Journal of

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Background and aim: Saffron possesses a lot of medical applications in traditional medicine. One of its properties is ultraviolet (UV) light absorption. The aim of this study was preparation, determination of properties and investigating sun protevtive effects of nanoliposomes containing saffron extract and safranal, a substance existing in saffron.
Methods: Nanoliposomal hydroalcoholic extract of saffron stigma in concentrations 2%, 4%, 8% and nanoliposomal safranal in concentrations 0.25% , 0.5% and 1% were prepared. Standard lotion of homosalate 8% was used according to FDA standards for sun protection factor (SPF) determination and assessment of accuracy of the method. SPFs of substances were calculated in vitro by diluted solvent method using Mansur, et al equation and absorptiometry.

Results: SPf of Nanoliposomal saffron 8% extract was significantly higher than standard sunscreen homosalate with similar concentration. SPFs of safranal (1% and 0.5%) component of saffron were significantly higher than the standard sunscreen homosalate 8%.
Conclusion: Saffron can act as a sunscreen. Safranal existing in saffron is much more sun protective than standard substance, homosalate 8%. Thus , the safranal existing in saffron may have significant sun protective effect in low concentration if encapsulated in liposome.

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Background and aim: it has been estimated that 70000-100000 cases of HIV infection exist in Iran. The main route of transmission is intravenous drug (IV) injection. Rapid spread of this disease necessitates its prompt diagnosis. About 90% of HIV infected patients express cutaneous manifestations therefore, recognition of these symptoms may be of help in early diagnosis.
Methods: HIV infected patients with suspected skin lesion were referred to Skin Disease and Leishmaniasis Research Center and were examined by an intern contributed in the study. All the information were gathered in data code sheets. Then, all of the patients were visited by the dermatologist for complementary examinations and the results including lesion type, location and duration were recorded in the check list.
Results: fifty persons were examined and 42 patients were selected. Prevalence of dermatologic manifestations was as follows: herpes zoster in 23.8%, seborrheic dermatitis in 14.3%, hyperpigmentation in 19%, oropharyngeal candidiasis in 14.3%, folliculitis in 14.3% dermatophytosis in 4.7%, wart in 4.7%, Kaposi’s sarcoma in 2.3%, and drug eruption in 2.3% , 75% of patient who had hyperpigmentation were infected by their sexual partner and 25% via IV injection. 33% of patient who had folliculitis were infected via IV injection, 33% through blood transfusion and 33% by sexual relationship.
Conclusion: According to the results of this study, paying attention to cutaneous signs HIV/AIDS patients, their early detection and diagnostic and therapeutic measures for them are advocated.

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Multiple surgical methods are available for the management of malignant melanoma. Often, these methods have limitations in terms of the ability of obtaining margin clearance in the context of an appropriate cosmetic outcome. This article, briefly reviews the use of different simple and excisional techniques as well as that of Mohs micrographic in the surgical management of malignant melanomas

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Backgound and Aim: One important limitation of random pattern skin flap in plastic surgery is the necrosis of distant parts of the flap resulting from ischemia. This effect cause unwanted increase in the costs and hospitalization. Previously, large number of factors has been evaluated to decrease the flap necrosis. In present study we used two drugs. Main reason was their mechanism of action that seems to be similar to preconditioning pathways.
Methods: ّFifty-six male rats were divided into four groups. In two groups 5% minoxidil or 5% azelaic acid were applied topically to the flap area before flap elevation. In some rats of minoxidil treated group, a non selective ATP sensitive potassium channel (KATP) blocker, glibenclamide (0.3mg/kg) was injected i.p. to evaluate the role of this channel in action. In azelaic acid treated rats, some were selected for evaluation of the role of nitric oxide and therefore L-NAME (20 mg/kg), a non-selective iNOS inhibitor, was administered. Seven days after operation, the extent of flap necrosis was calculated.
Results: Topical minoxidil or azelaic acid significantly recused necrotic area of skin flap to 42% (P<0.05) and 34% (P<0.01), respectively. Combination of minoxidil and azelaic acid was the most effictive intervantion on reducing of necrotic area to 26%. Glibenclamide abolished protective effect of minoxidil (P<0.001) and L-NAME inhibited the effect of azelaic acid on skin flap survival (P<0.05). Both L-NAME and glibenclamide completely inhibited the effect of combination topical therapy.
Conclusion: Present study suggested the role of KATP channels on minoxidil pathway and NO on L-NAME pathway of preserving skin flap survival. It seems that there is an overlap between the two pathways however precise mechanism remained to be determined.

