Effect of Laser-Assisted Hair Removal (LAHR) on the Quality of Life and Depression in Hirsute Females: A Single-Arm Clinical Trial

Introduction: Hirsutism, mainly due to polycystic ovary syndrome (PCOS), causes stress, anxiety, and depression in females. Laser-assisted hair removal (LAHR) is currently accepted as a good treatment option for hirsutism. The goal of the current study was to ascertain how LAHR affected the degree of hirsutism, quality of life, and depression in hirsute females. Methods: A single-arm before/after clinical trial was designed and performed in the Razi hospital Laser Clinic over a 15-month period. All hirsute females visiting the Razi hospital laser clinic were enrolled and received three sessions of LAHR every 4-6 weeks if they were interested and signed an informed consent form. Before the commencement of LAHR and six to eight weeks after the last session, the Ferriman-Gallwey score (hirsutism severity), Beck score (depression index) and DLQI score (quality of life index) were calculated and stored. Results: There were 80 subjects in all. The mean ± SD of the Ferriman-Gallwey score was reduced from 7.05 ± 2.27 to 4.91 ± 2.41, P < 0.001. The mean ± SD of the Beck depression score was reduced from 13.3 ± 8.7 to 10.2 ± 8.4, P < 0.001, and the mean ± SD of the DLQI score decreased from 5.6 ± 5.2 to 3.5 ± 2.3, P < 0.001. No significant complications were reported. Conclusion: LAHR can improve hirsutism-related depression and degradation of quality of life, as well as hirsutism physical signs.

Indirect immunofluorescence on rat bladder epithelium in patients with pemphigus vulgaris with an extended follow‐up

Background

Indirect immunofluorescence (IIF) on rat bladder epithelium (RBE) has been widely used to detect anti‐plakin antibodies present in paraneoplastic pemphigus (PNP). However, anti‐plakin antibodies have also been found in a group of patients with pemphigus vulgaris (PV).

Objectives

To assess the reactivity rate of PV sera in IIF using RBE as substrate and the diagnostic usefulness of the aforementioned test.

Methods

Patients diagnosed with PV presenting to Razi Hospital, Tehran, Iran, were recruited. The patients' demographics, disease severity, and response to the initial treatment were recorded. Sera were collected and tested by IIF on RBE and by desmoglein 3/1 (Dsg 3/1) enzyme‐linked immunosorbent assay. Patients were followed up closely for a mean of 53.9 months for any evidence of malignancy.

Results

Forty‐six patients were enroled (mean age of 42.9 years old, 31 females). Nine sera (19.6%) showed reactivity in IIF on RBE. Mean serum anti‐Dsg levels did not differ significantly among the two groups with positive and negative IIF results. Negative anti‐Dsg3 was related to a higher positive rate in IIF on RBE. There was no significant correlation between the reactivity of IIF on RBE and patients' demographic, clinical, or serological characteristics.

Conclusions

IIF on RBE is a sensitive test for detecting antibodies against plakins. However, it has a relatively high false‐positive rate in PV, probably due to the epitope spreading phenomenon. This test should be suggested when there is a clinical or immunohistopathological suspicion of PNP and should be interpreted with caution.

Botulinum toxin injection as a single or combined treatment with non-cross-linked high molecular weight and low molecular weight HA gel for neck rejuvenation: A Randomized Clinical Trial

BACKGROUND

The unpleasant appearance of the neck through the aging process could burden the psychosocial quality of life, therefore various treatment modalities have been used to rejuvenate the neck. The present study aimed to evaluate the efficacy of botulinum toxin injection as a single or combined treatment with Profhilo gel for neck rejuvenation.

METHODS

Patients with a request for neck rejuvenation meeting the inclusion criteria were randomly divided into two groups. Initial clinical scoring based on Wrinkle Severity Rating Scale (WSRS) and skin biomechanical parameters using a Multi Adaptor System (MPA) were performed before starting the treatment. Dysport Botox was injected for all of the participants, moreover, in one of the groups (intervention), Profhilo gel was injected after two weeks and a follow-up visit was performed for both groups 3 months later. Patients were evaluated according to the GAIS (global aesthetic improvement scale) by two blind dermatologists and skin biophysical parameters were measured by MPA such as TEWL, hydration, thickness, density, visco-elasticity, net elasticity, pliability/firmness.

