Iranian Journal Of Dermatology
Volume:24 Issue: 1, Winter 2021

The treatment of cutaneous leishmaniasis has long been a challenge. The application of heat to the lesions has been described in some studies, with no consensus regarding the types of thermotherapy and their practical implications.We sought to evaluate the efficacy of infrared thermotherapy in the treatment of cutaneous leishmaniasis.

We evaluated the results of infrared thermotherapy in 35 cutaneous leishmaniasis patients (53 lesions) who attended the leishmaniasis clinic of Imam Reza Hospital, Mashhad, Iran. Three times a week, the lesions were warmed to 45 degrees centigrade for two cycles of 10 minutes. Treatment outcomes were classified as complete (90-100%), good (50-89%), and poor responses (less than 50% size reduction).

Thirteen (24.5%) lesions were cured after three months; 31 (58.5%) and 9 (17%) lesions showed good and poor responses, respectively. Treatment outcomes were significantly related to the number of treatment sessions (P ≤ 0.05). No significant side effects were seen.

Infrared thermotherapy is a relatively effective and well-tolerated treatment for cutaneous leishmaniasis.

Vitiligo is a stigmatizing, chronic, and usually progressive skin disorder that affects patients' quality of life and can interfere with their social participation. There are no studies in developing countries focusing on this aspect. Hence, we assessed social participation in patients with vitiligo and its associations with Vitiligo Quality of Life (VitiQoL), Vitiligo Area Score Index (VASI), and demographic and clinical characteristics. This cross-sectional study was conducted between 2013-2014 on 170 patients, in Razi Hospital, Tehran, Iran. In the pilot phase, the Persian version of the Participation Scale (P-scale) and VitiQoL questionnaire were validated with the backward-forward translation method. Among 173 vitiligo patients, the mean participation score was 15.12 (SD=13.88, median=11). Overall, 91 patients (52.6%) had no significant restriction, 38 (22%) suffered from mild, 23 (13.3%) moderate, 20 (11.6%) severe, and 1 (0.6%) suffered from extreme restriction in participation. The association between VitiQol and P-scale was highly significant (r=0.58; p <0.001). This association was also observed with the three subscales of VitiQol, namely participation limitation (r=0.59, p <0.001), behavior (r=0.43, p <0.001), and stigma (r=0.23, P=0.002). We did not find a significant association between P-scale and demographic characteristics, overall VASI, and face, genitals, and exposed areas VASI. Although the majority of our patients perceived no or mild limitation in their social participation, the P-scale score was highly correlated with their quality of life and its components.

Becker’s nevus syndrome (BNS) is a benign hamartoma that is aesthetically bothersome and usually appears during puberty. Various modalities of laser therapy alone or in combination with other medications can be used for the treatment of BNS, but no unified approach with an acceptable response is yet available. The current study aimed to compare the outcomes of Q-switched ruby 694 nm laser (QSRL) alone and in combination with 4% topical flutamide for the management of BNS.

The current randomized clinical trial was conducted on twenty-two BNS patients between 2016-2018. The patients were randomly allocated to treatment with QSRL 694 nm alone (group A) versus in combination with 4% topical flutamide (group B). The QSRL was administered twice with four-week intervals for both groups, while group B was also administered topical flutamide 4% twice a day for eight weeks. The treatment outcomes were assessed and compared at baseline and then within 4 and 8 weeks of commencing the interventions.

The evaluation of the two groups in terms of lesion size alterations, response to treatment, and patients' satisfaction showed insignificant differences between the two groups (P>0.05). In addition, neither approach A (P=0.33) nor approach B (P=0.46) led to remarkable changes in lesion color.

Based on the findings of the current study, the use of QSRL alone or even in combination with topical 4% flutamide was not suitable for the management of BNS lesions.

