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Introduction: Lichen planus (LP) is a chronic inflammatory dermatosis that causes plaques and itchy papules on the skin, as well as erosion and ulcers in the mucous membranes. LP is characterized by a dense dermal T-cell infiltration. Perieccrine inflammation can be seen in a variety of dermatoses, but genuine lymphocyte permeation of the secretory coil or lymphocytic syringotropism is a rare sign that is typically seen in mycosis fungoides. Case Presentation: In this study, we present 2 uncommon instances of lymphocytic syringotropism in LP. Histopathological examination revealed dense T-cell infiltration and lymphocytic involvement of eccrine glands, confirming syringotropism. Conclusion: Lymphocytic syringotropism is an uncommon finding in LP. Its presence broadens the histopathological spectrum of LP and highlights the need to differentiate it from lymphoproliferative disorders like mycosis fungoides.

Abstract Background Dermatofibromas, also known as benign fibrous histiocytomas, are among the most common cutaneous soft-tissue lesions. Association of multiple dermatofibromas with some diseases was described and it has not been reported with Ehlers–Danlos syndrome before. We present a case with Ehlers–Danlos syndrome and multiple dermatofibromas. Case presentation An 18-year-old Iranian woman presented with multiple purple nodules ranging from 0.5 to 1.5 cm in diameter, which were mobile and located on the proximal part of the lower limb. The dimple sign of these lesions was positive. During the physical examination, several features suggestive of Ehlers–Danlos syndrome were observed, including hyperextensibility and fragility of the skin, wide atrophic scars on the upper limb, hypermobility of joints and fingers, swan neck deformities of the digits, nodules on the knee, and striae alba on the leg. The patient was previously unaware of having Ehlers–Danlos syndrome. She had a history of asthma and atopic dermatitis. Family history was negative. A biopsy of the nodular lesions was performed, and the findings confirmed the diagnosis of dermatofibromas. Conclusion We describe a patient with Ehlers–Danlos Syndrome who presented with multiple dermatofibromas. To our knowledge, this combination of findings is a previously unreported occurrence.

Key Clinical Message This case highlights the rare and atypical presentation of giant, multiple pilomatricomas (PMs) with a pseudo‐bullous appearance and lymphangiomatous pathology. It underscores the importance of considering PM in the differential diagnosis of atypical lesions, especially those mimicking cystic or hemorrhagic malignant conditions, to prevent misdiagnosis and ensure appropriate management.

Key Clinical Message Cutaneous leishmaniasis is caused by protozoan parasites of the genus leishmania. Atypical presentation and widespread progression of the lesions may be seen in an immunocompromised patient. We report a case of atypical and widespread cutaneous leishmaniasis in a young woman with breast cancer.

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 Background Dermatologic signs and symptoms can be the manifestations of a single disease or different diseases, and it is proven that some are associated with one another. These connections are not fully understood, but the answer lies in the pathophysiology of each disease. Case presentation We report the case of a 6-year-old Middle-Eastern girl who presented with two skin lesions on the dorsum of her foot, along with scaling of her soles and palms, face skin discoloration, and areas of patchy alopecia on her scalp. She was diagnosed as a case of acute onset of granuloma annulare with alopecia areata and dermatitis. The treatment regimen for the patient’s scalp consisted of topical minoxidil and betamethasone and three sessions with 1-month intervals of triamcinolone acetonide intralesional injections, which demonstrated modest effectiveness in treating alopecia areata. Conclusion Granuloma annulare is a benign inflammatory illness with no known cause that might be difficult to cure. The clinical course and prognosis might vary greatly depending on the disease subtype, and associating symptoms and diseases, such as alopecia areata, should be considered.

Key Clinical Message Necrobiosis lipoidica is a rare cutaneous granulomatous disease that mainly affects diabetic patients. The perforating type of the disease is an uncommon variant that is resistant to therapy and can be easily identified using dermoscopy. Abstract Perforating necrobiosis lipoidica (NL) is a rare NL variant that primarily affects patients with diabetes mellitus (DM). Dermoscopy helps to differentiate this type of disease. The disseminated form of perforating NL mainly occurs in the setting of DM. Here we present a case of disseminated perforating NL in a 24‐year‐old woman with type 1 DM.

Dermal melanocytosis includes several benign pigmented lesions which present as blue-gray color which is a result of the color transmission of melanin pigment through the dermis. While some types are present at birth, there is an acquired variant, acquired dermal melanocytosis (ADM), which usually involves faces of middle-aged Asian women. To the best of our knowledge, there are limited reports of extra facial ADM which all are on the trunk and extremities. Herein, we report a unique case of extra facial ADM affecting the scalp of a middle-aged man and provide a review of all extra facial ADM cases that have been reported.

