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Among therapeutic modalities of acne scars, subcision is a simple, safe procedure with a different and basic mechanism for correcting atrophic and depressed scars. Subcision releases scar surfaces from underlying attachments and induces connective tissue formation beneath the scar directly, without injury to the skin surface. Therefore, subcision is a valuable method, but due to high recurrence rate, its efficacy is mild to moderate. To increase the efficacy of subcision, a new complementary treatment of repeated suction sessions was added at the recurrence period of subcised scars. In this before and after trail, 58 patients with mild to severe acne scars of various types (rolling, superficial and deep boxcar, pitted), chicken pox, traumatic and surgical depressed scars were treated by superficial dermal undermining, with mainly 23-guage needles. The protocol for suctioning was: start of suction on third day after subcision for flat and depressing subcised scars and its continuation at least every other day for 2 weeks. Forty-six patients followed the protocol completely, had 60-90% improvement in depth and size of scars (significant improvement) with mean: 71.73%. 28.2% of them had '80% improvement or more' (excellent improvement). Twelve patients started suction late and/or had long interval suction-sessions, had 30-60% improvement (moderate improvement) with mean: 43.75%. Frequent suctioning at the recurrence period of subcision increases subcision efficacy remarkably and causes significant and persistent improvement in short time, without considerable complication, in depressed scars of the face. Therefore, subcision-suction method is introduced as a new effective treatment. [ABSTRACT FROM AUTHOR]

A family presented to our dermatology clinic with a complaint of white nails. Physical examination revealed clinical feature of leukonychia totalis and the presence of sensorineural hearing loss, palmo plantar keratoderma and knuckle pads (four essential criteria for the diagnosis of Bart Pumphrey syndrome).Three consecutive generations of this family were affected with variable presentations of Bart Pumphrey syndrome in male and female; and autosomal dominant pattern of inheritance.

Tinea corporis is a superficial fungal infection of the keratinized epithelial layer, presenting as erythematous scaling patches with central clearing. Sometimes it can resemble other skin disorders, so its misdiagnosis constitutes a problem of considerable practical importance. We describe a patient who presented with widespread Tinea corporis that morphology and distribution of the lesions mimicked lupus erythematosus and/or photodermatosis.

Background: Vitiligo is a commonly acquired autoimmune pigmentary disorder. Some patients resist conventional treatments, leading to the search for combination therapies., Aims: This study aimed to compare the efficacy of 308-nm excimer laser monotherapy versus combined treatment with topical bimatoprost 0.03% in patients with facial vitiligo., Patients and Methods: A single-blind randomized clinical trial was conducted at Razi Hospital, Tehran, on 38 patients with facial vitiligo who had at least one facial vitiligo patch and had not undergone treatment in the past 3 months. The patients were randomly allocated to either the intervention group (n = 18) or the control group (n = 20). Both groups received 308-nm EL therapy twice weekly for 15 weeks, while the intervention group additionally applied 0.03% bimatoprost solution daily. The patients were visited at the end of every 5 weeks and after the 15th week. Efficacy was evaluated using the scale for improvement assessment (SAI), visual analog scale satisfaction (VASS), and visual analog scale improvement (VASI). Data analysis was performed using the Mann-Whitney and t-tests, with a significance level set at p < 0.05., Results: Of the total patients, 27 (71.05%) were female and 11 (28.95%) were male. The male-to-female ratio was 50% in the intervention group and 33.33% in the control group. The mean VASI score, as the primary outcome, showed a significant increase over time in the intervention group (p ≤ 0.001), increasing from 4.53 to 7.20 (an increase of 2.67 units). Additionally, the intervention had a significant effect on the VASI outcome compared to the control (p ≤ 0.001; mean difference: 2.55 [1.63 to 3.47]). As the secondary outcomes, the mean VASS and SAI scores significantly decreased over time in the intervention group (p ≤ 0.05). The intervention also significantly affected the VASS and SAI outcomes compared to the control (p ≤ 0.001). The side effects of the intervention group were hypertrichosis in three patients and erythema burning in one patient., Conclusions: Adding bimatoprost 0.03% to the treatment regimen may improve the outcomes of patients with facial vitiligo who are resistant to conventional treatments., (© 2025 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Introduction: Hailey-Hailey disease (HHD) is a rare inherited blistering skin disorder characterized by a chronic relapsing course. While it does not pose a serious threat to the patient's health, the quality of life can change. Unfortunately, there is currently no standard treatment for this condition., Objectives: In this observational retrospective cohort study, our aim was to discover the demographic characteristics and treatment strategies for managing HHD., Methods: In this retrospective cohort study, we documented the demographic, clinical, and histopathological characteristics beside various treatment employed options of patients diagnosed with HHD at Razi Hospital over the past 14 years., Results: A total of 32 patients with HHD were enrolled in the study (15 male and 17 female). The mean age of patients was 50.41 ± 13.15 (22-77) years. The average age of disease onset was 37.31 ± 11.88 (15-60) years. Among the participants, 16 individuals (50%) affirm a positive family history of some kind of pemphigoid blisters. The most common site of disease activity was the inguinal area, observed in 14 patients (33.33%). Histopathological examination discovered the existence of suprabasal acantholysis in all of the specimens. Worthily, direct immunofluorescence analysis showed negative results in all skin biopsies. All patients received topical steroids and either topical or systemic antimicrobial agents. In cases of flares, systemic steroids were the most popular and favorable treatment choice during flares., Conclusion: Indeed, Hailey-Hailey disease, characterized by its chronic inflammatory and rare nature with a relapsing and remitting course, poses a significant challenge for dermatologists. The treatment of HHD has been less than satisfactory and it often presents a challenge and could be misdiagnosed. Among the available treatment options, topical steroids and antimicrobial agents are the most administered therapies.

