Iranian Journal Of Dermatology
Volume:23 Issue: 3, Autumn 2020

Acne is a common chronic inflammatory skin disease predominantly occurring during adolescence; this condition adversely affects a person’s self-esteem and can be associated with metabolic disorders. This study aimed to investigate the prevalence of metabolic syndrome and its components in adolescent girls with acne compared to a control group. 

In this cross-sectional study,105 adolescent girls aged 12-18 years were assigned to either the acne (case; n=55) or control group (n=50). The case group was selected from the Dermatology Department of a general hospital in Tehran, Iran, between January and August 2017. Acne lesions were confirmed and graded by a dermatologist. Clinical and biochemical parameters were evaluated for all participants.

The prevalence of metabolic syndrome in patients with and without acne was 18.2% and 14%, respectively. As a result, metabolic syndrome was not correlated with acne in adolescent girls (P=0.561). In addition, the mean body mass index (P=0.89), waist circumference (P=0.62), mean systolic and diastolic blood pressures (P=0.57 and 0.62, respectively), fasting blood sugar (P=0.59), total cholesterol, and low-density lipoprotein cholesterol levels were comparable between the studied groups (P>0.05). Moreover, triglyceride levels were significantly lower in the acne group (P=0.028), whereas this group featured a higher level of high-density lipoprotein cholesterol (P=0.02). However, the logistic regression results showed that none of the measured lipids were associated with acne.

The findings indicated that metabolic syndrome and its components (representing metabolic imbalance) were not correlated with acne in adolescent girls.

Psoriasis and its acceptance adversely affect the patient’s quality of life. This study aims to measure quality of life of psoriatic patients, psoriasis disability index and acceptance of psoriasis as a disease and their associated factors as well as their interaction.

A total of 125 psoriatic patients were included in the study. Socio-demographic and clinical data were collected. Psoriasis Area Severity Index (PASI), Psoriasis quality of life index (PQOL), Psoriasis Disability (PDI) and acceptance of psoriasis scale index (PAI) were measured using Arabic validated tools. Multivariate linear regression analysis was done to find out the independent predictors of the outcome variables.

The mean overall PQOL, PDI and PAI were 14.3, 20.8 and 60.1; respectively. Compared to the moderate/severe chronic plaque psoriasis, the mild chronic plaque shows significantly lower mean PQOL, lower mean PDI and higher mean PAI. There are positive moderate significant correlations between PQOL and PDI and PASI (r=0.59, r=0.54; respectively). However, there is inverse moderate significant correlation between PQOL and psoriasis acceptance index (r=-0.55). The linear regression revealed that the independent predictors of psoriasis quality of life are PDI, PASI and PAI. These three variables predict 0.42 of variability of PQOL.

psoriasis exerts significant, negative effect on patients' quality of life. Disease disability, severity and its acceptance are independent predictors of quality of life.

Self-inflicted acne excoriée is often observed in patients with compulsive skin picking, posing a challenge for diagnosis and treatment as the exact psychiatric cause remains unknown. Studies have suggested that serotonin reuptake inhibitors such as fluoxetine may help in the management of this condition. To determine the efficacy and safety profile of fluoxetine in the treatment of acne excoriée and to study the psychological profiles of patients.

Sixty patients of either sex aged ≥16 years with acne excoriée were assigned to either Group A (n=30), which received oral fluoxetine (F) (20 mg/day) and oral doxycycline (D) (100 mg/day) with topical clindamycin (1%), or Group B (n=30), which received a placebo (P), oral doxycycline (100 mg/day), and topical clindamycin (1%). Patients were evaluated for standardized rating scales and followed up every two weeks for 12 weeks.

Female gender predominance was observed in both groups, with most patients exhibiting anxiety and depression. With each follow-up visit (2nd, 3rd, 4th, and 5th) in both groups (A and B), the mean AESI (91.4% vs. 26.7%), HAM-A (80% vs. 27.7%), MADRS (68.1% vs. 28.2%), YBOCS (98.27% vs. 15.63%), PGA (88.47% vs. 31.38%), and VAS (99.17% vs. 37.67%) scores decreased from baseline by the final visit, indicating improved patient conditions. Significant differences were observed between the two groups (p <0.001) in the overall response, indicating that fluoxetine was more efficacious than the control. No remarkable side effects were noted.  

Fluoxetine efficiently managed acne excoriée without remarkable side effects.

Self-inflicted acne excoriée is often observed in patients with compulsive skin picking, posing a challenge for diagnosis and treatment as the exact psychiatric cause remains unknown. Studies have suggested that serotonin reuptake inhibitors such as fluoxetine may help in the management of this condition. To determine the efficacy and safety profile of fluoxetine in the treatment of acne excoriée and to study the psychological profiles of patients.

Sixty patients of either sex aged ≥16 years with acne excoriée were assigned to either Group A (n=30), which received oral fluoxetine (F) (20 mg/day) and oral doxycycline (D) (100 mg/day) with topical clindamycin (1%), or Group B (n=30), which received a placebo (P), oral doxycycline (100 mg/day), and topical clindamycin (1%). Patients were evaluated for standardized rating scales and followed up every two weeks for 12 weeks.

Female gender predominance was observed in both groups, with most patients exhibiting anxiety and depression. With each follow-up visit (2nd, 3rd, 4th, and 5th) in both groups (A and B), the mean AESI (91.4% vs. 26.7%), HAM-A (80% vs. 27.7%), MADRS (68.1% vs. 28.2%), YBOCS (98.27% vs. 15.63%), PGA (88.47% vs. 31.38%), and VAS (99.17% vs. 37.67%) scores decreased from baseline by the final visit, indicating improved patient conditions. Significant differences were observed between the two groups (p <0.001) in the overall response, indicating that fluoxetine was more efficacious than the control. No remarkable side effects were noted.

