Journal of

---

Introduction: Beckers’s nevus is a cutaneous hamartoma which usually appears as a circumscribed hyperpigmentation with hypertrichosis. It usually presents unilaterally and the usual site is shoulder and scapula. It is rarely congenital and it is usually noticed first during adolescence.

Case Report: Herein, we report a congenital bilateral large Becker’s nevus with positive familial history of Becker’s nevus. There were no associated anomalies in our patients.

Conclusion: Familial and bilateral cases of Becker’s nevus can present with no associated anomalies as “Becker’s syndrome”.

---

This is a letter to editor criticizing the paper entitled “Efficacy of licorice extract in the treatment of melasma: A randomized, double-blind, placebo-controlled clinical trial”. We discuss some methodological points on external and internal validity of results. The paper suffers from lack of detailed information on sample size and power calculation to make sure generalisability of results to study population. The paper also did not report blinding procedure and placebo details. The results of the paper also suffer from multiplicity (multiple comparisons) and suitability of data analysis approach. It is recommended to apply either repeated measure ANOVA or a mixed model to consider correlation between repeated measure of outcomes and multiplicity problem.

---

Mycetoma usually involves the skin, the subcutaneous tissues and deep structures such as the muscle and bone, but infection can also spread to more distant sites through the blood and lymph. If left untreated, the disease leads to deformity and loss of function, which may be fatal. The disease has a severe medical and socioeconomic impact on individuals, communities and health authorities. Elaborating a public health strategy for the prevention and control of mycetoma will require collection of epidemiological data on its burden as well as precise diagnosis and early treatment strategies.

---

ntroduction: Leprosy is an infectious disease which primarily affect skin and peripheral nerves. Mycobacterium leprae and Mycobacterium lepromatosis that are the acid-fast bacillus are known to be cause of leprosy. Genetic factors and immunological function have some roles in susceptibility of developing leprosy. There are some cases of familial leprosy.

Case Report: Here in, we report a case of familial leprosy which in one member it was symptomatic and others were asymptomatic with positive skin smear for mycobacterium leprosy bacilli.

Conclusion: We recommend in addition to approach and manage lepromatous patients, their families be also evaluated.

---

Introduction: Egyptian cockroach is one of the species of cockroaches, which has a worldwide distribution, and can live in closed human environments. In this paper, we present the first reported patient with skin reactions and dermatitis to Egyptian cockroach in Iran.

Case Report: An 80-year-old man referred to the clinic with skin lesions on his right foot. The patient lived in an adobe house in Rafsanjan city, and he had not past history of skin lesions. He reported severe itching at the beginig,one day later redness and swelling appeared. Physical examination, revealed inflammation and bite signs. Lesions disappeared after two weeks of medical treatment.

Conclusion: In general, cockroaches can cause skin reactions after body contact, so public knowledge and awareness about the prevention and control of these cockroaches should be increased in the community.

---

Introduction: Onycholemmal carcinoma is a rare slow-growing malignant epithelial neoplasm originating from nail bed epithelium. Clinical presentations are nonspecific and include warty mass, ulceration, and crust, onycholysis, periungual erythema, edema, and pain.

Case Report: Herein, we report a 65-year-old woman with a mass lesion in the second finger of right hand that lasted for 3 years, which finally managed by finger amputation. Histopathology of the tumor revealed solid islands of atypical keratinocytes with abrupt keratinization without granular layer formation. Immunohistochemistry for epithelial and cell proliferation markers was performed.

Conclusion: Malignant epithelial neoplasms of the nail should be considered in long-standing nail problems and appropriate nail biopsy should be performed.

---

Introduction: Medial canthus area, as one of most common sites of facial skin cancers, is notified for reconstruction. There are numerous reconstructive options to cover resulted skin defects, which have their own advantages and disadvantages. Here, we decided to present our experience in medial canthal area with amazing result.

Case Report: A 47-year-old man with basal cell carcinoma (BCC) of right medial canthus, without extra involvement, was admitted. Following lesion excision with safe margin, the resulted skin defect in 30 mm diameter was reconstructed with full thickness skin graft from posterior auricular area. Several months later, it was really difficult to find scar or operated skin, as supported by complete patient`s satisfaction.

Conclusion: The space between eyes has unbelievable aesthetic and social importance. Any added scar or incision to this area is always challenging. It seems full thickness skin graft - if harvested from proper donor site - can be acceptable in long term aesthetic outcome compared to other reconstructive options.
 

---

The aim of this study was to investigate the possibility of using saliva instead of serum (as a simpler method without the need for blood sampling) to determine the level of some cytokines and enzymes. In this study, the levels of cytokines IL10, IFN-Y, TNF-α, TGF-β and the antioxidant enzymes glutathione reductase and glutathione peroxidase were measured in the saliva and serum of three patients with alopecia totalis by ELISA. Comparison of the levels of these substances in saliva samples at 5 am, saliva at 11 am and serum at 11 am with Friedman test did not show a significant difference. Therefore, saliva samples may be a good alternative to serum in the study of immunological factors.

---

Introduction: Tinea capitis is the most common skin infection on the scalp and an uncommon dermatophytosis in adults. Its clinical appearance varies greatly depending on the causative organism, the type of hair involvement and the extent of the patient inflammatory response. Its common features are fragmented hair loss with varying degrees of scaling and erythema. However, if the clinical symptoms are mild, the diagnosis can be challenging.

Case report: We report a case of tinea capitis in a 60-year-old woman who initially had few clinical symptoms and according to the biopsy result and the presence of fibrosis, lichenpilanopilaris (LPP) were diagnosed and she received related treatment with methotrexate and cyclosporine, but after 4 months, no response to treatment and exacerbation of symptoms were observed. Tinea capitis was diagnosed and the patient was given appropriate treatment.

