Diagnosis of an occult gastric adenocarcinoma by oral manifestations (acanthosis nigricans): A case report.

BACKGROUND: Acanthosis nigricans (AN) is a condition with an important characteristics of symmetrical areas of thickened skin with grayish brown hyperpigmentation. The mucosa may show a papillomatous surface, with or without hyperpigmentation. Lips and sites at risk of trauma may be affected and palmoplantar keratosis might also be present. In some rare cases, acanthosis nigricans presents as a sign of internal neoplasia, mostly a gastrointestinal cancer, and is called malignant acanthosis nigricans (MAN). CASE PRESENTATION: In this study, a 55-year-old female Iranian patient with malignant acanthosis nigricans (MAN) is reported. She was seeking esthetic treatment for her oral and perioral regions. The peculiarity of this case is simultaneous skin manifestation consistent with MAN, "tripe palms" (TP) and Leser-Trélat (LT) sign and mucosal changes in the oral cavity such as papillomatosis and roughened surfaces of the lips, hard palate and buccal mucosa. These changes harbored gastric adenocarcinoma stage T3 N3, but the patient was asymptomatic except for pruritis. CONCLUSION: There is an urgent need to suspect a correlation between oral and skin changes and the possibility of an internal neoplasia, therefore it is of utmost importance to refer these patients for early diagnosis of the underlying disease. This would improve the prognosis and lessen the consequences to a great extent.

Association of serum lipid profiles and dietary intakes of vitamin E and fiber with psoriasis severity.

BACKGROUND: Dyslipidemia has been reportedly associated with an increased risk of atherosclerosis among psoriatic patients. Dietary intake can be a key factor in the pathophysiology of psoriasis. Herein, we assessed serum lipid profile and dietary intake in psoriatic patients, in comparison with healthy subjects. METHODS: In this case-control study, 45 psoriatic patients and 43 healthy controls were evaluated. We estimated the macro/micronutrient intakes and energy, using a food frequency questionnaire (FFQ). Anthropometric parameters and serum levels of triglyceride (TG), high-density lipoproteins (HDL), low-density lipoproteins (LDL), and very low-density lipoproteins were assessed. The case group was categorized by severity measured by PASI score (mild<10, moderate 10-20, severe >20). Diet plan 6.0 was used to analyze FFQs and data were analyzed in SPSS 16.0, with p<0.05 considered significant. RESULTS: The case group had markedly higher body mass index (BMI), LDL, and cholesterol and significantly lower HDL compared with controls (p<0.05). Carbohydrate, energy, fat intakes were significantly higher in cases, while folate, fiber, and vitamin E intakes were significantly lower in the case group, compared with the control group (p<0.05). BMI, cholesterol, and triglyceride values and dietary intakes of fiber and vitamin E were significantly associated with severity of psoriasis (p<0.05). CONCLUSION: Serum lipid profile and dietary intake are substantially important in psoriasis severity. Therefore, close monitoring of lipid profile and BMI during admission and follow-up and dietary modification can improve the severity of psoriasis.

Post-Rhinoplasty Acne, Frequency and Role Players.

INTRODUCTION: Acne is a common complain among post rhinoplasty patients. While rhinoplasty is done for aesthetic reasons and acne expressively affects the individual's appearance, we aimed to study its incidence and role players. MATERIALS AND METHODS: A descriptive cross-sectional study was performed on 152 (143 females and 9 males) patients admitted for rhinoplasty during January 2016 to March 2017. Patients were examined by a dermatologist prior to surgery and 7, 30 and 90 days after rhinoplasty using the Global Acne Grading System and responded to a list of questions on the probable risk factors of acne. Psychological status was examined by the perceived stress scale-14 and the Hospital Anxiety and Depression Scale. RESULTS: The patients' mean age was 28.9±3.82 yrs. Mild and moderate acne were observed in 21.7% (n=33) of the cases in the preoperative visit. The incidence of mild and moderate acne was 36.1%, 42.8% and 23% after 7, 30 and 90 days of surgery, respectively. One week after rhinoplasty, acne manifested in 14.9% of cases with no history of acne. Mean age significantly differed between those with and without post-surgical acne at all post-surgical visits (P> 0.001 and P=0.001 and P=0.015, respectively). Hospital anxiety and depression and perceived stress levels were significantly higher in patients who presented with acne on the first post-surgical visit compared to those with no acne presentations (P=0.04 and P=0.02, respectively). CONCLUSION: External psychological stress may be the main role player in post-rhinoplasty acne. Consultation or referral of patients to an experienced psychologist is highly recommended for a better outcome and fewer complications.