RESULTS

In this study, 19 participants in the control (Dysport) and intervention (Dysport + PROFhilo gel) groups were evaluated. Before starting the treatment, the two groups were similar in terms of WSRS scores and biophysical skin parameters. Three months after the treatment, it was observed that Hydration (p <0.001) and Thickness of the skin (p = 0.028) in the intervention group were significantly higher than in the control group. Similarly, the GAIS scores of the intervention group showed significantly better results comparing to the control group (p <0.001).

CONCLUSION

Profhilo gel following Dysport Botox can be considered as a safe and more effective treatment of neck aging comparing to Dysport Botox injection alone in patients who are not a candidate for surgery due to any reason.

Effect of Different Pulse Durations on the Efficacy of Long-Pulsed Alexandrite-Assisted Hair Removal; A Split-Face Comparison Study

Introduction: Laser-assisted hair removal is widely used by a large number of patients complaining of unwanted hair. However, little is known about the effect of varying the pulse duration on clinical results and side effects. This study aimed to investigate the effectiveness of hair removal using an alexandrite laser with different pulse durations. Methods: Fifty female patients with facial hirsutism were subjected to a hair removal procedure with an alexandrite laser, using 3 and 10 milliseconds pulse durations on each side of the face every 5 weeks for three sessions. Photographs were taken and hair counts were checked before the treatment and one month postoperatively. Results: one month after the laser treatment, the clearance rate was 56% with both 3 and 10 milliseconds pulse durations. There was not any significant difference in clinical efficacy or the side effect profile. Conclusion: Using a 755 nm alexandrite laser for hair removal is an effective and safe method for delaying hair regrowth and this delay is not markedly different by increasing the pulse duration from 3 to 10 milliseconds.

Does Double-Pass Pulsed-Dye Laser With Long and Short Pulse Duration Increase Treatment Efficacy of Port-Wine Stain? A Randomized Clinical Trial

BACKGROUND

Although pulsed-dye laser (PDL) 595 nm is known as the gold standard for treatment of port-wine stains (PWS), complete clearance of lesions occurs in a minority of cases.

OBJECTIVE

To compare the efficacy and safety of double-pass pulsed-dye laser (DPL), long pulse duration (20 m/s) followed by short pulse duration (1.5 m/s) within 20 minutes interval, with single-pass pulsed-dye laser (SPL) for (1.5 m/s) in the treatment of PWS.

METHODS

Twenty-four patients with PWS underwent 3 sessions of PDL. Each lesion was randomly divided into 2 portions to receive DPL or SPL. Colorimetric and dermoscopic evaluations were used to determine the response objectively. In addition, improvement was scored subjectively using the visual analog scale (VAS).

RESULTS

According to colorimetric analysis, the mean blanching rates for DPL and SPL treated sites were 48% (SD = 0.215) and 37% (SD = 0.213), respectively (p = .001). With VAS, 3.79 (SD = 0.93) and 3.33 (SD = 0.91) improvement scores were reported in the DPL and SPL treated areas, respectively (p = .008). Dermoscopic images showed that larger deep vessels were the most common remnant vessels in both treatment areas.

CONCLUSION

Compared with SPL, DPL with 20 minutes interval seems to be a more effective and safe method for the treatment of PWS.

Diagnostic value of cytology in oral ulcer and comparison with histopathology and direct immunofluorescence

Rapid diagnosis of pemphigus vulgaris (PV) is an important task in patient's prognosis and treatment. Although PV is routinely diagnosed through investigation of pathology specimens and direct immunofluorescence assays, Tzanck smear can be used as rapid, inexpensive, and easily used test to confirm its clinical diagnosis. This study aimed to determine the diagnostic value of Tzanck smear in erosive oral lesions of PV and also determine its sensitivity and specificity for diagnostic purposes. A total of 68 patients with erosive/ulcerated oral lesions were included in this study and divided into PV (case group) vs other causes of erosive oral lesions (control group). From all participants, two Tzanck smears were prepared for both Giemsa and hematoxylin-eosin (H&E) staining. For definite diagnosis, histopathology and direct immunofluorescence evaluations were performed based on clinical findings. The sensitivity of acantholytic cells in Tzanck smear of erosive oral lesions of PV cases was 80.5% (for both Giemsa and H&E staining), whereas specificity values of Giemsa and H&E staining were 84.6% and 96.3%, respectively. Based on our findings, the Tzanck smear of erosive oral lesions is a simple, quick, and inexpensive test for screening and primary diagnosis of PV.

