Iranian Journal Of Dermatology
Volume:26 Issue: 1, Winter 2023

Alopecia areata (AA) is a chronic, autoimmune disease that causes non-scarring hair loss. Recently, serum vitamin D has been implicated in the etiopathogenesis of AA due to its immunoregulatory effects. Its deficiency can cause a loss of selftolerance and predispose individuals to autoimmune diseases. This study compared the serum vitamin D levels between AA cases and controls. We aimed to compare the serum levels of vitamin D between AA patients and age and sex-matched healthy controls and to elucidate any correlation between AA and vitamin D serum levels in terms of disease pattern, severity, and extent. A case group comprising 25 AA patients and a second group of 25 healthy controls of 10 years of age or older were involved in the study. A detailed history was taken, along with a complete clinical examination. Serum vitamin D levels were measured and compared between the groups. The mean level of vitamin D in cases (17.15 ± 5.01 ng/ ml) was significantly lower as compared to controls (34.58 ± 20.83 ng/ml) (P < 0.001). The duration, pattern, and severity of AA had no significant relationship with patients’ serum vitamin D levels. We demonstrated a statistically significant variation in serum vitamin D between controls and cases, with lower values in patients. Our findings indicate a possible cause-and-effect relationship between low serum vitamin D and AA, which needs further exploration.

Silicone-based products are often used to improve signs and symptoms of hypertrophic and keloid scars. An improved silicone product, ScarLess™ Hydrogel (SH), is a 5% silicone-based super-oxidized hydrogel meant to reduce keloid scars’ vascularity, elasticity, and height. This study aimed to compare the efficacy between SH and hydrocortisone (HCT) 1% ointment in keloid treatment. This study was a prospective, single-centered, randomized, double-blind study involving twenty-eight subjects with keloid scars. The scars were assigned randomly as Scar A and Scar B in a 1:1 ratio to receive HCT or SH under occlusion, respectively, for over 12 weeks. The Patient and Observer Scar Assessment Scale (POSAS) was used for clinical evaluation. According to the POSAS, there were significant improvements in both patient and observer scorings in both treatment arms. SH has equal therapeutic efficacy as HCT in keloid treatment. SH did not present with any safety issues or side effects.

Autoimmune Bullous Diseases (AIBDs) are characterized by blistering skin and mucous membrane lesions. This study evaluated the quality of life and associated factors in patients with AIBDs. In this cross-sectional study, we included all clinicallyand laboratory-confirmed AIBD patients older than 16 years who sought care at the Dermatology and Hair Clinic of Sina Hospital (Tabriz, Iran) from March to September 2020. We collected the demographic characteristics, disease profile, Autoimmune Bullous Disease Quality of Life (ABQOL) score, and Autoimmune Bullous Skin Disorder Intensity Score (ABSIS). The recorded data were analyzed using SPSS v16 software. One hundred patients (44 men and 46 women) with a mean age of 52 ± 2 years participated in this study. Among them, 76 had pemphigus vulgaris, 18 had bullous pemphigoid, and 6 had pemphigus foliaceous. A median score of six was recorded for the ABQOL, and a median score of one was recorded for the ABSISscale. The relationship between quality of life and disease severity was statistically significant (P = 0.001). Also, a weak but statistically significant association was observed between the quality of life and patients’ age (P = 0.049). We demonstrated that increased disease severity significantly impairs AIBD patients’ quality of life. On this account, patients with severe AIBDs require more social, psychological, and financial support.

Mycosis fungoides (MF) is the most common form of primary cutaneous lymphoma, resulting from the infiltration of malignant T cells into skin tissues. The disease has three distinct stages: patch, plaque, and tumor. In the patch and plaque stages, it can mimic the clinical features of benign dermatoses. However, two scoring systems facilitate diagnosis at these stages, which will be discussed in more detail in this study. In this cross-sectional study, all formalin-fixed and paraffin-embedded skin specimens highly susceptible to MF based on clinical examination at the patch and plaque stages were collected from April 2017 to August 2019. They were subjected to H&E and IHC staining tests and examined according to Guitart and Pimpinelli criteria. Out of 78 samples, 76 had histological criteria for MF according to Guitart’s criteria, 54 were immunologically significant according to Pimpinelli’s criteria for MF, and 52 were classified as definitive MF according to both criteria. CD3 and CD4 markers were the most frequent markers, respectively. In contrast to previous studies, the CD7 marker was expressed at 10% or higher in 24 cases. In addition, 65 of 78 samples had a CD8 marker, and only 13 samples were CD8-. In the early stages of MF, a single scoring system does not have sufficient sensitivity for the diagnosis. The triad of the patient’s clinical presentation and histological and immunohistochemical features play a key role in achieving the correct diagnosis.

