Iranian Journal of Dermatology
Year:2012 | Volume:14 | Issue:4 (58)|Papers Count:8

Background: Psoriasis is a chronic hyper proliferative disease of the skin, scalp, nails, and joints that affects 2% of the general population. One of the extra cutaneous manifestations of psoriasis is psoriatic arthritis which occurs in 25–34% of the psoriasis cases.This type of inflammatory arthritis is characterized by pain, swelling, and tenderness around the joints, and may adversely affect patient’s functional abilities and the quality of life.Objectives: To evaluate depression and quality of life in Iranian patients with psoriasis and psoriatic arthritis.Materials and methods: From January 2009 to January 2010, 100 psoriasis patients who were randomly selected (through simple random selection) from the outpatient clinic of Razi Hospital and did not have any other skin or autoimmune diseases were asked to answer valid and reliable instruments such as the Beck Depression Inventory (BDI), SF-36, and DLQI (Dermatology Life Quality Index).Results: Mean scores of the BDI, SF-36, and DLQI of all the patients were 17.1±12.3, 59.8±19.5, and 12.4±6.1, respectively.The most common type of the disease was the plaque type in eighty eight cases. Thirty-one women and 26 men were depressed (P=0.06), and depressed individuals had higher DLQI scores (14.2±5.5us.9.9±6.2, r=0.3 P=0.001). Patients with arthritis had significantly higher BDI and lower SF-36 scores suggesting more severe depression and quality of life impairment than those without arthritis.Conclusions: Extra cutaneous manifestations of psoriasis and mood disorders should be considered in psoriatic patients to address the risk of markedly impaired quality of life.

Vitiligo is an autoimmune skin disease which is characterized by depigmented patches due to loss of pigment cells. Evidence suggests that cell-mediated immunity plays a role in melanocyte destruction while some patients have antibodies to melanocytes or melanocytic proteins.Vitiligo is strongly associated with a number of autoimmune disorders.Autoimmune thyroiditis is the most prevalent disease with a prevalence of 21% 1.Diabetes mellitus type I is found in 1-7% of the patients with vitiligo 2 and pernicious anemia is reported in 5% of the vitiligo patients 3.The goal of this study was to determine the association of vitiligo with other autoimmune diseases (diabetes, thyroid dysfunction, pernicious anemia) in Iranian patients.From January 2009 until January 2010, one hundred vitiligo patients were randomly selected (through simple random selection) from the outpatient clinic of Razi Hospital.

Background: Lichen planus is a common inflammatory disease that can involve the skin, nails, mucous membrane, and hair follicles. There is a long list of topical and systemic therapies for its treatment. Methotrexarte has some characteristics that make it a good choice for generalized lichen planus.Aim: The goal of this study was to assess the effect of low dose methotrexate in generalized lichen planus.Method: Eighteen patients (8 male and 10 female, mean age: 51.1, range: 22-80, SD: 14.9) with generalized lichen planus were enrolled in the study. After basic evaluations, low dose methotrexate (7.5-10 mg weekly) initiated. The response rate was appraised after 2, 4 and 8 weeks. Six-month follow-up was done for evaluating the recurrence rate.Result: At the end of the 8th week, 75% of the patients had more than 75% improvement. After six months, no case of recurrence was reported. Adverse effects were limited to laboratory abnormalities in two patients (abnormal liver function tests in one case and decreased hemoglobin in the other case).Conclusion: Low dose methotrexate is a very good and safe treatment for generalized lichen planus, especially when there is concern regarding the steroids undesired effects or when the disease is resistant to corticosteroids.

