Iranian Journal Of Dermatology
Volume:17 Issue: 2, Summer 2014

Squamous cell carcinoma (SCC) of the skin is one of the most common non melanoma skin cancers (NMSC), along with basal cell carcinoma (BCC). Besides ultraviolet radiation, exposure to industrial agents, ionizing radiation, and areas of chronic inflammation are associated with the development of SCC. Squamous cell carcinoma may also be associated with foreign bodies. We report a rare case of cutaneous SCC in an elderly Kashmiri female, which was developed subsequent to asubcutaneous non metallic foreign body and was successfully excised with negative margins and transposition flap closure.

Leptin, a 16-KDa peptide hormone secreted from the adipose tissue, plays an important role in the regulation of energyintake and expenditure and body weight regulation; furthermore, it has a regulatory function on the reproductive system. The aim of this study was to assess the relationship between serum leptin levels and sex hormones in psoriatic patients and control group and to determine the serum levels of leptin and sex hormones in patients and their association with disease severity. This cross-sectional study included 43 male patients with psoriasis and 42 age- and sex- matched healthy controls. We measured serum levels of leptin, sex hormone-binding globulin (SHBG), luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, and total testosterone in both groups. Psoriatic patients had significantly higher levels of leptin and lower levels of FSH than healthy controls. Psoriatic patients did not differ significantly in the serum concentrations of LH, total testosterone, SHBG, and PRL in comparison with healthy controls. The severity of the disease (PASI score) was positively correlated with leptin (p<.0001), Body Mass Index (p=0.001), and waist circumference (p=0.001), and was inversely correlated with serum LH levels (p=0.03). No significant associations were found between the severity of the disease and serum levels of FSH (p=0.38), total testosterone (p=0.14), SHBG (p=0.98), and PRL (p=0.76). Our results suggest that the serum leptin level is associated with psoriasis severity and duration; moreover, we found a relationship between LH and psoriasis severity. This association needs more extensive studies.

Job-related allergic contact dermatitis (ACD) may prolong the disease duration, increase disabilities, and decrease the patient’s quality of life. The aim of this study was to determine common allergens causing ACD, investigating certain features of the disease and evaluating its relation to the patients’ jobs. In this cross-sectional study, relevant data was obtained from patch test clinics at the Center for Research and Trainingin Skin Diseases and Leprosy, Tehran University of Medical Sciences, and two private dermatology clinics in Tehran, Iran. Nine hundred and forty six patients from different regions of Iran with a probable diagnosis of ACD were recruited into the study. Patch testing was used as the gold standard test to differentiate ACD from other differential diagnoses. Of 946 studied patients with a probable diagnosis of ACD, 649 (68.6%) cases were females. The mean age ± standard deviation (SD) of the patients was 31.9 ± 12.3 years. Five hundred and twenty eight (55.7%) cases had positive patch test results to at least one tested allergen. Comparing job-related and non jobrelated ACD patients revealed that while there was a significant difference in the mean age of the two group (30.6 ± 11.3 vs. 32.7 ± 12.9 years in job-related and non-job-related groups, respectively) (P=0.016), there were no significant differences in the gender distribution, number of positive patch tests, frequency of allergens, reaction time, and severity of reactions between the two groups. Nickel sulphate and cobalt chloride were the two most common allergens in both groups. Job-related patients were younger and most of them were female compared to non job-related patients. However, other characteristics were not different between the two groups.

Methicillin–resistant Staphylococcus aureus (MRSA) has recently emerged as a worldwide major nosocomial pathogen that causes significant morbidity and mortality. MRSA is frequently colonized on the skin. The aim of this study was to determine the MRSA colonization/infection prevalence and to evaluate the potential risk factors for its development in the hospitalized patients in a referral dermatology ward. In this cross sectional study, 203 patients with cutaneous lesions who were admitted to the dermatology ward of a tertiary teaching hospital from 2008 to 2010 were recruited. Samples were collected during the first 48 hours of admission. S. aureus was identified using gram staining, catalase, and coagulase tests. The disk diffusion method was used for testing the sensitivity of different bacteria to antibiotics. Mueller-Hinton agar was the culture medium used for MRSA susceptibility testing. Staphylococcus. aureus was the most common pathogen that grew in 56.2% (114/203) of isolates. MRSA was found in 35.5% (82/203) of isolates. The duration of the cutaneous lesions, age group, positive history of antibiotic use in past 12 months, and underlying diseases were statistically different between the patients with colonization of MRSA and methicillinsensitive Staphylococcus aureus (MSSA) (P<0.05). Using binomial multivariable logistic regression, it was determined that recent antibiotic therapy and presence of underlying diseases were the risk factors for MRSA colonization. This study showed that MRSA colonization is an important problem in dermatology wards. This finding should be noted for proper selection of antibiotics to treat the patients.

