Journal of

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Toxic epidermal necrolysis (TEN) is a server, life-threatening drug-induced mucocutaneous eruption that rarely affects scalp. There has been limited number of cases of TEN arising in patients receiving radiation therapy plus anticonvulsants.Here, we report a case of TEN secondary to anticonvulsant and radiation therapy. An unusual aspect shared by our patient as well as the other reported cases is that the eruption always begins at the site of recent radiation therapy. In this report, we discuss the possible hypotheses for this phenomenon.

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Tuberous sclerosis complex is a genetic disorder characterized by hamartoma formation in many organs. Its characteristic dermatologic manifestations include angiofibroma, shagreen patch, periungual fibroma and white macules. This disorder is usually accompanied by epilepsy and mental deficiency. Here, a 26-year-old man is presented who has been referred to a teaching hospital with a huge facial angiofibroma which had led to major psychological problems for him necessitating and appropriate treatment plan.

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Training of dermatology residents , their evaluation. Certification and recertification in each part of world id different from the other and is highly dependent to health care needs and standards, resources and expectations of those who receive the care for example in Australia a dermatologist is expected to be able to manage surgically all kinds skin cancers (melanoma or non-melanoma) and perform lymph node dissection himself without need to refer to a surgeon. However, learning about the process of dermatology residency training, certification and maintenance of certification in other countries will help us in curriculum planning and evaluation of our dermatology residents according to our own health care needs and social, economical and epidemiologic conditions.

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Background and aim: Saffron possesses a lot of medical applications in traditional medicine. One of its properties is ultraviolet (UV) light absorption. The aim of this study was preparation, determination of properties and investigating sun protevtive effects of nanoliposomes containing saffron extract and safranal, a substance existing in saffron.
Methods: Nanoliposomal hydroalcoholic extract of saffron stigma in concentrations 2%, 4%, 8% and nanoliposomal safranal in concentrations 0.25% , 0.5% and 1% were prepared. Standard lotion of homosalate 8% was used according to FDA standards for sun protection factor (SPF) determination and assessment of accuracy of the method. SPFs of substances were calculated in vitro by diluted solvent method using Mansur, et al equation and absorptiometry.

Results: SPf of Nanoliposomal saffron 8% extract was significantly higher than standard sunscreen homosalate with similar concentration. SPFs of safranal (1% and 0.5%) component of saffron were significantly higher than the standard sunscreen homosalate 8%.
Conclusion: Saffron can act as a sunscreen. Safranal existing in saffron is much more sun protective than standard substance, homosalate 8%. Thus , the safranal existing in saffron may have significant sun protective effect in low concentration if encapsulated in liposome.

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Background and aim: Skin rejuvenation is in demand. In recent years, mono- and bipolar radiofrequency (RF) have been reckoned as treatment of choice for this purpose. The studies on RF have shown the remodeling of collagen fibers and consequently improvement of skin texture although risks and side effects may exist.
Methods: Forty-eight patients requesting skin rejuvenation were treated by RF after obtaining written consent from them. The diagnosis had been made solely on the basis of examination and observation. The photography was performed in all patients pre- and post-treatment. The pictures were evaluated by a dermatologist unaware of the sequence of photos.
Results: the wrinkles improved in 26(54%) patients. The response was better with increasing age. Transient pain and erythema were reported by all patients.
Conclusion: Radiofrequency is an appropriate treatment for reducing the number and the depth of wrinkles and needs comprehensive education. At least, 4 treatment sessions with 2-week intervals are required for effectiveness.

