Dermatology and Cosmetic

Phenotyping of peripheral memory T cell subsets in cutaneous leishmaniasis

Hossein Keshavarz

Background and Aim: The heterogenous population of memory T lymphocytes is distinguished based on surface markers and effector functions such as cytokine secretion. Recently, two subsets of memory T cells are defined by expression of chemokine receptor CCR7 and CD45RA designating as "central memory" T cells (T_CM) and "effector memory" T cells (T_EM). The objective of this staudy was to evaluate the phenotype and function of these lymphocytes in healed cases of cutaneous leishmaniasis.
Methods: The phenotype of lymphocytes were determined in blood samples of 13 volunteers with history of self healing cutaneous leishmaniasis (HCL) and in 6 healthy controls.
Results: No significant difference was found in memory T cell subsets between HCL volunteers and healthy controls using flow cytometry. However, following sorting of different memory subsets, a significantly higher proliferation was seen in cells of HCL volunteers comparing to the control group. A significantly higher IFN-γ response in T_EM and a significantly higher IL-2 response in T_CM were observed in cell culture of HCL volunteers comparing controls.
Conclusion: The responses were elicited when the cells were stimulate with SLA in vitro, it is concluded Leishmania-specific T_EM and Leishmania-specific T_CM subsets exist in HCL volunteers and since the volunteers with history of CL presumed to be protected against reinfection, it seems that both T_CM and T_EM play role in the protection against Leishmania infection in these individuals.

Assesment of angiogenesis in basal cell carcinoma using CD31 & CD34 markers and relation with tumor invasiveness in histology

Zahra Safaei Naraghi

Background and Aim: Tumor angiogenesis is essential for tumor growth and appears to play an importating role both in invasive growth and metastasis. Basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) of the skin are derived from a similar cell type but differ in the invasive and metastatic potential. Basal cell carcinoma generally shows a relatively benign course in contrast to squamous cell carcinoma .This study investigates whether the behavior of these tumors could be explained by differences in their angiogenesis pattern.
Methods: Vessel counts were made of blood vessels in stroma and the body of 50 variants of BCC of skin samples including: nodular, micronodular, sclerosing and superficial, both after H&E and immunohistochemical staining for CD31 and CD34 markers.
Results: The body vessel counts of invasive variants (sclerosing & micronodular) differed significantly from the counts of noninvasive variants (nodular and superficial) using both CD31 & CD34 markers. The stromal vessel counts compared between invasive and noninvasive variants showed no significantly difference using CD31 & CD34 markers, respectively.
Conclusion: The invasive growth pattern of BCC variants correlated with the microvascular density and according to results, vessel counts of the body play a more important role.

Etiological diagnosis of hirsutism in premenopausal Iranian women

Dariush Akbari

Background and Aim: Hirsutism is defined as the presence of terminal hairs in androgen dependent areas in women. It is a common clinical condition and affects 5% to 10% of women of reproductive age. The aim of this study was to determine the clinical features and etiologic factors of hirsutism in premenopausal women.
Methods: In this cross-sectional study, 200 premenopausal women with hirsutism who were admitted at our dermatologic clinic during a 2-year period were nivestigated. After a careful history and physical examination, a transabdominal ultrasonography of the ovaries and laboratory evaluation including early morning total testosterone, prolactin, dehydroepiandrosterone sulfate (DHEA-S) and 17-hydroxyprogestron in all patients and thyroid stimulating hormone (TSH) in 10 patients were performed.
Results: Polycystic ovary syndrome (PCOS) was the most common cause of the hirsutism (54.5%) followed by idiopathic hirsutism (40%). Other causes of hirsutism were prolactinoma (2%), hypothyroidism (1%) and drugs intake (2.5%). Hirsutism was mild in 109 patients (54.5%), moderate in 85 patients (42.5%) and severe in 6 patients (3%). Family history of hirsutism was present in 105 (52.5%) patients. Clinical conditions associated with hirsutism were: acne (52.5%), menstrual irregularity (35%), androgenetic alopecia (15%), acanthosis negricans (7.5%) and obesity (37.5%).
Conclusion: PCOS and idiopathic hirsutism are the most common cause of the hirsutism in premenopausal women. A detailed history and physical exam often provide enough information to determine the etiology of hirsutism.