Infantile hemangioma is the most common type of vascular tumor in childhood. Risk factors for hemangioma include female gender, low birth weight, prematurity, higher maternal age, and multiple gestations. In this study, for the first time in Kerman, we describe and compare demographic features of infants with hemangiomatous lesions treated with two different systemic beta-blockers (atenolol or propranolol), examining their efficacy and adverse effects. Forty-one infants with hemangiomatous lesions admitted to the pediatric dermatology ward of Afzalipour Hospital from 2011 to 2017 were enrolled in this study. Demographic features of infants and their mothers and clinical features and complications of hemangiomatous lesions were recorded. Also, we compared the efficacy and adverse effects of treatment protocols with two betablockers (atenolol and propranolol). Most infants were female (70.7%), and 9.7% were premature. The majority of the lesions were superficial (53.7%) and located in the head and neck area (82.9%). Multiple hemangiomas were recorded in 4.8% of the cases. The most common complication was ulceration (29.3%). Two out of 18 patients treated with propranolol had a complete response rate. Adverse effects were observed more frequently with propranolol (26.8%) than with atenolol (14.6%). In our study, female gender and low birth weight were significantly more common in infantile hemangioma patients than in the normal population. Also, mothers of children with hemangioma had a significantly greater number of miscarriages than the average population. Propranolol and atenolol had no significant difference in efficacy and adverse effects.

Psoriasis is one of the most common skin diseases. For the first time in Iran, we conducted a case-control study to evaluate bone mineral density in patients with psoriasis vulgaris in comparison with a healthy control group (20 individuals in each group). Our study sample included patients referred to the dermatology clinic of Razi Hospital in Ghaemshahr, Iran, between May and October 2019. Densitometry was performed by the DEXA method on the 2nd to 4th lumbar vertebrae and hip bone. Patients’ demographic information and Psoriasis Area Severity Index (PASI) scores were recorded and analyzed using SPSS version 22.

The mean T-score in the case and control groups were -0.47 ± 1.04 and -0.19 ± 0.45, respectively (P = 0.274). The mean T-score had a significant inverse correlation with an age of 40 years or above (r = -0.873 and P < 0.001), disease duration of more than five years (r = -0.599, P = 0.05), and PASI score (r = -0.523, P = 0.001), but had a positive correlation with sunlight exposure (r = 0.581, P < 0.001).

Considering the decrease in bone density in patients with psoriasis and its relationship with the disease severity and duration and the effectiveness of sunlight in increasing bone density, preventive treatment should be provided for all patients to increase bone density and prevent osteoporosis.

Schnitzler’s syndrome is an autoinflammatory disorder presenting with wheals, monoclonal gammopathy, and signs of inflammation. A 55-year-old woman presented with reddish, moderately itchy wheals with intermittent fever and arthralgia for two years. Multiple erythematous, edematous plaques were noted all over the body. Dermographism was present. A diagnosis of chronic urticaria was considered and treated with antihistamines. The patient returned six weeks later with partial symptomatic relief. She was then investigated for the cause of chronic urticaria, and the following differentials were considered: systemic lupus erythematosus (SLE), dermatomyositis, urticarial vasculitis, and auto-inflammatory diseases. The patient was febrile, and her blood investigations revealed leukocytosis and a raised erythrocyte sedimentation rate along with IgM gammaglobulinemia and an M band on serum electrophoresis. Skin biopsy revealed a neutrophilic infiltrate in the dermis. Thus, based on the Strasbourg diagnostic criteria, a final diagnosis of Schnitzler syndrome was made. Urticarial rash is one of the most common complaints encountered by dermatologists. Other extremely uncommon diseases like autoinflammatory disorders (for example, Schnitzler syndrome) can mimic chronic urticaria. The appearance of the rash and associated symptoms should be carefully considered to identify these missed cases. Auto-inflammatory syndromes are severely debilitating, with little awareness among healthcare professionals. Thus, they are often recognized with a diagnostic delay of many years. Early diagnosis of such rare diseases is imperative for effective treatment and to prevent devastating long-term complications.

Leprosy, just like syphilis, has become a great imitator with its various atypical and unusual presentations. It presents in many diverse ways and can be confused with many infectious and non-infectious forms.It is often misdiagnosed as common disorders like psoriasis, pyoderma, angioedema, pre-vitiligo, sarcoidosis, and granuloma annulare. Appropriate history-taking with good clinical examination is required to diagnose atypical presentations of leprosy. Early diagnosis along with appropriate treatment is essential to prevent disability and other complications. We outline a case of lepromatous leprosy with an atypical psoriasiform presentation that mimicked psoriasis. Psoriasiform leprosy presents as erythematous plaques of varying sizes and shapes on the extensor regions of trauma-prone sites like the knees, elbows, and buttocks. This condition mimics psoriasis and is diagnosed as leprosy based on the slit skin smear and histopathology with a special Fite-Faraco stain.

Neonatal lupus erythematosus is a disorder of the fetus or infant caused by certain maternal autoantibodies. Manifestations are usually cutaneous; systemic manifestations are rare. Here, we report a case of neonatal lupus erythematosus, which led to identifying maternal Sjögren’s syndrome.