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The hyperkeratosis shows alternating circumferential para- and ortho-keratosis around the hair shaft (D). gl We evaluated the available dermoscopic images of 102 pathologically confirmed cicatricial-alopecia patients with clinically active disease. For instance, alopecia areata presents with Pohl-Pinkus constrictions.[6] We believe along with LPP, in other cicatricial alopecia like DLE or folliculitis decalvance, the same intermittent inflammation may occur. Lichen planopilaris (LPP) is the most common primary cicatricial alopecia defined by the follicular form of lichen planus.[1] Histopathologic examination is considered the gold standard diagnostic method. [Extracted from the article]

Objective Mycosis fungoides (MF) is a condition of the lymphatic tissues that mostly affects the skin (primary cutaneous T cell lymphoma), the most prevalent form of T-cell skin lymphoma. Central lymph node and other organs involvement are very poor prognostic factors that can gradually affect the quality of life of these patients. Therefore, in this study, we aimed to examine the quality of life in patients with MF. Methods In this descriptive study, a demographic questionnaire including age, gender, duration of MF, stage of the disease, and location of the lesion was completed. All participants were tested for quality of life using the SF36 questionnaire. Results There was a significant difference between different stages of the disease as well as the duration of the disease with respect to the overall quality of life score and its subscales, so that with increasing stage and duration of the disease, the quality of life decreased (P <0.05). The quality of life was lower in patients with sun-exposed areas than in those with other affected areas (P <0.05). Conclusion MF disease is correlated with reduced quality of life and the extent of which is inversely related to the duration of the disease as well as the stage of the disease. Additionally, patients with affected areas that are exposed to sunlight have a lower quality of life than those with other affected areas. [ABSTRACT FROM AUTHOR]

Background: Lichen planopilaris is an inflammatory cicatricial alopecia, and its management is a challenge for dermatologists. We aimed to compare the efficacy of methotrexate and hydroxychloroquine on refractory lichen planopilaris. Methods: In a randomized clinical trial, 29 patients were randomly allocated to receive either 15 mg methotrexate/week or 200 mg hydroxychloroquine twice a day for 6 months. Side effects, symptoms/signs, and laboratory tests were assessed periodically. Lichen Planopilaris Activity Index (LPPAI) was measured before intervention and at 2, 4, and 6 months after. The changes from baseline to the end of the study were analyzed within each group and between the two groups by per-protocol and intention-to-treat analysis. Results: After 2 months, mean (standard deviation [SD]) decrease in LPPAI in methotrexate group was significantly more than that in hydroxychloroquine group (1.68 [1.24] vs. 0.8 [0.71], respectively, P = 0.047). Furthermore, after 6 months, mean (SD) decrease in LPPAI in methotrexate group was significantly higher than that in hydroxychloroquine group (3.3 [2.09] vs. 1.51 [0.91], respectively, P = 0.01). The following symptoms/signs showed significant improvements in frequency and/or severity in methotrexate group after intervention: pruritus (P = 0.007), erythema (P = 0.01), perifollicular erythema (P = 0.01), perifollicular scaling (P = 0.08), spreading (P = 0.001), and follicular keratosis (P = 0.04). In hydroxychloroquine group, only erythema (P = 0.004) showed significant improvement. Conclusions: Methotrexate was more effective than hydroxychloroquine in treating refractory lichen planopilaris. [ABSTRACT FROM AUTHOR]

Parapsoriasis is exceedingly rare in children. The presentation, course, and prognosis of parapsoriasis in children have not yet been completely elucidated. Here, a case of large plaque parapsoriasis in 10-year-old boy is reported who was diagnosed recalcitrant pediatrics eczema for about 5 years. Other clinicians had previously treated him with emollients and topical corticosteroids with temporary relief but without improvement. The erythematous scaly patches were situated on the trunk and flank. On skin biopsy, the lymphocytic infiltrate was composed mainly of CD4+ and CD45RO+ lymphocytes. No T-cell receptor gene rearrangements were found. The paucity of knowledge about the evolution of this entity in childhood and its relationship to mycosis fungoides makes follow-up critical. [ABSTRACT FROM AUTHOR]

