Dermatology and Cosmetic

Editorial Note

Mansour Nassiri Kashani

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Comparison of the efficacy and safety of three Iran-made botulinum toxin type A products in improving moderate to severe glabellar lines

Alireza Firooz

Background and aim: In recent years, increasing demand for aesthetic treatments in Iran and the need for high-quality domestic products have encouraged several companies to produce botulinum toxin type A. This study aimed to evaluate and compare the clinical efficacy and safety of three such Iranian products.
Methods: In the first part of the study, the overall efficacy of the botulinum toxin type A products for treating glabellar lines was assessed in 230 participants who received one of the three Iranian formulations (mean age 42.69 ± 9.21 years), and compared with 230 participants who received the standard treatment (Dysport®) (mean age 42.50±9.79 years). Outcomes were evaluated on day 30 post-injection. In the second part, the comparative efficacy of the three domestic products during the same period and their safety profile up to month four post-injection were assessed.
Results: A clinically meaningful response (at least a two-grade improvement in glabellar line severity) was achieved in 68.6% of recipients of the Iranian products, compared with 52.8% of Dysport recipients, demonstrating a statistically significant superiority in equivalence studies (P<0.01). Among the three domestic products, only product No. 2 showed a significantly higher proportion of participants achieving ≥2-grade improvement (assessed by an independent physician). The type and frequency of adverse events (except for headache) were comparable to the standard drug monograph.
Conclusion: The findings indicate acceptable efficacy and safety of Iran-made botulinum toxin type A products compared with the reference product. Except for limited differences, the efficacy and safety profiles of the three formulations were generally similar up to day 30 post-injection.

Time Parameter optimization of the cryotherapy for the treatment of cutaneous warts: a numerical modeling study

Afshan Shirkavand

Cutaneous warts are among the most common benign skin lesions and, due to their high prevalence, risk of infection, and cosmetic concerns, they remain a frequent focus of clinical attention. Among the available treatment modalities, cryotherapy is widely used as a first-line option owing to its simplicity, low cost, and high success rate. However, the optimal choice of probe temperature and freeze duration still largely relies on clinical experience, and uncertainties in tissue thermal parameters may result in incomplete treatment or unintended damage to surrounding healthy tissue.
In this study, a numerical model was developed to investigate the temperature distribution within human skin during the cryotherapy of warts. The model is based on the radial heat-conduction equation and incorporates temperature-dependent thermophysical properties of human skin as reported by Agafonkina et al. (2021). Simulations were performed for a range of probe surface temperatures between -30 °C and -70 °C, and the temporal evolution of the wart center temperature was examined until it reached the cellular destruction threshold. The results indicate that lowering the probe temperature accelerates the freezing process; however, below approximately -55 °C, this enhancement becomes saturated and the risk of collateral tissue damage increases. Based on the obtained optimization map, the optimal probe temperature was found to lie within the interval -45 to -55 °C, for which the wart core reaches the critical temperature (-20°C) within 5 to 8 seconds. Comparison with clinical data demonstrates that the developed numerical model can serve as an effective tool for predicting and optimizing cryotherapy parameters, thereby improving treatment precision and reducing the likelihood of clinical error.

Importance of photodynamic therapy and inactivation in wounds and tissue repair: a review

Afshan Shirkavand

Antimicrobial photodynamic inactivation is emerging as a non‑antibiotic strategy for treating infected wounds, particularly those harboring multidrug‑resistant bacteria. aPDI relies on a photosensitizer that, when illuminated with an appropriate wavelength, generates reactive oxygen species (ROS) that cause rapid, non‑specific damage to microbial membranes, proteins and nucleic acids. Effective photosensitizers combine high quantum yield to penetrate both Gram‑positive and Gram‑negative organisms, while light sources such as LEDs or lasers provide precise control of irradiance and tissue penetration. Clinical investigations have demonstrated that aPDI, alone or in combination with low‑dose antibiotics or growth factors, can reduce bacterial load in chronic wounds by up to 84 % and accelerate healing. Current challenges include limited light penetration, optimal dosing, and potential phototoxicity, emerging solutions involve nanocarrier‑delivered photosensitizers, oxygen‑releasing dressings, and ultrasound‑mediated activation to enhance efficacy and safety.

