Iranian Journal Of Dermatology
Volume:16 Issue: 2, Summer 2013

Accurate diagnosis of cutaneous leishmaniasis would avoid unnecessary treatment and scar formation. Direct smear is the most common method for the diagnosis of this disease but its negative result could not rule out the infection; so, the need for more sensitive methods is obvious. We conducted this study to compare the efficiency of direct skin smear with smears prepared by fine needle aspiration (FNA) using polymerase chain reaction (PCR) as a reference method. In this cross-sectional study, which was conducted during two years from May 2008 to May 2010, 33 patients with suspicious acute cutaneous leishmaniasis based on clinical studies were randomly selected. Direct skin smears and FNA smears were taken from each patient and PCR was performed on biopsy samples; the results were then compared. The rate of positive results in each method was as follows: PCR 81.8%, direct skin smear 60.6% and FNA 42.4%. The sensitivity of the direct skin smear was significantly higher than the FNA method (74.1% versus 51.9%, P< 0.001). There was no lesion with a positive result on FNA and negative results on the direct skin smear and PCR, or a positive result on the direct skin smear and a negative result on PCR. It is clear that the FNA method is not a favorable method for the diagnosis of acute cutaneous leishmaniasis in comparison with the direct skin smear. Since the number of the leishman bodies in FNA is limited, it is better to use this method as a complementary method along with other methods such as culture.

The cold-induced inflammation of cryotherapy may alter the immunologic processes and structural components of the hair follicles responsible for AA. The aim of this study was to study the efficacy of cryotherapy in alopecia areata, and totalis. Forty-four patients with recalcitrant scalp alopecia areata or totalis were treated with cryotherapy. The cryo-system chosen was a closed contact CO2 system with metallic probes. The patients were evaluated for 4-8 weeks for hair growth. Satisfactory hair growth after 8 weeks was an indication for performing cryotherapy for the remaining untreated areas. Varying degrees of hair growth were detected in 52.50% of the patients four weeks and in 65.90 % eight weeks after treatment. About 38.64% of the patients showed more than 50% hair regrowth 8 weeks after therapy. Cryotherapy is effective for about two-thirds of the patients with alopecia areata, many of whom are unresponsive to conventional therapies.

Pemphigus is a group of autoimmune blistering skin diseases that is related to auto antibodies against desmoglein 1 and 3. Many reports have shown that HSV1, HSV2, VZV, EBV, CMV, HHV8, and HIV are triggering agents for the activation and exacerbation of pemphigus. In this study, we decided to evaluate the frequency of HSV1, HSV2, HHV8, and EBV in paraffin-embedded specimens of the new cases of pemphigus patients using immunohistochemical methods. Thirty patients with pemphigus whose diagnosis was proved with direct immunofluorescens studies (20 cases of pemphigus vulgaris and 10 cases of pemphigus foliaceus) and 10 specimens from the free margins of excised melanocytic nevi were collected. Immunohistochemical staining was performed for HSV1 and EBV (using Novo Castra kit) and for HSV2 and HHV8 (using Dako kit). The results showed a significance difference in the frequency of positive staining for HSV1 in skin lesions of pemphigus vulgaris, foliaceus, and controls (P= 0.041), foliaceus group more positive staining than vulgaris group and both more than controls, but not for HSV2, EBV, and HHV8 markers. Positive staining for HHV8 occurred in 30% of PF patients and 15% of PV patients but P value was not significant (0.171). Like previous studies, our research also indicated significant prevalence of HSV1 in lesions of pemphigus patients, especially in pemphigus foliaceus. We collected new cases of pemphigus before starting immunosuppressive therapy, so we think that the presence of HSV1 in skin lesions of patients can act as a triggering factor for the disease which could not be attributed to the suppressive therapy.

