The skin changes in pregnancy can be either physiological (hormonal), changes in pre-existing skin diseases or development of new pregnancy specific dermatoses. Pregnancy-specific skin dermatoses include an ill-defined heterogeneous group of pruritic skin eruptions which are seen only in pregnancy. These include atopic eruption of pregnancy, polymorphic eruption of pregnancy, pemphigoid gestationis and intrahepatic cholestasis of pregnancy. Atopic eruption of pregnancy is the most common of these disorders. Most skin eruptions resolve postpartum and require only symptomatic treatment. Antepartum surveillance is recommended for patients with pemphigoid gestationis and intrahepatic cholestasis of pregnancy as they carry fetal risk. This article deals with the classification, clinical features and treatment of the specific dermatoses of pregnancy.

Background: The etiology and pathophysiologic mechanism of vitiligo are still unclear. The relationship between increased oxidative stress due to the accumulation of radicals and reactive oxygen species and the associated changes in blood and epidermal component of vitiliginous skin have been reported many times. We investigated the possible changes of plasma malondialdehyde, glutathione, selenium, hydroxyproline and glutathione peroxidase activity levels in patients with vitiligo in order to evaluate the relationship between oxidative stress and etiopathogenesis of vitiligo. Materials and Methods: Plasma malondialdehyde, glutathione, hydroxyproline and glutathione peroxidase activity levels were measured by spectrophotometric methods, and HPLC was used for measurement of selenium concentrations. Results: Our results showed increased malondialdehyde, hydroxyproline and glutathione peroxidase activity levels in plasma of vitiligo group ( P < 0.05). Conclusion: Support of antioxidant system via nonenzymatic antioxidant compounds and antioxidant enzymes may be useful to prevent of melanocyte degeneration which occur due to oxidative damage in vitiligo.

Background: Despite worldwide prevalence of hirsutism studies on hirsutism in Indian patients are not many. Aims: This retrospective study was carried out to assess the clinico-investigative profile of patients presenting with hirsutism. Materials and Methods: Medical records of 82 hirsutism patients diagnosed consecutively during July 2005 to October 2007 were analyzed. Results: The complete data of 50 patients aged between 13 and 47 years were available. Fifty percent patients were aged 20 to 30 years. The average F-G score was 10.3 ± 2.46. Associated signs of hyperandrogenism were acne (64%), oligomenorrhea or menstrual irregularities (36%), androgenetic alopecia (16%), acanthosis nigricans (6%) and seborrhea (4%). Polycystic ovaries were detected in 30% patients and 22% patients had elevated serum free testosterone levels. Family history of hirsutism was present in 18% patients. Conclusion: Hirsutism in Indian patients is not uncommon. Adolescent patients appear to be more concerned about hirsutism as compared to those in the older age group who were more often worried of late onset acne. All patients, however, were more concerned for facial hair than those on other body areas signifying that facial hair need to be given higher than current value in F-G score.

Aims: To compare the therapeutic effects of topical Artremisia sieberi 5% lotion with topical clotrimazole 1% lotion in the treatment of pityriasis versicolor. Materials and Methods: 100 patients with pityriasis versicolor and microscopic identification of Malassezia furfur were randomly assigned to treatment with either topical Artemisia sieberi 5% lotion (group 1) or topical clotrimazole 1% lotion (group 2) for 2 weeks. Group 1 and group 2 consisted of 51 and 49 patients respectively. The patients were evaluated both clinically and mycologically at baseline and every 2 weeks for a period of 4 weeks. Results: At the end of the second week, clinical cure rates were 86.3% and 65.3% for group 1 and group 2 respectively ( P <0.01), but at the same time mycological cure rate was 92.2% for group 1 and 73.5% for group 2 ( P <0.05). At the end of the fourth week, clinical cure rates were 86.3% and 59.2% for group 1 and group 2 respectively ( P <0.01), and at the same time mycologic cure rate was 96.1% for group 1 and 65.3% for group 2 ( P <0.01). Conclusions: The results of this study demonstrated that Artemisia sieberi 5% lotion was more effective than clotrimazole 1% lotion in the treatment of pityriasis versicolor.

Background: Herpes Zoster (HZ) is reactivation of latent varicella-zoster virus that involves dermatomes. Aging and immunosupressed states are among the main risk factors. Some investigations showed that HZ is more common in diabetic patients than in normal population. Aim: To determine whether undiagnosed DM is more common in patients with HZ than in those without it. Materials and Methods: In this study 103 patients with HZ (cases) and 142 as control participated. They had no history of DM. Both groups were matched according to age, gender and family history of DM. Fasting plasma glucose was checked for all participants. DM was defined when the fasting plasma glucose was equal or more 126 mg/dl. Results: 35.9% of patients with HZ and 19.7% of the control group had DM. There was significant association between HZ and undiagnosed DM (OR = 2.28, 95% CI: 1.28-4.06). Conclusion: Our findings indicate that the prevalence of undiagnosed DM is more common in HZ patients and supports the policy to investigate patients with HZ for the presence of undiagnosed DM.

