Alopecia areata remains incurable, although it has been studied for years. Available treatment options at best are beneficial for milder cases, and the rate of relapse is high. Understanding the exact mechanisms of hair loss in alopecia areata is therefore of utmost importance to help identify potential therapeutic targets.

Summary Alopecia areata is a disease that causes hair loss, although it does not always look the same and its course is unpredictable. It typically presents as small spots of reversible hair loss on the beard or scalp that can easily be treated. It can also result in total scalp baldness (called alopecia totalis) with devastating psychological impacts for some patients, inadequate treatment options, and frequent relapses. This article is a narrative review of the main events that cause alopecia areata, conducted by researchers based in Iran and the U.S.A. Many environmental and genetic factors are involved in the development of alopecia areata but the mainstream event is an attack on hair follicles by the immune system, which usually serves to protect the body from harmful ‘foreign’ substances or illnesses. In a normal state, hair follicles are kept in a sanctuary out of reach of the immune system. A breach in this sanctuary activates the immune cells against hair follicles. This happens because the immune system has never been exposed to the hair follicles so it recognizes them as foreign material. What causes this breach is a matter of debate. It could happen as a result of a problems in the central immune system or a disturbance in the follicular environment, i.e. close to the follicles. Psychological stress has also been linked to both the initiation and exacerbation of alopecia areata. A cell line called the mast cells is the link between the immunologic (immune system) events and psychological stress. Stress activates mast cells leading to the release of histamine and other inflammation‐causing factors. Multiple treatment strategies have emerged in recent years aiming at immunological targets, called biologic agents, but most of them have not been able to establish long‐lasting remissions. This may be due to the complex nature of the immunologic events which cannot be targeted with a single agent. Overlooking strategies that aim to kick‐start the regrowth of hair, after treatments that restore the immune sanctuary, might be another reason for treatment failures.

Since the emergence of the new coronavirus disease 19 (COVID‐19) pandemic, there has been a concern for the patients with chronic autoimmune diseases including dermatological conditions over the potential exacerbation of these underlying conditions after infection with severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV2). We performed a systematic review to evaluate presentations, postinfection change in the manifestation, diagnosis, and management of flare‐ups of underlying dermatologic disease in patients with COVID‐19. A total of 17 articles were recovered reporting on flare‐ups of dermatological disease including pemphigus vulgaris, psoriasis, subacute cutaneous lupus erythematosus, acrodermatitis continua of Hallopeau, systemic sclerosis sine scleroderma, and Sézary syndrome (SS). Out of these, psoriasis and alopecia areata were the most common conditions. However, most cases of psoriasis could have been attributed to either antimalarial agents that were initially used for the treatment of COVID‐19 or discontinuation of treatment following SARS‐CoV2 infection.

According to this study, QOL is improved after rhinoplasty in Iranian adult patients. With proper patient selection and a successful operation, improvement of physical and mental health can be expected.

Summary Pachyonychia congenita (PC) is a rare autosomal dominant disorder characterized by nail dystrophy and palmoplantar keratoderma with severe plantar pain affecting quality of life. There is no effective treatment. Heterozygous mutations in the keratin genes KRT6A, KRT6B, KRT6C, KRT16 and KRT17 have been reported as a cause of PC. Herein we present a female patient with an amino acid substitution mutation in KRT6A (c.1381G>A, p.Glu461Lys in exon 7) and classic features of PC associated with oral leucokeratosis and follicular hyperkeratosis. We also demonstrate successful treatment of the patient with rosuvastatin. A 3.6‐mm reduction in plantar callosity thickness was demonstrated by sonography. Our patient also experienced significant pain relief that allowed her to increase physical activity (Children's Dermatology Life Quality Index score dropped nine points following treatment). Collectively, these improvements suggest that rosuvastatin may offer a promising treatment for PC. What's already known about this topic? Pachyonychia congenita (PC) is an autosomal dominant disease characterized by nail dystrophy and painful plantar keratoderma. Keratolytics, emollients, retinoids and steroids have been used for treatment but with limited benefits. What does this study add? A patient with PC who had a KRT6A mutation was treated with rosuvastatin with significant improvement in plantar hyperkeratosis and pain. Statins could be a promising treatment for PC with long‐term safety, but further studies are needed.

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PurposeTo compare the outcomes of bandage contact lens (BCL) removal on the fourth versus seventh post-operative day following photorefractive keratectomy (PRK).MethodsThis study recruited eyes of patients who underwent PRK surgery. The patients were randomly assigned to 2 groups. In Group 1 BCL was removed on the 4th postoperative day, while in Group 2, BCL was removed on the 7th postoperative day. After BCL removal, patients were asked to express their pain score and eye discomfort. At one and three months follow-up examinations, visual acuity scale was assessed. Slit-lamp examination was performed in all visits to evaluate complications.Results260 eyes of 130 patients underwent PRK. The age and sex ratio were not significantly different between the two groups. One month after the surgery, the logMAR uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were significantly lower in Group 2 (P value = 0.016, 0.001 respectively), however, the UDVA and CDVA were not significantly different after 3 months (P > 0.05). In Group 1, filamentary keratitis (FK) was observed in 10 (7.6%) eyes, 6 (4.61%) eyes were diagnosed with recurrent corneal erosion (RCE) and corneal haze was detected in 3 (2.3%) eyes. However, in Group 2, RCE was observed in 4 (2.3%) and FK was noted in 4 (3.07%) eyes. No haze was seen in Group 2. The difference in rate of complications was statistically significant (14.6% and 6.1% in Groups 1 and 2, respectively, P = 0.02). Pain and eye discomfort scores were not significantly different (P > 0.05). There was no major complications including infectious keratitis in either groups.ConclusionFollowing PRK surgery, BCL removal on the seventh postoperative day yields faster visual rehabilitation and lower rate of postoperative complications with no increase in eye pain, discomfort or infection.

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