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This article discusses a case study of a 5-year-old boy with angiokeratoma, a vascular skin condition. The boy's parents refused physical treatment due to a previous history of severe bleeding during pulsed dye laser treatment. Instead, the boy was treated with topical rapamycin ointment, which resulted in significant improvement of the lesions after three months. The article suggests that topical rapamycin may be a promising option for the treatment of angiokeratoma, although further studies are needed to establish its efficacy and safety. [Extracted from the article]

Objective To evaluate efficacy of combination of intralesional triamcinolone with PDL in patients with keloid. Methods This is a cross-sectional observational study on patients with keloid referring to Afzalipour hospital during five years. Efficacy of treatment was evaluated by physician's and patients' global assessment. PDL was done in monthly interval with single pulse, no overlapping, 5-10 mm spot size, 0.5-6 ms pulse duration and fluence of 6-10 j/cm2. Intralesional triamcinolone was injected (0.1cc in each one cm2, maximum 2cc) after laser with concentration from 10-40 mg/ml. Results Eighty-two patients (range 2-65 years) with keloid were treated with mean number of 4.05±0.51 treatment sessions (range 2-10). Side effects included purpura, hyperpigmentation, blister, crust formation, persistent erythema and hypopigmentation. Patients were mainly satisfied or very satisfied (73.1%) and physician evaluation demonstrated more than 50% improvement in 70.7% of cases. There was no significant correlation between response rate with demographic features of the patients, site of the lesions or treatment protocol. Conclusion In the current study, nearly third-quarter of the patients demonstrated more than 50% improvement and were satisfied or very satisfied with treatment results. Males, younger patients and lighter skin types showed better outcome. Furthermore, more number of treatment sessions and higher fluence accompanied with better results. [ABSTRACT FROM AUTHOR]

Carboxytherapy has been used in the treatment of autoimmune skin diseases such as psoriasis and morphea. Carboxytherapy has antioxidant effects, and leads to better tissue oxygenation, and release of growth factors. In this article, we decided to evaluate efficacy of combined carboxytherapy and narrowband‐ultraviolet B (NB‐UVB) compared to NB‐UVB alone in the treatment of vitiligo. This is a prospective, split‐body double‐blind comparative study performed in patients with generalized stable vitiligo in acral areas and extremities referred to dermatology clinic of Afzalipour hospital in Kerman University of Medical Sciences. NB‐UVB was performed three times a week in non‐consecutive days for 4 months. In each patient, one lesion was randomly treated with carboxytherapy (weekly sessions for total of 16 sessions). Efficacy of treatment was evaluated by percentage of repigmentation of the lesions. Chi‐square test and analysis of variance test (ANOVA) were used to compare efficacy of treatment based on demographic features of the patients and clinical features of the lesions, respectively. Twenty‐eight patients with mean age of 32.35 ± 7.37 years old completed the study. At the end of the treatment, 37% of the patients in combination therapy group demonstrated more than 75% improvement compared to 0% in the monotherapy group (p = 0.001). There was no significant difference between either demographic features of the patients (age, sex, and skin phototypes) or duration of disease with efficacy of the treatment in both groups. Combination of carboxytherapy with NB‐UVB leads to higher percentage of repigmentation and patients' satisfaction compared to monotherapy with NB‐UVB. [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]

Purpose: Combination of benzoyl peroxide (BPO) with topical antibiotics can lead to higher efficacy and less bacterial resistance, but it in turn increases adverse effects such as skin irritability and dryness. In this study, the efficacy of combination therapy of niosomal BPO 1% and clindamycin (CL) 1% is compared with niosomal CL in acne vulgaris. Methods: This is a double-blind clinical trial study on 100 patients with acne vulgaris in Afzalipour hospital in Kerman. Patients were randomly divided into 2 groups (case and control). The case group received niosomal combination of BPO 1% and CL 1%.The control group received niosomal CL1%. The efficacy of treatment protocols was evaluated in 2nd, 4th, 8th and 12th weeks of treatment by counting lesions (severity and grading acne lesions) and quality of life (QoL). Furthermore, side effect were evaluated at each treatment visits. Results: The reduction in mean percentage of acne lesions in case group (treated with BPO 1% and CL1%) (64.21%) was higher than control group (treated with niosomal CL 1%) (59.04%), but the statistical difference was not significant. Sum of excellent and good results were found in 80% and 76.1% of case and control groups, respectively (P = 0.377). Also adding BPO to the treatment formulation in case group did not increase adverse effects, as statistical difference between 2 groups was not significant. Conclusion: Combination of niosomal BPO 1% and CL 1% in treatment of acne vulgaris showed higher efficacy with no increase in adverse effects in comparison with niosomal CL 1%, but the statistical difference was not significant. [ABSTRACT FROM AUTHOR]

