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Background. Warts are a common skin disease affecting individuals of all ages worldwide. This clinical trial aims to compare the effectiveness of furosemide 0.125 percent topical gel and KOH 10 percent topical gel in treating patients with warts. Methods. Patients diagnosed with warts by dermatologists were included in the study and treated with either 0.125 percent furosemide or 10 percent KOH for two months. Patients were examined and imaged at the beginning of the study and in weeks 4 and 8 to assess the number, diameter, and height of warts and complications. Results. The study included 40 patients (48 lesions) with common warts, with 20 patients in each intervention group. In the furosemide group, the average diameter of warts decreased from 4.25 ± 1.43 mm in the first visit to 4.14 ± 1.47 mm in the final visit. In contrast, the average diameter of warts in the KOH group decreased from 3.89 ± 1.67 mm to 3.02 ± 1.49 mm. No complications were reported in the furosemide group, whereas seven complications related to redness and burning were observed in the KOH group. Conclusion. Furosemide 0.125 percent is effective and safe for treating skin warts. However, it is less effective than KOH in reducing the diameter and height of warts. This study's findings suggest that furosemide can be a promising alternative to KOH in treating warts, especially for patients with sensitive skin or those who experience complications with KOH treatment. Further research is needed to determine the optimal treatment duration and dosage of furosemide for treating warts. Practical Implications. We can find new ways to reduce complications in treating warts. [ABSTRACT FROM AUTHOR]

Background: Cutaneous leishmaniasis (CL) is a parasitic disease that presents a broad spectrum of clinical features. Treatment of CL is problematic. We aimed to compare the field therapeutic efficacy of topical nanoliposomes containing 0.4% amphotericin B (Nano Lip-AmB) alone and in combination with cryotherapy and/or Glucantime® on human CL in the endemic areas of Iran. Methods: This retrospective study was performed based on the results of using Nano Lip-AmB alone or with Glucantime® and/or cryotherapy in the treatment of zoonotic cutaneous leishmaniasis (ZCL) in patients referred to health centers of Isfahan, Golestan and Ilam Provinces of Iran as endemic foci of ZCL caused by Leishmania major besides Mashhad and Bam cities as endemic foci of anthroponotic cutaneous leishmaniasis (ACL) caused by with L. tropica. Results: Two hundred and seventy-eight patients with CL were included in the current study. All of the patients (100%) who received Nano Lip-AmB alone or in combination with Glucantime® and/or cryotherapy based on guideline of Iranian national committee for the treatment of CL. Two patients with 7 skin lesions, who was resident in ACL endemic area and received Nano Lip-AmB plus Glucantime® and another patient was a resident of ZCL endemic area and received Nano Lip-AmB plus cryotherapy showed clinical relapses after treatment. Conclusion: Sina Ampholeish® in combination with other standard protocols of treatment of CL is well tolerated and with acceptable clinical efficacy rate. [ABSTRACT FROM AUTHOR]

Background: Current strategies to control pain and anxiety of chest tube removal are not efficacious. The aim of this study is to determine the effects of cold therapy and respiratory relaxation exercise on pain and anxiety of chest tube removal. Materials and Methods: A parallel single-blind clinical trial study was conducted in Imam Khomeini Hospital, Iran, on 120 patients. Participants were randomized into 4 groups of 30. Numeric Rating Scale was used to assess pain and anxiety. One-way ANOVA test and Fisher's exact test were used to analyze demographic data. The Kruskal–Wallis test was used to compare the severity of pain and anxiety between groups; the Friedman and Mann–Whitney test were used to compare the severity of pain and anxiety within groups with a significance level of 0.05. Results: Pain intensity was weak before chest tube removal and there was no significant difference in basal pain. Pain immediately after chest tube removal was significantly higher than other times in each group (χ2 = 57.16, χ2 = 63.70, χ2 = 46.49, χ2 = 59.04, df = 3, p < 0.001). There was no significant difference in pain score immediately (p = 0.052) and 15 min (p = 0.329) after Echest tube removal in experimental groups compared to the control group. No significant difference was found between control and experimental groups in anxiety score immediately (p = 0.995) and 15 min (p = 0.976) before chest tube removal. Conclusions: Mentioned methods were not effective in reducing pain and anxiety. It is suggested to investigate effects of different methods of removing chest tubes and applying cold with a larger sample size. [ABSTRACT FROM AUTHOR]

