Iranian Journal of Dermatology
Year:2006 | Volume:9 | Issue:3 (37)|Papers Count:22

Background and aim: Azathioprine is the most widely used immunosuppressive agent as an adjunct to corticosteroids in the treatment of pemphigus vulgaris (PV). Thiopurine methyl transferees (TPMT) are a key enzyme in azathioprine metabolism and a genetic polymorphism controls its activity in human tissue. TPMT activity can provide a rational basis to determine suitable dose of azathioprine, theoretically. The aim of this study was to evaluate the clinical relevancy of this hypothesis in PV patients.Materials and Methods: In this cross sectional study in Razi Hospital, the activity of TPMT in the red blood cells of 52 PV patients who received azathioprine for at least 12 months and 29 PV patients who did not receive this drug was measured and correlated to the clinical response and side effects observed.Results: The mean of TPMT activity was not significantly different in patients with unfavorable response, comparing to patients with favorable response to azathioprine (P=0.087). No relationship was observed between total dose of corticosteroid and TPMT activity (r=0.089, P=0.583). There was no difference between the mean of TPMT activity in patients receiving azathioprine and those not receiving this drug (P=0.36).Conclusion: A direct relationship was not observed between TPMT activity and clinical efficacy and side effects in PV patients under treatment with azathioprine. Larger prospective studies in more homogenous patients are needed to evaluate the clinical relevance of TPMT polymorphism and to determine accurate azathioprine dosing guidelines based on TPMT activity.

Background and aim: Cutaneous leishmaniasis is an endemic disease in Iran. Although there are many different treatments for this disease, there is not any effective treatment yet. Since there have been a number of different reports on the effectiveness of Cassia fistula plant in the treatment of leishmaniasis, the efficacy of concentrated boiled extract and hydro alcoholic extract of Cassia fistula on the leishmaniasis disease was compared with intralesional injection of Glucantime in this study.Materials and Methods: In this randomized clinical trial a total of 165 patients, 6 to 60 years old, who had a positive leishmania smear referred to the Isfahan Skin and Leishmaniasis Research Center were divided into three groups using list of random numbers and were treated with: concentrated boiled extract of Cassia fistula, hydroalcholic extract of Cassia fistula, or intralesional injection of Glucantime. The patients were treated for 4 weeks and followed for three months after the study started. The efficacy of treatment was reported as complete cure, partial improvement and no improvement on the basis of clinical and parasitological evidence.Results: In the present study 63/6% of patients treated with the concentrated boiled extract, 52/7% of the hydroalcoholic extract and 45/5% of the Glucantime group were men. 22 patients (40%) of the concentrated boiled extract of Cassia fistula, 20 patients (36/4%) of the hydroalcoholic extract of Cassia fistula group and 36 patients (65/5%) of the Glucantime group showed complete cure. The efficacy in the third group was much more than the first (P<0.02) and second groups (P<0.005), but there was not any difference between concentrated boiled extract and hydroalcoholic extract of Cassia fistula.Conclusion: The results of this study showed that this plant might be used topically along with Glucantime for decreasing the time and dose of treatment with Glucantime.

Background and aim: Paederus dermatitis is an acute self-healing blistering disease caused by an insect from the genus Paederus species. Although it is a self-limited disease, it can cause disablement and suffering. The objective of this study was to investigate the efficacy of fluocinolone cream, triclocarban (TCC) soap and betamethasone lotion in comparison with placebo in the treatment of paederus dermatitis.Materials and Methods: This study was a randomized single blind placebo controlled trial which was performed in Behshahr hospitals during a period of two months. Seventy-seven patients with paederus dermatitis were randomized to treatment with fluocinolone cream, TCC soap, betamethansone lotion or a placebo. The condition of each patient was checked three times; i.e., on their first, fifth and twelfth day of receiving treatment. Finally, depending on their response to treatment, they were divided into two groups, those who fully recovered and those failing to recover.Results: Of the 77 patients studied, 18 were treated with a placebo, 17 with betamethasone lotion, 24 with fluocinolone cream and 17 with TCC soap. Complete recovery at the end of treatment was fluocinolone 100%, betamethasone 100%, TCC 58.8% and placebo 33.3%. Significant differences were observed between two first groups and the placebo group (P=0.0001) but no significant difference was observed between TCC soap and placebo.Conclusion: Topical corticosteroids displayed a relative and significant improvement in paederus dermatitis.

