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BACKGROUND Surgical management of hair loss has become an increasingly challenging procedure, when dealing with scar alopecia. We investigated the efficacy of hair transplantation in patients with head and neck scar alopecia. METHODS From 2016 to 2018 in Shiraz, Iran, all patients with scar alopecia in head and neck were evaluated for efficacy of follicular unit extraction (FUE), follicular unit transplantation (FUT) or a combination of two methods from donor sites in scalp and beard various hair-grafts were compared. RESULTS Fifty-six patients were enrolled. Most of them were between 31 and 40 yr old (48.3%) and male (71.4%). Trauma, burn, surgical excision of adjacent skin, radiotherapy and leishmaniasis were the registered causes. Scars were visible in scalp (39.3%), beard (28.6%), eyebrow (21.4%), and moustache (10.7%) regions. FUE (87.5%), FUT (10.7%) and a combination (1.8%) were the used methods. One-hair-grafts were used in eyebrows (100%), moustache (100%), beard (88%) and scalp (7.9%), while 2-hair-grafts in beard (6%) and scalp (47.4%) and 3-haired grafts in beard (6%) and scalp (44.7%) transplantations. CONCLUSION In head and neck scar alopecia, hair transplantation was selected based on type and depth of scar. FUE was targeted when huge grafts were not needed, including beard, moustache, and eyebrow, while FIT was used when extensive scars were present in scalp. One-hair-grafts were mostly applied for eyebrow, moustache and beard, 2-hair- and 3-hair- grafts for beard and scalp transplantation. These findings can be added to the literature when FUE, FIT, or their combination are targeted in hair restoration of scar alopecia in head and neck.

Purpose Vitiligo is an acquired hypopigmentation condition in which well-defined macules can develop virtually everywhere on the patients' skin. This analytic case-control study was conducted in Faghihi Hospital outpatient dermatology clinic, affiliated to Shiraz University of Medical Sciences, southern Iran from June to September 2019. Furthermore, we studied the relationship of hypertension with activity, age of onset, duration, affected body surface area and type of vitiligo. Patients and methods In the current case-control study, 166 individuals were enrolled in total (the case group was comprised of 83 vitiligo patients and 83 individuals actedas control group). The case group was made up of vitiligo patients (both segmental and non-segmental) between 20 and 50 years of age, no prior history of systemic disease and other hypopigmentation disorders, while individuals with any form of dermatologic findings were excluded from the control group. Individuals aged younger than 20 years old or older than 50, having a dermatologic disease other than vitiligo, being afflicted with the diseases which may lead to secondary hypertension, pregnancy, taking substances, and medication which can lead to hypertension were chosen as the exclusion criteria in this study. Results Data obtained from our study revealed that vitiligo patients had a higher prevalence of essential hypertension diagnosis than the control group (P=0.040). Also, no significant relationship was found between patients' age at the first lesion appearance (P=0.856), duration of vitiligo involvement (P=0.497), and percentage of vitiligo involvement (P=0.681) with hypertension. Conclusion According to our results, vitiligo patients were more susceptible to hypertension while no association could be found between characteristics of the disease and rise in blood pressure.

Background: Acne vulgaris is a common inflammatory disease of the pilosebaceous follicle thataffects many teenagers and young people. There is an obvious need for topical treatments with goodtolerability and efficacy for the management of acne lesions. Objective: This study determined the therapeutic efficacy of topical sodium hypochlorite solution(0.005%) in the treatment of mild to moderate acne lesions. Methods: This placebo-controlled randomized controlled trial compared 0.005% sodium hypochloriteto placebo administered topically on each side of the patients’ faces 3 times a day for 1 month. Thenumbers of papules and pustules were recorded at baseline, 1, 2 and 4 weeks after initiation. Results: The total number of papules and pustules decreased after topical application of sodiumhypochlorite 0.005% for 1 month. Conclusions: Topical sodium hypochlorite solution (0.005%) can be effective in the treatment of mildto moderate acne, and its clinical efficacy was evaluated between the male and female groups andbetween the hormonal and non-hormonal ones. Trial registration: Our study was registered in the Iranian Registry of Clinical Trials (IRCT) with thecode number IRCT20200701047976N1.

