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The fourth paper of review article series about COVID-19 includes a selection of interesting and useful information about this disease and dermatology. This paper contains materials published in literature in various basic fields such as epidemiology, pathogenesis, as well as clinical topics such as symptoms and treatments. The skin manifestations of COVID-19, the challenges of treating skin diseases and dermatoses caused by the virus have also been reviewed.

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Full term newborns have a skin that rapidly develops towards adult skin. From the anatomical point of view, the differences are limited, but some changes at birth are responsible for the physiological differences between the skin of infants and adults. Newborns skin exhibits the same barrier function and absorption properties as adults, but external conditions for newborns may be different from those for adults, and these differences may lead to different skin absorption profiles between these two groups. Also, a baby's temperature regulation (transepidermal water loss (TEWL) and sweating) is not completely developed and the skin becomes easily infected, which is mainly due to changes in pH and immaturity of the skins defense system. This implies why only cosmetics with safe ingredients should be used for newborns. The initial aim is to formulate a simple, pure, gentle and pathogen-free product. Systemic side effects are not expected with washable products but should be taken into account for leave-on products. Great attention should be given to cosmetic products used in the napkin area, especially where there is a possibility of rash. If necessary, more safety precautions should be taken for these products.

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The fifth paper of reviews on COVID-19 addresses COVID-19 vaccines, as vaccination has started in the world and Iran. In this paper, we review different types of available vaccines and also various platforms for production of COVID-19 vaccines as well as the vaccines produced in each platform in the world and Iran. Then the considerations about vaccination in patients with skin diseases, specially those using immunomodulator drugs will be presented. Finally, the cutaneous adverse effects of COVID-19 vaccines will be reviewed.

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The sixth article of COVID-19 review series is published while the virus is invading the world. In this issue, lastest findings about skin manifestations of this disease, skin diseases course, also diagnosis and treatment of COVID-19 and skin reactions due to vaccines are presented.

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Microneedles consist of micron-sized projections similar to needles. They are capable of piercing through the stratum corneum and increase the permeation of active ingredients. Besides active pharmaceutical ingredients, microneedles can also deliver cosmetic agents, biotherapeutics like insulin and vaccines and also are used in diagnostic purposes. This article examines the types of microneedles. It also describes the function, classification, and differences between them.

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Sports and the development of nations are very much intertwined. Sports dermatology is a growing discipline. Athletes’ skin diseases are a distinct group of diseases, and that repetitive physical activity combined with environmental stressors puts the athlete at the highest level of risk.The purpose of this study is to equip physicians with basic knowledge of skin diseases in athletes. Lack of knowledge about the role of exercise in the pathogenesis of skin diseases can lead to delayed diagnosis and consequently, incorrect treatment. Skin diseases can be caused directly or indirectly by exercise; there are some skin diseases which exist in a person but appear or intensify with the onset of exercise.
In general, before an athlete should exercise, he should be examined dermatologically to prevent the spread of skin diseases. They should be considered especially for lesions on the less noticeable areas such as the back and inner side of ears. It is better to prepare a map of the patient’s lesions that can be tracked over time, which the possibility of following their changes (Body Mapping).

Athletes should have no general symptoms such as fever for 72 hours before exercising. There should be no secretory skin lesions, otherwise, it is necessary to receive treatments before going to the gym and using the equipment to ensure that the disease does not spread to others.

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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.

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Although skin manifestations of COVID-19 were reported later than major organs affected, but it seems that they have gained relatively defined and definite described patterns. Regardless of strength and quantity of published papers and reports of rare cases, generally reported cutaneous manifestations are similar. However affection of vairous nail lesions have been mentioned recently. Even though no skin finding is recognized as specific, this does not mean not to look for and describe skin and nail changes. Common skin findings could be observed in many cutaneous diseases. In this issue, we decided to review literature about nail apparatus affected by COVID-19.

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The COVID-19 pandemic is still present and we are directly or indirectly affected by it. The skin is one of the organs that has some manifestations not only during the course of the disease, but also long after recovery and also after vaccination. Hair is one of the parts that, like the skin, may show disorders during and after recovery of the infection and also after vaccination. In this issue, we aimed to provide an overview of the effects of COVID-19 and vaccination on hair. We also express the instrumental role of hair in the study of other diseases, including psychological problems.

