Dermatology and Cosmetic

Comparing the efficacy of basal cell layer suspension implementation alone and in combination with topical calcipotriol in patients with stable vitiligo: A randomized controlled clinical trial

Behzad Anoush

Background and Aim: Vitiligo is an skin condition that results in the skin depigmentation. The implementation of a basal cell layer suspension is a novel treatment in cases with recalcitrant vitiligo. In this study, the efficacy of topical calcipotriol on the implementation site with basal cell layer suspension versus basal cell layer suspension application alone was compared.

Methods: In this randomized, controlled clinical trial, 20 patients with recalcitrant vitiligo were randomly allocated in two 10-patient groups, undergoing the implementation of basal cell layer suspension alone (controls) or along with daily application of topical calcipotriol (intervention group). Results and possible complications were compared between the two groups 6 months after initiation of the treatment.

Results: Six months after initiation of the study, 2 patients (20%) in the control group had poor responses, and 8 patients (80%) had moderate/good responses. In the intervention group, 1 patient (10%) showed poor response, and 9 patients (90%) showed moderate/good responses (P>0.05). Complications were trivial and self-limiting.

Conclusion: Although topical application of calcipotriol did not signigicantly change the primary outcome of the study, it was associated with better results and no major side effects.

Frequency and risk factors for steroid-induced diabetes in pemphigus vulgaris patients in Razi Hospital, Tehran

Abbas Karimi

Background and Aim: Pemphigus vulgaris is the most common autoimmune blistering disease. Prednisone, commonly in combination with an immunosuppressive adjuvant such as azathioprine or cyclophosphamide, is the standard treatment for pemphigus vulgaris. Approximately 5% to 15% of mortality of the disease is due to the complications of corticosteroids therapy. The aim of this study was to determine the prevalence and risk factors of steroid-induced diabetes in pemphigus patients hospitalized in Razi hospital, Tehran in 2009 and 2010.

Methods: In this cross-sectional study, 177 first-time admitted pemphigus vulgaris patients were studied regarding presence of risk factors for steroid-induced diabetes. Those risk factors were included age, sex, blood pressure, body mass index (BMI), family history of diabetes, medications used before and after initiation of treatment, fasting blood sugar (FBS) , triglyceride (TG) high density lipoprotein (HDL), low density lipoprotein (LDL) levels at the time of admission, and three weeks after the treatment was started.

Results: Twenty-nine patients (16.3%) were diagnosed with diabetes based on three weeks FBS levels evaluations. There were significant associations between BMI, HbA1c and taking nervous system agents and diabetes (P<0.05), but the differences between sex, family history, blood pressure, TG, LDL levels and occurrence of diabetes were not significant (P>0.05).

Conclusion: Close monitoring of FBS levels before and within the first three weeks of the initiation of steroid therapy allows early detection of storied-induced diabetes in pemphigus patients. Moreover, evaluation of other risk factors associated with diabetes may provide the opportunity of early diagnosis and treatment of steroid-induced diabetes.

Comparison of efficacy of topical colloidal silver and topical clotrimazole in the treatment of tinea capitis and tinea corporis: A non-randomized clinical trial

Afsane Radmehr

Background and Aim: Dermatophytoses are the infections caused by the fungi that are capable to invade and multiply within keratinized tissues such as the skin, hair and nails. Topical azoles are considered the first-line treatment in dermatophytosis, but systemic therapy may also be required in some cases. Fungal skin infections have become more common in recent years, and injudicious use of conventional drugs has led to emergence of resistant species. This study compared the therapeutic effects of topical colloidal silver with topical clotrimazole in the treatment of tinea capitis and tinea corporis.

Methods: In this double blind, non-randomized clinical trial, 40 patients with tinea capitis and tinea corporis were allocated into two groups, receiving either topical colloidal silver or topical clotrimazole, twice daily for at least 4 weeks. Systemic antifungals were also administreerd if needed. The response to treatment (negative KOH smear and resolved symptoms) was compared between the two groups at the end of the treatment period.

Results: The mean response time was 5.26±1.56 (range: 3-8) weeks in colloidal silver receivers and 5.00±2.20 (range: 3-12) weeks in the clotrimazole group (P=0.67). The response rates were 84.2% in the topical colloidal silver group, and 90.0% in the topical clotrimazole group (P=0.66). None of the patients experienced a side effect.

Conclusion: Topical colloidal silver may be as effective and safe as topical clotrimazole in patients with tinea capitis and tinea corporis. Further studies with larger sample sizes are recommended.

Primary cicatricial alopecia in patients admitted to a referral dermatology clinic in Hamadan, between 2002 and 2012: A clinico-pathologic study

Leila Khezrian

Background and Aim: Cicatricial alopecia refers to lesions that result in permanent and irreversible hair loss and are associated with destruction of hair follicles. In this alopecias the hair follicle is replaced with connective tissue. After remission of initial infection or inflammation, hair regrowth is unlikely.

