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Currently, psoriasis patients are advised to follow their standard therapeutic regimen, and are advised to be vaccinated against Covid-19. However, the data about the antibody responses, induced by the various kinds of SARS-CoV-2 vaccines in psoriasis patients who require systemic immunosuppressive treatment is scant. In this case report, we describe antibody responses induced by COVID-19 vaccine, in a 26-year-old male patient with psoriasis being treated with anti-TNF biotherapy, adalimumab biosimilar every two weeks. The patient was vaccinated against COVID-19, according to the national protocol. He experienced three episodes of symptomatic COVID-19. His first and second exposures did not result in antibody production. After the third episode of COVID-19, The SARS-CoV-2 anti-spike antibody (IgG) was more than 100 Ru/mL (ELISA; ≥8 Ru/mL is considered positive), and SARS-CoV-2 neutralizing antibody (total) was more than 40 micg/mL (ELISA; ≥2.5 micg/mL is considered positive). This is the first case with weak antibody response to vaccination and multiple episodes of COVID infection in a psoriatic patient with adalimumab biosimilar. However, we cannot assume causality due to the treatment.

Plectin, encoded by PLEC, is a cytoskeletal linker of intermediate filaments expressed in many cell types. Plectin consists of three main domains that determine its functionality: the N-terminal domain, the Rod domain, and the C-terminal domain. Molecular defects of PLEC correlating with the functional aspects lead to a group of rare heritable disorders, plectinopathies. These multisystem disorders include an autosomal dominant form of epidermolysis bullosa simplex (EBS-Ogna), limb-girdle muscular dystrophy (LGMD), aplasia cutis congenita (ACC), and an autosomal recessive form of EBS, which may associate with muscular dystrophy (EBS-MD), pyloric atresia (EBS-PA), and/or congenital myasthenic syndrome (EBS-MyS). In this study, genotyping of over 600 Iranian patients with epidermolysis bullosa by next-generation sequencing identified 15 patients with disease-causing PLEC variants. This mutation update analyzes the clinical spectrum of PLEC in our cohort and in the literature and demonstrates the relationship between PLEC genotype and phenotypic manifestations. This study has integrated our seven novel PLEC variants and phenotypic findings with previously published data totaling 116 variants to provide the most complete overview of pathogenic PLEC variants and related disorders., (© 2022 Wiley Periodicals LLC.)

Background: Psoriasis is an inflammatory disease associated with multiple comorbidities. Biomarkers for the assessment of psoriasis, its associated comorbidities, and the therapeutic response are not well characterized. A number of possible biomarkers for the diagnosis and monitoring of psoriasis have been proposed., Purpose: To assess potential biomarkers for diagnosis of psoriasis, its associated comorbidities and response to treatment., Methods: We investigated medical databases from 2000 to 2021 and assessed relevant research. In this review, we evaluated the important biomarkers to help predict potential risk of psoriasis and disease activity (Beta-defensin-2, VEGF, Lipocalin-2, and YKL-40) and its possible inflammatory-related comorbidities like cardiovascular diseases (hs-CRP, GlycA, Psoriasin, IL-18, NT-proBNP, and Adipokines). In addition, we described the potential biomarkers for psoriatic arthritis (CXCL10, S100A8 and S100A9, and MicroRNA) and related manifestations such as enthesitis. Finally, we discussed novel markers for monitoring the response to specific treatments (HLA-C 06, PLC, TARC, NLR, and PLR) as well as potentially useful biomarkers for evaluation of therapy-associated adverse events (liver fibrosis-related markers)., Conclusion: A wide range of genetic, tissue, and serum markers have been investigated in psoriasis; however, most of them are not used in routine clinical practice; and thorough physical examination along with the appropriate application of clinical scoring systems like Psoriasis Area and Severity Index score are still of particular importance.

