Niloufar Najar Nobari

Adipose‐derived exosomes may offer a novel therapeutic approach for lichen planopilaris (LPP) unresponsive to standard treatments, with preliminary evidence suggesting potential benefits in symptom control and hair preservation.

Androgenetic alopecia (AGA) is the most common form of hair loss, affecting a significant portion of both men and women. Despite the availability of various treatments, challenges such as limited efficacy, ongoing treatment requirements, side effects, and high costs persist. We sought to evaluate the efficacy and safety of erbium lasers, specifically erbium-doped yttrium–aluminum-garnet (Er: YAG) and erbium: glass lasers, in the management of AGA. A comprehensive search of PubMed/Medline, Web of Science, and Ovid-Embase databases was conducted until November 18th, 2023, adhering to PRISMA guidelines. Clinical studies involving Er: YAG or erbium: glass lasers for AGA treatment were included. A total of 12 studies recruiting 344 patients were included in this study; six of them investigated Er: YAG and six others evaluated erbium: glass laser. As a result, both erbium lasers were effective in treating AGA with respect to hair density, growth rate, and hair thickness. Erbium: glass lasers were particularly effective with combination therapies, such as those with minoxidil or Platelet-rich plasma. Er: YAG lasers also showed promising results, although some studies reported variability in patient satisfaction and aesthetic outcomes. The safety profile of erbium lasers was generally favorable, with minimal adverse effects. Erbium lasers, especially when used in combination with other therapies, show considerable potential in managing AGA. However, variability in treatment protocols and patient responses highlights the need for further research.

Systemic sclerosis (SSc) and localized scleroderma (LoSc) are rare connective tissue diseases that are identified by skin thickening and hardening with different mechanisms of action. Although advancements in treatments have been achieved in recent years, these conditions remain a major cause of morbidity and currently lack a definitive cure. We sought to evaluate the efficacy and safety of platelet-rich plasma (PRP) treatment in individuals with LoSc and SSc. PubMed/Medline, Ovid-Embase, and Web of Science were systematically searched until December 27th, 2024. A citation search was also carried out, and clinical studies published in English were eligible to be included. A total of 11 studies utilized PRP to treat different conditions of scleroderma. In limited and diffuse forms of SSc, PRP resulted in the improvement of mouth handicap in systemic sclerosis (MHISS) items, skin elasticity, skin ulcer healing, and vascularization both alone and alongside hyaluronic acid, autologous fat, and stromal vascular fraction. Moreover, PRP injections led to a significant decrease in the LoSc cutaneous assessment tool (LoSCAT), as well as a reduction in pain and disease symptoms. Furthermore, patients with en coupe de sabre experienced hair regrowth after PRP treatment. The adverse effects, which can be limited or diffuse, were mild and self-limited. PRP contains a considerable number of platelets, cytokines, and growth factors. PRP is considered a safe supplementary treatment option alongside standard therapy for both LoSc and SSc, with the potential to promote improvement in these patients, either as a standalone therapy or in conjunction with other therapeutic approaches. Graphical abstract The summary of systematic review methodology (systematic search, screening, eligibility criteria, and study selection) and applications of platelet-rich plasma in treating systemic sclerosis and localized scleroderma

Background: There is no definitive solution for the treatment of striae distensae (SD), and effectiveness of each treatment method remains controversial. We aimed to investigate and compare the efficacy of the combination of Erbium YAG (Er:YAG) laser and stromal vascular fraction (SVF), the combination of Er:YAG laser and platelet‐rich plasma (PRP) and Er:YAG laser plus saline in the treatment of SD. Materials and Methods: In 12 participating patients with at least three lesions (36 lesions in total), each lesion was treated with an Er:YAG laser. SVF was randomly injected intradermally for the first lesion, PRP for the second lesion, and normal saline as placebo for the third lesion. Treatment duration was one session, and the safety and efficacy of the treatment was assessed 3 months later using the following items: evaluation of biometric parameters including corneometery, erythema, melanin, tewametery, color, cutometery, complete thickness, epidermal thickness, dermal thickness, complete density, epidermal density, and dermal density; assessment of patient and physician satisfaction using Likert score; and recording of adverse effects of treatment. Results: The study involved 12 patients (evaluating 36 lesions in total), predominantly women (83%), with an average age of 39.16 years. The analysis revealed significant improvements in biometric indices, including complete thickness, epidermal thickness, dermal thickness, and R5 cutometer readings across all groups after the intervention. Notably, the SVF and PRP groups showed statistically significant enhancements in dermal and complete density compared to the placebo group. The SVF group demonstrated a significant increase in epidermal density (from 45.95 to 51.19, p = 0.001), unlike the PRP and placebo groups which showed nonsignificant changes. Comparing the average changes in biometric factors, the SVF group exhibited significantly greater increases in complete thickness, dermal thickness, complete density, epidermal density, and dermal density than the other groups. Both patient and physician satisfaction scores were highest in the SVF group ( p = 0.001), with no significant posttreatment complications reported. Conclusion: Our results showed that the combination of Er:YAG laser and SVF injection could be considered an effective and safe treatment method in the treatment of SD. Trial Registration: IRCT20200127046282N14

