Intense Pulsed Light and Red Light Photo Rejuvenation for Skin Rejuvenation: A Split Face Clinical Trial

INTRODUCTION: Intense pulsed light (IPL) has long been used for skin rejuvenation. Photo rejuvenation with red light (with or without photo sensitizer) is a newer noninvasive way for this purpose; but, until now few comparative studies between these modalities have been performed. The aim of this study was to compare efficacy, adverse effects, and compliance of intense pulsed light rejuvenation and red light photo rejuvenation in a homogeneous group of women.METHODS: In this clinical trial, ten female volunteers with Fitzpatrick skin types I, II, and III were enrolled. Patients underwent 6 sessions of IPL rejuvenation at 4-week intervals on one side, and 30 photo rejuvenation sessions (twice a week) with red light on the other side of their face. Improvement of the skin texture and reduction in the wrinkles were determined in two ways. Firstly, by comparing the photographs, and secondly, by measuring the skin elasticity with Reviscometer MPA 9 system, before and after the procedure.RESULTS: Both treatments were associated with improvement in the skin texture and wrinkle depth, but red light was more effective on the nasolabial fold and IPL was more effective on the fine wrinkles.CONCLUSIONS: Red light photo rejuvenation without the use of photosensitizer can be a new, effective and safe procedure for rejuvenatio

Therapeutic and preventive potential of probiotics against COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), was first detected in Wuhan, China and has since spread across continents. Although the globe grapples with the COVID-19 pandemic, neither a vaccine nor a drug has been proven to be effective for prevention and treatment of the disease. With millions of individuals are at high risk of contracting the disease, there is undoubtedly a need for finding a solution to control the spread of SARS-CoV-2 (1). Probiotics are living microorganisms, which exert health-beneficial attributes when consumed in sufficient amounts (2). Based on mechanism of immune regulation, probiotics can be categorized into two distinct groups, namely immunostimulatory and immunoregulatory probiotics. The former induces production of Interleukin-12 (IL-12), which stimulates interferon gamma (IFN-γ) in natural killer cells and promotes the development of T helper 1 (Th1) responses, whereas the latter is able to suppress pro-inflammatory responses through induction of IL-10 production and activation of regulatory T cells (Tregs) (3). Some probiotics can also enhance production of secretory Immunoglobulin A (sIgA) in lung tissues (4). Furthermore, probiotics are capable of interacting with intruding pathogens in several ways. For instance, they can bind to viral particles or saturate their host receptors, resulting in blockade of viral attachment (4). The genera Lactobacillus and Bifidobacterium are among the most frequently used probiotics in the management of various gastrointestinal disorders. For example, supernatants of Lactobacillus plantarum Probio-38 and Lactobacillus salivarius Probio-37 have been observed to impede in vitro infectivity of transmissible gastroenteritis virus (5), a coronavirus infecting enteric and respiratory tissues of newborn piglets with a mortality rate of almost 100%. This finding suggests that probiotics can ameliorate the severity of gastrointestinal symptoms caused by coronaviruses. Accumulating evidence also abounds on the prophylaxis and therapeutic effects of probiotics against respiratory tract viral infections (RTVIs). In this respect, pre-treatment of human laryngeal epithelial cell line HEp-2 and mouse lung epithelial cell line MLE12 with Lactobacillus gasseri SBT2055 (LG2055) suspension significantly protected the cells from respiratory syncytial virus (RSV) infection (6). In BALB/cCrSlc mice, daily oral administration of LG2055 for 21 days resulted in a perceptible decrement of RSV titers and pro-inflammatory cytokine production as well as up-regulating gene expression of type I and type II interferon in lung tissues (6). Figure 1: Possible anti-viral properties of probiotics against SARS-CoV-2 infection   In a randomized, double-blind, placebo-controlled trial, preterm infants receiving oral probiotics (Lactobacillus rhamnosus GG, ATCC 53103) exhibited a substantially lower incidence of RTVIs compared to those receiving placebo (7). One study showed that oral administration of L. rhamnosus GG is useful for achieving a reduction of antibiotics prescribed for hospitalized patients with ventilator-associated pneumonia (VAP) (2). In consistent with these findings, another randomized controlled multicenter trial demonstrated that consumption of Bacillus subtilis and Enterococcus faecalis prevents VAP as well as gastric colonization of potentially pathogenic microorganisms in critically ill patients (8). A pilot study demonstrated that nasal spray administration of Streptococcus salivarius 24SMBc for 3 days was well tolerated by all 20 healthy adult volunteers, of whom 95% were colonized by the probiotic in rhinopharynx tissues at least in the first 4 h after administration (9). According to these results, colonization of upper respiratory tract with probiotics may confer protection from viruses causing pulmonary infections, in particular rhinovirus, coronavirus, influenza virus, and RSV. Based on above-mentioned studies, we hypothesize that oral administration or even inhalation of aerosolized probiotics employing various formulations (in the form of live or heat-inactivated microorganisms) not only acts as prophylaxis, but also has the potential for adjunct therapy against SARS-CoV-2 infection. Possible beneficial roles of probiotics in COVID-19 therapy are depicted in Fig. 1. Nevertheless, clinical trials are needed to evaluate anti-viral effects of specific probiotic strains for treatment of SARS-CoV-2 infection. &nbsp

