Comparison of the efficacy of intralesional 5-fluorouracil/lidocaine/epinephrine injection with cryotherapy to treat common and palmoplantar warts: A randomized, controlled trial.

Cutaneous warts are treated by different treatments with various efficacy. Intralesional injection of 5-fluorouracil (IL 5-FU) has been compared with placebo and a few other wart treatments. Our objective was to compare the efficacy of IL 5-FU injection with cryotherapy to treat common and palmoplantar warts. Forty-five patients with common and palmoplantar warts were treated with either IL 5-FU admixed with lidocaine and epinephrine (5-FU + LE) or cryotherapy, once weekly for six sessions. The patients were assessed for clinical response score, the thickness of warts, pain score, and quality of life in treatment sessions, 2 and 8 weeks after the last session. Nine patients (64.3%) in the 5-FU + LE group, and five patients (35.7%) in cryotherapy group experienced complete response (p = 0.285). Both treatments caused improvement of clinical response score in the patients during the treatment time (p < 0.001), but the efficacy of treatments was not significantly different (p = 0.793). Changes in wart thickness were significantly more marked in the 5-FU + LE group compared to the cryotherapy group (p = 0.021). The patients in the cryotherapy group experienced more severe pain compared to the 5-FU + LE group (p = 0.011). The quality of life better improved in the 5-FU + LE group compared to the cryotherapy group (p = 0.02). To conclude, most of the patients that experienced complete clinical response had received 5-FU + LE injection, though the difference was not significant. However, 5-FU + LE injection accompanied less pain and caused more reduction in wart thickness and more improvement in quality of life compared to the cryotherapy.

Amyloidosis cutis dyschromica: report of 3 cases.

Amyloidosis cutis dyschromica (ACD) is a rare pigmentary disorder with about 50 cases having been reported in the English literature. Only one case of ACD has been reported from Iran. We present three patients who presented with generalized hyper- and hypopigmented patches, sparing face, hands, and feet in all three cases. The presence of amorphous eosinophilic deposits in the papillary dermis confirmed the diagnosis of ACD; the deposits were stained by crystal violet in the histopathological examination of the lesions. In all three cases, similar lesions were present in some of the family members. ACD should be considered in the differential diagnosis of diffuse hyperpigmentation studded with hypopigmentation, especially when beginning in childhood.

Hypo-pigmented mycosis fungoides is a rare malignancy in pediatrics.

Hypopigmented mycosis fungoides (HMF) is an uncommon form of cutaneous T-cell lymphoma. It can be seen in children and is usually mistaken for eczema, vitiligo, or progressive macular hypomelanosis, clinically and histopathologically. We present a boy with HMF confirmed by histopathology. The patient had a course with slow clinical progression without Sezary syndrome.

Eosinophilic pustular folliculitis with labial and oral involvement: report of a rare presentation.

Eosinophilic pustular folliculitis (EPF) is a recurrent inflammatory dermatosis primarily involving hair follicles. Several subtypes of EPF have been described: Classic EPF, infantile EPF, and immunosuppression-associated EPF. Although classic EPF has a predilection for face, involvement of hairless areas such as palms and soles has been reported frequently. There are rare case reports of mucosal EPF. Herein, we report a woman who presented with classic EPF involving the lip and oral mucosa.

Comparative efficacy of topical application of tacrolimus and clotrimazole in the treatment of pityriasis versicolor: A single blind, randomised clinical trial.

BACKGROUND: Pityriasis versicolor (PV) is a common superficial fungal disease. Possibility of emergence of resistant strains to azoles, and difficulty in differentiation of hypopigmented PV and early vitiligo, encouraged us to evaluate the efficacy of topical tacrolimus (a calcineurin inhibitor agent with proven in vitro anti-Malassezia effect) for PV treatment generally and its effect on PV-induced hypopigmentation specifically. OBJECTIVES: To evaluate the efficacy of topical tacrolimus on pityriasis versicolor. PATIENTS/METHODS: Fifty PV patients were randomly allocated into two equal groups applying either topical clotrimazol or tacrolimus twice daily for 3 weeks. They were evaluated at the beginning of study, in the third and fifth weeks clinically and mycologically (direct smear). RESULTS: Although both treatments resulted in global, clinical, and mycological cure of PV, there was no significant difference regarding the mentioned aspects of cure between tacrolimus and clotrimazole treated patients. (P-value: .63, .45, and .26, respectively) Tacrolimus had no significant effect on hypopigmentation in the fifth week follow-up. (P-value: .62). CONCLUSIONS: In spite of the lack of efficacy of tacrolimus on PV-induced hypopigmentation, the therapeutic effect on PV introduces tacrolimus as a therapeutic option for PV, especially when early vitiligo is among the differential diagnoses without concerning the aggravating effect of topical corticosteroids on PV.

