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Actinic keratosis (AK) is a pre-cancerous skin lesion, associated with development of squamous cell carcinoma. Current treatment options are limited. To compare the efficacy and safety of topical 5-fluorouracil cream (5-FU) and potassium hydroxide 5% (KOH) in the treatment of AK. Eighteen patients with AK applied KOH solution or 5-FU on each side of their scalp/face, randomly. The efficacy and safety of these treatments were compared. Thirteen (118 lesions) and ten (83 lesions) patients were successfully followed for one and three months, respectively. After one month, KOH showed a better clinical response (81% vs. 58%; p-value = 0.007) and dermoscopic response (KOH, 65% vs. 5-FU, 46%; p-value = 0.04); while no differences were noted after three months (clinical response, 83% vs.70%, p-value = 0.1; dermoscopic response, 76% vs. 59%, p-value = 0.1). No significant differences in the recurrence rate of the lesion between the two groups were noted at the end of the third month (p-value = 0.5). Regarding the safety of the treatments, the risk of developing erythema, scaling, sand swelling was higher in 5-FU group (p-value < 0.0001, for all), while more patients in KOH group had erosion and ulcer (p-value < 0.001 for both). KOH was up to 96% less expensive than 5-FU. Low number of patients and short-term follow-up limited the analysis. KOH solution offers a faster and less expensive resolution of AK lesions than does 5-FU. IRCT20180909040978N1 [ABSTRACT FROM AUTHOR]

Frontal fibrosing alopecia (FFA) is a scarring alopecia with no promising treatment. To evaluate the additive efficacy of oral isotretinoin to topical treatments. Between November 2017 and August 2018, FFA patients were randomly assigned to receive either isotretinoin (20 mg/d) plus topical treatments (clobetasol 0.05% and tacrolimus 0.1%) or monotherapy with topical treatments. Treatments' efficacy was evaluated through Frontal Fibrosing Alopecia Severity Index (FFASI) after two and 6 months. From 38 participants, 28 patients completed the study. Facial papules improved after 6 months (p value <.001) in the isotretinoin group. Moreover, frontotemporal hairline (p values for frontal <.001; R lateral: 0.03; L Lateral: 0.02), total scalp margins, total additional features' scores, and total combined (p value <.001 for all) improved more in the isotretinoin group than in the control group. Frontal band improved in the treatment group (p value:.02). Frontal margin (p value:.01), R lateral (p value:.01), total scalp (p value <.01), and combined total scores (p value:.01) worsened in the control group. Isotretinoin-related side-effects included lip dryness, telogen effluvium, and malaise. Small sample size and lost to follow-up. Isotretinoin combined with topical treatments is more effective than monotherapy with clobetasol and tacrolimus for FFA. (IRCT.ir) IRCT2017091736173N1. [ABSTRACT FROM AUTHOR]

Background: The optimal treatment for pemphigus vulgaris (PV) has not been clearly determined yet. Rituximab (RTX) was recently approved for the management of adults with moderate to severe PV. Objectives: This prospective observational study was designed to evaluate the efficacy and safety of biosimilar RTX in PV patients. Methods: The efficacy and safety were evaluated by assessing the pemphigus disease area index (PDAI) score, clinical response and any adverse events (AEs) during at least 12-month follow-up. We evaluated anti-desmoglein (Dsg) 1,3 level at baseline, 3 months and 12 months after RTX infusion. Results: A total of 110 patients treated with biosimilar RTX were enrolled between May 2016 and July 2017. The mean age was 43.58 ± 11.77 years and the mean follow-up time was 16.22 ± 3.45 months. A notable decrease in PDAI score, anti-Dsg 1,3 level and prednisolone dosage was observed. Median delay to achieve complete remission (CR), median duration of CR, and median time to relapse were 3, 9, and 12 months, respectively. Newly diagnosed patients (NDPs) experienced higher rate of CR, longer duration of remission and lower risk of relapse, compared to previously treated patients (PTPs). A total of 47 AEs were observed in 33 (30%) patients, which were mostly mild infusion-related reactions. Conclusion: Administration of biosimilar RTX in PV patients was associated with desirable outcomes in terms of efficacy and safety in both NDPs and PTPs.First-line use of RTX in NDPs was more effective and allowed a rapid tapering of corticosteroid doses compared to PTPs. [ABSTRACT FROM AUTHOR]

Port wine stain (PWS) is a congenital vascular malformation, which is visible at the birth as the red patches, mostly on the face and neck. Previous studies have shown good efficacy and safety of 595-nm pulsed dye laser (PDL). Here, we have conducted a prospective study to assess the efficacy and safety profile of pediatrics with PWS, treated with 595-nm PDL. Twenty-seven patients (10 males and 17 females) with the mean age of 5.7 ± 2.8 (range 1–13) years old were included in the study. Following 6.2 (range 4–10) sessions of treatment, 70.74 ± 18.5% of improvement was detected three months after the final session. Fourteen (51.8%) patients achieved a higher than 75% of improvement; nine (33.4%) patients experienced 50%-75% improvement; four (14.8%) patients experienced a less than 50% improvement. V1 involvement and a marked improvement within the first five sessions found to be good prognostic factors. Regarding age, sex, skin type, color and size of the PWS, no significant association with therapeutic response were detected. Blister and crust, atrophic macules, and hyperpigmentation were noted in six (22.2%), one (3.7%), and one (3.7%), respectively. In conclusion, 595-nm PDL looks an effective and relatively safe therapeutic approach in the treatment of Iranian pediatric PWS patients. [ABSTRACT FROM AUTHOR]

Lichen planopilaris (LPP) is an immune-mediated cicatricial alopecia. The main clinical presentations of LPP include classic form, frontal fibrosing alopecia (FFA), and Graham–Little–Piccardi–Lassueur syndrome (GLPLS). We reviewed medical records of all 291 patients diagnosied with LPP from 2006 to 2017 in Department of Dermatology, Tehran University of Medical Sciences. LPP was more common in women than men. Lichen planus (LP) was seen in 59 of patients (20.3%). Parietal lesions (69.75%), frontal (27.14%), occipital (23.71%), and temporal (21.64%) were frequently seen in LPP patients. However, trunk hair involvement (15.4% vs. 2.7%; p =.011) and eyebrow involvement (57.7% vs. 0%; p <.0001) were high in FFA patients. The response rates of cyclosporine (CSP) and methotrexate (MTX) were highest, 100% and 85%, respectively. Those treated with CSP achieved partial remission (PR) and complete remission (CR) faster than MTX-treated group. Moreover, MTX was more effective than MMF but not different in time to reach PR (p =.23) or CR (p =.56). However, CSP and MTX were less safe compared with MMF. 5-alpha reductase inhibitors, systemic retinoids (isotretinoin) or their combination were the most effective therapeutic options for FFA patients. [ABSTRACT FROM AUTHOR]