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Training of dermatology residents , their evaluation. Certification and recertification in each part of world id different from the other and is highly dependent to health care needs and standards, resources and expectations of those who receive the care for example in Australia a dermatologist is expected to be able to manage surgically all kinds skin cancers (melanoma or non-melanoma) and perform lymph node dissection himself without need to refer to a surgeon. However, learning about the process of dermatology residency training, certification and maintenance of certification in other countries will help us in curriculum planning and evaluation of our dermatology residents according to our own health care needs and social, economical and epidemiologic conditions.

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Background and Aim: The correlation between diseases and psychiatric problems had been evaluated recently. The aim of this study was to determine the prevalence of skin diseases in patients in psychiatric department of Yahya-Nejad Hospital in Babol, North of Iran, in 2008.
Methods: This cross sectional study was performed on 250 patients hospitalized in psychiatric department of Yahya-Nejad Hospital in Babol. They were examined by a dermatologist and laboratory examinations (skin smear and biopsy) were done if needed. Then a questionnaire including information about sex, age, job, past medical history and history of addiction, major stress, general appearance, psycological problems, previous and new dermatological diseases and treatment protocols was completed for every patient. Data were analyzed by SPSS 11 and P<0.05 was significant.
Results: Among two hundred and fifty patients (109 male and 141 female) with psychological problems, 166 patients had dermatologic diseases. Sixty six were male and 100 cases were female. Major depression and obsessive-compulsive disorders had highest frequency in psychologic disorders. Seventy patients had treated their skin disorders.There was a significant relationship between stressors in the last six months with eczema, lichen simplex chronicus, acne, and rosacea. Correlations between schizophrenia and herpes simplex labialis (P=0.02), and PTSD with pediculosis were significant (P=0.004).

Conclusion: Dermatological disorders are associated with a variety of psychological problems that can affect patients. Increased understanding of biopsychosocial approches and laision among physicians, psychiatrists and dermatologists can be very useful and highly beneficial.

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Dermatology is a branch of medicine which is related to the diagnosis, treatment and prevention of the diseases and disorders that affect the skin and its appendages including hair, nail, sweat glands and mucosal surfaces of mouth and external genitalia. There are about 3000 clinical entities in the field of dermatology, which are very diverse in terms of their etiologies. Although some of these diseases are really prevalent and some others of them have high incidence rates and acknowledging that because of their visibility in many cases they are associated with stress, anxiety and impairment of patients' quality of lives, their resultant burden of disease at individual, familial and social levels are usually ignored. Herein, we provide some examples of the adverse public health and health economics effects of different dermatological diseases and disorders in different countries and populations. We also provide some reasons for this negligence and suggest some strategies to tackle this problem.

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Conclusion: While 53% of the IBDEC members were disagree with that the written board examination can assess residents' different levels of knowledgeproperly, the majority of them were also disagree with the implementation of suggested approved methods for improving the validity of the written board examination. Most of them were also disagree with implementation of evaluation methods for improving oral examination validity.

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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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Topical corticosteroids (TCs) are very useful in the treatment of some skin disorders such as eczema and psoriasis. TCs exhibit potent anti-inflammatory and anti-proliferative effects responsible for their efficacy in the treatment of skin disorders. TCs can be classified into different groups according to their potency that depends on the intrinsic activity of the corticosteroid molecule, the characteristics of the vehicle (cream, ointment, lotion) that directly influence patient’s compliance and may modify penetration through the skin. British National Formulary classified them into four potency groups with Class I grouping the most potent molecules (e.g. clobetasol propionate) and Class IV the least potent (e.g. hydrocortisone). In contrast, the American classification considers seven potency groups, with super potent, potent, upper mid-strength, mid-strength, lower mid-strength, mild and least potent.

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Three decades have passed since the first time evidence-based medicine (EBM), in its current form, was introduced. Arguably, over the past two decades it has been the most significant movement in medicine. There is no need to emphasize any approach to clinical medicine practice, including EBM, has its proponents and opponents. Certainly, EBM has been subjected to many challenges and criticisms. Some of those challenges are basically related to misunderstanding and misinterpretations of EBM. However, there are some challenges that are real and are acknowledged by the most loyal EBM supporters. After hearing some criticisms posed by few knowledgeable and competent dermatologists during the recently held 7^th Evidence-Based Dermatology (EBD) seminar in Tehran, the authors of this letter, two of the pioneers of EBD in Iran, decide to open a gate for sharing and discussing different viewpoints on EBM and EBD.

