Iranian Journal Of Dermatology
Volume:22 Issue: 2, Summer 2019

Insulin resistance and increased insulin-like growth factor (IGF)-1 with consequent mammalian target of rapamycin complex (mTORC) 1 overexpression is responsible for acne pathogenesis, especially in women with polycystic ovary syndrome (PCOS). Metformin is shown to improve acne as an adjunct therapy in females with PCOS and males with altered metabolic profile. We evaluated the use of metformin in the treatment of resistant and late-onset acne in females, and compared it with isotretinoin.

Females with late-onset acne or acne resistant to common therapies (n=70) were randomized to receive metformin (n=35) or isotretinoin (n=35) for 6 months. Changes in acne severity were scored by global acne grading system (GAGS) which was the primary outcome. Other endpoints were changes in the components of metabolic profile.

Six-month treatment with metformin and isotretinoin significantly reduced the GAGS from 31.9 to 24.6 and from 34.1 to 13.3, respectively, indicating the superior impact of isotretinoin. Metfromin was more effective in decreasing the GAGS score in those with PCOS (13.5±7.1 vs. 24.2±19.4, P<0.05). Furthermore, patients with hirsutism had a higher reduction score with metfromin compared to patients without hirsutism (21.1±9.1 vs. 30.2±6.4) (P<0.05). Lipid profile and fasting blood sugar were improved following the 6-month treatment with metformin, and isotretinoin increased the levels of liver enzymes and bilirubin (P<0.05).

Metformin is effective in treating late-onset or resistant acne and improving metabolic status, without serious side effects. In patients with altered metabolic profiles such as PCOS, metformin seems to be superior to isotretinoin regarding acne treatment.

Microneedling is recently used to treat skin scars mostly atrophic scars; however, there are limited data about its effectiveness on hypertrophic burn scars. Carbon dioxide (CO2) laser is an effective method for the treatment of burn scars. Here, we aim to compare the efficacy of microneedling to CO2 laser in the treatment of hypertrophic burn scars in a randomized clinical trial.

Patients with second and third-degree burn scars (n=60) were randomized to receive 3 sessions of microneedling (n=30) or CO2 laser (n=30), 4-6 weeks apart. The outcomes, including physical characteristics of the scar scored by Vancouver Scar Scale (VSS) and patients’ satisfaction with the treatment measured by Visual Analogue Scale (VAS), were investigated at baseline, at the end of the treatment period, and at the 3-month follow-up.

The VSS score at the follow-up visit showed a significant reduction from 6.63±1.95 to 3.8±2.3 in the microneedling group and from 7.1+2.3 to 5.6±1.7 in the CO2 laser group; while, the reduced VSS score was significantly higher in the microneedling group (P<0.05), especially in reducing the thickness (P=0.001) and pliability (P=0.001) scores. The patients’ subjective assessments for acne improvement were significantly more satisfactory in the microneedling group (P=0.025).

Microneedling seems to be an effective method to improve hypertrophic burn scars. It also causes better scores in the physical characteristics of scar and the patients’ satisfaction compared to the CO2 laser at the 3-month follow-up.

Acne vulgaris is a multi-factorial disease affecting many aspects of life. This study was conducted to compare the efficacy of fenugreek seed extract and oral azithromycin in the treatment of acne vulgaris.

A total of 20 patients with acne vulgaris aged between 12 and 30 years old were entered into this 60-day, randomized, placebo-controlled, triple-blind study. The patients were randomly divided into two groups, (permuted block randomization, block size of 4), namely fenugreek and azithromycin groups. All the participants daily received two capsules containing 500 mg hydroalcoholic extract of fenugreek seeds or 125mg azithromycin, for two months. The patients were evaluated after 30 and 60 days from the start of the trial. The participants, investigators (the dermatologists who evaluated clinical responses), and statisticians who analyzed the data were blind for identity and allocation of the treatments.

The baseline GAGS scores in azithromycin and fenugreek groups were respectively equal to 19.66 and 23.12, and there was a reduction in both azithromycin (GAGS2=14.33) (P-value=0.019) and fenugreek extract group (GAGS2=22.75) (P-value=0.780) during the experiment. There was a statistically significant difference among the two groups (F= (2, 24) = 3.861, P=0.035).

