Journal of

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.

Background and Aim: Skin cancers are one of the most common malignancies in the world and create a high rate of morbidity but low rate of mortality with the exception of malignant melanoma that has a high mortality rate. In recent decades, incidence of skin cancer has been increased. The most important risk factors are sunlight and skin type. The aim of this study was to evaluate the frequency of skin cancers in patients who were admitted to Sina Hospital of Hamedan during a 17-year period.
Methods: In this cross-sectional study, 951 patients with different types of skin cancer, entered in the study. For each patient, data related to age, gender, location, occupation, pathologic type of cancer and site of skin involvement, were collected.
Results: The mean age (mean±standard deviation) of patients was 61.6±15.3 years (2-100 yrs) and most of them (67.2%) were males and workers (%38). The most common pathologic types of skin cancer were basal cell carcinoma (BCC) (59%) and squamous cell carcinoma (SCC) (29%). The most frequent site of tumor expression was face (61.2%) and the least frequent involved site was genitalia (0.4%).
Conclusion: This study showed that skin cancer is more common in males, old patients and workers. It was more common on the face. Screening program for detection of this disease at an earlier stage of elderly men especially in sun exposed occupations is recommended.

Background and Aim: Adolescents with polycystic ovary syndrome concern about weight gain, menstrual irregularities, acne and hirsutism. The aim of this study was to determine the frequency of facial and trunkal lesions of acne in 14- to 18-year-old high school students with polycystic ovary syndrome in Shiraz in 2009.
Methods: In this cross-sectional study, 3189 14- to 18-year-old female students were enrolled.  Using questionnaires, data on personal information, clinical features and laboratory findings of hyperandrogenism and results of ultrasound examination were collected. Severity of acne was classified as mild, moderate and severe, based on the type and number of the lesions. Chi-squared and independent t tests were used for comparing proportions and means, respectively.
Results: The prevalence of severe acne was 5%. Mean total testosterone in individuals with severe acne was higher in comparison with those without acne. Severity of facial and trunkal acne were associated with polycystic ovaries (P<0.05). Mean level of luteinizing hormone (LH) was higher in those without acne than in those with severe acne (P >0.05).
Conclusion: Associations between severity of facial and trunkal acne lesions and polycystic ovaries were observed. Considering the undesirbale effects of acne on quality of life, hormonal screening and ultrasound examination in girls with moderate acne is recommended.

Background and Aim: Malassezia is a lipophilic and dimorphic fungus which has different species. Some of them can be found as natural flora on skin and in some conditions may cause pityriasis versicolor. The aim of this study was to identify Malassezia species associated with pityriasis versicolor in Iranian patients, using PCR-RFLP.
Methods: In this study out of 65 patients with pityriasis versicolor to have pityriasis versicolor,isolates of 60 patients were positive. Malassezia species. using by 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. furfur (36.7%), M. globosa (30.0%), M. sympodialis (20.0%), M. slooffiae (8.3%), M. restricta (3.3%) and M. obtusa (1.7%) were the microorganisms responsible for the infection among participants. The M. sympodialis infection was strongly correlated with the female gender (P=0.02).
Conclusion: Our findings suggest that, the most common Malassezia species associated with pityriasis versicolor was M. furfur, followed by M. globosa.

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.

Background and Aim: Cosmetic surgery is performed for improvement of psycho-social function in­ absence physical cues. This multidimensional concept depends on many factors such as beliefs about appearance and inferiority feeling. The purpose of this study was to compare two factors of beliefs about appearance and inferiority feeling in volunteer and non-volunteer individuals for cosmetic surgery, investigation of the relationship between these factors, and evaluations of the predictors for seeking cosmetic surgery among the participants.
Methods: In this case-control research, 50 individuals who were seeking cosmetic surgery and were admitted at cosmetic clinics in Tabriz and 50  individuals who were not seeking cosmetic surgery were asked participate.
Results: The participants were enrolled to the study using available sampling mehods. There were differences between beliefs about appearance and inferiority feeling in those sought and those did not seek cosmetic surgery. Those who sought cosmetic surgery achieved higher scores in both factors in comparison with those did not seek those procedures. It also became clear that there was a relationship between beliefs about appearance and inferiority feeling of volunteers of the cosmetic surgery: the higher were the individuals scores in beliefs about appearance, the higher was the inferiority feeling. From another perspective, it was observed that the two factors of marital status and inferiority feeling were strong predictors for tendency to the cosmetic surgery.
Conclusion: Motivation for the cosmetic surgery has its roots in a combination of cognitional, personal, and interpersonal factors therefore, psychological counseling is advised before cosmetic surgery.

