Iranian Journal Of Dermatology
Volume:26 Issue: 4, Autumn 2023

Urticaria is a frequent and difficult-to-treat skin condition, described as temporary erythematous, raised, and itchy skin lesions (wheals) brought on by dilated blood vessels, elevated local blood flow, and increased vascular permeability. It can occur alone or in conjunction with angioedema. Urticaria can be diagnosed and treated in fields other than dermatology; patients often visit general physicians, internal medicine specialists, allergologists, and clinical immunologists. In 2018, the Iranian Society of Dermatology produced a clinical practice guideline on diagnosing and managing urticaria. To update the guideline, the Guideline Development Committee conducted an exhaustive search of scientific papers published on the topic from April 2018 to the end of August 2022, and the new guideline was developed. Finally, the updated guideline was critiqued by members of the Dermatology Board Certificate Examination Panel and chairs of dermatology departments in Iran, and it was improved using their feedback.

With the emergence of the coronavirus disease 2019 (COVID-19) pandemic, many people were affected worldwide.This study evaluated patients’ characteristics and skin diseases at a Dermatology Emergency Unit (DEU) of a university skin hospital in Tehran, Iran, during the COVID-19 pandemic. We also compared the results with those of a previous study performed at the same DEU in 2017. The data of all patients presented to the DEU during the first four months of the pandemic in Iran (February to June 2020) were studied, and variables such as age, sex, complaints, and finaldiagnosis were collected. A total of 3,745 patients (50.3% male) were studied. Infections (32.4%), dermatitis (20.5%), and urticaria (16.8%) were the most prevalent diagnoses in both genders. Infections were significantly more frequent in males (P < 0.001), while urticaria was more common in females (P < 0.001). The highest number of visits occurred between 12:00–18:00 (34.0%) and most patients were between 18–44 years old (48.8%). With the growing number of COVID-19 cases, the DEU of our skin hospital was involved as part of the medical community in screening COVID-19 patients. Compared to the previous study, the general framework of common causes of DEU visits was very similar to that of the non-pandemic era, although a significant increase in the proportion of dermatitis cases was observed. Likewise, the proportion of non-skin complaints was significantly higher, reflecting the public concern about the COVID-19 pandemic.

Psoriasis is an immune-mediated inflammatory disease with unclear pathophysiology. Although diverse medications have been applied, a paucity of knowledge is accessible regarding the use of corticosteroids for psoriasis management. We evaluated the efficacy of corticosteroid pulse therapy in combination with methotrexate versus methotrexate alone for psoriasis treatment. This cohort study was conducted on 51 hospitalized patients with erythrodermic or pustular psoriasis who were assigned to one of the therapeutic interventions of subcutaneous methotrexate alone (n = 33) or in combination with betamethasone pulse therapy (n = 18). The first group was treated with weekly 15 mg subcutaneous methotrexate for six weeks, and the second group received a similar dose of methotrexate plus 3 mg oral betamethasone weekly. The patients were followed for six months and assessed regarding the disease remission, relapses, the interval between the medication and relapse incidence, and patient satisfaction with the regimens. The studied groups were similar regarding gender (P = 0.296), age(P = 0.561), and the type of cutaneous lesions (P = 0.807). Six months follow-up of the two therapeutic interventions revealed insignificant differences in terms of early response to the treatment (P = 0.993), the incidence (P = 0.142) and frequency of relapses (P = 0.928), and the interval period between the treatment and relapse (P = 0.213). Besides, the patients’ treatment satisfaction did not differ between the groups (P = 0.453). Based on this study, combining methotrexate and lowdose corticosteroid pulse therapy does not lead to better outcomes than methotrexate alone for managing pustular and erythrodermic psoriasis. Further studies are strongly recommended.