An unusual case of multibacillary leprosy mimicking prurigo nodularis

Leprosy is a chronic infectious disease with a wide range of clinical manifestations. The early diagnosis of leprosy is a worldwide challenge. We present a case of leprosy with unusual severe pruritus and generalized excoriated papules and nodules.

Decreased Sox2 Messenger RNA Expression in Basal Cell Carcinoma

Background

Sox2, zeb1, and p21 have been implicated in aggressive behavior of squamous cell carcinoma (SCC) and melanoma. However, their expression level in basal cell carcinoma (BCC) has not been elucidated. We hypothesized BCC, contrary to SCC, and melanoma, could be a suitable model to study mechanisms which attenuate tumor metastasis. The aim of this study was to examine the messenger RNA (mRNA) expression levels of sox2, zeb1, and p21 in BCC.

Materials and Methods

Twenty-seven nonmetastatic BCC and twelve normal skin samples were evaluated using real-time reverse transcriptase polymerase chain reaction.

Results

The stemness marker sox2 demonstrated marked down-regulation, but zeb1 and p21 showed no significant change.

Conclusions

Here, we report a negative association between sox2 mRNA expression level and nonmetastatic BCC, thus, providing a likely explanation for the fact that normal skin is more reliant on sox2 than BCC. BCC may be using decreased sox2 mRNA to remain incognito from metastatic potential.

Mucous membrane pemphigoid and COVID-19 treated with high-dose intravenous immunoglobulins: a case report

This is a report of a case with mucous membrane pemphigoid (MMP) with severe eye involvement and concurrent COVID-19 treated successfully using simultaneous high dose intravenous immunoglobulin (IVIg) and anti-viral treatment as hydroxychloroquine, lopinavir/ritonavir, and ribavirin. He had finished a 2-g cycle of rituximab (RTX) in late January. He was receiving mycophenolate mofetil (MMF) for one month and 30 mg prednisolone for three months until his hospitalization. Prednisolone was tapered to 15 mg when current COVID-19 was suspected, considering his recent cough, dyspnea, and fever.

An enlarging scaly plaque localized on the previous keloid of the chest

Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma (CTCL). It may arise rapidly in a scar or keloid, presumably due to a long-standing proliferative state or autoimmune theory. There should be a low threshold for performing a skin biopsy if unusual lesions develop at those sites.

Relationship Between Level of Serum 25-Hydroxyvitamin D and Risk of Squamous Cell Carcinoma in an Iranian Population

Background

The relationship between vitamin D and skin squamous cell carcinoma (SCC) is not well defined.

Objective

To investigate the relationship between vitamin D levels and the incidence of skin SCC for the first time in Iran.

Methods and Study Design

In this case-control study, 126 subjects were enrolled (63 in each group) out of referents to Razi Skin Hospital in Tehran in 2014. The risk factors for cancer gathered by self-reported questionnaires and blood samples were obtained to measure the level of 25-hydroxyvitamin D. Multivariate logistic regression was used to neutralize the effect of confounding factors.

Results

Cases of SCC were more likely to be in men, older than 49 years and working in an outdoor environment, and with longtime exposure to sunlight and a personal history of skin cancers. Family history of skin cancer and of cigarette smoking were not significantly related to SCC. In the SCC and control groups, 69.8% and 31.7%, respectively, had sufficient levels of vitamin D (P < 0.001). Mean level of 25-hydroxyvitamin D was 40.99 ng/mL in the SCC group and 26.34 ng/mL in the control group (P < 0.05). In the unadjusted model, the level of vitamin D as a continuous variable was positively related to SCC risk. In the adjusted model, vitamin D did not independently predict the likelihood of SCC.

Conclusion

Vitamin D level and SCC risk are directly related, although not in an independent fashion. Indeed, this relation is severely confounded by exposure to sunlight, which was evidenced by an increased vitamin D level in the people working outside and the higher prevalence of SCC in the same population.

