Journal of

---

Background and Aim: Mycosis fungoides (MF) is the most common primary cutaneous lymphoma. Diagnosis of early MF (eMF) is often difficult due to its resemblance of benign dermatoses. The aim of this study was to evaluate the role of provided clinical information on the histopathology request forms for diagnosis of eMF according to the International Society of Cutaneous Lympoma (ISCL) criteria. Methods: In this cross-sectional study, 108 patients admitted to Razi Hospital, Tehran, between April 2012 and November 2013, who were biopsied as eMF cases, were recruited. Based on partial application of ISCL algorithm, the checklist of clinical and histopathological findings were scored. Results: Eighty-five (78.7%) patients received maximum total clinical and histopathological scores (4) and their eMF were definitely diagnosed. Sixteen (14.8%) patients received a total score of 3, and suggestive eMF diagnosis was made. Further work up such as immunohistochemistry (IHC) evaluation were recommended. Seven patients (6.5%) received a total score of 2, which did not confirm eMF diagnosis. Follow up was recommended. In 14 (87.5%) of 16 patients who had received a total score of 3, the definite diagnosis of eMF was made according to the results of IHC. They were referred to receive treatment. In 2 patients (12.5%) diagnosis of eMF were not confirmed by IHC. They were recommended to undergo polymerase chain reaction (PCR) evaluation Conclusion: Many MF cases can be diagnosed in the early stages using a combination of clinical and histopathological criteria.

---

David Lawrence Sackett, OC, MD, FRSC, FRCP was an American-Canadian physician, trialist, and teacher. He is best known as one of the pioneers of evidence-based medicine (EBM), which is arguably the most important movement in medicine over the past three decades. He founded the first clinical epidemiology department in McMaster University in Hamilton, Canada in 1967. In addition, he was the head of the Center for the Evidence-Based Medicine in Oxford, UK. He also was the first chair of Cochrane Collaboration and the first founding coeditor of the journal of Evidence-Based Medicine and had many other honors. He published 12 books, 60 chapters in other books, and about 300 articles in scientific and medical journals. He died on May 13, 2015 at age 80 because of cholangiocarcinoma. While Dr. Sackett will be missed by his friends, colleagues, mentees as well as EBM proponents and followers all over the world, his contributions to EBM in particular, and to medicine in general will never be forgotten.

---

Background and Aim: Androgenetic alopecia (AGA) is the most common form of alopecia in men, worldwide and topical minoxidil appears to be the most effective and safe treatment for AGA beside oral finasteride. Safety assessment of topical minoxidil formulation could be conducted using in vivo studies on human volunteers. Using skin biophysical parameters is a fast and noninvasive method for safety assessment of topical products.

Methods: A topical combination of Minoxidil 5% solution in combination with chamomile extract from Iran’s pharmaceutical market tested on the skin of the forearm of 15 healthy volunteers. Changes in transepidermal water loss (TEWL), stratum corneum hydration, pH, melanin and hemoglobin contents have been evaluated, using biometric assessments with MPA 580 Cutometer®.

Results: There was not any significant change in skin hydration (P=0.692), TEWL (P=0.191), stratum corneum pH (P=0.613), melanin (P=0.533), and hemoglobin (P=0.579) contents before and after topical minoxidil application.

Conclusion: No significant change detected in skin erythema and assessed parameters Application of minoxidil 5% + chamomile 7% topical solution on human volunteers has not shown any adverse effects and these formulations could be recommended to use.

---

Background and Aim: Trichomonas vaginalis infection is one of the most common sexually transmitted diseases of women and men in the world. To the best of our knowledge, there has been no previous report of the prevalence and complications of trichomoniasis in women of Qom.

Methods: In this cross-sectional study, the prevalence of T. vaginalis in women whom were admitted to a referral gynecology clinic in the city of Qom. For this purpose, two diagnostic methods, wet mount and ITS-PCR, were used to examin the vaginal swabs taken from the participants. Microscopic examination of cellular morphology and bacteria was also conducted on the stained smear.

Results: Three hundered volunteers were enrolled. Of 300 specimens, 7 (2.67%) by wet mount and 34 (11.3%) by ITS-PCR method were positive. The positive results of ITS-PCR were confirmed by sequencing of PCR products. In comparison with women without T. vaginalis infection, infection with T. vaginalis was associated with increased the risks of low birth weight (OR=43.3; 95% CI=2.8-671.9), in women with history of abortion (OR=91.8; 95% CI=15.5-544.2), and in women with premature rupture of membrane (PROM) (OR=21.6; 95% CI=2.1-22.9). Probability of finding of epithelial cells (OR=36.9; 95% CI=6.9-197.3) and white blood cells (OR=43.3; 95% CI=2.8-665.1) in stained smear were higher in women with T. vaginalis compared to those without T. vaginalis.

