Iranian Journal of Dermatology
Year:2004 | Volume:7 | Issue:2|Papers Count:12

Background: Melasma is a pattern of facial pigmentation that affects upper lip, cheeks, forehead and chin. The disease is seen mainly in 30-55-year-old women, and may be regarded as a physiological change in pregnancy. Its etiologic nature is still unknown. Objective: To determine the prevalence of melasma in women in Ardebil city. Patients & Methods: The study was cross sectional - descriptive study done on 855 women in Ardebil city in 2002. Sampling method was cluster and 855 women in the age range of 12-85 years in 25 health services (from each family one woman over 11years) were randomly selected and necessary information have been collected by a questionnaire. Descriptive and analytic statistics were used to analyze data in SPSS program. Results: the prevalence of melasma among total participants was 39.5%, and 9.5% of melasma cases were pregnant women. The distribution of hyperpigmentation was mainly centrofacial (64.7%), and in 40.8% cases there was a positive familial history for melasma. Conclusion: Melasma is a common disease in Ardebil, and abundant search is necessary to understand the etiology and treatment of this disease.      

Background: Humans, rodents and sandflies have role in transmitted cycle of cutaneous leishmaniasis. To control the disease, promoting the environment, killing the rodents and poisoning the vectors are recommended, individually all over the world. Since, there is no effective vaccine against this disease, the integration of methods is considerable. Objective: To evaluate the efficacy of integration method in the control of cutaneous leishmaniasis. Patients & Methods:This study was an interventional study, which after knowing the ecosystem around the Imamzadeh Agha Ali Abbas in Natanz in Isfahan, perform the plat covering within a radius of 100m, entrances correction, pool and garbage storage removal and sweepings for the rodents within a radius of 2 kms around the Imamzadeh and poisoning the vectors have been done. Results: The incidence of disease was 3.7% in 1996 (before intervention) which was decreased to 1/17 in 1997 and to 1/12 a year later. Conclusion: Integration method consisting of environment improvement, rodents removal and poisoning as well as training high risk people is recommended to control cutaneous leishmaniasis.      

Background: There is controversy about the relationship dysfunction between vitiligo and thyroid Objective: To evaluate the relationship between vitiligo and thyroid disorders. Patients & Methods: This was a case-control study carried out on individuals with vitiligo in 2004 in Zahedan, that had it for at least 6 months as cases and individuals without vitiligo considered as the control group (age and sex were matched with case group). T3, T4, TSH, T3RU in both groups were assessed and FTI was calculated. Then hypo-, hyper- and euthyoid states were determinded based on FTI and T3 level (for T3 hyperthyroidism) and data were analyzed by conditional logistic regression. Results: Each study group consisted of 50 individual, 52% female and 48% male. In the patient group, 16% had thyroid dysfunction, 14% of which had hyperthyroidism and 2% hypothyroidism. In control group, 4% had thyroid dysfunction, 2% of which had hyper thyroidism and 2% hypothyroidism. In case group only one patient had signs and symptoms of hyperthyroidism but in control group none had clinical symptoms. With statistical analysis was done odds ratio =7 (p<0.05) and the difference was significant. Conclusion: Vitiligo patients should be evaluated for thyroid dysfunctions to prevent complications of thyroid disease.      

Background: Considering the difficulties, adverse effects and unsuitable response to commonly used drugs, it is essential to find an alternative, particularly local treatment for cutaneous leishmaniasis (CL). Objective: Determination of efficacy of topical paromomycin (Paromo-U ointment) against CL caused by L. major in mouse model. Materials and Methods: Skin lesions were created 1 to 3 months after inoculation of L. major promastigotes to the base of tail of small, white mice (outbred),. Then the mice were randomly divided to three groups including interventional (treatment by Paromo-U), control I (treatment by urea) and control 2 (treatment by distiled water) groups. The mice were treated topically twice a day for 8 weeks. Results: The mean lesion diameter of the lesions prior to treatment in interventional and control groups (urea and distilled water) were measured 10.9, 5.9 and 6.0 mm respectively and changed to 4.0, 12.7 and 14.3 mm 8 weeks after treatment. No leishman bodies were observed within the lesions of interventional group, whereas they were seen in all control groups. Conclusion: Paromo-U ointment was effective in the treatment CL caused by L. major in mouse model.      