Prevalence and correlates of low physical activity in the Iranian population: National survey on non-communicable diseases in 2011

To assess the prevalence and correlates of low physical activity among Iranian population aged 15-64 years. We used the data collected in National Surveillance of Risk Factors of Non-Communicable Diseases in Iran, 2011. Physical activity was categorized in 3 levels of low, moderate, and high based on a Persian version of Global Physical Activity Questionnaire. The multistage cluster sampling design was accounted for using complex survey analysis method. The sample included 10016 individuals; 41.7% (n = 4178) were men and 58.3% (n = 5837) were women. The mean (SD) age of participants was 38.8 (14.9) years also, and 69.8% (n = 6991) of the participants were from urban areas. The prevalence of low physical activity in the whole population was estimated to be 44.8% (95% CI: 41.7, 48.1). The odds of lower physical activity in the women were 3 times greater than men (OR = 3.14; 95% CI: 2.64, 3.57); in the wealthiest people was 25% lower than the poorest people (OR = 0.75; 95% CI: 0.60, 0.94). The odds of lower physical activity in the age groups 55-64 years were 44% greater than the youngest age groups 15-24 years (OR = 1.44; 95% CI: 1.23, 1.68). The odds of lower physical activity in the obese participants were 18% greater than normal-weight people (OR = 1.18; 95% CI: 1.01, 1.38).). The odds of lower physical activity in diabetic patients were 30% greater than healthy people (OR: 1.30; 95% CI: 1.07, 1.57). The prevalence of low physical activity in Iran, 2011 was high. The correlates of low physical activity in Iran are different to those of Western populations. The main associated factors with low physical activity were female gender, urban area, low socioeconomic status, obesity, diabetes, and older age. Public health policies should target the groups at highest risk of low physical activity.

Characteristic features of cutaneous melanoma in a dermatology referral centre in Tehran, Iran

BACKGROUND/OBJECTIVES

The characteristics of cutaneous melanoma in the Middle-Eastern countries is poorly described. Therefore we conducted this study to determine the characteristics of melanoma in Iran.

METHODS

A retrospective, cross sectional study of melanoma patients seen at a tertiary referral centre, Iran, from May 2004 to October 2014. Clinical data included age and gender of the patients at the time of diagnosis, tumour location and tumour size. Histological characteristics included Breslow thickness, Clark level and subtype of tumour.

RESULTS

A total of 450 cases of melanoma with a male/female ratio of 1.1:1 were reviewed. The mean age of patients was 57.5 years. The most frequent histological subtypes were acral lentiginous melanoma (30%) and lentigo maligna melanoma (29%). In 215 cases (49%) the tumour was located on the extremities. The second most common site was the face. Tumour invasion was mainly at Clark level III and IV. The mean Breslow thickness was 2.8 mm; 143 (38%) melanomas had a Breslow thickness less than 1 mm (T1) and 86 (23%) were more than 4 mm (T4).

CONCLUSION

This study indicates that clinical and histological features of melanoma in Iranians (who are mainly of skin phototypes 3-4) are different from those observed in Western countries. Further cohort studies are required to evaluate the role of ethnic and environmental risk factors for melanoma in different populations.

Differential BMI1, TWIST1, SNAI2 mRNA expression pattern correlation with malignancy type in a spectrum of common cutaneous malignancies: basal cell carcinoma, squamous cell carcinoma, and melanoma

PURPOSE

Melanoma, squamous cell carcinoma (SCC), and basal cell carcinoma (BCC) can be used as a unique model to identify molecular mechanisms to distinguish rarely metastatic (BCC), often metastatic (SCC) and most metastatic (melanoma) cancer. It is known that epithelial-mesenchymal transition and stemness transcription factors (TWIST1, SNAI2/SLUG, and BMI1) play an important role in metastasis and their dysregulation has been demonstrated in metastatic cancers. We hypothesized that this spectrum of cutaneous cancers (BCC, SCC, and melanoma) would be a unique cancer model system to elucidate steps toward cancer invasion and metastasis.

METHODS

We evaluated the mRNA expression level of BMI1, TWIST1, and SNAI2/SLUG and studied clinicopathological features in 170 skin cancers along with normal tissue samples.

RESULTS

We demonstrate downregulation of BMI1 mRNA expression in BCC samples compared with controls (p = 0.0001), SCC (p = 0.001), and melanoma (p = 0.0001) samples. Downregulation of TWIST1 mRNA expression is seen in only BCC samples compared with controls (p = 0.031). High SNAI2 mRNA expression is represented in melanoma samples compared with controls (p = 0.022) and SCC samples (p = 0.031). High mRNA expression of TWIST1 is seen in patients with positive history of cancers. Extremely low mRNA expression of BMI1 is detected in patients with positive history of cancers other than skin cancer.