Cracked nipples represent the most common complication of breastfeeding. This study aimed to compare the therapeutic effect of the Cicalfate® commercial cream (containing copper, zinc, and sucralfate) with white soft paraffin in treating cracked nipples. This study was a double-blind clinical trial conducted on 115 patients with cracked nipples. Patients were randomly divided into two case and control groups. The case group received the Cicalfate® cream and the control group received white soft paraffin. After a period of one to two weeks of treatment, all patients were re-examined and the severity and rate of their recovery were recorded. Data were analyzed using SPSS version 15. In this study, 68 patients were in the case group and 47 were in the control group. The comparison of the two groups in terms of improvement of the right nipple with the removal of other variables showed that the degree of cracking reduction in the case group was 3.3 times that of the control group (OR=3.3; CI=1.3-8.3). Also, the comparison of the two groups in terms of improvement of the left nipple with removing the effect of other variables showed that the degree of cracking reduction in the case group was 5.3 times that of the control group (OR=5.3; CI=2.0-14.1). The results of this study showed that the therapeutic effect of Cicalfate® is more than that of white soft paraffin.

The Q-switched neodymium: yttrium aluminum garnet laser (QS-Nd:YAG) is effective in the treatment of tattoos and different pigmentary conditions; however, little has been published regarding the removal of facial cutaneous pigmented lesions. The aim of this study was to determine the effectiveness and safety of QS-Nd:YAG laser in the treatment of facial pigmentary lesions in Indian patients. Data of 100 patients with pigmented facial lesions treated with QS-Nd:YAG laser were analyzed. Clinical improvement of skin lesions was assessed by the physician’s global assessment of two blinded observers. This was done based on photographs taken at the baseline and after the last treatment session. Side effects were recorded if present, and patient satisfaction was evaluated after each treatment session. The majority of the patients had post-inflammatory hyperpigmentation (n=41), followed by melasma (n=19), photomelanosis (n=15), nevus of Ota (n=5), periorbital melanosis (n=5), nevus spilus (n=3), Riehl melanosis (n=3), Café-au-lait macules (n=2), freckles (n=2), lichen planus pigmentosus (n=2), compound nevus (n=1), Hori’s nevus (n=1), and pigmentary demarcation lines (n=1). 10% of patients showed more than 50% improvement in pigmentation from the baseline level; no response was seen in 22% of patients, while 7% experienced worsened pigmentation. The degree of improvement and efficacy in clearing pigmentation is partial, variable, and inconsistent. Worsening of pigmentation may be seen and needs to be discussed with the patient prior to treatment

Onychomycosis is a widespread problem in the clinical practice of dermatology, caused by dermatophytes, yeasts, and non-dermatophyte molds. In India, relatively little work has been done on this problem. It is a known fact that the geographical distribution of the fungi may change from time to time. Hence, through this study, an attempt was made to identify the clinical patterns and causative agents of onychomycosis. This study was conducted on 100 clinically suspected onychomycosis patients. The necessary clinical details were noted with their consent. Nail clippings were collected from the most severely affected parts and were subjected to direct microscopy in 40% potassium hydroxide before being inoculated into Sabouraud’s dextrose agar with and without cycloheximide at 25 °C and 37 °C for up to four weeks. Growth was identified following the standard protocols by assessing the rate of growth, colony character, lactophenol cotton blue mount, slide culture, urease test, germ tube test, etc. Among the 100 patients, the mean age was 40.8 years. The male/female ratio was 1.28:1. Fingernail (49%) involvement was more common than toenail involvement (32%). Distal lateral subungual onychomycosis (52%) comprised the predominant clinical pattern.  KOH mount was positive in 46%, while the culture was positive in 44% of patients. The causative agents isolated were non-dermatophyte molds (63.6%), dermatophytes (18.2%), and yeasts (18.2%). This work shows the broad spectrum of causative agents of onychomycosis with non-dermatophyte molds as the predominant isolates.

