Iranian Journal Of Dermatology
Volume:24 Issue: 3, Summer 2021

Skin disorders in neonates can be considered as determining concepts for prognosis and genetic counseling. So far, few studies have investigated the relative frequency of neonatal skin disorders. The present study aimed to investigate cutaneous lesions and their relationship with other variables in neonates hospitalized in the neonatal intensive care unit (NICU). This cross-sectional study was conducted on 403 neonates hospitalized in the NICU of Rasoul Akram Hospital in 2014. After selecting the patients via convenience sampling, data were collected from the medical records. Of the 403 neonates, 366 (90.8%) had no cutaneous lesions, while 37 (9.2%) had cutaneous lesions. Among the latter group, 18 (48.6%) cases were pathological. According to the results obtained, the gender, type of delivery, gestational age, and reason for hospitalization were not related to the presence of cutaneous lesions and their pathological status (P > 0.05). Moreover, gender, gestational age, and reasons for hospitalization had no significant relationship with the lesion type (P > 0.05). The type of delivery had a statistically significant association with the kind of cutaneous lesions (P = 0.043). Cutaneous lesions in neonates hospitalized in the NICU were less frequent in the present study compared to those in other studies, which can be attributed to the retrospective nature and the lack of direct medical examination of patients.

Psoriasis is a chronic and recurrent inflammatory skin disease. In some recent studies, the association between this disease and migraine headaches has been indicated. The present study aimed to determine the frequency of migraine headache in patients with psoriasis vulgaris. In this cross-sectional study, 72 patients with psoriasis vulgaris referred to dermatologists in Semnan from April 2018 to September 2018 were included using the complete enumeration method. After the confirmation of migraine headache by a neurologist, the migraine severity and clinical features were assessed. Data were collected and analyzed by SPSS 16 software. Among 72 patients with psoriasis vulgaris, 15 (20.8%) had a migraine. In patients with migraine headache compared to others, the mean and standard deviation of the visual analog scale-based headache severity (8.33 ± 1.05 vs. 4.11 ± 2.30, P < 0.001), MIDAS-based headache severity (13.85 ± 2.48 vs. 4.98 ± 2.11, P = 0.004), and PASI score-based psoriasis severity (22.55 ± 7.08 vs. 5.38 ± 2.95, P = 0.001) were significantly higher. The prevalence of migraine headaches is significantly higher in patients with psoriasis vulgaris, and patients with severe psoriasis are more likely to suffer from migraine headaches. We recommend screening for migraine headaches in patients with psoriasis, especially when the relevant risk factors are evident. High-risk patients should be given further consideration, facilitating the achievement of better management and higher patient satisfaction.

Periorbital hyperpigmentation (POH), a common problem of multifactorial etiology, is obvious on the face and can affect patients’ quality of life (QoL). It is essentially a clinical diagnosis, but dermoscopy might aid in further classification of the disease. Also, it might give us a clue regarding the etiology and help in the treatment, as different types of POH respond to varying treatments. We aimed to assess clinical, dermoscopic patterns and quality of life using the Melasma Quality of Life (MELASQOL) scale in POH and to compare it with controls. Detailed histories were obtained from 100 patients with POH. The clinical and dermoscopic examination was done, and the obtained results were compared against 100 controls. The MELASQOL scale was used to assess QoL. Family history (P = 0.013), lack of sleep (P = 0.003), stress (P = 0.001), and eye rubbing (P = 0.01) were the probable risk factors. Blotchy pattern (P < 0.0001), speckled pattern (P < 0.0001), and telangiectasia (P = 0.007) were the significant dermoscopic findings. Controls showed pseudoreticular (P < 0.001) and superficial dilated veins (P < 0.0001). Quality of life was affected in 30.6% of patients; it was more affected in grade 4 POH. Dermoscopy will aid in the classification of POH. Blotchy pattern, speckled pattern, and telangiectasia are the typical dermoscopic patterns, more so in higher grades. QoL may be affected in POH. However, MELASQOL is not adequate to assess QoL in POH.