CONCLUSIONS

These findings provide support for the hypothesis that the spectrum of cutaneous cancers could be better understood as a series of gene dosage-dependent entities with distinct molecular events. Oncogene-induced senescence, mechanism of which is still unclear, could be one explanation for these results.

Rituximab therapy improves recalcitrant Pemphigus vulgaris

Pemphigus is a severe life-threatening blistering disease associated with autoantibodies against cell adhesion proteins desmogleins 1 and 3. Patients with severe pemphigus commonly show high rates of relapse after conventional immunosuppressive therapy. The newly developed drug Rituximab showed impressing promises in the treatment of refractory pemphigus vulgaris (PV). In the present study the efficacy of a single course rituximab therapy in the treatment of PV was investigated. Eighteen patients with severe recalcitrant PV were recruited to this study. Pemphigus disease activity index (PDAI), anti-desmoglein 1 and anti-desmoglein 3 antibody titers, and percent of CD20 positive cells were measured at baseline, 10 ± 1, and 22 ± 2 weeks after rituximab therapy. Rituximab was given intravenously at dose 375 mg/m(2) once weekly for 4 weeks. Rituximab therapy caused a dramatic reduction in the PDAI, accompanied by decreases in anti-desmoglein 1 and anti-desmoglein 3 antibody titers over the follow-up course. The B-cell population decreased at the first follow-up, but returned to its baseline levels at the second follow-up. Rituximab therapy decreased the dose of immunosuppressive drugs required to control the disease. It seems that the rituximab may be effective and safe for treatment of refractory PV.

Rituximab therapy improves recalcitrant Pemphigus vulgaris

Pemphigus is a severe life-threatening blistering disease associated with autoantibodies against cell adhesion proteins desmogleins 1 and 3. Patients with severe pemphigus commonly show high rates of relapse after conventional immunosuppressive therapy. The newly developed drug Rituximab showed impressing promises in the treatment of refractory pemphigus vulgaris (PV). In the present study the efficacy of a single course rituximab therapy in the treatment of PV was investigated. Eighteen patients with severe recalcitrant PV were recruited to this study. Pemphigus disease activity index (PDAI), anti-desmoglein 1 and anti-desmoglein 3 antibody titers, and percent of CD20 positive cells were measured at baseline, 10 ± 1, and 22 ± 2 weeks after rituximab therapy. Rituximab was given intravenously at dose 375 mg/m(2) once weekly for 4 weeks. Rituximab therapy caused a dramatic reduction in the PDAI, accompanied by decreases in anti-desmoglein 1 and anti-desmoglein 3 antibody titers over the follow-up course. The B-cell population decreased at the first follow-up, but returned to its baseline levels at the second follow-up. Rituximab therapy decreased the dose of immunosuppressive drugs required to control the disease. It seems that the rituximab may be effective and safe for treatment of refractory PV.

BMI1 and TWIST1 downregulated mRNA expression in basal cell carcinoma

BACKGROUND

BMI1, TWIST1 and SNAI2/SLUG have been implicated in aggressive behavior of squamous cell carcinoma (SCC) and melanoma and BMI1 expression could identify subtypes of Merkel cell carcinoma (MCC). However, BMI1, TWIST1 and SNAI2 expression levels in basal cell carcinomas (BCCs) have not been elucidated. We hypothesized BCC could be a good model system to decipher mechanisms which inhibit processes that drive tumor metastasis. The aim of this study was to examine the mRNA expression level of BMI1, TWIST1, and SNAI2 in BCCs.

MATERIALS AND METHODS

Thirty-five fresh non-metastatic BCC tissue samples and seven fresh normal skin tissue samples were evaluated by real-time RT-PCR.

RESULTS

BMI1 and TWIST1 demonstrated marked down-regulation (p<0.00l, p=0.00l respectively), but SNAI2 showed no significant change (p=0.12).

CONCLUSIONS

Previous literature has clearly demonstrated a positive association between BMI1 and TWIST1 expression and metastatic BCC, aggressive SCC and melanoma. Here, we demonstrated a negative association between BMI1 and TWIST1 mRNA expression level and BCC.

