Dermatology and Cosmetic

Comparison between daily and alternate-day use of topical 5-fluorouracil in treatment of actinic keratosis: Randomized controlled clinical trial

Amir Houshang Ehsani

Background and aim: Actinic keratoses (AKs) are the third commonest complaint of patients visiting dermatologists. Topical treatment including 5-fluorouracil (5-FU) are among the commonest available therapies. According to local irritation induced by topical 5-FU The aim of current study was to compare efficacy of two different 5-FU based regimens with different application routes.
Methods: Patients with AKs confirmed by skin biopsy, matching our exlusion criteria were enrolled. Subjects randomized in two groups, receiving topical 5% 5-FU once daily or alternatedaily respectively. Two weeks after the end of one month period of the study, rate of reduction in number of lesions was documented by blinded academic dermatologists as well as treatment side effects.
Results: a total of 38 patients (23 male and 15 female) completed the study. Rate of side effects were lower in alternate-day applying patients (P<0.05) while rate of response to therapy were comparable in both groups (P>0.05).
Conclusion: alternate-day route for application of topical 5-FU is an acceptable alternative for classic daily application, to reduce rate of side effects and enhancing patients compliance.

The expression of tissue matrix metalloproteinase 2 and 9 in erosive and non-erosive oral lichen planus, inflammatory hyperplasia of oral mucosa by immunohistochemistry

Kambiz Kamyab-Hesari

Background and aim: Oral lichen planus, is a chronic inflammatory mucocutanous lesion which is defined as a premalignant lesion. Matrix metaloprotenase 2 (MMP-2) and MMP-9 are protenases which facilitates invasion of tumoral cells to connective tissue and are over-expressed in premalignant and malignant lesions. The aim of this study was to determine the expression of MMP-2 in erosive and non-erosive oral lichen planus and inflammatory hyperplasia by immunohistochemistry.
Methods: in this cross sectional study 39 specimens of non-erosive oral lichen planus (with and without dysplasia), 36 specimens of erosive ones (11 dysplastic and 25 non-dysplastic, 32 inflammatory hyperplasias and 6 samples of normal oral mucosa were chosen form pathology archive of Faculty of Dentistry, Mashhad university of Medical Sciences and were stained immunohistochemically by MMP-2 and MMP-9 markers. Kruskal-Wallis, Mann-Whitney and Spearman correlation coefficient were used.
Results: The highest mean expression of MMP-2 and MMP-9 (in all layers) were observed in erosive oral lichen planus (68.18±31.62 and 94.5±3.5, respectively). MMP-9 expression in erosive oral lichen planus in comparison to non-erosive one showed significant difference in all layers (P<0.001) and the expression of MMP-2 showed a significant difference in basal –para basal and prickle layers (respectively: P=0.008, P<0.001).
Conclusion: the linear increase seen in the expression of markers from normal mucosa to erosive oral lichen planus indicates the difference of biological behavior between erosive and non-erosive oral lichen planus. Hence, it is concluded that erosive oral lichen planus is of the higher premalignan potential compared with its non-erosive correspondent.

Prevalence of cutaneous lesions , route of infection and distribution of lesions in HIV positive patients in Isfahan province in 1385

Elaheh Haftbaradaran

Background and aim: it has been estimated that 70000-100000 cases of HIV infection exist in Iran. The main route of transmission is intravenous drug (IV) injection. Rapid spread of this disease necessitates its prompt diagnosis. About 90% of HIV infected patients express cutaneous manifestations therefore, recognition of these symptoms may be of help in early diagnosis.
Methods: HIV infected patients with suspected skin lesion were referred to Skin Disease and Leishmaniasis Research Center and were examined by an intern contributed in the study. All the information were gathered in data code sheets. Then, all of the patients were visited by the dermatologist for complementary examinations and the results including lesion type, location and duration were recorded in the check list.
Results: fifty persons were examined and 42 patients were selected. Prevalence of dermatologic manifestations was as follows: herpes zoster in 23.8%, seborrheic dermatitis in 14.3%, hyperpigmentation in 19%, oropharyngeal candidiasis in 14.3%, folliculitis in 14.3% dermatophytosis in 4.7%, wart in 4.7%, Kaposi’s sarcoma in 2.3%, and drug eruption in 2.3% , 75% of patient who had hyperpigmentation were infected by their sexual partner and 25% via IV injection. 33% of patient who had folliculitis were infected via IV injection, 33% through blood transfusion and 33% by sexual relationship.
Conclusion: According to the results of this study, paying attention to cutaneous signs HIV/AIDS patients, their early detection and diagnostic and therapeutic measures for them are advocated.

