Comparison of the efficacy of topical minoxidil 5% and adenosine 0.75% solutions on male androgenetic alopecia and measuring the patients\u27 satisfactory rate

Objective: According to the hypothesis regarding the stimulating effect of adenosine on increasing fibroblast growth factor-7 in dermal papilla cells and its vasorelaxant effect, we performed this study to compare the effect of topical minoxidil 5% and adenosine 0.75% on male pattern androgenic alopecia. Methods and materials: This prospective-randomized study recruited 110 male patients, who suffered from grade II-V Hamilton androgenic alopecia. Fifty-five patients received minoxidil 5% (group-1) and others received adenosine 0.75% (group-2). Later, 16 patients excluded due to allergic reactions or loss to follow-up. After 3 and 6 months of treatment, complete and relative recovery rates alongside patients\u27 satisfactory rate (faster prevention of primary hair loss and appearance of newly grown hair) were compared between groups. Results: After 3 months of treatment, relative recovery was achieved in 2.4% and 1.9% of patients in group-1 and group-2, which was not significantly different (p-value= 0.17). During 6 months, relative recovery rate did not change nighter within nor between the groups (p-value =0.99) and after 6 months none of the patients achieved complete recovery. However, the patients\u27 satisfactory rate was significantly higher in the group-2 (p-value =0.003). Conclusion: In light of the results, adenosine has no statistically superiority to minoxidil on treatment of androgenic alopecia according to the recovery rates. However, the patients were significantly more satisfied with the adenosine because of the faster prevention of hair loss and appearance of the newly grown hairs. It seems further studies with larger sample size or different drug dosages are required to clarify the findings. </span

1 Side Effects of Herbal Drugs Used in Dermatologic Disorders

Because of the awareness of the environmental damage caused by industrialization, a trend has developed to use products with natural ingredients. Herbal products have been used for the treatment of disease, most commonly in the last century. As herbal supplements become more popular, several adverse side effects have been reported in users who also take other medications. In dermatology, many botanic products are used especially with regard to cosmetic benefits of natural topical products on skin aging process, so dermatologists should face with higher side effects of these types of drugs. The most common presentation of topical aromatherapy side effects are contact dermatitis and the second in order will be contact urticaria reactions

Comparison the effectiveness of pyruvic acid 50% and salicylic acid 30% in the treatment of acne

Background: Acne vulgaris is a chronic inflammatory disease of the pilosebaceous follicles and one of the most common skin diseases. The peeling method has been recently found to be effective for acne treatment. This study aimed to compare the efficacy of pyruvic acid 50% and salicylic acid 30% peeling in the treatment of mild to moderate acne. Materials and Methods: In a prospective single-blinded clinical trial, 86 patients with acne were randomly assigned into two groups. In both groups, the routine treatment of acne (topical solution of erythromycin 4%, triclorocarban soap, and sunscreen) were used twice a day for 8 weeks. In addition, salicylic acid 30% for the control group and pyruvic acid 50% for the case group were used. In both groups, acne severity index (ASI) was calculated before and at week 2, 4, 6, and 8 of the treatment. Patient satisfaction was assessed at the end of the treatment. Side effects were recorded using a checklist. Results: In both groups, the reduction in the number of comedones, papules, and ASI were statistically significant (P < 0.001) in the course of treatment. However, it was not significant regarding the number of pustules (P = 0.09). None of the number of comedone, papules, pustules, and ASI was statistically different between study groups. Both treatment groups had similar side effects except for scaling in the fifth session, which was significantly lower in salicylic acid - treated patients (P = 0.015). Conclusion: Both pyruvic acid 50% and salicylic acid 30% are effective in the improvement of mild to moderate acne with no significant difference in efficacy and side effects

Solution of Azelaic Acid (20%), Resorcinol (10%) and Phytic Acid (6%) Versus Glycolic Acid (50%) Peeling Agent in the Treatment of Female Patients with Facial Melasma

