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Atopic dermatitis (AD) is a chronic skin disease that may be triggered by psychological conditions and several allergens. Patients with AD may be experienced disease exacerbation due to the COVID-19 pandemic lifestyle including home-quarantine and increased stress. We obtained the electronic data of 100 AD patients admitted to our hospital from 2016 to 2019 and called them with specific phone line.Out of 100 patients, 43 were male, and 57 were female (mean age±SD: 45.85±16.90). Sixty patients (37 females and 23males; mean age: 42.22±14.71) confronted disease flare-up during the COVID-19 era. Exacerbation of AD was correlated with treatment dose alteration, a lengthy history of atopic dermatitis, eczema duration, self-isolation, frequent handwashing, hand disinfection, and POEM scoring (P

Keratosis lichenoides chronica (KLC) is a rare dermatosis which represents different clinical characteristics between adult‐ and pediatric‐onset cases. We described a childhood case of KLC with features typical for adult‐onset disease. Acitretin led to partial improvement of her skin, but not mucosal, lesions., Keratosis lichenoides chronica (KLC) is a rare dermatosis which often manifests in adults and less commonly in childhood. Although its manifestation in children is described to be distinct from that of adults, its presentation could be analogous in both.

Osteoma cutis (OC) or cutaneous ossification refers to uncommon bone formation in the skin. Primary OC develops without any predisposing factor or pre-existing lesion, whereas secondary OC sets out as a dystrophic ossification following traumatic, cicatricial, and neoplastic factors or other cutaneous inflammations. Herein, we report a rare case of long-standing progressive primary OC of the scalp resected in 3 sessions with no recurrence after 1 year.

Background Subcision, also known as subcutaneous incisionless surgery, is a surgical intervention used to treat a variety of skin conditions including atrophic acne scars, depressed scars, cellulite, and wrinkles. Aims We plan to prepare a review article about the indications of subcision, its adverse reactions, and pearls. Patients/methods We searched the literature for the information about subcision and its applications from papers published up to March 2019. The search was performed through the databases of the National Library of Medicine. Results After a thorough review of the published papers about subcision, we finally chose to review 40 articles that had proper sample size and design to prepare this review article. Twenty-one papers were related to the application of subcision in the treatment of acne scar and other scars. Four articles were about the application of subcision to treat cellulite, and eight articles were related to other applications of subcision such as the treatment of striae or nasolabial fold. The remaining seven articles include published review papers about subcision or acne scar classification. Conclusion Subcision seems to be effective on various skin conditions including acne scar, other depressed scars, and cellulite. It is easy to apply and inexpensive with short downtime and no significant complications. Subcision needs proper technique and adequate experience.

Background The management of melasma is still challenging, and new treatment modalities with favorable side effect profile are required. Methimazole, a peroxidase inhibitor, seems to have a beneficial effect in the management of melasma but there is a paucity of studies for evaluation of its efficacy. This double-blinded trial was aimed to evaluate the efficacy and safety of methimazole vs hydroquinone 4% which is the gold standard treatment in the management of melasma. Methods Fifty patients with melasma were enrolled and randomly divided into two groups to receive 4% hydroquinone or 5% methimazole once daily for 8 weeks. Forty patients completed the study. The clinical response was assessed at 4th, 8th, and 12th weeks after treatment by MASI score, patient satisfaction, and physician scores. Results Both groups showed a reduction in the MASI score at the 8th week which was more significant in hydroquinone group but higher relapse rate was also observed in this group after discontinuing the drug. The side effects were similar between groups. Also, patient and physician satisfaction scores were also more in favor of hydroquinone 4%. Conclusion Methimazole could be an alternative treatment of melasma alone or in combination with other depigmenting drugs. Although not as effective as hydroquinone, the noncytotoxic and nonmutagenic aspects of methimazole may make it a promising alternative for the treatment of melasma.