Autoimmune progesterone dermatitis presenting as fixed drug eruption: a case report.

Autoimmune progesterone dermatitis (APD) is a rare disorder characterized by periodic skin lesions that erupt during the luteal phase of the menstrual cycle. Clinical manifestations of APD is caused by an unusual allergy to progesterone and has a wide range of clinical manifestations from eczema and urticaria to angioedema and erythema multiforme. A 46-year-old woman described recurrent, round erythematous plaques on the lower lip, both forearms and buttocks. These skin eruptions waxed and waned for 10 months, reoccurring 3-4 days before menstruation. Based on her medical history and physical examination, APD was suspected and the progesterone challenge test showed positive results. After treatment with oral prednisolone (30 mg/day) before menstruation, the severity of eruptions decreased dramatically but recurrence did not cease completely.

Hair removal laser-induced Fox-Fordyce disease emerging on the axillary and pubic areas: Report of a case and review of literature.

Key Clinical Message: Fox-Fordyce disease is a recognized adverse effect of depilating lasers. It should be considered among the differential diagnoses of the pruritic perifollicular papules that occur at the hair removal laser treatment site, including Alex/Diode laser. Abstract: Fox-Fordyce disease (FFD) is an uncommon skin disorder affecting the apocrine sweat glands and presents as pruritic skin-colored papules, mainly on the axillary and pubic areas. Some predisposing factors are proposed, including hormonal changes. A few cases of FFD have been reported after hair removal by light- and laser-assisted devices. Herein, we report FFD in some areas (axillary and pubic areas) treated with Alex/Diode hair removal laser.

Assessing the Effectiveness of Stabilized Cysteamine 5% Cream Compared to Hydroquinone 4%/Ascorbic Acid 3% Combination Cream in Treating Acne-induced Post-inflammatory Hyperpigmentation: A Randomized, Controlled Study.

Objective: Postinflammatory hyperpigmentation (PIH) is a common sequela of acne vulgaris. Topical treatment with hydroquinone is the standard treatment, but may be associated with complications. Cysteamine is a relatively safe depigmenting agent with an observed depigmenting effect. We designed this study to assess the efficacy of a cysteamine 5% cream in treating acne-induced PIH. Methods: Twenty-eight out of 32 participants finalized this investigator-blind, randomized, and controlled trial (registered in Iranian Registry of Clinical Trials [IRCTID: IRCT20140212016557N5]). We randomized the patients to apply either cysteamine 5% or hydroquinone 4%/ascorbic acid 3% (HC) cream. Postacne hyperpigmentation index (PAHPI) and melanin index were the assessment measures after four months of treatment. We evaluated the quality of life by the Dermatology Life Quality Index (DLQI) questionnaire. Results: Both cysteamine and HC cream significantly decreased the PAHPI score and melanin index of acne-induced PIH patients (p<0.05). The decrease in PAHPI score and melanin index were not significantly different in treatment groups after four months (p>0.05). Quality of life ameliorated significantly only with cysteamine treatment. However, no significant change in quality of life was observed between groups. Limitations: Limitations of our study include the relatively small sample size and absence of follow-up. Conclusion: Cysteamine cream is an effective treatment of post-acne PIH, with similar efficacy to the accepted treatment of PIH, i.e., hydroquinone cream.

A young woman with multiple cutaneous epithelioid angiomatous nodules (CEAN) on her forearm: a case report and follow-up of therapeutic intervention.

Cutaneous epithelioid angiomatous nodule (CEAN) is regarded as a very rare entity of benign vascular hyperplasia that clinically manifests as mainly single, small, rapidly-growing reddish to bluish nodules or papules, mainly on the head and neck of adults. Most patients present with solitary lesions. We present a 39-year-old female with multiple, rapidly-growing, erythematous nodules on her left forearm during a one-year period. The overall histologic picture suggested Cutaneous Epithelioid Angiomatous Nodule (CEAN). In this case we tried different treatments and compared the results.

COVID-19 infection and Leser-Trelat sign: Is there an association?

