Dermatology and Cosmetic

Lipid profile changes in hospitalized pemphigus patients after treatment with oral prednisolone alone or in combination with adjuvants

Abbas Karimi

Background and Aim: The standard treatment regimen for pemphigus is adminitration of systemic corticosteroids and adjuvant agents. Previous studies have shown that corticosteroid therapy may alter lipid profile and reduce the atherogenic index in some disorders. This study was conducted to evaluate the changes in lipid profile in pemphigus patients treated with oral corticosteroids alone or in combination with adjuvants.

Methods: In this retrospective corss-sectional study, medical records of 148 pemphigus patients admitted in Razi Hospital in Tehran were reviewed for serum levels of low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholestrol, and triglyceride on the day of admission till 3 weeks after initiation of the treatment.

Results: Fifty-eight percent of patients were female and the mean age of the patients was 47.1 years. 79.3% and 13.3% of patients had been treated with prednisolone plus azathiorine or prednisolone alone, respectively. The remainig patients were treated by administration of oral prednisolone and other adjuvants. Serum levels of LDL, HDL, total cholestrol and triglyceride were significantly higher 3 weeks after initiation of treatment compared to baseline (P<0.05). With the exception of the signifcantly higher level of triglycerides in women, there was no statistically significant association between the levels of other serum lipids at the end of 3 weeks treatment with gender, age, severity of the disease, use of statins, and the treatment regimen (P>0.05).

Conclusion: Although the level of different components of the lipid profile in Iranian patients with pemphigus changed after receiving treatment for 3 weeks, it seems that those changes were not associated with an increased atherogenic index of pemphigus patients.

Viewpoints of Iran Dermatology Board Examination committee members on improving its validity

Alireza Khatami

Background and Aim: Board certification in any specialty is associated with a better professional reputation as well as some other advantagessuch as the opportunity of working as an academician. Accuracy of any test in the assessment of its participant performance is of paramount importance. One of the main factors regarding test accuracy is its validity.The aim of this study was to investigate the views of the Iranian Board of Dermatology Examination Committee (IBDEC) Members onimproving its validity.

Methods: This study was a cross sectional survey. In order to extract the items for development of the instrument for the survey, unstructured individual interviews were conducted with two members of the IBDEC, two faculty members who were not members of the IBDEC, and two resident dermatologists. Afterperforming a content analysis, writing the items, and making revisions in accordance with the expert panel suggestions, the face and content validities of the developed instrument were confirmed by the panel. The instrument was distributed among the members of the IBDEC in September 2013. The collected data were entered into a data set.

Results: Fifteen of 16 present members of the IBDEC answered and returned the instrument to the distributer. Ten (%66.7) of participants were male. Mean (standard deviation [SD]) of age and membership duration in IBDEC of the participants were 56.1 (7.8) and 9.6 (6.2) years, respectively. The most difficult and easiest items for being agreed upon were: "Inclusion of key feature problems (KFP) in the written examination may result in better assessment of the residents' clinical decision making" and: "In the board examination, attitudes of the residents towards ethical issues are assessed properly".Cronbach's α was calculated for assessment of the internal consistency of the instrument and was equaled to 0.76.

Conclusion: While 53% of the IBDEC members were disagree with that the written board examination can assess residents' different levels of knowledgeproperly, the majority of them were also disagree with the implementation of suggested approved methods for improving the validity of the written board examination. Most of them were also disagree with implementation of evaluation methods for improving oral examination validity.

Demographic, clinical and histopathological characteristics in different kinds of cicatricial alopecias

Pedram Alirezaei

Background and Aim: Cicatricial alopecia is the result of irreversible substitution of hair follicles with fibrotic tissue and presents as permanent loss of hair. Only a few studies have investigated the clinical and histopathological characteristics of cicatricial alopecia in Iran. The aim of this study was to determine the demographic, clinical and histopathological characteristics of patients with cicatricial alopecia who referred to our dermatology outpatient clinic in Farshchian hospital in a two year period, and to evaluate the diagnostic value of histopathologic criteria in diagnosing different kinds of cicatricial alopecias.

Methods: This was a cross-sectional study. Eighty nine patients who underwent skin biopsy due to clinical diagnosis of cicatricial alopecia were included. Demographic and clinical characteristics of patients as well as clinical diagnosis were recorded and the biopsy samples were evaluated by two different pathologists who were unaware of each other's diagnosis. Histopathological diagnosis of patients according to each pathologist's opinion was recorded separately and statistical analysis was performed to obtain the coincidence coefficient between two pathological diagnosis.

Results: The most common forms of cicatricial alopecias due to clinical and histopathological diagnosis were: lichen planopilaris, disciod lupus erythematosus, alopecia areata, pseudopelade of Brocq, folliculitis decalvans and central centrifugal cicatricial alopecia. Moreover, our findings showed a powerful coincidence coefficient between clinical diagnosis and the first pathologist diagnosis (kappa=0.836), an average to powerful coincidence coefficient between the second pathologist diagnosis and clinical diagnosis
(kappa=0.703) and finally an average to powerful coincidence coefficient between the two pathologists diagnosis
(kappa=0.663).