Introduction: Vitiligo is a common pigmentation disorder manifested by white macules and patches. It is accompanied by some autoimmune and neurological diseases. Recently, it has been suggested that multiple sclerosis (MS) is more common in vitiligo patients and that they have a higher risk of developing MS during their lifetime., Objectives: In this study, we aimed to determine the prevalence of MS in patients with vitiligo and their first-degree relatives and compare it with the prevalence in the population., Methods: In this cross-sectional study, data were consecutively collected from patients referred to Razi Hospital from March 2020 to December 2021., Results: Seven hundred and nine patients with vitiligo participated in this study, and 15 reported a history of MS (2.12%, 95% confidence interval [CI] 1.06%-3.17%). This rate was significantly higher than the prevalence of MS in the average population of Tehran (P < 0.001). Of the 2886 first-degree relatives of the patients, 10 had MS (0.35%, 95%CI 0.13&-0.56%), which was higher than the prevalence of MS, yet not statistically significant., Conclusions: A significant association between vitiligo and MS was observed, which should be of clinical and therapeutic importance. However, the prevalence of MS in first-degree relatives of vitiligo patients was higher than the average rate, yet not statistically significant.

Background: Acne scar is an inflammatory condition, which commonly occurs in patients with acne vulgaris, especially in adults. Mesogels have been reported effective in improving atrophic acne scars., Aims: We investigated the efficacy of adding Profhilo (a hyaluronic acid-based filler) to subcision as a new treatment method., Methods: Twelve patients aged 18-45 years with atrophic acne scars on both sides of the face participated in this single-blinded, split-face, randomized controlled trial. Each side of the face was randomly assigned to one of the treatment methods, including subcision alone and subcision + Profhilo. Patients in the Profhilo arm received mesogel (1 cc) in addition to the subcision procedure. Both methods were carried out two times at 1-month intervals. Assessments were done based on the sonographic depth of scars, and two blinded observers examined photographs at baseline and 3 months after the final session and the results were reported based on an exclusively made formula as the total score. The Global Improvement Scale and Visual Analogue Scale (VAS) (for patient satisfaction) were also used., Results: The VAS score of patient satisfaction was statistically significant in the Profhilo arm, with a mean improvement of 528.08 and 219.06 in the subcision arm (p = 0.02). No significant difference was seen in total acne scar reduction comparing the two methods (29.74 in the Profhilo arm and 22.27 in the subcision arm, p = 0.56). Sonographic depth reduction was also non-significant, with a mean of 29.21 in the Profhilo arm and 28.53 in the subcision arm (p = 0.4). The mean global improvement was reported as four in both arms, and no statistical significance was observed (p = 0.89). The best response to treatment belonged to the rolling subtype in both methods (p = 0.029 for the Profhilo arm and p = 0.001 for the subcision arm)., Conclusion: Despite no significant difference between the methods, Profhilo is more effective due to a higher satisfaction rate and better physiologic effects., (© 2024 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Vitiligo is an acquired skin disease with a worldwide prevalence of 0.5%-2% and a tendency to involve both genders. Although the exact pathologic mechanism is unknown, there is some evidence for the role of autoimmunity in this disease. Based on this theory, various immunosuppressive agents, such as topical or systemic corticosteroids and phototherapy (including narrowband ultraviolet B), are used. Methotrexate is another immunosuppressant that has recently become popular as a single treatment for vitiligo; however, the synergistic effect and its superiority over other treatments are two crucial factors that are still obscure. This study aimed to compare the efficacy of methotrexate+ NB-UVB versus placebo+ NB-UVB in vitiligo patients., Methods: In this double-blinded, randomized controlled trial, 42 patients were randomly allocated into two groups: the first group received three times weekly NB-UVB plus placebo, and the second group was treated with three times weekly NB-UVB in combination with a weekly dose of 12.5 mg MTX. The total duration of treatment was 6 months, patients were followed up every 2 months, and the assessment tools were VASI (repigmentation indicator) and VIDA (disease activity indicator) scores., Results: Both treatment groups showed improvement in VASI and VIDA scores during 6-month follow-up, but no statistical significance was found between the two treatment methods., Conclusion: This study demonstrated that both treatment modalities were equally effective, and further studies are required to evaluate the efficacy of MTX with other medications with longer follow-up and a larger sample size., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Lichen planopilaris (LPP) is a scarring alopecia for which no treatment with remarkable effect has been identified. Pioglitazone has been reported as a possible therapeutic option. To compare the efficacy and safety of pioglitazone with clobetasol in LPP. This randomized, double-blind, parallel-group was conducted at Razi hospital. Patients were treated either with pioglitazone 15 mg/daily or clobetasol lotion 0.05% once at night for 6 months. Patients were visited every 2 months to assess the lichen planopilaris activity index (LPPAI) and record probable adverse events. Forty patients (mean age: 43.6 years; 62.5% female) were randomized 1:1. The mean of LPPAI at baseline and last session were 4.68 ± 1.97 and 2.59 ± 0.97 in the clobetasol group and 5.01 ± 1.71 and 3.04 ± 1.36 in the pioglitazone group, respectively. Both treatments significantly decreased the LPPAI over the two-month interval visits (p < 0.001). No significant difference in the LPPAI reduction was detected between groups. Regarding the safety profile, three clobetasol-treated patients developed folliculitis, and two in the pioglitazone group developed mild headaches. Pioglitazone effectively controlled the signs and symptoms of the LPP with no serious side effects. It can be considered a treatment option for LPP, although it was not superior to clobetasol., (© 2022 Wiley Periodicals LLC.)

