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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: 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]

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]

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]

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]

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]

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: Topical zinc sulfate application has lower efficacy in comparison with intralesional usage, due to less penetration of ionic drug within the epidermis. Niosomes introduce new method of drug delivery with improved penetration and sustained release of medicaments within epidermis. On the other hand, combined cryotherapy with topical immunomodulators can increase the efficacy of cryotherapy with less recurrence rate. In this study, we compared the efficacy of 2% niosomal zinc sulfate suspension with cryotherapy versus combined conventional 2% zinc sulfate and cryotherapy in the treatment of Verruca vulgaris. Methods: This is a triple-blind randomized clinical trial on 60 patients. Patients were randomized in 2 groups including combined 2% niosomal zinc sulfate suspension with cryotherapy versus combined 2% conventional zinc sulfate suspension combined with cryotherapy. The efficacy of treatment was evaluated during the treatment sessions until 12 weeks. Patients were followed for 3 months after the end of the treatment to evaluate recurrence rate. We used chi-square test to evaluate the efficacy of treatment and side effects. Mean number of treatment sessions was evaluated by t-test. Results: Mean number of the treatment sessions for complete remission was 3.66±0.92 and 4.63±0.66, in niosomal group and conventional group, respectively (P=0.001). The rate of complete remission was higher at the 6th and 8th weeks of the treatment in niosomal group compared to conventional group (P=0.001). Conclusion: This study demonstrated significant rapid remission of wart lesions treated with cryotherapy plus 2% niosomal zinc oxide suspension in comparison with cryotherapy plus 2% conventional zinc oxide suspension. [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: 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]