IRANIAN JOURNAL OF DERMATOLOGY
Year:2015 | Volume:18 | Issue:3 (73)|Papers Count:10

Urticaria is a common and challenging skin disorder. Diagnosis and treatment of urticaria is not limited to the field of dermatology. General physicians, allergologists and clinical immunologists are also commonly involved in the management of patients with urticaria.One of the missions of the Iranian Society of Dermatology is to develop strategies in order to provide the best possible management for patients suffering from dermatological conditions. To accomplish this mission, the Society assigned a committee to search and critically appraise the recent research evidence and available guidelines to develop a clinical practice guideline concerning diagnosis and treatment of urticaria.

Background: With aging, the facial folds, grooves, and sagging tissue become more prominent. It is characterized by loss of the collagen mass in the dermis and an increased array of elastin whirls in the deeper dermis. The aim of this study was to determine whether correction of nasolabial folds could be achieved using an allogeneic collagen product.Methods: Nine healthy volunteers participated in this beforeafter, pilot clinical trial. Human allogeneic collagen (Collagel, Kimia Teb Rahavard Co., Tehran, Iran) was injected in both nasolabial folds of the volunteers. Skin hydration was measured using the Corneometer ® 580 device (CK GmbH, Cologne, Germany). Ultrasonic dermal changes were measured using an ultrasonography device (22 MHz, TPM, Germany) before and 24 weeks after the injection. One independent investigator assessed the efficacy using standardized photographs before and 24 weeks after injections. The patients’ satisfaction rate was also evaluated.Results: All patients showed improvement in wrinkles and the mean satisfaction rate on a 0-10 VAS was 7.4±0.5. The hydration of the stratum corneum increased from 32.32±13.54 to 52.61±12.55 and the echo-density of the dermis increased from 8.05±3.18 to 9.55±3.36 mm 24 weeks after the injection (P£0.05). No treatment related adverse events were reported.Conclusion: Collagel is an effective filler that can provide a safe and effective correction of the nasolabial folds. This correction lasts for at least 24 weeks on ultrasound evaluations. Further larger blind-randomized controlled clinical trials are required to pave the way for suggesting it as a possible therapeutic option.

Background: The aim of this study was to investigate the thyroid function status in patients with lichen planopilaris.Methods: In this case control study, 26 (8 male and 18 female) consecutive lichen planopilaris patients, and 36 age and sex matched controls were evaluated for thyroid function status.Results: The median ant ithyroglobulin serum level was higher in patients than controls (47.1 IU/mL vs. 10.2 IU/mL, P<0.0001).Conclusion: The results of our study showed that a significant percentage of lichen planopilaris patients had an abnormal thyroid function, especially hypothyroidism. As the sample size of our study was small, further studies with more patients are required.

Background: Scarring (cicatricial) alopecia represents a complex group of inflammatory disorders, mainly characterized by destruction of the hair follicle unit. Lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) are the two main causes of primary cicatricial alopecia (PCA), both leading to hair follicle destruction and irreversible alopecia. However, they are different in pathogenesis and sometimes are diagnostically challenging.Methods: Twenty-eight formalin-fixed paraffin-embedded (FFPE) specimens of skin biopsies from 17 patients with a clinicopathologic diagnosis of LPP and 11 patients diagnosed as DLE were included. Histopathological study was performed with Haematoxylin and Eosin (H&E)-stained slides; then, immunohistochemical staining (IHC) was performed against CD20, CD3, CD4, and CD8 to evaluate and compare the type and distribution pattern of dermal inflammatory infiltrate.Results: Immunohistochemical findings showed a predominance of T-cells in both groups. CD8+ T-cells were significantly more abundant in LPP (15 cases with 10-50% of infiltration) than DLE (11 cases with <25% of infiltration) with preferential involvement of the perifollicular region (P <0.05). The proportion of CD4+ T-cells in DLE cases was significantly higher than LPP cases (9 cases with 10-50% of infiltration versus 15 cases with 0-10% of infiltration, respectively) (P <0.05) with perivascular and perifollicular distribution.Conclusions: This study supports the usefulness of IHC for CD4 and CD8 in the differential diagnosis of LPP and DLE in problematic cases.

