Iranian Journal Of Dermatology
Volume:24 Issue: 4, Autumn 2021

Secukinumab is a fully humanized IL-17A antagonist approved for managing moderate-to-severe plaque psoriasis as well as psoriatic arthritis. This study assessed the speed of action of secukinumab and the improvement in the quality of life in a series of patients. We aimed to assess changes in the PASI (Psoriasis Area Severity Index) and DLQI (Dermatology Life QualityIndex) following a course of secukinumab injections. This hospital-based study was conducted in the Department of Dermatology, Venereology and Leprosy of ESIC Medical College & Hospital, Hyderabad, India. Starting from 8 weeks after initiation of treatment with secukinumab 300 mg, a clinically significant response was observed, with progressive reduction of skin disease indices. Twenty-four patients were included in the study, with a mean age of 42 years. The male to female ratio was 15:9. Thirteen (54.16%) patients achieved PASI 75 at eight weeks. At the end of 52 weeks, 20 (83.33%), 15 (62.5%), and 8 (33.33%) patients maintained PASI 75, PASI 90, and PASI 100, respectively. Secukinumab is a highly-efficacious, biologic therapy that provides rapid relief with a relatively favorable safety profile in patients with moderate-severe plaque psoriasis. In addition, secukinumab is a preferred treatment for patients with comorbid psoriatic arthritis or arthralgia symptoms due to its ability to arrest the progression of arthritic disease in the early course.

Vitamin C and long-pulsed Laser Nd:YAG 1064 nm can reduce the severity of acne scars by increasing the number and density of collagen fibers. Furthermore, applying vitamin C after the skin resurfaces can improve its penetration into the skin. This study aimed to prove the difference between the effectiveness of the long-pulsed Nd:YAG 1064 nm laser with 15% vitamin C (L-ascorbic acid) solution combination therapy and isolated long-pulsed Nd: YAG 1064 nm laser therapy in atrophic acne scars by assessing the decrease in Goodman and Baron scores. This study took the form of a double-blind, randomized controlled trial using a pretest-posttest comparison group design on patients with atrophy acne scars on the face. Both groups were assessed using the Goodman and Baron scores before and after therapy for three months. Subsequently, descriptive analysis andhypothesis testing were performed. In the treatment group, the mean Goodman and Baron score decreased significantly after treatment to 13.9 ± 7.39 (P = 0.008), while in the control group, the mean score decreased significantly to 18.2 ± 9.34 (P = 0.007). Goodman and Baron Delta scores in the treatment group were significantly higher at 7.3 ± 2.78 compared with the control group at 3.1 ± 1.05 (P < 0.001). Long-pulsed Nd:YAG 1064 nm laser with 15% vitamin C solution (L-ascorbic acid) combination therapy is more effective in lowering the Goodman and Baron scores for atrophic acne scars than isolated long-pulsed Nd:YAG 1064 nm laser.

Little data on severe cutaneous adverse drug reactions (SCADRs) is available, especially in Iran. Therefore, there is a need for more studies in this field. We aimed to evaluate the clinical pictures and laboratory data of patients with SCADR in a tertiary dermatology center in Tehran, Iran. In this retrospective study, patients with a clinical diagnosis of SCADR based on the World Health Organisation’s definition and histopathologic findings were included. Causality and preventability measures were assessed based on previous criteria, including the Naranjo score and the Schomock and Thronton scale. Thirty-nine patients with a mean age of 43 ± 17 years participated in the study. SCADRs were more common in females than in males (2.9/1). SCADRs included Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), acute generalized exanthematous pustulosis (AGEP), and drug reactions with eosinophilia and systemic symptoms (DRESS). Thirty-one patients presented a Naranjo score of 5-8, indicating probable drug reactions. The remaining eight patients (with scores of 1-4) were determined as having possible drug eruptions. Regarding the category of culprit drugs, anticonvulsants (49%), antimalarials (15%), antibiotics (13%), and antihypertensives (10%) were themost frequent causes of SCADR, with lamotrigine being the single most common agent. The most frequent clinical presentation of SCADR was SJS/TEN, followed by AGEP and DRESS. The most frequent cause of SCADR was anticonvulsant drugs.