Melasma is a chronic hyperpigmentation disorder. Although several treatment methods are used for patients, it remains a challenging problem for physicians. Erbium-YAG laser is one of the laser treatment methods that proved its efficacy in melasma treatment. We aimed to compare the efficacy of combining the fractional Er: YAG laser and Kligman's formula with Kligman's formula alone in the treatment of melasma. Twenty female patients with bilateral melasma were randomly treated in a split-face controlled manner with a fractional Er: YAG laser followed by Kligman's formula on one side and Kligman's formula on the other side. All patients received three laser sessions with four-week intervals. The efficacy of treatments was determined through photographs, Visioface, and Melasma Area Severity Index (MASI) score, all performed at baseline and three months after the end of laser sessions. Fractional Er: YAG laser and Kligman's formula showed a significant decrease in MASI score than Kligman's formula alone (P = 0.005). There was a significant decrease in cheek Visioface score on Er: YAG laser and Kligman's formula vs Kligman's formula (P = 0.02). However, the Patient Global Assessment Scale of both sides was not statistically significant (P = 0.23). The combination of Fractional Er: YAG laser with Kligman's formula is an effective treatment method for melasma., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Competing Interests: Competing interests: None.

Lichen planopilaris (LPP) is a chronic inflammatory disorder of hair without a proven effective and safe treatment. To objectively assess the clinical efficacy of mycophenolate mofetil (MMF) in patients suffering from LPP, a retrospective cohort study was conducted on 52 patients who treated with MMF (2 g/day) at least for 6 months. LPP activity index (LPPAI) before and after treatment was calculated and compared. Most of the patients were female and belonged to the age group of 50-60 years. All of the disease activity indices were significantly improved after 6 months of therapy (p < 0.001). The majority of patients had LPPAI 4-6 and 0-2, before and after treatment, respectively. After 6 months of treatment, half of patients showed a disease activity decrease (LPPAI reduced >25% compared to the baseline value). Systemic MMF is an effective and relatively safe treatment modality for patients with LPP and could lead to significant reduction in disease activity regarding both subjective and objective indices., (© 2022 Wiley Periodicals LLC.)

