Journal of

---

Background and Aim: Microneedle technology has led to huge changes in the field of drug delivery medicine. Using microneedles, the drug can be injected locally, painlessly, and in very low and controlled doses with high precision. Local drug delivery through the skin with microneedles has many advantages over other methods of drug delivery. In this method, the drug does not enter the gastrointestinal tract and blood circulation, and therefore non-target organs are protected from the side effects of the drug. The present study is designed to construct an array of micron needles using the lithography method.

Methods: In this study, a silicon microneedle array is fabricated using the photolithography method with proper adjusting of the effective parameters. The constructed microneedle array has 256 needles with a height of 500 microns, a base diameter of 250 microns, and a center-to-center distance of 600 microns.

Results: Microscopic images show that the microneedles are tapered with a relatively sharp tip. Their surface is smooth and without cracks, and they also have an acceptable resemblance to the original design.

Conclusion: The produced microneedle array can be used directly to pierce the skin and increase its permeability by creating micron holes. In addition, this array can be used as a mold for the production of microneedles with malleable materials in the casting method.

---

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.

---

Background and Aim: Although several commercial moisturizers are available in the market, continued role of pharmaceutical compounding have been still felt in dry skin management. This study aimed to evaluate the effect of a two urea- based compounded moisturizers on barrier function, compared to similar commercial product. 15 volunteers (14 females and one male) age 36.15 ±9.55 years old (range 21-56 years old) with non-pathologic dry skin, recruited to the study applied 5% urea containing hydrophilic petrolatum and 10% urea containing hydrophilic petrolatum during two following phases.
Methods: Upper parts of right and left forearms randomly were assigned for twice a day application of commercial or compounded products. Biophysical assessments including trans epidermal water loss (TEWL), skin hydration, friction co efficient, pH and surface lipids, performed before intervention, 1, 4 after single application and at 24 hours and one week twice daily application. 
Results: In both phases, commercial and compounded moisturizers showed appropriate and comparable effect on skin barrier function compared to the baseline. However commercial products, led to better improvement in TEWL, 4 hours after single application in both phases (P=0.04). The rate of increase in skin hydration was also significantly higher for commercial emollient, compared to compounding product (57.48±11.23 vs. 50.59±11.42, P=0.01).
Conclusion: Commercial formulation led to higher acceptability and better improvement on skin barrier function after single application, probably due to influence of excipients. Present study did not find sufficient added value for pharmacy product relative to commercial one and suggest to be replaced in similar condition.

---

Introduction: Tinea incognito is a localized skin infection caused by a fungus. Due to the use of corticosteroids, the shape and severity of the lesion are different from the usual skin manifestations by dermatophytes.

Background and Aim: A 39-year-old female with history of erythematous, scaly skin lesions on her hands, buttock, inguinal and both legs for 7 months referred to clinician, who prescribed Calamine-D and hydrocortisone without any treatment and clobetazole was recomended. She self-continued clobetazole. This case highlight the importance of mycological test in case of atypical skin lesions to choose an appropriate treatment and avoiding to spread of drug resistance species.

Methods: Regarding to history of patient, the mycological test (Direct Microscopy and culture) was made. In direct microscopy and culture mycelia of dermatophyte species was seen.

Results: In our case steroid discontinued and she was treated with oral terbinafine 250 mg once a day for 4 weeks in combination with topical clotrimazole cream.

Conclusion: the prescription of topical/oral corticosteroids should still be limited and take a caution until confirmation of diagnosis, particularly since the use of steroids during COVID 19.

---

Background and Aim: Skin injuries with various causes may lead to legal action. Complaints are referred to specialized authorities such as Razi Hospital, before specialized forensic medicine commission comment. The present study surveyed demography of patients' complaints and initial diagnosis at the time of referral over a period of 6 months.
 

Methods: In this retrospective study, patients referred for initial visit, from Forensic Medicine Office in the September 2018-March 2019, were examined. The patients' complaints at the time of referral and the clinical diagnosis made at the initial examination were recorded. 
 

Results: A total of 220 patients including 176 women (80%) and 44 men (20%) with a mean age of 34.8 years were included. 42 different complaints were documented, including traumatic hair loss with 91 cases (41.4%) - the most common - followed by complications of laser hair removal with 32 cases (14.6%) and filler injections with 16 cases (7.3%). Scarring from trauma, reaction to chemicals during work or accidental contact, rare injuries from various treatments, and even cases of pediculosis (contamination of the accommodation) or zoster (complaint about care in the treatment center), etc. were observed.
 

Conclusion: Traumatic hair loss (mainly due to fight) was the most common complaint. Knowing other cases may expand physicians' awareness regarding the wide range of complaints that can be raised and improve the process of some treatment measures.

