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Abstract Background Folliculotropic mycosis fungoides (FMF) is a rare variant of MF that involves hair follicles and requires a more aggressive treatment regime. Significantly, some patients with classic MF can eventually have some degree of follicular involvement. Objectives The aim of this study was to describe the dermoscopic features of FMF in nonscalp areas to facilitate early diagnosis and posttreatment monitoring. Methods The clinical and dermoscopic features in 11 FMF patients were analyzed and compared with the reports in the literature. Results Obliteration of hair follicles, loss of terminal hairs and hair loss were detected in all patients. Follicular accentuation, follicular dilation and broken hairs were found in almost all patients (90.9%). Other common follicular‐based dermoscopic features (

Abstract Despite the little information about the facial papules due to Lichen planopilaris (LPP), we have many cases with facial skin roughness in which histological study has showed LPP. Additionally, in those patients treating for frontal fibrosing alopecia or scalp LPP there was no improvement in facial papules.

Background. Lichen planopilaris (LPP) is a rare inflammatory disorder of the scalp that causes cicatricial alopecia. No therapeutic approach has been approved for this disease due to the rare frequency. Methotrexate and corticosteroid are commonly considered second- or third-line therapy. The efficacy of a combination of methotrexate and corticosteroid has been reported in some dermatological and immunological diseases. However, the efficacy of this combination in LPP is not clear. Therefore, this study aimed to compare the impact of methotrexate alone and in combination with corticosteroid on LPP. Materials and Methods. This randomized clinical trial was performed on 28 patients who referred to the dermatology clinic affiliated with Isfahan University of Medical Sciences, Isfahan, Iran during February 2015-December 2016, and 24 of them completed the trials. Fourteen patients received 15 mg methotrexate per week alone and the other fourteen subjects received 200 mg prednisolone plus 15 mg methotrexate per week. The primary outcome was Lichen planopilaris activity index (LPPAI) score. Moreover, we evaluated photographic changes and symptoms during the study. Results. The mean of LPPAI in both groups decreased during the follow-up with a similar pattern of LPPAI changes in both groups. No statistically significant difference was found between the two intervention groups regarding the LPPAI score. We found no difference in the symptoms and photographic assessments in methotrexate and combination therapy groups during follow-up. In both groups, exclusively one adverse effect was reported. Conclusions. Our results showed that methotrexate therapy with and without corticosteroids had similar efficacy and safety.

Acute generalized exanthematous pustulosis (AGEP) is an exanthematous condition, predominantly occurring as a result of drug reactions. We, hereby, present the first case of AGEP following treatment with remdesivir in a patient with COVID-19, without hydroxychloroquine use, which serves as a reminder to consider remdesivir as a possible causative agent when dealing with AGEP presentation in COVID patients.

Background: Rosacea is a skin chronic inflammation with an unknown cause and cure. Environmental and genetic factors could not entirely explain the disease pathogenesis. Recently, infections like Chlamydia pneumoniae are of more attention in the rosacea progression. This study investigated the relationship between the C. pneumoniae seropositivity and the rosacea disorder. Materials and Methods: We aimed at a cohort of 100 patients with the rosacea disorder (60 active and 40 inactive) and from 100 sex- and age-matched healthy controls in Isfahan and determined the immunoglobulin M (IgM)/IgG antibodies titers to C. pneumoniae in the serum using the enzyme-linked immunosorbent assay method. The groups were compared using the analysis of variance procedure at the significant level of P < 0.05, statistically. Results: The mean of IgG in the controls was significantly higher than the levels in both the active and the inactive rosacea patients (p < 0.022). Also, the titer of serum IgM to C. pneumoniae in the controls was different, compared with the active (p < 0.019) and the inactive (p < 0.02) rosacea patients. In addition, the median titer of serum IgG (not IgM) to C. pneumoniae in the females with the inactive rosacea disorder was lower than the active rosacea disorder (p < 0.019) and controls women (p < 0.008). Furthermore, the serum level of IgG or IgM to C. pneumoniae in the controls males was higher than the males with the rosacea disorder (p < 0.05) and (p < 0.02), alternatively. Conclusion: C. pneumoniae seropositivity in the rosacea patients and controls was insignificant.

