Iranian Journal Of Dermatology
Volume:15 Issue: 3, Autumn 2012

Chronic lupoid leishmaniasis (CLL) is a chronic form of cutaneous leishmaniasis that is usually resistant to anti leishmania agents and leishmania is not seen in the histologic sections. We used polymerase chain reaction (PCR) to detect leishmania DNA in CLL specimens. This descriptive cross sectional study was done on 20 paraffin embedded specimens of CLL cases referred to the dermatology clinic of Imam Reza Hospital, Mashhad, Iran.Patients’ information including age, sex, duration and location of the lesion was obtained and then skin specimens were reviewed histopathologically and assessed for leishmania DNA using PCR. Eleven male and 9 female patients with a mean age of 17.95 years were included in our study. The mean duration of lesions was 3.69 years. Most of the lesions (18 of 20 cases) were located on the face and others were on the limbs. Histologic study showed tuberculoid granulomatous inflammation with a variable ratio of histiocytes and lymphocytes without detection of leishman body. PCR was positive in 12 cases (60% of cases). We could not find any correlation between the results of PCR and sex, age, duration and location of the lesions. Histiocyte- prominent lesions were more prone to be positive on PCR examination butthat was not statistically significant. Despite the very high sensitivity of PCR for the diagnosis of usual forms of cutaneous leishmaniasis, it fails to detect leishmania in a remarkable proportion of CLL specimens.

Preexisting guidelines about clinical management of cutaneous wounds are based on wound dressing and avoiding water exposure for at least 48 hours. In this study, infectionrate in the patients who underwent melanocytic nevus surgery with dressed dry wounds were compared with the patients who allowed their wounds to become wet. In a controlled randomized clinical trial study, the incidence rate of infection in facial melanocytic nevi surgery in the wounds that became wet 24 hours after surgery (234 wounds)were compared with similar wounds that were kept dry for at least for 48 hours (234 wounds). The infection rate was 3.4 % (8 wounds) for the dry wounds versus 2.6 % (6 wounds) for the wet wounds; comparison of these two rates showed no statistically significant difference (P=0.548, odds ratio= 1.345, CI 95%: 0.459-3.939). The results of this study showed that it was safe to remove the dressing of the wounds within 24 hours after minor surgery without concern about infections and allow wounds to become wet after 24 hours under normal circumstances.

Acne is a common problem in adolescent and young age groups, for which several risk factors have been suggested.One of the risk factors is smoking. In studies on the relationship between smoking and acne, conflicting results have been obtained. This study was conducted on 133 male patients who were visited at the dermatology clinic of Imam Reza hospital due to acne as the case group, and 133 healthy individuals without any skin diseases including acne among those accompanying the patients as the control group. The case and the control groups were age matched. For each patient who had the criteria for inclusion in the study, a questionnaire was completed and the necessary information was collected and then analyzed statistically. The questionnaires were filled for 133 patients with acne and 133 healthy controls. Twenty-nine patients with acne (21.8%) and 12 patients in the control group (9.1%) were smokers, and the difference between them was significant (P = 0.004). The number of cigarettes smoked per day was significantly different in the two groups (4.75 in the case group versus 1.88 in the control group). No correlation was found between smoking and acne localization, severity of acne, the type of lesion, symptomatic or asymptomatic nature of acne and acne omplications. In the case group, the smokers developed acne at an older age than the non-smokers. Patients with acne were more likely to smoke than patients without acne; thus, smoking might be a factor affecting the incidence of acne.

Diaper rash is a common but non life threatening condition during infancy. Different modalities of treatment are suggested. Sucralfate acts as a physical barrier to irritants and has antibacterial activities. Promising reports of the effect of topical sucralfate on wound epithelialization along with its bacteriostatic properties led us to carry out a trial to evaluateits role as a topical agent in the treatment of diaper dermatitis and compare its efficacy with topical zinc oxide. This double blind randomized clinical trial was conducted in Shariati hospital from April 2008 to September 2009. Sucralfate and zinc oxide were formulated as 20% ointments with the same excipients. All patients were randomly treated topically with either sucralfate (N=25) or zinc oxide (N=21) for 7 days. Diaper severity scores were obtained before treatment and at days 3, 5, 7 by the authors. A total of 46 infants (54.3% female and 45.7% male) with mean age of 4.4±6.5 months entered the study. The mean age,sex, frequency of diaper change (per day) and everity of diaper rash showed no statistically significant difference between two groups. Sucralfate 20% ointment was significantly superior in healing diaper dermatitis at days 5 and 7 (p < 0.05 and 0.01respectively) and showed a significantly shorter healing time (3.24+/-2.02 days) in comparison with zinc oxide 20% ointment (5.42+/-2.39 days) (P = 0.002). Since sucralfate in topical formulations acts as a physical barrier with proved safety and no noticeable absorption,it may be used as a potential treatment for diaper dermatitis.

