Maryam Nasimi; Robabeh Abedini; Zahra Halaji; Maryam Hosseinizadeh; Fariba Mohammadi
Abstract
Background: Basal cell carcinoma (BCC) is the most common form of malignancy in white populations. It has been hypothesized that dietary factors may play a role in BCC development. In this study, serum levels of folic acid and vitamin B12 were evaluated in patients with BCC to investigate the potential ...
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Background: Basal cell carcinoma (BCC) is the most common form of malignancy in white populations. It has been hypothesized that dietary factors may play a role in BCC development. In this study, serum levels of folic acid and vitamin B12 were evaluated in patients with BCC to investigate the potential role of these vitamins in BCC development.Methods: Forty-five BCC patients and 45 age- and sex-matched healthy controls were enrolled in the study. Patients with a history of radiotherapy in the affected area were excluded. All participants completed a questionnaire including demographic characteristics, and blood samples were taken to evaluate serum levels of folic acid and vitamin B12.Results: There were no significant differences in serum levels of vitamin B12 and folic acid between healthy controls and BCC patients. Serum levels of vitamin B12 were significantly higher in female patients than male patients.Conclusion: It seems that BCC is not related to serum levels of vitamin B12 and folic acid; however, this issue should be studied with larger sample sizes.
Saeedeh Farajzadeh; Mahin Aflatoonian; Saman Mohammadi; Hamid Sharifi; Maryam Khalili
Abstract
Background: Hyperhomocysteinemia and vitamin D deficiency maybe involved in the pathogenesis of vitiligo. This study comparedthe serum levels of vitamin D, homocysteine, vitamin B12, andfolic acid between vitiligo-affected children and healthy children.Methods: Using a case-control design, 30 children ...
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Background: Hyperhomocysteinemia and vitamin D deficiency maybe involved in the pathogenesis of vitiligo. This study comparedthe serum levels of vitamin D, homocysteine, vitamin B12, andfolic acid between vitiligo-affected children and healthy children.Methods: Using a case-control design, 30 children with vitiligoand 30 age and sex-matched healthy children were enrolledfrom April 2018 to August 2020. Serum levels of vitamin D,homocysteine, vitamin B12, and folic acid were analyzed in bothgroups during the same season of the year. Additionally, theassociation between serum levels of these factors with demographicand clinical features of the children (collected by interview andphysical examination) was evaluated. Data were analyzed usingthe independent T-test, Fisher’s exact test, and chi-squared test.Results: The vitiligo group had significantly lower vitamin Dand folic acid serum levels compared with the control group[95% CI -19.87 to -2.96 and -4.15 to -4.18, respectively]. Amongpatients, the vitamin D level was negatively correlated with age(r = -0.459, P = 0.011) and disease duration (r = -0.373, P = 0.042).Moreover, there was a significant association between vitiligoactivity and serum homocysteine levels (P = 0.027).Conclusion: Routine measurement of vitamin D and folic acidserum levels might be suggested, especially in children withlong-standing disease. Monitoring the homocysteine level maybe beneficial, particularly in children with progressive vitiligo.
Maryam Zahed; Ladan Dastgheib; Maryam Sadat Sadati; Asma Soukhakian
Abstract
Background: Pemphigus vulgaris (PV) is a life-threatening autoimmune disease that affects the skin and mucosa. In most regions, little data is available on its epidemiology. This study aimed to present an overview of the worldwide epidemiology of pemphigus and evaluate the epidemiological features of ...