Study of the in vitro and in vivo antileishmanial activities of nimodipine in susceptible BALB/c mice.

BACKGROUND & OBJECTIVES: Pentavalent antimonials are the standard treatment for cutaneous leishmaniasis (CL), however, treatment failures are frequent. Nimodipine, a calcium channel blocker is known to show promising antiprotozoal effects. Here, we investigated the antileishmanial effect of Nimodipine in both in vitro and in vivo BALB/c mice model of CL. We also compared the in vivo effect with amphotericin B and meglumine antimoniate in the experimental CL mice model. METHODS: Colorimetric alamar blue assay and J774 A.1 mouse macrophage cells were used to determine the effect of nimodipine on promastigotes and amastigotes viability, respectively. Then, the in vivo activity of nimodipine was compared to that of conventional therapies in both the early and established courses of Leishmania major infection in susceptible non-healing BALB/c mice. RESULTS: Nimodipine was highly active against promastigotes and amastigotes of L. major with IC50 values of 49.40 and 15.03 µM, respectively. In the early model, the combination therapy with meglumine antimoniate and nimodipine showed no parasites in the spleen or footpad of animals. The footpad thickness was significantly lower in mice treated with either nimodipine (1 mg/kg or 2.5 mg/kg) or amphotericin B compared to the control group in the established lesions model. However, no complete remission was observed in the footpad lesion of any of the treatment groups (nimodipine, amphotericin B, meglumine antimoniate, and combination therapy). INTERPRETATION & CONCLUSION: The effect of nimodipine was comparable to that of amphotericin B and meglumine antimoniate in early and established CL lesion models. Since nimodipine is more cost-effective than conventional therapies, our results merit further investigation in other animal models and voluntary human subjects.

The effect of platelet-rich plasma injection in the treatment of androgenetic alopecia.

BACKGROUND: Androgenetic alopecia is the most common type of hair loss in men, which is manifested by a progressive terminal hair loss in specific areas of scalp. Platelet-rich plasma (PRP) is among treatment options for androgenetic alopecia. PRP is a human platelet concentrate in a small volume of plasma containing certain cytokines. AIM: The aim of this study was to evaluate the efficacy and safety of autologous PRP in treatment of male androgenetic alopecia. METHODS: This was a clinical trial in 19 patients with grade III vertex to grade V androgenetic alopecia referring to the Clinic of Ghaem Hospital between March 2015 and March 2016. All obtained liquid PRP (5 cc) was injected at around 125 points (equals to 125 cm2 ) into the scalp, and operation was repeated in three sessions at 0, 4, and 8 weeks. We took macroscopic and dermoscopic pictures of each patient in 0, 4, and 8 weeks and 3 months after the last injection session. A dermatologist evaluated the treatment response using dermoscopy photos. RESULT: Our results showed that the trend of hair thickness and number variations during study period was significant (P < 0.001). However, there was no significant change in the hair thickness from the second injection forward. Our findings indicate the number of hair follicles during follow-up in pairwise comparison was significantly more than baseline. CONCLUSION: Findings of our study were in line with other studies in this field and showed that the use of PRP as a new and safe treatment can be effective in androgenetic alopecia.

Real life management of chronic urticaria: Multicenter and cross sectional study on patients and dermatologists in Iran.

Recently, advances in understanding the etiology of urticaria and updates of diagnostic and therapeutic management guidelines have drawn attention to chronic urticaria (CU) morbidity. The present study aimed to evaluate Iranian dermatologists' practice and real life management of CU patients. A total of 35 dermatologists and 443 patients were included in the study. Number of female patients was 321 (72.5%). Mean (standard deviation) age of the study patients was 38 (13) years and the median (inter quartile range) of disease duration was 12 (6-48) months. Severity of patients' symptoms was mild for 32.1%, moderate for 38.7%, severe for 18.8%, and 10.4% of them had no evident signs or symptoms. The most common diagnostic methods were physical examination (96.6%), differential blood count (83.5%), erythrocyte sedimentation rate (77.4%), and C-reactive protein (62.8%). The number of dermatologists prescribed nonsedating antihistamines (nsAH) in regular dose and high dose mono therapy were 26 (74%) and 6 (17%), respectively. About 66% of dermatologists were familiar with British Association of Dermatologists (BAD) guideline. The most common first-line treatment for CU by Iranian dermatologists was nonsedating antihistamines in regular or high doses. The real-life management of patients with CU in Iran was in accordance with the available practice guidelines.

