Iranian Journal Of Dermatology
Volume:25 Issue: 3, Summer 2022

Basal cell carcinoma (BCC) represents nearly 80% ofcutaneous malignancies. Dermoscopy is a useful tool to increasethe precision of diagnosis, but its findings for BCC are mainlydescribed in patients from Europe, the US, and Australia. BCCdermoscopy patterns are not fully known in patients with skinphoto-types III and IV in Latin America, especially in Colombia.We aimed to describe dermoscopy findings in patients with BCCand III-IV Fitzpatrick skin types in a Colombian population. A descriptive, retrospective and prospectiveobservational study was carried out on patients with BCC.Clinical and dermoscopy photos were taken, with the diagnosisconfirmed via histopathology. Thirty-six tumors were evaluated. Women were moreaffected. The main BCC feature was a nodular clinical andhistological subtype. The more frequent dermoscopy findingswere arboriform microvessels, thin telangiectasias, and multiplegray-blue globules. Tumors greater than 6 mm predominantlyshowed ulceration and polymorphic vessels. The presence ofovoid nests, structures in maple leaves, and polymorphic vesselswere related to the superficial clinical subtype. Different features related to size, clinical pattern, andthe presence of vascular and pigmentary changes in dermoscopywere present in this population. A new dermoscopy finding ofa yellowish type “amber background” in BCC was described.

Atopic dermatitis is a chronic relapsing inflammatoryskin disease that has possible associations with other diseases suchas allergic conditions, autoimmune skin diseases, and systemicdiseases. We evaluated the prevalence of alopecia areata andthyroid autoimmunity in children with atopic dermatitis. This was a cross-sectional study on 124 children(62 children with atopic dermatitis and 62 healthy children).Demographic features of the participants and duration of diseasein children with atopic dermatitis were recorded. Antithyroidperoxidase and thyroid stimulating hormone were evaluated inboth groups. Odds ratio (OR) and 95% confidence interval (CI)were calculated to estimate relative risk. The chi-squared testand analysis of variance test (ANOVA) were used to evaluatethe association of thyroid autoimmunity with the demographicand clinical features of patients. Thyroid autoimmunity was only detected in atopicdermatitis children and not in the control group, and the differencewas statistically significant [OR = 4.32, 95% CI = 2.15–10.81,P = 0.04). Furthermore, overt thyroid disease was significantlymore common in the atopic dermatitis group compared withthe control group (OR = 4.46, 95% CI = 1.15–17.24, P = 0.03). Apersonal history of alopecia areata was also significantly morecommon in the atopic dermatitis group (OR = 4.46, CI = 1.17–15.29,P = 0.030). In addition, there was no significant difference betweenthyroid autoimmunity and overt thyroid disease in the patients’severity of atopic dermatitis and demographic features (P > 0.05). Patients with atopic dermatitis had a significantlyhigher percentage of thyroid autoimmunity, overt thyroid disease,and alopecia areata than the control group.

Alopecia areata is one of the most common causesof hair loss. In this study, the personality traits and stress levelsof patients with alopecia areata were assessed and comparedwith a control group based on the NEO Five-Factor Inventory(FFI) and Perceived Stress Scale (PSS) questionnaires. This cross-sectional study was performed on 120patients with alopecia areata and 120 healthy individuals as acontrol group from 2015 to 2017 in Mashhad, Iran. The controlgroup was selected from the families of patients who did not havecurrent involvement and no history of alopecia areata, matchedby gender, mean age, and level of education. A dermatologistevaluated the severity score of alopecia in participants. TheNEO FFI and PSS questionnaires were used to assess patients’personality aspects. SPSS v. 20 was used to analyze the data. The results of the NEO FFI questionnaire showed thatstatistically, the mean score of neuroticism in alopecia areatapatients was significantly higher than in the control group(P = 0.023), but the extraversion and flexibility scores weresignificantly higher in the control group than in alopecia areatapatients (P = 0.026 & 0.049, respectively). The PSS questionnaireresults showed that the mean stress score of alopecia areatapatients was similar to the control group (P = 0.12). Our results suggest that compared with healthyindividuals, patients with alopecia areata have higher neuroticismscores and lower extraversion and flexibility scores on the NEOFFI.

