Iranian Journal Of Dermatology
Volume:25 Issue: 1, Winter 2022

Xeroderma pigmentosum variant (XP-V) is a genetic disorder that starts in early childhood with a mild disease course. The aim of study was to record all cases of XP-V that were seen and examined over a specific period. This descriptive study included 48 patients; there were 4 (8.33%) patients with xeroderma pigmentosum (XP) and 44 (91.66%) patients with XP-V. Patients with XP-V were divided into childhood and adult-onset types. Childhood-onset type was detected in 34 patients, including 20 (58.82%) males and 14 (41.17%) females. Their ages ranged from 3-25 years, with a mean of 15 years. Freckling and solar keratosis were observed in 100% and 23.68% of patients, respectively, while non-melanoma skin cancer (NMSC) was detected in 8 (21.05%) patients, including one case with squamous cell carcinoma (SCC) and 7 with keratoacanthoma. In the adult-onset type, ten cases were seen, half of each gender. Their ages ranged from 23-60 years, with a mean of 32 years. Patients gave a history of early adult onset of their disease. Skin hyper-photosensitivity was the first problem, followed gradually by other features of solar damage to the face, including freckles and solar keratosis. SCC and keratoacanthoma were each observed in two patients.
The clinical picture of XP-V was similar to ordinary XP but with late age onset and a slower course. The clinical picture of adult-onset XP-V was similar to the childhood type.

Malassezia folliculitis (MF) is a chronic disease that develops in the pilosebaceous unit, caused by Malassezia species. Patients’ characteristics, clinical manifestations, laboratory examination, and treatment choice affect the clinical recovery in patients with MF. This study aimed to identify several potential factors that determine the treatment outcome of MF. This retrospective study was conducted at Dr. Cipto Mangunkusumo Hospital, Jakarta, from 2013 to 2017. Eligible patients diagnosed with MF based on clinical and microscopic examinations were included. Clinical outcomes were defined as complete cure or improvement with a decrease in the subjective symptoms (itchiness) and objective symptoms (lesions). Analyses were carried out using STATA version 5.0, and some analyses and graphics were generated in R (version 3.2.2 for Windows), GraphPad Prism version 6.01, and Microsoft Excel. A total of 30 patients with MF were recruited. Several factors had a significant effect on the clinical outcomes such as predilection site (chest; HR 1.422; 95% CI 1.262–1.696; P = 0.018), isolated systemic therapy (HR 1.915, 95% CI 1.441–2.532; P = 0.002), and combination therapy (HR 1.858; 95% CI 1.350–2.541; P = 0.041). Lesions in the chest area, isolated systemic antifungal therapy, and combination therapy were associated with good outcomes following antifungal treatment.

Psoriasis is a disease that influences the physical, psychological, and social dimensions of the lives of those affected. We aimed to evaluate the effect of psoriasis disease on the quality of life of patients and their partners. Forty psoriasis patients were eligible for inclusion in this study. Each participant’s clinical data were collected, including age, sex, PASI score, history of treatment, family history of the disease, educational level of the patients and their spouse, profession, and history of divorce. The patients and partners completed the Dermatology Life Quality Index (DLQI) and Family Dermatology Life Quality Index (FDLQI) questionnaires, respectively. The results were compared against 40 age and sexmatched healthy individuals and their partners. The mean DLQI score was 11.75 ± 7.25 among patients, and the mean FDLQI score of their partners was 12.20 ± 5.63. There was a significant difference between the patients/partners and the respective control groups in DLQI and FDLQI scores (P < 0.001). There was a significant correlation between disease severity and DLQI/FDLQI scores (P < 0.05). Also, a meaningful relationship was noted between the quality of life of patients and their spouses (r = 0.48, P = 0.001). Besides, the PASI score shared a significant relationship with the DLQI (P = 0.003, r = 0.46) and FDLQI (P = 0.001, r = 0.56) scores. We conclude that psoriasis harms the quality of life of both patients and their families, which deteriorates with an increase in disease severity and PASI scores.