Key Clinical Message: The etiology of the Leser-Trélat sign is still unknown, it is likely that viral infections like COVID-19 can be associated with eruptive seborrheic keratosis, although the exact pathogenesis is still not clear, but this phenomenon can be due to TNF-alpha and TGF-alpha and immunosuppression condition as well as in COVID-19 infection. Abstract: Seborrheic keratosis is a typical benign skin lesion that is almost always seen in elderly populations. The sudden increase in size or an increase in the number of these lesions is called Leser-Trelat sign, this sign is suggesting as a paraneoplastic appearance of internal malignancy. But, Leser-Trelat sign is also described in some nonmalignant conditions, for example, human immunodeficiency virus infection and human papillomavirus infection. Herein, we describe a patient with Leser-Trelat sign after recovery from COVID-19 infection with no evidence of internal malignancy. This case was partially presented as a poster in the 102nd Annual Congress of British Association of Dermatologists in Glasgow, Scotland from July 5 2022 to July 7 2022. British Journal of Dermatology, 187, 2022 and 35. The patient signed written informed consent to permit the publication of the case report without identifying data and to use the photography for publication. The researchers committed to maintaining patient confidentiality. Institutional ethics committee approved the case report (ethics code: IR.sums.med.rec.1400.384).

Clinicopathologic evaluation of granuloma annulare: Study of 136 Iranian cases, south of Iran.

Background and Objectives: Granuloma annulare (GA) is a benign skin disorder with various histopathologic features that are rarely investigated in Iranian population. We performed this study to find out the clinical and histopathologic features of GA in our referral centre. Methods: One hundred-thirty-six patients with biopsy-proven GA were reviewed. Clinical data and pathological features were recorded. Results: One hundred-eight female patients and 28 male patients (Female/male ratio: 3.85) with mean age of 42.54 ± 21.2 years (range: 2-83 years) were recruited. Eighty-eight (64.7%) patients had interstitial infiltrative pattern and 48 (35.3%) patients had complete palisading granulomas. The infiltrate occupied both upper and lower dermis in most of the cases (67.7%). Significant mucin was detected more commonly in complete GA compared to interstitial GA (p = 0.019), but inflammation degree, eosinophils, plasma cells, and giant cells were not different between two subtypes of GA (p > 0.05). The significant inflammation contained more significant plasma cells (p = 0.006). The significantly more giant cells were detected in patients between 20 and 60 years of age (p = 0.015); but other factors were not different between age groups. Conclusions: In our study, the prevalence of GA in women was significantly higher than in men. Interstitial GA was the more common histological subtype and the inflammation was less severe and the infiltrate was mostly pandermal in our cases. More severe inflammation contained more plasma cells, and more dense giant cells were seen in middle aged patients.

Comparison of the efficacy of cysteamine 5% cream and hydroquinone 4%/ascorbic acid 3% combination cream in the treatment of epidermal melasma.

BACKGROUND: Few safe and effective treatments are available for melasma. Cysteamine, a non-melanocytotoxic molecule is a safer alternative to hydroquinone and usable for long-term use. AIM: To evaluate the effect of cysteamine 5% cream in the treatment of melasma. METHODS: Sixty-five of 80 patients completed this single-blind, randomized, controlled trial. The patients received cysteamine 5% or hydroquinone 4%/ascorbic acid 3% (HC) cream. The therapeutic response was evaluated by modified MASI (mMASI) and melanin index (SkinColorCatch) after 2 and 4 months of treatment. The effect of treatment on the quality of life was also assessed. RESULTS: The decrease in mMASI score was from 6.69 ± 2.96 to 4.47 ± 2.16 in the cysteamine group and from 6.26 ± 3.25 to 3.87 ± 2.00 in the HC group after 4 months (p values < 0.001). The melanin index decreased from 37.72 ± 10.17 to 31.47 ± 11.90 in the cysteamine group and from 36.37 ± 10.80 to 23.16 ± 8.83 in the HC group after 4 months (p-value = 0.003 and <0.001, respectively). The difference between mMASI score at baseline and month 4 was not significant between both groups (p-value > 0.05). The difference between the melanin index at baseline and month 4 was significantly more pronounced in the HC group (p-value = 0.002). Quality of life improved in both groups (p-value < 0.05), but was not significantly different between groups (p-value > 0.05). CONCLUSION: Cysteamine was confirmed to be an effective treatment for melasma, with equivalent results to HC in reducing mMASI score and improving quality of life, despite lesser melanin index reduction observed. Cysteamine and HC efficacy was confirmed in patients recalcitrant to previous treatments, by a significant reduction of mMASI and melanin index.

