Iranian Journal Of Dermatology
Volume:16 Issue: 1, Spring 2013

Alopecia areata (AA) is an autoimmune disorder of hair follicles. We aimed to find the association between Vitamin D level and AA. Eligible AA patients and controls were enrolled in this case-control study and serum samples were assessed for 25-hydroxy vitamin D (25-(OH)-D3). The levels of 25-(OH)-D3 were categorized as deficient (<10ng/ml), insufficient (10 to <30 mg/ml) and sufficient (>30ng/dl) and the SALT (Severity of Alopecia Tool) score was used to assess the severity of the disease. The data was analysed and the association between vitamin D levels and AA, disease distribution, and the pattern of hair loss was investigated. Twenty eight patients (19 males, 9 females) and 44 healthy controls (16 males, 28 females) were assessed. There was no statistically significant difference between patients and controls with regard to the level of 25(OH)D3 when the data was adjusted for gender (Ordinal odds ratio: 0.49 (0.18-1.34 and 95% CI, p-value=0.16). The level of 25(OH)D3 was lower in patients with nail involvement in contrast to those without it (P=0.02); moreover, no significant difference was found between patients with different patterns of hair loss. After adjustment for gender, there was no association between AA and the level of vitamin D.

Hirsutism is defined as the presence of terminal hairs with a male-like pattern in women, due to the increased levels of androgens or increased responses of the target organs to androgens. Facial hirsutism has a negative effect on the quality of life in female patients. Among the many therapeutic modalities for hirsutism, laser therapy is of great acceptability. The long pulse Alexandrite laser, diode laser, and Nd:YAG laser are the most commonly used lasers in the treatment of hirsutism. In this study, we assessed the effect of laser therapy on the quality of life of the patients with hirsutism, using the Dermatology Life Quality Index (DLQI) and Visual Analog Scale (VAS). Forty-two female patients with idiopathic hirsutism, ranging from 18 to 34 years old, were studied during a course of laser therapy lasting for at least 4 months for up to 3 courses. Each patient completed a DLQI and VAS questionnaire before and after treatment. The VAS questionnaire was also filled out by the dermatologist. Following laser therapy, the average DLQI score, decreased by 10 points (a statistically significant difference with p- value<0.001). VAS also declined and there was a moderate to good correlation between the VAS scores given by the patient and the dermatologist. This study demonstrated that laser therapy improved the quality of life in patients with hirsutism.

To our knowledge, there is a hypothesis regarding the association of vitiligo with other autoimmune disorders. Organ-specific autoantibodies are found more frequently in the serum of vitiligo patients. Recent studies have demonstrated the role of alterations in serum transforming growth factor-beta (TGF-beta) released from regulatory T cells in the pathogenesis of depigmentation observed in vitiligo. It has been shown that in comparison with patients without autoimmune diseases, serum TGF-beta levels increase in patients whose vitiligo is associated with autoimmune diseases. We hypothesized a relationship between serum TGF-beta levels and organ-specific autoantibodies that could predict other autoimmune diseases in vitiligo patients. Forty-five patients with a mean age of 35.96±13.34 years who had stable vitiligo since 1 year ago and involvement of up to 30% body surface area were enrolled. Organ-specific autoantibodies (ANA, anti mitochondrial Ab, anti TPO (anti thyroid microsomal Ab), anti parietal cell Ab, anti thyroglobulin Ab) and serum TGF-beta level were evaluated. Twenty-three patients (51.11%) had at least one positive organ-specific autoantibody. Anti TPO in 16 patients, anti thyroglobulin Ab in 9 patients, anti parietal cell Ab and ANA each in 5 patients, and anti mitochondrial Ab in 4 patients were positive. Mean serum TGF-beta level was 105.82±30.33; there was no significant difference in serum TGF-b level between patients with and without positive organ-specific autoantibody (P=0.26). Although another study showed the relationship between serum TGF-beta levels and autoimmune disorders in vitiligo patients, we did not find a significant difference in serum TGF-beta levels in these patients regarding the positivity of organ-specific antibodies. It may be due to the fact that our patients had autoantibodies without clinical autoimmune disease except vitiligo.