Introduction: Lichen planopilaris (LPP) is a lymphocyte-mediated type of scarring alopecia and considered to have autoimmune etiology. Studies about systemic comorbid conditions are limited. Our goal is to identify the prevalence of medical comorbidities in patients with LPP., Methods: In a retrospective case-control study, the medical records of 208 LPP patients and 208 controls were reviewed for existing comorbidities such as thyroid diseases, cardiovascular disorders, hypertension, hyperlipidemia, and lupus erythematous., Results: Hyperlipidemia was found in 41.8% of all patients with LPP and in 17.3% of controls ( p value <0.001, OR = 4.167). Chances of hypertension and cardiovascular disorders were lower in the LPP group in comparison to controls ( p value = 0.009). Thyroid disorders were more prevalent in LPP patients, but the difference was not statistically significant ( p value = 0.277)., Conclusion: Our study further emphasizes that LPP patients should be screened for medical comorbidities, especially lipid profile abnormalities., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2022 by S. Karger AG, Basel.)

Pemphigus is a group of autoimmune diseases characterized by flaccid lesions on the skin and mucous membranes. In pemphigus vulgaris, the most common subtype of pemphigus, lesions might be appeared anywhere on the oral mucosa, mostly in the buccal mucosa. However, the gingiva is a less frequently affected site. Here, we performed a retrospective study at Tehran University of Medical Sciences, covering a two-year period to identify pemphigus patients with active lesions confined to the gingiva. Considering 1787 initially evaluated pemphigus cases, 512 (28.6%) were found to have a history of gingival involvement. Among them, 31 patients had only gingival involvement during their last visit, including 29 (93.5%) women and only two (6.5%) men. The mean of disease duration in this group was 5.29 ± 3.46 years, and they had gingival involvement for a mean of 23.9 ± 19.3 months. Of 28 patients, nine were negative for anti-Dsg3 and 24 were negative for anti-Dsg1. In 24 patients, who received rituximab, the mean pemphigus disease area index specifically for gingiva was 4.76 ± 0.74 at baseline, which had changed to 4.13 ± 0.75 and 3.26 ± 0.63 three and 6 months after rituximab administration, respectively. After 3 months, gingival lesions were either entirely resolved (n = 3), partially resolved (n = 11), remained unchanged (n = 2), or progressed (n = 7). Gingiva-confined presentation of lesions in pemphigus could be non-anti-Dsg1/3 dependent in some patients. Such patients do not respond well to conventional treatments and rituximab therapy. More studies on the pathogenesis of gingiva-confined presentation of pemphigus are required., (© 2022 Wiley Periodicals LLC.)

In this case-control study, class І and ІІ human leukocyte antigen (HLA) alleles in Iranian patients with benign and severe cutaneous adverse drug reactions (CADRs) due to aromatic anticonvulsants and antibiotics were evaluated. Patients diagnosed with CADRs (based on clinical and laboratory findings) with a Naranjo score of ≥ 4 underwent blood sampling and HLA-DNA typing. The control group comprised 90 healthy Iranian adults. Alleles with a frequency of more than two were reported. Deviations from Hardy-Weinberg equilibrium were not observed. Eighty patients with CADRs including 54 females and 26 males with a mean age of 41.49 ± 16.08 years were enrolled in this study. The culprit drugs included anticonvulsants (lamotrigine, carbamazepine, and phenytoin) and antibiotics (ciprofloxacin and co-trimoxazole). The comparison of allele frequencies in the Iranian healthy control group and the group with benign CADRs revealed that HLA-Cw*04, and HLA-A*24 were significantly associated with lamotrigine-induced maculopapular CADRs. Furthermore, HLA-B*51 showed a significant correlation with carbamazepine-induced maculopapular CADRs. Significant associations were also detected between ciprofloxacin-induced urticarial CADRs with HLA-B*40, and HLA-DRB1*14. In the severe group, HLA-B*38 and HLA-DRB1*13 were significantly associated with lamotrigine-induced Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Moreover, HLA-A*31 and HLA-Cw*04 were significantly correlated with carbamazepine-induced drug reactions with eosinophilia and systemic symptoms (DRESS). HLA-B*08 also showed a significant correlation with ciprofloxacin-induced acute generalized exanthematous pustulosis (AGEP). In conclusion, Lamotrigine-induced MPE was significantly correlated with HLA-Cw*04, and HLA-A*24. Similarly, lamotrigine-induced SJS/TEN was significantly associated with HLA-B*38 and HLA-DRB1*13. Additionally, HLA-A*31 was associated with DRESS caused by carbamazepine. The most frequent CADR-inducing drugs were anticonvulsants., (© 2022 Wiley Periodicals LLC.)