Conclusion: Comparing with wet mount, ITS-PCR seems to be a more sensitive and reliable technique in detection of T. vaginalis infection in women. The high prevalence of trichomoniasis emphasizes the need for screening of women in Qom. Early examination and accurate diagnosis of T. vaginalis, especially in middle-aged women, could prevent pregnancy-related complications of T. vaginalis.

---

Background and Aim: Lack of information on how to protect and prevent cutaneos leishmaniasis plays an important role in the susceptibility to the disease. Therefore, preventive measures will be effective if the parents have awareness about the disease. This study was aimed to invetigate the effects of educational interventions on mother’s knowledge and attitude towards cutaneous leishmaniasis.

Methods: In this quasi-experimental study, 120 married women who were 15 years of age or older and were referred to Ab-o-Bargh Health Center in Mashhad were recruited. The participants were divided into three groups: participation in an educational lecture, participation in an educational group discussion session, and a control, non-intervention group. A researcher-developed questionnaire including questions on demographic data, and developed knowledge and attitude towards cutaneous leishmaniasis were used for data gathering. The evaluation of educational intervention effects were assessed before, immediately after the interventions, and one month after the educational interventions.

Results: Before the intervention, there was no significant difference in the mean of awareness scores between the three groups (P=0.71). However, there was a significant difference in awareness scores between the three groups immediately after the intervention. The observed scores did not change significantly after one month (P=0.001). Also, there was there was a significant difference in the rate of attitude score towards cutaneous leishmaniasis after the intervention between three groups (P=0.001).

Conclusion: Individual and group educational interventions regarding cutaneous leishmaniasis were effective to increase the knowledge and improve the attitude of the participants towards the disease. We recommend to apply effective educational interventions like group discussions to improve the mothers' knowledge and their insights about cutaneous leishmaniasis.

---

Background and Aim: Malignant melanoma is one of the most dangerous types of skin cancer. The aim of this study was to evaluate Spatial Thermographic Imaging (STI) in differentiating benign from malignant skin lesions.

Methods: One-hundred and ten STI images were taken from the volunteers who had lesions being suspected for malignant melanoma. Benignity or malignancy of lesions was determined according to the changes detected in tissue using texture filters. The STI data were compared with histopathology results.

Results: Out of 110 investigated patients with STI, three cases of malignant melanoma were found. Two cases were in men and the other one was in a woman. Accuracy of STI in diagnosis of malignant melanoma was 98%.

Conclusion: STI may potentially be used as a non-invasive method for the detecting skin malignant melanoma.

---

Background and Aim: Melasma is a common acquired disorder characterized by symmetric, hyperpigmented patches with an irregular outline, occurring most commonly on the face. The goal of this study was to evaluate the efficacy of a cream containing 4% licorice extract with a novel formulation based on solid lipid nanoparticles technology in the treatment of melasma. To the best of our knowledge, it is the first study designed to investigate the efficacy of this novel formulation in the treatment of melasma all over the world.

Methods: In this randomized, double-blind, placebo-controlled clinical trial, 44 women with clinical diagnosis of melasma referred to the Afzalipour hospital dermatology clinic were randomly allocated into two treatment groups of equal size. All the patients were interviewed and examined every four weeks during the trial and their Modified Melasma Area and Severity Index (MMASI) score were evaluated at 4, 8 and 12 weeks. The efficacy of the interventions were classified in four levels: complete response, significant response, partial response and no response.

Results: Forty patients were enrolled in the study. At the end of the study (12 weeks), mean± standard deviation of MMASI score changed from 11.03±2.7 to 1.41±0.6 in the intervention group and from 11.25±2.9 to 2.37±1.2 in the placebo group, respectively (P<0.001).

Conclusion: Licorice extract can be used as a skin-lightening agent with minimal side effect in the treatment of melasma. Nano/micro solid lipid particles are used as carriers with unique properties like size, surface electrical bar. Moreover, a large amount of the drug might be loaded to increase the efficacy and decrease the adverse events.

