Journal of

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Background and aim: Actinic keratoses (AKs) are the third commonest complaint of patients visiting dermatologists. Topical treatment including 5-fluorouracil (5-FU) are among the commonest available therapies. According to local irritation induced by topical 5-FU The aim of current study was to compare efficacy of two different 5-FU based regimens with different application routes.
Methods: Patients with AKs confirmed by skin biopsy, matching our exlusion criteria were enrolled. Subjects randomized in two groups, receiving topical 5% 5-FU once daily or alternatedaily respectively. Two weeks after the end of one month period of the study, rate of reduction in number of lesions was documented by blinded academic dermatologists as well as treatment side effects.
Results: a total of 38 patients (23 male and 15 female) completed the study. Rate of side effects were lower in alternate-day applying patients (P<0.05) while rate of response to therapy were comparable in both groups (P>0.05).
Conclusion: alternate-day route for application of topical 5-FU is an acceptable alternative for classic daily application, to reduce rate of side effects and enhancing patients compliance.

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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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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.

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Background and Aim: Treatment of cutaneous leishmaniasis, especially when caused by L. tropica, is challenging. Meglumine antimoniate (Glucantime^®) is used as the standard treatment, but multiple injectiond are necessary. The objective of this study was to compare the efficacy of weekly intralesional injections with twice weekly injections of Glucantime for the treatment of anthroponotic cutaneous leishmaniasis (ACL).
Methods: This randomized open clinical trial was conducted, in Bam, Kerman province, Iran. 96 eligible patients according to inclusion and exclusion criteria who were willing to participate were included. The included patients were randomly assigned into two groups, one group treated with weekly intralesional injections of Glucantime^® and the other group treated with intralesional Glucantime^® twice a week. Type and size of each lesion (induration, ulcer and scar) were recorded weekly. Complete healing was defined as complete re-epithelialization and absence of induration in all lesions and was considered as the primary outcome measure.
Results: A total of 48 patients completed the study complete cure was seen in 24 of 27 (89%) patients who received weekly intralesional MA with a mean duration of healing equals to 70±10 days. Complete cure was seen in 24 of 31 (77%) patients who received intralesional MA twice a week, the mean duration of healing in the latter group was 58±5 days. There was no significant difference between the two groups (P=0.23).
Conclusion: It seems that the efficacy of intralesional injections of Glucantime^® once a week is similar to efficacy of twice a week Glucantime^® injections.

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Background and Aim: Cutaneous leishmaniasis (CL) is endemic in Iran, where it is one of the most important health problems. Both anthroponotic CL (ACL) caused by L. tropica and zoonotic CL (ZCL) caused by L. major are reported. Antimoniate derivatives as the standard therapy for CL need multiple injections and are not easy to tolerate for the patients. This study was conducted in Mashhad to compare the efficacy of weekly versus twice a week intralesional injections of meglumine antimoniate (MA) in the treatment of ACL.
Methods: This randomised controlled trial was performed during 2006 to 2008 in Mashhad, Iran. Using computerized sequence of random numbers, participants were randomly allocated in the two arms of the study: one receiving weekly and the other receiving twice-a-week intralesional injections of MA. The lesion size, induration and healing rate were assessed, recorded and compared. Healing was defined as complete re-epithelialisation and disappearance of induration.
Results: A total of 252 suspected CL patients with 372 lesions were screened. 82 parasitologically proven cases with 121 lesions caused by L. tropica were included and 74 patients with 113 lesions completed the study. At 12^th week after initiation of treatment, complete healing was observed in 38 out of 44 lesions (86.4%) in the group which received weekly intralesional MA injection. The median time-to-heal in this group was 36 days (95% confidence interval [CI]: 32.0-39.9). Complete healing was recorded in 60 out of 69 lesions (86.9%) in the group which received twice a week intralesional injections of MA with a median time-to-heal of 25 days (95% CI: 20.9-29.1). While no significant difference was observed between the two groups in terms of complete healing rate (P=0.999), time-to-heal was significantly different between the 2 groups (P=0.003).
Conclusion: It seems that the effectiveness of twice-weekly intralesional injections of MA is similar to once-weekly regimen while the former regimen causes more rapid healing of lesions.