Lichen planopilaris (LPP) is the most common form of immune-mediated scarring alopecia. We evaluated the histopathologic features of LPP in vertical sections of scalp biopsies and compared findings between the scarring and nonscarring phases of the disease. From June 2019 to June 2020, vertically sectioned scalp biopsies of 70 new cases of LPP were examined (H&E) according to North American Hair Research Society criteria. Furthermore, patients were divided into two groups based on either the presence or the absence of vertical fibrous bands, and other histopathological features were compared between these two groups. Characteristic findings of LPP were perifollicular lymphocytic infiltration (97.1%), follicular interface degeneration (60%), and perifollicular plasmacytic infiltration (21.4%). Vacuolar degeneration in the dermo-epidermal junction (38.6%), perifollicular lamellar fibroplasia (67.1%), loss of sebaceous glands (87.1%), perifollicular cleft formation (28.6%), and vertical fibrous tracts (65.7%) were also found. Furthermore, we found a significant correlation between the presence of fibrous tracts with both loss of sebaceous glands (P = 0.005) and the presence of lamellar fibroplasia (P = 0.015). The most common findings in the histopathological examination of LPP slides are perifollicular lymphocytic infiltration and loss of the sebaceous glands. Furthermore, sebaceous gland loss and perifollicular lamellar fibroplasia correlate with the scarring phase of LPP.

Pemphigus vulgaris (PV) is an autoimmune disease with worldwide distribution. Human leukocyte antigen G (HLA-G) is postulated to be associated with this inflammatory and autoimmune condition. However, its role has not been well established in the literature. The study aimed to evaluate the plasma level of HLA-G in PV patients and assess its correlation with disease severity and compare it with normal subjects. Thirty PV patients were enrolled in this cross-sectional study. A blood sample was taken from each participant; samples were analyzed for the soluble HLA-G (sHLA-G) plasma level by applying an ELISA kit (sHLA-G ELISA kit; Exbio, Czech Republic). Patients’ clinical and demographic data were recorded and analyzed. Higher levels of sHLA-G were seen in PV patients compared to the control group (P < 0.05). There was a negative linear relationship between plasma HLA-G level and PV based on all ABSIS indices except for oral involvement (-1 < R < 0); however, these correlations were not statistically significant (P≥0.05). Our data showed higher plasma sHLA-G levels in PV patients, which did not correlate with disease severity.

Simvastatin is a beta-hydroxy-beta-methylglutaryl- CoA (HMG-CoA) inhibitor molecule with several pleiotropic (immunomodulatory, anti-inflammatory, and antioxidant) activities. In this study, we evaluated the protective effect of simvastatin on ultraviolet B (UVB)-induced photoaging of normal human dermal fibroblast cultures by assessing fibroblast proliferation, collagen deposition, and fibroblast morphology. This study was an in vitro experiment using normal human skin fibroblast cell cultures. Fibroblasts were then cultured and observations were made of fibroblast proliferation, collagen deposition, and cell morphology using various concentrations of simvastatin (0 nM, 0.01 nM, 0.1 nM, 0.5 nM, 1 nM, and 5 nM) and UVB exposure (100 mJ/cm2). After UVB exposure, a significant decrease in fibroblast proliferation and collagen deposition was observed. Cells appeared thinner, and fibroblasts were less organized and more pointed. Simvastatin with 0.01 nM, 0.1 nM, 0.5 nM, 1 nM, and 5 nM levels could significantly maintain cell proliferation and collagen deposition compared to UVB-irradiated cell groups without simvastatin. Interestingly, fibroblast proliferation and collagen deposition in the simvastatin group above 0.5 nM were not significantly different from the normal human dermal fibroblast group. An increased level of collagen deposition was also confirmed by observing the fibroblast morphology, which had more red-smeared cells on Sirius red staining. The antioxidant activity of simvastatin might play a role in fibroblast proliferation and collagen deposition, protecting against UVB by inhibiting reactive oxygen species. Simvastatinmaintained fibroblast morphology, possibly by preventing DNA damage and maintaining membrane-bound collagen fiber deposition. Our findings revealed that simvastatin pretreatment mitigated UVB-induced photoaging in human dermal fibroblast cells by maintaining fibroblast proliferation, collagen deposition, and fibroblast morphology.

