Iranian Journal of Dermatology

Abstract Background: This study aimed to investigate the prevalence and phenotypic variations of Demodex mites among individuals referred to the dermatology department of Sayad Shirazi Hospital at Gorgan, northern Iran.
Methods: A total of 242 participants were sampled, and the collected specimens underwent microscopic analysis to assess the prevalence of Demodex in the studied population. Furthermore, this study examined the risk factors associated with Demodex infestation, as well as the various phenotypes of the mites.
Results: The findings revealed that 27.68% (67 out of 242; 95% CI: 22-33%) of the participants were infested with Demodex mites. The age group most affected by Demodex infestation was 21 to 30
years, accounting for 11.57% (28 out of 242) of positive cases. No statistically significant correlation was found between Demodex infestation and skin type (P = 0.76). However, individuals with acne exhibited a significantly higher prevalence of Demodex infestation at 16.96% (41 out of 242) compared to 10.74% (26 out of 242) in those without acne (P = 0.0013). Overall, a significant association was noted between the prevalence of Demodex mites and the risk factors of age (P = 0.000003), the use of skin cleansing products (P = 0.002), and the presence of acne (P = 0.0013). The study identified two phenotypes, both classified as Demodex folliculorum.
Conclusion: The findings suggest that the use of skin cleansing products is associated with a reduced prevalence of Demodex mites, while the presence of acne is linked to an increased prevalence. Furthermore, a unique indentation observed in the podosomal/opisthosomal connection of Demodex, which differs from previously documented phenotypes, may represent a novel characteristic for phenotypic classification.

Abstract Background: The surgical treatment of vitiligo becomes essential in cases where there is a delayed therapeutic response to medical treatment or a complete lack of response, particularly in acral areas. The need for phototherapy following surgical interventions for vitiligo is a subject of debate.
Methods: Patients with a clinical diagnosis of acral vitiligo were enrolled in this investigator-blind, randomized clinical trial. The patients underwent suction blister epidermal grafting (SBEG) on both sides. The lesions on only one side were randomized to receive topical psoralen plus ultraviolet A (PUVA) phototherapy. The therapeutic response on both sides was evaluated using the reverse Vitiligo Area Severity Index (VASI) score, and Vitiligo Extent Score for a Target Area (VESTA) at the first, second, fourth, and sixth months following SBEG. Additionally, we measured the repigmentation rate, patient satisfaction, and quality of life.
Results: Fifteen patients were enrolled in the study. The reverse VASI and VESTA scores decreased significantly on both sides after treatment (P < 0.001). The improvements in reverse VASI and VESTA scores were not significantly different between the sides (P = 0.703 and P = 0.910, respectively). The time to achieve 50% repigmentation did not differ between the sides (P = 0.915). Patients reported greater satisfaction with the color of the lesion following phototherapy compared to SBEG alone (P = 0.01). Treatment for acral vitiligo significantly improved the quality of life for the patients (P < 0.001).
Conclusion: SBEG is an effective treatment for acral vitiligo. The addition of PUVA phototherapy following SBEG does not significantly enhance the clinical response and can therefore be omitted from the therapeutic protocol.

Abstract Background: Kligman’s Triple Bleaching Formula is a widely recognized treatment for skin hyperpigmentation. Reports have suggested that methimazole may enhance the effectiveness of Kligman’s formula. This study investigates the potential synergistic effects of incorporating methimazole into this treatment for melasma.
Methods: In this randomized clinical trial, facial melasma was treated with Kligman’s formula on one half of the face, while the other half received an additional 5% methimazole. The Melasma Area and Severity Index (MASI), patient satisfaction measured using a visual analogue scale, and adverse effects were evaluated at eight and 16 weeks after the initiation of treatment.
Results: Forty female patients were selected for this study. Eight weeks after the initiation of treatment, both groups showed a significant decrease in MASI scores (P < 0.0001). However, at 16 weeks after protocol initiation, the MASI scores significantly increased in both groups (P < 0.0001). The changes in MASI scores over time between the two treatment groups were not statistically significant (P = 0.611). Patient satisfaction scores at eight weeks were significantly higher for the Kligman + methimazole group compared to the Kligman-only group (P = 0.001). Sixteen weeks after treatment, the satisfaction scores in the Kligman + methimazole group remained higher, although this difference was not statistically significant (P = 0.269).
Conclusion: Despite the non-significant effect of adding 5% topical methimazole to Kligman’s formula, the results indicate that epidermal melasma appears to benefit more from this combination than dermal and mixed types. Larger studies are required to further investigate its potential in this context.

Abstract Background: Skin diseases are among the most prevalent health conditions, encompassing a wide range of disorders. However, the number of studies examining the epidemiology of dermatology consultations is limited. Conducting research to evaluate dermatology consultations can provide valuable insights into their role in the patient treatment process.
Methods: In this cross-sectional study, data related to all dermatology consultations conducted at teaching hospitals affiliated with Shiraz University of Medical Sciences from March 21 to June 21, 2023, were collected.
Results: A total of 212 dermatology consultations were conducted, resulting in a prevalence rate of 1.20%. The highest frequency of consultations occurred among male patients aged 50 to 70 years. Most of the consultations were requested by male physicians holding the academic rank of professor. The majority of consultations originated from the emergency and internal medicine departments, primarily due to conditions such as eczema and hypersensitivity reactions. In most instances, responses to the consultations were provided within 8 to 24 hours. Only 5.7% of the consultations were classified as emergencies, and in 31% of cases, more than one consultation request was submitted for the same patient. The diagnoses made by the requesting physician and the dermatologist were consistent in only 22.6% of cases. Notably, dermatology consultations led to a change in the treatment plan in 96.7% of cases.
Conclusion: The findings of this study underscore the necessity of enhancing dermatological knowledge among primary care physicians and specialists in other fields.

