Iranian Journal Of Dermatology
Volume:13 Issue: 2, Summer 2010

The role of food allergy in atopic dermatitis (AD) is controversial. The aim of this study was to determine the frequency of food allergens in children with AD. Fifty one atopic dermatitis children aged 6 months to 5 years entered our study. The severity of AD was determined by scoring index of AD (SCORAD). Skin prick test (SPT) was done using 15 allergens including the white of the egg, yolk, peanut, kiwi, strawberry, cow''s milk, walnut, fish, banana, wheat, orange, tomato, cereals, apple and cocoa. Thirty four patients (66.7%) had a positive reaction to one or more allergens and in 17 patients (33.3%), the SPT was negative to all allergens. Eleven patients (21.6%) had a positive SPT to one food allergen, 9 patients (17.6%) to two allergens, 9 patients (17.6%) to three allergens, 3 patients (5.9%) to four allergens, 1 patient (2%) to seven allergens and 1 patient (%2) to ten allergens. The most common food allergen among 15 allergens was white egg in 19 patients (37.3%). Yolk was the second most common allergen in 11 patients (21.6%). The relationship between the severity of the SPT with AD severity was observed only for cow''s milk, which showed a reverse relationship (R=-0.337). White egg was the most common allergen in all ages and both sexes. Food allergens may play a role in the pathogenesis of atopic dermatitis.

Acne vulgaris is a frequently encountered skin disease in daily practice. Its clinico-epidemiological status was evaluated in this study. Four hundred patients were studied by record-based observation for 2 years in the Acne Clinic of a tertiary care hospital. This study revealed a male preponderance (53%) with a higher prevalence in adolescents (75%). Women with a regular menstrual cycle had a lower acne grading (ρ = – 0.31). Increased physical activity led to a decrease in acne grading (ρ = – 0.20). An association was found between acne and family history (42%) and nonvegetarian, oily, spicy fast food (99%). Our prescribed allopathic treatment in the Acne Clinic showed improvement. No drug induced ocular toxicity was observed. Hot, humid, dusty environment influenced the majority (87%) of the respondents. Urbanization (69%) increased the occurrence of acne. Community based studies are required to find out the actual burden of acne vulgaris.

A clinicopathological study of 75 cases of pemphigus was carried out at Saurashtra region of Gujarat State, India. This study was done to subtype this disease with evaluation of clinical and histopathological presentation. The study was carried out in a two-year period at skin department of Guru Gobind Singh Hospital, Jamnagar. Seventy five patients of pemphigus were examined, admitted and treated. Histopathological examination was done at the department of pathology and direct immunoflouroscence was advised and done at higher centers when it was needed. Out of 75 cases, pemphigus vulgaris constituted the single largest group of cases which made 72 (96%) cases with three (4%) cases of pemphigus foliaceus. The majority of the cases were seen in the age group of 21-60 years, with a slight female predominance. The youngest patient was 18 years while the eldest was 70 years old. Oral mucosal involvement was seen in almost all cases of pemphigus vulgaris while 7 cases of pemphigus vulgaris had mucosal involvement at other sites in addition to oral mucosal involvement. No mucosal involvement was present in cases of pemphigus foliaceus. Flaccid bullae were present in 100% of the cases. Pruritus was present in 15 cases of pemphigus vulgaris. Most of the patients had pemphigus vulgaris followed by pemphigus foliaceus. Pemphigus is more prevalent at certain areas of Saurashtra region showing a geographic distribution.

Solar lentigo is local and benign proliferation of melanocytes which is common in old individuals and creates a major concern considering beauty. Despite several and somehow expensive treatments such as laser and cryotherapy, chemical peeling with Trichloroacetic Acid (TCA) has recently attracted attentions considering its low cost and availability. The present study was designed to compare the efficacy and side effects of Trichloroacetic Acid (TCA) 35% and cryotherapy in the treatment of solar lentigo. This randomized clinical trial was performed on 35 individuals with solar lentigo on their hands. First, images were taken from both hands. Then, one side was treated with cryotherapy and the other side was treated with TCA 35%, randomly. This treatment was repeated after one month. The imaging was repeated at the end of the second month and both sides were compared with previous images regarding the degree of the improvement (lightening) of the lesions and the resultant side effects. Descriptive statistical methods and 2-chi square relation were used for analyzing data with SPSS 16. The results demonstrated that cryotherapy resulted in more than 50% recovery (lightening >50%) in 60% of the cases which was statistically significant (P<0.05). In contrast, TCA 35% yielded more than 50% recovery in 46% of the cases which was significant, too. Comparing these modes of treatments regarding 50% recovery showed no statistically significant difference (P=0.219). Side effects were seen in 40% and 13.3% of the individuals who used cryotherapy and TCA 35%, respectively, which was statistically significant (P<0.05). According to the findings of the research, TCA 35%, compared to cryotherapy, has similar efficiency but fewer side effects in the treatment of solar lentigo.

