Iranian Journal of Dermatology
Year:2004 | Volume:3 | Issue:3 (27)|Papers Count:13

Background: In spite of different methods of treatment, there is not a simple, safe and complete curative treatment for cutaneous leishmaniasis (CL), yet. Objective: To compare the efficacy of intralesional Glucantime injection alone, with the combined triple therapy of cryotherapy, paramomycm ointment and intralesional Glucantime in the treatment of CL. Patients & Methods: 157 patients with CL were randomly allocated into two groups, 81 patients in group I were injected with intralesional Glucantime (twice a week up to healing of the lesions or maximum 6 weeks). 76 patients in group 2 were treated with paramomycin ointment (15% in 10% urea, twice a day), cryotherapy (maximum 3 times 2 weeks apart and injection of intralesional Glucantime (once a week), for the same period as group 1. Results: After 6 weeks, complete cure rate in group 2 (89.5%) was significantly more than group 1 (70.4%) (P<0.05). Conclusion: Our results indicating of more efficacy of the triple therapy is in accordance with the previous studies of combined cryotherapy and paramomycin. It could be recommended as a better treatment modality for CL wherever possible.      

Background: Basal cell carcinoma (BCC) is the most common skin cancer in whites. Objective: Determination of anatomical localization of BCC in relation to histological subtypes of this tumor. Patients and Methods: This survey is a descriptive cross sectional study carried out on 189 cases of BCC patients diagnosed in Hamadan Sina Hospital between 1997-1999. Results: This study showed seven histologic subtypes of BCC. Nodular type was the most common type (55/16%) and metatypical type had the lowest frequency (3.7%). Head and neck were the most common sites of all subtypes of this tumor and nose was the most common site of involvement (22.7%). Conclusion: Superficial BCC was more common on the scalp which may be due to irradiation used for the treatment of tinea capitis in the past.      

Background: P53 tumor suppressor gene mutation is one of the most common genetic alterations in human malignancies. The mutated form of the gene is stable and can be detected with immunohistochemistry methods. There is much controversy about the expression rate of this gene in malignant melanoma. Objective: To determine the frequency of the P53 antigen expression by sex, age, type and thickness of melanoma, and site of the antigen expression. Patients & Methods: Paraffin embedded blocks of 50 patients (45 primary and 5 metastatic) with documented diagnosis of melanoma were deparaffinized and immunostained with D0-7 monoclonal antibody. The lesions were divided depending on the degree of the staining as follows: 1-(no staining), 2-mild (less than 10%), 3-moderate (10% - 50%), 4-severe (more than 50%). Results: Of 50 cases, 27 (54%) evaluated skin biopsy specimens belonged to female patients and 23 (46%) skin biopsies were related to male patients. 40% of lesions were graded as no staining. 36% of lesions showed mild staining, 14%moderate and 10% severe staining. Site of expression was exclusively in the cytoplasm. There was no meaningful statistical relationship between severity of staining and the age group, and sex of the patients, type and thickness of melanoma (P>0.05). Conclusion: Mutation in P53 tumor suppressor gene probably occurs in the early stages of melanoma.        

Background: Recurrent aphthous stomatitis (RAS) is a common disease which several etiologic factors have been considered for it. The infectious agents and immunological factors are the most suspected causes. Recently a few studies with varied results have been done to clarify the role of Helicobacter pylori (H.pylori) in etiology of RAS. Objective: To find correlations between serum IgG and IgA levels to Helicobacter pylori and RAS. Patients & Methods: A total number of 29 patients with RAS referred to Urmia Skin Hospital were included in this case-control study. Control group consisted of 57 persons and was chosen from healthy individuals. Blood samples were taken and blood levels of IgG and IgA antibodies of patients and control were measured by ELISA method and collected data were analyzed by chi-square test. Results: IgG antibodies to H.pylori were found in the sera of %75.9 of RAS patients and %66.7 of controls. IgA antibodies were detected in %51.9 of RAS and %70.9 of controls. These differences were not statistically significant. Conclusion: There was no significant difference between IgG and IgA levels to Helicobacter pylori in patients with RAS compared to control group.      