---

Onychomycosis is a nail infection caused by dermatophyte and non-dermatophyte molds and yeasts. The nail involvement is a feature of psoriasis, although skin manifestations are the most principal findings in psoriasis. Onychomycosis and psoriasis are both common disorders in communities. It is possible that in some patients these two diseases are present at the same time. A review was performed using the keywords including nail psoriasis, onychomycoses, dermatophytes, non-dermatophyte molds and yeasts in valid medical databases, such as PubMed, Google scholar, Scopus and Science direct. Articles that were most relevant to the purpose of the study were selected and studied. We investigated the incidence and pathogenic function of fungal agents in causing fungal infections in psoriasis nails.

---

Background and Aim: The aim of this study was to determine the effectiveness of psychotherapy based on improving quality of life on depression and self-esteem in women with vitiligo.
 

Methods: The present study was a quasi-experimental study (Pre-test - post-test with follow-up and control group). The statistical population of this study included all women with vitiligo skin disease referred to Isfahan Dermatology and Leishmaniasis Research Center , among which, 20 people were selected by available sampling method and randomly assigned to experimental and control groups (10 people for each group). Both groups completed Beck Depression Inventory (1996) and Rosenberg Self-Esteem (1965) Questionnaires as a pre-test and after completing eight sessions of psychotherapy based on improving quality of life (one 90-minute session per week for eight weeks), the post-test was performed again and one month later for the control and experimental groups. The collected data were analyzed using repeated measures analysis of variance in SPSS 23 software.
 

Results: Based on the findings of repeated measures analysis of variance, it was found that psychotherapy based on improving quality of life reduced the average depression scores and increased the self-esteem of women with vitiligo.
 

Conclusion: Considering that psychotherapy based on improving the quality of life has an effect on depression and self-esteem in women with vitiligo, so teaching this therapeutic approach is recommended as an effective intervention method to reduce depression and improve the self-esteem of women with vitiligo.

---

Background and Aim: The use of leech extract in the preparation of cosmetic supplements and medicinal compounds has always been of interest. So far, the effect of this extract on the volume of the skin's epidermal tissue has not been scientifically confirmed, and no research has been done regarding the comparison of the effects of different types of base oils in this extract.
 

Methods: The purpose of this study was to investigate the effect of leech extract in the bases of olive oil, castor oil and bitter almond oil on the facial skin using the basic geometric morphometry software. For this purpose, 25 people from the age group of 45 to 55 years were selected. In order to compare morphological changes for forty days at a specific hour, pictures were taken using a digital camera. 12 landmark points were placed on the two-dimensional images using TpsDig2 software. The shape data obtained after superimposition analysis were analyzed using Procrust analysis with multivariate PCA and CVA statistical methods and cluster analysis (CV).
 

Results: The results showed that there is a significant difference between leech extract in volumizing and removing wrinkles with olive oil base (P>0.001), but the two groups of castor oil and bitter almond oil did not have a significant difference (P>0.001).
 

Conclusion: Leech extract has no effect on removing wrinkles and does not cause local swelling in the epidermal tissue in the time frame of the present study.

---

Background and Aim: Considering the increase of dermatophytosis trough the Iran and world as well, especially ringworm of the body and groin due to terbinafine-resistant species and the high speed of disease transmission, in order to choose the appropriate treatment, considering the time required for the treatment of the disease and early detection of resistant cases treatment is required. The present study was conducted to determine the antifungal sensitivity of Trichophyton rubrum, Microsporum canis and Epidermophyton flucosum strains to common antifungal drugs.
 

Methods: Antifungal sensitivity test (broth microdilution) was performed for 20 specimens obtained from patients according to CLSI (Clinical and Laboratory Standard Institute) M38-3^rd ED protocol, for terbinafine, itraconazole and voriconazole.
 

Results: According to the antifungal susceptibility test results, 5 patients were resistant to terbinafine and showed a minimum inhibitory concentration more than 2, 3 patients were tolerant to terbinafine and showed a minimum inhibitory concentration between 0.5 and 1. Based on the results of the antifungal susceptibility test, 7 patients were tolerant to itraconazole and showed the minimum inhibitory concentration between 0.5 and 1. All isolates responded well to voriconazole.
 

Conclusion: The results of the antifungal sensitivity test highlight the importance of mycological tests on dermatophytic skin lesions to prevent the spread of drug-resistant species.

---

Background and Aim: In line with the increase in cases of dermatophytosis of the body and dermatophytosis of the groin, the cases of species resistant to antifungal drugs, especially terbinafine, are increasing. The present study was designed to investigate the drug resistance pattern of dermatophyte species isolated from 27 patients referred to Razi Skin Hospital.
 

