Mozhdeh Sepaskhah

Background: Nail psoriasis is a common and challenging-to-treat manifestation of psoriasis. The efficacy of several medications has been studied in treating nail psoriasis with different results. Aim and Objective: This trial assessed the therapeutic efficacy and safety of intralesional methotrexate injection compared to intralesional triamcinolone injection for nail psoriasis. Patients and Methods: Seventeen patients (69 nails) were recruited in this investigator-blind, randomized, controlled trial, and 13 patients (65 nails) completed the study. The severity of the disease was evaluated by the modified Nail Psoriasis Severity Index (mNAPSI) before starting treatment, after each injection, and 8 weeks after the last injection. Thirty-three nails were randomly treated with methotrexate and 32 nails with triamcinolone. A volume of 0.1 mL of the diluted (5 mg/mL) triamcinolone (0.5 mg) or 0.05 mL of methotrexate (1.25 mg) was injected at each point every 3 weeks for four sessions. (Clinical trial registry: Iranian Registry of Clinical Trials. [ID: IRCT20140212016557N7]). Results: Both interventions significantly reduced the mNAPSI score ( P < 0.001). The percentage of reduction of mNAPSI score was more in the triamcinolone-treated nails at the end of treatment ( P = 0.015), but not significantly different in the 8-week follow-up ( P = 0.906). Deterioration of the mNAPSI score was seen only in the triamcinolone group at the end of 8 weeks after discontinuation of treatment ( P = 0.01). Limitations: A relatively small sample size, lack of prolonged follow-up, and absence of response assessment of the nail matrix and bed separately. Conclusion: Intralesional methotrexate is an effective and safe treatment for nail psoriasis, with similar efficacy to intralesional triamcinolone. Methotrexate showed more persistent efficacy compared to triamcinolone.

Background and Aims: Seborrheic dermatitis (SD) is a common, chronic, and relapsing disease affecting the patients’ quality of life. Expanding the treatment armamentarium provides better care for patients. Topical ivermectin, an anti‐inflammatory and anti‐parasitic agent, is a potential treatment for SD. We designed this study to assess the effectiveness of topical ivermectin in treating facial SD. Methods: Thirty‐six out of 40 patients completed this double‐blind, randomized controlled study. In the first group, 17 patients received 2% ketoconazole cream twice a day and cold cream at night, and in the second group, 19 patients applied 1% ivermectin cream once nightly and cold cream twice daily. At the beginning of the study, 1 and 2 months later, the parameters of SEborrheic Dermatitis Area and Severity Index (SEDASI), erythema index, pruritus severity, and quality of life (DLQI score) were measured in both groups. Results: Repeated measures analysis of variance showed that both ivermectin and ketoconazole significantly improved SEDASI scores and erythema index over time ( p < 0.001), but the efficacy of treatments was not significantly different ( p = 0.60 and p = 0.72, respectively). Both itch severity and quality of life significantly improved in patients from both treatment groups ( p < 0.001). However, there was no statistically significant difference between the two treatments in terms of their effect on itch score ( p = 0.20) or quality of life ( p = 0.09), indicating that neither treatment was superior to the other in these outcomes. Conclusion: Ivermectin cream is a safe and effective treatment for facial SD, and is as effective as topical ketoconazole in reducing SEDASI score, erythema index, itch score, and DLQI score of SD patients. Topical ivermectin could be added to the therapeutic armamentarium of SD.(Iranian Registry of Clinical Trials registration No: IRCT20210222050452N1).

Monilethrix is a rare genetic disorder characterized by sparse, brittle hair, primarily affecting the scalp, although it may also affect other parts of the body. Trichorrhexis nodosa (TN) is another hair shaft disorder characterized by brittle and fragile hair shafts. Concurrence of monilethrix and TN is exceedingly rare. We report a 6‐year‐old girl with sparse and brittle hair in the occipital and frontotemporal regions, accompanied by perifollicular papules and follicular hyperkeratosis. Hair shaft disorders and loose anagen syndrome were among the differential diagnoses. Dermoscopy revealed a beaded appearance of the hair caused by uniform elliptical nodes and internodal constriction. Additionally, light microscopy examination confirmed the presence of elliptical nodes and intermittent constrictions in the hair, along with splitting of the hair shafts exhibiting a paintbrush bristle pattern. Subsequently, the diagnosis of concurrent monilethrix and TN was made for the patient. We observed minimal clinical improvement after treatment with low‐dose oral and topical minoxidil.

