Iranian Journal of Dermatology

Abstract Background: Alopecia areata (AA) is an autoimmune disorder of
hair follicles. We aimed to find the association between Vitamin
D level and AA.
Method: Eligible AA patients and controls were enrolled in
this case-control study and serum samples were assessed for
25-hydroxy vitamin D (25-(OH)-D3). The levels of 25-(OH)-D3
were categorized as deficient (<10ng/ml), insufficient (10 to
<30 mg/ml) and sufficient (>30ng/dl) and the SALT (Severity
of Alopecia Tool) score was used to assess the severity of the
disease. The data was analysed and the association between
vitamin D levels and AA, disease distribution, and the pattern
of hair loss was investigated.
Result: Twenty eight patients (19 males, 9 females) and 44
healthy controls (16 males, 28 females) were assessed. There
was no statistically significant difference between patients and
controls with regard to the level of 25(OH)D3 when the data was
adjusted for gender (Ordinal odds ratio: 0.49 (0.18-1.34 and 95%
CI, p-value=0.16). The level of 25(OH)D3 was lower in patients
with nail involvement in contrast to those without it (P=0.02);
moreover, no significant difference was found between patients
with different patterns of hair loss.
Conclusion: After adjustment for gender, there was no association
between AA and the level of vitamin D.

Abstract Background: Hirsutism is defined as the presence of terminal
hairs with a male-like pattern in women, due to the increased
levels of androgens or increased responses of the target organs to
androgens. Facial hirsutism has a negative effect on the quality of
life in female patients. Among the many therapeutic modalities
for hirsutism, laser therapy is of great acceptability. The long
pulse Alexandrite laser, diode laser, and Nd:YAG laser are the
most commonly used lasers in the treatment of hirsutism. In this
study, we assessed the effect of laser therapy on the quality of
life of the patients with hirsutism, using the Dermatology Life
Quality Index (DLQI) and Visual Analog Scale (VAS).
Method: Forty-two female patients with idiopathic hirsutism,
ranging from 18 to 34 years old, were studied during a course
of laser therapy lasting for at least 4 months for up to 3 courses.
Each patient completed a DLQI and VAS questionnaire before
and after treatment. The VAS questionnaire was also filled out
by the dermatologist.
Result: Following laser therapy, the average DLQI score,
decreased by 10 points (a statistically significant difference with
p- value<0.001). VAS also declined and there was a moderate to
good correlation between the VAS scores given by the patient
and the dermatologist.
Conclusion: This study demonstrated that laser therapy improved
the quality of life in patients with hirsutism.

Abstract Background: To our knowledge, there is a hypothesis regardingthe association of vitiligo with other autoimmune disorders.Organ-specific autoantibodies are found more frequently in theserum of vitiligo patients. Recent studies have demonstratedthe role of alterations in serum transforming growth factor-beta(TGF-beta) released from regulatory T cells in the pathogenesisof depigmentation observed in vitiligo. It has been shown that incomparison with patients without autoimmune diseases, serumTGF-beta levels increase in patients whose vitiligo is associatedwith autoimmune diseases. We hypothesized a relationshipbetween serum TGF-beta levels and organ-specific autoantibodiesthat could predict other autoimmune diseases in vitiligo patients.Method: Forty-five patients with a mean age of 35.96±13.34years who had stable vitiligo since 1 year ago and involvementof up to 30% body surface area were enrolled. Organ-specificautoantibodies (ANA, anti mitochondrial Ab, anti TPO (antithyroid microsomal Ab), anti parietal cell Ab, anti thyroglobulinAb) and serum TGF-beta level were evaluated.Result: Twenty-three patients (51.11%) had at least one positiveorgan-specific autoantibody. Anti TPO in 16 patients, antithyroglobulin Ab in 9 patients, anti parietal cell Ab and ANAeach in 5 patients, and anti mitochondrial Ab in 4 patients werepositive. Mean serum TGF-beta level was 105.82±30.33; there wasno significant difference in serum TGF-b level between patientswith and without positive organ-specific autoantibody (P=0.26).Conclusion: Although another study showed the relationshipbetween serum TGF-beta levels and autoimmune disordersin vitiligo patients, we did not find a significant difference inserum TGF-beta levels in these patients regarding the positivityof organ-specific antibodies. It may be due to the fact that ourpatients had autoantibodies without clinical autoimmune diseaseexcept vitiligo.