Ellagic acid (2,3,7,8-tetrahydroxy-chromeno[5,4,3-cde]chromene-5,10-dione) is a polyphenol found in several fruits. We think that it can be effective in the treatment of COVID-19 .

Estimating population counts for multidimensional tables based on a representative sample subject to known marginal population counts is not only important in survey sampling but is also an integral part of standard methods for simulating area-specific synthetic populations. In this article several estimation methods are reviewed, with particular focus on the iterative proportional fitting procedure and the maximum likelihood method. The performance of these methods is investigated in a simulation study for multidimensional tables, as previous studies are limited to 2 by 2 tables. The data are generated under random sampling but also under misspecification models, for which sample and target populations differ systematically. The empirical results show that simple adjustments can lead to more efficient estimators, but generally, at the expense of increased bias. The adjustments also generally improve coverage of the confidence intervals. The methods discussed in this article along with standard error estimators, are made freely available in the R package mipfp. As an illustration, the methods are applied to the 2011 Australian census data available for the Illawarra Region in order to obtain estimates for the desired three-way table for age by sex by family type with known marginal tables for age by sex and for family type.

Background: Cutaneous Squamous Cell Carcinoma (cSCC) is an invasive primary cutaneous malignancy and the second common cancer among whites. Objectives: To define the frequency and epidemiologic features of cSCC. Methods: This study was carried out on 311 patients referred to the Department of Dermatology at Faghihi Hospital of Shiraz, Southwest Iran, between 2015 - 2016. cSCC was diagnosed by pathologists using the standard criteria. The reports were collected along with general information such as age, sex, location, type, and depth of invasion; then it was analyzed by using the statistical software known as SPSS version 23.0 and Minitab software version 18. Chi-square test was used to evaluate the statistical significance. A P value lower than 0.05 was considered as significant. Results: The age range of patients was 21 - 95 years old with an average age of 67.63. The sex ratio (male to female) was 2.87 for the total number of cases. The most common stage was well differentiation 97 (31.2%). The most frequent tumor thickness was between two to four millimeters and the most frequent lesion locations were the nose and then the scalp. Conclusions: The frequency of cSCC increased over the years in regards to patients that were referred to the Faghihi Hospital. This results along with other data which are available from other hospitals and medical centers confirm that the frequency of cSCC is increasing in Iran and plan for management of cSCC is essential, nationally.

Contact dermatitis is a common complication in prosthetic limb users. There are no effective, available and cheap treatments for skin problems of these patients. In traditional Iranian medicine, henna (Lawsonia inermis L.) is a plant that has anti-inflammatory, antimicrobial and skin-enhancing properties, all of which are beneficial for people with artificial limbs. The aim of this study was to assess the efficacy of a topical henna preparation in management of contact dermatitis in patients using lower limb prosthetics.The current randomized, double-blind, placebo-controlled clinical trial was conducted on ninety-five participants with lower extremity amputation using limb prosthetics, aged 12-70 years who complained of contact dermatitis. They were randomly assigned to receive either two weeks of topical henna preparation every night as the intervention group, or topical placebo as the control group. Participants were instructed to spread henna preparation on the surfaces of the amputated limb that were in contact with the prosthesis. Severity of contact dermatitis symptoms was set as the primary outcome measure. Edema, papules and erythema were evaluated by a physician using standard color atlas. Secondary outcomes included symptoms such as burning, itching, pain, thickness and skin sweating evaluated by a self-administered questionnaire.A significant improvement was observed in the symptoms of contact dermatitis including skin edema, itching, sweating, skin thinning and pain (p-value0.05) in the henna group compared to the placebo group. Skin burning decreased more in the henna group compared to the placebo group, but this was not statistically significant (p-value = 0.052). Moreover, skin redness significantly increased in the henna group (p-value = 0.001).Topical formulation of henna might be a complementary choice for improving contact dermatitis in patients using lower limb prosthetics.

