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.

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.

Tissue Extract from Brittle Star Undergoing Arm Regeneration Promotes Wound Healing in Rat.

This study set out to evaluate the wound healing properties of brittle star extracts in vitro and in vivo. Due to the great arm regeneration potential of the brittle star, Ophiocoma cynthiae, the present study aimed to evaluate the wound healing effect of hydroalcoholic extracts of brittle star undergoing arm regeneration in wound healing models. The brittle star samples were collected from Nayband Bay, Bushehr, Iran. After wound induction in the arm of brittle stars, hydroalcoholic extracts relating to different times of arm regeneration were prepared. The GC-MS analysis, in vitro MTT cell viability and cell migration, Western blot, and computational analysis tests were performed. Based on the in vitro findings, two BSEs were chosen for in vivo testing. Macroscopic, histopathological and biochemical evaluations were performed after treatments. The results showed positive proliferative effects of BSEs. Specifically, forty-two compounds were detected in all groups of BSEs using GC-MS analysis, and their biological activities were assessed. The MTT assay showed that the 14 d BSE had a higher proliferative effect on HFF cells than 7 d BSE. The cell migration assay showed that the wound area in 7 d and 14 d BSEs was significantly lower than in the control group. Western blot analysis demonstrated an increase in the expression of proliferation-related proteins. Upon the computational analysis, a strong affinity of some compounds with proteins was observed. The in vivo analysis showed that the evaluation of wound changes and the percentage of wound healing in cell migration assay in the 7 d BSE group was better than in the other groups. Histopathological scores of the 7 d BSE and 14 d BSE groups were significantly higher than in the other groups. In conclusion, the hydroalcoholic extract of O. cynthiae undergoing arm regeneration after 7 and 14 days promoted the wound healing process in the cell and rat skin wound healing model due to their proliferative and migratory biological activity.

Evaluation of peritumoral inflammatory infiltration and its relationship with different prognostic factors in cutaneous squamous cell carcinoma.

BACKGROUND: Cutaneous squamous cell carcinoma (cSCC) is one of the most common skin cancers. Prognostic factors, such as tumor thickness, play a crucial role in the management of these patients. Peritumoral inflammatory infiltration has been shown to influence the prognosis of malignancies. This study aimed to determine different prognostic factors and investigate peritumoral inflammatory infiltration in patients with cSCC. METHODS: The study population consisted of 272 patients with a diagnosis of cSCC. Clinical data, such as age and tumor location, were extracted from pathology reports, and other information was gathered by contacting the patients via phone calls. All pathology slides were reviewed by an expert dermatopathologist, and the histopathological features and prognostic factors were evaluated. RESULTS: The highest number of tumors was found in the scalp and forehead (21.3%), while the lowest number was found in the trunk and thighs (3.31%). The highest mean tumor thickness was observed in the group with no inflammatory cells; on the other hand, the lowest tumor thickness was found in the group of lymphocytes and plasma cells. The group with severe eosinophilic infiltration had the highest mean tumor thickness, while the group with no eosinophilic infiltration had the lowest mean tumor thickness. CONCLUSION: Depending on the type of peritumoral inflammatory cells, the prognosis of cSCC may be predictable.

Association of Non-Melanoma Skin Cancer with Temperament from the Perspective of Traditional Persian Medicine: A Case-Control Study.

Background: Non-melanoma skin cancer (NMSC) is the most common type of cancer in the world. In traditional Persian medicine (TPM), various types of temperament (Mizaj) are considered to diagnose, treat, and prevent a variety of illnesses. The present study aimed to evaluate the temperament of patients with NMSC in comparison with a control group. Methods: A case-control study was conducted in 2018 at the Dermatology Clinic of Shahid Faghihi Hospital affiliated with Shiraz University of Medical Sciences (Shiraz, Iran). A total of 110 patients, aged ≥20 years with confirmed NMSC (case group), and 181 individuals without NMSC (control group) were enrolled in the study. The temperament of the participants in both groups was evaluated using Mojahedi's Mizaj questionnaire. The data were analyzed using SPSS software, and P<0.05 was considered statistically significant. Results: The results showed that the odds ratio of developing NMSC was 2.62 (95%CI: 1.42-4.83, P=0.002) times higher in individuals with dry temperament than other types of temperament. Moreover, the odds ratio of patients with a history of chronic skin ulcers and other types of cancer was 35.7 (95%CI: 11.9-107.15, P<0.001) and 5.22 (95%CI: 1.43-19.06, P=0.012) times higher, respectively, than the control group. Conclusion: Temperament is associated with NMSC, particularly the dry temperament type, and should be considered a risk factor.

