Journal of

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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: 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: Treatment of cutaneous leishmaniasis, especially when caused by L. tropica, is challenging. Meglumine antimoniate (Glucantime^®) is used as the standard treatment, but multiple injectiond are necessary. The objective of this study was to compare the efficacy of weekly intralesional injections with twice weekly injections of Glucantime for the treatment of anthroponotic cutaneous leishmaniasis (ACL).
Methods: This randomized open clinical trial was conducted, in Bam, Kerman province, Iran. 96 eligible patients according to inclusion and exclusion criteria who were willing to participate were included. The included patients were randomly assigned into two groups, one group treated with weekly intralesional injections of Glucantime^® and the other group treated with intralesional Glucantime^® twice a week. Type and size of each lesion (induration, ulcer and scar) were recorded weekly. Complete healing was defined as complete re-epithelialization and absence of induration in all lesions and was considered as the primary outcome measure.
Results: A total of 48 patients completed the study complete cure was seen in 24 of 27 (89%) patients who received weekly intralesional MA with a mean duration of healing equals to 70±10 days. Complete cure was seen in 24 of 31 (77%) patients who received intralesional MA twice a week, the mean duration of healing in the latter group was 58±5 days. There was no significant difference between the two groups (P=0.23).
Conclusion: It seems that the efficacy of intralesional injections of Glucantime^® once a week is similar to efficacy of twice a week Glucantime^® injections.

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Background and Aim: Cutaneous leishmaniasis (CL) is endemic in Iran, where it is one of the most important health problems. Both anthroponotic CL (ACL) caused by L. tropica and zoonotic CL (ZCL) caused by L. major are reported. Antimoniate derivatives as the standard therapy for CL need multiple injections and are not easy to tolerate for the patients. This study was conducted in Mashhad to compare the efficacy of weekly versus twice a week intralesional injections of meglumine antimoniate (MA) in the treatment of ACL.
Methods: This randomised controlled trial was performed during 2006 to 2008 in Mashhad, Iran. Using computerized sequence of random numbers, participants were randomly allocated in the two arms of the study: one receiving weekly and the other receiving twice-a-week intralesional injections of MA. The lesion size, induration and healing rate were assessed, recorded and compared. Healing was defined as complete re-epithelialisation and disappearance of induration.
Results: A total of 252 suspected CL patients with 372 lesions were screened. 82 parasitologically proven cases with 121 lesions caused by L. tropica were included and 74 patients with 113 lesions completed the study. At 12^th week after initiation of treatment, complete healing was observed in 38 out of 44 lesions (86.4%) in the group which received weekly intralesional MA injection. The median time-to-heal in this group was 36 days (95% confidence interval [CI]: 32.0-39.9). Complete healing was recorded in 60 out of 69 lesions (86.9%) in the group which received twice a week intralesional injections of MA with a median time-to-heal of 25 days (95% CI: 20.9-29.1). While no significant difference was observed between the two groups in terms of complete healing rate (P=0.999), time-to-heal was significantly different between the 2 groups (P=0.003).
Conclusion: It seems that the effectiveness of twice-weekly intralesional injections of MA is similar to once-weekly regimen while the former regimen causes more rapid healing of lesions.

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Background and Aim: Malassezia is a lipophilic and dimorphic fungus which has different species. Some of them can be found as natural flora on the skin and in some conditions may cause seborrheic dermatitis. The aim of this study was to identify Malassezia species associated with seborrheic dermatitis in Iranian patients, using PCR-RFLP.
Methods: In this study out of 79 patients with seborrheic dermatitis, isolates of 70 patients were positive for Malassezia species using PCR-RFLP. The Internal Transcribed Spacer 2 (ITS2) region was amplified by PCR employing the ITS3 and ITS4 primers and The restriction endonucleases AluI, BanI and MspAI were selected for producing distinct RFLP patterns.
Results: M. globosa (48.6%), M. furfur (40.0%), M. slooffiae (8.6%) and M. sympodialis (2.8%), were the microorganisms responsible for the infection among participants. M. pachydermatis, M. japonica, M. dermatis, M. restricta, M. obtuse, M. nana and M. yamatoensis were not isolated from any samples.
Conclusion: Our findings suggest that the most common Malassezia species associated with seborrheic dermatitis was M. globosa, followed by M. furfur.