Background: Leishmaniasis is a parasitic infection that may lead to a variety of manifestations. In Iran, cutaneous leishmaniasis (CL) has a high prevalence. There are many treatment modalities for CL. The use of oral terbinafine in the treatment of CL has recently been considered. The aim of this study was to compare combination of oral terbinafine plus cryotherapy versus systemic meglumine antimoniate plus cryotherapy in CL. Methods: Patients with proven direct smear for CL were divided randomly in 2 groups of 40 cases. For the first group systemic glucantime prescribed (IM, 15 mg/kg/day) for 3 weeks. For the second group oral terbinafine as two folds of usual dose in the treatment of fungal diseases prescribed [125 mg/day for body weight (BW) <20 kg, 250 mg/day for BW 20-40 kg, 500 mg/day for BW>40 kg] for 4 weeks. Both groups received cryotherapy every 2 weeks for 4 weeks. The patients were followed monthly for 3 months after the treatment. Results: Partial (HR= 0.55, CI 95%= 0.3-1.1) and complete (HR= 0.53, CI 95%= 0.3-0.98) clinical improvement in terbinafine group was much slower than glucantime group, although at the end of treatment protocols no significant difference between groups were statistically observed (P=0.27). Conclusion: Considering more convenient suitable route of administration and approximately comparable results, it seems that terbinafine can be used as an alternative treatment, especially in the case of allergy or resistance to systemic glucantime. [ABSTRACT FROM AUTHOR]

Objectives: Genital wart is a sexually transmitted disease caused by human papillomavirus (HPV) and is responsible for discomfort, and decreased quality of life and productivity in victims with a high recurrence rate after treatments. This study aimed to compare the efficacy and safety of formaldehyde 5% with cryotherapy for the treatment of female genital warts. Methods: Eighty women with at least two similar genital warts who visited the outpatient dermatology clinic of Shahid Faghihi hospital, Shiraz, Iran, were enrolled in this study. One lesion of each patient was self-treated with formaldehyde 5% in flexible collodion gel once daily for 28 days and the other matched lesion was treated by weekly repeated cryotherapy courses. The number of eradicated lesions and the mean days needed to treat, pain scores, complications and patient satisfaction were compared between the treatment methods. Results: Complete clearance of lesions was observed in 58.7% of formaldehyde-treated lesions compared to 88.7% for cryotherapy (P value = 0.000). With formaldehyde-treated lesions, 51% complained of pain, 36.3% had pruritus, 86.3% had skin dryness, 88.8% complained of burning sensation and 93.7% showed erythema. In the cryotherapy group, 92.5% complained of pain, 15% had burning sensation, 75% showed erythema, 5% had atrophy, 80% developed post-inflammatory hyper or hypopigmentation (PIH) and 92.5% suffered from ulceration. Seventy-five (93%) found it easy to apply and (47) 58% were satisfied with their treatment results. Conclusions: Self-administration of formaldehyde 5% resulted in a lower clearance rate but had better cosmetic outcomes with lower pain scores compared to cryotherapy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of cryotherapy on pain scores and satisfaction levels of patients during cataract surgery under topical anesthesia. Eighty patients aged between 55 and 75 years scheduled for cataract surgery were randomly allocated to two study groups to receive topical anesthesia with cryotherapy (TC) or topical anesthesia alone (T) groups. Visual analog pain scores, patient satisfaction level, hemodynamic parameters, and quality of operating conditions were recorded., Results: Cryotherapy significantly reduced VAS pain scores during surgery (P = 0.014). Although no significant difference in postoperative pain scores, opioid consumption, heart rate, and mean arterial blood pressure was seen in the postoperative period. The surgeon reported better quality of operating conditions in the TC group (P = 0.018). Cryotherapy as a complementary method with topical anesthesia reduced pain scores of patients during surgery. It also produced a better quality of operating conditions for surgeons. There was no significant difference in either postoperative pain scores or opioid consumption. Trial registration This trial was registered at Iranian clinical trial registering: IRCT registration number: IRCT2017052734091N2., (© 2022. The Author(s).)