Melasma is a common acquired hyperpigmentation disorder often appearing on the face of young women. Melasma is classified into four groups based on Wood’s lamp examination: epidermal, dermal, mixed, and indeterminate. The goal of this study was to evaluate the relationship between clinicoepidemiological characteristics of melasma and the level of involvement under Wood’s lamp examination. In a cross sectional study, 50 melasma patients who were visited at the dermatology clinic of Imam Reza Hospital from March 2010 to September 2011 were studied. The level of melasma involvement in all patients was determined using a Wood’s lamp, and the patients’ information such as age, occupation, location of melasma, marital status, pregnancy, oral contraceptive pill consumption and Fitzpatrick skin type was collected in a questionnaire. In single patients, dermal involvement and in married patients, epidermal involvement was more common. Involvement was more frequently dermal in jobs with exposure to sun and more epidermal in indoor jobs. In the malar region, epidermal involvement was more common. In patients with a history of pregnancy, epidermal involvement was more prevalent as well, while in the participants without a history of pregnancy, dermal involvement was more frequent. In the pregnant patients with melasma, epidermal involvement was more frequent. In patients without a family history of melasma, epidermal involvement was more frequently observed than the other two levels of involvement. Based on the findings of this study, melasma in cases with the involvement of the malar region, starting in pregnancy, in patients without a family history of melasma, and in the individuals who have indoor occupations is most likely to be epidermal and may have a better response to treatment. On the other hand, melasma in single persons and in those who have outdoor occupations and are exposed to sun light is mostly dermal with a worse response to treatment according to previous studies.

Birthmarks are common reasons for parents’ concern. Some of them may need further investigation to find out the underlying systemic disorders or their potential for malignant transformation. The purpose of this study was to determine the frequency of vascular and pigmented birthmarks in infants from the Northeast of Iran. This descriptive study was conducted on 1000 healthy infants born in a University Hospital in the Northeast of Iran from 2003 to 2005. The cutaneous lesions of neonates were examined by a dermatologist. The salmon patch was reported as the most common birthmark (233 cases). The most common site of involvement was the eyelid. A case of congenital hemangioma and a case of the port-wine stain were also observed both in the fifth nerve path. The most common pigmented birthmark was the Mongolian spot (171 cases). The congenital melanocytic nevus was seen in 50 cases. The lumbosacral area and trunk were reported as the most common sites of involvement for the Mongolian spot and congenital melanocytic nevus, respectively. Fortunately, the most common birthmark is the salmon patch that is evanescent. The congenital melanocytic nevus had a relatively high prevalence rate (5%) in comparison with other studies. Since the appearance of these lesions can concern parents and there is an increased risk of melanoma in the cases of congenital melanocytic nevi, follow up is needed in some cases; we recommend careful examination of the infant’s skin and training of physicians working in neonatal wards.

Reactive perforating collagenosis is one of the perforating dermatoses; the acquired form is characterized by transepithelial elimination of altered collagen bundles. It has been seen in association with multiple disorders including diabetes mellitus, renal failure, hyperparathyroidism, liver disease, neurodermatitis, IgA nephropathy, and periampullary carcinoma with jaundice. According to the literature, there is no report of reactive perforating collagenosis in association with pulmonary papillary adenocarcinoma, and our study is the first to report it.

Autoimmune polyendocrine syndromes are a heterogeneous group of rare diseases characterized by autoimmune activity against more than one endocrine organ, although non-endocrine organs can also be affected. We report the association of APS I with erythema annulare centrifugum in an 18-years-old male who presented with multiple figurate erythema spreading on his trunk and extremities along with a history of multiple endocrine disorders such as diabetes mellitus, hypothyroidism, hypoparathyroidism, hypogonadism, and adrenal insufficiency from one year ago. To our knowledge this is a very rare association.

A 61-year-old man was referred to our dermatology department for the evaluation of a single asymptomatic plaque on his left lower back that has been present for one year. The lesion began as an erythematous scaly plaque that slowly increased in size; he had been treated with topical antifungals and topical corticosteroid without any improvement. Clinical examination revealed a solitary erythematous scaly plaque measuring 2.5× 5 cm in diameter.

A 12 years old boy, diagnosed with psoriasis since childhood was referred to the dermatology clinic of Aleppo University Hospital,Syria with the chief complaint of erythematous hyperkeratotic lesions on the palms and soles.