Journal of

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Background and Aim: The women’s main purpose of cosmetic rhinoplasty is to have a nose that they think has a better harmony with their face, so they could reach to a more desirable body image. This study investigated the effects of cosmetic nose surgery on women`s body image.
Methods: Thirty women referred to the private clinics of cosmetic surgeons for nose cosmetic surgery were selected. The multidimensional body-self relations questionnaire developed by Cash (1998) was employed to measure the women`s body image. This questionnaire was filled out before and five months after rhinoplasty.
Results: Using paired t test, the analyses of the data demostrated that nose cosmetic rhinoplasty increased the levels of women`s satisfaction of their subjective body and subjective nose images (P=0.0001 and , respectively).
Conclusion: The findings of the present study showed that cosmetic nose surgery increases the of levels of women’s satisfaction of their body image and it causes the person to have higher satisfaction of her nose and body image.

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Background and Aim: Skin basal cell carcinoma (BCC) is the most common cancer in human beings. Prevalence of this tumor has increased over the past decades. The standard treatment is complete excision, however some risks for recurrence still exist. The aim of this study was to determine the frequency of margin involvement in skin BCC as well as to investigate the demographic characteristics of the patients.
Methods: This study was conducted from April 2011 to April 2012 on the patients who had skin lesions suspected for BCC. The patients were undergone elliptical excision surgeries for removing their suspected lesions with 5-millimeter margins of clinically normal skin in Farchian Hospital, Hamadan, Iran. Following data were collected and recorded: age, sex, anatomical location, duration of the disease, primary clinical diagnosis, histopathologic type, and margin involvement.
Results: In total, 125 lesions from 115 patients were investigated (70 males, 45 females). The range of the ages of the patients were from 32 to 93 years, with a mean of 64.6 years. The most common histopathological type was nodular type (61.0%). Twenty percent of the excised lesions showed margin involvement. Risk factors for incomplete excision were older age and anatomical locations (ears and peri-ocular lesions). There was no statistically significant differences between sex, histological type, primary clinical diagnosis, and duration of the disease. In almost all cases, the clinical and histopathological diagnoses were similar.
Conclusion: To avoid repeated surgeries and to reduce the risk of incomplete excision for lesions on high risk locations, particularly in elderly, it is recommended that BCCs be excised with wide margins or Mohs micrographic surgery.

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Background an Aim: parapsoriasis is a rare chronic idiopathic dermatosis which commonly manifests with round or oval scaling and itching erythematosus plaques on trunk and extremities. Considering the size of the lesions, parapsoriasis is divided into two groups: small plaque and large plaque. Study of demographic characteristics of this disease may help to identify the high risk groups who are more susceptible to cutaneous lymphoma with high mortality as well as proper allocation of health service resources.
Methods: In this retrospective cross-sectional study, affected parapsoriasis patients whom were referred to Razi Hospital in Tehran between April 2003 to March 2009 were studied. Three hundred and twenty patients were investigated for variables: age, sex, place of residence, location of the lesions and clinical subgroups according to the histopathology reports.
Results: 53.4% of patients were female. The disease was most commonly observed in age group of 20 to 50 years and the mean age of the patients was 43.3 years. Eighty-five percent of the patients were inhabitant of Tehran province. 88.1% of patients had large plaque lesions and 11.9% had small plaque lesions. The most common sites of lesions were on the trunk (53.4%) followed by the extremities (38.7%).
Conclusion: Based on these findings, it was determined that parapsoriasis most commonly affects middle-aged women. Involvement of trunks and extremities were most commonly observed. Large plaque type was the most common type. 

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Background and Aim: Pemphigus is one of the most common types of autoimmune blistering disease that requires systemic immunosuppressive therapy. Immunosuppressive therapy has improved the disease outcome in recent decades, but long-term use of them has side effects. Recently, it has been tried to evaluate immunosuppressive drugs with less side effects. One of them is mycophenolate mofetil. The aim of this study was to evaluate of therapeutic efficacy of this drug in the patients with refractory pemphigus vulgaris.
Methods: Three hundred files of patients with pemphigus vulgaris were reviewed and among them 28 patients who had received mycophenolate mofetil due to resistance to treatment were entered to this study. The data were obtained from patients’ files and were analyzed using Kendall's tau-c correlation, Mann-Whitney and ANOVA tests.
Results: Male to female ratio was 1.8:1 with an average age of 43.3±13.6 year. Twenty-eight cases of pemphigus vulgaris were treated receiving 2gr/day mycophenolate mofetil + 1mg/kg/day prednisolone. Remission occurred after 3 months. Seventeen patients (10 men and 7 women) had complete remission. There was no significant association between gender and treatment response (P=0.58). There was no significant association between mean age of treated patients and untreated patients with treatment response (P=0.77). Also, there was no significant association between severity of mucosal (P=0.80) and severity of skin involvement with treatment response (P=0.80). Ten patients who received mycophenolate mofetil more than 12 months had treatment response to mycophenolate mofetil and they did not have any relapse in the follow up period.
Conclusion: Mycophenolate mofetil is effective and safe as an adjuvant therapy in patients with pemphigus vulgaris especially in refractory pemphigus. Initiation of the therapeutic effect is slow.

