Journal of

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Hair loss can be viewed a problem from different perspectives: as a disease, a disorder which affects appearance of an individual, and its psychological effects. Therefore, it is crucial to determine the causes and types of hair loss. This review summarized hair loss evaluation methods with significant emphasis on their clinical aspects. According to relevant literature reviews, the major approaches to hair loss are taking medical history, primary investigations and detailed hair examination. Although several invasive and non-invasive, clinical and paraclinical examinations can be used for hair loss assessment, it is generally accepted that using clinical evaluation methods and physical examinations are more efficient. In conclusion, diagnosing hair loss is complex and sometimes time-consuming process. However, precise hair examination may lead to the suspicion of an endocrine disorder.

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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, metaanalyses, and randomized controlled trials). We briefly review the latest evidence-based guideline for the treatment of vitiligo provided by European Dermatology Forum.

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Skin is the largest organ of the integumentary system with multiples important functions. Due to its complex structure, the permeability skin status can be modified by different external and internal factors such as chemical and physical stresses, and several skin and systemic diseases. Today, different non-invasive methods are used to assess the skin barrier biophysical properties. The parameters such as transepidermal water loss, stratum corneum hydration, skin surface pH and skin surface lipids is essential for evaluation of the epidermal barrier status. Application of these methods is critical for evaluation of disease treatments, the effectiveness of topically applied drugs and cosmetic products. The aim of this article is to review application of several methods for skin biophysical and biomechanical properties in humans.

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According to evidence-based medicine, randomized controlled clinical trials are a group of research designs which provides the highest level of clinical evidence, particularly regarding therapeutic or preventive interventions. Considering the dramatic increase in the number of published clinical trials in medical journals, the readership need to have knowledge about the problems that may occur during design and conduct of these studies, as well as about proper reporting of them. Due to importance of these studies in clinical medicine, several guidelines have been developed regarding designing, conducting and reporting clinical trials. One of the most important guidelines which has been developed to alleviate the problems in reporting randomized clinical trials is Consolidated Standards for Reporting Trials (CONSORT). In this article, some crucial points with regards to the report of the comparison of outcomes of interventions in randomized controlled trials will be reviewed briefly.

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Great progress in optics, electronic engineering, and computer science provide an opportunity to diagnosis of skin diseases, estimating effectiveness of drugs and skin care products using non-invasive, non-destructive methods of analysis. Also many noninvasive methods using analytic devices are developed to assessment of the outcomes of dermatologic surgeries on malignant skin tumors. The aim of this article is to review advanced methods for skin analysis on human’s skin such as magnetic resonance imaging and time domain reflectometry. Many kind of interesting applications are defined for using these methods especially in cosmetic pressures.

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Skin is one of the most sensitive parts of the body and is important to maintain the beauty of man. Herbal products have fewer side effects than chemicals and have pharmacological effects on the skin, so are used in cosmetic preparations. Books, articles and electronic databases including ISI Web of Science, PubMed, Magiran and IranMedex were searched to identify plants with positive effects on the skin, regardless of adverse effects and their interactions. A number of plants which were used in the treatment of skin diseases and their effects had been established, were chosen and reviewed. Avocado, thyme, aloe vera, chamomile, almond, licorice, calendula, olive and yarrow were included in this review. There are many herbs that have a role in the prevention and treatment of skin diseases, and are used in either traditional medicine or the preparation of cosmetics. The effects of a number of them have been scientifically proved and this information for the production of cosmetic and pharmaceutical products can be used.

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It is more than a decade that teledermatology has been considered as a potential substitute for the face to face visits. To evaluate its quality, the reliability and accuracy of teledermatology diagnoses are compared to those which are made in face to face visits. In this article, the results of the studies which have compared the reliability and accuracy of diagnoses had been made using teledermatology to the face to face visits were reviewed.

Different resources, such as electronic databases and e-journals were used to choose relevant articles related to teledermatology published between 1997 and 2013, and their main focus was on the reliability and accuracy of diagnoses in teledermatology compared to those in the face to face visits.

