Evaluation of Efficacy of Intense Pulsed Light (IPL) System in the Treatment of Facial Acne Vulgaris:Comparision of Different Pulse Durations; A Pilot Study

INTRODUCTION: Adequate control of acne is difficult, regardless of the various conventional modalities. Intense Pulsed Light (IPL) system is one of the emerging options that are become increasingly useful.METHODS: To achieve the best IPL parameters we evaluated the efficacy and tolerability of IPL at 752-nm wavelength, 35 j/cm2 fluence, 55-ms pulse duration in comparison with 572-nm wavelength, 35 j/cm2 fluence, 101-ms pulse duration, in a 5 week, controlled, double-blind, split-face clinical trial. Final assessment was made by comparison of the changes in inflammatory and non-inflammatory acne lesions count and the Acne Global Severity Scale (AGSS) between two groups, based on standardized photography.RESULT: Fifteen female patients, with mean age of 23.53±2.47 years (range 20-28) completed the 5-week therapy period. For both therapies, significant reductions (approximately 30%) in the comedone and inflammatory lesions count were observed (p=0.0024). There was no significant difference in the efficacy of the two treatments in reducing the percentage of comedone and inflammatory lesions count from baseline to 5th week (p=0.76 and p=0.61, respectively). Based on acne global severity scale (AGSS), no significant difference in the severity of acne lesions of the two treatments was observed at 5th-week visit (p=0.26).CONCLUSION: Considering the lack of significant difference between the two treatments and since greater risks are associated with lower pulse duration, the use of longer pulse durations is recommended, especially in darker skin phenotype. Further studies with larger number of patients are required to fully comparison of efficacy of these parameters in IPL systems for acne vulgaris

The effect of low level laser therapy on Pemphigus vulgaris lesions: A Pilot Study

Background: Pemphigus vulgaris is a chronic blistering skin disease. Management of recalcitrant pemphigus ulcers is a great problem. Low Level Laser Therapy (LLLT) is known to supply direct biostimulative light energy to body cells. Objective: This study evaluates the efficacy of low power laser in the healing of pemphigus lesions.Methods: Ten patients with pemphigus vulgaris were enrolled in the trial. The LED-LLLT system used was the Thor LED clusters (109, 69 or 19 diode) (ENGLAND) with 660 nm wave length in continuous wave (CW) and 30 MW energy. Both sides of the patients’ lesion were photographed prior to the study and in each laser therapy sessions.Results: The pattern of changes in QWS patterns differed significantly over time between the two therapies (treatment × time interactions, p<.0001). When compared to the routine therapy, the laser therapy showed more decreases in mean QWS in all sessions in comparison with baseline.Limitations: This is a pilot study.Conclusion: Application of Low Level Laser simultaneously with conventional therapy could result in sensational healing of ulcers especially in patients who do not respond to conventional treatment or suffering from recalcitrant lesions

How to test normality distribution for a variable: a real example and a simulation study

Many commonly used statistical methods require that the population distribution be nearly normal. Unfortunately, in some papers the one-sample Kolmogorov-Smirnov test has been used for testing normality while the assumptions of applying this test are not satisfied. To conduct this test, it is assumed that the population distribution is fully specified. In practical situation where the mean and SD of population distribution is not specified in advance, one can use a modification of the K-S test for checking the normality assumption which is called, Lilliefors test. In this paper, we explain the method of computing this test with some common statistical softwares such as SPSS, S-PLUS, R and StatXact and utilize a dermatology dataset from Skin Research Center of Shohada-e-Tajrish hospital to illustrate how the use of the one-sample K-S (with the mean and SD estimated from the sample) instead of its modification can be misleading in practice. We also use Monte Carlo simulation to compare the approximate power of the one-sample K-S test (with the estimated population mean and SD) with Lilliefors test in some common specified continuous distributions. The result indicates that one should not use the one-sample K-S test for assessing the normality assumption in practical situation.

Evaluating the effect of mechanical debridement with adjunctive antimicrobial photodynamic therapy in comparison with mechanical debridement alone on the peri-implant parameters in type 2 diabetic mellitus patients with peri-implantitis: a systematic review and meta-analysis

