Iranian Journal of Dermatology
Year:2006 | Volume:9 | Issue:1 (35)|Papers Count:25

Background and aim: Human keratinocytes have been cultivated in vitro using different methods. Using small size skin, large epidermal sheets have been produced. These epidermal sheets have been used for the treatment of injured epidermis, especially bum and other skin clinical disorders, and also for research purposes. The objective of this study was isolation and in vitro cultivation of human skin keratinocytes and preparation of epidermal sheet without using mouse 3T3 fibroblast feeder layer. Materials and Methods: Small size human skin with a relative thickness was divided to small pieces and the epidermis was separated from dermis using warm trypsin. Then keratinocytes were isolated from epidermis and cultured with high density in DMEM containing FBS and other supplements like cholera toxin and epidermal growth factor. The resulting epidermal sheet was separated using dispase grade II and transferred to vase line gauze. Histological studies were also carried out on the epidermal sheet. Results: Keratinocytes grew as multiple colonies and produced a thin confluent epidermal sheet consisted of a few layers of cells. With time, number of cell layers was increased and a thicker epidermal sheet was produced. Fibroblasts, which were present in the original cell suspension, grew in the culture when the growth of keratinocyte was slow or when a low density of keratinocytes was used. The histological examination of epidermal sheet showed the presence of germinative basal cells, suprabasal cells with relative differentiation and also melanocytes. The dimension of epidermal sheet was decreased when it was separated from tissue culture flask using dispase. Conclusion: Cultured epidermal autografts have several clinical and investigative indications. Even though the cultivation of keratinocytes with high density is easy, however, the surface area of resulting epidermal sheet is limited and its subculture is difficult. In this method there is the risk of growth of dermal fibroblasts. To produce thicker epidermal sheet with more cellular layers, it is better to separate it within two to three weeks after cultivation.      

Background and aim: Cutaneous leishmaniasis is a common parasitic disease in Iran specially in Isfahan. The first line of treatment for this disease are antimonial compounds, however, because of the increasing unresponsiveness and significant side effects alternative therapeutic measures have been advocated. This study was performed to evaluate the efficacy of meglumine antimoniate (Glucantime) plus pentoxifylline in the treatment of cutaneous leishmaniasis. Materials and Methods: This double blind randomized controlled clinical trial with simple sampling was perfonned on 64 patients with cutaneous leishmaniasis referred to Skin Diseases and Leishmaniasis Research Center. The patients were randomly divided in two groups. One group was treated with systemic Glucantime combined with pentoxifylline and the other group was treated with Glucantime plus placebo for 20 days and the patients were followed up for 3 months. The response to treatment was categorized into complete improvement (the lesions had been flattened, there was no induration and epidennal creases had been appeared), partial improvement (reduction in the size of the lesions, but without appearance of epidennal creases) and poor response (no reduction in the size of lesions). Results: Of 64 participants 32 patients in trial group and 31 patients in control group were  followed for 3 months. After this time complete improvement, partial improvement and poor response to treatment were 81.3% , 12.5% and 6.2% in trial group and 52% , 29% and 19% in control group; respectively(P=0.04). We also observed no adverse effects due to pentoxifylline. Conclusion: Combined therapy with Glucantime plus pentoxifylline was more effective than Glucantime alone.      

Background and aim: Anogenital wart is a common skin disease and 1.3 million new cases are diagnosed in the US each year. About one percent of sexually active adults suffer from anogenital warts. This study was performed to evaluate human papilloma viruses (HPV) in anogenital warts using Polymerase Chain Reaction (PCR) method in patients admitted to the Skin Clinics of Skin Research Center, Shahid Beheshti Univesity of Medical Sciences. Materials and Methods: This cross sectional study was performed on 32 patients with anogenital warts, whose clinical diagnosis was confirmed by histopathologic examination. Biopsy specimens of the patients were evaluated by PCR method and virus type was determined. Results: In 12 (37%) patients HPV infection was confirmed using PCR method. The distribution of patients among infections with high-and low-risk HPVs was not different. There was no  correlation between clinical features and HPV type. Conclusion: Controlled studies with larger sample sizes are recommended.      

Background and aim: Skin cancer is the most common malignancy in the world, and carries a high rate of morbidity but low rate of mortality with the exception of malignant melanoma, which has a high mortality rate. In recent decades, incidence of skin cancers has been increased. The  most important risk factors are sunlight and skin type. This study was performed to evaluate the demographic characteristics of skin cancers in Mashhad. Materials and Methods: This cross-sectional study was performed on 2786 cases of skin cancer from the archive of the pathology department of Qaem hospital in a twenty-year period (1975- 1995). Sex, age and localization of lesions in all registered cases were studied. Results: Frequency of three common skin cancers in 2786 cases were basal cell carcinoma (BCC) 1606 (57.7%), squamous cell carcinoma (SCC) 562 (20.3%), malignant melanoma (MM) 122 (4.5%) and skin metastasis 96 cases (3.5%). Ratio of BCC/SCC was 2.85/1. BCC, SCC and MM were more common in men, and BCC, SCC, MM and skin sarcoma were most commonly observed in the sixth decade. Median of age in BCC, SCC and MM was 54±15.9, 56±15.4 and 53± 14.7 years; respectively. Ninety-three percent of BCC and 74% of SCC lesions were located on head and neck region and lower limb was the most common site of melanoma and skin sarcoma. Conclusion: Frequency of BCC, SCC and skin metastasis was similar to reports from other countries, but ratio of malignant melanoma to non-melanoma skin cancers (NMSC) was 50% lower than other studies. The median age in BCC was 54 years, which was lower than other studies. The most common sites of NMSC were in sun exposed areas which can emphasize the role of sunlight in the etiology of skin cancers.      