Background: Melasma is a chronic hyperpigmentation skin disorder mainly affecting women in the reproductive age. Available treatments for melasma do not lead to long-term satisfactory results. Aims: This study aimed to compare the efficacy of fractional CO2 laser in combination with topical therapy to topical therapy alone. Materials and Methods: Forty women with bilateral melasma were studied in this randomized single-blinded clinical trial. Each side of the face was randomly allotted to either topical hydroquinone 4% or combination of topical hydroquinone 4% and fractional CO2 laser. Patients received three sessions of laser therapy at 3-week intervals. Hydroquinone 4% application on both sides maintained for 3 months after the last laser session. The clinical improvement (darkness [D] and homogeneity [H] of hyperpigmentation) was measured by a blinded main investigator and an outcome assessor. Furthermore, improvement was assessed by physician's global assessment (PGA) and patient satisfaction (visual analog scale [VAS] score). Results: Significant reduction in D observed 3 weeks after combination therapy (P0.05). Furthermore, control and experiment sides were not significantly different considering VAS score and PGA (P>0.05). Conclusion: Considering the short-term outcome of laser and hydroquinone therapy, we can apply it to obtain earlier positive results. However, because of the lack of significant difference between the two methods and also the high cost of laser therapy, it seems better not to recommend fractional CO2 laser to patients as adjunctive therapy for long-term treatment of melasma.

Eruptive syringoma is a rare variant of syringoma presenting with skin-colored or slightly pigmented papules mostly before or during puberty. In this report, we presented a rare case of eruptive syringoma in a 30-year-old woman. She exhibited multiple skin lesions in dorsal areas of her both hands, developed from the age of 15.

Background: Androgenic alopecia (AGA) is one of the most common problems among men; in some societies, 50 percent of 50-years-old men are involved. In the past, opium versions of therapeutic compounds for the treatment of hair loss were used. Therefore, this study aimed to examine the relationship of opium consumption and androgenic alopecia in men. Methods: In this case-control study, 604 men referred to the Isfahan Amin Hospital, Iran, were enrolled. The sampling method was a simple classification (convenient) and men were divided to 2 equal groups of control (non-consumer of opium) and addict (consumer of opium). The intensity of androgenic alopecia was compared on the basis of a Hamilton Norwood scale. Data were collected using physical examination and a researcher-made questionnaire. Statistical analysis was carried using chi-square, Student's t, Spearman and One-way ANOVA tests. Findings: Percentage frequency of androgenic alopecia in addict men was significantly less than control group (P < 0.001). In addition, the intensity of androgenic alopecia had significant inverse relationship with the amount of opium consumption per year in the distinct range (P < 0.001). Conclusion: Our finding indicates that the prevalence of androgenic alopecia in opium-addict men is lower than non-consumer men.