Melasma is a common acquired hypermelanosis seen mainly in women which occurs on the sun-exposed skin of the face. The exact cause of melasma is unknown. The majority of the cases are attributed to pregnancy, combined oral contraceptive pills, genetic factors, sun exposure, use of cosmetic products, thyroid disorders and anti-convulsant drugs. This study was performed to evaluate the relationship between thyroid autoimmunity and melasma. In this case-control study, 45 females with melasma who were 20-50 years old and were referred to our clinic and 45 age-matched healthy females with no history of melasma as the control group were evaluated. The skin and thyroid of all of them were examined carefully and their sera were collected and evaluated for thyroid function tests and anti thyroid peroxidase (anti TPO). Data was also statistically analyzed. Serum anti TPO level was higher than normal in %24.4 of the patients and %6.7 of the controls. The difference between two groups was statistically significant (P=0.019). Serum T3 level was higher than normal in %75.6 of the patients and %48.9 of the controls. The difference between the two groups was also statistically significant (P=0.008). Mean serum anti TPO, T3 and TSH were higher in the case group than the control group, but the difference was not statistically significant. A possible relationship might be observed between thyroid autoimmunity and melasma.

Various factors are involved in the pathogenesis of acne vulgaris. Recently, G6PD deficiency has been proposed in the pathogenesis of acne. G6PD has an important role in the oxidant/antioxidant balance. According to this theory, antioxidants are used in the treatment of acne recently. The aim of this study was to evaluate G6PD deficiency in patient with acne vulgaris. The activity of G6PD enzyme was measured in the venous blood of 82 patients with acne vulgaris of different severity. The fluorescent lamp method was used in order to determine the activity of G6PD enzyme. The mean age of the patients was 25± 3. From 82 patients, the level of the G6PD enzyme was normal in 77 (93.9%) patients. Also, 4 (4.9%) patients had relative G6PD deficiency and 1 (1.2%) patient had severe G6PD deficiency. As the incidence of G6PD deficiency is 5.7% in the normal population, there was no statistically significant difference in G6PD deficiency between patients and the normal population. No significant relationship was found between acne severity and G6PD deficiency. In order to detect the association between acne and G6PD deficiency, other case-control studies with lager sample sizes are recommended.

Sarcoidosis and foreign body reactions are common differential diagnoses of skin granuloma formation. We report a 40 year –old man with sarcoid type granulomas containing polarized foreign materials, and also bilateral hilar adenopathy. It appears that detection of foreign bodies in histopatologic studies of granulomas does not necessarily exclude the possibility of sarcoidosis.

Peeling skin syndrome (PSS) is a very rare keratinization disorder, characterized by spontaneous exfoliation of the stratum corneum. Herein, we report a case of non-inflammatory (type A) PSS.

A 40-year old woman was visited at our clinic with a history of palpable purpura appearing after alexandrite laser (Apogee 5500 Alex, 15mm spot shot, 755 nm wave length, 18 j/cm2 fluence) hair removal. The skin lesions were located bilaterally on the lower extremity (Figure1). Other physical examinations were unremarkable. The patient had no history of taking medications, underlying systemic diseases and family history of collagen-vascular diseases. Blood biochemical analysis was normal and all the tests for collagenvascular diseases were negative. The patient declined skin biopsy. After six weeks of conservative therapy, the purpura faded. Laser-assisted hair removal has recently become popular. The number of lasers and light sources currently available for hair removal and their various treatment protocols has created much confusion; but, the fact is that all photoepilation systems target follicular melanin. Therefore, all hair removal devices provide a significant opportunity for epidermal and dermal injury during the epilation process 1. Alexandrite laser system can produce a number of side effects including transient erythema, perifollicular edema, treatment pain, hyperpigmentation, hypopigmentation and crusting 2,3. Other rare side effects of this laser are folliculitis, erosions and purpura 1. The extent of these complications is determined by skin type, seasonal variations, and patient''s history of recent sun exposure. Complication rates also vary according to the anatomic location treated. The extremities are most commonly affected. Blistering, fine epidermal crusting, hypopigmentation and purpura are experienced more commonly in darker skin tones (phototypes III and higher) or in tanned skin 1. The prominent point of our report was the appearance of purpura in a patient with skin phototype II and in a sun protected area. This report indicates that it is essential for the laser operator to be well educated upon the potential risks of photoepilation and to have a thorough understanding of laser-tissue interaction before embarking upon the laser-assisted hair removal process.