Iranian Journal of Dermatology

Abstract Background: Latanoprost has been recently shown to have promising effect on skin repigmentation and the treatment of vitiligo. This study aims to evaluate the efficacy of micro-needling combined with latanoprost compared to micro-needling alone.
Methods: This prospective clinical trial was conducted on 30 lesions from 15 patients presenting with stable facial vitiligo. In each patient, one lesion was treated with latanoprost 0.005% solution, applied daily for 3 months, while both lesions underwent microneedling (3 sessions at 4-week intervals). Clinical outcomes were assessed 6 months after treatment initiation by two independent dermatologists.
Results: Clinical improvement was observed in most patients in both groups of facial lesions. However, this improvement was significantly more pronounced in lesions treated with microneedling combined with latanoprost compared to those treated microneedling alone (P = 0.009).
Conclusion: We suggest that combining skin microneedling with latanoprost is an effective and safe therapeutic option for treating facial vitiligo lesions.

Abstract Background: Psoriasis is a common papulosquamous skin disease and immune system disorder that primarily affects the extensor surfaces of the body and the scalp. Consequently, psoriasis activity can adversely impact patients’ self-esteem and social interactions. This study aims to evaluate the demographics, clinical characteristics, and treatment options of psoriasis patients with scalp involvement.
Methods: This cross-sectional study involved psoriasis patients with scalp involvement who were undergoing treatment and follow-up at our center. Adult patients with scalp psoriasis, without evidence of other skin or rheumatologic disorders, were enrolled. Patient characteristics, clinical findings, and treatment modalities were documented.
Results: Eighty patients with psoriasis involving the scalp were included in the study. The mean age of the patients was 46.49 ± 15.34 years. The average Psoriasis Area and Severity Index (PASI) score was 8.86 ± 9.71. Additionally, the mean intensity of scalp involvement, based on the PASI score, was 1.35 ± 1.30. Plaque-type psoriasis was the most common form, and small seborrheic dermatitis-like scales were the most prevalent presentation of scalp psoriasis.
Conclusion: Scalp involvement in psoriasis is a common presentation of the disease that can mimic seborrheic dermatitis or manifest as adherent peripheral scales or pityriasis amiantacea. We found no relationship between the severity of scalp psoriasis and smoking. However, patients with scalp psoriasis more frequently report hair loss and dissatisfaction with their hair growth, even though their hair pull test may be negative and show no evidence of frank alopecia.

Abstract Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that significantly impairs quality of life and is associated with multiple comorbidities, including cardiovascular risk factors. Delayed diagnosis, often averaging seven years, exacerbates disease progression. This study aims to evaluate the clinical and demographic characteristics of HS patients, focusing on cardiovascular risk factors.
Methods: A cross-sectional study was conducted involving 128 patients diagnosed with HS, treated at Razi Dermatology Hospital between March 2017 and March 2023. Demographic data, smoking status, disease duration, and cardiovascular risk factors-including obesity, diabetes, hyperlipidemia and hypertension- were retrospectively collected from patient records. Data were analyzed using descriptive statistics via SPSS software (version 28).
Results: The mean patient age was 32.02 ± 10.39 years, with a disease duration of 6.7 ± 5.20 years. Sixty percent of the patients were male, and 34% were daily smokers. Cardiovascular risk factors were prevalent: 32% of patients were overweight, and 45% were classified as obese. Additionally, 12.5% had hypertension, 12% had diabetes, and 8% had hyperlipidemia. Only 3% of patients were diagnosed with ischemic heart disease. A significant portion (36.5%) had no identifiable risk factors, while 27.5% had multiple risk factors.
Conclusion: This study highlights a significant prevalence of cardiovascular risk factors among HS patients, emphasizing the importance of early screening and management. HS patients are at an increased risk of cardiovascular events, and addressing these risk factors could reduce the long-term health burden. Further research is needed to explore preventive strategies and improve patient outcomes.

Abstract Background: Vitiligo is an autoimmune disorder characterized by depigmented patches, affecting 0.2-1.8% of the population. Effective treatments are essential due to the significant impact of the disease on patients’ quality of life. The excimer laser, which emits UVB light at 308 nm, has shown promise in treating vitiligo, however its efficacy in non-facial lesions remains underexplored. This study investigates the response of Iranian patients with extra facial vitiligo to excimer laser treatment and identifies factors influencing clinical outcomes.
Methods: We conducted a retrospective study involving 50 patients treated at two dermatology centers in Tehran between 2023 and 2024. All patients had stable non-segmental vitiligo affecting nonfacial areas. Treatment was administered assessed using a 308-nm excimer laser (MED-UV®). Clinical photography and physicianassessed improvement scores were used to evaluate outcomes. Statistical analyses included Student’s t-test, ANOVA, and correlation coefficients.
Results: Overall treatment response varies by body location, with the neck and abdomen showing the greatest improvement, while the back, elbow, and knee exhibited the least response (P < 0.001). Factors such as gender, Fitzpatrick skin type, and age did not significantly affect the outcome. The number of treatment sessions positively influenced the response in the chest and elbow, and higher laser doses were associated with greater improvement in the neck, chest, and total lesions.
Conclusion: The 308-nm excimer laser is an effective treatment for non-facial vitiligo. Key factors influencing treatment efficacy include the laser dose and the number of treatment sessions, while demographic factors appear to have little impact. These insights can help optimize treatment plans for patients with vitiligo.