---

Transdermal drug delivery (TDD) is a non-invasive, topical administration method for therapeutic agents. Transdermal delivery also has advantages including providing release for long periods of time, improving patient compliance, and generally being inexpensive. Despite these advantages, the use of TDD has been limited by innate barrier functions of the skin. Only small (<500 Da), lipophilic molecules can passively diffuse through the skin. As a result of the barrier function of the skin, passive transdermal delivery has primarily been limited to small molecules. The skin, which consists of several layers including the stratum corneum, other epidermal layers, and dermis, is the primary defense system of the body. The main barrier to therapeutic delivery is the outermost layer of the skin, the stratum corneum. As a result, various methods of skin permeabilization have been explored for their ability to enhance the transport of drugs across the stratum corneum. Scientists evaluated new drug delivery systems such as nano-carriers and drug delivery systems and enhancer methods such as penetration enhancers. The purpose of drug delivery systems are to deliver sufficient drug molecules into the skin with maximum stability and minimal toxicity. To guarantee successful transdermal drug delivery, a drug delivery system must exhibit several essential properties including drug protection, targeted drug delivery, biocompatibility and biodegradability.

This paper reviews transdermal drug delivery systems, recent enhancement techniques to optimize drug delivery such as microneedles and especially vesicular systems.  Herein, we focus on the differences in their composition, physico-chemical properties and applications of those drug delivery systems. We hope recent innovations can work as a foundation for further research and development in transdermal drug delivery system.

---

No Abstract #####

---

Background and Aim: Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit. Retinoids are used as the first line therapy in acne. Systemic absorption and skin irritation including redness, pruritus and exfoliation are some of their side effects. In this study we compared the efficacy of isotretinoin 0.05% niosomal gel versus adapalen 0.1% gel in treatment of acne vulgaris.

Methods: In this randomized double blind clinical trial, 144 patients with mild to moderate acne vulgaris aged from 15 to 30 years were enrolled. The patients were randomly allocated into two groups of A, whom were treated with isotretinoin 0.05% niosomal gel and B whom were treated with adapalen 0.1% gel. The patients were evaluated for clinical reponse, decrease in the number of inflammatory and non-inflammatory lesions and side effects after 2, 4, 8, and 12 weeks of the initiation of treatment.

Results: At the end of the study the clinical responses of comedones and inflammatory lesions in isotretinoin 0.05% niosomal gel group were 68% and 79%, in comparison with 65% and 76% in the adapalen gel group,  respectively. The differences were not statistically significant. At the end of the treatment period more decrease in number of inflammatory and non-inflammatory lesions were seen in group A patients (niosomal isotretinoin) than group B (adapalen 0.1% gel) (P<0.001). Also side effect of skin redness was found more in group B (P<0.001).

Conclusion: Isotretinoin 0.05% niosomal gel has less side effects and more efficacy in the treatment of mild to moderate acne vulgaris in comparison with adapalen 0.1% gel.

---

Background and Aim: Lichenoid tissue reactions are a group of skin diseases with hydropic degeneration of the basal cell layer and inflammatory infiltrations in papillary dermis. The aim of this study was to investigate the clinicopathological features of skin diseases with lichenoid tissue reaction.

Methods: This retrospective cross-sectional study was conducted on 118 cases with lichenoid tissue reactions. Pathological and clinical features such as age, sex, location of the lesions were evaluated.

Results: 53.4% of the patients were female. Mean age of the patients was 39.9±17.37 years. Mean duration of the disease was 21.82±14.3 months. The most common site of involvement was upper limb (24%). The most frequent histopathological findings in epidermis and dermis were hydropic degeneration of the basal cell layer and papillary lymphocytic infiltration (89.9%, 85.5%, respectively). Lymphocytes were the most frequent inflammatory cells in dermis. Colloid bodies and melanin incontinency also were seen in 60.2% and 78% of cases, respectively.

Conclusion: Pathological evaluation can be helpful in differentiating skin disease with lichenoid tissue reactions, if there is a doubt in clinical diagnosis.

---

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare disease due to benign proliferation of dermal and subcutaneous capillaries. It is most commonly seen in young to middle-age females. Skin lesions include single or multiple red papules, plaques and nodules. It most commonly involves head and neck. Its etiology has not been determined. ALHE lesions are usually resistant to commonly suggested treatment methods including surgery. Recurrence of treated lesions is also common. Herein, we report a 38-year-old pregnant woman who presented with multiple red papules and nodules on her periauricular and occipital skin. Her lesions were confirmed to be ALHE after histopathological assessment.

---

Editor Note

---

No ABSTRACT###

---

Background and Aim: One of the most important characteristics of women and girls is their eagerness for showing their beauty, which is commonly achieved by using cosmetics and doing makeup. The aim of this study was to determine the prevalence of cosmetics use among high school and university students girls in Yazd city and to measure their  knowledge, attitude and practices.