Methods: In this retrospective cross-sectional study, 222 patients with cicatricial alopecia, admitted to Farshchian Hospital, Hamadan, Iran were investigated. Hospital records of patients with cicatricial alopecia were reviewed, and their demographic as well as clinical data were extracted and entered into prepared data gathering forms.

Results: One-hundred and ten patients (49.5%) had discoid lupus erythematosus, 71 patients (31.9%) had lichen planopilaris, 23 patients (10.4%) had pseudopelade of Brocq, 11 patients (4.9%) had keratosis pilaris spinulosa decalvans and 3 patients (1.3%) had central centrifugal cicatricial alopecia. Each of alopecia mucinosa and dissecting cellulitis/folliculitis were observed in 2 patients (0.9%). The correlation between of illness, extent of disease, gender, location, occupation, and clinical features of the disease were studied.

Conclusion: Cicatricial alopecia usually results in irreversible hair loss, but early diagnosis and treatment can prevent the progression of the lesions and its complications. The diagnosis of this disease is possible with a clinicopathologic study.

Frequency of methicillin-sensitive and resistant- Staphylococcus aureus carriers in hospitalized pemphigus patients in Tehran: A cross-sectional study

Tahereh Soori

Background and Aim: Pemphigus is a chronic autoimmune blistering disease characterized by intraepidermal blisters.
These blisters damage the skin barrier and increase the risk of life-threatening infections. Nasal colonization of
Staphylococcus aureus can increase the risk of infections and delay the wound healing process.The aim of this study was to
determine the frequency of staphylococcal carriers in hospitalized patients with pemphigus.
Methods: In this prospective cross-sectional study, medical records of 72 hospitalized patients with pemphigus in the
period from March 2013 to March 2014 were reviewed.Samples were collected from anterior nares and cultured at the
time of admission and one week after hospitalization for evaluation of S. aureus colonization and Methicillin-resistant
Staphylococcus aureus (MRSA) types.
Results: Forty-five patients (62.5%) were male and 27 patients (37.5%) were female. The frequency of S. aureus
carriers was 58.3%. Thirty patients had colonization at the time of hospital admission among them, 22 (73.3%) patients
had MRSA. In forty (55.6%) patients colonization were found one week after hospitalization. Thirty-three (82.5%) patients
in this group were MRSA positive. There was no significant difference between S. aureus colonization at the time of
admission and one week after hospitalization (P>0.05).
Conclusion: S. aureus and MRSA carriers (communityacquired and hospital-acquired carriers) were prevalent
among patients with pemphigus. With identifiction and isolation of carriers of S. aureus in pemphigus patients, not
only could prevent spreading S. aureus and MRSA associated infections, bul also would facilitate wound healing. More
robust studies are required to assess the role of potential riskfactors.

Hair follicle bulge stem cells: A new source for skin regeneration

Maliheh Nobakht

Emergence and spread of various diseases in the past century have been associated with many problems for the health care providers. Now a days, with advancement of technology, new methods such as cell therapy, are available, efficient and successful in some clinical areas. To use any cell, it is necessary to identify its source, so herein, we reviewed the literature of a new source of adult stem cells in the bulge of hair follicle.

Hair is composed of two parts: root and shaft. Proximal two-thirds of the hair root, called hair follicle that is surrounded by two dermal and epidermal sheaths. Epidermal sheath included inner and outer root sheath. Outer root sheath at the junction of the errector pilli muscle and sebaceous glands make the bulge that includes stem cells.

In this review we described anatomy of the hair follicle, hair growth cycle, hair follicle bulge, embryonic source of hair follicle, isolation of bulge stem cells using cell surface markers, gene expression and differentiation in bulge stem cells directing differentiation of bulge stem cells in normal skin repair, and practical advantages of bulge stem cells over other stem cells.

Evidence-based dermatology: It is open to debate

Alireza Khatami

Three decades have passed since the first time evidence-based medicine (EBM), in its current form, was introduced. Arguably, over the past two decades it has been the most significant movement in medicine. There is no need to emphasize any approach to clinical medicine practice, including EBM, has its proponents and opponents. Certainly, EBM has been subjected to many challenges and criticisms. Some of those challenges are basically related to misunderstanding and misinterpretations of EBM. However, there are some challenges that are real and are acknowledged by the most loyal EBM supporters. After hearing some criticisms posed by few knowledgeable and competent dermatologists during the recently held 7^th Evidence-Based Dermatology (EBD) seminar in Tehran, the authors of this letter, two of the pioneers of EBD in Iran, decide to open a gate for sharing and discussing different viewpoints on EBM and EBD.