Generalized vitiligo is characterized by autoimmune destruction of melanocytes, which results in patches of the depigmented skin and the overlying hair. Vitamin D is an essential hormone synthesized in the skin and is responsible for skinpigmentation. Low vitamin D levels have been noted in patientswith a variety of autoimmune diseases. A recent study showed that low vitamin D levels may be associated with vitiligo. The aim of this study was to compare 25-hydroxyvitamin D (25[OH] D) levels in Iranian patients with vitiligo with normal controls. In this case-control study, we studied 30 newly diagnosed patients with vitiligo and 30 healthy controls through a case control design. Two groups were matched for gender, age, and the season in which the serum levels of 25-hydroxy vitamin D were measured. The serum levels were categorized as sufficient, insufficient and deficient. The mean serum level of vitamin D was 10.24±1.27 ng/ mL in patients compared to 18.31±7.39 ng/mL in the control group. Male patients had lower levels of vitamin D compared to controls (7.25 ng/mL vs. 13.31ng/mL, P=0.03), while no significant difference was observed between females and controls (14.12 ng/ mL vs. 16.25 ng/mL, P=0.51). The present study demonstrated that there may be an association between low levels of Vitamin D3 and vitiligo in men.

Although most cases of drug eruptions are mild and self-limited and are relieved after discontinuation of the responsible drugs, statistics of life threatening outcomes should be kept in mind. Moreover, it is important to identify the most common age and sex groups, and the most vulnerable groups in any area related to offending drugs. Thus, we collected the basic information of patients with skin drug reactions who were admitted to Razi Hospital, Tehran, Iran, during 2010-2012 (18 months). In this study, all patients with a diagnosis of drug reactions who were admitted to Razi Hospital, Tehran, Iran, during 2010-2012 (18 months) were enrolled. The types of drugs and skin reaction manifestations were reported. One hundred and thirty one patients were admitted with a diagnosis of drug reactions. The mean age of the participants was 40 years. Forty one patients were male (31.3%) and 90 were female (68.3%). Antibiotics and anticonvulsants were the most common drugs associated with reactions. Carbamazepine was the most common drug that caused reactions (21 cases, 17.4%) followed by penicillin (20 cases, 16.5%), and lamotrigine (16 cases, 13.2%). Morbilliform rash (40 cases, 30.5%), erythroderma (18 cases, 13.7%), and urticaria/angioedema (14 cases, 10.7%) were the most common patterns of skin involvement. The results of our study are consistent with the results of other studies. It is recommended that drugs that commonly cause adverse reactions be prescribed with more precaution in females aged 20-40 years, and if possible, be replaced with appropriate drugs. Moreover, it is recommended that patients who are allergic to these drugs carry a certain card that demonstrates their sensitivity.

Lupus vulgaris, a common form of cutaneous tuberculosis, usually has different patterns including the plaque form, ulcerative and mutilating form, vegetative form, tumor-like form, and papular and nodular form. Lupus vulgaris commonly appears on the normal skin as a solitary lesion. However, certain uncommon forms are identified that pose a diagnostic dilemma. Sporotrichoidlike spread has been rarely reported. Atypical presentations of cutaneous tuberculosis are not very uncommon but are frequently overlooked in the clinical practice, leading to a late diagnosis and increased morbidity. We report two cases of lupus vulgariswith a sporotrichoid pattern. Our patients presented with the characteristic morphologic features of lupus vulgaris (LV) in a different distribution pattern. The diagnosis was supported by laboratory investigations, histopathological examination, and an excellent response to antitubercular therapy. Both cases demonstrated a linear arrangement of lesions mimicking sporotrichosis. We emphasize that cutaneous tuberculosis can occur in an unusual form in an immunocompetent person. The aim of this communication is to bring this often overlooked but definitely curable clinical entity to attention.

Focal epithelial hyperplasia or Heck’s disease is a benign, rare viral disease of the oral cavity and is associated with human papillomavirus 13 and 32 (HPV-13 and HPV-32). Most patients are children but adults may also be at risk. Clinically, the patients have multiple small white or pink papules on the mucosal surface of the lips, buccal mucosa and the tongue. In Iran, this disease seems to be rare. Herein, we describe an adult Iranian case of focal epithelial hyperplasia.

Health problems after a nuclear crisis are an interesting issue in medicine. After the recent Japanese nuclear crisis, several health issues underwent monitoring. There are few considerations on mucocutaneous diseases. Indeed, there is no doubt that the skin and mucocutaneous issues are the main organs affected by leaked radiations. It is important to take care of mucocutaneous lesions in acute radiation syndrome.