Dermatology and Cosmetic

Editorial Note

Mansour Nassiri Kashani

ـــــ

Evaluation of treatment response to dysport Botulinum Toxin based on different glabellar frown line patterns

Alireza Firooz

Background and aim: Pattern-based approaches for botulinum toxin injection in the glabellar region have been proposed to optimize treatment outcomes according to individual muscular contraction patterns. However, evidence regarding the necessity of modifying injection techniques based on these patterns remains inconsistent. This study compared the efficacy of a standardized 3-point abobotulinumtoxinA (Dysport®) injection technique among different glabellar contraction patterns in an Iranian population.

Methods: A total of 224 Iranian patients with moderate-to-severe glabellar lines were included. Patients were classified into five glabellar contraction patterns: U, V, Omega, Inverted V, and Converging Arrow. All participants received 40–60 IU of Dysport using the same 3-point injection technique. Clinical efficacy was assessed 30 days after treatment using the Glabellar Line Severity Scale (GLSS) based on live investigator assessment, independent evaluator assessment, and patient self-assessment. Treatment response was defined as a≥2-point reduction in glabellar line severity during maximum frown.

Results: No significant differences were observed among groups regarding age, sex distribution, or onset of treatment response (P>0.05). Patients with the Inverted V pattern received significantly higher toxin doses than those with U and V patterns (P=0.039 and P=0.031, respectively). Response rates based on live assessment, independent assessment, and patient self-assessment showed no statistically significant differences among contraction patterns (P=0.371, P=0.113, and P=0.360, respectively).

Conclusion: Glabellar contraction patterns did not significantly affect short-term clinical response to a standardized 3-point Dysport injection technique, suggesting that complex pattern-based injection modifications may not be necessary for satisfactory early outcomes.

Divergent regulation of proliferation and COL1A1 expression by PDRN and magnesium ascorbyl phosphate in human dermal fibroblasts

Hamidreza Ahmadi Ashtiani

Background and aim: Human dermal fibroblasts (HDFs) are key regulators of skin homeostasis through extracellular matrix remodeling. Polydeoxyribonucleotides (PDRN) and magnesium ascorbyl phosphate (MAP) are recognized as skin regenerative agents, but their molecular effects on HDFs are not fully elucidated. This study aimed to investigate the effects of PDRN and MAP on cellular proliferation and type I collagen gene expression in HDFs.

Methods: The HDF cell line was treated with PDRN and MAP, and cell viability was evaluated using the MTT assay at 24, 48, and 72 hours. Based on viability outcomes, optimal concentrations of PDRN (100 ng/ml) and MAP (250 µg/ml) were selected. Seventy-two hours post-treatment, the expression levels of KI-67 and COL1A1 genes were analyzed via qPCR (P<0.05).

Results: Cell viability analyses demonstrated significant time- and dose-dependent responses for both PDRN and MAP. At the molecular level, independent treatments with PDRN and MAP upregulated KI-67 gene expression, confirming an enhanced cellular proliferative capacity. Conversely, in a divergent manner, COL1A1 gene expression was downregulated under these exact treatment conditions.

Conclusion: PDRN and MAP induce a divergent response in HDFs; while promoting mitogenic activity, they simultaneously suppress fibrogenesis and COL1A1 expression. This cellular reprogramming underscores the therapeutic potential of these compounds in anti-fibrotic strategies and scarless wound healing. However, in vivo studies are required to conclusively validate these findings.

Chronic mucocutaneous candidiasis in inborn errors of immunity: a review of pathogenesis, diagnostic approaches, and emerging therapeutic strategies

Mahsa Fattahi

Chronic mucocutaneous candidiasis (CMC) is one of the major clinical manifestations observed in patients with inborn errors of immunity (IEIs), typically presenting as recurrent or persistent infections of the skin, nails, and mucosal surfaces. Recent advances in molecular genetics and next-generation sequencing (NGS) technologies have led to the identification of a broad spectrum of genetic defects associated with CMC and have significantly improved the understanding of antifungal immune mechanisms. Host defense against Candida species depends on the coordinated interaction between innate and adaptive immunity, and defects in fungal recognition, IL-17 signaling pathways, or Th17 cell development and function may predispose individuals to CMC. The most important genetic disorders associated with CMC include STAT1 gain-of-function mutations, STAT3 loss-of-function mutations, DOCK8 deficiency, APS-1/APECED, IL-17RA/RC and ACT1 deficiencies, and CARD9 deficiency. In addition to fungal infections, these disorders may also be associated with autoimmunity, allergic manifestations, malignancies, and multisystem involvement. Diagnosis of CMC requires comprehensive clinical evaluation, immunologic investigations including lymphocyte profiling, immunophenotyping, and assessment of Th17 function, followed by genetic testing, which remains the gold standard diagnostic approach. Management strategies include antifungal therapy as well as targeted immunomodulatory approaches such as JAK inhibitors, biologic therapies, and hematopoietic stem cell transplantation in selected patients. This review summarizes the pathogenic mechanisms, clinical and laboratory characteristics, diagnostic approaches, and emerging therapeutic strategies for CMC associated with inborn errors of immunity.

