سیمین شمسی میمندی

Hobnail hemangioma ( targetoid hemosiderotic hemangioma( is a benign vascular tumor that is usually characterized as a papule with an ecchymotic halo on the periphery. It is usually seen in young adults and most commonly affects limbs. The lesion is seen equally in both sexes. This vascular tumor is rare in the world and, according to our acknowledge, only one case has been reported in Iran. In this case report, we described the second case of targetoid hemosiderotic hemangioma.
Material and The patient is an 8 years old boy with a targetoid asymptomatic red popular lesion on his lower leg from 5 years ago .The lesion was completely excised. Skin biopsy showed dilated vascular spaces with hobnail endothelial cells in the superficial dermis accompanied with narrower vessels in the deep dermis which was compatible with targetoid hemosiderotic hemangioma. In a follow up period of three years the lesion did not recur.
Distinction between targetoid hemosiderotic hemangioma and malignant skin lesions such as melanoma, Kaposi sarcoma and angiosarcoma is necessary. Thus, knowledge of clinical picture and pathology of this lesion can prevent unnecessary aggressive procedures.

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit. Retinoids are used as the first line therapy in acne. Systemic absorption and skin irritation including redness, pruritus and exfoliation are some of their side effects. In this study we compared the efficacy of isotretinoin 0.05% niosomal gel versus adapalen 0.1% gel in treatment of acne vulgaris.
In this randomized double blind clinical trial, 144 patients with mild to moderate acne vulgaris aged from 15 to 30 years were enrolled. The patients were randomly allocated into two groups of A, whom were treated with isotretinoin 0.05% niosomal gel and B whom were treated with adapalen 0.1% gel. The patients were evaluated for clinical reponse, decrease in the number of inflammatory and non-inflammatory lesions and side effects after 2, 4, 8, and 12 weeks of the initiation of treatment.
At the end of the study the clinical responses of comedones and inflammatory lesions in isotretinoin 0.05% niosomal gel group were 68% and 79%, in comparison with 65% and 76% in the adapalen gel group, respectively. The differences were not statistically significant. At the end of the treatment period more decrease in number of inflammatory and non-inflammatory lesions were seen in group A patients (niosomal isotretinoin) than group B (adapalen 0.1% gel) (P Isotretinoin 0.05% niosomal gel has less side effects and more efficacy in the treatment of mild to moderate acne vulgaris in comparison with adapalen 0.1% gel.

Lichenoid tissue reactions are a group of skin diseases with hydropic degeneration of the basal cell layer and inflammatory infiltrations in papillary dermis. The aim of this study was to investigate the clinicopathological features of skin diseases with lichenoid tissue reaction.
This retrospective cross-sectional study was conducted on 118 cases with lichenoid tissue reactions. Pathological and clinical features such as age, sex, location of the lesions were evaluated.
53.4% of the patients were female. Mean age of the patients was 39.9±17.37 years. Mean duration of the disease was 21.82±14.3 months. The most common site of involvement was upper limb (24%). The most frequent histopathological findings in epidermis and dermis were hydropic degeneration of the basal cell layer and papillary lymphocytic infiltration (89.9%, 85.5%, respectively). Lymphocytes were the most frequent inflammatory cells in dermis. Colloid bodies and melanin incontinency also were seen in 60.2% and 78% of cases, respectively.
Pathological evaluation can be helpful in differentiating skin disease with lichenoid tissue reactions, if there is a doubt in clinical diagnosis.