Abstract Background: Melasma is an acquired therapeutically problematicdisease characterized by symmetrical facial hypermelanosis. Theaim of this study was to evaluate the efficacy of azelaic acid20% cream in the treatment of melasma in Iranian patients andcompare it with hydroquinone 4% cream which has been thestandard treatment.Method: The study was an open clinical trial with a split-facedesign. All patients applied hydroquinone 4% cream on theright side and azelaic acid 20% cream on the left side for 20weeks. Modified melasma area and severity index (mMASI) wasdetermined for each patient at the beginning and at the end ofstudy and compared statistically.Result: Thirty-three patients were included in the study. Althoughboth medications were effective in reducing mMASI, there wasno statistical difference between the two (P value=0.6). Overall,69.7% of the patients on the hydroquinone 4% side and 63.6%on the azelaic acid 20% side showed good to excellent response.The subjective patient assessment of improvement was 75.7% forhydroquinone 4% and 66.6% for azelaic acid 20%.Conclusion: Both topical hydroquinone 4% and topical azelaicacid 20% had almost similar effects. Considering the relativelyless known side effects of azelaic acid compared to hydroquinone,it can be an appropriate substitute in the treatment of melasma.

Abstract Background: Although cryotherapy has been reported as atechnique for depigmenting residual pigmented patches inpatients with universal vitiligo, Q-switched Nd-YAG lasershave not yet been used for this purpose. The aim of this studywas to compare the efficacy of cryotherapy with that of 532nmQ-switched Nd-YAG laser therapy for depigmentation in patientswith universal vitiligo.Method: Six adult patients (4 male and 2 female) with universalvitiligo and facial residual pigmented patches were treatedsimultaneously with cryotherapy on the right and the frequencydoubled532nm Q-switched Nd-YAG laser therapy on the leftside. The laser parameters used were spot size 3-5mm, frequencyrate 10 hertz, and the fluence was 5J/cm2. The cryo system wasa closed contact CO2 Cryo gun. The patients were scheduled tobe treated monthly.Result: The depigmentation was complete after three successivesessions of cryotherapy and 30-45 days after the last session, incomparison with simultaneous 30-70% depigmentation of the laserside. No scar or permanent sequellae developed on either side.Conclusion: Cryotherapy is more effective and fast-actingthan Q-switched Nd-YAG laser for depigmentation of residualpigmented patches in patients with universal vitiligo.

Abstract Background: The skin is among the main tissues affected by
Sulfur Mustard (SM) in chemical attacks. Iranian researchers
have performed extensive studies on the exposed victims and
have reported a wide spectrum of information in this field. The
main objective of this study was to develop a comprehensive
revision of data on the pathology, pathogenesis, clinical findings,
complications, and treatment of sulfur mustard exposure.
Method: This study was part of a systematic search which
included all the war related studies on Iranian victims. Among
nearly 300 retrieved articles, a total of 193 medical articles were
approved in terms of quality and were related to the Iraq-Iran
chemical war (1984-1988) out of which 48 were directly related
to the dermatologic effects of sulfur mustard. We used known
international databases such as ISI, Medline, Scopus, and Iranian
databases such as Iranmedex, SID, and Irandoc in this study.
Publishing the articles in approved journals was the main criterion
for their quality.
Result: In this study, the most common symptom in the delayed
phase of the exposure to SM was itching which was more frequently
seen in women as compared to men. The most common sign was
erythema in the skin. One of the chronic complications at the
site of exposure was mustard scar. Lipoma and cherry angioma
were the most common skin tumors which were reported.
Iranian researchers have presented different approaches for the
management of exposed victims.
Conclusion: In this study, in addition to the effects of SM on
the skin, some methods were presented for decontamination,
management of itching, vesicles, blisters and treatment of chronic
skin lesions.

Abstract Primary cutaneous large B-cell lymphoma leg type is a rare andaggressive neoplasm as defined by the recently updated WorldHealth Organization - European Organization for Research andTreatment of Cancer. We report a case of an 80-year-old manwith multiple cutaneous lesions. Here, we review the availableliterature and summarize clinical features and management ofthis type of cutaneous B-cell lymphoma.

Abstract Aplasia cutis congenita is the congenital absence of skin mostcommonly affecting the scalp. No definite etiology is available butmultiple causes such as intrauterine infection, fetal exposure tococaine, heroin, alcohol or antithyroid drugs, vascular disruption,genetic causes, syndromes and teratogens have been suggested.We present an infant with extensive aplasia cutis of the trunk andthigh. He was the third child of his parents while the outcomeof the first and the second pregnancy was intrauterine death;the dead fetuses however had no skin anomaly.

Abstract Verrucous hemangioma is a rare, localized vascular malformation.The lesions are bluish-red, well demarcated, and compressible. Wereport a case of a 10-year-old girl with coexistent disseminatedverrucous hemangioma and subcutaneous hemangioma overthe nape of neck.

Abstract A 38- year-old man in good general health and normal intellectualfunctioning referred to the dermatologic clinic with numerouspruritic reticulate pigmentations on his neck, chest and upperback since 10 years ago. We noticed similar lesions on his axillae,groin and infra mammary area with no family background.