Background: At present time, the diagnosis of onychomycosis is based on clinical signs, direct exam and fungal culture, whereas Pathologic methods have shown to be more sensitive than other methods. Objective: Evaluation of pathologic methods in the diagnosis of onychomycosis in comparison to direct smeer and culture. Patients and Methods: A nail sample was cut from 96 suspected onychomycosis patients by nail clipper. Then it was divided to four parts, and one part was stored. One part was fixed in 4% formalin and examined pathologically (PATH-PAS method). Another part was cultured in mycosilagar and Sabourand Dextrose Agar media and kept in room temperature for 4 weeks. Another part was directly examined by 10% KOH. The results of each method were recorded separately without knowing the results of others. Clinical signs with at least one positive result were considered as onychomycosis and the sensitivity of these methods were compared. Results: The most sensitive method was the combination of PATH-PAS and direct smeer (98%). There was no sigi1ificant difference between the sensitivity of smeer and pathological method, where as PATH-PAS and culture differed significantly. Conclusion: PATH-PAS is a simple and very sensitive method in the diagnosis of onychomycosis.    

Physicians' daily need for valid information about diseases, their limited time for finding this information, the inadequacy of traditional sources (e.g. textbooks) to address this matter, the disparity between physicians diagnostic skills and clinical judgment (which increase with experience) and their up to date knowledge and clinical performance (which decline by time), as well as dramatic development in the field of information technology that provides easy access to an uncountable number of data resources, all have resulted in the consideration of evidence-based medicine (EBM) as an appropriate approach to slove these problems. EBM is defined as: "the conscientious, explicit, and judicious use of current best evidence in making clinical decisions about the care of individual patients". The full-blown practice of EBM comprises five steps: step 1- asking a well-built clinical question; step 2- tracking down the best evidence which answer that question; step 3-critically appraising that evidence for its validity, importance, and applicability; step 4- integrating the critical appraisal with the clinical expertise and with the patients unique values and circumstances; and step 5- evaluating our effectiveness and efficiency in executing steps 1-4 and seeking ways to improve them for next time.      

Cutaneous leishmaniasis is a parasitic hyperendemic disease in Isfahan. Its lesions , can be solitary or multiple depending on the number of insect bites and is usually seen on exposed areas. The possibility of insect bite on palpebral area is rare due to the protection by eyelashes and palpebral motion. In this area, lesions are usually presented as chalazion, dacryocystitis and rarely ulcerative and cancerous forms. As there is a chance of dissemination of the parasite to conjunctiva, cornea and sclera from the adjacent skin, and it is also possible that scarring of cutaneous leishmaniasis may cause some ophthalmologic side effects, this kind of leishmaniansis can potentially be  very serious for eyes. In this report, a 13-year-old boy with upper and lower palpebral cutaneous leishmaniasis who consequently developed conjunctivitis and trichiasis is presented. This patient responded to treatment with systemic glucantime, but ultimately developed conjunctival and palpebral scar, exposure keratitis and loss of eyelashes.      

Basal Cell Carcinoma (BCC) is a malignant tumor that may arise in skin damaged by sunlight and ionizing radiation in bum or vaccination scars. Clinical variants of BCC include nodular, morphea type, superficial and polypoid. Tattoo reactions are histologically diverse and can be classified in three main classes: 1- allergic, granulomatous, and lichenoid reactions; 2- inoculation and infectious lesions; 3- coincidental lesions. The patient reported here was a 72-year-old woman with an erythematous fungiform lesion on her upper lip just on the tattooing line for 2 years, confirmed to be BCC on routine histopathology exam. Tattooing might be responsible for the development and unusual presentation of BCC in this case.