Iranian Journal Of Dermatology
Volume:17 Issue: 1, Spring 2014

The standard patch test is known as the most reliable test to identify and confirm causative agents of allergic contact dermatitis (ACD). Previous studies have shown that the prevalence of specific allergens varies by geographic area. The results of patch test in patients visiting our dermatology clinics with suspected ACD were prospectively investigated and compared with those reported in the literature of Iran. We performed the European Standard Series patch test produced by Almiral Hermal GmbH, containing 28 allergens in a group of 100 patients (55 females and 45 males) with suspected ACD who were referred to Emam Reza and Ghaem Hospitals, Mashhad, in 2010-2011. The tests were read after 2 and 4 days. Fifty-four percent of the patients had 1 or more positive reactions of which 65% were relevant to current or past dermatitis. Positive reactions were due to 12 allergens. The most frequent allergens were nickel sulfate (25%) and potassium dichromate (25%), followed by cobalt chloride (15%), thiuram mix (11%), para tertiary butylphenol formaldehyde resin (5%), fragrance mix II (3%), para-phenylenediamine free base (3%), colophony (1%), wood alcohols (1%), mercapto mix (1%), budesonide (1%), and sequiterpene lactone mix (1%). The positive reaction to nickel was significantly more common in women (p<0.001). Men showed significantly more positive reactions to chrome (p<0.001). According to the localization of ACD, hands, as the most common site, were involved in 59 (59%) cases, followed by the feet in 28 (28%) cases. Nickel sulfate and potassium dichromate are the most common allergens in Iran. As the causative agents of contact dermatitis are different in various geographic areas, modifying standard patch test series in each region with regard to its allergen prevalence might be a reasonable and cost effective approach for more appropriate preventive measures and therapeutic strategies.

The description on patients with pigmented back patches is rarely reported in the literature. We decided to study the clinicopathological aspects of these patients for reaching a better understanding of this disease. In this study, the clinicopathological aspects and probable responsible factors in the manifestation of posterior pruritic pigmented patches in patients referred to the dermatology clinic of Qaem University Hospital from October 2007 to September 2009 were surveyed. All 60 patients who were enrolled in our study were female with a mean age of 31.43±9.71 years. Six patients did not consent to biopsy. The most common finding in pathological examination of the skin samples of the 54 patients was the presence of melanophage in the dermis in 100% of them. After considering all findings in the medical history, physical examination and histopathological studies, the final diagnosis was as follows: macular amyloidosis in 26 (48.15%), post-inflammatory hyperpigmentation in 14 (25.93%), rubbing melanosis in 9 (16.67%), notalgia paresthetica in 3 (5.55%), and papular amyloidosis in 2 (3.10%) patients. According to our results, the most common causes of posterior pruritic pigmented back patches are macular amyloidosis and post-inflammatory hyperpigmentation.

Acne vulgaris is a common skin disorder that affects 79% to 95% of the young population. Some studies have focused on the role of overweight and obesity in initiation and exacerbation of acne. This study investigated the relationship between BMI and the severity of acne. This cross-sectional study was conducted on 107 acne patients. One form was completed for each patient with regard to demographic characteristics including age, sex, weight, height, BMI, and also the severity of acne based on the Global Acne Severity Scale (GEA Scale), duration of the disease, type of medication, smoking history, duration of exposure to sunlight and intake of dairy products and chocolate. In this study, 93 patients (86.9%) were female and 14 patients (13.1%) were male, with a mean age of 22.5 years. The mean BMI of the participants was 23.36 kg/m2. With regard to acne severity groups, the moderate acne group had the highest frequency in total (37.4%). The highest mean BMI was seen in the very severe acne group (24.4 kg/m2), and the lowest mean BMI was observed in the severe acne group (21.86 kg/m2). There was no significant correlation between the acne severity and BMI (p=0.806).The mean disease duration was 4.13 years, which was not significantly associated with BMI. There was no significant association between the type of medical therapy and BMI. The prevalence of acne with severity more than moderate was much lower in patients who were underweight (BMI less than 18.5). However, this study showed no statistically significant difference in BMI among people with different severities of acne. Population-based studies, as well as age restriction of the participants, can lead to more accurate and reliable results in this regard.

