Journal of

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It is more than a decade that teledermatology has been considered as a potential substitute for the face to face visits. To evaluate its quality, the reliability and accuracy of teledermatology diagnoses are compared to those which are made in face to face visits. In this article, the results of the studies which have compared the reliability and accuracy of diagnoses had been made using teledermatology to the face to face visits were reviewed.

Different resources, such as electronic databases and e-journals were used to choose relevant articles related to teledermatology published between 1997 and 2013, and their main focus was on the reliability and accuracy of diagnoses in teledermatology compared to those in the face to face visits.

The reliability and accuracy of diagnoses in teledermatology compared to those in the face to face visits was more than 60%. Moreover, improving the reliability and accuracy depended on different factors, such as image quality, clinical information, differential diagnoses, consultation with other colleagues and gaining their secondary opinions.

It seems that providing adequate clinical information about patients can help to improve the reliability and accuracy of diagnoses in teledermatology. In this case, teledermatology can be used to provide healthcare services for the distant areas and the poor.

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Background and Aim: Shampoos are surfactant systems to clean hair and body. Two kinds of surfactants are generally used in shampoo formulations: anionic and amphoteric. These agents, especially anionic ones may cause skin irritation and dryness after bathing. So, using a simple and fast method to determine the types and concentrations of surfactants can help to choose a product with high efficacy and low side effects. This study was aimed to determine surfactant concentrations using potentiometric titration method. Methods: Ten hair and body shampoos were selected from Iran's market to determine concentration of anionic and amphoteric surfactants using potentiometric titration method with prepared standard solution. Results: All formulations contain both surfactants, but one formulation did not have the amphoteric one. Conclusion: When we want to choose a shampoo for irritated and dry skin, formulations with more amphoteric surfactant should be chosen because they are much milder on the skin in comparison with anionic surfactants. Potentiometric method which was described in this study is one of the easiest ways to find out which shampoo is suitable for each patient.

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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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Osteoma cutis is a rare benign disease characterized by the presence of osseous nodules in the dermal layer of the skin. The cause of osseous depositions is unknown still. It may be primary or secondary. Herein, we reported a 55-year-old woman that presented with multiple skin color papules on her face.

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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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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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Age related skin disorders due to structural and functional changes in the skin of the elderly may increase health care costs. As a result of an increase in the number of aging population in Iran, provision of dermatology services to the elderly group due to the limitation of resources and the high cost of those services will be a challenge for the health care system. Moreover, by increasing the elderly residents in private nursing homes, problems of the providing dermatology services costs as well as limitations in physical performance of the elderly to receive specialized services, the necessity of the existence of alternative and low-cost solutions to meet the needs of this group, will help to clarify the importance of the issue. By providing the facilities for physicians to examine the patients by telemedicine, access to medical care services (in broad geographic level) will be improved besides transferring of the patients for medical centers and the cost of physician care will be reduced

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Background and Aim: Skin cancer is one of the most common human cancers. Its incidence rate trend is increasing in Iran. The aim of this study was to investigate the prevalence, incidence rate and geographical distribution of skin cancer to identify the high risk areas in Kurdistan province, Iran. Methods: In this descriptive cross-sectional study, the collected data were analyzed using version 16 of SPSS software, and t-test and analysis of variance (ANOVA) were used for comparison of the means. The distribution map of skin cancer in the province was prepared using Geographic Information System (GIS) software, version 9.3 between the beginning of 2006 and the end of 2010. In order to investigate the reason for high rates of skin cancer in some cities, ultraviolet (UV) radiation distribution map was also prepared. Results: Sanandaj with 17.55/100000 had the highest and SarvAbad with 3.73/100000 had the lowest incidence rates. The number of male patients (542) was nearly two times of female cases (324), (P<0.0001). In addition, skin cancer was about two times more prevalent in urban (%68.01) than rural (%31.99) residents (P=0.008). Conclusion: Life style of men and their sun exposure because of their job seemed to be a major risk factor in increasing the incidence of skin cancer in Kurdistan province, Iran. There was no correlation between the skin cancer incidence at the district level and UV index. Further research is recommended to explain this finding.

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The function of the horny layer of the skin as a barrier is to protect the underlying tissues from infection, dryness, and mechanical stress. Disruption of this function results in increased transepidermal water loss (TEWL) and is associated with conditions like atopic dermatitis and other chronic skin diseases. Moisturizers have been shown to improve these conditions through restoration of the integrity of the stratum corneum, acting as a barrier to water loss and replacement of skin lipids and other compounds. Also, moisturizers are commonly used to reduce fine lines and make the skin appear smooth and soft. They contain varying combinations of emollients, occlusives, and humectants to achieve their beneficial effects, and there are an overwhelming number of formulations available.

