Iranian Journal of Dermatology

Abstract Background: Vitiligo is a common cutaneous depigmentation disorder caused by the destruction of melanocytes. The exact etiopathogenesis of this disorder is not well known, but a complex of genetic, immunologic, inflammatory, and cytotoxic factors have been implicated. According to reports on the role of vitamin B12 and folic acid deficiency as important co-factors in the metabolism of homocysteine, we expected an increase in homocysteine levels in patients with vitiligo; therefore, our aim was to investigate the serum levels of homocysteine in Iranian
patients with vitiligo.
Method: Forty patients with vitiligo and 40 healthy controls matched for age and sex were studied. After exclusion of cases with diseases that could affect the homocysteine level, serum homocysteine levels were measured by ELISA.
Result: Males comprised 57.5% of the participants in both groups and 42.5% were female. The mean age of the patients was 24.68 ± 12.44 years. The level of homocysteine in the case and
control groups was 18.56 ± 5.69 and 10.19 ± 4.40, respectively, which was significantly higher in patients with vitiligo (P ? 0.001). There was no correlation between homocysteine levels and age,
sex, history of previous treatment, duration of disease, and the extent of body surface involvement. Serum homocysteine levels in patients with regressive vitiligo (13.8) were lower than
progressive (18.4) and stable (20.4) cases (P = 0.05).
Conclusion: We found that the increase in serum homocysteine level in patients genetically susceptible to vitiligo could be a predisposing factor for the development of vitiligo. The serum
homocysteine level is associated with disease activity, and may be used as a prognostic factor for disease activity.

Abstract Background: Plantar warts may be refractory to any form of treatment and are associated with pain and a decreased quality of life. There are very few randomized controlled studies that focus
on the treatment of plantar warts. Cryotherapy and radiofrequency ablation (RFA) have been used in the treatment of this recalcitrant condition. However, no data exists comparing the efficacy of
these treatment options in the treatment of plantar warts. The aim of the study was to compare the efficacy of cryotherapy and RFA in the treatment of plantar warts.
Method: Fifty patients with a clinical diagnosis of plantar warts were included in the study. They were randomly divided into  two groups of 25 patients. After paring the warts, Group A was
treated with cryotherapy with nitrous oxide and Group B was treated by RFA of warts every 2 weeks for a maximum period of 12 weeks. The results of the two groups were compared at
the end of 12 weeks.
Result: Fifty patients had a total of 212 warts. Eighty four percent (21/25) of the patients receiving RFA experienced subjective benefits within 2 sessions whereas in the cryotherapy group, 72% (19/25) of the patients required three to four sessions to experience subjective benefits (p = 0.00189). Eighty four percent (21/25) of the patients and 91.6% (121/132) of the warts in the
RFA group achieved complete clearance by the end of 12 weeks whereas only 32% (8/25) of the patients and 31.25 % (25/80) of the warts receiving cryotherapy achieved complete clearance by
the end of 12 weeks (p = 0.00681).
Conclusion: Radiofrequency ablation is more effective than cryotherapy in the treatment of plantar warts and gives quicker subjective and objective results.

Abstract Background: There are different treatment options with variable results for the management of pyogenic granuloma (PG). The aim of this study was to evaluate and compare the cosmetic results and recurrence rate of classic surgical excision with a novel proposed method, curettage and punch excision of the vascular stalk (C&P) in patients diagnosed as PG.
Method: Forty consecutive cases of PG (20 with hand and 20 with facial lesions) were randomized into 2 treatment groups (total excision vs. C&P). The patients were visited by another physician
who was blind to the method to evaluate the recurrence of the esions and measure the scar size.
Result: Thirty-eight cases completed the study. There was only one recurrence in the hand C&P group that was not statistically significant when compared with the hand excision group (P < 0.05). The mean scar size in the cases with total excision was significantly larger than the C&P group (P < 0.001). Also, there were no detectable scars in 72% of the cases who underwent C&P.
Conclusion: It seems that our proposed method, i.e. C&P, is an effective option in the treatment of PG with a very low recurrence rate and more favorable cosmetic results.