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Background: Pemphigus vulgaris (PV) is a life-threatening autoimmune disease that affects the skin and mucosa. In most regions, little data is available on its epidemiology. This study aimed to present an overview of the worldwide epidemiology of pemphigus and evaluate the epidemiological features of PV in the southwest of Iran.Methods: In this study, data including sex, age, time of disease onset, phenotype of the disease, geographic location of birth, geographic location of residence, level of education, and occupation of PV patients from 2004 to 2019 were collected from the records existing in the Oral Medicine Department of Shiraz Dental School and Shahid Faghihi Hospital, Shiraz, Iran.Results: In total, 249 PV patients with a mean age of 42.72 ± 13.3 years were included. The female to male ratio was 1.74:1. The annual incidence of PV in Fars province was 2.7 per million people. In this region, the most frequent phenotype was the mucocutaneous phenotype in 204 patients (81.9%), followed by the mucosal dominant phenotype in 40 (16.1%) and the cutaneous phenotype in 5 (2%). Regarding the level of education, 43.4% had less than a high school diploma, 24.9% had a high school diploma, 17.3% had an associate diploma or higher, and 14.5 % were illiterate. Moreover, 55.8% were housewives, 21.7% were self-employed, 19.3 % were employed, and 3.2% were jobless.Conclusion: The findings indicate that PV is a rare disease in the southwest of Iran compared with other regions. According to previous studies in this region, the incidence has decreased since 2005.
Arunima Dhabal; Jayanta Kumar Barua; Kingshuk Chatterjee; Ananya Chandra; Sumana Khan; Manab Kumar Ghosh; Saswati Halder
Abstract
Background: Lichen planus (LP) is a chronic inflammatorydisorder involving the skin, mucosa, hair, and nails. Previousreports have shown a possible association between LP andmetabolic derangement, leading to increased cardiovascular riskamong these patients. Our study aimed to assess the prevalenceof ...
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Background: Lichen planus (LP) is a chronic inflammatorydisorder involving the skin, mucosa, hair, and nails. Previousreports have shown a possible association between LP andmetabolic derangement, leading to increased cardiovascular riskamong these patients. Our study aimed to assess the prevalenceof metabolic syndrome (MetS) and its components in LP patientsand to study their relationship with mucosal involvement in LP.Methods: We conducted a cross-sectional observational study of123 LP patients. Demographic and clinical data were obtained,and evaluation was done for the presence of abdominal obesity,hypertension, hyperglycemia, and dyslipidemia. MetS wasdiagnosed according to the modified National CholesterolEducation Program: Adult Treatment Panel III (NCEP-ATP III)criteria for the South Asian population. Data analysis was doneusing appropriate statistical methods.Results: The prevalence of MetS in LP patients was 31%. The meanage of LP patients having MetS was considerably higher thanthose without MetS (44.8 ± 13.6 vs. 33.3 ± 15.9 years; P = 0.0002).Although statistically insignificant, female patients and patients withmucosal involvement showed a higher prevalence of MetS. Centralobesity, hypertension, hyperglycemia, and hypertriglyceridemiawere more prevalent in mucosal LP patients than in those withoutmucosal lesions, with hyperglycemia having a significantly higherprevalence in mucosal LP (41% vs. 18%; P = 0.015).Conclusion: Incre ased age, female gender, and mucosalinvolvement are important predictors of concurrent metabolicderangement in LP patients. Thus, these patients should bescreened for the presence of MetS and its components.
Maryam Khalili; Saman Mohammadi; Mohamadhosein Saeidi; Rezvan Amiri; Amireh Heshmatkhah; Simin Shamsi Meymandi; Mahin Aflatoonian
Abstract
Background: Treatment failure of antimony drugs for anthroponoticcutaneous leishmaniasis (ACL) is rising. Recognizing predictivefactors of unresponsiveness to treatment can substantiallyinfluence better ACL management. The goal of this study wasto investigate predictive factors associated with treatment ...
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Background: Treatment failure of antimony drugs for anthroponoticcutaneous leishmaniasis (ACL) is rising. Recognizing predictivefactors of unresponsiveness to treatment can substantiallyinfluence better ACL management. The goal of this study wasto investigate predictive factors associated with treatment failurein ACL in Kerman, southeast Iran.Methods: This case-control study was conducted retrospectivelyon 2,128 ACL cases in Kerman over ten years from 2011 to 2020.The case group included patients whose lesions failed to resolveafter one treatment course. The control group included thosewhose lesions were cured after one treatment course.Results: Treatment failure was observed in 13.5% of cases (10.7%of systemic therapy and 16.7% of local therapy). No significantdifference was reported between the type of treatment andtreatment failure. The association of treatment failure withwinter-onset (P = 0.001, OR = 1.39, CI = 1.23–1.56), face (P = 0.001,OR = 1.86, CI = 1.38–2.49), ulceration (P = 0.01, OR = 0.51, CI = 0.30–0.85), small diameter (P = 0.005, OR = 0.57, CI = 0.38-0.84) andlong duration of lesions (P = 0.01, OR = 1.57, CI = 1.11–2.21) wasvalidated by multivariate logistic regression analysis.Conclusion: Efficient detection and timely management of ACLcases are essential to reduce resistant cases, as lesions lastinglonger than four months show poor response to treatment.Furthermore, early treatment of facial lesions with systemictherapy is suggested to optimize results and reduce the risk ofdisfiguring scars. Further surveys are required to determine thereason behind more treatment failure in winter-onset lesions.