The effect of azithromycin was higher than fenugreek in the treatment of acne vulgaris.

Psoriasis is a chronic-relapsing inflammatory skin disorder, in whose pathogenesis oxidative stress is suggested to be involved. Among different enzymes that play a role in maintaining the cellular redox balance, we aimed to assess the alteration of glutathione peroxidase (GPX) activity in cutaneous lesions and its correlation with the disease severity, firstly, to support the possible candidacy of this enzyme for future topical therapeutic regimens, and secondly, to move forward in understanding the etiology of the disease and the pathogenic mechanisms involved in cutaneous lesions so as to pave the way for further investigations.

The clinical severity of disease was determined according to Psoriasis Area and Severity Index (PASI) scoring system. The level of GPX activity in the skin biopsies from 20 psoriatic patients was measured using Cayman’s glutathione peroxidase assay kit, and its association with disease severity was assessed in each patient.

Tissue GPX activity was significantly higher in patients with mild psoriasis (149.02 ± 24.213 nmol/min/ml) compared to patients with moderate psoriasis (120.58±21.038 nmol/min/ ml) (p-value < 0.05). There was a significant negative correlation between the activity of GPX and each PASI-associated criterion, including redness, scaling and thickness. Among all the criteria of PASI, scaling was independently correlated with the activity of GPX (p-value < 0.05).

The reduced activity of GPX in dermal lesions might be associated with the disease pathogenesis, having a valuable role in diagnosis and therapy.

All cellular events depend upon the DNA synthesis and gene expression involving complex interplay between ligands such as interleukins and interferons, with various cell membrane receptors. These ligand-receptors interactions transmit signals within the cell via numerous signal transduction pathways to affect gene expression. Janus kinase/signal transducer and activator of transcription pathway (JAK-STAT) are one of these pathways involved in the pathogenesis of various inflammatory and immunologic diseases. The therapeutic inhibition of this pathway has yielded promising results in many cutaneous and systemic disorders. It should be noted that, there are 4 JAK proteins and 7 STAT proteins. Currently, the first and second generations of JAK inhibitors are used for different indications, while more selective and pan-JAK inhibitors are under research.

we searched PubMed, Scopus, Cochrane library and Embase as search engines. The terms used to find the useful and appropriate articles were, “JAK-STAT pathway, janus kinase inhibitors and JAK-STAT inhibitors in dermatology”.

This article has summarized the different components of the JAK-STAT pathway, their regulation, classification of JAK inhibitors, and their adverse effects.

Based on the encouraging results of many ongoing clinical trials, their indications have been extended to various autoimmune dermatologic conditions in recent years.

Vitiligo is a pigmentation disorder involving 1% of the population. One of the first line depigmenting agents is monobenzyl ether of hydroquinone (MBEH). Repigmentation following sun exposure; however, can occur after successful treatment with MBEH. This study describes a 54-year-old gentleman who presented with a 7-year history of hyperpigmented lesions on his face following depigmentation therapy with MBEH. The patient was successfully treated with intralesional injections of tranexamic acid.

CLINICAL PRESENTATION
A 28-year-old man referred to the dermatology clinic with an asymptomatic firm, well demarcated violaceous plaque with bumpy surface on his right medial upper shin since two years ago. At first, the lesion was an erythematous patch and gradually became like a plaque. He had pain and sensation of heaviness in his leg (Figure 1). He had no other skin lesions and was otherwise healthy. There was no family history of the same skin lesion. There were no clinically significant abnormalities in laboratory evaluation. The result of serum screening for antinuclear antibodies (ANA) by ELISA was negative. The color Doppler sonography of the right leg demonstrated multiple varicose veins in the medial aspect of the right leg draining into the distal part of the right greater saphenous vein and incompetency of the right saphenofemoral junction. A punch biopsy was performed on the plaque.

CLINICAL PRESENTATION
A 44-year-old lady came to a dermatology clinic due to an asymptomatic, hyperpigmented plaque on her right thigh since 4 months ago. On physical exam, hypertrichosis on the lesion was notable (Figure 1). Rubbing the lesion resulted in erythema and edema of the lesion. She had no systemic disease and her family history was unremarkable.