Successful Treatment of Unilateral Klippel-Trenaunay Syndrome With Pulsed-Dye Laser in a 2-Week Old Infant

Introduction: Klippel–Trenaunay syndrome (KTS) is a rare congenital mesodermal abnormality characterized by varicose veins, cutaneous capillary malformation, as well as bone and soft tissue hypertrophy.Case Report: A 2-week-old female infant presented to our clinic because of vascular nevus and progressive enlargement of her right extremities and trunk since birth. The patient was treated with 595-nm pulsed-dye laser (PDL). Her port-wine stain (PWS) disappeared completely after third PDL session and the soft tissue hypertrophy stopped. The patient experienced neither recurrence nor any change in size after 7 years of follow up.Conclusion: PDL can treat KTS completely with no reccurence if it is used in “early stage” of disease

Therapeutic Potentiality of Coenzyme Q10 for COVID-19

As coronavirus disease 2019 (COVID-19) death toll continues to surge around the globe, researchers are trying to reposition already-approved drugs for battling against sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Diet and nutritional status have long been acknowledged to be associated with certain diseases. Coenzyme Q10 (CoQ10), also known as ubiquinone, is a fat-soluble, vitamin-like substance which plays a pivotal role in mitochondrial bioenergy transfer. Furthermore, it is an anti-oxidant with superb free radical-scavenging activities (1). Emerging evidence also hints that CoQ10 possesses immunomodulatory and anti-inflammatory properties. Regarding the latter, CoQ10 has been observed to inhibit expression of nuclear factor-κB, interleukin-6 (IL-6), and tumour necrosis factor-α (2). In light of the foregoing, CoQ10 has been assessed in numerous studies for its potential in treating various health conditions and maladies such as neurodegenerative disorders, cardiovascular diseases, cancers, periodontitis, diabetes, renal failure, and acquired immunodeficiency syndrome, to cite just a few (1). There have been some attempts to assess potential associations between CoQ10 levels and symptom severity in patients who suffered from pulmonary infections (2-4). In a clinical trial, elderly hospitalized patients with community-acquired pneumonia who received oral CoQ10 (200 mg/d) as an adjunct to ceftriaxone plus azithromycin for 14 days exhibited improvement with defervescence and shorter length of hospital stay as compared to the placebo group (2). Likewise, another study revealed a significant correlation between serum levels of CoQ10 and chest radiographic findings of children with pneumonia caused by H1N1 influenza (3). The same authors also demonstrated that CoQ10 levels were remarkably lower in a pediatric population infected with H1N1 influenza in comparison to both controls and seasonal influenza patients (3). This finding was further substantiated by another investigation in which patients with acute influenza showed significantly lower levels of serum CoQ10 in comparison to healthy controls (P = 0.004), suggesting that diminished levels of CoQ10 may predispose individuals for acquiring viral respiratory diseases (4). Serum levels of CoQ10 in influenza patients were also inversely correlated with certain inflammatory markers (4). Interestingly, one study has reported the beneficial effects of CoQ10 supplementation (100 mg/d for 4 weeks) in asthma patients, which was evident by a significant enhancement in forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio (5). Furthermore, different nanosuspensions of CoQ10 for nebulization have been recently developed for pulmonary disorders (6), providing more effective drug medication delivery. A recent study on rats revealed that CoQ10 protects sepsis-induced acute lung injury (7). Of note, the levels of high-mobility group box 1, IL-6, macrophage inflammatory protein 2, and keratinocyte chemoattractant were significantly diminished in CoQ10 group compared with the untreated controls (P < 0.05). Similarly, administration of CoQ10 was shown to ameliorate lung and liver fibrosis in rats through modulation of autophagy in methotrexate treated rats (8). Patients suffered from COVID-19 have augmented levels of pro-inflammatory cytokines, increased risk of pneumonia, and acute respiratory distress syndrome. Owing to obvious anti-inflammatory and immunomodulatory properties of CoQ10, we envisage that the nutrient has the potential for adjuvant therapy against SARS-CoV-2 infection. On the other hand, there will be remarkable fibrotic consequences following the infection in some patients (9). Anti-fibrotic properties of CoQ10 may have a preventive role against pulmonary fibrosis secondary to COVID-19. Future clinical trials should scrutinize the therapeutic benefits of CoQ10 (in an inhaled form or oral administration) in critically ill patients. &nbsp

