Dermatologic Therapy

Background. Despite the availability of numerous therapies, keloid treatment remains a challenging clinical issue. Intralesional triamcinolone has been established as an effective corticosteroid treatment for keloids, while sporadic reports suggest the efficacy of intralesional verapamil. This study aimed to evaluate the safety and efficacy of bevacizumab as an adjuvant therapy for keloid treatment. Methods. This randomized controlled trial involved 38 patients diagnosed with keloid according to clinical criteria. The study compared the effects of intralesional triamcinolone combined with bevacizumab injections with intralesional triamcinolone alone. Patients were randomly assigned to either the combination treatment group, which received intralesional triamHEXAL® (20 mg/ml, every two weeks for three months) plus Avastin® (2.5 mg/ml, every two weeks for two months), or the single treatment group, which received intralesional triamHEXAL® alone. The Vancouver Scar Scale (VSS) was used for serial photographic records of scar evaluation, with differences in VSS scores considered the primary outcome, and changes in height and patient satisfaction visual analog score (VAS) were secondary outcomes. Results. A total of 38 patients participated, with a mean age (SD) of 35.32 (14.02) years and 50% male. No significant differences in age, BMI, disease duration, gender, causing, family history, or site were observed between the two groups. The single treatment group exhibited a mean reduction of 0.60 (95% CI: (−1.18, −0.01); ) in pigmentation score and a mean decrease of 1.37 (95% CI: (−2.68, −0.07); ) in total score compared to the combination treatment group after three months of treatment. There was a significant reduction in keloid height in the combination group after the end of the treatment (). No significant differences in side effects were observed between the two groups. Conclusion. Our study demonstrates that bevacizumab can be considered an effective and safe adjuvant therapy option for keloid treatment, suggesting its potential as a promising treatment for the management of keloids. This trial is registered with IRCT20131119015455N5.

Background. Breaking the itch-scratch cycle and facilitating lesion healing are pivotal in managing prurigo nodularis (PN). This study seeks to assess the efficacy of baricitinib, an oral JAK1/2 inhibitor, for treating PN. Methods. In this prospective pilot study, 12 patients with moderate to severe PN were administered oral baricitinib at a dosage of 4 mg/day for 12 weeks. The primary objective was to assess the efficacy of baricitinib in PN patients using the numeric rating scale (NRS) for pruritus, NRS sleep score, a 5-point investigator’s global assessment (IGA) scale, dermatology life quality index (DLQI), and nodular lesion count at weeks 0, 1, 2, 4, 8 and 12. In addition, the NRS pruritus and sleep scores were assessed via phone on days 2 and 4 after baricitinib treatment. Results. Baricitinib treatment led to a statistically significant improvement in the mean NRS pruritus and sleep scores, evident as early as day 2 (57.7% change from baseline; , and 34.7% change from baseline, , respectively) and consistently declining thereafter. Evaluation of nodular lesions revealed a significant reduction starting from week 2 (mean difference of 37.08 from baseline; ). Analysis of other endpoints, including mean DLQI and IGA scores, also demonstrated substantial improvement at all time points (week 1, 2, 4, 8, and 12) compared to baseline. However, it is important to acknowledge the limitation of a small sample size. This constraint warrants consideration when interpreting the results and generalizing the findings. Conclusion. This preliminary study underscores baricitinib’s potential for PN treatment by providing a rapid clinical response. The larger and longer randomized controlled trials are essential to determine the effectiveness, longevity, and safety of baricitinib in managing PN. This trial is registered with TCTR20230227002.

The vehicles used for topical dermatological treatments can significantly contribute to treatment effects while also delivering ingredients to maintain skin barrier function and reduce irritation. Tazarotene 0.045% lotion was developed using proprietary polymeric emulsion technology to provide uniform and efficient delivery of the active ingredient as well as improved safety and tolerability compared to higher-dose tazarotene formulations. The lotion vehicle additionally provides rapid and sustained improvements in moisturization and skin barrier function with patient-friendly application and cosmetic properties. Compared with trifarotene 0.005% cream, tazarotene 0.045% lotion demonstrated ∼30% greater spreadability and a lower potential for irritation. In clinical trials and investigator-initiated studies, tazarotene 0.045% lotion demonstrated efficacy in the treatment of facial and truncal acne and improved skin oiliness. Facial acne improvements were similar among study participants grouped by sex, race, ethnicity, or age. In a head-to-head study, efficacy was comparable to tazarotene 0.1% cream with approximately half the rate of treatment-emergent adverse events. Tazarotene 0.045% lotion is a beneficial acne treatment option for patients of varying ages, races, ethnicities, and skin types, delivered in a formulation that can be easily used on the face, back, and chest.