Background and Objectives: Lichen planopilaris (LPP) is one of the important causes of cicatricial alopecia. We aimed to evaluate the efficacy and safety of low-dose naltrexone (LDN) in the setting of a clinical trial in patients with LPP., Methods: We included patients with LPP between 2018 and 2020. Patients were allocated to two groups. The first group received topical clobetasol plus oral low dose naltrexone (3 mg) while the second received topical clobetasol plus placebo. The assessment was made for the disease severity by lichen planopilaris activity index (LPPAI) instrument and the safety of the drug in 2-month intervals up to 6 months. To compare both groups, we used the ANOVA test for repeated measures. Clinical trials registry code: IRCT20180809040747N1., Results: Thirty-four patients were analyzed in an intention-to-treat fashion. There was a decrescendo pattern on LPPAI scores that was statistically significant within the LDN ( p  = .001) but almost significant within the placebo group ( p  = .060) and non-significant between the groups ( p  = .813). The side effects attributable to the low dose naltrexone was not statistically different between studied groups., Conclusion: Low-dose naltrexone (3 mg) failed to improve the severity of the LPP more than what is achievable with topical clobetasol.

Background: Changes in the appearance of melanocytic nevi have been increasingly reported following hair removal lasers. This could be a source of anxiety in patients doing cosmetic hair removal lasers. Moreover, taking biopsy of any changed nevus following laser is not routinely practical. Therefore, this study was designed to describe dermoscopic changes happened on acquired junctional melanocytic nevi after photo-depilation methods., Method: In this prospective study, 66 melanocytic nevi in 27 patients were chosen. Dermoscopic images were taken at the baseline visit and 2 months following single session of hair removal laser. Afterward, the before and after laser images were compared for any change in the structure and color of the nevi., Results: Dermoscopic images showed alterations in nevi following laser including changes in size in 33%, color in 63.6%, newly developed asymmetry in 12.1%, and regression in 3% of nevi. Besides, alteration in reticular and dots and globules pattern was found in 92.5% and 69.32%, respectively., Conclusions: Hair removal laser could induce considerable changes in appearance of acquired junctional melanocytic nevi. Dermoscopic study before and after the process could help to avoid unnecessary excision of suspected lesions., (© 2021 Wiley Periodicals LLC.)

Background: The diagnosis of purpuric mycosis fungoides (PMF) is often challenging to be clinically differentiated from inflammatory diseases such as pigmented purpuric dermatosis (PPD). Dermoscopy as a non-invasive method can be employed for the visualisation of features invisible to the naked eye., Objectives: This study aimed to survey the dermoscopic findings of PMF in comparison with PPD., Methods: Forty-one patients with an established diagnosis of PMF (n = 28) and PPD (n = 13) were prospectively recruited. Dermoscopic images were taken by FotoFinder Medicam 1000 (FotoFinder Systems GmbH, Bad Birnbach, Germany)., Results: Characteristic dermoscopic patterns consisting of fine short linear vessels (35.7%, P = 0.017) and spermatozoa-like structures (50%, P = 0.014) were found to be significantly more common in PMF lesions, while PPD lesions were typified by erythematous globules (76.9%, P = 0.01), in the background colour of dull red (61.5%, P = 0.01) and reticular pigmentation (61.5%, P = 0.044)., Conclusions: This study showed the usefulness of dermoscopy for the diagnosis of PMF and PPD cases. Studies with long-term follow-up are needed to affirm the value of these dermoscopic patterns in the differentiation between the two entities., (© 2021 The Australasian College of Dermatologists.)

Actinic keratosis (AK) is a precancerous skin lesion associated with the development of squamous cell carcinoma. Approved topical treatments for AK are unmet needs. To evaluate the safety and efficacy of hydrogen peroxide topical solution 35% (H 2 O 2 ) with cryosurgery for the treatment of AKs. Eligible subjects were randomly assigned to receive H 2 O 2 and cryosurgery on each side of their scalp/face. Patients were assessed at baseline and after 3 months of follow-up. Efficacy was evaluated based on the Actinic Keratosis Area and Severity Index (AKASI) and dermoscopic assessments. Fifteen patients with 98 lesions completed the study. At the follow-up visit, the mean improvement of AKASI from baseline was 1.7 ± 0.9 for H 2 O 2 and 1.7 ± 0.8 for cryosurgery (p < 0.001, both). Both treatments significantly improved dermoscopic features of yellow scale, white scale, linear-wavy vessels, pigmented dots, and rosette at the end of the 3-month follow-up. Complete dermoscopic response occurred in 57.7% and 73.9% of lesions treated with H 2 O 2 and cryosurgery, respectively (p > 0.05). Regarding safety, hypopigmentation occurred more frequently in the cryosurgery group (28.3% vs. 9.6%; p = 0.017). Moreover, patients endured more pain with cryosurgery application than H 2 O 2 (p < 0.001). The effect of H 2 O 2 solution was comparable to cryosurgery. This treatment was well tolerated and had a favorable safety in patients with AKs., (© 2021 Wiley Periodicals LLC.)