Isolated Langerhans Cell Histiocytosis of the Vulva in a 28-Year-Old Lady: A Report of a Case and Brief Review of the Literature.

Langerhans cell histiocytosis (LCH) is a rare, proliferative disorder of Langerhans' cells. The presentation can vary from single organ involvement to multisystem and disseminated in severe cases, affecting children more than adults. Isolated vulvar involvement of LCH in a 28-year-old woman has rarely been described and also there are limited data for diagnosis and treatment. Herein, we report the case of a 28-year-old woman with isolated vulvar LCH, misdiagnosed with herpes simplex infection, successfully treated with thalidomide.

The effect of hydroalcoholic extract of Psidium guajava L. on experimentally induced oral mucosal wound in rat.

BACKGROUND: The aim of this study was to evaluate the biological effects of hydroalcoholic extract of Psidium guajava L leaves and phenytoin as a standard agent on the induced oral mucosal wound. METHODS: Hundred seventy Sprague Dawley rats were grouped in 5 clusters randomly. Oral mucosal wounds were induced in all rats except for the control group. Phenytoin and guajava leaf extract were used as a mouthwash. Twelve rats from the 5 groups were euthanized on day 7th and 10th, and 10 rats from each group were sacrificed on the 14th day. Interleukin-6 and total antioxidant capacity were determined in the serum. The tissues were evaluated for pathological and stereological assessments. Phytochemical analyses were performed on the hydroalcoholic extract of Psidium guajava L to determine the antioxidant potency. RESULTS: Total phenolic content test and DPPH analysis demonstrated the high potential of antioxidant capacity of Psidium guajava L. Decreasing IL-6 and increasing TAC were seen in the guajava hydroalcoholic extract and phenytoin groups. The difference of IL-6 between the wound treated guajava group and the wounded group was significant. The wound treated guajava group and wound treated phenytoin group on the 14th day increased the number of fibroblast cells and volume density of sub-mucosae effectively to the same thickness to be considered as a healed sub-mucosae layer. The volume density of the epithelium changes showed statistically significant different responses based on gender. CONCLUSION: In conclusion, hydroalcoholic extract of Psidium guajava L leaves might exert theraputic effects on oral mucositis.

BRAF Mutation Analysis in Primary Acral Melanoma of 41 Cases from South of Iran.

BACKGROUND & OBJECTIVE: Acral melanoma (AM) is a common type of cutaneous melanoma that occurs in the skin of the palms, soles, and nail beds. This malignancy, like other types of cancer, has different genetic alterations. To date, despite decades of research the roles of oncogenic BRAF mutations in the pathogenesis of AM has not been fully clarified. The present study was designed to identify V600E mutation in patients with AM from the south of Iran. METHODS: The samples were collected from the pathology lab archive of Shiraz University of Medical Sciences (2015-2020). A total of 41 patients with primary invasive AM underwent excisional biopsy or amputation were collected to evaluate BRAF V600E mutation using Polymerase Chain Reaction (PCR) and Sanger sequencing. RESULTS: Total number of 41cases (21 male and 20 female) and age range of 34-87 years were enrolled. The histological subtypes were 24 acral lentiginous melanomas (ALM), 10 cases of nodular melanoma (NM), and 7 cases of superficial spreading melanoma (SSM). In our study, only one case (a 44-year-old male with nail bed AM and the histological subtype of acral lentigenous melanoma) showed BRAF-V600E mutation. CONCLUSION: These findings suggest that the population of our interest showed a very low prevalence of this mutation providing novel insights into the pathobiology of AM and its related treatment.

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.

Re-evaluation of Negative Cone Biopsy Results with Ki-67 and p16 Immunostaining following Positive Cervical Biopsy.

