Iranian Journal of Dermatology
Year:2008 | Volume:10 | Issue:4 (42)|Papers Count:17

Background and aim: The skin has some appendages that give origin to various tumors. These tumors are generally divided to pilosebaceous and sweat glands tumors according to embryologic and histological features. Clinical and histological characteristics of these tumors are also divergent. In addition, classification of them according to histological background has been changed considerably in recent years. The aim of this study is to asses the frequency and clinicoepidemiologic characteristics of these tumors based on re-evaluation of the tissue specimens by applying new histological criteria for a better understanding, experience and reclassification.Materials and methods: All tissue samples with a definite, differential, probable or uncertain diagnosis of any kind of skin appendage tumors, archived in Pathology Department of Imam Reza University Hospital of Mashhad, during the past 30 years (1976-2005) were elicited. All the specimens were reobserved histopathologically by applying new diagnostic criteria and if necessary, were recut and stained with H&E and special histochemical stains. Clinical data were gathered and presented in tables and charts and analyzed statistically by SPSS software.Results: From 134748 archived specimens, 444 appendageal tumors were found of which 161 were of follicular origin composed of 119 pilomatrixoma (73.9%), 19 trichoepithelioma (11.8%), 15 inverted follicular keratoses (9.3%), 4 proliferating pilar tumor (2.5%), 2 trichoblastoma (1.2%), 1 trichofolliculoma (0.6%) and 1 trichoadenoma (0.6%), with a mean age of 28 years in 71 men and 90 women. The most prevalent location was head and neck area (57.5%) and the most common presentation was a nodule (81%), mostly single (94%). In most cases previous pathologic diagnosis was confirmed (95.2%) and clinico-epidemiologic features were in accordance with other world wide reports, although some changes in tissue diagnosis and differences in clinico-epidemiologic features were noted.Conclusion: Hair follicular tumors are relatively uncommon tumors, mostly benign and occurring in youngs specially in head and neck. Some differences in clinico-epidemiologic features could be related to race, genetic background, environment and etc. Some mistakes in previous tissue diagnosis alarm the 35 pathologist to pay special attention to the wide range of differential diagnosis and to employ definite histopathologic criteria regarding differences in patterns of involvement.

Background and aim: Subcision is a procedure that has been reported to be beneficial in treatment of acne scars. The objective of this trial was to assess the efficacy of subcision in the treatment of rolling acne scars and evaluate a novel subdermal filler" absorbable plain catgut suture" with subcision.Materials and methods: 22 patients with rolling acne scars underwent subcision, 20 of whom completed treatment and follow-up period. One side of the face underwent subcision and another side subcision with subdermal implant. The patients and investigators' assessments of improvement were both recorded.Results: Subcision showed mild improvement in about 60% of patients and moderate improvement in about 40% of them. The rate of response showed no significant difference with the use of subdermal implant. The side effects of local edema, bruising, and infections were all transient.Conclusion: Subcision appears to be a safe method to correct the rolling acne scars with long term improvement. However, the subdermal implant led to no significant superior results.

Background and aim: Cutaneous leishmaniasis is a common disease in the world and is an endemic disease in Iran. Highly variable results of systemic treatment of cutaneous leishmaniasis with levamisole have been reported in literature so far. The purpose of this study was to evaluate the efficacy and tolerability of levamisole as an adjuvant therapy with intralesional Glucantime.Materials and methods: Sixty patients with cutaneous leishmaniasis were included in this clinical trial.The patients were divided randomly in two groups. Thirty patients in group 1 received intralesional Glucantime along with placebo (vitamin B complex tablets, 1 tablet every 8 hours for 2 successive days per week) and 30 patients in group 2 received intralesional Glucantime plus levamisole 150 mg tablet every 8 hours in two successive days per week in adults and 3-5 mg/kg for children under 30 kg for 6 weeks.Results: The clinical response of combination therapy (78%) was significantly better then group 1 (64%), the difference was statistically significant (p<0.001). The difference in rate of re-epithelization between the two groups was also statistically significant (p<0.01).Conclusion: This study demonstrated that levamisole can be used as an adjuvant therapy in combination with intralesional Glucantime for the treatment of cutaneous leishmaniasis.

