Iranian Journal of Dermatology

Abstract Background: Solar lentigo is one of the earliest signs of the sun's damaging effects on the skin. Various light-based treatments, including laser therapy, can be used to remove these pigmented lesions. This study aims to evaluate the outcomes of treating solar lentigines using a Q-switched Nd:YAG laser device.
Methods: This cross-sectional study was conducted on 50 patients presenting with solar lentigo between 2021 and 2022. The patients received monthly laser treatments for up to five sessions.
Results: Treatment of solar lentigo lesions has been associated with a complete or partial response in 98% of cases. The response to treatment in skin phototype II was not statistically significantly different from that in other phototypes (P = 0.068). However, clinically, both patient's and dermatologists' assessments of treatment response at the end of the third session showed a significant relationship with skin phototype (P < 0.001 and P = 0.03, respectively).
Conclusion: According to the results, the Q-switched 532 nm Nd:YAG laser may be an effective treatment option for removing solar lentigines. Although it is more expensive than other methods, it could be considered a suitable choice due to its higher success rate and lower complication rate.
 
 

Abstract Background: Microneedling is widely used in dermatology due to its effectiveness and favorable safety profile. It promotes dermal collagen and elastin remodeling, thereby improving skin texture, scars, photodamage, and pigmentation disorders. Despite its popularity, microneedling can cause side effects and complications. This study aims to assess the adverse effects of microneedling and to investigate their relationship with demographic and clinical factors.
Methods: This cross-sectional study included patients treated with microneedling at Razi Hospital for facial skin conditions. Demographic data, including age, sex, and indication for treatment, were collected prior to treatment. One-month post-procedure, patients were surveyed regarding side effects such as post-inflammatory hyperpigmentation, hypopigmentation, persistent erythema, and itching. The relationship between adverse effects and demographic factors was analyzed.
Results: A total of 120 patients participated, with a mean age of 32.41 ± 7.44 years. The majority were women (86.7%), and treatment indications included scars (76.6%), melasma (10.8%), and skin rejuvenation (12.5%). Reported side effects included hyperpigmentation in 6.7%, hypopigmentation in 1.7%, persistent erythema in 2.5%, and itching in 9.2% of patients. Patients with persistent erythema were significantly younger than those without this complication (P = 0.001). No significant relationship was found between adverse effects and either sex or treatment indication.
Conclusion: Itching was the most frequently reported side effect, followed by hyperpigmentation, persistent erythema, and hypopigmentation. Clinicians should address these adverse effects, particularly in younger patients, to ensure optimal care following microneedling.
 
 

Abstract Background: Vitamin C is well recognized for its role in collagen synthesis and wound repair; however, its effects on critical healing parameters warrant further investigation. This study aimed to evaluate the impact of vitamin C on fibroblast count, collagen density, and epithelial thickness in Wistar rats with incisional wounds.
Methods: This experimental study investigated the effects of vitamin C on wound healing in Wistar rats with incisional wounds. The rats were divided into a control group and a treatment group, with the latter receiving daily subcutaneous injections of vitamin C (nine mg) for seven days. Histopathological analyses were performed on skin biopsies from the rats' backs using Hematoxylin-Eosin and Masson’s trichrome staining to assess fibroblast count, collagen density, and epithelial thickness. Data were analyzed using SPSS version 24.0, employing Mann-Whitney U tests for fibroblast counts and independent t-tests for collagen density and epithelial thickness. Pearson’s correlation coefficient was used to assess the relationship between fibroblast count and collagen density.
Results: Vitamin C treatment significantly increased fibroblast count by 28.08% (P = 0.018), collagen density by 25.75% (P = 0.013), and epithelial thickness by 34.07% (P = 0.001) compared to the control group. No significant correlation (P = 0.125) was observed between fibroblast count and collagen density.
Conclusion: Vitamin C can increase the number of fibroblasts, collagen density, and epithelial thickness in incision wounds in Wistar rats. These findings suggest that vitamin C may enhance wound healing outcomes; however, further research is necessary to explore the complex interactions among these factors.
 

