Journal of

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It is more than a decade that teledermatology has been considered as a potential substitute for the face to face visits. To evaluate its quality, the reliability and accuracy of teledermatology diagnoses are compared to those which are made in face to face visits. In this article, the results of the studies which have compared the reliability and accuracy of diagnoses had been made using teledermatology to the face to face visits were reviewed.

Different resources, such as electronic databases and e-journals were used to choose relevant articles related to teledermatology published between 1997 and 2013, and their main focus was on the reliability and accuracy of diagnoses in teledermatology compared to those in the face to face visits.

The reliability and accuracy of diagnoses in teledermatology compared to those in the face to face visits was more than 60%. Moreover, improving the reliability and accuracy depended on different factors, such as image quality, clinical information, differential diagnoses, consultation with other colleagues and gaining their secondary opinions.

It seems that providing adequate clinical information about patients can help to improve the reliability and accuracy of diagnoses in teledermatology. In this case, teledermatology can be used to provide healthcare services for the distant areas and the poor.

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Background and Aim: Dandruff and seborrheic dermatitis (SD) are common chronic skin diseases. There are many chemical drugs for treating dandruff and SD. Prolonged use of them may cause side effects and drug resistance. The aim of this study was to compare the efficacy of a herbal extract lotion with clotrimazole 1% lotion in the treatment of SD.

Methods: Twenty volunteers (12 men and 8 women) aged 20 to 40 years, with seborrheic dermatitis were enrolled in this trial and were randomly allocated into two groups. One group was treated with a herbal extract lotion and the other group with clotrimazole lotion. The herbal extract contained common sage, thyme vulgaris, tea tree oil, lavender, willow, rosemary, and aloe vera. The patients were instructed to use the lotions three times a week for 4 weeks. We evaluated the patients by clinical assessment and measured the scalp sebum, pH, and dandruff number before two weeks, and four weeks after completed a treatment. At the end of the study, each participant satisfaction form.

Results: At the end of the study, the participants whom received the herbal extract lotion had a significantly greater reduction in scalp scaling, erythema, itching, and number of dandruff compared with those who received clotrimazole (P<0.05). The patient satisfaction score was also higher in the herbal extract group (60% versus 10%).

Conclusion: This study showed that herbal extracts lotion was effective in the treatment of dandruff and seborrheic dermatitiand can be an appropriate alternative to chemical agents.

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Introductio: Intravascular papillary endothelial hyperplasia (Masson’s hemangioma) is an unusual, benign,
non-neoplastic, vascular lesion. The lesion is a vascular proliferative reaction following traumatic vascular stasis.

Case Report: In our case a submandibular lesion occurred after insect bite and pathology confirmed it as Masson hemangioma.

Conclusion: Post traumatic red-blue firm lesions should be evaluated pathologically for many differential diagnosis including rare cases such as Masson,s hemangioma.

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Introduction: Beckers’s nevus is a cutaneous hamartoma which usually appears as a circumscribed hyperpigmentation with hypertrichosis. It usually presents unilaterally and the usual site is shoulder and scapula. It is rarely congenital and it is usually noticed first during adolescence.

Case Report: Herein, we report a congenital bilateral large Becker’s nevus with positive familial history of Becker’s nevus. There were no associated anomalies in our patients.

Conclusion: Familial and bilateral cases of Becker’s nevus can present with no associated anomalies as “Becker’s syndrome”.

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Onychomycosis is a common nail disorder. If left untreated, it may cause nail deformity and nail plate dystrophy. Since nails have aesthetic importance, onychomycosis may have some impact on quality of life by causing a change in the appearance of nail and/or nail dystrophy and by interfering with fine activities carried out by hand. The aim of this review is to evaluate the quality of life in patients with onychomycosis.

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ntroduction: Leprosy is an infectious disease which primarily affect skin and peripheral nerves. Mycobacterium leprae and Mycobacterium lepromatosis that are the acid-fast bacillus are known to be cause of leprosy. Genetic factors and immunological function have some roles in susceptibility of developing leprosy. There are some cases of familial leprosy.

Case Report: Here in, we report a case of familial leprosy which in one member it was symptomatic and others were asymptomatic with positive skin smear for mycobacterium leprosy bacilli.

Conclusion: We recommend in addition to approach and manage lepromatous patients, their families be also evaluated.

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The aim of this study was to investigate the possibility of using saliva instead of serum (as a simpler method without the need for blood sampling) to determine the level of some cytokines and enzymes. In this study, the levels of cytokines IL10, IFN-Y, TNF-α, TGF-β and the antioxidant enzymes glutathione reductase and glutathione peroxidase were measured in the saliva and serum of three patients with alopecia totalis by ELISA. Comparison of the levels of these substances in saliva samples at 5 am, saliva at 11 am and serum at 11 am with Friedman test did not show a significant difference. Therefore, saliva samples may be a good alternative to serum in the study of immunological factors.