Parapsoriasis is exceedingly rare in children. The presentation, course, and prognosis of parapsoriasis in children have not yet been completely elucidated. Here, a case of large plaque parapsoriasis in 10‑year‑old boy is reported who was diagnosed recalcitrant pediatrics eczema for about 5 years. Other clinicians had previously treated him with emollients and topical corticosteroids with temporary relief but without improvement. The erythematous scaly patches were situated on the trunk and flank. On skin biopsy, the lymphocytic infiltrate was composed mainly of CD4+ and CD45RO+ lymphocytes. No T‑cell receptor gene rearrangements were found. The paucity of knowledge about the evolution of this entity in childhood and its relationship to mycosis fungoides makes follow‑up critical. [ABSTRACT FROM AUTHOR]

Background: Primary axillary hyperhidrosis (PAH) is a chronic idiopathic disorder causing major stress in patients. Among the common therapies for PAH, only surgical interventions have proven feasible as a permanent solution. Objective and Aim: The aim of this study was to evaluate the efficacy and safety of fractional microneedle radiofrequency (FMR) as an alternative permanent treatment for PAH with long-term follow-up. Materials and Methods: This was a single-blind, sham-controlled comparative study. Twenty-five patients with severe PAH were provided three treatments of FMR at 3-week intervals (the treatment group), and a control group was provided the sham treatment. Clinical efficacy was evaluated using the hyperhidrosis disease severity scale (HDSS) at baseline and the end of the study, as well as during the 1 year follow-up phase. Results: HDSS demonstrated significant improvement after treatment in the treatment group compared to the sham control. The mean (±standard deviation) of HDSS in the group being treated with radiofrequency was 2.50 (±0.88) after 1 year follow-up, and that of the control group was 3.38 (±0.49; P < 0.001). Follow-up results show that there were 10 patients (41.6%) with no relapse and 11 patients (45.9%) with relapse after 1 year. There was a significant correlation between HDSS changes in relapse and body mass index (BMI) (P = 0.03). Conclusion: Treatment of PAH with FMR is a safe and noninvasive procedure with a positive therapeutic effect on HDSS. It is recommended, however, that sessions of FMR be repeated after 1 year, particularly in overweight patients with high BMIs. Clinical Trial Registration: IRCT2013111915455N1. Level of Evidences: Level II-l. [ABSTRACT FROM AUTHOR]

Background: Primary axillary hyperhidrosis (PAH) is a common condition with a great impact on the patient's quality of life (QOL). It is associated with serious social, emotional, and occupational distress. The aim of this study was to investigate the QOL in patients with PAH before and after treatment with fractionated microneedle radiofrequency (FMR). Materials and Methods: We evaluated 25 patients with severe PAH. Each patient had three sessions of FMR treatment using a novel applicator at 3-week intervals. The study was based on Dermatology Life Quality Index (DLQI) Questionnaires. Patients were evaluated at baseline and 3 months after the last session. Results: Our patients included 32% males and 68% females. The mean ± standard deviation (SD) age of subjects was 30.2 ± 6.27 years. The mean ± SD of the DLQI before and after treatment was 12.96 ± 5.93, and 4.29 ± 2.21, respectively. There was a statistically significant difference between the before and after intervention (P < 0.001). No major, permanent adverse eff ects were shown. Conclusion: Treatment with FMR can improve the DLQI of patients with PAH. [ABSTRACT FROM AUTHOR]

Background: In recent times, tranexamic acid (TA) is claimed to have whitening effects especially for ultraviolet-induced hyperpigmentation including melasma. The aim of our study was to evaluate the efficacy and safety of topical solution of TA and compare it with combined solution of hydroquinone and dexamethasone as the gold standard treatment of melasma in Iranian women. Materials and Methods: This was a double-blind split-face trial of 12 weeks which was conducted in Isfahan, Iran. Fifty Iranian melasma patients applied topical solution of 3% TA on one side of the face, and topical solution of 3% hydroquinone + 0.01% dexamethasone on the other side two times a day. The Melasma Area and Severity Index (MASI) and the side effects were evaluated at baseline and every 4 weeks before and after photographs to be compared by a dermatologist were taken. The patient satisfaction was documented at week 12. Results: A repeated measurement analysis was used to evaluate the changes in the MASI score before and after treatments. A significant decreasing trend was observed in the MASI score of both groups with no significant difference between them during the study (P < 0.05). No differences were seen in patients' and investigator's satisfaction of melasma improvement between two groups (P < 0.05). However, the side effects of hydroquinone + dexamethasone were significantly prominent compared with TA (P = 0.01). Conclusion: This study's results introduce the topical TA as an effective and safe medication for the treatment of melasma. [ABSTRACT FROM AUTHOR]

