Diffuse pigmentation of back and arms: macular amyloidosis or other?

The study was undertaken to answer the question that how many patients with pigmentation of back and arms actually have amyloid deposits in pathology. 44 patients presenting with diffuse pigmentation of back and arms [DPOBA] were selected. Skin biopsies were performed in all cases from the affected sites. On all formalin fixed and paraffin embedded specimens, the following histochemical stains were performed: Haematoxylin and eosin [H and E], Congo red and immunohistochemical staining using anti-cytokeratin monoclonal antibody. In 9 of 44 cases [20%], amyloid deposits were found. In the remaining 35 cases [80%], H and E, Congo red and immunohistochemical staining failed to show any amyloid deposition. We were unable to find amyloid deposition in most of the patients presented with DPOBA. It seems that the signs may be attributable other disorders with similar clinical but different pathophysiologic aspects

Solar lentigines: evaluating pulsed dye laser [PDL] as an effective treatment option

Solar lentigines are among commonest cosmetic problems. There are many topical therapies suggested to treat these lesions including cryotherapy, chemical peeling with tri chloro acetic acid [TCA] and laser therapy with q-switched lasers as well as long pulsed lasers. Considering possible treatment side effects [PIH, scar] with cryotherapy and peeling in Iranian patients [darker skin types] it seems necessary to try to find alternative measures. The aim of the present study was to evaluate effect of long pulsed dye laser [LPDL] on lentigines via an objective method [computerized dermoscopy]. Patients with pathologically confirmed lentigines were selected if they agreed to participate in the study,were not treated before, hadn't history of psoriasis, vitiligo, scar formation and were not pregnant. Letigines were dermoscopied before and after treatment with PDL [V-beam, 595nm, Candela Corp. Wayland, USA] using fluence of 10 joules, without DCD [dynamic cooling device] via extra compress lens provided with laser system. The resulting figures were compared by two academic unrelated dermatologists as well as by computerized analysis. Post laser side effects were treated with topical antibiotics and mild topical steroids. Patients were followed for six months after the end of the study to determine the rate of recurrence via dermoscopy of sites of previous lesions and also delayed side effects. A total of 21 patients with the same number of lesions, were included in the study. Mean age of patients was 54.2 years [ +/- 23.3] ranging from 39 to 71 years. Included patients were 18 females and three males. From 21 treated lesions, 11 were located on the hands and 10 on the face. Comparing before and after photographs taken through dermoscopy system, revealed that approximately 57% of patients had more than 75% improvement. Mean pigment analysis score [calculated by computerized dermoscope software] was respectively 8 and 2 before and after PDL therapy, showing noticeable decrease in pigment density of lesions. Side effects were mild erythema and local irritation responding to topical mild steroids. No hypo or persistent hyper pigmentation or other delayed side effects was seen after six months follow up. One patient experienced transient hyper pigmentation of treatment site after treatment. During six months follow up, no recurrences were seen. In conclusion, PDL is a safe and effective option to treat lentigines if applied properly using compression method, especially in Iranian patients. However, further studies with larger sample size are required to confirm these results

[Prevalence of body dysmorphic disorder in patients referred to razi hospital cosmetic clinic with complaints of cosmetic disorders]

Body dysmorphic disorder [BDD] is characterized by a preoccupation with an imagined defect in ones appearance or an exaggeration of a slight physical anomaly. Any part of the appearance may be the focuse of BDD patients. Thus preoccupation with appearance leads to significant damages of social and job functioning. The aim of this study is to determine the prevalence of BDD in patients referred to cosmetic clinic of Razi hospital. Patients visiting cosmetic clinic of Razi hospital were selected if they agreed to participate in the study. They were evaluated by Yale brown obsessive compulsive scale modified for body dysmorphic disorder [YBOCS-BDD] as well as questionnaires containing demographic characteristics of patients including gender, educational status, marital status, history of reference to psychiatrist or psychologist, other medication, history of cosmetic surgery and rate of satisfaction of cosmetic surgery. YBOCS-BDD questionnaires then processed by educated specialist to determine BDD score of patients. Demographic questionnaires, also analysed to evaluate epidemiologic properties of patients visiting cosmetic clinic of Razi hospital. The prevalence of BDD in current sample was 33.3%.70.7% of BDD patients were female while 29.3% were male. The commonest age range was 21-50 years [82.8%].65.5% were educated to level of diploma or lower, while 34.5% had academic degrees.51.7% were married.20.7% had history of reference to psychiatrist or psychologist. 17.2% had history of cosmetic surgery with satisfaction ranging from unsatisfied [20%] to relative satisfaction [80%]. None were fully satisfied. BDD had high prevalence in patients visiting cosmetic clinic of Razi skin hospital. This high rate of prevalence show the necessity of diagnosis of BDD in skin patients and it is critical for them to refer to psychiatrists or psychologists.