Background and Aim: Lichen planus (LP) is a cutaneous disease characterized by violaceus flat topped papules in variable size. It may involve body surface areas such as mocus membranes. Some studies have reported an association between oral LP ad diabetes mellitus. The aim of this study was to compare the frequency of diabetes mellitus between patients with and individuals without LP.
Methods: A case-control study was done on 30 patients suffering oral LP as case group and 60 healthy individuals as control group. Diagnosis of oral LP was confirmed by typical clinical and histopathologic findings. Participants in control group were selected from general population after matching for sex and age. Venipuncture was done to take 5 ml blood sample for measuring fasting serum blood glucose levels in both groups. A repeated blood sampling was done for ones with abnormal results in the first sampling. Findings of the study were analyzed using SPSS 16.0 statistical software.
Results: Thirty LP patients [man 13 (43.3%), woman 17 (56.7%)] with mean age (mean±stabdard deviation) of 46±13.7 years and 60 healthy individuals [man 26(43.3%), woman 34 (56.7%)] with mean ages of 46±14 years were recruited to this study. In case group only one person (3.3%) suffered from diabetes mellitus, but none of healthy group had fasting blood sugar above the normal value. In quantative evaluation, mean level of fasting blood sufar was 102.5±33 mg/dL in case group and 111.1±49.3 mg/dLin control group (P=0.09).

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.

Hyaluronic acid (HA), the main and most important constituent of extracellular matrix, is a glycosaminologycan with water-absorbing capacity found in large amount in growing and repairing tissues. One of the main causes of skin problems, particulary in aging skin, is HA deficiency. More than half of the body HA is in the skin and is necessary for the maintenance of internal matrix and several cellular functions. Filler gels containing HA are used to repair skin defects. As these substances are derived from animals and bacteria, not the human, may cause skin reactions and have short half-life. So efforts to maintain and/or increase HA secretion from skin fibroblasts are important in the prevention and treatment of skin aging.

Epidermolysis bullosa (EB) is a group of dermatological conditions characterized by development of bullae and ulcers following trivial trauma. One of the most important complications of EB is squamous cell carcinoma. While occurance of skin squamous cell carcinoma is common in epidermolysis bullosa, its occurence on mucosal surface is rare. Herein, we report two members of a family who developed squamous cell carcinoma on their esophagus and tongue.

Background and Aim: Pruritus is one of the most disabling complications in patients with chronic renal failure that have negative effect on patients' quality of life. The aim of this study was to determine the frequency of the uremic pruritus and its associated factors in hemodialysis patients referred to the dialysis centers in Golestan Province.

Methods: In this cross-sectional study, all 375 patients referred to eight dialysis centers in Golestan Province were selected via census sampling method. Data were gathered by using demogeraphic and Yosipovitch pruritus questionnaires. Data analysis was performed using SPSS software through conducting t and chi square tests.

Results: The mean ± standard deviation of patients' age was 48.36 ± 13.27 years and 51.2% of patients were male. One hundred and eighty one (48.3%) patients had uremic pruritus. The lowest and highest frequency of pruritus among surveyed centers were 37.9% and 57.1%, respectively. 60.2 % of patients had localized pruritus and the most common location was back (68.8 %). There was a statistically significant correlation between uremic pruritus with number of dialysis session (P<0.001) and serum level of phosphorus (P<0.001). 

Conclusion: The results indicated that uremic pruritus is still one of the most common problems in hemodialysis patients. Therefore it seems necessary providing ways to eliminating or reducing the problem.

