Journal of

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Background and Aim: Xanthelasma is a benign condition considered which is mainly as a cosmetic problem. There are many destructive treatment options that may result in scar formation and dyspigmentation such as cryotherapy and electro-cauthery. According to these side effects finding a non-invasive solution could be important. At this study we aimed to evaluate the effect of PDL laser in the treatment xanthalasma.
Methods: Patients with bilateral palpebral xanthelasma having normal serum lipid profile were eligible for the study if they had no history of a collagen vascular disease or dermatologic disorders that were associated with Koebner phenomenon. All patients had two separate pulsed dye laser (PDL) treatment sessions, with a four-week gap in between and were photographed before every laser treatment session and four weeks after the second session. Visual analogue scale (VAS) scoring system was used to determine effect of treatment by two academic dermatologists blinded to the study as the referees. Mean healing score by the two referees considered as final score.
Results: Nine patients with a mean age (±standard deviation) of 38.0 (±9.2) years were included. All patients were female. The commonest site of lesions was upper lid, and final resolution score for all patients was less than 25%. There were no significant differences between viewpoints of the two referees. There were no major post operative complications. Patients followed for six months after the end of the treatment and there was no adverse effect.
Conclusion: The present study failed to demonstrate therapeutic efficacy of PDL in the treatment of xanthelasma. PDL with limited session numbers could not be considered as an alternative treatment for xanthelasma palpebrarum.

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Background and Aim: Malignant melanoma is one of the most lethal skin tumors. Its prevalence and demographic specifications are different in European and western countries from those in the Middle East. This study was aimed to evaluate the demographic and clinical characteristics of malignant melanoma in Iran. Methods: In this cross-sectional study, the patients with the diagnosis of malignant melanoma who atteneded the tumor clinic of Razi Hospital, Tehran, Iran were included. Demographic and clinical data were registered in specific questionnaires. Histopathology findings were also recorded in the questionnaires. Results: A total of 2500 patients attending tumor clinic of Razi Hospital were evaluated. Out of them, 166 cases had malignant melanoma including 89 (53.6%) females and 77 males (46.4%). The mean age of patients 60.5 years. History of chronic sun exposure was found in 65 (39.2%) cases. Mean delay time between commencement of lesion and diagnosis was 9 months. The most common histopathologic type was acral lentiginous and the most common observed stage of tumor was Clark 3. The most common frequent observed tumor site was head and neck which was followed by limbs. Conclusion: Malignant melanoma is common in patients with skin tumors in Iran. Considering morbidity and mortality of malignant melanoma and the relatively high stages of tumors, at the fist time the patients sought medical care, screening programs seems to be necessary to find the patients in earlier stages, as well as the mass education. Some of our findings such as the most common location of the tumors, family history and relation with dysplastic naevies, remain to be confirmed in studies with larger sample sizes.

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Background and Aim: Due to new popularity of cosmetic tattoos especially among women and its potential relationship with sarcoidosis, the present study was conducted to evaluate clinical presentation and some demographic data about tattoo granuloma, as part of non-infectious dermatologic granulomas. Methods: In this retrospective cross-sectional study, all patients with the histopathological diagnosis of non-infectious granulomatous lesions whom were admitted between at the dermatology clinics at Razi Hospital, Tehran, Iran between March 21, 2007 and March 20, 2012 were included. Results: A total of 1099 patients were included in the study. The commonest form of granuloma was foreign body granuloma in 511 (46.4%) of the patients and was followed by tattoo granuloma in 102 (9.2%) of the patients. All patients with tattoo granuloma were females whose ages were from 40 to 60 years. The mean±standard deviation age of the patients was 43±8.57 years. Twenty-six (25%) of patients with tattoo granuloma showed sarcoidal pattern, and one case (1%) showed caseouse pattern, after histopathological evaluation of biopsy specimens. Majority of the lesions were papular (32.3%) followed by nodular (24.5%) lesions. Conclusion: Tattoo granuloma is the second common form of non-infectious granulomas, and in one-quarter of cases has sarcoidal pattern. Considering this finding, it seems reasonable to evaluate these patients for sarcoidosis.