This paper systematically reviews the current articles regarding the use of dupilumab in the treatment of bullous pemphigoid (BP) to evaluate its safety and efficacy. PubMed, Embase, Cochrane Library, and Web of Science databases were searched for publications on dupilumab for BP from inception to 10 March, 2023. A total of 26 studies were included for systematic review. The primary outcome was clinical remission, and the secondary outcomes were recurrence and adverse events. Among 96 patients, 71.8% (n = 69/96) received systemic or topical steroids, immunosuppressants, immunomodulators, intravenous immunoglobulins, antihistamines, plasmapheresis, rituximab, and omalizumab, but none of them were successful. After dupilumab treatment, 66.7% (n = 64/96) of patients achieved complete remission, 25.0% (n = 24/96) had partial remission, 5.2% (n = 5/96) showed no remission, and no patients experienced deterioration. In addition, 1.0% (n = 1/96) and 2.0% (n = 2/96) patients stopped using dupilumab due to adverse reactions and cost, respectively. The average remission time was 4.5 months. 46.2% (n = 25/96) of the patients were followed up with a median follow-up of 8 months and only 2 patients relapsed at 8 and 7 months, respectively. Adverse event was 16.9% (n = 12/71), of which transient eosinophilia was the most common. This study indicates that the dupilumab is a promising treatment for BP with high clinical benefit associated with low recurrence rate, adverse event rate, and mortality. However, a large-scale randomized controlled trial is needed to further confirm the safety and efficacy of dupilumab in patients with BP treatment.

Background. Edematous fibrosclerotic panniculopathy (EFP), commonly known as cellulite, is a cosmetic concern affecting a large percentage of women. Radiofrequency diathermy (RFD) and focused ultrasound (FUS) are noninvasive treatments proposed for the reduction of EFP. Objective. This study aimed to evaluate the efficacy of RFD versus FUS, both combined with intermittent pneumatic compression (IPC) for the treatment of EFP in female thighs. Methods. A randomized intrasubject assessor-blind trial was conducted (NCT03474523) on 40 lower limbs of 20 women with EFP grades I, II, or III according to the Nürnberger & Müller scale. Each lower limb was randomly assigned to receive either seven RFD sessions or seven FUS sessions, both combined with IPC. Measurements were collected at baseline and post-treatment, including lower limb circumferences at different levels, weight, grade of EFP, and physical activity level. Results. Both RFD and FUS treatments, both combined with IPC, showed significant intragroup reduction in thigh circumference measurements for RFD at 15 cm (), 20 cm (), and midpoint () and for FUS at 15 cm (), 20 cm (), midpoint (), 30 cm (), and 40 cm (). No statistically significant differences were observed between the two treatments. Weight did not change with treatment, and physical activity levels did not significantly affect EFP improvement. Conclusion. Both RFD and FUS, combined with IPC, were effective noninvasive methods for treating EFP. This study found that there was no significant difference between RFD and FUS in terms of efficacy in reducing EFP in the thighs. Therefore, both techniques can be used to treat EFP from a clinical perspective. Further studies with objective measurements are required to confirm these results and to guide clinical decision-making. This trial is registered with NCT03474523.

Background. Cutaneous warts are caused by the human papillomavirus that can affect a patient’s quality of life. Current treatments have high cost, low efficacy, adverse effects, and recurrence. Therefore, novel therapeutic approaches are needed. Complementary and Alternative Medicines (CAMs) are gaining popularity as a therapeutic approach. Phoenix dactylifera L. (date palm) is used in folk medicine to treat warts. Antiviral effects of P. dactylifera L. have been demonstrated due to its polyphenolic compounds, especially gallic acid and tannins in various studies. So, this trial evaluates the efficacy and safety of P. dactylifera L. leaf extract (formulated as WartOver®) as a novel treatment for cutaneous warts. Study Design. Based on the results of our previously published pilot clinical trial and the CONSORT guideline, this randomized, double-blind, and placebo-controlled study was performed on 70 eligible patients divided into intervention and placebo groups (N = 35/per group). Every 2 weeks, patients were examined to assess the rate of complete clearance, duration of treatment, patient satisfaction (measured using a Likert scale), and occurrence of any adverse effects and recurrence in a maximum of 12 weeks of treatment and at the 6-month follow-up. Results. Based on the intention-to-treat (ITT) analysis approach, complete clearance was achieved in 24 patients in the intervention group (68.57%; confidence interval 95% = 0.51–0.81), which was significantly higher than that in the placebo group (8.57%; CI 95% = 0.02–0.23, ). The time to complete clearance was 7.6 weeks (mean ± SD: 53.30 ± 17.17 days). The treatment was very satisfactory (Likert score of 4.24 ± 1.15 (mean ± SD)) with no recurrence or adverse effects. Conclusion. WartOver® is a novel efficacious treatment for cutaneous warts with minimal risk for adverse events or recurrence. Due to the rising popularity of CAM approaches in medicine, including herbal medicines, WartOver® can be a valuable choice for clinicians against cutaneous warts. This trial is registered with IRCT20200509047352N2.