Epigenetics in the service of aesthetics: a review of novel skin rejuvenation strategies based on epigenetic modifications

Amin Bakhtiyari

Skin aging is a complex process characterized by structural alterations, reduced elasticity, and wrinkle formation, adversely affecting self-confidence and quality of life. Emerging evidence indicates that epigenetic mechanisms—including DNA methylation, histone modifications, and microRNA regulation-play pivotal roles in initiating and progressing these changes. These modifications, which occur without altering the DNA sequence, are reversible and thus represent promising targets for rejuvenation interventions. This review provides a comprehensive analysis of the role of these pathways in skin aging, as well as the impact of environmental factors such as ultraviolet (UV) radiation, air pollution, and nutrition. Furthermore, it discusses innovative therapeutic strategies, including Sirtuin activators, histone modification inhibitors, platelet-rich plasma (PRP), cell-based therapies, and epigenetic editing technologies. Although preliminary results are encouraging, limitations such as the paucity of longitudinal studies, methodological heterogeneity, and safety and ethical concerns remain. Overall, a deeper understanding of epigenetics may open new avenues for personalized and non-invasive skin rejuvenation therapies.

A review of lead contamination in various Surma products available in the Iranian market

Behrouz Akbari Adergani

Cosmetic products used around the eyes, such as kohl, eyeliner, eye pencil, mascara, and eyeshadow are of particular importance due to the sensitivity of the eyes and the potential for contamination. Among these, kohl is a traditional product widely used in Middle Eastern countries, especially among infants, based on the belief in its therapeutic and protective properties. However, kohl has been reported to contain the highest concentration of lead among these products. This study aimed to assess the lead content in different types of kohl, which is an important step toward raising awareness among consumers of this cosmetic-hygienic product. The objective of this systematic review was to evaluate studies published in recent years that investigated the lead content of kohls available on the Iranian market. To achieve this, a comprehensive search was conducted in national and international databases including Pubmed, Scopus, Science Direct, Google Scholar using relevant keywords. Findings indicate that in some cases, the concentration of lead in tradithinal or handmade kohls greatly exceeded the permissible limits. Repeated or prolonged use particularly in children can lead to elevated blood lead levels and symptoms of lead poisoning. Considering the health risks associated with this product, stricter monitoring of its production and distribution, as well as public education regarding the safe use of kohl, appears to be essential.

Applications of artificial intelligence in wound management: a review

Hoda Keshmiri Neghab

The treatment of wounds has historically been a significant challenge in medicine, incurring substantial financial and emotional costs for both governments and patients. Consequently, researchers have continuously sought novel methods to enhance the wound healing process. In recent years, with the advancements in computer science and the emergence of Artificial Intelligence (AI), many professional fields, including medical sciences, have undergone transformations. There has been a general effort to utilize AI as an assistant or even a human replacement in certain processes. In the field of wound care, the application of AI-based tools is expected to improve the speed and accuracy of the treatment system, leading to faster wound healing and better outcomes for patients.
AI has been presented in various models, each operating on different datasets and employed in diverse research studies. Both software and hardware tools based on AI have been designed and introduced in several investigations. Their performance has been evaluated at various levels, from laboratory to clinical settings, and their efficacy has been demonstrated.
Based on the findings, it can be stated that AI can provide effective assistance to clinical and research staff in the diagnostic, therapeutic, and educational processes of wound treatment. In some cases, it may even reduce the need for direct clinical staff involvement for patients.

Itraconazole-resistant tinea capitis caused by Microsporum canis in a child with Chronic Granulomatous Disease: a case report

Mahsa Fattahi

Background: Chronic granulomatous disease (CGD) is a rare primary immunodeficiency caused by defects in the NADPH oxidase complex, predisposing patients to severe bacterial and fungal infections. Dermatophytosis with severe inflammatory presentations such as tinea capitis is uncommon but challenging to manage in these patients.

Case presentation: We report a 9-year-old Iranian girl with autosomal recessive CGD who presented with refractory inflammatory scalp lesions. Mycological examination confirmed tinea capitis caused by Microsporum canis. Antifungal susceptibility testing showed reduced susceptibility to itraconazole, while susceptibility to terbinafine and fluconazole was preserved. Due to limited access to terbinafine, the patient received alternative management including antibacterial and anti-tuberculosis therapy, leading to clinical improvement.
Conclusion: This case highlights the diagnostic and therapeutic challenges of dermatophytosis in CGD patients and emphasizes the importance of accurate mycological diagnosis, antifungal susceptibility testing, and individualized multidisciplinary management, particularly in resource-limited settings.