Background and aim: Lichen planus (LP) is an inflammatory papulosquamous disease that affects skin, mucous membranes, nails and hair. As the disease presents in various clinical types, the objective of this study was to determine the frequency of clinical variants of LP in dermatological out-patients in Kerman.Materials and methods: In this study 300 patients with LP were evaluated during 1382-83 in dermatological out-patients in Kerman. Diagnosis was based on clinical features and skin biopsy. The demographic features including age, sex, and the clinical pictures of the disease including clinical types, site of involvement, duration of the disease and associated diseases were assessed. The hepatitis B surface antigen, anti hepatitis B core antibody, hepatitis C antibody and liver function tests were measured.Results: Patients consisted of 167 men (55.5%) and 133 women (44.5%) with a mean age of 32.4 years and a mean duration of 11.6% months. The age of patients ranged from 4 to 78 years, most being in the age range from 30 to 50 years. The majority of patients (70.6%) had classical lesions followed by mucosal (65%), annular (21%), hypertrophic (19%), and lichen nitidus (18%). The dermatomal type obtained the least frequency (2.6%). Upper extremity was the most frequent site of onset (70.6%). Mucosal involvement was observed in 65% and nail and hair changes were observed in 33.6% and 6.6% of patients, respectively. Pruritus was the chief complaint of the majority of patients.Conclusion: Classic LP was the most common type and extremities were the most common site of involvement in this study.

Background and aim: Isfahan is one of the most important endemic areas of zoonotic cutaneous leishmaniasis (ZCL) in Iran. The objective of this study was to present different clinical pictures of ZCL and to identify the responsible Leishmania species using polymerase chain reaction (PCR).Materials and methods: This cross-sectional, descriptive-analytic study was performed from September 2006 to February 2007, in skin Disease and Leishmania Research Center, which is a referal center for leishmaniasis. Among 440 suspected patients, Leishmania promastigotes were isolated from 3Iatypical and 60 classic CL lesions and identified using Permissively Primed Polymorphic-PCR method.Results: From a total of 600 observed patients, 440 were parasitologically proved using direct smear, 409 patients (92.9%) showed typical clinical picture of volcano-shape and 31 (7.1%) of patients showed atypical forms. PCR method identified all isolates as L.major.Conclusion: ZCL lesions may present with various clinical manifestations in the same endemic area, which limits the identification of responsible parasite based on clinical features. The reasons for diversities in clinical pictures are not yet known.

Background and aim: Acne is a common skin disorder that can affect patient's quality of life. Most of acne patients do not seek medical treatment or are not adherent to it, while acne is a treatable condition.There are several methods that can be used to improve medical adherence, education is one of them.There are several models for patient's education. Regarding to belief and insight nature of barriers of adherence in acne patients, health belief model was chosen for intervention in order to increase their medical adherence.Materials and methods: We randomly assigned 141 patients with mild acne to one of following three groups. Group one received face to face education and pamphlet according to health belief model, group two only received pamphlet and group three received no education as control. Rate of adherence was calculated by self-reported log of patients and by weight of consumed medication. We followed all of patients for three months.Results: 101 patients completed study in three months. At baseline all demographic features were similar in three groups. At end of study, mean adherence rate that was calculated from patients log was different (p<0.05) between groups one and three. Mean adherence rate that was calculated from medication weight was different between group one and groups two or three (p<0.01).Coclusion: Health belief model based education is effective in improving medical adherence of acne patients. The main reason for efficacy of this model is related to removing of subjective barriers of adherence and to encourage the patient to better taking of medication. According to our results the education will be effective if patient received face to face education and education through pamphlets alone is not be effective. Measuring of adherence with weight of medication is more accurate than patients' self report.

Background and aim: Psoriasis is a dermatologic disease which not only involves the patient physically, but also affects patient's quality of life. Due to its life time duration and psychologic burden, we decided to evaluate patient's quality of life using psoriasis disability index (PDI).Materials and methods: From August 2006 till March 2007, 80 patients referring to Imam-Reza dermatology clinic completed the PDI questionnaire and a demographic questionnaire. Collected data were analyzed by Hest, one way ANOVA tests using SPSS software.Results: 46.2% of patients were male and 53.8% female. The mean age of patients was 40.2 years. 10% had positive family history of psoriasis. 47.5% had a history of hospitalization. 41.3% had articular and 53.8% had nail involvement. Mean morbidity duration was 12.6 years and mean PDI score was 17.4±10 (maximum and minimum scores: 37 and 1 respectively). There was significant difference in mean PDI score in groups considering age, sex, education, location, duration and extent of disease, hospitalization history, nail involvement and type of treatment. Most disability was seen in the treatment field (both sexes) and occupation /school (men) and least disability were seen in individual relationships.Discussion: Psoriasis can reduce the patient's quality of life and satisfaction severely. Therefore supportive strategies can improve their quality of life.