مقدمه: آلوپسی ‌آره‌آتا (AA یا Alopecia areata) یک بیماری شایع و بدون علامت است که با ریزش سریع مو در یک منطقه مشخص می‌شود. علت آن هنوز به طور کامل شناخته نشده است. بعضی مطالعات ارتباط بین AA و سلیاک را نشان داده‌اند. هدف از انجام این مطالعه، مقایسه‌ی سطح Anti-tissue transglutaminase IgA (Anti-tTg IgA) در بیماران مبتلا به AA با گروه شاهد بود. روش‌ها: این مطالعه، یک مطالعه‌ی مورد- شاهدی بود که گروه مورد آن بیماران مبتلا به AA بودند. در هر گروه، 35 نفر وارد شدند. سپس آزمایش Anti-tTg IgA برای هر دو گروه انجام شد. جواب به صورت مثبت/منفی گزارش‌ گردید. در پایان، توزیع فراوانی این اتوآنتی‌بادی در گروه‌ها با هم مقایسه شد. یافته‌ها: بر حسب آزمون 2χ برای جنس و آزمون t برای سن، تفاوت معنی‌داری بین دو گروه از نظر جنس (151/0 = P) و سن (621/0 = P) مشاهده نشد. در گروه مورد، Anti-tTg IgA تنها در یک فرد (۸/۲ درصد) مثبت بود. در گروه شاهد، هیچ یک از افراد از نظر این آنتی‌بادی مثبت نبودند. بر حسب آزمون 2χ، بین گروه‌ها تفاوت معنی‌داری مشاهده نشد (۳۱۴/۰ = P). شایع‌ترین فرم AA (6/88 درصد) Patchy و شایع‌ترین نوع درگیری ناخن در گروه مورد، Pitting بود. 1/17 درصد گروه مورد، سابقه‌ی خانوادگی AA داشتند. نتیجه‌گیری: توزیع فراوانی Anti-tTg IgA در بیماران مبتلا به AA نسبت به جمعیت طبیعی جامعه‌ی اصفهان بالاتر نمی‌باشد. از این رو، پیشنهاد می‌شود اتوآنتی‌بادی‌های دیگر سلیاک نظیر Anti-gliadin IgA و Anti-gliadin IgG نیز در این بیماران مورد بررسی قرار گیرد.

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 effects were shown. Conclusion: Treatment with FMR can improve the DLQI of patients with PAH.

Background: Primary cutaneous lymphomas (PCLs) represent a heterogeneous group of T- and B-cell lymphomas that present in the skin with no evidence of extracutaneous disease at the time of diagnosis. The aim of this study was to assess and report the epidemiological characteristics of PCLs in Isfahan, Isfahan Province, Iran - as a main province of Iran. Materials and Methods: A total of 99 patients were recruited over a recent 10-year period (2003-2013) with diagnosis of PCLs; the patients were classified according to the The World Health Organization/European Organization for Research and Treatment of Cancer (WHO-EORTC) criteria. Mean and standard deviations (SDs) were used to describe continuous data, numbers, and percentages for categorical data. Statistical significance was defined as P < 0.05. Results: The patients comprised 45 men and 54 women aged 5-80 years (median 36) at diagnosis. The male-to-female ratio was 1:1.2. Histological examination showed features of primary cutaneous B-cell lymphomas (PCBCLs) in four cases. The mean ± SD age in primary cutaneous T-cell lymphomas (PCTCLs) and PCBCLs was 37.9 ± 16.5 years and 39.7 ± 9.1 years, respectively (P = 0.72). The mean ± SD latent period between the time of diagnosis and initiation of skin lesions in men and women was 2.3 ± 4.1 years and 5.9 ± 10.1 years, respectively (P = 0.02). The most frequent subtypes were mycosis fungoides (MFs) (86.9%) followed by Sιzary syndrome (SS) (4%). Five patients died from PCL-related deaths. Conclusion: The distinguishing epidemiologic characteristics of PCL in Iran are the absence of a male predominance and a lower age of diagnosis. The study highlights the ethnic or regional variations in the clinicoepidemiological characteristics of PCLs.

مقدمه: سودوكاتالاز/سوپراکسید دیسموتاز (PSD یا Pseudocatalase/superoxide dismutase) یک ژل موضعی است که به خاطر داشتن اثرات درمانی، در درمان ویتیلیگو مورد استفاده قرار می‌گیرد. این مطالعه به منظور بررسی اثر این ترکیب در ویتیلیگو طراحی شد. روش‌ها: این مطالعه، یک کارآزمایی بالینی مقدماتی (پایلوت) تصادفی دوسوکور کنترل شده با دارونما بود. 46 ضایعه‌ی متقارن ویتیلیگو در اندام 23 بیمار که به کلینیک‌های پوست اصفهان در سال 1389 مراجعه کرده بودند، به این مطالعه وارد شد. به بیماران، فرمول سودوكاتالاز/سوپراکسید دیسموتاز یا ژل دارونما برای ضایعات سمت چپ یا راست داده شد. مساحت ضایعه‌ی پوستی و درجه‌ی رنگدانه‌ی پیگمنتاسیون در ابتدا و 2، 4 و 6 ماه بعد مورد بررسی قرار گرفت. یافته‌ها: هیچ تغییر معنی‌داری در مساحت ضایعه‌ی پوستی و دور فولیکولی (اطراف یا مجاور فولیکولی) در گروه‌های مورد مطالعه یافت نشد (05/0 = P). نتیجه‌گیری: نتایج نشان‌دهنده‌ی عدم وجود تأثیرات درمانی معنی‌دار برای سودوكاتالاز/سوپراکسید دیسموتاز در درمان ویتیلیگو بود.

