conclusive image of the cysteamine's role in treating this recalcitrant condition. [ABSTRACT FROM AUTHOR]

Melasma is a recalcitrant pigmentary disease with a complex pathogenesis. Monotherapy often results in unsatisfactory results with high recurrence rate. In this review article, we evaluate efficacy of energy‐based devices combination therapy for melasma. We reviewed published literature since 2010 up to November 2020 regarding adjuvant therapy of energy‐based devices with other treatment modalities in the treatment of melasma. After final selection, we assessed 49 articles. Energy‐based devices include lasers, non‐coherent lights, radiofrequency, iontophoresis, sonophoresis, microneedling, and microdermabrasion. Adjuvant therapies other than energy‐based devices were lightening agents, chemical peels, platelet rich plasma (PRP) and mesotherapy. Combination of Q‐switched neodymium‐doped: yttrium, aluminum, and garnet (QSNY) with either intense pulsed light therapy (IPL) or pulsed‐dye laser (PDL) are recommended in recalcitrant melasma in patients with light skin photo types and with dilated skin vessels (especially with PDL). Combination of fractional microneedling radiofrequency or microneedling with QSNY leads to promising results and is a safe treatment modality, especially in darker skin types. Application of topical lightening agents in combination with laser therapy leads to higher efficacy with less adverse effects (post‐inflammatory hyperpigmentation) and rebound of melasma. Combination of ablative techniques with QSNY is not recommended, due to the high risk of permanent adverse effects such as guttate hypopigmentation and exacerbation of melasma. [ABSTRACT FROM AUTHOR]

Background: Epidemics of cutaneous leishmaniasis (CL) are occurring more frequently and spreading faster and farther than before in many areas of the world. The present study aimed to assess a long-lasting emerging epidemic (2005–2019) of 5532 cases with anthroponotic CL (ACL) in peri-urban areas of Kerman city in southeastern Iran. Methods: This descriptive-analytical study was carried out for 15 years in Kerman province, southeastern Iran. The data were passively obtained through the health surveillance system and the Kerman Leishmaniasis Research Center. Every subject was diagnosed using direct smear microscopy. The representative causative agent was further examined by ITS1-PCR, PCR-RFLP, 7SL RNA gene sequencing and phylogenetic analyses. For each subject, a case report form designating demographic and clinical data was recorded. Results: A different pattern of ACL incidence was found in peri-urban areas compared to that in the city of Kerman. The incidence rate of ACL cases has significantly increased (P < 0.001) from 2005 to 2016 in new settlements with a gradual decline after that. The overall average risk of contracting the disease was 7.6 times higher in peri-urban areas compared to Kerman city, an old endemic focus. All isolates consisting of six variants were confirmed to be Leishmania tropica. The overall pattern of the ACL infection indicates that the etiological agent of ACL is propagated and transmitted by the bite of female Phlebotomus sergenti sandflies from person to person from dissimilar clones as reflected by the complexity of the migrants' backgrounds in the province. Conclusions: The movement of populations and establishment of new settlements in peri-urban areas close to endemic areas are major risk factors for and are directly linked to CL. The underlying factors of this emerging ACL epidemic caused by L. tropica were disasters and droughts, among others. A robust commitment to a multilateral approach is crucial to make improvements in this area. This will require decisive coordinated actions through all governmental factions and non-governmental organizations. Furthermore, active and passive case detection strategies, early diagnosis, and effective treatment could help control the disease. [ABSTRACT FROM AUTHOR]