Quercetin A potential treatment for keloids

Letter to the Edito

Does Pimecrolimus Cream Enhance the Effect of Excimer Laser on Eyelid Vitiligo?

INTRODUCTION: Vitiligo is a cutaneous disorder of pigmentation, for which, there are some proven modalities of treatment. In this study, we evaluated the efficacy of the addition of topical pimecrolimus to 308nm Excimer laser in reducing treatment duration and improving the response rate of eyelid vitiligo, compared with 308nm Excimer laser monotherapy.METHODS: Fifty two symmetrically localized lesions of eyelid vitiligo in 26 patients were observed. Each of vitiliginous patches was treated with 308nm Excimer laser twice a week for a total of 30 sessions. Topical pimecrolimus 1% cream was applied to the patches of right eyelid(group A lesions) and eucerine cream as a placebo to the left side patches(group B lesions)twice daily, throughout the study. Photographs were taken at baseline, 6 and 15 weeks after starting the treatment.RESULTS: Twenty two patients (44 lesions) completed the study. Repigmentation was appeared in all (100%) of groups A and B lesions. A 75% or more repigmentation was achieved in 17(78%) of group A versus 14 (64%) of group B lesions. The average number of sessions needed for the appearance of repigmentation was 8 for group A lesions and 12 for group. The repigmentaion of 50% or more in patients with disease duration of 2 years or less and those with more than 2 years duration ere 100% and 59.2%, respectively.CONCLUSION: Repigmentation rate obtained by the combination therapy of eyelid vitiligo with 308nm Excimer laser and topical Pimecrolimus 1%cream is significantly higher, and obtained in fewer sessions in comparison with 308nm Excimer laser and placebo combination therapy.

Focused Ultrasound Lipolysis in the Treatment of Abdominal Cellulite: An Open-Label Study

 Introduction: Despite a growing popularity of noninvasive ultrasonic lipolysis procedure, there is a lack of evidence about the efficacy of this method. This study was performed to evaluate the efficacy of focused ultrasonic lipolysis on abdominal cellulite treatment.Methods: Twenty-eight consecutive subjects (age: 37.8 ± 8 years) underwent weekly transdermal focused ultrasonic lipolysis (Med Contour, General Project Ltd., Florence, Italy) and vacuum drainage for a maximum of eight sessions. Largest abdominal girth and 2 lines at 4 cm to 7 cm distance above and under it were located as fixed points of measurements. The mean value of the three fixed lines was considered as the abdominal circumference. Subjects were evaluated using measurements of circumference, immediately after and 3 weeks after the final treatment and compared using paired t test.Results: One hundred ninety-four ultrasonic lipolysis procedures were performed on 28 subjects. A statistically significant (P < .001) average of 1.89 cm (95% CI: 1.63-2.02 cm) decrease of circumference value was observed in each session of ultrasonic lipolysis. The mean pretreatment to posttreatment circumference reduction was 8.21 cm (95% CI: 6.38-10.04, P < .001) that declined to 7 cm (95% CI: 3.2-10.8, P < .001) at the 3-month follow-up visit. Conclusion: Focused ultrasonic lipolysis appears to be an effective method for reduction of abdominal cellulite, although some amount of circumference reduction reversal may be observed in long term follow-up visit