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Background and Aim: Atopic dermatitis (AD) is a chronic, relapsing, pruritic skin disease more common in infancy and childhood. Emollients, topical corticosteroids, and avoidance of irritating factors are the mainstay of its treatment, but fear of side effects has limited the use of topical corticosteroids. The objective of this study was to evaluate the safety and efficacy of topical tacrolimus 0.03% ointment in the treatment of AD.
Methods: In this randomized, double-blind, clinical trial, 76 patients with AD older than 2 years were randomly allocated in two groups and treated with either tacrolimus 0.03% ointment (Abu-Rayhan Co., Iran) or placebo, twice a day for 6 weeks. Responses to treatment were compared every 2 weeks using SCORAD.
Results: Twenty-nine patients in tacrolimus group and 26 in placebo group completed the trial. The reduction in SCORAD after 2 and 4 weeks in tacrolimus group was significantly higher than placebo group (P<0/05). The frequency of treatment-induced pruritus and burning sensation was similar in both groups but erythema was more observed in the placebo group (P<0/05).
Conclusion: Tacrolimus 0.03% ointment is more effective than placebo in the treatment of AD.

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Background and Aim: C-reactive protein (CRP) is an inflammatory biomarker and its level increases in serum of psoriatic patients. Its level is also associated with Psoriasis Area and Severity Index (PASI) score.

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Background and Aim: Palmoplantar pustulosis is a chronic dermatosis of palms and soles, which is associated with a high recurrence rate and resistance to treatment. Various treatments with different success rates have been used.The purpose of this study was to evaluate the efficacy of local bath PUVA in the treatment of palmoplantar pustulosis.

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Clinical practice guidelines are the most important and valid guidelines for treatment of diseases, and are developed through experts consensus on a subject, considering the highest available evidence (systematic reviews, metaanalyses, and randomized controlled trials). We briefly review the latest evidence-based guideline for the treatment of vitiligo provided by European Dermatology Forum.

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Background and Aim: Skin basal cell carcinoma (BCC) is the most common cancer in human beings. Prevalence of this tumor has increased over the past decades. The standard treatment is complete excision, however some risks for recurrence still exist. The aim of this study was to determine the frequency of margin involvement in skin BCC as well as to investigate the demographic characteristics of the patients.
Methods: This study was conducted from April 2011 to April 2012 on the patients who had skin lesions suspected for BCC. The patients were undergone elliptical excision surgeries for removing their suspected lesions with 5-millimeter margins of clinically normal skin in Farchian Hospital, Hamadan, Iran. Following data were collected and recorded: age, sex, anatomical location, duration of the disease, primary clinical diagnosis, histopathologic type, and margin involvement.
Results: In total, 125 lesions from 115 patients were investigated (70 males, 45 females). The range of the ages of the patients were from 32 to 93 years, with a mean of 64.6 years. The most common histopathological type was nodular type (61.0%). Twenty percent of the excised lesions showed margin involvement. Risk factors for incomplete excision were older age and anatomical locations (ears and peri-ocular lesions). There was no statistically significant differences between sex, histological type, primary clinical diagnosis, and duration of the disease. In almost all cases, the clinical and histopathological diagnoses were similar.
Conclusion: To avoid repeated surgeries and to reduce the risk of incomplete excision for lesions on high risk locations, particularly in elderly, it is recommended that BCCs be excised with wide margins or Mohs micrographic surgery.

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Background and Aim: Pemphigus is one of the most common types of autoimmune blistering disease that requires systemic immunosuppressive therapy. Immunosuppressive therapy has improved the disease outcome in recent decades, but long-term use of them has side effects. Recently, it has been tried to evaluate immunosuppressive drugs with less side effects. One of them is mycophenolate mofetil. The aim of this study was to evaluate of therapeutic efficacy of this drug in the patients with refractory pemphigus vulgaris.
Methods: Three hundred files of patients with pemphigus vulgaris were reviewed and among them 28 patients who had received mycophenolate mofetil due to resistance to treatment were entered to this study. The data were obtained from patients’ files and were analyzed using Kendall's tau-c correlation, Mann-Whitney and ANOVA tests.
Results: Male to female ratio was 1.8:1 with an average age of 43.3±13.6 year. Twenty-eight cases of pemphigus vulgaris were treated receiving 2gr/day mycophenolate mofetil + 1mg/kg/day prednisolone. Remission occurred after 3 months. Seventeen patients (10 men and 7 women) had complete remission. There was no significant association between gender and treatment response (P=0.58). There was no significant association between mean age of treated patients and untreated patients with treatment response (P=0.77). Also, there was no significant association between severity of mucosal (P=0.80) and severity of skin involvement with treatment response (P=0.80). Ten patients who received mycophenolate mofetil more than 12 months had treatment response to mycophenolate mofetil and they did not have any relapse in the follow up period.
Conclusion: Mycophenolate mofetil is effective and safe as an adjuvant therapy in patients with pemphigus vulgaris especially in refractory pemphigus. Initiation of the therapeutic effect is slow.