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Alterations in barrier function are associated with a number of skin diseases, including xerosis, atopic dermatitis, and psoriasis. Urea, a component of the natural moisturizing factor of the skin, plays an important role in the preservation of skin hydration and integrity. Several studies have investigated the effects of urea in the clinical setting. Here, we summarize the available clinical evidence regarding the effects of urea in the maintenance of healthy skin and management of skin disorders. At lower doses (≤10%),
urea-containing topical formulations act as a skin moisturizer, while at higher concentrations (>10% urea), urea-based preparations exert a keratolytic action. Urea is also useful in combination therapies with anti-inflammatory and anti-fungal drugs, due to its activity as a penetration enhancer.

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Putting Khadab and promoting this act can be effective in improving mental and physical health. Therefore, putting Khadab and its effect on the health of the human body and the herbs used in it need further investigation, as this research can be used to enhance the knowledge of the experts of traditional medicine.

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Today, the valuable metabolites of microalgae are widely used in the production of many cosmetic products, as the biomass of algae contains pigments, proteins, essential fatty acids, polysaccharides, vitamins and minerals, all of which are present in both natural foods and cosmetics are used. In fact, these secondary metabolites with anti-blemish and anti-microbial, anti-aging, sunscreen and skin whitening effects can repair and heal the skin and protect the skin from UV damage and prevent inflammation. Existing cosmetics can in many cases be replaced with microalgae-derived cosmetics that are environmentally friendly as well as safe. The effects of microalgae and their derivatives have been tested in various nutritional studies around the world. However, there are very few studies on their cosmetic applications, so in this review article we tried to study several species of microalgae, cultivation methods, use of biomass and bioactive molecules derived from microalgae in the production of anti-aging products, sunscreen and skin whitening in the formulation of cosmetic compounds.

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Leishmaniasis is a neglected disease caused by different Leishmania species and transmitted by various sand flies. Iran is endemic to both visceral and cutaneous form of the diseases. The aim of this study was to investigate the epidemiological factors of leishmaniasis in patients referred to the Center for Research and Training Skin Disease and Leprosy from 1399-1400. The present study is a cross-sectional study in which every patient with suspected cutaneous leishmaniasis lesion(s) referred to the center during 1399-1400 were included. The results showed a higher number of patients with leishmaniasis are in the age group of 10 to 19 years. Among the mentioned jobs, a higher percentage was assigned to housewives in the affected women and workers in the affected men. According to the results, autumn is the most common season for cutaneous leishmaniasis. The average time from beginning to the diagnosis of leishmaniasis was 1.5-3 months and most patients showed a history of traveling to rural areas. The number of wet type lesions were higher than dry type and most of the lesions were in the hands. Most cases were reported from Isfahan province.

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COVID-19 pandemic has led to many mortalities since the beginning of 2020. As there was no previous experience, no specific therapy was used, except for gloves, masks, special clothes, and antiseptics. So various pharmacologic and
non-pharmacological treatments were tried. World Health Organization published therapeutic protocols in the first weeks of the pandemic that has been changed over months. As there are constant and variable signs and symptoms in different patients in different countries, therapeutic modalities and drugs are various too. Some of these drugs have been used for viral and nonviral diseases, including Tamiflu (that has been used in the treatment of influenza), Ribavirin (an effective drug in hepatitis C infection), immunoglobulin (that has been used in the treatment of various disorders like Stevens-Johnson syndrome), hydroxychloroquine (for the treatment of systemic lupus erythematosus and other rheumatologic disorders), azithromycin (that is used for upper respiratory tract infections, acne, etc.). On the other hand, consuming spices such as ginger and turmeric, vitamins like vitamin C and vitamin D, and zinc supplements have been suggested. Over months, treatment complications, including side effects of drugs and protective equipment appeared. Complications included a broad spectrum of pruritus and nonspecific rash to Stevens-Johnson syndrome and angioedema. Aggravation and recurrence of dermatitis due to the use of protective equipment and antiseptics have been observed. Increasing knowledge about treatment complications will result in early diagnosis and management and obviously decreasing mortality rates and costs.
This article is a review of common cutaneous side effects of therapeutic modalities and preventive methods in COVID-19.
 

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Portwine stains (PWS) lesions are one of the most common childhood vascular malformations that gradually increase in color and thickness without treatment and have profound devastating psychological effects on the child. For this reason, and also because the lesions become resistant to treatment over time, early treatment of these lesions is very important. pulsed dye laser (PDL) is currently the treatment of choice for these lesions. In almost all aspects of the treatment of these lesions with PDL laser, disagreement and sometimes contradictory data are found among various studies. These include the uncertainty of the optimal number of treatment sessions, the appropriate age to start treatment, the optimal parameters to start treatment with and possible methods to increase the effectiveness of PDL, possible treatment side effects and how to deal with them, as well as using different methods to reduce patient discomfort during treatment. The present article collects and reviews existing studies in this field.