Background. Primary cutaneous T-cell lymphomas (CTCLs) are a group of extranodal non-Hodgkin lymphomas that may be present in the skin without any evidence of extracutaneous disease. The aim of this study was to evaluate the epidemiological characteristics of primary CTCL in Isfahan, Iran. Method. A total of 95 patients who were diagnosed as having primary CTCL were recruited during a 10-year period (2003-2013) and were classified according to the new WHO-EORTC criteria. Results. The patient group consisted of 43 (44.8%) males and 53 (55.2%) females, which indicated a female predominance (M: F ratio 1: 1.2). The mean age at the time of diagnosis was 41.78 ± 16.88 years (range: 7-84 years). Prior to diagnosis, the lesions had persisted for a mean of 8.34 ± 4.38 years (range: 0-55 years). The age at peak diagnosis was 20-40 years (43%). The most frequent subtypes were mycosis fungoides (MF) (88.5%). Four patients died from CTCL-related complications. Conclusions. The distinguishing epidemiologic characteristics of primary CTCL, particularly those MF, in Iran, are the absence of a male predominance and lower age at diagnosis. This is likely because of the characteristic ethnic group diversity and increased susceptibility among younger population. [ABSTRACT FROM AUTHOR]

Context: Rapid stretching of the skin over the weak connective tissue leads to development of striae distensae. Recently, researchers have shown special interest towards use of fractional photothermolysis in treatment of striae and several studies have shown its usefulness. Our aim was to assess the efficacy of Fractional CO2 laser in treatment of striae alba. Materials and Methods: A randomized clinical trial was carried out in female patients with striae alba. Ninety two striae were randomly selected and divided into two groups. Five sessions of laser resurfacing, were performed in Group 1, every 2-4 weeks. Group 2 was treated with 10% glycolic acid+0.05% tretinoin cream nightly during the study. Photographs were taken from the striae before and two weeks after the end of treatment. Mean surface area of striae compared between two groups. Patients' views regarding the degree of improvement were assessed via visual analogue scale (VAS). Results: Forty six striae in Group 1 underwent laser resurfacing and 46 matched striae in Group 2, were treated with topical cream. Mean difference of striae surface area, was significantly decreased after treatment in Group 1 (-37.1±15.6 cm2) in comparison with Group 2(-7.9±9 cm2) (P value >0.001). Mean VAS was significantly higher in Group 1 (3.05±0.74) compared to Group 2 (0.63±0.66) (P value >0.001). Conclusions: Fractional photothermolysis via Fractional CO2 laser seems to be an effective method for treatment of striae alba. [ABSTRACT FROM AUTHOR]

Background: Acne vulgaris is a common skin disease that involves pilosebaceous units.Oral antibiotics are the most widely administered drugs, which are prescribed as systemic therapy for treatment of moderate to severe acne vulgaris. Azithromycin is one of the antibiotics that has been recently used for acne treatment. There are several protocols of oral azithromycin is one of the antibiotics that has been recently used for acne treatment. There are several protocols of oral azithromycin in the treatment of acne. to compare three various regimens of oral azithromycin in the treatment of acne. Methods: Sixty- four patients with moderate to severe acne were divided into three groups randomly. First group (21 patients) received azithromycin as follow: five consecutive days, 500 mg on the first day and 250 mg daily for a further four days per month. Second group (22 patients): 500 mg daily for four consecutive days per month and the last group (21 patients): 250 mg daily thrice weekly. After the baseline visit, patients were scheduled to return at four- weekly intervals among 12 weeks. Findings: There were no differences between three groups in decreasing of acne grading score (p>0.05). Efficacy of minimal dose was equal to maximum dose of azithromycin in treatment of acne. Oral azithromycin in all group resulted in a significant decrease in acne grading score in each consecutive visit (P<0.001). Conclusion: Because of expensiveness of azithromycin. We recommend azithromycin in low dose (1500 mg monthly) which is as effective as a high dose (3000 mg monthly) with lower cost, has more compliance and fewer side- effects. [ABSTRACT FROM AUTHOR]

