Iranian Journal Of Dermatology
Volume:21 Issue: 2, Summer 2018

Rosacea is a chronic inflammatory disease of unknown etiology. Few studies have been published on the use of oral ivermectin in the treatment of the inflammatory subset of rosacea. The aim of the present research was to evaluate the efficacy and safety of oral ivermectin prescribed for a series of patients with inflammatory rosacea. On a weekly basis, 29 patients with papulopustular rosacea were orally given ivermectin at a dose of 200 µg/kg before meal for three consecutive weeks. Subjects were evaluated weekly and during the follow-up period for two successive treatment-free months. After 3 doses of ivermectin, there was a significant reduction in the total count of inflammatory lesions compared to the base line (the mean was reduced from 51.6±27.4 to 21±14.7) (P<0.05). At the end of the two-month follow-up period, more reduction was observed in inflammatory lesions (mean was reduced to 9.3±7), and 62% of the patients showed excellent responses to the treatment (? 80% reduction in the lesions). Nausea was reported in 10%. A three-week use of oral ivermectin is an effective, safe, and well-tolerated approach to treating inflammatory rosacea

Alopecia Areata (AA) is an autoimmune disease affecting hair follicles. Although many details are well specified in the pathogenesis of the disease, there exist certain aspects which require more investigations. Given the fact that the increase in Th-1 immunity is the essential part of the pathogenesis, the incrimination of osteopontin, as a Th-1 cytokine, is considered appropriate in the pathogenesis of the disease. The aim of the present research was to evaluate the role of osteopontin in alopecia areata and its correlation with disease pattern and severity. This case-control study consisted of 45 patients with alopecia areata and 45 healthy individuals. The level of osteopontin was measured through blood sampling and ELISA method. The mean plasma level of osteopontin was significantly lower in patients with alopecia areata than controls (P<0.05) The plasma level of osteopontin in patients with alopecia areata is lower than healthy controls. Moreover, there is no significant relationship between the plasma level of osteopontin and disease severity. The clinical manifestations of alopecia areata might be a sign of the altered protective effects of osteopontin. Needless to say, more investigation is required to clarify the correlation between alopecia areata and osteopontin

Recently, rituximab has been successfully used for the treatment of pemphigus family, the main subtype of which is pemphigus vulgaris (PV). The aim of this study was to determine the efficacy and safety of rituximab in refractory PV. In an observational study extending from November 2014 to February 2016, 30 patients with refractory PV were treated with rituximab. Response to therapy, duration of clinical remission, relapse rate, serology, and side effects of treatment with rituximab were evaluated. At the end of the follow-up with a mean duration of 7.6 (6-14) months, 25 (83.3%) patients achieved complete remission with or without systemic therapy. The mean duration of disease control was 2.8 months. In all patients, the serum levels of antidesmoglein 1 and 3 IgG antibodies were reduced after rituximab therapy. In 23.4% of the patients, a clinical relapse occurred at a mean of 9.6 months following the initiation of the treatment. Infusion-related reactions occurred in 18 (60%) patients. The lack of a control group, concomitant use of corticosteroid and immunosuppressive agents, and a limited follow-up period were among the limitations of our research. Rituximab is a good treatment modality for refractory PV, which extends the mean time to relapse in patients. To further extend our knowledge on the efficacy and safety of rituximab therapy, more randomized controlled trials with larger sample sizes and prolonged follow-up durations are required.

  Oral lichen planus (OLP) is a common inflammatory disease of unknown origins. Recent studies have considered nutritional factors concerning the pathogenesis of many autoimmune disorders. The objective of the present study was to investigate the plasma levels of magnesium (Mg), calcium (Ca), zinc (Zn), copper (Cu), and iron (Fe) in this disorder. Included in this observational case-control study was 40 patients with OLP and 40 age and sex matched healthy control subjects. Plasma levels of Mg, Ca, Zn, Cu, and Fe were specified using an autoanalizer. The serum level of Ca was higher, but Mg, Cu, Fe and Zn serum concentration did not differ significantly between the patients with OLP and the healthy controls. Mean Zn concentration was lower in patients with erosive lichen planus compared to the non-erosive group and the healthy controls. However, only the difference between erosive lichen planus patients and healthy participants was significant. The mean Zn level was lower than the normal range (70 µg/dl) in both the cases and controls. The concentration of Fe was significantly higher in men male patients than in females; however, the difference between men and women was not significant in the healthy control group. The mean Cu/Zn ratios in erosive and patient groups were slightly higher compared with the controls. Trace elements such as Ca may play a role in the ethiopathogenesis of OLP. Nevertheless, other elements such as Zn or Cu may influence OLP, which requires further evaluation on larger samples.

Paget’s disease of the nipple is an unusual manifestation of breast cancer. Most cases of mammary Paget`s disease are associated with an invasive or in situ breast tumor, even with no mass observed in mammography imaging. Very rarely does Paget’s disease occur in the absence of any underlying neoplasia .Herein, we report an 82-year-old woman with an unusual presentation of mammary Paget’s disease with a 12-year duration, and no palpable mass, density or calcification in imaging assessments. Immunohistochemistry showed that the tumor cells stained positive for cytokeratin-7, and Her-2-neu, yet negative for S-100, HMB-45, CEA, and P63. Skin biopsy and immunohistochemistry findings corresponded with Paget’s disease.

Angioma serpiginosum (AS) is a nevoid capillary malformation developed congenitally or thereafter. The AS stops growing after puberty and may remain persistent throughout life. The pulsed dye laser (PDL) and KTP are used to treat the AS usually after several sessions. We treated a patient with AS with only one session of intense pulsed light (IPL) therapy. A 40-year-old lady with Fitzpatrick skin type 3 and AS on the left maxillary and infraorbital area was scheduled to be treated with IPL. The lesion was treated by a single pass of IPL therapy with 8 joules/ cm2, in the telangiectatic mode. No anesthesia more than cooling was used, and a mild erythema was developed immediately after IPL therapy, which subsided soon after the procedure. Two months later, telangiectatic lagoons were completely removed, and only very faint erythema remained. IPL is an effective and more tolerable device for the treatment of AS, with no purpura and discoloration, as frequently observed following PDL therapy.

Angiosarcomas of the scalp are aggressive invasive tumors that, more often than not, mimic benign painless skin lesions. We here report a case of angiosarcoma that was timely diagnosed and treated thanks to the dermoscopic rainbow pattern.