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Introduction Letrozole is an aromatase inhibitor that used to treat breast cancers. Letrozole-associated skin vasculitis is a rare side effect of this medication, in this study we report a case of necrotizing type of Small vessel cutaneous vasculitis associated with letrozole consumption. Case presentation A 45-year-old woman was referred to the dermatology clinic with painful necrotic annular lesions on the lower limbs. Her past medical history showed evidence of breast cancer and taking letrozole. Five months after the start of letrozole, the patient's signs and symptoms had appeared. Physical examination revealed annular plaques with erythematous margin and multiple necrotic centers that were painful to touch. The histopathology showed extravasated red blood cells and leukocytoclasis as well as neutrophils surrounding and infiltrating the wall of blood vessels in superficial and mid dermis. We discontinued letrozole, then prescribed topical clobetasol, systemic prednisolone, and colchicine; the lesions began to heal after 1 month from the start of treatment, and did not recur after discontinuing the treatment. Discussion Pathogenesis of vasculitis caused by aromatase inhibitors is not fully elucidated, but estrogen depletion and idiosyncratic drug reaction has been proposed. Cutaneous leukocytoclastic small vessel vasculitis (CLSVV) resulting from aromatase inhibitors is relatively rare so it is recommended to consider drug-induced CLSVV in other patients treated with aromatase inhibitors.

Although the coexistence of alopecia areata and lichen planopilaris is rare, if alopecic patches appear abruptly, this possible association should be kept in mind.

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.

Lichen planus pigmentosus is a rare variant of lichen planus with different patterns and manifestations. The coexistence of LPP and PV suggests that there might be a relationship between these two conditions in terms of immunologic mechanisms.

Pustular psoriasis of pregnancy is a rare skin condition which mostly affects women in the third trimester and is sometimes followed by adverse outcomes for the mother and the fetus.

Giant melanocytic nevus is a rare condition caused by benign proliferation of melanocytes. There is a slight risk of malignancy in these lesions which should be noticed especially when they become larger. GCMN can be removed by plastic surgery.

Vitiligo is a prevalent destructive melanocyte skin disease that negatively affects the patients' life in terms of self-esteem. Suction blister and dermabrasion plus 5-fluorouracil are effective treatments for vitiligo. The present study was conducted to compare the outcomes of these two techniques. The present clinical trial was conducted on 36 patients with persistent refractory vitiligo which defined as the lack of any new or progressed lesion during the previous year as well as no responding to conventional therapies of vitiligo including topical treatments and phototherapy. Individuals with two vitiligo patches, with similar baseline Vitiligo Area Severity Index (VASI) scores were randomly allocated to dermabrasion plus 5-fluorouracil or suction blister treatments. VASI and repigmentation scores were measured and compared at the baseline, four, and 12 weeks after performing the procedures. Both of the approaches accompanied with significant improvement in both entities of VASI and repigmentation scores (P value .05) at the end of the study, besides the trend of VASI and repigmentation scores between the two groups revealed insignificant difference (P .05). The short-term follow-up of the patients was the limitation of this study. The present findings suggested that both surgical techniques of dermabrasion plus 5-fluorouracil and suction blister posed acceptable outcomes within 12-week follow-up.

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 & Objective: Basal cell carcinoma (BCC) is a common skin cancer arising from the basal layer of the epidermis and its appendages. They are locally invasive, aggressive, and destructive of skin and the surrounding struc- tures. β-Catenin is a multifunctional protein located to the intracellular side of the cytoplasmic membrane coded by the CTNNB1 gene, which maps to chromosome 3p22.1. It has a critical role in cell-to-cell adhesion by linking cadherins to the actin cytoskeleton and has a central role in transcriptional regulation in the Wnt signaling pathway. We evaluated the diagnostic value of the Beta catenin immunohistochemistry marker in distinction of aggressive and non-aggressive Basal cell carcinoma. Methods: This cross sectional and descriptive-analytical study was done on archived formalin fixed, paraffin embed- ded tissue blocks in pathology library of Al-Zahra hospital in Isfahan city. We used immunochemistry to determinate the role of β-Catenin in aggressiveness in BCC with higher rate of relapse. Results: A total of 76 samples were evaluated in two groups (aggressive &none aggressive). The mean percentage of cytoplasmic β-Catenin staining in aggressive group was more significant than the other group (sensitivity: 86.8% specificity: 81.6%, PPV: 81.5% and NPV: 86.1%) and the mean percentage of membranous β-Catenin staining in non- aggressive group were significant more than the aggressive group. Intensity of membranous staining in both groups significant less than normal epithelium. Conclusion: Cytoplasmic β-Catenin staining in aggressive BCC is more significant than non-aggressive subtypes, so this indicates that the use of β-Catenin IHC marker maybe helpful in the diagnosis of aggressive BCC.