Cutaneous verrucae (warts) are benign epithelial proliferations caused by human papillomavirus (HPV). HPV acts by upregulating epithelial cell replication and downregulating host immune responses. Hence, treatment could be aimed at the virus (via antiviral drugs like valacyclovir) or the immune system (via immunomodulators like zinc sulfate). It is important to identify which pathogenesis should be preferably targeted for safe and effective therapy. We aimed to compare the efficacy and safety of oral valacyclovir versus oral zinc sulfate in the treatment of cutaneous verruca. Fifty patients clinically diagnosed with warts were randomly divided into two groups: Group A (n = 25), treated with oral valacyclovir (1000 mg/day), and Group B (n = 25), treated with oral zinc sulfate (400 mg/day). All patients were evaluated using a Visual Analogue Scale (VAS) and the Physician’s Global Assessment (PGA) and were followed up for 12 weeks. The results were analyzed using R software version 3.6.0. A significant decrease in the number of warts from baseline to the fifth follow-up visit was noted in Group A (P < 0.05) but not in Group B (P > 0.05). Both the groups showed a significant improvement visit-wise (P < 0.05) with respect to both VAS and PGA scores, but Group A (25.00 ± 28.58 and 1.60 ± 1.61; P < 0.05) showed marked improvement compared to Group B (60.40 ± 8.89 and 2.96 ± 0.35; P < 0.05). Oral valacyclovir is more efficacious than oral zinc sulfate in the treatment of cutaneous verrucae. Both are equally safe.

Lichen planus (LP) is a chronic inflammatory disease of unknown etiology. There is conflicting data on the link between LP and metabolic syndrome. This study evaluated the association of chronic subtypes of LP, namely oral lichen planus and lichen planopilaris (LPP), with metabolic syndrome. In this cross-sectional study, 66 patients with oral and follicular LP were evaluated for metabolic syndrome based on the US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) criteria and were compared against 66 healthy controls. Waist circumference, body mass index (BMI), systolic and diastolic blood pressure, fasting blood sugar (FBS), and lipid profile were measured for each individual. There was no significant difference in the prevalence of metabolic syndrome (13 [19.7%] vs. 8 [12.1%]; P = 0.23) and dyslipidemia (51 [77.3%] vs. 49 [74.2%]; P = 0.68) between the study groups. These findings remained statistically insignificant in both genders. The waist circumference (P = 0.008) and diastolic blood pressure (DBP) (P = 0.02) were significantly higher in the LP group than the healthy individuals. Our data showed that each unit increment in waist circumference and DBP leads to a 4.1% (P = 0.02) and 4.7% (P = 0.03) increase in the chance of LP,respectively. Patients with oral LP and LPP do not have a higher prevalence of metabolic syndrome or dyslipidemia than healthy individuals. However, they are more vulnerable to central obesity and high diastolic pressure, for which they should be routinely screened.

Linear skin eruptions are commonly encountered in dermatology practice. They may be the manifestations of various skin diseases resembling each other, leading to difficulty in diagnosis and treatment. This study aimed to document linear dermatoses and analyze them demographically, clinically, and etiologically in order to facilitate diagnosis. A cross-sectional study was conducted on 100 patients presenting with linear skin eruptions to a tertiary care center’s dermatology outpatient/inpatient department over two years (2016 to 2018). These patients were evaluated and classified after clinico-etiological correlation into several subgroups of acquired and congenital linear skin eruptions. The major etiological group encountered was acquired dermatoses (79%), followed by nevoid/congenital dermatoses (21%). Among acquired dermatoses, the majority belonged to the papulosquamous group (33%), mostly lichen striatus cases (21%). The significant group were ≤ 40 years and ≤ 20 years in the acquired and papulosquamous groups, respectively (P = 0.001). In nevoid/congenital dermatoses, linear verrucous epidermal nevus was the predominant group (10%). We also attempted to find correlations with variables like gender, duration of symptoms, and distribution; however, there was no statistically significant correlation. Among other causes, 56% had the Blaschkoid distribution (P = 0.007). This novel study attempted a comprehensive clinicoetiological compilation of linear skin eruptions by analyzing many variables and risk factors. It documents some uncommon dermatoses that occasionally present with linear configuration and need to be considered in the differential diagnoses.

Melasma is a hypermelanosis disorder of the skin induced by UV radiation, which triggers various inflammatory mediators, including prostaglandin E2 (PGE2) and interleukin-17 (IL-17). This study aimed to evaluate the difference in serum PGE2 and IL-17 levels between melasma and non-melasma patients. We consecutively sampled the melasma and nonmelasma patients in the Dermatovenereology Outpatient Clinic of Dr. Saiful Anwar Hospital, Malang, Indonesia, from November to December 2017. As many as 46 people, ranging from 21–55 years old, were divided into two groups based on the inclusion and exclusion criteria. The examination of PGE2 and IL-17 serum levels was done using ELISA. The average serum PGE2 level was 886.04 ± 785.32 ng/L in the melasma group and 541.70 ± 408.54 ng/L in the non-melasma group. The average serum IL-17 level was 82.23 ± 61.08 ng/L in melasma subjects and 52.66 ± 28.62 ng/L in non-melasma. The increased PGE2 serum level in melasma plays a role in the process of melanogenesis in keratinocytes and melanocytes and affects the mechanism of vasodilation. IL-17 augments COX-2 levels, thereby causing chronic melasma.