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Background and Aim: Acne vulgaris is a common skin disorder. This study was conducted to evaluate the impact of Ramadan fasting on acne healing in patients admitted to the dermatology clinic, Razi Hospital, Tehran.

Methods: In this prospective cohort study, 10 fasting persons (9 women and 1 man) and 10 non-fasting persons (9 women and 1 man) with acne were studied. Their baseline acne severities were recorded and acne improvement was evaluated in both groups after Ramadan month.

Results: Acne improvement was 71% in fasting persons and 49% in non-fasting persons. Improvement in fasting persons i.e. was 1.4 times of non-fasting ones (P=0.158). However, no significant statistical difference was detected. Also, it was determined that improvement was different according to acne grading. Improvement in acne lesions in patients with grade 2 severity was 100%, in those with grade 3 acne was 78%, and in patients with grade 4 acne was 35 % (P=0.025). But in non-fasting patients there was not a statistical difference between acne severity and improvement rate. Furthermore in patients younger than 24, improvement rate of acne was 1.6 fold more than non-fasting persons and in patients older than 24, this ratio was 1.3 (P=0.011).

Conclusion: This study did not show any statistically significant difference in acne improvement between who were fasting and who were not during Ramadan. Studies with larger sample size are recommended.

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ackground and Aim: Vitiligo is a chronic skin disease which manifests with depigmented patches as a result of absence of skin melanocytes. Vitiligo results in beauty problems which could cause mental disorders. The purpose of this research was to compare the tendency to suicide and stress in patients with vitiligo with those without any skin disease.

Methods: For conducting this research, 30 patients with vitiligo who were referred to the Behsima Skin and Laser Clinic in Tehran during 2016 were recruited. Data were collected using Beck suicide scale ideation and Kohen stress  questionnaires. Thirty demographically-matched individuals without active skin disease over the past six months  were recruited into the study as the control group.

Results:  Mean±standard deviation (SD)  of Beck suicide scale ideation (BSSI) score in patients with vitiligo was 3.67±1.33, significantly higher than 0.37±0.17 in the control group (P=0.02). Mean scores of stress in vitiligo patients was 28.33±9.20, which was also higher than the control group mean, 21.77±8.19 (P=0.005).

Conclusion: Patients with vitiligo had more suicide ideation and stress than normal population. So, in taking care and treating in vitiligo patients, a special attention to the  psychological effects of disease on the lives of the patients is recommended.

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Background and Aim: Psoriasis is a common chronic skin disease with high morbidity and economic burden for patients and healthcare system. The goal of this study was to evaluate the impact of age, disease severity, and therapeutic regimen on the quality of life of the patients with psoriasis who were treated with biological drugs.

Methods: This cross-sectional study was conducted on 110 patients suffering from psoriasis whom were admitted to the psoriasis clinic in Razi Hospital, Tehran, Iran in 2015 and 2016. The Persian version of the  Dermatology Life Quality Index (DLQI) questionnaire was used to evaluate patients' quality of lives. Using IBM SPSS Statistics (IBM Corp., Armonk, NY, USA) version 22, descriptive and inferential statistics methods were applied to summarize and present the collected data. Chi square test was used for making comparisons.

Results: Seventy-four male patients and 36 female patients were enrolled. The mean age of the participants was 38.8 (range: 18 to 73) years. DLQI scores had a normal distribution and a mean ± standard deviation (SD) equals to 6.51±6.66. The correlations between age and disease severity, quality of life and age, as well as quality of life and disease severity, and quality of life and treatment were not significant (P>0.05).

Conclusion: It seems that the quality of lives of the patients were not affected by the age, severity of the disease, and therapeutic regimen of biological drugs.

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Background and Aim: The aim of this study was to evaluate surgery approach outcomes in patients with squamous cell carcinoma (SCC) of lower lip.

Methods: We retrospectively analyzed medical records of patients that diagnosed with SCC of the lower lip at Razi hospital at Tehran University of Medical Sciences in a 5 year period. Data analysis included descriptive statistics and bivariate analyses using the chi-square and Fisher’s exact tests to compare the variables.