Determination of properties and evaluation of sun protective effects of saffron and safranal nanoliposomes

Mahmoud Reza Jaffari

Background and aim: Saffron possesses a lot of medical applications in traditional medicine. One of its properties is ultraviolet (UV) light absorption. The aim of this study was preparation, determination of properties and investigating sun protevtive effects of nanoliposomes containing saffron extract and safranal, a substance existing in saffron.
Methods: Nanoliposomal hydroalcoholic extract of saffron stigma in concentrations 2%, 4%, 8% and nanoliposomal safranal in concentrations 0.25% , 0.5% and 1% were prepared. Standard lotion of homosalate 8% was used according to FDA standards for sun protection factor (SPF) determination and assessment of accuracy of the method. SPFs of substances were calculated in vitro by diluted solvent method using Mansur, et al equation and absorptiometry.

Results: SPf of Nanoliposomal saffron 8% extract was significantly higher than standard sunscreen homosalate with similar concentration. SPFs of safranal (1% and 0.5%) component of saffron were significantly higher than the standard sunscreen homosalate 8%.
Conclusion: Saffron can act as a sunscreen. Safranal existing in saffron is much more sun protective than standard substance, homosalate 8%. Thus , the safranal existing in saffron may have significant sun protective effect in low concentration if encapsulated in liposome.

Skin rejuvenation with radiofrequency

Hassein Tabatabaei

Background and aim: Skin rejuvenation is in demand. In recent years, mono- and bipolar radiofrequency (RF) have been reckoned as treatment of choice for this purpose. The studies on RF have shown the remodeling of collagen fibers and consequently improvement of skin texture although risks and side effects may exist.
Methods: Forty-eight patients requesting skin rejuvenation were treated by RF after obtaining written consent from them. The diagnosis had been made solely on the basis of examination and observation. The photography was performed in all patients pre- and post-treatment. The pictures were evaluated by a dermatologist unaware of the sequence of photos.
Results: the wrinkles improved in 26(54%) patients. The response was better with increasing age. Transient pain and erythema were reported by all patients.
Conclusion: Radiofrequency is an appropriate treatment for reducing the number and the depth of wrinkles and needs comprehensive education. At least, 4 treatment sessions with 2-week intervals are required for effectiveness.

Dermatology residency training , certification and maintenance of certification in the United States

Mehran heydari Seradj

Training of dermatology residents , their evaluation. Certification and recertification in each part of world id different from the other and is highly dependent to health care needs and standards, resources and expectations of those who receive the care for example in Australia a dermatologist is expected to be able to manage surgically all kinds skin cancers (melanoma or non-melanoma) and perform lymph node dissection himself without need to refer to a surgeon. However, learning about the process of dermatology residency training, certification and maintenance of certification in other countries will help us in curriculum planning and evaluation of our dermatology residents according to our own health care needs and social, economical and epidemiologic conditions.

Toxic epidermal necrolysis of scalp: A case report

Navid Bouzari

Toxic epidermal necrolysis (TEN) is a server, life-threatening drug-induced mucocutaneous eruption that rarely affects scalp. There has been limited number of cases of TEN arising in patients receiving radiation therapy plus anticonvulsants.Here, we report a case of TEN secondary to anticonvulsant and radiation therapy. An unusual aspect shared by our patient as well as the other reported cases is that the eruption always begins at the site of recent radiation therapy. In this report, we discuss the possible hypotheses for this phenomenon.

Angiofibroma: A rare case

Amir Houshang Ehsani

Tuberous sclerosis complex is a genetic disorder characterized by hamartoma formation in many organs. Its characteristic dermatologic manifestations include angiofibroma, shagreen patch, periungual fibroma and white macules. This disorder is usually accompanied by epilepsy and mental deficiency. Here, a 26-year-old man is presented who has been referred to a teaching hospital with a huge facial angiofibroma which had led to major psychological problems for him necessitating and appropriate treatment plan.