Dermatology and Cosmetic

Editorial Note

Mansour Nassiri Kashani

No Abstract No Abstract No Abstract

COVID-19 and nail (7)

Zahrabeigom Moosavi

Although skin manifestations of COVID-19 were reported later than major organs affected, but it seems that they have gained relatively defined and definite described patterns. Regardless of strength and quantity of published papers and reports of rare cases, generally reported cutaneous manifestations are similar. However affection of vairous nail lesions have been mentioned recently. Even though no skin finding is recognized as specific, this does not mean not to look for and describe skin and nail changes. Common skin findings could be observed in many cutaneous diseases. In this issue, we decided to review literature about nail apparatus affected by COVID-19.

Treatment of scars after aesthetic surgery utilizing of a combination of pulsed dye laser and fractional CO2 laser

Gholamhosein Hayatollah

Background and Aim: Undesirable appearance of the scar tissue after aesthetic surgery can affect the outcomes and patient satisfaction. In recent years, early laser therapy had been encouraged to reduce the scar tissue formation. However, the available evidence regarding the outcomes of laser therapy utilizing combined lasers are limited. In the current study, the effects of combined laser therapy using pulsed dye laser (PDL) and fractional CO2 laser on the appearance of the scar tissue after aesthetic surgeries were investigated.

Methods: There were 15 patients enrolled in the current study including 13 mammoplasty and 2 abdominoplasty patients. In mammoplasty, each breast was randomly assigned to the laser therapy or control group. In abdominoplasty, split scar design was used. In laser therapy group, at the end of the third postoperative week, PDL 585 nm was radiated. Furthermore, at the end of the sixth week, fractional CO2 laser was radiated. The patients were followed for 6 months after the last laser therapy session. Visual analogue scale was used to rate the appearance of the scar tissues by 3 surgeons blinded to the treatment of scars. The appearance of the scars was determined as poor, fair, good or excellent.

Results: VAS averaged 5.5±0.8 in laser therapy group and 4.8±0.8 in the control group. The difference was not statistically significant (P=0.057). There was no scar with excellent appearance in the current study. All of the scars were fair and good in the laser therapy group. In the control group, 13 scars were fair. The difference was not significant (P=0.227).

Conclusion: Early combined laser therapy using PDL and fractional CO2 laser was associated with improved appearance of the scar tissue in short-term follow up, however, the effects were not statistically significant.

Evaluation of biopsy specimens of skin and genital warts in pathology department of Shahid Sadoughi Hospital in Yazd during the years 2012 to 2020

Shokouh Taghipour Zahir

Background and Aim: Warts are one of the most common lesions sent to the pathology department. Genital warts are at risk for malignancy transformation, especially in the cervix. By recognizing these lesions as soon as possible, especially in the genital areas, malignancies can be prevented with prompt treatment.

Methods: In this retrospective and descriptive study, demographic information (age and sex) and anatomical location of the lesion were extracted from patients' pathology records according to a pre-arranged checklist. Data were entered into SPSS version 22 and then statistical analysis was performed using descriptive tests or mean±standard deviation, or analytical statistical tests (with 95% confidence, interval). P<0.05 was considered statistically significant.

Results: A total of 267 patients were included in the study. 143 patients (53.6%) were women. The age range of patients was 2 to 80 years (31.3+15.5). The locatin of warts were on limbs in 150 (56.2%), genital area in 82 (30.7%), head and neck in 25 (9.4%) and trunk in 10 (3.7%) patients. The distribution frequency of lesions on the limbs was higher in males (P=0.01). Warts in the genital area, trunk and neck were more common in females (P=0.02).

Conclusion: Genital warts were more common in female patients and on the other hand, warts on limbs were more common in males. Therefore, any lesion with wart characteristics in women should be taken seriously.

Estimation of direct and indirect costs of one year treatment for psoriasis outpatients in Iran: a study in Razi Hospital in 2017-2018

Atefeh Gholamhosseini

Background and Aim: Psoriasis is a systemic and non-transmissible chronic inflammatory autoimmune skin disease that about 2-3% of Iranians suffer from it. Cost of management and budgeting and planning for the treatment of patients with psoriasis requires accurate information. The present study estimates the direct and indirect costs for one-year treatment of patients admitted in Razi Dermatology Hospital.

Methods: In this descriptive-analytical study, treatment costs of 170 patients with psoriasis, including direct (medical and non-medical) and indirect costs were evaluated by census method and using a researcher-made checklist, from October 2017 to October 2018. The fee was collected through reviewing patients' bills in the hospital information system and through telephone interviews with patients.