BACKGROUND Facial papules (FPs) are considered to be created by the inflammatory process, which involves facial vellus hairs, in frontal fibrosing alopecia. AIM To demonstrate the histopathological features of FPs and the composition of the inflammatory infiltrate. METHODS In total, 18 patients with FPs were enrolled in the study after histopathological confirmation of lichen planopilaris. Histopathological evaluation of the specimens was performed by two dermatopathologists. The samples were immunostained with CD4, CD8 and CD123 monoclonal antibodies, and the percentage and proportion of cells stained with these markers were investigated. RESULTS A follicular lichenoid reaction and perifollicular fibrosis were present in all cases. Vellus hairs were detected in 83.3% of biopsy specimens (15 cases), all of which were involved by the inflammation. The majority of the follicles (72%) revealed follicular plugs. Reduction and destruction of elastic fibres were visible in the perifollicular (adventitial) and the papillary dermis (100% and 78% of specimens, respectively). Prominent sebaceous glands and dilated ducts were detected in 78% and 72% of samples, respectively. CD4-positive T cells formed 67.72% and CD8-positive T cells 32.28% of the infiltrate, and the mean CD4/CD8 ratio was 2.48. In 13 (72.2%) biopsy specimens

Although Necrotizing fasciitis can evolve from a trivial lesion, whenever it develops it requires a prompt surgical intervention and broad‐spectrum antibiotic therapy.

In-hospital transmission is one of the main routes of the 2019 novel coronavirus (SARS-CoV-2) spreading among health care workers (HCWs) who are the frontline fighters. However, coming into contact with COVID-19-positive patients is unavoidable. Therefore, hand hygiene is of utmost importance for the prevention of COVID-19 among HCWs. This purpose can be achieved by applying alcohol-based hand rubs, washing hands properly with soap and water, and applying other antiseptic agents. Nevertheless, regular hand hygiene could also be challenging, because water, detergents, and disinfectants may predispose HCWs to hand dermatitis. The current article reviews the risk factors for the development of hand dermatitis, with further focus on the most common agents used among HCWs. In addition, the risk of occupational hand dermatitis for each agent is evaluated to increase awareness of this common condition. Finally, some recommendations are discussed to reduce the effect of hand dermatitis on HCWs.

Pyodermatitis-pyostomatitis vegetans is a rare inflammatory dermatosis. There is a strong association between pyodermatitis-pyostomatitis vegetans and inflammatory bowel disease, particularly ulcerative colitis. Herein, we report a case of pyodermatitis-pyostomatitis vegetans with positive direct immunofluorescence staining findings and review the literature for the past 18 years to characterize the disease, its epidemiologic characteristics, its associations, and the pathology and direct and indirect immunofluorescence findings. The total number of cases was 38, including 22 men and 16 women, with an average age of forty. Direct immunofluorescence staining had been performed for 32 patients, of which 12 had positive findings. Of those with positive direct immunofluorescence, 6 patients showed IgA cell surface staining. A recent approach suggests that these immunological findings may not be accidental and indicates a possible overlap with autoimmune bullous diseases discussed in this review.

BACKGROUND Microneedling and fractional lasers have been used in facial rejuvenation with acceptable results and low adverse effects. AIMS To compare the efficacy of microneedling with fractional Er:YAG in facial skin rejuvenation. PATIENTS/METHODS This study was planned as a split-face clinical trial. Volunteers were randomly allocated to receive three monthly treatments on each side of the face, one with fractional Er:YAG laser and one with microneedling. The assessments included investigating clinical outcomes by two blinded dermatologists accompanied by measuring skin biophysical characteristics including cutaneous resonance running time (CRRT) and transepidermal water loss (TEWL). Moreover, possible adverse effects, downtime, and patients' satisfaction were recorded at baseline, 1 month after each treatment, and 3 months after the last treatment session. The protocol was approved by the Iranian Registry of Clinical Trials (IRCT20160820029436N3). RESULTS Of the 32 selected volunteers, 24 subjects completed the study. The clinical assessment showed a significant improvement of the face appearance along with a significant reduction in dyschromia, and periorbital wrinkling (P-value

