Iranian Journal of Dermatology

Abstract Background: Determining the various consequences of lichen planopilaris (LPP) is essential for improving patient care strategies. The aim of this study was to evaluate sleep quality in patients with LPP.
Methods: In this case-control study, 58 patients with LPP were enrolled, along with an equal number of age- and sex-matched healthy controls. The Pittsburgh Sleep Quality Index (PSQI) was utilized to evaluate sleep disturbances in all participants. Additionally, the Dermatology Life Quality Index (DLQI) was assessed.
Results: The mean PSQI score was 11.2 ± 4.8 for the case group and 4.4 ± 2.7 for the control group, indicating a statistically significant difference (P = 0.001). Additionally, the mean quality of life score was 11.6 ± 7.2 for the case group and 3.1 ± 3.04 for the control group, which also demonstrated a statistically significant difference (P = 0.001).
Conclusion: This study demonstrated that patients with LPP experienced decreased sleep quality and a lower quality of life compared to the healthy population. We recommend screening for sleep disturbances in patients with LPP, as these disturbances may serve as prodromal symptoms of mood disorders.

Abstract Background: Hair loss significantly impacts both the physical and social dimensions of health-related quality of life (HRQOL). In the absence of available Persian tools to assess HRQOL in these patients, this study aims to fill this gap by evaluating the psychometric properties of the Persian version of the Hair-Specific Skindex-29 (HSS-29) among Persian- speaking adults experiencing hair loss.
Methods: This psychometric study was conducted from September 2021 to June 2022 in Tehran, Iran, involving participants from dermatology clinics who were diagnosed with various types of hair loss. The HSS-29 was translated into Persian, back-translated to ensure accuracy, and reviewed for consistency. Face and content validity were rigorously assessed through expert reviews and patient feedback. Construct validity was evaluated with 192 participants using confirmatory factor analysis (CFA). Convergent validity was established by correlating the Persian version of the Dermatology Life Quality Index (PVDLQI) among 109 patients. Reliability and internal consistency were assessed using test-retest methodology and Cronbach’s alpha. Statistical analyses were performed using SPSS and R software.
Results: An expert panel’s assessment of content validity led to the removal of nine items from the initial instrument. Consequently, the final version, named the Modified Persian version of HSS-29 (MPVHSS-29), comprised 20 items. The Spearman’s correlation coefficient between the MPVHSS-29 and the PVDLQI was significant, indicating a strong relationship (r = 0.71). CFA demonstrated acceptable goodness-of-fit indices for the model. The Cronbach’s alpha values for the instrument’s subscales were in the good range (≥ 0.70), indicating solid internal consistency. Additionally, the intraclass correlation coefficient (ICC) results showed that the MPVHSS-29 possesses suitable external reliability (r = 0.84, P = 0.001).
Conclusion: The study confirms that the MPVHSS-29 is an effective psychometric tool for assessing HRQOL in Persian-speaking patients experiencing hair loss. This instrument can be utilized to evaluate the effectiveness of various treatments for hair loss, offering a comprehensive tool for both clinical assessment and the evaluation of treatment efficacy.
 

Abstract Background: This study was conducted to assess anxiety disorders and observe preventive health principles in patients with epidermolysis bullosa (EB) during the coronavirus disease 2019 (COVID-19) pandemic.
Methods: This cross-sectional descriptive study was conducted in 2021 involving patients with EB residing in the Tehran and Alborz provinces of Iran. Demographic and clinical characteristics were assessed, and the level of anxiety in patients was evaluated using the Beck Anxiety Inventory and the Spence Children’s Anxiety Scale. Statistical significance was established at P < 0.05.
Results: A total of 136 participants were included in the study, with 68 (50%) patients with EB in the case group and 68 (50%) in the control group. There were no significant differences in age or sex between the two groups (P > 0.05). The Spence Anxiety Scale score was 24.25 ± 7.79 in the case group and 11.79 ± 5.89 in the control group (P = 0.0001). Separation anxiety was observed in 11 (45.8%) patients with EB and 23 (95.8%) individuals in the control group (P = 0.0001). The Beck Anxiety Inventory score was 13.98 ± 6.16 in the case group and 5.50 ± 5.63 in the control group (P = 0.0001).
Conclusion: Patients with EB experienced higher levels of anxiety compared to individuals without this condition during the COVID-19 pandemic. This heightened anxiety can be attributed to the challenges of managing their disease, compounded by the additional stressors associated with the pandemic, which may further complicate their adherence to prevention protocols.

