White Sponge Nevus: Report of a Case and Review of the Literature.

White sponge nevus is a rare benign autosomal dominant disorder with variable penetrance. It is characterized by asymptomatic white plaques affecting mainly the oral mucosa. Careful clinical and histopathological examination is indicated to exclude other more serious conditions presenting as oral white lesions. Herein, we present a new case of oral white sponge nevus in a 17-year-old Iranian male with no familial background.

Granuloma annulare: relationship to diabetes mellitus, thyroid disorders and tuberculin skin test.

BACKGROUND: Granuloma annulare is a benign inflammatory disease of the skin. The etiology and pathogenesis of the disease are not yet determined, but some authors have proposed that it might be associated with a variety of underlying conditions such as thyroid disorders, diabetes mellitus and positive tuberculin skin test. OBJECTIVE: This study was conducted to find the probable relationship between granuloma annulare and diabetes mellitus, thyroid disorders and positive tuberculin skin test. PATIENTS AND METHODS: A total of 28 patients with granuloma annulare were recruited from our dermatology outpatient clinic, and data on sex, age and distribution of granuloma annulare lesions were collected. Forty-one age- and sex-matched apparently healthy volunteers serving as controls were also included. Thyroid stimulating hormone (TSH), fasting blood sugar (FBS) and tuberculin skin tests were performed for both groups. RESULTS: Mean serum level of FBS in the patient group was significantly higher than the mean serum level of FBS in the control group (110.60±46.31 mg/dL versus 88.39±10.58 mg/dL, respectively, p=0.004). Mean serum level of TSH in the patient group was 3.43±2.73 mIU/L, which was not significantly different from the mean serum level of TSH in the control group (3.26±2.11 mIU/L, p=0.772). Four individuals in the patient group and only 1 in the control group had a positive tuberculin skin test. CONCLUSION: Granuloma annulare patients are better to be assessed for diabetes mellitus, but the relationship between this skin disease and thyroid disorders or tuberculin skin test still needs to be investigated.

Serum Levels of IL-10 and IL-22 Cytokines in Patients with Psoriasis.

BACKGROUND: As a chronic inflammatory condition, psoriasis results from an interaction between genetic and immunologic factors in a predisposing environment. In spite of compelling evidence for the role of T cells and cytokines in psoriasis, interleukin (IL)-10 and IL-22 have not been sufficiently investigated. OBJECTIVE: To assess the serum levels of IL-10 and IL-22 in patients with psoriasis compared to healthy controls. METHODS: A total of 28 patients with psoriasis were compared with 28 age and sex-matched healthy subjects. Psoriasis Area and Severity Index (PASI) criteria were used to measure the severity of the disease. Serum levels of IL-10 and IL-22 were measured in both groups and compared. RESULTS: The mean serum level of IL-10 was 89.5±18.7 in patients compared to 117.2±23.4 pg/ml in the controls (p=0.36). Also, serum level of IL-22 was 284.1±49.7 in patients versus 425.4±82.8 pg/ml in control group (p=0.17). There was a significant direct correlation between levels of IL-10 and IL-22 in patients group (p=0.0005). The clinical severity of psoriasis was significantly correlated with high levels of IL-22 (p<0.0001). CONCLUSION: The direct correlation between higher levels of IL-22 and disease severity supports the clinical implication of this cytokine in psoriasis.

Spectrum of autoimmune vesiculobullous diseases in Iran: a 13-year retrospective study.

BACKGROUND: Autoimmune bullous diseases (ABDs) represent a group of rare, acquired disorders characterized by overlapping features with involvement of the skin and mucous membranes, resistance to treatment, and potential lethality that comprise pemphigus, bullous pemphigoid (BP), epidermolysis bullosa, dermatitis herpetiformis, and linear immunoglobulin A bullous dermatosis. AIM: The main aim of this study was to identify the epidemiologic characteristics and clinical courses of these common diseases in Hamadan, Iran. Few surveys have been carried out to demonstrate the whole spectrum of ABDs in the literature. Notably, in Hamadan we are the first. MATERIALS AND METHODS: This 13-year retrospective study was designed to evaluate all of documented data obtained from hospitalized patients with ABDs at Farshchian Hospital from October 1999 to October 2012. We collected information on epidemiologic data, clinical aspects, histologic findings, and therapy prescribed. Data were analyzed using SPSS. RESULTS: Of 168 patients, 78% had pemphigus. The age of patients at presentation ranged from 1 month to 115 years, with a mean of 47.5±19.93 years. Mucosal or skin involvement of ABDs was statistically significant (P<0.001). The incidence of ABDs differed significantly based on anatomic location (P=0.003). We documented three deaths. CONCLUSION: Compared to previous literature, our findings showed equal epidemiologic properties in Iran. Although pemphigus was the most common ABD followed by BP, it is expected that in line with the global trend, an increase in BP will be driven by population aging in Iran.

