Pachydermodactyly with Broder Hand Span and Long Fingers: A Case Report.

Pachydermodactyly is a rare and benign disease that may be idiopathic, genetic, acquired as a response to repetitive trauma, or associated with several other acquired conditions often pushing the health caregiver to do a bunch of costly lab tests and diagnostic workups to rule out other entities. All health care givers must be aware about this disease for reassure the patients and cut unnecessary costs. Moreover, there seems to be an issue of association with certain occupations. A good example might be computer keyboards causing special damages to certain organs like eyes and musculoskeletal system. We have observed deleterious effects of excess work with computer keyboards on fingers in the form of Pachydermodactyly in our case. A 27-yr-old man presented with wider hand span and longer fingers to Dermatology Clinic of Rasoul-E-Akram Hospital in June 2015, especially the ring finger in our case, considered a big symptom who depressed due to their fingers appearance as a rare disease. We gave him an emollient to make his hand smoother. The patient improved both clinically and psychologically on a simple emollient. This disease with its deleterious psychological effects and a simple way of management should be appreciated more by the health care system.

Neutrophilic Dermatosis of Dorsal Hands and Legs.

We present a case of neutrophilic dermatosis of dorsal hands (NDDH), with lesions on the dorsal part of the hands with pustular features and histologic picture of vasculitis.This case highlights the notion that low dose oral steroid can offer a useful first therapeutic option for NDDH. Interstingly, in this case, a few additional lesions were located on the legs, making it different from some previously described cases of NDDH. As with other authors, we believe that this recently described neutrophilic dermatosis is a localized and acral variant of SS. To our knowledge, this is the first case report of NDDH from Iran.

Hypertrichosis Is Not so Prevalent in Becker's Nevus: Analysis of 47 Cases.

Becker's nevus is a relatively common cutaneous hamartoma, but is often overlooked or misdiagnosed. This nevus usually begins during the second decade of life as a circumscribed, hyperpigmented patch with irregular outline that gradually enlarges with associated hypertrichosis, developing several years later. The purpose of this study was to determine the prevalence of lesional hypertrichosis associated with Becker's nevus. Methods. 47 patients who had sharply demarcated brown patch with or without coarse hair, presence or enlargement of the lesion at the time of puberty, and compatible Wood's light examination were enrolled. Patients who had axillary freckling, previous skin inflammation, and gray pigmentation of the lesions were excluded. Results. In summary, the mean age of onset was 11.89 (range 0-19). The most commonly involved site was the arm (34%), followed by shoulder (23.4%), chest, face, flank, buttock, and leg. Lesional hypertrichosis was found in only 8 (17%) of the 47 patients. In 29 cases (61.7%) the lesions were in the right side of the body. Conclusion. Hypertrichosis was not so frequent among patients with Becker's nevus. There was a higher preponderance of the lesions on the right side.

Efficacy of fixed daily 20 mg of isotretinoin in moderate to severe scar prone acne.

BACKGROUND: Despite advances in acne therapy in recent years, treatment failure is common. Isotretinoin is the only drug that affects almost all factors in acne pathogenesis, but side-effects are common at the doses reported in published studies in the literature. The aim of this study was to investigate the efficacy of low daily dose isotretinoin in moderate to severe acne patients. The secondary objective was to measure the rate of relapse 5 years after the completion of therapy. MATERIALS AND METHODS: In this retrospective, noncomparative study, 146 patients with moderate to severe scare prone acne. Treatment regimen consisted of isotretinoin, fixed 20 mg daily, and duration of treatment-based on the weight of patient, until total cumulative dose of 120 mg/kg of body weight is achieved. No topical or other systemic therapy was allowed during the trial. Liver function tests (serum glutamic-oxalocetic transaminase, serum glutamate pyruvate transaminase, direct and total bilirubin), and lipid profiles (total cholesterol, low-density lipoprotein, high-density lipoprotein, triglyceride) were evaluated for all patients, before the initiation of treatment and again after the 2(nd) month of treatment. All data analyzed by Microsoft Office Excel 2007; in descriptive statics frequency and SPSS.18 software. RESULTS: At the end of treatment course, (96.4%) demonstrated complete clearing of their acne, defined as no acne or occasional isolated lesions. In 5-year follow-up, relapse accrued in 11 (7.9%) of patients. All adverse effects were mild, and discontinuation of treatment was not necessary. CONCLUSION: Low dose isotretinoin was found to be a safe and effective choice for patients with moderate to severe scar prone acne vulgaris.

A comparison study of lipid profile levels between skin tags affected people and normal population in Tehran, Iran.

