Iranian Journal Of Dermatology
Volume:20 Issue: 3, Autumn 2017

Porokeratoses are uncommon hereditary or acquired keratinization disorders due to abnormal clones of keratinocytes in the epidermis. Porokeratoses have several clinical features which may occur simultaneously. A rare type is verrucous porokeratosis (VPK). Herein, we present a 47-year-old man with a 4-year history of perianal verrucous lesions and one year history of annular pruritic lesions on his extremities. Tissue biopsies from the annular and verrucous lesions showed cornoid lamellation in the horny layer with epidermal invagination and lichenoid reaction in the dermis that favored porokeratosis (PK). Genotyping for human papilloma virus (HPV) on the paraffin block of the verrucous lesion was negative. Shave excision was performed with moderate improvement. Annular and VPK lesions might coexist in an individual patient and we should consider VPK in the differential diagnoses of perianal warty lesions.

Vitiligo is an acquired skin discoloration with melanocytic destruction. Vitiligo is associated with other autoimmune disorders; hence, an autoimmune etiology is among the most important theories for this disorder. The nails can be involved in numerous cutaneous or systemic non-cutaneous disorders. We have taken into consideration previous studies on nail abnormalities in vitiligo and alopecia areata (AA), which are ethologically closely-related, in addition to the few, not well designed studies on nail changes in vitiligo, and lack of similar studies in Iran. This case-control study was conducted to evaluate the autoimmune etiology of vitiligo with a larger number of participants.
In this case-control study, we assessed the nail characteristics of 303 participants at Razi Hospital, Tehran, Iran from 2013-2014. These changes were also assessed in terms of diseases properties of the case group and included distribution, duration, and presence of other concomitant cutaneous disorders.
There was a statistically significant odd’s ratio (OR) for leukonychia in the case and control groups. The relationship between the prevalence of leukonychia and disease duration was meaningful (P0.05). There was no other significant difference between each type of nail abnormality in the case and control groups. We observed no association between these abnormalities and disease duration. None of the nail abnormalities, including leukonychia, had an association with distribution pattern of the disorder.
Leukonychia was the most common abnormality in nails of vitiligo patients that had a relation to disease duration.

ABO blood group antigens may play a role in the pathophysiology of certain diseases. Several studies have investigated the relation between blood group and autoimmune disorders. In this research, we evaluated the associations between ABO blood types and rhesus (Rh) factor in pemphigus patients.
In this case-control, hospital-based study, we evaluated the prevalence of blood group on 110 pemphigus patients and 126 controls. The chi-square test was used to compare qualitative variables and examine the relationship between blood groups and Rh in pemphigus patients and a control group.
Blood group (O) was found in 46.3% (O 38.2%) of patients with pemphigus, followed by blood type A (30.0%; A 27.3%), and blood groups B and AB. Compared to the control group, we noted that the distribution of blood groups, with Rh (P=0.73) or without Rh (P=0.52), did not significantly differ.
Although some associations between blood group antigens and specific diseases have been reported in the literature, this study did not find any statistically significant relationship between blood groups and pemphigus disease.

Psoriasis is a chronic autoimmune skin disorder with relapsing erythematous scaling plaques and joint or nail involvement. A greater occurrence of other autoimmune diseases has been reported in these patients. Additionally, their family members are more likely to be diagnosed with psoriasis. The aim of this study is to assess the prevalence of certain autoimmune diseases in first degree relatives of patients with psoriasis compared with a control group.
In this cross-sectional study we used a questionnaire to compare the frequency of type 1 diabetes, autoimmune thyroid disease, vitiligo, lupus erythematosus, multiple sclerosis, ulcerative colitis, Crohn’s disease, and rheumatoid arthritis in first degree relatives of 109 pathologically confirmed psoriasis cases with the first degree relatives of 109 age-sex matched controls. R programming language (version 3.3.1 for Windows) and the rattle graphical user interface (GUI) package were applied for statistical analysis. A P-value?0.05 was considered to be statistically significant.
We compared 955 first degree relatives of psoriatic patients with 934 family members of the controls. There was significantly greater total autoimmune diseases [odds ratio (OR): 2.74, 95% confidence interval (CI): 1.95-3.87, P First degree relatives of patients with psoriasis had significantly higher autoimmune diseases. This finding was particularly noticed for psoriasis and autoimmune thyroid disease.

Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are 2 inflammatory indicators that increase in many pathologic and physiologic conditions. Pemphigus vulgaris (PV) is an autoimmune skin disease in which autoantibodies against desmogleins cause acantholysis. In this study we have measured ESR and CRP levels in patients with PV to evaluate the relationship between an increase in these markers and disease severity.
In this cross-sectional study, we selected patients with proven diagnosis of PV who referred to the Dermatology referral clinic, Faghihi hospital, Shiraz, Iran during a one year period. There were 30 patients enrolled in this study who provided blood samples to measure their ESR and CRP levels. We used the Mahajan scoring system to determine the disease severity.
In 27 (90%) cases, ESR was normal and 20 (66.7%) cases had negative CRP. There was a significant correlation between CRP and PV severity (P=0.015); however, there was no correlation between ESR and disease severity (P=0.126).
A correlation existed between CRP and severity of PV. Further studies must be undertaken to prove the prognostic role of CRP in PV. The discovery of new prognostic factors can change the treatment strategy and protocol for PV.

Perforating necrobiosis lipoidica (PNL) is a very rare variant of necrobiosis lipoidica (NL), almost always associated with diabetes. A non-diabetic 43-year-old man referred to us with a gradually enlarging plaque on his forehead. The patient was initially diagnosed with cutaneous tuberculosis based on the histopathologic findings, but failed to respond to antituberculosis therapy. Upon further evaluation and observation of the transepidermal elimination of degenerated collagen in the pathology slides, we rendered a diagnosis of PNL. The patient underwent successful treatment with topical tacrolimus and systemic hydroxychloroquine

Cutaneous Crohn’s disease (CCD) is a relatively rare disease. Two-thirds of the affected patients are female with a mean age of onset of 35 years. CCD is divided into a genital type and an extra-genital type, each with their own unique different clinical manifestations. The usual presentation of genital Crohn’s disease (CD) is in the form of erythema and edema of the labia and scrotum. Here, we have reported the rare case of a patient with late-onset genital CCD. The patient was a 61-year-old woman with a history of chemotherapy for breast cancer. She presented with genital, intergluteal, and perianal ulcers without any fistula, sinus or scars, which was treated as an unusual presentation of CD. The patient has not had any intestinal manifestation during three years of follow-up.