Abstract Background: Skin flap viability is a major concern in surgical procedures due to the detrimental effects of ischemia-reperfusion, oxidative stress, and inflammation, which can lead to necrosis. Finasteride and all-trans retinoic acid (ATRA) have potential antioxidant and anti-inflammatory characteristics. The aim of this study is to investigate the effects of their combination therapy on survival rates, oxidative stress markers, and histopathological alterations in a rat model of skin flap.
Methods: Male Wistar rats were divided into five groups: Sham, Control, Finasteride, ATRA, and Finasteride & ATRA. Finasteride (5 mg/kg) was administered orally, while ATRA (1%) was applied topically. On the seventh day post-flap surgery, tissue samples were collected. The necrotic area of the flaps, levels of malondialdehyde (MDA), myeloperoxidase (MPO) activity, and superoxide dismutase (SOD) activity were measured. Histopathological evaluations for fibroblast migration, granulation tissue formation, inflammation, and necrosis were conducted using hematoxylin and eosin (H&E) staining.
Results: Combination therapy with finasteride & ATRA significantly reduced the percentage of flap necrosis, levels of MDA, MPO activity, as well as microscopic necrosis, and inflammation (P < 0.05). Additionally, this combination therapy enhanced SOD activity, granulation tissue formation, and fibroblast migration (P < 0.05).
Conclusion: Our findings demonstrate that combination therapy with finasteride and ATRA has potential benefits for improving survival rates and mitigating histopathological alterations in skin flap tissue. Additionally, this approach may effectively reduce oxidative stress and enhance the antioxidant defense mechanisms of flap tissue. However, further investigation is essential to elucidate the underlying molecular mechanisms and potential clinical applications of this therapeutic strategy.

Abstract Frontal fibrosing alopecia (FFA), a type of primary cicatricial alopecia, has an unknown exact pathogenesis, which may be influenced by environmental factors. Allergic contact dermatitis (ACD) is a frequently observed comorbidity in patients with FFA. In this article, we analyze the potential association between ACD and FFA by reviewing the published literature from PubMed and Google Scholar. We examined relevant articles related to ACD and contact allergens in FFA patients published since 2012. The use of cosmetics and facial products among FFA patients is significantly higher than in the healthy population. The presence of ACD in conjunction with FFA can be indicated by one or more positive patch test reactions to common contact allergens found in everyday products, particularly cosmetics and facial products. Contact allergens identified in patients with FFA include nickel sulfate, benzyl salicylate, gallates, propolis, limonene hydroperoxides, cobalt(II) chloride hexahydrate, alkylphenolic compounds, and linalool. Overall, the literature suggests that ACD is prevalent among patients with FFA and may play a role in its pathogenesis.

Abstract Mucoepidermoid carcinoma is a malignant epithelial neoplasm and the most common malignant tumor of the salivary glands. Although it primarily occurs in the salivary glands, it can rarely be found in other locations, such as the sinonasal tract, nasopharynx, lungs, and intraosseous mandible. This tumor is more frequently diagnosed in middle-aged adults. Overall survival rates are highly dependent on the tumor’s histologic grade, with a significant decrease in survival associated with higher grades. The five-year survival rate is approximately 98% for low- and intermediate- grade tumors, while it drops to about 67% for high-grade tumors. In this report, we present an extremely rare case of primary mucoepidermoid carcinoma in an 88-year-old man who exhibited a nodular lesion on the left temporal side of the scalp. Histopathological examination revealed glandular and squamous differentiation, and an immunohistochemical studies, including CK7, P63, and EMA, confirmed the diagnosis. This case is presented due to its rarity and emphasizes the importance of adequate sampling for accurate diagnosis.

Abstract Granuloma multiforme is an extremely rare condition characterized by multiple confluent annular skin lesions of unknown etiology. Although the first case was reported in Africa, there have been a few additional reports from other regions in Asia. We present a case of granuloma multiforme diagnosed in a middle-aged woman from Ahvaz, the capital of Khuzestan Province in southwestern Iran. Clinically, the skin lesions were characterized by multiple confluent, skin-colored annular lesions on the trunk and upper extremities. Histologically, the lesions exhibited multiple granulomas at the periphery and a notable absence of elastic fibers in the center. The patient was treated with topical corticosteroids and demonstrated a favorable response.

Abstract Oral melanoacanthoma is a benign, reactive, pigmented mucocutaneous lesion. It typically presents as a solitary macule on the buccal mucosa, followed by the palate, lips, and gingiva, with a higher prevalence in women. The diagnosis of this lesion is established through histological examination. Once diagnosed, no treatment is required. We present a case of oral melanoacanthoma located in the posterior region of the right buccal mucosa in a 34-year-old woman. The lesion appears as a pigmented macule with indistinct borders in certain areas and an uneven dark brown coloration. The observations and findings noted in this case are atypical. This case report underscores the importance of clinicians’ awareness of oral melanoacanthoma in the differential diagnosis of oral pigmented lesions. Given that malignant melanoma is included in the differential diagnosis of pigmented lesions, a biopsy of oral pigmentations—particularly those with unclear borders and non-uniform coloration—is essential.

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