Background: Monotherapy is not usually effective in the treatment of hirsutism. Objective: Comparison of two therapeutic regimens in the treatment of hirsutism. Patients and Methods: In this open parallel controlled clinical trial, 101 patients suffering from hirsutism were randomly divided into two equal groups. Fifty patients were treated with spironolactone ( 50 mg /day) plus cyproterone compound (from 5th to 26th day of menstrual cycle) and the other group (51 patients) received cyproterone acetate 50 mg /day (from 5thto 14thday of menstrual cycle) in addition to the above mentioned drugs for 6 months. The serum level of sex hormones and hirsutism score (Ferriman-Gallway) were determined before and after treatment. T-test, chi-2 test and linear regression analysis were used for data analysis. Results: Mean hirsutism score was 22/12±0/34 in first group and 22/15±0/34 in second groups before treatment. Hirsutism score was reduced to 12/74± 0/32 after treatment with 3 drugs and reduced to 16/73± 0/35 after treatment with two drugs. This reduction was significantly more in the first group after adjustment for other confounding variables (P<0/001). Conclusion: These two therapeutic regimens were both effective in the treatment of hirsutism without serious hepatic, renal and metobolic side effects. Treatment with 3 antiandrogen drugs was more effective in reduction of hirsutism scores.  

Background: Sarcoidosis is a granulomatous multisystem disease of unknown etiology. It has recently been tried to detect mycobacterial genome in biopsy specimens of patients with sarcoidosis by Polymerase Chain Reaction method. Objective: To detect and identify mycobacteria species in cutaneous lesions of the patients with sarcoidosis by PCR-RFLP. Materials and Methods: Twenty patients with clinical diagnosis of sarcoidosis were enrolled in this study. Clinical manifestations, appearance of naked granuloma under light microscope and exclusion of other diagnoses confirmed the diagnosis of sarcoidosis in the patients. By PCR-RFLP, genome of mycobacteria species was searched in paraffin embedded specimen of skin biopsies of the patients. Four PCR positive skin biopsy specimens of patients with cutaneous tuberculosis were used as positive control. Ten skin biopsy specimens with diagnoses other than tuberculosis were used as negative control. Results: Mycobacteria genome was not detected in any specimens of the patients. Conclusion: Our findings do not support the role of mycobacteria species in the pathogenesis of sarcoidosis.    

Immunosuppression is known to be associated with increased rate of malignancies and widespread dermatophytosis in the patients with Sezary syndrome and this may account for the occurrence of Kaposi' s sarcoma and generalized dermatophytosis in patient in this report. Herein, we report a 58-year-old farmer man, who admitted with two months history of severely pruritic skin lesions, which progressed to erythroderma. Concurrently some vascular lesions were observed on glans penis of the patient suggestive of Kaposi's sarcoma. Leukocytosis with eosinophilia (20%) and atypical lymphocylosis (more than 10%) were present. Microscopic examination of biopsy of erythrodermic skin lesions on trunk revealed Pautrier microabscess with dermal lymphocytic infiltration and cellular atypia, and the peripheral blood sample showing Sezary cells and high ratio of CD4/CD8 (45) lymphocyte were in favour of diagnosis of Sezary syndrome. The pathologic evaluation of the vascular lesion of glans penis proved the diagnosis of Kaposi's sarcoma. During the progression of disease, the patient was invaded by generalized dermatophyte infection. KOH smear of annular skin lesion showed mycelia of dermatophyte and culture proved Trichophyton rubrum to be the pathogenic agent.      

Ellis-van Creveld syndrome is a very rare congenital disorder which its principal features are polysyndactyly, chondrodysplasia, cardiac abnormalities and ectodermal dysplasia. We report a 10-year-old girl with major manifestations of this syndrome who also had multiple brownish macules and patches on trunk and extremities with aortic and pulmonary stenosis in echocardiographic evaluations.    

Granuloma annulare (GA) is an inflammatory benign cutaneous disease of unknown etiology that may manifest different clinical features. The most common presentation or classic form of the disease is flesh colored, annular, grouped papules. They usually begin on the extremities especially on the lateral or dosal surfaces of the fingers, hands, wrists, ankles, and insteps. Several clinical manifestations have been reported for this disease. Variants, such as localized, generalized, subcutaneous, linear, perforating and patch GA, have been reported. The generalized form may present as either disseminated, individual, usually skin-colored papules arise anywhere on the skin surface especially trunk, or annular to circinate erythematous lesions that resemble erythema multiforme, erythema migrans, erythema annulare centrifugum and erythema gyratum repens. In latter group, the popular quality is less obvious than the erythema. In these lesions, rings may spread centrifugally and centeral hyperpigmentation may be present. This report describes a case of generalized GA in a 46-year-old diabetic woman with annular and circinate erythematus plaques resembling erythema annulare. At first according to clinical and histological findings, diagnosis of erythema gyratum repens had been suggested but later, GA was confirmed.      

Basal cell carcinoma (BCC) is the most common malignant tumor of the skin which originates from the basal cell layer of the skin. It is more common in white race with skin types I and II. Some predisposing factors are sunlight, ionizing radiation, arsenic salts, PUVA and scar. We present a case of BCC which appeared over an old scar of localized cutaneous leishmaniasis in a 49- year-old woman.