Dermatology and Cosmetics
Year:2011 | Volume:2 | Issue:1|Papers Count:12

Background and Aim: Cutaneous leishmaniasis (CL) is endemic in Iran, where it is one of the most important health problems. Both anthroponotic CL (ACL) caused by L. tropica and zoonotic CL (ZCL) caused by L. major are reported.Antimoniate derivatives as the standard therapy for CL need multiple injections and are not easy to tolerate for the patients.This study was conducted in Mashhad to compare the efficacy of weekly versus twice a week intralesional injections of meglumine antimoniate (MA) in the treatment of ACL.Methods: This randomised controlled trial was performed during 2006 to 2008 in Mashhad, Iran. Using computerized sequence of random numbers, participants were randomly allocated in the two arms of the study: one receiving weekly and the other receiving twice-a-week intralesional injections of MA. The lesion size, induration and healing rate were assessed, recorded and compared. Healing was defined as complete re-epithelialisation and disappearance of induration.Results: A total of 252 suspected CL patients with 372 lesions were screened. 82 parasitologically proven cases with 121 lesions caused by L. tropica were included and 74 patients with 113 lesions completed the study. At 12th week after initiation of treatment, complete healing was observed in 38 out of 44 lesions (86.4%) in the group which received weekly intralesional MA injection. The median time-to-heal in this group was 36 days (95% confidence interval [CI]: 32.0-39.9). Complete healing was recorded in 60 out of 69 lesions (86.9%) in the group which received twice a week intralesional injections of MA with a median time-to-heal of 25 days (95% CI: 20.9-29.1). While no significant difference was observed between the two groups in terms of complete healing rate (P=0.999), time-to-heal was significantly different between the 2 groups (P=0.003).Conclusion: It seems that the effectiveness of twice-weekly intralesional injections of MA is similar to once-weekly regimen while the former regimen causes more rapid healing of lesions.

Background and Aim: Vitiligo is a common skin disorder that presents as depigmented patchs and associated with psychosocial morbidity. Photochemotherapy with methoxsalen plus ultraviolet A (PUVA) is an effective and commonly used modality in treatment of vitiligo and is available in Khorasan Province since more than ten years ago.Methods: This uncontrolled clinical trial included patients with vitiligo referred to phototherapy center in Emam Reza Hospital in Mashhad during 1998-1999. Treatment was done topically on patients with involvement less than 2% of the body area and systemic in cases with involvement more than that. Data including improvement rate and side effects were analyzed by SPSS software version 11.5.Results: One-hundred and thirty-five patients, 79 female and 56 male, were enrolled. One-hundred and twenty-six patients were treated systemically and 9 patients underwent topical therapy. Complete (100%) repigmentation was observed in one patient. Repigmentation of 80-99%, 60-79%, 40-59%, 20-39% and less than 20% were observed in 53, 43, 12, 6 and 20 patients; respectively. Results were significantly better in generalized vitiligo, face involvement, and cases whom recieved more than 200 treatment sessions, but there was not significant relationship between improvement and patients' age, family history, the first involved area, beginning time of repigmentation, the observed interval between initiation of treatment and disorder appearance, and skin type. Common side effects were pruritus (69.6%), erythema (52.6%), nausea and vomiting (28.9%), and headache (17.8%).Conclusion: PUVA therapy is an effective and safe treatment in patients with vitiligo, and has good results in nonsegmental vitiligo and facial involvement.

Background and Aim: Today, despite numerous advances in medical sciences, the number of complaints against physicians shows an increasing trend. Studying the causes of these complaints and identify contributing factors may reduce medical litigation. The aim of this study was to assess the reasons of complaints in the field of dermatology and cosmetic.Methods: In this retrospective cross-sectional study, we investigated the medical malpractice records related to dermatology and cosmetics, registered in the office of Forensic Medicine, province of Tehran from 2002 to 2010.Results: In 63.4%, 35.3%, and 1.2% of cases, verdicts of malpractice, acquittal and closing the file without a verdict, were issued; respectively. The most common types of negligence were related to improvidence (63.4%), lack of proficiency (27%), and disregarding of governmental provisions (5.7%). Most frequent causes of complaints were related to scar and darkening of skin after laser therapy (24.4%), dissatisfaction of hair transplantation (19.5%), and complications after injection of filler gels, botollonium toxin, etc (15.8%). Most plaintiffs were women, in their 20s, with a highschool diploma and were housewives. The most frequent age range of the physicians was 30-39 years old and most of them were male.Conclusion: Considering medical ethics and professionalism, good communication between physician, medical personnel and patient including his entourage, full examination, adequate explanations about therapeutic procedures and possible complications, lack of exaggerating the results of therapy, continuous study and updating medical knowledge, improvement of medical skills and experiments, refrain from dealing with procedures that did not pass its training courses, properly selected patient, take informed concept and innocence may reduce the number of complaints.

