Dermatology and Cosmetic

Editorial

Efficacy of licorice extract in the treatment of melasma: A randomized, double-blind, placebo-controlled clinical trial

Siavash Mohammadzadeh Shanehsaz

Background and Aim: Melasma is a common acquired disorder characterized by symmetric, hyperpigmented patches with an irregular outline, occurring most commonly on the face. The goal of this study was to evaluate the efficacy of a cream containing 4% licorice extract with a novel formulation based on solid lipid nanoparticles technology in the treatment of melasma. To the best of our knowledge, it is the first study designed to investigate the efficacy of this novel formulation in the treatment of melasma all over the world.

Methods: In this randomized, double-blind, placebo-controlled clinical trial, 44 women with clinical diagnosis of melasma referred to the Afzalipour hospital dermatology clinic were randomly allocated into two treatment groups of equal size. All the patients were interviewed and examined every four weeks during the trial and their Modified Melasma Area and Severity Index (MMASI) score were evaluated at 4, 8 and 12 weeks. The efficacy of the interventions were classified in four levels: complete response, significant response, partial response and no response.

Results: Forty patients were enrolled in the study. At the end of the study (12 weeks), mean± standard deviation of MMASI score changed from 11.03±2.7 to 1.41±0.6 in the intervention group and from 11.25±2.9 to 2.37±1.2 in the placebo group, respectively (P<0.001).

Conclusion: Licorice extract can be used as a skin-lightening agent with minimal side effect in the treatment of melasma. Nano/micro solid lipid particles are used as carriers with unique properties like size, surface electrical bar. Moreover, a large amount of the drug might be loaded to increase the efficacy and decrease the adverse events.

Treatment of hypertrophic scar with intralesional injection of botulinum toxin A: A double-blind, randomized controlled clinical trial

Ahmad Reza Taheri

Background and Aim: Hypertrophic scars are highly resistant to the treatment and have a high recurrence rate. Affected patients suffer from aesthetic and functional complications, which may influence their quality of life. Nowadays, various therapeutic modalities have been used in the treatment of hypertrophic scars, but patients' problems remain because of high recurrence rate. This study evaluated the efficacy of intralesional injection of botulinum toxin A in the treatment of hypertrophic scar lesions.

Methods: This randomised controlled trial was performed during 2014 and 2015. Each patient`s lesion was randomly allocated in ine of the two arms of the study: one half of the lesion received monthly 8 IU/cm³ of 200 IU/ml intralesional botulinum toxin A (Dysport, Ipsen Biopharma Ltd., UK) and the other half was injected with the same volume of normal saline. Injections were repeated three times. After 9 months, lesions were evaluated according to Vancouver scar scale.

Results: Twenty-one patients with a mean age of 27.2 years completed the study. In the intervention the mean lesions` pigmentation scale decrease to 0.73, vascularity to 0.9 and pliability to 0.98 (P<0.01), but there was no significant change in lesions height (P=0.32).

Conclusion: It seems that injection of botulinum toxin A in hypertrophic scar lesions acts as useful adjuvant for other treatment methods.

Depression in women with hair loss in a referral clinic in Yazd, Iran: A cross-sectional study

Mohamad Ebrahimzadeh Ardakani

Background and Aim: Hair loss is a chronic and frequent dermatological condition. It negatively affects the psychological status, social relationships and daily activities of the patients The aim of this study was to evaluate the prevalnce of depression in women with hair loss in a referral dematology clinic in Yazd, Iran.

Methods: This cross-sectional study was conducted from March 21 to June 21, 2015. Fifty-four women suffering from hair loss referred to the Shahid Sadoughi Dermatology Clinic in Yazd were recruited. Depression assessed by using the Beck Depression Inventory. Data were analyzed using versioin 18 of PASW (IBM Corp., Armonk, NY, USA) and Fisher's exact test was used for comparing proportions in different groups.

Results: The mean ± standard deviation score of depression was 16.1±13.5. The study showed that 67% of hair loss patients were experiencing depression. While not statitically significant, frequency of depression seems to be associated with the level of education (P=0.052). There was no associatioin between the frequency of depression and age, marital status, previous medical history, or drug use.

Conclusion: This study showed that depression is highly frequent among women with hair loss. Beauty is crucial for most women and feeling the lack of beauty and not being attractive decrease their social interaction. More effective treatment of hair loss may improve depression and community relations, and consequently result in higher quality of life in a hair loss patient.

Prevalence of hirsutism and its related factors in dormitory students of Semnan University of Medical Sciences

Abbas Ziari

Background and Aim: Hirsutism as a clinical presentation of hyperandrogenism has a negative impact on the mental health and quality of life. Therefore, determination of its prevalence and associated factors in communities are important. The aim of this study was to determine the prevalence of hirsutism and its associated factors in dormitory students of Semnan University of Medical Sciences in Semana, Iran.

Methods: In this cross-sectional study, all of the female students of Semnan University of Medical Sciences dormitory were given a questionnaire which consists of three parts. The first two sections was designed to collect the demographic data and medical history including past medical history, drug history, menstrual condition and familial history of hirsutism. The third section included the grading scale of Ferrimen-Gallwey, that contains images of various parts of the body and hair growth. Participants were asked to determine their hair growth on the pictures. Data was analyzed using IBM SPSS Statistics (IBM Corp., Armonk, NY, USA) version 19. Chi squared test was used for comparison of proportions in different groups.

