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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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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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Langerhans cell histiocytosis (LCH) is a proliferative disorder of langerhans cells and lymphocytes having different subtypes and a wide range of clinical manifestations and severity ranging from a unifocal self-limited disorder to multi-system involvement and even death. Along with clinical manifestations, diagnosis is made through existence of specific immunohistochemistry markers. Where treatment is necessary, different treatment modalities have been proposed though none have found to be optimal.This paper introduces a 23-year old girl with an extensive yellowish to red-brown maculopapular rash over her face accompanied with polyuria, polydipsia, and fatigue.

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Background and Aim: Atopic dermatitis (AD) is a chronic, relapsing, pruritic skin disease more common in infancy and childhood. Emollients, topical corticosteroids, and avoidance of irritating factors are the mainstay of its treatment, but fear of side effects has limited the use of topical corticosteroids. The objective of this study was to evaluate the safety and efficacy of topical tacrolimus 0.03% ointment in the treatment of AD.
Methods: In this randomized, double-blind, clinical trial, 76 patients with AD older than 2 years were randomly allocated in two groups and treated with either tacrolimus 0.03% ointment (Abu-Rayhan Co., Iran) or placebo, twice a day for 6 weeks. Responses to treatment were compared every 2 weeks using SCORAD.
Results: Twenty-nine patients in tacrolimus group and 26 in placebo group completed the trial. The reduction in SCORAD after 2 and 4 weeks in tacrolimus group was significantly higher than placebo group (P<0/05). The frequency of treatment-induced pruritus and burning sensation was similar in both groups but erythema was more observed in the placebo group (P<0/05).
Conclusion: Tacrolimus 0.03% ointment is more effective than placebo in the treatment of AD.

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Background and Aim: Basal cell carcinoma (BCC) is the most common type of malignancy that rarely causes death but results in cosmetic problems and is associated with high treatment cost. Clinical characteristics of this cancer are related to the host and environmental factors. Theses factors are specific for each area and may change over the time. The aim of this study was to find clinical characteristics of BCC in Kermanshah city.

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Background and Aim: Irritant contact dermatitis of hands is a chronic and recurrent cutaneous disorder following the contact with detergents and chemicals. Obsessive compulsive disorder is highly frequent among dermatologic patients, and may be presented with signs of irritant contact dermatitis of hands. The aim of this study was to assess the frequency and relationship between obsessive compulsive disorder and irritant contact dermatitis, among women with chronic and recurrent irritant contact of hands dermatitis in Haj Daie Dermatology Clinic in Kermanshah.
Methods: This case-control analytic study was carried out on 139 females with irritant contact dermatitis of hands and 102 female patients without any history of irritant contact dermatitis of hands. Obsessive compulsive disorder was determined based on the clinical interview using DSM-IV-TR (SCID) by a psychiatrist. Data analysis was performed using chi-square and z-test.
Results: The mean age in the case group was 28.2±8.4 and in the control group was 28.4±6.3 years. Fifty-eight (41.7%) of hand dermatitis patients and 5 (4.9%) of control group had obsessive compulsive disorder (P<0.05). Obsessive compulsive disorder was seen in 29 and 14 patients with moderate and severe irritant contact dermatitis, respectively.
Conclusion: Obsessive compulsive disorder is common in irritant contact dermatitis of hands. Psychiatric evaluation in female patients with chronic irritant contact dermatitis of hands especially moderate and severe forms is suggested.

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Background and Aim: Bullous pemphigoid is an acquired autoimmune disease with subepidermal blisters commonly seen in the elderly over 60 years old. The exact survival rate of the patients with bullous pemphigoid was not available in Iran. The aim of this study was to evaluate the risk factors of 5-year mortality of bullous pemphigoid patients.

Methods: In this retrospective study, 66 bullous pemphigoid patients referred to Razi hospital from 1986 to 2006 were studied. Age, sex, consumed corticosteroid type, duration of hospitalization, and clinical form of bullous pemphigoid, ESR and comorbidities were evaluated to determine the risk factors associated with patients’ 5-year mortality rate.

Results: Forty-seven patients (71.2 %) had 5-year survival. The most common comorbidities were cardiovascular diseases (28.8%), diabetes (15%) and chronic respiratory diseases (9%). There was a significant relationship between the age and the 5-year survival rate, in other words patients aged over 70 years had a less 5-year survival rate (P<0.001). There was no statistically significant association with gender, the type of corticosteroid, the disease clinical forms, duration of hospitalization or ESR and 5-year survival (P>0.05).

Conclusion: The current study found a significant relationship between the age of the patients and 5-year survival. Larger studies considering more potential risk factors and more appropriate designs might help to estimate the survival rate of patients with bullous pemphigoid more precisely.