Abstract Background: Melanoma is a type of tumor that originates from melanocytes, the pigment-producing cells in the skin. To ensure a clear surgical margin, it is crucial to employ the appropriate surgical technique promptly. Mohs micrographic surgery is one such technique. This study examines the outcomes of patients with melanoma who underwent delayed Mohs surgery.
Methods: This retrospective cross-sectional study included 30 patients who underwent delayed Mohs surgery. We collected demographic data, including age and sex, as well as clinical information such as the age of melanoma onset, the location and size of the lesion, disease stage, lesion characteristics before Mohs surgery, recurrence rate, mortality rate, and the interval between Mohs surgery and disease recurrence. Data were analyzed using SPSS software.
Results: Among the patients, 73.3% were women. The mean age of patients at the time of the study was 39.1 ± 8.55 years, while the mean age at the time of diagnosis was 35.5 ± 7.8 years. The recurrence rate was 0.77 ± 0.5, and the number of Mohs procedures performed per patient was 1.4 ± 0.56. Additionally, 13.3% of the patients had died by the time of the study. The findings of the present study demonstrated that recurrence is significantly associated with the stage of the disease.
Conclusion: The findings of this study indicate that the recurrence of melanoma is significantly associated with the stage of the disease, while the location of the lesion does not appear to have a significant impact. Additionally, the recurrence rate and mortality associated with melanoma in patients examined in this study are higher than those reported in previous research. This discrepancy may be attributed to the relationship between these factors and the disease stage. Furthermore, it is possible that the higher recurrence rates observed in this study compared to others may be due to the effectiveness of classical Mohs surgery over delayed Mohs surgery, making it a more suitable option for patients. However, further research is necessary to validate the findings of this study.

Abstract Background: The scalp is a unique anatomical region characterized by a stratified structure and a high incidence of both benign and malignant tumor growth. In this study, we aimed to retrospectively evaluate the demographic and histopathological diagnostic factors associated with scalp tumors in patients.
Methods: This cross-sectional study involved 267 patients with scalp tumors who were referred to the dermatology clinic at Razi Hospital in Tehran, Iran. Data were collected from the patients’ medical records. Statistical analysis was conducted using SPSS version 26.
Results: This study evaluated a cohort of 267 patients with scalp tumors, comprising 198 men and 69 women, with a mean age of 68.66 ± 9.78 years. Statistical analysis revealed a significant correlation between tumor type and sex (P = 0.000), with male patients exhibiting higher frequencies across all tumor types. The most commonly diagnosed tumor was basal cell carcinoma (BCC), which primarily presented as pigmented and nodular lesions at baseline. BCC was predominantly located in the temporal and frontal regions, while other prevalent tumors, such as actinic keratosis and squamous cell carcinoma, were primarily found on the vertex (P = 0.028).
Conclusion: Demographic variables are significant predictors of the presentation and types of scalp tumors in patients, as demonstrated by the results of this study. Clinicians should be aware of the correlation between specific tumor types and their anatomical locations, as this knowledge may assist them in accurately diagnosing and treating scalp tumors.

Abstract Background: In recent years, fat transplantation and hyaluronic acid fillers have been widely used to restore volume loss and rebalance facial features. This study aims to compare the volumetric durability of autologous fat transplantation alone with that of autologous fat transplantation combined with hyaluronan hybrid cooperative complexes (Profhilo®) injections.
Methods: A randomized controlled pilot study was conducted from July 2020 to March 2021, involving 10 patients, of whom 9 completed the procedure. Patients were randomly assigned to two groups: the first group received autologous fat transplantation with two injections of hyaluronic acid (Profhilo®) using the Bio Aesthetic Points (BAP) technique. In contrast, the second group received only autologous fat transplantation to the cheeks (buccal area). The Wrinkle Severity Rating Scale (WSRS) and the Global Aesthetic Improvement Scale (GAIS) were used for assessment. Two parameters were measured to evaluate efficacy: improvement as assessed by two blinded dermatologists and patient self-assessment through photographs. Participants were evaluated at one and six months after the baseline.
Results: The WSRS scores indicated no significant difference between the two groups at baseline. Similarly, the GAIS scores assessed by blinded evaluators revealed no significant difference between the groups at both one and six months post-procedure. However, patients’ self-assessed GAIS scores demonstrated significant improvement at one month, although this significance was not sustained at six months. No serious adverse events were reported in either group.
Conclusion: This study did not demonstrate that Profhilo® (hyaluronic acid) enhances the volume durability of autologous fat over a period of six months.