The management of third-degree burns primarily aims to enhance the re-epithelialization process. Any impairment in this process may cause delayed wound healing. Rosella calyx (Hibiscus sabdariffa L.) can act as an immunomodulator, possibly affecting the re-epithelialization process. Rats were randomized after adaptation for a week. Rats (n = 30) were induced with third-degree burns, and it was ensured that they met the criteria for third-degree burns. We divided them into six groups and administered treatment according to each group: 1) negative control group using cold cream only; 2) positive control using silver sulfadiazine (SSD) only; 3) treatment group using rosella calyx extract orally (250 mg/kg) + cold cream; 4) treatment group using rosella calyx extract topically only (250 mg/kg); 5) treatment group using rosella calyx extract orally (250 mg/kg) + SSD; and 6) treatment group using rosella calyx extract orally and topically (each 250 mg/kg). They were sacrificed on day 17 and then stained with hematoxylin and eosin. The variable studied was the re-epithelialization length (mm). Statistical analysis involved analysis of variance (ANOVA) and post hoc correction with P < 0.05 taken as significant. Despite treatment using rosella calyx extract orally + topically showing the longest re-epithelialization, this group showed no significant difference compared with SSD treatment, indicating they may show a similar effect in the re-epithelialization process. Rosella calyx extract applied orally and topically may show a therapeutic effect in the re-epithelialization process. Further research needs to be conducted.

Scabies is an infestation caused by Sarcoptes scabiei var. hominies, prevalent in children with poor nutritional status and hygiene, particularly in overcrowded communities. Indonesia has 14.5% cases of the double burden of malnutrition among school-aged children. As there has been no study establishing the role of nutritional status in the occurrence of scabies, this study aims to investigate the association between body mass index (BMI) and height with scabies infestation in an Islamic boarding school in Indonesia. This was a cross-sectional study conducted in an Islamic boarding school in Indonesia with children aged 11-17 years old as participants. Physicians performed anthropometry measurements, and a dermatologist confirmed the diagnosis of scabies through history taking and physical examination. Logistic regression was used to analyze the association between BMI and height and the prevalence of scabies. Of 287 subjects, 135 (47%) were diagnosed with scabies, with a male predominance (66.1%). Most of the subjects had normal weight (76.7%) while 20 (7%) were underweight, and 153 subjects (53.3%) had short stature. Male subjects were four times more likely to be infested by scabies (P < 0.001). Obese and short subjects were 4 and 1.67 times more likely to develop scabies, respectively. Poor nutritional status represented by BMI and height cannot be regarded as an independent risk factor for scabies, while environmental factors might be the most crucial factors in the development of scabies. A holistic approach addressing these factors should be implemented to eradicate scabies in addition to appropriate pharmacological management.

Warts are among the most common skin diseases with various recommended treatments, including topical ablation, chemotherapy, and immunotherapy. However, given the unsatisfactory response rate, complications, and recurrence, effective treatment remains controversial. This study compared formalin against an anti-wart compound containing salicylic acid and lactic acid.

This clinical trial recruited 58 patients with wart lesions on hands and feet randomly divided into two groups of daily topical treatment: formalin 5% (n = 29) and anti-wart lotion containing salicylic acid 16.7% and lactic acid 16.7% in flexible collodion (n = 29) for eight weeks. Patient satisfaction and recovery were assessed and compared between the groups at weeks four and eight.

Patient satisfaction did not change significantly in either group (P > 0.05), and no significant difference was observed between the groups (P = 0.838). The number of wart lesions fell significantly after eight weeks in both groups (P < 0.001), with no significant difference between them (P = 0.225). There was no significant difference between the two methods in terms of side effects (P = 0.084).

Both formalin and salicylic acid plus lactic acid lotion effectively treated plantar and common warts, and neither had any significant side effects. The treatment choice should be based on the patient’s age, the number of lesions, and the site affected.

