Iranian Journal Of Dermatology
Volume:25 Issue: 4, Autumn 2022

Psoriasis is a prevailing continual inflammatory affliction, carrying a considerable risk of cardiac diseases, sometimes even not traceable by conventional predisposing factors. Detection of subclinical atherosclerosis in psoriasis by ultrasonography is beneficial, and it has been solitarily explored in carotid arteries. It was found to have a weak predictive value, and so the femoral arteries have now been contemplated. This study aims to determine subclinical atherosclerosis occurrence by evaluating the femoral and carotid arteries’ intima-media thickness (IMT) by ultrasonography in patients with psoriasis.

The study was carried out in the departments of dermatology and radiology at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation for eight months. The sample size consisted of 30 chronic plaque psoriasis cases and 30 controls, matched for age and sex. Patients with comorbidities were excluded. Femoral & carotid arteries were assessed for IMT by ultrasonography.

In our study, the age range was 30–80 years, and a male (56.7%) preponderance was observed in cases and controls. The mean femoral artery and carotid artery IMTs were remarkably greater in cases than in controls, with P-values < 0.001 and 0.04, respectively. The mean femoral artery IMT was significantly more elevated (1.4 ± 0.63 mm) than the carotid artery IMT (1.0 ± 0.62 mm) in cases (P = 0.01).

Ultrasonographic screening of femoral artery IMT enhances the early discernment of subclinical atherosclerosis when compared with carotid artery IMT. Thereby, it helps in the early identification of cardiovascular disease in patients with psoriasis. Keywords: femoral artery, carotid artery, intima-media thickness, psoriasis, atherosclerosis

Hyperhomocysteinemia and vitamin D deficiency may be involved in the pathogenesis of vitiligo. This study compared the serum levels of vitamin D, homocysteine, vitamin B12, and folic acid between vitiligo-affected children and healthy children.

Using a case-control design, 30 children with vitiligo and 30 age and sex-matched healthy children were enrolled from April 2018 to August 2020. Serum levels of vitamin D, homocysteine, vitamin B12, and folic acid were analyzed in both groups during the same season of the year. Additionally, the association between serum levels of these factors with demographic and clinical features of the children (collected by interview and physical examination) was evaluated. Data were analyzed using the independent T-test, Fisher’s exact test, and chi-squared test.

The vitiligo group had significantly lower vitamin D and folic acid serum levels compared with the control group [95% CI -19.87 to -2.96 and -4.15 to -4.18, respectively]. Among patients, the vitamin D level was negatively correlated with age (r = -0.459, P = 0.011) and disease duration (r = -0.373, P = 0.042). Moreover, there was a significant association between vitiligo activity and serum homocysteine levels (P = 0.027).

Routine measurement of vitamin D and folic acid serum levels might be suggested, especially in children with long-standing disease. Monitoring the homocysteine level may be beneficial, particularly in children with progressive vitiligo.

Lichen planus (LP) is a chronic inflammatory disorder involving the skin, mucosa, hair, and nails. Previous reports have shown a possible association between LP and metabolic derangement, leading to increased cardiovascular risk among these patients. Our study aimed to assess the prevalence of metabolic syndrome (MetS) and its components in LP patients and to study their relationship with mucosal involvement in LP.

We conducted a cross-sectional observational study of 123 LP patients. Demographic and clinical data were obtained, and evaluation was done for the presence of abdominal obesity, hypertension, hyperglycemia, and dyslipidemia. MetS was diagnosed according to the modified National Cholesterol Education Program: Adult Treatment Panel III (NCEP-ATP III) criteria for the South Asian population. Data analysis was done using appropriate statistical methods.

The prevalence of MetS in LP patients was 31%. The mean age of LP patients having MetS was considerably higher than those without MetS (44.8 ± 13.6 vs. 33.3 ± 15.9 years; P = 0.0002). Although statistically insignificant, female patients and patients with mucosal involvement showed a higher prevalence of MetS. Central obesity, hypertension, hyperglycemia, and hypertriglyceridemia were more prevalent in mucosal LP patients than in those without mucosal lesions, with hyperglycemia having a significantly higher prevalence in mucosal LP (41% vs. 18%; P = 0.015).