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Background and Aim: Eczema is a common chronic inflammatory skin disease that reduces quality of life of the patient. The present clinical trial with control group aimed to determine therapeutic effects of natural honey plus cold cream compared to cold cream alone on hand eczema. Methods: Through a blind clinical trial, 72 patients with hand eczema were categorized in two equal groups. The first group used a mixture of honey plus cold cream and the other group applied cold cream alone. Patients used either Treatment 2 times a day for 21 days on their lesions. The effects including relief of symptoms such as dryness, redness, itching and scaling were evaluated by a dermatologist as well as the patients themselves. The results were analyzed using SPSS software and P values less than 0.05 were considered statistically significant. Results: According to the physician’s evaluation, 26 (36.1 %) patients in group combined honey and coldcream, were cured and 9 (59.12%) patients do not recover while in cold cream alone group, 6 (3.8%) patients were recovered and 30 (7.41%) patients did not. This difference was statistically significant (P<0.001). According to the patients evaluation in group combined honey and coldcream, 26 (36.1%) felt better and 9 cases (59.12%) did not, while the corresponding rates in group cold cream alone were 6 (2.8%) and 30 patients (7.1%) respectively. This finding was statistically significant (P<0.001). Conclusions: With respect to the therapeutic effects of honey on hand eczema, it is recommended to use honey with other therapies to treat eczema.

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Urticaria is a common and challenging skin disorder. Its diagnosis and treatment is not limited to the field of dermatology. General physicians, and allergologists and clinical immunologists are also commonly involved in the management of urticaria patients. One of the missions of the Iranian Society of Dermatology is to develop strategies to provide the best possible management for patients suffering dermatological conditions. To accomplish this mission, the Society assigned a committee to search and critically appraise the recent research evidence and available guidelines to develop a clinical practice guideline concerning diagnosis and treatment of urticaria.

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Background and Aim: Internal evaluation is one of the most effective educational assessment processes. Due to involvement of all educational department stake-holders, this evaluation has high efficacy and enforcement. Appropriate use of the findings of such evaluations improve educational quality. The aim of this study was to evaluate various aspects of education, research and facilities at the Department of Dermatology, Kermanshah University of Medical Sciences, Iran.

Methods: In this cross-sectional study, objectives, organizational status, management and authority, faculty members, students, teaching-learning strategies, educational equipments, theses and sabbaticals, and graduates of the Department of Dermatology, Kermanshah University of Medical Sciences were evaluated. Questionnaires were designed, and obtained data were analyzed by IBM SPSS Statistics (IBM Corp., Armonk, NY, USA) version 22.

Results: Most of evaluated components were satisfying. Learning-teaching strategy was the most satisfying factor with an average satisfaction rate of 87.5%, and the graduates issues was the least satisfying factor with an average satisfaction rate of 66.7%.

Conclusion: Planning and proceedings at the  department and medical school levels according to feedbacks based on the results of this study not only could improve educational quality at the department, but also may help obtaining  approval for initiating a dermatology residency program.

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Background and Aim: Preoperative assessment of skin tumors extensions have a potential role to increase the efficiency of surgery and maximal preservation of function and cosmetics in the treatment of invasive types of basal cell carcinoma (BCC).
Methods: A total of 72 patients with BCCs on face were included in the study. Gross maximal width of tumors were documented, and then high frequency ultrasonic (HFUS) maximal width and depth of these lesions were determined. Then conventional surgical excision was done and these margins were determined in pathology lab. The comparison of ultrasonic and pathologic depth, and difference of HFUS and pathologic widths from gross clinical width were done with paired t-test.
Results: The mean depth of BCCs were 3.09 mm (SD= 1.02) in HFUS and 2.86 mm (SD=1.22) in pathology (P=0.1). The mean difference from gross width were 4.05 mm (SD=1.18) in HFUS and 4.26 mm (SD=1.70) in pathology (P=0.09).
Conclusions: High frequency sonography has a good accuracy in detection of width and depth of BCCs of face, especially in tumors smaller than 10 mm, and can help to determine safe margins non-invasively, especially in cosmetic and functional critical areas.

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Urticaria is a common and challenging skin disorder. Diagnosis and treatment of urticaria is not limited to the field of dermatology. General physicians, allergologists and clinical immunologists are also commonly involved in the management of patients with urticaria.

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Sports and the development of nations are very much intertwined. Sports dermatology is a growing discipline. Athletes’ skin diseases are a distinct group of diseases, and that repetitive physical activity combined with environmental stressors puts the athlete at the highest level of risk.The purpose of this study is to equip physicians with basic knowledge of skin diseases in athletes. Lack of knowledge about the role of exercise in the pathogenesis of skin diseases can lead to delayed diagnosis and consequently, incorrect treatment. Skin diseases can be caused directly or indirectly by exercise; there are some skin diseases which exist in a person but appear or intensify with the onset of exercise.
In general, before an athlete should exercise, he should be examined dermatologically to prevent the spread of skin diseases. They should be considered especially for lesions on the less noticeable areas such as the back and inner side of ears. It is better to prepare a map of the patient’s lesions that can be tracked over time, which the possibility of following their changes (Body Mapping).

Athletes should have no general symptoms such as fever for 72 hours before exercising. There should be no secretory skin lesions, otherwise, it is necessary to receive treatments before going to the gym and using the equipment to ensure that the disease does not spread to others.

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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.

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