Results: The age range of patients was 35 to 94 years (mean, 64.1 years; SD, 13.27 years), with a 5:1 male-female ratio. SCC of the lower lip occurred more frequently in patients older than 60 years. 62.1 % of the patients were addicted to cigarette and other tobacco compounds. It was noted
sig­nificant association between chronic solar exposure in the job’s environment and incidence of SCC in lower lip. Mean diameter of the tumor was 28.1 mm (range, 5 to 63 mm). Recurrence was detected in 17 patients (24.6%). Two patients (2.89%) died due to lower lip SCC in this series.

Conclusion: our study revealed that lower lip SCC is more prevalent in men and in eighth decade of life. As well, considering the low recurrence rate and high survival rate, surgery could be considered as an effective method of treatment.

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Background and Aim: Regarding the relatively high prevalence of depression in people with psoriasis, the present study was conducted to determine the role of type D personality and difficulties in emotion regulation in predicting the symptoms of depression in patients with psoriasis.

Methods: This study was a descriptive correlational study. Among patients referred to the Dermatology Clinic of Razi Hospital in Tehran from November to January 2016, 60 patients with psoriasis were selected using available sampling method. The research instruments included type D Personality Questionnaire (DS-14 scale), Difficulties in Emotion Regulation Scale (DERS), and Beck Depression Inventory (Second Edition) (BDI-II). Finally, the data were analyzed using Pearson correlation coefficient and multiple regression tests.

Results: The results of this study showed that there is a significant positive correlation between type D personality and difficulties in emotion regulation with symptoms of depression in patients with psoriasis (P<0/01). Regression analysis with enter method also showed that the two components of type D personality (negative affect and social inhibition), as well as two subscales (lack of emotional awareness and lack of emotional clarity) in difficulties in emotion regulation scale can predict the symptoms of depression in psoriasis.

Conclusion: Type D personality traits and difficulties in emotion regulation can affect the psychological consequences of psoriasis, including depression in people with this disease.

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Background and Aim: Burn is a risk, which threatens human beings every day in various forms. It is one of the most destructive injuries, associated with various physical and psychological complications. Burn affects the quality of life and life satisfaction . Evaluation of life satisfaction is very important due to its close relationship with physical and mental health. Given the high prevalence of burn in Iran and the presence of challenges in the treatment and rehabilitation of these patients, we decided to conduct this research to evaluate the life satisfaction in burned patients, admitted to Burn Injuries and Reconstructive Surgery Center in Rasht.

Methods: In this descriptive-analytical research, 379 burned patients were included in the study using convenient sampling method. The Diner Life Satisfaction Questionnaire was used to collect the data. Data were analyzed using descriptive and analytical statistics. The significance level was considered to be less than 0.05.

Results: Most of the subjects were male (64.1%) and had high level of education (34.6%). Also, most of them returned to their previous jobs (83.4%). Most of patients (48.5%) were satisfied with their life and the variables of lodging (P<0.0001), educational level (P<0.0001), marital status after burn (P=0.05), pre-burn job (P=0.016), post-burn job (P=0.014), skin graft (P<0.0001) and insurance (P<0.0001) were considered as predictive variables related to life satisfaction.

Conclusion: Since burn injury was expected to cause more than obtained dissatisfaction , other factors such as the power of faith and satisfaction with divine providence, high life expectancy, etc may influence their state of satisfaction. Thus, it is recommended that supporting and charity institutions (such as welfare, relief committee, IRIB, etc.) provide more support for these patients. It is also recommended that programs and classes with advisory and educational content be held for patients and their families.

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COVID-19 was announced pandemic by March 2020. Due to the high prevalence of the disease and its staggering spread, it is very important to identify various manifestations of this viral infection.
The aim of this study is to review published articles about cutaneous involvement of COVID-19 disease.
Cutaneous manifestations are rare in COVID-19 disease and it is essential to recognize these possible skin manifestations in order to detect and treat COVID-19 disease and to prevent further transmission.

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Background and Aim: Psoriasis is a systemic and non-transmissible chronic inflammatory autoimmune skin disease that about 2-3% of Iranians suffer from it. Cost of management and budgeting and planning for the treatment of patients with psoriasis requires accurate information. The present study estimates the direct and indirect costs for one-year treatment of patients admitted in Razi Dermatology Hospital.