Methods: This cross-sectional study was conducted on 400 female high school and university students in Yazd city in 2016. Data were gathered using a four-part questionnaire, which was designed to collect demographic data of the participants as well as, items needed for assessment of knowledge, attitudes, and practice of the participants about using cosmetics. The collected data were described and analyzed using IBM SPSS Statistics (IBM Corp., Armonk, NY, USA) version 22. Independent t, one-way analysis of variance (ANOVA), and chi square tests were used for statistical analyses.

Results:  The mean scores of knowledge, attitude and practices of the participants showed that the mean knowledge score of them was related to the age, level of education of parents, parent's occupation and household income (P<0.05). The mean attitude score of the participants was also related to the age, level of education of parents, and parent's occupation (P<0.05). The mean practices score of the participants was related to the age, level of education of parents, and parent's occupation as well (P<0.05). Those who did not use cosmetics, had a more proper attitude towards using cosmetics (P=0.01).

Conclusion: This study demonstrated that the use of cosmetics among female high school and university students in Yazd was high. Proper training in appropriate use of the cosmetics is needed.

---

Background and Aim: Non-Melanoma Skin Cancer (NMSC), including squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) is the most common cancer in Iran. This study aimed to infer implicit information in the cases of NMSC patients referred to the Cancer Institute of Tehran.

Methods: A number of 865 cases of NMSC related to 2007-2015 years were selected from the archives of Cancer Institute using simple random sampling method. Initially, epidemiological variables, were extracted and after preprocessing of the data, descriptive statistics were used to classify and graphic display of information.

Results: The mean age for patients was identified 65 years and the highest and lowest numbers of cases were in age groups of 69-60 and 19-10 years respectively. The incidence of SCC was higher than BCC in the first four age decades and this trend was reversed in the next decades. About 56% of cases were BCC and 44% were SCC and frequency of NMSC in men was 2/33 times more than women. The head/neck and trunk were the highest and lowest involved positions. The disease had relapsed at least twice in 32% of cases. The disease history showed that most of patients were previously affected by kinds of cancers, cardiovascular or metabolic diseases. The occupation of 114 patients was found to be as high-risk jobs. Most patients were referred to Cancer Institute from northern and western parts of the country.

Conclusion: Along with other studies, we found more cases of BCC than SCC, involvement of patients over 60 years at the head-neck and a previous history of cancer. But against other studies, SCC cases was found more in the first four decades of life than BCC cases, feet affected twice than hands and the locality of most cases was found in high latitudes. Patient records are potential resources that can help management of the diseases.

---

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.

---

---

Background and Aim: Psoriasis vulgaris is a chronic skin disease which is treated by many systemic or topical drugs. There is no cure for this disease and patients have to take medicaments for a long time, so having knowledge on adverse effects of current medicaments may prevent them and improve treatment process. The aim of this study was to evaluate the incidence of side effects of non biologic systemic drugs in psoriasis.

Methods: In this observational study, we evaluated 200 hospital charts of patients with moderate to-severe psoriasis referred to dermatology clinics of Shohada and Loghman Hospitals in Tehran in 2016. SPSS statistical tools were used to determine the percentage of adverse events. Chi square was used to show the association of gender-related complications and student T-test to evaluate age-related complications.

Results: %56 of patients were male, %26.5 were 25-34 year-old, with mean age of 42±14.2 years and %83.5 of patients had no family history of psoriasis. 11% of patients were hypertensive. Methotrexate was the most commonly used drug and the most common reported adverse event for it was increasing liver function tests (%6.2 in oral and %21.2 in IM injections). The most common reported adverse event for cyclosporine was increased blood pressure which was seen in 17 patients (15.3%). The most common side effect of acitertin was scaling, observed in 11 (%9.6) of patients. There was no relationship between age and sex of patients and development of side effects.

Conclusion: This study showed systemic treatments for psoriasis can change laboratory biomarkers and cause skin eruptions.

---

Recently, a new technology called nano-fractional radiofrequency has been developed in the treatment of skin rejuvenation. This novel technology can reduce side effects and recovery time due to the smaller pin size. The clinical trials have reported the effectiveness and safety of this new technology for treating many skin disorders such as rhytides, acne erythema, scarring, rosacea, striae and skin laxity. Despite its growing usage in aesthetic fields many clinical trials are needed to evaluate the effectiveness of this novel technology.