Incre ased age, female gender, and mucosal involvement are important predictors of concurrent metabolic derangement in LP patients. Thus, these patients should be screened for the presence of MetS and its components.

Treatment failure of antimony drugs for anthroponotic cutaneous leishmaniasis (ACL) is rising. Recognizing predictive factors of unresponsiveness to treatment can substantially influence better ACL management. The goal of this study was to investigate predictive factors associated with treatment failure in ACL in Kerman, southeast Iran.

This case-control study was conducted retrospectively on 2,128 ACL cases in Kerman over ten years from 2011 to 2020. The case group included patients whose lesions failed to resolve after one treatment course. The control group included those whose lesions were cured after one treatment course.

Treatment failure was observed in 13.5% of cases (10.7% of systemic therapy and 16.7% of local therapy). No significant difference was reported between the type of treatment and treatment failure. The association of treatment failure with winter-onset (P = 0.001, OR = 1.39, CI = 1.23–1.56), face (P = 0.001, OR = 1.86, CI = 1.38–2.49), ulceration (P = 0.01, OR = 0.51, CI = 0.30– 0.85), small diameter (P = 0.005, OR = 0.57, CI = 0.38-0.84) and long duration of lesions (P = 0.01, OR = 1.57, CI = 1.11–2.21) was validated by multivariate logistic regression analysis.

Efficient detection and timely management of ACL cases are essential to reduce resistant cases, as lesions lasting longer than four months show poor response to treatment. Furthermore, early treatment of facial lesions with systemic therapy is suggested to optimize results and reduce the risk of disfiguring scars. Further surveys are required to determine the reason behind more treatment failure in winter-onset lesions.

Malignant melanoma is a prevalent, offensive, and fatal cancer in developed countries. Most of our information is related to studies conducted in western countries. This study aims to evaluate demographic and clinical data of melanoma in the Kermanshah province of Iran.

This was a descriptive study on data available in the Cancer Registry Center of Kermanshah, which includes 70 patients during eight years from 2010–2017. Clinical recognition of melanoma was based on American Joint Committee on Cancer criteria. Data were analyzed by SPSS 20 software and shown in ArcGIS (Version 10.7).

Patients included 46 men (65.7%) and 24 women (34.3%) with a mean age of 60.49 ± 16.08. The general prevalence of melanoma was 4.4 in every 1,000,000 persons annually. Most patients had skin type III (65.7%), indoor jobs (61.4%), and lived in the city (67.1%). Also, 35.7% had a trauma history, 2.8% had familial melanoma history, and 17.1% had other types of skin cancer. Extremities (51.4%), acral lentiginous melanoma (50.1%), Clark IV (61.4%), and inguinal lymph nodes (14.3%) were the most prevalent location, clinical type, pathological level, and involved lymph nodes, respectively.

Acral lentiginous melanoma and extremities involvement are prevalent in our region. Most patients go to doctors at an advanced level due to delays in referral, lack of follow-up by patients, lack of recognition at the initial care level, and lack of access to specialty centers. We recommend general instructions through media and holding special workshops for physicians for better familiarity with melanoma.

Evidence shows that article titles might affect citation metrics. This study aimed to evaluate the association between selected citation metrics and the title characteristics in dermatology journals.

We enrolled 305 reviews and original articles published during 2016 from four dermatology journals consisting of the “Journal of the American Academy of Dermatology,” “Journal of the European Academy of Dermatology and Venereology,” “Indian Journal of Dermatology, Venereology and Leprology,” and “International Journal of Dermatology” using a stratified and simple random sampling method. The list of articles was extracted from Scopus; then, the title characteristics were reviewed. Moreover, we extracted the citation metrics, including the citation count, Field-Weighted Citation Impact (FWCI), and citation benchmarking percentile of the articles until the end of October 2021 using Scopus. For statistical analysis, we used Stata software version 14.2.

Overall, 239 (78.36%) original and 66 (21.64%) review articles were included. The citation count and FWCI significantly and positively correlated with the number of words, characters, and punctuation marks in the titles. By adjusting the covariates, linear logistic regression showed that the title length and the presence of acronyms in the title were the most effective factors in increasing the citation count and FWCI of the articles.