Abstract Background Fusarium species are saprophytic fungi with a worldwide distribution. These fungi cause various infections among immunocompromised patients; however, they can also involve immunocompetent individuals. Case presentation We report a case of a 41-year-old Iranian woman who presented with ulcerative lesions on her lips 10 months ago. She had a long history of anxiety but had no history of classical risk factors such as trauma, cosmetic lip tattoo, burning in her lips, smoking or use of alcohol and opium. A skin biopsy from the lower lip was performed and sent for microbiological examinations. Hyaline septate hyphae were seen on direct microscopy with potassium hydroxide. The clinical specimen was subcultured on sabouraud dextrose agar with chloramphenicol and prepared for antifungal susceptibility testing and molecular identification. Considering the minimum inhibitory concentrations (MIC) for antifungals, itraconazole (100 mg orally twice a day) was started for her, and after 2 months, the lesions were treated. She followed up for 3 months, and no signs of disease recurrence were observed. Conclusions Selecting an appropriate treatment strategy according to the laboratory assessments is essential in clinical practice and the management of rare infections to prevent related mortality and morbidity of opportunistic fungal infections.

Key Clinical Message Connective tissue nevus is a hamartoma composed of excess amounts of one or several components of the dermis, such as collagen, elastin, and proteoglycans. This report introduces a 14‐year‐old girl with grouped flesh color papules and skin color nodules distributed unilaterally with a dermatomal pattern. These lesions involved more than one segment. Histopathology is the gold standard for diagnosing collagenoma and mucinous nevus. We reported the first case of mucinous nevus with multiple collagenoma that shows the specific clinical features.

Background and aims: Lichen planus (LP) and discoid lupus erythematosus (DLE) are two relatively common mucocutaneous lesions whose clinical and histopathological features overlap in some cases. The present study aimed to distinguish between these two lesions histopathologically in order to treat them more accurately. Methods: In a cross-sectional descriptive-analytical study, 29 and 48 microscopic slides of skin samples of DLE and LP, respectively, were examined in the pathology archive of Al-Zahra hospital of Isfahan from 2008 to 2018. The slides prepared by hematoxylin-eosin staining were examined simultaneously and blindly by three pathologists with a light microscope and compared according to certain histopathological criteria. Then obtained data were analyzed by SPSS version 24 using chi-square, Fisher’s exact, Mann-Whitney, and t tests (P

Abstract Proteus syndrome (PS) is a rare syndrome characterized by asymmetric limb overgrowth, vascular malformation, and hamartomas. In this study we report a case of PS in a 13‐year‐old girl with chief complaint of a new cutaneous lesion that was diagnosed and treated as leishmaniasis.

Abstract Background Umbilical endometriosis is a rare entity accounting for 0.5–4% of cases with endometriosis. Case presentation Here we report a rare case of umbilical endometriosis with concurrent ovarian endometriomas in a 37-year old primiparous Iranian woman. Conclusion This interesting coexistence reflects the importance of thorough gynecological assessment in patients with cutaneous endometriosis to enable appropriate management.

Abstract Sarcoidosis is an inflammatory and granulomatous disorder, developed due to dysregulation between immune response and certain environmental antigens. We hereby report an interesting case of sarcoidosis following COVID‐19 vaccination (COVIran Barekat), which presented with inflammation of previous tattoo sites as well as the development of erythema nodosum and systemic lymphadenopathy, suggested a possible link between the COVID vaccination and dysregulation of the inflammatory process and served as a reminder for clinicians to have enough vigilance before proposing a vaccine booster to these patients.

Abstract Radiotherapy was commonly applied to treat benign skin diseases such as tinea capitis. Some patients treated with radiation have developed skin malignancies over the years. This article reported a 72‐year‐old man presenting with two distinct non‐melanoma skin tumors on his scalp, including squamous cell carcinoma and metastatic pleomorphic sarcoma.

Abstract Development of pemphigus foliaceus (PF) following SARS‐CoV‐2 infection has only been reported in one patient who had received Bamlanivimab and thus might be considered as a drug‐induced case of PF. Here, we reported the first case of PF arising solely after COVID infection without taking any culprit drug.

Abstract Pemphigus vulgaris is an autoimmune bullous dermatosis which if occurred during pregnancy may result in neonatal complications. In this study we report a 41 years old woman with pemphigus vulgaris that triggered by pregnancy in first trimester of pregnancy followed by the premature birth of a healthy neonate.