Abstract Background Type 2 diabetes mellitus (T2DM) is a major risk factor for localized diseases such as peri-implantitis that may affect ideal implant treatment. This study was aimed to evaluate the effect of mechanical debridement (MD) + antimicrobial photodynamic therapy (a-PDT) in patients with peri-implantitis who have T2DM in terms of bleeding on probing (BOP) and probing depth (PD) as primary outcomes and plaque index (PI) and crestal bone loss (CBL) as secondary outcomes. Methods Publications compared outcomes between MD + aPDT and MD alone in T2DM patients with peri-implantitis, containing more than 3-month follow-up duration, were involved in the systematic review and meta-analysis. Literature until July 2023 using MEDLINE (through PubMed), Scopus, Cochrane Library, Embase, Web of Science, and Google Scholar were collected. Results Two randomized controlled trials (RCTs, 88 individuals) and one controlled clinical trial (CCT, 67 individuals) with follow-up periods ranged from 3 to 12 months were recruited. All studies used diode laser with wavelengths ranged from 660 to 810 nm. The results demonstrated that the MD + aPDT group showed significant benefits for BOP reduction after 6 months (SMD = -2.15, 95% CI: -3.78 to -0.51, p = 0.01). However, a great amount of heterogeneity was observed (I 2   = 91.52%, p < 0.001). Moreover, there was a significant difference between MD + aPDT and MD alone groups in CBL (SMD = -0.69, 95% CI: -1.07 to -0.30, p < 0.001). In addition, homogeneity assumption was satisfied (I 2  = 22.49%, p = 0.28). Significant differences in PD and PI reduction were not found except for PI reduction after 3 months (SMD = -0.79, 95% CI: -1.24 to -0.33, p < 0.001. Also, no heterogeneity was observed (I 2   = 0.00%, p = 0.47). Conclusion Given that high heterogeneity in BOP and PD outcome was found in this systematic review, future long-term CTs with MD + aPDT should be examined to arrive at a firm conclusion

Serum Leptin Levels in Pemphigus: A Case Control Study

Background. Pemphigus is an autoimmune blistering disease mediated by autoantibodies directed against keratinocyte adhesion molecules. Leptin, an adipocyte-derived hormone, plays a role in immune responses and promotes autoimmunity. Objectives. This study was conducted to determine whether serum leptin levels are altered in pemphigus patients and whether there is any correlation between leptin levels and the severity of disease. Methods. This study included 47 newly diagnosed patients with pemphigus and 43 age- and sex-matched healthy controls. Clinical characteristics and pemphigus area and activity score (PAAS) were assessed. Serum leptin levels (ng/mL) were measured by a commercial enzyme-linked immunosorbent assay (ELISA). Results. Patients did not differ significantly in serum leptin levels from healthy controls (median (range): 10.8 (0.1–110) ng/mL versus 12 (0.5–69.9) ng/mL and P=0.53). There was no significant association between serum leptin concentrations and severity of disease measured by PAAS (rs=0.06, P=0.70). Conclusion. The results suggest that pemphigus does not have a direct influence on serum leptin levels and the pathogenesis of pemphigus seems to be not dependent on the connection with adipose tissue

Evaluation of anxiety and depression in patients with morphea taking immunosuppressive drugs during the COVID-19 pandemic

Background During the coronavirus disease 2019 (COVID-19) pandemic, individuals especially those with chronic diseases face various problems like psychological distress. Aim To evaluate anxiety and depression among morphea patients taking immunosuppressants compared with controls during the COVID-19 pandemic. Methods In this case-control study, electronic data of 42 eligible morphea patients and 42 age- and sex-matched healthy subjects were extracted. All participants were asked about adherence to the health protocols and the symptoms of COVID-19. To investigate anxiety and depression, we provided the participants with an online version of the Hospital Anxiety and Depression Scale (HADS) Questionnaire. In this standard questionnaire, a score ≥ 11 represents a significant psychological disorder. Results The two groups did not differ significantly in the mean HADS-Anxiety (HADS-A) and HADS-Depression (HADS-D) scores (p= .08 and p= .79, respectively). HADS-A and HADS-D scores were ≥ 11 in 16.67% and 11.90% of the patients, respectively. Among the morphea patients, those with sleeping problems during COVID-19 had a significantly higher mean HADS-D score (p= .048). Notably, 21.43% of patients discontinued their treatment due to fear of COVID-19 and experienced disease recurrence. Adherence to health protocols was higher in patients compared with controls. The rate of COVID-19 occurrence was not significantly different between the groups. Conclusions Although there was no significant difference in anxiety and depression between the groups, it is recommended to provide psychiatric counseling opportunities to morphea patients to improve treatment outcomes during this pandemic

Photobiomodulation Therapy for the Management of Patients With Inferior Alveolar Neurosensory Disturbance Associated With Oral Surgical Procedures: An Interventional Case Series Study: Photobiomodulation THERAPY for Inferior Alveolar Neurosensory Disturbance