Abstract Background: Hidradenitis suppurativa (HS) is a chronic dermatological condition of uncertain etiology, high recurrence rates, and significant impacts on quality of life. Surgical treatment is commonly employed; however, recurrence remains a major concern. This study investigated the recurrence rates and factors influencing recurrence following surgical intervention in patients with HS.
Methods: This retrospective study analyzed patients diagnosed with HS who underwent surgical treatment at Razi Hospital in Tehran during 2022 and 2023. Data on demographics, clinical features, surgical techniques, and recurrence rates were collected. Recurrence was defined as the reappearance of lesions at the same or different anatomical sites during follow-up.
Results: Among 18 patients, the mean age was 31 ± 10.8 years, and 65% were men. The mean body mass index (BMI) was 31 ± 7.5. The axilla was the most commonly affected site. The overall recurrence rate was 27.7%, with significantly higher recurrence rates in the perineum and breast (100%) compared to the axilla (16.7%) (P = 0.018). Women exhibited a higher recurrence rate (57%) than men (9.1%) (P = 0.025). The highest recurrence rate (45%) occurred in the 20–40 age group (P = 0.047). Prior surgery at the same site was associated with a 75% recurrence rate (P = 0.021). Patients from outside Tehran had significantly higher recurrence rates (P = 0.001). Logistic regression identified female sex as a significant predictor (P = 0.046), with a 13-fold increased risk.
Conclusion: Recurrence of HS after surgery is common, particularly in women, in non-axillary regions, and in patients with a history of prior surgery. Multidisciplinary management, including weight reduction and biologic therapies, is essential for optimizing outcomes in severe cases.

Abstract Background: Injectable neuromodulators are commonly used in facial aesthetic procedures, particularly for treating glabellar wrinkles. The five-point injection technique is widely utilized; however, the effectiveness of a single injection into the procerus muscle has not yet been evaluated. This study aimed to compare the efficacy of a single-point injection of 50 units of abobotulinum toxin A into the procerus muscle with that of the five-point injection technique using the same dose for treating glabellar lines.
Methods: Eleven patients received a single injection of 50 units of abobotulinum toxin A into the procerus muscle, while nine patients received a total of 50 units divided equally across five injection sites. For patients requiring a touch-up injection at week two, five to ten units of abobotulinum toxin A were administered. The evaluation of results was based on measuring the distance between the medial eyebrow heads at baseline, week two and week four. Changes in this distance before and after the procedure were then analyzed.
Results: Repeated measures ANOVA indicated a significant change in the distance between the medial eyebrow heads from baseline through week four for both techniques (P = 0.03 and P < 0.01 for the fivepoint and single-point injection techniques, respectively). However, there was no significant difference between the two techniques at week two and week four (P = 0.91 and P = 0.72, respectively).
Conclusion: The efficacy of the single-point injection method in treating frown lines is comparable to that of five-point injection method.

Abstract Background: Filler-induced facial skin ischemia is a potential complication of dermal filler injections that can result in tissue damage and necrosis. Due to its vasodilatory properties, nitroglycerin has been proposed as a treatment option; however, its effectiveness in this context remains uncertain.
Method: A narrative review was conducted to investigate the existing evidence on the effectiveness of nitroglycerin in treating filler-induced facial skin ischemia. Relevant studies were identified through searches of electronic databases and manual screening of reference lists.
Results: findings demonstrated limited evidence supporting the efficacy of the nitroglycerin in this context. Although there are case studies indicate that the combination of nitroglycerin and hyaluronidase effectively treats filler-induced facial skin ischemia, only one case report demonstrates the efficacy of nitroglycerin alone. Furthermore, a rat model showed no benefits from nitroglycerin and revealed harmful results.
Conclusion: The evidence regarding the efficacy of nitroglycerin in treating filler-induced facial skin ischemia is inconclusive, which calls into question its routine use. Further studies are needed to ascertain the efficacy of nitroglycerin both as a standalone treatment and in combination with other therapies for this condition. Clinicians should consider the limited available data when selecting treatment options for individuals with filler-induced facial skin ischemia.

Abstract Radiation therapy is one of the main treatments for patients with breast cancer. Dermatitis is a common side effect of breast cancer radiation. The use of adjuvant molecules can enhance the anticancer effects of radiotherapy while reducing damage to surrounding healthy tissues by either killing tumor cells or slowing their growth. Melatonin, a natural hormone secreted by the pineal gland, has been shown to increase the therapeutic efficacy of radiation and mitigate side effects in normal tissues. It can also act as a radiosensitizer in breast cancer. These effects are likely due to reduced oxidative stress, decreased apoptosis of healthy cells, and diminished inflammation. However, few studies have explored the role of melatonin in radiation therapy for breast cancer, the optimal dosage of melatonin, and its impact on patients’ quality of life. Further research suggests that higher doses of melatonin and corticosteroids may affect the efficacy of melatonin cream in preventing radiation-induced dermatitis. This review investigated the radioprotective mechanisms of melatonin and its effects on radiation-induced dermatitis in women with breast cancer.

