Journal of

---

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

---

Pulse Dye Laser (PDL) is mainly used to treat vascular lesions but several studies performed in different research centers have shown the efficacy of this safe laser in the treatment of non-vascular lesions as well. The aim of this study was to review, sum up and summarize these studies.PDL is a known alternative for cryotherapy in the treatment of some viral lesions such as periungual warts and molluscum contagiosum.The effect of this laser in the management of inflammatory lesions is not yet known and there have been controversial results. PDL has a very little effect on these dematoses and it is limited to the lesions with a clear vascular component, such as psoriasis and acne. Finally, regarding collagen remodeling and its usage in rejuvenation and in the treatment of hypertrophic scars, keloid and striae, the results from various studies are different and while they confirm its possible effect, more studies have to be conducted in order to determine appropriate treatment parameters.

---

Backgound and Aim: Skin cancer is the most prevalent type of cancer in Yazd city. Childhood and adolescense is an important time for preventing the skin cancers. The aim of this study was to survey the role of appearance concern with skin cancer prevention behavior based on protection motivation theory.
Methods: Participants in this cross- sectional study were 360 female students from 4 high schools in Yazd city. Data were gathered by using self-reporting questionnaires and were analyzed using SPSS software applying ANOVA, Pearson's correlation coefficient and linear regression tests.
Results: Using Pearson's correlation test, a statistically significant correlation between the appearance concern with perceived susceptibility, perceived severity, self-efficacy, response efficacy, protection motivation and behaviors was found (P<0.01). The perceived susceptibility, perceived severity, self- efficacy, response efficacy, protection motivation, response costs and appearance concern could predict 0.56 of the behaviors and perceived susceptibility was the strongest predictor (β=0.120). Also, protection motivation could predict behavior (41 %).
Conclusion: Results of this study support the effectiveness of protection motivation theory variables and the role of appearance concern for prediction of skin cancer prevention behaviors in participants.

---

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.

---

Background and Aim: Sarcoidosis is a non-caseous granulomatous disease that can involve several organs such as lung, kidney, liver, heart and skin. In systemic sarcoidosis, skin lesions occur in 20-35% of patients. Cutaneous sarcoidosis with no systemic involvement was found in about 25% of patients. Mutation within Butyrophilin-like 2 (BTNL2) gene, rs2076530 was reported in systemic sarcoidosis. However, there is no report of evaluation of mutation in BTNL2 gene with the diagnosis of skin sarcoidosis.
Methods: In this study ten patients with skin sarcoidosis were evaluated for the mutation of rs2076530 allele in exon 5 of BTNL2 gene. This assessment was performed by the single strand conformation polymerase chain reaction (SSCP-PCR) in which the existing mutations with positive shift were deteced using directl sequence analysis. Data from sequence analysis were evaluated and blusted by means of Choroms computer software.
Results: Our results showed the BTNL2 G→A transition of rs2076530 in seven patients and three patients were normal.
Conclusion: This pilot study concludes the presence of a mutation at rs2076530 in exon 5 of BTNL2 gene in patients with skin sarcoidosis. Larger studies are needed to evaluate the role of this finding.

---

Background and Aim: several studies have been conducted to evaluate skin pH in various diseases, but there are few reports in normal population. The aim of this study was to evaluate skin pH in healthy individuals.
Methods: Fifty healthy volunteers were enrolled in this study. The subjects were divided by age into 5 groups, i.e., 10-20, 21-30, 31-40, 41-50 and 51-60 years old. In each group, 5 females and 5 males were examined. A pH meter (Courage & Khazaka electronic GmbH, Germany) was used to measure pH in 8 different locations of the body (forehead, cheek, nasolabial fold, neck, forearm, dorsal side of hand, palm and leg).
Results: The mean values for pH in these locations were 5.25, 5.15, 5.06, 4.90, 4.75, 4.80, 4.69, and 4.83 respectively. pH was significantly higher in women (P<0.001). There was a significant difference between skin pH in different age groups (P=0.002). The highest and lowest amounts of pH belonged to the forehead (5.26 ± 0.68) and leg (4.69 ± 0.40), respectively.
Conclusion: Age and sex and location have remarkable effects on skin pH.