Evaluation of some psychological factors in psoriatic patients

BACKGROUND

Psoriasis is a disease which may have a direct impact on the psychological and social aspects of the patient, particularly due to its visibility. To date, we are unaware of any study showing a relationship between psoriasis and psychological parameters such as psychological vulnerability and coping strategies.

OBJECTIVE

The aim of this study was to evaluate the effects of psoriasis on some psychological parameters in an Iranian population.

METHODS

Patients having histopathologically confirmed psoriasis for at least 6 months attending the Dermatology Clinic of Razi Hospital were included if they agreed to participate in the study. Patients with history of schizophrenia, major depression or other psychological disorders were excluded. All patients were at least 18 years old. The patients were then referred to the researchers for filling out the appropriate questionnaires under the guidance of an involved psychologist. To evaluate skin involvement, Psoriasis Area Severity Index (PASI) score was calculated and used for all patients. All data were stored in files for further analysis.

RESULTS

There were 101 females and 99 males with the mean age of 43.2(±16.32). The mean PASI Score was 6.58 ± 6.04. Diffuse skin involvement was the commonest form of disease (133 patients, 66.5%). The highest score for Illness perception belonged to those with genitalia involvement (185.2, worst illness perception), and the lowest score for Illness perception belonged to those with nail involvement (168.2). Consistently, the lowest score of facing the problems (CISS: approach strategy to disease) belonged to those with hand involvement (50.5) whereas the highest score belonged to those with genitalia involvement (60.4). There was a significant correlation between psychological vulnerability vs. Illness perception score as well as psychological vulnerability vs. coping strategies score. Surprisingly, PASI score had an insignificant relationship with illness perception, coping strategies or psychological vulnerability score.

CONCLUSION

PASI score as a representing factor of skin involvement has a limited role in predicting the effect of psoriasis on mental status and illness perception of psoriatic patients. Psychological vulnerability of the patients is the main predicting factor of illness perception and coping strategies (representing patients approach to their disease or their treatment beliefs).

The effect of isotretinoin (roaccutane) therapy on depression and quality of life of patients with severe acne

OBJECTIVE

Acne is the most common skin disease and isotretinoin is the most powerful drug among the various drugs used for its treatment, but it has some adverse effects. The aim of this study was to evaluate the effect of isotretinoin on depression and quality of life of a group of patients undergoing isotretinoin therapy before and after the treatment course.

METHODS

In this prospective study, 98 patients with severe acne were enrolled consecutively and underwent isotretinoin therapy receiving 0.5 mg/kg/d of isotretinoin for 16 weeks. Isotretinoin effects on quality of life and depression were evaluated using Dermatology Life Quality Index (DLQI) and Beck Depression Inventory (BDI) questionnaires, respectively.

RESULTS

In this study, 98 patients suffering from severe acne (38 males and 60 females) were enrolled. Treatment of acne was associated with improvement of quality of life scores in both male and female patients (p = 0.001). Considering the cutoff value of 13 for mild depressive mood in the BDI score, in total, 48 (49%) of the enrolled patients (21 males and 33 females) had a mild depressive mood before the commencement of the treatment in this study. The analysis of before and after treatment BDI scores showed that the number of patients and also the mean score of BDI were increased in both male and female patients after the treatment (p<0.05).

CONCLUSION

Isotretinoin therapy improved the quality of life of patients suffering from acne, but depression was accentuated in the patients to some extent.

Diffuse pigmentation of back and arms: macular amyloidosis or other?

The study was undertaken to answer the question that how many patients with pigmentation of back and arms actually have amyloid deposits in pathology. 44 patients presenting with diffuse pigmentation of back and arms (DPOBA) were selected. Skin biopsies were performed in all cases from the affected sites. On all formalin fixed and paraffin embedded specimens, the following histochemical stains were performed: Haematoxylin and eosin (H&amp;E), Congo red and immunohistochemical staining using anti-cytokeratin monoclonal antibody. In 9 of 44 cases (20%), amyloid deposits were found. In the remaining 35 cases (80%), H&amp;E, Congo red and immunohistochemical staining failed to show any amyloid deposition. We were unable to find amyloid deposition in most of the patients presented with DPOBA. It seems that the signs may be attributable other disorders with similar clinical but different pathophysiologic aspects.

