Vitiligo associated with esophageal adenocarcinoma

Vitiligo is a disease that results in depigmented areas in the skin. It may develop at any age but the average age at onset is 20 years. Association of vitiligo and melanoma has been commonly reported, but malignancies other than melanoma have been rarely associated with vitiligo. We report a 73-year-old patient with new onset vitiligo who developed esophageal adenocarcinoma in the following years

Role of E-cadherin in differentiation between squamous and basal cell carcinoma

Some type of basal cell carcinoma [ex Keratotic variant] is often misdiagnosed as squamous cell carcinoma and basal cell carinoma. The objective of this study was to determine the role of E-cadherin in differentiation between Squamous and basal cell carcinoma. The sampling was performed by simple method. Entry criteria to the study included 2 groups of 34 primary, untreated BCCs and SCCs each from a different patient. They were surgically removed and the diagnosis was confirmed by histopathology. The stained sections were scored by levels of expression and intensity of E-cadherin. Distribution of E-cadherin staining was more in BCC than SCCs [P=0.006] but the decreased staining intensity of E-cadherin in SCC compared with BCC was not statistically significant [P=0.056]. When the results [score of distribution and intensity of E-cadherin] were added together, the acquired E-cadherin index in a statistical analysis was meaningful to differ between SCC and BCC [P=0.002]. Our study showed that E-cadherin distribution and index but not intensity is lower in SCC cells than BCC cells and it can justify the cause of metastasis in SCC. However, this is ambiguous to use it for differentiating of aggressive forms of BCCs from SCCs, practically

A case of giant sebaceoma

Sebaceoma is a benign tumor with sebaceous differentiation. It usually presents as a yellowish papule or nodule on the face and scalp. This is a report of a 27-year-old-woman who presented with a giant, 6cmx4.5 cm exophytic tumor on her head. Clinically, we considered several diseases; however, the histological and immunohistochemical features matched those of sebaceoma. The lesion was excised and the defect was repaired by a split-thickness graft

Efficacy of 5-fluorouracil plus epinephrine, pulsed dye laser and betamethasone on the improvement of psoriatic plaques [a comparative study]

Many efforts are made to find new and more effective treatments for psoriasis. Intralesional 5-Fluorouracil [5-FU] +epinephrine is a cheap option which can be administered with long intervals. The effectiveness of Pulse Dye Laser [PDL] on psoriasis has been already assessed. We decided to evaluate the effectiveness of 5-FU+epinephrine and compare it to betamethasone and PDL. A group of 22 patients with chronic stable plaque psoriasis were included. Three plaques on each patient were treated with 5- FU + epinephrine, PDL and betamethasone, respectively. Psoriasis Severity Index [PSI] scoring was applied to assess each plaque before treatment and in weeks 2, 4, 6, 12, and 24. Photos of each plaque were taken before treatment and at each treatment and follow-up session. They were finally compared and scored by a dermatologist. Decline in mean Psoriasis Severity Index [PSI] in week 6 [2 weeks after treatment] and in week 24 [the last follow-up session] was statistically significant as compared to baseline in all groups. [P<0.001] The highest decline in mean PSI score was in the 5-FU + epinephrine group while the lowest belonged to the PDL group [80% vs. 27%].The mean period of remission in the 5-FU+epinephrine group was significantly longer in comparison to the two other groups. [P<0.001] In photographic evaluation, the best response was observed in the 5- FU + epinephrine group. 5-FU + epinephrine is a cheap option which can provide a rapid response and long remission .With respect to limited effectiveness, short remission and high cost; PDL dose not seem to be a preferred choice in the treatment of psoriasis

Incidence of non-melanoma skin cancers in Isfahan

Non-melanoma skin cancers [NMSC] are one of the most prevalent malignancies of the human. Although the morality rate is not high for these cancers, they may cause high mortality for the patients. In addition to the skin type, factors such as sun exposure, head and neck radiotherapy, inappropriate use of sunscreen and cultural changes may increase the incidence of these cancers. The objective of this study was to determine NMSC in Isfahan. We used data of the cancer resistery center for performing this study and the incidence of NMSC per 100,000 papulation was determined. Overall 1681 cases were registered. The incidence of NMSC was calculated to be 10.67/100.000 population. The most common site for BCC and SCC was middle face. NMSC incidence in Isfahan is lower than west countries although this incidence is 10.67/100,000 in a year. It means that 5-6 thous and cases of NMSC occur in Iran each year. We can prevent its morbidity and mortality by early correct diagnosis

Efficacy of 3% diclofenac gel for the treatment of actinic keratoses: a randomized, double-blind, placebo controlled study.