Parvaneh Hatami; Zeinab Aryanian; Hamed Nicknam Asl; Azadeh Goodarzi
Abstract
Since coronavirus disease 2019 (COVID-19) vaccines were approved without long-term monitoring, tracking their adverse effects appears to be necessary. Mucocutaneous adverse events are of great importance due to their visibility and the potential effect on inducing fear in patients leading to vaccine ...
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Since coronavirus disease 2019 (COVID-19) vaccines were approved without long-term monitoring, tracking their adverse effects appears to be necessary. Mucocutaneous adverse events are of great importance due to their visibility and the potential effect on inducing fear in patients leading to vaccine hesitancy. We searched PubMed, Google Scholar, and Scopus in this regard, and all of the relevant papers published until June 28, 2021, were included if we could access their full texts. Moreover, we included some of our cases from Iran. We found various mucocutaneous manifestations after COVID-19 vaccination, including local injection site reactions (acute or delayed), urticarial lesions, pityriasis rosea-like rashes, angioedema, morbilliform rashes, pernio-like lesions, acrocyanosis, petechial/ purpuric/ecchymotic lesions, herpes flare-up, herpetiform rashes, oral erosive lesions, acral pustular rashes, erythema multiform, dermographism, herpes zoster, generalized pruritus, contact dermatitis, reaction to dermal fillers and non-specific rashes. We categorized them by their time of initiation (acute or delayed) and site of involvement (local injection site, remote area, or generalized). Delayed local reactions, local injection site reactions, urticarial lesions, and pityriasis rosea-like and morbilliform rashes were among the most common cutaneous adverse events. Dermatologists should be aware of these potential reactions to manage them properly, reassure patients, and encourage them to continue their vaccination.
Hossain Kawosi; Nader Salari; Arash Golpazir Sorkhe; Ibrahim Shakiba; Roya Safarpour; Masoud Mohammadi
Abstract
Background: Malignant melanoma is a prevalent, offensive, andfatal cancer in developed countries. Most of our information isrelated to studies conducted in western countries. This studyaims to evaluate demographic and clinical data of melanoma inthe Kermanshah province of Iran.Method: This was a descriptive ...
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Background: Malignant melanoma is a prevalent, offensive, andfatal cancer in developed countries. Most of our information isrelated to studies conducted in western countries. This studyaims to evaluate demographic and clinical data of melanoma inthe Kermanshah province of Iran.Method: This was a descriptive study on data available in theCancer Registry Center of Kermanshah, which includes 70patients during eight years from 2010–2017. Clinical recognitionof melanoma was based on American Joint Committee on Cancercriteria. Data were analyzed by SPSS 20 software and shown inArcGIS (Version 10.7).Results: Patients included 46 men (65.7%) and 24 women (34.3%)with a mean age of 60.49 ± 16.08. The general prevalence ofmelanoma was 4.4 in every 1,000,000 persons annually. Mostpatients had skin type III (65.7%), indoor jobs (61.4%), and livedin the city (67.1%). Also, 35.7% had a trauma history, 2.8% hadfamilial melanoma history, and 17.1% had other types of skincancer. Extremities (51.4%), acral lentiginous melanoma (50.1%),Clark IV (61.4%), and inguinal lymph nodes (14.3%) were themost prevalent location, clinical type, pathological level, andinvolved lymph nodes, respectively.Conclusion: Acral lentiginous melanoma and extremitiesinvolvement are prevalent in our region. Most patients go todoctors at an advanced level due to delays in referral, lack offollow-up by patients, lack of recognition at the initial care level,and lack of access to specialty centers. We recommend generalinstructions through media and holding special workshops forphysicians for better familiarity with melanoma.
