Iranian Journal of Dermatology
Year:2004 | Volume:7 | Issue:4|Papers Count:17

Isotretinoin (13-cis-retinoic acid) received United States Food and Drug Administration (FDA) approval for treatment of severe recalcitrant nodular acne in 1982. Today, it is used to treat a spectrum of dermatologic conditions. The efficacy of isotretinoin in treating severe nodular acne, disorders of cornification, and chemoprevention of non-melanoma cutaneous carcinoma in high-risk individuals is well documented. For some patients unresponsive to other standard therapies, isotretinoin is a miracle drug.    

Background: Several treatment modalities have been used for cutaneous leishmaniasis (CL) with various results. In vitro and in vivo studies have shown inhibitory effects of zinc sulfate (ZnS04) on Leishmania parasites. Objective: To compare the efficacy of intralesional injections of 2% ZnS04 solution with meglumine antimonate (Glucantime) in the treatment of acute Old World CL. Patients & Methods: Seventy-two patients with CL with a duration of less than 8 weeks were recruited in a randomized, double-blind, clinical trial in Isfahan province-an area endemic for Leishmania major-after giving written informed consent. They were treated with 6 weekly intralesional injections of either 2% sterile ZnSO4 solutions or Glucantime prepared in identical vials. The primary outcome measure was complete re-epithelialization of CL lesions. Results: Among 36 patients with 53 lesions treated with ZnS04 and 36 patients with 53 lesions treated with Glucantime, 13patients with 19 lesions and 22 patients with 31 lesions completed the trial, respectively. Inadequacy of treatment was the main reason for drop-out in 12 (33.3%) and 2 (5.5%) patients in ZnS04 and Glucantime groups, respectively (P<0.05). Complete re-epithelialization was observed in 2 (10.5%) and 19(61.3%) lesions 1 week after the end of treatment in the ZnS04 and Glucantime groups, respectively (P<0.05). Conclusion: A six-week course of weekly intralesional injections of 2% ZnSO4 solution was less effective than Glucantime in the treatment of acute Old World CL.      

Background: Latex allergy is a major occupational disease with prevalence nearly 5-17% among the health care workers. Objective: To determine the prevalence of latex glove allergy and its contributing factors among operation room staff. Patients & Methods: In this study, 512 operation room staff were evaluated for latex allergy, using a complete questionnaire. Those suspected to have latex allergy underwent these tests: eosinophil counting, measurement of serum total and latex specific IgE, latex skin prick test, latex and glove additives patch test. Results: From evaluated staff, 178 (34.8%) had a history of sensitivity to latex gloves, from which 59 persons underwent the tests voluntarily. According to the results of the tests, 13(22%) had type I allergy to latex, 3(5.1%) had type N allergy to latex and 9(15.3%) had both allergies. There was no significant relationship between latex allergies and age, sex, job, season, family and personal history of allergies. Significant relationship was found between type I allergy to latex and allergy to kitchen gloves and also between type IV allergy and allergy to other plastic clothing. Conclusion: Prevalence of latex allergy in this study is much higher than similar studies, which demands more evaluation to determine the contributing factors.      

Background: Various environmental factors can induce or exaggerate hand eczema. Objective: Evaluation of patch test results in hand eczema patients. Patients and Methods: In this descriptive study 100 patients with hand eczema referred to Loghman Hakim & Booali Hospital in Tehran underwent patch testing with 23 allergens obtained from Hennal Company. Results: 240 positive reactions observed in 86 patients. The most common positive reactions were related to nickel sulfate (30 patients, 13.5%) and potassium dichromate (28 patients, 11.7%). In positive group 28 patients were male and 58 were female. In negative group 3 patients were male and 11 were female (P>0.05). The mean age was 31.7±11.9 years and 24.8± 9.2 years for positive group and negative group, respectively (P<0.05). In positive patch test group 49 patients had subacute and 37 patients had chronic eczema. In negative patch test 11 patients had subacute eczema and 3 patients had chronic eczema (P>0.05). Conclusion: Performing patch test, the allergens involved in hand eczema can be detected. Detecting type of allergens, patients will be able to avoid those materials which can lead to improvement of disease.        

Background: Psoriasis treatment is very important regard to mental sequeler and creating orbidity. First line treatment of generalized plaque type psoriasis includes methotrexate,  phototherapy and retinoids. Objective: To compare bath-PUVA and acitretin in the treatment of generalized plaque type psoriasis. Patients & Methods: 40 patients with generalized plaque type psoriasis with PASI scores of 15-20 in Razi Hospital in Tehran were randomly divided into 2 groups after giving consent. Each group included 20 patients. The first group was treated three times a week with bath-PUVA and the second group treated with acitretin 0.7 the efficacy of 2 treatments was mg/kg/day. The efficacy of 2 treatments regimens were determined and compared using PASI scores. Results: The clearance rate was 65% in bath-PUVA group and 75% in acitretin group. Patients in bath-PUVA needed 29 sessions and accumulative dose of 105.46 J/cm2 for clearance. Conclusion: Psoriasis patients responded to bath-PUVA treatment but this response required more sessions and higher total dose. The inherent differences and distinctive responses to light in the patients under study (in Iran) compared with patients with skin phototypes I, II might explain these differences.      