Curcumin (diferuloylmethane) is one of the mostactive components of turmeric. This herbal compound has antiinflammatoryand positive wound-healing impacts. The principalobjective of this study was to evaluate the impacts of curcuminnanoliposomes on cell viability and motility of mouse fibroblastNIH 3T3 cells and its wound healing effects on second-degreeskin burns in BALB/c mice. Mature male BALB/c mice (n = 48) were dividedinto 4 groups (n = 12 per group). Group one received curcuminnanoliposome ointment; the positive and negative control groups(groups 2&3) were treated with silver sulfadiazine and placebo,respectively, and group four (sham) received no treatment. Theburn wound was created by a metal device with a diameter of 1cm. Animals received treatment twice daily. On days 4, 7, 10, and14, deep anesthesia and a biopsy of the wound were performed,and a microscopic study and MTT assay were carried out. Cellular studies on mouse fibroblast NIH-3T3 cellsshowed that low-dose curcumin nanoliposomes increased cellproliferation and motility at 8, 12, and 24 hours in comparisonwith the control group. In tissue samples of mice treated withcurcumin nanoliposome (day 14), less inflammation was observed,while granulation tissue formation, fibroblast proliferation,epithelialization, and collagen fiber synthesis increased significantlycompared with the control groups. Our study indicates the positive effects of curcuminnanoliposomes on the motility process of mouse fibroblast NIH-3T3 cells (in vitro) and on the inflammatory and proliferativephases (in vivo) of burn wound healing in mice.

Brimonidine tartrate is an alpha-2 adrenergic receptor agonist approved for treating rosacea. This study aimed to assess the efficacy and safety of a brimonidine gel in rosacea patients with skin types III and IV.
This study was a phase II before-after clinical study in 20 patients with moderate to severe rosacea treated with brimonidine 0.33% gel. Clinician’s Erythema Assessment (CEA), Patients’ Self-Assessment (PSA), skin erythema (ΔE), lightness (ΔL), and biophysical parameters were measured before treatment and 4 and 8 weeks later. Ultrasound parameters were also measured at the same time points.
Eighteen patients completed the study. CEA and PSA decreased significantly from 3.05 to 2.10 and 2.15 after 4 weeks and 2.20 and 2.15 after 8 weeks, respectively (P<0.01 for both). Furthermore, ΔE and ΔL, as well as the skin erythema index, improved after 4 weeks of treatment. The skin echo density of both the epidermis and dermis also increased after 8 weeks (P<0.05). During the study, no serious adverse events occurred other than some reports of temporary moderate redness.
Daily application of brimonidine 0.33% gel is safe and effective for the treatment of rosacea in darker skin types.

Among many coronavirus disease 2019 (COVID-19)integumentary system involvements, alopecia is one of the leastinvestigated. This disorder has been reported in many individualswho have suffered from varying severities of COVID-19. Weaimed to systematically review studies evaluating the onset ofdifferent types of alopecia following COVID-19.

The PubMed, Scopus, Web of Science, and Embasedatabases were searched with a specified string of relevantkeywords. After quality assessments, the data of eligible studieswere qualitatively and quantitatively synthesized.

Sixteen studies were included in our review, six ofwhich underwent meta-analysis for the differences in the risk ofalopecia between males and females. Though the disorder wasnot differentiated in all the cases, we found that COVID-19 wasassociated with several different types of alopecia, includingtelogen effluvium, alopecia areata, alopecia parvimaculata, andlichen planopilaris. Moreover, although statistically insignificant,the odds of developing alopecia favored the female population.

Although many hypotheses have been suggested asto why an individual might be more predisposed to developingalopecia following COVID-19, the data obtained from the studiesyielded results that could not lead to definite conclusions. Therefore,we recommend that further studies be conducted to evaluatethe association between the two phenomena more confidently.

About 20% of patients with coronavirus disease2019 (COVID-19) present with mucocutaneous eruptions. Earlyskin or dermatological manifestations can help pediatriciansprevent the spread of the disease by suspecting COVID-19 inasymptomatic or minimally symptomatic patients.

PubMed, Scopus, Embase, Google Scholar, and theNottingham University website were searched on Sep. 1st, 2020,to retrieve studies regarding COVID-19-related mucocutaneousmanifestations in patients under the age of 18.

Data were extracted from 76 articles including 38,387 cases.Chilblain/pernio-like lesions were the most common dermatologicalmanifestation, followed by multisystem inflammatory syndrome inchildren (MIS-C)/Kawasaki-like syndrome. Most dermatologicalsigns were self-limited, presenting before, simultaneously with,or after other COVID-19 manifestations. In 40% of the affectedchildren, these signs were the sole presentation of COVID-19.