Conclusion: Diagnosis of cicatricial alopecia depends upon clinical and also histopathological examination. Diagnostic value of histopathological criteria even at the end of scarring process when there is considerable overlap between microscopic findings of different etiologies of cicatricial alopecias is still acceptable and there is no need to re-evaluate the biopsy specimen by a second pathologist in order to confirm the diagnosis.

Skin cancer incidence rate and trend in 2004-2008 in Tehran province

Hamid Salehiniya

Background and Aim: Skin cancer is the most common cancer in the world, which is associated with mortality, mortality and health care costs. Planning prevention and control of this cancer, information about its incidence rates and incidence trends is necessary. The present study aimed to determine the incidence rates and trends of skin cancer in Tehran.

Methods: In this cross-sectional study, necessary data were extracted from the Cancer Registry, Ministry of Health and Medical Education between 2003 and 2008. Age - and sex -standardized incidence rates were calculated and the incidence rate trends were determined.

Results: Between 2003 and 2008, 7429 skin cancer cases were recorded, of which 4807 were men and 2622 were women. Skin cancer incidence had an increasing trend in Tehran and its incidence rate has increased from 8.99 in women and 11.52 in men in 2003 to 18.03 in women and 28.16 in men in 2008, respectively. In addition, incidence of skin cancer was increased with aging in both men and women. The incidence rate was higher in men than women.

Conclusion: Skin cancer incidence in Tehran is increasing, which could be due to population aging, environmental risk factors, and changes in life style. More comprehensive research is suggested to investigate the risk factors for this cancer in Tehran.

Frequency of primary generalized pruritus in bullous pemphigoid patients referring to Tehran Razi Hospital between 1996 to 2011

Abbas Karimi

Background and Aim: Bullous pemphigoid (BP) is an acquired autoimmune disease with subepidermal blisters commonly seen in the elderly over 60 years. Although the disease is usually manifested with tense blisters, but in some cases generalized pruritus is the only symptom of disease, which is less studied.

Methods: In a retrospective study, the medical records of 416 BP patients confirmed in pathology laboratory were evaluated for clinical findings, direct immunofluorescence (DIF) testing for BMZ-binding IgG antibodies and histological findings.

Results: Of the 416 confirmed BP patients, 213 were male and 203 were female. The mean age of patients was 64.36 years. Thirty four patients at the onset of the disease had generalized pruritus, which in the course of the disease, 29 patients also showed other symptoms of the disease. In 5 patients generalized pruritus was seen as the only symptom. Concerning to the results of DIF, 117 (90%) patients showed autoantibody deposit, and in 13 (10%) patients the test was negative. There was no significant relationship between DIF results and histological findings (p> 0.05).

Conclusion: According to the findings of this study, generalized pruritus is uncommon as the first symptom of the disease. There was not any association between generalized pruritus and histological observations including dermal edema, presence of eosinophils in tissue, subepidermal blister as well as DIF results. Further studies on the early detection of the disease are required to decrease complications of the disease.

Anderson-Fabry disease: A case report

Sahar Aziziahari

Anderson-Fabry which is also known as Fabry disease is an X-linked recessive enzyme deficiency disorder. Its clinical manifestations are caused by storage of sphingolipids in the lysosomes of the endothelial, perithelial, and smooth muscle cells, which is due to alpha galactosidase A enzyme deficiency. Its hallmark dermatological manifestation is diffuse angiokeratomas known as angiokeratoma corporis diffusum. Peripheral painful neuropathy, eye involvement, cardiovascular problems, cerebrovascular complications, and renal failure are other manifestations of Fabry disease.

Herein, we report a 22-year-old man who had been referred to a dermatology clinic for evaluation of his skin lesions. The patient had diffuse angiokeratomas, which were characteristic for Fabry disease as well as painful acral neuropathy. Histpathologic examination of one of his skin lesions was reported as angiokeratoma. Since cornea verticillata was observed in his eyes and he also suffered from sensory-neural hearing loss, he was diagnosed as a case of Fabry disease.

Access to the skin health service through teledermatology in nursing homes: necessity or choice?

Age related skin disorders due to structural and functional changes in the skin of the elderly may increase health care costs. As a result of an increase in the number of aging population in Iran, provision of dermatology services to the elderly group due to the limitation of resources and the high cost of those services will be a challenge for the health care system. Moreover, by increasing the elderly residents in private nursing homes, problems of the providing dermatology services costs as well as limitations in physical performance of the elderly to receive specialized services, the necessity of the existence of alternative and low-cost solutions to meet the needs of this group, will help to clarify the importance of the issue. By providing the facilities for physicians to examine the patients by telemedicine, access to medical care services (in broad geographic level) will be improved besides transferring of the patients for medical centers and the cost of physician care will be reduced