Background Altered levels of sex hormones have been observed in many autoimmune disorders, but there is no considerable data about pemphigus. The aim of this study is to compare serum total and free prolactin and dehydroepiandrosterone sulfate (DHEAS) levels between patients with pemphigus and healthy controls and to determine the correlation of these hormones with disease severity. Methods This study included 52 newly diagnosed cases of pemphigus and 57 healthy controls. Serum prolactin (total and free) and DHEAS were measured in all subjects. Data analyses were performed using JMP, Version 7. Results Pemphigus patients had significantly higher levels of total and free serum prolactin (both P = 0.01) and lower levels of DHEAS (P = 0.005) than healthy controls. A significant association was found between severity of pemphigus and total prolactin levels (r = 0.40, P = 0.003). Conclusions The patients with pemphigus had higher total and free prolactin and lower DHEAS concentrations, and patients with more severe disease had higher levels of serum total prolactin. These new data may suggest a potential role for sex hormones in the pathogenesis of pemphigus disease and provide new insights for the better management of this chronic and life-threatening disease.

Liveability is a concept closely related to the notion of well-being and refers to the environmental conditions that contribute to the quality of life, alongside individual features. Subjective and objective measurements of liveability are both of considerable practical and theoretical importance. A survey is conducted in this paper by which individuals tend to shape their preferences according to six factors describing various aspects of living conditions: (1) home, (2) neighbourhood, (3) transport, (4) entertainment, (5) services and (6) work. The survey data helps us to work out some indicators representing the perceived liveability in the targeted areas. A linear mixed model is used to explore possible relationships between objective factors and perceived liveability. A model-based estimate of liveability index can be then calculated for each non-sampled individual based on his/her socio-demographic characteristics and area of living.

The long-term planning approach with its central aim of changing the urban form using zoning regulations and improving transportation may no longer be the only conceivable solution. Participants in planning and land development processes formulating plans today are predominantly land developers, entrepreneurs, and landlords. However, community groups are increasingly active participants, providing a counterbalance to the profit-driven agenda of corporations. Explores that landscape for current smart city development.

Summary If unit-level data are available, small area estimation (SAE) is usually based on models formulated at the unit level, but they are ultimately used to produce estimates at the area level and thus involve area-level inferences. This paper investigates the circumstances under which using an area-level model may be more effective. Linear mixed models (LMMs) fitted using different levels of data are applied in SAE to calculate synthetic estimators and empirical best linear unbiased predictors (EBLUPs). The performance of area-level models is compared with unit-level models when both individual and aggregate data are available. A key factor is whether there are substantial contextual effects. Ignoring these effects in unit-level working models can cause biased estimates of regression parameters. The contextual effects can be automatically accounted for in the area-level models. Using synthetic and EBLUP techniques, small area estimates based on different levels of LMMs are investigated in this paper by means of a simulation study.

Background: Pulse therapy is a type of systemic management in which large amounts of medications are administered to patients in short time and intervals (e.g. weekly) to get the stronger effects of medication sooner and avoid long term use of them. Objective: To determine how therapy-resistant dermatology diseases respond to oral minipulse steroids . Methods: Articles with Mesh terms "pulse therapy", "dermatology" and "steroid" were searched in PubMed database .we chose case reports and clinical randomized controlled trials on oral steroid minipulse therapies of dermatology diseases. Results: Most articles and case reports mentioned the successful treatment of refractory diseases like lichen planus, vitiligo and alopecia areata with oral mini -pulse steroids. Conclusions: Oral mini pulse has stronger beneficial effects and fewer side effects than daily systemic corticosteroids. Since it is administered twice weekly , patient compliance will be better. Therefore, oral corticosteroids minipulse can be a good alternative to daily systemic corticosteroids in dermatologic diseases. Egyptian Dermatology Online Journal Vol. 10 No 2: 1, December 2014 2 http://www.edoj.org.eg Introduction Corticosteroids have been used in dermatology since a long time ago. Pulse therapy is a type of systemic management in which large amounts of medications are administered to patients in short time and intervals (e.g. weekly) to get the stronger effects of medication sooner and avoid long term use of them [1]. Pulse steroid therapy was firstly used in a patient with renal allograft in 1969 [2]. Oral mini pulse (OMP) is a type of pulse steroid therapy which is given orally in intervals to patients[1]. It is more comfortable for patients to comply with than daily systemic steroid therapy [3]. Pasricha et al. [4] used OMP in the treatment vitiligo for the first time and later it was used in other dermatological conditions such as lichen planus, alopecia areata, nail dystrophy, infantile periocular hemangioma and etc. Our article is a short review about the clinical use of oral minipulse steroid in the treatment of different dermatological diseases to determine how therapy-resistant cases respond to oral steroid pulse therapy till now. Methods: We searched the PubMed data bank using the following MESH-terms: pulse therapy, steroid, dermatology. We limited our search for clinical trials and case reports on treating dermatologic refractory cases with only oral mini pulse steroids. We didn't have access to the most full articles so we used abstract forms of the articles. There were 7 case reports and 17 original articles found on oral minipulse therapy and dermatology diseases.