The reliability and accuracy of diagnoses in teledermatology compared to those in the face to face visits was more than 60%. Moreover, improving the reliability and accuracy depended on different factors, such as image quality, clinical information, differential diagnoses, consultation with other colleagues and gaining their secondary opinions.

It seems that providing adequate clinical information about patients can help to improve the reliability and accuracy of diagnoses in teledermatology. In this case, teledermatology can be used to provide healthcare services for the distant areas and the poor.

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The use of sunscreens should also be recommended in order to work against all kind of ultarviolet (UV)-induced skin damage such as photoallergies, skin wrinkles, sunburn or even skin cancer. Sunscreens contain chemical filters (organic absorb regularly UVB radiation) and physical filters (e.g., TiO2 and ZnO). The second group has been said to reflect and scatter UVB and UVA radiation. TiO2 is also extensively used in sunscreen formulations as active broadband sunscreens that blocks both UVB (290–320 nm) and UVA (320–400 nm). Although titanium dioxide is listed as a safe pigment, with no known adverse effects when it is used in cosmetics, but we should concern about ultrafine or nanoparticle form of titanium dioxide. If titanium dioxide particles used to act as a sunscreen are small enough, they can penetrate the cells, leading to photocatalysis within the cell, and cause DNA damage after exposure to sunlight.

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Basal cell carcinoma (BCC) is the most common cancer in Iran and in the world and its prevalence may become equivalent to the prevalence of all other cancers combined in the future. The Hedgehog (Hh) signaling pathway has an important role in tumorigenesis of BCC. Mutations in PTCH and Smo molecules of this pathway account for 85% to 95% of sporadic BCCs and also most cases of inherited cases. Currently, several treatment methods exist for this cancer. Mohs surgery and removing the whole tumor with free margins are the most efficient way for metastatic and highly invasive BCCs. According to the latest findings, small inhibitor molecules of the Hh pathway are becoming highlighted in drug production. Vismodegib an inhibitor of Smo, was approved by the Food and Drug Administration in 2012 as a drug for metastatic and highly invasive BCCs. Therefore, strategic targeting of signaling molecules has demonstrated success and holds great potential in medicine.

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Although ultraviolet rays constitute a small portion of the sunlight, they are destructive on skin. Ultraviolet rays cause sunburn, skin damage and skin cancers. Sunscreens are one of the most widely used cosmetic products which protect skin from cancer or other damages. There are two categories of sunscreen agents: chemical and physical. Physical sunscreens containing zinc oxide work through two mechanisms of reflection and scattering. Physical sunscreens are non-allergenic, non-irritating and non-comedogenic. Currently, by using zinc oxide nanoparticles in sunscreen formulation, both prevention of harmful sun rays and receiving cosmetic benefits are achieved.

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Psoriasis is a chronic inflammatory disease which may occur in childhood. In many psoriasis cases, the disease develops in individuals younger than 18 years old. Psoriasis in children presents with a variety of clinical manifestations. Becouse of its atypical presentations, early diagnosis of psoriasis is difficult in children. The plaque type psoriasis is the most common form of the disease in children. Different treatments such as phototherapy and systemic therapies have been proposed, but using any of them leads to serious complications in children. Therefore, early diagnosis and proper management of the disease are the main components of the treatment in pediatric psoriasis cases. Herein, we aimed to provide a general overview on the pediatric psoriasis, including its epidemiology, pathogenesis, clinical manifestations as well as the treatment and discussing the latest related information.

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Paederus dermatitis is a common dermatitis in northern parts of Iran. Clinically, the most common presentation of paederus dermatitis is sudden onset of erythematous plaques with vesicles. The lesions usually affect exposed areas such as face, neck and arms. It is a common dermatitis between residents and tourists in northern provinces of Iran during spring and summer. Preventive measures include typical insect repellents precautions, such as using bed nets, long-sleeve clothing, and avoiding fluorescent lights. If the beetles are found on the skin, brushing them off, rather than crushing them, helps to prevent the dermatitis. Treatment includes washing the affected area immidiatley, applying cold and wet compresses, and in some cases, treatment with antibiotics, steroids, and antihistamines. Herein, we report a paederus dermatitis case in a 9-year old Kashani boy who had traveled to northern Iran as a tourist. We also review the related literature.