Background and Aim: Cutaneous drug reaction is a common side effect of antiepileptic drugs and a frequent cause of treatment discontinuation. These reactions ranges can be a mild maculopapular rash to Stevens-Johnson Syndrom and toxic epidermal necrolysis. Among the traditional anticonvulsant drugs the aromatic compounds Phenytoin, Phenobarbital and Carbamazepin have been associated with relatively higher incidences of cutaneous reactions which can hospitalized the patient. Some of the newer drugs also can induce this problem, especially lamotrigine.Methods: All records of patiens who were hospitalized at hospitals related to Islamic Azad as well as Rasol Akram hospital with a diagnosis of cutaneous drug reaction to anticonvulsant therapy in 8 years period were reviewed.Results: The most common culprit was phenytoin (32%) and the least common drug was lamotrigin (3%).Conclusion: Cutaneous reaction to anticonvulsant drugs is common and sometimes may be life threatening which needs serious treatment options.

Sulfur mustard (SM) or mustard gas is a chemical weapon which for the first time was employed during world war I; later on it was used by Iraqi military forces against Iranian army and civilians (1980-88). This agent injured over 100000 Iranians and one-third of them are still suffering from its complications. SM is an alkylating agent with cytotoxic, mutagenic and vesicating properties, which targets the skin, eyes and respiratory systems. In this study we review the acute and chronic effects of SM on the skin. We obtained information of this paper from a search of PubMed. Google, Iran Medex, Irandoc and SID until beginning of 2011. The most common acute effects of SM on skin were: pruritus and burning (26%-96.8%), pain (25%-77.4%), erythema (20.6%-83.9%), hyperpigmentation (20%-83.9%), and vesicle and bulla (15.4%-80.6%). The most common chronic effects were: pruritus (24.7%-94.7%), burning (9.9%-52.1%), scar (4.5%-70%), hyperpigmentation (5.9%-55%), hypopigmentation (3.2%-40%), xerosis (2.1%-43.7%) and cherry angioma (12.2%-70.5%). After passing more than 20 years of the end of the Iraq-Iran war, the victims still suffer from many skin complications of SM and some of them such as itching and dry skin have negative effects on the performance and quality of their life. Up to now, serious skin complications like malignant skin tumors have been rare and a longer time may be required to establish. Therefore further follow-up is needed to detect and treat any kind of skin cancers promptly.

In the recent years, advances in different fields of technology have been resulted in a dramatic increase in the diagnostic methods and tests in different branches of clinical medicine with a consequent increase in the number of scientific publications related to the application of those tests and methods in the diagnosis or prevention of diseases.Dermatology is not an exception. Since, evidence-based medicine emphasizes on the appropriate use of the current best clinical research evidence in the diagnosis or treatment of each individual patient acknowledging his/her values, the capability of dermatologists in appraisal and application of the publications, which reports the results of diagnostic test accuracy studies cannot be ignored. In this article, after a brief review on basic issues in diagnostic test accuracy studies, principles of critical appraisal of these studies, from an evidence-based viewpoint, will be discussed. General strategies for evaluation of validity, applicability and quality assessment of a diagnostic test study will be provided.

Eruptive syringoma is a rare benign tumor of eccrine sweat gland. Clinically, it presents as successive crops of symmetric, small yellow-brown to erythematous or skin-colored papules on the anterior body surfaces. It usually occurs in young women. Definitive diagnosis can be made on histopathological findings. The pathogenesis of eruptive syringoma is unclear but there are few reports about its association with antiepileptic drugs, radiation, trisomy 21, depilation and hyperthyroidism. The presented case was a 25-year-old woman who had referred with papules in forehead, periorbital regions, cheek, chin, chest, abdomen and forearm. Eruptive syringoma was confirmed based on its distinctive pathological findings. She thought her skin lesions were related to consumption of oral contraceptives. The importance of this disease is its cosmetic problem.

Fabry disease is a X-linked lysosomal storage disorder due to alpha galactosidase A deficiency leading to abnormal accumulation of glycosphingolipids in different parts of body.This case report introduces a 35-year-old man with diffuse keratotic erythematous papules. Histopathological evaluation of the skin biopsy suggested the diagnosis of angiokeratoma.With attention to his nephropathy and the same skin lesions and renal involvement in his brother, which led him to receive renal transplantation, the diagnosis of Fabry disease was suggested.