Over the last years, there has been a remarkable increase in the number of unresponsive patients with anthroponotic cutaneous leishmaniasis (ACL) reported worldwide. The primary objective of this study was to explore the role of demographic, clinical and environmental risk related-factors in the development of treatment failure, relapse and chronic cases compared to responsive patients with ACL. Moreover, molecular, histopathological and immunohistochemical (IHC) findings between these forms were explored. This work was undertaken as a prospective and case-control study in southeastern Iran. Culture media and nested PCR were used to identify the causative agent. Univariate multinomial and multiple multinomial logistic regression models and the backward elimination stepwise method were applied to analyze the data. A P<0.05 was defined as significant. Also, for different groups, skin punch biopsies were used to study the histopathological and immunohistochemical (IHC) profile. All samples showed that L. tropica was the only etiological agent in all unresponsive and responsive patients with ACL. Data analysis represented that 8 major risk factors including nationality, age groups, occupation, marital status, history of chronic diseases, duration of the lesion, the lesion on face and presence of domestic animals in the house were significantly associated with the induction of unresponsive forms. The histopathological and immunohistochemical findings were different from one form to another. The present findings clearly demonstrated a positive relation between ACL and distinct demographic, clinical and environmental risk determinants. Knowledge of the main risk factors for ACL infection is crucial in improving clinical and public health strategies and monitor such perplexing factors. Author summary: Negligible data are present related to anthroponotic cutaneous leishmaniasis (ACL) treatment outcome and resultant unresponsiveness risk determinants. The role of demographic, clinical, and environmental risk associated-factors in the development of treatment failure, relapse, and chronic forms of ACL has not been studied. We carried out a case-control study for a period of 4 years (2015–2019) using culture media and nested PCR to identify the causative agent. Afterward, we analyzed the data by univariate multinomial and multiple multinomial logistic regression models and the backward elimination stepwise method. Also, we examined skin punch biopsies to study the histopathological and immunohistochemical (IHC) profile for different comparative groups. The findings identified 8 major risk factors were significantly associated with the creation of unresponsive forms. Clinical practitioners and health surveillance systems should be aware of and monitor such perplexing factors. Awareness of the major determinants for unresponsiveness to the treatment of ACL is critical to improving clinical strategies and public health measures. These multidisciplinary approaches need to address specific barriers that directly affect the treatment outcome. [ABSTRACT FROM AUTHOR]

Traditional treatment modalities for wart require long‐term treatment course and usually have high recurrence rates and unwanted side effects. In this review article, we evaluated different types of laser therapy in the treatment of warts. Published articles since 2000 up to July 2020 about laser therapy in genital and non‐genital warts were searched and assessed. Fifty articles were selected for the final review, including 22 pulsed dye laser (PDL), 10 neodymium‐yttrium‐aluminum‐garnet (Nd: YAG), 3 erbium‐doped yttrium‐aluminum‐garnet (Er: YAG), 14 carbon dioxide (CO2) laser and one systematic review. Complete response rates were different in terms of laser type used (0%‐100%, 9.1%‐100%, 83.3%‐100%, and 59.15%‐100% for PDL, Nd: YAG, Er: YAG, and CO2 laser, respectively). There was no significant difference between conventional treatment modalities and laser therapy regarding efficacy and recurrence rate. Combination of lasers with keratolytic agents, immunomodulators and photodynamic therapy can be helpful especially in immunosuppressed patients, refractory, and recurrent lesions. PDL has the lowest occurrence of adverse effects relative to other types of lasers. [ABSTRACT FROM AUTHOR]

Background Adverse effects including pruritus and erythema as well as increased bacterial resistance have been reported with topical clindamycin. Niosomal structures can lead to improved drug efficacy and decreased side effects because of selective effect on target organ. In this study, we decided to evaluate efficacy of niosomal clindamycin in comparison with conventional form. Methods This study is a double-blinded clinical trial on 100 acne patients divided into 2 groups (50 patients in each group) that has been done from 2014 to 2017 in Kerman, Iran. The efficacy of niosomal clindamycin 1% in comparison with conventional form was evaluated by counting acne lesions and grading acne with Global Acne Grading System. The Chi-square test and student t test were used to determine drug efficacy and side effects. The data were analyzed using SPSS 16 (SPSS Statistics, IBM, Armonk, NY, USA). P value <0.05 was considered significant. Results There was a significant difference between 2 treatment groups in reduction of acne lesions at the end of the study (P<0.05). The mean score of acne according to Global Acne Grading System at the end of the study was 6.64± 3.26 and 8.21±3.42 in niosomal and control group, respectively and this difference was statistically significant(P=0.023). Conclusion Niosomal clindamycin has higher efficacy without increased adverse effects than conventional type. So, we can use niosomal form in treatment of inflammatory acne lesions, particularly in patients with low adherence to treatment and high expectations from treatment. [ABSTRACT FROM AUTHOR]

