Iranian Journal of Dermatology
Year:2001 | Volume:4 | Issue:4|Papers Count:11

Introduction: Evaluation of the impacts of cutaneous leishmaniasis (CL) on the patients, their family and government are necessary. Unfortunately these evaluations have not been done. Objective: Due to increased incidence of CL in Isfahan province especially in rural areas, this study was done to assess the expenses of this disease in Isfahan in 1999. Patients and Methods: 196 patients were selected randomly from four areas of Isfahan province (2 rural and 2 urban), on the basis of data from Health Center in 1999. The amount of money that was paid for physician visit, traveling, accessory expenses (for example to buy insecticide), injections, dressing and drugs for treatment of CL were asked and recorded. Results: The mean amount paid in rural and urban areas were 208307 and 457327 Rials, respectively. Conclusion: Incidence of CL is about 10-30 thousands of patients in Isfahan each year, therefore the yearly expense of treatment is about 3-6 milliard Rials. We must change our strategies for controlling and eradicating this problem.

Background: Dermatomyositis IS an automimmune inflammatory myopathy with distinct cutaneous findings. Its etiology is unknown. Objective: The purpose of this study was to evaluate demographic, clinical and paraclinical findings in patients with dermatomyositis in Ahwaz. Patients & Methods: This is descriptive, retrospective study and the records of all patients with dermatomyositis admitted to Sina Hospital in Ahwaz from December 1990 to March 2000 analysed. Results: 10 cases with dermatomyositis were admitted during the time. The ages of 5 patients were less than 16 years and 5 were over twenty years. Nine of the patients were female and 1 was was male. Heliotrope rash was the first cutaneous sign in 9 and 6 patients had Gottron"s papules. All of the patients had proximal muscle myopathy and 1 patient also had nasopharyngeal involvement. The most common abnormal laboratory tests were the rise of SGOT and CPK. EMG were done on 9 patients and all haddignostic findings. 1 patient was pregnant and she also had pneumonia and perianal abscess. In 1 patients wound healing was impaired. None of patients had malignancy. Conclusion: Dermatomyositis IS more common in women then in men and the most common sign of the disease is heliotrope rash in Ahwaz.

Background: Paederus dermatitis, an acute erythemato - vesiculo - bullous dermatitis contracted through contact with the secretions of the Paederus species, is frequently seen among the people living in the south-west part of our country during spring and early summer months. Objective: This study was conducted to elucidate the responsible arthropod in Khuzestan Province and to study the clinical spectrum as well as the pathological findings at different stages of the disease. Patients & Methods: Within a period of about 3 months, from April to July 1999, 72 patients referred to our clinic with erythema, vesicles, bullae, pustules, superficial skin necrosis or combination of few or all of these findings clinically suggestive of Paederus dermatitis. Biopsy samples were obtained from 19 patients at different stages of the disease, stained by HE and studied histologically. All arthropods submitted by the patients and their families were crushed on our skin to identify the causative species. Results: The dermatosis is contracted through contact with the secretions of a Coleoptera specIes called Paederus Ramtinus. The painless and nonpruritic reaction developed 2- 3 days following contact as erythema and vesiculation which may gradually extend to necrosis and bullae. The pathologic changes were also variable and ranged from epidermal spongiosis to complete epidermal and upper dermal necrosis. Conclusion: Paederus dermatosis developed as a result of contact with the secretions of the species Paederus Ramtinus if by any way crushed or brushed off over the skin. The dermatosis is benign in contrast to its acute course no sequela is seen except for post inflammatory hyperpigmentation.