BACKGROUND: For many years the association of skin tags and endocrynopathies has been postulated, although many reports are available but it has never been evaluated to mean normal population. Dyslipidemia is a frequent disorder among people and seemed to be necessary for screening within skin tag condition. This study is designed to find any possible association between skin tags and dyslipidemia. MATERIALS AND METHODS: From April 2009 to June 2011, 168 patients enrolled the study. Among the remaining 152 patients, there were 89 females (58.5%) and 63 males (%41.5). Based on the TLGS study 136 men and 220 women enrolled the control group of study. The mean age was 28.4 years. Patients trained to have normal free diet for at least 1 month then referred to the laboratory. Blood samples were taken over 12 hours fasting with 2 hours intervals. Hypertriglyceridemia was defined as plasma level ≥160 mg/dl for men and ≥130 mg/dl for women. Hypercholesterolemia pointed at its value >200 mg/dl. Normal HDL levels was defined as >39 mg/dl for men and >35 mg/dl to women. RESULTS: Mean skin tag number was 12.6 per subject. The most frequent localizations of skin tags were neck and upper chest (mean number: 13.4, 48.9%) followed by axilla (mean number: 11.6, 33%) and breast (10.2, 10.1%) in the patient group. The mean cholesterol level of case group was 192.2 ± 33.1 mg/dl, while it was 187.0 ± 42 mg/dl in the control group). The mean ± SD for triglyceride was 132.1 ± 69 mg/dl in comparison to 129 ± 74 in the control group. CONCLUSION: The study showed no significant differences between normal population and patients' lipid profile.

Leech therapy for epidermoid cysts and review of the literature.

UNLABELLED: Hirudo medicinalis sucks blood directly through the external mammalian skin. We recently observed a healthy 64-year-old Iranian man, who presented with numerous asymptomatic multilobular oval-to-round well-defined 0.5 to 1.5 cm cystic lesions with central umbilication (central black eschar) over the upper portion of his chest. We made the diagnosis of epidermoid cyst, giant comedone and leech bite on the basis of the constellation of clinical features. The patient was treated with oral ciprofloxacin at a dose of 2 g daily, and 2% topical erythromycin solution. Despite improvement, the evidence of cystic lesions persisted. There was no history of similar lesions in any other family member. There was no history of trauma. The patient was not using any topical or systemic medication. Two weeks before his visit, he had a history of leech therapy under the supervision of a general practitioner. His medical history was significant for leech therapy of the lesions, five days previously. He was followed up for another two weeks and after disappearance of the inflammation, with the patient under local anesthesia, the well-circumscribed mass was completely evacuated with a sharp curette and comedone extractor. The patient was subsequently lost to follow-up. CONCLUSION: Considering the efficacy of leeches, it would be favorable to breed a germ-free leech. In Iran, the use of the leeches in surgery, in recent years, has been infrequent. It appears that the positive effects of this ancient remedy may now be explained through scientific methods, promising potentially even more uses of this admirable creature in medicine.

Efficacy of oral metronidazole in treatment of cutaneous and mucosal lichen planus.

INTRODUCTION: Response to different antimicrobial agents supports the infection hypothesis for lichen planus (LP). There are individual case reports describing the improvement of LP with oral metronidazole treatment in patients with concomitant intestinal amebiasis or giardiasis. There are two small studies that reported metronidazole might be effective in some patients with idiopathic LP who did not have concomitant protozoal infections of the intestinal or genital tracts. The authors performed an open trial to evaluate the effectiveness of metronidazole, as a single treatment, on different forms of LP. PATIENTS AND METHODS: A total of 49 patients, 24 male and 25 female, were selected from the dermatology outpatient clinic with a diagnosis of LP in one of its forms. Metronidazole was administered at 250 mg every eight hours daily without any concomitant therapy. Patients were examined at baseline and at days 21, 42, 63, 84 of treatment, and the follow-up period was three months. The authors used SPSS software (Version 15) for data analysis. RESULTS: A total of 20 (40.82%) skin lesions had complete response (CR) to treatment by metronidazole, 16 (32.65%) had relative healing (PR) and 13 (26.53%) did not improve (NR). The overall treatment response (CR + PR) of LP skin lesions was 73.47 percent in this study. In mucosal involvement, the overall treatment response was 66.6 percent, and finally the overall treatment response for itching was obtained in 75 percent of the cases. CONCLUSION: Based on the authors' findings, metronidazole can be an alternative therapy in treatment of LP, and is a safe agent to be considered.