Ramin Radmanesh; Mohammad Radmanesh
Abstract
Background: There is no cure for xeroderma pigmentosum (XP) patients who suffer from persistent freckling and recurrent lifethreatening malignancies. We aimed to remove facial lentiginous pigmentations using CO2 laser resurfacing.Methods: 5 patients with clinically proven XP living in their third decade ...
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Background: There is no cure for xeroderma pigmentosum (XP) patients who suffer from persistent freckling and recurrent lifethreatening malignancies. We aimed to remove facial lentiginous pigmentations using CO2 laser resurfacing.Methods: 5 patients with clinically proven XP living in their third decade were scheduled to be treated with CO2 laser resurfacing. After tumescent anesthesia, the whole facial skin was treated with 3 UltraPulse® conventional CO2 ablation passes. The parameters used were 6 mJ, 5 mJ, and 4 mJ for the first to third passes. The mandibular areas were treated with two passes of 4 and 3.2 mJ, while the eye contours were treated with two passes of 3.6 mJ and 3.2 mJ.Results: The face was edematous and almost free of freckling immediately after resurfacing. The edema persisted for a week. The facial skin oozed within the first three days, followed by crust formation. After a week and after complete shedding of the crusts, smooth and erythematous skin appeared. The erythema persisted for more than two months. The patients were free of malignancy and freckling for up to 16 months follow-up.Conclusion: CO2 laser can remove lentiginous pigmentation and prevent or postpone malignancies for a considerable length of time.
Muhammed Mukhtar
Abstract
An ingrown toenail is a painful disorder of the lateral nail fold associated with inflammation, infection, and granuloma formation. Various conservative modalities have been described to reduce the pressure of an ingrown nail on its gutter. The invasive option is preferred for severe ingrown nails (grade ...
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An ingrown toenail is a painful disorder of the lateral nail fold associated with inflammation, infection, and granuloma formation. Various conservative modalities have been described to reduce the pressure of an ingrown nail on its gutter. The invasive option is preferred for severe ingrown nails (grade III). Here an innovative, less invasive technique is described to treat severe grades of ingrown nails with the use of mosquito artery forceps and cyanoacrylate glue. The glue on curing becomes a hard cast that blunts and insulates the nail from its gutter, protecting the gutter from nail injury. The glue is hygroscopic and antiinfective, making the gutter dry, healthy, and maceration-free. The ingrown nail becomes asymptomatic within half an hour of splinting, and the granuloma heals within 3 to 6 weeks. Thus chemical splinting with cyanoacrylate glue is a novel and fast conservative technique for treating severe grades of ingrown toenails in outpatient care units.
Mohammad Mahdi Parvizi; Farhad Handjani; Leila Ghahramani; Nasrin Shokrpour
Abstract
Background: Evidence shows that article titles might affectcitation metrics. This study aimed to evaluate the associationbetween selected citation metrics and the title characteristics indermatology journals.Methods: We enrolled 305 reviews and original articles publishedduring 2016 from four dermatology ...
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Background: Evidence shows that article titles might affectcitation metrics. This study aimed to evaluate the associationbetween selected citation metrics and the title characteristics indermatology journals.Methods: We enrolled 305 reviews and original articles publishedduring 2016 from four dermatology journals consisting of the“Journal of the American Academy of Dermatology,” “Journalof the European Academy of Dermatology and Venereology,”“Indian Journal of Dermatology, Venereology and Leprology,”and “International Journal of Dermatology” using a stratifiedand simple random sampling method. The list of articles wasextracted from Scopus; then, the title characteristics werereviewed. Moreover, we extracted the citation metrics, includingthe citation count, Field-Weighted Citation Impact (FWCI), andcitation benchmarking percentile of the articles until the end ofOctober 2021 using Scopus. For statistical analysis, we used Statasoftware version 14.2.Results: Overall, 239 (78.36%) original and 66 (21.64%) reviewarticles were included. The citation count and FWCI significantlyand positively correlated with the number of words, characters,and punctuation marks in the titles. By adjusting the covariates,linear logistic regression showed that the title length and thepresence of acronyms in the title were the most effective factorsin increasing the citation count and FWCI of the articles.Conclusion: Using longer titles and including acronyms in thetitles may help augment the citation of articles in dermatologyjournals.
