Ladan Dastgheib

Background: Mycosis fungoides (MF) is the most common cutaneous T‐cell lymphoma, presenting with variable clinical features that can be pruritic. Pruritus and the overall disease burden may disrupt sleep and diminish quality of life; yet, sleep disturbances in MF remain under‐investigated. Aims: To evaluate sleep quality and quality of life in MF patients compared with healthy controls. Methods and Results: In a cross‐sectional, case–control study at a referral clinic in Shiraz, Iran, 78 MF patients (TNMB stages IA–IIIA) and 76 age‐ and sex‐matched controls completed the Pittsburgh Sleep Quality Index (PSQI), the 12‐Item Short Form Survey (SF‐12), and the Hospital Anxiety and Depression Scale (HADS). MF patients had significantly poorer sleep quality, with 62.8% reporting poor sleep quality compared to 27.6% of controls ( p < 0.001). Among MF patients, poorer sleep quality was significantly associated with greater pruritus intensity, more advanced disease stage, and a higher modified severity‐weighted assessment tool score (mSWAT) (all p < 0.05). In contrast, histopathological subtype and treatment modality showed no significant association. MF patients exhibited higher rates of moderate‐to‐severe anxiety (34.6% vs. 15.8%) and depression (30.7% vs. 14.6%) ( p < 0.05). Physical health scores on the SF‐12 were significantly lower in the MF group ( p < 0.01), whereas the decrease in mental health scores did not reach significance. Conclusion: MF is associated with significant sleep dysfunction, psychological distress, and impaired physical quality of life. Pruritus intensity, disease stage, and cutaneous disease burden are key contributors to poor sleep quality. Larger studies are warranted to further elucidate the extent and mechanisms of sleep disturbance in this population.

Introduction: The quality of life (QoL) of patients suffering from cutaneous malignancies like cutaneous T-cell lymphoma (CTCL) and their family caregivers is widely affected by the disease and its treatment. Objectives: This study aimed to evaluate the impact of the disease and its treatment on patients with MF and their families through self-administered questionnaires in our referral center in Shiraz. Methods: Patients with MF, the most common variant of CTCL and 1 of their family members participated in this study by filling out the questionnaires on Dermatology Life Quality Index (DLQI), and Family Dermatology Life Quality Index (FDLQI). The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) was also completed by patients and healthy controls. Results: A total of 113 cases, 91 patients’ relatives, and 129 healthy controls participated in this study. The mean DLQI total score was 8.00 ± 6.41. WHOQOL-BREF and/or their subdomains were ameliorated with advanced stage, active disease, increasing MSWAT score, early disease, the head/neck location, as well as interferon and gemcitabine. “Symptoms and feelings” and “leisure” dimensions of DLQI were the most affected, while regarding WHOQOL-BREF, the disease significantly impacted the “psychological”, “environmental” and “general health” aspects (P<0.001, P=0.045, and P<0.001, respectively). Given the sociodemographic characteristics of the study participants, patients with a higher level of education suffered more (P=0.035). Conclusions: Due to the distress that patients and caregivers experience during the first year of diagnosis, head/neck lesions and specific treatment, appropriate measures to prevent unrealistic expectations and better coping mechanisms are recommended.

Background: Autoimmune blistering diseases (ABDs) such as pemphigus vulgaris (PV) and bullous pemphigoid (BP) are a group of immunological skin disorders, with a complex and multifactorial pathogenesis. However, the limited centralization and standardization of available data have hindered research into the epidemiologic risk factors associated with these diseases. Materials and Methods: This cross-sectional retrospective study was conducted, including 228 patients selected from Shahid Faqhihi hospital through the census sampling method. Epidemiological data, such as age, gender, disease duration, dietary habits, physical activity, lifestyle choices, sunlight exposure, and family history, were assessed. Descriptive statistics were used to present the data. Results: The study included patients with a mean age of 50.3±14.8 years, disease duration of 4.52±5.3 years, and a female predominance (64.5%). The most common disease types were PV (75%), BP (10.5%), and pemphigus foliaceus (8.8%). Most patients reported no consumption of garlic (86.4%), onion (76.8%), tea or coffee (68%), and spicy foods (89%). The results showed high rates of abstaining from alcohol (99.1%), not smoking (87.7%), and not using hair dye (70.2%). Physical activity levels were primarily minimal or less (68%). Almost none of the participants (97.4%) reported exposure to pesticides. Additionally, 43.4% reported sunlight exposure of more than three days a week. Conclusion: The study revealed a male-to-female ratio of 2:1 among patients, with PV being the most prevalent disease type. Tea and coffee were the most consumed beverages, and a significant proportion of patients reported frequent sunlight exposure and smoking. A comprehensive approach involving lifestyle modifications and individualized care is crucial for managing ABDs effectively.