Background: 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. We aimed to assess the efficacy of Fractional CO2 laser in treatment of striae alba. Methods: A randomized clinical trial was carried out in 6 women with striae alba. Ninety two striae were randomly 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 and 0.05% tretinoin cream nightly. Photographs were taken from the striae before and two weeks after the end of the treatment. Mean surface area of striae compared between two groups. Patients’ views regarding the degree of improvement were assessed via visual analogue scale (VAS). Findings: Mean difference of striae surface area was significantly more after treatment in group 1 (-37.1 ± 15.6 cm2) in comparison with group 2 (-7.9 ± 9.0 cm2) (P < 0.001). Mean VAS was significantly higher in group 1 (3.05 ± 0.74) compared to group 2 (0.63 ± 0.66) (P < 0.001). Conclusion: Fractional photothermolysis via Fractional CO2 laser seems to be an effective method for treatment of striae alba.

Background: Mycosis fungoides (MF) is the most common and indolent form of cutaneous T-cell lymphomas (CTCL), that usually occurs in old adults. We aimed to determine epidemiologic features and patients' characteristics of Mycosis fungoides in Isfahan, Iran. Methods: We performed a retrospective study in Mycosis fungoides clinic of Alzahra hospital, that is the main center for treatment of patients with Mycosis fungoides in Isfahan, and evaluated clinicopathologic features of the disease. Findings: In 3 years, from 25 referred patients, 18 were diagnosed as Mycosis fungoides. Seven (38.9%) patients were men and 11 (61.1%) were women with male to female ratio of 1:1.57. The mean age of patients was 41.06 years. 88.9% of patients were in stages ΙA and ΙB. Conclusion: Most of our patients presented in early stages that were similar to other studies; while male to female ratio was different from other studies.

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.

Background: Vitiligo is an acquired, idiopathic disorder characterized by circumscribed depigmented macules and patches. The exact etiology and pathogenesis of vitiligo is not clear. Many theories have been presented regarding this subject among them aautoimmune theory is the most important one. The association of vitiligo with other autoimmune disorders has been reported, but the relationship between vitiligo and celiac disease is controversial. The aim of this study was to study the frequency of celiac autoantibodies in a group of vitiligo patients compared with control. Methods: This was a cross sectional case control study that involved 128 individuals, 64 vitiligo patients and 64 individuals as control group. The means age of participants was 30.3 ± 14.4 years. IgA anti Endomysial antibody and IgA anti-glutaminase antibody were measured by ELISA method in the serum of all participants. Data were analyzed by SPSS software version 15. Results: The serum of two vitiligo patients (3.1%) was positive for antibodies. All control groups were seronegative for these antibodies (P < 0.05). There was no significant effect of sex and job on seropositivity. Conclusion: There may be a relationship between celiac disease and vitiligo. This may indicate a common basic autoimmune mechanism that is an explanation for few case reports that gluten free diets were effective in the treatment of vitiligo patients. Both T test and exact fisher test showed no effect of age, sex and job on seropositivity of these patients (P = 0.56 and P = 0.74, respectively)

Background. A consistent treatment has not been proposed for treatment of Striae Alba (SA). The present study was designed to compare the fractionated microneedle radiofrequency (FMR) alone and in combination with fractional carbon dioxide laser (FMR + CO2) in the treatment of SA. Methods. Forty-eight pairs of SA from six patients were selected. Right or left SAs were randomly assigned to one of the treatment groups. The surface area of the SA before and after treatment and clinical improvement using a four-point scale were measured at the baseline, after one and three months. Results. The mean age of the patients was 30.17±5.19 years. The mean difference of the surface area between pre- and posttreatment in the FMR + CO2 group was significantly higher than that in the FMR group (p=0.003). Clinical improvement scales showed significantly higher improvement in the FMR + CO2 group than in the FMR group in the first and second follow-up (p=0.002 and 0.004, resp.). There were no major persistence side-effects in both groups. Conclusions. The results showed that FMR + CO2 laser was more effective than FMR alone in the treatment of SA.