Anup Kumar Tiwary
Abstract
Bednar tumor or pigmented dermatofibrosarcoma protuberans is a rare slow-growing dermal tumor of neuromesenchymal origin having low malignant potential. It usually presents as a black, firm plaque or exophytic nodule on the back or shoulder, mostly in black people in their third to fourth decades of ...
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Bednar tumor or pigmented dermatofibrosarcoma protuberans is a rare slow-growing dermal tumor of neuromesenchymal origin having low malignant potential. It usually presents as a black, firm plaque or exophytic nodule on the back or shoulder, mostly in black people in their third to fourth decades of life. The head, neck, and extremities are less common sites. Herein, we reported a 55-year-old female presenting with a well-defined, dark-colored, ulcerated, painful plaque on the fifth toe of the right foot that had developed since two years beforehand. Malignant melanoma and dermatofibroma were considered as clinical differential diagnoses. An incisional biopsy was done. Histopathologic evaluation showed dermal proliferation of plump elongated cells and spindled cells (with oval to elongated hyperchromatic nuclei and scanty eosinophilic cytoplasm) arranged in storiform pattern and sheets. Melanin-laden dendritic cells were also present, interspersed with neoplastic elongated and spindle-shaped cells. Based on these clinical and histopathologic features, a diagnosis of Bednar tumor was made.
Mohammad Asad Haroon; Tapan Kumar Dhali; Paschal D'Souza; Anu Singhal
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant disorder characterized by the development of hamartomatous tumors in multiple organs, including the skin. Most patients present early in life with seizures, intellectual disability, and cutaneous angiofibromas. However, patients may often not ...
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Tuberous sclerosis complex (TSC) is an autosomal dominant disorder characterized by the development of hamartomatous tumors in multiple organs, including the skin. Most patients present early in life with seizures, intellectual disability, and cutaneous angiofibromas. However, patients may often not present these features until late adulthood. A 55-year-old female presented with complaints of sudden and florid appearance of multiple fibrokeratomas around all twenty of her nails, along with multiple hyperpigmented papules on her face. On examination, she also had gingival fibromas and a single skin-colored plaque on her lower back. Histopathology of lesions over the face, back, and fingernails were compatible with the diagnoses of angiofibroma, shagreen patch, and fibrokeratoma, respectively. She was advised laser ablation of the facial lesions and excision of the nail fibrokeratomas. MRI of the brain showed multiple cortical tubers and subependymal nodules. Late presentation of TSC during adulthood may delay the diagnosis and prevent the screening of early tumor formation, potentially increasing morbidity. This was exemplified in our clinical case, where asymptomatic cortical tubers were discovered on MRI only after the appearance of skin lesions and fibrokeratomas around the nails.
Karen Christelle; Maryam Mohd Zulkifli; Nani Draman
Abstract
Pemphigoid gestationis is an unusual autoimmune dermatosis of pregnancy, and recurrences may occur in consequent pregnancies. This dermatosis begins with intense itching, which progresses to papules and annular plaques and, consequently, vesicles and tense bullae. These lesions typically arise from the ...
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Pemphigoid gestationis is an unusual autoimmune dermatosis of pregnancy, and recurrences may occur in consequent pregnancies. This dermatosis begins with intense itching, which progresses to papules and annular plaques and, consequently, vesicles and tense bullae. These lesions typically arise from the umbilical region then spread centrifugally to the abdomen, thighs, palms, and soles. Diagnosis is based on clinical examination and immunohistopathologic studies. Here, we report the case of a 29-year-old women who developed recurrent pemphigoid gestationis in her second pregnancy and the postpartum period in 2020. The condition initially manifested during her first pregnancy in 2014. She was successfully treated with oral prednisolone and the local application of betamethasone cream. Pruritic skin lesions are a common complaint among pregnant women. Clinicians should be aware of autoimmune dermatosis of pregnancy, its fetomaternal and neonatal complications, and its possibility of recurrence in subsequent pregnancies.