Using longer titles and including acronyms in the titles may help augment the citation of articles in dermatology journals.

Acne vulgaris is a common chronic inflammation of pilosebaceous units with a multifactorial pathogenesis. Traditional treatment may have limited success with potential side effects. The long-pulsed neodymium-doped yttrium garnet (Nd:YAG) laser may be a desirable alternative.

A prospective clinical trial was conducted on 61 acne patients at the Department of Dermatology, Basrah Teaching Hospital, from April 2019 to April 2020. Three treatments with long-pulsed Nd:YAG were performed across two-weeks intervals (fluence 50 J/cm2, spot size 5 mm, pulse duration 15 ms, and frequency 1.5 Hz). Patients were assessed at baseline and 2, 4, 6, and 12 weeks later by counting the acne lesions and scoring the response according to the percentage of lesions’ reduction.

Sixty-one patients completed the study (49 females and 12 males); the mean age was 18.7 ± 1.67 years. A significant reduction of acne lesions at the end of therapy was observed compared to the baseline. The mean number of total lesions was reduced from 84.2 ± 25.8 to 16 ± 23.3 (P < 0.05). Overall, 49 (80.3%) patients achieved an excellent response, 3 (4.9%) good, 1 (1.6%) moderate, and 8 patients (13.1%) showed a poor response. The treatment was well tolerated with insignificant adverse effects.

Long-pulsed Nd:YAG laser is an effective and safe modality for treating acne vulgaris and may be considered an alternative option for cases of recurrence after conventional treatment. However, more sessions are needed for severe cases.

Rheumatoid vasculitis, an uncommon extraarticular manifestation of rheumatoid arthritis, usually develops in long-standing cases affecting small-to-medium-sized vessels. It is a poor prognostic marker when multiple systems are affected, skin and neurologic involvement being most frequent. Rheumatoid vasculitis is seen more commonly in seropositive and nodular rheumatoid arthritis patients who are male or smoke. Herein, we present the peculiar case of a 48-year-old female with rapid onset, progressive, multiple ulcers predominantly over the flexures. Differential diagnoses of pyoderma gangrenosum, pyoderma vegetans, pemphigus vegetans, and vasculitis were considered, and the patient was evaluated. On investigation, her rheumatoid factor titer was strongly positive; a skin biopsy revealed leukocytoclastic vasculitis. On clinical, serological, and histopathological correlation, a diagnosis of rheumatoid vasculitis was made, responding well to high-dose prednisolone. On follow-up at six months, her skin lesions had healed well with moderate scarring; however, she developed severe joint pain, warranting the initiation of disease-modifying antirheumatic drugs. To the best of our knowledge, this is a previously unreported clinical and morphological presentation of rheumatoid vasculitis.

Bullous pemphigoid is the most common type of subepidermal autoimmune bullous disease. It usually affects older people; isolated cases among people younger than 65 have been reported with various presentations, usually more severe and active than those seen in the elderly. Toxic epidermal necrolysis (TEN) is a potentially life-threatening dermatologic disorder characterized by widespread necrosis and bullous detachment of the epidermis and mucous membranes resulting in exfoliation and possible sepsis. Various morphological variants of bullous pemphigoid have been reported, with reports of the TEN-like variant of bullous pemphigoid being scarce. In this study, we report a case of bullous pemphigoid with TEN-like presentation in a middleaged female.

Cutis laxa (CL) is a connective tissue disease that is either inherited or acquired. It is characterized by redundant, pendulous, and inelastic skin. Loss of elasticity is a pathological feature of some degenerative and inflammatory diseases. Matrix metalloproteinases (MMPs) can cleave elastin fibers by damaging the microfibrils and the elastin core, resulting in the loss of elasticity. In this study, we report eight patients with different types of cutis laxa along with the quantitative measurement of serum levels of MMP-2 and MMP-9. The cutis laxa patients showed various clinical and histopathological findings, indicating the heterogeneity of this rare skin connective tissue disease. The serum level of MMP-2 and MMP-9 were elevated in these patients. Increased MMP-2 and MMP-9 might be associated with cutis laxa. However, our findings need to be validated in larger clinical settings.