The efficacy of time-based short-course acyclovir therapy in treatment of post-herpetic pain.

INTRODUCTION: Various treatments have been used to manage post-herpetic neuralgia (PHN). Safe and effective therapies to prevent PHN are needed. METHODOLOGY: A clinical trial involving 152 patients diagnosed with acute herpes Zoster (HZ) was conducted to determine whether short-course acyclovir therapy (800 mg five times a day for four days) can alleviate HZ-associated pain and prevent post-herpetic neuralgia (PHN).  The patients were divided into two groups: Group 1 had a rash with a duration of less than 72 hours and Group 2 had a rash with a duration of more than 72 hours. To assess PHN, the patients categorized and assessed the severity of their symptoms using a four-point verbal rating scale (VRS). RESULTS: By the fourth week, 134 out of 152 patients (88.2%) had complete pain response (CPR). Of these, 68 patients (89.5%) were from Group 1 and 66 from Group 2 (86.8%). After four weeks, the mean VRS scores had changed significantly in both groups compared to the scores at the beginning of study (p = 0.001), but there was no difference between the two groups (0.88 ± 0.66 Vs. 0.94 ± 0.72; p = 0.66) After three months no differences were observed in the treatment results between the two groups (0.51 ± 0.13 Vs.0.54 ± 0.19; p = 0.77). CONCLUSION: Short-course acyclovir therapy is an effective treatment for zoster and its efficacy in patients with a rash duration of more than 72 hours is similar to that in patients with rash duration of less than 72 hours.

Malassezia yeast species isolated from Iranian patients with pityriasis versicolor in a prospective study.

The goal of this study was to determine the prevalence of Malassezia species in pityriasis versicolor lesions and to examine if the range of species varies with patients characteristics such as: age, sex and family history and also clinical findings such as site and number of the lesions. In a prospective study from July 2006 to July 2007, the patients with a clinical diagnosis of pityriasis versicolor (n = 166) were asked to participate in the study. A total of 116 patients had positive culture for Malassezia species: M. globosa was found in 52 (31.3%) cases, M. furfur in 34 (20.5%) cases, M. pachydermatis in 12 (7.2%) cases, M. restricta in 12 (7.2%) cases, M. slooffiae in 6 (3.6%) cases. According to our data, M. globosa is the main species causing pityriasis versicolor, M. furfur was found to be the second-most frequent species. M. sympodialis and M. obtusa were not found in any case, and in 30.2% of patient's Malassezia culture was negative.

Association between plaque-type psoriasis and perianal streptococcal cellulitis and review of the literature.

Perianal streptococcal dermatitis is an uncommon superficial cutaneous infection of the perianal area almost exclusively described in children. Perianal streptococcal dermatitis is caused by group A beta-hemolytic streptococci and occurs mainly in children between six months and ten years of age. Prior therapy with topical antifungal agents, topical corticosteroids, and oral preparations for pinworms either fails to improve or worsens patient's symptoms. Early antibiotic therapy causes a dramatic and rapid improvement of symptoms. Treatment protocol consists of amoxicillin 40 mg/kg/day, divided into three doses, and/or topical application of mupirocin 2% ointment three times per day for ten days. We describe a four-year-old boy with perianal streptococcal dermatitis who was brought to our clinic with plaque type psoriasis.

Late-onset porokeratotic eccrine ostial and dermal duct nevus associated with sensory polyneuropathy and hyperthyroidism.

This 66-year-old Iranian gentle man had a one-year history of asymptomatic keratotic papules with a linear distribution on the skin of his right palm near the wrist. On histopathologic examination-cornoid lamella-like parakeratotic columns above eccrine ducts were observed. The acrosyringium was also dilated. The diagnosis was porokeratotic eccrine ostial and dermal duct nevus. The late-onset development of the disease in our patient was interesting to us, because it is considered a congenital hamartoma.

Oral erythromycin is ineffective in the treatment of pityriasis rosea.

BACKGROUND: Despite the availability of various medical treatments for pityriasis rosea, a large percentage of patients fail to achieve satisfactory results. Erythromycin is reported to be effective in the treatment of pityriasis rosea. METHODS: We designed a placebo-controlled study on 184 patients with pityriasis rosea attending the outpatient dermatology department at Hazrat-e-Rasul Hospital in Tehran, Iran. Adult patients were treated with 200 mg of erythromycin 4 times daily and children were treated with 20 to 40 mg/kg daily in 4 divided doses. Controls were given a placebo (an emollient cream) that was not identical in appearance. Subjects were seen at follow-up visits 2, 4, 6, and 8 weeks after starting treatment. RESULTS: Both groups were comparable with regard to sex, age, and mean duration of disease at the time of attending the clinic. We found no significant difference between the 2 treatment groups at weeks 4, 6, and 8 after beginning of treatment. (p > .05 Chi2).

