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Kathren H Shango,1 Fouad A Abdole,1 Sarah M Gonzalez,1 Mehdi Farshchian,2 Meena Moossavi2 1Wayne State University School of Medicine, Detroit, MI, USA; 2Department of Dermatology, Wayne State University, Detroit, MI, USACorrespondence: Mehdi Farshchian, Department of Dermatology, Wayne State University, 18100 Oakwood Blvd., Suite 300, Dearborn, MI, 48124, USA, Email mfarshch@med.wayne.eduPurpose: To evaluate medical student confidence in diagnosing dermatologic diseases in skin of color.Methods: A voluntary supplemental module was implemented as part of the second-year dermatology curriculum at Wayne State University School of Medicine (WSU SOM) in Detroit, Michigan. The goal of the module was to ascertain whether it may increase confidence in students with their approach to diagnosing diseases in darker skin tones.Results: Seventy-seven of 295 students (26%) completed a “Skin of Color” optional module consisting of thirteen cases of common skin pathologies in African American patients. A pre- and post-survey performed to assess students’ confidence using a five-point Likert scale. After completing the module, medical students demonstrated a statistically significant increase in confidence in diagnosing skin pathologies in skin of color.Conclusion: Dermatology pre-clinical course work should include supplementary materials to increase student confidence in diagnosing skin diseases in darker skin tones.Keywords: medical education, health disparities, epidemiology, skin of color

Sabrina E Dass,1 Taryn Huizenga,2 Mehdi Farshchian,2 Darius R Mehregan2 1Wayne State University School of Medicine, Detroit, MI, USA; 2Department of Dermatology, Wayne State University, Detroit, MI, USACorrespondence: Mehdi FarshchianDepartment of Dermatology, Wayne State University, 18100 Oakwood Blvd., Suite 300, Detroit, MI, 48124, USAEmail mfarshch@med.wayne.eduPurpose: Different immunohistochemical stains are used in dermatopathology to stain melanocytes and diagnose benign and malignant melanocytic lesions.Methods: SOX-10, HMB-45, and Melan-A immunohistochemical stains were used to assess 32 biopsy specimens with a histologic diagnosis of lentigo. The total number of melanocytes stained with each immunohistochemical stain was counted and an average count was obtained from two readings.Results: Analysis of the data revealed a significant difference in staining melanocytes between these three immunostains (p=0.0010, ANOVA). SOX-10 stained 0.195 more melanocytes than HMB-45 (p=0.0026). Similarly, Melan-A stained 0.195 more melanocytes than HMB-45 (p=0.0011). However, the difference between SOX-10 and Melan-A was not statistically significant (p=0.9810).Conclusion: SOX-10 and Melan-A immunostaining stain more melanocytes than HMB-45. No significant difference was noted between Melan-A and SOX-10.Keywords: immunohistochemical stains, melanocytes, benign melanocytic lesion, lentigo, atypical junctional melanocytic hyperplasia

Joshua Brady,1 Reem Kashlan,1 Julie Ruterbusch,2 Mehdi Farshchian,3 Meena Moossavi3 1Wayne State University School of Medicine, Detroit, MI, USA; 2Department of Oncology, Wayne State University, Detroit, MI, USA; 3Department of Dermatology, Wayne State University, Detroit, MI, USACorrespondence: Mehdi FarshchianDepartment of Dermatology, Wayne State University, 18100 Oakwood Blvd., Suite 300, Dearborn, MI, 48124 Email mfarshch@med.wayne.eduPurpose: As the most common cause of skin cancer death, incidence and mortality of melanoma vary widely between ethnic and racial groups.Methods: Surveillance, Epidemiology, and End Results (SEER) data were used to examine the incidence and survival in patients with melanoma concerning race and ethnicity in Wayne County, Michigan between 2000 and 2016.Results: Analysis of data revealed significantly higher melanoma-specific death in non-Hispanic black patients compared to their non-Hispanic white counterparts (p < 0.001). However, no increased risk of death due to melanoma was observed following adjustment of data for the stage, age, and sex (H.R. = 1.00, 95% CI 0.64– 1.56).Conclusion: Non-Hispanic black patients have the highest percentage of late-stage melanoma. Increased incidence of melanoma mortality in non-Hispanic black patients is likely a consequence of late-stage diagnosis.Keywords: melanoma, racial disparities, epidemiology, clinical research, skin of color