Neutrophil or platelet to lymphocyte ratio (NLR and PLR) has been proposed to be used as prognostic purposes in a variety of diseases. The aim of this study was to evaluate the usefulness of these ratios in monitoring of response to TNF-α-inhibitors in psoriatic patients. Eighty psoriatic patients were included and treated with TNF-α-inhibitors for 12 months based on drug protocol. Hematologic indices, including NLR and PLR values were assessed before and after treatment. Data on psoriasis area and severity index (PASI), smoking behavior, alcohol intake habit, nail abnormality, body mass index (BMI), joint involvement, and disease duration were also recorded. PASI scores were improved significantly after one-year treatment (P = .000). Furthermore, this type of treatment significantly reduced the NLR and PLR (P = .000). These changes were in accordance with PASI scores. Patients with BMI greater than 24.9 had higher, but non-significant NLR and PLR than normal or lean individuals. Cigarette smokers and alcohol consumers had lower NLR and PLR values than other individuals (P < .05). There was no significant association between NLR and PLR and joint or nail involvement. Although NLR and PLR will not be helpful in primary diagnosis of inflammatory diseases, they could be accounted as monitoring tools in management of psoriasis or globally indicators of inflammation.

Purpose Lichen planopilaris (LPP) is a chronic lymphocytic- mediated disorder that selectively involves hair follicles, leading to cicatricial alopecia. The eyelash follicle and meibomian gland (MG) might also be involved in the disease process leading to ocular surface problems. Methods In this Cross-sectional case -control study, twenty-three patients with histologically confirmed LPP and 23 healthy controls were recruited in this controlled study. To quantify the signs and symptoms of LPP, we used the Lichen Planopilaris Activity Index. The ophthalmologic examination was performed by the same ophthalmologist at Farabi Eye Hospital. Results Patients with LPP had a statistically significant lower tear breakup time (worse test outcome) compared with the control (7.1 6 4.1 vs. 9.6 6 4.4; respectively, P = 0.011). Both MG quality score and expressibility were higher in patients with LPP than in control subjects (14.1 6 4.3 vs. 9.3 6 4.4; P = 0.001; 1.5 6 1.0 vs. 0.4 6 0.8; P = 0.001; respectively). The Schirmer test score was not different between groups. A significant but weak correlation was found between the Lichen Planopilaris Activity Index and tear breakup time. Other ophthalmologic examinations including conjunctiva, lid margin shape, intraocular pressure, and funduscopy were normal in patients with LPP. Conclusions Patients with LPP, scored worse in ocular surface tests. This finding warrants special scrutiny for dry eye and MG dysfunction in these patients.

Sir,The immunosuppressive drugs used for the treatment of psoriasis may affect the clinical presentation and outcome of COVID-19 infection (1). Herein, we report a 73-year-old male patient with sev...

Papulonecrotic tuberculid (PNT) is a relatively rare subtype of cutaneous tuberculosis believed to represent a hypersensitivity reaction to tuberculosis antigens. Yet, the simultaneous occurrence of PNT and Erythema Induratum (EI) is even more uncommon. Here, we present a case of concomitant PNT and EI in a 53-year-old woman without any previous history of Mycobacterium tuberculosis infection who was successfully treated with anti-tuberculosis agents without recurrence in a subsequent follow-up

Steroid pulse therapy has shown satisfactory efficacy and safety in treating pemphigus vulgaris (PV). However, there is a paucity of data about the efficacy and safety of methylprednisolone, despite its frequent administration. The aim of this study is to evaluate the efficacy and safety of steroid pulse therapy in treating PV. In this 10-year retrospective cohort study, 312 patients with PV, who had received methylprednisolone pulse therapy, were included. Data of pulse therapy sessions, adjuvant medications, dosages, remission rates, complications, and mortalities were collected from all patients. A total of 276 patients out of 312 underwent the final follow-up at least 6 months after the last session of pulse therapy. Complete remission off therapy was achieved in 83 patients (30%), and 152 patients (55%) had complete remission on therapy. About 29 (10.5%) patients had lesions of pemphigus at the time of the study follow-up, and 26.8% of remained patients were on the minimal therapy. Methylprednisolone pulse therapy could be considered as an option for proper control of PV in severe cases. It might lead to shorter periods of hospitalization and reduce the need to take long-term high-dose oral steroid therapy.