Acne vulgaris is a common inflammatory skin disorder which is recognizable by dermatological lesions and scars. In addition to some pathogenetic factors such as hyperkeratinization, upregulated sebum secretion, and immunoinflammatory reactions, recent studies have also connected oxidative stress to the pathogenesis of acne vulgaris. In this article, we will briefly review clinical studies that interrogated alterations in oxidative stress biomarkers by a systematic search conducted in PubMed, Web of Science, and Scopus using “acne”, “oxidative stress”, and “reactive oxygen species” keywords. Overall, studies have shown that oxidative biomarkers (e.g. lipid peroxidation final products) are higher in acne vulgaris lesions. A significant positive correlation has also been noted between acne severity and oxidative biomarkers. In contrast, diminished levels of antioxidant enzymes (e.g. superoxide dismutase and catalase) have been observed in acne. We propose four probable mechanisms for the role of reactive oxygen species (ROS) in acne pathogenesis. We believe that ROS can contribute significantly to the acne vulgaris pathobiology via toll-like receptor (TLR), peroxisome proliferator-activated receptor (PPAR), mTOR pathway, and innate immune system, resulting in inflammation by alterations in the generation of several proinflammatory cytokines including IL-1, IL-8, and TNF-a.[GMJ. 2019;8:e1291]

IntroductionSilymarin (SM), was reported to have anti-inflammatory and antioxidant activities and has been suggested as a positively effective agent on skin tissue regeneration and wound healing. In this study we aimed to determine the effect of topical administration of SM on stereological parameters of the wound healing process in rats.Material and methodsThirty six Wistar rats, with a 1cm2 full-thickness wound created on the posterior of their neck, were divided into three groups; the control group which received no treatment; the SM-treated group that received 2% SM-gel, and the gel-base treated group. At the end, full thickness skin samples from the wound site were obtained to determine volume density of collagen bundles, vessels, and hair follicles as well as fibroblast population, length density, vessel’s mean diameter, and wound closure rates by using unbiased stereological methods.ResultSM increased fibroblast proliferation, collagen bundle synthesis, hair follicle population and consequently wound closure in comparison to the gel-base and the control groups (P

Skin aging has received tremendous attention in recent years by both scientists and the lay public. This article reviews the evidence that homocysteine, an intermediary sulfhydryl-containing amino acid implicated in atherosclerosis, can accelerate skin aging and the aging of internal organs (universal aging).

Background. Uremic pruritus (UP) is still a common tormenting symptom among patients on hemodialysis (HD). The pathogenesis of UP is complex and not fully clarified. Some preliminary studies indicate that UP is a systemic inflammatory disease with a deranged balance of T helper (TH) cell differentiation toward TH1 predominance. The aim of this study was to further elucidate the potential contribution of TH1 cytokines to the pathogenesis of UP. Methods. In this study, 112 HD patients were screened for UP. After meeting the required criteria, 31 HD patients with UP were included in the study as case group and 30 age- and sex-matched HD patients without UP were enrolled as controls. The serum levels of interleukin (IL)-2 and interferon-c (as TH1 cytokines), IL-4 (as a TH-2 cytokine), high-sensitive C-reactive protein (as an inflammatory marker), parathyroid hormone, calcium, phosphate, albumin and ferritin were measured in all patients. Moreover, blood variables including hemoglobin and mean corpuscular volume were also determined. The correlations of measured factors with UP severity were determined as well. Results. Except for the serum levels of IL-2, which were significantly higher in HD patients with itch versus those without it [0.544 6 0.126 (U/mL) versus 0.318 6 0.145 (U/mL); P < 0.0001], no statistically significant difference was observed in the levels of each of the above-mentioned factors between the two groups. Additionally, no correlation was detected between the levels of measured factors and UP severity. Conclusions. The results of our study, for the first time, point to the potential important role of IL-2 in UP and further support the notion of TH1 overactivity in its pathogenesis. Our study paves the way for further studies focusing on the contribution of IL-2 to the UP, such as the experimental use of anti-IL-2 receptor antibodies.