Key Clinical Message Acute generalized exanthematous pustulosis (AGEP) is a self‐limited drug reaction. Hydroxychloroquine (HCQ) is an uncommon cause of AGEP with a prolonged recovery course; Thus, the physicians should take the possibility of this rare but severe event in their minds and try to diagnose correctly and better management.

Muehrcke's lines are a type of apparent leukonychia that are common in patients receiving chemotherapeutic agents. They are self‐limited, and there is no need to more workup.

Amelanotic melanoma (AM) of the heel is a very rare subtype of malignant melanoma in which the tumour cells, unlike other types of melanoma, are characterised by little or no melanin pigmentation. AM resembles many benign dermatological complications that often lead to late diagnosis of lesions, poor prognosis, and occasionally misdiagnosis at an early stage of the disease. We report a case of a 73-year-old man with a heel ulcer who was admitted to Al-Zahra Hospital (Isfahan, Iran). Chronic osteomyelitis was considered the primary diagnosis, and several courses of antibiotics were prescribed for the patient. The ulcer failed to improve after 9 months' of therapy, and because of an increase in the size of the ulcer and the growth of two tumours in the right heel, a biopsy of the lesion was conducted. The pathology report confirmed invasive AM. The present report emphasises the necessity to biopsy all skin lesions, even with low clinical significance, to avoid wrong subsequent treatments, prevent a delay in diagnosis, reduce misdiagnosis, and improve the survival rate of patients.

Introduction: fluoroquinolones have many adverse effects include the gastrointestinal tract and the central nervous system, phototoxicity, and dermal toxicity. Levofloxacin has favorable adverse reaction profiles compared to other fluoroquinolones. Among the reported dermal toxicity, there are few reports of TEN in association with levofloxacin usage. However, there is no published study on levofloxacin induced stomatitis. Stomatitis is characterized by pain, inflammation, and ulceration in the oral cavity. It can affect patient ability to eat, talk or daily workout. Hence, caution is advised while administering drugs with this potential adverse effect. Case Presentation: A 36-year-old man was referred to the hospital for ‘painful oral swelling and ulceration’. Before the admission due to a fever and productive cough, 750 mg levofloxacin were prescribed for him. After 2 days of consumption, the patient experiences painful ulcerative and erythema lesions in the oral cavity that consistent with stomatitis. Upon hospitalization, the patient only had 38 degrees and all laboratory value was in normal ranges except ESR, that was 89. Due to the possibility of a drug reaction, levofloxacin was discontinued and no other antibiotic was used. Oral lesions were managed with mouthwash and after 5 to 7 days, lesions recovered. Conclusions: To the best of our knowledge, this is the first case of a patient who developed stomatitis adverse drug reaction after two doses of levofloxacin and recovered just with topical therapy and without any systemic treatment. Further fluoroquinolone use should be avoided in such patients.

Lichen Planopilaris (LPP) is a primary scarring alopecia with unknown etiology and its management is a challenge for dermatologists. We aimed to compare the safety and efficacy of methotrexate and cyclosporine in LPP patients.In a randomized clinical trials, 33 patients were randomly allocated to receive either 15-mg oral methotrexate per week or 3-5-mg/kg/day cyclosporine for six months. During the treatment course, side effects, signs/symptoms and laboratory test were assessed periodically. Lichen planopilaris activity index (LPPAI) was measured at baseline and 2, 4, and 6 months after the intervention. Score of both photography and patient's opinion were also obtained. The collected data were analyzed in SPSS software (Ver.25.0. Armonk, NY: IBM Corp).Both medications had positive effects on the signs and symptoms of LPP with a significant difference between the variables (p 0.05), and the results showed similar efficacy at the end of 6th months of the therapy with both cyclosporine and methotrexate (p 0.05).Regarding the results of the present study, both cyclosporine and methotrexate are effective in treating refractory lichen planopilaris and we propose methotrexate as a possible earlier choice over cyclosporine. This study was registered in Iranian Registry of Clinical Trials (IRCT20190717044256N1).