Background/aim: Acute unintentional and deliberate poisoning by medications and chemicals is a frequent emergency, especially in Iran. This study aimed to evaluate the frequency and character of skin findings occurring in patients with acute intentional and aunintentional poisoning. Materials and methods: This prospective observational study was performed at the Loghman Hakim Hospital Poison Center over a period of 6 months from April 2016 to September 2016. Data including patient demographics, cause of poisoning, and level of consciousness were collected. Pediatric patients (under the age of 13) and patients who died in the first hours of admission were excluded from the study. Results: The most common cause of toxicity-related admission in our patients was methadone overdose. The most common skin finding in these patients was xerosis. According to our results, there was an association between tramadol poisoning and self-induced lesions. Shin hyperpigmentation was found to be significantly more frequent in patients with lead poisoning. Conclusion: Further study is recommended to shed light on the possible association of drug poisoning and skin lesions.

SummaryBackground and aim A comprehensive study comparing two different modalities, Nokor needle subcision (NNS) and blunt cannula subcision (BCS), for treatment of acne scars, has not been reported previously. The aim was to compare the effectiveness of these two methods based on patient's and doctor's satisfaction measures, in addition to the late complications 3 months postsubcision. Method of intervention Patients had 18-65 years old, with acne scars on both malar sides. They were treated at one malar side with NNS and with BCS at another side. They were monitored during the first week, at one and 3 months postintervention. Patient's and two dermatologist's satisfactions were compared during 3 months, for each modality and between modalities. Results From 34 patients, 29.4%, 55.9%, and 14.7% had mild, moderate, and severe acne scars, respectively. Ecchymosis, nodule formation post-NNS, and edema after BCS were the complications. Patients were satisfied with BCS during 3-month monitoring (P = .021), but not with NNS (P = .353). Physician-1 was satisfied from the outcome of both BCS and NNS procedures (P = .044 and .006, respectively). However, physician-2 was only satisfied with NNS at the month 3 than the month 1 (P = .002). All patients and physicians were significantly more satisfied with BCS than NNS (P = .000). Anyway, at the month 3, physician-2 had no significant different points of view about applied methods (P = .25). Discussion Considering the complications and satisfaction rates, BCS was more efficient than NNS for acne scar treatment. Then, we suggest BCS as a good replacement for NNS.

Systemic sclerosis (SSc) is a rare systemic autoimmune disease, characterized by progressive cutaneous and internal organ fibrosis. Orofacial manifestations of systemic sclerosis are extremely disabling and treatment options are limited. In this study, we aimed to assess the safety and efficacy of autologous fat grafting in the face of patients with systemic sclerosis. We enrolled 16 SSc patients suffering from facial sclerosis and limited mouth opening capacity. Autologous fat injection ranging from 15 to 40 ml was administered per patient, based on their face morphology. The patients were evaluated at baseline and 3 months after fat injection. Evaluations included mouth opening capacity, mouth handicap in systemic sclerosis (MHISS), Rodnan skin sclerosis score, skin biophysical properties using a sensitive biometrologic device with the assessment of cutaneous resonance running time (CRRT), volumizing and aesthetic effects based on pre- and posttreatment photographs, possible side effects, and global patient satisfaction. Clinical assessment showed autologous fat transfer significantly improved mouth opening capacity and the MHISS and Rodnan score of patients with facial scleroderma (p value

Isotretinoin has revolutionized the treatment of acne by improving the cosmetic outcome and decreasing the psychological damage. However, use of isotretinoin is associated with significant side-effects such as mucocutaneous involvement, dyslipidaemia and liver dysfunction, as indicated by increases in liver enzymes. The responsible enzyme for homocysteine metabolism, cystathionine-beta-synthase, might also be affected by isotretinoin-induced liver dysfunction, which leads to hyperhomocysteinaemia, an independent risk factor for thrombovascular diseases. The aim of this study was to evaluate homocysteine levels and the responsible vitamins for its metabolism in patients with moderate to severe acne vulgaris on isotretinoin treatment, before and after treatment. We found increased level of homocysteine in patients after 2 months of taking isotretinoin. Our findings suggest that isotretinoin may increase the risk of cardiovascular disorders by causing hyperhomocysteinaemia.