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Connective tissue nevi are types of hamartoma with increased collagen in which the amounts of elastin may vary. This report introduces an 18-year-old case with various nodular lesions in upper thigh area. Performed biopsy suggested the diagnosis of collagenoma which is a sub-type of connective tissue nevus.

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Background and Aim: Tumor angiogenesis is essential for tumor growth and appears to play an importating role both in invasive growth and metastasis. Basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) of the skin are derived from a similar cell type but differ in the invasive and metastatic potential. Basal cell carcinoma generally shows a relatively benign course in contrast to squamous cell carcinoma .This study investigates whether the behavior of these tumors could be explained by differences in their angiogenesis pattern.
Methods: Vessel counts were made of blood vessels in stroma and the body of 50 variants of BCC of skin samples including: nodular, micronodular, sclerosing and superficial, both after H&E and immunohistochemical staining for CD31 and CD34 markers.
Results: The body vessel counts of invasive variants (sclerosing & micronodular) differed significantly from the counts of noninvasive variants (nodular and superficial) using both CD31 & CD34 markers. The stromal vessel counts compared between invasive and noninvasive variants showed no significantly difference using CD31 & CD34 markers, respectively.
Conclusion: The invasive growth pattern of BCC variants correlated with the microvascular density and according to results, vessel counts of the body play a more important role.

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N-acetylcysteine (NAC) is the acetylated metabolite of cysteine and is approved by the Food and Drug Administration (FDA) for treating acetaminophen toxicity. By boosting glutathione, NAC acts as an antioxidant and through replenishing glutathione, it can also prevent paracetamol toxicity. From the other hand, NAC has mucolytic and antiinflammatory effects and also is a glutamate precursor and therefore can be used in a variety of diseases. Regarding the various pharmacological effects of NAC and its low rate of adverse events, NAC has attracted increasing interest for a range of indications during the recent years. Here, the possible applications of this drug in dermatology are reviewed.

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Pseudo-Kaposi sarcoma (PKS) or acroangiodermatitis is a benign angioproliferative disease which shares many clinical and histopathological features with Kaposi sarcoma. Clinical presentations include violaceous macules, papules or plaques in the lower extrimities, which is usually associated with chronic venous insufficiency or congenital or acquired arterio-venous malformations. Its pathogenesis is not well recognized yet but the ischemia due to venous insufficiency or arterio-venous malformation is considered to play a role. The diagnosis is made through the histopathologic examination of biopsy specimens. Different treatment modalities have been suggested including conservative treatment or correction of vascular abnormalities.This paper introduces a 28-year old man with a brown linear plaque in a scar of 3-month duration due to trauma on the anterior of left thigh. A biopsy was performed and the histopathologic examination confirmed the clinical diagnosis of Pseudo-kaposi sarcoma.

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In the recent years, advances in different fields of technology have been resulted in a dramatic increase in the diagnostic methods and tests in different branches of clinical medicine with a consequent increase in the number of scientific publications related to the application of those tests and methods in the diagnosis or prevention of diseases. Dermatology is not an exception. Since, evidence-based medicine emphasizes on the appropriate use of the current best clinical research evidence in the diagnosis or treatment of each individual patient acknowledging his/her values, the capability of dermatologists in appraisal and application of the publications, which reports the results of diagnostic test accuracy studies cannot be ignored. In this article, after a brief review on basic issues in diagnostic test accuracy studies, principles of critical appraisal of these studies, from an evidence-based viewpoint, will be discussed. General strategies for evaluation of validity, applicability and quality assessment of a diagnostic test study will be provided.

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Background and Aim: Skin cancers are one of the most common malignancies in the world and create a high rate of morbidity but low rate of mortality with the exception of malignant melanoma that has a high mortality rate. In recent decades, incidence of skin cancer has been increased. The most important risk factors are sunlight and skin type. The aim of this study was to evaluate the frequency of skin cancers in patients who were admitted to Sina Hospital of Hamedan during a 17-year period.
Methods: In this cross-sectional study, 951 patients with different types of skin cancer, entered in the study. For each patient, data related to age, gender, location, occupation, pathologic type of cancer and site of skin involvement, were collected.
Results: The mean age (mean±standard deviation) of patients was 61.6±15.3 years (2-100 yrs) and most of them (67.2%) were males and workers (%38). The most common pathologic types of skin cancer were basal cell carcinoma (BCC) (59%) and squamous cell carcinoma (SCC) (29%). The most frequent site of tumor expression was face (61.2%) and the least frequent involved site was genitalia (0.4%).
Conclusion: This study showed that skin cancer is more common in males, old patients and workers. It was more common on the face. Screening program for detection of this disease at an earlier stage of elderly men especially in sun exposed occupations is recommended.

