Dermatology and Cosmetic

Management of urticaria: Iranian Society of Dermatology clinical practice guideline

Alireza Khatami

Urticaria is a common and challenging skin disorder. Its diagnosis and treatment is not limited to the field of dermatology. General physicians, and allergologists and clinical immunologists are also commonly involved in the management of urticaria patients. One of the missions of the Iranian Society of Dermatology is to develop strategies to provide the best possible management for patients suffering dermatological conditions. To accomplish this mission, the Society assigned a committee to search and critically appraise the recent research evidence and available guidelines to develop a clinical practice guideline concerning diagnosis and treatment of urticaria.

Estimation of seasonal effect on the psoriasis recurrence using time dependent coefficient rates model for recurrent events

Ebrahim Hajizadeh

Background and Aim: Psoriasis is an inflammatory skin disease, which is related to the immune system and is characterized by the rapid growth of skin cells. The aim of this study was to investigate some risk factors in psoriasis and also to check that whether the rate of recurrence is fixed or variable in different seasons by using a time-dependent coefficients rate model. Methods: After reviewing the files of psoriasis patients that had been hospitalized in March 2011 to March 2014 in the dermatology ward of Imam Khomeini Hospital in Tehran, a total of 160 patients who had relapses leading to hospitalization, entered to the study. A rate model with time dependent coefficients by using R software version 3.1 was fitted and risk factors for recurrence were identified. Effect of the season on the recurrence of psoriasis was evaluated. Results: Recurrence rate of psoriasis was 7.2 times higher in winters than in springs, which had the lowest recurrence rate. Spring and summer were associoated with lower recurrence rates. Effect of season on the relapse of the disease was significantly different for different seasons (P<0.01). Also, infection, stress, positive family history, hypocalemia, the normal number of white blood cells and temperature changes were associated with psoriasis relapse (P<0.05). Conclusion: Recurrence rate of psoriasis is different in different seasons. Psoriasis recurrence rate was 7 times higher in winters in comparison with springs.

Evaluation of provided clinical information on the histopathology request forms and histopathological findings to detect early mycosis fungoides according to ISCL algorithm

Alireza Khatami

Background and Aim: Mycosis fungoides (MF) is the most common primary cutaneous lymphoma. Diagnosis of early MF (eMF) is often difficult due to its resemblance of benign dermatoses. The aim of this study was to evaluate the role of provided clinical information on the histopathology request forms for diagnosis of eMF according to the International Society of Cutaneous Lympoma (ISCL) criteria. Methods: In this cross-sectional study, 108 patients admitted to Razi Hospital, Tehran, between April 2012 and November 2013, who were biopsied as eMF cases, were recruited. Based on partial application of ISCL algorithm, the checklist of clinical and histopathological findings were scored. Results: Eighty-five (78.7%) patients received maximum total clinical and histopathological scores (4) and their eMF were definitely diagnosed. Sixteen (14.8%) patients received a total score of 3, and suggestive eMF diagnosis was made. Further work up such as immunohistochemistry (IHC) evaluation were recommended. Seven patients (6.5%) received a total score of 2, which did not confirm eMF diagnosis. Follow up was recommended. In 14 (87.5%) of 16 patients who had received a total score of 3, the definite diagnosis of eMF was made according to the results of IHC. They were referred to receive treatment. In 2 patients (12.5%) diagnosis of eMF were not confirmed by IHC. They were recommended to undergo polymerase chain reaction (PCR) evaluation Conclusion: Many MF cases can be diagnosed in the early stages using a combination of clinical and histopathological criteria.

Incidence rate and geographical distribution of skin cancer in Kurdistan province of Iran

Omid Eskandari

Background and Aim: Skin cancer is one of the most common human cancers. Its incidence rate trend is increasing in Iran. The aim of this study was to investigate the prevalence, incidence rate and geographical distribution of skin cancer to identify the high risk areas in Kurdistan province, Iran. Methods: In this descriptive cross-sectional study, the collected data were analyzed using version 16 of SPSS software, and t-test and analysis of variance (ANOVA) were used for comparison of the means. The distribution map of skin cancer in the province was prepared using Geographic Information System (GIS) software, version 9.3 between the beginning of 2006 and the end of 2010. In order to investigate the reason for high rates of skin cancer in some cities, ultraviolet (UV) radiation distribution map was also prepared. Results: Sanandaj with 17.55/100000 had the highest and SarvAbad with 3.73/100000 had the lowest incidence rates. The number of male patients (542) was nearly two times of female cases (324), (P<0.0001). In addition, skin cancer was about two times more prevalent in urban (%68.01) than rural (%31.99) residents (P=0.008). Conclusion: Life style of men and their sun exposure because of their job seemed to be a major risk factor in increasing the incidence of skin cancer in Kurdistan province, Iran. There was no correlation between the skin cancer incidence at the district level and UV index. Further research is recommended to explain this finding.

Skin moisturizers

Saman Ahmad Nasrollahi

The function of the horny layer of the skin as a barrier is to protect the underlying tissues from infection, dryness, and mechanical stress. Disruption of this function results in increased transepidermal water loss (TEWL) and is associated with conditions like atopic dermatitis and other chronic skin diseases. Moisturizers have been shown to improve these conditions through restoration of the integrity of the stratum corneum, acting as a barrier to water loss and replacement of skin lipids and other compounds. Also, moisturizers are commonly used to reduce fine lines and make the skin appear smooth and soft. They contain varying combinations of emollients, occlusives, and humectants to achieve their beneficial effects, and there are an overwhelming number of formulations available.

Malassezia species in dermatology: A review

Mahdi Taheri Sarvtin

Malassezia species (previously Pityrosporum) are normal flora of human and warm-blooded animals skin. The genus Malassezia is now divided into 13 species. Most of the yeasts show an absolute requirement for long fatty acid chains and specific procedures are required for their isolation, conservation and identification. Under appropriate conditions, the fungi can cause various skin diseases. The aims of this review were to describe recent classification of genus Malassezia their virulence factors, and their association to dermatlogical diseases.

In memory of Dr. David L. Sackett (1934-2015)

Alireza Khatami

David Lawrence Sackett, OC, MD, FRSC, FRCP was an American-Canadian physician, trialist, and teacher. He is best known as one of the pioneers of evidence-based medicine (EBM), which is arguably the most important movement in medicine over the past three decades. He founded the first clinical epidemiology department in McMaster University in Hamilton, Canada in 1967. In addition, he was the head of the Center for the Evidence-Based Medicine in Oxford, UK. He also was the first chair of Cochrane Collaboration and the first founding coeditor of the journal of Evidence-Based Medicine and had many other honors. He published 12 books, 60 chapters in other books, and about 300 articles in scientific and medical journals. He died on May 13, 2015 at age 80 because of cholangiocarcinoma. While Dr. Sackett will be missed by his friends, colleagues, mentees as well as EBM proponents and followers all over the world, his contributions to EBM in particular, and to medicine in general will never be forgotten.