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The function of the horny layer of the skin as a barrier is to protect the underlying tissues from infection, dryness, and mechanical stress. Disruption of this function results in increased transepidermal water loss (TEWL) and is associated with conditions like atopic dermatitis and other chronic skin diseases. Moisturizers have been shown to improve these conditions through restoration of the integrity of the stratum corneum, acting as a barrier to water loss and replacement of skin lipids and other compounds. Also, moisturizers are commonly used to reduce fine lines and make the skin appear smooth and soft. They contain varying combinations of emollients, occlusives, and humectants to achieve their beneficial effects, and there are an overwhelming number of formulations available.

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Malassezia species (previously Pityrosporum) are normal flora of human and warm-blooded animals skin. The genus Malassezia is now divided into 13 species. Most of the yeasts show an absolute requirement for long fatty acid chains and specific procedures are required for their isolation, conservation and identification. Under appropriate conditions, the fungi can cause various skin diseases. The aims of this review were to describe recent classification of genus Malassezia their virulence factors, and their association to dermatlogical diseases.

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David Lawrence Sackett, OC, MD, FRSC, FRCP was an American-Canadian physician, trialist, and teacher. He is best known as one of the pioneers of evidence-based medicine (EBM), which is arguably the most important movement in medicine over the past three decades. He founded the first clinical epidemiology department in McMaster University in Hamilton, Canada in 1967. In addition, he was the head of the Center for the Evidence-Based Medicine in Oxford, UK. He also was the first chair of Cochrane Collaboration and the first founding coeditor of the journal of Evidence-Based Medicine and had many other honors. He published 12 books, 60 chapters in other books, and about 300 articles in scientific and medical journals. He died on May 13, 2015 at age 80 because of cholangiocarcinoma. While Dr. Sackett will be missed by his friends, colleagues, mentees as well as EBM proponents and followers all over the world, his contributions to EBM in particular, and to medicine in general will never be forgotten.

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Topical corticosteroids (TCs) are very useful in the treatment of some skin disorders such as eczema and psoriasis. TCs exhibit potent anti-inflammatory and anti-proliferative effects responsible for their efficacy in the treatment of skin disorders. TCs can be classified into different groups according to their potency that depends on the intrinsic activity of the corticosteroid molecule, the characteristics of the vehicle (cream, ointment, lotion) that directly influence patient’s compliance and may modify penetration through the skin. British National Formulary classified them into four potency groups with Class I grouping the most potent molecules (e.g. clobetasol propionate) and Class IV the least potent (e.g. hydrocortisone). In contrast, the American classification considers seven potency groups, with super potent, potent, upper mid-strength, mid-strength, lower mid-strength, mild and least potent.

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Leprosy is a chronic infectious disease which mainly affects the skin and peripheral nervous system. It has been associated with significant fear and stigma because of causing disabilities and deformities. According to the latest reports by World Health Organization (WHO), there were more than 180000 registered leprosy cases in the first quarter of 2014 and over 214000 new cases were detected in 2013. In this brief review, updates on a new causative agent for leprosy, Mycobactrium leprosmatosis, armadillos and the possibility of existence of a zoonotic form of leprosy, new strains of M. leprae and their importance, and the latest available leprosy statistics in Iran will be presented.

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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.

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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.

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Postsurgical scars are of significant concern to both the patients and surgeons. Different laser systems have been used to accelerate and improve the healing process in surgical scars. Some studies have demonstrated the benefits of prophylactic laser application on pre-scars. It seems that using laser energy in the early phase of the healing process may produce changes in the physiology of wound healing toward a more fetal-like tissue regeneration and healing. Laser-Assisted Skin Healing (LASH) is a new approach in which laser irradiation is applied immediately after surgery in order to improve the resulting surgical scars. LASH produces controlled homogenous heating throughout the full thickness of the skin around the wound which accelerates wound healing without thermal damage to the tissue.

The purpose of this paper is to provide an overview of the available peer-reviewed research literature on the application of LASH, the in-vitro, animal and human studies and the suggested mechanisms of action. Further studies are necessary to optimize the best laser parameters especially according to different skin phototypes and  better understanding of the mechanisms of action.