BACKGROUND: Actinic keratoses (AKs) are premalignant skin lesions caused by excessive sun exposure. AIMS: To explore the therapeutic efficacy of 3% diclofenac in 2.5% hyaluronan gel in the topical treatment of AK. METHODS: Sixty-four lesions in 20 patients were evaluated. They were randomized to receive either the active treatment, 3% diclofenac in 2.5% hyaluronan gel or placebo, which consisted of the inactive gel vehicle, hyaluronan for a period of three months. The collected data were analyzed by using Student t- tests. RESULTS: There was a reduction in the lesion size in 64.7% of diclofenac-treated lesions and 34.3% of control lesions during the three-month course of treatment. Only 9.3% of the lesions in the diclofenac group were completely cleared during three months of treatment. During the treatment, no significant side-effect was observed in both groups. CONCLUSION: Considering the malignant potential of actinic keratoses and the importance of clearing them to prevent their transformation to squamous cell carcinoma, the efficacy of diclofenac gel seen in our study seems to be low. This treatment may be useful for patients who do not tolerate other, more effective kinds of treatment for actinic keratoses.

Evaluation of the efficacy of topical caffeine in the treatment of psoriasis vulgaris: a randomized, double-blind clinical trial

Psoriasis is one of the most common papulosquamous diseases that often requires long-term maintenance therapy. Long-term use of topical corticosteroids on the face and intertriginous areas will increase the risk of steroids side effects such as striae and atrophy development. A safe, effective and inexpensive modality in topical therapy of inverse psoriasis is required. Beta adrenergic antagonists have been reported to exacerbate existing plaque psoriasis because of increasing concentration of intracellular cAMP. On the other hand, caffeine is a methylxanthin that inhibits phosphodiesterase enzyme and results in a higher concentration of intracellular cAMP. We evaluated the efficacy of topical caffeine 10% in the treatment of psoriasis. This randomized, double blind, controlled clinical trial was performed on 39 patients with typical lesions of psoriasis vulgaris who referred to dermatology clinics of Isfahan University of Medical Sciences from December 2002 to July 2003. These patients were randomized in two groups and treated by topical application of drug or placebo, three times per day. The patients were seen in two-week intervals for 8 weeks, and their PASI score was assessed in each visit. The decrease of PASI score after 2,4,6 and 8 weeks compared to the first visit in caffeine treated group were 23%, 41%, 54%, and 62% and in placebo treated group were 15%, 19%, 25%, and 29% respectively [P<0.05]. Topical caffeine may be an effective, safe and inexpensive therapy in psoriasis but its onset of action is late

Imaging techniques in dermatology

Since the discovery of X-rays, the use of imaging technology has continued to play an important role in medicine. Technological advancements have led to the development of various imaging modalities, most of which have been used to image organs deep within the human body. More recently, attention has focused on the application of imaging technology for evaluation of the skin. A variety of techniques are currently being used to examine the skin and these include specialized photography, surface microscopy, ultrasound, laser Doppler perfusion imaging, confocal microscopy, magnetic resonance imaging and optical coherence tomography. These modalities can provide information that can assist in the management of skin problems. Although many of these techniques are still undergoing research, they are showing promise as useful clinical tools in dermatology. In this review article we discuss about each of these technologies in brief

[Skin carcinoma arising in leishmania scar: report of four cases]

Basal cell carcinoma [BCC] and squamous cell carcinoma [SCC] are the most frequent skin cancers. The etiology of these tumors is multifactorial: Environmental and exogenous factors, genotype and phenotype factors. The development of malignant neoplasms at sites of previous dermal scars is an uncommon but well recognized phenomenon, and since almost all of them were developed on exposed areas it has been hypothesized that the accompanying atrophy and decreased vascularity and adnexal structures in areas of scarring may render the affected tissues more susceptible to the effects of environmental factors, eg. ultraviolet light. We report four cases of BCC and SCC on old leishmania scars on face, and recommend that any changes on scars must be evaluated clinically and pathologically

[Disseminated cutaneous leishmaniasis with tuberculousdactylitis: a case report]

Herein we report a 6-year-old Afghans patient referred to Department of Dermatology, St. AL-Zahra Hospital in Isfahan with ulcerative and nodular lesions disseminated over the face, arms, buttocks, pelvic girdle and legs in 2002. Direct smears of the lesions were positive for Leishman bodies. Leishmanin skin test was negative. He also had dactylitis in some digits and toes. PCR from bone biopsy showed Mycobacterium tuberculosis. So he was treated according to diagnosis of disseminated cutaneous leishmaniasis with tuberculousdactylitis

[Cutaneous and pulmonary nocardiosis in a patient with pemphigus]

Pemphigus is a chronic blistering mucocutaneous disease, classified in immunobullous skin diseases. Infections, particularly septicemia due to Staphylococcus aureus and Pseudomonas aeroginosa are the most common and dangerous disorders due to immunosuppressive therapy in this disease. Infection with nocardia is rare, so that only 6 cases have been reported yet. Herein, we report a 56-year-old man with one-year history of pemphigus treated with prednisolone and cyclophosphamide, who at the same time developed skin and pulmonary nocardiosis. He had a good response to treatment with cotrimoxazole