---

Mastocytosis most frequently manifests in the skin, so most often is diagnosed by dermatologists at first. Low threshold in clinical suspicion helps early detection of these cases. Cutaneous mastocytosis is an increase of cutaneous mast cells without known underlying disease or inflammatory infiltrate. A skin biopsy with staining specific for mast cells (toluidine blue, Wright-Giemsa) and tryptase immunohistochemical analysis should be considered in all patients with characteristic skin lesions. There is no treatment that cures cutaneous matocytosis and the major concern in the treatment is patient's quality of life. Although systemic mastocytosis occurs in greater than 25% of cases of cutaneous matocytosis in adults, there is little evidence that symptomatic therapy substantially alters the course of the disease. Almost all patients with cutaneous matocytosis belong to the indolent category of the consensus revised classification and have a good prognosis. This review aimed to provide best practices recommendations based on the evidence and patients perspectives.

---

Background and Aim: Pregnancy affects all organs and systems in the body including skin. Some skin changes are physiologic, whereas others are pathologic such as the dermatoses of pregnancy. The purpose of this study was to determine the frequency of physiological skin changes during pregnancy in hospitalized women at postpartum unit at Shabih Khani Hospital in Kashan/Iran in 2009.
Methods: One-hundred and eighty women were evaluated during their post partum periods for evidence of skin changes. Excluding factors were foreign citrizens, multiple pregnancies and gestational age under 20 weeks. Data were collected by using questionnaires before discharge from hospital.
Results: The frequencies of various observed changes included: melasma (33.9%), striae (82.3%), edema of eyelid (30%), increased acne severity (26.7%), hirsutism (17.2%) and decreased acne severity (1.7%).
Conclusion: Considering the high incidence of skin changes during pregnancy, it is recommended to instruct the mothers on skin care.

---

Background and Aim: Chronic renal failure is a clinical state which results in declining the kidney function. Chronic renal failure has numerous cutaneous manifestations, when the process of hemodialysis begins, new changes may appear as a result. The aim of this study was to assess the prevalence of cutaneous problems among patients with chronic renal failure undergoing hemodialysis in Bandar Abbas, Iran.
Methods: In this cross-sectional study, 60 patients with chronic renal failure under hemodialysis in Shahid Mohammadi Hospital Dialysis Center were examined by a dermatologist. The data were gathered and analyzed by SPSS software (version 16) using descriptive statistics, t and chi2 tests. P less than 0.05 was considered significant.
Results: The most common skin findings were dry skin (78.3%), followed by pallor (71.7%) and pruritus (58.3%). Other common cutaneous manifestations were half-half nail (35%), idiopathic guttate hypomelanosis (33.3%), yellowish skin color change (31.7%), subungal hyperkeratosis (30%), onycholysis (20%), beau's line (15%), cherry angioma (15%), skin hyperpigmentation (15%) and purpura (13.3%).
Conclusion: Chronic renal failure is associated with various cutaneous manifestations caused by hemodiaysis or the disease itself. The most common ones are dry skin and pallor. The early diagnosis of cutaneous changes may decrease the morbidity and eventually lead to quality of life improvement in these patients.

---

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.

---

Background and Aim: Today, despite numerous advances in medical sciences, the number of complaints against physicians shows an increasing trend. Studying the causes of these complaints and identify contributing factors may reduce medical litigation. The aim of this study was to assess the reasons of complaints in the field of dermatology and cosmetic.
Methods: In this retrospective cross-sectional study, we investigated the medical malpractice records related to dermatology and cosmetics, registered in the office of Forensic Medicine, province of Tehran from 2002 to 2010.
Results: In 63.4%, 35.3%, and 1.2% of cases, verdicts of malpractice, acquittal and closing the file without a verdict, were issued respectively. The most common types of negligence were related to improvidence (63.4%), lack of proficiency (27%), and disregarding of governmental provisions (5.7%). Most frequent causes of complaints were related to scar and darkening of skin after laser therapy (24.4%), dissatisfaction of hair transplantation (19.5%), and complications after injection of filler gels, botollonium toxin, etc (15.8%). Most plaintiffs were women, in their 20s, with a highschool diploma and were housewives. The most frequent age range of the physicians was 30-39 years old and most of them were male.
Conclusion: Considering medical ethics and professionalism, good communication between physician, medical personnel and patient including his entourage, full examination, adequate explanations about therapeutic procedures and possible complications, lack of exaggerating the results of therapy, continuous study and updating medical knowledge, improvement of medical skills and experiments, refrain from dealing with procedures that did not pass its training courses, properly selected patient, take informed concept and innocence may reduce the number of complaints.