Pilomatricoma is a benign skin adnexal neoplasm. Various histological features are observed on microscopic examination. We aimed to evaluate this tumor’s demographic and histological features in detail. One hundred cases with a diagnosis of pilomatricoma were selected, and demographic and clinical data were entered into a checklist. The pathology slides were reviewed to confirm the diagnosis. The demographic profile of all patients, including age and gender, primary clinical impression, multiplicity of the tumor, microscopic features, and location of tumoral involvement, were extracted. Qualitative data were summarized using frequencies and percentages. Regarding descriptive analysis, the frequency of each histopathologic feature was calculated. Two groups of patients were identified regarding age. This tumor was more common in males among adult patients, while a female preponderance was seen in those under 18. Most lesions were located on the face (40%), followed by upper (32%) and lower (10%) limbs. In addition to well-known histological features, we observed intraepidermal pilomatricoma in two cases presenting unique histopathologic features. Both showed foci of suprabasal cleft formation, while one showed the Borst-Jadassohn phenomenon. These features, in addition to sebaceous differentiation and acantholysis of ghost cells, were not addressed in previous literature. Understanding the diverse and new histological features of pilomatricoma is necessary for differentiating it from other adnexal and soft tissue tumors.

Survival studies are needed in patients with cutaneous malignant melanoma (CMM) due to the growing incidence trend worldwide. We aimed to determine the survival trend in patients suffering from CMM, considering various demographic and tumor characteristics. In this descriptive-analytical study, we examined 57 patients with confirmed melanoma from April 2014 to February 2019. Using the Kaplan-Meier method and log-rank test, we assessed the correlation between survival probability and factors with prognostic potential, such as gender, age, tumor thickness, mitotic rate, anatomical sites, and chemotherapy. Out of 57 patients with a mean age of 59.5 ± 22.7 years, 33 (57.9%) were females. The mean survival was 43 ± 15 months, ranging from 15 to 82 months. Regarding tumor thickness, 26 patients had 1–4 mm tumor thickness, 18 patients 5–10 mm, and five patients 11–30 mm. The tumor mitotic rate was 1–2 mitoses/ mm2 in 19 patients and ≥ 3 mitoses/mm2 in 32 patients. Infiltrated lymphocytes were present in 36 patients (36.6%). In the case of therapeutic intervention, 55 patients received chemotherapy. According to the results of the Kaplan-Meyer test, the mean survival did not show a significant difference (P < 0.05) in patient subgroups. Moreover, a profound correlation was not found between survival rate and different age groups, mitotic rate, thickness, lymphocyte infiltration, and chemotherapy. Irrespective of disease stage and histopathology examination, we found no significant correlation between survival rate and demographic/tumor characteristics in patients with CMM.

Cutaneous manifestations of coronavirus disease 2019 (COVID-19) are not uncommon and can be the presenting sign of the disease. We aimed to investigate the cutaneous manifestations in COVID-19 patients. This cross-sectional study was performed on COVID-19 patients referred to Shohada-e Tajrish and Modarres hospitals, Tehran, Iran, from January 1, 2021 to March 31, 2021. Patients with cutaneous lesions were included in the study; if needed, patients were visited in person, and a biopsy was taken. Of the 100 COVID-19 patients in this study, with a mean age of 45.53 ± 17.75 years, 37 (37%) were males. The most common cutaneous manifestation was urticaria (21%), followed by maculopapular eruptions (17%), petechiae/purpura (15%), pityriasis rosea-like lesions (15%), erythema multiforme (7%), pernio (6%), Vesicles/pseudovesicles/bullae (5%), and others (24%). Most lesions were erythematosus (87.63%). Legs (40%) were most frequently involved. The most common accompanying symptom was pruritus (52%), followed by burning sensations (18%) and pain (7%). Six patients had mucosal lesions; these lesions were the only mucocutaneous manifestations in three of them. Skin biopsies were taken from 11 patients, revealing epidermal changesin 10 (90.9%), dermal changes in 7 (63.6%), mucin deposition in 1 (9.1%), perivascular lymphocyte infiltration in 10 (90.9%), and neutrophil infiltration in 1 (9.1%). The frequency of skin manifestations was relatively high in this study, with urticaria as the most common cutaneous presentation of COVID-19. Special attention must be paid to the cutaneous lesions of COVID-19.

This study aimed to assess the single nucleotide polymorphisms (SNPs) of lncRNA (long non-coding RNA) H19 rs217727 in patients with oral lichen planus (OLP) compared to controls.

