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The article focuses on assessing whether sites of primary lesions in pemphigus vulgaris (PV) are more susceptible to relapse. It identifies the anatomical locations where initial lesions occur and determines if these same sites are more likely to experience relapses. It suggests that tissue-resident memory T cells may play a significant role in this phenomenon, potentially explaining why certain sites are recurrently affected.

Evaluation and monitoring of pemphigus vulgaris (PV) typically involve autoantibody detection by enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence (IIF). We aimed to determine the levels of antipemphigus immunoglobulin (Ig) G autoantibodies using ELISA and IIF (as standard biomarkers), and compare it to prolactin, macrophage migration inhibitory factor (MIF), and Creactive protein (CRP) (as nonstandard biomarkers) to determine which of these non-standard biomarkers is appropriate for PV monitoring. The experiment was performed before and during therapy. Anti-Dsg immunoglobulin G autoantibodies were measured using ELISA and IIF (as standard biomarkers) versus prolactin, MIF, and CRP (nonstandard), before 1 and 3 months after the treatment. Before beginning the treatment, the severity of the disease was determined using the pemphigus disease area Index (PDAI). We enrolled 60 newly diagnosed patients with PV (32 men and 28 women; mean age=43.8±14.2 years). Before treatment, the levels of anti-Dsg1, anti-Dsg3, and IIF were high and had a significant relationship with PDAI. PDAI also had a connection with the levels of CRP and prolactin. The anti-Dsg1, anti-Dsg3, IIF, and CRP titers decreased in patients treated with conventional (prednisolone plus azathioprine) and rituximab therapy during and after treatment. In conclusion, anti-Dsg1, anti-Dsg3, and IIF autoantibody titers remain standard biomarkers for assessing disease activity, severity, and PV monitoring. The trend of CRP was similar to that of anti-Dsg1, anti-Dsg3, and IIF. Thus, CRP may be used for PV monitoring. [ABSTRACT FROM AUTHOR]

Background: Rituximab is widely used for treatment of pemphigus patients. B‐cell activating factor (BAFF) and a proliferation‐inducing ligand (APRIL) play key roles in B cell survival, maturation, and differentiation. Here, the effect of rituximab on BAFF and APRIL in patients with pemphigus vulgaris (PV) was studied. Methods: Fifty PV cases and 56 healthy individuals were recruited. Patients received rituximab for a period of 6 months. The levels of BAFF and APRIL were measured in the serum samples. The frequency of CD19+ B cells was measured by flow cytometry. Results: The level of BAFF was significantly higher in the patients at the baseline level than controls (P = 0.0005). The level of BAFF was significantly higher at the 3rd month follow‐up compared to the baseline (P = 0.033). There was a significant increase in the BAFF level at the 6th month follow‐up compared to baseline (P = 0.0134). There was no significant difference in the CD19+ B cells/total lymphocytes ratio in the PV patients between the 3rd and 6th month follow‐ups. Conclusions: Elevated BAFF in the sera could be associated with PV immunopathogenesis. Inhibition of BAFF after rituximab therapy might interfere with repopulation of B cells and confer a therapeutic approach in PV. [ABSTRACT FROM AUTHOR]

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 and Aim: Integrons play an essential role in disseminating drug resistance genes among bacteria. The aim of this study was to determine the prevalence of integrons, and Extended-Spectrum β-Lactamase (ESBL) genes in Escherichia coli (E. coli) isolates collected from patients with urinary tract infection (UTI) referred to teaching hospitals in Ardabil, Iran. Materials and Methods: In this descriptive, cross-sectional study (2017-2018), 163 isolates of E.coli were collected from patients with UTI. The drug susceptibility pattern of these isolates to 12 common antibiotics was investigated using the disk diffusion method based on CLSI guidelines. The prevalence of class 1, 2,3 integrons and ESBL genes was verified by the PCR method. Finally, the genetic variation of isolates was analyzed using the ERIC-PCR method. Results: Of 163 isolates, 138 (84.7%) isolates were multidrug-resistance (MDR) strains. The lowest and highest antibiotic resistance was reported to nitrofurantoin and ampicillin, with a resistance rate of 1.2% and 89.6%, respectively. The incidence of class 1 and 2 integrons was obtained in 39.9% and 14.1% of the isolates, respectively. Class 3 integron was not found in any of the isolates. Based on the ERIC-PCR fingerprinting method, 4 ERIC types were detected. Conclusion: Our study showed that E. coli isolates taken from patients mainly were MDR strain and resistant to many of the common antibiotics used to treat urinary tract infections. Using the correct dose of medication and multidrug therapy would be effective in reducing the incidence of antibiotic resistance. [ABSTRACT FROM AUTHOR]

Background: Port Wine Stain (PWS) is a congenital capillary malformation. Although multiple treatments are required, the gold standard treatment for PWS is Pulsed Dye Laser (PDL). Given its anti‐angiogenic effects, sirolimus can be considered as an adjuvant to PDL in PWS. Aim: To evaluate the efficacy and safety of topical sirolimus (Rapamycin) 0.2% cream as adjuvant therapy for PDL for PWS. Methods: In this randomized double‐blind placebo‐controlled trial, 15 patients with PWS were enrolled. Each lesion was divided into upper and lower parts, and each part was assigned randomly to receive PDL (4 sessions, 2 months apart) plus sirolimus vs PDL and placebo. The response was evaluated using colorimetry, investigator global assessment (IGA), and patient global assessment (PGA) every two months for eight continuous months. Results: According to the colorimetric analysis, medial and lateral sides of the treatment and placebo parts did not differ significantly (both P‐value >.05). However, according to PGA and IGA, there was a significant difference in favor of sirolimus (P‐values =.041 and.039, respectively). Itching and dryness (86.7%), contact dermatitis (20%) were the most common adverse effects in the sirolimus group, while none of them were observed in placebo. Conclusion: Although the improvement was significant subjectively, topical sirolimus 0.2% as an adjuvant to PDL does not appear to improve PWS erythema using calorimetric assessment. [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]