Iranian Journal Of Dermatology
Volume:13 Issue: 3, Autumn 2010

Pemphigus vulgaris is an autoimmune blistering disease of the skin and mucous membrane. Antiphospholipid antibodies are a group of autoantibodies found in patients with autoimmune diseases. Due to the risk for thrombotic events in autoimmune diseases, we decided to evaluate the correlation between pemphigus vulgaris and predictive elements of atherothrombosis including antiphospholipid antibodies and homocysteine. IgG and IgM anticardiolipin antibodies, IgG anticardiolipinbeta 2 glycoprotein I, lupus anticoagulant and total homocysteine were evaluated in the serum of 39 new cases of pemphigus vulgaris and healthy matched controls. The prevalence of antiphospholipid antibodies, lupus anticoagulant and total homocysteine in pemphigus vulgaris patients showed no significant difference with healthy controls. Pemphigus vulgaris seems not to be similar to some other organ specific autoimmune diseases in which there is an increase in atherothrombotic factors including antiphospholipid antibodies and homocysteine.

Basal Cell Carcinoma (BCC) is the most common type of skin cancer in human beings. Photodynamic therapy (PDT) is a novel therapeutic method which may be regarded as a non-invasive useful alternative for traditional treatments of BCC. This study was designed with the aim of evaluating the primary response of BCC to PDT. This clinical trial was performed on 28 BCC lesions. Patients were treated with ALA-PDT monthly for 1-6 sessions and evaluated for clinical response, cosmetic results and probable side effects. Twenty three out of 28 lesions showed response to PDT (9 showed complete response and 14 showed partial response). The cosmetic result was excellent or good in 77.5% of the cases. In 92.8% of the cases, no or mild side effects were observed. Patients with a positive history of radiotherapy responded less (p<0.05). No significant relationship was found between patient's age, sex, localization, diameter or type of BCC with clinical response. PDT might be a good therapeutic option in the treatment of BCC, especially the superficial type, with high efficacy and few side effects.

The correlation between coronary artery disease and androgenic alopecia has been demonstrated, but the mechanism of this association still remains to be cleared. To investigate lipid profile, as an indicator of coronary artery disease, in women with female pattern alopecia. Fifty one women with female pattern alopecia and thirty one healthy women with normal hair status were selected as the case and control groups, respectively. Lipid profile including cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, lipoprotein (a), apolipoprotein A1, and apolipoprotein B were measured in both groups. The most important result of our study was a remarkably higher level of lipoprotein (a) in the case group. On the other hand, 55.3% of the patients and 16.7 % of the controls had lipoprotein (a) level >30 mg/dl, higher than the critical level for atherosclerosis. Lipid profile, especially lipoprotein (a), which is an important risk factor for coronary artery disease, should be investigated in women with androgenic alopecia. Those with disturbance in lipid profile should be referred to a cardiologist.

Benign pigmented lesions, including freckles, are common and various treatment modalities including lasers and peeling have been evaluated for their effectiveness in their treatment. To compare the clinical effects of focal peeling with Trichloroacetic Acid (TCA) and Nd:YAG (532 nm) laser on freckles. Twenty patients with freckles were treated with focal peeling with TCA 25% on their left-sided lesions and Nd:YAG (532 nm, Fluence 9.5 J/cm2, spot size 1.5 mm) on their right-sided lesions. Photographs were taken prior to treatment and at follow-up visits and were evaluated by three dermatologists and the results were analyzed. Eighteen out of the 20 patients (90%) with freckles manifested more than 50% improvement in laser treated areas whereas clinical improvement in focal peeling treated areas was observed in 15 out of 20 (75%). The mean improvement rate for laser and focal peeling was 66.50±12% and 58.3±15%, respectively. No significant difference was observed in the treatment results between these modalities. Focal peeling with TCA 25% could be as effective as frequency-doubled Nd:YAG (532 nm) laser in the treatment of freckles.