Background/aim: The majority of psoriatic arthritis (PsA) patients present at dermatology clinics with cutaneous psoriasis up to 10 years prior to arthritis onset; therefore, applying a suitable screening tool to detect PsA early is essential for dermatologists. This study aimed to validate and evaluate the Persian version of two PsA screening questionnaires, the early arthritis for psoriatic patients questionnaire (EARP) and the psoriasis epidemiology screening tool (PEST) in Iranian psoriatic patients., Materials and Methods: In this cross-sectional study, psoriatic patients who presented to the dermatology clinic without a previously established PsA were asked to fill out the Persian version of EARP and PEST. PsA was diagnosed by a rheumatologist based on the fulfillment of the classification criteria for psoriatic arthritis. Receiver operator characteristic (ROC) curves, sensitivity, and specificity were calculated for both questionnaires., Results: A total of 75 patients (33 [44%] female, 42 [56%] male, with a mean age of 43.2 ± 14.6) were enrolled in the study. The prevalence of PsA based on rheumatologist diagnosis was 25.3% (19 patients had PsA). The ROC curve analysis of EARP and PEST were 0.949 (95% CI: 0.897–1) and 0.922 (95% CI: 0.834–1). The sensitivity of EARP and PEST questionnaires was 94.7% and 58%, respectively, while the specificity was 78.6% and 96.4%, respectively, with a cut-off of 3., Conclusion: The Persian version of both questionnaires showed good performance. We suggest EARP as a screening tool for PsA in the dermatology clinics due to much higher sensitivity with acceptable specificity compared to PEST., Competing Interests: The authors declare that there is no conflict of interest or funding for the study., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Background: Pemphigus is a potentially fatal disease if left untreated. Valid scoring systems and defined cut-off values for classification of patients would help with better management through specified pharmaceutical and non-pharmaceutical treatments., Methods: In this study, pemphigus patients who were receiving immunosuppressive treatments and had recent disease relapse were recruited for examination of pemphigus disease area index(PDAI), autoimmune bullous skin disorder intensity score (ABSIS), physician global assessment (PGA), autoimmune bullous disease quality of life (ABQoL), anti-desmoglein 1 (anti-Dsg1), and anti-Dsg3 autoantibody titers from December-2017 to February-2018. Cut-off values were estimated using model-based clustering classification and the 25th and 75th percentiles approach, performed separately for the exclusive cutaneous, exclusive mucosal, and mucocutaneous groups., Results: In the 109 included patients, the 25th and 75th percentiles cut-offs were 6.2 and 27 for PDAI score, and 4 and 29.5 for ABSIS score. The model-based analysis resulted in two groups (cut-point:15) for PDAI score, and three groups (cut-points:6.4 and 31.5) for ABSIS score. The groups were significantly different for the PDAI, ABSIS, PGA, and ABQoL values. Based on anti-Dsg1 autoantibody values, the model-based analysis cut-point was 128 and the 25th and 75th percentiles cut-offs were 98 and 182. Anti-Dsg3 autoantibody values did not differentiate between pemphigus severity classes., Conclusions: Estimated cut-off values based on the anti-Dsg1 level, PDAI, and ABSIS scoring systems could be used to classify patients into different severity grades for better management and prognosis.

Lichen planopilaris (LPP) is the prototype of cicatricial alopecia and is the follicular form of lichen planus. Some studies showed viral agents such as hepatitis C virus; Epstein Bar virus and human Herpes viruses are associated with classic and oral lichen planus. We conducted this study to find if there is a relationship between LPP and human herpes virus-6 (HHV-6) as this virus is prevalent worldwide. This cross-sectional study was conducted in Razi Hospital, Tehran, during one-year interval. Total of 30 treatment naïve LPP patients and 30 healthy matched controls enrolled the study. Serum anti-HHV-6 antibody and the presence of virus genome examined using ELISA and Nested PCR technique, respectively. HHV-6 genome was also determined three months after treatment in LPP patients. Twenty-nine (96.6%) and 3(10%) of LPP patients were positive for anti-HHV-6 antibody and DNA genome, respectively; while 28(93.3%) and 3(10%) were positive in the control group. The presence of anti-HHV-6 antibody and HHV-6 genome was not statistically different between LPP patients and controls (p value >0.05). The comparison between LPP cases after three months of systemic therapies and the same controls also showed no statistically significant difference (P value >0.05). This study showed there is no association between lichen planopilaris and HHV-6.