Background: Acne vulgaris is one of the most common skin disorders in youth especially during the puberty. Objective: This in vitro study was performed to determine the antibiotic resistance and sensitivity in acne vulgaris. Materials and Methods: Samples were collected from normal skin and nodulocystic and pustular skin lesions of one hundred youngsters (64 girls, 36 boys) among college students in the age range of 18-24 years old. The specimens were cultured individually on blood agar and Muller-Hinton media. The cultures were then incubated under both aerobic and anaerobic conditions for 2 to 7 days. Bacteria were identified and their resistance to common antibiotics was evaluated according to the standard procedures. Results: In aerobic culture of pustular and nodulocystic skin lesions, Staphylococcus aureus was present in 41% of subjects, Staphylococcus epidermidis in 53% and Micrococcus spp in 45% of subjucts. In anaerobic bacterial culture of pustular and nodulocystic skin lesions, Staphylococcus aureus was present in 39%, Propionibacterium acne in 33% and Staphylococcus epidermidis in 21% of subjects. The results of present study revealed that clindamycin and erythromycin were the least effective antibiotics for Propionibacterium acne while tetracycline was the least effective for Staphylococcus aureus in vitro . A synergic effect of benzoyl peroxide, erythromycin or clindamycin was noticed. Rifampin was the most effective antibiotic in vitro . Conclusion: Our results showed that rifampin was the most sensitive antibiotic in vitro for acne vulgaris. To achieve a better treatment, a combination of rifampin with other antibiotics may be more efficient. We suggest in vivo studies for better evaluation and treatment of acne patients with rifampin.

Background: Onychomycosis is a difficult condition to treat and cure rates are disappointing. Moreover fungicidal action of antifungal agents in NCCLS assays and their rapid accumulation in nails in vivo are not compatible with the duration of treatment. Aims: This study aimed to find the effectiveness of 4 different antifungal agents in an in vitro model with some similarities to in vivo conditions. Materials and Methods: Strains of Trichophyton rubrum I-III, Trichophyton mentagrophytes (usual form), Trichophyton mentagrophytes 73, Epidermophyton Flucosom, Microsporum Canis, and Trichophyton Schoenleini which were isolated from the nails of patients, were hired. Inocula suspensions were prepared from 7 to 14 day-old cultures of dermatophytes. Antifungal agents including fluconazole, ketoconazole, terbinafine, and griseofulvin were obtained as standard powders. For each antifungal agent, initial MIC was calculated by registering the optical density for 10 two-fold serially diluted forms which was incubated with diluted fungal suspensions with RPMI 1640. Human nail powder inoculated with different strains and incubated in RPMI 1640 and different concentrations of antifungal drugs for 4 weeks. Final MIC at different steps of 1, 2, 3 and 4 weeks were investigated. Results: The final MIC that resulted from the incubation of dermatophytes with nail powder was much more than the initial which was concluded from conventional MIC assay. Terbinafine had the lowest rate of initial and final MICs. Conclusion: The model described here may present more similar conditions to clinical fungal infections; therefore the results such as MIC may be more helpful for hiring the most effective antifungal agent.

Background: Cutaneous Leishmaniasis (CL) is a parasitic disease characterized by single or multiple ulcerations. Secondary bacterial infection is one of the complications of the disease that can increase the tissue destruction and the resulting scar. Objective: To effectively determine the incidence of real secondary bacteria infection in cutaneous leishmaniasis, we designed the current study. Methods and Materials: This was a cross-sectional study performed in Skin Diseases and Leishmaniasis Research Centre, Isfahan, Iran. In this study, 854 patients with confirmed CL were enrolled. Samples were taken from all the patients. Sterile swaps were achieved for the ulcer exudates and scraping was used for nonulcerated lesions. All the samples were transferred to tryptic soy broth medium. After 24 h of incubation in 37°C, they were transferred to eosin methylene blue agar (EBM) and blood agar. Laboratory tests were used to determine the species of bacteria. All of the collected data were analyzed by SPSS software and chi-square. Results: Among 854 patients with confirmed cutaneous leishmaniasis, 177 patients (20.7%) had positive cultures for secondary bacterial infection. Bacteria isolated from the lesions were as follows: Staphylococcus aureus - 123 cases (69.4%), coagulase negative Staphylococcus - 41 cases (23.1%), E. coil - 7 cases (3.9%), Proteus - 3 cases (1.7%) and Klebsiella - 3 cases (1.7%). Conclusions: The incidence of secondary bacterial infection in lesions of CL was 20.7%. The most common isolated pathogen was Staphylococcus aureus . The incidence of secondary bacterial infection was significantly more in the ulcerated lesions as compared with nonulcerated lesions ( P = 0.00001).