Background and Aim: Diabetic neuropathy occurs in about 50% of individuals with long-standing type 1 and type 2 diabetes mellitus. The aim of the study was to detect sensory neuropathy in diabetic patients at risk for foot ulceration, using monofilament and neuropathic symptoms in Diabetes clinic of Kashan University of Medical Sciences from 2008 to 2010.

Methods: Three-hundred and fifty-two diabetic patients were enrolled in this cross-sectional study. Firstly patients were surveyed with a questionnaire concerning their subjective symptoms. The neuropathic symptoms were assessed using a quantitative neuropathy symptom score. Then the patients were examined by 5.07/10g monofilament. Data description and analysis were performed by reporting mean ± standard deviations, proportions, odds ratios (OR) and 95% confidence interval (95% CI) and conducting chi square and kappa tests. 

Results: 15.6% of patients had sensory neuropathy using monofilament test. 19.4% of men and 14.3% of women had neuropathy (OR=1.4, P=0.24). The mean duration of diabetes in patients with neuropathy was longer than patients without neuropathy (9.96 vs 9.68 year, P>0.05). 72.7% of patients with history of foot ulcer had neuropathy (OR=16.6, P<0.001). According to neuropathic symptoms 17.6% of patients had no neuropathy, 12.8% had mild neuropathy, 41.8% had moderate neuropathy and 27.8% had severe neuropathy.

Conclusion: Screening with monofilament test is necessary for all diabetic patients to prevent diabetic foot ulcer development, without considering neuropathic symptom

Background and Aim: Psoriasis is a chronic, relapsing disease of the skin with psychological and somatic impacts that leads to substantial effects on the quality of life. The aim of this study was to determine the quality of life in psoriatic patients.

Methods: This cross-sectional study was conducted on 97 psoriatic patients in dermatology and PUVA clinic in Afzalipour hospital in Kerman from March 2009 to March 2010. Quality of life and disease severity were Dermatology Life Quality Index (DLQI) and Psoriasis Area Severity Index (PASI). Data analysis was done through conducting, chi-square and one-way AVONA tests and P<0.05 was considered as significant. 

Results: 55.7% of patients were male and mean age of them was 35.3 years (range: 16-75 years). Psoriasis vulgaris was the most common type (76.3%), and arthropathy was seen in 3.1% of patients. The mean duration of the disease was 21 months (range: 11 months-30 years).The mean of DLQI score was 14.1(range: 1-29) and mean PASI score was 18.6 (range: 0.6-66.6). DLOI score correlated with severity of disease (PASI), marital status, and type of the disease (P<0.05).

Conclusion: Psoriasis has a severe negative impact on the quality of life of the patients. Therefore, supportive social and spiritual efforts are necessary to decrease these effects.

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.

Background and Aim: Anti-inflammatory and hypo- pigmenting effects of topical tretinoin and alpha-hydroxy acids have been documented. This study was designed to compare the efficacy of 0.05% tretinion cream with 7% alpha-hydroxy acid in the treatment of ephelides.
Methods: In this clinical trial 80 patients with ephelides were selected and allocated into two groups. One group was treated with 0.05% tretinoin cream every other night. The other group was treated with 7% alpha-hydroxy acid cream in the same manner. Both groups were treated with antisolar creams and followed every month for 5 months.
Results: After 5 months excellent therapeutic response was achieved in 3 (7.5%) of patients who were treated with 0.05% tretinoin cream compared to 8 (20%) in alpha-hydroxy acid cream. Good therapeutic response was observed in 20 (50%) of tretinoin group versus 16 (40%) in alpha-hydroxy acid group. Patient's satisfaction from treatment was consistent with evaluation by dermatologists (P=0.384 and P=0.132).
Conclusion: Both 0.05% tretinoin cream and 7% alpha-hydroxy acid cream are equally efficient in the treatment of ephelides.