BACKGROUND: Naevus of Ota is seen infrequently among Iranian individuals with a Mediterranean complexion. OBJECTIVE: Treatment of Ota's naevus by closed contact CO[sub 2] cryotherapy. PATIENTS AND METHODS: Four patients, three female and one male, were enrolled in this study. A closed contact CO[sub 2] cryogun with a round, flat-topped cryoprobe was preferred because of its easy control and monitoring. A small area was tested first to assure the patients of the procedure's effect and its lack of complications. At 6-8 weeks later when the patients returned with a hypopigmented patch the lesions were totally frozen or were sectioned first for the cases with extensive diameters. The procedure was repeated every 6–8 weeks until there was an acceptable colour match of the lesion with normal skin. RESULTS: Oedema and wheal developed soon after freezing. Oedema may lead to crust formation and less likely to bullae within 24–48 h, with the crust peeling 5–7 days later, leaving an erythematous area gradually followed by a hypopigmented patch. Three to five and occasionally more sessions may be required for full and acceptable colour matching. No permanent complications were seen. CONCLUSION: Cryotherapy is a cheap and safe method that can be used as an alternative method for the treatment of naevus of Ota. [ABSTRACT FROM AUTHOR]

Bleomycin is an antineoplastic agent, which is used off label for various dermatologic conditions. There are numerous reports on the use of intralesional bleomycin (ILB) for the treatment of common warts. However, reports on the efficacy of bleomycin in the treatment of anogenital warts (AGWs) are still limited. The aim is to compare the efficacy/tolerability and recurrence rates of AGW treatment with ILB versus cryotherapy. In this prospective study, 50 patients with AGWs were assigned either to receive triple freeze-thaw cycle of cryotherapy or to receive 1.5 mg/mL ILB for a maximum of four sessions with 3-week intervals. Clinical efficacy was determined by the percentage of the patients with complete clearance. The patients with complete clearance were visited by passing 3 months from the last treatment session to evaluate any recurrence. Of 44 patients completing the study, 16 of 21 (76.19%) patients in the ILB group and 15 of 23 (65.22%) patients in the cryotherapy group showed complete resolution ( p value = .425). Moreover, recurrence occurred after 3 months in 18.75% and 46.66% of the ILB and the cryotherapy groups' patients, respectively ( p value = .096). The most common local adverse events in both treatment groups were pain, dyspigmentation, and ulceration/erosion, while the delayed ulceration and secondary infection were only observed in the bleomycin group. Intralesional bleomycin is as effective as cryotherapy in the treatment of AGWs, but it is more invasive and associated with post-treatment pain, the delayed ulceration, and cutaneous infection. Intralesional bleomycin is not accompanied with the major risk of necrosis or fibrosis, so the use of ILB in the anogenital area is likely to be safe.This clinical trial was registered in Iranian Registry of Clinical Trials site with code: IRCT20190519043631N1.

Background: Old World cutaneous leishmaniasis (OWCL) is endemic in Iran and most cases of cutaneous leishmaniasis (CL) are caused by Leishmania major , and then Leishmania tropica, and rarely by Leishmania infantum ., Objective: We aimed to describe clinical variants of OWCL and their treatments., Method: Through literature search in PubMed, Scopus and Embase and google scholar, we have found articles about variant clinical pictures of OWCL and their treatments., Results: The following clinical variants of OWCL namely; localized forms, zosteriform, erysipeloid, eczematoid, warty, localized Leishmania lymphadenitis, sporotrichoid, hyperkeratotic, impetiginized, mucosal involvement in CL, lupoid leishmaniasis, chronic lesions due to leishmanization, disseminated cutaneous leishmaniasis, reactivation of CL after transplantation and coexistence of CL with other diseases, are reported from Iran. The mainstay of therapy remains pentavalent antimonial compounds and cryotherapy is an adjuvant to therapy. Treatment with antifungal agents, miltefosine, amphotericin B and herbal extract such as ZH-E have also been used. Treatment of CL in chronic cases and in immunosuppressed patients is difficult and relapse may occur., Conclusion: In clinical variants of CL with long duration and multiple lesions, systemic pentavalent antimonial compounds are first step of therapy. In case of incomplete response or resistant to classic treatment, combination therapy is indicated.