Samer A Dhaher; Ali M Yosif
Abstract
Background: Acne vulgaris is a common chronic inflammation ofpilosebaceous units with a multifactorial pathogenesis. Traditionaltreatment may have limited success with potential side effects.The long-pulsed neodymium-doped yttrium garnet (Nd:YAG)laser may be a desirable alternative.Methods: A prospective ...
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Background: Acne vulgaris is a common chronic inflammation ofpilosebaceous units with a multifactorial pathogenesis. Traditionaltreatment may have limited success with potential side effects.The long-pulsed neodymium-doped yttrium garnet (Nd:YAG)laser may be a desirable alternative.Methods: A prospective clinical trial was conducted on 61 acnepatients at the Department of Dermatology, Basrah TeachingHospital, from April 2019 to April 2020. Three treatments withlong-pulsed Nd:YAG were performed across two-weeks intervals(fluence 50 J/cm2, spot size 5 mm, pulse duration 15 ms, andfrequency 1.5 Hz). Patients were assessed at baseline and 2, 4,6, and 12 weeks later by counting the acne lesions and scoringthe response according to the percentage of lesions’ reduction.Results: Sixty-one patients completed the study (49 femalesand 12 males); the mean age was 18.7 ± 1.67 years. A significantreduction of acne lesions at the end of therapy was observedcompared to the baseline. The mean number of total lesions wasreduced from 84.2 ± 25.8 to 16 ± 23.3 (P < 0.05). Overall, 49 (80.3%)patients achieved an excellent response, 3 (4.9%) good, 1 (1.6%)moderate, and 8 patients (13.1%) showed a poor response. Thetreatment was well tolerated with insignificant adverse effects.Conclusion: Long-pulsed Nd:YAG laser is an effective and safemodality for treating acne vulgaris and may be considered analternative option for cases of recurrence after conventionaltreatment. However, more sessions are needed for severe cases.
Fariba Binesh; Aliakbar Akaberi; Mohammad Ebrahimzadeh-Ardakani; Sara Mirhosseini
Abstract
One of the benign tumors of the sweat glands is a syringoma. A rare subtype of this tumor is the eruptive type, which is often seen before or during puberty. Here we report a case of eruptive syringoma in a 15-year-old girl. A 15-year-old girl was visited in our department, with a three-year history ...
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One of the benign tumors of the sweat glands is a syringoma. A rare subtype of this tumor is the eruptive type, which is often seen before or during puberty. Here we report a case of eruptive syringoma in a 15-year-old girl. A 15-year-old girl was visited in our department, with a three-year history of numerous tancolored papules territorialized on both the forearms. There were no other skin or systemic findings, and our differential diagnoses included xanthoma, lichen planus, and sarcoidosis. A skin biopsy was performed, revealing mild epidermal acanthosis. There were ductal structures lined by a double epithelium in association with elongated, tadpole-like epithelial cells in the dermis. Dermal collagen had thickened. Inflammatory cells were inconspicuous. Taken together, the above morphologic findings confirmed the diagnosis of an eruptive syringoma. Clinical diagnosis of eruptive syringoma is hard and histological evaluation is decisive for achieving the correct diagnosis.
Hamed Zartab; Behzad Iranmanesh; Rezvan Amiri; Simin Shamsi Meymandi
Abstract
Background: Alopecic and aseptic nodule of the scalp (AANS) is a rare entity characterized by the presence of sterile, culturenegative nodules/cysts and areas of non-scarring alopecia.Methods: We describe a case on the vertex of a 26-year-old man with a two-week history of a nodular, moderately-fluctuant, ...
