Iranian Journal Of Dermatology
Volume:21 Issue: 1, spring 2018

Active Leptospermum honey has non-peroxide antibacterial and anti-inflammatory effects, rendering it suitable for wound healing. Leptospermum honey is endemic in New Zealand belonging to the manuka bush (Leptospermum scoparium). The objective of the present research was to compare the efficacy of manuka honey dressing with conventional dressing regarding skin graft donor sites following a burn injury. This study was carried out in the department of surgery, Iran University of Medical Sciences, Tehran, Iran. It is a noncontrolled prospective trial, and an open-label study, analyzing Leptospermum honey and conventional dressing for the treatment of donor site areas for skin grafts. Data were collected from 15 eligible patients with burn wound. Two independent donor sites were formed, one of which was treated with active Leptospermum honey dressing and the other covered through the conventional method. Further collected was information regarding subjects’ demographics, self-reported pain (VAS scale), wound surface areas and bacterial wound culture. In the treatment of skin graft donor sites, honey proved to be less painful compared with the conventional group (P=0.001). Three and seven days following treatment, a significant decrease was observed in the mean wound surface areas in the honey group (P=0.001). There was no significant difference between honey and conventional dressings with regards to the rate of infection (20% in honey dressing versus 40% in conventional group; P=0.068). Active Leptospermum honey dressing accelerates the healing process, decreases pain and has antimicrobial activity and can be used for care of skin graft donor sites.

Atopic dermatitis is a chronic, recurrent inflammation of the skin, accompanied by severe pruritus. Immune system dysregulation and skin barrier defects are associated with the abnormalities in atopic dermatitis. Myriad pieces of evidence have pointed to the major roles of LL-37 and interleukin-31 (IL31)in atopic dermatitis. The studies on atopic dermatitis are still limited in Indonesia, particularly in Malang city. The objective of the present study was to understand the association of LL-37 and IL-31 serum levels with SCORing Atopic Dermatitis (SCORAD) in atopic dermatitis patients. The present research is an analytical observational cross-sectional study with 30 atopic dermatitis patients as subjects. Through a consecutive sampling method, samples were collected from the outpatient clinics of dermatovenereology and pediatric department, Dr. Saiful Anwar General Hospital (RSSA), Malang, Indonesia. LL-37 and IL-31 serum levels were examined via Enzyme-Linked Immunosorbent Assay (ELISA) method. Subjects were allocated into two groups of atopic dermatitis severity, mild and moderate-severe, based on the SCORAD index. Based on the Pearson correlation test, there was no correlation between LL-37 serum level, IL-31 serum level and the SCORAD score (r=-0.238 with P=0.205, and r=0.15 with P=0.939). LL-37 and IL-31 serum levels are not associated with atopic dermatitis severity.

Diabetes is an important metabolic disease with myriad manifestations and complications, affecting many people. Cutaneous infections impact numerous diabetic patients. Among different bacterial infections in diabetic patients, the infections caused by mycobacteria other than Mycobacterium tuberculosis (MOTT) eventuate in complications owing to the paucity of accurate detection methods. The articles reporting nontuberculous mycobacteria (NTM) in cutaneous infections of diabetic patients, published until the end of 2017 were assessed in the present research. The organisms reported from cutaneous infections of diabetic patients are Mycobacterium chelonae, Mycobacterium abscessus, Mycobacterium immunogenum, Mycobacterium kansasii and Mycobacterium fortuitum. NTM infection, along with prolonged disease cycle, decelerates the healing process in diabetic patients. Considering NTM during infection diagnosis, along with other possible opportunistic bacteria, conduces to accelerating the treatment process. In most cases, clarithromycin and erythromycin have been reported as effective alternatives for the treatment of diabetic patients.

Subcutaneous fat atrophy at the site of multiple injections can follow intradermal or intramuscular administration of steroids to treat inflammatory diseases. This condition takes several months to develop, and usually patients seek medical attention due to cosmetic deformities. Several methods, including fat transfer, filler injection and normal saline injection haven been proposed to treat steroid-induced atrophy. However, no standard procedure has been established for normal saline injection in terms of quantity and time interval between sessions. Normal injectable saline was administered every other week for 3 months, followed by 3 months’ rest. During follow-up, the response was satisfactory. As far as the authors are aware, this is the first demonstration of this method’s applicability to cases of steroid-induced atrophy in pediatric settings.

PHACES syndrome (Posterior Fossa Malformations, Hemangioma, Arterial Anomalies, Cardiac Defects and Coarctation of the Aorta, Eye Abnormalities, and Sternal Abnormalities or Ventral Developmental Defects) is a rare neurocutaneous syndrome, which characteristic feature is large segmental hemangioma. Extracutaneous involvement is an important cause of morbidity in this syndrome.
Described below is an infant with large hemangiomatous lesions on the right side of the face, suprasternal notch, midline sternal defect and supraumbilical raphe. Based on the new consensus on the diagnostic criteria of PHACES syndrome, a definitive diagnosis of PHACES syndrome has been corroborated. Accordingly, our patient was analyzed with regards to other clinical features through magnetic resonance imaging of the head, neck and abdomen, all of which were normal. In echocardiography, the patient showed atrial septal defect, in addition to ipsilateral conductive hearing loss, contralateral cataract and Horner’s syndrome, which was reported only in very few cases. The clinical presentation of the present case was different from most previous reported ones, as segmental hemangioma in PHACES syndrome was, for the most part, located on the left side of the face and ocular involvement was predominantly reported ipsilateral to hemangiomatous lesion.

For more than 25 years, honey has been employed to facilitate the healing of complex wounds with excellent results. Here, we report the case of a two-and-a-half-year-old agammaglobulinemia patient admitted in our unit for severe sepsis with extensive skin necrosis in the groin, penis and scrotum. An Ecthyma Gangrenosum was corroborated by the isolation of Pseudomonas aeruginosa in wound swab culture. The child was treated by broad-spectrum antibiotics. Following resuscitation, the prognosis of external genitalia remained reserved. An extended necrosectomy was performed on the groin, leaving a large and deep wound. No improvement occurred with standard local therapy; moreover, the striking particularity of the present immunosuppressed case was that necrosis extended and engaged the genitalia. Such condition left us with no alternative except to try honey dressings without much conviction, which, surprisingly, resulted in an improvement in the wound, until total healing was achieved. Honey seems to be the local treatment of choice for ecthyma gangrenosum.

It is a challenging task to diagnose mycosis fungoides (MF), a type of primary cutaneous lymphoma, in the early stages of its development, due to the unspecific presentations associated with the disease. Histopathology and immunohistochemistry conduce to a more definite diagnosis. Presence of atypical T-cells in epidermis and upper dermis is the most significant pathologic finding. Herein, we present an 80-year-old lady with unusual generalized lesions resembling prurigo nodularis for 3 years, who was finally diagnosed as a case of MF with eosinophilic infiltrations in her lesions and serum eosinophilia.

A 51 year old woman was referred to dermatology clinic with multiple asymptomatic erythematus papules and plaques on her back, which she had developed over the previous 2 months ago. In the dermatological examination, there were multiple atrophic papules with hypopigmented centers and sharp borders on her back, some of which were annular with elevated violaceous borders (Figures 1, 2). Further observed were multiple purple, polygonal, shiny papules and plaques on her lower extremities. Mucosa was normal, and there was no nail change. The general physical examination was normal, and she had no family history of similar problems. An incisional biopsy was carried out on one of the atrophic papules.