Dermatology and Cosmetic

Clinical and laboratory adverse effects of oral isotretinoin in patients with nodulo-cystic acne

Pouran Layegh

Background and Aim: Oral isotretinoin is the only drug that is effective on almost all factors involved in the pathogenesis of acne. Although several studies have been conducted on side effects of this drug, few studies have been conducted on Iranian patients. The aim of this study was to evaluate common clinical and laboratory side effects of this drug in patients with nodulo-cystic acne in Mashhad, Iran.

Methods: One-hundred nodulo-cystic acne patients without previous history of hematologic, renal or hepatic diseases and with negative pregnancy tests (in female patients) were enrolled to this study. Patients were treated with standard regimen of oral isotretinoin with a cumulative dose of 120 mg/kg for a treatment course. Demographic data of each patient and results of baseline laboratory tests including serum lipids profile, liver function tests and cell blood counts were recorded.Laboratory tests and the clinical side effects were assessed every two months.

Results: All patients completed treatment course. The most common side effects were cheilitis (87%), dry skin (71%), various types of dermatitis (37%), epistaxis (21%), arthralgias and myalgias (21%). All side effects were mild and treatment discontinuation was not necessary in any case. Although some changes were observed in serum lipid profiles and liver function tests, but these changes were within normal range.

Conclusion: Treatment with oral isotretinoinis associated with few complications in patients with nodulo-cystic acne, but the possibility of serious side effects should always be considered.

Prevalence and reasons for cosmetic products use among female students in Hamedan universities

Mohammad Ahmadpanah

Background and Aim: High consumption of cosmetic products may result in several health problems. Cosmetics use among Iranian girls and women is common, so identifying factors affecting cosmetic use seems necessary. The aim of this study was to determine the prevalence and reasons for cosmetic products use among female university students.

Methods: This cross-sectional study was carried out on 540 female university students of Hamedan universities, which were recruited according to a random sampling method. The data gathering tool was a self-reporting questionnaire.

Results: Lipstick (62.2%), mascara (50.9%) and liner (43.3%), were the most commonly used products among students. Feeling beautiful and improved self-confidence were the most common reasons for using cosmetic products.

Conclusion: Considering the findings of this study, it seems that providing educational programs for promotion of self-esteem can be beneficial for preventing unnecessary cosmetic use.

Positive family history of herpes zoster as a risk factor for the disease: a case-control study

Seyed Mostafa Ghasemzadeh

Background and Aim: In addition to the age and immune suppression, several risk factors for herpes zoster have been studied. The aim of this study was to evaluate the family history of herpes zoster as a risk factor for this disease.

Methods: This case-control study was conducted at Farshchian hospital, Hamedan, Iran. The cases were patients with confirmed diagnosis of herpes zoster. The controls were chosen from individuals with minor or chronic dermatologic diseases or their companions, who had no history of herpes zoster. Immune deficiency was the main exclusion criteria. Information was asked using special questionnaires administered by blinded investigators. Data were analyzed using chi squared test. Odds ratios (OR) with 95% confidence interval (95% CI) were calculated to compare proportions in two groups.

Results: Case and control groups included 217 and 200 participants, respectively. The mean ± standard deviation of ages in case and control groups were 49.08±15.59 and 49.96±15.54 years, respectively (P=0.936). 53.5% of cases and 54.5% of controls were women (P=0.845). The frequency of herpes zoster in first-degree relatives in cases and controls was 65/217 (30%) and 16/200 (8%) respectively (OR [95%CI] = 4.91 [2.73-8.85]). Positive history for second degree relatives was 36 (16.6%) and 8 (4%) in cases and controls, respectively (OR [95%CI] = 4.77 [2.16-10.54]). This proportion for at least one relatives was 101 (46.6%) and 24 (12%) in cases and controls, respectively (OR [95%CI] = 6.26 [3.79-10.36]).

Conclusion: This study suggests that positive family history is a risk factor for herpes zoster.

Outbreak of pediculosis capitis in students of Bahar in Hamedan province

Ehsan Mostafavi

Background and Aim: Head louse, pediculosis capitis, is a major health problem in the world. Head louse infestation is still common in many countries including Iran. It causes serious health problems in many communities particularly among the school-age children. The aim of this study was to determine the major factors in an outbreak of pediculosis capitis in students of Bahar in 2011.

Methods: All confirmed and recorded cases that were diagnosed in an outbreak of pediculosis capitis in students of Bahar in Hamedan province in October-December 2011 were included in this study and their demographic and epidemiological data were analyzed.