Objective: To explore the antileishmanial effect of tioxolone and its niosomal form against Leishmania tropica. Methods: Tioxolone niosomes were prepared by the hydration method and were evaluated for morphology, size, release study, and encapsulation efficiency. The cytotoxicity of tioxolone and its niosomal form was measured by MTT assay, leishmanicidal activity against promastigote and amastigote by MTT assay, apoptosis by flow cytometry, IL-12, IL-10 and metacaspase gene expression levels by q-PCR. Results: Span/Tween 40 and Span/Tween 60 niosomes had good physical stability as depicted in their size distribution curves and high encapsulation efficiency (>99%). The release profile of the entrapped compounds showed Fickian's model of tioxolone delivery based on diffusion through lipid bilayers. With the IC50 value for amastigote as (24.5±2.1) μg/mL and selectivity index as 10.5, the Span/Tween 60 niosome (NT2) had a superior effect to other drugs. The CC50 value and IC50 of promastigote value for NT2 were (257.5±24.5) μg/mL and (164.8±20.6) μg/ mL, respectively. The flow cytometric analysis showed that tioxolone and niosomal forms induced apoptosis of Leishmania tropica promastigotes in a dose-dependent manner. NT2 increased the expression level of IL-12 and metacaspase genes and decreased the expression level of the IL-10 gene. Conclusions: Niosomes of tioxolone play an immunomodulatory role in increasing Th1 cytokine profile and inhibiting the Th2 cytokine profile. It could be used for treatment of anthroponotic cutaneous leishmaniasis. [ABSTRACT FROM AUTHOR]

Background: There are different treatment modalities for common warts and all of them have side effects. Niosomal drug delivery systems have increased efficacy by enhanced transport of therapeutic agents through stratum corneum with decreased side effects. In this study, we assessed the efficacy of combined 2% niosomal zinc sulfate cream plus cryotherapy compared with combination of placebo plus cryotherapy. Methods: Sixty patients with verruca vulgaris enrolled in this randomized clinical trial study. Patients were divided in 2 groups. Group A received 2% niosomal zinc sulfate cream and group B received placebo twice a day. Also, patients in both groups were treated with cryotherapy (liquid nitrogen) every other week. Treatment protocols continued for a maximum of 3 months or until total clearance of the lesions. Results: Mean number of the sessions for complete remission was 4.5±1.38 in group A and 5.36±0.88 in group B and the difference between the two groups was statistically significant. Complete remission was observed in 60% in group A compared with 43.3% in group B that was not statistically significant. Conclusion: Combination therapy with niosomal zinc plus cryotherapy can lead to faster and greater percentage clearance of the lesions without significant increase in adverse effects in comparison with cryotherapy plus placebo. [ABSTRACT FROM AUTHOR]

Acne vulgaris is one of the most common inflammatory skin diseases. Topical antibiotics and retinoids are the first-line therapy in mild to moderate acne vulgaris. Due to increased resistance of Propionibacterium acnes (P. acnes) to topical antibiotics, searching for new formulations of drug release such as niosomes is considered in order to increase efficacy and decrease drug resistance. This study compared the efficacy of niosomal erythromycin4% versus combination of erythromycin 4% and zinc acetate 1.2% in the treatment of mild to moderate acne vulgaris. In this double-blind clinical trial, 70 patients with mild to moderate acne vulgaris of both genders aged between 12 to 30 years were included. The patients were evaluated by counting of the lesions and assessment of quality of life during the 2nd, 4th, 8th and 12th weeks. At the end of the study, 40% and 66.6% of the patients in the niosomal erythromycin group showed a reduction in the number of non-inflammatory and inflammatory lesions, respectively. The percentages for erythromycin and zinc acetate group were 46.6% and 63.3%. One hundred percent of excellent response (8 out of 30 patients) was observed in the niosomal group (P=0.002). A significant improvement in the quality of life was also observed in the niosomal group (P=0.001). Side effects were much less severe in the niosomal group than in the control group. The results showed that niosomal erythromycin has higher efficacy and less severe side effects in comparison with the combination of erythromycin and zinc acetate. [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]