Abstract Yellowish nail discoloration has a wide range of differential diagnoses. It may be associated with infectious or non-infectious etiologies, but discoloration can also result from the consumption or topical application of natural or synthetic compounds found in additives. This case report demonstrates that, in a patient with psoriasis, yellowish nail discoloration can be caused by over-the-counter vitamin C-containing skincare products, in addition to psoriasis exacerbation. A 24-year-old woman presented with yellow-orange discoloration of the fingernails that began two months prior and worsened over the last month. The discoloration was more prominent on the right hand and fluctuated, appearing lighter at night. Physical examination revealed yellow-orange discoloration extending from the distal nail plate to the perionychium of digits I-IV on the right hand and digits II-III on the left hand. Neither onychodystrophy nor nail pitting was observed. The patient had a history of psoriasis and psoriatic arthritis, which were re-evaluated due to recurring joint pain. After five weeks of treatment with 5 mg methotrexate, the discoloration did not fully resolve. A review of her skincare routine revealed that she had been using a new over-thecounter vitamin C-containing facial cream for six months. She applied the cream using her fingertips, predominantly the second to fourth fingers of the right hand. One week after discontinuing the vitamin C cream, the discoloration disappeared, with no onychodystrophy noted, as confirmed by dermoscopy performed by a dermatologist. Nail discoloration due to skincare product application should always be considered a potential benign cause. Recognizing such conditions requires a thorough review of the skincare routine, especially by
dermatologists, to identify possible active ingredients or vehicles responsible for the discoloration.

Abstract Pemphigus vulgaris is a severe autoimmune disorder with blistering of the skin and mucous membranes due to antibodies targeting desmoglein 3. It typically manifests in adults between 40 and 50 years of age, with a higher prevalence in females. Presentation in children is rare and poses greater challenges in diagnosis and management. Childhood pemphigus vulgaris, a variant affecting children under 12 years old, accounts for a small proportion of vesiculobullous eruptions in the pediatric population. The most common condition in the differential diagnosis of childhood vesiculobullous eruptions is chronic bullous disease of childhood (CBDC). Here, we describe a seven-year-old girl who presented with vesicles, flaccid bullae, and erosions with crusting over the body, accompanied by oral mucosal involvement. Skin biopsy revealed the characteristic suprabasal cleft with a tombstone appearance, while direct immunofluorescence demonstrated a fishnet pattern, confirming the diagnosis of childhood pemphigus vulgaris. She was successfully treated with intravenous antibiotics, tapered systemic corticosteroids, and azathioprine.

Abstract Primary Cutaneous Follicle Center Lymphoma (PCFCL) is a rare subtype of Non-Hodgkin Lymphoma that primarily affects the skin without systemic involvement. It often mimic other dermatologic conditions, leading to diagnostic challenges. We report the case of a 54-year-old male who presented with multiple facial lumps persisting for 1.5 years, progressively increasing in size and number, particularly on the cheeks. The lesions were pruritic and worsened with sweating and fish consumption, but there was no associated pain or numbness. Initial evaluation excluded leprosy based on the absence of clinical signs and negative acid-fast bacilli on skin slit smear. Treatment with topical corticosteroids and antihistamines was ineffective. Histopathological examination initially suggested granuloma faciale; however, immunohistochemistry confirmed the diagnosis of PCFCL, demonstrating positivity for CD20, Ki67 (50%), CD21, CD10, CD23, and BCL-6, and negativity for BCL-2 and CD5. The patient was referred for chemotherapy and completed four of six planned cycles but discontinued treatment due to adverse effects. Notably, clinical improvement was observed after three sessions, and no signs of relapse were detected after six months after therapy discontinuation. This case underscores the importance of considering PCFCL in the differential diagnosis of persistent facial lesions and highlights the critical role of histopathological and immunohistochemical analyses in establishing an accurate diagnosis. Early recognition and a multidisciplinary approach involving dermatologists, pathologists, and oncologists are essential for effective management. Patient adherence and close follow-up also significantly contribute to favorable long-term outcomes in PCFCL.

Abstract

Abstract Trachyonychia is an inflammatory nail disorder characterized by a rough and brittle nail surface. It typically arises as a primary condition with no known cause. However, it can also occur secondary to dermatological disorders, including alopecia areata, psoriasis, lichen planus, ichthyosis vulgaris, vitiligo, and atopic dermatitis. Although the literature has primarily documented cases in adults, it frequently occurs in children as well. We present the case of a 4-year-old girl who refered to us with dystrophy of all her fingernails and toenails. In cases where a biopsy is impractical, such as in children, our goal is to review dermoscopic findings that can help identify the disorder’s etiology.