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Background and Aim: Xanthelasma is a benign condition considered which is mainly as a cosmetic problem. There are many destructive treatment options that may result in scar formation and dyspigmentation such as cryotherapy and electro-cauthery. According to these side effects finding a non-invasive solution could be important. At this study we aimed to evaluate the effect of PDL laser in the treatment xanthalasma.
Methods: Patients with bilateral palpebral xanthelasma having normal serum lipid profile were eligible for the study if they had no history of a collagen vascular disease or dermatologic disorders that were associated with Koebner phenomenon. All patients had two separate pulsed dye laser (PDL) treatment sessions, with a four-week gap in between and were photographed before every laser treatment session and four weeks after the second session. Visual analogue scale (VAS) scoring system was used to determine effect of treatment by two academic dermatologists blinded to the study as the referees. Mean healing score by the two referees considered as final score.
Results: Nine patients with a mean age (±standard deviation) of 38.0 (±9.2) years were included. All patients were female. The commonest site of lesions was upper lid, and final resolution score for all patients was less than 25%. There were no significant differences between viewpoints of the two referees. There were no major post operative complications. Patients followed for six months after the end of the treatment and there was no adverse effect.
Conclusion: The present study failed to demonstrate therapeutic efficacy of PDL in the treatment of xanthelasma. PDL with limited session numbers could not be considered as an alternative treatment for xanthelasma palpebrarum.

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Psoriasis is a chronic inflammatory disease which may occur in childhood. In many psoriasis cases, the disease develops in individuals younger than 18 years old. Psoriasis in children presents with a variety of clinical manifestations. Becouse of its atypical presentations, early diagnosis of psoriasis is difficult in children. The plaque type psoriasis is the most common form of the disease in children. Different treatments such as phototherapy and systemic therapies have been proposed, but using any of them leads to serious complications in children. Therefore, early diagnosis and proper management of the disease are the main components of the treatment in pediatric psoriasis cases. Herein, we aimed to provide a general overview on the pediatric psoriasis, including its epidemiology, pathogenesis, clinical manifestations as well as the treatment and discussing the latest related information.

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Background and Aim: The standard treatment regimen for pemphigus is adminitration of systemic corticosteroids and adjuvant agents. Previous studies have shown that corticosteroid therapy may alter lipid profile and reduce the atherogenic index in some disorders. This study was conducted to evaluate the changes in lipid profile in pemphigus patients treated with oral corticosteroids alone or in combination with adjuvants.

Methods: In this retrospective corss-sectional study, medical records of 148 pemphigus patients admitted in Razi Hospital in Tehran were reviewed for serum levels of low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholestrol, and triglyceride on the day of admission till 3 weeks after initiation of the treatment.

Results: Fifty-eight percent of patients were female and the mean age of the patients was 47.1 years. 79.3% and 13.3% of patients had been treated with prednisolone plus azathiorine or prednisolone alone, respectively. The remainig patients were treated by administration of oral prednisolone and other adjuvants. Serum levels of LDL, HDL, total cholestrol and triglyceride were significantly higher 3 weeks after initiation of treatment compared to baseline (P<0.05). With the exception of the signifcantly higher level of triglycerides in women, there was no statistically significant association between the levels of other serum lipids at the end of 3 weeks treatment with gender, age, severity of the disease, use of statins, and the treatment regimen (P>0.05).

Conclusion: Although the level of different components of the lipid profile in Iranian patients with pemphigus changed after receiving treatment for 3 weeks, it seems that those changes were not associated with an increased atherogenic index of pemphigus patients.