Nail disorders present with a wide range of manifestations. The problems associated with nail biopsiesmake the diagnosis even more challenging. Identifying the most common features of each nail disorder can prevent unnecessary biopsies and facilitate early diagnosis. We conducted a cross-sectional study on 528 pathology reports, documented from March 2018 to March 2019 in the Razi Dermatopathology Hospital, Tehran, Iran. We extracted the demographic data and the nails’ clinical and pathologic presentations. We used Fisher’s exact test to determine the nail features’ clinicopathological correlations. The mean age of the 359 included patients was 38.81 ± 18.11 years, and 50.81% were male. Benign melanonychia (12.82%), traumatic nail (11.96%), and junctional nevus (11.11%) were the most prevalent disorders. Onycholysis (P < 0.001), longitudinal ridges (P < 0.001), subungual hyperkeratosis (P = 0.003), dystrophy (P = 0.017), discoloration (P = 0.052), and pitting (P < 0.001) correlated significantly with nail psoriasis. The presence of subungual hyperkeratosis, onycholysis, and longitudinal ridges significantly increased the odds of nail lichen planus. Only 6.79% of patients with longitudinal melanonychia had malignant melanoma, while most (26.54%) correlated with benign melanonychia. A detailed examination can narrow the differential diagnosis and avert unnecessary biopsies. However, in high-risk cases, physicians should regularly monitor the nails’ changes and response to treatment.

Radiation therapy is frequently associated with a variety of adverse cutaneous effects. Some of these complications, such as radiodermatitis, are well known. However, some other skin reactions, such as radiation-induced lichen planus (LP) as a kind of isoradiotopic response, are rare, less known, and often underrecognized. An isoradiotopic response refers to the appearance of a secondary dermatosis in previously irradiated areas. In an isoradiotopic response, the new skin lesion presents with all the hallmarks of the primary dermatosis; however, the eruption is restricted to the field of radiation therapy. Radiation-induced LP as a kind of isoradiotopic response refers to the appearance of LP lesions in previously irradiated areas. This article presents a narrative review of the current literature about radiation-induced LP cases. The search was conducted on electronic databases, including PubMed, Web of Science, Cochrane, Scopus, Medline, Embase, and Google Scholar with the keywords, “isoradiotopic response,” “isotopic response,” “Koebner phenomenon,” “lichen planus,” “cancer treatment,” “radiotherapy,” and “radiation therapy.” According to the results of this search, there were only nine case reports of radiation-induced LP in the literature. Due to the limited number of articles published in this field, there are important questions, the answers of which are not known yet. By reporting more patients with post-radiation LP, investigators will be able to gather more information about the pathogenesis of the disease and evaluate the significance of different factors in the development of post-radiation LP.

The coronavirus disease 2019 (COVID-19) pandemic, the scale of its damage to all sectors, and its high rate of mortality urgently called all scientists and researchers into action to find solutions that can mitigate its multi-dimensional burden. As of October 1st, 2021, COVID-19 has claimed more than 4.5 million lives and infected more than 200 million individuals. Therefore, every small effort that can positively contribute to the alleviation of the disease and its spread can tremendously help minimize the damage. The application of light as a therapeutic agent has been effective since the beginning of civilization. During the last century, artificial light and its combination with other chemical substances to fight microorganisms have been applied substantially in many domains, such as therapeutics and immunomodulation. In this review, we present the scalable application of light as an antimicrobial and immunomodulatory agent and its potential in fighting COVID-19 and in mitigating its damages by representing the recent developments in this area.

Erythroderma or generalized scaling dermatitis is a condition marked by redness and scaling of more than 90% of the body surface. This study aimed to review the epidemiological and clinical features of erythroderma patients hospitalized in the Dermatology Ward of Shahid Faghihi Hospital, Shiraz, Iran. This retrospective cross-sectional was conducted from 2001 to 2017 using patient records. All patients with a diagnosis of erythroderma on record were included in the survey, and those whose data were missing or were not compatible with the clinical diagnosis were excluded. Data were analyzed with SPSS version 22 and Stata version 14.2. Overall, 217 erythroderma patients were admitted to this ward, including 119 (54.8%) men and 98 (45.2%) women. The mean age of the patients was 47.27 ± 19.68 years (range: 4-92 years). Moreover, the most frequent cause of erythroderma was drug reaction (67%); lamotrigine, with a frequency of 12 patients, was the most prevalent prescribed medication in patients with drug reaction-induced erythroderma. The mean duration of hospital stay was 6.64 ± 4.50 days; this parameter was directly associated with the erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) level. Pruritus (41.9%) and fever (15.2%) were the most frequent clinical manifestations among these patients. As erythroderma is a dermatologic condition that medications can induce, patients should be informed about the warning signals and course of the disease before certain medications are prescribed.