Background and aim: Patch testing is an important diagnostic tool to confirm allergic contact dermatitis. Determination of the validity and usefulness of a standard patch test allergen series with consideration of age, sex and race difference can reduce diagnostic errors in patients with allergic contact dermatitis. This study was done to determine the frequency of contact sensitization to 28 common allergens in patients with clinical diagnoses of contact and/or atopic dermatitis. Materials and Methods: In a cross sectional study during 6 months, 250 patients with contact and/or atopic dermatitis were patch tested with DKG standard patch test series and evaluated after 24, 48 and 72 hours after application of patch test. Data were analyzed using SPSS. 11 software by X2, Fisher's exact and t tests. Results: Positive patch test results were seen in 32% of all evaluated patients. 45.8% of patients with age above 40 years and 28.0% of patient with age below 40 years had a positive patch test. Potassium dichromate and nikel sulfate were the most common allergens in our study. In this study only 13 of 18 (46.4%) tested allergens showed positive reaction. Conclusion: Low positive rate of standard DKG series in this study shows that allergen series of standard patch test should be revised based on regional conditions, allergens and social habits.      

Background and aim: Sulfur mustard (SM) is a blistering agent which has been used as a chemical warfare agent in many wars since 1917. It has been used several times by Iraqi forces during Iraq- Iran war (1980-88). Lungs, skin and eyes are the three major targets affected by SM. We had observed an increased number of cherry angiomas, benign vascular tumors, in Iranian veterans after exposure to SM, so we decided to assess number and size of cherry angiomas in Iranian veterans several years after exposure to SM. Materials and Methods: In this historical cohort study, 99 veterans exposed to SM were compared to 52 non-exposed individuals. Participants were examined for number and maximum size of cherry angiomas and the findings were compared between the two groups. Results: All participants were male. The age range in case group was from 30 to 60 years (mean ±SD: 42.7±7.6) and in control group was from 30 to 65 years (mean±SD: 39.9±9.9). In case group, number of angiomas and maximum size of them were significantly greater than those in control group (P=0.001 and P=0.0001 respectively). There was a direct correlation between number of angiomas and maximum size of them in case group (P=0.0001). Most of lesions were located in trunk and upper extremities. Conclusion: SM seemed to be responsible for the presence of multiple cherry angiomas in veterans several years after exposure. Maximum size of angiomas in veterans was significantly grea r than those were observed in non-exposed individuals.      

Background and aim: Lichen planus is a common inflammatory disease of the skin, mucous membranes, nail and hair follicles. This study was performed to determine therapeutic efficacy of, oral metronidazole in generalized cutaneous lichen planus in patients referred to the dermatology clinic of Razi Hospital from 2003 to 2004. Materials and Methods: Fifteen patients with lichen planus whose diagnosis was confirmed pathologicaly were treated with oral metronidazole 500 mg twice daily for 60 days and were followed up for 1 month after the end of treatment. Results: Nine of fifteen patients (60%) had complete response, four patients (26.7%) partial response and two patients (13.3%) had no response. Conclusion: Oral metronidazole may be useful in the treatment of generalized cutaneous lichen planus.    

Background and aim: Tinea faciei is an uncommon fungal infection, which infects glabrous skin of the face. All species of dermatophytes can produce this disease. The objective of this study was to determine the frequency of various dermatophyte species that produce tinea faciei and frequency of correct primary diagnosis in this disease in patients referred to Razi Hospital in Tehran. Materials and Methods: In this cross-sectional study, 22 patients with tinea faciei referred to Razi Hospital from April 2004 to March 2005 were evaluated considering species of dermatophyte and  the accuracy of primary diagnosis. Results: The most common species was Trichophyton tonsurans that was the causative agent in 10 patients. Fifteen patients had been admitted in other centers before coming to Razi Hospital and in 86% of them tinea faciei had been misdiagnosed. Conclusion: Clinical presentation of tinea faciei may be atypical in many cases and can lead to incorrect diagnosis. Therefore tinea faciei should be considered as a differential diagnosis in any localized erythematous lesion on the face.      