A 4-week comparison of capillaroscopy changes, healing effect, and cost-effectiveness of botulinum toxin-A vs prostaglandin analog infusion in refractory digital ulcers in systemic sclerosis.

INTRODUCTION: Systemic sclerosis (SSc) is a systemic multi-organ disease. Raynaud's phenomenon (RP) and digital ulcers (DUs) in SSc patients can be resistant to usual treatments. We studied the clinical benefits, capillaroscopy changes, and cost-effectiveness of local injection of botulinum toxin-A (BTX-A) and intravenous prostaglandin analogs (iloprost/alprostadil) in patients with SSc with resistant DUs. METHOD: In a clinical trial study, we evaluated 26 patients fulfilling the ACR/EULAR SSc criteria with resistant DUs. Visual analog scale of pain and RP, skin color and type of ulcers, and capillaroscopy were assessed before and 1 month after treatment. In the first group, 20 units of BTX-A was injected at the base of each involved fingers by a dermatologist. In the second group, 20 µg iloprost or 60 µg alprostadil was infused daily. The cost of these treatments was compared. RESULT: In 26 patients (43 fingers), there were 16 patients (22 fingers) in the BTX-A and 10 patients (21 fingers) in the prostaglandin group. In 95.5% of the BTX-A and 90.5% of the prostaglandin group, the ulcers were healed. In both groups, a significant decrease in pain was seen (p < 0.0001). Capillaroscopy patterns in both groups were not changed although the microhemorrhages disappeared significantly (p value: BTX-A: 0.03 and prostaglandin: 0.002). The cost was significantly lower in the BTX-A injection group (p < 0.0001). CONCLUSION: Both BTX-A and prostaglandins helped in the healing and pain control of DUs. In capillaroscopy, microhemorrhages were significantly decreased in both groups. In the BTX-A group, the cost was significantly lower as an outpatient treatment and was more time-saving. KEY MESSAGES: • BTX-A and prostaglandin analogs both contributed to the healing of digital tip ulcers and improving the pain • In capillaroscopy, microhemorrhages were significantly decreased or disappeared after both treatments • There was no significant side effect in both groups • Comparing both groups, in the BTX-A group, the cost was significantly lower when performed on an outpatient treatment and more time-saving.

COVID-19 vaccine-induced Radiation Recall Dermatitis: Report of a case.

Radiation Recall Dermatitis (RRD) is an inflammatory process in the site of irradiation, induced by physical and medical agents. Few cases of RRD in the skin and lung have been reported after COVID-19 vaccination. Here, we report radiation recall dermatitis after both doses of inactivated SARS-CoV-2 vaccine (Sinopharm, China).

Intermittent chronic telogen effluvium with an unusual dermoscopic finding following COVID-19.

Various conditions, including infections, can cause telogen effluvium (TE). One of them is coronavirus disease 2019 (COVID-19), where hair loss usually begins between 2 and 12 weeks after the illness. TE can be acute or chronic, and the chronic type can be intermittent. Here, we present the case of a 17-year-old girl with severe and widespread hair loss following an upper respiratory infection suspected to be COVID-19, with the patient having a history of such attacks since childhood. Evidence from biopsy and dermoscopy indicated a diagnosis of TE.

Cutaneous pseudolymphoma: A clinicopathological study and immunohistochemical patterns.

BACKGROUND: Cutaneous pseudolymphoma can histologically and clinically simulate various types of cutaneous lymphoma. We conducted the current study to evaluate the clinicopathological and immunohistochemical (IHC) aspects of cutaneous pseudolymphoma (PSL). METHODS: 30 cases of cutaneous PSL were selected from the archives of 2013-2017 in Shahid Faghihi Hospital pathology lab, Shiraz University of Medical Sciences. Available clinical data, histopathological features and IHC findings were statistically analyzed. RESULTS: The female: male ratio was 2:1 and the median age was 47±14.9 years. The lesions were located on the head and neck 26 (86.7%), trunk 2 (6.7%) and extremities 2 (6.7%). 23 (76.7%) cases had nodular pattern, while 7 (23.3%) showed diffuse pattern. The grenz zone was seen in 24 (80%) cases. Sixteen (53.3%) cases showed top heavy infiltration, 11 (36.7%) showed the same distribution of infiltration at the superficial and deep dermis, often involving the subcutaneous fat and 3(10%) showed bottom heavy infiltration. In IHC, 11(36.6%) cases showed the B cell type, 10 (33.3%) T cell type and 9 (30%) mixed type (B and T cells). CONCLUSION: None of the cases was suspicious for cutaneous lymphoma, applying IHC staining. Gender distribution, and the site of cutaneous lesions were similar to previous studies. The most common histological subtype was nodular, while the B-cell cutaneous pseudolymphoma was slightly more common compared to the T-cell type.