Background: Cutaneous leishmaniasis (CL) is an endemic disease in Iran. Pentavalent antimonial drugs have been the first line of therapy in CL for many years. However, the cure rate of these agents is still not favorable. This study was carried out to compare the efficacy of intralesional glucantime and topical trichloroacetic acid 50% in combination with non-ablative radiofrequency heat therapy on cutaneous leishmaniasis. Methods: A total of 30 patients with 38 lesions were treated with intralesional injection of meglumine antimoniate (Glucantime) (Sanofi-Aventis, France) as Group 1. An equal number of 38 lesions in the remaining 30 patients were treated with the combination of non-ablative radiofrequency and topical trichloroacetic acid 50% as Group 2. Complete cure rate besides changes in lesion size and size of scars were assessed and compared between the two groups. Data was then analyzed by SPSS. Findings: Complete cure at after 4 months of treatment was significantly more in Group 1 than the other group (P = 0.01). However, the complete cure rate at the 6th month was not significantly different between the two groups (P = 0.06). Conclusion: This study showed that intralesional glucantime has significantly higher cure rate of cutaneous leishmaniasis in shorter time than trichloroacetic acid 50% in combination with non-ablative radiofrequency. Moreover, it could significantly induce efficient size reduction of more than 50% in most of lesions. The analyses revealed that intralesional glucantime still has the superiority to be the first line of therapy in cutaneous leishmaniasis. [ABSTRACT FROM AUTHOR]

BACKGROUND Cryotherapy combined with intralesional triamcinolon injection is the most common traditional therapy for hypertrophic scars and keloids. The literature contains few articles on the use of bleomycin tattoo for treatment of these conditions. OBJECTIVE This study compares the efficacy of bleomycin tattoo with that of cryotherapy combined with intralesional triamcinolon injection for the treatment of keloids and hypertrophic scars. MATERIALS AND METHODS Forty-five patients with hypertrophic scars or keloids were randomly divided into two groups. Group A was treated with bleomycin tattoo, and group B, with cryotherapy combined with intralesional triamcinolon injection. There were four therapeutic sessions at 1-month intervals. All patients were followed for 3 months after the end of treatment. RESULTS Therapeutic response in lesions less than 100 mm2 was higher than 88% in both groups, but in larger lesions, the therapeutic response to bleomycin was significantly better than cryotherapy combined with intralesional triamcinolon injection ( p=.03). In group A, no relationship was observed between therapeutic response and lesion size ( p=.58); however, in group B smaller lesions (<100 mm2) displayed better therapeutic response ( p=.007). CONCLUSIONS Bleomycin tattoo may be more effective than cryotherapy combined with intralesional triamcinolon injection in treatment of larger keloids and hypertrophic scars (size>100 mm2). [ABSTRACT FROM AUTHOR]

The article discusses the successful treatment of a 25 year old man with refractory primary axillary hyperhidrosis with fractionated microneedle radiofrequency (FMR). The patient underwent 4 treatment sessions of fractionated microneedle radiofrequency FMR involving 4 steps that include the sizing of the area to be treated, topical anesthesia under occlusion and dressing with sterile vaseline gauze and erythema and pin point bleeding as the only adverse effects.

Mycosis fungoides is the most common type of cutaneous T‑cell lymphoma (CTCL) and a rare disorder that typically affects older adults with erythematous scaling patches and plaques. Hypopigmented patches are a rare clinical variant of the disease. Granulomatous mycosis fungoides (GMF) is also a rare type of CTCL. No particular clinical criteria are available for the diagnosis of GMF, because of its variable presentations, and so the detection of GMF is primarily considered as a histopathological diagnosis. Rarely, a co‑existence of more than one clinical or histopathological feature of mycosis fungoides may be present. To the best of our knowledge this is the first report of MF that shows the simultaneous co‑existence of more than one clinical and histopathological variant of MF. We present a 29‑year‑old female with clinical presentations of both classic and hypopigmented mycosis fungoides (MF), and also the histopathological features of the classic and granulomatous types of the disease. [ABSTRACT FROM AUTHOR]

Background: Alopecia areata (AA) is a noncicatricial (nonscarring) alopecia. The association between AA and celiac disease (CD) is debatable. Several studies declare the relationship between AA and CD as measurement of celiac autoantibodies (anti-gliadin IgA and anti-gliadin IgG), but a few studies consider anti-tissue transglutaminase IgA. The aim of this study was to evaluate the frequency distribution of celiac autoantibodies (all of them) in patients with AA compared with controls. Methods: This study is a case-control study. Thirty-five patients entered in each group. Anti-gliadin IgA, anti-gliadin IgG, and anti-tissue transglutaminase IgA were tested in all patients. Samples were examined in ELISA method with binding site's kits, and the result was reported as positive/ negative. Finally, the frequency distribution of autoantibodies was examined. Results: The age average did not show a significant difference between two groups (P = 0.62). In addition, there was no significant difference between the two groups based on gender (P = 0.15). The prevalence of antibody in case and control groups was 2.85% and 0%, respectively. There was no significant difference between the two groups (P = 0.31). Conclusions: There may be a relationship between CD and AA, but the absence of statistical association between AA and CD does not mean that there is no relationship between gluten and AA in certain patients. Thus, we have shown here that the biological tests to search for CD do not bring information and proof enough, and it is why we recommend another approach to disclose gluten intolerance in AA patients. [ABSTRACT FROM AUTHOR]

