Iranian Journal Of Dermatology
Volume:16 Issue: 3, Autumn 2013

Different modalities have been tried in order to treat stable vitiligo. Culturing melanocytes is time consuming and expensive. Therefore, new methods using autologous melanocytes are sought. We aimed to compare the mixed noncultured autologous melanocytes of the outer root sheath and the bulge area of hair follicle transplantation plus dermabrasion with dermabrasion alone in stable generalized vitiligo patches repigmentation. Eight patients with stable generalized vitiligo were recruited. Two patches were selected and assigned to one of the study groups: one was treated with dermabrasion alone, and the other was treated with dermabrasion and transplantation. Uncultured melanocytes were extracted from the patients’ hair follicle outer root sheath and bulge. The patches were assessed monthly for the next six months. The primary outcome was to determine the percentage changes of the depigmented patches from the baseline. Although the repigmentation changes were statistically significant in transplantation patches, there was only one patch with good and another with fair pigmentation. Furthermore, seven patches without and one patch with poor pigmentation were observed as control lesions. The transplanted patches demonstrated a significantly better repigmentation rate in contrast to their controls (p=0.03). Although this method is fast and economic, the clinical response was not satisfactory.

Despite great advances in therapeutic regimens، complete repigmentation in vitiligo is still out of reach. The aim of this assay was to study the efficacy and tolerability of repeated needling combined with narrowband ultraviolet B (NBUVB) therapy in the treatment of generalized، stable، refractory vitiligo. Twenty-six patients with stable generalized intractable vitiligo were recruited in before/after clinical trial. The patients received needling for selected patches weekly for 12 weeks. All the patients received NBUVB phototherapy three times a week. Repigmentation improvement was assessed by two blinded investigators at weeks 4، 8 and 12. Tolerability was assessed by a 5-point scale. Twenty-two patients (16 women and 6 men) with a mean (SD) age of 34. 41 (12. 75) years completed the 12-week therapy period. In comparison with the baseline، improvement in the mean percentage of repigmentation was 7. 10±10. 15، 12. 95±20. 29، and 15. 57±17. 38 at week 4، 8 and 12 of therapy، respectively. A significant improvement was observed in repigmentation percentages in the three time points (p<0. 0001). Although our patients showed repigmentation improvement، the overall repigmentation was very low (about 15. 57 %); therefore، we do not recommend needling as an alternative to other available surgery procedures that have more favorable efficacy and tolerability in contrast to this new procedure.

Melanin pigmentation of the gingiva occurs in all ethnicities. Excessive pigmentation is an esthetic concern that has increased awareness about depigmentation procedures. The purpose of the present study was to correlate the skin color and gender with the intensity and distribution of gingival melanin pigmentation in a group of South Indians for treatment strategies. Two hundred male and female non smoking healthy subjects aged 18-35 years were included. A clinical examination of gingiva was performed to assess the anatomic distribution of gingival pigmentation. The intensity of gingival pigmentation and the phenotype of gingiva were also assessed. Subsequently, the skin color was visually examined and assessed as fair, wheatish, brown, and dark. Six classes of gingival pigmentation were defined based on the anatomic distribution. Gingival pigmentation was observed as highest in the attached gingiva and interdental papilla (25.4%) and least in the marginal gingiva and interdental papilla (10.2%). The correlation between the skin color and the intensity of pigmentation was statistically significant, with dark skinned subjects having heavy gingival pigmentation. However, no correlation was found between the gender and the phenotype of gingiva with intensity and distribution of pigmentation. South Indians predominantly have pigmentation in the attached gingiva and interdental papilla and their skin color is positively correlated with the intensity of pigmentation. The incidence of pigmentation does not differ between the sexes. We noted that a majority of the subjects had thick gingival phenotype. Anatomic delineation of gingival pigmentation and their contributory factors may help design treatment strategies in depigmentation procedures.

Pemphigus is a rare autoimmune disease caused by autoantibodies against desmoglein. It clinically presents with painful blisters and erosions on the skin and mucous membranes. Few studies have been conducted on the quality of life in pemphigus patients which have all indicated the strong impact of the disease on emotional and physical status of the patients. According to evident differences in the culture and quality of life between our society and western societies, we assessed the quality of life in patients with pemphigus in the Northeast of Iran. This study was conducted on 78 pemphigus vulgaris patients who were visited or hospitalized in the dermatology clinics of Qaem and Imam Reza Hospitals in Mashhad, Iran. Data collection was done by the Dermatology Life Quality Index (DLQI) questionnaire in patients with pemphigus vulgaris. Statistical analysis was performed using SPSS 11.5 software with Chi-square, T-test and ANOVA statistical tests. The disease had a significant impact on the quality of life in the majority of patients (31 (39.7%) patients). Hospitalized and newly diagnosed cases and those receiving higher doses of steroid had lower quality of life. The patient’s age, sex, education level, and therapeutic regimen did not have a significant effect on the quality of life. Pemphigus is not just a physical disease and has various aspects. It is responsible for many changes in healthrelated quality of life in patients. Therefore, we will be successful in treating this disease only when psychological and social aspects of pemphigus are considered in addition to clinical improvement of the patients.