Comparison of Autoimmune Thyroid Disease in Patients With Progressive and Stable Vitiligo.

BACKGROUND AND OBJECTIVE: Activity of vitiligo has not been considered as a patient selection criteria in previous studies; we decided to compare the presence of elevated thyroid auto-antibodies in patients with progressive and stable vitiligo. METHODS: Seventy-two patients with vitiligo were examined for thyroid problems and were divided into 2 groups of stable and progressive vitiligo according to their history and physical examination. Anti-thyroid peroxidase antibodies (anti-TPO antibodies), thyroxine (T4), and thyroid stimulating hormone (TSH) levels were assessed for all patients. RESULTS: Elevated levels of anti-TPO antibodies were observed in 43.7% of the patients with stable vitiligo and in 37.5% of patients with progressive vitiligo, which was not statistically significant (P = .315). CONCLUSION: This study not only confirmed thyroid dysfunction in patients with vitiligo but also showed that there was no difference in thyroid dysfunction and anti-TPO antibody levels in the subgroups of patients with stable or progressive vitiligo.

Evaluation between Association of Psoriasis and Vitiligo.

BACKGROUND: Although the occurrence of psoriasis and vitiligo is reported in a few studies, no proper relationship has been found between these two diseases. OBJECTIVE: The aim of this study was to identify the frequency of the coincidence of these two diseases. METHOD: A descriptive and cross-sectional study was conducted on 6,200 patients referred to dermatology clinics from September 2004 to June 2005. RESULTS: Among these patients, 219 and 154 patients suffered from psoriasis (3.53%) and vitiligo (2.48%), respectively, and 12 patients (0.19%) had psoriasis and vitiligo simultaneously. The coincidence in the psoriasis group was 5.48% and in the vitiligo group was 7.79%, so the coincidence of both diseases was greater than the incidence of each alone. This association was significant (p = .004). CONCLUSION: Coincidence of these two diseases was seen, but more studies should be done to find common genetic and immunologic factors.

Designing a deep brain stimulator to suppress pathological neuronal synchrony.

Some of neuropathologies are believed to be related to abnormal synchronization of neurons. In the line of therapy, designing effective deep brain stimulators to suppress the pathological synchrony among neuronal ensembles is a challenge of high clinical relevance. The stimulation should be able to disrupt the synchrony in the presence of latencies due to imperfect knowledge about parameters of a neuronal ensemble and stimulation impacts on the ensemble. We propose an adaptive desynchronizing deep brain stimulator capable of dealing with these uncertainties. We analyze the collective behavior of the stimulated neuronal ensemble and show that, using the designed stimulator, the resulting asynchronous state is stable. Simulation results reveal the efficiency of the proposed technique.

Evaluation of the incidence of discoid lupus erythematosus in patients with systemic lupus erythematosus and its relationship to disease activity.

BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with wide clinical features ranging from cutaneous manifestations to systemic disease. Skin is one of the most commonly affected organs in SLE. OBJECTIVE: To determine whether there is any correlation between discoid lupus erythematosus (DLE) and the severity of SLE. METHODS: In a prospective cross-sectional study, 60 consecutive patients with newly diagnosed SLE were enrolled. Skin biopsy was performed to establish the diagnosis of DLE. Disease activity was determined by the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). A SLEDAI-2K score ≥ 10 was considered active and severe disease. RESULTS: Eleven SLE patients (9 females and 2 males) had DLE (18.3%) and 49 patients (46 females and 3 males) had SLE without DLE (81.7%). The mean age of patients with DLE was 30.18 ± 11.07 years and in patients without it was 28.4 ± 10.26 years (p  =  .6). Three of 11 patients with DLE (27.3%) and 14 of 49 patients without DLE (28.6%) had a SLEDAI-2K score ≥ 10 (p  =  1). CONCLUSION: The presence of DLE in our patients with SLE was not associated with less severe disease.

Evaluation of PUVA-Induced Skin Side Effects in Patients Referred to the Imam Reza Hospital of Mashhad in 2005-2007.