Melasma is an acquired therapeutically problematic disease characterized by symmetrical facial hypermelanosis. The aim of this study was to evaluate the efficacy of azelaic acid 20% cream in the treatment of melasma in Iranian patients and compare it with hydroquinone 4% cream which has been the standard treatment. The study was an open clinical trial with a split-face design. All patients applied hydroquinone 4% cream on the right side and azelaic acid 20% cream on the left side for 20 weeks. Modified melasma area and severity index (mMASI) was determined for each patient at the beginning and at the end of study and compared statistically. Thirty-three patients were included in the study. Although both medications were effective in reducing mMASI, there was no statistical difference between the two (P value=0.6). Overall, 69.7% of the patients on the hydroquinone 4% side and 63.6% on the azelaic acid 20% side showed good to excellent response. The subjective patient assessment of improvement was 75.7% for hydroquinone 4% and 66.6% for azelaic acid 20%. Both topical hydroquinone 4% and topical azelaic acid 20% had almost similar effects. Considering the relatively less known side effects of azelaic acid compared to hydroquinone, it can be an appropriate substitute in the treatment of melasma.

Although cryotherapy has been reported as a technique for depigmenting residual pigmented patches in patients with universal vitiligo, Q-switched Nd-YAG lasers have not yet been used for this purpose. The aim of this study was to compare the efficacy of cryotherapy with that of 532nm Q-switched Nd-YAG laser therapy for depigmentation in patients with universal vitiligo. Six adult patients (4 male and 2 female) with universal vitiligo and facial residual pigmented patches were treated simultaneously with cryotherapy on the right and the frequencydoubled 532nm Q-switched Nd-YAG laser therapy on the left side. The laser parameters used were spot size 3-5mm, frequency rate 10 hertz, and the fluence was 5J/cm2. The cryo system was a closed contact CO2 Cryo gun. The patients were scheduled to be treated monthly. The depigmentation was complete after three successive sessions of cryotherapy and 30-45 days after the last session, in comparison with simultaneous 30-70% depigmentation of the laser side. No scar or permanent sequellae developed on either side. Cryotherapy is more effective and fast-acting than Q-switched Nd-YAG laser for depigmentation of residual pigmented patches in patients with universal vitiligo.

The skin is among the main tissues affected by Sulfur Mustard (SM) in chemical attacks. Iranian researchers have performed extensive studies on the exposed victims and have reported a wide spectrum of information in this field. The main objective of this study was to develop a comprehensive revision of data on the pathology, pathogenesis, clinical findings, complications, and treatment of sulfur mustard exposure. This study was part of a systematic search which included all the war related studies on Iranian victims. Among nearly 300 retrieved articles, a total of 193 medical articles were approved in terms of quality and were related to the Iraq-Iran chemical war (1984-1988) out of which 48 were directly related to the dermatologic effects of sulfur mustard. We used known international databases such as ISI, Medline, Scopus, and Iranian databases such as Iranmedex, SID, and Irandoc in this study. Publishing the articles in approved journals was the main criterion for their quality. In this study, the most common symptom in the delayed phase of the exposure to SM was itching which was more frequently seen in women as compared to men. The most common sign was erythema in the skin. One of the chronic complications at the site of exposure was mustard scar. Lipoma and cherry angioma were the most common skin tumors which were reported. Iranian researchers have presented different approaches for the management of exposed victims. In this study, in addition to the effects of SM on the skin, some methods were presented for decontamination, management of itching, vesicles, blisters and treatment of chronic skin lesions.

Primary cutaneous large B-cell lymphoma leg type is a rare and aggressive neoplasm as defined by the recently updated World Health Organization - European Organization for Research and Treatment of Cancer. We report a case of an 80-year-old man with multiple cutaneous lesions. Here, we review the available literature and summarize clinical features and management of this type of cutaneous B-cell lymphoma.

Aplasia cutis congenita is the congenital absence of skin most commonly affecting the scalp. No definite etiology is available but multiple causes such as intrauterine infection, fetal exposure to cocaine, heroin, alcohol or antithyroid drugs, vascular disruption, genetic causes, syndromes and teratogens have been suggested. We present an infant with extensive aplasia cutis of the trunk and thigh. He was the third child of his parents while the outcome of the first and the second pregnancy was intrauterine death; the dead fetuses however had no skin anomaly.

Verrucous hemangioma is a rare, localized vascular malformation. The lesions are bluish-red, well demarcated, and compressible. We report a case of a 10-year-old girl with coexistent disseminated verrucous hemangioma and subcutaneous hemangioma over the nape of neck.

A 38- year-old man in good general health and normal intellectual functioning referred to the dermatologic clinic with numerous pruritic reticulate pigmentations on his neck, chest and upper back since 10 years ago. We noticed similar lesions on his axillae, groin and infra mammary area with no family background.