Journal of

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.

Background and Aim: Pemphigus vulgaris (PV) is an autoimmune blistering disease which is specific for skin and mucosal membranes. Its association with connective tissue diseases has already been reported. Considering this association, presence of Anti Nuclear Antibodies (ANAs) in PV patients will not be surprising. The aim of this study was to compare the frequency of ANA positive cases in patients suffering PV with a control group.
Methods: In this case-control study, the cases were selected from the patients with PV whom were hospitalized at Razi Hospital, Tehran. The controls were chosen from patients who did not have PV. The data were collected using a questionnaire, which was designed for gathering information on participants' age, sex, PV phenotypes, and the result of ANA test. ANA positivity was assessed using indirect immunofluorescence, HEP2.
Results: In 8 (26.7%) of 30 PV patients and 3 (10.0%) of 30 controls ANA was positive (P=0.095). The most common ANA positive patterns among cases and controls were homogeneous and speckled patterns, respectively (P=0.26).
Conclusion: Although in this study the frequency of positive ANA result among controls was similar to what were reported in previous studies, the frequency of this finding among PV patients was different from the previous reports. Differences in the sensitivity of the laboratory kits used in different studies as well as in the threshold for ANA positivity, and differences in the patients' eligibility criteria in different studies may explain the observed discrepancies. Clinical follow up of the PV and requesting an ANA test in the case of appearance of the signs of connective tissue diseases is recommended.

Background and Aim: Consumption of the epidermis (COE) is defined as thinning of the epidermis with attenuation of the basal and suprabasal layers and loss of rete ridges in areas of direct contact with malignant melanocytes. The aim of this study was to investigate the importance of COE as an additional diagnostic criterion for malignant melanoma and to evaluate its relationship to clinicopathological findings.

Methodes: The age, gender, localization of the lesion and the histopathological parameters such as tumor type, Breslow thickness, ulceration, and Clark's level were recoeded in 90 malignant melanoma cases.

Results: In contrast to other studies, we found that COE was more common in tumors with an acral localization and in the acral lentiginous melanoma.

Conclusion: Although COE can be used as a pathological criterion in the diagnosis of malignant melanoma, but no correlation no of COE with ulceration and other prognostic factors were found.

Background and Aim: Direct immunofluorescence (DIF) is represented as a gold standard method in diagnosis of autoimmune blistering dermatoses. Normal saline, liquid nitrogen and michel’ solution are a widely accepted media for preserving biopsy samples of skin or mucosa before DIF examination. Occasionally clinicians put the biopsy specimen taken for DIF in formalin 10%, occasionally clinicians ordered DIF retrogradely and only a paraffin-embedded biopsy specimen exposed to formalin 10% is available. To determine the diagnostic value of DIF when it was performed on biopsy samples of skin or mucosa exposed to formalin 10% in comparison to the same biopsy samples exposed to normal saline.
 

Methods: In 74 patients (38 immunobullous and 23 chronic dermatitis), which the latter served as the normal controls, 2 perilesional punch biopsy of skin or mucosa were done, one put in formalin 10% and fixed in paraffin and one put in normal saline, and DIF was done on both samples. 
 

Results: DIF sensitivity and specificity was with IgG 31.5% and 100% in pemphigus and 15.36% and 93.44% in BP, with C3 39.47% and 100% in pemphigus and 7.69% and 91.80% in BP, respectively.
 

Conclusion: DIF on specimens exposed to formalin 10% in comparison to specimens exposed to normal saline is less sensitive but approximately as specific as it is in the diagnosis of pemphigus and BP patients and especially can be useful in pemphigus patients when only a formalin exposed samples is available.

Background and Aim: One of the most important pathologies of tattooing is granulomatous reaction to the tattoo which is usually represented by symptoms like pain, inflation, redness and tenderness at the tattoo area. Granulomatous reaction to tattoo occurs at all ages and has been seen among both male and female. Due to the new rise in popularity of cosmetic tattoos and its pathologies, we intend to explore a descriptive study of the demographic and histopathologic characteristics of the granulomatous reactions due to cosmetic tattoos.
 

Methods: Razi hospital patients with proven tattoo granuloma pathology in a 3-year period were identified and studied and their demographic-histological characteristics were recorded. The study is of a cross-sectional type. 196 patients were enrolled in the study, a questionnaire was prepared for each patient and information was collected through them. 
 

Results: The mean ± standard deviation age of the patients was 45.46±8.54. The mean ± standard deviation tattoo time was 4.18±4.33. The mean ± standard deviation frequency of tattooing was 1.64±1.8. The most common tattoo area was eyebrow in 88.3% of the patients and least common was upper eyelid in 0.6%. The most common pathology result was tattoo granuloma in 41.7% of the patients and the least common was Lichenoid in 2.8%.
 

Conclusion: Considering the highest frequency of pathological diagnosis of tattoo-granuloma (Sarcoidal and foreign body) with 41.7% in our study and observing the relationship between tattoo-granuloma and sarcoidosis in previous studies, complete examination of patients, long-term follow-up of patients which will have sarcoidosis in the future and examining the clinical response to treatment seems logical and beneficial. It is also important to consider whether the treatment of current lesions will play a role in preventing sarcoidosis in the future or not.

Introduction: Darrier disease is a genodermatoses evolving more in adolescence and appears mostly in seborrheic areas. Because of the absence of typical lesions and other diseases appearing in these areas, diagnosis of darrier may be delayed
 

Case report: A 46 year-old woman came with inguinal, asymptomatic lesions lesions since 3 years ago. The report of biopsy which was taken, showed findings compatible with Darrier disease. Oral isotretinoin initiated with good response after 2 months.
 

Conclusion: In intertriginous areas, some less common diseases may be mis diagnosed as other more common and similar diseases.