Value of CD123 Immunohistochemistry and Elastic Staining in Differentiating Discoid Lupus Erythematosus from Lichen Planopilaris.

BACKGROUND: Differentiating scarring alopecia secondary to lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) has always been a challenge clinically and pathologically. Plasmacytoid dendritic cells (PDCs) have been reported in the cutaneous lupus erythematosus by CD123 immunostaining. This study assesses CD123 marker positivity and patterns of elastic fiber loss in scalp biopsy to differentiate DLE from LLP. PATIENTS AND METHODS: Forty-three cases with clinical and pathological diagnosis of LPP and DLE were selected, and CD123 immunohistochemistry staining and elastic staining were performed on them. The presence of CD123-positive cells, clustering and distribution of cells, and patterns of elastic fibers loss in the dermis were evaluated. To analyze the data, the Chi-square test was used; moreover, the sensitivity and specificity of CD123 were calculated based on a diagnostic test for 2-by-2 tables. RESULTS: Infiltration of PDC was seen in 90% of DLE cases. The presence of more than 10% and 20% PDC cells in inflammatory cells had 90% and 85% sensitivity and 34.7% and 91.3% specificity, respectively. PDC clusters more than 20 cells had 100% specificity for DLE. Location and patterns of PDC infiltration were not statistically significant (P = 0.378). The wedge-shaped loss of elastic fibers and the diffuse loss were the dominant patterns in LPP and DLE, respectively (P = 0.006). CONCLUSION: Our results suggested that CD123 along with elastic staining and histological features might be useful to diagnose challenging cases of lymphocytic scarring alopecia with clinical differential diagnosis of LPP and DLE.

Cutaneous Pseudolymphoma As a Rare Adverse Effect of Medicinal Leech Therapy: A Case Report and Review of the Literature.

Hirudotherapy (leech therapy) is one of the oldest practices in medical history, and nowadays it is used for several purposes in medicine. Salvage of flaps, wound healing, pain management, and treatment of varicose veins are among the common therapeutic applications of leeches. Complications associated with leech therapy include infections, bleeding, anemia, and allergic reaction. Cutaneous pseudolymphoma (benign proliferation of lymphoid cells in the skin) follows several underlying conditions. Although persistent arthropod bite reaction is one of the conditions associated with cutaneous pseudolymphoma, it has been rarely reported after medicinal leech therapy. Here we describe the case of a patient who presented with cutaneous pseudolymphoma after leech therapy as a rare cutaneous complication of hirudotherapy.

Thiopurine S-methyltransferase and Pemphigus Vulgaris: A Phenotype-Genotype Study.

BACKGROUND & OBJECTIVE: Thiopurine drugs are considered as a treatment modality in various autoimmune disorders including pemphigus vulgaris (PV). These drugs are metabolized by an enzyme "Thiopurine S-methyl transferase" (TPMT). Various variants of this enzyme may have decreased activity leading to serious drug side effects. To investigate the phenotype and genotype of TPMT in PV patients receiving thiopurine drugs. METHODS: A total of 50 patients (29 women and 21 men) with pemphigus vulgaris treating with standard dose of Thiopurine drugs were selected. Sex, age, result of liver function test and complete blood count were recorded. Genotyping of two common non-functional allele (TPMT*2 and TPMT*3C) by Allele-specific and RFLP-PCR was performed. TPMT enzymatic level was determined by an ELISA based method. RESULTS: Of patients, 36 (72%) were found to have normal TPMT level; and 12, (24%) had higher level of enzyme and 2, 4% had low TPMT enzyme, but none of the patients showed mutant TPMT*2 and TPMT*3C alleles. None of the patients showed hepatotoxicity and bone marrow suppression. CONCLUSION: The phenotypic assay based on ELISA method may have false positive and misleading results but genotyping using PCR-RFLP and allele specific PCR is accurate, simple and cost-effective and can be used in patients decided to undergo thiopurine treatment.