Results: The average cost of one year was 9037480 Tomans ($ 758), of which direct cost of treatment was 90.22% (8178681 Tomans) and indirect cost of treatment was 9.78% (858799 Tomans). The highest cost of treatment was related to pharmaceutical services with 5825233 Tomans. Also, the total direct medical cost was equal to 7069890 Tomans, of which 62% was the insurance share and 38% was the patient share. The findings showed that injecting biological drugs and accommodation had a significant effect on the direct cost of treatment. Supplementary insurance and accommodation variables also affect out-of-pocket costs.

Conclusion: Drugs made up most of the costs. The high price of biologics and the low coverage of these drugs by insurance companies have caused many economic problems for these patients. According to the findings of this study, it seems necessary to review the more complete insurance coverage of these drugs as well as the use of charitable assistance to cover part of the cost for treatment.

Fabrication of conical microneedles array using photolithography

Background and Aim: Microneedle technology has led to huge changes in the field of drug delivery medicine. Using microneedles, the drug can be injected locally, painlessly, and in very low and controlled doses with high precision. Local drug delivery through the skin with microneedles has many advantages over other methods of drug delivery. In this method, the drug does not enter the gastrointestinal tract and blood circulation, and therefore non-target organs are protected from the side effects of the drug. The present study is designed to construct an array of micron needles using the lithography method.

Methods: In this study, a silicon microneedle array is fabricated using the photolithography method with proper adjusting of the effective parameters. The constructed microneedle array has 256 needles with a height of 500 microns, a base diameter of 250 microns, and a center-to-center distance of 600 microns.

Results: Microscopic images show that the microneedles are tapered with a relatively sharp tip. Their surface is smooth and without cracks, and they also have an acceptable resemblance to the original design.

Conclusion: The produced microneedle array can be used directly to pierce the skin and increase its permeability by creating micron holes. In addition, this array can be used as a mold for the production of microneedles with malleable materials in the casting method.

Prevalence of androgenetic alopecia in patients and its relationship with the history of coronary heart disease

Athar Moin

Background and Aim: Androgenetic alopecia is a type of androgen and genetic dependent hair loss and although it is more of a beauty issue, but in recent years studies have shown that this type of alopecia is associated with underlying disorders such as coronary artery disease. The aim of this study was to evaluate the frequency of androgenetic alopecia in hospitalized patients and its relationship with the history of coronary heart disease and its risk factors.

Methods: In this cross-sectional descriptive-analytic study, 250 patients (125 women and 125 men) admitted to Shahid Mostafa Khomeini Hospital in Tehran from October to December 2020 were examined and after examination and data collection, the data were analyzed using SPSS statistical software SPSS Statistics 25 version.

Results: The prevalence of alopecia was generally 46.8% in hospitalized patients, 61.6% in men and 32% in women. The prevalence of coronary heart disease in hospitalized patients was 25.6%, 34.4% in men and 16.8% in women. In patients with alopecia, the frequency of history of coronary heart disease was 39.31%, the history of hypertension was 20.8%, history of hyperlipidemia was 17.2%, history of diabetes was 14.4% and the smoking history was 15.6%. All of these factors were significantly associated with alopecia, except for smoking.

Conclusion: According to the results of this study, the frequency of androgenetic alopecia in patients admitted to the hospital is common and its prevalence in men is more than twice that of women. History of coronary heart disease and its risk factors in patients with alopecia are high, and have a significant relationship with it. This can be important and help in screening and early diagnosis of coronary heart disease and its subsequent prevention.

A case of dermatophytosis with uncommon clinical manifestations by Trichophyton indotinea

Mahsa Fattahi

Introduction: Dermatophytosis are micro-organisms which can lead to skin diseases. In rare occasions they can have atypical skin manifestations, which could result in delay in diagnosis.

Case Report: A 20-year-old Iranian boy was referred to our center with a 5-month history of circular, symmetrical, itchy crusted skin lesions on his groin. Direct microscopy, culture test and PCR-sequencing of ITS regions of the rDNA gene were conducted and showed T. indotinea as the causative agent. Based on antifungal susceptibility test oral pulse therapy with itraconazole 100 mg twice daily for 1 week combined with topical clotrimazole cream for 1 month was initiated, which cleared the lesions.

Conclusion: This case report is of significance since T. indotinea produces atypical skin lesions, as well as, multidrug resistance to antifungal agents.