Importance: A clear dosing regimen for methotrexate in psoriasis is lacking, and this might lead to a suboptimal treatment. Because methotrexate is affordable and globally available, a uniform dosing regimen could potentially optimize the treatment of patients with psoriasis worldwide., Objective: To reach international consensus among psoriasis experts on a uniform dosing regimen for treatment with methotrexate in adult and pediatric patients with psoriasis and identify potential future research topics., Design, Setting, and Participants: Between September 2020 and March 2021, a survey study with a modified eDelphi procedure that was developed and distributed by the Amsterdam University Medical Center and completed by 180 participants worldwide (55 [30.6%] resided in non-Western countries) was conducted in 3 rounds. The proposals on which no consensus was reached were discussed in a conference meeting (June 2021). Participants voted on 21 proposals with a 9-point scale (1-3 disagree, 4-6 neither agree nor disagree, 7-9 agree) and were recruited through the Skin Inflammation and Psoriasis International Network and European Academy of Dermatology and Venereology in June 2020. Apart from being a dermatologist/dermatology resident, there were no specific criteria for participation in the survey. The participants worked mainly at a university hospital (97 [53.9%]) and were experienced in treating patients with psoriasis with methotrexate (163 [91.6%] had more than 10 years of experience)., Main Outcomes and Measures: In a survey with eDelphi procedure, we tried to reach consensus on 21 proposals. Consensus was defined as less than 15% voting disagree (1-3). For the consensus meeting, consensus was defined as less than 30% voting disagree., Results: Of 251 participants, 180 (71.7%) completed all 3 survey rounds, and 58 participants (23.1%) joined the conference meeting. Consensus was achieved on 11 proposals in round 1, 3 proposals in round 2, and 2 proposals in round 3. In the consensus meeting, consensus was achieved on 4 proposals. More research is needed, especially for the proposals on folic acid and the dosing of methotrexate for treating subpopulations such as children and vulnerable patients., Conclusions and Relevance: In this eDelphi consensus study, consensus was reached on 20 of 21 proposals involving methotrexate dosing in patients with psoriasis. This consensus may potentially be used to harmonize the treatment with methotrexate in patients with psoriasis.

COVID-19 caused by the SARS-CoV-2, became pandemic very quickly. Management of severe dermatologic disorders in patients who require systemic immunosuppressive treatment is a major concern in COVID-19 pandemic era. Here, we report a 45-year-old homeless addicted male with second flare of psoriatic erythroderma and positive PCR test for COVID 19. His first attack occurred two months earlier, when he was screened for SARS-CoV-2 before admission which all evaluations showed nagative results. The patient was treated and relatively controlled with cyclosporine and therefore he was discharged. During this interval, he not only discontinued his medication, but also became SARS-CoV-2 positive. It seems that both factors participated in flare of his erythroderma.

Psoriasis is known to be associated with increased risk of cardiovascular diseases. High-sensitivity C-reactive protein (hs-CRP) is a marker of inflammation and an independent risk factor for atherosclerosis. We aimed to assess the correlation between hs-CRP and subclinical atherosclerosis in psoriatic patients. In 60 patients with moderate to severe psoriasis and 60 age- and gender matched healthy controls, we evaluated the serum hs-CRP level and mean intima-media thickness of the common carotid artery (MIMT-CCA). Psoriatic patients had higher levels of hs-CRP (median, 2.25 mg/L; IQR, 0.98-3.80; and range, 0.29-11.60) than did those in the control group (median, 1.03 mg/L; IQR, 0.36-2.15; and range, 0.10-3.35). Psoriatic patients also had higher mean MIMT (0.74 ± 0.19 and 0.54 ± 0.12, respectively, and P < .0001) compared with healthy subjects. The serum level of hs-CRP was significantly correlated with MIMT (P < .0001). Our results indicate that psoriatic patients have a higher risk of subclinical atherosclerosis and hs-CRP may be a useful marker for future risk of cardiovascular diseases in these patients. So, not only does anti-inflammatory drugs play a key role in the treatment of psoriasis, but also they may reduce the risk of cardiovascular diseases by decreasing level of inflammatory markers including hs-CRP., (© 2020 Wiley Periodicals LLC.)

Objectives: To assess ocular abnormalities in psoriatic patients (new-cases versus patients under treatment) in comparison with healthy controls. Methods: A total of 200 psoriatic patients and 100 healthy controls were enrolled in this prospective, observational study. The demographic data of the individuals were recorded. Dermatological and ophthalmologic examinations were conducted; ocular surface disease index (OSDI), Schirmer's and tear break-up time (TBUT) values were also measured. Results: The mean values of TBUT and Schirmer's tests in patients were significantly lower than the controls and significantly higher scores of OSDI were observed among patients compared to the controls ( p  < .0001); dry eye disease was more frequent in the patients than the healthy subjects ( p  = .001). Other ocular findings including cataract and uveitis were not significantly different between the groups. Although no significant differences were found between the ocular findings of new cases and patients under treatment, ocular findings in cases under treatment were associated with the type of treatment and more frequent in those treated with methotrexate, followed by acitretin and biologic drugs. Conclusions: Ocular surface problems in psoriatic patients are more common than previously thought; in addition to the role of treatment modalities, psoriasis itself and a probable systemic inflammation may play an important role.Key PointsThere are limited case-control studies about ocular manifestations in psoriasis and also its pathogenesis is not yet clear.This study shows that ocular surface problems in psoriatic patients are higher than healthy subjects; in addition to the role of treatment modalities, psoriasis itself and a probable systemic inflammation may play a pivotal role.Regular ophthalmological evaluations are recommended in psoriatic patients especially those with more severe and chronic form of the disease, to prevent any complications.