Background: Striae distensae (SD) are a common cosmetic concern for many patients. So far, there is no definitive and markedly effective treatment for SD. Considering the histological similarities of SD and scars, and the effectiveness of nanofat in scar treatment, nanofat could be a potential treatment of SD. Objectives: To assess the effect of nanofat in the treatment of SD. Methods: In this randomized, investigator‐blinded, intrapatient split‐body clinical trial, patients with bilateral SD received a single session of nanofat grafting on one side of the body and three monthly sessions of microneedling on the contralateral side. Participants were evaluated at baseline and at months 1, 2, and 5 after the initial treatment session for Global Aesthetic Improvement Scale (GAIS), texture improvement, striae width, patient satisfaction, pain severity, and adverse events. Results: Twenty patients completed the study. Both nanofat and microneedling gradually improved the aesthetic appearance of the striae lesions over treatment sessions ( p < 0.001). At follow‐up, more nanofat‐treated lesions were rated as “very much improved” than microneedling‐treated lesions, although the between‐group difference was not statistically significant ( p = 0.242). The texture of striae gradually improved by both treatment regimens ( p < 0.001); nevertheless, the effects of treatments were not statistically different ( p = 0.39). Also, treatments gradually improved striae width during treatment sessions ( p < 0.001), but the effectiveness of treatments was not significantly different ( p = 0.16). Post‐inflammatory hyperpigmentation (PIH) developed in 40% of microneedling‐treated patients, but none of the nanofat‐treated striae cases (0%) developed PIH ( p = 0.003). Patient satisfaction was not significantly different between groups ( p = 0.77). Conclusion: In this pilot study, nanofat grafting and microneedling produced comparable improvement in SD, with no significant differences in the main efficacy outcomes. The lower PIH incidence with nanofat should be interpreted cautiously. Larger adequately powered trials are needed to confirm these preliminary findings. Trial Registration: Iranian Registry of Clinical Trials: IRCT20140212016557N10

Background: Mycosis fungoides (MF) is the most common cutaneous T‐cell lymphoma, presenting with variable clinical features that can be pruritic. Pruritus and the overall disease burden may disrupt sleep and diminish quality of life; yet, sleep disturbances in MF remain under‐investigated. Aims: To evaluate sleep quality and quality of life in MF patients compared with healthy controls. Methods and Results: In a cross‐sectional, case–control study at a referral clinic in Shiraz, Iran, 78 MF patients (TNMB stages IA–IIIA) and 76 age‐ and sex‐matched controls completed the Pittsburgh Sleep Quality Index (PSQI), the 12‐Item Short Form Survey (SF‐12), and the Hospital Anxiety and Depression Scale (HADS). MF patients had significantly poorer sleep quality, with 62.8% reporting poor sleep quality compared to 27.6% of controls ( p < 0.001). Among MF patients, poorer sleep quality was significantly associated with greater pruritus intensity, more advanced disease stage, and a higher modified severity‐weighted assessment tool score (mSWAT) (all p < 0.05). In contrast, histopathological subtype and treatment modality showed no significant association. MF patients exhibited higher rates of moderate‐to‐severe anxiety (34.6% vs. 15.8%) and depression (30.7% vs. 14.6%) ( p < 0.05). Physical health scores on the SF‐12 were significantly lower in the MF group ( p < 0.01), whereas the decrease in mental health scores did not reach significance. Conclusion: MF is associated with significant sleep dysfunction, psychological distress, and impaired physical quality of life. Pruritus intensity, disease stage, and cutaneous disease burden are key contributors to poor sleep quality. Larger studies are warranted to further elucidate the extent and mechanisms of sleep disturbance in this population.

Background and Aims: The Varicella‐zoster virus (VZV) primarily causes chickenpox and can later reactivate as herpes zoster (HZ) from latent VZV in sensory ganglia. HZ generally presents with unilateral dermatomal pain and vesicular skin eruptions. Immunosuppression, advanced age, and underlying comorbidities increase the risk of severity, hospitalization, and longer length of stay (LOS), adding a substantial burden to the healthcare system. In this study, we examined factors influencing LOS in hospitalized HZ patients. Methods: We aimed to identify factors contributing to prolonged LOS in hospitalized patients with confirmed HZ at a tertiary referral center in southwestern Iran, from March 2020 to September 2024. We performed statistical analyses to explore the relationships between demographics, clinical features, comorbidities, medications, and laboratory findings (ESR, CRP) with LOS. Results: Of the 109 hospitalized HZ patients (50.5% female), the mean LOS was 6.1 ± 5.2 days. LOS showed significant correlations with elevated ESR ( r = 0.304, p = 0.006), severe complications like encephalitis and Ramsay Hunt Syndrome ( p < 0.001), and pre‐existing neurological and renal conditions ( p < 0.05). No links were observed with age, CRP levels, gender, or immunosuppressant drug use. Conclusion: Severe neurological complications such as encephalitis and Ramsay Hunt syndrome, along with specific comorbidities and high ESR, notably extend hospital stays for HZ patients. These findings highlight the burden of severe HZ and identify key factors affecting LOS. By quantifying these elements, we provide practical insights to optimize inpatient care and emphasize the importance of prevention in high‐risk populations.