Alopecia areata (AA) is an autoimmune condition with unpredictable progression, negatively impacting the quality of life. Despite various therapeutic options, refractory cases remain challenging to treat. Emerging evidence highlights the regenerative and immunomodulatory potential of exosomes, particularly in tissue repair and hair follicle regeneration. Herein, we aim to evaluate the therapeutic efficacy of adipose tissue–derived exosomes (ASC‐exosomes) in two patients with severe, refractory AA. Two female patients with chronic AA resistant to multiple conventional treatments underwent a single session of intradermal administration of exosomes derived from adipose tissue. Baseline evaluations, including the Severity of Alopecia Tool (SALT) score, were conducted and reassessed 3 months posttreatment. Clinical and laboratory parameters were monitored throughout the follow‐up. Both patients demonstrated significant hair regrowth and improvement in SALT scores (Case 1: 79.6–59.6; Case 2: 70.2–58.6) without adverse events. The treatment was well‐tolerated, with sustained clinical benefits observed alongside adjunctive topical minoxidil. ASC‐exosomes represent a promising and safe therapeutic strategy for refractory AA, combining immunomodulatory and regenerative properties. Further randomized, controlled studies are necessary to validate these findings and refine cell‐free therapeutic protocols for broader clinical applications.

Hair shaft abnormalities, often linked to genetic or acquired conditions, present significant treatment challenges with limited and inconsistent therapeutic success. This report describes an eight‐year‐old female with severe hair shaft abnormality, unresponsive to standard treatments, including topical minoxidil and platelet‐rich plasma therapy, who demonstrated marked improvement following a single session of adipose tissue (AT)–derived exosome therapy. The exosomes were administered via intradermal scalp injections, resulting in significant enhancement in hair structure, strength, and growth within 3 months, with no adverse effects observed. AT‐derived exosomes, leveraging mechanisms such as Wnt/β‐catenin activation and vascular endothelial growth factor expression, hold substantial promise for promoting hair follicle regeneration. This case highlights the potential of exosome therapy as an innovative and effective treatment for hair shaft abnormalities, emphasizing the need for further clinical studies to validate its efficacy and safety.

Managing burn scars in children presents significant challenges. This study investigates effective treatment methods for burn scars, focusing on efficacy, safety, standard protocols and tolerability. Major databases such as PubMed, Scopus and Web of Science were thoroughly searched up to August 2024, emphasizing procedural treatments for burn scars in children. Key data collected included participant demographics, sample sizes, intervention methods, follow‐up protocols, treatment effectiveness and reported adverse events. A total of 256 children were assessed, with all procedural treatments yielding satisfactory outcomes. Among the various methods, trapeze‐flap plasty and percutaneous collagen induction showed improvements in all patients. In the laser treatment group, which included 161 children, the Vancouver Scar Scale (VSS) score reduction ranged from 55.55% to 76.31%, with outcomes rated as good (24.61%) to excellent (60%). Laser treatment using local anaesthesia proved to be well tolerated by children. Our findings indicate that various methods—including trapeze‐flap plasty, percutaneous collagen induction, phototherapy and fractional CO₂ laser—demonstrate a relatively good response and an acceptable safety profile. Notably, light‐based therapies/lasers may serve as safe, effective and tolerable options for scar treatment in this age group, often eliminating the need for general anaesthesia.