Precancerous lesions are disorders that are highly likely to become malignant. Early diagnosis of precancerous skin lesions helps to prevent skin cancers. The aim of this study wasclinicopathological assessment of precancerous skin lesions in patients referred to the dermatology department of Imam Reza hospital.

Two hundred and nine patients who were diagnosed with precancerous lesions and referred to the dermatology department of Imam Reza hospital from 1997 to 2007 were studied. Study parameters included participants’ age, sex and occupation, type of precancerous skin lesion, clinicopathological type of the lesion and location. The data was collected from the patients’ records in the dermatology department and their microscopic slides inthe pathology department.

The most common precancerous skin lesion was actinic keratosis (68.4%) followed by Bowen’s disease (7.2%). About 67.5% of the patients were male with a mean age of 61.7 years. Moreover, 53.1% of the patients worked outdoors. The most common site of the lesions was head and neck (83.3%) and 18.7% of lesions were associated with malignancy. The most common pathological form of actinic keratosis was the proliferative type (28.9%).

The results of this study showed that precancerous skin lesions were more prevalent in men aged over 50 years, in sun-exposed areas and in occupations practiced outdoors. In addition to squamous cell carcinoma, these lesions could alsobe associated with basal cell carcinoma.

Intravesical instillation of Bacillus Calmette-Guerin (BCG) has become an established adjuvant treatment for superficial bladder carcinoma. This treatment is associated with a relatively high rateof side effects which are mostly reversible spontaneously or can be treated symptomatically. Serious systemic side effects are less frequent. One of rare complications is granulomatous cutaneous reaction. We report a 50-year-old man with disseminated papules and plaques following intravesical BCG.

Adrenocortical carcinoma is an uncommon and aggressive malignancy. Despite a high frequency of metastasis, cutaneous metastasis of adrenocortical carcinoma is rare with only isolated case reports. Its diagnosis can be challenging based solely on histopathological findings. Yet, the clinical history in combination with an immunohistochemical panel consisting of inhibin,vimentin, chromogranin, synaptophysin, melan- A, neuron specific enolase and calretinin, can be useful in differentiating it from other tumours with similar morphology. We report a case of a 52-year-old female who presented with subcutaneous nodules on her abdominal wall which, on histopathology, proved to be metastasis from adrenocortical carcinoma diagnosed one and a half years ago.

Carcinoma erysipeloides is a well-demarcated erythematous plaque resembling erysipelas. Malignant cells are predominantly within the dermal lymphatic vessels, with malignant thrombiinduced lymphatic obstructions causing the erysipeloid induration.Carcinoma erysipeloides, as the first manifestation of breast cancer, is very rare and accounts for about 2-5% of all cases.

Indeterminate cell histiocytosis is a very rare proliferative disorder of histiocytes which displays both langerhans cell histiocytosis and non langerhans cell histiocytosis immunophenotypic features.The majority of the patients develop multiple lesions which are clinically indistinguishable from generalized eruptive histiocytosis.We report a 14-year-old girl with multiple papules on the face, scalp and trunk.

Laser– assisted permanent hair removal is commonly performed for the treatment of unwanted hair. This procedure is usually associated with pain and pain reduction has an important role in the success of this treatment. A common method of reducing pain is to use topical analgesics. A mixture of lidocaine and prilocaine (EMLA) is a commonly used and very effective topical anesthetic.Another agent is diclofenac gel. Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) and is a potent inhibitor of inducible cyclo-oxygenase (COX-2). Oral administration of this medication can result in adverse effects. There are no studies on its efficacy as a topical anesthetic in laser hairremoval.