Background: According to WHO, migraine is a neurological disorder that has ranked third among the most prevalent medical conditions. Androgenetic alopecia (AGA), on the other hand, is a patterned hair loss disorder due to excessive response to androgens, affecting about half of the world's population. This disorder is presented by progressive hair loss in males and females after puberty, and sex hormones influence both diseases. Methods: A total of 50 women with clinically diagnosed AGA and a mean age of 37.5 referring to dermatology outpatient clinics of Shiraz University of Medical Sciences during 2020 were included in this study. The control group consisted of 50 women of similar age without alopecia. Hair loss was evaluated using the Ludwig classification, and the Persian versions of migraine screen questionnaire (MS_Q) and migraine disability assessment tests (MIDAS) were used to assess migraine among participants. Pain intensity was also measured using the Visual Analog scale (VAS). Results: According to the MS_Q Questionnaire, seven females (14%) in the case group and six females (12%) in the control group had migraines, and no significant correlation was observed between migraine and AGA (P = 0.766). There was no significant correlation between Ludwig score and migraine disability score in the case group with migraine (Spearman correlation coefficient = 0.367, P = 0.419). The only significant positive correlation was between Ludwig score and VAS in the case group with migraine (Spearman correlation coefficient = 0.844, P = 0.017) Conclusions: Based on the results, no significant correlation was found between migraine and AGA.

Pyoderma gangrenosum (PG) is a rare dermatological disease characterized by the rapid development of painful skin ulcers. While systemic infliximab is considered a standard treatment for patients with PG, herein, we report our success with the use of intralesional infliximab in a 40-year-old woman with systemic lupus erythematosus (SLE) and PG.

Although antibiotics are among the most commonly used treatments of acne, there are refractory cases, or they can cause some complications. Recently, leukotriene B4 has been found to play a major role in inflammatory acne lesions. This double blind, randomized clinical trial was conducted on 108 patients with acne who needed systemic therapy and referred to dermatology clinics affiliated to Shiraz University of Medical Sciences. One group (53 patients) received 100 mg doxycycline daily plus placebo and the other group (55 patients) received 100 mg daily doxycycline plus 10 mg daily montelukast. Both groups also received topical benzoyl peroxide 5% every other night. The study period was 3 months and the patients were investigated by lesion count, investigator global assessment (IGA), global acne grading system (GAGS), and Cardiff acne disability index (CADI) scoring systems. Total lesion count, inflammatory lesion count, and non-inflammatory lesion count as well as IGA and GAGS decreased in both treatment groups. At the end of the study, however, the inflammatory lesion count and IGA score reduced more significantly in the montelukast group (p = 0.018 and 0.045, respectively). In addition, the two groups were significantly different with regard to the percentage of decrease in the total lesion count, inflammatory lesions, and IGA (p = 0.033, 0.003, and 0.044, respectively). Thus, montelukast can be used as an adjuvant therapy besides other treatments of acne, especially for inflammatory lesions.

Lichen planus is considered a chronic inflammatory disease which affects different sites, such as the skin, mucous membranes, hair, and nails. Based on the evidence, a complex cytokine network plays a crucial role in lichen planus pathogenesis. The study was aimed at assessing the serum IL‐23 levels in the patients with cutaneous and oral lichen planus compared to healthy controls. Method. The study included 30 cutaneous lichen planus patients, 20 oral lichen planus patients, and 33 control subjects. Five milliliters of peripheral blood was obtained from each patient, and the serum was separated. IL‐23 levels were determined using the ELISA kit, and the data were analyzed using the Mann–Whitney test. Results. IL‐23 levels in the patient serum with oral lichen planus (P value ≤ 0.001) were significantly higher than in controls. Furthermore, there were significant differences in IL‐23 serum levels in the patients with cutaneous lichen planus compared to the healthy controls (P value ≤ 0.001). Moreover, IL‐23 serum levels were statistically different between patients with cutaneous lichen planus and patients with oral lichen planus (P value ≤ 0.001). Based on the mean concentration of interleukin‐23, IL‐23 levels were higher in the patients with oral lichen planus than in the patients with cutaneous lichen planus. Conclusions. Elevated serum IL‐23 levels in the patients with oral lichen planus may indicate that IL‐23 plays a crucial role in the pathogenesis of oral lichen planus. However, more research is needed with a larger sample size.