Mucocutaneous manifestations may occur in every stage of human immunodeficiency virus (HIV) infection. Some of them may be the first presentations. In this study, we evaluated the prevalence of dermatologic manifestations as the first presentations of HIV/AIDS in 25 Iranian patients. In a cross sectional study, we evaluated 25 new cases of HIV infection whose HIV infections were diagnosed during work up for their recent dermatological problems. The type of mucocutaneous manifestations and general information such as age, sex, risk factors, dermatologic problem duration and educational level was recorded in a questionnaire. Warts (anogenital and generalized warts) were the most common cutaneous manifestation in new HIV infected patients (36%) followed by psoriasis and cutaneous abscess. Some mucocutaneous diseases such as anogenital or generalized warts, psoriasis, and cutaneous abscess may present as the first manifestation of HIV infection.

Pemphigus vulgaris (PV) is a potentially fatal autoimmune mucocutaneous blistering disease. Although PV occurs predominantly in adulthood, in the 3rd to 5th decades of life, there have rarely been reports of childhood cases which are often misdiagnosed. It presents as oral blisters that rupture rapidly and progress to painful erosions. Most patients develop cutaneous flaccid blisters that rupture easily and leave painful erosions, which are slow to heal. These erosions are prone to secondary bacterial infection. Without treatment, the disease is progressive and the mortality rate is about 100%. We report an 8-year-old girl who was referred to our clinic from a pediatric center with mucocutaneous recalcitrant blisters.

Bullous ichthyosiform erythroderma (BIE) is a rare disorder of keratinization (mutations in either keratin 1 or 10). It typically presents with fragile skin, which gives way to gradual evolution of hyperkeratosis. Flaccid blisters, peeling, and superficial erosions at sites of minor trauma or friction are apparent within the first few hours of life. Yellow-brown, waxy, ridged or corrugated scales build up in skin creases, sometimes forming spiny (Hystrix) outgrowths. Cobble stone-like keratoses occur at other sites such as the dorsal aspects of the hands and feet and over the trunk. We report an 11-year-old boy with a generalized hyperkeratosis on the neck, trunk, extremities, and scalp.

A 65-year-old woman presented with complaint of unremitting ulcer between her breasts from 6 months ago. Initially, it was manifested as the development of painless, firm, subcutaneous erythematous nodules that gradually enlarged and evolved into a chronic ulcer. She also had a history of mild weight loss. There was no history of anorexia, fever, cough, hemoptysis, or local trauma.On physical examination, a 6 by 4 cm ulcer was noted on her anterior upper chest, between breasts, with a little serous discharge and a granulation tissue at the base surrounded by densely erythematous woody margins with some telangiectasia.

Treatment of melasma has remained a hot topic in dermatology because of its resistance to therapy and high recurrence rate. For many years hydroquinone was the foundation of melasma treatment, but its use has been limited during these years due to a number of adverse events, such as skin irritation, hyper and hypo pigmentation, nail discoloration, conjunctival melanosis and ochronosis. Furthermore hydroquinone is quite unstable and is quickly oxidized and become inactive. So Hydroquinone is gradually being replaced by new lightning substances, such as kojic acid, phytic acid, azaleic acid, arbutin, mequinol, aleosin, ascorbic acid, soya proteins, N-acetyl glucosamine and licorice. In this study we evaluate the effect of a licorice containing product (lightening serum, LANGE Paris) for the treatment of melasma. There are several active ingredients in licorice extract effective on melasma. These are liquiritin, glabridin, licochalcone A and isoliquertin.

The novel H7N9 influenza infection is still the big problem in China and it is under focus for the worldwide epidemic. As an outbreak of new emerging disease, the clinical presentation of the novel H7N9 influenza is very interesting. In most cases, the patients present with acute respiratory tract signs and symptoms, according to the nature of influenza virus infection. In some cases, additional non-respiratory signs and symptoms can be observed. Many atypical clinical features can be observed and this should be recognized by practitioners. Here, the authors summarize on the observed skin abnormality among 130 available cases.