Iranian Journal of Dermatology

Abstract Background: The aggravating role of Staphylococcus aureus is well known in atopic dermatitis but has not yet been proven in psoriasis. The role of Staphylococcus aureus superantigens is emphasized in the initiation, maintenance and complications of psoriasis. We investigated the frequency of nasal, axillary, and perineal carriage of Staphylococcus aureus (SA) in patients with psoriasis and its possible influence on the severity of the disease. Methods: one hundred patients with the clinical diagnosis of psoriasis participated in the study. Cultures of the bacterial flora were obtained from the right and left axilla and nasal nares and perineum, inoculated on standard bacterial medium (blood agar), and incubated at 37°C degrees for 48 h. Results: one hundred patients with the clinical diagnosis of psoriasis (42% female and 58% male) comprised the study group. Mean age of the patients was 41.1±17.1 years. About 42 % of the patients carried S. aureus; of these, 32 % were from the nose, 13 % from axilla, and 11% from the perineum. Three patients were carriers in all 3 sites. There was no significant difference in the severity of the disease between the carriers and non-carriers measured by the psoriasis area and severity index (PASI) score. Conclusions: According to our findings, S.aureus carriage in psoriasis had no significant influence on disease severity. It might be relevant for a subgroup of patients only when superantigen productions are found.

Abstract Background: Human fibroblasts are the part of the dermis that secrete extracellular matrix for the purpose of tissue repair. Culturing fibroblasts, which leads to formation of a monolayer of these cells, is used for treating various conditions including thermal burns and other skin defects such as diabetic and varicose vein leg ulcers. Therefore, we aimed at developing a fibroblast bank to accomplish multiple goals including skin repair in defects such as burns and ulcers and also performing various research projects on these cells in order to further study of the mechanisms involved in wound healing, rejuvenation and medication effects. Method: We initially developed primary cultures of skin fibroblasts in a DMEM medium. These primary cultures were formed by washing and trypsinizing foreskin specimens followed by separation of epidermis from dermis and cutting the dermis into small pieces. In about 10 days, a monolayer of fibroblasts was formed. Result: We were able to develop the fibroblast bank successfully and to initiate other projects utilizing this bank. Conclusions: With these cultured cells, we would be able to perform different research projects including studying the mechanisms of wound healing, rejuvenation, drug affects, inflammatory mediators, growth factors, etc. Moreover, further progress in this field will result in our independence from requesting these cells from external sources.

Abstract Background: An elevated homocysteine level is an independent risk factor for cardiovascular disorders. Psoriatic patients have an increased risk of cardiovascular diseases; In addition, hyperhomocysteinemia is a complication of methotrexate treatment. We undertook a study to evaluate the plasma levels of homocysteine, vitamin B12 and folate in patients with psoriasis before and after short-term low-dose methotrexate treatment. Methods: Twenty six patients with psoriasis were recruited. The plasma levels of homocysteine, vitamin B12 and folate were evaluated before and 8 weeks after methotrexate therapy (in the peak of methotrexate effect). Results: No significant difference was found between the plasma profile of homocysteine, vitamin B12 and folate before and after methotrexate treatment. Conclusion: In the short-term treatment of psoriasis, methotrexate does not increase homocysteine level.

Abstract Background: Dermatophytes are a group of closely related fungi that invade keratinized tissues (skin, hair and nails) of humans and animals and produce infections called dermatophytosis. Our objective was to determine causative agents of dermatophytosis in Gorgan, North of Iran. Methods: Data was based on collecting specimens from 1108 patients clinically suspected to have fungal infection during five years from 2003 through 2007. Specimens were collected from hair, nail and skin and were investigated by direct examination and cultured in Sabouraud dextrose agar. Fungal colonies were identified by macroscopic and microscopic examination and supplementary tests. Results: 351 samples out of 1108 were positive for dermatophytes and 277 ones had positive cultures. Epidemophyton floccosum was the most frequent species (70.4%) followed by Trichophyton rubrum (14.5%) and Microsporum audouinii (7.2%). Regarding the location of the lesions, groin and nails were the most frequent sites that developed dermatophytosis in the majority of the patients. Conclusion: Dermatophytosis is probably still one of the most infectious diseases in Iran. The anthropophilic (E.fluoccosum) and zoophilic (T. rubrum) species were the most common causes of dermatophyte of tinea in Gorgan, north of Iran. The frequency of tinea was higher in females and tinea cruris showed a remarkably increasing rate and can be an important public health issue in Gorgan.