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Malassezia species (previously Pityrosporum) are normal flora of human and warm-blooded animals skin. The genus Malassezia is now divided into 13 species. Most of the yeasts show an absolute requirement for long fatty acid chains and specific procedures are required for their isolation, conservation and identification. Under appropriate conditions, the fungi can cause various skin diseases. The aims of this review were to describe recent classification of genus Malassezia their virulence factors, and their association to dermatlogical diseases.

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Background and Aim: Skin cancer is the most common cancer in the Iran. The first step in planning for the prevention and treatment of cancers is collecting information about their incidence and trends. The present study aimed to investigate the epidemiology of skin cancer and its trend in southern Iran. Methods: This retrospective cross-sectional study was conducted by analyzing the existing data obtained from the National Cancer Registry System in Iran. The data included all records of skin cancer cases in southern Iran. Then, the incidence rates were standardized using direct method. The data were demonstrated in frequency tables and Cochrane-Armitage test for linear trend was used for evaluation of the incidence trend. Results: Skin cancer had a high incidence in the southern provinces of Iran. A total of 6230 cases of skin cancer during 6 years (2003-2008) were recorded in those provinces and the incidence rate of skin cancer was increasing (P=0.001). In all years of the study, skin cancer incidence was higher in males than women. In terms of frequency, Fars, Khuzestan, Bushehr and Hormozgan provinces had the highest age-standardized incidence. Conclusion: Considering the high incidence of skin cancer and its relationship to sun exposure, educating people on the correct sun protection, educating and empowering physicians and the people about early detection of skin cancers seems to be important in preventing its increasing trend.

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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.

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Postsurgical scars are of significant concern to both the patients and surgeons. Different laser systems have been used to accelerate and improve the healing process in surgical scars. Some studies have demonstrated the benefits of prophylactic laser application on pre-scars. It seems that using laser energy in the early phase of the healing process may produce changes in the physiology of wound healing toward a more fetal-like tissue regeneration and healing. Laser-Assisted Skin Healing (LASH) is a new approach in which laser irradiation is applied immediately after surgery in order to improve the resulting surgical scars. LASH produces controlled homogenous heating throughout the full thickness of the skin around the wound which accelerates wound healing without thermal damage to the tissue.

The purpose of this paper is to provide an overview of the available peer-reviewed research literature on the application of LASH, the in-vitro, animal and human studies and the suggested mechanisms of action. Further studies are necessary to optimize the best laser parameters especially according to different skin phototypes and  better understanding of the mechanisms of action.

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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.

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Background and Aim: The present world is a world of short-sectional relationships, most people identify themselves by acknowledging their appearance instead of considering their inherited or acquired different characteristics. In this study, we decided to compare the body image between patients with skin diseases and healthy participants.

Methods: In this case-control study, 300 (150 cases and 150 controls) individuals aged from 18 to 64 years were selected in the Isfahan city. Satisfaction with body image and feelings of respondents regarding their apparent looks in different situations and different conditions were investigated using an a researcher-constructed questionnaire. To analyze the collected data, we used the analysis of covariance and compared the means.

Results: Single, younger, and less educated women had body image scores higher and more positive look to their bodies. Healthy people had higher score of body image than the patients with skin diseases. There was no significant relationship between gender and body image scores.

Conclusion: Skin diseases had an important role in body image. So we suggest that the effect of other diseases, that somehow affect the appearance of people on body image, be examined deeply for each disease.

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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.

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Background and Aim: Staphylococcus aureus is the second cause of hospital acquired infections, and responsible for 80% of purulent infections, and majority of skin infections. About 30 to 50 percent of normal people carry staph in their nose or groin and armpits. VanA, VanB, VanC1, VanC2/C3, VanG, VanL, and VanX are genes responsible for encoding resistance to vancomycin, TychoPlanyn and Avoparcyn, among them vanBand vanAare the most common cause of resistance that could be located on a plasmid or a chromosome and can be transferred via conjugation. The aim of this study was to The aim of this study was to investigatethe role of VanA and VanB genes in Cefoxitin resistant Staphylococci aureuscausing skin infections in patients admitted to Razi Hospital in Tehran using real time PCR method.

Methods: The samples were collected from Khordad 1394 for one year in the Microbiology Department of the Clinical Laboratory of Razi Hospital. Exudative skin lesions were sampled by sterile swab and cultured on the blood agar and EMB medium. Then catalase, oxidase and coagulase tests were performed on the gram-positive cocci and the sensitivity to vancomycinin Cefoxitin-resistant Staphylococcus aureus was determined using the E-test method. The presence of vanAand vanBgenes were investigated by Real Time PCR.

Results: Out of 978 patients with infected skin lesions, 733 samples of Staphylococcus aureus were isolated. Of these, 124 were Cefoxitin resistant, among them 8 samples had a high response rate of 3, and 5had high response above 16. But VanA and VanB genes were not responsible for resistance in any of them.

Conclusion: Due to the development of resistant strains of Staphylococcus in skin and hospital infections, identification of its encoding genes are necessary in order to use appropriate antibiotics to reduce the course of treatment and the side effects of taking antibiotics.