The higher frequency of malignant skin tumors is of great significance in renal transplant recipients (RTRs) who should receive immunosuppressive therapy for a long time. This study was designed to determine the frequency of malignant skin tumors in RTRs in Imam Reza Hospital, Mashhad, Iran, in 2001-2002. This descriptive study was performed on 322 recipients who were examined by a dermatologist for malignant skin tumors in the renal transplant unit. A questionnaire containing a detailed history of age, sex, and site of the lesion, time of transplantation, occupation, and time of cancer development was completed for patients with a biopsy proven skin cancer. Nine patients (2.8%) had malignant skin tumors. Five patients (55.55%) had Kaposi sarcoma (KS) and 4 patients (44.44%) had non melanoma skin cancer (NMSC). The mean age of the patients was 44.4 ±11.4 years. Eight patients (88.88%) were male. The mean time to development of Kaposi sarcoma and NMSC development was 9.1 months and 5.75 years, respectively. Three patients (60%) with Kaposi sarcoma had lesions on lower extremities and all the NMSCs were located in the head and neck region. Outdoor occupations were seen in at least 50% of NMSCs. This study again showed the importance of regular dermatologic examination for early diagnosis of skin malignancies, particularly, in high risk groups including renal transplant recipients.

Vitiligo is a common acquired disorder of the skin. The disease is characterized by depigmented macules and patches on the skin. Autoimmunity has a crucial role in the pathogenesis of the vitiligo. Vitiligo is frequently associated with different autoimmune diseases such as thyroid abnormalities and diabetes. This study aimed to evaluate the association between vitiligo and diabetes mellitus. This case-control study was conducted on 70 patients with established vitiligo disorder and 70 non vitiligo individuals as the control group. In the case group, we performed two tests, fasting blood sugar (FBS) and oral glucose oral tolerance test (OGTT), while only FBS was checked in the control group. The results of our study showed that out of 70 people in the case group, 18 (25.71%) had impaired FBS while only 4 (5.7%) had impaired GTT3. Statistical analysis showed p-value=0.015 which indicated a significant difference in impaired FBS between case and control groups. We had half and 1 hour GTT data (GTT1 and GTT2) and all patients with impaired GTT1 (4 individuals) and GTT2 (5 individuals) were females with a significant difference (P-value = 0.021 and 0.017, respectively). Periodical laboratory investigation for diabetes mellitus in vitiligo patients, particularly in females, seems to be necessary.

Non melanoma skin cancer (NMSC) is the most common cancer worldwide. In most cases, the general outlook is excellent; however, local recurrence or metastasis can occur. In this study, we investigated possible tumor and host characteristics affecting the treatment outcome in our department of radiation oncology. We retrospectively studied cases with non melanoma skin cancer (NMSC) who were consecutively referred to department of radiation oncology in Omid and Ghaem Hospitals between 1997 and 2007. The effect of the patients’ characteristics (age, sex), tumor characteristics (histology, size, location), and treatment modalities on prognosis were evaluated. We studies 426 patients with a median age of 65 (range: 14 to 102) and a male to female ratio of 1.4:1. Pathologic review showed 72% of the patients had basal cell carcinoma (BCC) and 28% had squamous cell carcinoma (SCC) with a 5-year event free survival of 87±3% and 67±8%, respectively (p < 0.001). The local recurrence rate was higher in cases with scalp lesions (35%). The patients who underwent combined modality treatment experienced significantly more instances of failure as compared to those receiving radiotherapy alone (5-year event free survival of 81±6% vs. 84±6%, p=0.04) which reflects the higher number of cases with adverse features including larger lesions and/or a positive surgical margin in this group. Sex, age, and multifocality were not significant predictors of prognosis. SCC histology and scalp location were predictive of higher rates of treatment failure in patients with NMSC. There was no correlation between age, sex, multifocality and overall outcome. The higher rate of recurrence in cases receiving combined modality treatment is most probably due to the high number of tumors with adverse prognostic features in these cases.

Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare variant of adenoid cystic carcinoma (ACC) which originates from the skin adnexa, most probably eccrine and apocrine glands. This tumor has a head and neck predilection and also occurs in the chest, abdomen, back, and perineum. We hereby present a 63-year-old man with PCACC located on the shin. No previous similar case has been reported in English literature; therefore, we decided to share our experience about its clinical behavior, histopathologic findings, and management.

We hereby report a 79-year-old Iranian man presenting with nail dystrophy and subsequent development of purpuric and ecchymotic plaques, hemorrhagic bullae, and infiltrated papules on the head, neck and trunk. Histological examination of the gingiva, bone marrow aspiration, and biopsy confirmed the diagnosis of primary systemic amyloidosis. In this case, nail dystrophy was the presenting sign of primary systemic amyloidosis, which is a recognized but rare manifestation of this disorder. According to this case report, we could suggest that nail dystrophy may provide a clue for early diagnosis of primary systemic amyloidosis, which would ultimately increase the survival of the patient.

Bacillary angiomatosis (BA) is a rare condition that usually affects immunosuppressed patients. It is a vascular proliferative disorder due to Bartonella henselae or B. quintana. We present here an immunocompetent patient with BA. There was no history of the patient direct or indirect contact with cats.