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Background and aim: Oral lichen planus, is a chronic inflammatory mucocutanous lesion which is defined as a premalignant lesion. Matrix metaloprotenase 2 (MMP-2) and MMP-9 are protenases which facilitates invasion of tumoral cells to connective tissue and are over-expressed in premalignant and malignant lesions. The aim of this study was to determine the expression of MMP-2 in erosive and non-erosive oral lichen planus and inflammatory hyperplasia by immunohistochemistry.
Methods: in this cross sectional study 39 specimens of non-erosive oral lichen planus (with and without dysplasia), 36 specimens of erosive ones (11 dysplastic and 25 non-dysplastic, 32 inflammatory hyperplasias and 6 samples of normal oral mucosa were chosen form pathology archive of Faculty of Dentistry, Mashhad university of Medical Sciences and were stained immunohistochemically by MMP-2 and MMP-9 markers. Kruskal-Wallis, Mann-Whitney and Spearman correlation coefficient were used.
Results: The highest mean expression of MMP-2 and MMP-9 (in all layers) were observed in erosive oral lichen planus (68.18±31.62 and 94.5±3.5, respectively). MMP-9 expression in erosive oral lichen planus in comparison to non-erosive one showed significant difference in all layers (P<0.001) and the expression of MMP-2 showed a significant difference in basal –para basal and prickle layers (respectively: P=0.008, P<0.001).
Conclusion: the linear increase seen in the expression of markers from normal mucosa to erosive oral lichen planus indicates the difference of biological behavior between erosive and non-erosive oral lichen planus. Hence, it is concluded that erosive oral lichen planus is of the higher premalignan potential compared with its non-erosive correspondent.

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Background and aim: it has been estimated that 70000-100000 cases of HIV infection exist in Iran. The main route of transmission is intravenous drug (IV) injection. Rapid spread of this disease necessitates its prompt diagnosis. About 90% of HIV infected patients express cutaneous manifestations therefore, recognition of these symptoms may be of help in early diagnosis.
Methods: HIV infected patients with suspected skin lesion were referred to Skin Disease and Leishmaniasis Research Center and were examined by an intern contributed in the study. All the information were gathered in data code sheets. Then, all of the patients were visited by the dermatologist for complementary examinations and the results including lesion type, location and duration were recorded in the check list.
Results: fifty persons were examined and 42 patients were selected. Prevalence of dermatologic manifestations was as follows: herpes zoster in 23.8%, seborrheic dermatitis in 14.3%, hyperpigmentation in 19%, oropharyngeal candidiasis in 14.3%, folliculitis in 14.3% dermatophytosis in 4.7%, wart in 4.7%, Kaposi’s sarcoma in 2.3%, and drug eruption in 2.3% , 75% of patient who had hyperpigmentation were infected by their sexual partner and 25% via IV injection. 33% of patient who had folliculitis were infected via IV injection, 33% through blood transfusion and 33% by sexual relationship.
Conclusion: According to the results of this study, paying attention to cutaneous signs HIV/AIDS patients, their early detection and diagnostic and therapeutic measures for them are advocated.

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Background and aim: Actinic keratoses (AKs) are the third commonest complaint of patients visiting dermatologists. Topical treatment including 5-fluorouracil (5-FU) are among the commonest available therapies. According to local irritation induced by topical 5-FU The aim of current study was to compare efficacy of two different 5-FU based regimens with different application routes.
Methods: Patients with AKs confirmed by skin biopsy, matching our exlusion criteria were enrolled. Subjects randomized in two groups, receiving topical 5% 5-FU once daily or alternatedaily respectively. Two weeks after the end of one month period of the study, rate of reduction in number of lesions was documented by blinded academic dermatologists as well as treatment side effects.
Results: a total of 38 patients (23 male and 15 female) completed the study. Rate of side effects were lower in alternate-day applying patients (P<0.05) while rate of response to therapy were comparable in both groups (P>0.05).
Conclusion: alternate-day route for application of topical 5-FU is an acceptable alternative for classic daily application, to reduce rate of side effects and enhancing patients compliance.