Background: Leishmaniasis is a parasitic infection that may lead to a variety of manifestations. In Iran, cutaneous leishmaniasis (CL) has a high prevalence. There are many treatment modalities for CL. The use of oral terbinafine in the treatment of CL has recently been considered. The aim of this study was to compare combination of oral terbinafine plus cryotherapy versus systemic meglumine antimoniate plus cryotherapy in CL. Methods: Patients with proven direct smear for CL were divided randomly in 2 groups of 40 cases. For the first group systemic glucantime prescribed (IM, 15 mg/kg/day) for 3 weeks. For the second group oral terbinafine as two folds of usual dose in the treatment of fungal diseases prescribed [125 mg/day for body weight (BW) <20 kg, 250 mg/day for BW 20-40 kg, 500 mg/day for BW>40 kg] for 4 weeks. Both groups received cryotherapy every 2 weeks for 4 weeks. The patients were followed monthly for 3 months after the treatment. Results: Partial (HR= 0.55, CI 95%= 0.3-1.1) and complete (HR= 0.53, CI 95%= 0.3-0.98) clinical improvement in terbinafine group was much slower than glucantime group, although at the end of treatment protocols no significant difference between groups were statistically observed (P=0.27). Conclusion: Considering more convenient suitable route of administration and approximately comparable results, it seems that terbinafine can be used as an alternative treatment, especially in the case of allergy or resistance to systemic glucantime. [ABSTRACT FROM AUTHOR]

Objective To study the prevalence of autoimmune thyroid disorders - thyroid auto-antibodies in patients with alopecia areata (AA) in Kerman, a city in South-East part of Iran. Methods 52 patients with AA from those attending the dermatology ward of Afzalipour hospital in Kerman were enrolled. An equal number of age- and sex-matched controls (n=52) was included. Physical examination of thyroid was done for all patients and controls. The rate of positivity of anti-thyroid peroxidase (TPO) antibodies and abnormal thyroid hormone levels in both groups were measured and compared. Results In both cases and controls, 48.1% and 51.9 % were males and females, respectively. The mean age in group of cases and control groups were 30.55 and 31.80 years, respectively. The number of lesions ranged from 1 to 10, and the duration of disease ranged from 0.6 to 96 months. No meaningful statistical difference was seen between prevalence of thyroid disorders in patients of AA and controls. Conclusion In this study no correlation between AA and thyroid disorders was noted. [ABSTRACT FROM AUTHOR]

Objective To assess the prevalence of cardiovascular disease (CVD) risk factors in patients with psoriasis. Patients and methods The study group included seventy-three patients with psoriasis aged 20-50 years and an equally sized sex and age matched control group. CVD risk factors including diabetes mellitus (DM), hypertension (HTN), dyslipidemia, obesity and smoking history were assessed. Results Most of the CVD risk factors were more prevalent in psoriasis patients versus controls. The risk factors with a positive correlation included: DM (OR: 4.96, CI: 1.165-14.89), HTN (OR:3.16, CI:1.01-9.81), hypertriglyceridemia (OR:3.91, CI: 1.51-10.09), obesity (OR: 2.74, CI: 1.34-5.60) and increased level of low density lipoprotein-cholesterol (LDL-C) (OR:1.77, CI:1.08-1.73). No significant differences were found between two groups for high density lipoprotein-cholesterol (HDL-C) and cigarette smoking. Conclusion CVD risk factors were more common in this young and middle aged psoriasis patients group, so early screening test for CVD risk factors is recommended in this group of patients. [ABSTRACT FROM AUTHOR]