Skin tag as a cutaneous marker for impaired carbohydrate metabolism: a case-control study.

BACKGROUND: Skin tags are common benign skin tumors usually occurring on the neck and major flexors of older people. A possible association with impaired carbohydrate metabolism has been suggested in previous studies, but the results are not conclusive. OBJECTIVE: To investigate and compare the prevalence of diabetes and impaired glucose tolerance (IGT) in patients with skin tag and a control group. PATIENTS AND METHODS: A case-control study was conducted in individuals over 15 years old, comparing cases (n = 104) with at least three skin tags and age-, sex-, and body mass index (BMI)-matched controls (n = 94) without skin tag. Cases and controls were recruited from patients consecutively seen at an academic outpatient dermatology clinic. All patients underwent a standard 2-h oral glucose tolerance test with 75 g glucose. RESULTS: Patients with skin tag had higher frequency of diabetes than the control group (23.07% vs. 8.51%, chi(2)-test, P = 0.005). The difference in the frequency of IGT was not significant (13.46% vs. 10.63%, chi(2)-test, P = 0.543). There was a positive correlation between the total number of skin tags and the mean fasting plasma glucose (Pearson correlation, r = 0.260, P = 0.031); patients with more than 30 skin tags were particularly at an increased risk of diabetes (52.0%). No correlation was found between the number of skin tags and BMI. We did not find any correlation between the anatomical localization of skin tags and impaired carbohydrate metabolism, except for skin tags under the breast in women. CONCLUSION: These results show an increased risk of diabetes mellitus in patients with multiple skin tags. With regard to the importance of early diagnosis of diabetes, we recommend a high level of suspicion for impaired carbohydrate metabolism in patients with skin tag.

Metastatic carcinoma of the ovary presenting as zosteriform lesions.

Distant metastases are unusual at presentation and during the course of ovarian carcinoma. Skin metastases may be the first presenting sign of metastatic carcinoma of the ovary. Ovarian epithelial adenocarcinoma rarely metastasizes to the skin, and can be seen in less than 4% of patients. It usually presents as subcutaneous nodules and, less commonly, as inflammatory metastases, which mimic viral or bacterial skin infections. The histology in most of the tumors is serous papillary adenocarcinoma (grade 1 or 2). The prognosis in most patients is poor, thus palliative treatment is usually indicated. We report a patient with widespread skin metastases and review the literature on this rare presentation.

Clinical presentation and etiologic factors of hirsutism in premenopausal Iranian women.

BACKGROUND: Hirsutism is a common clinical condition with different etiologies. Many of these patients have frank or subclinical abnormalities in the adrenal and ovarian steroidogenesis. The disease may be associated with other clinical signs of hyperandrogenism. The objective of this study was to investigate the clinical features of hirsutism and its etiologic factors in premenopausal Iranian women. METHODS: In a cross-sectional study, 790 consecutive premenopausal women referred to the dermatology Clinics of Hazrat-e Rasool and Firoozgar University Hospitals and three private dermatology clinics during 2001 - 2003 with the clinical diagnosis of hirsutism were studied. All patients underwent detailed clinical assessment and transabdominal ultrasonography of the ovaries. Endocrinologic work-up was performed for 285 patients. RESULTS: Hirsutism was mild in 65%, moderate in 32.5%, and severe in 2.5% of the patients. Positive family history was found in 56.2%. Hormonal studies revealed some abnormalities in 35.2% of the patients. Coexisting medical conditions included acne in 70% of the patients, menstrual irregularity in 38.6%, androgenic alopecia in 21.3%, obesity in 6.5%, acanthosis nigricans in 4.9%, and diabetes in 0.6% of the patients. Etiology of hirsutism was identified as polycystic ovary syndrome (62.53%), idiopathic (35.19%), congenital adrenal hyperplasia (0.38%), prolactinoma (0.13%), and undetermined (1.77%). Polycystic ovary syndrome was diagnosed more frequently in women with menstrual irregularity than eumenorrheic patients (97.70% vs. 40.41%, P < 0.001). CONCLUSIONS: Hirsute patients frequently have either elevated androgen levels or clinical conditions associated with hyperandrogenemia. Eumenorrhea does not rule out endocrine abnormality and particularly polycystic ovary syndrome which is a common cause of hirsutism. We recommend performing endocrinologic work up, investigation of coexisting hyperandrogenic states, and evaluation of polycystic ovary syndrome in all patients with hirsutism.