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Epidermolysis bullosa (EB) is a group of dermatological conditions characterized by development of bullae and ulcers following trivial trauma. One of the most important complications of EB is squamous cell carcinoma. While occurance of skin squamous cell carcinoma is common in epidermolysis bullosa, its occurence on mucosal surface is rare. Herein, we report two members of a family who developed squamous cell carcinoma on their esophagus and tongue.

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Background and Aim: Diabetic neuropathy occurs in about 50% of individuals with long-standing type 1 and type 2 diabetes mellitus. The aim of the study was to detect sensory neuropathy in diabetic patients at risk for foot ulceration, using monofilament and neuropathic symptoms in Diabetes clinic of Kashan University of Medical Sciences from 2008 to 2010.

Methods: Three-hundred and fifty-two diabetic patients were enrolled in this cross-sectional study. Firstly patients were surveyed with a questionnaire concerning their subjective symptoms. The neuropathic symptoms were assessed using a quantitative neuropathy symptom score. Then the patients were examined by 5.07/10g monofilament. Data description and analysis were performed by reporting mean ± standard deviations, proportions, odds ratios (OR) and 95% confidence interval (95% CI) and conducting chi square and kappa tests. 

Results: 15.6% of patients had sensory neuropathy using monofilament test. 19.4% of men and 14.3% of women had neuropathy (OR=1.4, P=0.24). The mean duration of diabetes in patients with neuropathy was longer than patients without neuropathy (9.96 vs 9.68 year, P>0.05). 72.7% of patients with history of foot ulcer had neuropathy (OR=16.6, P<0.001). According to neuropathic symptoms 17.6% of patients had no neuropathy, 12.8% had mild neuropathy, 41.8% had moderate neuropathy and 27.8% had severe neuropathy.

Conclusion: Screening with monofilament test is necessary for all diabetic patients to prevent diabetic foot ulcer development, without considering neuropathic symptom

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Background and Aim: Anti-inflammatory and hypo- pigmenting effects of topical tretinoin and alpha-hydroxy acids have been documented. This study was designed to compare the efficacy of 0.05% tretinion cream with 7% alpha-hydroxy acid in the treatment of ephelides.
Methods: In this clinical trial 80 patients with ephelides were selected and allocated into two groups. One group was treated with 0.05% tretinoin cream every other night. The other group was treated with 7% alpha-hydroxy acid cream in the same manner. Both groups were treated with antisolar creams and followed every month for 5 months.
Results: After 5 months excellent therapeutic response was achieved in 3 (7.5%) of patients who were treated with 0.05% tretinoin cream compared to 8 (20%) in alpha-hydroxy acid cream. Good therapeutic response was observed in 20 (50%) of tretinoin group versus 16 (40%) in alpha-hydroxy acid group. Patient's satisfaction from treatment was consistent with evaluation by dermatologists (P=0.384 and P=0.132).
Conclusion: Both 0.05% tretinoin cream and 7% alpha-hydroxy acid cream are equally efficient in the treatment of ephelides.

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Background and Aim: Consumption of the epidermis (COE) is defined as thinning of the epidermis with attenuation of the basal and suprabasal layers and loss of rete ridges in areas of direct contact with malignant melanocytes. The aim of this study was to investigate the importance of COE as an additional diagnostic criterion for malignant melanoma and to evaluate its relationship to clinicopathological findings.

Methodes: The age, gender, localization of the lesion and the histopathological parameters such as tumor type, Breslow thickness, ulceration, and Clark's level were recoeded in 90 malignant melanoma cases.

Results: In contrast to other studies, we found that COE was more common in tumors with an acral localization and in the acral lentiginous melanoma.

Conclusion: Although COE can be used as a pathological criterion in the diagnosis of malignant melanoma, but no correlation no of COE with ulceration and other prognostic factors were found.

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Background and Aim: Oral isotretinoin is the only drug that is effective on almost all factors involved in the pathogenesis of acne. Although several studies have been conducted on side effects of this drug, few studies have been conducted on Iranian patients. The aim of this study was to evaluate common clinical and laboratory side effects of this drug in patients with nodulo-cystic acne in Mashhad, Iran.