Methods: Skin samples of patients were collected from the groin, buttock and body from the active margin of the lesion. Some of the sample was examined under the microscope for the presence of arthroconidia and fungal hyphae. Cultivation on Saburo dextrose agar 2% special medium with chloramphenicol and cyclohexamide was used to determine the primary identity of dermatophyte species, morphological characteristics were used. To accurately identify trichophytons isolated from the skin of patients by (molecular) genotyping method, ITS1 and ITS4 primers were used. Universal primers) were used. Microdilution broth drug sensitivity test was performed according to M38-3^rd ed - CLSI protocol for dermatophyte isolates to terbinafine, itraconazole, fluconazole and voriconazole.
 

Results: 25 patients were infected with Trichophyton indotinae. 2 patients were infected with Trichophyton interdigitale. In the present study, 4.27 (14.81%) of the patients had antifungal resistance (1 μg/ml≤the minimum concentration of fungal growth inhibition for terbinafine).
 

Conclusion: Failure to perform mycological examinations before initiating treatment can result in misdiagnosis.  Do not use the antifungal susceptibility test lead to  challenging to manage treatment-refractory cases. inadequate and inappropriate treatment combinations can increase the number of resistant species worldwide.

---

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.

---

Worldwide, 16,000 deaths occur daily due to wound injuries, leading to increased concern in low- and middle-income countries. Today, with the increasing demand of consumers to use natural biological compounds instead of using harmful and carcinogenic chemical compounds, algae were introduced to the market as an effective clinical skin alternative. In fact, ease of cultivation and low nutritional requirements make algal polysaccharides an attractive alternative for advanced wound dressings. Micro and macroalgae are a new source of biological saccharide polymers for wound healing. The hydrophilic nature of these polymers due to their capacity to trap water molecules in their structure makes hydrogels that have a high ability to absorb and release liquid. In this review article, by studying the latest articles, some algae polysaccharides that are widely used as wound healing dressings such as alginates, fucoidans, carrageenans, laminarin, agar-agar and olvan are discussed. These compounds are not only used as functional biomaterials for controlled drug delivery, but also for cell stabilization and preparation of scaffolds for tissue engineering.

---

Background and Aim: Angiokeratomas are rare vascular lesions, typically presenting as small red to purple macules or papules on the skin. These lesions are usually benign, though they can undergo changes in thickness and color over time. Certain types of angiokeratomas may also signal underlying metabolic disorders, necessitating careful clinical attention. This study aims to analyze the clinical and demographic features of angiokeratoma in Iranian patients at Razi Dermatology Hospital.
Methods: This descriptive, retrospective cross-sectional study examined 199 patients diagnosed with angiokeratoma between 2013 and 2023. Data on demographics, lesion characteristics (location and size), family history, and treatment methods were collected from medical records and analyzed using SPSS. Both parametric and non-parametric statistical tests were applied to assess associations, with a significance level set at 0.05.
Results: The mean age of patients was 24.75 years, with the second and third decades showing the highest prevalence. Among the patients, 51.3% were male and 48.7% female. Lesions most commonly appeared on the lower extremities (40.7%) and genital area (18.6%). Treatment methods included cryotherapy (68.14%), laser (27.14%), and electrodessication (4.44%), with cryotherapy proving the most effective among them.
Conclusion: This study provides valuable insights into the prevalence, clinical characteristics, and preferred treatment approaches for angiokeratoma in Iranian patients. Broader studies across various centers, along with long-term follow-up, are recommended to further investigate the clinical course, therapeutic outcomes, and potential complications associated with different treatment methods.

---

Impaired wound healing following significant tissue damage such as severe burns, trauma, or surgery can result in scarring and skin fibrosis. Pathological scarring leads to changes in the natural shape of the wound and, in addition to cosmetic problems, may be accompanied by pain and even limit the person's normal movement. The immune response plays a very important role in the wound healing process. Activation of immune cells and factors initiates the inflammatory process, facilitates wound cleansing, and tissue repair and regeneration. However, disruption of the immune system during the wound healing process leads to persistent inflammation and delayed healing, ultimately leading to the development of chronic wounds. The microenvironment of a chronic wound contains a large number of immune cells, including proinflammatory macrophages, and high expression of inflammatory mediators such as TNF-α and IL-1β is observed in it. Among them, macrophages, as innate immune cells, play a key role in promoting the immune response and activating adaptive immunity. These cells are also key factors in the transition from the inflammatory phase to the tissue repair phase. As a result, dysregulation of macrophage function will have consequences such as scarring. Therefore, knowledge of the exact mechanism of the inflammatory process during wound healing, the inflammatory and anti-inflammatory mediators produced, and the effect of macrophages on this process can promise the achievement of new strategies in scarless wound healing. Therefore, this article discusses the mechanism of the immune system during the inflammatory process, and the key role of macrophages in this process, as well as scar formation.
 

---

Background and aim: Macular amyloidosis (MA) is a form of primary localized cutaneous amyloidosis (PLCA), characterized by amyloid deposits in the papillary dermis. This study aimed to compare the biophysical properties of MA lesions with those of adjacent uninvolved skin.
 