Abstract Background: Immunobullous diseases are morphologically heterogeneous and the differentiation between various subtypes is essential for proper treatment and prognosis. The aim of our study was to analyze and correlate clinical, histopathological, and immunofluorescence findings in autoimmune bullous diseases.
Method: A cross-sectional study was conducted over a period of two years (2010-2012) after receiving the ethics committee approval. Sixty patients who met the inclusion criteria of immunobullous disease were included in the study. Skin biopsy for histopathological and direct immunofluorescence (DIF) examination was taken. DIF was also done in a few of the cases using the salt-split technique. The final diagnosis was based on clinical, histopathological, and DIF
findings.
Result: Sixty cases with a clinical diagnosis of autoimmune bullous diseases were evaluated. In 95% of the cases, the histopathological diagnosis was consistent with the clinical diagnosis and in 75% of the cases, the DIF diagnosis was consistent with the clinical diagnosis. A positive relationship was seen between clinical and DIF findings with r = 0.67 and between histopathologic and DIF findings with r = 0.76. DIF positivity was seen in 100% of the cases of bullous pemphigoid (BP), 100% of the cases of pemphigus foliaceus, and 94.7% of the cases of pemphigus vulgaris which was statistically significant with P < 0.05.
Conclusion: Our study provides evidence-based guidance for the diagnosis and classification of various immunobullous disorders. DIF test should be done in conjunction with histopathology to
make a definite diagnosis and minimize both false-positive and false-negative results.

Abstract Background: Bowen’s disease is a form of intraepidermal squamous cell carcinoma (SCC) characterised by a persistent, non-elevated, red, scaly or crusted plaque with a small potential
for invasive malignancy. Most cases of typical Bowen’s disease in the white population are found on the lower legs of the elderly women. However, in this part of the world, i.e. Kashmir, the most
common site is thighs followed by the lower abdomen. A range of treatment options are available for it including cryotherapy, curettage and cautery, photodynamic therapy, laser destruction,
surgical excision, 5-fluorouracil cream, imiquimod cream, and radiotherapy. The aim of this study was to evaluate the efficacy of surgical excision in Bowen’s disease.
Method: All the patients with biopsy proven Bowen’s disease were included for the study. A detailed
history was taken for each patient including the history of medical treatment for Bowen’s disease. Wide surgical excision (including either fusiform excision, W-plasty, or Z-plasty) was performed in each patient and the patients were then followed up for any recurrence. No sign of renewed disease activity at 6 months follow-up was taken as cure. All patients are intended to be followed up for 5 years.
Result: Ten out of 12 patients reported the use of topical imiquimod cream but complained of the progression of lesions. Surgical excision was performed in 12 patients. All the patients are currently under regular follow-up. Except for secondary infection and wound dehiscence in one patient, all the patients are in good condition with no signs of recurrence.
Conclusion: Although it was a preliminary study, we recommend surgical excision in treatment of Bowen’s disease due to low recurrence rate.

Abstract Nevus lipomatosus superficialis (NLS) is a hamartomatous skin lesion defined by the presence of mature adipose tissues among the collagen bundles of the dermis. It is classified into two forms:
the classical form and the solitary form. The classical NLS most commonly involves the pelvic or gluteal region. In this paper, we report a case of classical NLS over the neck because of its atypical
site. In addition, our patient had some uncommon features of NLS such as the presence of comedo-like lesions on the plaque and a foul-smelling discharge.

Abstract Cutaneous skin tags are common skin growths, usually harmless, which protrude from the skin and may have a short, narrow stalk. Typically, they are the same color as the skin or a little darker
and appear mostly in the axilla, groin, and cervical area. In this report, we present a 30-year-old female with pedunculated and sessile papules in both of her ear canals with no history of any
related illnesses and a negative family history. Histopathological examination of the papules showed intra-auricular skin tags. Most of the cases of skin tags near the ear canals are reported in
patients with congenital disorders and malformations. Therefore, to the best of our knowledge, this is the first reported case of skin tags in both ear canals in an otherwise healthy adult.

Abstract Monocytic sarcoma is a neoplasm of immature monocytes involving any extramedullary site such as skin. The definite diagnosis is important for adequate therapy, which is often delayed because
of misdiagnosis. We report a 51-Year-old diabetic woman who presented with several erythematous itchy papules and plaques on her scalp, trunk and upper extremities during a five-month period.
Clinical differential diagnoses were scleredema diabeticorum, scleromyxoma, mucinosis, eruptive histiocytosis, leprosy and sarcoidosis. Skin biopsy showed features of monocytic sarcoma. We
present this case to alert dermatologists and dermatopathologists of erythematous skin lesions clinically resembling bland-looking dermatoses such as scleredema diabeticorum, scleromyxoma,
mucinosis and eruptive histiocytosis, which, in rare instances, may be a presenting feature of a monoblastic leukemia with initial dermal presentation.

Abstract