Solar Lentigines: Evaluating Pulsed Dye Laser (PDL) as an Effective Treatment Option

INTRODUCTION

Solar lentigines are among commonest cosmetic problems. There are many topical therapies suggested to treat these lesions including cryotherapy, chemical peeling with tri chloro acetic acid (TCA) and laser therapy with q-switched lasers as well as long pulsed lasers. Considering possible treatment side effects (PIH, scar) with cryotherapy and peeling in Iranian patients (darker skin types) it seems necessary to try to find alternative measures. The aim of the present study was to evaluate effect of long pulsed dye laser (LPDL) on lentigines via an objective method (computerized dermoscopy).

METHODS

Patients with pathologically confirmed lentigines were selected if they agreed to participate in the study,were not treated before, hadn't history of psoriasis, vitiligo, scar formation and were not pregnant. Letigines were dermoscopied before and after treatment with PDL (V-beam, 595nm, Candela Corp. Wayland, USA) using fluence of 10 joules,without DCD (dynamic cooling device) via extra compress lens provided with laser system.The resulting figures were compared by two academic unrelated dermatologists as well as by computerized analysis. Post laser side effects were treated with topical antibiotics and mild topical steroids. Patients were followed for six months after the end of the study to determine the rate of recurrence via dermoscopy of sites of previous lesions and also delayed side effects.

RESULTS

A total of 21 patients with the same number of lesions, were included in the study.Mean age of patients was 54.2 years (±23.3) ranging from 39 to 71 years. Included patient swere 18 females and three males. From 21 treated lesions, 11 were located on the hands and 10 on the face. Comparing before and after photographs taken through dermoscopy system,revealed that approximately 57% of patients had more than 75% improvement. Mean pigment analysis score (calculated by computerized dermoscope software) was respectively 8 and 2 before and after PDL therapy, showing noticeable decrease in pigment density of lesions.Side effects were mild erythema and local irritation responding to topical mild steroids.No hypo or persistent hyper pigmentation or other delayed side effects was seen after six months follow up. One patient experienced transient hyper pigmentation of treatment site after treatment. During six months follow up, no recurrences were seen.

CONCLUSION

In conclusion, PDL is a safe and effective option to treat lentigines if applied properly using compression method, especially in Iranian patients. However, further studies with larger sample size are required to confirm these results.

Efficacy and safety of long-pulse pulsed dye laser delivered with compression versus cryotherapy for treatment of solar lentigines

Background:

Although cryotherapy is still the first-line therapy for solar lentigines, because of the side effects such as post-inflammatory hyperpigmentation (PIH), especially in patients with darker skin types, pigment-specific lasers should be considered as a therapy for initial treatment.

Aim:

The aim of this study is to evaluate the efficacy and safety of cryotherapy compared with 595-nm pulsed dye laser (PDL) with cutaneous compression in the treatment of solar lentigines.

Materials and Methods:

Twenty-two patients (skin type II–IV) with facial or hand lentigines participated in this study. Lesions of one side of the face or each hand were randomly assigned and treated with either cryotherapy or PDL. Treatments were performed with radiant exposures of 10 J/cm² , 7-mm spot size and 1.5 ms pulse duration with no epidermal cooling. Photographs were taken before treatment and 1-month later. The response rate and side effects were compared.

Results:

PDL was more likely to produce substantial lightening of the solar lentigines than cryotherapy, especially in skin type III and IV (n = 8, n = 9; P < 0.05), but might be no difference in type II (n = 5; P > 0.05). PIH was seen only in cryotherapy group. PDL group had only minimal erythema. No purpura was observed.

Conclusion:

PDL with compression is superior to cryotherapy in the treatment of solar lentigines in darker skin types.

The comparison between the efficacy of high dose acyclovir and erythromycin on the period and signs of pitiriasis rosea

Background:

Pityriasis Rosea (PR) is an acute inflammatory and self-limiting skin disorder, sometimes with troublesome symptoms. To date, there are few treatments available for this disorder.

Aim:

Compare the traditional treatment with erythromycin to a newly introduced antiviral treatment acyclovir for PR.

Materials and Methods:

Patients with clinically confirmed diagnosis of PR, matching our exclusion criteria, were enrolled. They were randomized in two groups that received high-dose oral acyclovir or erythromycin. The participants were evaluated two, four, and eight weeks after commencement of the study and followed for one year.