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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: The change of the age pattern for using cosmetics in Iran is an important issue. The objective of this study was to evaluate factors affecting the cosmetics usage by the girls under 20 years old.
Methods: This survey was done in Yazdanshahr NajafAbad (Isfahan) using of measurement method and questionnaire instrument in the year 2011-2012. Three hundred indivisuals were randomly selected from 1800 female students in high school, secondary school and per-university levels.
Results: Most of the respondents named their close friends and relatives as their model of make up. 31.7% of the girls have set satellite channels as their model and 7.7% used internet sites. 44.3% of the girls agreed with the effect of relation with opposite gender on the amount of cosmetics usage. There is a meaningful relation between age, multimedia consumption, marriage status, social reliability and the tendency to the cosmetics usage.
Conclusion: The factors influencing the cosmetics usage include population characteristics, socio-economic base, multimedia consumption, relations, family and reliability which explain almost 55% of the changeability of the variances.

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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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Idiopathic (primary) hyperhidrosis is defined as an excessive sweating with no clear cause and usually results in social, psychological, and professional disturbances.

In this study, tap water and normal saline iontophoresis were used in a 21-year-old female suffering from severe idiopathic palmoplantar hyperhidrosis.The result of 8 sessions iontophoresis showed that tap water and normal saline iontophoresis are effective in treatment of idiopathic hyperhidrosis. However, in contrast with other studies, normal saline iontophoresis was twice more effective than tap water iontophores. Quality of life of the patient was improved.

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The use of sunscreens should also be recommended in order to work against all kind of ultarviolet (UV)-induced skin damage such as photoallergies, skin wrinkles, sunburn or even skin cancer. Sunscreens contain chemical filters (organic absorb regularly UVB radiation) and physical filters (e.g., TiO2 and ZnO). The second group has been said to reflect and scatter UVB and UVA radiation. TiO2 is also extensively used in sunscreen formulations as active broadband sunscreens that blocks both UVB (290–320 nm) and UVA (320–400 nm). Although titanium dioxide is listed as a safe pigment, with no known adverse effects when it is used in cosmetics, but we should concern about ultrafine or nanoparticle form of titanium dioxide. If titanium dioxide particles used to act as a sunscreen are small enough, they can penetrate the cells, leading to photocatalysis within the cell, and cause DNA damage after exposure to sunlight.

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Basal cell carcinoma (BCC) is the most common cancer in Iran and in the world and its prevalence may become equivalent to the prevalence of all other cancers combined in the future. The Hedgehog (Hh) signaling pathway has an important role in tumorigenesis of BCC. Mutations in PTCH and Smo molecules of this pathway account for 85% to 95% of sporadic BCCs and also most cases of inherited cases. Currently, several treatment methods exist for this cancer. Mohs surgery and removing the whole tumor with free margins are the most efficient way for metastatic and highly invasive BCCs. According to the latest findings, small inhibitor molecules of the Hh pathway are becoming highlighted in drug production. Vismodegib an inhibitor of Smo, was approved by the Food and Drug Administration in 2012 as a drug for metastatic and highly invasive BCCs. Therefore, strategic targeting of signaling molecules has demonstrated success and holds great potential in medicine.

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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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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: Androgenetic alopecia (AGA) is the most common type of alopecia in men. Currently, minoxidil is the only topical drug which has been approved by FDA for the treatment of AGA. However, its efficacy is restricted because of its low skin penetration. Since vesicular systems such as liposomes and niosomes have higher efficacy and lower adverse effects, this study was conducted to compare the efficacy of topical niosomal minoxidil with conventional minoxidil in the treatment of AGA. Methods: This study was a randomized, controlled double-blind clinical trial. Ninety male patients with AGA according to Hamilton criteria were enrolled into this trial. The participants applied the interversion to which they were allocated twice a day, and were evaluated monthly for 6 months by a physician and patients self-assessments. Results: Eighty-eight patients completed the trial. Mean increased hair count in niosomal minoxidil group and conventional minoxidil group in the last visit were 28.18±11.00 and 14.22±5.23, respectively (P<0.001). Moreover, evaluation of treatment response according to the patients self-assessments were 8.72±5.03 and 3.33±2.67 in niosomal and conventional minoxidil, respectively, which revealed more satisfaction in niosomal group (P=0.001). With the exception of two cases in niosomal minoxidil group whom were withdraw due to scalp itching and erthema no other adverse effect was observed in either group. Conclusion: In the present study, application of topical niosomal minoxidil revealed an increase in the hair count in comparison with conventional minoxidil solution. Application of this new formulation for the treatment of AGA may be recommended.