Background: Recent studies suggest that psoriasis may be a pathogenic factor for the metabolic syndrome and atherosclerosis.The aim of our study was to investigate the metabolic state in psoriatic patients in order to clarify the association between psoriasis and insulin resistance.Methods: This single-centre, case- control study was performed between 2008 and 2010 to evaluate the metabolic state of thirty chronic plaque type psoriatic patients in comparison with the control group. The criteria of insulin resistance (Body Mass Index (BMI), Systolic Blood Pressure, Fasting Plasma Glucose, Oral Glucose Tolerance Test (OGTT), Serum Insulin and Lipid Profile) were assessed for each participant.Results: Thirty psoriatic patients with a mean disease duration of 3.94+2.96 years and 30 healthy controls were recruited for the study.Only one patient in each group filled the criteria of insulin resistance, and there was no significant difference between the two groups. The mean Fasting Plasma Glucose (FPG), Triglyceride (TG) and Systolic Blood Pressure (SBP) levels were significantly higher in psoriasis patients as compared to the controls (p=0.044, p=0.014 and p=0.001, respectively). In contrast, no statistically significant differences were observed in mean BMI, OGTT, insulin and HDL levels between the two groups.Conclusion: Despite the absence of any significant association between insulin resistance and psoriasis, it could be concluded that psoriasis may be an independent risk factor for diseases such as Ischemic Heart Disease (IHD) and Diabetes Mellitus (DM), hypertension and obesity.

Background: Alopecia Areata (AA) is a skin disease which affects 0.2% of general population. Unlike its little physical impairment, Alopecia areata causes a lot of cosmetic problems but most clinicians do not pay attention to mood disorders and the impaired quality of life as the consequences of disease.Objectives: To evaluate depression and quality of life in Iranian patients with Alopecia areata.Methods: From January 2009 until January 2010 one hundred alopecia areata patients who were randomly selected (through simple random selection) from the outpatient clinic of Razi Hospital were asked to answer valid and reliable instruments such as Beck Depression Inventory (BDI), SF-36 and DLQI (Dermatology Life Quality Index) questionnaires.Results: The mean scores of BDI, SF-36and DLQI of the patients were 14.4±9.7, 68.04±15.1 and 6.4±5.5, respectively. The BDI score was significantly different between male and female participants (F=18.1±11.2 vs. M=12.7±8.5, p=0.01) but SF -36 and DLQI scores did not significantly differ between the two gender groups. Duration of the disease, BDI and age had no significant correlation with DLQI scores. Patients with extensive beard involvement had the highest BDI score and the lowest SF-36 score.Conclusion: mood disorders should be considered in Alopecia areata patients to address the risk of markedly impaired quality of life.

Sarcoidosis (Besnier-Boeck-Schaumann disease) is a multisystem disease of unknown etiology with various cutaneous presentations.It is characterized by the presence of non-caseating ‘naked’ granulomas in the affected tissue. We report a case of polymorphic cutaneous sarcoid in a 39-year-old immunocompetent male.He was visited at our outpatient department with multiple asymptomatic red colored raised lesions on different parts of the body. His history was significant for smoking and diabetes mellitus of varying duration. Cutaneous examination revealed multiple well-defined erythematous plaques of various shapes and sizes with minimal scaling. His blood investigations were normal except for raised serum angiotensin converting enzyme levels.Radiological investigations showed reticulonodular, fibrotic changes and hilar adenopathy on the chest film. We report this case to apprise clinicians of the fact that cutaneous sarcoid is a great mimicker due to lesional polymorphism and could be mistaken for a common dermatosis like psoriasis in our case.

A 45-year-old man presented with multiple ulcerated and erythematous nodules on his scalp. The first lesion appeared on his vertex as an erythematous plaque five years ago and there was gradual increase in size and number of the lesions ever since.He was otherwise healthy.Physical examination showed multiple erythematous nodules, some were crusted, on the vertex (Fig.1). No lymphadenopathy was detected and general examination was unremarkable.The scalp lesion was biopsied and immunohistochemical staining was performed on the specimen.What is your diagnosis.

Pityriasis versicolor (P.V) is a common superficial fungal infection of the skin caused by the fungus Malassezia furfur and is characterized by hypopigmented or hyperpigmented plaques generally on the back, trunk, scalp and upper arms. It is frequently seen in tropical regions with a prevalence rate as high as 40%. The commonest affected age group is 25-30 years in males and 20-25 years in females. Despite the effective therapeutic regimes currently available for PV in contemporary medicine, it often poses a therapeutic challenge.