Dermatology and Cosmetic

Editorial Note

Mansour Nassiri Kashani

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COVID-19 and dermatologists (6)

Zahrabeigom Moosavi

The sixth article of COVID-19 review series is published while the virus is invading the world. In this issue, lastest findings about skin manifestations of this disease, skin diseases course, also diagnosis and treatment of COVID-19 and skin reactions due to vaccines are presented.

Prevalence of atopic dermatitis in patients with acne vulgaris

Mahshidsadat Ansari

Background and Aim: Atopic dermatitis is a chronic inflammatory disease that is caused by an inflammatory process stimulated by Th2 cells. Acne vulgaris is a chronic inflammatory skin disease. It is associated with an increase in sebum secretion, unusual pilosebaceous keratinization and an increased inflammatory immune response. Propionibacterium acne can induce IL-17 production and Th1/Th17 response. The present study was designed to determine the prevalence of atopic dermatitis in patients with acne.

Methods: In this case-control study, the case group consisted of 75 individuals with acne and the control group consisted of 75 individuals without acne matched in age and gender. Both groups were interviewed for atopic dermatitis, asthma and allergic rhinitis symptoms in the past and present.

Results: Prevalence of atopic dermatitis at present in patients who had acne was significantly lower than those who did not have acne. There was no significant difference between case and control groups in frequency of atopic dermatitis in the past and frequency of asthma and allergic rhinitis in the present and past time.

Conclusion: The inverse relationship between prevalence of acne and atopic dermatitis can be related to activation of different immune responses (Th1 versus Th2), but more studies should be done to confirm this relationship.

Satisfaction of parents of children referring to the clinic of Razi Dermatology Hospital in 2018

Narges Ghandi

Background and Aim: So far, the relationship between patient experiences and the quality of services provided to them has not been widely studied. However, evidence suggests that improving patient experiences can improve clinical outcomes. The aim of this study was to determine the satisfaction of parents of children referring to the pediatric clinic as well as the related factors.

Methods: This descriptive study was conducted using a pre-designed Press Ganey questionnaire in Persian language and through interviews with 207 parents of children who referred to the pediatric clinic of Razi Dermatology Hospital in 2018.

Results: Of the 207 participants, 87 were fathers (42%) and 105 were mothers (50.7%). The remaining 15 had other relationships with the child. Overall satisfaction (recommending our clinic to others) was 62.8%. Also, 72.5% of the participants believed they would recommand their doctors. The lowest level of satisfaction was due to the lack of introduction of clinic staff and the difficulties in setting up an appointment. The factors that most closely correlate with the patient's overall satisfaction included respectively: the cheerfulness of the visit by the doctor, the confidence in the doctor, and the likelihood of recommending the doctor.

Conclusion: The relationship between a physician and a patient is significantly related to the quality of patients' experiences in the pediatric dermatology clinic. Families and patients, when evaluating their experiences, focused on clear language and doctor's sensitivity.

Antifungal susceptibility to azoles drugs in Candida species isolated from patients with onychomycosis

Azam Fattahi

Background and Aim: Onychomycosis is an infection caused by yeast, filamentous and non-filamentous fungi, due to diverse conditions. This study aimed to investigate the pattern of azole susceptibility of candidate species isolated from Iranian patients in Tehran.

Methods: After sampling from patients, identification of the isolated strains were performed with Candida chrom agar medium and PCR-sequencing test. Drug Susceptibility pattern of the species to fluconazole, itraconazole and ketoconazole were determined by CLSI-M27-A3/S4 standard method.

Results: In this study, 34 candidate isolates were identified, of which 26 isolates (76.5%) were Candida albicans and 8 isolates (23.5%) were Candida glabrata. In fluconazole, 4 (11%) of the isolates were dose-dependent sensitive and the others were sensitive. In itraconazole, 21 (61%) dose-dependent isolates and 2 (5%) resistant isolates were identified, and in ketoconazole, all isolates were sensitive. The geometric mean (GM) of the minimum inhibitory concentration for fluconazole, itraconazole and ketoconazole was 0.32, 0.21 and 0.15 μg/mL, respectively. In this study, the most frequently isolated species was C. albicans. According to the GM values, the most effective azoles was ketoconazole.

Conclusion: The prevalence and pattern of susceptibility of Candida species to azole may vary in different populations of patients. Therefore, it is recommended that the clinicians pay attention to the results of drug susceptibility tests and then treat patients by considering drug interactions and side effects.

Skin diseases in athletes

Mansour Nassiri Kashani

Sports and the development of nations are very much intertwined. Sports dermatology is a growing discipline. Athletes’ skin diseases are a distinct group of diseases, and that repetitive physical activity combined with environmental stressors puts the athlete at the highest level of risk.The purpose of this study is to equip physicians with basic knowledge of skin diseases in athletes. Lack of knowledge about the role of exercise in the pathogenesis of skin diseases can lead to delayed diagnosis and consequently, incorrect treatment. Skin diseases can be caused directly or indirectly by exercise; there are some skin diseases which exist in a person but appear or intensify with the onset of exercise.
In general, before an athlete should exercise, he should be examined dermatologically to prevent the spread of skin diseases. They should be considered especially for lesions on the less noticeable areas such as the back and inner side of ears. It is better to prepare a map of the patient’s lesions that can be tracked over time, which the possibility of following their changes (Body Mapping).

Athletes should have no general symptoms such as fever for 72 hours before exercising. There should be no secretory skin lesions, otherwise, it is necessary to receive treatments before going to the gym and using the equipment to ensure that the disease does not spread to others.

A review of immunologic factors involved in alopecia areata and the effects of diphencyprone on these factors

Hamidreza Pazoki Toroudi

Alopecia areata (AA) is a sudden non-scarring hair loss that can be seen in any hairy area in the form of round or oval patches. It is an autoimmune disorder with an immunological response against hair follicles that is caused by genetic and environmental factors. The prevalence of AA is about 0.1% to 0.2% worldwide. Depending on the severity of the disease and sites of involvement, it can be divided into: Alopecia with Patchy pattern, alopecia reticularis, alopecia totalis, alopecia universalis, alopecia ophiasis, alopecia sisiapho, diffuse type and perinevoid alopecia areata. There are various treatment options for AA, but once terminated, they have a high recurrence rate. AA is known for the infiltration of T lymphocytes around the hair follicle bulb, and corticosteroids are its main treatment. Another treatment is topical immunotherapy, the most important of which is Diphenylcyclopropenone (DPCP). It is used in cases that have more than 50% hair loss or are resistant to treatment. The exact DPCP mechanism of action is not well understood, but it may have some kind of antigenic competition and reduce the production of anti-hair follicle antibodies. It can alter the immune response in the skin and alter the ratio of CD4 to CD8 cells around the hair follicle in a way that enhances healing of the disease. It is stated that the rate of hair regrowth in DPCP treatment is about 50% on average. In this article, we review the latest findings of about AA and discuss its therapeutic aspects, especially with DPCP.

A review of the microneedles for transdermal drug delivery

Saman Ahmad Nasrollahi

Microneedles consist of micron-sized projections similar to needles. They are capable of piercing through the stratum corneum and increase the permeation of active ingredients. Besides active pharmaceutical ingredients, microneedles can also deliver cosmetic agents, biotherapeutics like insulin and vaccines and also are used in diagnostic purposes. This article examines the types of microneedles. It also describes the function, classification, and differences between them.