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Diode 1470 nm laser is a minimally invasive laser used for skin lifting and tightening. It can reduce laxity and excessive fat tissue. Three patients with facial fat lump due to past facial fat injection treated by this laser in one session.

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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.

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Background and Aim: Hair loss is one of the most common problems among the skin and hair related diseases. Hair loss can lead to anxiety, depression, low self-esteem and dissatisfaction with appearance.
 

Methods: Patients with androgenetic alopecia who met the eligibility criteria entered the study. Participants were asked to randomly apply a solution of valproic acid 8.3% or a solution of minoxidil 5% on the affected areas according to the treatment protocol (twice a day). Before and 2 months after treatment, the participants were evaluated. The studied indices included the number of hair follicles in the specified area, the number of velus hairs, the number of terminal hairs, the average hair thickness, and the percentage of hairs in the anagen and telogen phases, as well as the skin reactions in the area. Hairs were examined at the beginning of the study and at 2 months after treatment using Foto Finder-trichoscale device.
 

Results: Two months after treatment compared to baseline in the valproic group, anagen hair count index (P=0.02), general hair count index (P=0.03), and terminl hair count index (P=0.012) showed significant changes. While telogen hair count (P=0.059) and vellus hair count (P=0.097) did not show significant changes. These changes were more significated in minoxidil group.

Conclusion: 8.3% valproic acid solution showed positive effects in increasing the number of hairs and decreasing the percentage of telogen hairs. Due to the delayed mechanism of valproic acid, the duration of treatment with this compound should be considered longer than minoxidil as a positive control.

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Background and Aim: Candida albicans have the ability to colonize living and non-living surfaces and form biofilms that are very resistant to common antifungals. The present study was designed to evaluate the fungicidal activity of itraconazole on Candida albicans biofilm.

Methods: The present study was conducted on 10 nail samples. Routine mycological and molecular tests were performed to identify and determine the type of fungus. Biofilm was formed in the 96-well plate and was subjected to the itraconazole. ROS accumulation was measured. ROS levels were determined in biofilms treated with itraconazole in the presence of antioxidants.The minimum inhibitory concentration of itraconazole was measured in the presence of ascorbic acid (10 mM) according to the protocol of the previous step. Annexin V-FITC apoptosis detection kit was used to investigate the possibility of apoptosis induction following itraconazole use. 

Results: Mann-Whitney showed a significant difference between biofilms treated with itraconazole and untreated biofilms for 10 tested strains. Treatment with itraconazole resulted in a significant reduction in the number of biofilms. Ascorbic acid significantly reduced ROS accumulation caused by itraconazole for biofilms of all Candida albicans strains. The findings show that itraconazole induces ROS-dependent apoptosis in a dose-dependent manner in biofilm cells.

Conclusion: In this study, it was found that the presence of intracellular ROS is the main cause of the apoptosis mechanism of itraconazole. The ability of itraconazole to induce ROS in Candida cells appears to be a very effective fungicidal strategy.

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Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disorder characterized by intensely itchy eczema. Sensitivity to Malassezia species may be associated with the severity of AD symptoms. The growth conditions for Malassezia spp. on children's skin are lower than on adult skin, making adults more susceptible to Malassezia. There is a minor suspicion that Malassezia spp. plays a role in AD as it may interact with skin immune reactions and barrier function, and sensitization against this skin-colonizing yeast can be correlated with illness activity. Additionally, antifungal treatment shows beneficial effects in some patients. However, the pathogenetic process and mutual interaction between Malassezia spp. and AD remain relatively unclear, necessitating further research.

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Background and Aim: Recently, many Iranian companies have started manufacturing hyaluronic acid based dermal fillers. Current review aimed to assess and compare the clinical safety and efficacy of 5 Iranian hyaluronic acid based dermal fillers.
Methods: The first part of the study reported, the overall safety and efficacy of 5 Iranian hyaluronic acid based dermal fillers for improvement of nasolabial folds in 150 participants (age 44.30±9.97 years) using clinical and objectives assessment methods. In the second part, we performed a comparative study among 5 tested dermal fillers.
Results: Generally, at weeks 2, 12, and 24, 80.6%, 63.3%, and 60.66% of the participants, showed one grade or more improvement in the severity of nasolabial folds respectively. In all visits, the nasolabial folds biophysical parameters as well as the echo density dermis improved significantly compared to baseline. In comparative study, two fillers with the hyaluronic acid concentration of 24 mg/ml, showed the best objective efficacy, while in clinical evaluations, the filler containing mannitol has the best performance in reducing the severity of nasolabial folds showed.
Conclusion: Iranian hyaluronic acid based dermal fillers showed different levels of safety and efficacy for improvement of moderate to severe nasolabial folds, with efficacy.