BACKGROUND: Cervical conization is a standard diagnostic method for precancerous lesions. However, its results could be negative despite an initially positive punch biopsy. The present study aimed to re-evaluate pathological biopsies with Ki-67 and p16 immunostaining to assess the diagnostic accuracy of punch biopsies. METHODS: This retrospective study performed in Motahhari Clinic and Shahid Faghihi Hospital, (Shiraz, Iran). 88 punch and cone biopsy slides from 2007-2016 were re-evaluated by two pathologists, and the results were compared with the original diagnoses. Agreement between the initial diagnoses and re-evaluations and between our pathologists were assessed with the kappa coefficient. Twenty-two negative conization results after positive punch biopsy were re-sectioned and evaluated with Ki-67 and p16 immunostaining. RESULTS: The overall agreement (kappa) between the primary punch diagnoses by the original pathologists and those made in the present study (by the first and second pathologists) before immunohistochemical (IHC) staining was 0.33 and 0.43, respectively. The kappa coefficient between punch biopsy diagnoses by the first and second pathologists before IHC staining was 0.73, while it increased to one after IHC staining with Ki-67 and p16. Out of the 22 specimens with the positive punch and negative cone biopsies on initial diagnosis, cervical intraepithelial neoplasia (CIN) was not confirmed in 11 specimens by our pathologists after IHC staining with Ki-67 and p16. These cases were reclassified as transitional metaplasia or acute/chronic cervicitis. CONCLUSION: Punch biopsy can be misdiagnosed as CIN positive, leading to unnecessary conization. The use of Ki-67 and p16 markers as appropriate ancillary tests are recommended.

Comparison of Immunostaining with Hematoxylin-Eosin and Special Stains in the Diagnosis of Cutaneous Macular Amyloidosis.

Background Although macular amyloidosis is a relatively rare disease, it is a common cutaneous disease in Asia and the Middle East. On hematoxylin and eosin (H&E) stained slides, early lesions could easily be missed without the use of special stains and/or immunohistochemistry. Methods We enrolled 42 patients with the clinical impression of macular amyloidosis who had undergone two 4-mm punch biopsies from 2015 to 2016 at a dermatology clinic affiliated to Shiraz University. Besides, 14 cases with a clinical diagnosis other than macular amyloidosis were selected as the negative control group. Congo red, crystal violet, and immunohistochemical (IHC) staining of CK5 and high molecular weight keratin (HMWK) were performed for each specimen. Results H&E slides showed globular depositions in 15 (35.7%) out of 42 patients. None of the patients showed apple-green birefringence with Congo red stain. Evaluation of crystal violet stained sections revealed purplish violet amyloid deposits in 15 (35.7%) patients. IHC study showed expression of CK5 in 52.4% and HMWK in 50% of the patients, which was not a significant difference (p = 0.715). The findings of both IHC markers had a significant difference with H&E stains (p = 0.039) and crystal violet (p = 0.008). Additionally, we found that two punch biopsies from two sites in the involved area did not have a significant preference over one punch biopsy. All of the cases in the control group were negative for amyloid deposition in H&E, special stains, and IHC stained slides as expected. Conclusions IHC evaluation using CK5 and HMWK might be a useful tool for diagnosing macular amyloidosis.

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.

In Vitro and In Vivo Evaluation of Poly (3-hydroxybutyrate)/Carbon Nanotubes Electrospun Scaffolds for Periodontal Ligament Tissue Engineering.

STATEMENT OF THE PROBLEM: Tissue engineering was an idea, today it has become a potential therapy for several tissues in dentistry, such as periodontal disease and oral mucosa. PURPOSE: In this experimental study, periodontal regeneration is one of the earliest clinical disciplines that has achieved therapeutic application in tissue engineering. The aim of the present study was to prepare electrospun Poly (3-hydroxybutyrate) (PHB)/1% Carbon nanotubes (CNTs) scaffolds for periodontal regeneration. MATERIALS AND METHOD: 1% w/v of CNTs was added to the polymer solutions and electrospinned. Physical properties of the scaffolds were evaluated by scanning electron microscopy (SEM) and universal testing machine. Chemical characterization of the scaffolds was also assessed by Fourier-transform infrared spectroscopy (FTIR). Biological properties of the scaffolds were also evaluated in vitro by culturing periodontal ligament stem cells (PDLSCs) on the scaffolds for 10 days and in vivo by Implanting the scaffolds in rat model for 5 weeks. RESULTS: Results showed that the scaffolds mimicked fibrous connective tissue of the (PDL). CNTs improved the mechanical properties, similar to 23-55 years old human PDL. In vitro biocompatibility study showed more attachment and proliferation of the PDLSCs for PHB/1%CNTs scaffolds compared to the PHB controls. In vivo study showed that CNTs in the scaffolds caused mild foreign body type giant cell reaction, moderate vascularization, and mild inflammation. CONCLUSION: The results showed that the PHB/1%CNTs composite scaffolds might be potentially useful in periodontal regeneration.

