Evaluation of PSP technique including dot peeling, subcision and intradermal injection of PRP in the treatment of atrophic post‐acne scars

Background Atrophic post‐acne scars are common complications of acne. Many modalities are proposed, but each does not yield satisfactory clinical outcomes. To evaluate the therapeutic effect of PSP technique including dot peeling, subcision and intradermal injection of autologous platelet‐rich plasma (PRP) for the treatment of atrophic post‐acne scars. Patients and Methods Twenty patients with different types of atrophic acne scars on the face were included. All patients received PSP technique in the form of dot peeling, then after 2 weeks, subcision and intradermal PRP injection were done simultaneously. PSP technique was performed for each patient every month for 3 months. Results After 3 months of the last session, 30% of 20 patients had excellent improvement, 20% of patients had good improvement, 20% of patients had moderate improvement, and 30% of patients had mild improvement. There was statistically significant difference after treatment ( p  ≤ .001). Side effects were mild and tolerable and included erythema, ecchymosis, and hyperpigmentation. All types of scars showed significant improvement with no significant difference between them. Conclusion PSP technique was found to be a safe and cost‐effective treatment option for atrophic acne scars.

Efficacy of topical latanoprost in the treatment of eyelid vitiligo: A randomized, double‐blind clinical trial study

Numerous studies have demonstrated that the pigmentation of iris and around the eyelid is a common side effect of latanoprost, a prostaglandin F2alpha analogue used in the treatment of glaucoma. Hence, the authors decided to study the effectiveness of topical latanoprost on vitiligo patches around the eyelid. In this randomized, double‐blind, clinical trial study, 31 patients with vitiligo vulgaris and focal vitiligo involving the eyelids were evaluated. Patients were randomly divided into two groups. First group received topical latanoprost gel twice daily for 12 weeks, whereas the second group received placebo with the same protocol. To evaluate severity of the disease the VIDA rating system was used. Serial photos of the patches were taken to compare and evaluate the repigmentation percentage of the patches. The patients in both groups had almost similar VIDA score ( p > .05). First group showed improved pigmentation, whereas participants in the second group did not show any improvement in the pigmentation. The group treated with latanoprost showed significant reduction in the symptoms of the disease, whereas those treated with placebo did not show any alteration ( p > .05). No significant complications were observed in either groups. Latanoprost proved effective in treating vitiligo disease involving eyelids.

Basilaphelenchus gorganensis n. sp. (Aphelenchoidea, Tylaphelenchinae) from wood from northern Iran

Basilaphelenchus gorganensis n. sp. is described and illustrated from wood and bark of a dead tree from northern Iran. The new species is characterized by female body length (415–559 µm), three‐lined lateral fields, a sclerotized cephalic vestibule and cephalic framework, thin stylet with three elongate backwardly directed knobs, small spherical to oval metacorpus, with small and posteriorly located valve, simple vulva without any flap apparatus, 59‐ to 79‐µm‐long post‐vulval uterine sac, functional rectum and anus and dorsally convex, ventrally concave, usually ventrally bent conical female tail with a sharp tip. Males are common, apparently functional and characterized by well‐curved spicules, three pairs of small caudal papillae and no bursa at tail tip. Molecular phylogenetic inferences using partial sequences of small and large subunit ribosomal RNA genes (SSU and LSU rDNA) from different isolates of the new species revealed it differs from currently sequenced species and belongs to the Tylaphelenchinae clade.

Expression analysis of PD‐1 and Tim‐3 immune checkpoint receptors in patients with vitiligo; positive association with disease activity

The contribution of immune checkpoint receptors in the immunopathogenesis of various autoimmune diseases has been addressed in previous reports. In this study,  the expression profile of T‐cell immunoglobulin and mucin‐domain containing‐3 (Tim‐3) and programmed cell death‐1 (PD‐1) checkpoint molecules was investigated in CD8 + T cells of Vitiligo patients. The association of Tim‐3 and PD‐1 expression with disease activity was also explored. The frequency of Tim‐3 + /PD‐1 + /CD8 + T cells in 30 patients with vitiligo and 30 sex‐ and age‐matched controls was determined by flow cytometry. CD8 + T cells were then positively isolated by magnetic beads, and the mRNA expression of PD‐1 and Tim‐3 was determined by TaqMan‐based real‐time PCR. To measure the cytokines production, PBMCs were stimulated with PMA/ionomycin and concentrations of IL‐4, IFN‐γ and TNF‐α were measured in culture supernatants by ELISA. Disease activity of patients with vitiligo was determined using the Vitiligo Area Severity Index. Patients with vitiligo have significantly shown more expression of Tim‐3 and PD‐1 on their CD8 + T cells compared with controls. Expression analysis of Tim‐3 mRNA, but not PD‐1, confirmed the results obtained from flow cytometry. While the production levels of TNF‐α and IFN‐γ were found higher by patients with vitiligo, IL‐4 production was lower in patients compared with controls. A direct association was observed between the Tim‐3 and PD‐1 expression and also the production of pro‐inflammatory cytokines with disease activity of patients with vitiligo. Our results indicate that Tim‐3 and PD‐1 are involved in immune dysregulation mechanisms of CD8 + T cells in vitiligo and may introduce as potential biomarkers for disease progression and targeted immunotherapy.