Abstract Background: Discoid Lupus Erythematosus (DLE) is a chronic autoimmune skin disease that primarily affects sun-exposed areas and has a low risk of progression to systemic lupus erythematosus (SLE). It typically presents as erythematous papules or plaques, exhibiting histological features such as vacuolar degeneration and lymphocytic infiltration. This study aimed to analyze the demographic and histological characteristics of DLE patients at Razi Hospital, with a focus on improving disease management and understanding.
Methods: A retrospective cross-sectional study was conducted at Razi Hospital in Tehran, examining patients with DLE from 2022 to 2024. Data were collected from hospital records, with primary outcomes including the number of lesions, their sizes, and histopathological findings. Descriptive and comparative statistical analyses were performed using SPSS version 28.
Results: Among the 97 patients studied, 64.95% were female, with an average age of 42.85 years. Lesions predominantly occurred on the face (62.89%), with red being the most frequently observed color (45.36%). Symptoms such as pruritus or burning sensations were reported in 50.5% of cases. Scalp involvement was noted in 39.17% of patients, and 23.71% had a history of systemic disease. The mean duration for lesion development was 56.84 weeks. Histopathological analysis revealed lymphohistiocytic inflammation in 84.54% of cases, with epidermal changes significantly affecting the timing of lesion appearance (P = 0.011). Dermal changes did not demonstrate a significant impact on the timing or number of lesions.
Conclusion: The study concluded that DLE lesions predominantly occur on the face and are primarily red in color. Lymphohistiocytic inflammation was identified as the most common histopathological finding, with epidermal changes significantly influencing the onset of lesions.

Abstract Wells syndrome, also known as eosinophilic cellulitis, is a rare skin disorder characterized by recurrent inflammatory erythematous eruptions associated with eosinophilia. Histopathological examination reveals dermal eosinophilic infiltration. We report a case involving a 44-year-old female patient who presented with recurrent erythematous plaques on the left flank and lower limbs for six months. Recently, she experienced moderate to severe pain on the posterior surface of the right shin at the site of one of her cellulitis-like lesions, which was diagnosed as deep vein thrombosis through a color Doppler ultrasound examination. The skin lesions were refractory to various treatments, including corticosteroids and antihistamines. The patient was subsequently treated with a course of oral cyclosporine (100 mg daily), which successfully resolved her symptoms within a few days, with no observed side effects. This case report suggests that low-dose cyclosporine may be a safe and effective therapeutic option for patients with Wells syndrome.

Abstract Acral Lentiginous Melanoma (ALM) is a variant of cutaneous melanoma that occurs on the skin of the palms, soles, and nail units. Despite prompt surgical intervention and advancements in the treatment of these lesions, patient outcomes remain suboptimal. In this report, we present a case of a 69-year-old man with melanoma located on the heel. The lesion was resected, followed by a sentinel lymph node biopsy (SLNB), and the wound was reconstructed using a reverse sural flap. The application of the reverse sural flap technique for wound closure highlights the significance of plastic and reconstructive surgery in optimizing both functional and cosmetic outcomes. By addressing the specific challenges posed by the heel region, this reconstructive approach exemplifies the innovative nature of surgical interventions in complex cases. This case report demonstrates the successful management of ALM on the heel through a combination of SLNB and reverse sural flap reconstruction performed in a single stage. This multidisciplinary approach, guided by accurate staging and innovative surgical techniques, resulted in effective tumor resection, optimal wound closure, and favorable functional outcomes.

Abstract Epidermodysplasia verruciformis (EV) is a rare hereditary condition characterized by an increased susceptibility to infections caused by specific human papillomaviruses (HPVs), resulting from an impaired cell-mediated immune response. HPV infection can lead to the development of warty lesions, pityriasis versicolor-like spots, and an elevated risk of skin cancer, particularly Bowen’s disease and squamous cell carcinoma. The most favorable outcomes for individuals with EV can be achieved through early diagnosis and treatment. In this report, we present a 16-year-old female patient who exhibited asymptomatic pityriasis versicolor-like lesions on her neck, chest, back, and extremities. Physical examination revealed multiple yellowish-gray papules and plaques with well-defined borders. Evaluation of the hair, mucous membranes, and nails, along with other systemic examinations, showed no abnormalities. A skin biopsy confirmed the diagnosis of EV, and the patient was prescribed isotretinoin, along with sunscreen and regular dermatological check-ups. By enhancing awareness and understanding of this rare genetic disorder, healthcare professionals can improve the quality of life for affected individuals and mitigate their risk of developing malignancies.

Abstract A mutation in uroporphyrinogen III synthase results in congenital erythropoietic porphyria (CEP), a rare autosomal recessive type of cutaneous porphyria that most commonly manifests in infancy. This genetic defect can cause the accumulation of porphyrin metabolites and heme precursors in different tissues, resulting in a range of clinical signs and symptoms. These manifestations include severe photosensitivity of the skin, presenting as blisters and scarring, hypertrichosis, acro-osteolysis, reddish discoloration of the teeth and urine, and a reduced life expectancy.  Furthermore, these heme precursors can have adverse effects on bones, blood vessels, nerves, the eyes, and other organs. There are very few documented cases of porphyria patients with sclerocorneal involvement. We present a case of scleromalacia in a patient with a rare genodermatosis similar to CEP, who survived into adulthood, making this case interesting and challenging.

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