Background: Neurofibromatosis 1 (NF1) is a relatively common autosomal dominant condition. Among the complications of the disease, such as neurological disorders, hypertension and skeletal deformities, malignancy is the most serious one and is the main cause of early death in these patients. Objective: Review of cases of NF-1 associated with malignancies. Patients & Methods: In a retrospective, descriptive study, 17 patients with malignancy and NF1 disease referred to oncology department of Qaem and Omid Hospitals (Mashad) in a IO-year-period between 1993 and 2003 were reviewed. Results: 11 patients were male and 6 were female. The median age of patients was 23 years. We observed 9 cases with malignant peripheral nerve sheath tumors, 4 with CNS malignancies, 2 with rhabdomyosarcoma and one case with breast carcinoma. Conclusion: Regarding the importance of early diagnosis of these malignancies, and especially considering the young age of involved patients, it is logical to plot a schedule to examine the NFI patients periodically. Physicians who are in contact with these patients should educate them to be aware of any suspicious signs and symptoms of malignancy.      

Background: The need for a rapid, noninvasive method for unwanted hair removal has led to the development of various light sources for this purpose. Objective: To evaluate the efficacy of Intense Pulsed Light Source (IPLS) on unwanted hairs. Patients & Methods: In this open, uncontrolled clinical trial, 77 different anatomical areas in 34 referred patients to "Novin Didegan Clinic" in Tehran in 1380-1381, were treated by IPLS at fluencies ranging from 22 to 34 j/cm2 after their demographic data and the number of hairs were recorded. The 3 to 7 treatment sessions were accomplished 4 to 6 weeks apart. All of the patients were followed 6 months after the last therapy. The quantitative data were  analyzed by paired t test. Results: Six months after the last therapy, more than 50% reduction in number of hairs was noted in 80% of the treated areas; with mean reduction of 72±23 percent. Side effects were mild and reversible and occurred in ten patients. Conclusion: The IPLS appears to provide an effective and safe method for long term excess hair removal in various skin types.      

Background: In spite of prevention and control programs, dermatophyte infections have a high prevalence worldwide. Objective: To do a descriptive study of dermatophytosis in Guilan.Patients & Methods: 217 patients whom were visited in Razi Hospital in Rasht in 1381 were screened for dermatophytosis and if had suspicious lesions, direct smear with KOH and culture were done. Results: 93 patients had positive smear (KOH 10%) and culture for dermatophytes. 50 patients were women and 43 patients were men. The most common patterns of dermatophytosis were tinea cruris (47.2%), tinea pedis (14%), tinea capitis (12.9%), onychomycosis, tinea manum, and tinea facei. Trichophyton mentagrophytes was the most common causative agent of tinea cruris that occurred more significantly in hot seasons. Conclusion: Tinea cruris was the most common type of dermatophytosis in this study. High prevalence of tinea cruris specially in women in comparison to the previous studies, may be due to occupational activity (agriculture) and clothing of women in north of Iran.    

Background: Prolactin, a neurohormone, can act as a stimulator of immunity in a number of autoimmune diseases and its high levels have been shown in these diseases. Objective: This study was designed to discover the possible role of prolactin in autoimmune blistering skin diseases. The main gole was to compare the serum prolactin levels and the frequency of hyperprolactinemia in autoimmune skin patients with a control group. Patients & Methods: Serum prolactin levels were measured In 44 patients with autoimmune blistering skin diseases and 44 ag.eand sexes matched normal persons. Results: The mean serum prolactin level was higher in the patients group than the control group (13.7 ng/ml vs 8.4 ng/ml). Seven of 44 patients (16%) had htperprolactinema which was significantly higher than control group (p=0.006). Conclusion: According to this study a higher frequency of hyperprolactinema was observed in patients suffering from autoimmune blistering diseases in comparison with a control group.    

Circumscribed juvenile pityriasis rubra pilaris (PRP) is a form of PRP that manifests with well defined erythematous scaly plaques with follicular keratosis mainly over knees and elbows. There are several reports of the association of PRP with other conditions. We report a boy with scattered erythematosquamous skin lesions and follicular hyperkeratotic papules since the age of six years. Skin biopsy was compatible with PRP. He also had hypoparathyroidism and brachyonychia. To our knowledge, this association has not been reported so far.      

Cutaneous larva migrans is a self-limited cutaneous eruption caused by larva of roundworms that do not normally parasitize humans. Ankylostoma brazielensis, the dog and cat hookworm, is the most common agent. The disease is found in tropical and subtropical regions and may be seen in travellers from these regions. We report a case of a 37-year-old Iranian man who had cutaneous larva migrans after traveling to Mexico. The patient was successfully treated with oral thiabendazole.