Abstract Background: Cutaneous drug reaction seems to be relatively common The aim of the study was to recognize offending drugs, evaluate patients' characteristics and educate the patients to avoid selfadministration and re-administration of drugs. Methods: We retrospectively and prospectively analyzed data from Sina hospital in Tabriz (2000-2005) to determine the number of hospitalizations and visits with primary diagnoses of skin conditions that are often attributed to drugs. A physical examination was done by a dermatologist who completed a standardized questionnaire. Requested information included patient characteristics (associated disorders, severity scores), drug intake and characteristics of the skin reaction (type, course).Using statistical methods for surveys, we determined the demographic characteristics of patients with these diagnoses. Results: Three hundred patients (148 males and 152 females) with cutaneous drug eruption were studied. The most common eruptions were erythroderma (41.3%) and maculopapular rash (26%) and the most common offending drugs were carbamazepine (28%), carbamazepinevalproate (20%) and Co-Ttrimoxazole-carbamazepine-diclofenac sodium combination (26.7%). The highest number of the patients belonged to the age group of 30-39 years (15%). The interval between developing lesions and intake of the offending drug varied from 1 day to 45 days. Drug reactions showed that 20-30% of the ADRs from anticonvulsants, 15-25% of the ADRS from sulfonamides, 10% of the ADRs from antibiotics, and 7% of the ADRs from non-steroidal antiinflammatory and anti-hypertensive drugs were dermatological. Conclusion: The pattern of ADRs and the drugs causing them is remarkably different in our population. Knowledge of these drug eruptions, the causative drugs and the prognostic indicators is essential for clinicians. It is recommended to advise patients to carry a card or some other form of an emergency identification in their wallets that lists drug allergies and/or intolerances, especially if they have had a severe reaction.

Abstract Two different cases of Stevens - Johnson syndrome are reported. We used intravenous immunoglobulin in their management and compared the results of treatment with the conventional lines of therapy in a historical control.

Abstract Segmental neurofibromatosis type I (SNF-I) is a rare variant of neurofibromatosis (NF). It is classified as NF type V and defined as cafe'-au-lait macules and/or neurofibromas in a single ,unilateral segment of the body .We report two cases with SNF-I with striking similar manifestations.

Abstract Lipedematous scalp (LS) and Lipedematous Alopecia (LA) are uncommon disorders of unknown etiology, pathogenesis and treatment. They are characterized by thickening of the subcutaneous layer of the scalp and a boggy scalp on palpation. Also, hair loss or shortening of hair is seen in LA. In this report, we describe LS in a 42-year-old woman presented with a diffuse thickened and spongy scalp. To date, only 10 cases of LS and 18 cases of LA have been reported and we report the 11th case of LS but it seems to be more prevalent than reported.

Abstract There are various methods to treat keloid. However, the recurrence of keloidal lesions seems important in this regard. Herein, we report a case of successful treatment of earlobe keloids with imiquimod after shave excision.

Abstract A 43-year-old middle-eastern woman was visited with a 15-year history of multiple painful cutaneous nodules on her back. The first lesion appeared on her back when she was 28 years old. As she aged, the lesions became larger, more numerous, and more painful with cold or physical contact. Her medical history was not significant. The patient’s medications included naproxen, calcium-D, and vitamins. Her family history was notable as her brother had developed similar cutaneous lesions. Physical examination revealed more than 30 pinkish papules, measuring up to 1 cm in diameter, in a grouped arrangement on her back (Figure 1). The complete blood cell count, serum chemistry profile, and serum erythropoietin levels were within normal limits. Abdominal ultrasonography was normal. A skin biopsy specimen was obtained from a nodule on her back (Figure 2).

Abstract A 40-year-old man was visited at our clinic with a history of pruritic cutaneous papules in a zosteriform pattern from 3 months ago. The skin lesions were located unilaterally on the right side of his thorax. On examination, there were multiple shiny, erythematous, violaceous and slightly scaly papules limited to right T7 dermatome (Figure.1). General physical examination was unremarkable and mucous membranes were intact. A biopsy was taken and the specimen exhibited hyperkeratosis, focal increases in the granular cell layer, and irregular acanthosis with a saw tooth appearance, liquefactive degeneration of the basal cell layer and a band-like lymphocytic infiltrate at the dermo-epidermal junction and a number of Civatte bodies. He was treated with potent topical steroids. After 2 months, he came back with generalized lesions and typical mucosal lesions. This time, he was treated with systemic steroids. After 2 months, pruritus subsided and post inflammatory hyperpigmentation was formed, but mucosal lesions persisted. Lichen planus (LP) is an idiopathic inflammatory disease of the skin and mucous membrane. It is characterized by pruritic violaceous papules that favor the extremities1. Linear LP refers to LP with a unilateral linear distribution. This variant may present as an example of the Wolf’s isotopic response on the site of healed zoster2. In very rare instances, linear LP presents in a segmental fashion corresponding to one dermatome and is termed zosteriform LP. In extremely rare cases, zosteriform or linear distributions appear de novo on previously normal, non-traumatized skin, as in our patient. Although case reports of de novo dermatomal LP have been reported3, this entity is controversial. Happle argued that the term zosteriform lichen planus has been applied inappropriately in cases who have developed lesions de novo in the lines of Blaschko, rather than in true dermatomes4. Some authors believe that true zosteriform LP only exists in cases who have developed lesions on the sites of healed herpes zoster. In our patient, the distribution of lesions was limited to T7 dermatome. The patient denied prior history of herpes zoster. The linear eruption seemed to follow a true dermatome rather than in the Sshape pattern of the lines of Blaschko on the trunk. Although it is difficult to differentiate the two, these atypical distribution patterns may provide clues to the pathogenesis of a condition with a currently unknown etiology.