Background and aim: Deficiency of zinc -as a necessary trace element - causes exacerbation of acne and development of acne lesions. Also zinc has been used in acne treatment. In this study serum zinc level was evaluated in severe acne cases.Materials and methods: Severe acne cases as well as sex and age matched controls were selected from dermatology clinics of Imam Reza and Qaem Hospitals during 2003 to 2005. Five ml of blood was sampled from each individual and serum zinc level was measured by atomic absorption spectrophotometric method. The mean of zinc serum level between the two selected groups was compared by t and Mann-Whitney tests.Results: Thirty patients (16 females and 14 males) with mean age of 19.8±2.05 years and 28 cases in control group (13 females and 15 males) with mean age of20.78±2.46 years were included in this study.The mean serum zinc level in patients and control groups were 99.85±18.07and 101.57±10.52 mg/dl, respectively. There was no significant difference between the serum zinc levels of the two groups.Conclusion: In this study, there was no relation between the serum zinc level and severe acne disease.Considering the high prevalence of acne and the rarity of zinc deficiency in the general population, the etiologic role of zinc deficiency in acne needs a study in a very large sample, or evaluation of acne prevalence in zinc deficient patients.

Background and aim: Skin diseases in childhood have differences from adulthood in many aspects, so the detection of the pattern of the disease frequency, have an important role in treatment and research protocol. The detection of the frequency pattern of the dermatology diseases in children was the main aim of this study.Materials and methods: In this cross-sectional study 937 children under 16-years-old that referred to dermatology clinics of Kerman city from September 2006 to February 2007 were enrolled. The data collection forms. including sex, age, parent education, residential area were completed, The diagnosis of the disease has been done by dermatologist by history taking and physical examination and paraclinical methods including biopsy, bacterial smear and culture, fungal smear, Woods lamp and Tzank test.Results: The results showed that dermatitis and infectious diseases were the most common diseases. The most common dermatitis was atopic and then seborrheic and the least common ones were plantar dermatosis and chronic lichen simplex. Viral and parasitic skin infections were more common than bacterial and fungal skin infections. The melanocytic nevus was more common in girls than boys (P=0.02). Keratinization disorders were more common in urban area than rural area (P=0.05). Dermatitis and nevi and keratinization disorders in children of educated mothers were less common than non educated mothers (P=0.006).Conclusion: Atopic dermatitis was the most common disease in this study. It may be the result of changes in the diet regimen, perinatal risk factors, more contact with environmental allergens and weather condition. The next common disease was skin infections which show the importance of planning better hygiene strategy in this age group.

Contact dermatitis can affect dentists, orthodontists, technicians, nurses and the patients. The increase of dental patients in recent years caused an increase in reports of dermatitis and other allergies in patients and in dentists too.With changes in dental materials through years, allergy and contact reactions in persons in contact with new allergens had been increased. So dentists and dermatologists should be aware of new allergens and try to avoid contact with these materials as possible. This review is performed to increase the knowledge of medical personnel about this issue with description of each allergen.

Atrichia with papular lesions (APL) is a rare, autosomal recessive syndrome with total alopecia in which mutations in the hairless gene have been shown to underlie the phenotype. We report here three cases, two 16 and 18 years old cousins and a 15 year-oId-girl with a history of shedding of scalp, eyebrow and eye lashes in infancy. Later in life they developed numerous erythematous papules on their limbs predominantly on the knees and elbows. According to their history, clinical presentation and pathologic findings, diagnosis of atrichia with papular lesions (APL) with some different features was postulated.Comparing to the known cases of APL with scalp, facial and truncal lesions, the cases presented here do not show such lesions in these sites.

Sulphur Mustard is a potent chemical warfare agent that was widely used during First World War and Iran- Iraq conflict. Over 100,000 Iranians were injured by sulphur mustard and one-third is of them were suffering from late effects until today.This vesicant agent has a lot of acute and chronic destructive effects on the skin, eye and respiratory system. Sulphur mustard via the alkylation of several cellular proteins (structural, cytoplasmic and enzymes) and cell nuclei, produce several toxic, mutagenic and carcinogenic effects on epidermis, dermis, dermal appendages and hypodermis.We report a 41-year-old man who was poisoned with sulphur mustard in 1988.After exposure he developed severe skin blisters on upper trunk, posterior aspect of both hands and genitalia along with ocular and respiratory complications.He also had atrophy, pigmentation and vascular changes on skin of penis with pigmentation, atrophy and related findings in histopathologic studies, so the diagnosis of "sulphur mustard induced poikiloderma" was postulated.The absence of any complication on palm.s. despite of their recurrent exposure to sulphur mustard is another remarkable finding in this case. It has been suggested that palm.s. can act as a transport vector of sulphur mustard to other sites of skin.

Netherton syndrome is a rare autosomal recessive condition with variable expression. It comprises an ichthyosiform dermatitis and erythroderma of variable intensity associated with hair abnormalities and features of atopy. The pathognomic (required for diagnosis) feature is trichorrhexis invaginata identified by microscopic examination of hair shaft. Ichthyosis linearis circumflexa is another typical lesion that may not always be observed. It comprises an episodic migrating erythematous and scaling annular and polycyclic flat patch with an advancing double edge of peeling scale. Here we present two cases of Netherton syndrome with characteristic manifestations mentioned above.