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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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Clinical practice guidelines are the most important and valid guidelines for treatment of diseases, and are developed through experts consensus on a subject, considering the highest available evidence (systematic reviews, meta-analyses, and randomized controlled trials). We briefly review the latest evidence-based guidelines for the treatment of two common diseases of acne (provided by European Academy of Dermatology and Venereology) and androgenetic alopecia (provided by German Society of Dermatology).

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Clinical practice guidelines are the most important and valid guidelines for treatment of diseases, and are developed through experts consensus on a subject, considering the highest available evidence (systematic reviews, metaanalyses, and randomized controlled trials). We briefly review the latest evidence-based guideline for the treatment of vitiligo provided by European Dermatology Forum.

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Skin is the largest organ of the integumentary system with multiples important functions. Due to its complex structure, the permeability skin status can be modified by different external and internal factors such as chemical and physical stresses, and several skin and systemic diseases. Today, different non-invasive methods are used to assess the skin barrier biophysical properties. The parameters such as transepidermal water loss, stratum corneum hydration, skin surface pH and skin surface lipids is essential for evaluation of the epidermal barrier status. Application of these methods is critical for evaluation of disease treatments, the effectiveness of topically applied drugs and cosmetic products. The aim of this article is to review application of several methods for skin biophysical and biomechanical properties in humans.

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Great progress in optics, electronic engineering, and computer science provide an opportunity to diagnosis of skin diseases, estimating effectiveness of drugs and skin care products using non-invasive, non-destructive methods of analysis. Also many noninvasive methods using analytic devices are developed to assessment of the outcomes of dermatologic surgeries on malignant skin tumors. The aim of this article is to review advanced methods for skin analysis on human’s skin such as magnetic resonance imaging and time domain reflectometry. Many kind of interesting applications are defined for using these methods especially in cosmetic pressures.

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There are different ways to treat local obesity and cellulite including invasive and noninvasive methods. Due to the fact that noninvasive methods have significantly lower rates of adverse effects, they become more popular. One of these methods is acoustic wave therapy (AWT) or shock wave therapy (SWT). In addition to treating cellulite, SWT has been found useful for some other conditions. In this paper, we briefly introduce SWT and describe the protocol and results of treating cellulite and local obesity using Callactor® SC1 device (Storz Medical, Switzerland) in three females with normal body mass indices.

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Background and Aim: Acne is one of the most common skin diseases. One of the best treatments is systemic isotretinoin. Some studies link its use with depression, psychiatric problems and suicide, but it is still a matter of debate. So, this study was designed to determine the frequency of depression in acne patients, treated with isotretinoin.
Methods: Fifty-nine acne patients between 16 -30 years old were included. The patients received 0.5-1 mg/kg/day isotretinoin for 16 weeks. At the beginning and at the end of study, the Beck questionnaire was completed by the patients and the results were analyzed.
Results: The mean score of the Beck questionnaire was 13.19 at the beginning of the study and 14.80 after 4 months of treatment with isotretinoin (P=0.0001).
Conclusion: The results of this study showed that isotretinoin may have a small, but still noticeable increase in depression scores of acne patients. However, it is important to consider that various other parameters, such as individual’s psychological status at the time of completing the questionnaire, might influence the results. So, further studies with more patients and longer durations, and the use of other pertinent questionnaires, are recommended.

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Despite the large number of patients presenting with hirsutism and high prevalence of polycystic ovary syndrome, for which hirsutism is an important sign, no national guidelines are currently available to Iranian primary-care and family physicians for its diagnosis and management. We have integrated highest levels of evidence and expert consensus to provide a national guideline to standardize and unify the Iranian primary-care and family physician’s approach to hirsutism.