Objective: The aim of this study was to evaluate the epidemiology, clinical presentation and types of treatment of cutaneous leishmaniasis (CL) in the province of Ilam (Western Iran) in 5 years (from May 2013 to January 2018). This cross-sectional study involved patients diagnosed with CL who were referred to Mehran City Health center., Methods: All patients were diagnosed by clinical and parasitological (Giemsa staining of lesion to observe the parasite) methods. Moreover, a structured questionnaire on demographic data including age, sex, occupation, number and site of the lesions, treatment regimen was administered to each case., Results: In total, 2001 positive CL cases were observed in this study. The highest prevalence of CL was reported in the autumn season and mainly among male subjects residing in urban communities. The prevalence of CL varied with the age group: higher in the age group of 1-10 years than other groups. Besides, hands and faces were the most affected regions of the body. Most of the cases (47.35%) were managed by topical treatment (glucantime) and cryotherapy followed by systemic treatment (pentavalent antimony) 26.85%., Conclusions: The prevalence of disease varied with age, increasing the prevalence rate in children due to their habitats, the highest prevalence in autumn due to climatic conditions. These findings help to better discuss the prevention and treatment of infections.

Plantar warts can cause pain near the toes and the sole of the foot and may result in referral for treatment. This study was aimed at comparing 40% trichloroacetic acid (TCA) and cryotherapy (Cryo) for the treatment of plantar warts. This single-blind, randomized clinical trial was performed on 60 subjects presenting with plantar wart in Sabzevar, Iran in 2018. The first intervention group was treated with 40% TCA in four sessions within 4 weeks. The second intervention group was treated with Cryo using liquid nitrogen in four sessions within 8 weeks. The mean (SD) age of subjects was 20.16 ± 5.96 years and 68.33% (n = 41) were male. Although the resolution rate of warts in the TCA 40% group was greater than the Cryo group, there was no statistical association found between the two groups by adjusting age, sex, and basal time (P = .648). Findings suggest that although 40% TCA was almost as effective as Cryo in the treatment of plantar warts, considering the lower adverse effects of TCA 40% group as compared to the Cryo group, it could be a proper alternative., (© 2020 Wiley Periodicals LLC.)

Objective: Cutaneous leishmaniasis (CL) is one of the common parasitic diseases in tropical and subtropical areas and is one of the important health problems in Iran. In order to investigate epidemiological aspects of CL disease in city of Aran va Bidgol in Isfahan province, this study was carried out in this central region of Iran., Methods: This cross-sectional study was conducted in over a period of eight years between 2009-2016. Direct smears were prepared from all patients and were examined by a light microscopy. The basic demographic and clinical data of patients with CL disease referred to health care centers were collected and then were analyzed by using the SPSS software., Results: Overall, 926 patients, including 542 (58.5%) males and 384 (41.5%) females with confirmed CL were identified. The CL disease was more common among males (58.5%). The highest and lowest incidence of the CL disease were estimated as 238.5 and 44.2 per 100000 people in 2009 and 2016, respectively. The highest incidence of the CL disease (26.3%) was observed in the age group of 0-9 years. Most of the cases (54%) were seen in autumn. More lesions (44.7%) were seen on the hands. Of the patients, 65.4% were treated by systemic glucantime regimen., Conclusion: According to the results of this investigation, although there is a trend of decrease in the incidence of the CL disease in this 8-year period, incidence of the CL disease is still high. This is an alarming condition and careful planning for control and prevention of the disease is highly recommended.