Objective : Pseudocatalase/superoxide dismutase (PSD) is a topical gel considered having therapeutic effects in vitiligo. This study was designed to evaluate the efficacy of this combination in vitiligo. Methods : This was a pilot randomized, double-blind, placebo-controlled trial on 46 symmetrical vitiligo lesions of limbs in 23 patients referring to dermatology clinics, Isfahan, Iran in 2010. Patients were received this formula or placebo gels for the right and left lesions. Lesion area and degree of pigmentation were assessed at baseline, 2, 4, and 6 months. Findings : There were no significant changes in lesion area and perifollicular pigmentation in each group (P > 0.05). Conclusion : The results indicated no significant therapeutic effect for PSD in vitiligo.

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 CO 2 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 cm 2 ) in comparison with Group 2 (-7.9±9 cm 2 ) (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 CO 2 laser seems to be an effective method for treatment of striae alba.

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.

مقدمه: به منظور کاهش درد ناشی از لیزر تاکنون از بی‌حس کننده‌های موضع چون کرم EMLA استفاده شده است. هدف ما در این مطالعه، بررسی اثر ژل پیروکسیکام در کاهش درد بیمار در حین انجام لیزر و پس از آن و کاهش التهاب و اریتم پوست بیماران و پیگمانتاسیون متعاقب آن بود. روش‌ها: این مطالعه به صورت کارآزمایی بالینی دو سوكور در مركز نوین لیزر بر روی ۱۲۲ نفر از بیماران ۱۸ تا۶۰ سال که کاندید انجام لیزر فراکسل Co2 بودند، انجام گرفت. جمعیت مورد مطالعه قبل از لیزر در یک طرف صورت از ژل پیروکسیکام و در طرف دیگر از ژل لوبریکات استفاده کردند. درد، شدت اریتم و پیگمانتاسیون پس از لیزر در دو طرف صورت در زمان‌های مشخص به کمک آزمون Repeated measures ANOVA و نرم‌افزار SPSS نسخه‌ی 18 با یکدیگر مقایسه شد. یافته‌ها: ژل پیروکسیکام نسبت به ژل لوبریکانت در کاهش درد ناشی از لیزر فراکسل مؤثرتر بود (01/0 > P)، ولی از نظر شدت اریتم و پیگمانتاسیون پس از لیزر بین دو ژل تفاوت معنی‌داری وجود نداشت. نتیجه‌گیری: ژل پیروکسیکام می‌تواند به عنوان یک داروی مطمئن و مؤثر، بدون عارضه‌ای ناخوشایند برای کاهش درد ناشی از لیزر فراکسل استفاده شود ولی این دارو روی اریتم و پیگمانتاسیون ناشی از لیزر اثری ندارد.

Background. Mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma. Extensive studies on Iranian MF patients are absent. The present study aimed to produce updated clinical information on Iranian MF patients. Methods. This was a retrospective, descriptive, single-center study, including all cases of MF seen in the Department of Dermatology, University Hospital of Isfahan, Iran, between 2003 and 2013. Data systematically recorded for each patient included clinical, biological, histological, and molecular findings. Results. Eighty-six patients with clinical and histologic diagnosis of MF were included in the study. Thirty-nine patients (45.3%) were male. Female predominance was observed in patients (male : female ratio is 1 : 1.2). Patients were between 7 and 84 years of age (median: 41). The interval from disease onset to diagnosis ranged from 0 to 55 years (median: 1 year). Eighteen cases (20.9%) had unusual variants of MF. The most common types included hypopigmented and poikilodermatous MF. Childhood cases of MF constituted 5.8% (5/86) of all patients. The early stages were seen in 82 cases (95.34%). Conclusion. The major differences in epidemiologic characteristics of MF in Iran are the lack of male predominance and the lower age of patients at the time of diagnosis.