Background: Many international guidelines have been introduced with the aim of helping clinicians by providing evidence-based advice for the prescription of biologic therapies in psoriasis. Because no local or regional guideline is available, the treatment of psoriasis with biologics is mainly based on clinical experiences regarding the international guideline among Iranian dermatologists., Objective: To assess the knowledge and attitudes among Iranian specialists regarding the use of biologic agents to manage psoriasis., Methods: Data were collected using an electronic questionnaire specifically designed for this study based on a review of the literature. The designed Google form consisted of 53 multiple choice questions divided into five sections., Results: A total of 111 dermatologists agreed to participate in this study. There was considerable variation among the responding dermatologists in terms of their knowledge and attitudes toward biologics. There were some significant associations between knowledge and attitudes of dermatologists toward biologics and their personal and professional characteristics., Conclusions: More comprehensive educational approaches, both in the dermatology residency and postgraduation periods, could be very beneficial to promote the knowledge and attitude of the dermatologist in treating psoriasis with biologic agents. This study could be one of the first steps to develop a country-based or a region-based plan to improve the knowledge and attitude among dermatologists regarding the use of biologic drugs in psoriasis and possibly to reach a better status to prescribe these agents in the management of psoriasis., (© 2019 Published by Elsevier Inc. on behalf of Women's Dermatologic Society.)

Purpose: The objective of the current study was to evaluate the effect of intravenous methylprednisolone pulse therapy on myocardial repolarization alterations, especially QT dispersion in anticipation of cardiovascular risks in patients with pemphigus vulgaris., Methods: The current study is a prospective-controlled study on the electrocardiographic changes after methylprednisolone pulse therapy in 50 patients with pemphigus vulgaris., Results: A total of 50 patients (28 female and 22 male) were included in our study. The mean heart rate was significantly higher in male patients both before (92 ± 10.80 versus 82.75 ± 12.01 ms) and after pulse therapy (102.73 ± 14.26 versus 91.07 ± 15.02 ms) (p value < .01). The value of heart rate was significantly greater after receiving steroid pulse therapy. Corrected QT dispersion before pulse therapy was 19.92 ± 8.2 ms that increased to 40.68 ± 18.12 ms after treatment (p value < .001)., Conclusion: Our study shows that there is a relationship between pulse steroid infusion and increased predisposition to the occurrence of cardiac arrhythmias. QT dispersion could be a good marker to assess this risk in these patients.

Competing Interests: Competing interests: The authors have no conflicts of interest to disclose.

Background: Mutations in the ST14 gene, encoding the serine protease matriptase, have been associated with ichthyosis-hypotrichosis syndrome (IHS), a Mendelian disorder with skin and hair manifestations which include, in addition to ichthyosis and hypotrichosis, hypohidrosis and follicular atrophoderma. However, the understanding of the specific consequences of mutations in ST14 on the development of this syndrome is incomplete., Results: Using a targeted next-generation sequencing array of 38 ichthyosis-associated genes on a large cohort of 180 ichthyosis patients from a primarily consanguineous background, a previously unreported homozygous p.Asp482Asn mutation in ST14 was identified in a patient with IHS. This mutation affects an essential site within a ligand-binding domain of matriptase. Comparison with previous reports of IHS allowed further delineation of the phenotype of IHS in correlation with mutations present in these patients. Histological and ultrastructural analysis of skin and hair identified novel features in this disorder., Conclusions: This study correlates genotypic and phenotypic features of the rare disorder, IHS, expands the spectrum of pathology associated with the disorder, and provides clinical evidence of the importance of the Asp482 amino acid, previously shown to have an essential role in matriptase activation.

Colloid milium is a rare cutaneous deposit disease that usually presents clinically by the development of yellowish translucent or flesh-colored papules or plaques on sun-exposed skin. Histologically, it is characterized by the presence of colloid in the dermal papillae. In this case report, we present a 52-year-old man who presented with a nodule on his upper lip that mistakenly was diagnosed and treated as keloid., (© 2017 Wiley Periodicals, Inc.)