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Background and Aim: Pemphigus vulgaris (PV) is the most common bullous autoimmune disease, which can cause mortality and morbidity in the patients who suffer from it. Researches to find reliable noninvasive laboratory tests to diagnose and monitor PV patients are being conducted.The aim of this study is to find the sensitivity of serum and salivary anti-DSG1 and anti-DSG3 antibodies in the diagnosis of PV by ELISA and to compare the results of serum and salivary autoantibodies with each other. Methods: In this case-control study, 40 newly diagnosed patients with PV were recruited. Forty healthy controls were also recruited to this study. The clinical diagnosis of PV was confirmed by histopathology and direct immunofluorescence (DIF). Demographic data, disease severity and phenotypes were recorded on the questionnaires, which were developed for this study. DSG1 and DSG3 ELISA test were performed on serum and salivary samples of patients and controls. Results: The mean±standard deviation age of patients, 43.37±11.94, with a range of 26 to 71 years. The sensitivities of serum anti-DSG3 and anti-DSG1 were 85% (34 cases had positive test results) and 90%, (36 cases had positive test results) respectively. The sensitivities of salivary anti-DSG3 and anti-DSG1 antibodies were accordingly 42.5% (17 cases had positive test results) and 60%, (24 cases had positive test results) respectively. Conclusion: While the sensitivities of serum ELISA in detection of anti-DSG1 and anti-DSG3 were significantly higher than those of salivary ELISA, since the levels of the latter are chnaging in parallel to those of serum ELISA, they might be used to monitor the disease activity.

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Background and Aim: Skin cancer is the most common type of cancer constitutes and 75% of all cancers in the world. Malignant melanoma is the most invasive and lethal form of skin cancer. The objective of this study was to evaluate infrared thermography in differentiation of benign and malignant skin lesions. Methods: This study was conducted on 120 patients (60 female, 60 male) with a lesion suspicious for melanoma and identifying the type of lesion (benign or malignant) based on thermal model using Fuzzy C-Means (FCM) clustering. In this imaging method, the difference on temperature responses between the normal and abnormal tissue was compared and data obtained was compared with biopsy results. Results: In 120 cases studied, 3 cases of skin cancer (2 male, 1 female) were found which all could be detected based on analysis of thermal images. Conclusion: At present, new methods for the detection of skin cancer, especially non-invasive diagnostic tools, have been discovered in several laboratories. The method presented in this paper could be considered as a non-invasive and cost effective method for the detection of skin cancer.

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Skin cancer is the most common cancer in humans worldwide. It is also the most common cancer in Iran. To achieve primary prevention in skin cancers, avoidance of direct sun exposure is recommended. Sunscreen use is one of the methods to reduce sun exposure. However, while using sunscreens has increased recently, the incidence rate of skin cancers has also increased. One of the reasons for observing this paradox may be caused by counterfit sunscreen products, in particular in Iran. The author imagines that this letter may result in proper decision making among health policy makers to tackle this problem.

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Background and Aim: Malignant melanoma is a rare and most malignant type of skin cancer which is originated from melanocytes. It is capable of infiltrating into interior organs and could cause mortality. The aim of this study is to analyze the survival of patients with malignant melanoma according to their age, gender, mitosis count, tumor thickness, level of lymphocyte infiltration, tumor location and the stage of the tumor. Methods: This is a descriptive-analytical study which has been done on, the data of 61 patients with malignant melanoma registered in pathology laboratory of Shahid Sadoughi hospital, Yazd. A questionnaire was used to collect the data via phone call, examining pathology slides and reviewing patients information. Results: The average survival time was 61.09±6.12 months.The mean age of the patients was 67.9±6.0 with the range of 18 to 89 years. Stage Ι had the best and stage ΙΙΙ and VΙ had the worst prognosis. The best survival rate was seen in malignant melanomas located on trunk, head and neck. Malignant melanoma of extremities had the worst prognosis. There was a statistically significant relationship between survival rate and stage (P=0.033) as well as the location of the tumor (P=0.0421). Conclusion: The survival of patients with malignant melanoma in Yazd had a statistically significant relationship with stage and the location of tumor but there was no significant relationship with mitosis count, gender, age, tumor depth and lymphocyte infiltration.

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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.