Iranian Journal of Dermatology
Year:2006 | Volume:8 | Issue:6 (34)|Papers Count:19

Background and aim: Side effects of long-term systemic isotretinion use with high accumulative doses on skeletal system have been known, but there are few studies about the effects of short term isotretinoin therapy for acne patients. This study was aimed to recognize the effects of systemic isotretinion on calcium homeostasis and bone density in acne patients referring to clinics affiliated to the Skin Research Center of Shahid Beheshti University of Medical Sciences.Materials and Methods: In this before and after clinical trial, 20 patients with severe acne vulgaris in whom systemic treatment with isotretinoin was indicated were assessed. They included 13 female and 7 male patients with a mean age of 24.3±4.7 years. Serum levels of calcium, phosphorus and alkaline phosphatase as well as lumbar and hip bone mineral density (BMD) of the patients were evaluted before and after treatment with 120 mg/kg total dose of isotretinion. Results were analysed using Wilcoxon signed ranked test before and after treatment and P values less than 0.05 were considered statistically significant.Results: The mean levels of serum calcium and alkaline phosphatase were decreased after treatment course while the mean level of serum phosphorus was increased in comparison to their mean levels before the treatment but the changes were statistically non-significant. BMD of neck and total femur showed no significant difference, but trivial increase (0.0151 gr/cm2) was detected in lumbar BMD after treatment (P<0.05).Conclusion: Considering no significant change in neck and total femur BMD and trivial and clinically unimportant increase in lumbar BMD (L2-L4), it seems that 120 mg/kg total dose of isotretinion that is used for acne has no significant effect on skeletal system.

Background and aim: Pentavalent antimony compounds are the first line treatment for cutaneous leishmaniasis. Clinical resistance to pentavalent antimony in the form of meglumine antimoniate (Glucantime) has been recognized as a problem in leishmaniasis. Herein, clinical response to Glucantime was studied in patients suffered from cutaneous leishmaniasis.Materials and Methods: In a cross-sectional study 370 patients with cutaneous leishmaniasis were treated with systemic Glucantime, 50 mg/kg/day, for 2 to 3 weeks. They were visited weekly for 3 weeks and also followed up for 3 months after treatment was completed. The clinical and parasitological response to this treatment was evaluated, and classified into partial and complete response and failure to treatment.Results: Two hundred forty-seven men and 123 women were followed up. The mean age was 36.7±16 years. There were 64.1% partial response after 2 weeks and 73% partial response at the third week of treatment. 11.6% of lesions were not cured after 3 weeks of treatment and 8.1% were not still cured 12 weeks thereafter.Conclusion: Clinical resistance to Glucantime is an important problem. The mechanisms of resistance and using drug combinations are needed to be considered.

Background and aim: Psoriasis is one of the most common papulosquamous diseases that often requires long-term maintenance therapy. Long-term use of topical corticosteroids on the face and intertriginous areas will increase the risk of steroids side effects such as striae and atrophy development. A safe, effective and inexpensive modality in topical therapy of inverse psoriasis is required. b adrenergic antagonists has been reported to exacerbate existing plaque psoriasis because of increasing concentration of intracellular cAMP. On the other hand, caffeine is a methylxanthin that inhibits phosphodiesterase enzyme and results in a higher concentration of intracellular cAMP. We evaluated the efficacy of topical caffeine 10% in the treatment of psoriasis. Materials and Methods: This randomized, double blind, controlled clinical trial was performed on 39 patients with typical lesions of psoriasis vulgaris who referred to dermatology clinics of Isfahan University of Medical Sciences from December 2002 to July 2003. These patients were randomized in two groups and treated by topical application of drug or placebo, three times per day. The patients were seen in two-week intervals for 8 weeks, and their PASI score was assessed in each visit.Results: The decrease of PASI score after 2,4,6 and 8 weeks compared to the first visit in caffeine treated group were 23%, 41%,54%, and 62% and in placebo treated group were 15%, 19%,25%, and 29% respectively (P<0.05).Conclusion: Topical caffeine may be an effective, safe and inexpensive therapy in psoriasis but its onset of action is late.

Background and aim: Acanthosis nigricans (AN) is characterized by hyperpigmented velvety plaques of body folds and neck. Insulin can have a role in the pathogenesis of this disease and hyperinsulinemia as a consequence of insulin resistance may stimulate the formation of the characteristic plaques of AN. In this study insulin resistance was compared in obese women with and without AN.Materials and Methods: Glucose tolerance test (GTT) and fasting blood insulin were measured in two groups of obese women (BMI>30 kg/m2) with AN (32 cases) and without AN (34 cases) and insulin resistance was determined using HOMA formula.Results: The mean fasting blood insulin in two groups with and without AN were 15.5±8.5 and 12.2±4.1 m IU/mL; respectively (P<0.05). The mean of insulin resistance in two groups with and without AN were 3.5±1.9 and 2.6±0.9; respectively (P<0.05). The results of GTT showed that the mean fasting blood sugar was 89.5±12mg/dl and following using glucose were 144±7 mg/dl after 30 minutes, 132±45 mg/dl after 60 minutes, 107±30 mg/dl after 120 minutes in persons with AN and in the other group were 87±8, 130±3, 122±26 and 100±26 mg/dl; respectively. The difference between two groups was only significant after 60 minutes.Conclusion: Acanthosis nigricans maybe a marker of insulin resistance in obese women.