Basal cell carcinoma (BCC) is the most common skin cancer but usually has a good prognosis. However, there is a subset of BCC cases with a less favorable prognosis. For patients with locally advanced, recurrent or metastatic BCCs who are not suitable for surgery or radiotherapy, small-molecule drug inhibitors of hedgehog pathway are a new therapeutic opportunity. Here, we present a case of infiltrative BCC with multiple recurrences. Wide excision with reconstructive plastic surgery was performed initially with adjuvant radiotherapy. Due to multiple recurrences afterward, radiotherapy, topical imiquimod and oral itraconazole were used but were not effective. Finally, the patient was treated with vismodegib which led to a complete response. Moreover, the patient's symptoms due to the locally diffused cancer resolved., (© 2017 Wiley Periodicals, Inc.)

Ivermectin (IVM) is a broad-spectrum anti-parasitic drug with significant anti-inflammatory properties. The emergence of treatment resistance to lindane, permethrin, and possibly malathion complicates the global strategy for management of common parasitic skin diseases such as scabies and head lice. In this regard. IVM has been safely and effectively used in the treatment of these common human infestations. In addition, IVM may be useful in inflammatory cutaneous disorders such as papulopustular rosacea where demodex may play a role in pathogenesis. Herein, we review the current applications of topical IVM in dermatology.

Background: Psoriasis is associated with increased risk of atherosclerotic disorders. Vascular endothelial growth factor (VEGF) is an angiogenic factor that was overexpressed in both psoriatic and atherosclerotic lesions. In a prospective controlled study, we investigated the correlation between serum levels of VEGF and subclinical atherosclerosis in patients with moderate to severe psoriasis., Method: Sixty patients with moderate to severe psoriasis and 60 age- and gender-matched healthy controls were recruited to the study. Mean intima-media thickness of the common carotid artery (MIMT-CCA) and serum VEGF levels of all subjects were measured. Subclinical atherosclerosis was defined as having an MIMT-CCA ≥0.8 mm., Results: Serum VEGF levels in psoriatic patients were significantly higher compared with healthy controls (P < 0.0001). Psoriatic patients had significantly greater MIMT-CCA than healthy controls (P < 0.0001). Forty-five percent of patients and 6.7% of the healthy controls had subclinical atherosclerosis (P < 0.0001). In the patient group, subclinical atherosclerosis was significantly associated with serum VEGF levels, age, disease duration, and psoriasis area and severity index (PASI)., Conclusion: This study supported the possible role of VEGF in the pathogenesis of subclinical atherosclerosis in psoriatic patients., (© 2015 The International Society of Dermatology.)

Background: The treatment of tinea capitis using radiotherapy was introduced at the beginning of the twentieth century. A variety of cancers including basal cell carcinoma (BCC) are seen years after this treatment., Objective: We sought to determine the clinical characteristics of BCCs among irradiated patients., Methods: The clinical records of all patients with BCC in a clinic in north of Iran were reviewed., Results: Of the 58 cases of BCC, 29 had positive history for radiotherapy in their childhood. Multiple BCCs were seen in 79.3% and 10.3% of patients with history and without history of radiotherapy, respectively., Conclusions: X-ray radiation is still a major etiologic factor in developing BCC in northern Iran. Patients with positive history for radiotherapy have higher rate of recurrence.

Chondroid syringoma (CS) is an uncommon benign adnexal tumor of the skin with eccrine and apocrine origin, which usually involves the head and neck region. The presentation of CS in other areas of the body is rare. A 45-year-old male patient presented to the dermatology clinic with a chief complaint of a painless, slow-growing mass on his left forearm, which gradually developed over the course of 2 years. A solitary, firm, purple, mobile, non-tender nodule was located in the distal part of left dorsal forearm, which was 1.8 cm in diameter. The tumor was surgically excised and sent for the histopathological evaluation. Results of biopsy and hematoxylin and eosin staining confirmed the diagnosis of CS and showed no evidence of malignancy. Although CS is an uncommon tumor in uppr limb region, it should be considered as one of the differential diagnoses, when dealing with tumors of this area.