Melasma is a common acquired disorder characterized by symmetric, hyperpigmented patches with an irregular outline, occurring most commonly on the face. The goal of this study was to evaluate the efficacy of a cream containing 4% licorice extract with a novel formulation based on solid lipid nanoparticles technology in the treatment of melasma. To the best of our knowledge, it is the first study designed to investigate the efficacy of this novel formulation in the treatment of melasma all over the world.
In this randomized, double-blind, placebo-controlled clinical trial, 44 women with clinical diagnosis of melasma referred to the Afzalipour hospital dermatology clinic were randomly allocated into two treatment groups of equal size. All the patients were interviewed and examined every four weeks during the trial and their Modified Melasma Area and Severity Index (MMASI) score were evaluated at 4, 8 and 12 weeks. The efficacy of the interventions were classified in four levels: complete response, significant response, partial response and no response.
Forty patients were enrolled in the study. At the end of the study (12 weeks), mean± standard deviation of MMASI score changed from 11.03±2.7 to 1.41±0.6 in the intervention group and from 11.25±2.9 to 2.37±1.2 in the placebo group, respectively (P Licorice extract can be used as a skin-lightening agent with minimal side effect in the treatment of melasma. Nano/micro solid lipid particles are used as carriers with unique properties like size, surface electrical bar. Moreover, a large amount of the drug might be loaded to increase the efficacy and decrease the adverse events.

Androgenetic alopecia (AGA) is the most common type of alopecia in men. Currently، minoxidil is the only topical drug which has been approved by FDA for the treatment of AGA. However، its efficacy is restricted because of its low skin penetration. Since vesicular systems such as liposomes and niosomes have higher efficacy and lower adverse effects، this study was conducted to compare the efficacy of topical niosomal minoxidil with conventional minoxidil in the treatment of AGA. This study was a randomized، controlled double-blind clinical trial. Ninety male patients with AGA according to Hamilton criteria were enrolled into this trial. The participants applied the interversion to which they were allocated twice a day، and were evaluated monthly for 6 months by a physician and patients self-assessments. Eighty-eight patients completed the trial. Mean increased hair count in niosomal minoxidil group and conventional minoxidil group in the last visit were 28. 18±11. 00 and 14. 22±5. 23، respectively (P<0. 001). Moreover، evaluation of treatment response according to the patients self-assessments were 8. 72±5. 03 and 3. 33±2. 67 in niosomal and conventional minoxidil، respectively، which revealed more satisfaction in niosomal group (P=0. 001). With the exception of two cases in niosomal minoxidil group whom were withdraw due to scalp itching and erthema no other adverse effect was observed in either group. In the present study، application of topical niosomal minoxidil revealed an increase in the hair count in comparison with conventional minoxidil solution. Application of this new formulation for the treatment of AGA may be recommended.

Common wart is a viral infection of epithelial tissues caused by human papiloma virus (HPV). In order to increase the efficacy and concurrent reduction of complications، different types of combination therapies have been recommended. One of them is the combination of cryotherapy with cantharidin. As cantharidin causes little pain and leaves small scars، we decided to design and conduct a randomized، controlled trial to investigate the efficacy of combined cryotherapy and topical cantharidin versus cryotherapy and a topical placebo. The mean number of the treatment sessions and complications of treatments were also compared between the two groups. This study was a randomized، controlled double blind clinical trial in which 110 patients with verruca vulgaris were randomly allocated into two groups. After cryotherapy in both groups، topical lotion of cantharidin 0. 7% (Canthacur) and flexible collodion as placebo were applied topically in the intervention and control groups، respectively. Patients were followed for healing rates، complications and recurrence of the lesions. The healing rates of lesions in both groups were 100%. The mean number of treatment sessions in the intervention and control groups were 3. 4 and 4. 7، respectively (P<0. 001). The incidence of hyperpigmentation in the intervention and control group were 29. 1% and 10. 9%، respectively (P=0. 017). Atrophic scars in the case group were less common than the control group (9. 1% versus 29. 1%). Within 4 weeks of follow up after completion of the treatment protocol، the frequency of other complications and recurrence of the lesions showed no statistically significant difference between the two groups. Combination of cryotherapy and cantharidin reduced the number of treatment sessions and atrophic scars، but increased the hyperpigmentation. Also، this combination therapy was ineffective in reducing other complications and the recurrence rate of the lesions.

Common wart is a benign proliferation or tumor of mucocutaneous surfaces caused by different types of human papilloma virus (HPV). It is very common in children and young adults.

The aim of this study is to compare therapeutic and side effects of Cryotherapy versus Pulsed Dye Laser (PDL) in the treatment of common warts.