Physiologic skin changes during pregnancy in hospitalized women at postpartum unit at Shabih Khani Hospital in Kashan/Iran in 2009

Mahboobe Kafaei Atrian

Background and Aim: Pregnancy affects all organs and systems in the body including skin. Some skin changes are physiologic, whereas others are pathologic such as the dermatoses of pregnancy. The purpose of this study was to determine the frequency of physiological skin changes during pregnancy in hospitalized women at postpartum unit at Shabih Khani Hospital in Kashan/Iran in 2009.
Methods: One-hundred and eighty women were evaluated during their post partum periods for evidence of skin changes. Excluding factors were foreign citrizens, multiple pregnancies and gestational age under 20 weeks. Data were collected by using questionnaires before discharge from hospital.
Results: The frequencies of various observed changes included: melasma (33.9%), striae (82.3%), edema of eyelid (30%), increased acne severity (26.7%), hirsutism (17.2%) and decreased acne severity (1.7%).
Conclusion: Considering the high incidence of skin changes during pregnancy, it is recommended to instruct the mothers on skin care.

Prevalence of androgenetic alopecia among women between 20-70 years old in Isfahan province in 2008-2009

Elaheh Haftbaradaran

Background and Aim: Androgenetic alopecia is an extremely common disorder affecting both men and women. The incidence is generally considered to be greater in males than females, although some evidence suggests that the apparent differences in incidence may be a reflection of different expression in males and females. This genetically determined disorder is progressive through the gradual conversion of terminal hairs into indeterminate hairs and finally to vellus hairs. Patients have a reduction in the terminal-to-vellus hair ratio, normally at least 2:1. Following miniaturization of the follicles, fibrous tracts remain. Patients with this disorder usually have a typical distribution of hair loss.
Methods: This is a cross sectional study that conducted in Isfahan health center in 2007-2008 .Using simple random sampling, we selected 1800 women in urban health center areas for hair loss. We evaluated the type of hair loss by Ludwig classification. The data was collected through administration of a specifically designed questionnaire and was analyzed using SPSS software. The chi-square and student tests were used for data analysis.

Results: According to results of this study the of 1800 women, 712 (39.6%) had hair loss. Mean age of females who had hair loss was 50.4±13 years.
Conclusion: Thyroid disorders, ferritin serum level and androgenic hormones may play role in hair loss and their existance should be assessed.

A review of mastocytosis with best practices

Afsaneh Alavi

Mastocytosis most frequently manifests in the skin, so most often is diagnosed by dermatologists at first. Low threshold in clinical suspicion helps early detection of these cases. Cutaneous mastocytosis is an increase of cutaneous mast cells without known underlying disease or inflammatory infiltrate. A skin biopsy with staining specific for mast cells (toluidine blue, Wright-Giemsa) and tryptase immunohistochemical analysis should be considered in all patients with characteristic skin lesions. There is no treatment that cures cutaneous matocytosis and the major concern in the treatment is patient's quality of life. Although systemic mastocytosis occurs in greater than 25% of cases of cutaneous matocytosis in adults, there is little evidence that symptomatic therapy substantially alters the course of the disease. Almost all patients with cutaneous matocytosis belong to the indolent category of the consensus revised classification and have a good prognosis. This review aimed to provide best practices recommendations based on the evidence and patients perspectives.

Connective Tissue Nevus: A Case Report

Amirhoushang Ehsani

Connective tissue nevi are types of hamartoma with increased collagen in which the amounts of elastin may vary. This report introduces an 18-year-old case with various nodular lesions in upper thigh area. Performed biopsy suggested the diagnosis of collagenoma which is a sub-type of connective tissue nevus.

An unusual presentation of deep morphea (morphea profunda): peripheral sensory motor nerve involvement, insulin dependent diabetes mellitus and hypothyroidism

Mansour Nassiri-Kashani

This case report introduces a 28-year-old male patient with morphea profunda, peripheral sensory motor nerve involvement, insulin dependent diabetes mellitus and hypothyroidism as an unusual presentation of deep morphea who dramatically responded to prednisolone and metothrexate after 4 months of treatment.