Iranian Journal Of Dermatology
Volume:13 Issue: 4, Winter 2010

Due to their chronic nature, influences on the body image, hopelessness toward complete recovery and frequent recurrences, dermatological diseases seem to be one of the important predisposing factors in depression and suicidal ideation. Thus, the present study aimed at evaluating the degree of depression and suicidal ideation in patients with psoriasis, acne, alopecia areata and vitiligo. The study was carried out on 300 patients with psoriasis, acne, alopecia and vitiligo who were referred to the dermatology clinic of Ghaem Hospital in Mashad. Beck depression questionnaire was used to collect the data which was then statistically analyzed with ANOVA and T-test, using SPSS software. In this study, 35.7% (107) of the subjects were female and 64.3% (193) were male with a mean age of 26.55±10.81 years. The prevalence rate of clinical depression was found to be 47.4% in patients with acne; 69.4% in those with psoriasis; 70.1% in those suffering from vitiligo; 50% in diffuse alopecia areata; 60% in universalis alopecia areata; 100% in ophiasis alopecia areata and 68.3% in patients with localized alopecia areata. As for suicidal ideation, there was no sign in 88.3% (265); however, 6.3% (19) of the patients reported to have thought of suicide but they had no desire for the attempt while 4% (12) of them had some desire for suicide and 1.3% (4) were seriously determined to commit suicide if only they would find themselves in an appropriate situation. As shown by the findings of the study, there was a close relationship between dermatological diseases and psychological factors; thus, it is important to immediately diagnose concurrent psychological effects, especially those of depression and suicidal ideation. We found that there was a significant relationship between the prevalence rate of dermatological conditions and psychological effects; i.e. depression (P=0.008) and suicidal ideation (P=0.001). We also found out that the rate of suicide attempt was highest among the patients with universalis alopecia, diffuse alopecia areata and vitiligo, respectively.

Basal Cell Carcinoma (BCC) is a type of non-melanoma skin cancer. Alteration in gene expression is the important event that happens in cancer cell. Detection of this event is possible by proteomics techniques. Normal and tumor tissues were taken from BCC patient. Total proteins were purified by standard methods, and proteins were separated by two-dimensional electrophoresis (2DE). Mass spectrometry (MS-MALDI method) was used as a powerful instrument for protein identification. Eighty seven spots of protein were detected in 2DE gels out of which, 76 spots had different expression in normal and cancer gel images. Comparison with the data base showed 11 proteins. Nine spots had no association with BCC, but expression of ceruloplasmin and C3b were decreased and increased respectively in cancer tissues, compared to normal cell. The mass spectrometry results were aldolase C, Prx-cis and VDAC. These recognized proteins, either with increased or decreased expression in cancer tissue, might be considered as new biomarkers in BCC patients.

Pemphigus vulgaris (PV) is a rare autoimmune blistering disease with a high rate of morbidity and mortality without treatment. Until now, treatments consist mostly of the use of corticosteroid and immunosuppressive drugs. Optimum dosage for corticosteroid therapy is yet to be determined. The aim of the present study was to clear whether different initial corticosteroid therapeutic dosages change the recurrence rate of the disease. Patients hospitalized with confirmed PV from 2000 to 2006 were enrolled if they received systemic corticosteroids without any adjuvant therapy for no more than three weeks when hospitalized, received their first treatment in the period of the study and were followed for at least two years in the PV clinic of Razi Hospital periodically. Initial steroid dosage as well as the number and type of the recurrence(s) were documented and analyzed. A total of 62 patients with a mean age of 46.8 (± 15.9) were enrolled. Twenty-one patients were female (33.9%) and 41 patients (66.1%) were male. According to the initial dose of systemic corticosteroid, patients were divided into two groups: group A included patients treated with less than 2mg/kg (10 patients or 16.1%) while group B included patients treated with 2mg/kg systemic steroids (52 patients or 83.9%). There was no significant difference in the recurrence rate between the two groups. Recurrence rate was 40% in group A and 51% in group B (P>0.05). According to the type of recurrence, there was a significant difference between the two groups; in group A, the first recurrence was major in 33% of the patients while in group B, this rate was about 28.8% (P<0.05). According to the present study, initial therapeutic dosage did not influence the recurrence rate although the type of recurrence was influenced. Patients treated with higher initial steroid dosages experienced their first episode as a minor recurrence while patients treated with lower initial steroid dosages experienced major recurrences with a higher probability as their first episode.