Abstract Background: Lichen striatus (LS) is a rare, self-limiting inflammatory dermatosis characterized by distinct clinical and histopathological features. This study aimed to evaluate the demographic, clinical, and histopathological characteristics of LS. Methods: This retrospective case series included all patients diagnosed with LS at Razi Hospital, Tehran, Iran, from 2019 to 2023, based on biopsy and histopathological examination. Data were collected from archived patient records and included demographic details, lesion characteristics, disease duration, seasonal distribution, and histopathological findings. Statistical analysis was performed using IBM SPSS Statistics. Quantitative variables were expressed as means ± standard deviations (SD), and categorical variables were presented as frequencies and percentages. Results: Among 50 patients, 18 (36%) were male and 32 (64%) were female. The age range was 1 to 74 years, with a mean of 24.32 ± 16.62 years. The highest prevalence was observed in the 0–10-year age group. The lower extremities were the most commonly affected sites (26% in females and 14% in males). Most lesions appeared during autumn and winter. The average disease duration was 7.6 months. A positive family history was noted in only one patient, while four patients had a history of similar lesions. Lymphocytic infiltration (94%) was the most common histopathological finding, followed by lichenoid reaction (68%), whereas Civatte bodies were the least frequently observed feature. Conclusion: This study highlights the predominance of LS in females, young adults, and the lower limbs. Lymphocytic infiltration remains the hallmark histopathological feature. The findings support the self-limiting nature of LS and its minimal hereditary influence.    

Abstract Background: Autoimmune blistering diseases (AIBDs) are rare and potentially life-threatening conditions that are often associated with various bacterial infections. This study aimed to assess the prevalence of bacterial skin infections and their association with other risk factors in patients with infected AIBDs. Methods: This study was conducted on 47 patients with AIBDs. Two swabs for bacterial culture were obtained from each patient: one from wound secretions and the other from the nose. To determine the association between bacterial infections and other risk factors, patient information—including demographic data, AIBD types, hospitalization details, medical history, symptoms, and medications—was collected. Results: Pemphigus vulgaris and bullous pemphigoid were identified as the most common immunobullous diseases, with prevalences of 61.7% and 25.6%, respectively. Twenty-three of 47 patients (48.9%) were found to be nasal carriers of Staphylococcus aureus, with the predominant strain being methicillin-susceptible Staphylococcus aureus (MSSA) at 42.6%. Bacterial skin infections were detected in 72.3% of patients, of whom 59.6% had infections at the time of admission, while 12.7% acquired nosocomial infections. Conclusion: MSSA was the most frequently isolated bacterial strain from wound secretions, followed by methicillin-resistant Staphylococcus aureus (MRSA) and Klebsiella pneumoniae. Most MSSA and MRSA isolates exhibited resistance to erythromycin and clindamycin. No significant association was found between the incidence of bacterial infections and the severity of AIBDs, comorbidities, immunosuppressive medication use, or the duration and frequency of hospitalizations.  

Abstract Background: Body dysmorphic disorder (BDD) is a psychiatric condition characterized by an obsessive preoccupation with perceived flaws in one’s physical appearance. This study was conducted to investigate the prevalence of BDD among patients attending the Shahid Faghihi Dermatology Clinic in Shiraz, Iran. Methods: In this cross-sectional study, 163 patients attending the Shahid Faghihi Dermatology Clinic were selected. Inclusion criteria included age over 18 years, while and the exclusion criterion involved insufficient literacy to complete the questionnaire. Patients completed the Persian version of the Yale-Brown questionnaire and provided demographic information after giving informed consent. The questionnaire results were analyzed using SPSS version 24 statistical software. Results: Of the 163 participants, 119 (73%) were female, and the remainder were male. The age group with the highest frequency was 26-35 years. Among the studied population, 62 individuals (38%) were diagnosed with BDD. Marital status and age showed a statistically significant relationship with BDD (P < 0.05). Other variables examined did not demonstrate a significant relationship with the prevalence of BDD. Conclusion: Considering the higher prevalence of BDD among young, divorced, and unmarried individuals, dermatologists and cosmetic surgeons should be particularly vigilant in recognizing and addressing this condition in these populations.    