Postpartum hair loss is one of the most common childbirth complications, sharing an association with certain clinical and disease-related factors. The aim of this study was to determine the frequency of postpartum hair loss and risk factors in women referring to Yazd primary healthcare clinics. This descriptive cross-sectional study was conducted in 2016 in four dermatology clinics in Yazd, Iran. The statistical population included all women aged 17 to 48 years who had given birth during the previous six months and attended primary healthcare clinics. Cluster sampling was performed to select the participants; 329 women visiting four clinics in Yazd were examined for hair loss and its risk factors. Study data were analyzed using SPSS software (t-test, ANOVA, and chi-squared test). The mean age of the participants was 29.29 ± 6.12 years. In this study, 68.4% of participants had postpartum hair loss. There was a statistically significant relationship between postpartum hair loss and variables such as anemia (P = 0.001), breastfeeding (P = 0.002), nocturnal feeding (P = 0.001), gestational diabetes (P = 0.019), history of hypothyroidism (P = 0.001), and stress before and during delivery (P = 0.001 for both). This study revealed that a history of hair loss, breastfeeding, gestational diabetes, and stress could affect postpartum hair loss. Therefore, these factors might be used as hair loss predictors in women undergoing pregnancy.

Pityriasis versicolor is a recurrent non-inflammatory superficial fungal infection. Application of antifungal shampoo is a simple treatment modality for pityriasis versicolor that can be used on an extensive surface area. Currently, there is no study to evaluate the efficacy of climbazole shampoo. In this study, the efficacy of 2% ketoconazole shampoo was compared to 2% climbazole shampoo in the dermatologic clinic of Afzalipour Hospital, Kerman, Iran. This triple-blind randomized clinical trial was performed on 60 patients diagnosed with pityriasis versicolor. Participants were categorized into groups A (ketoconazole shampoo) and B (climbazole shampoo) based on simple randomization. KOH smear was achieved from all participants at the baseline, four weeks after commencing treatment, and at three months follow up. Participants were instructed to apply shampoo three times a week for three weeks on all body surfaces and scalp for 10 minutes before rinsing. Evaluation of treatment was based on clinical improvement and results of KOH smears. Complete cure was defined as negative KOH smear and complete clinical improvement. Seventy percent of the patients in the ketoconazole group and 43.3% of the patients in the climbazole group had negative smears four weeks after commencing treatment (P = 0.037). Complete clinical improvement at the three-month follow-up was 26.7% and 13.3% in the ketoconazole and climbazole groups, respectively (P = 0.402). In the present study, 2% ketoconazole shampoo had significantly greater efficacy in terms of mycological cure than climbazole shampoo among pityriasis versicolor patients.

Hand hygiene plays a vital role in controlling pathogenic microorganisms’ transmission and maintaining the interaction between skin microbiota and biometric parameters. This study evaluated the effects of hand cleansers including alcoholic gel, alcoholic pad, antibacterial, and simple wipes on skin biometric parameters and microbiota. Samples were collected from the hands of 15 healthy office workers with a mean age of 37.70 ± 9.6 years. Then, the subjects were instructed to use cleansers in four following rounds, with a one-week washout period between the rounds. Sample collection was performed before, right after, and one hour after using the cleansers. Microbial isolates were investigated via standard microbiological techniques, and biometric measurements were made using the Cutometer® MPA 580. The obtained data were analyzed using the paired t-test and repeated measures ANOVA. Overall, there were no significant differences between cleansers in reducing the total aerobic microbial count (TAMC). Also, there was an approximate return to the initial count of resident microbiota one hour after using the alcoholic pad. A significant difference was observed in decreasing the Staphylococcus aureus count using antibacterial wipes rather than simple wipes. Simple wipes had the most increasing effect on transepidermalwater loss (TEWL), showing a significant difference with the alcoholic gel. Furthermore, alcoholic gel caused a greater pH decrease in comparison to other products. Alcoholic cleaners are more effective than antibacterial and simple wipes due to maintaining the skin’s biometric parameters. An additional advantage is that alcoholic pads can preserve the resident microbiota.