Background and aim: Vitiligo is a progressive condition and relatively common depigmentary disorder that affects about 1-4% of general population. There is no effective treatment for it so far. In Iran, no exact estimation of vitiligo prevalence is available, but it has been estimated that 0.9 to 1.2% of the total population is suffering from vitiligo. As vitiligo does not result from a traumatic event or significantly impair physical health and it causes no pain, it represents an ideal model for examining the psychological phenomena of living with an appearance altering disease. Materials and Methods: Sixteen women who suffered from vitiligo were recruited into this herrneneutic phenomenological study. Data were analyzed using Dickelman and Allen method. Results: Four subordinate themes were identified: perceptions of self, perceptions of disease, adaptation to the disease (acceptance or non acceptance of the disease), others and disease (significant others, supportive behavior and threatening behavior). Women affected with vitiligo during their marriage-ready years, in addition to their mental problems resulting from a skin disease and marred beauty; face various other social problems such as rejection by associates, isolation, divorce and an obligatory choice of a single life. Conclusion: Since stress is a known exacerebating factor for vitiligo, social support and psychotherapy, increasing awareness level of general population about this disease, revision of social law, may help to break the viscous cycle of disease exacerbation.    

Background and aim: The etiology of alopecia areata is not clear, but a possible autoimmune cause has been suggested. Serum zinc levels in alopecia areata have been studied, but the eported results were discordant. The aim of this study was to measure the serum zinc levels of the patients with alopecia areata and to compare it with those of the control group. Materials and Methods: In this case-control study, 46 alopecia areata patients admitted to the skin clinic of Imam Khomeini Hospital, Jundishapour University of Medical Sciences in Ahwaz and 33 sex and age matched individuals were studied. The serum zinc levels of both groups were measured using atomic absorption spectrometry and the results were compared. Results: The mean±SD serum zinc level was 873±154.9 micg/1 and in alopecia areata patients 831.8±155.8 micg/1 in control group (P>0.05). Conclusion: No difference was observed between the serum zinc levels of patients with alopecia areata and controls. More studies for evaluation of a possible relationship between serum zinc levels and alopecia areata is recommended.      

Background and aim: Sunscreens are used for prevention of skin damage caused by the sun. Since various products are available, people should be encouraged to find the most appropriate one for their skin. We performed this study to detect the awareness level regarding appropriate sunscreen usage in patients referred to Sari dermatology clinics in 2004. Materials and Methods: This cross-sectional study was done in the autumn and summer of 2004 in Sari dermatology clinics. The study sample size was 400 participants. The measuring device was a questionnaire consisted of questions about sun light and sunscreen usage and demographic data. Results: Most participants had moderate (35.4%) (Correct answers to 50-70% of questions) and good (35.5%) (Correct answers to 70-100%) awareness level, 26.4% had weak (correct answers to 25-50%) and 1.7% had unacceptable (correct answers to less than 25%) awareness about correct method of application of sunscreens. In this study the awareness level among females was significantly higher than males. There was a significant correlation between education level and awareness level (P<0.001),but no correlation between marital status, age and job and the awareness level was found. Conclusion: The awareness level in females was moderate and good. The awareness level in males was less than females, which shows their less attention to skin care. The weak and unacceptable level of awareness was considerable indicating the need for social educational interventions.      

Sunscreens have been used since 1928. At that time they were used to prevent sun bums mostly because of filtering ultraviolet (UV) B light, the major cause of sunburning and tanning. Over recent decades, the knowledge concerning other harmful effects of UVB on the skin and the role of UVA in skin damage has widely grown. In this article, evidence regarding the efficacy of sunscreen use in the prevention of skin cancers and melasma will be reviewed.      

Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a pregnancy-specific dermatosis, which is a tremendously uncomfortable condition that effects primigravid women in their third trimester of pregnancy. The severe itching of PUPPP reduces sleep in the weeks prior to parturition. Erythematous urticarial papules and plaques with small vesicles are noted, but true bullae formation has not been reported. We present a 33-year-old woman with clinical findings of PUPPP with large bullae formation on her lower abdominal and periumbilical skin. Considering herpes gestationis as the first clinical diagnosis, a skin biopsy was performed. Histopathological findings confirmed the diagnosis of PUPPP.      

Acral lentiginous melanoma (ALM) is a type of malignant melanoma (MM) that involves glabrous skin. It is the dominant type of MM in Asians, Hispanics and Blacks. ALM usually presents as a brown patch with lentiginous spots on its surface. The lesion may become ulcerated. This type of MM is prone to be misdiagnosed and when it occurs on the plantar skin its diagnosis may be delayed. Herein, a case of ALM at the fourth interdigital space of foot in a 65-year-old diabetic patient is reported. This patient had been misdiagnosed as case of cutaneous candidiasis with fissures and had received antifugal agents.      

Basal cell nevus syndrome (Gorlin's syndrome) is a rare autosomal dominant tumor-predisposing syndrome which is classically consisted of multiple cutaneous basal cell carcinomas, odontogenic, keratocysts of the jaw, pits of the palms and soles, ectopic calcification of cranial membranes and various skeletal abnormalities. We report a typical case of Gorlin's syndrome in a 50-year-old man who presented with a tender mass of jaw.