Evaluation of treatment results and prognostic factors of uterine sarcoma: A single-center experience.

BACKGROUND: Uterine sarcomas (US) constitute a rare heterogeneous group of gynecological malignancies with aggressive characteristics and poor prognosis. Identifying the histopathological factors that determine the prognosis of the tumor and efficacy of various treatment modalities provides a reliable source for efficient treatment of affected patients. This study presents our 11-year experience with US in the south of Iran. METHODS: Medical records of 42 patients (2001-2012) with endometrial stromal sarcoma (ESS), leiomyosarcoma (LMS), and malignant mixed Müllerian tumor (MMMT) were investigated. Hazard ratio (HR) and 2- and 5-year survival of patients were analyzed based on the patients' age, histopathological characteristics (tumor type, stage, necrosis, and mitotic index), and treatment modalities. RESULTS: Twenty-four patients survived with median follow-up of 42.5 months; 18 died within 17 months, and 52.4% had recurrence, of whom 12 died. Two- and five-year survival rate was 78.6% and 61.9%, respectively, longest for ESS and shortest for MMMT. Higher age, tumor stage, necrosis, and mitotic index increased the HR of mortality. Radiotherapy resulted in a better survival, compared with chemotherapy alone or combined with radiotherapy. CONCLUSION: Although ESS had the best prognosis, MMMT was the most aggressive tumor with the shortest survival time. Histological type of the tumor, staging, tumor necrosis, and mitotic index had prognostic roles. Adjuvant radiotherapy resulted in a better survival, compared with surgery alone in early stage.

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.

Tufted angioma arising at the site of hepatitis B vaccination: A case report.

Sepaskhah M, Hajizadeh J, Sari-Aslani F, Jowkar F. Tufted angioma arising at the site of hepatitis B vaccination: A case report. Turk J Pediatr 2018; 60: 188-190. Tufted angioma is a benign vascular proliferation which presents most commonly in infants and children and could occasionally be complicated by Kasabach-Merritt syndrome. Here, we report a 4-month-old girl with erythematous firm plaque on left thigh at the site of hepatitis B vaccine injection accompanied with thrombocytopenia. Histological examination showed multiple lobules of capillary sized vascular proliferation in the dermis and subcutaneous fat (cannonball appearance) with dilated thin walled vascular channels at the periphery of the lobules. According to our search this patient is the second case of tufted angioma arising at the site of vaccination.

Non-scarring Alopecias in Iranian Patients: A Histopathological Study With Hair Counts.

BACKGROUND AND OBJECTIVE: Non-scarring alopecia is a challenge in the diagnosis and treatment, rarely studied in Asian countries.The current study aimed at evaluating histopathological features including hair count of different subtypes of non-scarring alopecia in Iranian patients. METHODS: The current study was conducted on 114 cases diagnosed with non-scarring alopecia in Molecular Dermatology Research Center and Pathology Department of Shiraz University of Medical Sciences, Shiraz, Iran. Cases with two 4-mm scalp punch biopsies were selected. Patients' clinical data were compared with histological findings. RESULTS: Androgenetic alopecia (AGA) was the most common subtype followed by alopecia areata (AA) and combined AGA/telogen effluvium (TE). Perifollicular inflammation was observed in 21% of AGA with a significant difference in males and females (66.7% vs. 33.3%; P-value <0.05). Clinical and histopathologic diagnoses were correlated in 55% of cases. Maximum correlation was observed in combined AGA and chronic TE (88%). For vertical sections, the diagnostic rate was 33.6%, while 88% for transverse sections. CONCLUSION: Transverse together with vertical sectioning provides most of the information in non-scarring alopecias, while transverse sectioning is enough to diagnose the majority of non-scarring alopecias. Perifollicular inflammation was observed in a significant number of cases with AGA, more common in males. It is suggested to report such cases as possibly curable.

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.