Iranian Journal Of Dermatology
Volume:15 Issue: 1, Spring 2012

T cell activation is discussed as an important factor in the pathogenesis of psoriasis. Recently, a lot of attention has been paid to the role of superantigens in T cell activation in the pathogenesis of psoriasis. In this study, the role of staphylococcal superantigens in the pathogenesis of psoriasis with identification of staphylococcal toxin levels in the skin lesions of patients with chronic plaque psoriasis has been studied. In this case-control study, biopsies were taken from the skin of 40 patients with chronic plaque type psoriasis and 40 controls. Staphylococcal superantigens such as staphylococcus enterotoxin A, staphylococcus enterotoxin C, and toxic shock syndrome toxin 1 were investigated using polymerase chain reaction. Staphylococcus aureus was isolated from 6.5% of the psoriasis patients and 2.5% of the individuals in the control group and all of them were toxin producer. There was a significant difference between controls and patients. Bacterial superantigens probably play an important role in the pathogenesis of chronic plaque type psoriasis.

Malignant melanoma is the most aggressive form of skin cancer. In contrast to other tumors, the role of estrogen in the initiation and progression of melanoma remains unclear. The aim of this study was to evaluate estrogen receptor beta protein expression in human melanoma tissues and in the benign melanocytic lesions. Twenty-one patients, 11 with cutaneous melanoma and 10 with benign melanocytic lesions were enrolled in this study. Estrogen receptor beta expression in benign melanocytic lesions and melanoma was analyzed by using immunohistochemical staining. All melanocytic lesions expressed estrogen receptor beta protein. We found lower estrogen receptor beta protein levels in melanoma. These initial observations, to be confirmed by further comprehensive studies, could suggest a role for estrogen receptor beta in melanoma, pointing at the possibility of using estrogen receptor beta expression for differentiating between malignant and benign lesions.

Acne vulgaris is the most common disorder of pilosebaceous unit. Systemic antibiotics are known to be effective in its treatment. We performed this investigation to compare the efficacy of azithromycin with doxycycline in the treatment of acne vulgaris. A twelve-week study was performed on 69 patients with moderate facial acne to compare the efficacy of oral azithromycin with oral doxycycline. Sixty patients completed the study. Patients in the treatment arm one were scheduled to receive 500 mg azithromycin once daily three times a week, and patients in the treatment arm two were instructed to use 100 mg doxycycline daily. All patients administered topical tretinoin cream every other night. Clinical assessment was made at baseline and then every 4 weeks. There were statistically significant improvements in comedones and inflammatory lesion counts in both groups. Neither drug was shown to be more effective than the other. This study indicated that azithromycin had similar efficacy to doxycycline in reducing acne lesions.

Melasma is a brown or grayish brown symmetrical facial hyperpigmentation.A number of medicamens can be used for the treatment of this condition. For better results in treating melasma, combination therapy is preferred. The aim of this study was to determine the clinical efficacy and adverse effects of azelaic acid 20% plus hydroquinone 5% versus hydroquinone 5% alone in the management of melasma. This study was performed as a double blind randomized clinical trial. We randomly prescribed two regimes including azelaic acid 20% cream plus hydroquinone 5% or hydroquinone 5% alone once daily for 4 months in 64 patients. Clinical efficacy (with MASI score) and side effects were assessed after one, two and four months of treatment. MASI score reduction was from 9.35 to 2.9 in patients using azelaic acid 20% plus hydroquinone and from 9.58 to 4.02 in patients using hydroquinone 5%. Drug adverse effects, including burning (most frequent), itching, stinging, dryness and erythema, were present in 50% of the participants in the azelaic acid 20% plus hydroquinone group and 35% of the individuals in the hydroquinone 5% group (P= 0.034), but were tolerated by most patients. Both therapeutic regimens showed a remarkable efficacy in the treatment of melasma but azelaic acid 20% plus hydroquinone was more effective with a more rapid onset of therapeutic response. Azelaic acid 20% plus hydroquinone had more side effects although they were slight in most cases.

Accurate clinical information provided on dermatopathology requisition forms is often very important to achieve correct diagnosis. We searched to evaluate the clinical information actually provided on the Dermatopathology requisition forms of melanocytic lesions submitted to our laboratory. The provided clinical information and given microscopic diagnoses were recorded for melanocytic lesions submitted as wet tissue to our dermatopathology department. Biopsy specimens were received from our dermatology clinics at our hospital that were filled in by residents of dermatology. According to ABCDE criteria, 76% of cases had none, 11.5% had one criterion, 19% had two criteria, 5.6% had 3 criteria, 1.1% had 4 criteria, and none had all 5 criteria. Asymmetry was provided in none of the requests, but border irregularity was provided in 7.6% of the time, color 10.1%, diameter 5.9%, and evolution 21.8%. No requisition forms mentioned the ‘‘ugly duckling’’ sign. Actually, most of the requisition forms did not provide the clinical information that is very important for the clinicopathologic correlation in the diagnosis of the pigmented lesions.

Cutaneous pseudolymphoma (PL) refers to a reactive T or B- cell proliferative disorder in reaction to some known or unknown stimuli. The most common site of involvement of pseudolymphoma is the face followed by the scalp. Because of its similarity with true lymphoma in both clinical and pathological aspects, differentiating between them is often difficult but fundamental due to their completely different prognoses and treatments. We report a case of cutaneous pseudolymphoma of the breast in association with fibrocystic change of the breast, and a long history of taking hormonal drugs, in a 35-year-old woman. There was a very good response to intralesional steroid injections and oral hydroxychloroquine.

Sweet’s syndrome and erythema nodosum are rarely seen together. Herein, we report a case of concurrent Sweet’s syndrome and erythema nodosum and review previous cases.

A 25-year-old woman referred to our department with a lesion in the anterior part of her neck (Figure 1) since childhood. She complained of a clear discharge from the lesion which increased with pressure. Two years ago, the lesion was treated with electrosurgery but relapsed a few months later. Examination revealed an erythematous papule in the anteriorinferior part of the neck with a clear mucoid discharge from its orifice upon pressure. Physical exam was otherwise normal. The patient had no other medical problems. She had never taken any medications. There was no family history of a similar problem. We advised the patient to be visited for excisional biopsy of the lesion.

A 20-year-old girl presented with a one-week history of fever and chills, malaise, generalized erythema (including the face, trunk, back and extremities), edema (initially the face and then lower limbs) and hoarseness (Figure 1). Physical examination revealed low-grade fever, jaundice, lymphadenopathy (posterior cervical, submandibular, <1 cm, no axillary, no inguinal). Dermatological examination showed diffuse erythema (erythroderma), edema (generalized, especially periorbital and lips), and mild jaundice (scleral and sublingual). No mucosal lesions or nail changes were seen. She had a history of epilepsy since 3 years ago and had been under treatment with sodium valproate until 1.5 month ago when she discontinued the medication. She had an epileptic attack then and therefore carbamazepine was started for her. Positive laboratory findings were anemia, leukocytosis with eosinophilia (20%), elevated liver enzymes, and direct hyperbilirubinemia. Other routine laboratory tests, electrocardiogram, chest x-ray, and viral markers (including HBV, HCV and EBV) were unremarkable. Abdominal sonography revealed thickening of gall bladder and fluid in posterior choledosac. A punch biopsy was taken from her forearm skin.