Introduction: Melasma is a benign, acquired and chronic hypermelanosis. Topical hydroquinone (HQ) is a conventional choice to treat melasma. Tranexamic acid (TA) is a relatively new brightening agent that interferes with keratinocyte–melanocyte interactions. The aim of the present study was to compare the efficacy and safety of TA intradermal injections with HQ in treating melasma. Materials and methods: In this split-face controlled trial, 37 patients were randomized to receive three monthly sessions of TA intradermal injections either on the right or the left side of their face and topical HQ once a night for three months on the other side. Melanin and erythema were measured for each side of the face at the baseline and at the end of each month. Results: A reduction in melanin value was observed for TA and HQ separately (p value <.001). Monthly TA injection was better than daily HQ in reducing the melanin value during the first four weeks (p value =.013); but after 20 weeks, the overall changes was not different between the two groups (p value =.17). Conclusion: Monthly TA intradermal injections can be an effective treatment for melasma. Further studies are required to support our results.

Background and Objective. Psoriasis is a common chronic inflammatory skin disorder affecting any age and gender. The clinical presentation of the nail disease depends on the location of the pathology: nail bed or nail matrix. We aimed to compare the therapeutic effects of triamcinolone acetonide iontophoresis (TI) and topical calcipotriol/betamethasone dipropionate in the nail bed and nail matrix involvements of psoriasis using Nail Psoriasis Severity Index (NAPSI). Materials and Methods. In the present bilateral comparison clinical trial, sixteen patients with clinical diagnosis of nail psoriasis were enrolled and randomized to receive six monthly TI treatment sessions either on their right or on the left hand target nails and daily application of topical calcipotriol/betamethasone dipropionate for six months on their other hand. Clinical efficacy was evaluated according to target nails NAPSI before and after the treatment. Wilcoxon sign-rank test and repeated measures ANOVA were used to compare the efficacy of the treatments. Results. The results did not show any difference between the therapeutic effects of TI and topical calcipotriol/betamethasone dipropionate regarding the nail bed score (P value = .356), matrix score (P value = .137), and total NAPSI (P-value = .098). Conclusion. Monthly TI has an equal efficacy compared to daily topical calcipotriol/betamethasone dipropionate. It can be used as a safe, easy, and compliant treatment for nail psoriasis. This study is registered under IRCT2017050233778N1.

Primary localized cutaneous amyloidosis (PLCA) is a recalcitrant sporadic dermatological condition and most treatments have failed so far. We studied the efficacy of topical Dimethyl sulfoxide (DMSO) 50% solution in comparison with tretinoin 0.5% cream in treatment of macular amyloidosis. In this split‐side within‐person single‐blinded randomized clinical trial, 18 patients with bilateral macular amyloidosis received topical DMSO 50% solution and tretinoin 0.5% cream either on their right or the left side. The colorimetry, pruritis scoring and photography were done. A significant pigmentation decline per each follow up was observed in DMSO group compare to the tretinoin group (tretinoin:‐1.31 vs DMSO:‐7.34; difference in slopes:‐6.03 [95% Confidence Interval:‐12.06 ‐ −0.01], p _Interaction = 0.049). An insignificant diminution trend in pigmentation was observed for both treatments (p _tretinoin = 0.672, p _DMSO = 0.092). Also, both treatments relived itchiness, but DMSO completely dispatched itchiness from the first follow up (P = 0.003 for tretinoin and < 0.0001 for DMSO). In Conclusion, Our results showed DMSO and tretinoin cream have the positive effect on the both pigmentation and itchiness in PLCA. DMSO may be more beneficial than tretinoin, since DMSO was significantly better in reducing itchiness. More investigations are warranted to provide sufficient evidence. IRCT20181114041658N1 IR.SUMS.MED.REC.1397.388.

Objectives: Individual studies in the Eastern Mediterranean Region (EMR) have shown the high prevalence of diabetic retinopathy. We conducted a meta-analysis to yield an estimate of the prevalence of diabetic (type 1 and 2) retinopathy in the EMR. Additionally, we explored its potential modulators. Methods: Two-step screening of relevant articles published from 1 January 2000 to 13 December 2019 was carried out. An estimation of summary proportions, subgroup analysis, meta-regression, and publication bias assessment were performed. Results: One hundred nine articles were included in the meta-analysis, involving 280,566 patients. The prevalence of diabetic retinopathy was 31% (95% confidence interval [CI] = 28, 33). The highest and lowest diabetic retinopathy prevalence rates were observed in low human development index (HDI) countries (63.6; 95% CI = 52.4, 74.0) and very high HDI countries 22.6 (95% CI = 20.5, 24.7), respectively. Conclusions: The prevalence of diabetic retinopathy is high in the EMR. Our results provide important information for diverse healthcare surveillance systems in the EMR to implement the modifiable risk factors, diabetes screening to decrease undiagnosed diabetes, early detection of retinopathy, and proper diabetes care to decrease untreated diabetes.