Nonablative Fractional Laser Resurfacing

The desire to achieve cosmetic rejuvenation and reduce effects of aging and photodamage urged scientists to develop effectual techniques which have minimal side effects and impressive long-term efficacy. Traditional ablative resurfacing laser therapy has been used for several years;however, it has harmful side effects on the patient’s skin such as dyspigmentation, persistent erythema, infections, acneiform eruptions and scarring. It also prolongs downtime, so it puts a significant burden on society. Nonablative resurfacing laser therapy declines side effects of traditional therapies, although it has lower effectiveness in comparison with ablative one.Nonablative fractional resurfacing laser therapy commenced a modern technique which diminished side effects, while maintains the efficacy of traditional methods. The aim of of this current review is to sum up nonablative fractional laser therapies used for skin photorejuvenation at the past and present time and to evaluate the indications,advantages and classification of it and non-fractional resurfacing laser therap

Development of leukocytoclastic vasculitis during long-term methotrexate therapy in patients with rheumatoid arthritis: description of two clinical cases

Leukocytoclastic vasculitis (LCV) is a small vessel vasculitis characterized by immune complex depositions involving dermal post-capillary venules. Cutaneous small vessel vasculitis is most often idiopathic but may be aggravated by secondary causes, such as inflammatory conditions, infections, neoplasms, and drugs exposure.Herein, we describe two patients with a long history of rheumatoid arthritis (RA) treated with methotrexate (MTX) for more than ten years, who later developed generalized LCV with pancytopenia after a viral infection, one with herpes simplex virus, and the other with SARS-CoV-2 virus. Because of the worldwide use of MTX in treatment of RA, strict follow-up and preventive measures are needed nowadays, especially during COVID-19 pandemic, in order to avoid any infection which may provoke LCV with or without systemic manifestations. So, using MTX for treating RA or other similar disorders may be considered a double-edged sword, especially during COVID-19 pandemic.

Laser Irradiation on Growth of Trichophyton Rubrum: An in Vitro Study

Introduction: Trichophyton rubrum is one of the most common species of dermatophytes which affects superficial keratinous tissue. It is not especially virulent but it can be responsible for considerable morbidity. Although there are different therapeutic modalities to treat fungal infections, clinicians are searching for alternative treatment because of the various side effects of the present therapeutic methods. As a new procedure, Laser therapy has brought on many advantages in clinical management of dermatophytes. Possible inhibitory potential of laser irradiation on fungal colonies was investigated invitro in this study.Methods: A total of 240 fungal plates of standard size of trichophyton rubrum colonies that had been cultured from the lesions of different patients  at the mycology laboratory, were selected. Each fungal plate was assigned as control or experimental group. Experimental plates were irradiated by a laser system (low power laser or different wavelength of high power laser). The effects of different laser wavelengths and energies on isolated colonies were assessed. After laser irradiation, final size of colonies was measured on the first, the 7th and the 14th day after laser irradiation.Results: Although low power laser irradiation did not have any inhibitory effect on fungal growth, the Q-Switched Neodymium-Doped Yttrium Aluminium Garnet (Nd:YAG) laser 532nm at 8j/cm2, Q-Switched Nd:YAG laser 1064nm at 4j/cm2 to 8j/cm2 and Pulsed dye laser 595nm at 8j/cm2 to 14j/cm2 significantly inhibited growth of trichophyton rubrum in vitro.Conclusion: Q-Switched Nd:YAG 532nm at 8j/cm2, Q-Switched Nd:YAG laser 1064nm at 4j/cm2 to 8j/cm2 and pulsed dye laser (PDL) 595nm at 8j/cm2 to 14j/cm2 can be effective to suppress trichophyton rubrum growth