Iranian Journal of Dermatology
Year:2007 | Volume:10 | Issue:3 (41)|Papers Count:19

Background and aim: Genital wart is a common sexually transmitted disease caused by different types of human papilloma virus (HPV). Cryotherapy is one of the most commonly used treatment options. Trichloroacetic acid (TCA) is another therapycommorily used in treatment of genital warts. Materials and methods: The objective of his study was to evaluate and compare the efficacy and adverse effects of TCA and cryotherapy (with liquid nitrogen). Sixty female patients with external genital warts were enrolled into this prospective clinical trial. Thirty of them received topical solution of 80% TCA and the other 30 received cryotherapy with liquid nitrogen, once a week, until complete clearance of lesions or a maximum duration of 8 weeks.Results: Twenty-sevenpatients (93.1%) of those who received up to eight treatments of cryotherapy had complete clearance of their warts, compared with 28 (96.5%) of patients who were treated with TCA (P>0.05).The mean duration for complete clearance was 4.4 weeks for TCA and 5.2 weeks for cryotherapy (P=0.5). Patients who received TCA experienced a significantly greater number of local inflammatory reactions (P=0.01).Conclusion: Both cryotherapy and TCA are effective treatments. In comparison, TCA showed its efficacy earlier during the course compared to cryotherapy. TCA is more likely to cause adverse reactions.

Background and aim: The scars of the cutaneous leishmaniasis and psychologic problems of this disease need different intervention for its correction. Our objective in this study was to compare the efficacy of trichloroacetic acid (TCA) 50 percent solution and CO2 laser for treatment of the atrophic scars due to leishmaniasis.Materials and methods: This was a randomized clinical trial perfumed in 92 patients. Patients were randomized in to 2 groups, first group were treated with TCA 50 percent solution, once monthly and for maximum of 5 months, second group were treated with CO2 laser that was performed for only one time. Patients were followed at 3 months and 6 months after starting treatment. The improvement of scar was graded by 6-point scale using digital camera and the collected data were analyzed using SPSS software and t, Wilcoxon and Mann-Whitney tests.Results: In this study that 74 females and 18 males were followed, the improvement of scar was 48.13% in the TCA group and 44.87% in the CO2 laser group. This difference was not statistically Significant (P=0.55).There was also no significant difference regarding side effects between these 2 groups.Conclusion: The results of our study showed efficacy of topical treatment with 50 percent TCA solution is comparable with CO2 laser in the treatment of leishmaniasis scar. Because of the low cost and simple application of TCA solution in comparison with CO2 laser, we suggest the use of this treatment for correction of leishmaniasis or atrophic scars.

Background and aim: The frequency of sensitization to contact allergens varies in different countries because of both genetic and, more importantly, allergen exposure variations. The objective is to determine the frequency of sensitization to contact allergens in Iranian patients with dermatitis.Materials and methods: Four hundreds and one patients with a clinical diagnosis of contact dermatitis and/or atopic dermatitis were evaluated with a 24-allergen European standard series in four major cities in Iran. The patches were applied on the back of the patients, removed after 24 hours and the readings were taken on 24, 48 and 72 hours after application.Results: One hundred and seventy-six patients (43.8%) showed at least 1 positive reaction with total positive reactions of 268, and 64 patients (15.9%) had 2 or more positive reactions. The 5 most common allergens were nickel sulfate [64 (15.9%)], potassium dichromate [40 (10.0%)], thiuram mix [27 (6.7%)], cobalt chloride [23 (5.7%)], and Balsam of Peru [17 (4.2%)]. Contact allergy to nickel sulfate was significantly more common in female patients and in patients under 40 years of age (P<0.001).Conclusion: Nickel sulfate is the most common contact allergen in Iran, mostly affecting women and younger patients probably because of more exposure. Thiuram had a significant increase in its prevalence during the previous years and further studies need to distinguish its causes.

Background and aim: Pemphigus vulgaris (PV) is an autoimmune blistering disease which is known to involve the female genital tract but the frequency at which this occurs is unknown. There are relatively few reports in the literature of the cytological appearance of PV on cervicovaginal smears. Our aim was to evaluate involvement of the female genital tract and cervicovaginal Papanicolaou (Pap) smears in PV.Materials and methods: The study included 77 patients with PV visited from April 2005to February 2007. Each patient was subjected to gynecological examination and cervicovaginal Pap smear. Results: The mean age of patients was 44.7±13 years. Genital lesions were observed in 39 patients (50.6%).Labia minor was involved in 36 patients (92.3%), while labia major in 11(28.2%), vagina in 14 (35.8%), and cervix in six (15.3%). Cervicovaginal smears of 20 patients (25.9%) showed PV. Among 72 satisfactory smears, cervical Pap smears were normal in 25 patients (34.7%), inflammatory in 43 patients (59.7%), and dysplastic (low-grade cervical intra-epithelial neoplasia [CIN I] in four patients (5.5%). In 2 of these patients, Pap smears were normal repeated when patients were in remission.Conclusion: Involvement of the female genital tract might not be as infrequent as was previously thought and it is probably the second most common mucosal site of PV after oral mucosa. Genital lesions maybe missed and the need for thorough pelvic examination shouldn't be overlooked.

