Journal of

Background and Aim: Alopecia areata is an autoimmune disease of hair follicle. Osteopontin is an early T lymphocyte activator that may play a role in some immunological diseases. The aim of this study was to evaluate the serum level of osteopontin in patients with alopecia areata and compare it with the level in normal subjects.
 

Methods: 54 patients with alopecia areata who presented to the Razi Hospital in Tehran in 2017 and 2018 were enrolled. Half of the patients had severe disease and half of them had mild disease. Also, 52 healthy subjects were selected as control group (age and sex matched). The severity of disease was determined using SALT Score. Serum osteopontin levels were measured by ELISA method.
 

Results: The results showed that serum osteopontin levels were significantly higher in patients with alopecia areata than healthy subjects. There was no significant relationship between osteopontin level and SALT score or duration of the disease.
 

Conclusion: The level of osteopontin is higher in AA patients than normal subjects but it does not correlate with the severity of disease.

Background and Aim: Distance E-learning has been proved as an efficient modality of learning in medical education. Use of “social media” for e-learning is an emerging issue in medical education. There is no study about WhatsApp in the medical education literature from Iran. To determine the effectiveness of the WhatsApp application, for dermatology education to 6^th year medical students (interns).
 

Methods: This research is a quasi-experimental study. Every month a WhatsApp group was created by mentor as group administrator and all interns joined the group as members. Various cases of Common skin diseases were presented by mentor in the group and using educational method of question and answer, mentor helped Interns to make the correct diagnosis. At the end of 30 days teaching practice schedule, a questionnaire was distributed among the interns and their feedbacks regarding their experience in the group, were gathered.
 

Results: Over a 6-month period, A total of 61 people were included in the study. an average of 50 cases per month were discussed. 97%of the participants were satisfied of using WhatsApp for dermatology education and majority of them found the discussions very useful in improving interpersonal relationship and improving their ability to diagnose real dermatology cases.
 

Conclusion: This study showed that WhatsApp is a suitable tool for teaching dermatology to interns, and the increasing use of this tool will help improving medical education.

Background and Aim: National studies on the prevalence of skin problems of the Iranian are very limited. The aim of this study was to determine the skin complaints of adult male population.
 

Methods: In this cross-sectional study, 1419 men over 35 years from 32 provinces participated by invitation. Demographic information, underlying disease history and presence of skin problems/diseases were collected by dermatologists. The participants were evaluated in terms of the presence of skin complaints (itching, burning, dry skin, redness, scaling, and skin color change); and any skin complaints with type, severity and location. 
 

Results: About one third 31.6% of the Iranian male middle-aged and elderly, had an underlying disease (n=449). High blood pressure, diabetes, and neurological disorders constituted 79.7% of the chronic diseases. In total, n=344 persons (24.2%) were rated as having skin complaint. Most people who had a skin complaint reported more than one skin complaint 75.6% (n=260). The most common skin complaints were related to itching 14.6% (n=207) and dry skin 5.6% (23.3%) in studied population, which were mostly mild 59.3% (n=204) and localize 58.4% (n=201). The use of corticosteroids was stated in 7.2%(n=103) and the most common types of usage was oral 62.1% (n=64). There was significant correlation between skin complaint and occupational exposure (P=0.01); lower education level (P=0.05); corticosteroid usage in general (P<0.001) and both oral (P=0.02) and topical (P<0.001) corticosteroid.
 

Conclusion: Skin complaint is common among middle-aged and elderly Iranian men. The most common skin complaint are mostly mild and localized itching and dry skin.

Background and Aim: Importance of hand hygiene with the COVID-19 has been raised around the world from 2019. We aimed to determine the effect of hand skin health in menopausal women during the covid-19 pandemic.
 

Methods: It was a cross-sectional study which has conducted on 94 subjects those were referred to menopause clinic in Imam Khomeini Hospital in Ahvaz city during September to November 1999. The tools of this study were the Personal Characteristics Questionnaire and Hand and skin self-assessment tool (Appendix 3 of “WHO GUIDELINES ON HAND HYGIENE IN HEALTH CARE “). Data has entered and analyzed by using software SPSS version 22. The level of significance was considered as less than 0.05.
 

Results: The mean age of women participating in the study was 53.6. The average frequency of hand washing outdoors was 5.28 and 10.43 indoors. Most women (94.7%) had reported at least some degree of skin problem and reported that their hand skin problems increased significantly during the COVID-19 pandemic.
 

Conclusion: Finding this study has shown that about 95% of women had felt at least one problem in their hands. During COVID-19 pandemic, hand washing with disinfectants were repeated more and more, furthers skin of the hands will be two times more damaged as compared to normal conditions, so the need to increase hand health training as part of general health, especially in older adults' women in advance.

Background and Aim: Oral hydrolyzed collagen is one of the newest and most popular systemic supplementations for skin rejuvenation. However, there are limited information in case of Middle Eastern consumers. The purpose of this study was to evaluate the tolerability and efficacy of an oral collagen supplement for improvement of skin elasticity, hydration and roughness.
 