Keloids and hypertrophic scars are abnormal responses of body to skin injuries. Overproduction of compacted fibrous tissue is the basic cause of these lesions. In this study the result of treatment of these skin conditions with bleomycin tattoo are compared with cryotherapy and triamcinolone injection. This study involved 45 patients with hypertrophic scar or keloid. Patients were divided into two groups consecutively. Group A (23 patients) was treated with bleomycin tattoo and the group B with cryotherapy and triamcinolone injection. There were four therapeutic sessions one month apart. All patients were followedup for three month after the end of treatment .The therapeutic response was determined as reduction of lesion size or flattening relative to initial size. Therapeutic response was 88.3±14% in group A and 67.4 ±22.5% in group B (p

BACKGROUND: Hirsutism is the condition of excessive terminal hair growth in women with a typical male pattern distribution. Hirsutism is a common disorder that affects about 5% -10% of women of reproductive age. Adipose tissue contributes up to 50% of the circulating testosterone in premenopausal women Because of excessive androgen production in fat tissue. Therefore, it seems that hirsutism must be more common in people with simple obesity but controversy exist regarding this subject. The aim of this study is to evaluate the relation between Body Mass Index and hirsutism in a representative sample of Iranian woman. METHODS: This is a cross sectional case control clinical trial. The study involved 800 individuals; 400 hirsute females and 400 healthy women as control group. The mean age of the participants was 28 ± 6.2 years. Hirsutism was determined by the Ferriman-Gallwey scoring system. Height and weight were measured by a Seca scale, Body Mass Index was calculated as weight/height² (kg/m²), and collected data were analyzed by SPSS software version 18 using T-test and chi-square statistical test. RESULTS: There were no significant differences between the two groups regarding age and height. However, Body Mass Index and weight were significantly higher in the case group than the control group. The chi square test revealed significant differences between the case and control groups regarding Body Mass Index (P < 0.001). CONCLUSION: In the current study hirsutism was more common in patients with a higher Body Mass Index. The increased frequency of hirsutism in overweight women could be explained by increased insulin resistance and more androgen production by adipose tissue. Keywords: Body Mass Index, Hirsutism, Obesity.

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.

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-1.

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.

Background: Mycosis Fungoides (MF) is he most common and indolent form of Cutaneuse T-cell Lymphomas (CTCL), that usually occurs in old adults. Objectives: To determine epidemiologic features and patients characteristics of MF in Isfahan (Iran). Methods: We performed a retrospective study in MF clinic of alzahra hospital that is the main center for treatment of MF patients in Isfahan (Iran) and evaluated clinicopathologic features. Results: in 3 years 25 patients were referred to Alzahra MF clinic. 18 patients diagnosed as MF. Seven (38.9%) patients were male and 11 (61.1%) were female with male to female ratio of 1:1.57. The mean age of patients was 41.06 years. 88.9% of our patients were in stages ΙA and ΙB. Conclusion: most of our patients presented in early stages that were similar to other studies, while male: female ratio is different from other studies.

Background: Laser systems that are commonly used for the treatment of hirsutism include the ruby laser (694 nm), the diode laser (800 nm), the alexandrite laser (755 nm) and the Nd: YAG laser (1084 nm). The diode laser and alexandrite laser are considered effective in treatment of hirsutism in dark-skinned patients. The response of hairs to these laser systems is variable and not complete. In this study, we compared the efficacy of these two laser systems for permanent hair removal. Methods: This was a randomized controlled clinical trial in women with age range 15-45 years old. After obtaining an informed consent, the subjects were randomized into two groups using random allocation software. The first group was treated with alexandrite laser alone (four sessions, two months apart). The second group was treated sequentially with diode laser for the first and alexandrite laser for the next two sessions. Findings: Overall, 111 patients (57 patients in the alexandrite laser group and 54 patients in the sequential diode-alexandrite laser group) were evaluated. There was no statistically significant difference in the mean hair reduction of the two groups during the treatment. Except for the first session, there was no significant difference in patient satisfaction between the two groups (P > 0.05). No significant difference was found between groups one month, three months and six months after the last treatment (P > 0.05). Conclusion: There was no significant difference between sequential treatment with diode and alexandrite lasers versus alexandrite laser alone in the treatment of hirsutism. We suggest that the efficacy of sequential treatment with other laser systems should be evaluated against single treatment methods in the future studies.

