Zabihollah Shahmoradi

1. Androgenetic Alopecia (AGA) is the most common type of baldness in men. Its prevalence increases with age, such that ∼50% of men over the age of 50 eventually experience some degrees of baldness...

Psoriasis is an immune‐mediated skin disease in which genetic and environmental factors have a significant role. Olive oil with antioxidant properties is an effective adjunct treatment for skin diseases. Furthermore, ozone by introducing O ₂ into the bloodstream controls the response of cell‐mediated immunity and leads to improve disease. So, the aim of this study was to evaluate the efficacy of ozone therapy in the treatment of Psoriasis. Topical therapy of lesions of a man suffering from psoriasis was carried out using ozonate olive oil two times a day and ozone sauna once a week during a month. Patient showed considerable improvement after about twenty days. As the itching and silvery‐white scaling decreased, the lesions began to resolve after three weeks. Furthermore, no recurrence was noted after 3 months of follow‐up. It is suggested that ozone therapy, in appropriate formulations and in controlled cases, has a role in the treatment of patients with psoriasis by inhibiting the inflammatory pathways and prompting regenerative characteristics, without significant adverse effects and the necessity for systemic pharmacological agents. So, more studies on a greater population are needed to confirm this finding.

Leishmania RNA viruses (LRVs) have emerged as significant modulators of disease severity, therapeutic response, and clinical outcomes in various forms of leishmaniasis. This review provides a comprehensive overview of the current knowledge surrounding LRV1 and LRV2, focusing on their taxonomy, molecular biology, epidemiological patterns, and pathogenic roles across Leishmania species. LRV1, predominantly infecting New World Leishmania ( Viannia ) species such as L. guyanensis and L. braziliensis , and LRV2, primarily associated with Old World species such as L. major , L. tropica , and L. infantum as viral endosymbionts, have both been associated with increased mucocutaneous dissemination, treatment failure, and disease relapse. Mechanistically, these viruses enhance parasite virulence through immune modulation—particularly via Toll‐like receptor 3 (TLR3)—leading to chronic inflammation and host tissue damage. The presence of LRV has been correlated with unresponsiveness to first‐line treatments such as meglumine antimoniate and amphotericin B, especially in endemic regions. Furthermore, LRV may serve as a prognostic biomarker, and its detection could guide therapeutic decision‐making in high‐risk patients. The review also discusses emerging therapeutic strategies targeting viral components, such as capsid proteins and RNA‐dependent RNA polymerase, as well as vaccine development using recombinant viral antigens. Finally, it emphasizes the urgent need for expanded surveillance, standardized diagnostics, and deeper exploration of host–virus–parasite interactions to better understand the clinical and epidemiological impact of LRV‐positive leishmaniasis.

Background: Vitiligo, an acquired depigmentation disorder, significantly impacts patients’ quality of life due to psychological and aesthetic concerns. Surgical techniques such as suction blister (SB) and micro punch grafting (MPG) are used for stable vitiligo, but their effects have not been fully compared. Aims: This study aims to compare the efficacy of SB and MPG in treating stable vitiligo, focusing on repigmentation outcomes and patient satisfaction. Materials and Methods: This study is a double-blind randomized clinical trial with a self-controlled design. Thirty-one participants were randomized to receive SB or MPG on paired vitiligo patches. Lesions were assessed at baseline, 4 weeks and 12 weeks post-treatment using the Vitiligo Area Scoring Index (VASI) and repigmentation percentages. Data were analyzed using paired t -tests and repeated measures analysis of variance. Results: Both techniques demonstrated significant increases in VASI and repigmentation over time ( P < 0.05). However, MPG showed superior outcomes at 12 weeks, with significantly higher repigmentation rates compared to SB ( P < 0.05). Patient satisfaction scores and repigmentation quality were notably better in the MPG group. Adverse effects, including scarring and discolouration, were minimal in both groups. Conclusion: Both SB and MPG effectively improved stable vitiligo lesions, with MPG showing greater efficacy in repigmentation and patient satisfaction. These findings suggest MPG as a preferred option for stable vitiligo treatment in clinical settings.

Background and Aims: Cutaneous leishmaniasis (CL) represents the most common form of leishmaniasis. It imposes a significant medical burden due to long‐lasting ulcers and disfiguring scars, underscoring the need for comprehensive CL control strategies, particularly in endemic regions. This study aims to classify atypical CL presentations for clinical practitioners. Additionally, we compiled and categorized original images from our clinical encounters with CL to create a clinical atlas enhancing the existing literature. Methods: A systematic search for atypical manifestations of Old World CL was conducted in June 2023 via the PubMed database, utilizing MeSH‐based keywords including leishmaniasis, atypical, manifestation, and characteristics. All of the records were included. Exclusion criteria included records published before the 20th century, non‐English articles, review articles, nonclinical studies (experimental and epidemiological), studies focusing on New World CL (based on the study geographical location), or focusing on Post‐Kala‐Azar leishmaniasis. Relevant articles were selected and assessed. Results: Based on the clinical manifestations described in the selected studies, articles were classified into the following categories: (a) subacute CL, (b) chronic CL, (c) CL associated with lymphatic involvement, (d) CL associated with an immunocompromised state, and (e) cutaneous leishmaniasis on special anatomical sites. Clinical, diagnostic, and therapeutic facets were subsequently explored. Conclusion: The diagnosis of leishmaniasis can be challenging. Given the broadening spectrum of differential diagnoses for CL in clinical settings, dermatologists, pediatric dermatologists, internists, infectious disease specialists, and pediatricians must be aware of this classification of atypical CL.