Methods: It was a 12-week, before-after clinical study, conducted on 20 participants (18 women and two men) aged 44.15±5.36 years with skin type III-IV. Skin elasticity parameters (R0, R2, R5 and R7), skin hydration and friction, as well as the thickness and echo density of the dermis, were measured after six and 12 weeks daily intake of the study product, as well as four weeks after stopping its use (week 16). Participants’ satisfaction was assessed on the basis of their answers to the standard questionnaire, and tolerability of the product was assessed by monitoring the adverse effects.
 

Results: A significant improvement was detected in R2, R5 and skin friction at week 12 (P<0.041, P<0.012 and P<0.01, respectively). At week 16, the values remained at an increased level, which indicates the stability of the results. The increase of dermis density in week 16 was also significant (P=0.03). Moderate overall satisfaction was reported with the treatment, and a few gastrointestinal complications were reported.
 

Conclusion: The study demonstrated that oral collagen peptides could significantly improve the skin elasticity, roughness, and dermis echo density, and they also proved to be safe and well-tolerated.

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.

Background and Aim: The purpose of this study is to investigate the histopathology and immunohistochemistry of the effect of 5% Plantago labceolata. extract on open wound healing in rat skin.
 

Methods: After extracting the plant extract using the mixed method, 40 healthy male rats with an average weight of 200-250 grams were selected and randomly divided into two main groups of 20. Group 1 is the treatment group and group 2 the control group each of the main groups being divided into 4 subgroups (days 3, 7, 14,21) were divided. For the histopathological and immunohistochemical investigation of the healing process, the wounds of the mice of the subgroups in both the main groups were removed in full thickness and with a diameter of 15 mm and examined for histological studies. After sectioning, with the qualitative staining method of hematoxylin eosin and Masson's trichrome,using antibodies against transforming growth factor beta and vascular endothelial growth factor of the study groups, and the obtained information was converted into quantitative information. and was subjected to statistical analysis.
 

Results: Finding this study has shown that about 95% of women had felt at least one problem in their hands. During COVID-19 pandemic, hand washing with disinfectants were repeated more and more, furthers skin of the hands will be two times more damaged as compared to normal conditions, so the need to increase hand health training as part of general health, especially in older adults' women in advance.
 

Conclusion: The results show that it is possible to use the polar extract of Plantago Lanceolata L. plant 5% for wound healing.

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.

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.

Background and Aim: Candida albicans have the ability to colonize living and non-living surfaces and form biofilms that are very resistant to common antifungals. The present study was designed to evaluate the fungicidal activity of itraconazole on Candida albicans biofilm.

Methods: The present study was conducted on 10 nail samples. Routine mycological and molecular tests were performed to identify and determine the type of fungus. Biofilm was formed in the 96-well plate and was subjected to the itraconazole. ROS accumulation was measured. ROS levels were determined in biofilms treated with itraconazole in the presence of antioxidants.The minimum inhibitory concentration of itraconazole was measured in the presence of ascorbic acid (10 mM) according to the protocol of the previous step. Annexin V-FITC apoptosis detection kit was used to investigate the possibility of apoptosis induction following itraconazole use. 

Results: Mann-Whitney showed a significant difference between biofilms treated with itraconazole and untreated biofilms for 10 tested strains. Treatment with itraconazole resulted in a significant reduction in the number of biofilms. Ascorbic acid significantly reduced ROS accumulation caused by itraconazole for biofilms of all Candida albicans strains. The findings show that itraconazole induces ROS-dependent apoptosis in a dose-dependent manner in biofilm cells.

Conclusion: In this study, it was found that the presence of intracellular ROS is the main cause of the apoptosis mechanism of itraconazole. The ability of itraconazole to induce ROS in Candida cells appears to be a very effective fungicidal strategy.

Background and Aim: The purpose of this research was to compare the effectiveness of cognitive behavioral and emotion-focused group therapy on reducing the symptoms of psoriasis, psychological distress and perception of body image.

Methods: This was a semi-experimental research of pretest posttest type with a control group. The statistical population of this research included all patients who were diagnosed with psoriasis in spring of 2022 by referring to dermatologists in Mashhad. 45 psoriasis patients were selected by available sampling method and replaced randomly in two experimental groups (CBT and EFT) and control group (each groups 15). The experimental groups was treated for 8 sessions, one session of 90 minutes per week. The control group received no intervention. Parents completed the Psychological Distress Scale, Body Image Concern Inventory and the Physical Symptoms Questionnaire with Psoriasis Area Severity Index before and after the treatment sessions. The data were analyzed by Analysis of covariance. 

Results: The findings showed that cognitive-behavioral and emotion-focused reduced psychological distress (P<0.01, F=21.06), improved perception of body image (P<0.01, F=33.65) and reducing the severity of psoriasis symptoms (P>0.01, F=12.67) are effective. Also, cognitive behavioral therapy is more effective method to reduce psychological distress and improve perception of body image (P<0.01). However, there is no significant difference between the effectiveness of cognitive-behavioral therapy and emotion-focused therapy in reducing psoriasis symptoms of patients (P<0.05).