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Multiple surgical methods are available for the management of malignant melanoma. Often, these methods have limitations in terms of the ability of obtaining margin clearance in the context of an appropriate cosmetic outcome. This article, briefly reviews the use of different simple and excisional techniques as well as that of Mohs micrographic in the surgical management of malignant melanomas

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Pulse Dye Laser (PDL) is mainly used to treat vascular lesions but several studies performed in different research centers have shown the efficacy of this safe laser in the treatment of non-vascular lesions as well. The aim of this study was to review, sum up and summarize these studies.PDL is a known alternative for cryotherapy in the treatment of some viral lesions such as periungual warts and molluscum contagiosum.The effect of this laser in the management of inflammatory lesions is not yet known and there have been controversial results. PDL has a very little effect on these dematoses and it is limited to the lesions with a clear vascular component, such as psoriasis and acne. Finally, regarding collagen remodeling and its usage in rejuvenation and in the treatment of hypertrophic scars, keloid and striae, the results from various studies are different and while they confirm its possible effect, more studies have to be conducted in order to determine appropriate treatment parameters.

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Backgound and Aim: Skin cancer is the most prevalent type of cancer in Yazd city. Childhood and adolescense is an important time for preventing the skin cancers. The aim of this study was to survey the role of appearance concern with skin cancer prevention behavior based on protection motivation theory.
Methods: Participants in this cross- sectional study were 360 female students from 4 high schools in Yazd city. Data were gathered by using self-reporting questionnaires and were analyzed using SPSS software applying ANOVA, Pearson's correlation coefficient and linear regression tests.
Results: Using Pearson's correlation test, a statistically significant correlation between the appearance concern with perceived susceptibility, perceived severity, self-efficacy, response efficacy, protection motivation and behaviors was found (P<0.01). The perceived susceptibility, perceived severity, self- efficacy, response efficacy, protection motivation, response costs and appearance concern could predict 0.56 of the behaviors and perceived susceptibility was the strongest predictor (β=0.120). Also, protection motivation could predict behavior (41 %).
Conclusion: Results of this study support the effectiveness of protection motivation theory variables and the role of appearance concern for prediction of skin cancer prevention behaviors in participants.

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Backgound and Aim: One important limitation of random pattern skin flap in plastic surgery is the necrosis of distant parts of the flap resulting from ischemia. This effect cause unwanted increase in the costs and hospitalization. Previously, large number of factors has been evaluated to decrease the flap necrosis. In present study we used two drugs. Main reason was their mechanism of action that seems to be similar to preconditioning pathways.
Methods: ّFifty-six male rats were divided into four groups. In two groups 5% minoxidil or 5% azelaic acid were applied topically to the flap area before flap elevation. In some rats of minoxidil treated group, a non selective ATP sensitive potassium channel (KATP) blocker, glibenclamide (0.3mg/kg) was injected i.p. to evaluate the role of this channel in action. In azelaic acid treated rats, some were selected for evaluation of the role of nitric oxide and therefore L-NAME (20 mg/kg), a non-selective iNOS inhibitor, was administered. Seven days after operation, the extent of flap necrosis was calculated.
Results: Topical minoxidil or azelaic acid significantly recused necrotic area of skin flap to 42% (P<0.05) and 34% (P<0.01), respectively. Combination of minoxidil and azelaic acid was the most effictive intervantion on reducing of necrotic area to 26%. Glibenclamide abolished protective effect of minoxidil (P<0.001) and L-NAME inhibited the effect of azelaic acid on skin flap survival (P<0.05). Both L-NAME and glibenclamide completely inhibited the effect of combination topical therapy.
Conclusion: Present study suggested the role of KATP channels on minoxidil pathway and NO on L-NAME pathway of preserving skin flap survival. It seems that there is an overlap between the two pathways however precise mechanism remained to be determined.

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Background and Aim: Sarcoidosis is a non-caseous granulomatous disease that can involve several organs such as lung, kidney, liver, heart and skin. In systemic sarcoidosis, skin lesions occur in 20-35% of patients. Cutaneous sarcoidosis with no systemic involvement was found in about 25% of patients. Mutation within Butyrophilin-like 2 (BTNL2) gene, rs2076530 was reported in systemic sarcoidosis. However, there is no report of evaluation of mutation in BTNL2 gene with the diagnosis of skin sarcoidosis.
Methods: In this study ten patients with skin sarcoidosis were evaluated for the mutation of rs2076530 allele in exon 5 of BTNL2 gene. This assessment was performed by the single strand conformation polymerase chain reaction (SSCP-PCR) in which the existing mutations with positive shift were deteced using directl sequence analysis. Data from sequence analysis were evaluated and blusted by means of Choroms computer software.
Results: Our results showed the BTNL2 G→A transition of rs2076530 in seven patients and three patients were normal.
Conclusion: This pilot study concludes the presence of a mutation at rs2076530 in exon 5 of BTNL2 gene in patients with skin sarcoidosis. Larger studies are needed to evaluate the role of this finding.