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Background and Aim: Basal cell carcinoma (BCC) is the most common type of malignancy that rarely causes death but results in cosmetic problems and is associated with high treatment cost. Clinical characteristics of this cancer are related to the host and environmental factors. Theses factors are specific for each area and may change over the time. The aim of this study was to find clinical characteristics of BCC in Kermanshah city.

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Background and Aim: Cicatricial alopecia is characterized by permanent destruction of the pilosebaceous unit, leading to irreversible hair loss, and has primary and secondary types. Primary type, based on predominant inflammatory infiltration in histology, is divided to neutrophilic, lymphocytic and mix types. Decalvans folliculitis, dissecting cellulitis and acne keloidalis are 3 subtypes of neutrophilic group. In this study frequency of each subtype and the distribution of age, gender and duration of disease have been reviewed.

Methods: This retrospective study was performed on patients with clinical diagnosis of cicatricial alopecia and histologic confirmation referred to Razi hospital in Tehran in 2005-2009.

Results: Of 135 patients with mean (mean±SD) age of 32±10.6 years, 71.9% were male and 28.1% were female. The diagnoses included decalvans folliulitis (72.6%) with mean age of 31.89 years, dissecting cellulitis (25.0%) with mean age of 32.4 years and acne keloidalis (1.5%) with mean age of 52 years. The mean duration of disease was 4.2±3.9 years (4.08 years in male and 4.7 years in female). The mean duration of disease in decalvans folliulitis was 4.7, in dissecting cellulitis was 1.9 and in acne keloidalis was 17.5 years.

Conclusion: Neutrophilic scarring alopecia is more common in men and in the third decade of age and the most common type is decalvans folliulitis.

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Background and Aim: Psoriasis is a chronic inflammatory dermatosis that affects 0.6% to 4.8% of the general population. Our aim was to compare the effect of narrow band UVB (NB-UVB) on normal flora of cutaneous plaques and normal skin in psoriatic patients.

Methods: Twenty psoriatic patients without any contraindication of phototherapy were enrolled in this study. Samples from psoriatic lesions and adjacent normal skin, before and after phototherapy with NB-UVB were taken. Patients were treated with NB-UVB three times weekly until complete remission. Finally, quantity of normal cutaneous flora on normal and involved skin, before and after treatment was compared.

Results: The mean±SD of the NB-UVB sessions and the mean cumulative dose were 26.35±4.95 and 2.05±0.57 J/cm², respectively. The number of Staphylococcus epidermidis, S. aureus and diphtheroids on psoriatic plaques reduced after phototherapy.

Conclusuion: The quantity of normal cutaneous flora on normal skin is less than psoriatic plaques, and it reduced on normal and involved skin after phototherapy.

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Hair loss can be viewed a problem from different perspectives: as a disease, a disorder which affects appearance of an individual, and its psychological effects. Therefore, it is crucial to determine the causes and types of hair loss. This review summarized hair loss evaluation methods with significant emphasis on their clinical aspects. According to relevant literature reviews, the major approaches to hair loss are taking medical history, primary investigations and detailed hair examination. Although several invasive and non-invasive, clinical and paraclinical examinations can be used for hair loss assessment, it is generally accepted that using clinical evaluation methods and physical examinations are more efficient. In conclusion, diagnosing hair loss is complex and sometimes time-consuming process. However, precise hair examination may lead to the suspicion of an endocrine disorder.

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Background and Aim: Acne vulgaris is a common disorder of adolescence which may lead to significant cosmetic and psychological problems. Different topical and systemic therapeutic modalities have been used to treat acne vulgaris. This study was designed to compare the efficacy of topical 0.05% isotretinoin gel with 1% clindamycin solution in the treatment of acne vulgaris.
Methods: In this randomized clinical trial, 60 patients with mild to moderate papulopustular acne vulgaris were randomly allocated into two groups of equal sizes. One group was treated with 0.05% isotretinoin gel every night. The other group was treated with 1% clindamycin solution twice daily. Both groups were followed every month for 3 months.
Results: The mean of total lesion count decreased significantly after treatment in comparison with its mean before the treatment in both groups (P<0.001). The mean of acne severity index significantly reduced after treatment in both groups (P<0.001). Satisfaction of patients in clindamycin group was higher (P<0.001).
Conclusion: Decrease in total lesion count and acne severity index in both treatment groups were statistically significant however, considering the minimal complications and satisfaction of patients in clindamycin group, 1% solution of clindamycin may be recommended in the treatment of papulopustular of acne vulgaris.