Results: From 330 participants, 119 students (36.1%) complained from hirsutism. 105 (31.8%) patients had mild and 14 (4.3%) students had moderate hirsutism. There was a significant correlation between hirsutism and irregular menstrual cycles, positive familial history of hirsutism, congenital adrenal hyperplasia, polycystic ovary, hypothyroidism, use of danazol, and hoarseness (P<0.05).

Conclusion: This study showed a high prevalence of hirsutism in dormitory students of Semnan University of Medical Sciences. More clinical evaluation is suggested to determine various forms of hirsutism and the underlying conditions.

Hirsutism in premenopausal women in Northern Iran: Etiology and associated clinical findings

Seyed Naser Emadi Chashmi

Background and Aim: Hirsutism is defined as the presence of terminal hairs in androgen dependent areas like upper lip, cheeks, chin, breasts, lower area of abdomen and thigh in women. The aim of this study was to determine the etiologic factors and clinical features of hirsutism in premenopausal women.

Methods: In this cross-sectional study, 180 premenopausal women with hirsutism who were admitted at a referral dermatologic clinic in a 1-year period were investigated. After taking full medical history and performing physical examinations, a transabdominal ultrasonography of the ovaries, and laboratory evaluation including early morning total and free serum testosterone, prolactin, dehydroepiandrosterone sulfate, FSH, LH and 17-hydroxyprogestron in all patients were performed.

Results: The most common causes of hirsutism were idiopathic (51.1%), polycystic ovarian syndrome (37.7%), hyperprolactinemia (4.4%), adrenal hyperplasia (3.8%), and drug-induced (2.8%). Hirsutism was mild in 93 (51.6%) patients, moderate in 78 (43.3%) patients and severe in 9 (5%) patients. Family history of hirsutism was present in 100 patients. Clinical conditions associated with hirsutism were: acne (58.3%), obesity (55.5%), menstrual irregularity (38.8%), androgenic alopecia (17.7%) and acanthosis negricans (8.4%).

Conclusion: Idiopathic hirsutism and polycystic ovary syndrome were the most common causes of the hirsutism in premenopausal women. Obesity also had a significant role in hirsutism occurrence.

Internal evaluation: A tool for improving educational quality in the Department of Dermatology of Kermanshah University of Medical Sciences

Hossein Kavoussi

Background and Aim: Internal evaluation is one of the most effective educational assessment processes. Due to involvement of all educational department stake-holders, this evaluation has high efficacy and enforcement. Appropriate use of the findings of such evaluations improve educational quality. The aim of this study was to evaluate various aspects of education, research and facilities at the Department of Dermatology, Kermanshah University of Medical Sciences, Iran.

Methods: In this cross-sectional study, objectives, organizational status, management and authority, faculty members, students, teaching-learning strategies, educational equipments, theses and sabbaticals, and graduates of the Department of Dermatology, Kermanshah University of Medical Sciences were evaluated. Questionnaires were designed, and obtained data were analyzed by IBM SPSS Statistics (IBM Corp., Armonk, NY, USA) version 22.

Results: Most of evaluated components were satisfying. Learning-teaching strategy was the most satisfying factor with an average satisfaction rate of 87.5%, and the graduates issues was the least satisfying factor with an average satisfaction rate of 66.7%.

Conclusion: Planning and proceedings at the department and medical school levels according to feedbacks based on the results of this study not only could improve educational quality at the department, but also may help obtaining approval for initiating a dermatology residency program.

Permeation enhancement strategies in transdermal drug delivery

Maryam Iman

Transdermal drug delivery (TDD) is a non-invasive, topical administration method for therapeutic agents. Transdermal delivery also has advantages including providing release for long periods of time, improving patient compliance, and generally being inexpensive. Despite these advantages, the use of TDD has been limited by innate barrier functions of the skin. Only small (<500 Da), lipophilic molecules can passively diffuse through the skin. As a result of the barrier function of the skin, passive transdermal delivery has primarily been limited to small molecules. The skin, which consists of several layers including the stratum corneum, other epidermal layers, and dermis, is the primary defense system of the body. The main barrier to therapeutic delivery is the outermost layer of the skin, the stratum corneum. As a result, various methods of skin permeabilization have been explored for their ability to enhance the transport of drugs across the stratum corneum. Scientists evaluated new drug delivery systems such as nano-carriers and drug delivery systems and enhancer methods such as penetration enhancers. The purpose of drug delivery systems are to deliver sufficient drug molecules into the skin with maximum stability and minimal toxicity. To guarantee successful transdermal drug delivery, a drug delivery system must exhibit several essential properties including drug protection, targeted drug delivery, biocompatibility and biodegradability.

This paper reviews transdermal drug delivery systems, recent enhancement techniques to optimize drug delivery such as microneedles and especially vesicular systems. Herein, we focus on the differences in their composition, physico-chemical properties and applications of those drug delivery systems. We hope recent innovations can work as a foundation for further research and development in transdermal drug delivery system.