Methods: In this descriptive-analytical study, treatment costs of 170 patients with psoriasis, including direct (medical and non-medical) and indirect costs were evaluated by census method and using a researcher-made checklist, from October 2017 to October 2018. The fee was collected through reviewing patients' bills in the hospital information system and through telephone interviews with patients.

Results: The average cost of one year was 9037480 Tomans ($ 758), of which direct cost of treatment was 90.22% (8178681 Tomans) and indirect cost of treatment was 9.78% (858799 Tomans). The highest cost of treatment was related to pharmaceutical services with 5825233 Tomans. Also, the total direct medical cost was equal to 7069890 Tomans, of which 62% was the insurance share and 38% was the patient share. The findings showed that injecting biological drugs and accommodation had a significant effect on the direct cost of treatment. Supplementary insurance and accommodation variables also affect out-of-pocket costs.

Conclusion: Drugs made up most of the costs. The high price of biologics and the low coverage of these drugs by insurance companies have caused many economic problems for these patients. According to the findings of this study, it seems necessary to review the more complete insurance coverage of these drugs as well as the use of charitable assistance to cover part of the cost for treatment.

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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.

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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, internal medicine specialists, allergologists and clinical immunologists are also commonly involved in the management of patients with urticaria.
Iranian Society of Dermatology developed a clinical practice guideline concerning diagnosis and treatment of urticaria that was published in 2018. The current guideline is the result of scientific papers that got published from April 2018 to August 2022.

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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.

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Background and Aim: Lower limb telangiectasias are commonly seen in the general population and especially in females. This disorder not only causes cosmetic problems but also can cause pain and related problems of increased venous blood pressure. These varicose veins are one of the most common causes that patients refer to dermatology clinics. Considering some complications and limitations of sclerotherapy, we decided to investigate the efficacy and safety of the Long-Pulsed Nd:YAG 1064-nm laser as an alternative method.
 

Methods: 29 patients underwent at least three sessions of 1064 nm Nd: YAG laser treatment at intervals of 4 weeks. Before the first treatment session, after each session, and six months after the last session, photos were taken of the treatment site. Finally, clinical response and satisfaction rate with the treatment were recorded based on the score of a secondary dermatologist and the patient himself based on the improvement criteria from 0 to 4.
 

Results: According to the dermatologist's judgment, the average satisfaction with the treatment is 3.38 out of 4 with a standard deviation of 0.5, and based on the patient's assessment, it is 3.2 out of 4 with a standard deviation of 0.71, which is equivalent to more than 76% of the effectiveness of Nd:YAG 1064 nm laser in the treatment of telangiectatic veins. The pain during laser treatment was recorded as 6.27 with a standard deviation of 2.64 based on The VAS Scale.
 

Conclusion: Our experience has demonstrated that the long-pulsed 1064 nm Nd:YAG laser is an effective, reliable, safe method in the treatment of telangiectatic and reticular veins of the lower limbs with minimal side effects and complications.

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Background and Aim: Genital wart disease is an infectious disease caused by a type of human papilloma virus that is transmitted through direct contact with the skin of people and mainly as a result of sexual intercourse. Therefore, the profile of psychological vulnerability in people with genital warts and its role in the level of impulsivity It was studied in patients at Razi Hospital.
 

Methods: The current research was of a descriptive-correlation type. The statistical population of the research consisted of all the people referred to Razi Hospital who were suffering from genital warts. 122 people were selected and included in the study. Psychological vulnerability questionnaire and Barat impulsivity questionnaire were used in this research. Data analysis was done with analysis of variance and independent t test, Pearson correlation and stepwise regression and SPSS 18 software.
 

Results: The results showed that psychological vulnerability is normal in people with genital warts. Psychological vulnerability plays a role in impulsivity. Paranoid thoughts have an effect coefficient of 0.3030 and a prediction of 0.30.
 

Conclusion: Considering the role of psychological vulnerability in the formation of behavioral disorders such as impulsivity on the one hand and the role of impulsivity in contracting genital warts on the other hand, this research has practical implications in highlighting the areas of prevention and treatment of impulsivity.