Zinc is an effective factor in the immune response against infectious agents; its effect on the course of cutaneous leishmaniasis (CL) is unknown. This study aimed to compare the serum zinc level in patients with acute and chronic CL. A descriptive study was conducted on 120 CL cases and controls. This included 30 cases of acute CL (less than one year of lesion recovery), 30 cases of chronic CL (period of illness over one year), and 60 healthy subjects with age and gender proportional to the patients. Volunteers entered the study with knowledge and consent. The serum zinc level was measured by atomic absorption spectrophotometry. The percentages of people with reduced serum zinc levels in the healthy, acute, and chronic groups were 13.3, 50, and 43.3%, respectively, whereby there was a significant difference between the leishmaniasis groups (acute and chronic) and the control group (p <0.001). However, the mean serum zinc level did not differ significantly between the acute (75.36 ± 15.72 µg/dl) and chronic (73.96 ± 17.98 µg/dl) leishmaniasis groups (P=0.94). A reduced serum zinc level is associated with symptomatic CL, but does not affect the clinical outcome and recovery.

The relationship between body mass index (BMI) and the severity of psoriasis is of debate. We investigated the relationship between BMI and psoriasis area and severity index (PASI) in Northern Iran. In this prospective, observational descriptive study, 190 patients with chronic plaque-type psoriasis were included from January 2015 to 2017. None of the patients used systemic therapy for psoriasis during the last month. There was a slight female predominance in our study (n=116; 61.1%). The mean age of our patients was 28.88 ± 18.17 (mean ± standard deviation) years. We found a positive correlation between BMI and PASI in the groups of psoriatic patients who had normal weight or were overweight (r = 0.369, P=0.006 and r=0.287, P=0.019, respectively). In the final logistic regression model, it was shown that in cases with BMI<18.5, the mean PASI score was lower in comparison with those with normal BMI (OR = 0.074, CI: 0.009, 0.636). A relationship between BMI and PASI was only seen in psoriatic patients who had normal weight or were overweight. To reduce the effect of factors such as systemic treatments, it is suggested to evaluate the relationship between BMI and PASI score as soon as the diagnosis of psoriasis is confirmed.

Viral skin diseases range from simple superficial exanthems to complex systemic diseases, affecting people of all ages. Careful assessment of infectious contacts and immunization status is of considerable importance along with a thorough physical examination. Recent research has linked a deficiency of vitamin D to an increased risk of autoimmune, infectious, and atopic disorders. Intralesional vitamin D3 may be an effective treatment option for warts. Vitamin D3 derivatives are effective for various skin conditions, including psoriasis, transient acantholytic dermatosis, actinic porokeratosis, and keratosis palmaris et plantaris. Vitamin D3 treatment has been shown to decrease chemokine synthesis and monocyte trafficking, as well as to downregulate toll-like receptors (TLRs) 2 and 4 of monocytes. This suggests an association between TLRs and vitamin-D-mediated innate immunity. The effect of vitamin D derivatives was speculated to be derived from its potential to regulate epidermal cell proliferation and differentiation and to modulate cytokine production. According to some studies gathered here, not only we can use different forms of vitamin D as therapy for viral skin disease, but also there is an important relationship between them. Therefore, we should consider the serum level of vitamin D for better management of these disorders. Also, keeping vitamin D levels within the normal range may be a preventative healthcare strategy.

Heterotopic ossification is the formation of bone tissue at an abnormal site. The ossification of soft tissue outside the skeletal system can occur anywhere and can be found in mucosal tissues. This is the first case report of an osteoma mucosalis affecting the nail bed. We also reviewed the heterotopic ossification and calcification of cutaneous and mucosal sites in the PubMed, Scopus, and Google Scholar databases.

Deep vein thrombosis (DVT) is a common disorder that can lead to severe complications. Many factors can increase the risk of developing this disease. As we know, bulla formation due to DVT is extremely rare. A 45-year-old woman was referred to Shahid Sadoughi Hospital (Yazd, Iran) with pain and swelling of the left lower limb from one day beforehand. One day after admission, a large bulla (13 x 19 cm) appeared on the posterior part of her left leg. She had used the low-dose estrogen type of oral contraceptive pills ten days earlier. Color doppler sonography confirmed the presence of DVT. Heparin therapy was done and the patient was discharged in good condition.  Bulla formation due to DVT is a very rare complication. It should be considered in patients of low socioeconomic classes and those using oral contraceptive pills. After the occurrence of DVT, we must rapidly move to avert its complications and prevent pulmonary embolism.