Background: Melasma, a common acquired disorder of hyperpigmentation, especially in women, is often resistant to therapy. This study was aimed to evaluate the efficacy and safety of azelaic acid, resorcinol and phytic acid solution in chemical peeling of melasma in comparison to 50% glycolic acid. Materials and Methods: This clinical trial was performed, on 42 female patients with bilateral melasma. Severity of melasma was assessed by melasma area and severity index (MASI). Combination of (20% azelaic acid + 10% resorcinol + 6% phytic acid) was used as a new peeling agent on the right side of the face and 50% glycolic acid on the left side every 2 weeks for 6 times. Follow-up was carried out for 3 months after the last session. Any decrease in MASI score and unwanted complications following peeling were evaluated and compared during the trial. Results: Patients showed marked improvement as calculated with MASI score before and after treatment in both sides of the face. The efficacy of combination formula (azelaic acid, resorcinol and phytic acid) was similar to glycolic acid, but with fewer complications. There was no statistically difference in improvement between two groups (P > 0.05). However, the patient's discomfort following procedures was significantly lower with azelaic acid, resorcinol and phytic compared with the glycolic acid peels (P < 0.05) and there was the same duration in the beginning of the therapeutic response in both groups. Conclusion: Results showed that triple-combination was found to be an effective and safe peeling agent in the treatment of melasma and it was as effective as 50% glycolic acid peel

Fractional erbium:YAG laser (2940 nm) plus topical hydroquinone compared to intradermal tranexamic acid plus topical hydroquinone for the treatment of refractory melasma: a randomized controlled trial

Objectives Melasma is a chronic acquired condition characterized by grayish-brown macules and patches with a distinct border on the face. Although various treatments methods have been suggested for treating melasma, none has been completely successful. The aim of the study was to compare the efficiency of erbium: yttrium–aluminum–garnet (Er:YAG) laser and 4% hydroquinone (HQ) with the effects of intradermal tranexamic acid (TA) and 4% HQ for the treatment of refractory melasma. Methods The study included 31 female patients with refractory melasma. The left or right side of the patient’s face was chosen randomly to receive laser therapy with topical HQ on the one side (i.e. the laser side) and intradermal injection of TA plus topical HQ on the other side (i.e. the mesotherapy side). Digital photography was performed at baseline, at the end of the treatment, and three months after the treatment as follow-up. Two independent dermatologists evaluated the modified Melasma Area and Severity Index (mMASI) score according to the pictures. Overall, 27 patients completed the study and went through the clinical evaluation. Results Treatment using HQ in combination with either Er:YAG laser therapy or intradermal injection of TA significantly improved the hemi-mMASI and resulted in higher patient satisfaction. While the improvement was not significantly different between the two regiments after the treatment and upon follow up and both were equally efficient in the treatment of refractory melasma (p = 1.308), recurrence rate was higher after treatment with Er:YAG laser than TA (12% vs 34%). Conclusion This study confirmed the comparable efficacy of TA plus topical HQ versus Er:YAG laser plus topical HQ for the treatment of refractory melasma. Both groups improved significantly and no subject left the treatment because of adverse effects. Trial registration number IRCT20191011045057N

The efficacy of 5% dapsone gel plus oral isotretinoin versus oral isotretinoin alone in acne vulgaris: A randomized double-blind study

Background: Acne vulgaris, a common human skin condition, is an inflammatory disease characterized by comedones, papules, nodules and possibly scarring. This study aimed to evaluate the efficacy of a combination of 5% dapsone gel plus oral isotretinoin in the treatment of acne vulgaris. Materials and Methods: A randomized, placebo-controlled, study was carried out on patients with moderate to severe acne. The patients were randomly divided in two groups: (dapsone gel and vehicle gel). All Patients were administered oral isotretinoin 20 mg daily and topical gel twice a day for 8 weeks. The Global Acne Assessment Score (GAAS), the number lesions and side-effects were documented at base line and weeks 4, 8 and 12. Results: A total of 58 patients (age range: 18-25 years) were included in our study. The number of lesions was significantly lower in the dapsone-treated group at all follow-up visits (P < 0.001). The mean GAAS score in the dapsone-treated group and in the Placebo-treated group decreased, but there was no statistical difference in two groups (P < 0.001). The side-effects on the dapsone-treated group were a mild burning sensation in 7 patients (24.13%), mild erythema of the skin and mild dryness in 4 (13.79%) and 3 (10.34%) cases respectively (P < 0.001). In our study, adverse effects were common but they were minor and tolerable. No clinically significant changes in laboratory parameters were observed (P < 0.001). Conclusions: Dapsone gel was an effective medication for patients who received isotretinoin for acne vulgaris treatment resulting in a significant reduction of the number of lesions