Fluoxetine efficiently managed acne excoriée without remarkable side effects.   Keywords: acnevulgaris,fluoxetine, doxycycline

Psoriasis is an immune-mediated chronic skin disorder. Information regarding its clinic-epidemiological manifestations is limited in parts of Asia. This study was conducted to determine the risk factors, clinical presentation, and management of psoriasis among patients in Mangalore, India. The medical records of 225 psoriasis patients over the past ten years (from January 2009 till March 2019) were examined by the investigators. Data were collected using a semi-structured form. The mean age at diagnosis of psoriasis was 42.2 ± 16.0 years. Nail psoriasis and psoriatic arthritis (PsA) were present in 66 (29.3%) and 21 (9.3%) patients, respectively. Relapse of psoriasis was seen more among patients with a history of disease exacerbation in winter (P=0.009) or in rainy seasons (P=0.031). Systemic therapy with methotrexate and topical therapy with steroids were used in the management of 52 (23.1%) and 72 (32%) patients, respectively. Phototherapy (n=11) was the most common modality used among the 18 patients with extensive psoriasis. Co-morbidities like diabetes mellitus (P=0.02) and complications like PsA (P=0.008) were associated with greater disease durations among the patients. The proportion of patients with extensive psoriasis was high in the current setting probably because of delayed diagnosis. Awareness about the disease and its clinical manifestations might help in its early identification. Seasonal exacerbation was an important risk factor for psoriasis and it was associated with its relapse. The most common management modalities were topical steroids for psoriasis and phototherapy for extensive psoriasis.

Since its recognition, frontal fibrosing alopecia (FFA) has increasingly been studied globally in terms of its diverse aspects. Having found no studies describing this condition in Southern Iran, we examined the different clinicopathological features of patients with FFA who referred to Faghihi Hospital, Southern Iran, between 2013 and 2018. We searched the archives of the Pathology Department of Faghihi Hospital for the cases with a diagnosis of FFA. Due to its similar histopathologic features with lichen planopilaris, the final diagnosis was made using clinical correlations. Twenty-two patients were enrolled; all were female. Fifteen (68.2%) presented with the disease before menopause. Besides frontal and/or temporal hairline involvement in all the patients, eyebrow alopecia, eyelash loss, body hair loss, and facial papules were present in 81.8%, 27.3%, 50%, and 68.2% of them, respectively. Dermoscopic findings included follicular opening loss (100%), honeycombing of the scalp (81.8%), multiple white dots (77.3%), perifollicular erythema (63.6%), and perifollicular scales (59.1%). The histopathologic examination revealed follicular dropout (95.4%), perifollicular lymphocytic infiltration in the infundibulum and isthmus of the follicles (81.8%), perifollicular fibroplasia (77.3%), intact interfollicular epidermis (59.1%), mild perivascular lymphocytic infiltration in the upper dermis (54.5%), and apoptotic keratinocytes in the infundibulum and isthmus (50%). The most common comorbidity was hypothyroidism (40.9%).  Thediagnosis of FFA should be considered in both premenopausal and postmenopausal women. Eyebrow alopecia, eyelash loss, body hair involvement, and facial papules are helpful clues in the diagnosis. The coexistence of hypothyroidism with FFA suggests immunological involvement in the pathogenesis.

Oral lichen planus (OLP) is a mucocutaneous disease characterized by inflammation leading to severe damage to the epithelial basal layer. This report describes a case of a 65-year-old Iranian female with a complaint of multifocal white lesions on the buccal and tongue mucosa with a reticular pattern and a focal pseudomembranous appearance (similar to thrush), together with burning symptoms for fourteen months. The patient was using topical fluocinolone acetonide 0.1%, two to three times a day at least for six months to control the ulcers and erythema. Molecular analysis of the thrush sample revealed Candida glabrata as the causative agent. Histopathologic examination confirmed the diagnosis of OLP. The minimum inhibitory concentration analysis was performed according to CLSI-M60 and revealed that this C. glabrata isolate was multidrug-resistant (resistant to nystatin, fluconazole, micafungin, and caspofungin). Finally, this patient was treated with amphotericin B oral suspension (0.5 g/5 ml) thrice daily for 14 days. The thrush disappeared completely and the patient no longer had any pain or burning sensations. Candida glabrata, the second most common cause of candidemia, is a major opportunistic fungal pathogen of humans that causes systemic as well as, mucosal and superficial infections. This case is the first case of OLP accompanied by multidrug-resistant C. glabrata.

Lichen planus pigmentosus (LPP) develops as an asymptomatic and dusky pigmentation of the facial skin with no effective treatment. Herein we report a 54-year-old lady with clinical and histopathologic confirmation of LPP who was scheduled to be treated with CO2 laser resurfacing. After tumescent anesthesia, the whole facial skin was treated with three passes of Ultrapulse conventional CO2 ablation. The energy used in the first, second, and third passes were 6.6, 5.4, and 4.8 mJ, respectively. The mandibular area was treated with two passes (4.2 and 3.6 mJ). The eye contours were treated with two passes (3.9 and 3.3 mJ). The patient’s face remained edematous for a week, with the facial skin oozing within the first three days before it became crusted. The crust shed out from day three to six. After a week, smooth and erythematous skin appeared. The erythema persisted for up to four months, after which uniform skin with considerable bleaching and rejuvenation developed. No recurrence occurred within 18 months of follow-up. We conclude that LPP can be treated with CO2 laser resurfacing without any complications.