Abstract Background: Erythroderma is a severe dermatologic emergency characterized by generalized erythema and scaling over more than 90% of the body surface area. It may result from various underlying conditions, including pre-existing dermatoses, infections, and adverse drug reactions. The COVID-19 pandemic has introduced new complexities to the pathogenesis of erythroderma, such as flare-ups triggered by viral infections or vaccines.
Methods: This descriptive cross-sectional study analyzed 16 patients diagnosed with erythroderma at Razi Dermatology Hospital in 2023. Patient data, including demographic details, medical history, and histopathological findings, were collected retrospectively from hospital records. Only patients with complete medical records were included in the analysis. Descriptive statistics were used to analyze the data, and histopathological examinations were conducted to investigate the underlying causes.
Results: Among the 13 patients analyzed, the majority were male (76.9%), with a mean age of 57.7 years. Most patients had no prior history of chronic skin conditions, while psoriasis was the most common final diagnosis (46.2%), followed by drug-induced erythroderma (30.8%) and mycosis fungoides (15.4%). Histological analysis most frequently demonstrated spongiosis (76.9%), lymphocytic exocytosis (84.6%), and epidermal hyperplasia (100%). Notably, drug-induced cases were associated with post-COVID status and vaccine-related reactions.
Conclusion: Erythroderma remains a complex dermatologic condition with a multifactorial etiology. In this cohort, psoriasis and drug-induced reactions, including those triggered by COVID-19 vaccination, were predominant causes. Early diagnosis and histopathological evaluation are crucial for effective management, particularly given the evolving challenges posed by the COVID-19 pandemic. Further studies are needed to clarify the long-term implications of COVID-19 on erythroderma.
 

Abstract Background: Lichen planus (LP) is a chronic inflammatory mucocutaneous disorder increasingly associated with systemic metabolic abnormalities, particularly dyslipidemia. Emerging evidence suggests that chronic inflammation in LP may alter lipid metabolism, thereby contributing to an elevated cardiovascular risk profile. This study aimed to evaluate changes in lipid profiles across different clinical variants and durations of LP, with a focus on identifying patterns associated with disease distribution, severity, and metabolic risk.   Methods: A cross-sectional study was conducted over six months at Al-Kindy teaching hospital involving 64 adult patients clinically diagnosed with LP. Demographic data, disease characteristics, and lipid profiles—including total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL)—were collected. Patients were stratified according to LP subtype, BMI, and disease duration. Results: LP patients with a disease duration >12 months exhibited significantly elevated TC (213.92 ± 26.41 mg/dL) and TG (166.23 ± 30.78 mg/dL). A biphasic pattern in HDL was observed, with the lowest levels during 6–12 months of disease (P = 0.005). The oral and cutaneous subtype demonstrated the highest mean cholesterol, while the oral and genital subtype exhibited the highest triglycerides. Significant associations were found between BMI and LP subtype (P = 0.008), with obese patients showing a higher prevalence of multisite involvement. Conclusion: LP, particularly in its chronic and multisite forms, is associated with dysregulated lipid metabolism. These findings underscore the importance routine metabolic screening in LP patients to prevent long-term cardiovascular complications.  