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Background and Aim: Shampoos are surfactant systems to clean hair and body. Two kinds of surfactants are generally used in shampoo formulations: anionic and amphoteric. These agents, especially anionic ones may cause skin irritation and dryness after bathing. So, using a simple and fast method to determine the types and concentrations of surfactants can help to choose a product with high efficacy and low side effects. This study was aimed to determine surfactant concentrations using potentiometric titration method. Methods: Ten hair and body shampoos were selected from Iran's market to determine concentration of anionic and amphoteric surfactants using potentiometric titration method with prepared standard solution. Results: All formulations contain both surfactants, but one formulation did not have the amphoteric one. Conclusion: When we want to choose a shampoo for irritated and dry skin, formulations with more amphoteric surfactant should be chosen because they are much milder on the skin in comparison with anionic surfactants. Potentiometric method which was described in this study is one of the easiest ways to find out which shampoo is suitable for each patient.

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Although ultraviolet rays constitute a small portion of the sunlight, they are destructive on skin. Ultraviolet rays cause sunburn, skin damage and skin cancers. Sunscreens are one of the most widely used cosmetic products which protect skin from cancer or other damages. There are two categories of sunscreen agents: chemical and physical. Physical sunscreens containing zinc oxide work through two mechanisms of reflection and scattering. Physical sunscreens are non-allergenic, non-irritating and non-comedogenic. Currently, by using zinc oxide nanoparticles in sunscreen formulation, both prevention of harmful sun rays and receiving cosmetic benefits are achieved.

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Background and Aim: Sunscreens are an important part of photoprotection strategy. They are exposed to strict safety evaluation using human subjects such as in vivo studies of skin irritation. Biophysical parameters measurements could be used as fast and noninvasive methods to measure any destructive effect of cosmetic formulations on skin application sites. Methods: Five sunscreens were selected from Iran's market to determine changes in Transepidermal Water Loss (TEWL), stratum corneum hydration, pH, melanin and hemoglobin contents by biometric assessments with MPA 580Cutometer®. Results: There was no significant change in skin pH, melanin and hemoglobin contents before and after sunscreen application. Significant change in TEWL and stratum corneum hydration after use of some sunscreens might be contributed by the occlusive and humectant ingredients which used in base cream. Conclusion: Application of the studied sunscreens on human volunteers has not shown any adverse effects and these formulations could be recommended to use.

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Background and Aim: Moisturizers have important roles in the treatment of dry skin. Their safety has to be evaluated on human volunteers in order to assess their potential skin irritation. Measurements of skin biophysical parameters can be used as fast and noninvasive methods to assess any harmful effect of cosmetic formulations on the skin sites where those products are applied. Methods: Two moisturizers were selected from Iran's market to determine the changes in Trans Epidermal Water Loss (TEWL), stratum corneum hydration, pH, melanin and hemoglobin contents by biometric assessments with MPA 580 Cutometer®. Results: There was no any significant change in TEWL, skin pH, melanin and hemoglobin contents before and after products application. Stratum corneum hydration was increased after application of Neu Derm Renutrive Honey Shea from 0.09 to 0.39 (P0.001). Neu Derm Optimal Hydrosense increased stratum corneum hydration from 0.23 to 0.48 (P0.001). Conclusion: Application of the studied moisturizers on human volunteers did not show any adverse effect. So, those products could be recommended for safe use. Significant changes in the stratum corneum hydration associated with application of each moisturizer were related to humectant ingredients which were used in each product.

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Conclusion: While 53% of the IBDEC members were disagree with that the written board examination can assess residents' different levels of knowledgeproperly, the majority of them were also disagree with the implementation of suggested approved methods for improving the validity of the written board examination. Most of them were also disagree with implementation of evaluation methods for improving oral examination validity.

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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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The function of the horny layer of the skin as a barrier is to protect the underlying tissues from infection, dryness, and mechanical stress. Disruption of this function results in increased transepidermal water loss (TEWL) and is associated with conditions like atopic dermatitis and other chronic skin diseases. Moisturizers have been shown to improve these conditions through restoration of the integrity of the stratum corneum, acting as a barrier to water loss and replacement of skin lipids and other compounds. Also, moisturizers are commonly used to reduce fine lines and make the skin appear smooth and soft. They contain varying combinations of emollients, occlusives, and humectants to achieve their beneficial effects, and there are an overwhelming number of formulations available.