Introduction: The quality of life (QoL) of patients suffering from cutaneous malignancies like cutaneous T-cell lymphoma (CTCL) and their family caregivers is widely affected by the disease and its treatment. Objectives: This study aimed to evaluate the impact of the disease and its treatment on patients with MF and their families through self-administered questionnaires in our referral center in Shiraz. Methods: Patients with MF, the most common variant of CTCL and 1 of their family members participated in this study by filling out the questionnaires on Dermatology Life Quality Index (DLQI), and Family Dermatology Life Quality Index (FDLQI). The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) was also completed by patients and healthy controls. Results: A total of 113 cases, 91 patients’ relatives, and 129 healthy controls participated in this study. The mean DLQI total score was 8.00 ± 6.41. WHOQOL-BREF and/or their subdomains were ameliorated with advanced stage, active disease, increasing MSWAT score, early disease, the head/neck location, as well as interferon and gemcitabine. “Symptoms and feelings” and “leisure” dimensions of DLQI were the most affected, while regarding WHOQOL-BREF, the disease significantly impacted the “psychological”, “environmental” and “general health” aspects (P<0.001, P=0.045, and P<0.001, respectively). Given the sociodemographic characteristics of the study participants, patients with a higher level of education suffered more (P=0.035). Conclusions: Due to the distress that patients and caregivers experience during the first year of diagnosis, head/neck lesions and specific treatment, appropriate measures to prevent unrealistic expectations and better coping mechanisms are recommended.

Follicular porokeratosis (FPK) is a rare subtype of porokeratosis. Follicular porokeratosis mainly occurs in men and may be localized or diffuse. Involvement of the scalp is rarely reported, and we found only one case of alopecia due to scalp FPK. Diabetes mellitus has not been reported in association with FPK We report a 35‐year‐old diabetic woman that presented with brown follicular keratotic papules and spicules involving the scalp, face, trunk, and extremities, accompanied by scalp alopecia. The differential diagnoses were lichen planopilaris, papular eczema, and phrynoderma. Histopathologic examination of skin punch biopsies revealed the follicle‐centered cornoid lamella as the feature of FPK. The patient was treated with oral isotretinoin, and the lesions improved partially within 6 weeks of follow‐up. Follicular porokeratosis might be considered among the differential diagnoses of keratotic papules (with or without spicules) and in the cases of alopecia with keratotic papules. Diabetes mellitus may be associated with FPK.

Postinflammatory hyperpigmentation (PIH) is a common sequela of acne vulgaris. Topical treatment with hydroquinone is the standard treatment, but may be associated with complications. Cysteamine is a relatively safe depigmenting agent with an observed depigmenting effect. We designed this study to assess the efficacy of a cysteamine 5% cream in treating acne-induced PIH. Twenty-eight out of 32 participants finalized this investigator-blind, randomized, and controlled trial (registered in Iranian Registry of Clinical Trials [IRCTID: IRCT20140212016557N5]). We randomized the patients to apply either cysteamine 5% or hydroquinone 4%/ascorbic acid 3% (HC) cream. Postacne hyperpigmentation index (PAHPI) and melanin index were the assessment measures after four months of treatment. We evaluated the quality of life by the Dermatology Life Quality Index (DLQI) questionnaire. Both cysteamine and HC cream significantly decreased the PAHPI score and melanin index of acne-induced PIH patients (p0.05). Quality of life ameliorated significantly only with cysteamine treatment. However, no significant change in quality of life was observed between groups. Limitations of our study include the relatively small sample size and absence of follow-up. Cysteamine cream is an effective treatment of post-acne PIH, with similar efficacy to the accepted treatment of PIH, i.e., hydroquinone cream.