Basal cell carcinoma (BCC) is the most common form of malignancy in white populations. It has been hypothesized that dietary factors may play a role in BCC development. In this study, serum levels of folic acid and vitamin B12 were evaluated in patients with BCC to investigate the potential role of these vitamins in BCC development. Forty-five BCC patients and 45 age- and sex-matched healthy controls were enrolled in the study. Patients with a history of radiotherapy in the affected area were excluded. All participants completed a questionnaire including demographic characteristics, and blood samples were taken to evaluate serum levels of folic acid and vitamin B12. There were no significant differences in serum levels of vitamin B12 and folic acid between healthy controls and BCC patients. Serum levels of vitamin B12 were significantly higher in female patients than male patients. It seems that BCC is not related to serum levels of vitamin B12 and folic acid; however, this issue should be studied with larger sample sizes.

Pemphigus vulgaris (PV) is a life-threatening autoimmune disease that affects the skin and mucosa. In most regions, little data is available on its epidemiology. This study aimed to present an overview of the worldwide epidemiology of pemphigus and evaluate the epidemiological features of PV in the southwest of Iran. In this study, data including sex, age, time of disease onset, phenotype of the disease, geographic location of birth, geographic location of residence, level of education, and occupation of PV patients from 2004 to 2019 were collected from the records existing in the Oral Medicine Department of Shiraz Dental School and Shahid Faghihi Hospital, Shiraz, Iran. In total, 249 PV patients with a mean age of 42.72 ± 13.3 years were included. The female to male ratio was 1.74:1. The annual incidence of PV in Fars province was 2.7 per million people. In this region, the most frequent phenotype was the mucocutaneous phenotype in 204 patients (81.9%), followed by the mucosal dominant phenotype in 40 (16.1%) and the cutaneous phenotype in 5 (2%). Regarding the level of education, 43.4% had less than a high school diploma, 24.9% had a high school diploma, 17.3% had an associate diploma or higher, and 14.5 % were illiterate. Moreover, 55.8% were housewives, 21.7% were self-employed, 19.3 % were employed, and 3.2% were jobless. The findings indicate that PV is a rare disease in the southwest of Iran compared with other regions. According to previous studies in this region, the incidence has decreased since 2005.

Since coronavirus disease 2019 (COVID-19) vaccines were approved without long-term monitoring, tracking their adverse effects appears to be necessary. Mucocutaneous adverse events are of great importance due to their visibility and the potential effect on inducing fear in patients leading to vaccine hesitancy. We searched PubMed, Google Scholar, and Scopus in this regard, and all of the relevant papers published until June 28, 2021, were included if we could access their full texts. Moreover, we included some of our cases from Iran. We found various mucocutaneous manifestations after COVID-19 vaccination, including local injection site reactions (acute or delayed), urticarial lesions, pityriasis rosea-like rashes, angioedema, morbilliform rashes, pernio-like lesions, acrocyanosis, petechial/ purpuric/ecchymotic lesions, herpes flare-up, herpetiform rashes, oral erosive lesions, acral pustular rashes, erythema multiform, dermographism, herpes zoster, generalized pruritus, contact dermatitis, reaction to dermal fillers and non-specific rashes. We categorized them by their time of initiation (acute or delayed) and site of involvement (local injection site, remote area, or generalized). Delayed local reactions, local injection site reactions, urticarial lesions, and pityriasis rosea-like and morbilliform rashes were among the most common cutaneous adverse events. Dermatologists should be aware of these potential reactions to manage them properly, reassure patients, and encourage them to continue their vaccination.

There is no cure for xeroderma pigmentosum (XP) patients who suffer from persistent freckling and recurrent lifethreatening malignancies. We aimed to remove facial lentiginous pigmentations using CO2 laser resurfacing.

5 patients with clinically proven XP living in their third decade were scheduled to be treated with CO2 laser resurfacing. After tumescent anesthesia, the whole facial skin was treated with 3 UltraPulse® conventional CO2 ablation passes. The parameters used were 6 mJ, 5 mJ, and 4 mJ for the first to third passes. The mandibular areas were treated with two passes of 4 and 3.2 mJ, while the eye contours were treated with two passes of 3.6 mJ and 3.2 mJ.