Results:

A total of 30 patients including 15 males and 15 females completed the study. After eight weeks, 13 patients in the acyclovir group experienced complete response, while in the erythromycin group only six patients had complete response (P < 0.05). Also, patients in the acyclovir group experienced faster resolution of pruritus in comparison with the erythromycin group (not significant). No adverse drug reaction was detected in both groups.

Conclusion:

It seemed that a high-dose of oral acyclovir was a safe and effective therapy for PR, although this remained to be confirmed in larger studies.

Incidence of incomplete excision in surgically treated cutaneous squamous cell carcinoma and identification of the related risk factors

Squamous cell carcinoma (SCC) is the second most common type of skin cancer with potential risks for metastasis and recurrence if left untreated or incompletely excised. This case series study was designed to determine the frequency of incompletely excised SCCs and the related risk factors. A total of 273 SCCs (253 patients) excised in Razi dermatology hospital of Tehran from 2006-2008, were evaluated and were analyzed by Chi-square or t-test. The incidence of incomplete excision was 17.58 % and deep margin involvement was observed in 73% of lesions. Risk factors associated with incomplete excision of SCCs were being female, location of the tumors (in particular the lesions on lateral canthus, upper lip, foot, forehead, cheek, neck, nose and ear), large lesions and grafting method of repair. There was no statistically significant difference for the age, degree of histological differentiation, childhood history of radiotherapy for tinea capitis and the type of anesthesia. More care should be taken for high risk SCCs as complete excision avoids potential risk of recurrence and metastasis.

Benign and malignant skin lesions in renal transplant recipients

BACKGROUND

Skin lesions - benign and malignant - occur frequently in organ transplant recipients receiving long-term immunosuppressive therapy. These patients are at greater risk of skin cancers.

AIMS

To study dermatologic problems in renal transplant recipients (RTRs).

METHODS

One hundred patients (53 men and 47 women) were consecutively examined for benign and malignant skin complications since transplantation in Razi Hospital in Tehran Medical University. The main immunosuppressive therapy regimen in these patients was a combination of prednisolone, azathioprine, and cyclosporine.

RESULTS

The early and most common complication was cosmetic side effects that occurred in 98% patients. Skin infections occurred in 83% of the patients and most of them were viral infections (65%), especially of human papilloma viruses (HPVs) in 40% of the patients. We found six cases of malignancy in these patients in that four cases were skin cancers, including one case of SCC, one BCC, and two cases of Kaposi's sarcoma. Dermatologic problems occur most frequently in RTRs, especially skin cancers which have higher frequency in these patients than general population, particularly, Kaposi sarcoma. Sun exposure has an important role in developing epithelial skin cancers following transplantation. The age of developing skin cancer in these patients was early than normal population.

CONCLUSION

Our results emphasize the importance of dermatologic examinations and monitoring RTRs to obtain an early diagnosis and treatment of cutaneous manifestations.

Psycho-cutaneous disorders: an epidemiologic study

BACKGROUND AND AIMS

Psycho-dermatology addresses the interaction between mind and the skin. Effective management of at least one third of the patients attending the skin department depends, to some extent, upon the recognition of emotional and psychologic factors. The aim of this study was to provide epidemiologic data about common psycho-dermatoses and their prevalence in dermatologic patients in Iran.

MATERIALS AND METHODS

Patients suspicious to have psychocutaneous problem with primary dermatologic chief complaint were included. After detailed dermatologic evaluation, all patients were visited by an expert psychologist to determine prevalence of DSM-IV disorders in each psychocutaneous category including delusion of parasitosis, trichotillomania, dermatitis artefacta and neurotic excoriation.

RESULTS

A total of 178 patients including 78 (43.8%) males and 100 (56.2%) females entered the study. The commonest psychocutaneous disorder was neurotic excoriation followed by trichotillomania, delusion of parasitosis and dermatitis artefacta. Mood disorder was the commonest DSM-IV disorder in our patients, then anxiety disorder and drug-induced symptoms.

CONCLUSION

According to our results, it seems that all psychocutaneous disorders but delusion of parasitosis are commoner in females. Mood and anxiety disorders were common in patients with dermatitis artefacta, as patients with neurotic excoriation. In trichotillomania, obsessive compulsive disorder was the commonest disorder. Drug abuse is a major background of delusional parasitosis.