Drug-induced skin reactions: a 2-year study.

BACKGROUND: The aim of this study was to analyze the clinical characteristics of patients with adverse cutaneous drug reactions, which occur when a medicinal product results in cutaneous morbidity. METHODS: The study included 308 patients who were diagnosed as having an adverse cutaneous drug reaction during the study period (2007-2009). In 84 cases, histopathologic examination of skin biopsies were also performed. RESULTS: Patients with drug reactions were found to be more commonly female (63%) than male (37%). Beta-lactam antibiotics were found to be the most frequent cause of adverse cutaneous drug reactions (42.7%), followed by non-steroidal anti-inflammatory drugs (16.5%). Acute urticaria was the most common clinical presentation (59.2%) followed by fixed drug eruptions (18.5%), and maculopapular eruptions (14.9%). CONCLUSION: Adverse cutaneous drug reactions in our study population were mainly induced by beta-lactam antibiotics and non-steroidal anti-inflammatory drugs. The most common forms of cutaneous adverse drug reactions were found to be acute urticaria, fixed drug eruptions, and maculopapular rashes.

Association between family history and herpes zoster: a case-control study.

BACKGROUND: There are many risk factors besides age and immune suppression for herpes zoster. Family history as a risk factor is suggested in some recent studies. The aim of this study was to evaluate the association between herpes zoster and family history. METHODS: This case-control study was undertaken in Farshchian Hospital, Hamadan, Iran. "Case group" included patients with confirmed diagnosis of herpes zoster. "Control group" was chosen among other dermatologic patients or their companions without any history of herpes zoster. Immune deficiency was the main excluding criteria. Information about age, gender, dermatome involved (only in patient group), history of chronic dermatologic or systemic diseases and family history of herpes zoster was asked using special questionnaires. RESULTS: Case and control groups included 217 and 200 participants respectively. Mean age of cases and controls was 49.08±15.59 and 49.96±15.54 years old respectively (P=0.936). 53.5% of cases and 54.5% of controls were women (P=0.845). Most frequent dermatomes involved in patients were thoracic (85/217; 39.25%) and cervical dermatomes (55/217; 25.3%). Frequency of herpes zoster in first-degree blood relatives in cases and controls was 65/217 (30%) and 16/200 (8%) respectively (OR=4.91; 95% CI: 2.73, 8.85; P=0.001). CONCLUSIONS: Our findings indicated a significantly higher proportion of patients with family history of herpes zoster comparing to controls. This study confirms family history as a risk factor for herpes zoster. Therefore, the old patients with positive family history of herpes zoster may be appropriate candidates for vaccination with Zostavax. However, more evidence based on large cohort studies in needed to confirm our findings.

Cutaneous manifestations of diabetes mellitus: a case series.

Diabetes mellitus (DM) is a common disorder with a broad spectrum of cutaneous manifestations. Our purpose was to evaluate the prevalence and main clinical presentation of skin disorders in patients with DM. For a period of 6 months, all of the patients with DM attending the outpatient dermatology and diabetes clinics of the Hamedan University of Medical Sciences, Iran, were clinically examined for cutaneous manifestations of DM. Patients also were evaluated for glycemic control and evidence of other diabetes-related complications. Diabetic skin manifestations were detected in 110 of 155 (71%) patients with DM. The most common skin lesions in both patients with type 1 and type 2 DM were infectious in origin (72%). No statistically significant differences in cutaneous manifestations were observed between the 2 types of DM. In the outpatient population with DM there is a high prevalence of skin lesions mainly represented by cutaneous infections.

Clinical and histopathologic study of pilomatricoma in Iran between 1992 and 2005.

Pilomatricoma (calcifying epithelioma of Malherb) is a tumor of hair follicle matrix cells and is almost always benign. In this study we reviewed the clinical and histopathological features of 45 cases of pilomatricoma during 13 years (1992-2005). Although few malignant transformations have been reported in other studies, no evidence of malignancy or aggressiveness is observed in this study.