Background: There are several studies about the positive relation between physical inactivity or low cardio respiratory fitness with development of metabolic syndrome (MS). In contrast, physical activity had favourable effects on all components of MS but the quantity and the frequency of physical activity necessary to produce this beneficial effect has not been defined as yet. The aim of this survey was to study the association of regular physical activity, measured by patient's estimation of walking time per day, with MS. Materials and Methods: This cross-sectional study was conducted as a part of Isfahan Healthy Heart Program (IHHP). Persons who had no component of MS were considered as reference group. Demographic data were collected by questionnaire. Relation between walking time and MS was evaluated by using logistic regression adjusted by age, sex, socioeconomic status (SES), life style and food item. Results: The study populations consisted of 4151 persons. Lower physical activity was associated with higher prevalence of MS (P < 0.001). There was a negative relation between the usual daily walking time and MS. Adjusted odds ratio for age groups, sex, SES, life style and food items (fat and oil, sweet and sweet drink, rice and bread, fried food) revealed that MS decreases with increasing walking time (P < 0.05) [OR = 0.70 (0.52-0.94)]. Conclusion: Total daily walking time is negatively associated with MS and increasing daily walking time is an effective way for preventing MS. [ABSTRACT FROM AUTHOR]

The multiple etiologic factors involved in acne make the use of various medications necessary to treat the condition. This study aimed to determine the efficacy of mupirocin and rifampin used with standard treatment in the management of acne vulgaris. In a multicentre, randomized controlled, triple-blinded study, a total of 105 acne patients, with a clinical diagnosis of moderate to severe acne,were randomizedly divided into three groups (35 per group), for treatment of acne. The first group was treated with standard treatment alone, the second group received mupirocin plus standard treatment and the third group received rifampin plus standard treatment. There were three study visits according to Global Acne Grading System (GAGS): at baseline and weeks 6 and 12. The absolute changes of GAGS score from baseline to week 6 and 12 demonstrated a reduction in the mean score of GAGS in the three treatment groups (p < 0.001). Due to the difference between GAGS score at the baseline of study, the data were adjusted using the general linear model. The findings showed that all of the treatments significantly improved acne lesions. Nevertheless, none of the treatments was shown to be more effective than the others (p = 0.9). The three treatments were well tolerated, and no serious adverse events were reported. These findings provide evidence on the efficacy of combining mupirocin and rifampin with standard treatment in the management of acne vulgaris, although none of the treatments had superior efficacy compared with the others. [ABSTRACT FROM AUTHOR]

Background: There is considerable evidence which suggests a possible pathogenetic role for Staphylococcus aureus (S. aureus) in acne vulgaris. Aim: The study was to determine S. aureus colonization and antibiotic susceptibility patterns in patients with acne and of healthy people. Materials and Methods: In the case-control study, a total of 324 people were screened for nasal carriage of S. aureus: 166 acne patients and 158 healthy persons. One control subject was individually matched to one case. Nasal swabs from anterior nares of individuals were cultured and identified as S. aureus. Antibiotic sensitivity was performed with recognized laboratory techniques. Results: S. aureus was detected in 21.7% of the subjects in acne, and in 26.6% of control groups. There was no statistical difference in colonization rates between two groups (P=0.3). In patient group, most of S. aureus isolates were resistant to doxicycline and tetracycline (P=0.001), and were more sensitive to rifampicin compared to other drugs. In control samples, the isolated demonstrated higher resistance to cotrimoxazole compared to patient samples (P=0.0001). There was no difference between groups regarding resistance to rifampicin, vancomycin, methicillin, and oxacillin. Conclusion: It is still unclear whether S. aureus is actually a causal agent in the pathogenesis of acne. Based on microbiological data of both healthy and acne-affected persons, we propose that contribution of S. aureus in acne pathogenesis is controversial [ABSTRACT FROM AUTHOR]