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Recently, the cases of dermatophytosis have increased sharply, which is associated with frequent reports of chronic cases of the disease, uncommon skin manifestations, and treatment failure. Cases of emergence of resistant species in other geographical areas such as Denmark, Switzerland, and China, Belgium, Germany, Japan, Iran, Finland, Switzerland, France, Iraq and Bahrain are also known. Antifungal drug susceptibility testing for dermatophyte species has not yet been standardized. Antifungal Susceptibility Tests (AFST) are used to determine the minimum growth inhibitory concentration (MIC) of a specific drug in laboratory conditions with the aim of predicting whether a patient will respond to standard antifungal treatment or not. In the continuation of this article, we gave an overview of the antifungal sensitivity test, including its strengths and weaknesses and its role in helping to make therapeutic decisions.

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Dermatophytes are keratinophilic fungi responsible for common and benign infections worldwide. However, in immunocompromised patients, they may lead to rare and severe diseases. Severe forms include widespread and/or invasive dermatophytosis, such as deep dermatophytosis and Majocchi’s granuloma. These cases have been reported in individuals with primary immunodeficiencies (such as autosomal recessive CARD9 deficiency) or acquired immunodeficiencies (such as solid organ transplantation, autoimmune diseases treated with immunosuppressive therapies, or HIV infection). The clinical manifestations of these infections are non-specific. Lymph node and organ involvement may also occur. Diagnosis requires mycological and histopathological evidence. There is no consensus on treatment. Systemic antifungal agents, such as terbinafine and azoles (e.g., itraconazole or posaconazole), are effective. However, the long-term outcome and management depend on the site and extent of the infection and the type of underlying immunodeficiency.

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The indications for botulinum toxin have evolved tremendously since its introduction in 1989. This review highlights the potential of the use of BoNT based on the latest studies that indicate botulinum toxin injections may be beneficial as an alternative method of therapy in treating, among others, hyperhidrosis, hidradenitis suppurativa, Raynaud phenomenon, or anal fissure. Currently, there are numerous studies suggesting the effectiveness of botulinum toxin in the discussed diseases; however, it should be emphasized that the majority of evidence is based on low scientific quality publications and more clinical trials need to be conducted. Despite many favorable utilizations, the use of botulinum toxin is not without ramifications. To serve patients with relevant therapy and reduce related complications, dermatologists should be aware of both on- and off-label applications of botulinum toxin. Undoubtedly, a consensus on the treatment protocol for each indicator should be a topic of interest for practitioners to standardize all regimens with specific doses of BoNT.
 

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Human lip aging is one of the natural signs of the body’s aging process, occurring over time due to factors such as a decrease in collagen and elastin, exposure to sunlight, environmental stress, and genetic changes. As time passes, the lips may lose their appearance, and fine lines or deep wrinkles may form around the lips and the upper lip area. These changes can lead to a reduction in lip volume and the loss of their natural shape. Additionally, dryness and chapping of the lips are other issues commonly observed with lip aging. Skin care, the use of moisturizers, and avoiding prolonged sun exposure can help slow down this process.

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Background and aim: In recent years, increasing demand for aesthetic treatments in Iran and the need for high-quality domestic products have encouraged several companies to produce botulinum toxin type A. This study aimed to evaluate and compare the clinical efficacy and safety of three such Iranian products.
Methods: In the first part of the study, the overall efficacy of the botulinum toxin type A products for treating glabellar lines was assessed in 230 participants who received one of the three Iranian formulations (mean age 42.69 ± 9.21 years), and compared with 230 participants who received the standard treatment (Dysport®) (mean age 42.50±9.79 years). Outcomes were evaluated on day 30 post-injection. In the second part, the comparative efficacy of the three domestic products during the same period and their safety profile up to month four post-injection were assessed.
Results: A clinically meaningful response (at least a two-grade improvement in glabellar line severity) was achieved in 68.6% of recipients of the Iranian products, compared with 52.8% of Dysport recipients, demonstrating a statistically significant superiority in equivalence studies (P<0.01). Among the three domestic products, only product No. 2 showed a significantly higher proportion of participants achieving ≥2-grade improvement (assessed by an independent physician). The type and frequency of adverse events (except for headache) were comparable to the standard drug monograph.
Conclusion: The findings indicate acceptable efficacy and safety of Iran-made botulinum toxin type A products compared with the reference product. Except for limited differences, the efficacy and safety profiles of the three formulations were generally similar up to day 30 post-injection.