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Background and Aim: Internal evaluation is one of the most effective educational assessment processes. Due to involvement of all educational department stake-holders, this evaluation has high efficacy and enforcement. Appropriate use of the findings of such evaluations improve educational quality. The aim of this study was to evaluate various aspects of education, research and facilities at the Department of Dermatology, Kermanshah University of Medical Sciences, Iran.

Methods: In this cross-sectional study, objectives, organizational status, management and authority, faculty members, students, teaching-learning strategies, educational equipments, theses and sabbaticals, and graduates of the Department of Dermatology, Kermanshah University of Medical Sciences were evaluated. Questionnaires were designed, and obtained data were analyzed by IBM SPSS Statistics (IBM Corp., Armonk, NY, USA) version 22.

Results: Most of evaluated components were satisfying. Learning-teaching strategy was the most satisfying factor with an average satisfaction rate of 87.5%, and the graduates issues was the least satisfying factor with an average satisfaction rate of 66.7%.

Conclusion: Planning and proceedings at the  department and medical school levels according to feedbacks based on the results of this study not only could improve educational quality at the department, but also may help obtaining  approval for initiating a dermatology residency program.

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About 25 years have been passed since the evidence-based medicine (EBM) group declared it as a new approach to teaching and practicing clinical medicine. EBM was based on the combination of three principles: use of current best evidence from research, clinical expertise, and patients' values and preferences. Practically, EBM substitutes pathophysiological reasoning based on basic science research with use of clinical evidence from high quality randomized controlled clinical trials. Like all other approaches to clinical medicine, EBM has been criticized since it was introduced. Herein, we review common problems of EBM according to its critics, introduce what is known as real EBM, and briefly discuss how we could move towards real EBM.

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The International Association of Cosmetic dermatology has been founded to promote dermatologists and estheticians knowledge. Annual congresses are held by this association. The 12^th congress was hold on 4-6 May 2017 in Bangalura. In that event many topics were presented including cosmetic procedures, lasers, PRP, dyspigmented diseases among others. A combination of dermatologic diseases and cosmetic modalities were the interesting point in this event.

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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.

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Probiotics are living microorganisms that, when used adequately, have beneficial effects on the host, and their superiority is that they are safe and secure for the host. The use of probiotics in addition to the digestive tract, has been studied in immune function, skin diseases, diabetes, cancer, liver disease, hypertension, urogenital system and oral cavity. In general, probiotics seem to be a promising and safe treatment. Nevertheless, more extensive studies are needed to use probiotics as alternative treatments along with old treatments. In dermatology, there is also a widespread use of probiotics and prebiotics. The use of probiotics has been studied in the treatment of atopic dermatitis, acne, eczema, allergic diseases, skin aging, bacterial and fungal infections, chronic wound healing, including diabetic foot ulcers, with promising results. In this review, papers related to the use of probiotics in the treatment of skin diseases were searched in data bases of Pubmed, Google scholar and Medline. Relevant papers were selected and presented. It is expected that probiotics will be used as complimentary treatment in several skin disorders.

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Background and Aim: Medical residents play an important role in visiting the patients; also they're the future specialists of their country. Thus, their job satisfaction is of significant importance. In this study, we aimed to assess Iranian dermatology residents' job satisfaction and its related factors.

Methods: We used short Minnesota Satisfaction Questionnaire (MSQ), in which, intrinsic and extrinsic job satisfaction factors are assessed with 20 questions. The data collection method was accidental sampling. Data analysis was performed by SPSS (version 17) program.

Results: Data were collected from 62 residents in years 2016-2017, majority of whom were studing in Tehran universities. Mean intrinsic and extrinsic satisfaction rates were 79% and 60% respectively. General satisfaction was 71.6%. In analytical assessment, attending attitude to residents (P=0.005), how much teaching performed by attendings (P<0.001), senior residents' attitude (P=0.003) and teaching skills by seniors (P<0.001) had a significant positive correlation with job satisfaction.

Conclusion: Generally, job satisfaction among Iranian dermatology residents was found as above average. The lowest satisfaction belonged to payments, job physical conditions, the hospital rules and education that all were extrinsic factors. It seems that change in educational program such as increasing training sessions, develop and implementation of rules halting non dermatologists practitionaires working in dermatology fields can promote dermatology residents' job satisfaction.