Issue Information

Serum Vitamin B12 and Methylmalonic Acid Status in Migraineurs: A Case‐Control Study

Background Although the exact pathophysiological mechanistic pathways that result in the initiation of migraine attacks remain unclear, there are some proposed mechanisms including neurogenic inflammation, trigeminovascular system activation, vascular dysfunction, and augmented release of nitric oxide (NO) and homocysteine (Hcy). Vitamin B12 is thought to be involved in important pathways that seem to be related to the pathogenesis of migraine including scavenging against NO and prevention of hyperhomocysteinemia. Therefore, the aim of the current study was to evaluate the serum vitamin B12 and methylmalonic acid (MMA) status in a group of migraine patients compared to healthy controls. Methods After the recruitment of cases and controls, demographic data and migraine characteristics (including the number of headache days, severity of headaches, and duration of each attack in hours) were recorded. Serum vitamin B12 and MMA levels were measured using the enzyme‐linked immunosorbent assay technique. Results Seventy migraine patients and 70 healthy subjects were enrolled in this case control study. The serum levels of B12 were found to be significantly lower in migraine patients than in healthy subjects (512 ± 300 vs 667 ± 351 pg/mL, P = .007); whereas migraineurs had higher levels of MMA than controls (1.39 [0.59,4.01] vs 1.01 [0.49,1.45] µg/dL, P = .027). In the fully adjusted multiple regression model, those in the highest vs the lowest serum B12 quartile had 80% decrease in the odds of having migraine ([OR = 0.20, 95% CI = 0.05‐0.73], [ P for trend = .008]); while, patients in the highest quartile of MMA had more than 5 times increased risk of having migraine ([OR = 5.44, 95% CI = 1.49‐19.87] [ P for trend = .002]). There was no association between serum B12 and MMA levels and headache characteristics. Conclusion Taken together, these findings suggest that participants with lower vitamin B12 and higher MMA levels that considered as lower functional activity of B12 had higher odds of migraine.

Comparison of Diet Quality Between Women With Chronic and Episodic Migraine

Background/Objectives Different triggers including environmental, hormonal, and dietary factors have been introduced as migraine risk factors. There is some evidence to suggest that a high quality of diet could be effective regarding management of migraine. In this present study, we hypothesized that the diet quality of women with chronic migraine (CM) might be different from women with episodic migraine (EM). Methods In this cross‐sectional study, 116 women with chronic and 169 women with episodic migraine (25‐55 years old) were recruited from the neurology clinics of Golestan hospital in Ahvaz (southwest Iran) based on the International Classification of Headache Disorders‐III. Anthropometric data including weight, height, waist, and hip circumference were measured. Dietary intake data were obtained using a reliable and valid semi‐quantitative food frequency questionnaire that included 168 food items. The diet quality of subjects was calculated using the Healthy Eating Index‐2015 (HEI‐2015). Results The mean HEI score of participants was 57.29 ± 7.98. The participants were classified into 3 groups of “poor,” “needs improvement,” and “good” based on their diet quality. The frequencies of each group were 50/285 (17.5%), 233/285 (81.8%), and 2/285 (0.7%), respectively. Moreover, the mean of HEI score in women with CM was significantly lower than women with EM (55.93 ± 7.90 vs 58.93 ± 7.93, P  = .02). Moreover, there was a significant negative association between CM and HEI score of women ( β  = −2.03; 95% CI: [−3.97 to −0.10]; P  = .04). Conclusions Women with CM had a lower diet quality than that of EM. Moreover, CM was significantly and inversely associated with HEI score in women.