For centuries, Hirudo medicinalis (medicinal leech) has been used as a remedy to treat many discomforts, such as muscle and joint pain. Nowadays, using leech in reconstructive surgery, microsurgery, wound and flap healing, venous insufficiency, varicosities and many other disorders has increased. In this study, we report a 45 year old female patient with six pruritic papules on her legs since10 months ago that appeared about 4 weeks after one session of leech application. Skin biopsy was performed on one of the papules, and in histopathology, superficial ulceration with a dense superficial and deep inflammatory infiltrate within the dermis composed of lymphocytes and eosinophils detected that considering history of leech application at this site, these constellation of data was compatible with the diagnosis of cutaneous lymphoid hyperplasia induced by leeches and the patient was cured by a topical steroid and cryotherapy.

Vitiligo is a skin disorder with melanocyte destruction and an autoimmune basis. Given the importance of cytokines in autoimmunity, we aimed to find the cytokine profile of innate and adaptive immunity in vitiligo patients, and correlate them with clinical parameters. The serum levels of innate immunity [interleukin(IL)-1α, IL-1β, IL-6, IL-8, IL-12, IL-15 and tumor necrosis factor (TNF)-α] and T helper(Th)1 [IL-2, interferon (IFN)-γ, TNF-β], Th2 (IL-4, IL-5, IL-10, IL-13) and Th17 (IL-17, IL-23) cytokines in 44 vitiligo patients were measured by multiplex cytokine assay and compared with 44 healthy subjects. All innate immunity (p < 0.04), Th1 (p < 0.01), Th2 (p < 0.05) and Th17 (p < 0.001) cytokines were higher in patients than controls. Total summation levels of innate immunity and adaptive immunity cytokines showed a remarkable up-regulation in the patients (p < 0.0001). The ratio of innate immunity to Th1 (p = 0.03), Th2 (p = 0.01) and Th17 (p = 0.03) cytokines was significantly higher in patients vs. controls. We found significant higher ratio of Th1 to Th2 cytokines and TNF-β elevated levels in patients with a family history of autoimmunity (p < 0.05). IL-4 and IL-13 (p < 0.04) levels were lower in patients with amelanotic hair. Increased IL-10 level was observed in patients with stable disease (p = 0.02). In conclusion, the profile of cytokines in patients showed a dominant role of innate immunity pro-inflammatory cytokines in vitiligo, which suggests the potential of targeting these cytokines for vitiligo treatment. While a higher ratio of Th1/Th2 cytokines was observed in the patients, association of decreased Th2 cytokines with disease complications suggests a protective role for Th2 pathway.

Pemphigus vulgaris is an autoimmune disease that mostly affects the mucosa and oral cavity. Candida species can invade the mucosal lesions of these patients and cause diseases. The aim of this study was to identify the fungal agents isolated from mucosal lesions and evaluate antifungal activity profile against the isolates. A total of 25 patients with pemphigus vulgaris with active oral lesions and 25 healthy people serving as a control group were included in this study. Identification of the fungal isolates was performed based on conventional methods and DNA sequence analysis of the internal transcribed spacer (ITS) rDNA gene region. The sequence results were deposited in the NCBI database using the Basic Local Alignment Search Tool. Antifungal activity of fluconazole, itraconazole, ketoconazole, posaconazole, econazole, and amphotericin B against the isolates were evaluated based on the CLSI M-44 A protocol. Oral candidiasis was detected in 20% of the patients. Candida species isolated from oral lesions of patients with pemphigus were identified as Candida albicans 22/25, Candida glabrata 2/25, and Candida dubliniensis 1/25. All of the isolates were sensitive to amphotericin and econazole, 96% to fluconazole and posaconazole, and 92% to ketoconazole and itraconazole. One patient showed a profile resistant to fluconazole, posaconazole, and ketoconazole, simultaneously. Ninety six percent of control group isolates were sensitive to six antifungals. Candida albicans was the most prevalent species isolated from oral lesions of patients with pemphigus vulgaris and the control group. Amphotericin B and econazole were the most effective antifungals against the isolates.