Background The prominence of minimally invasive aesthetic approaches has become increasingly pivotal. The endo-lift laser method is an intralesional 1470 nm diode laser connected to a fiber that serves both therapeutic and aesthetic properties. We sought to evaluate the efficacy and safety of the endo-lift laser method for dermatological aesthetic applications. Methods PubMed, Ovid-Embase, and Web of Science were systematically searched up to November 5^th, 2023. A citation search was also performed. The National Institute of Health (NIH) Quality Assessment Tool was used to evaluate the quality of the studies. Results Out of 339 articles, twenty-three relevant studies were included in the current review. Applying the endo-lift laser method for rejuvenation, including face and neck lifting, enhancing skin laxity, and disappearing wrinkles, folds, and lines, demonstrated favorable efficacy and safety profile. Moreover, most studies have shown that the endo-lift laser method is promising in eliminating the adipose tissue in the jowl, abdomen, thighs, and arms. The endo-lift laser technique was also efficacious in nose remodeling and blepharoplastic procedures, including treating eyelid and eyebrow ptosis, eye bag, eyebrow position, and eyelid laxity. Patients who suffer from several diseases, such as hidradenitis suppurativa, progressive lipodystrophy, acne vulgaris, scars, and keloids, benefit from procedural treatment with the endo-lift laser technique. Across all studies, the adverse events were mild and self-limiting. Investigating the endo-lift laser method in all aesthetic and therapeutic indications resulted in high patient satisfaction rates. Conclusion The endo-lift laser technique has therapeutic effects and is recommended for various dermatological aesthetic indications. Further clinical studies with control groups and larger sample sizes are needed to acquire more reliable evidence. Levels of Evidence III and IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Background and aims Hidradenitis suppurativa (HS) is an inflammatory skin disease affecting apocrine gland-bearing sites of the body. Radiofrequency (RF) is a minimally invasive method that acts by minimizing thermal damage to the dermis, resulting in collagen synthesis and scar improvement. We systematically reviewed the efficacy and safety of RF in treating HS. Methods A systematic search was performed up to November 18th, 2023, in PubMed/Medline, Ovid Embase, and Web of Science. Clinical studies with English full texts were included. The National Institute of Health (NIH) Quality Assessment Tool for clinical trials and Methodological quality and synthesis of case series and case reports by Murad et al. were utilized for critical appraisal. Results Out of 55 identified studies, 11 met our inclusion criteria with 167 subjects who underwent RF therapy alone or combined with an intense pulsed laser (IPL), known as LAight®. LAight® significantly improved clinical outcomes in mild-to-moderate HS patients based on the Dermatology Life Quality Index (DLQI), International Hidradenitis Suppurativa Score System (IHS4), Pain-Numerical Rating Scale (NRS), and Hidradenitis Suppurativa Clinical Response (HiSCR). Moreover, RF therapy alone significantly alleviated the clinical manifestations in patients with mild-to-moderate HS. Additionally, fractional microneedling RF significantly decreased HS-associated inflammatory markers. RF was found to be safe with limited adverse events. However, in moderate-to-severe HS, RF has failed to yield satisfactory results. Conclusion RF is a safe energy-based method with promising outcomes, especially for long-term application in mild-to-moderate HS. In moderate-to-severe cases, RF should be combined with a systemic medication for further beneficial impacts.

Background: Notalgia paresthetica (NP) is a rare condition characterized by localized pain and pruritus of the upper back, associated with a distinct area of hyperpigmentation. Given the lack of standardized treatment and the uncertain efficacy of available options, applying procedural methods is of growing interest in treating NP. Aims: We sought to comprehensively evaluate the role of procedural treatments for NP. Methods: We systematically searched PubMed/Medline, Ovid Embase, and Web of Science until November 14th, 2023. We also performed a citation search to detect all relevant studies. Original clinical studies published in the English language were included. Results: Out of 243 articles, sixteen studies have reported various procedural modalities, with or without pharmacological components, in treating NP. Pharmacological procedures, including injections of botulinum toxin, lidocaine, and corticosteroids, led to a level of improvement in case reports and case series. However, botulinum toxin did not show acceptable results in a clinical trial. Moreover, non‐pharmacological procedures were as follows: physical therapy, exercise therapy, kinesiotherapy, acupuncture and dry needling, electrical muscle stimulation, surgical decompression, and phototherapy. These treatments result in significant symptom control in refractory cases. Physical therapy can be considered a first‐line choice or an alternative in refractory cases. Conclusion: Procedural modalities are critical in the multidisciplinary approach to NP, especially for patients who are refractory to topical and oral treatments. Procedural modalities include a spectrum of options that can be applied based on the disease's symptoms and severity.