Abstract Background: Leishmaniasis, caused by the obligate intracellular parasite Leishmania, is transmitted through the bite of infected female sandflies and infects host mononuclear phagocytes, leading to cutaneous lesions or fatal visceral disease. Understanding the immune dynamics of leishmaniasis is essential for developing immunotherapies, vaccines, and control strategies. This review explores the immunological landscape of leishmaniasis, with a focus on host immune cell interactions with Leishmania and the parasite’s evasion mechanisms.
Methods: We systematically reviewed articles published between 1998 and 2022 from PubMed, SciELO, ScienceDirect, Scopus, Google Scholar, and Web of Science, using the search terms “immunology” OR “leishmaniasis.” Studies on in vitro and in vivo models of Leishmania-immune cell interactions were included.
Results: Protective immunity against leishmaniasis depends on Th1-mediated responses, which activates macrophages through nitric oxide (NO) production, oxidative bursts, and pro-inflammatory cytokines (e.g., IFN-γ, IL-12) to eliminate the parasite. In contrast, Th2 dominance, marked by IL-10 and TGF-β, exacerbates disease by suppressing these defenses. Leishmania employs sophisticated evasion strategies, including apoptotic mimicry and neutrophil-mediated “Trojan Horse” entry into macrophages, allowing it intracellularly and subvert host immunity.

Conclusion: Elucidating the  cellular interaction between Leishmania and the immune system—particularly its manipulation of apoptosis and cytokine balance—offers new avenues for innovative treatments, prevention strategies, and vaccine development against leishmaniasis.    

Abstract Bier spots are asymptomatic, transient macules that commonly appear on the upper and lower extremities of young adults. They can be induced by physical or emotional stress, venous congestion, or exercise, and typically fade when the triggering factor is eliminated. We present the case of a 35-year-old man with Bier spots on his face for the past three years, which become more visible when he turns his head downward or rubs his forehead.

Abstract A novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for the recent global coronavirus disease 2019 (COVID-19) pandemic. Currently, there is limited data on COVID‐19 and its impact on the prevalence, management, and outcomes of dermatologic diseases. Therefore, this study aimed to evaluate the clinical findings and outcomes of patients admitted for dermatologic diseases who exhibited COVID-19 symptoms during hospitalization. We identified 13 cases of PCR-positive COVID-19 among 1,017 patients admitted to Razi Hospital, a tertiary dermatologic center, from February 2020 to 2021, representing an incidence of 1.27%. Of these, eight were male. The reasons for admission included acute generalized exanthematous pustulosis (AGEP) (3/13), pemphigus vulgaris (3/13), bullous pemphigoid (1/13), eczematous dermatitis (1/13), leishmaniasis (1/13), neurotic excoriation (1/13), fixed drug eruption (1/13), zinc deficiency (1/13), and wound infection (1/13). Six patients (46.2%) were asymptomatic for COVID-19 and did not receive any specific treatment. COVID-19-related skin manifestations were observed in two patients (15.4%), both presenting with erythematous pustular lesions attributed to drug injections. Additionally, one of these cases exhibited urticarial rashes, a recognized skin manifestation of COVID-19. No deaths or ICU admissions occurred, and all patients were discharged after a mean hospital stay of 7.30 ± 1.79 days. The prognosis of COVID-19 in patients with dermatological conditions was generally favorable in this series. Nevertheless, patients should be monitored regularly and carefully for any changes in clinical status or COVID-19 symptoms, and clinicians should tailor the treatment approaches on a case-by-case basis while ensuring protection against COVID-19.  

Abstract The human immunodeficiency virus (HIV) pandemic has been associated with increased resistance against mycobacterium tuberculosis (MTB), leading to the reemergence of tuberculosis (TB) and posing a significant public health threat, particularly in developing countries. According to the World Health Organization (WHO), TB is the ninth leading cause of death worldwide and the leading cause of death from a single infectious agent. Lupus vulgaris (LV), the most common type of cutaneous tuberculosis, is considered a great imitator in dermatology due to its diverse clinical presentations, including nodular, papular, plaque, ulcerative, tumor-like, and psoriasiform lesions. Additionally, laboratory investigations LV often have low sensitivity and specificity, complicating diagnosis. The complex nature of its clinical presentations and diagnostic challenges frequently result in delayed diagnosis. Moreover, untreated lesions tend to progress, leading to scarring, contractures, and tissue destruction. Here, we present an unusual case of extensive LV with multiple negative investigations except for a positive GeneXpert MTB/RIF assay. We report this case to highlight and analyze various diagnostic modalities for LV to prevent delayed management.  