Background and aim: An epidemiological association of lichen planus (LP) with hepatitis C virus (HCV) infection has been found only in certain parts of the world and in some countries no association has been noted. The present study was done to evaluate the association of LP with HCV in patients admitted to Sina hospital, Hamedan, Iran from 2002 to 2004.Materials and Methods: The presence of anti HCV antibody in 32 patients with LP was compared with 43 patients suffering from other dermatoses not related to HCV. Both patient and control groups were screened for the anti HCV antibody using ELISA. The positive cases were tested again using RIBA method. Only confirmed positive cases with the RIBA method, were considered as anti HCV antibody positive.Results: Anti HCV-antibody was positive in 3.1% of patient group (one out of 32) and in 7% of control group (3 out of 43).Conclusion: In Hamedan province no association was found between HCV infection and LP therefore the routine test of LP patients for anti HCV antibody is not necessary.

Background and aim: Low-power lasers relief pain in some musculoskeletal disorders and accelerate wound healing process. However, there are few reports on effects of low-power lasers on mast cells. In this study the effects of low-power gallium aluminium arsenide laser (Ga.Al.As.laser) radiation on number and deregulation of mast cells of open skin wound bed of rats were studied using quantitative histological methods.Materials and Methods: Forty-six male rats were randomly divided into experimerital and control groups. Each group divided into 3 subgroups based on duration of study: 4, 7 and 15 days. Under general anesthesia and sterile conditions one circular full thickness skin wound was made on the doesum of neck of each rat. The wounding day was considered as the day zero. From the day one, experimental rats received Ga. Al. Ar. laser radiation at a energy density of 1.2 J/cm2. After doing daily treatments, on days 4, 7 and 15, rats were killed by ether and samples were obtained from wound bed and normal adjacent skin from each rat. Samples were fixed in formalin saline and were prepared for routine histological study. Sections were stained by 0.1% watery solution of toluidine blue and total number of mast cells and their grades (one, two and three) were counted. In grade one, mast cell is intact, in grade two some granules have been extruded from the cell and in the mast cells of grade 3, degranultion is more extensive and widespread. Data were analysed by Student t test.Results: On the day 4, total number and grade one mast cells were significantly higher in the control group (P<0.01). On days 7 and 15, total number of mast cells and their grades were higher in the experimental group. The grade 2 mast cells on day 7 and grade 1 mast cells on day 15 of experimental group was significantly higher than control group (P<0.05).Conclusion: Low-power gallium aluminium arsenide laser irradiation on open skin wound of rats reduced significantly total number of mast cells and intact ones at inflammatory phase, and significantly increased active mast cells at proliferation, and intact ones at remodeling phases of the wound healing process.

Background and aim: Shortening of the duration of wound healing is an attractive subject for investigators in recent years. In this study, the effects of topical phenytoin, silver sulfadiazine, estrogen and their combination on wound healing were evaluated.Materials and Methods: This experimental study was accomplished on 30 male albino rats, which had an approximate weight from 110 to 150 grams and were kept under standard conditions. A skin wound with a diameter of 20 mm was cut on the back of neck of each rat. Animals were divided into 6 groups and each animal was cared in a special isolated cage. For the first group, no drugs were used on the wounds. Topical 1% silver sulfadiazine cream was used in the second group.Third group received topical 1% phenytoin ointment. Wounds in fourth group were treated with 0.06% estrogen cream. Wounds in the fifth group were treated with the combination of 1% silver sulfadiazine and 1% phenytoin creams and wounds in the sixth group were treated with combination of 1% silver sulfadiazine cream and the estrogen cream. Surgery day was considered as the first day and animals were followed up for 28 days. Wound surface area was assessed on each animal and the healing rate was assessed on days: 1, 3, 7, 14, 21.Results: The most effective treatments were topical estrogen cream alone and topical phenytoinsilver sulfadiazine combination. Combination of topical estrogen and other drugs and phenytoin alone showed less acceleration on wound healing.Conclusion: Although application of topical estrogen cream alone or combination of phenytoin and silver sulfadiazine creams showed more healing effect, but there was no significantly difference on the wound healing of animals that were treated by these products. Further studies on human wounds with larger sample size are suggested.