Background Earlier studies on breastfeeding (BF) and atopy in infants have yielded contradictory results. Objective To evaluate the relationship between duration of BF and developing of AD. Patients and methods Seven hundred fifty infants between 2 to 3 years old from kindergartens of Kerman, Iran were enrolled in this cross-sectional study. Data were obtained by questionnaires. Diagnosis of atopic dermatitis (AD) was made according to UK Working Party criteria. Results There was a significant association between duration of BF and the risk of AD (OR=0.93, 95% CI=0.90-0.96). Early supplement feeding increased the risk of AD (OR=0.69, 95% CI=0.52-0.92). The adjusted odds ratios of variables show that a positive family history of atopy, contact with smoke during pregnancy, suffering from asthma and rhinoconjunctivitis increased the risk of AD in infants. On the other hand, having elder siblings and taking oral contraceptive pills by mother decreased the risk of AD. Conclusion Our results suggest that duration of BF has a protective effect against developing AD in infants. We recommend prolonged BF in all infants for protection against AD. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is one of the most common infantile diseases. Immunological dysfunctions in AD patients may predispose them to infections. The aim of this study was to evaluate the relationship between infantile AD and urinary tract infection (UTI). In this cross sectional study, we enrolled 57 patients with AD aged 1 to 24 months that referred to dermatology clinic, and 57 healthy controls who were referred to pediatric clinic. The groups were matched according to age and gender. Urine samples were collected by clean-voided bag method. If a single organism was cultured at concentration of ≥105 organisms per millimeter and the existence of white blood cells more than 10 per microscopic field was seen the patients underwent suprapubic aspiration. The presence of one organism in suprapubic aspiration sample was regarded as positive culture. Data were analyzed using SPSS version 15 software. P value <0.05 was considered as the level of significance. Twelve (21.1%) of AD patients and 1(1.8%) of normal controls had positive urine culture tests. The difference between two groups was statistically significant (p = 0.001). The most common bacteria was E-coli. Infants with AD showed a higher frequency of UTI in this study. So, we suggest screening all AD infants for urinary tract infection. [ABSTRACT FROM AUTHOR]

Recently, advances in understanding the etiology of urticaria and updates of diagnostic and therapeutic management guidelines have drawn attention to chronic urticaria (CU) morbidity. The present study aimed to evaluate Iranian dermatologists' practice and real life management of CU patients. A total of 35 dermatologists and 443 patients were included in the study. Number of female patients was 321 (72.5%). Mean (standard deviation) age of the study patients was 38 (13) years and the median (inter quartile range) of disease duration was 12 (6–48) months. Severity of patients' symptoms was mild for 32.1%, moderate for 38.7%, severe for 18.8%, and 10.4% of them had no evident signs or symptoms. The most common diagnostic methods were physical examination (96.6%), differential blood count (83.5%), erythrocyte sedimentation rate (77.4%), and C‐reactive protein (62.8%). The number of dermatologists prescribed nonsedating antihistamines (nsAH) in regular dose and high dose mono therapy were 26 (74%) and 6 (17%), respectively. About 66% of dermatologists were familiar with British Association of Dermatologists (BAD) guideline. The most common first‐line treatment for CU by Iranian dermatologists was nonsedating antihistamines in regular or high doses. The real‐life management of patients with CU in Iran was in accordance with the available practice guidelines. [ABSTRACT FROM AUTHOR]

Background: Childhood vitiligo differs from adult vitiligo in many aspects. To the best of the authors' knowledge, there is no systematic review of different clinicoepidemiological patterns of vitiligo in children. This study aimed to review the characteristics of vitiligo among the paediatric population., Methods: In June 2022, a comprehensive search was conducted using MeSh-based keywords on online databases including PubMed, Scopus and Web of Sciences. The papers were assessed, and the eligible articles were selected. The selection of articles followed three distinct steps. The extracted clinicoepidemiological data were then imported into the STATA software for meta-analysis., Results: The meta-analysis of 17 studies with 4365 subjects yielded 2475 women (estimated=56.8%, 95% CI 54.45 to 59.22). The female-to-male ratio was determined to be 1.3:1. Meta-regression demonstrated a significant relationship between continents and gender (p=0.03). The most prevalent types of non-segmental vitiligo were vulgaris (42.49%), focal (27.21%) and acrofacial (17.8%). The pooled ratio of non-segmental to segmental was 4.6:1. The highest and lowest ratios were found in Africa with one study (estimated=11.56%, 95% CI -0.98 to 24.10) and America with two studies (estimated=3.02%, 95% CI 1.54 to 4.50), respectively. Using meta-regression, the relationship between continents and vitiligo type was found to be insignificant (p=0.47). Positive family history was recorded in 657 patients (estimated = 16.88%, 95% CI 13.37 to 20.39). Positive family history varied by country of study from 13.91% (Asia with 11 studies) to 27.01% (Europe with two studies) (p=0.11). Kobner phenomena and leukotrichia were noted in 687 (25.47%) and 461 (18.52%) patients, respectively., Conclusion: The review indicated that childhood vitiligo is more prevalent in women. Non-segmental forms of childhood vitiligo were the most common, including vulgaris, focal and acrofacial. The clinicoepidemiological pattern of childhood vitiligo is variable in different geographic areas., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)