Journal of

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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.

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Alopecia areata (AA) is a sudden non-scarring hair loss that can be seen in any hairy area in the form of round or oval patches. It is an autoimmune disorder with an immunological response against hair follicles that is caused by genetic and environmental factors. The prevalence of AA is about 0.1% to 0.2% worldwide. Depending on the severity of the disease and sites of involvement, it can be divided into: Alopecia with Patchy pattern, alopecia reticularis, alopecia totalis, alopecia universalis, alopecia ophiasis, alopecia sisiapho, diffuse type and perinevoid alopecia areata. There are various treatment options for AA, but once terminated, they have a high recurrence rate. AA is known for the infiltration of T lymphocytes around the hair follicle bulb, and corticosteroids are its main treatment. Another treatment is topical immunotherapy, the most important of which is Diphenylcyclopropenone (DPCP). It is used in cases that have more than 50% hair loss or are resistant to treatment. The exact DPCP mechanism of action is not well understood, but it may have some kind of antigenic competition and reduce the production of anti-hair follicle antibodies. It can alter the immune response in the skin and alter the ratio of CD4 to CD8 cells around the hair follicle in a way that enhances healing of the disease. It is stated that the rate of hair regrowth in DPCP treatment is about 50% on average. In this article, we review the latest findings of about AA and discuss its therapeutic aspects, especially with DPCP.