Background and aim: New modalities in the treatment of end-stage renal disease (ESRD) patients have increased their life expectancy and quality of life. A wide range of cutaneous manifestations are seen in ESRD patients. This study was conducted to determine the prevalence of cutaneous manifestations in ESRD patients on maintenance hemodialysis in the dialysis department of Imam Khomeini hospital.Materials and Methods: One hundred and four hemodialysis patients on maintenance hemodialysis in April, May, and June 2003 were interviewed and examined for skin problems. Results: Almost all patients had at least one cutaneous lesion. The most common cutaneous findings were changes in skin color and nail disorders (79.8%). The other common cutaneous manifestations were xerosis (74%) and pruritus (51%). Xerosis was more common in those patients with serum calcium level greater than 9.3 gr/dl (P<0.05). Hyperpigmentation was more frequent in patients with urine volume<500 ml (P<0.05) and in those who were more than 24 months on continuous hemodialysis (P<0.05). Pruritus was more common in those patients with a history of drinking alcohol (P<0.05). Nail involvement was seen in all 14 patients who were positive for HCV Ab, but was absent in those 5 patients who were positive for HBs Ag.Conclusion: Cutaneous manifestations are very common in ESRD patients on maintenance hemodialysis.

Background and aim: Cicatrical alopecia refers to lesions associated with permanent destruction of hair follicles. Several diseases such as folliculitis decalvans, lichenplanopilaris (LPP) and discoid lupus erythematosus (DLE) may result in cicatricial alopecia. Since cicatricial alopecia is scarring and affects both the appearance and psychosocial behaviours of the patients and also it can be an alarming sign of some systemic diseases, making an early diagnosis and proper treatment can prevent progression and further complications. The aim of this study was to determine the epidemiologic and clinicopathologic characteristics of cicatricial alopeica.Materials and Methods: A total of 100 patients with cicatricial alopecia were selected from those referred to the skin clinic of Sina hospital in Tabriz for further assessment from 1997 to 2004, Their disease was pathologically proven. All epidermiologic and clinicopathologic data were obtained through questionaires. The results were analysed by means of descriptive statistical methods.Results: Fifty-two of hundred patients were male and 48 were female. The highest incidence rate was found in 3rd,4th and 5th decades of life. The underlying diseases in descending order were: 30% (24 male, 6 female) had folliculitis decalvans, 25% (10 male and 15 female) had DLE, 18 ( 6 male, 12 female) pseudopelade of Brocq, 14%(4 male and 10 female) had LPP, 8% (4 male, 4 female) had morphea and 5 (4 male, 1 female) had keloidalis folliculitis. From a his to-pathologic point of view, lymphocytic cicatricial alopecia was more common among middle aged women (65%) whereas the neutrophilic type was more prevalent among middle aged men (35%). The ratio of lymphocytic to neutrophilic cicatricial alopecias was 2/1.Conclusion: Considering the high incidence of cicatricial alopecia, early stage diagnosis by biopsy and proper treatment will reduce further progression and especially alleviate psychosocial disturbances.

Background and aim: Atopic dermatitis (AD) is a chronic relapsing skin disease that commonly begins during infancy and early childhood. Research studies refer to a relationship between exacerbation of atopic dermatitis and exposure to house dust mite (HDM), but the role of HDM in the pathogenesis of AD is controversial. The objecitve of this study was to assess the correlation of density of HDM in homes of AD patients with clinical severity of AD and total serum IgE level. Materials and Methods: The severity of AD was determined in 150 patients referred to Hazrat-E-Rasoul hospital dermatology clinic from May 2001 to February 2003 using SCORAD. Total serum IgE level and mite population densities in 5 minutes suction of floors and mattresses at the homes of patients were determined.Results: There was a statistical correlation between relative mite population densities and total serum IgE with SCORAD (P=0.01).Conclusion: Reducing HDM population in homes of AD patient may help a better management of the patients.

Acute hemorrhagic edema of infancy (AHEI) is a rare skin disorder which was first described by Snow in 1913. Clinical manifestations are usually limited to cutaneous lesions and are most commonly observed in infants under the age of 1 year. Usually, there is a history of recent upper respiratory tract infection and antibiotic administration. Clinical presentation of this disease includes petechia and ecchymosis on the head, face and distal extremities. Herein, a typical case of AHEI in a 10-month-old infant is reported. Differential diagnoses of AHEI are discussed.

Hereditary benign telangiectasia is an uncommon idiopathic skin disorder characterized by generalized telangiectases and angiomatous lesions of the skin. The diagnosis should be suspected in patients with such cutaneous lesions, positive family history, no associated bleeding problems, and no mucosal involvement. We present six cases of hereditary benign telangiectasia in three generations of one family.