We studied the efficacy of an herbal semisolid formulation, prepared from hexane extract of seeds of Psoralea Corylifolia, which has anti-inflammatory and antimicrobial properties, in the treatment of eczema. Extraction of seeds of Psoralea Corylifolia was done in Soxhlet apparatus using hexane as the solvent. Furthermore, Oil in Water (O/W) cream was formulated with a stearic acid base and was evaluated for various parameters like pH, viscosity, rheology, etc. This cream was then utilized for the treatment of eczema. The formulation was effective in treating eczema in this open clinical trial. Thirty patients suffering from eczema were treated for 1 month, out of whom twenty five completed the study. The patients recovered from their symptoms using the cream twice daily and were assessed every week for 1 month. It was observed that the symptoms score reduced at the end of 2 weeks onwards. At the end of the study, the symptom score for eczema reduced from 6.367±1.098 to 0.333 ± 0.279 for length of the lesion, from 1.333 ± 0.994 to 0.165 ± 0.087 for exudation rate, and from 2.567 ± 0.504 to 0.165 ± 0.132 for the rate of itching. The plant Psoralea Corylifolia has been used in treatment of various skin disorders, and the present research concluded that this plant could be effectively used for the treatment of eczema

Rosacea is a chronic skin disease with an unknown etiology. Some reports have suggested an increased prevalence of Helicobacter pylori infection in rosacea patients, but it is controversial. This study was designed to compare the prevalence of H. pylori and serological cag A+ species between the rosacea patients and the healthy control group. This case-control study was performed on 30 rosacea patients and 60 healthy individuals as the control group. The results were reported based on clinical and serological enzymelinked immunosorbent assay IgG antibody and cag A examination in two groups. Mean age of the rosacea patients and the control group was 45.8 ± 14.05 and 41.4 ± 12.3 years respectively and 56.7% of the patients and 86.2% of controls were infected by H. Pylori (P=0.002). Furthermore, cag A+ was seen in 53.5% of the patients and 50% of the controls (P=0.23). This study showed a reduction in the prevalence of Helicobacter Pylori in acne rosacea patients compared to other studies in the world. The authors believe that it is necessary to conduct more studies to demonstrate the exact prevalence of this organism in Iranian rosacea patients.

Hand eczema is one of the most common dermatologic diseases requiring treatment but common therapeutics such as corticosteroids and anti-histamines have numerous side effects. So, use of herbal agents, which generally have no major side effects, may be useful especially if their efficacy is established. Malva Sylvestris (MS) is a tropical plant in Iran with cooling characteristics. Hence, in this study, its efficacy in of the treatment of hand eczema was evaluated. In this randomized clinical trial, 50 patients with hand eczema who were visited at Shohada-e Tajrish and Loghman hospitals, Tehran, Iran, between 2006 and 2008, were recruited and divided into two groups. In the first group, MS 4% ointment was applied twice a day and in the other group, placebo ointment was usd. The efficacy and side effects were evaluated three and six weeks after beginning of the treatment. Mean age of the patients was 37.3 years and 35.6 years in MS and placebo groups, respectively (P > 0.05). There were no therapeutic adverse effects in the groups. There was a statistically significant difference in all measured scores between two groups in the first and second follow-up sessions (P < 0.0001). Malva Sylvestris seems to be a safe and effective therapeutic modality for the treatment of hand eczema and can be used as an optimal substitute for corticosteroids and antihistamines.

The association between actinic granuloma and giant cell arteritis (temporal arteritis) has been claimed by some authors. There is a hypothesis that actinic radiation has the principal role in the etiology of both diseases in a similar way. Here, we report a case of actinic granuloma that had characteristic pathologic features of giant cell arteritis in histopathologic examination without clinical evidence of giant cell arteritis.