Background Pemphigus vulgaris (PV) is a blistering autoimmune bullous disease that is usually fatal without proper treatment. There are no clear treatment guidelines for PV at this time. Purpose We suggest a standard treatment regimen for patients with PV based on the success of our treatment. Methods A retrospective chart review of 18 patients with PV was conducted to assess response to a similar approach using mycophenolate mofetil (MMF) and prednisone. Diagnosis was confirmed through routine histology, direct immunofluorescence, and indirect immunofluorescence, and patients were followed up for a total average of 35.2 months. Results We achieved complete disease control in 89% of patients using our treatment algorithm. Fourteen of 18 patients achieved complete disease control on therapy with prednisone and MMF. Three of the 4 patients who did not achieve control on MMF and prednisone went on to receive rituximab therapy, and two of those patients achieved disease control on rituximab. The average length of time from initiating therapy to 75% clearance of lesions was 4.5 months. Three of 18 patients were able to discontinue therapy after an average of 3 years and have remained in complete remission for more than 1 year. Limitations This was a retrospective chart review with a small patient sample size. Conclusions The combination therapy of MMF and prednisone is an effective treatment regimen to achieve rapid and complete control of PV. For those patients who fail treatment with MMF and prednisone, rituximab is an efficacious alternative therapy.

Statins are competitive inhibitors of 3-hydroxy-3-methylyglutaryl-coenzyme A reductase and reduce low-density lipoprotein-C levels. Statins are well-tolerated drugs used for prevention of atherosclerosis and cardiovascular events. Statins possess anti-inflammatory, immunomodulatory, antioxidant, metabolic, and possible anticancer effects. Statins are reported to be effective against psoriasis, dermatitis, graft-versus-host disease, uremic pruritus, vitiligo, and hirsutism. Topical forms of statins are employed in the treatment of acne, seborrhea, rosacea, and rhinophyma. Animal studies show the beneficial effect of statins against contact dermatitis and wound healing. They have promising anti-HIV effects as well. This article succinctly reviews the various cellular and molecular effects of statins, their applications in cutaneous medicine and their side effects.

Fetal wound healing occurs rapidly and without scar formation early in gestation. Studying the mechanisms of scarless repair can lead to novel scar-preventive approaches. In fetal wounds, collagen is deposited early and is fine and reticular with less cross-linking. Several important differences of fetal vs. postgestational wound-healing response have been determined, such as the presence of less inflammation, higher hyaluronic acid concentration and a greater ratio of collagen type III to type I. Compared with typical wounds, there are also altered ratios of signaling molecules, such as higher ratios of transforming growth factor (TGF)-β3 to TGF-β1 and -β2, and matrix metalloproteinases to tissue inhibitors of metalloproteinases. Furthermore, fetal fibroblasts do not exhibit TGF-β1-induced collagen production compared with their mature counterparts. Patterning genes (homeobox genes) involved in organogenesis are more active in the fetal period and are believed to be the "first domino" in the fetal cutaneous wound repair regulatory cascade. The recommended scar-preventive agents, such as Scarguard MD®, silicone gel and sheet, Seprafilm® Bioresorbable Membrane, topical hyaluronan, onion extract, oral tamoxifen and 585-nm pulsed dye laser are reviewed in this study. Despite the lack of supporting evidence, there is a widespread false presumption that the acceleration of healing with the widely assumed scar-preventive commercial agents is associated with decreased scar formation. Humans are erroneously inclined to make a negative correlation between the healing rate and the degree of scar formation, while such a correlation does not exist in reality. Despite the importance of scar prevention, no FDA-approved therapy for this purpose is available in the 21st century, which reflects the important challenges, such as the presence of redundant pathways, that these approaches are facing.