---

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.

---

Hyaluronic acid (HA), the main and most important constituent of extracellular matrix, is a glycosaminologycan with water-absorbing capacity found in large amount in growing and repairing tissues. One of the main causes of skin problems, particulary in aging skin, is HA deficiency. More than half of the body HA is in the skin and is necessary for the maintenance of internal matrix and several cellular functions. Filler gels containing HA are used to repair skin defects. As these substances are derived from animals and bacteria, not the human, may cause skin reactions and have short half-life. So efforts to maintain and/or increase HA secretion from skin fibroblasts are important in the prevention and treatment of skin aging.

---

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.

---

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.

---

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.

---

Background and Aim: Quality of life is a broad concept that reflects an individual’s perspective on the level of life satisfaction experienced in a variety of situations including housing, recreation, environmental conditions, health and job. In this way it is a subjective measure that is affected by factors well beyond health status. To evaluate quality of life in patients with common pigmentation disorders such as vitiligo, melasma, and freckles refer to dermatologic clinics of Kashan University of medical sciences during 2010 and 2011.

---

Skin is the largest organ of the integumentary system with multiples important functions. Due to its complex structure, the permeability skin status can be modified by different external and internal factors such as chemical and physical stresses, and several skin and systemic diseases. Today, different non-invasive methods are used to assess the skin barrier biophysical properties. The parameters such as transepidermal water loss, stratum corneum hydration, skin surface pH and skin surface lipids is essential for evaluation of the epidermal barrier status. Application of these methods is critical for evaluation of disease treatments, the effectiveness of topically applied drugs and cosmetic products. The aim of this article is to review application of several methods for skin biophysical and biomechanical properties in humans.

---

Skin is one of the most sensitive parts of the body and is important to maintain the beauty of man. Herbal products have fewer side effects than chemicals and have pharmacological effects on the skin, so are used in cosmetic preparations. Books, articles and electronic databases including ISI Web of Science, PubMed, Magiran and IranMedex were searched to identify plants with positive effects on the skin, regardless of adverse effects and their interactions. A number of plants which were used in the treatment of skin diseases and their effects had been established, were chosen and reviewed. Avocado, thyme, aloe vera, chamomile, almond, licorice, calendula, olive and yarrow were included in this review. There are many herbs that have a role in the prevention and treatment of skin diseases, and are used in either traditional medicine or the preparation of cosmetics. The effects of a number of them have been scientifically proved and this information for the production of cosmetic and pharmaceutical products can be used.

---

Background and Aim: Skin cancer is the most common malignancy in the world with high morbidity and relatively low mortality. Basal cell carcinoma (BCC) is the most common type of cancer and its incidence is increasing. The purpose of this study was to investigate the incidence of skin cancer in the years 1386 to 1390 is in the Markazi Province, Iran.

Methods: In this study the data of Markazi Province Cancer Registry were used and incidence rate was calculated per 100,000 person. Age standardized incidence rates were calculated via direct standardization method using world standard population. Finally, the data were analyzed using SPSS, Excel, and WinPepi softwares.

Results: In Markazi Province, 958 patients with skin cancer were recorded during 1386-90. The age-standardized incidence rates in these years were 21.54, 12.06, 13.79, 18.29 and 15.79 per 100,000 people respectively. There was no significant change in the trend of skin cancer incidence rates.

Conclusion: Skin cancer was higher in men than women, and most cases occur in the elderly. Development of screening programs is recommended to detect skin cancer in its early stages in older men, especially in those who have been exposed to the sun for long times.