Background and purpose: Cutaneous leishmaniasis poses significant health and socioeconomic challenges, making vaccine development a top priority, especially in endemic regions. Cysteine proteases, KMP-11, and HASPB proteins are promising candidates for leishmaniasis vaccine development owing to their immunogenic properties and capacity to provoke robust immune responses, as evidenced by different investigations. This study aimed to design a recombinant chimeric protein (MEV-Fc) vaccine using multi-epitopes from these Leishmania major proteins. Experimental approach: The antigens were subjected to immunoinformatic prediction and screening of HTL, CTL, and B-cell epitopes. The multi-epitope protein was designed with significantly high-scoring epitopes and suitable linkers. Natural adjuvants were then added to enhance immunogenicity. Vaccine potency was innovatively improved by covalently fusing human IgG1 Fc with multi-epitope protein. To investigate how the MEV-Fc vaccine interacts with Toll-like receptors, molecular docking, multi-scale normal mode analysis simulation, and computational immune simulation were employed to study humoral and cellular immune responses. Findings/Results: The results demonstrated the vaccine’s antigenicity, stability, and nontoxicity. The structural validation confirmed the accuracy of the 3D models, indicating robust interactions with TLR2 and TLR4, with binding free energies of -1269.9 and -1128.7 (kcal/mol), respectively. Immune simulation results showed significant increases in IgM and IgG antibody levels following three vaccinations, along with enhanced activation of B cells, helper T cells, and cytotoxic T lymphocytes. Conclusion and implications: These findings provide novel insights for developing effective candidates for cutaneous leishmaniasis vaccines. However, laboratory experiments are necessary to evaluate its protective effects.

Background: Primary cutaneous macular amyloidosis (PCMA) is a chronic pruritic cutaneous disease characterized by heterogeneous extracellular deposition of amyloid protein in the skin. Aims: This study aimed to evaluate the efficacy of topical 6% gabapentin cream for the treatment of patients with PCMA. Materials and Methods: In this triple‐blind clinical trial, a total of 34 patients, who were diagnosed with PCMA, treated using two different strategies of topical gabapentin as the active group and vehicle cream as the control group. Results: Pruritus score reduction in both groups was statistically significant compared with the baseline value ( p < 0.001). There was a significant pigmentation score reduction in intervention group compared with control group after 1 month of the study ( p < 0.001). The differences of pigmentation score changes between the groups were not significant at month 2 ( p = 0.52) and month 3 ( p = 0.22). Conclusions: The results of this study suggest that topical gabapentin cream may be effective as a topical agent in the treatment of pruritus associated with PCMA without any significant adverse effects. It is recommended to perform similar studies with a larger sample size and longer duration in both sexes.

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); P = 0.045) in pigmentation score and a mean decrease of 1.37 (95% CI: (−2.68, −0.07); P = 0.039) 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 (P = 0.024). 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: Melasma is a hyperpigmentary disorder causing cosmetic disfigurement. We aimed to compare the efficacy and safety of tranexamic acid (TXA) microinjections with TXA mesoneedling for facial melasma.Methods: This randomized assessor‐blind split‐face controlled trial included patients with symmetric facial melasma. One side of the face received TXA (100 mg/ml) mesoneedling and the other side intradermal TXA microinjections. The interventions were repeated three times with 4‐week intervals (weeks 0, 4, and 8). The primary outcome was improvement in modified Melasma Area and Severity Index (mMASI) 4 weeks after the final treatment session. Secondary outcomes were complications and patient satisfaction with the treatments evaluated by a visual analog scale (VAS).Results: All 27 patients included in the study were female (mean age: 44.22 ± 8.39 years). Both groups were comparable in terms of mMASI scores before and after treatment (standardized mean difference [SMD] = 0.32, 95% confidence interval [CI] −0.22; 0.85, p = 0.248 and SMD = −0.13, 95% CI −0.66; 0.40, p = 0.633, respectively). The mMASI score change from baseline was not different (SMD = −0.39, 95% CI −0.93; 0.15, p = 0.157). However, patient satisfaction was significantly higher with TXA mesoneedling (SMD = 0.77, 95% CI 0.21; 1.32, p = 0.007). Post‐inflammatory hyperpigmentation occurred in one patient in the TXA mesoneedling group. Erythema, scaling, and edema were significantly higher with TXA mesoneedling (p < 0.001).Conclusions: TXA mesoneedling was comparable with TXA microinjection in the treatment of facial melasma, while patient satisfaction was significantly higher with TXA mesoneedling; however, the high frequency of complications occurring with this treatment should be taken into account.