Results: Among all of the 17722 students in Bahar, 1217 (6.74%) were infested. From these infested students, 98.1% were female, 59.8% resided in urban area and 57.6% were studying in primary schools. Statistically significant relationships were found between head lice infestation, and factors such as sex, residency status and level of education of the students (P<0.05).

Conclusuion: This is the first time that an outbreak of head lice infestation was reported in Bahar city among students. As it is probable that personal and public hygiene by seasonal and nomadic migrant workers was the primary cause of the outbreak providing facilities for workers and upgrading the knowledge of these workers', people and students about the prevention and treatment of infested cases is essential.

CRP serum level in patients with psoriasis before and after treatment with narrow-band ultraviolete B

Vali-o-allah Hosseinpoor

Background and Aim: C-reactive protein (CRP) is an inflammatory biomarker and its level increases in serum of psoriatic patients. Its level is also associated with Psoriasis Area and Severity Index (PASI) score.

Methods: CRP serum levels in patients with psoriasis were measured before and after treatment with narrow-band ultraviolet B (NB-UVB) and the data were analyzed in relation the PASI score improvement.

Results: Baseline CRP levels among psoriatic patients were higher than normal. These levels decreased significantly after treatment. At the beginning of the study, patients with higher levels of CRP also had more extensive and severe skin involvement. Highest decrease in CRP was observed in patients who responded better to the treatment and acheived higher PASI 75%. There was an association between baseline PASI scores and CRP levels.

Conclusion: Patients with moderate to severe plaque-type psoriasis had systemic inflammation too, which was demonstrated by having higher levels of CRP. Skin disease activity also was associated with higher levels of CRP. Phototherapy healed the psoriatic skin lesions and also reduced inflammation and decreased CRP levels.

Serum zinc level in alopecia areata patients: a cross-sectional study

Amir Reza Hanifnia

Background and Aim: Alopecia areata is a non-scarring hair disorder. Trace elements imbalance (like zinc) has been reported as its triggering factor. In this study we compared serum zinc level in alopecia areata patients with normal values.

Methods: Twenty-three female and 19 male patients with alopecia areata were recruited and their serum zinc levels were assessed using absorption spectrometery. Chi squared, t and ANOVA tests were used for statistical analysis.

Results: Sixteen patients with more extensive and prolonged disease, had serum zinc level lower than normal (70 µg/dL). The means of serum zinc levels in patients and normal population were 81.88 µg/dL and 83.5 µg/dL, respectively. This difference was not significant (P=0.668). The means of serum zinc level in different types of alopecia areata were not significantly different (P>0.05). There was an association between serum zinc level and disease duration (P=0.022).

Conclusion: Patients with more severe forms of alopecia areata had lower serum zinc level than other forms of the disease.

Effects of adipose derived stem cell-conditioned medium (ADSC-CM) on synthesis and degradation of yaluronic acid in human dermal fibroblasts

Hossein A. Tehrani

Background and Aim: Synthesis of extracellular matrix (ECM) is a key factor in wound healing. The predominant component of ECM is hyaluronic acid (HA). Recent studies have shown that adipose derived stem cell-conditioned medium (ADSC-CM) can increase the expression and synthesis of collagen I, III and fibronectin which are the components of ECM. The purpose of this study was to investigate the effects of ADSC-CM on the expression of HA synthase and degrading genes in human dermal fibroblasts (HDF).

Methods: ADSCs were isolated from three liposuction samples and their conditioned medium was collected. Skin biopsies were isolated from six patients and their fibroblasts were isolated. These cells were cultured in 100% of ADSC-CM. Expression of three HA synthase and two hyaluronidase genes were assessed with the use of real time PCR, with ELISA and final amounts of secreted HA were measured in the treated and control groups.

Results: Gene expression of two HA synthase genes HAS1 and HAS2 were upregulated in treated samples compared to the control group. The expression of one hyaluronidase gene, HYAL2, was downregulated in them. Final amount of HA was increased in the treated samples.

Conclusion: The expression and synthesis of HA can be increased by the stimulatory effect of growth factors present in ADSC-CM. Thus, secretomes of ADSCs could play a crucial role in wound healing by up-regulating the production of ECM’s components in HDFs.

Evidence-based clinical guidelines for treatment: Acne - Androgenetic alopecia

Alireza Firooz

Clinical practice guidelines are the most important and valid guidelines for treatment of diseases, and are developed through experts consensus on a subject, considering the highest available evidence (systematic reviews, meta-analyses, and randomized controlled trials). We briefly review the latest evidence-based guidelines for the treatment of two common diseases of acne (provided by European Academy of Dermatology and Venereology) and androgenetic alopecia (provided by German Society of Dermatology).