In this prospective controlled randomized clinical trial (RCT), 20 patients with 100 wart lesions were enrolled. The patients were randomly divided into two groups each consisting of 10 patients (with 50 lesions). The treatment protocol for the first group consisted of laser therapy with PDL (wavelength of 585 nm), and the second group treated with Cryotherapy. Patients in both groups were treated every 3 weeks up to 5 times till complete clearance of the lesions achieved. All of the patients were examined in every session of treatments for the clinical response or probable side effects. After completing the proposed course of treatments, patients were examined every 4 weeks for 2 months in order to detect recurrence or probable side effects.

The clinical response for the first group (treated with PDL) and second group (treated with Cryotherapy) were 46.1% and 53.9% respectively. So it was concluded that Cryotherapy has provided better clinical response than PDL, while statistically no meaningful difference between these groups was observed (PV=0.056).

The results of this study showed that laser therapy with PDL in comparison with Cryotherapy leads to less side effects, so the laser therapy could be used as the first line in the treatment of common warts, of course the results of the current study needs to be confirmed.

Psoriasis is a chronic, relapsing disease of the skin with psychological and somatic impacts that leads to substantial effects on the quality of life. The aim of this study was to determine the quality of life in psoriatic patients.

This cross-sectional study was conducted on 97 psoriatic patients in dermatology and PUVA clinic in Afzalipour hospital in Kerman from March 2009 to March 2010. Quality of life and disease severity were Dermatology Life Quality Index (DLQI) and Psoriasis Area SeverityIndex (PASI). Data analysis was done through conducting,chi-square and one-way AVONA tests and P<0.05 was considered as significant.

55.7% of patients were male and mean age of them was 35.3 years (range: 16-75 years). Psoriasis vulgaris was the most common type (76.3%), and arthropathy was seen in 3.1% of patients. The mean duration of the disease was 21 months (range: 11 months-30 years).The mean of DLQI score was 14.1(range: 1-29) and mean PASI score was 18.6 (range: 0.6-66.6). DLOI score correlated with severity of disease (PASI), marital status, and type of the disease (P<0.05).

Psoriasis has a severe negative impact on the quality of life of the patients. Therefore, supportive social and spiritual efforts are necessary to decrease these effects.

Melasma is an acquired symmetrical brown hyperpigmentation of the face or neck. Melasma has been shown to have a significant emotional and psychologic distress on affected patients. Although this pigmentary disorder is more prevalent among women of reproductive age, the effect of melasma on quality of life in this population is unknown. The aim of this study was to evaluate health-related quality of life in patients with melasma attending to dermatology clinics in Kerman city, Iran A cross-sectional study was carried out by clinical examination and questionnaire on 200 patients with melasma. Melasma area and severity index (MASI), Dermatology Life Quality Index (DLQI) and Melasma Quality of Life Scale (MELASQOL) were used to assess melasma severity and quality of life. There were 200 women with mean age 31.86±6.42 years old (range: 18-55 years). The mean score of DLQI and MELASQOL were 6.90±4.48 and 40.24±14.95, respectively. In 113 (56.5%) patients, melasma had very large effect on their quality of life. There was a significant correlation between the scores of quality of life questionnaires and MASI (P<0.001). In DLQI scale the most frequent impairment was related to emotional well-being and based on MELASQOL questionnaire, embarrassment due to skin appearance had an important impact on quality of life. This study revealed that physicians must consider the devastating psychosocial impact of pigmentary imperfections in addition to pharmacological and physical treatment.

Diabetes mellitus is one of the most common types of chronic disease leading to serious complications such as blindness, end stage renal disease (ESRD), neuropathy and cardiac disorders. Skin tag is a common benign skin tumor that its association with impaired carbohydrate metabolism has been reported in some studies. The aim of this study was to compare the frequency of diabetes and other carbohydrate metabolism disorders in patients with and without skin tag.

In a case- control study on 200 individuals over 30 years old referring to Dermatology Clinic of Afzalipour Hospital, 100 individuals with at least 3 skin tags as case group and 100 individuals without skin tag as control group underwent FBS and standard GTT tests.