Background: Lichen planopilaris (LPP) is a relatively uncommon inflammatory skin condition that causes permanent hair loss. Irreversible hair loss can have a significant psychosocial and psychological impact on patients' lives. Limited studies have assessed the psychological status of patients suffering from LPP, and to our knowledge, none have evaluated patients with LPP as a separate group in this regard., Objective: This study aimed to assess the quality of life (QoL) and general health of patients with LPP using the Dermatology Life Quality Index (DLQI) questionnaire and General Health Questionnaire-28 (GHQ-28), respectively., Methods: Our study employed a cross-sectional design. In total, 41 patients with LPP attending the follow-up skin clinic at the Razi Hospital in Tehran, Iran were asked to complete the DLQI and GHQ-28. Furthermore, selected demographic information was obtained from patients to evaluate their association with general health and QoL., Results: Forty-one patients (14 men and 27 women) with a mean age of 44.02 ± 10.8 years completed both questionnaires. QoL was affected moderately to extremely in 70.7% of patients. Also, 26 patients (63.4%) were at risk for psychological disorders. Lower QoL was reported by patients age <45 years ( p  < .05). Both QoL and general health had a negative relation with the disease activity index ( p  < .05), but were not affected by sex, marital status, education level, treatment type, presence of mucous lesions, and disease duration., Conclusion: LPP significantly affects patients' QoL and general health. Dermatologists should address these issues in patients with LPP alongside treating physical symptoms., (© 2020 Published by Elsevier Inc. on behalf of Women's Dermatologic Society.)

Background: Pemphigus vulgaris (PV) is a rare but seriously disabling disorder of the skin and mucous membranes that can gravely impact the quality of life (QoL) of patients., Objective: The aim of the present study was to identify how family members of patients with PV are affected by the disease., Methods: A total of 118 patients with confirmed PV and one of their family members (caregivers) were enrolled in the study. To calculate disease severity, the Autoimmune Bullous Skin Disorder Intensity Score was used. The Persian version of the Dermatology Life Quality Index (DLQI) questionnaire was used to evaluate the QoL of patients and the Family Dermatology Life Quality Index (FDLQI) to evaluate the QoL of caregivers., Results: The mean age of patients was 43.14 ± 12.5 years. Ninety patients (76.3%) were female. Eighty-one patients (68.6%) had the mucocutaneous phenotype and 37 cases (31.4%) the mucosal phenotype. The DLQI score was 10.1 ± 7.1 for patients. The DLQI score was higher for patients with the mucocutaneous phenotype (11.8 ± 7.5) than those with the mucosal phenotype (6.4 ± 4.9; p  < .001). QoL was significantly affected by disease severity. FDLQI score was 13 ± 7 for caregivers, and was significantly higher in older caregivers and married ones. There was a positive correlation between patients' admission frequencies and FDLQI score. FDLQI score was also significantly affected by the Autoimmune Bullous Skin Disorder Intensity Score of patients' disease severity. The QoL of patients and their caregivers showed a significant positive correlation., Conclusion: The QoL of patients and their families are impaired significantly, and is considerably prominent in the mucocutaneous phenotype of PV and more severe forms., Limitation: Pemphigus Disease Area Index (PDAI) and Autoimmune Bullous Disease QoL (ABQoL) were not used in this study., (© 2020 Published by Elsevier Inc. on behalf of Women's Dermatologic Society.)

Introduction: Thiazolidinediones have shown a good therapeutic effect in psoriasis treatment with no major adverse effects. The purpose of this study was to evaluate and compare the therapeutic effects of the combination of phototherapy and Pioglitazone with the phototherapy alone on plaque psoriasis patients. Methods and Materials: About 60 adults with plaque type psoriasis entered the study. They were randomly divided into two groups; one with pioglitazone and one with placebo and both underwent 30 sessions of phototherapy during 10 weeks. Before and after the treatment Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) were assessed. Side effects of the treatment were also investigated. Results: The average PASI of the pioglitazone group was reduced from 20.9 ± 9.8 to 1.8 ± 1.4 ( p  < .001) versus the placebo group in which the PASI was reduced from 22 ± 8.5 to 4.4 ± 4. In other words, PASI was reduced in the pioglitazone and placebo group by 83.5% and 56.7% respectively ( p  < .05). The two groups didn't have a significant difference in reducing the DLQI ( p  = .315). Conclusion: Pioglitazone can vastly enhance the effectiveness of phototherapy in plaque psoriasis patients without causing any important adverse effect and with no success in improving the score of DLQI.