Introduction:: Inferior alveolar nerve (IAN) injury is a serious complication during intraoral surgeries. We aimed to evaluate the outcome of photobiomodulation (PBM) therapy in patients with IAN injury associated with third molar or implant procedures. Methods: Eight patients with alteration of sensory function of the IAN after third molar or implant surgeries were enrolled in this case series study. The patients received 10 sessions of PBM therapy (810 nm diode laser, 200 mW, 10 J/cm2 per point, three times a week). Pinprick (PP) and visual analog scale (VAS) neurosensory tests were recorded at each treatment session and 14 days after the last treatment. &nbsp;Results: The median percentage change of outcomes from first to last visit was as follows: VAS score: +125.00% (range: 50.00 to 166.67); PP score: +350% (range: 150 to 800). The duration of paresthesia was inversely correlated with changes of VAS and PP scores. No significant association was found between the gender or age of patients and changes in VAS and PP scores. Conclusion: Considering the limitations of this study, PBM with the parameters used in this study presented positive effects on neurosensory recovery in patients suffering from IAN injury associated with routine intraoral procedures. Patients with a shorter duration of paresthesia tended to respond more favorably to PBM therapy

Serum angiotensin converting enzyme in pemphigus vulgaris

Background: Pemphigus vulgaris is an autoimmune blistering skin disease with unknown etiology. Drugs such as angiotensin-converting enzyme (ACE) inhibitors may contribute in the pathogenesis of pemphigus. Objective: We plan this essay to evaluate the serum ACE level in pemphigus vulgaris patients in comparison with healthy controls to recognize its possible role in disease pathogenesis or activity. Methods: This study was planned and performed in the dermatology clinics of Shahid Beheshti University of MedicalSciences′ Hospitals between July 2010 and June 2011. Patients with new onset of pemphigus vulgaris were enrolled in our study. Control subjects were frequency-matched to cases by sex and age. Serum ACE was determined by the spectrophotometric method. Results: Thirty-four patients with pemphigus vulgaris and 35 healthy individuals were recruited in the study. No statistical significant difference was detected in the mean level of serum ACE of the two groups (t-test, P = 0.11). The mean ACE level was significantly lower in male patients compared with male controls (P = 0.04). Moreover, a significant higher serum ACE level of patients with cutaneous involvement was observed compared to patients with mucosal involvement (P = 0.02). Conclusions: Despite lack of any significant difference of serum ACE level between pemphigus and control group, the serum ACE level was considerably lower in male pemphigus vulgaris patients compared with male controls. Therefore, ACE might have some association with pemphigus vulgaris especially in male patients; however, further studies are required to confirm this association

Evaluation of Elastic Fibers Pattern with Orcein Staining in Differential Diagnosis of Lichen Planopilaris and Discoid Lupus Erythematosus

Differential diagnosis of lichen planopilaris and discoid lupus erythematosus especially in late stages is a problem for clinicians and pathologists. Our aim was to find discriminator histopathologic findings that help us to achieve definite diagnosis without using immunofluorescence study. The histopathologic findings in 77 cases of lichen planopilaris were compared with those of 26 cases of discoid lupus erythematosus with Hematoxylin & Eosin and especially staining (Alcian blue pH 2.5, Periodic Acid Shiff, Orcein). Final histopathologic diagnosis was based on histologic findings, clinicopathological correlation, past medical history and immunofluorescence studies if were applied before. Then elastic fibers pattern in dermis and follicular sheath with orcein staining were described without having information about final diagnosis. New and subtle presentations of histologic changes were assessed. We compared all histopathologic finding for each staining method. Some histologic changes such as hypergranulosis, epidermal atrophy, mucin deposition, diffuse scar and some other patterns were not specific for any diagnosis. A setting of histopathologic findings and clinicopathological correlation were needed for accurate diagnosis. We had only one specimen for the vertical section, and we had no horizontal sections. Description of elastic fibers pattern in orcein staining may be helpful in achieving a specific diagnosis, but this is not completely reliable, and we had overlap features. Finally, immunofluorescence study may be recommended for suspicious cases

Skin Biophysical Characteristics in Patients with Keratoconus: A Controlled Study

Background. Keratoconus is a relatively common corneal disease causing significant visual disability. Individuals with connective tissue disorders that affect the skin such as Marfan’s syndrome and Ehlers-Danlos syndrome or patients with atopic dermatitis show an increased prevalence of keratoconus. It seems that there are some concurrent alterations of skin and cornea in patients with keratoconus. Objective. We plan to compare skin biophysical characteristics in patients with keratoconus and healthy controls. Methods. Forty patients with keratoconus (18 females and 22 males) with mean (SD) age of 33.32 (9.55) years (range 19–56) and 40 healthy controls were recruited to this study. Skin biophysical characteristics including cutaneous resonance running time (CRRT), stratum corneum hydration, and melanin values were measured in patients and controls. Results. The median CRRT, stratum corneum hydration, and melanin measurements were significantly lower in patients with keratoconus in comparison with healthy controls. Conclusion. There are some alterations of skin biophysical properties in patients with keratoconus. Therefore, the assessment of these skin parameters could provide us some clues to the possible common biophysical variations of cornea and skin tissue in diseases such as keratoconus