Cryotherapy for anogenital warts: factors affecting therapeutic response.

Human papilloma virus genital infection remains a treatment dilemma; there is still no gold standard therapy, treatment options are limited, expensive and often ineffective, and recurrence rates are relatively high. The primary objective of this study is to establish the efficacy, safety, and tolerability of cryotherapy in the treatment of these lesions. From 1999 to 2003, 100 consecutive patients with at least ten genital warts were treated with liquid nitrogen cryotherapy using a cotton-tipped applicator and two freeze-thaw cycles at the outpatient dermatology clinic of Hazrat-e Rasool University Hospital. Treatment was repeated every 3 weeks until the disappearance of all visible lesions was achieved. Patients were followed up every 4 months for 18 months. Complete clinical cure (CCC) was defined as complete clearance of all lesions and no evidence of disease for a minimum of 18 months. The CCC and relapse rate were evaluated based on different demographic and clinical characteristics. Overall, 86 percent of the patients achieved CCC after an average of 3.31 treatment sessions. All of the failed cases were attributed to recurrence of warts in new sites. The cure rate increased in parallel with increasing treatment sessions until the 6th session, after which it remained constant. The cure rate was lower and the number of treatment sessions higher in older patients. The age of the patient and number of treatment sessions affect the cure rate. The recurrence rate was significantly higher for the married or multi-partner group than for unmarried patients. We concluded that cryotherapy is an effective method for treatment of anogenital warts. The age of the patient and size of the lesions affect the cure rate. However, the most important factor in relapse of the lesions is unprotected sexual contact during and after treatment.

Unilateral non-pigmenting fixed drug eruption associated with cotrimoxazole.

The pathogenesis of fixed drug eruption (FDE) is still unknown. One of the most common associations of FDE is the use of sulfonamides. Cotrimoxazole (trimethoprim with sulfamethoxazole) is one of the most commonly prescribed sulfonamide drugs. Non-pigmenting FDE (NPFDE) is a a relatively rare condition and only a few cases have been reported. We describe a case of unilateral NPFDE in a 45-year-old man whose lesions were on his right leg and foot as well as his ipsilateral penile skin. Cotrimoxazole was suspected as the offending drug and its role was confirmed by an oral challenge test.

Circumscribed juvenile-onset pityriasis rubra pilaris with hypoparathyroidism and brachyonychia.

Circumscribed juvenile-onset pityriasis rubra pilaris (PRP) manifests as well-defined erythematous scaly plaques with follicular keratosis mainly over the elbows and knees. There are several reports of the association of PRP with other conditions. We report a boy with scattered erythematosquamous skin lesions and follicular hyperkeratotic papules since he was 6 years old. Results of a skin biopsy were compatible with PRP. The patient also had hypoparathyroidism and brachyonychia. To our knowledge, this association has not been reported to date, though minor disturbances of calcium and vitamin D metabolism have been mentioned in some disorders of keratinization. We further discuss the epidemiologic, clinical, and pathologic features of PRP; review the conditions associated with brachyonychia; and give a brief discussion about the possible role of calcium metabolism in disorders of keratinization.

Becker's nevus with ipsilateral breast hypoplasia: a case report and review of literature.

Specific cutaneous associations in patients with Becker's nevus have been reported. We present a patient with typical clinical and histopathological features clearly consistent with Becker's nevus associated with ipsilateral breast hypoplasia. The changes were distinct and could be separated from smooth muscle hamartoma. We include clinical and histological illustrations of our case.

Macular amyloidosis: an assessment of prevalence, sex, and age.

Macular amyloidosis is a relatively common cutaneous disease in Asia and the Middle East. It is characterized by a reticulated or rippled pattern of pigmentation mostly in the upper back. This study was performed not only to determine the disease sex and age distribution, but also to evaluate its risk factors and the frequency among the dermatology clinic patients. Based on the clinical and random histopathologic findings, 100 macular amyloidosis patients were evaluated in a period of 3 years. Although the sex distribution (9 : 1, female : male ratio) differed dramatically from most of the previous reports, it was consistent with few other series. Eighty one percent of patients were between 21 and 50 years of age. The mean age of the female patients was higher than that of the males (difference of two means was 10.26 years and P = 0.027). Backscatching during bathing probably is not a common practice in Iran, therefore we could not consider this as a risk factor in our study. We found no evidence of any other associated risk factors.