Background: Acne vulgaris is a common skin disease that involves pilosebaceous units. Orally administered antibiotics are the most widely systemic therapeutics prescribed for the treatment of moderate to severe acne vulgaris. Azithromycin is among the antibiotics that have been recently used in acne treatment. There are several protocols for oral administration of azithromycin. Our aim was to compare three different oral regimens of azithromycin in the treatment of acne vulgaris. Methods: Sixty-four patients with moderate to severe acne were divided into three groups randomly. First group (21 patients) received azithromycin as follows: five consecutive days per month, 500 mg on the first day and 250 mg daily for the next four days. Second group (22 patients) received 500 mg daily for four consecutive days per month and the last group (21 patients) was administered 250 mg daily thrice weekly. After the baseline visit, patients were scheduled to return at four-weekly intervals for 12 weeks. Findings: Oral azithromycin in all groups resulted in a significant decrease in acne grading score in consecutive visits (P < 0.001). There was no difference between the three groups in the decreasing trend of acne grading score (P > 0.05). The efficacy of the minimum dose was equal to the maximum dose of azithromycin in our experiment. Conclusion: Because of the high cost of azithromycin, we recommend administering lower doses (1500 mg/month), which is as effective as higher doses (3000 mg/month) and has better compliance and fewer side-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.

Background: No ideal treatment has been established for Striae distensae (SD), particularly in the late phase (Striae Alba (SA)) .Various types of lasers have been recently proposed as treatment options for SD. This study aims to compare the clinical efficacy of a fractional CO2 laser as well as a combination of fractional CO2 laser and Pulsed dye Laser (PDL) in the treatment of SA. Materials and Methods: Eighty-eight SA lesions in three female patients were included. Lesions on each half of the body were randomly enrolled in each group. Group 1 (n = 44) were treated by Fractional CO2 laser resurfacing and group 2 (n = 44) by a combination of PDL and Fractional CO2 laser, alternately. Digital Photographs were taken and the surface area of each lesion was measured digitally (using the PictZar Digital Planimetry Software) at the baseline and four weeks after treatment. The clinical improvement was assessed by comparison of the pre- and post-treatment photos and the participants′ views about their degree of improvement, using a 10-point verbal analog scale (VAS). Results: The mean surface area decreased significantly in both groups after treatment. The mean difference between the pre- and post-treatment surface area was 0.62 ± 053 for group 2 and 0.41 ± 0.43 for group 1 (P-value = 0.03). Mean VAS and dermatologist assessed improvement scale in group 2 (6.68 ± 0.77 and 2.2 ± 0.76 respectively) were significantly higher than those in group 1 (5.45 ± 0.90 and 1.8 ±0.72 respectively, P-value

Mycosis fungoides (MF) a cutaneous T-cell lymphoma, is a subgroup of non-Hodgkin′s lymphomas, characterized by skin infiltration and occasionally systemic involvement. MF coincidence with pregnancy is rare. The effect of pregnancy on MF and the effect of this disease on pregnancy are still unknown. There are few case reports about pregnancy and its deleterious effect on the clinical course of MF. This case report is about a 30-years-old female with MF who became pregnant and after delivery developed CD30+ large cell transformation; this is the first report of large cell transformation of MF related to pregnancy.

Byline: Sanaz. Nourmohammadi Abadchi, Farahnaz. Fatemi Naeini, Elham. Beheshtian Background: Melasma is a chronic hyperpigmentation skin disorder mainly affecting women in the reproductive age. Available treatments for melasma do not [...]

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]