Advantages, challenges, and safety considerations of nanotechnology applications in the cosmetic industry: a narrative review

Behrouz Akbari Adergani

Over the past two decades, nanotechnology has played a pivotal role in transforming the cosmetic and personal care industry, establishing itself as one of the most revolutionary achievements in materials science. The reduction of particle size to the nanometer scale, by increasing the specific surface area and enhancing physicochemical properties, has enabled improved skin penetration, increased stability of active compounds, and facilitated the targeted release of active ingredients, leading to the production of products with higher efficacy. However, concurrent with the expansion of this technology, concerns regarding the biosafety, potential toxicity, and environmental consequences of nanoparticles have been raised, highlighting the necessity for rigorous evaluation. Therefore, this article aims to provide a comprehensive analysis of the advantages, limitations, and safety considerations associated with the application of nanotechnology in the cosmetic and personal care industry. In this analytical review, articles and sources published in reputable scientific databases between 2015 and 2025 were evaluated and analyzed. The results indicated that the utilization of nanostructures such as nanoliposomes, nanoemulsions, metallic nanoparticles, and lipid nanoparticles in the formulation of cosmetic products, while optimizing performance and increasing bioavailability, has created significant potential for innovation in this industry. Conversely, evidence has been reported regarding the induction of oxidative stress, inflammatory responses, and regulatory challenges in the context of long-term risk assessment. The application of nanotechnology in the cosmetic and personal care industry holds substantial innovative capacity and high added value; nevertheless, ensuring consumer safety necessitates long-term toxicological studies and the development of clear regulatory frameworks. Establishing a balance between industrial innovation and public health considerations is a fundamental condition for the sustainable development of this technology.

A comprehensive review of the epidemiological, pathophysiological, and therapeutic aspects of androgenetic alopecia based on the latest evidence

Amirali Barkhordarioon

Androgenetic alopecia (AGA) is the most common form of non-scarring hair loss in both men and women, characterized by progressive miniaturization of hair follicles in androgen-sensitive areas. This condition is usually genetically determined and influenced by androgenic hormones, particularly dihydrotestosterone (DHT). The present review aims to summarize the epidemiological, pathophysiological, clinical, and therapeutic aspects of AGA based on the most recent scientific evidence up to 2025. Current evidence indicates that AGA is not merely a cosmetic issue but also a significant factor affecting patients’ psychological and social well-being. Available treatments include FDA-approved medications such as finasteride and minoxidil, as well as emerging modalities such as platelet-rich plasma (PRP) injection, microneedling, and low-level laser therapy. However, limited efficacy, the need for long-term treatment, and the occurrence of adverse effects have prompted ongoing research into novel and combination therapeutic approaches.

Efficacy of laser therapy in the management of melasma and skin hyperpigmentation: a descriptive review

Afshan Shirkavand

Melasma is one of the most common disorders It is an acquired skin pigmentation that occurs especially in sun-exposed areas, mainly on the face. The chronic, recurrent nature and multifactorial pathophysiology of this disease make its treatment associated with significant challenges. In recent years, lasers have been considered as new and complementary methods in the treatment of melasma, but the results reported in different studies have been variable.
The aim of this study is to review the studies conducted on the role of various lasers in the treatment of melasma and compare their effectiveness, safety and limitations. This study was conducted as a review and published articles on the use of various lasers including Nd: YAG, fractional lasers, picosecond lasers, pulsed-dye lasers (PDL) and intense pulsed light sources (IPL) were examined. The findings of the studies were analyzed and compared descriptively.
The results of the review of studies showed that lasers can reduce the severity of melasma and improve the appearance of skin lesions, but the degree of effectiveness and durability of results depends on the type of laser, treatment parameters, patient skin type and compliance with post-treatment care. Among the various methods, the low-fluence Nd: YAG laser has shown the most scientific evidence in terms of the balance between effectiveness and safety. However, the risk of recurrence and complications such as post-inflammatory hyperpigmentation remain important challenges for laser treatment of melasma.
Overall, the available evidence suggests that lasers have an effective role in the management of melasma, but the best results are achieved when these methods are used as part of a comprehensive and combined treatment approach, along with topical treatments and appropriate sun protection.

Dental procedures as a trigger for delayed granulomatous reactions at dermal filler sites: a case series

Toomaj Shahverdi

Background: Dermal filler injections have gained increasing popularity for face augmentation, skin wrinkle treatment, and contouring. Although generally safe, complications may develop following filler administration. Granulomatous formation reactions to dermal fillers are important adverse reactions. Dental procedures are highly recognized to be a trigger for delayed granulomatous reactions at dermal filler field.
Case presentation:
Case 1: A 32-year-old woman presented with erythema, tenderness, and edema 6 months after ultra4 Juvéderm filler injection at left and right nasolabial folds and both lips. One month prior to the appearance of these symptoms, she had undergone dental scaling and polishing. Histopathological results showed granulomatous reaction to dermal filler. The patient was successfully treated with 2 doses of intralesional corticosteroid injection.
Case 2: A 58-year-old woman presented with nodular growths on her left marionette line and right nasolabial fold subsequent to dental scaling and polishing. Two years prior, she had received injections of Ellansé and Lunaphil Volume dermal filler at both nasolabial folds. An ultrasound examination confirmed a granulomatous response to dermal fillers. The symptoms significantly improved after 2 doses of intralesional corticosteroid injection.
Case 3: A 48-year-old woman, developed a tender erythematous induration in the nasolabial folds where she had received Ellansé filler injection 4 years earlier. The symptoms appeared one month after a surgery on buccal area. Ultrasonography revealed granuloma formation. A regimen of systemic and intralesional corticosteroids resulted in a significant improvement of the symptoms.
Conclusion: These cases highlight dental procedures as a clinically shown factor for granulomatous responses following dermal filler injections, including dental and surgical interventions. More research is required to enhance understanding of the mechanisms and risk factors involved.