Pemphigus vulgaris (PV) is an autoimmune blistering disease affecting the skin and/or mucosa. Rituximab (RTX) has been approved recently by US FDA as an effective and safe treatment of PV. The high incidence of PV in Iran encouraged our team to prepare a consensus guideline for RTX administration based on literature review and a decade experience of an expert panel. RTX is recommended for the treatment of new cases of PV as well as patients not responding to conventional therapy. Contraindications include history of anaphylaxis or IgE-mediated hypersensitivity to murine proteins of RTX, severe active infections, pregnancy, breastfeeding, severe heart failure, and arrhythmia. Prophylactic antiviral therapy is recommended in patients at risk of reactivation of HBV and isoniazid for those at risk of reactivation of tuberculosis. Concomitant use of systemic corticosteroids is recommended as a rule. Except for methotrexate, the combination with other immunosuppressive drugs is discouraged. Intravenous immunoglobulin is recommended for those at risk of infections or with extensive disease. The recommended dosage of RTX for the first cycle is 2 g either 500 mg weekly or 1 g biweekly. There is no general consensus whether the next doses of RTX be administered upon relapse or as maintenance therapy. We strongly recommend RTX sooner in the course of pemphigus., (© 2019 Wiley Periodicals, Inc.)

Lichen planopilaris (LPP) is an immune-mediated cicatricial alopecia. The main clinical presentations of LPP include classic form, frontal fibrosing alopecia (FFA), and Graham-Little-Piccardi-Lassueur syndrome (GLPLS). We reviewed medical records of all 291 patients diagnosied with LPP from 2006 to 2017 in Department of Dermatology, Tehran University of Medical Sciences. LPP was more common in women than men. Lichen planus (LP) was seen in 59 of patients (20.3%). Parietal lesions (69.75%), frontal (27.14%), occipital (23.71%), and temporal (21.64%) were frequently seen in LPP patients. However, trunk hair involvement (15.4% vs. 2.7%; p = .011) and eyebrow involvement (57.7% vs. 0%; p < .0001) were high in FFA patients. The response rates of cyclosporine (CSP) and methotrexate (MTX) were highest, 100% and 85%, respectively. Those treated with CSP achieved partial remission (PR) and complete remission (CR) faster than MTX-treated group. Moreover, MTX was more effective than MMF but not different in time to reach PR ( p  = .23) or CR ( p  = .56). However, CSP and MTX were less safe compared with MMF. 5-alpha reductase inhibitors, systemic retinoids (isotretinoin) or their combination were the most effective therapeutic options for FFA patients.

Background/objectives: Videodermoscopy is a valuable tool for the diagnosis of cicatricial alopecias such as lichen planopilaris. Lichen planopilaris activity index is used for evaluating lichen planopilaris severity. Our aim was to examine the utility of videodermoscopy in the assessment of lichen planopilaris severity., Methods: One hundred and seventeen histopathologically confirmed lichen planopilaris patients under went videodermoscopy. Lichen planopilaris activity index was calculated according to cicatricial alopecia standardised flowchart. Differences and correlations between trichoscopic features, clinical findings and lichen planopilaris activity index were calculated., Results: Most trichoscopic features had statistically significant higher prevalence than similar clinical findings. Targetoid pigment pattern, perifollicular scale and milky-red areas were significantly correlated with lichen planopilaris activity index (P-value < 0.05). There was statistically significant correlation between targetoid pigment pattern and positive anagen pull test (P-value < 0.001)., Conclusion: Using trichoscopic features in calculating lichen planopilaris activity index with videodermoscope can help in early lichen planopilaris diagnosis and improve post-treatment follow-up., (© 2019 The Australasian College of Dermatologists.)

Background: One of the most important organ involvements in psoriasis is atherosclerotic cardiovascular disease. Homocysteine is known to have atherogenic properties, but some inconsistency exists in the literature about its probable role as a risk factor of cardiovascular disorder in patients with psoriasis., Objective: Because of some controversies, we compared homocysteine levels and related parameters of metabolic cycles in patients with psoriasis and healthy individuals., Methods: This case-control study was conducted on 50 patients with psoriasis and 50 healthy individuals as the controls. Serum homocysteine, vitamin B12 levels, and erythrocyte folate concentrations were checked in all participants., Results: Mean serum homocysteine, erythrocyte folate, and vitamin B12 levels did not show any significant difference between the two groups ( p > .05), but interestingly, in patients with psoriasis, men had a significantly higher incidence of hyperhomocysteinemia and lower levels of erythrocyte folate ( p = .14). Overall, there is no significant difference in serum levels of homocysteine and metabolic-related parameters between the case and control group. There was no significant relationship between the severity of psoriasis and the body mass index of patients ( p > .05)., Conclusion: Patients with psoriasis had a higher body mass index and higher levels of homocysteine in men. Hyperhomocysteinemia could be a predisposing factor of cardiovascular events, but more evaluations as a part of metabolic syndrome in patients with psoriasis are needed.