Abstract Patients who undergo allogeneic hematopoietic stem cell transplantation (HSCT) may experience oral complications related to chronic graft-versus-host disease (cGVHD), which can significantly reduce patients’ quality of life. The immediate pain- relieving effect of Non-thermal CO2 laser therapy (NTCLT), a novel and non- invasive photobiomodulation approach, has shown immediate pain-relieving effects in various painful oral lesions. This study aims to evaluate the palliative effects of a single session of NTCLT on the oral lesions of a patient with cGVHD. We present the case of a 16-year-old male with a history of acute myeloid leukemia (AML) and cGVHD following allogeneic HSCT. He was referred to our laser clinic for pain management associated with his painful oral cGVHD lesions using NTCT. The CO2 laser (set at 1 watt power) was irradiated through a thick layer of a completely transparent gel with a high-water content, while the surface of the lesion was scanned with a defocused handpiece with rapid circular motion of the handpiece. The patientexperienced immediate and marked pain relief following NTCLT, without any visible thermal adverse effects. The procedure was painless, and no anesthesia was required. This report proposes that NTCLT could be a promising, non-invasive and safe intervention for rapid pain relief in oral cGVHD lesions. However, further research is necessary to confirm its efficacy and safety in this clinical context  

Abstract Cutaneous mastocytosis (CM)is a rare disorder characterized by abnormal accumulation of mast cells within the skin. Although it most commonly presents in childhood, adult-onset cases are less frequent and often associated with systemic involvement. The clinical presentation can vary, which can make diagnosis challenging without histopathologic confirmation. A 43-year-old male presented with a 6-year history of progressive, pruritic, reddish-brown truncal plaques and papules, which were exacerbated by spicy foods and stress. Physical examination revealed no systemic involvement, and laboratory tests were unremarkable. Histopathological examination confirmed the diagnosis of cutaneous mastocytosis.Treatment included a combination of fexofenadine, montelukast, a topical compound ointment, and phototherapy. After two months of therapy, the patient reported significant relief from pruritus and moderate improvement in the appearance of the skin lesions. This case highlights the critical role of histopathologic evaluation in establishing the diagnosis of adult-onset CM and demonstrates the potential benefits of a multimodal therapeutic approach in symptom management and lesion control.  

Abstract Eruptive seborrheic keratoses (ESK) is characterized by the sudden onset of multiple benign skin lesions. While typically diagnosed clinically, biopsy may be needed in uncertain cases. Although generally harmless, ESK can serve as a marker for underlying conditions, including malignancy (e.g., gastrointestinal adenocarcinoma), infections, inflammatory disorders, or drug reactions. The Leser-Trélat sign reffering to the abrupt increase in seborrheic keratoses (SK), is particularly associated with malignancy, often adenocarcinoma, and lung cancer. ESK typically involves the back, chest, and extremities. We report a 38-year-old woman presented with abrupt onset of multiple pigmented trunk papules/plaques developing over a 3 months period. Her history included clonazepam use for post-traumatic stress disorder (PTSD). Clinical examination revealed numerous hyperpigmented papules andplaques localized to the trunk, with no other involvement. Macroscopic evaluation identified a 1275 mm brownish tumor. Histopathological analysis showed acanthotic epidermis with basaloid cells and horn pseudocysts, leading to a diagnosis of ESK. Further evaluation revealed primary biliary cholangitis (PBC), despite the absence of symptoms. The patient was started on Ursodeoxycholic acid (UDCA). While the association between PBC and SK is unclear, most studies focusing on conditions like vitiligo and xanthomas. This case suggests that SK may serve as a marker for liver issues. We suggest that further research explore potential links between PBC and ESK, particularly when cutaneous findings precede the hepatic issues diagnosis.