We collected 270 DNA samples of OLP cases and healthy individuals. We used the ARMS-PCR tetra primer for DNA genotyping and applied specific primer pairs.

The prevalence of the rs217727 C allele was lower in OLP cases than in healthy subjects (P = 0.005). The prevalence of TT genotypes of H19 rs217727 was greater in OLP patients compared with healthy subjects (5.71% vs 1.5%). Also, the TT genotype in the codominant model was associated with a 5.15-fold higher risk of OLP (P = 0.02). In the dominant model, the CT+TT genotypes were associated with a 2.09-fold greater risk of OLP (P = 0.007). The H19 rs217727 polymorphism was linked to a 3.95-fold greater risk of OLP in the recessive model (P = 0.05) (TT vs. CC+CT).Also, in the over-dominant model, the CT genotypes were related to a 1.78-fold greater risk of OLP (P = 0.03).

This study demonstrated a significant link between lncRNA H19 polymorphism and OLP lesions. Further studies on larger populations are necessary to confirm this relationship.

Tufted angioma is an uncommon vascular benign tumor of infancy or early childhood with slow and indolent growth. We report the case of a four-year-old boy with an asymptomatic annular lesion over the nape of the neck resembling granuloma annulare. Punch biopsy revealed multiple scattered vascular lobules or tufts. Aggregates of closely packed, dilated to compressed vascular spaces with plump endothelial cell lining were seen in the dermis, confirming the diagnosis of tufted angioma. Immunohistochemical positivity was present with CD31 and CD34 staining of endothelial cells. It is a slow-growing tumor; Kasabach–Merritt syndrome (KMS) and consumptive coagulopathy are rare complications. Blood coagulation profiles were within normal limits. In our case, the lack of reliable distinguishing characteristics of the vascular tumor and atypical annular presentation was a source of diagnostic confusion. Tenderness, typically present in tufted angiomas, was absent in our patient. This unusual case illustrates that clinicians should recognize an annular configuration as an atypical manifestation of tufted angioma.

Dermoscopy helps detect melanoma on the acral volar skin. A parallel ridge pattern is one of the characteristic dermoscopic findings of melanoma but is also seen in benign lesions, including drug-induced hyperpigmentation. Histological examination is therefore necessary for definitive diagnosis. A 74-year-old Japanese man was referred to our department with irregular-shaped brown macules on his palms and soles. The pigmented lesions had a parallel ridge pattern on dermoscopic examination. The largest lesion was resected at the patient’s insistence and considering the possibility of melanoma. Histopathological examination revealed increased melanin granules in basal keratinocytes and many melanophages in the superficial dermis, especially underlying the crista profunda intermedia, agreeing with the dermoscopic findings. The patient had been receiving tegafurgimeracil- oteracil (TS-1) for advanced gastric cancer. The pigmented lesions gradually regressed after cessation of TS-1, consistent with TS-1-induced hyperpigmentation. Further studies are needed to elucidate the pathogenesis, including analyses of the relationship between acrosyringeal endothelin-1 expression and the presence of volar melanocytes in relation to potential drug metabolism.

We report a case of clinically amyopathic dermatomyositis (CADM) with anti-MDA5 positivity associated with rapidly progressive interstitial lung disease. The analogies between CADM-associated interstitial lung disease and coronavirus disease 2019 (COVID-19) pneumonia may hinder the diagnosis and delay the start of immunosuppressive therapy. High-resolution computed tomography revealed an evident worsening of the bilateral consolidation, interlobular septal thickening, and ground-glass opacities, highlighting the diagnosis of rapidly progressive interstitial lung disease. The radiological presentation, combined with the laboratory findings, underscored the diagnosis of CADM. In the following days, the respiratory failure progressed, and the patient required extracorporeal membrane oxygenation and lung transplantation. The typical cutaneous rash of dermatomyositis and non-pulmonary clinical differences can help the physician reach a correct diagnosis. Assessing patients with interstitial lung diseases during the COVID-19 pandemic is difficult. Through experience with systemic autoimmune diseases such as clinically amyopathic dermatomyositis, we can develop new pathophysiology models and therapeutic strategies for COVID-19.