Methods: We measured several parameters in active MA lesions of 22 patients, including stratum corneum (SC) hydration, transepidermal water loss (TEWL), surface friction, pH, sebum, melanin, erythema, temperature, elasticity parameters (R0, R2, and R5), as well as epidermal and dermal thickness and echo-density using ultrasonography. Measurements from the lesions were compared with those from healthy skin adjacent to the lesions, serving as controls. Statistical analysis was performed using the paired t-test, with P-values less than 0.05 considered significant.
 

Results: Compared to adjacent normal skin, MA lesions demonstrated significantly lower SC hydration and surface friction, while TEWL, pH, erythema index, melanin content, and epidermal thickness were significantly increased. No significant differences were found in sebum levels, temperature, elasticity parameters, or dermal thickness and echo-density.
 

Conclusion: MA lesions exhibit distinct biophysical and ultrasonographic changes consistent with their histopathological features. These characteristic alterations may serve as useful, non-invasive markers for the early diagnosis of cutaneous macular amyloidosis.

---

Kerion Celsi is a severe inflammatory fungal infection of the scalp that affects deeper layers of the skin. While it is uncommon in newborns, its incidence increases in children aged 3 years and older. It typically presents with swelling, spongy or boggy lesions, tenderness, hair loss (alopecia), and purulent discharge. Secondary bacterial infections are frequently seen following skin breakdown or maceration. Systemic symptoms may include enlarged lymph nodes, fever, and in very rare instances, fungal bloodstream infection (fungemia). Hypersensitivity reactions (Id reactions) can also occur. Diagnosis is guided by clinical evaluation, including patient history and physical examination, and must be confirmed using microscopy, fungal culture, and molecular diagnostic techniques. The most commonly isolated pathogens are anthropophilic Trichophyton tonsurans and zoophilic Microsporum canis. In contrast, geophilic fungi and molds are rarely implicated. Treatment is non-surgical, involving a combination of systemic and topical antifungal agents, with systemic antibiotics added when bacterial coinfection is suspected. Surgery should be avoided. Early and adequate therapy is critical to prevent permanent scarring and hair loss. The primary differential diagnosis includes bacterial infections of the skin and soft tissue.

---

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.

---

Onychomycosis is one of the most common human fungal infections, affecting both fingernails and toenails and accounting for approximately 50% of all chronic nail disorders. It may be caused by various dermatophytes, yeasts (especially Candida spp.), and non-dermatophyte molds. Risk factors include advanced age, underlying conditions such as diabetes, immunosuppression, chronic moisture, and prolonged use of closed footwear. Accurate diagnosis requires clinical examination along with direct microscopy, culture, and, in advanced cases, molecular techniques. Treatment options include topical, systemic, or combined antifungal therapies, chosen based on the infection’s severity, causative agent, and patient status. Due to high recurrence rates, preventive measures and complete treatment follow-up are essential. This review provides a comprehensive overview of the epidemiology, clinical manifestations, etiologic agents, diagnostic methods, and therapeutic approaches to onychomycosis, highlighting current challenges in its management.

---

Antimicrobial photodynamic inactivation is emerging as a non‑antibiotic strategy for treating infected wounds, particularly those harboring multidrug‑resistant bacteria. aPDI relies on a photosensitizer that, when illuminated with an appropriate wavelength, generates reactive oxygen species (ROS) that cause rapid, non‑specific damage to microbial membranes, proteins and nucleic acids. Effective photosensitizers combine high quantum yield to penetrate both Gram‑positive and Gram‑negative organisms, while light sources such as LEDs or lasers provide precise control of irradiance and tissue penetration. Clinical investigations have demonstrated that aPDI, alone or in combination with low‑dose antibiotics or growth factors, can reduce bacterial load in chronic wounds by up to 84 % and accelerate healing. Current challenges include limited light penetration, optimal dosing, and potential phototoxicity, emerging solutions involve nanocarrier‑delivered photosensitizers, oxygen‑releasing dressings, and ultrasound‑mediated activation to enhance efficacy and safety.

---

Case presentation: We report a 9-year-old Iranian girl with autosomal recessive CGD who presented with refractory inflammatory scalp lesions. Mycological examination confirmed tinea capitis caused by Microsporum canis. Antifungal susceptibility testing showed reduced susceptibility to itraconazole, while susceptibility to terbinafine and fluconazole was preserved. Due to limited access to terbinafine, the patient received alternative management including antibacterial and anti-tuberculosis therapy, leading to clinical improvement.
Conclusion: This case highlights the diagnostic and therapeutic challenges of dermatophytosis in CGD patients and emphasizes the importance of accurate mycological diagnosis, antifungal susceptibility testing, and individualized multidisciplinary management, particularly in resource-limited settings.