Background: Methotrexate (MTX) is a risky medication requiring careful attention to dosing and monitoring. Dosing and monitoring practices are not well characterized., Aims: The aim of this study was to assess variation in the dosing and monitoring of methotrexate among Iranian dermatologists., Methods: A questionnaire was administered to forty experts in psoriasis concerning the use of MTX., Results: Among the 39 responding dermatologists (15 women, 24 men), 54% saw fewer than 10 psoriatic patients per week, 23% 10-20 patients, and 23% more than 20 patients. About half of the dermatologists treat their patients with an initial MTX dose of <7.5 mg/week (range 5-17.5 mg/week), an average dose of <10 mg/week (range 5-25 mg/week), and a maximum dose of <20 mg/week (range 7.550 – mg/week) with 71.8% prescribing the medication orally and 28.2% intramuscularly. Subcutaneous injection was preferred by none of the dermatologists as a usual route of administration. Nearly 5% of the dermatologists believe that liver biopsy should be performed prior to treatment with MTX in all patients, and another 5% consider this procedure prior to treatment only in patients with risk factors. About 44 and 33% of the dermatologists do the liver biopsy after 1.0-1.5 g and 3.54 g total cumulative doses, respectively., Conclusion: After more than a half century, there are still noticeable controversies on the manner of using MTX in treating psoriasis among Iranian dermatologists. A national guideline may help standardize treatment practices., (© 2013 The International Society of Dermatology.)

Fox-Fordyce disease is an uncommon disorder primarily affecting postpubertal females. It is characterized by intensely pruritic, papular eruptions in apocrine-gland bearing regions. Rarity and scant literature have resulted in a lack of definitive treatment options or pathognomonic diagnostic indicators. We report a 16-year-old boy with typical findings of Fox-Fordyce disease including numerous, grouped, rounded (1-3 mm), skin-colored papules confined to the axillary and periareolar areas, bilaterally. These lesions started before puberty, and were exacerbated by hyperhidrosis.

We report a 29-year-old woman with multiple small keratotic papules on her lateral fingers and first and second toes. Histopathology revealed a compact parakeratotic column with a poorly developed stratum granulosum, indicating punctate porokeratotic keratoderma (PPK). We discuss demographics, etiology, histopathology, differential diagnosis, and treatment of this disease.

Celiac disease is an autoimmune disease associated with increased risk of several diseases including a variety of malignancies. This is the first report of the concomitance of atopic dermatitis and Hodgkin's lymphoma in a child with celiac disease. Here, we report an 11-year-old boy with chronic diarrhea, glossitis, chronic dermatitis, and megaloblastic anemia who later developed Hodgkin's lymphoma.

Monoclonal antibodies have been employed in the treatment of dermatologic disease for quite some time, primarily for psoriasis. Nevertheless, there are numerous case reports detailing successful and unsuccessful treatment of non-psoriatic dermatologic disease with these agents. In most cases, their use is off-label, as the FDA has approved monoclonal antibody use for only a few dermatologic diseases. The most commonly used monoclonal antibodies in dermatology are omalizumab, infliximab, rituximab, adalimumab, and efalizumab, and the disorders of interest include but are not limited to hidradenitis suppurativa, atopic dermatitis, pyoderma gangrenosum, and various blistering diseases. A review of these cases will hopefully encourage the use of monoclonal antibodies in dermatology via development of large, adequately powered clinical trials. This will hopefully result in FDA approval of monoclonal antibodies for a larger variety of recalcitrant, difficult-to-treat dermatologic illnesses.

Pentoxifylline (PTX) is a methylxanthine derivative with a variety of anti-inflammatory effects. Currently, PTX is approved by the Food and Drug Administration for the treatment of intermittent claudication, but studies have shown that it has a variety of physiological effects at the cellular level, which may be important in treating a diverse group of diseases.

Background: Internet use has grown rapidly in Iran, but there is no information about how Iranian Internet users gather medical information through this medium., Objective: To study the use of the Internet as a medical resource by Iranian patients with chronic dermatologic problems., Methods: We carried out a structured interview of all patients 20-40 years of age attending a private dermatology clinic between July and September 2003 for chronic skin disease., Results: Of the 205 patients enrolled in the study, 104 (50.8%) had computer access and 74 (36.1% of the total) had Internet access. Nine patients (4.4%) had performed a search on the Internet for their skin condition, but only one had used an academic website., Conclusion: Despite the significant growth in Internet use in Iran, it appears that the Internet is not a significant medical resource for patients in Iran.