Antropometheric measures can widely vary among different populations. Given the rising popularity of nonsurgical and surgical aesthetic procedures, standard facial anthropometric measurements are necessary for evaluating the outcomes of cosmetic and rejuvenating procedures. This study aimed to determine the anthropometry profile of Persian women, focusing on key facial parameters. Our secondary goal was to explore any change in these dimensions secondary to rhinoplasty. Facial anthropometric measurements were successfully evaluated in 207 healthy Iranian adult women. Using nine landmarks (trichion, glabella, nasion, subnasale, labiale superius, labiale inferius, gnathion, endocanthion, and exocanthion), ten standard anthropometric measurements and two angles were obtained. The measurements were analyzed separately for those with a history of rhinoplasty and those with a natural nose. The height of the upper third, middle third, and lower third of the face was 7.04 (36.43%), 5.61 (29.04%), 6.67 (34.53%) cm, respectively. Other key measurements included: total face height 19.33 cm, nasal height 5.62 cm, philtrum length 1.61 cm, lower lip to gnathion 3.50 cm, right palpebral fissure length 3.79 cm, left palpebral fissure length: 3.82 cm, interocular diameter 3.71 cm, nasolabial angle 80.06°, and frontonasal angle 135.47°. There was no significant difference between the measurements for those with or without rhinoplasty. Also, the different age groups (18-25, 25-40, and 40-65 years) were statistically similar in these measurements. The difference in anthropometric measurements of this study with previous reports reveals the necessity of using specific anthropometric standards for Persian/Iranian women.

Palmoplantar psoriasis (PPP) and hyperkeratotic eczema (HPKE) are common and troublesome entities affecting the palms and soles. The diagnosis is made clinically, but differentiation is difficult; histopathology helps but is often impossible in daily practice. Dermoscopy is increasingly utilized to diagnose inflammatory disorders and has been used to differentiate PPP from HPKE. The present study was carried out to evaluate the role of dermoscopy in the differentiation of PPP and HPKE in a tertiary care center of eastern India. This hospital-based observational study included 20 patients with each of clinically diagnosed PPP and HPKE. Dermoscopy examinations were done, and the results were tabulated and summarized. Fisher’s exact test was employed to assess statistical significances in differences. Diffuse white and yellow scales were found in both PPP and HPKE without any significant difference. Brown orange globules, clustered dotted vessels, yellow, orange crusts, and perilesional scaling were found more in HPKE (P < 0.05). On the other hand, uniformly dotted vessels and background erythema were more characteristic of PPP (P < 0.05). The results of the current study had deviations from the results of studies done abroad, which can be ascribed to differences in skin color. Dermoscopy is a valuable tool to sort out diagnostic dilemmas in cases of PPP and HPKE. It should be used more commonly to gain more experience and information in the diagnosis of inflammatory dermatoses.

Vitiligo is a chronic pigmentary disorder of the skin. Although predominantly asymptomatic and not life-threatening, vitiligo may considerably affect patients’ quality of life (QoL). It has been suggested that vitiligo patients suffer from low selfesteem and poor body image, which may cause a lower level of QoL. The objective of this study was to evaluate the effect of vitiligo on patients’ QoL in Herat, Afghanistan. This descriptive study was conducted at Hooshmand Skin and Cosmetic Hospital and the associated phototherapy center from November 2015 to April 2017. A total of 170 patients above 16 years of age were recruited. A valid translated Persian version of the Dermatology Life Quality Index (DLQI) was completed by subjects, and data were collected using structured datasheets. On average, patients were 27.84 ± 10.74 years old, and 40.6% were males. The overall mean DLQI score was 9.72 ± 5.82, including 9.93 ± 4.64 in women and 9.42 ± 6.11 in men. The DLQI score was significantly related to the age, type of disease, treatment history, and employment status. Compared to males’, females’ QoL was more impaired in feeling (Q2) and type of clothing (Q4) (P = 0.020 and P = 0.021, respectively). Vitiligo patients showed a moderate limitation in their QoL. Hence, the managing team should focus on the QoL and psychosocial well-being of vitiligo patients in addition to their clinical condition.