Background and aim: Basal cell carcinoma (BCC) is the most common skin cancer in white-skin populations. Recent studies suggest that BCC is not a single entity and different histological subtypes show different clinical behavior and might have different etiology. The aim of this study was to assess differences in age, sex, site of distribution and proliferative activity in histological subtypes of BCC. In addition association of BCC with solar keratoses is assessed. Materials and methods: We studied 299 cases of BCC from the archives of department of pathology, Mashad University of Medical Sciences in a three-year period. Clinical data were recorded and histological slides were reviewed to confirm the diagnosis and histological sub types.Results: We recorded 345 BCC in 299 patients with mean age of 59.2 years. 70.8% of patients were male and 29.2% were female. Ninety-four percent of lesions were located in head and neck. Solid pattern of BCC was the most frequent subtype. In superficial and micro nodular subtypes, patients were younger and the oldest patients had basosquamous BCC. Adenoid BCC had the most mitotic activity. In 22.2% of cases association with solar keratoses were observed.Conclusion: This study showed difference in age, sex, site of tumor, and proliferative activity in various histological subtypes of BCC that might represent different etiologic factors in different subtypes.

Background and aim: Basalcell carcinoma (BCC) is the most common cancer in humans. Activation of Hedgehog (Hh) signal has a key role in development of BCC. The end result of Hedgehog signal is Gli proteing. Gli 1 is a member of this family which activates DNA transcription. Previous studies showed increased expression of Gli 1 in BCC.Materials and methods: In this study 38 pathologic samples from patients with BCC were evaluated for expression of Gli 1. Results: In this study Gli 1 was most of time found in the nuclei and its expression was higher in invasive forms of BCC. We did not find any relationship between Gli 1 expression and location, recurrence, age, sexor history of radiotherapy in our patients. Conclusion: This study confirms the key role of Gli 1 in the pathogenesis of BCC. Gli 1 protein can help us to determine the prognosis.

Background and aim: Dermatophytosis (tinea, ringworm) is the infection of skin, hair or nail that is caused by various keratinophilic fungi (dermatophytes). Dermatophytosis is a common infection throughout the world including all parts of Iran. As conventional laboratory procedures for identification of different dermatophytes are slow or lack specificity, more rapid and reliable methods are still required.Materials and methods: Dermatophyte fungi were isolated from patients with dermatophytosis and preliminarily identified by macroscopic and microscopic morphological criteria. Total cellular DNA was extracted from isolates using conical grinder. ITSI-5.8s-ITS2 region of rDNA region was amplified by the universal fungal primers ITSI and ITS4 and digested with EcoRII enzyme.Results: 650-750 bp bands was produced, as expected. Digestion of the PCR products with the Restriction enzyme EcoRII produced different electrophoretic pattern and allowed us the identification and differentiation of common pathogenic dermatophytes including Trichophyton rubrum, T.interdigital, T. mentagrophytes, T. tonsurans, T.violaceum, T. schoenleinii, T. verrucosum, M.canis, M.gypseum and Epidermophyton floccosum.Conclusion: It seems that this PCR-restriction enzyme (PCR-RE) profile is a rapid and reliable tool for discrimination of important dermatophytes and can be an applicable method in reference medical mycology laboratories for diagnostic, as well as for large-scale epidemiological purposes.

Background and aim: Cutaneous leishmaniasis (CL) is a health problem of many countries in tropical and subtropical regions including Iran. Isfahan province is one of the foci of CL with the highest prevalence in Iran. This study was done 10 identify the species of Leishmania isolated from the patients in Ghohab Mohammad Abad, located in southwest of Isfahan which is a new foci of CL. Identification of the causative agent of CL is required to plan control measures and therapeutic strategies.Materials and methods: All residents of the village (18,477 individuals) were visited and interviewed to recruit patients with active lesion of CL. Direct samples and culture was taken from the suspected lesions for isolation and identification of Leishmania species. Identification was performed using kDNA minicircles in a PCR manner.Results: Forty three patients with suspected CL lesion were recruited and 25 parasitologically proven cases were identified. Eighteen isolates were used for identification and 7 isolates were excluded due to fungi contamination. All 18 isolates were characterized by PCR amplification to be Leishmania major.Conclusion: The etiologic agent of the CL in the region was identified to be L.major. Larger studies are needed to confirm that L. major is the rule etiologic agent of CL in this region.

Background and aim: Pruritus is a common disabling problem in patients with end stage renal disease. Several studies have recorded the relation between pruritus with hemodialysisin chronic renal failure (CRF) patients. This study was designed to evaluate the effect of hemodialysison pruritus of patients with CRF.Materials and Methods: After recording the demographicdata and the diagnosis of disease by a specialist, 44 patients with CRF undergoing hemodialysis with 44 CRF non-hemodialysjs patients were evaluated.Results: Pruritus in case group was 2.8 times of control group (P=0.033). Pruritus in female patients with CRF undergoing hemodialysis was 7.4 times of non-hemodialysis patients (P=0.006 N). No relation was found between itching and hemodialysis in male patients with CRF. Conclusion: Pruritus is a common problemin CRF patient with hemodialysis and hemodialysisis an important factor in the initiation of pruritus.

Cutaneous leishmaniasis is an endemic disease in Iran and there is no curative treatment. The disfiguring scar that remains after it subsidesis a major psychologic and emotional problem in these patients. Chronic leishmaniasisis a rare form of this malady which is seen in 5-7 percent of cases. In this article we report a 46-year-old man who was refered to us for a large leishmaniasis lesion consisting of a scaling erythematous plaque with several papules on the right side of face and nose. This patient was treated by a combination of systemic Glucantime, 50% trichlroacetic acid and oral fluconazole. Complete resolution was achieved after 4 months.

Psoriasis is a chronic inflammatory proliferative disorder of the skin that appears in many different forms and affects different parts of the body including the nails and joints. It may affect the quality of life by causing psychosocial stress. Psoriatic arthritis is a seronegative spondyloarthropathy with involvement of axial and peripheraljoints. Involvement of temporomoandibular joint is also a rare presentation of psoriatic arthritis. In this article we report a rare case of bilateral temporomandibular joint ankylosis secondary to psoriasis in a 50-year-old woman.