[Comparison of thyroid function tests in alopecia totalis and universalis with control group]

Alopecia areata [AA] is a common cause of noncicatricial alopecia that occurs as a patchy, confluent or diffuse pattern. Exact etiologic factor of AA not yet recognized. Among many hypothesis, relationship between AA and autoimmune disease, especially thyroid disorders, was more interesting. The objective of this study was to determine the prevalence of thyroid test disorders in the patients with alopecia totalis and universalis in comparison with normal population. We analyzed medical records of 100 patients, including 44 male and 56 female in Tehran Razi Hospital from1388 to 1389. The mean age was 24.1 years. Patients having totalis and universalis form of AA considered as case group while 100 normal person [42 male and 58 female with mean age of 26.1] who had not any form of AA considered as control group. Both groups had not any sign of thyroid disease at clinical examination according to their available medical records. Collected data were analyzed statistically in SPSS software 17[th]version. In the majority of patients [54%] the disease was manifested in the first two decades of life. History of atopia was seen in9.8% of patient. Presence of the similar disease in first-degree family members was seen in14.3% of patients. Abnormal T3, T4 and TSH were significantly higher in case group. Abnormal T3 uptake was higher in case group but not statistically significant. Paraclinical thyroid disorders were significantly higher in the alopecia areata patients than in normal population. There was no significant association between the age, sex and duration of disease and presence thyroid dysfunction.

Refractory port wine stains [PWS]: long pulsed alexandrite laser as an option

Port wine stains [PWS] are congenital vascular malformations. Pulsed dye laser [PDL] is the treatment of choice till now, although many lesions do not respond completely. One of possible options is long pulsed alexandrite laser. Some literatures confirmed its efficacy. The aim of the present study is to determine the efficacy of this laser as an option in treating refractory PWS in Iranian patients. Patients with refractory PWS lesions that did not respond to at least six PDL sessions were included if they had no history of Isotretinoin consumption in past year, history of keloid or hypertrophic scar formation, active infection in laser site and if they were not pregnant. All patients signed an informed consent. Alexandrite laser with fluencies from 36-40J/Cm[2], 12 mm spot size, 3 ms pulse duration and dynamic cooling device tuned to 50/50 ms was used in three successive sessions to treat lesions. All patients photographed before each session and after 8 weeks from the last sessions. Then, pictures were rated by two blinded dermatologist rater to determine degree of response based of visual analog scaling from score 1[below 25% response] to score 4 [more than 75% response]. A total of 20 patients comprised of 12 males and 8 females with mean age of 23 years were included. 35% [7 patients] had score of 1, 35% [7 patients] had score of 2, 25% [5 patients] had score of 3 while one patient [5%] reached score 4. No serious side effect was observed. There was no significant relationship with age, gender and size of lesions and response rate. It seems that considering a conservative approach, long pulsed alexandrite laser may be an effective option in treating refractory PWS lesions. Although future studies with higher sample size using higher fluences are required to confirm these results

595nm pulsed dye laser: an alternative to treat basal cell carcinomas

Basal cell carcinoma [BCC] is the most common cutaneous malignancy. Proffered treatment for these lesions is surgery. Based on patient's age, drug allergies, and place of lesions, surgery may not be the best option, and alternative treatments should be considered. Pulsed dye laser [PDL] may be a good alternative therapy. The aim of the present study was to determine the effectiveness and safety of this laser in the treatment of BCCs in Iranian patients. Patients with definite diagnosis of BCC enrolled in the study. For each patient, one lesion proved to be superficial, or nodular BCC via histopathology was treated with PDL for four sessions and after the last session, re-biopsy was done to determine any remnant of tumor. All patients were followed for 6 to 13 months to capture any recurrence of as soon as possible. A total of 12 patients including eight male and four female were selected. All patients completed the study in accordance to the treatment protocol. All patients cleared clinically resulting flat hypo pigmented scar, but in pathology, two patients showed remnants of tumor and were referred for surgery. No side effects, but mild erythema and irritation were noted in all patients. No recurrences were found during the follow up period. It seems that PDL may be an effective alternative therapy for some subtypes of BCCs with acceptable safety profile. Further studies with larger sample sizes are required to support this opinion