Dermatology is a branch of medicine which is related to the diagnosis, treatment and prevention of the diseases and disorders that affect the skin and its appendages including hair, nail, sweat glands and mucosal surfaces of mouth and external genitalia. There are about 3000 clinical entities in the field of dermatology, which are very diverse in terms of their etiologies. Although some of these diseases are really prevalent and some others of them have high incidence rates and acknowledging that because of their visibility in many cases they are associated with stress, anxiety and impairment of patients' quality of lives, their resultant burden of disease at individual, familial and social levels are usually ignored. Herein, we provide some examples of the adverse public health and health economics effects of different dermatological diseases and disorders in different countries and populations. We also provide some reasons for this negligence and suggest some strategies to tackle this problem.

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.

Skin injury caused by burns, surgery and other traumas may result in unpleasant psychological experiences and be reflected in behaviors. Extracellular matrix (ECM) is the largest component of natural skin which is gel-like and is produced by skin cells. ECM synthesis is a key factor for filling up skin wounds such as burns, leishmaniasis, chicken pox, acne, etc. ECM is composed of a variety of polysaccharides, water, and collagen proteins. Considering its weight, natural skin strength and its expandability are like steel, while it has high elasticity and compaction capacities. These characteristics are due to dual effects of main ECM molecules, which are secreted by fibroblasts and epidermal cells: 1) structural fiber proteins like: elastin, fibronectin and laminin which give strength and flexibility to ECM, and 2) proteoglycans such as dermatan sulfate and hyaluronic acid which are consisted of few glycosaminoglycan chains that branch out from a linear protein core. Proteoglycans are large and hydrated molecules which are resistant to external forces and protect underneath cells. In general, understanding the skin structure and wound healing phases can help us to design useful experiments and to conduct proper researches in this area.

Background and Aim: Androgenic alopecia is one of the most common dermatological disorders. Hormonal and genetic factors determine the incidence of alopecia. Androgenic alopecia is the most common form of hair loss. It is progressive and symmetric in both sexes. The aim of this study was to determine the prevalence of androgenic alopecia in 14- to 18-year-old female high school students in Shiraz.

Methods: This cross-sectional study was conducted on 3190 14- to 18-year-old female high school students in Shiraz. A questionnaire was designed to collect personal information and record clinical features of androgenic alopecia.  Moderate and severe hair losses were defined as alopcia. For evaluation of alopecia associated with polycystic ovary syndrome, total and free testosterone blood levels were measured and abdominal ultrasound was performed. The collected data were described and analyzed through performing chi-square, Fisher's exact and and t tests using SPSS.

Results: 135 (4.2%) of participants had moderate to severe alopecia according to Ludwig's classification. No statistically significant correlation was observed in the mean of eather total or free testosterone levels between patients with androgenic alopecia, and those without (P>0.05). There was no statistical significant association between alpocia and polycystic ovary existence (P=0.2).

Conclusion: This study did not show a statistically significant relationship between patients with alopecia and androgenic hormones and polycystic ovary syndrome.

Background and Aim: Adverse drug reactions are inevitable outcomes of drug therapy, which may cause mortality and morbidity for those whom are treated in this way. Cutanous adverse drug reactions are abserved in 2% to 3% of inpatients but only 2% of them are considered serious and may cause death. The aim of this study was to determine the cause and clinical forms of adverse drug reactions referred to department of dermatology.

Methods: This cross-sectional study that was done on patients with diagnosis of cutanous adverse drug reactions in 2007 and 2009. All patients suspected with diagnosis of adverse drug reactions were examined by an experienced dermatologist for determination of different kinds of clinical manifestations.

Results: During the study period, 308 patients were recruited. Cutanous adverse drug reactions were found to be more frequent in females (63%) than in males (37%). Betalactam antibiotics were found to be the most frequent cause of adverse cutaneous drug reactions (42.7%), followed by non-steroidal anti-inflammatory drugs (16.5%). Acute urticaria was the most frequent observed drug reaction (59.2%) followed by fixed drug eruption (18.5%) and maculopapular rashes (14.9%).

Conclusion: In this study adverse cutaneous drug reactions was mainly induced by betalactam antibiotics and non-steroidal anti-inflammatory drugs. The most common forms of cutaneous adverse drug reactions were found to be: acute urticaria, fixed drug eruption and maculopapular rashes.