The evaluaton of prevalence rate of p53 antigen expression in cutaneous malignant melanoma and it&#x2032;s relation to tumor thickness

P53 tumor suppressor gene mutation is one of the most common genetic alteration in human malignancies. This study was done to determine the prevalence of the P53 antigen expression by sex, age, type of melanoma, thickness of the lesion and site of the antigen expression either cytoplasmic or nuclear. Paraffin embeded block of 50 patients (45 primary and metastatic)with documented diagnosis of melanoma deparaffinized and immuno stained with DO-7 monoclonal antibody. The lesions were divided depending on the degree of the staining as follow: 1. no staining, 2. mild (less than 10&#x0025;), 3. moderate (10&#x0025;-50&#x0025; staining), 4. severe (more than 50&#x0025;). Fifty four percent of evaluated patients were female and 46&#x0025; were male. Forty percent of lesions were graded as no staining, 36&#x0025; of lesions showed mild staining, 14&#x0025; moderate and 10&#x0025; severe staining site of expression was excusively in the cytoplasm. There was no meaningful statistical deference between severity of staining and the age group, sex, type and thickness of melanoma. (p value was 0.532, 0.488, 0.626, 0.954 respectively)

A comparative study on the usefulness of fractional CO2 and fractional Er:YAG in acne scars: A split-face trial

Background: Acne is a dermatologic condition with a high burden in terms of psychosocial consequences as a result of scars remaining on the skin. Its effects are severe in adolescence and finding treatments with short therapy courses, superior results, and fewer adverse effects are of high importance. Materials and Methods: We included 30 individuals with acne vulgaris scars in Al-Zahra academic training hospital from June 2018 to Jan 2019. Each individual received both fractional CO2 and fractional Er:YAG lasers on right and left sides of the face, respectively. Three sessions of laser treatment were applied to each side with one-month intervals. Results were evaluated by patients according to subjective satisfaction and physicians' assessment and photo evaluation by two blinded dermatologists. Improvement was graded by a quartile grading scale: less than 25%: mild, 25% to 50%: moderate, 51% to 75%: good, and 76% to 100%: excellent response. Assessments were obtained at baseline and one month after the last visit. Results: Based on subjective satisfaction (p < 0.05) and physicians' assessment (p < 0.01), fractional CO2 laser was significantly more effective than Erbium:YAG laser. Also, Post-treatment side effects were mild and transient in both groups. Conclusion: Laser therapies are common in the treatment of scars and each modality has special advantages and disadvantages. Choosing among them should be based on various criteria. Fractional CO2 lasers have been revealed favorable results in most reports. Large comprehensive trials could help experts in choosing among alternatives for different subgroups

Mortality and cause of death in patients with dermatologic diseases: An 11-year record-based observational study

Background: Information on the cause of death is critical in guiding decisions on health infrastructure. However, there is a relative paucity of mortality data in patients with dermatologic diseases. Objectives: We aim to assess the overall mortality from dermatological disorders in a third-level university hospital which serves as a dermatology referral center. Methods: A retrospective medical note review of patients with dermatologic diseases who died during an 11-year period (from March 2008 to February 2020) was undertaken. Results: There were 63 death cases out of 2810 admissions for patients with dermatologic diseases (crude mortality 2.24%). The average age was 61.8 years and the male-to-female ratio was 2.3. Cutaneous malignancies (53.96%) were the primary causes of death, followed by drug reactions (23.8%). Among skin cancers, squamous cell carcinoma (SCC; 47.05%) and melanoma (35.29%) were the leading causes of death. Toxic epidermal necrolysis (53.33%) was the leading cause of death among drug reactions. Sepsis (30.74%) was the most common immediate cause of mortality in this series. A large fraction of patients (73%) had significant underlying comorbidities. Conclusion: The principal cause of mortality was cutaneous malignancies (mainly SCC and melanoma) followed by drug reactions. Sepsis was the most common immediate cause of death