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Background and Aim: The present study aims to assess the prevalence of obstructive sleep apnea in patients with psoriasis referring to Razi Hospital.
 

Methods: Participants were assessed for demographic characteristics, Psoriasis Area and Severity Index (PASI), disease duration, place of residence, education level, and were also evaluated using the Stop-Bang and Berlin questionnaires to assess the risk of obstructive sleep apnea. The high and low-risk groups for obstructive sleep apnea were compared regarding these parameters.
 

Results: Based on the Stop-Bang criteria, 43 individuals (41.3%) had moderate risk, and 23 individuals (22.1%) had high risk of obstructive sleep apnea. According to the Berlin questionnaire, 48 individuals (46.2%) were at high risk for obstructive sleep apnea. The mean age of individuals with high risk of obstructive sleep apnea according to the STOP-BANG criteria was significantly higher than those with moderate risk (mean=58.3, standard deviation=10.6, compared to mean=48.1, standard deviation=16.1, P = 0.039) and low risk (mean=41.7, standard deviation=17.8, P< 0.001). Additionally, BMI differed significantly among the three groups based on the Stop-BANG criteria, with higher BMI observed in individuals at higher risk for obstructive sleep apnea (P<0.05). BMI was significantly higher in individuals with high risk of obstructive sleep apnea according to the Berlin criteria compared to those with low risk (mean 31.1 versus mean 26, P<0.001).
 

Conclusion: The findings of this study highlight obstructive sleep apnea as a comorbidity associated with psoriasis.

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Background and aim: As the use of botulinum toxin to treat glabellar lines increases, particularly in Iran, where foreign products (e.g. Dysport) are relatively expensive, it becomes important to compare the efficacy, side effects, and duration of action of two locally produced botulinum toxin brands, Masport® and Dyston®. This study seeks to assess and compare the treatment results of these two medications.
 

Methods: In this cross-sectional, descriptive, retrospective study, the medical records of 81 patients who visited Razi Dermatology Hospital for the treatment of moderate to severe glabellar lines were reviewed. Data related to patient satisfaction, duration of action, and side effects of Masport® and Dyston® botulinum toxin were collected and analyzed via a questionnaire.
 

Results: The mean satisfaction score was 7 for the Dyston® group and 7.7 for the Masport® group, with no statistically significant difference between the two groups (P=0.142). Additionally, the mean duration of action was 3.5 months for Dyston® and 3.8 months for Masport®, with no significant difference observed. Headache was the most common side effect reported, with no other major adverse events noted. Furthermore, there was no statistically significant difference in the incidence of side effects between the two groups.
 

Conclusion: The findings of this study indicate that both Dyston® and Masport® have similar efficacy and safety profiles. The choice between them can be primarily based on cost and patient or physician preference rather than any significant therapeutic differences. Larger studies are recommended to further validate these findings.

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Background and aim: Pityriasis lichenoides (PL) is a rare papulosquamous disorder with an unknown etiology. Due to limited recent studies on this subject, the present research was conducted to describe the clinical manifestations and treatment course of these patients.
Methods: This retrospective cross-sectional study (2019-2023) was conducted on patients diagnosed with PL at Razi Dermatology Hospital, Tehran University of Medical Sciences, Iran confirmed by biopsy of skin lesions. Basic information was obtained from hospital records, and treatment follow-up was gathered from medical files and phone interviews with patients. Data were analyzed using R software, with a P<0.05 considered statistically significant.
Results: A total of 147 patients were evaluated. No significant difference was found between genders (P=0.358). The predominant subtype was PLC (91.8%), with a mean age of onset of 29.79 ± 18.73 years. The most common type of skin lesion was papules (48.4%), and generalized body involvement was the most frequent manifestation, observed in 58 patients (32.4%). The most commonly used treatment was topical corticosteroids, administered to 86 patients (52.4%). The average duration from onset to full recovery was 160.80±221.40 days. A total of 45 patients (30.6%) reported recurrent episodes of the disease. No significant association was found between treatment efficacy and gender (P=0.620), underlying conditions (P=0.293), or age (P=0.876).
Conclusion: Given the limited clinical data on patients with pityriasis lichenoides, establishing an electronic database and a national registry system for this condition is recommended.

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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.