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.

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

Abstract Herpes Zoster caused by reactivation of latent Varicella–Zoster virus (VZV). The rare disseminated form of it occurred mainly in immunocompromised patients. We hereby present the first case of atypical disseminated herpes zoster in a 54‐year‐old woman admitted with serious COVID. In this case, disseminated herpes zoster developed by purpuric lesions mimicking vasculitis and cutaneous drug reaction. Hence, this case serves as a reminder for considering atypical presentations of cutaneous disorders in immunocompromised patients, especially those affected with severe COVID.

ABSTRACT: Tyrosine kinase inhibitors are anticancer drugs that disrupt signal transduction pathways in protein kinases by different mechanisms. This group of pharmacologic agents has significantly improved the outcome of patients with chronic myeloid leukemia. However, their effect is not limited to cancer cells, and various complications, particularly cutaneous reactions, have been reported. We report a very rare case of a 35-year-old female with a history of chronic myeloid leukemia who presented with elephantine psoriasis after the treatment with nilotinib.Conclusions: This case highlights a critical side effect of tyrosine kinase inhibitors. Awareness of this subject can be useful for better management of similar patients.

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.

Objectives. To investigate the histopathological characteristics of cutaneous melanoma in Isfahan from 2013 to 2018, according to histopathological subtype, lesions location, Clark level, and Breslow thickness. Methods. A descriptive, retrospective study in reports of Alzahra Hospital and Dr. Rajabi Pathology Laboratory in Isfahan. Results. In total, 45 patients were included in this study. The most prevalent histopathological subtype was acral lentiginous melanoma (48.89%), followed by lentigo maligna melanoma (17.78%), nodular melanoma (11.11%), and superficial spreading melanoma (8.89%). Most malignant lesions were on the foot and toes (31.1%) and face (24.4%). Tumor invasion level was mainly at Clark level IV (42.2%). Furthermore, the mean depth of tumor penetration (Breslow thickness) was 3.87 ± 3.35. Conclusions. Our study revealed the characteristics of melanoma in the Iranian population. Our results showed a similar trend with previous studies in the Asian population. Further investigations are needed to elucidate the role of ethnic and environmental risk factors for developing melanoma in different populations.

Leukemia cutis is a rare cutaneous manifestation of chronic lymphocytic leukemia (CLL) which mostly occurs in the late stages of the disease. We reported an unusual case of a patient with leukemia cutis that developed before the diagnosis of CLL and mimicked cutaneous leishmaniasis (CL). A 52-year-old female presented with an ulcerative nodule on the right forearm. The lesion initially was suspected of being cutaneous leishmaniasis; however, the examination of skin lesion biopsy revealed a dense, diffuse, and monomorphous infiltration of lymphocytes in the dermis. Furthermore, immuno-histochemistry analysis of skin lesion biopsy was indicative of small lymphocytic lymphoma (SLL). The result of laboratory tests showed high white blood cell and lymphocyte counts. The results of bone marrow smear, flow cytometric analysis, and computed tomography of the abdomen and pelvis were suggestive of CLL/SLL (stage I). This case has clinical implications for early diagnosis and management of CLL/SLL.

Abstract 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.

Abstract 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.

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 structures. 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 embedded 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.

Abstract 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.

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.

Prurigo pigmentosa (PP) is a rare skin disorder presenting as erythematous urticarial papules on the chest and leaving reticulated pigmentation. Although the etiology of PP is unknown, conditions associated with ketosis such as diabetes mellitus, ketogenic diet (KD), and anorexia nervosa are implicated. Herein, we report a 21-year-old woman who developed PP after adhering to a KD and responded to resuming a regular diet.

The aim of this study was to investigate the relationship between product market competition and the audit fees with regard to the role of corporate governance. Using TOPSIS, a ranking index of companies was made based on corporate governance. The index included six factors: board of director size, board independence, CEO duality tasks, institutional ownership, ownership concentration and independent auditors. The test research hypotheses, multivariate regression analysis and panel data approach with fixed effects is used. Sample includes firms listed in Tehran Stock Exchange (TSE) and Iran Fara Bourse (IFB) market during 2009 to 2014. Findings indicate that there is a positive relationship between product market competition and audit fees and corporate governance mechanisms have the reverse effect on this relation and reduce the strength of this relationship. This means that in competitive environment, business risk is high and so, audit risk and audit fee are increased. However, if client has appropriate corporate governance mechanisms, increase in the audit fee is less.

Abstract 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.

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.