The face was edematous and almost free of freckling immediately after resurfacing. The edema persisted for a week. The facial skin oozed within the first three days, followed by crust formation. After a week and after complete shedding of the crusts, smooth and erythematous skin appeared. The erythema persisted for more than two months. The patients were free of malignancy and freckling for up to 16 months follow-up.

CO2 laser can remove lentiginous pigmentation and prevent or postpone malignancies for a considerable length of time.

An ingrown toenail is a painful disorder of the lateral nail fold associated with inflammation, infection, and granuloma formation. Various conservative modalities have been described to reduce the pressure of an ingrown nail on its gutter. The invasive option is preferred for severe ingrown nails (grade III). Here an innovative, less invasive technique is described to treat severe grades of ingrown nails with the use of mosquito artery forceps and cyanoacrylate glue. The glue on curing becomes a hard cast that blunts and insulates the nail from its gutter, protecting the gutter from nail injury. The glue is hygroscopic and antiinfective, making the gutter dry, healthy, and maceration-free. The ingrown nail becomes asymptomatic within half an hour of splinting, and the granuloma heals within 3 to 6 weeks. Thus chemical splinting with cyanoacrylate glue is a novel and fast conservative technique for treating severe grades of ingrown toenails in outpatient care units.

Bednar tumor or pigmented dermatofibrosarcoma protuberans is a rare slow-growing dermal tumor of neuromesenchymal origin having low malignant potential. It usually presents as a black, firm plaque or exophytic nodule on the back or shoulder, mostly in black people in their third to fourth decades of life. The head, neck, and extremities are less common sites. Herein, we reported a 55-year-old female presenting with a well-defined, dark-colored, ulcerated, painful plaque on the fifth toe of the right foot that had developed since two years beforehand. Malignant melanoma and dermatofibroma were considered as clinical differential diagnoses. An incisional biopsy was done. Histopathologic evaluation showed dermal proliferation of plump elongated cells and spindled cells (with oval to elongated hyperchromatic nuclei and scanty eosinophilic cytoplasm) arranged in storiform pattern and sheets. Melanin-laden dendritic cells were also present, interspersed with neoplastic elongated and spindle-shaped cells. Based on these clinical and histopathologic features, a diagnosis of Bednar tumor was made.

Tuberous sclerosis complex (TSC) is an autosomal dominant disorder characterized by the development of hamartomatous tumors in multiple organs, including the skin. Most patients present early in life with seizures, intellectual disability, and cutaneous angiofibromas. However, patients may often not present these features until late adulthood. A 55-year-old female presented with complaints of sudden and florid appearance of multiple fibrokeratomas around all twenty of her nails, along with multiple hyperpigmented papules on her face. On examination, she also had gingival fibromas and a single skin-colored plaque on her lower back. Histopathology of lesions over the face, back, and fingernails were compatible with the diagnoses of angiofibroma, shagreen patch, and fibrokeratoma, respectively. She was advised laser ablation of the facial lesions and excision of the nail fibrokeratomas. MRI of the brain showed multiple cortical tubers and subependymal nodules. Late presentation of TSC during adulthood may delay the diagnosis and prevent the screening of early tumor formation, potentially increasing morbidity. This was exemplified in our clinical case, where asymptomatic cortical tubers were discovered on MRI only after the appearance of skin lesions and fibrokeratomas around the nails.

Pemphigoid gestationis is an unusual autoimmune dermatosis of pregnancy, and recurrences may occur in consequent pregnancies. This dermatosis begins with intense itching, which progresses to papules and annular plaques and, consequently, vesicles and tense bullae. These lesions typically arise from the umbilical region then spread centrifugally to the abdomen, thighs, palms, and soles. Diagnosis is based on clinical examination and immunohistopathologic studies. Here, we report the case of a 29-year-old women who developed recurrent pemphigoid gestationis in her second pregnancy and the postpartum period in 2020. The condition initially manifested during her first pregnancy in 2014. She was successfully treated with oral prednisolone and the local application of betamethasone cream. Pruritic skin lesions are a common complaint among pregnant women. Clinicians should be aware of autoimmune dermatosis of pregnancy, its fetomaternal and neonatal complications, and its possibility of recurrence in subsequent pregnancies.