During the COVID-19 pandemic, each newmucocutaneous event in children, especially acral lesions withvascular color, should be considered a possible indicator ofCOVID-19.

Porokeratosis is a heterogeneous group of keratinization disorderswith an autosomal dominant inheritance pattern. The etiology andpathogenesis of this disease have not been completely elucidated.The porokeratosis clinically presents with a characteristic prominentperipheral ridge and central dell. The histological feature of theparakeratotic column known as ‘cornoid lamellae’ is a hallmarkfeature observed in the peripheral rim. Among the variousmorphological forms, linear porokeratosis is a rare variant withfour subtypes. When compared to other forms, the linear variantcarries an increased risk of malignancy, particularly squamouscell carcinoma, warranting a regular follow-up. Though there aremultiple treatment options, achieving complete clinical resolutionis difficult. We report an interesting case of linear porokeratosiswith generalized lesions in a 60-year-old male. The lesions weretypical and predominantly distributed in the extremities. Thebiopsy was diagnostic in our patient. This case is reported forits rare presentation and clinical interest.

Bowen’s disease (BD) is an in situ squamous cell carcinoma ofthe skin. Pigmented Bowen’s disease (pBD) is a rare variant,representing less than 2% of all BD cases. We report a case ofGiant pBD arising from seborrheic keratosis in a 65-year-old man.The dermoscopy showed a scaly surface, structureless brown togrey-black areas with dotted vessels, glomerular and reticulatevessels, and a few brown globules. Histopathology was classicalwith a “windblown appearance”; prominent melanophages wereseen in the dermis. Owing to the size and thickness of the plaque,a wide excision with a split-skin graft was done. The graft uptakewas good, and the patient was followed up on days 4 and 26post-surgery. We present our experience with the diagnosis andmanagement of this rare case of giant pBD. To the best of ourknowledge, such a case has not been previously reported.

Acquired digital fibrokeratoma (ADFK) is a rare benign fibroustissue tumor that occurs over the extremities, predominantly inthe periungual area. We report a case of ADFK over the digitof the right hand presenting as a finger-like growth; the base ofthe lesion showed a collarette of scales. The lesion was excisedwith ablative CO2 laser. The histopathology was typical, showinghyperkeratosis and acanthosis. The core of the lesion had abundantcollagen fibers perpendicular to the long axis of the epithelium.There was good healing with minimal scarring; the patient wasfollowed up, and no recurrence was reported more than oneyear later. ADFK is a relatively rare tumor, with less than 150cases reported worldwide; we present a concise review of thepublished ADFK cases with their clinical and histopathologicalcharacteristics. To the best of our knowledge, this is the seventhsuch case to be reported from India.

Cutaneous tuberculosis is an extrapulmonary form of tuberculosischaracterized by distinct clinical and histopathologicalpresentations. Tuberculous chancre, a form of primary inoculationtuberculosis, primarily affects individuals with no natural oracquired immunity against the tubercle bacilli. It is commonlyacquired after minor trauma or any traumatic procedures. Initially,it starts as a papule or nodule that gets ulcerated. The ulcer istypically painless, has undermined bluish margins, is friable innature, and heals with atrophic scarring. If left untreated, it canlead to various complications. The tuberculous chancre respondswell to antituberculous therapy. The emergence of resistant strainsand the AIDS epidemic led to a global resurgence of cutaneoustuberculosis in the last century. Hence, awareness of the clinicalmanifestations of cutaneous tuberculosis is necessary for its earlydiagnosis and management. We report a case of tuberculouschancre in a 45-year-old previously healthy male.

Sneddon-Wilkinson disease, also known as subcorneal pustulardermatosis (SPD), is a relapsing pustular dermatosis of unknownetiology. The vesiculopustules typically present on the trunkand intertriginous areas. The mainstay of SPD treatment isdapsone; second-line therapies include corticosteroids and otherimmunosuppressive drugs. Here, we report a case of recalcitrantsevere SPD that responded dramatically to adalimumab. Thepatient was a 30-year-old man who presented with generalizederythroderma and vesiculopustules on the trunk and extremities.In some pustules, the pus settled with gravity into the lowerhalf of the blister. He responded dramatically to a combinationof adalimumab (80 mg on day 1, 40 mg on day 7, and 40 mgbiweekly afterward) and prednisolone 50 mg daily. During followup,prednisolone was tapered to 5 mg daily over 2 months, andadalimumab was maintained biweekly; he is still in remissionafter 8 months. Thus, adalimumab can be used as an effectiveand easy-to-use treatment in refractory cases of SPD.