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Background and Aim: Care of patients with skin diseases may lead to high financial costs and burden on health system for societies and family members. In this study, we decided to evaluate the costs of treatments of patients admitted in the dermatology ward of Afzalipour Hospital, Kerman.

Methods: This is a retrospective, cross-sectional study performed from 2011 to 2017 on patients admitted in the dermatologic ward of Afzalipour Hospital. Demographic features of patients, duration of admission, cost of treatment, number and type of prescribed drugs as well as the patients’ and insurance organizations’ shares of the cost were recorded.

Results: In this study, 940 patients were evaluated for six years. The mean age of the patients was 38.05±22.35 years and most of them were female. The mean duration of admission was 8.42±2.54 days. The insurance companies’ and patients’ shares of the fees were 93.8% and 6.2%, respectively. The highest costs belonged to prescribed drugs (37.9%) and hoteling (30.3%). The most common prescribed drugs were antihistamines (33.1%), topical steroids (27.7%) and systemic steroids (24.5%). The mean number of prescribed drugs in each admission was 6.30±4.02 (range
0-20). Patients suffering from Erythema and urticaria had the total highest costs of admission (81,360,000 Iran Rials).

Conclusion: In this study, the most frequent skin diseases were infectious and papulosquamous diseases. The highest and lowest cost of admission belonged to prescribed drugs and consultations, respectively. Also, the highest cost of admission belonged to patients with erythema and urticaria.

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Background and Aim: So far, the relationship between patient experiences and the quality of services provided to them has not been widely studied. However, evidence suggests that improving patient experiences can improve clinical outcomes. The aim of this study was to determine the satisfaction of parents of children referring to the pediatric clinic as well as the related factors.

Methods: This descriptive study was conducted using a pre-designed Press Ganey questionnaire in Persian language and through interviews with 207 parents of children who referred to the pediatric clinic of Razi Dermatology Hospital in 2018. 

Results: Of the 207 participants, 87 were fathers (42%) and 105 were mothers (50.7%). The remaining 15 had other relationships with the child. Overall satisfaction (recommending our clinic to others) was 62.8%. Also, 72.5% of the participants believed they would recommand their doctors. The lowest level of satisfaction was due to the lack of introduction of clinic staff and the difficulties in setting up an appointment. The factors that most closely correlate with the patient's overall satisfaction included respectively: the cheerfulness of the visit by the doctor, the confidence in the doctor, and the likelihood of recommending the doctor.

Conclusion: The relationship between a physician and a patient is significantly related to the quality of patients' experiences in the pediatric dermatology clinic. Families and patients, when evaluating their experiences, focused on clear language and doctor's sensitivity.

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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.

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The current monkeypox outbreak reawakens the concern that poxviridae have a high potential for zoonotic spillover and causing a pandemic. Much fieldwork and research have been done by health care and public health workers in Africa during previous human outbreaks, and their knowledge should inform our global response to the current outbreak. However, unusual clinical presentations now have potential implications for recognizing the disease. In addition, infections from poxviridae, such as monkeypox, have common cutaneous signs that occur early, may be related to periods of transmissibility, and can leave scarring. Therefore, dermatologists will play a key role in recognizing and diagnosing infections and educating and preparing frontline health care workers for the early detection of new cases and clusters of monkeypox.

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The indications for botulinum toxin have evolved tremendously since its introduction in 1989. This review highlights the potential of the use of BoNT based on the latest studies that indicate botulinum toxin injections may be beneficial as an alternative method of therapy in treating, among others, hyperhidrosis, hidradenitis suppurativa, Raynaud phenomenon, or anal fissure. Currently, there are numerous studies suggesting the effectiveness of botulinum toxin in the discussed diseases; however, it should be emphasized that the majority of evidence is based on low scientific quality publications and more clinical trials need to be conducted. Despite many favorable utilizations, the use of botulinum toxin is not without ramifications. To serve patients with relevant therapy and reduce related complications, dermatologists should be aware of both on- and off-label applications of botulinum toxin. Undoubtedly, a consensus on the treatment protocol for each indicator should be a topic of interest for practitioners to standardize all regimens with specific doses of BoNT.