Mohammadreza Sobhan, Mahmoud Farshchian Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences, Hamadan, Iran Objective: Compared with healthy people, overweight and obesity are more commonly found among those suffering from skin conditions such as psoriasis. The present study was an attempt to survey the relationship between obesity and intensity of psoriasis.Patients and methods: A total of 42 patients with psoriasis who were referred to Farshchian Hospital, Hamadan, participated in this cross-sectional descriptive–analytical study. Patients were classified into mild, moderate and severe based on the intensity of the disease measured by Psoriasis Area and Severity Index (PASI). Body mass index (BMI), waist size, age, gender, smoking and drinking habits of the participants were measured and compared.Results: A total of 15 (35.07%) patients had mild psoriasis, 9 (21.4%) patients had moderate psoriasis and 18 (42.9%) patients suffered from severe psoriasis. Mean BMI of mild psoriasis patients was 25.86±5.93 kg/m2, and this figure for the moderate and severe psoriasis patients was 30.85±3.77 kg/m2 and 26.96±5.68 kg/m2, respectively (P=0.096). Mean waist size of the mild psoriasis patients was 91.54±11.49 cm, and for moderate and severe patients, it was 99±8.39 cm and 92.17±10.73 cm, respectively (P=0.211).Conclusion: The results of this study showed no significant difference between mean value of body mass index, waist size, age and gender in mild, moderate and severe groups of the psoriasis patients. Keywords: psoriasis, body mass index, PASI measure

Pedram Alirezaei, Mahmood Farshchian Department of Dermatology, Psoriasis Research Center, Farshchian Hospital, Hamadan University of Medical Sciences, Hamadan, Iran Background: Granuloma annulare is a benign inflammatory disease of the skin. The etiology and pathogenesis of the disease are not yet determined, but some authors have proposed that it might be associated with a variety of underlying conditions such as thyroid disorders, diabetes mellitus and positive tuberculin skin test. Objective: This study was conducted to find the probable relationship between granuloma annulare and diabetes mellitus, thyroid disorders and positive tuberculin skin test. Patients and methods: A total of 28 patients with granuloma annulare were recruited from our dermatology outpatient clinic, and data on sex, age and distribution of granuloma annulare lesions were collected. Forty-one age- and sex-matched apparently healthy volunteers serving as controls were also included. Thyroid stimulating hormone (TSH), fasting blood sugar (FBS) and tuberculin skin tests were performed for both groups. Results: Mean serum level of FBS in the patient group was significantly higher than the mean serum level of FBS in the control group (110.60±46.31 mg/dL versus 88.39±10.58 mg/dL, respectively, p=0.004). Mean serum level of TSH in the patient group was 3.43±2.73 mIU/L, which was not significantly different from the mean serum level of TSH in the control group (3.26±2.11 mIU/L, p=0.772). Four individuals in the patient group and only 1 in the control group had a positive tuberculin skin test. Conclusion: Granuloma annulare patients are better to be assessed for diabetes mellitus, but the relationship between this skin disease and thyroid disorders or tuberculin skin test still needs to be investigated. Keywords: granuloma annulare, thyroid, diabetes mellitus, tuberculin skin test

Mohammadreza Sobhan, Mahmood Farshchian, Maryam TamimiPsoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences, Hamadan, IranBackground: Autoimmune bullous diseases (ABDs) represent a group of rare, acquired disorders characterized by overlapping features with involvement of the skin and mucous membranes, resistance to treatment, and potential lethality that comprise pemphigus, bullous pemphigoid (BP), epidermolysis bullosa, dermatitis herpetiformis, and linear immunoglobulin A bullous dermatosis.Aim: The main aim of this study was to identify the epidemiologic characteristics and clinical courses of these common diseases in Hamadan, Iran. Few surveys have been carried out to demonstrate the whole spectrum of ABDs in the literature. Notably, in Hamadan we are the first.Materials and methods: This 13-year retrospective study was designed to evaluate all of documented data obtained from hospitalized patients with ABDs at Farshchian Hospital from October 1999 to October 2012. We collected information on epidemiologic data, clinical aspects, histologic findings, and therapy prescribed. Data were analyzed using SPSS.Results: Of 168 patients, 78% had pemphigus. The age of patients at presentation ranged from 1 month to 115 years, with a mean of 47.5±19.93 years. Mucosal or skin involvement of ABDs was statistically significant (P