There was no significant difference between case and control groups in the frequency of diabetes (19% vs. 10%), IGTT (11%vs.13%) and IFG (19% vs. 15%).Mean FBS and GTT were significantly higher in the case group compared to the control group.There was a positive correlation between the total number of skin tags and mean FBS (r= 0.33, P= 0.001) and GTT (r= 0.37, P= 0.000). The frequency of diabetes in patients with at least 20 skin tags was 45.8%. Positive predictive value, negative predictive value, sensitivity and specificity of skin tag for the diagnosis of diabetes were 19%, 90%, 52% and 65% respectively.

This study revealed that patients with skin tags are at a higher risk of carbohydrate metabolism disorders. Therefore, screening of patients with skin tag for carbohydrate metabolism disorders is recommended.

Dry type localized cutaneous Leishmaniasis due to Leishmania tropica is one of the most prevalent cutaneous parasitic infections in Kerman province. It seems that cellular immune response and the nature of immune inflammatory cells comprising the inflammatory background play a determinant role in this infection. Skin biopsies of 53 patients with acute(<2 years duration), nonlupoid chronic(≥2 years duration) and lupoid chronic (new lesions around old scar) types of cutaneous leishmaniasis due to Leishmania tropica were studied by hematoxylin-eosin staining for evaluation of inflammatory cells and epidermal and dermal changes. Immunohistochemical staining was used to determine immunophenotypic patterns (CD1a, CD68, CD3, CD8, CD4, CD20) and to evaluate host immune response at tissue level, the correlation between the presence and concentration of certain cell types, and the clinical presentation and duration of disease. Mean percentages of epidermal and dermal Langerhans cells CD1a+ were higher in lupoid than in acute lesions. Also, the predominant T lymphocyte in acute, chronic and lupoid leishmaniasis was T CD8+. It seems that Langerhans cells CD1a+ are responsible for the suppression of the inflammatory response against L.tropica infection and by providing Leishmania antigens in a steady state induce tolerance to the Leishmania antigens and consequently cause cutaneous chronic lupoid leishmaniasis. This study also suggests that T CD8+ play an effective role in parasite elimination and in the process of healing of cutaneous leishmaniasis due to Leishmania tropica.

Allergic and irritant compounds are frequent in nature, and the environmental allergic factors which can induce or exacerbate eczema are different and often unknown in different areas. The aim of this study was to determine the frequency of contact dermatitis in patients with chronic dermatitis referring to dermatology clinics in kerman. In this descriptive study, standard patch test containing 24 allergens was done for 156 cases (56 males and 69 females) with confirmed chronic dermatitis who had been referred to Afzalipoor Hospital Dermatology Clinics. Evaluation of the results was done for every case 24, 48 and 72 hours after application of the patch test. In whole, 153 positive patch tests were seen in 66 (52.8%) cases of 125 patients who had been examined. The most common allergic agent was nickel sulfate detected in 20 (13.1%) patients (17 females and 3 males). The hypersensitivity reaction to this agent was significantly more common in females than males (P<0.05). Potassium dichromate with frequency of 11.1% (12 males and 5 females) was the second common allergic agent and males showed significantly more positive reaction to this agent than females (p<0.05). There was no statistically significant difference according to the age and sex between groups with positive and negative patch test results (P>0.05). As the causative agents of contact dermatitis are different in various areas, by doing patch test in each area the allergic agents can be detected for more appropriate preventive measures and treatment strategies. In this study, the first and second common allergens were respectively Nickel and Chrome compounds. Thiorum, Cobalt, benzocaine and theazolin compounds were in the third rank.

Dermatofibrosarcoma protuberans is a tumor of intermediate malignancy characterized by its aggressive local growth and marked propensity to recur after surgical excision. Many forms of the tumor has been reported. We report a pedunculated form of tumor. A 45-year-old woman felt a growing tumor on her trunk for 6 years but did not seek medical consultation until it had ulcerated 6 months ago. Skin biopsy confirmed the diagnosis of dermatofibrosarcoma protuberans. Radiological and sonographical examination failed to reveal any metastatic lesion.