BACKGROUND: Systemic oral psoralens plus UVA therapy (PUVA) is a therapeutic method used with considerable success in many different skin disorders. PUVA therapy causes some cutaneous and noncutaneous side effects and in the present research we deal with cutaneous side effects. AIMS: Evaluation of patients to know the different skin side effects of PUVA and their importance. MATERIALS AND METHODS: All patients referred to the phototherapy unit of Imam Reza Hospital of Mashhad entered the research and skin examination was taken place initially and every 3 months thereafter. Whenever any side effect appeared, it was recorded in the information sheet. RESULTS: One hundred and twenty-eight patients were included in the research, 61 were male between 15 and 75 years and 67 were female between 10 and 61 years of age. Age of female patients at the time of cutaneous side effect appearance was less than male patients. The most common early side effect was pruritus (34.3%) and the rarest was telangiectasia (0.7%). One case of late side effect in the form of squamous cell carcinoma was observed in a patient who had received other carcinogenic drugs as well. Complications such as skin dryness, pruritus, erythema and burning sensation occurred at low doses of UVA, while dermatitis, severe limb pain and acne at moderate doses and PUVA lentigines, hypertrichosis and lichenoid lesions appeared at high doses of UVA. CONCLUSION: Considering the significant therapeutic effects and few serious side effects, PUVA therapy is a suitable and safe method for treatment of certain skin diseases.

Synchrony suppression in ensembles of coupled oscillators via adaptive vanishing feedback.

Synchronization and emergence of a collective mode is a general phenomenon, frequently observed in ensembles of coupled self-sustained oscillators of various natures. In several circumstances, in particular in cases of neurological pathologies, this state of the active medium is undesirable. Destruction of this state by a specially designed stimulation is a challenge of high clinical relevance. Typically, the precise effect of an external action on the ensemble is unknown, since the microscopic description of the oscillators and their interactions are not available. We show that, desynchronization in case of a large degree of uncertainty about important features of the system is nevertheless possible; it can be achieved by virtue of a feedback loop with an additional adaptation of parameters. The adaptation also ensures desynchronization of ensembles with non-stationary, time-varying parameters. We perform the stability analysis of the feedback-controlled system and demonstrate efficient destruction of synchrony for several models, including those of spiking and bursting neurons.

Cutaneous Manifestations in HTLV-I Positive Blood Donors.

OBJECTIVE(S): Infection with the human T-cell lymphotrophic virus type-I (HTLV-I) is endemic in Mashhad, Iran. In our research we evaluated the relation between exposure to this infection and the occurrence of dermatologic manifestations. MATERIALS AND METHODS: 100 blood donors, who were seropositive but asymptomatic for infection with HTLV-I, were selected as case group. They were identified by the Blood Transfusion Organization Mashhad via the ELISA test and documented by PCR. Another 100 blood donors, that were seronegative for HTLV-I via the ELISA test and who were matched to the case group for age, gender, and existence of systemic diseases, were considered as the controls. Dermatologic evaluations and skin biopsies were performed if deemed necessary, and the results were statistically analyzed. RESULTS: 73% of the case and control groups were male, while 27% in each of these groups were female. The mean age in both groups was 40.96±11.94 years. The examination indicated that 58% of the case group and 37% of the control group had cutaneous manifestations (P<0.01). The most common diseases found in the case group were aphthous stomatitis, herpes labialis, and non-genital warts, while common diseases found in the control group were herpes labialis, aphthous stomatitis, and skin tag. The frequency of aphthous stomatitis, eczema, and non-genital warts in the case group were significantly more than the control group (P<0.05). Conclusion : Cutaneous diseases can be found more frequent in asymptomatic carriers of HTLV-I than those who are HTLV-I seronegative. The aphthous stomatitis, eczema, and non-genital warts are more prevalent in those infected by HTLV-I.

Study of the Association between Human T-cell Lymphotropic Virus Type 1 Infection and Lichen Planus.