During the current coronavirus disease 2019 (COVID-19) pandemic, patients with malignancies like primary cutaneouslymphomas (PCLs) are considered at high risk for severe disease progression given their underlying condition. Mycosis fungoides (MF) is a type of PCL that often needs lifelong treatments, including immunosuppressive drugs that predispose patients to catastrophic COVID-19 outcomes. Accordingly, several issues are to be addressed in the management of patients with MF. First of all, patients with this chronic condition may lose access to healthcare services such as phototherapy and inpatient treatments like electron beam therapy. Secondly, the patients’ anxiety of becoming infected while referring for the follow-up visits might impair their adherence to treatments. Finally, the current situation may affect the management strategies of dermatologists adopted for MF patients.We decided to perform this teledermatology study to assess the clinical condition of patients with MF in our referral center. We also evaluated patients’ perceived anxiety during the COVID-19 pandemic based on the Corona Disease Anxiety Scale (CDAS). Our results demonstrated that lockdown could influence adherence to treatment modalities (especially phototherapy) in these patients.

Atrichia with papular lesions (APL) is a rare autosomal recessive disease caused by a genetic mutation in the human hairless gene’s zinc finger domain. It suddenly appears in the first months after birth and causes irreversible hair loss and keratin cysts on the head, face, and other body parts. Our patient is a 31-year-old female of a consanguineous marriage living in a deprived and remote city of Iran. She suffered from total hair loss and papules spreading all over the body. The patient showed no signs of other physical or mental health issues; she also had healthy physical growth and standard eyesight and hearing. Bone and teeth development were developed, and sweat glands were also robust. APL was diagnosed based on the clinical findings (total hair loss, emergence of papules, morbidity over the body from early childhood, and hypopigmented suture-like lines on the scalp), standard laboratory tests rejecting other differential diagnoses, and lack of response to all available treatments.

The use of highly active antiretroviral therapy (HAART) has prevented opportunistic infections that often lead to death in HIV-positive patients. However, in resource-poor countries, HAART is only initiated at an advanced stage. This could lead to the antiretroviral-induced immune reconstitution syndrome or the immune reconstitution inflammatory syndrome (IRIS). The most frequently implicated pathogens associated with these syndromes are mycobacteria, varicella-zoster, herpes viruses, and cytomegalovirus. There are few numbers of case reports of leprosy that have an association with HIV. Meanwhile, lepra reactions are immunological phenomena that can occur before, during, or at the end of multi-drug treatment (MDT). Here, we report the case of a 39-year-old man who presented with four hypoesthetic skin lesions with left ulnar nerve thickening after two months on antiretroviral treatment. He was diagnosed with borderline tuberculoid leprosy as his slit-skin smear showed negative results with four skin lesions and his skin biopsy revealed tuberculoid leprosy with perineural involvement. The patient was started on the paucibacillary MDT regime consisting of dapsone and rifampicin. However, he developed two new hypoesthetic skin lesions over the left gluteal region and left arm, thus being switched to multibacillary MDT. He further developed a type 1 lepra reaction after one month of the regime, though this was successfully treated with prednisolone.

Recessive dystrophic epidermolysis bullosa (RDEB) is an autosomal recessive disorder that affects type VII collagen, one of the main components of the basement membrane. Patients present with non-healing chronic wounds in the body, extremities, and mucosal areas. There are many suggestive medical and surgical treatments, but most are ineffective. In this case, we discuss a new laserassisted surgical protocol for these types of patients. A 54-year-old male patient was suffering from RDEB with large, excruciating, non-healing wounds on his extremities dating ten months, with no reasonable improvement, despite receiving intensive wound care. After ruling out other diagnoses (particularly malignancies), treatment was performed with a fractional Er:YAG laser for a single session. After four weeks of follow-up, the patient showed significant improvement, with no considerable complications reported. Fractional ablative Er:YAG laser could be an effective treatment option in RDEB patients. Clinical trials are required with long-term follow-ups for this novel treatment approach.

Lymphangioma is an unusual congenital malformation of the lymphatic system that affects the skin and subcutaneous tissue. A surgical procedure is among the options for lymphangioma treatment, although it can lead to significant complications. The Nd:YAG Laser appears to be one of the safest therapeutic options rarely proposed to treat oral cavity lesions. This paper comprehensively reviewed the studies published from 2010 to date on the treatment of cutaneous and mucosal lymphangioma with different types of lasers. In the current report, an 18-yearold female presented with a lymphangiomatous lesion on the tongue diagnosed through a pathologic study. The patient initiallyunderwent three sessions of pulsed-dye laser (PDL) therapy that evoked an insignificant response. Therefore, the approach was changed to long-pulsed Nd:YAG laser therapy, and a dramatic response was observed within three sessions of the treatment.