Background: Cutaneous leishmaniasis (CL) is a common cutaneous disease in the middle east countries such as Iran. Khoozestan is an endemic area for it. The importance of this disease is in the formation of an ugly scar on the face which damages beauty. There hasn"t been any effective topical treatment for this disease yet. Objective: To assess the effect of topical opium in the treatment of CL. Patients and Methods: A double blind, placebo controlled study was perfonned in Ahwaz during 1378 and 1379. 96 patients were included in this study and treated with a topical preparation of opium or placebo. The inclusion criteria for patient were: age more than 2 years, number of lesion less than 6, duration of disease less than 3 months, not usmg any drug with anti-leishmaniasis effect and positive direct smear. Pregnant or nursing patients were excluded. Results: From 58 patients who completed the study, 34 patients were given topical opium, 5 (4.2%) of them got cured. From 24 patients who were given placebo, only I (4.2%) patient got cured. This study did not show a significant difference between response to drug and placebo (p=0.12, chi-square test). Conclusion: From this study suggested that high concentration of topical opmm or combination of topical opium with other material to be carried out.

Background: Warts are common in renal allograft recipients (RAR) with reported incidence of 24% to 100%. These patients also demonstrate an accelerated malignant transformation of warts. Although in immunocompetent patients, the histology of common warts is quite predictable, this is not so in RAR. Objective: The purpose of this study was to evaluate the histopathologic findings of warty lesions in RAR. Patients and Methods: We examined 55 RARs for warty lesions. We took biopsy specimens from lesions that clinically appeared to be common warts and evaluated their hisopathologic features. Results: Among 55 RARs, 17 cases (30.9%) had warty lesions, and among 50 biopsied lesions, 47 lesions (94%) showed changes of verruca vulgaris and only 3 Lesions (6%) showed warts with dysplasia. No malignant transformation was reported. All patients were under treatment with prednisolone, cyclosporin and azathioprine. The median time passed from transplantation was 49 months. Conclusion: We couldn"t find evidence of dysplasia or malignancy in most verrucous lesions of RAR. This maybe due to relatively short time passed from transplantion In our patients.

We report of a 29-year-old man presented with yellow-red, scaling papules on the skin of scalp, retro-auricular folds, inguinal, axillary, chest and abdomen. The lesions had a poikilodermatious appearance in some areas, such as trunk. The patient also had diabetes insipidus and skull osteolytic lesions. The diagnosis of langerrhans cell histiocytosis (LCH) was suggested based on H& E staining of skin biopsy specimen. S-100 staining was positive in immunohistochemistry. Birbeck granules were seen in electron microscopic examination confirming the diagnosis of LCH. Considering the systemic involvement, he is a case of an extensive LCH in new classification and a case of Hand-SchullerChristian in the old classification. The cutaneous lesions of the-patients responded to oral thalidomide 200 mg daily after 2 months and did not recur after 6 months follow up.

Lupus vulgaris is a progessive form of skin tuberculosis occuring in the patients with a moderate to high degree of immunity. It is reported to be the commonest type of skin tuberculosis. Our case was a 40 year-old man who referred whith multiple, erythematous, annular plaques, 30-50 mm in diameter with active margin and few studded pustules throughout the lesions. Our first impression was thiea incognito so he received grisofulvin for one month, terbinafine and antibiotics (with diagnosis of chronic deep folliculitis and the prescence of multiple pustules )each for two weeks but showed no response. Family history of tuberculosis, positive PPD test, presence of multiple giant cells and inflammatory infiltration around adnexa in histopathologic examination made the diangosis of tuberculosis more possible. The patient was treated with anti- tuberculosis regimen. Improvement was noticed after 2 weeks and complete recovery occurred six months after treatment.

Proteus syndrome is a rare congenital disorder comprised of subcutaneous and internal hamartomas, miscellaneous skin and vascular nevi, skeletal and nervous system and eye malformations, characteristic with manifestaions including hemihypertrophy, local gigantism, macrodactyly and cerebriform thickness of soles and palms. A 23 year-old man with a diagnosis of proteus syndrome, had severe anemia due to chronic rectorrhagia due to haemorrhoid. In addition to this problem, he was operated on for atrial septal defect. He also had syndactyly as well as macrodactyly.