Treatment of common warts with an intralesional mixture of 5-fluorouracil, lidocaine, and epinephrine: a prospective placebo-controlled, double-blind randomized trial.

BACKGROUND: 5-Fluorouracil is an antimetabolite that has been known to be effective for the treatment of common warts. OBJECTIVE: The objective was to evaluate the efficacy of a combination of 5-fluorouracil, lidocaine, and epinephrine (5-FU+LE) for the treatment of common warts. MATERIALS AND METHODS: Of the 40 patients initially enrolled, 34 patients with at least 68 verruca vulgaris (one pair for each subject) completed the study. The selected warts were randomized into two treatment groups, with one wart on each patient receiving intralesional 5-FU+LE (4 mL of 50 mg/mL 5-fluorouracil and 1 mL of a mixture of 20 mg/mL [2%] lidocaine and 0.0125 mg/mL epinephrine) and the other receiving intralesional normal saline placebo using a Mantoux needle. Patients received up to four injections at weekly intervals and were followed at 1 and 6 months after the initial injection. RESULTS: Complete response was observed in 64.7% of the warts treated with 5-FU+LE compared to 35.3% in the warts treated with placebo (p<.05). Systemic reaction or treatment-related adverse medical events and recurrence rate did not differ significantly between two groups. CONCLUSION: The results show that intralesional 5-FU+LE is a safe and effective approach for common warts with high success rate.

A 10-year study of squamous cell carcinoma in Hamedan in the west of Iran (1993-2002).

BACKGROUND: Cutaneous squamous cell carcinoma (SCC) is the second most common form of skin cancer in Caucasians. Environmental factors, especially sunlight, play an important role in its pathogenesis. Aim To better define the frequency and characteristics of SCC in patients biopsied at Hamedan Sina Hospital in the west of Iran. METHODS: This descriptive cross-sectional study was carried out in patients diagnosed with SCC in the Department of Dermatology, Hamedan Sina Hospital, Hamedan, Iran, in the 10-year period from 1993 to 2002. RESULTS: From a total of 6846 biopsies, 669 skin cancers were diagnosed, including 449 (66.67%) basal cell carcinomas (BCC) and 179 (26.76%) SCC. The head and face were the most common sites of SCC location. Farming was the most common occupation. CONCLUSION: SCC is the second most common form of skin malignancy in the west of Iran. Sunlight may play a role in the etiology of this tumor.

Clinico-pathological study of 12 cases of patients with leprosy admitted to Sina Hospital, Hamadan, Iran, from 1991 to 2000.

BACKGROUND: Leprosy is considered a chronic disabling condition. Many clinical and immunological aspects of the disease remain ill defined. AIM: The study of clinico-pathological and laboratory findings of patients with leprosy admitted to Sina Hospital, Hamadan, Iran, from 1991 to 2000. METHODS AND PATIENTS: This is a descriptive retrospective cross-sectional study. The statistical community comprised all patients diagnosed leprosy. This diagnosis was clinical and confirmed through pathology (skin-biopsy) and laboratory (peripheral smear) measures. RESULTS: In this study, the disease was more common in males than females with a mean age of 48.5 +/- 16.2 years. Most of the patients were more than 40 years old. Among 12 patients in this study, six cases were urban and six cases were rural. Six cases were living in Hamadan province and two cases migrated to Hamadan province (one of them from Afghanistan and the other from Kurdestan). Clinical diagnosis was confirmed by pathology in 11 cases, but in one case the clinical diagnosis did not match the pathology. In four cases the clinical diagnosis did not match the peripheral smear. Eight cases were admitted just once. Four cases had a history of recurrence and readmission (two patients had one time recurrence and the other two patients had two recurrences). There was no difference in the clinical findings between first presentation and recurrence. From the point of complication and disability, extremity disability was more common than eye disability. Increased severity of complications was found in patients with a delayed diagnosis and incomplete treatment. CONCLUSION: This study showed that a rapid and correct diagnosis and complete treatment was necessary for prevention of complication and disability in patients with leprosy. Also the accuracy of pathology (skin biopsy) in the diagnosis exceeded the peripheral smear. Skin biopsy is recommended to confirm the diagnosis in all cases of leprosy. In the absence of pathology, patients must be considered as multibacillary patients and treated as such.