Conclusion: Both therapies can play a key and effective role in controlling the symptoms of psoriasis.

Background and Aim: Cutaneous leishmaniasis is one of the most important health problems in Iran. There is still no effective vaccine available against human leishmaniasis and current treatment is based on chemotherapy. Conventional drugs are toxic and expensive, and drug resistance has caused the search for new treatments. Tofacitinib is a Janus kinase inhibitor that disturbs the signaling pathway of several cytokines in the immune system. The aim of this study was to evalute the effect of topical tofacitinib 2% ointment in healing cutaneous leishmaniasis in Balb/C mice.
 

Methods: This experimental study was performed using tofacitinib and glucantim drugs in 40 female Balb/C mice. The metacyclic form of promastigote of Leishmania major standard strain (MRHO/IR/75/ER) was injected into the footpad of the mice, the mice were divided into 4 treatment groups: tofacitinib, glucantim, tofacitinib-glucantim and control without treatment. The treatment period was 28 days. The footpad thickness of all groups was measured at the end of each week.
 

Results: After the end of the treatment in the groups treated with tofacitinib, a significant decrease in the size of lesion and the footpad thickness was observed compared to the control group without treatment (P<0.01).
 

Conclusion: It seems that tofacitinib ointment accelerates lesion healing in Balb/C mice and has worked similarly to standard glucantim treatment. Ointment can be a better option for leishmaniasis treatment and due to its ease of use and no need for painful injections it can be considered as an option for the treatment of patients with cutaneous leishmaniasis.

Background and Aim: In order to overcome the local side effects of the conventional treatments for atopic dermatitis, a new attitude regarding alternative treatments would be needed, which herbal medicines are promising approachs in this case.
 

Methods: It was a 4-week, before-after clinical study, conducted on 20 participants (16 women and 4 men) aged 39.95±11.04 years. The severity scoring of atopic dermatitis was determined based on total & local SCORAD. skin biophisical parameters including TEWL ,skin hydration, pH, temperature, sebum and skin erythema were also measured after 2 and 4 weeks application of the study product. Participants’ satisfaction as well as tolerability of the product were assessed by monitoring the adverse effects.
 

Results: A significant improvement was detected in LOCAL and TOTAL SCORAD at weeks 2 and 4 (P<0.01). The intensity of burning and pruritus also showed a significant decrease at weeks 2 and 4 (P<0.01). A significant increase in the skin hydration was shown at weeks 2 and 4 after treatment (P<0.01). 84.1% and 78.9% of participants described their skin lesions as "improved" or "much improved", 2 and 4 weeks after treatment respectively.
 

Conclusion: The test cream containing oats and chamomile extract is considered a safe and effective product for improving mild to moderate lesions of atopic dermatitis.

Background and Aim: The aim of this study was to determine the effectiveness of psychotherapy based on improving quality of life on depression and self-esteem in women with vitiligo.
 

Methods: The present study was a quasi-experimental study (Pre-test - post-test with follow-up and control group). The statistical population of this study included all women with vitiligo skin disease referred to Isfahan Dermatology and Leishmaniasis Research Center , among which, 20 people were selected by available sampling method and randomly assigned to experimental and control groups (10 people for each group). Both groups completed Beck Depression Inventory (1996) and Rosenberg Self-Esteem (1965) Questionnaires as a pre-test and after completing eight sessions of psychotherapy based on improving quality of life (one 90-minute session per week for eight weeks), the post-test was performed again and one month later for the control and experimental groups. The collected data were analyzed using repeated measures analysis of variance in SPSS 23 software.
 

Results: Based on the findings of repeated measures analysis of variance, it was found that psychotherapy based on improving quality of life reduced the average depression scores and increased the self-esteem of women with vitiligo.
 

Conclusion: Considering that psychotherapy based on improving the quality of life has an effect on depression and self-esteem in women with vitiligo, so teaching this therapeutic approach is recommended as an effective intervention method to reduce depression and improve the self-esteem of women with vitiligo.

Background and Aim: Allergic contact dermatitis is the most frequent cause of eyelid dermatitis; but it is often misdiagnosed. This study aims to evaluate the characteristics of patients with eyelid dermatitis who referred for patch test.
 

Methods: This was a retrospective study. Three major subgroups were made: patients with only eyelid involvement, involvement of eyelids and other areas, and without eyelid involvement. Collected data included past history, diagnoses, personal care product & make-up use, occupational dermatitis, and positive allergens. Chi-squared, independent t-test, and one-way ANOVA were used for analysis. 
 

Results: 139 patients with eyelid dermatitis who referred for patch test were included in the study. Allergic contact dermatitis was the most common diagnosis in all three groups referred for patch test. Use of shaving cream and hair conditioner was significantly higher in patients with only eyelid involvement and nickel sulphate was the most common allergen among them.
 

Conclusion: Patch testing is an important tool in the evaluation of the common dermatologic disease of eyelid contact dermatitis, as the gold standard. It is a necessity in the treatment of eyelid dermatitis, because of accurate identification of responsible allergens.

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.