Background: Fixed drug eruption (FDE) is an uncommon adverse reaction to medications. Mucosal areas, particularly the male genitalia, are favored sites. To our knowledge, no study has investigated the causative agent (s) in FDE occurring on male genitals of Iranian patients. So, we conducted a study to determine the most common agents and areas of involvement in fixed genital drug eruption of male patients.Methods: Diagnosis of FDE was supported by a positive history and physical examination. Data including age, site of lesions, time interval between drug administration and FDE development was collected and analyzed.Results: The age range of the 36 male patients was 17 to 60 years with a mean age ± standard deviation of 36.1±10.9 years. The most common causative drug was co-trimoxazole in 33 patients (91.7%). In the genital area, the most frequent involved site was the glans penis in 22 patients (61.1%), followed by the penis shaft in 11 patients (30.6 %) and the scrotum in 2 patients (5.6%).Conclusion: The most common causative drug is co-trimoxazole and the most common site is the glans penis.

Background: With the increase in life expectancy, middle aged and elderly people comprise a substantial percentage of the population worldwide. Since aging often manifests itself in the human skin, skin rejuvenation methods have gained a lot of popularity. Current medical modalities such as botulinum toxin injection, fillers, and laser therapy can provide symptomatic relief of skin aging signs without the ability to induce changes at a cellular level. In recent years, Platelet Rich Plasma (PRP) therapy has been emerging as a revolutionary treatment with the ability to induce cell growth in the skin, which results in retarding and reversing the aging process. Therefore, this study was conducted to determine the efficacy of PRP therapy in skin rejuvenation.Methods: A comprehensive search was conducted using PubMed, Google Scholar, and Cochrane library. Articles published only in English from 2000 to 2015 were included. The keywords used were platelet rich plasma, PRP, skin rejuvenation, skin aging, skin, platelet rich plasma therapy.Results: A total of ten articles were retrieved and included for analysis. Eight studies showed improvement of the skin wrinkles. The other two studies reported improvements in the nasolabial fold. Clinical assessments were based on patient satisfaction or feedback questionnaire, pre- and post-treatment photography, and skin biopsy. The results showed a significant improvement in the skin appearance, elasticity, texture, and homogeneity.Conclusion: In conclusion, PRP therapy is an effective and safe treatment for skin rejuvenation with no significant difference in varying techniques of PRP preparation and injection.

Polyacrylamide hydrogel (PAAG) was initially considered to be a compatible, non-toxic, non-biodegradable material. However, recent studies have shown that numerous adverse events occur after using this permanent filler. The incidence of complications following PAAG injection has been reported to be about 6.7%. Herein, we report a 32-year-old female who developed an inflammatory reaction 12 years after PAAG injection for zygomatic facial augmentation. Microscopic evaluation of the lesion showed giant cells and granuloma formation. The patient was successfully treated with prednisolone. PAAG is associated with inflammatory reactions which may present even years after injection.

Sweat gland adenocarcinoma is a relatively uncommon malignancy. Clinical features are painless red or violet papules and nodules that can occasionally become ulcerated. The biological behavior is aggressive and metastatic sweat gland carcinoma spreads through the lymphatic. The treatment of choice is wide surgical excision with regional lymph node dissection. The portrayed ase was a 60-year-old female who presented with an ulcerative plaque on the scalp. Skin biopsy, radiologic examination, and immunohistochemistry (IHC) assay revealed adenocarcinoma of the sweat gland. Reconstructive surgery was performed immediately after Mohs surgery to repair the damaged site.

Lichenoid and granulomatous dermatitis is a new entity which is histologically defined by a band like lymphocytic infiltration in the upper portion of the dermis with obscuring the dermoepidermal junction and accompanied by basal layer degeneration and granulomatous inflammation. Herein, we presented two Iranian women with similar cutaneous and histopathologic findings. Both patients had asymptomatic subcutaneous nodules on their hands. The pathological manifestation in both of them was lichenoid and granulomatous dermatitis.Our investigations indicated different underlying causes of the lesions in our patients. In one patient, the lesion was associated with hyperthyroidism and in the other one it was accompanied by rheumatoid arthritis.

Melkersson-Rosenthal syndrome is an uncommon disorder which is presented by a triad of lip swelling, facial nerve palsy, and a fissured tongue. A number of treatments have been reported for this syndrome with variable outcomes. We have reported a 38-year-old female patient with lower lip swelling and a fissured tongue on clinical examination. She was also suffering from facial nerve paralysis since 8 years ago. A significant improvement of the signs was achieved with a combination of intralesional corticosteroid injection and oral azithromycin. Although our patient showed the triad, she had an atypical clinical course due to the initiation of syndrome with facial nerve palsy, resulting in a delay in definite diagnosis of her disease. The anti-inflammatory and immuno-modulatory effects of azithromycin and the therapeutic properties of the intralesional injection of corticosteroid have an important role in managing this syndrome.