Pemphigus vulgaris is one of the most common autoimmune blistering disorders, with most patients presenting in late stages with severe and extensive erosions over the skin. Along with systemic management of the disease, it is important to provide local wound care to prevent secondary infection. Here, we report the case of a patient who presented with extensive erosions and showed no response to standard dressing protocols. Thus, it is important to review alternate, easily available, environmentfriendly dressing materials. This case report discusses how banana leaves and gentian violet were used to manage severe and extensive erosions in a pemphigus patient who showed no improvement with modern-day dressings. We also compared the costs of modern-day dressings with the banana leaf dressing used in our setup. Following the success of this methodology, we have been using banana leaves for various chronic non-healing wounds and ulcers.

Genital herpes has superseded the bacterial sexually transmitted diseases (STD) as the most prevalent STD seen worldwide, with an estimated 491 million being affected. It is encountered with an increasing frequency, with a prevalence of 11.9% in the USA, and can present in atypical and severe ulcerative forms, especially in human immunodeficiency virus (HIV)-infected individuals. Though a definitive antiviral treatment with acyclovir, valacyclovir or other derivatives exists, the property of latency and reactivation leads to its increasing incidence and prevalence. The common sites of involvement in the males are the glans, prepuce, and shaft of the penis. The male condom, if used appropriately, is the most effective among the barrier methods of contraception, with an additional advantage of protection from STDs. However, it has a failure rate of up to 13%. The efficacy of condoms in preventing herpes simplex virus 2 (HSV-2) transmission has been studied in several contexts; condoms are often associated with a decreased risk of HSV-2 transmission, yet fallacies can occur. Here, we describe a male who developed a primary episode of genital herpes at the base of the penis, despite proper usage of condoms during intercourse. This presentation can be likened to condom chancre, a much-described entity of primary syphilis.

Acute blue finger syndrome is a rare benign condition with an unknown etiology. It predominantly affects middle-agedfemales and may be associated with pain, itching, or a burning sensation. The bluish discoloration is usually idiopathic, and it is necessary to rule out other causes of blue fingers. The syndrome is a diagnosis of exclusion and has a good prognosis. The sudden color change can lead to patient anxiety, but the physician’s insight regarding the benign nature can alleviate unnecessary distress. We present the case of an adult female with bluish discoloration of the proximal phalanx of the left index finger, which was sudden in onset and asymptomatic. Following a thorough history and workup, the patient was counseled, and on follow-up, a spontaneous resolution was observed. We intend to report this case due to the rarity of blue finger syndrome as well as to highlight the significance of its benign nature and spontaneous resolution.

Papulosquamous disorders constitute one of the common pediatric dermatoses. They are a heterogeneous group consisting of psoriasis, eczema, pityriasis rubra pilaris, and other conditions, where the differential diagnoses are close to each other clinically. Moreover, the presentation of the same disease in children can differ from that occurring in adults. We report two infants with erythematous scaly papules and plaques diagnosed as two different disorders, albeit with a grossly similar appearance. Both these dermatoses are considered to be quite uncommon in infancy and can pose significant challenges in management. These disorders sometimes present with atypical variants, rendering it increasingly difficult to distinguish them. Some of these disorders tend to progress to erythroderma, and the infant may occasionally present directly in the erythrodermic stage, further compounding the conundrum. In such situations, identification of subtle clinical and histopathological clues allows accurate diagnosis, which is imperative for appropriate prognostication and treatment. This article illustrates the importance of histopathology and immunohistochemistry in aiding diagnosis and outlines the management of these disorders while emphasizing the importance of timely intervention in averting inadvertent complications in these young individuals.

Once popularly known as whiskey nose or rum blossom, rhinophyma is a permanent thickening of the nasal skin composed of confluent erythematous papules and prominent follicles. The etiology is not fully known, but many authors describe rhinophyma as the fourth stage of acne rosacea, a chronic inflammatory cutaneous disease characterized by erythema, telangiectasia, papules, pustules, and edema. It is benign yet disfiguring and can be stigmatizing. Here, we report the case of a 54-year-old man who presented with a mass on the nose that had slowly grown over the prior two years. He had a history of acne, treated with isotretinoin 10 mg daily by a dermatologist, one year before the onset of this mass. Examination from the frontal view revealed asymmetric, diffuse, multilobulated skin hypertrophy over the middle and lower nasal vault. On the basal view, there was a 10 x 7 mm epithelizing ulceration over the right alar rim. He underwent a partial-thickness resection of the hypertrophied nasal skin, and the resulting wound was left to heal via secondary intention, with a good cosmetic outcome.