Chronic generalized pruritus without primary skin lesions: a longitudinal prospective observational study

Pruritus is among the most common complaints in the field of dermatology. It is also a disturbing symptom of many systemic disorders. Chronic pruritus ( CP ) refers to the cases of the symptom which last longer than 6 weeks. We conducted a prospective analysis of patients with generalized pruritus without primary skin lesions. All patients underwent primary evaluations and then were followed from 12 to 18 months for further evaluations. Of the 5,127 patients referred to our dermatology clinic, 49 patients with generalized pruritus without primary skin lesions were evaluated. Most of the patients (44%) were in the age group of 40–60 years and female (58%). The duration of pruritus was 37.04 ± 30.4 weeks. Fifty percent of the patients with generalized pruritus had a systemic cause of pruritus. The most common underlying diseases were thyroid disorders (16.67%), diabetes mellitus (12.5%), and malignancy (8.33%). There were no significant statistical differences among the patients in terms of their age, gender, and disease duration with the underlying diseases ( P = 0.47, P = 0.99, P = 0.816, respectively). However, the average age of the onset of pruritus was 12 years earlier in the women regardless of the underlying diseases ( P = 0.011). Based on the findings of the study, we recommend considering endocrine disorders and malignancies as the most common underlying diseases leading to chronic pruritus without primary skin lesions.

Dermoscopic features of lichen planopilaris in Northern Iran: a prospective observational study

Background Dermoscopy can be helpful in assessing nonpigmented lesions and inflammatory processes like lichen planopilaris (LPP). Material & Methods In this observational prospective study, 81 patients with a cicatricial alopecic patch on their scalp were included and underwent dermatologic examination. A biopsy was taken from the active part of the lesion based on dermoscopy evaluation. Results Analysis of 44 patients with definite diagnosis of LPP revealed that the mean age at the time of presentation was 44.05 ± 12.62 years. More than 77% of patients had at least one form of the follicular opening disorder. About 75% of patients had shaft disorders. The most common pattern of pigmentation was milky‐red (97.73%). The irregular and ectatic vascular network were seen in 59.09% of patients. Patients with coiled and twisted hairs, small yellow dots, large yellow dots, and peripilar sign were more likely to have shorter disease duration ( P  < 0.05). Those with overall shaft disorders were younger ( P  = 0.02). Small yellow dots ( P  = 0.025) and peripilar sign ( P  = 0.039) were more common in female patients. Conclusion Dermoscopy can be a helpful diagnostic tool in differentiating LPP among patients with primary cicatricial alopecia (PCA). Larger cohort studies are recommended to find the role of demographic factors in predicting the dermoscopic patterns among LPP patients.

Prevalence and risk factors for painful diabetic neuropathy in secondary healthcare in Qatar

Aims/Introduction Painful diabetic peripheral neuropathy (PDPN) has a significant impact on the patient's quality of life. The prevalence of PDPN in the Middle East and North Africa region has been reported to be almost double that of populations in the UK. We sought to determine the prevalence of PDPN and its associated factors in type 2 diabetes mellitus patients attending secondary care in Qatar. Materials and Methods This was a cross‐sectional study of 1,095 participants with type 2 diabetes mellitus attending Qatar's two national diabetes centers. PDPN and impaired vibration perception on the pulp of the large toes were assessed using the Douleur Neuropathique en 4 questionnaire with a cut‐off ≥4 and the neurothesiometer with a cut‐off ≥15 V, respectively. Results The prevalence of PDPN was 34.5% (95% confidence interval [CI] 31.7–37.3), but 80% of these patients had not previously been diagnosed or treated for this condition. Arabs had a higher prevalence of PDPN compared with South Asians ( P  < 0.05). PDPN was associated with impaired vibration perception adjusted odds ratio (AOR) 4.42 (95% CI 2.92–6.70), smoking AOR 2.43 (95% CI 1.43–4.15), obesity AOR 1.74 (95% CI 1.13–2.66), being female AOR 1.65 (95% CI: 1.03–2.64) and duration of diabetes AOR 1.08 (95% CI 1.05–1.11). Age, poor glycemic control, hypertension, physical activity and proteinuria showed no association with PDPN. Conclusions PDPN occurs in one‐third of type 2 diabetes mellitus patients attending secondary care in Qatar, but the majority have not been diagnosed. Arabs are at higher risk for PDPN. Impaired vibration perception, obesity and smoking are associated with PDPN in Qatar.