Background: Permethrin, a pyrethroid insecticide, is not yet available in Iran and may be a useful substitute for the control of scabies in Iran., Aim: To compare the efficacy of topical lindane with topical permethrin in the treatment of scabies in a population in Iran., Methods: In a double-blind, randomized study, all consecutive patients with scabies were randomized into two groups. One group and their family contacts received 1% lindane cream, and the other group and their family contacts were treated with topical 5% permethrin cream. Subsequently, patients were followed up at 2- and 4-week post-treatment., Results: Of the 99 patients enrolled in the study, 47 patients received 1% lindane cream, and 52 patients were treated topically with 5% permethrin cream. Permethrin provided an improvement rate of 84.6% after two weeks, whereas lindane was effective only in 48.9% of patients., Conclusion: Permethrin (5%) cream was found to be significantly more effective in the treatment of scabies in comparison with lindane in this study, and it seems that it could be an alternative treatment.

Psoriasis is a chronic inflammatory skin disease whose pathogenesis is modulated by numerous genetic and immunologic factors. During the last decade, our understanding of the pathophysiology of psoriasis has significantly improved, and the disease is now accepted as a T-cell mediated process. This concept has dramatically altered the approach to the treatment of psoriasis. Tumor necrosis factor-alpha (TNF-alpha) is one of the key chemokines in the pathophysiology of psoriasis and its expression is notably increased in psoriatic plaques. Infliximab is a chimeric anti-TNF-alpha monoclonal antibody that binds to both transmembrane and soluble TNF-alpha with high affinity, specificity, and avidity. Presented here is a severe recalcitrant case of psoriasis with sustained benefit from low-dose infliximab in combination with methotrexate.

Although the cutaneous effects of hydroxyurea have been described for patients with sickle cell anemia, myeloproliferative disorders, and psoriasis, there are no reports of cutaneous adverse effects from hydroxyurea when used for patients with intermediate thalassemia. Therefore 43 patients with intermediate thalassemia treated with hydroxyurea were examined by a dermatologist, and pertinent cutaneous findings were recorded. These patients had received hydroxyurea for a mean of 15.5 months. Nineteen had cutaneous hyperpigmentation, eight had xerosis, and three were found to have one cafe au lait macule each. Eleven patients had nail abnormalities, including nail ridging, partial leukonychia, and longitudinal melanonychia. There were no cases of leg ulceration. It was concluded that the risk of developing leg ulcers and pigmentary disorders appears to be related to the underlying disease being treated, as well as to a patient's age, gender, and pigmentation.

A 40-year-old man presented in January 2001 with multiple purple plaques and nodules, which had been present on the back for approximately 3 years. The lesions had gradually extended over the face, trunk and proximal extremities. He had no symptoms except occasional mild pruritus. The patient was in good health and was on no medications. Physical examination revealed multiple violaceous to brown, indurated, 5-50-mm, round to oval plaques on the face, arms, shoulders, and back (Fig. 1), as well as a solitary lesion on the right thigh. Surface telangiectases were noted, especially on the shoulder lesions. There was no scaling or ulceration. Routine laboratory tests were unremarkable. In April 1999, another medical center performed a biopsy of what they thought was sarcoidosis. The results were reported as "possible angiolymphoid hyperplasia with eosinophilia." With the possibility of granuoma faciale (GF) in mind, another skin biopsy was obtained from a facial lesion. This revealed a diffuse, relatively dense infiltrate of neutrophils, eosinophils and mononuclear inflammatory cells in dermis with an obvious Grenz zone (Fig. 2). Pilar units were intact, and endothelial cell swelling was present (Fig. 3). Retrospective evaluation of the initial biopsy, taken from the back, revealed the same changes, and helped confirm the diagnosis of GF. The patient was treated with liquid nitrogen for 20 s followed immediately by intralesional triamcinolone acetonide (5 mg/ml). This treatment was repeated every 4 weeks for three courses, resulting in partial resolution of the lesions.

Background: Paederus dermatitis develops when beetles of the genus Paederus (often called rove beetles) are crushed on the skin, releasing the vesicant pederin. These beetles are found in many tropical and subtropical habitats., Methods: We describe 156 patients who presented to a dermatology clinic in the Guilan province of northern Iran during a 6-month period (May-October 2001)., Results: The peak time of presentation was in September, and the face and neck were the most common sites of involvement. Clinically, the most common presentation comprised geographic erythematous plaques with micropustules. In three-quarters of patients, more than one lesion was present. Kissing lesions were seen in 5% of cases, and 15% of patients developed diffuse desquamation. The majority of patients resided within 1 km of rice fields and used fluorescent lighting at home. In half of the cases, another family member was also affected., Conclusions: Paederus dermatitis is a common skin condition in northern Iran. We believe that increased public awareness of this condition can decrease mucocutaneous exposure to pederin.