One of the benign tumors of the sweat glands is a syringoma. A rare subtype of this tumor is the eruptive type, which is often seen before or during puberty. Here we report a case of eruptive syringoma in a 15-year-old girl. A 15-year-old girl was visited in our department, with a three-year history of numerous tancolored papules territorialized on both the forearms. There were no other skin or systemic findings, and our differential diagnoses included xanthoma, lichen planus, and sarcoidosis. A skin biopsy was performed, revealing mild epidermal acanthosis. There were ductal structures lined by a double epithelium in association with elongated, tadpole-like epithelial cells in the dermis. Dermal collagen had thickened. Inflammatory cells were inconspicuous. Taken together, the above morphologic findings confirmed the diagnosis of an eruptive syringoma. Clinical diagnosis of eruptive syringoma is hard and histological evaluation is decisive for achieving the correct diagnosis.

Alopecic and aseptic nodule of the scalp (AANS) is a rare entity characterized by the presence of sterile, culturenegative nodules/cysts and areas of non-scarring alopecia.

We describe a case on the vertex of a 26-year-old man with a two-week history of a nodular, moderately-fluctuant, alopecic lesion. The patient also had cutis verticis gyrata (CVG).

The aspirate culture was negative and histopathologic findings were nonspecific. We also performed a trichoscopy of the lesion. After eight weeks, the patient showed dramatic clinical response to doxycycline and a dose of intralesional corticosteroid.

This is the first report of the simultaneous occurrence of AANS and primary essential CVG. AANS is a probably under-reported cause of non-scarring alopecia with a rapid and dramatic response to non-surgical treatment and a generally good prognosis.

Composite hemangioendothelioma (CHE) is a rare and little-known condition with combined benign, intermediate, and malignant features. In the current study, we describe the case of a young female with the presentations of CHE, representing the second known case in Iran. Also, we have comprehensively reviewed previous case reports of CHE. A 30-year-old female was referred with a reddish hemorrhagic painless mass in the small right finger that appeared within a few days following trauma. The mass was primarily excised but recurred within three weeks; therefore, she underwent thorough clinical, laboratory, and imaging studies. Finally, the lesions were biopsied and diagnosed as CHE. Accordingly, the involved finger was amputated, and the patient underwent chemoradiotherapy. Although CHE is a rare malignant condition worldwide, attention to the clinical presentations of this malignancy can help scientists make better therapeutic approaches leading to the best outcomes.

Factitious disorder (FD) is a psychiatric condition in which the affected person deliberately makes up diseases, injuries, or symptoms. Diagnosing this condition is a serious medical challenge. No studies have been conducted in Iran to show these patients’ clinical and demographic profiles in an adequate sample size. The present article attempts to extract demographic and clinical details of Iranian FD patients by reviewing the related published articles.

A search was conducted on this disorder in English and Persian articles published by Iranian researchers between 1960 and 2020 in the MEDLINE, Web of Science, EMBASE, PsychInfo, Google Scholar, and SID databases using factit*, artefacta*, artefactua*, and Munchausen* as keywords in combination with “by proxy” and “imposed upon another”. Ultimately, 33 case report articles and 35 cases in total were included in the study, and demographic and clinical details of patients were extracted from the articles.

Of the 35 FD patients, 27 were women. The patients’ mean age was 32.5 years. Factors leading physicians to the diagnosis of FD were atypical presentation (n = 18) followed by an unsubstantiated presentation. FD symptoms were mainly physical (n = 31), and reporting unusual and atypical wounds were the most common cause of patients’ visits, with a frequency of 25%. Most patients had not undergone a thorough psychiatric examination, and in those who had been evaluated, the most common diagnoses reported were mood disorder and anxiety disorder.

It appears that greater attention is required to teach the diagnosis and assessment of FD.