Crouzon syndrome is a rare inherited autosomal dominant syndrome characterized by craniosynostosis, midface hypoplasia. Acanthosis nigricans may be associated with Crouzon syndrome, but it differs from the classic crouzon syndrome. This is a report of a 30-year-old-woman who presented acanthosis nigricans coexist with crouzon syndrome.

Case: A 54-year-old woman was visited with a history of asymptomatic gray-brown discoloration of the facial skin at our dermatology clinic. The lesions first appeared on her chin and then became progressively darker and extended to her nose and, to a lesser extent, to the periphery of her face over a period of five years. She mentioned that the lesions worsened with heat and sun exposure. Her past medical history was unremarkable. The patient’s medications included sunscreens, and hydroquinone lightening creams from many years ago. Physical examination revealed a previous depressed scar of cutaneous leishmaniasis on her forehead, brown to black hyperpigmented macules and patches, more in her midface area, especially the nose and chin, with superimposed small pigmented papules scattered on normal and hyperpigmented facial skin (Figures 1,2). She had no discoloration on other body sites such as the neck, hands or trunk and there was no evidence of arthritis or joint pain. The complete blood cell count, urine analysis and creatinin levels were normal.

The pat ient was a female neonate bor n prematurely on 36 weeks of gestation by normal vaginal delivery. During pregnancy, mother had no history of fever, drug use or x-ray exposure. The mother was gravida 2 and had no history of abortion. Her first baby was well. On physical examination, the skin was markedly thickened, hard and hyperkeratotic with deep crevices running transversely and vertically. She had ectropion and the globe was abnormal. The ears and nose were underdeveloped, flattened and distorted and the lips were everted and gaping (fish-mouth). Extreme inelasticity of the skin with flexion deformity of all joints was noted. The hand and foot were hard and waxy in appearance, with poorly developed distal digits (Figure 1,2). She had respiratory distress, was ill and sucked poorly. Harlequin ichthyosis (or harlequin fetus) is a rare but very severe disorder of keratinization. Inheritance is likely autosomal recessive, but new autosomal dominant mutations are possible 1. The genetic abnormality in harlequin ichthyosis has been identified as a mutation in the lipid-transporter gene ABCA12 on chromosome 2. In harlequin ichthyosis, the ABCA12 -mediated transfer of lipid to lamellar granules is absent 2. The skin of the affected infants is markedly thickened, hard (armor-like), and hyperkeratotic, with deep crevices running transversely and vertically (Figure 1). The fissures are most prominent over areas of flexion. Rigidity of the skin around the eyes results in marked ectropion, although the globe is usually normal; however, our patient had ectropion with an abnormal globe (Figure 2). The ears and nose are underdeveloped, flattened, and distorted, and the lips are everted and gaping, producing a “fish-mouth” deformity. The nails and hair are hypoplastic or absent. Extreme inelasticity of the skin is associated with flexion deformity of all joints. The hands and feet are ischemic, hard, and waxy in appearance, with poorly developed distal digits 3. Affected neonates have respiratory difficulty, suck poorly, and are subject to severe cutaneous infection 4. Common histopathological abnormalities include hyperkeratosis, accumulation of lipid droplets within corneocytes, and absence of normal lamellar granules 1,5. Prenatal diagnosis has been accomplished by fetoscopy, fetal skin biopsy, and microscopic examination of cells from amniotic fluid taken at the 17th and 21st weeks of gestation 6. We confirmed diagnosis in this report by ultrasound in the prenatal period and clinical findings during the neonatal period. Suspicion in this case was aroused only with findings of a persistently open mouth and fixed flexion deformities on two dimensional sonography whereas three dimensional sonography may disclose facial features more commonly associated with the condition, echogenic amniotic fluid, short foot length and fixed flexion deformity. Initial treatment includes high fluid intake to avoid dehydration from transepidermal water loss and use of a humidified heated incubator, emulsifying ointments, careful attention to hygiene, and oral retinoids 4. Unfortunately, our patient died because of sepsis.