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Background: Alopecic and aseptic nodule of the scalp (AANS) is a rare entity characterized by the presence of sterile, culturenegative nodules/cysts and areas of non-scarring alopecia.Methods: We describe a case on the vertex of a 26-year-old man with a two-week history of a nodular, moderately-fluctuant, alopecic lesion. The patient also had cutis verticis gyrata (CVG).Results: The aspirate culture was negative and histopathologic findings were nonspecific. We also performed a trichoscopy of the lesion. After eight weeks, the patient showed dramatic clinical response to doxycycline and a dose of intralesional corticosteroid.Conclusion: This is the first report of the simultaneous occurrence of AANS and primary essential CVG. AANS is a probably under-reported cause of non-scarring alopecia with a rapid and dramatic response to non-surgical treatment and a generally good prognosis.
Sunil Gupta; Jaspriya Sandhu; Palvi Singla; Aditi Bansal; Bhavna Garg; Harpreet Kaur
Abstract
Rheumatoid vasculitis, an uncommon extraarticular manifestationof rheumatoid arthritis, usually develops in long-standing casesaffecting small-to-medium-sized vessels. It is a poor prognosticmarker when multiple systems are affected, skin and neurologicinvolvement being most frequent. Rheumatoid vasculitis ...
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Rheumatoid vasculitis, an uncommon extraarticular manifestationof rheumatoid arthritis, usually develops in long-standing casesaffecting small-to-medium-sized vessels. It is a poor prognosticmarker when multiple systems are affected, skin and neurologicinvolvement being most frequent. Rheumatoid vasculitis is seenmore commonly in seropositive and nodular rheumatoid arthritispatients who are male or smoke. Herein, we present the peculiarcase of a 48-year-old female with rapid onset, progressive, multipleulcers predominantly over the flexures. Differential diagnoses ofpyoderma gangrenosum, pyoderma vegetans, pemphigus vegetans,and vasculitis were considered, and the patient was evaluated. Oninvestigation, her rheumatoid factor titer was strongly positive;a skin biopsy revealed leukocytoclastic vasculitis. On clinical,serological, and histopathological correlation, a diagnosis ofrheumatoid vasculitis was made, responding well to high-doseprednisolone. On follow-up at six months, her skin lesions hadhealed well with moderate scarring; however, she developedsevere joint pain, warranting the initiation of disease-modifyingantirheumatic drugs. To the best of our knowledge, this is apreviously unreported clinical and morphological presentationof rheumatoid vasculitis.
Ali Asilian; Samaneh Mozafarpoor; Azadeh Goodarzi; Mohammad Amin Jafari; Parvin Rajabi; Mehdi Eftekhari
Abstract
Composite hemangioendothelioma (CHE) is a rare and little-known condition with combined benign, intermediate, and malignant features. In the current study, we describe the case of a young female with the presentations of CHE, representing the second known case in Iran. Also, we have comprehensively reviewed ...
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Composite hemangioendothelioma (CHE) is a rare and little-known condition with combined benign, intermediate, and malignant features. In the current study, we describe the case of a young female with the presentations of CHE, representing the second known case in Iran. Also, we have comprehensively reviewed previous case reports of CHE. A 30-year-old female was referred with a reddish hemorrhagic painless mass in the small right finger that appeared within a few days following trauma. The mass was primarily excised but recurred within three weeks; therefore, she underwent thorough clinical, laboratory, and imaging studies. Finally, the lesions were biopsied and diagnosed as CHE. Accordingly, the involved finger was amputated, and the patient underwent chemoradiotherapy. Although CHE is a rare malignant condition worldwide, attention to the clinical presentations of this malignancy can help scientists make better therapeutic approaches leading to the best outcomes.
Anil Prakash Gosavi; Ravindranath Brahmadeo Chavan; Neelamkumari Bhatt; Nitika Deshmukh; Darshana Rajendra Kundale
Abstract
Bullous pemphigoid is the most common type of subepidermalautoimmune bullous disease. It usually affects older people;isolated cases among people younger than 65 have been reportedwith various presentations, usually more severe and active thanthose seen in the elderly. Toxic epidermal necrolysis (TEN) ...