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Background and Aim: Psoriasis is a chronic skin disorder involving many parts of the body including skin, nails and joints with severe negative effects on patient's quality of life. Nail involvement is one of the most difficult involvements of this disease to treat. Psoriatic arthritis categorized in sero-negative spondilo-arthropaties with some deforming characteristics. The aim of the present study was to evaluate the relationship between psoriatic arthritis and nail involvement based on standard psoriatic nail involvement score (NAPSI).
Methods: Psoriatic patients visiting dermatology clinic of Razi hospital were selected. Patients with arthritis enrolled as the case group while patients that had no joint involvement participated in control group. After matching, demographic data of both groups as well as NAPSI score and nail involvement characteristics collected through special questionnaires and analyzed with SPSS version 14.
Results: A total of 30 patients with psoriatic arthritis and 75 patients without arthritis were enrolled the study. Analysis of collected data demonstrated that nail involvement among patients with psoriatic arthritis (mean NAPSI score=46) was more common and severe than patients without joint involvement (mean NAPSI score=9.23) (P<0.05).
Conclusion: It seems that there is a significant difference between psoriatic patients presenting with or without arthritis and presence of arthritis probably can determine occurrence and extension of nail involvement.

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Background and Aim: several studies have been conducted to evaluate skin pH in various diseases, but there are few reports in normal population. The aim of this study was to evaluate skin pH in healthy individuals.
Methods: Fifty healthy volunteers were enrolled in this study. The subjects were divided by age into 5 groups, i.e., 10-20, 21-30, 31-40, 41-50 and 51-60 years old. In each group, 5 females and 5 males were examined. A pH meter (Courage & Khazaka electronic GmbH, Germany) was used to measure pH in 8 different locations of the body (forehead, cheek, nasolabial fold, neck, forearm, dorsal side of hand, palm and leg).
Results: The mean values for pH in these locations were 5.25, 5.15, 5.06, 4.90, 4.75, 4.80, 4.69, and 4.83 respectively. pH was significantly higher in women (P<0.001). There was a significant difference between skin pH in different age groups (P=0.002). The highest and lowest amounts of pH belonged to the forehead (5.26 ± 0.68) and leg (4.69 ± 0.40), respectively.
Conclusion: Age and sex and location have remarkable effects on skin pH.

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Background and Aim: There are some reports regading the anti-inflammatory and antimicrobial effect of honey and Nigella sativa and their therapeutic effects in improvement of wound healing. This study was designed to evaluate the efficacy of adding honey and Nigella sativa extract compared to honey alone in patients with cutaneous leishmaniasis receiving intralesional Glucantime.
Methods: In this clinical trial, 150 patients with confirmed cutaneous leishmaniasis were randomly allocated into two groups. One group was treated with topical honey twice daily along with weekly intralesional injection of Glucantime. In the second group, patients were treated with topical honey and 60 % hydroalchoholic Nigella sativa extract instead of honey alone. The patients were treated until complete healing of the ulcer or for maximum of 12 weeks.
Results: At 12 weeks, complete cure was achieved in 61 (81.3%) of patients treated with topical honey and 60 % hydroalchoholic Nigella sativa extract versus 48 (64%) in the second group (P=0.002).
Conclusion: The efficacy of adjunct honey and Nigella sativa extract along with intralesional Glucantime is more than honey alone in increasing complete cure rate and decreasing the residual scar size and the required dose of Glucantime.

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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.

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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.

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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.

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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.