Background: In recent years, skin diseases in wrestling have finally received the attention they deserve. Outbreaks of tinea corporis are often associated with sports involving extensive bodily contact; such sports include wrestling. Tinea corporis gladiatorum is primarily caused by Trichophyton tonsurans , infecting wrestlers at alarming rates. The management of skin infections in wrestlers and other athletes in sports involving skin-to-skin contact entails numerous challenges, from making an accurate diagnosis to determining eligibility for playing the sports. To control outbreaks, we conducted an epidemiologic investigation. The purpose of this article is to determine the prevalence of tinea corporis gladiatorum in wrestlers in Tehran, Iran. Materials and Methods: A study of dermatophytosis was carried out during the period of March 2004 to December 2005 on 612 mycological proven cases of dermatophytosis found in male wrestlers in Tehran. Mycological examination consisted of culturing of pathologic material followed by direct microscopic observation. Diagnosis was based on macroscopic and microscopic characteristics of the colonies. Results: T. tonsurans was the predominant dermatophyte, accounting for >90% of all tinea corporis gladiatorum isolates during the 2 year analysis. Tinea corporis gladiatorum was found to be more frequent in individuals between the ages of 10 and 20 years of age (72.7%). Wrestlers with tinea corporis gladiatorum were predominantly from wrestling clubs in southern and southeastern Tehran. Transmission of tinea corporis is primarily through skin-to-skin contact. Conclusion: Rapid identification and treatment of tinea corporis gladiatorum is required to minimize the disruption of team practices and competitions. Infection with dermatophytes can disqualify a wrestler from competing in matches, and thus, vigilant surveillance and rapid initiation of treatment is important to prevent the suspension of team practices and competitions.

Background: Development of skin neoplasms is one of the most important chronic complications of radiation therapy. Basal cell carcinoma (BCC) is the most frequent carcinoma occurring at the region of the body to which radiotherapy was delivered. Aim: The aim of this study was to evaluate clinical and histological aspects of basal cell carcinoma in patients with a history of radiotherapy. Materials and Methods: Medical records and microscopic slides of 80 patients with basal cell carcinoma who had received radiotherapy (1996-2006) were reviewed in pathology department of Imam Reza hospital of Mashhad, Iran. Collected data were analyzed statistically using descriptive test. Results: 60 men and 20 women were included, majority of them in their sixties. Plaque was the most common clinical pattern of basal cell carcinoma. Fifty one percent of the patients had pigmented and 42.5% had multiple lesions. Scalp was the most common site of involvement. Histologically, macronodular and pigmented carcinoma were the most predominant forms of basal cell carcinoma. Discussion: Majority of patients had scalp involvement and multiple lesions. Nodular and pigmented forms were the most common histological findings. We suggest the need for close supervision in patients with a history of radio therapy in the past.

Basal cell carcinoma (BCC) is the most common malignant skin tumor, amongst which the nodular, nodulo ulcerative and superficial types comprise nearly 80% of all BCCs. Topical Imiquimod, an immune response modifier has been found to be effective in superficial and nodular types of BCC with histological clearance rates of up to 100%. We report our experience of treatment a large pigmented BCC on the face with topical Imiquimod 5% cream.

Mycophenolate mofetil has been tried in 20 cases of chronic relapsing erythema nodosum leprosum reaction where long use of systemic steroid produce complications or are contraindicated. Excellent results have been observed in all the cases to arrest the reaction followed for a period of six to eight months duration.

We describe a 76-year-old man presenting with a chronic, non-healing ulcer of six-year duration on his left zygomatic area. The skin biopsy specimen taken from the lesion, showed increased vascular proliferation, edematous endothelial cells in the dermal blood vessels and perivascular eosinophilic/lymphocytic infiltration. The routine and specific blood tests were unremarkable. On the basis of these features, the patient was diagnosed as having angiolymphoid hyperplasia with eosinophilia (ALHE). We present the case because of its rarity in older people, atypical clinical appearance; and stress the consideration of ALHE in the differential diagnosis of chronic non-healing superficial ulcers confined to face and neck.

Metastatic Crohn's disease is an uncommon extraintestinal manifestation of Crohn's disease. Its hallmark features include the presence of cutaneous noncaseating granulomas that are noncontiguous with the gastrointestinal tract or fistula. We report a rare case of metastatic Crohn's disease involving the external genitalia in a 14-year-old girl. Diagnosis was based on skin biopsy. Patient had complete recovery on treatment with oral and topical steroids along with azathioprine.

Tuberculosis, one of the oldest diseases known to affect humans is caused by the bacteria mycobacterium tuberculosis. The disease usually affects the lungs, although, in up to one third of cases, other organs are involved. Metastatic tuberculosis abscess is a rare form of skin tuberculosis. It is characterized by nodule and abscess formation throughout the body after hematogenous spread of mycobacterium tuberculosis from a primary focus during a period of impaired immunity. Tuberculosis osteomyelitis is also a rare form of extrapulmonary tuberculosis in pediatric age group. Skeletal tuberculosis pathogenesis is related to reactivation of hematogenous foci or spread from adjacent paravertebral lymph nodes. Weight-bearing joints are affected most commonly. Bilateral hand and foot bone involvement is rarely reported. We present a five-year-old girl with two very rare presentations of the disease such as osteomyelitis and metastatic skin abscess.

A 55-year-old female patient presented to our outpatient department with complaints of persistent erythema, oozing and crusting restricted to the left breast over the last 6 months. The patient underwent investigations to rule out the possibility of mammary Paget's disease, all of which were negative. A possibility of contact dermatitis to topical medication was considered and confirmed by patch testing.