Background: Despite ducks being birds resistant to infection, the favorable habitat of ducks such as subtropical climate or stagnant water is also a perfect place for survival of the parasites. Methods: This study was conducted from Dec 2014 to Apr 2015 to determine the prevalence of gastrointestinal parasites of domestic ducks in Ahvaz and environs, southwest of Iran. Overall, 41 fresh fecal samples were collected and prepared using formol-ether concentration, modified Ziehl-Neelsen, sheather's floatation and zinc sulfate sedimentation methods. Light microscopic morphometry was used for identification of helminth eggs and oocysts. Results: 60.97% of ducks were infected with three different nematodes and/or four protozoan parasites. The identified nematodes were Capillaria sp., (50%) Subulura spp. (16.66%) and Echinuria spp. (33.33%). The protozoan oocystes were Cryptosporidium spp. (50%) and coccidian species (%58.33) and included Wenionella philiplevinei, Tyzerria spp. and Isospora. mandari. Mixed infection with two or more parasites was common. Twenty (80%) had single, four (16%) double and one (4%) triple infection. Conclusion: This is the first report of coccidian infection in domestic ducks of Iran. Further studies will be necessary on epidemiology and pathogenicity of the parasitic infections in ducks of this area. [ABSTRACT FROM AUTHOR]

A simple efficacious topical treatment for cutaneous leishmaniasis ( CL) is still an unresolved challenge. This study aimed to evaluate the efficacy of the topical use of thioxolone plus benzoxonium chloride ( Thio- Ben) tincture in combination with cryotherapy in comparison with intralesional meglumine antimoniate (Glucantime) along with cryotherapy in treating anthroponotic CL ( ACL). The study was conducted in Leishmaniasis Center in Dadbin Health Care Clinic, Kerman, Iran. Sixty-four CL lesions were randomly assigned to receive Thio- Ben plus cryotherapy ( TC) ( n = 32) or Glucantime plus cryotherapy ( GC) ( n = 32). Thio- Ben was used topically every other day and Glucantime was used intralesionally once a week for a maximum of 3 months. In both study groups, cryotherapy was administered using liquid nitrogen once every 2 weeks. Of 64 recruited lesions, 47 lesions completed the study protocol. Twenty lesions (91%) in TC group and 23 lesions (92%) in GC group showed complete cure. TC group showed faster clinical response. Pain, hypersensitivity reaction, dizziness, and nausea were only seen in GC group. This study showed that the topical use of Thio- Ben combined with cryotherapy has a good efficacy in treating ACL with the benefit that Thio- Ben has more patient compliance and less side effects than intralesional Glucantime. [ABSTRACT FROM AUTHOR]

Objective To determine the association between the severity of AD and serum level of 25(OH) vitamin D in Kerman, a desert area in southeast of Iran, that was performed for the first time in Iran. Methods In this cross-sectional study 57 AD subjects and 19 healthy children under the age of 18 years old were enrolled. The serum levels of 25(OH) vitamin D were measured in the both groups. The severity of AD was evaluated according to SCORAD. Results According to our study, there was a significant association between serum level of vitamin D and severity of AD especially in moderate and severe forms of AD (p<0.001). Conclusion Our study revealed vitamin D deficiency in AD patients, thus, it is recommended to take vitamin D supplementation in AD patient. Additional research is needed in order to evaluate dysfunction of vitamin D receptor in AD patients. [ABSTRACT FROM AUTHOR]