Alopecia areata is one of the most common human autoimmune disorders and its severe types are refractory to all conventional therapies. Corticosteroids have been used in severe alopecia areata since 1950s but there is concern over complications caused by high doses of corticosteroids. Methotrexate has been used as an adjunctive therapy in some autoimmune disorders and has been proposed to be effective in the treatment of severe alopecia areata both as a monotherapy and in combination with corticosteroids. In this study, 120 patients of intractable alopecia areata totalis and universalis with a mean duration of 3.27 ±1.60 years were studied. We treated them with methotrexate in combination with intravenous and low dose of prednisolone for one year. Methotrexate 10 mg per week was administered in combination with three monthly methylprednisolone and oral prednisolone 15 mg per day for one year. Response to the treatment was evaluated clinically and by serial photographs. Sixty four patients (57.7%) gained total hair regrowth after treatment with no significant difference between alopecia totalis and universalis. Almost half of the patients (44.75%) remained disease free until the end of the one-year follow-up. Relapse occurred in 34 patients (56.25%); of them 20% were focal relapses. Nine patients out of 120 patients (7.5%) experienced severe adverse effects of the therapy. Our study suggested that methotrexate could be used as a safe and well tolerated adjunctive therapy for severe alopecia areata although careful monitoring of adverse effect is necessary. Furthermore, controlled prospective clinical trials are warranted to answer many of the questions regarding methotrexate therapy for severe alopecia areata.

Vitiligo, an autoimmune disorder, is known to co-localize with other immunological disorders like lichen planus and psoriasis. However, there are no reports regarding the co-localization of an autoimmune disorder (vitiligo) and a developmental disorder (verrucous epidermal nevus). We hereby present a 10-month-old infant who was visited for white patches on the right buttock and adjoining anterolateral thigh since 2 months of age. Lesions started as flat depigmented patches which gradually became raised. Examination revealed depigmented verrucous plaques along Blaschko’s lines on the right buttock and adjoining thigh with depigmented macules and patches in the periphery. Histopathology revealed features of classical verrucous epidermal nevus in addition to focal interface dermatitis. Immunohistochemistry showed melanocytopenia. Hence, this was a rare case of verrucous epidermal nevus co-localized with a vitiliginous patch, clinically simulating a depigmented variant of verrucous epidermal nevus.

Leishmaniasis affects 1.5-2 million new cases in the world annually. Two major complications of cutaneous leishamaniasis include diffuse cutaneous leishamaniasis (DCL) occurring in the setting of deficient cell mediated immunity, typically with HIV infection, and chronic cutaneous leishamaniasis (CCL) developing in approximately 4% of L. tropica infections in Iran and Afghanistan which also may complicate vaccination with a live strain of leishmania (leishmanization). The Iran – Iraq war took place in a hyper endemic area of Old-World cutaneous leishmaniasis. We report two Iranian soldiers who were both infected in the battle field and presented several years after the war; one was an HIV positive patient with DCL and the other was a previously leishmaniazed patient with CCL.

Amniotic Band Syndrome is a sporadic congenital disorder that may result in constriction bands, amputation and multiple craniofacial, visceral and body wall defects. Its incidence is estimated at approximately 1:5000 to 1:10,000 pregnancies. Band formation most frequently affects the distal segments, including the hand. We report a case of constriction amniotic bands involving the trunk.

Scabies is one of the health care problems in our community and is an endemic problem at any time. Its current therapy in Iran is lindane 1% lotion, which is deleted from market in many countries because of multiple side effects and better alternatives. The aim of this study was to evaluate the efficacy and side effects of lindane in patients with scabies and to replace lindane with other safer and more effective scabicides in case of high treatment failure rates. 100 patients with clinical diagnosis of scabies were treated with two lindane 1% lotions with an interval of one week. The patients were examined two and four weeks after the initial treatment in order to evaluate clinical cure. Data was analyzed with SPSS-13. The mean age of the patients was 33.74 years. Of them, 52% were male and 48% were female, 60% were married and close contact was found in 100% of the patients as the route of transmission of the disease. Symptoms reduced in 75% of the patients after two times of applying lindane. Itching decreased 3 days after applying Lindane and disappeared completely on the seventh day. Fifty four percent were free of disease 28 days after treatment. In this study, the failure rate of treatment with lindane was relatively high; therefore, it seems necessary to think of other alternative scabicides (such as permethrin 5% cream) for the treatment of scabies. Furthermore, with accurate usage, lindane is a safe topical modality and we found no adverse effects related to lindane.