Conclusion: Tinea capitis can imitate clinical features of lichenplanopilaris and mistreatment with corticosteroids can lead to extension of the disease.

---

Introduction: Fleas are small, blood-sucking insects that can transmit some pathogens to human and animals.

Case Report: This paper presents a 21-year-old woman with severe skin reactions in her right forearm. After initial examinations, the symptoms were recognized as skin reaction caused by the bite of some human blood-sucking insects. Finally, after 15 days of flea bites, the symptoms were treated with topical after bite cream and oral antihistamines. In order to prevent and control the infestation of this blood-sucking pest, public awareness should be increased specially in at risk populations.

Conclusion: Increasing awareness among physicians, about the symptoms of this health pest can help to accelerate treatment process.

---

Introduction: Auricular reconstruction of partial ear defects is usually challenging, especially in extended resections or traumas. Helical rim is the most noticeable part of ear with aesthetic significance, which demands detailed procedures. Helical rim advancement is a known procedure to reshape lacerated rim. In the original technique, a chondrocutaneous flap is raised in order to preserve the posterior skin and consequently, the blood supply.

Case Report: Due to auricle’s rich blood supply, we selected an inferiorly based flap of helical rim, which we incised completely, even the posterior skin, in order to advance the flap more freely to the cephalic side and relaxed cephalically. In five patients with helix tumors, this reconstructive procedure was done without threatening the blood supply and flap ischemia. Moreover, posterior skin traction or subsequent deformity, as one of concerns of reconstructive surgeons, were also eradicated.

Conclusion: It appears that this modification can be noteworthy in auricular reconstruction.

---

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.

---

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: Skin lesions and need for tissue evaluation, makes skin surgery an important part of treatment. Each excision is accompanied by skin repair. One of side effects of lesion excision is dog ear and cosmetic problems, particulary on face.

Case Report: A middle age woman presented with an old leishmaniosis scar in her face. she asked how can we remove the lesion with minimal scar. In the planned operation the lesion was excised some deeper fatty tissues at both ends. At the end of wound closure, there was not ant dog ear around wound.

Conclusion: There are numerous options to prevent and correct dog ears at the end of skin closure- depending on size and location of the lesion. in our recommended technique, subdermal fatty excision attached to the lesion, may remain minimal extra skin at the end of skin closure.

---

Background: Tarantulas (Camel spiders) are order that belong to classes of arachnida and phylum of arthropoda. They can make a painful bite in human.
 

Case Report: This paper presents 34 and 40-year-old men with skin reactions in their left legs. After initial examinations, the symptoms were recognized as skin reaction caused by the bite of some nuisance insects. After one day, a lesion including 2 red dots appeared on the patient's leg. After a few hours, skin lesions were observed in both patient, and by washing with soap and water after 7 days, the symptoms completely disappeared and the bite improved.
 

Conclusion: Increasing awareness among physicians, about the symptoms of this nuisance insects can help to accelerate treatment process.

---

Introduction: Chondroidsyringoma or apocrine mixed tumor is a benign skin tumor that usually manifests as a nodular lesion with slow growth and no symptoms in the head and neck area, and based on histologicalcharacteristics, it can be apocrine or eccrine. Tumor diagnosis is based on clinical features and histopathology and its treatment is surgical removal of the lesion.
 

Case report: In this study, we report a case of apocrine chondroidsyringoma in a 33-year-old man who presented with a complaint of an asymptomatic nodular lesion in the area above the upper lip, and after biopsy and histopathological examination, the diagnosis of apocrine chondroidsyringoma was made.
 

Conclusion: Chondroidsyringoma does not have a specific clinical manifestation and its diagnosis is challenging and is based on attention to histological features in addition to clinical manifestations. This tumor should be considered in the differential diagnosis for subcutaneous nodules, especially in the head and neck area.

---

Introduction: Skin lesions and masses of forehead are challenging topics in the field of reconstruction. Skin grafts and local flaps have significant role in reconstruction of skin defects of forehead. Proper design of flap can save hairline configuration and symmetry of eyebrows.
 

Case report: A young woman with congenital sebaceous nevus-Jadassohn-wanted to remove this lesion. After excision, there was skin defect of 4 cm diameter. A O to T flap designed and incisions were on bilateral hairline. The defect was covered without any disruption of hairline.
 

Conclusion: Rotational-advancement flaps are among reliable flaps in reconstruction of forehead skin defects. O to T flap belongs to this category which is effective in traumatic patients and reconstruction following tumor resections.

---

Introduction: Darrier disease is a genodermatoses evolving more in adolescence and appears mostly in seborrheic areas. Because of the absence of typical lesions and other diseases appearing in these areas, diagnosis of darrier may be delayed
 

Case report: A 46 year-old woman came with inguinal, asymptomatic lesions lesions since 3 years ago. The report of biopsy which was taken, showed findings compatible with Darrier disease. Oral isotretinoin initiated with good response after 2 months.
 

Conclusion: In intertriginous areas, some less common diseases may be mis diagnosed as other more common and similar diseases.

---

Background and Aim: Spiders are one of the largest orders of arachnids, found worldwide on all continents except Antarctica. Many species of spiders live in close proximity to humans and generally inject poison into other animals, including humans, to protect themselves or to hunt.
Case Report: In this paper, a seven-year-old boy is presented who came to the hospital complaining of skin reactions in the eye, knee, and lower leg area. Skin lesions appeared on the boy's body after a few hours. After 24 hours, the skin lesions intensified, and inflammation and redness along with itching occurred on the boy's body. Finally, after 5 days, the skin lesions disappeared completely by washing with soap and water along with the use of Calamine lotion and the bite site improved.
Conclusion: Increasing awareness among physicians, about the symptoms of this nuisance insects can help to accelerate treatment process.