OBJECTIVE(S): Lichen Planus is a common disease with unknown etiology which affects the skin and mucosa. Recent studies have focused on the possible role of the virus in the pathogenesis of Lichen Planus. The purpose of this study was to determine the association between the human T-cell lymphotropic virus type 1 and Lichen Planus. MATERIALS AND METHODS: This case control study was conducted on a total of 200 patients. The case group consisted of 100 patients with a confirmed histopathological diagnosis of lichen planus disease, and the control group consisted of 100 healthy blood donors without any signs or symptoms of skin diseases, and who were similar in age and sex to the case group. Blood samples of both participants in the case and control groups were examined for the presence of anti -HTLV-I antibodies using the ELISA method. The polymerase chain reaction for human T-cell lymphotropic virus type 1 was conducted in cases in which the findings for antihuman T-cell lymphotropic virus type 1 antibody test was positive, and statistical analysis was conducted on the obtain results. RESULTS: One case in the case group was infected with human T-cell lymphotropic virus type 1; however, no infection was observed in the control group. The difference was not statistically significant (P = 1). CONCLUSION: Based on the obtained results, no association was observed between the human T-cell lymphotropic virus type 1 infection and Lichen Planus.

Association Between HTLV-I Infection with Chronic Lupoid Leishmaniasis.

OBJECTIVE(S): One of the different types of skin leishmaniasis is the Chronic Lupoid Leishmaniasis (CLL), which is caused by abnormal immune response. On the other hand, HTLV-I has been known to exist in some infectious diseases. Human T cell lymphotropic virus type1 (HTLV-I) and cutanous leishmaniasis exists endemically in Mashhad. The objective of this study was to evaluate the prevalence of HTLV-I in CLL patients. MATERIALS AND METHODS: This cross sectional study involved 51 CLL patients admitted to cutaneous leishmaniasis clinics of Ghaem and Imam Reza hospitals in Mashhad, Iran. The blood samples were examined for serology tests through ELISA method. RESULTS: The results of the experiments for evaluating the existence of HTLV-I in 51 patients under study in this research were proved to be negative. CONCLUSION: According to this pilot study, the distribution of HTLV-I in CLL patients is not higher than normal population.

Comparative study of topical 80% trichloroacetic acid with 35% trichloroacetic acid in the treatment of the common wart.

BACKGROUND: Common warts caused by the human papillomavirus (HPV) are considered to be the most common infectious skin disease. No individual treatment for common warts is effective as monotherapy in eradicating the lesions. The aim of this study is to evaluate the clinical efficacy of a 35% and an 80% trichloroacetic acid (TCA) solution in the treatment of the common wart. METHODS: In this single-blinded clinical trial, 62 eligible patients with common warts referred to the dermatology clinic of Ghaem Hospital in Mashhad, Iran. Patients were randomly divided into two groups, each treated with a TCA solution (group A, TCA 80%; group B, TCA 35%) once per week until complete clearance of the lesions or for a maximum duration of six weeks. Seven patients were excluded from the final analysis (one patient in group A and six patients in group B) for various reasons, including irregular follow-up, using physical tools such as razor blades to remove the lesion, and failure to complete treatment; and 55 patients were included in the final analysis. RESULTS: Improvement to treatment responses was classified as: no change (no changes in the number of warts), mild (clearing of less than 25% of warts), moderate (clearing of 25% to 75% of warts), and good (clearing of more than 75% of warts). At the end of follow-up, the clinical improvement of group A (n=30) was: 10 patients (33.3%) with a mild response, 6 patients (20%) with a moderate response, and 14 patients (46.7%) with a good response. In group B (n=25), 16 patients (64%) showed a mild response, 6 patients (24%) a moderate response, and 3 patients (12%) a good response. There was a statistically significant difference in improvement between the two treatment groups (P=.017). Improvement was greater with a higher concentration of TCA solution. CONCLUSION: This study showed that a different concentration of TCA solution was an effective form of treatment for common warts. Trichloroacetic acid 80% is more effective, but this solution must be used only with careful consideration by a physician.

An association of human papillomaviruses low risk and high risk subtypes with skin tag.

OBJECTIVES: Human papillomavirus (HPV) infections are related to the genesis of various benign lesions and some malignant tumors, but no clear relationship has been identified so far between the subtypes of HPV and skin tag. MATERIALS AND METHODS: The present case-control study was designed to detect the existence of low risk and high risk HPV types in lesions of 50 patients with skin tag (case group) and normal skin around the melanocytic nevus of 30 patients (control group), using PCR. RESULTS: All of the samples were negative for HPV subtypes, except two samples in control group which were positive for high risk HPV. There was no significant relationship between the HPV subtypes and skin tag. CONCLUSION: There is no association between skin tag and low risk and high risk human papillomaviruses.