Iranian Journal Of Dermatology
Volume:8 Issue: 1, 2004

Provisional hypomyopathic juvenile dermatomyositis is a subgroup of clinically amyopathic juvenile dermatomyositis provisional. The diagnostic criteria include: Classic dermatomyositis skin lesions – which have to be confirmed by biopsy –, no involvement of proximal muscles, subclinical involvement of these muscles and normal level of muscle enzymes. These criteria should be present for a minimum of 6 months and maximum of 24 months. Here a 13-year-old boy is presented who developed non-Hodgkin lymphoma 15 months after the diagnosis of his dermatomyositis.

Cyclosporin and azathioprine are immunosuppressive drugs, used widely in kidney transplant patients. A significant association between immunosuppressive therapy and multiple warts was described several years ago. There are also some reports of sebaceous gland hyperplasia in kidney transplant patients receiving cyclosporin. We report herein a 57-year-old woman who developed multiple warts on her hands and feet, lower lid syringomas, sebaceous gland hyperplasia of forehead and multiple mucosal irritation fibromas on tongue after kidney transplantation and a long course of treatment with oral cyclosporin, azathioprine and prednisolone since 6 years ago.

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most frequent skin cancers. The etiology of these tumors is multifactorial: Environmental and exogenous factors, genotype and phenotype factors. The development of malignant neoplasms at sites of previous dermal scars is an uncommon but well recognized phenomenon, and since almost all of them were developed on exposed areas it has been hypothesized that the accompanying atrophy and decreased vascularity and adnexal structures in areas of scarring may render the affected tissues more susceptible to the effects of environmental factors, eg. ultraviolet light. We report four cases of BCC and SCC on old leishmania scars on face, and recommend that any changes on scars must be evaluated clinically and pathologically.

Herein we report a 6-year-old Afghans patient referred to Department of Dermatology, St. AL-Zahra Hospital in Isfahan with ulcerative and nodular lesions disseminated over the face, arms, buttocks, pelvic girdle and legs in 2002. Direct smears of the lesions were positive for Leishman bodies. Leishmanin skin test was negative. He also had dactylitis in some digits and toes. PCR from bone biopsy showed Mycobacterium tuberculosis. So he was treated according to diagnosis of disseminated cutaneous leishmaniasis with tuberculous dactylitis.

Lyme disease is caused by the spirochete Borrelia burgdorferi. Depending on the stage of illness, infection may be limited to the skin or involve the cardiac, nervous and musculoskeletal systems. Herein, we report a case of Lyme disease in a 23-year-old woman from North of Iran (Mazandaran) in early-localized stage of erythema chronicum migrans. The diagnosis was confirmed by the presence of serum antibody using ELISA method.

Sulfur mustard or mustard gas has been widely used as a chemical weapon in the first world war and Iraq-Iran war. It causes acute and chronic complications in lungs, eyes and skin. In skin, mustard is toxic, mutagenic, and carcinogenic via alkylation of cellular proteins in enzymes, cell membranes, cytoplasm and particularly cell nucleus as well as in DNA components of the epidermis, dermis and skin appendages. Herein, we report a 37-year-old man who developed widespread blistering on his right thigh after sulfur mustard exposure in 1988. Now multiple cherry angiomas, decreased hair growth and pigmentary disorder are visible at the site of previous injury.

Cutaneous leishmaniasis (CL) is a parasitic disease, which is hyperendemic in Isfahan, usually caused by L.major and L.tropica. Herein we report a patient with post-mastectomy lymphedema on right upper limb accompanying with the lesions of cutaneous leishmaniasis on the right and left forearms. Following radiotherapy, the lesions on the limb with lymphedema were disseminated. But the lesions on left side showed no change. This finding may be the result of immune disorder due lymphedema and radiotherapy.

Patients with keratotic lesions distributed in a unilateral, linear, zosteriform or localized pattern and revealing histopathologic features of dyskeratotic acantholysis have been reported previously. There is some controversy in the appropriate nosologic classification of this entity. Some authors consider it as a localized form of Darier’s disease while others place it as a variant of epidermal nevus. We report a 19-year-old girl who presented with 14 years history of an asymptomatic, hyperkeratotic area of skin-colored papules in a dermatomal distribution on the dorsum of her left hand and forearm. Pathological evaluation showed acantholysis and dyskeratosis. The controversy regarding the correct classification of such a patient is discussed.

Pretibial epidermolysis bullosa is a rare variant of hereditary epidermolysis bullosa characterized by the delayed onset of lesions and their localization. We present two cases, a 35-year-old woman and a 21-year-old man. They clinically had pruritus, nodular prurigo-like or lichenified lesions, violaceous scarring, milia, nail dystrophy and in one case albopapuloid lesions on the trunk. Physical signs of disease were first noticed between 3 and 9 years of age. Histologic examination showed a subepidermal blister with milia formation, and a mild mixed inflammatory infiltrate. These patients represent an nusual, poorly recognized form of dystrophic epidermolysis bullosa with features that resemble a variety of acquired dermatoses.

Pemphigus is a chronic blistering mucocutaneous disease, classified in immunobullous skin diseases. Infections, particularly septicemia due to Staphylococcus aureus and Pseudomonas aeroginosa are the most common and dangerous disorders due to immunosuppressive therapy in this disease. Infection with nocardia is rare, so that only 6 cases have been reported yet. Herein, we report a 56-year-old man with one-year history of pemphigus treated with prednisolone and cyclophosphamide, who at the same time developed skin and pulmonary nocardiosis. He had a good response to treatment with cotrimoxazole.

Allergic granulomatous angiitis (Churg-Strauss syndrome) is a variant of systemic vasculitis characterized by pulmonary and systemic small vessel vasculitis, extra-vascular granulomas and eosinophilia. Clinical features include presence of asthma and/or allergic rhinitis with constitutional symptoms such as fever and weight loss. Multisystem involvement includes pulmonary infiltrations, monoeuritis multiplex, purpura and cutaneous nodules. Churg-Strauss syndrome is an uncommon condition, occur even more rarely in association with pregnancy and usually have a poor prognosis with increased risk of fetal death. In this article a 23-year-old patients who had developed signs and symptoms of the disease during pregnancy is reported. The full-flown picture of disease was revealed in peripartum period.

Sometimes we see patients with disappearing vermilion totally or in some parts. It seems that the marginal skin has advanced to the lip surface with the same color. It occurs mainly in lower lip. The majority of patients had history of recurrent herpes labialis on their lips, in the same location as disappearing vermilion. Disappearing vermilion is not accompanied by any change in consistency of labial skin. There is no symptom and most patients are unaware of it. Sometimes they refer to the physician for other reasons. Rarely patients, particularly women, complain of the disease. We collected a series of 14 cases of disappearing vermilion to evaluate this disease.