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Urticaria is a common and challenging skin disorder. Its diagnosis and treatment is not limited to the field of dermatology. General physicians, and allergologists and clinical immunologists are also commonly involved in the management of urticaria patients. One of the missions of the Iranian Society of Dermatology is to develop strategies to provide the best possible management for patients suffering dermatological conditions. To accomplish this mission, the Society assigned a committee to search and critically appraise the recent research evidence and available guidelines to develop a clinical practice guideline concerning diagnosis and treatment of urticaria.

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Background and Aim: The aim of this study was to investigate various aspects of the treatment in patients with cutaneous leishmaniasis in Iran in the first half of 2014. Methods: This cross sectional study was conducted on the existing data of 3684 patients with cutaneous leishmaniasis, whom were registered at the Disease Management Center of the Iranian Ministry of Health in the first half of 2014. Version 11 of Stata was used for statistical analysis and the level of significance was considered equals to 0.05. Results: Of 3684 patients entered into the study (%55.1) were male and the mean age of the patients was 27±18 years. More than 34% of patients were treated with intralesional injections of meglumine antimoniate (MA) and 25% of patients recieved systemic MA injections. There were statistically significant correlations between the size and number of the lesions and the chosen treatment regimen (P<0.001). Thirty-five percent of patients treated with systemic MA between 7 to 10 days and 43.3% of patients recieved intralesional MA injections for 5 to 8 weeks. Conclusion: More than %99 of patients fully recovered without complication or treatment failure. It seems that Iranian patients suffered milder CL in comparison with some other coutries.

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Platelet-rich plasma (PRP) is a solution derived from whole blood that is enriched in the platelet fraction. Platelets serve as a reservoir of growth factors and cytokines. When platelets are activated in vivo, signaling molecules are released into the immediate microenvironment and activate receptors for various pathways. PRP has been applied to bedsores to promote healing. Over the last decade, it has been used as a valuable therapeutic method in various specialties such as maxillofacial surgery, plastic surgery, orthopedics and sports medicine. Only recently has PRP been utilized for dermatologic purposes, psrticularly, for the treatment of male and female pattern hair loss.

In this review, we discuss molecular and cellular pathways up-regulated by PRP important in hair folliculogenesis, and examine clinical evidence from all previously published studies involving the use of PRP for pattern hair loss.

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Background and Aim: Vitiligo is a common pigmentary disorder that melanocytes are destroyed. Treatment of vitiligo depends on the extent of the disease and its distribution pattern. The aim of this study was to compare the efficacy of PUVA and NBUVB in patients with vitiligo.

Methods: A clinical trial has been performed on 60 patients with vitiligo referred to Bouali hospital and Mehrgan laser center in 1392 and treated with UVB and PUVA therapy methods. In first group treated with PUVA, oral tablets containing 8-methoxypsoralen were taken 3 hours before phototherapy twice a week. The second group was treated with NBUVB twice a week.

Results: In patients treated with PUVA, 40% and in patients treated with NBUVB, 43.3% were male. Seventeen (56.7%) of patients treated with PUVA had generalized vitiligo, 30% of them had segmental Vitiligo and 13.3% had focal Vitiligo.  Seventeen (56.7%) patients that were treated with NBUVB generalized vitiligo, 30% had segmental and 10% had focal vitiligo. Repigmentation was significantly higher in patients treated with NBUVB than PUVA 3 and 6 months after initiation of treatment (P<0.05).

Conclusion: NBUVB is superior to PUVA in treatment complications and its recovery rate was acceptable.

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Introduction: Idiopathic granulomatous mastitis (IGM) is a rare benign breast disease. The importance of this disease relies on its similar clinical manifestation to those of mammary carcinoma and a group of mastitis with other causes.

Case Report: The patient was a 32-year-old woman, that suddenly got fever, pain and swelling in left breast. In examination several masses were felt. Performed core needle biopsy reported IGM.

Conclusion: Similarity of clinical presentations and diagnostic tests to the other kinds of mastitis and malignancies may lead to misdiagnosis and mistreatment, which imposes socioeconomic and psychological burden to patients.

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Urticaria is a common and challenging skin disorder. Diagnosis and treatment of urticaria is not limited to the field of dermatology. General physicians, allergologists and clinical immunologists are also commonly involved in the management of patients with urticaria.