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Bullous pemphigoid is the most common type of subepidermalautoimmune bullous disease. It usually affects older people;isolated cases among people younger than 65 have been reportedwith various presentations, usually more severe and active thanthose seen in the elderly. Toxic epidermal necrolysis (TEN) is apotentially life-threatening dermatologic disorder characterizedby widespread necrosis and bullous detachment of the epidermisand mucous membranes resulting in exfoliation and possiblesepsis. Various morphological variants of bullous pemphigoidhave been reported, with reports of the TEN-like variant ofbullous pemphigoid being scarce. In this study, we report a caseof bullous pemphigoid with TEN-like presentation in a middleagedfemale.
Atieh Ebadi; Farhad Malekzad; Mohmmadreza Khorramizadeh; Ariana Kariminejad; Fahimeh Shahabipour; Reza M Robati
Abstract
Cutis laxa (CL) is a connective tissue disease thatis either inherited or acquired. It is characterized by redundant,pendulous, and inelastic skin. Loss of elasticity is a pathologicalfeature of some degenerative and inflammatory diseases. Matrixmetalloproteinases (MMPs) can cleave elastin fibers by ...
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Cutis laxa (CL) is a connective tissue disease thatis either inherited or acquired. It is characterized by redundant,pendulous, and inelastic skin. Loss of elasticity is a pathologicalfeature of some degenerative and inflammatory diseases. Matrixmetalloproteinases (MMPs) can cleave elastin fibers by damagingthe microfibrils and the elastin core, resulting in the loss ofelasticity.In this study, we report eight patientswith different types of cutis laxa along with the quantitativemeasurement of serum levels of MMP-2 and MMP-9.The cutis laxa patients showed various clinical andhistopathological findings, indicating the heterogeneity of thisrare skin connective tissue disease. The serum level of MMP-2and MMP-9 were elevated in these patients.Increased MMP-2 and MMP-9 might be associatedwith cutis laxa. However, our findings need to be validated inlarger clinical settings.
Karjigi Siddalingappa; Prabodh Gaikwad; Kallappa C Herakal; Vedasree Reddy
Muhammed Mukhtar
Ruohollah Seddigh; Hossein MansourKiaei; Amirreza Haji Azizi
Abstract
Background: Factitious disorder (FD) is a psychiatric condition in which the affected person deliberately makes up diseases, injuries, or symptoms. Diagnosing this condition is a serious medical challenge. No studies have been conducted in Iran to show these patients’ clinical and demographic profiles ...
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Background: Factitious disorder (FD) is a psychiatric condition in which the affected person deliberately makes up diseases, injuries, or symptoms. Diagnosing this condition is a serious medical challenge. No studies have been conducted in Iran to show these patients’ clinical and demographic profiles in an adequate sample size. The present article attempts to extract demographic and clinical details of Iranian FD patients by reviewing the related published articles.Methods: A search was conducted on this disorder in English and Persian articles published by Iranian researchers between 1960 and 2020 in the MEDLINE, Web of Science, EMBASE, PsychInfo, Google Scholar, and SID databases using factit*, artefacta*, artefactua*, and Munchausen* as keywords in combination with “by proxy” and “imposed upon another”. Ultimately, 33 case report articles and 35 cases in total were included in the study, and demographic and clinical details of patients were extracted from the articles.Results: Of the 35 FD patients, 27 were women. The patients’ mean age was 32.5 years. Factors leading physicians to the diagnosis of FD were atypical presentation (n = 18) followed by an unsubstantiated presentation. FD symptoms were mainly physical (n = 31), and reporting unusual and atypical wounds were the most common cause of patients’ visits, with a frequency of 25%. Most patients had not undergone a thorough psychiatric examination, and in those who had been evaluated, the most common diagnoses reported were mood disorder and anxiety disorder.Conclusion: It appears that greater attention is required to teach the diagnosis and assessment of FD.
Vijayasankar Palaniappan; Premjith Raveendran; Karthikeyan Kaliaperumal; Ramya Gandhi
Nasrin Saki; Fatemeh Sari Aslani; Mohammad Javad Najafzadeh; Roya Radanfar; Seyed Ali Hosseini; Najmeh Ahramiyanpour