Mahmoud Farshchian, Akram Ansar, Mohammadreza Sobhan Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences, Hamadan, Iran Background: Psoriasis is a common chronic inflammatory skin disease. There is overwhelming evidence on the higher risk of cardiovascular diseases in patients with psoriasis as a result of hyperlipidemia, which is more common in these patients. Objectives: The aim of this study was to elucidate the association between the cardiovascular risk factors and psoriasis. Methods: In a cross-sectional study, 55 patients with psoriasis and 55 matched (sex and age) controls were entered the study at the Department of Dermatology between March 2011 and March 2013. Blood samples were obtained following 14 hours fasting status and serum levels of triglyceride, cholesterol, high-density lipoprotein, and low-density lipoprotein were determined using standard laboratory methods, and other variables such as sex, age, smoking, alcohol consumption, and the type of disease were recorded. Results: Our findings showed that levels of triglyceride, low-density lipoprotein, and smoking were significantly higher in psoriatic patients when compared with controls, whereas the level of high-density lipoprotein and cholesterol was not significantly different between two groups. Body mass index of psoriatic patients was not significantly higher than controls. Patients with psoriasis also had an increased prevalence of hypertension. Conclusion: Our findings further verify lipid abnormalities in psoriatic patients. Psoriasis is associated with higher rate of hypertension, which may be resulted in increasing the risk of cardiovascular diseases in these patients. Thus, serum lipid profile and blood pressure in all patients with psoriasis, regardless of disease severity, deserve consideration to be checked. Keywords: cardiovascular disease, risk factors, psoriasis, lipid profile

Mahmood Farshchian,1 Akram Ansar,1 Abbas Zamanian,2 Ghasem Rahmatpour-Rokni,1 Arash Kimyai-Asadi,3 Mehdi Farshchian1,4 1Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences, Hamedan, Iran; 2Department of Dermatology, Iran University of Medical Sciences, Tehran, Iran; 3Derm Surgery Associates, Houston, TX, USA; 4Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland Background: The aim of this study was to analyze the clinical characteristics of patients with adverse cutaneous drug reactions, which occur when a medicinal product results in cutaneous morbidity. Methods: The study included 308 patients who were diagnosed as having an adverse cutaneous drug reaction during the study period (2007–2009). In 84 cases, histopathologic examination of skin biopsies were also performed. Results: Patients with drug reactions were found to be more commonly female (63%) than male (37%). Beta-lactam antibiotics were found to be the most frequent cause of adverse cutaneous drug reactions (42.7%), followed by non-steroidal anti-inflammatory drugs (16.5%). Acute urticaria was the most common clinical presentation (59.2%) followed by fixed drug eruptions (18.5%), and maculopapular eruptions (14.9%). Conclusion: Adverse cutaneous drug reactions in our study population were mainly induced by beta-lactam antibiotics and non-steroidal anti-inflammatory drugs. The most common forms of cutaneous adverse drug reactions were found to be acute urticaria, fixed drug eruptions, and maculopapular rashes. Keywords: adverse drug reaction, acute urticaria, exanthematous eruption

Summary: Background: The incidence of epidermal keratinocyte‐derived cutaneous squamous cell carcinoma (cSCC) is increasing worldwide. Objectives: To study the role of the complement classical pathway components C1q, C1r and C1s in the progression of cSCC. Methods: The mRNA levels of C1Q subunits and C1R and C1S in cSCC cell lines, normal human epidermal keratinocytes, cSCC tumours in vivo and normal skin were analysed with quantitative real‐time polymerase chain reaction. The production of C1r and C1s was determined with Western blotting. The expression of C1r and C1s in tissue samples in vivo was analysed with immunohistochemistry and further investigated in human cSCC xenografts by knocking down C1r and C1s. Results: Significantly elevated C1R and C1S mRNA levels and production of C1r and C1s were detected in cSCC cells, compared with normal human epidermal keratinocytes. The mRNA levels of C1R and C1S were markedly elevated in cSCC tumours in vivo compared with normal skin. Abundant expression of C1r and C1s by tumour cells was detected in invasive sporadic cSCCs and recessive dystrophic epidermolysis bullosa‐associated cSCCs, whereas the expression of C1r and C1s was lower in cSCC in situ, actinic keratosis and normal skin. Knockdown of C1r and C1s expression in cSCC cells inhibited activation of extracellular signal‐related kinase 1/2 and Akt, promoted apoptosis of cSCC cells and significantly suppressed growth and vascularization of human cSCC xenograft tumours in vivo. Conclusions: These results provide evidence for the role of tumour‐cell‐derived C1r and C1s in the progression of cSCC and identify them as biomarkers and putative therapeutic targets in cSCC. What's already known about this topic? The incidences of actinic keratosis, cutaneous squamous cell carcinoma (cSCC) in situ and invasive cSCC are increasing globally.Few specific biomarkers for progression of cSCC have been identified, and no biological markers are in clinical use to predict the aggressiveness of actinic keratosis, cSCC in situ and invasive cSCC. What does this study add? Our results provide novel evidence for the role of complement classical pathway components C1r and C1s in the progression of cSCC. What is the translational message? Our results identify complement classical pathway components C1r and C1s as biomarkers and putative therapeutic targets in cSCC. Linked Comment: Kopecki. Br J Dermatol 2020; 182:530–531. Plain language summary available online [ABSTRACT FROM AUTHOR]