Background and aim: Cutaneous leishmaniasis (CL) is an edemic disease widely spread in Iran. Although several treatments have been tried, none has been found as simple and effective. Honey has been used in the treatment of chronic ulcers and its anti-leishmanial effects have also been reported. So we assessed the efficacy of honey in acute CL.Materials and Methods: In a randomized clinical trial, 100 patients with CL referred to Skin and Leishmaniasis Research Center were treated with either weekly intra-lesional injection of Glucantime alone or combined with twice daily topical application of honey. The patients were evaluated clinically 2, 3 and 4 months after treatment.Results: Ninety patients completed the study, forty-five patients were treated in each group. At the end of trial, 32 patients (71/1%) of these treated with Glucantime alone and 23 patients (51/1%) treated with honey were cured (P=0.04).Conclusion: Drug interference and inhibition of bioavailability of Glucantime by honey may decrease the efficacy of Glucantime in treatment of CL.  

Background and aim: Adult T cell leukemia/lymphoma (ATLL) is an aggressive malignancy which may occur in human T lymphotropic virus 1 (HTLVI) infected persons. HTLVI is endemic in Khorasan with prevalence of 2.3% in general population. Since specific cutaneous manifestations of lymphomamay occur in a significant number of patients, we studied ATLL patients in Mashhad. Materials and Methods: In this descriptive study the demographic and clinical data of 23 patients suffering from ATLL who were admitted in hematology and dermatology departments of Ghaem Hospital, during 1995-2004 and had specific cutaneous lesions confirmed histopathologically with atypical lymphocytes in skin lesions, were recorded and analyzed.Results: Eleven patients were male and 12 were female. The mean age of patients was 48.17±14.1 years. Birth places of over 85% of cases were north of Khorasan. The most common types of specific skin lesions were maculopapular rash in 11 cases (47.8%) and papular lesions in 4 cases (17.4%). Other lesions included plaque, icthyosis like, erythroderma, tumor, and nodular lesions. In most of patients (56.5%) the skin lesions were generalized.Conclusion: The most common type of specific skin lesions in ATLL was maculopapular rash especially with generalized distribution. Other types of specific skin lesions in order of frequency were papule, plaque, icthyosis like, nodule, tumor and erythroderma.

Background and aim: Atopic dermatitis (AD) is a chronic disorder that is most common in early childhood. Both immunological and psychological factors are important in AD pathogenesis and should therefore be taken into account. The aim of this study was to compare behavioral characteristics of 30 infants (3-12 month-old) with AD with 40 controls.Materials and Methods: The infants with the definite diagnosis of atopic dermatitis referring to Children Medical Center and Center for Research & Training in Skin Diseases & Leprosy were included in the study. The severity of atopic dermatitis was determined by SCORAD criteria. For assessing behavioral characteristics Infant Behavior Questionnaire (IBQ) for measuring 11 scales of behavioral characteristics was used. Questionnaires were filled by the researchers with the cooperation of the patents or the child care givers.Results: The AD group showed significantly higher scores in perceptual sensitivity, soothability and high pleasure, but not other characteristics.Conclusion: Infants with AD tend to have higher perceptual sensitivity to the environment around them and show more pleasure and excitement when subjected to an intense, rapid, novel or incogruit stimuli compared with non atopic infants.

Background and aim: Hirsutism is a common clinical problem among women; however estimates regarding its prevalence in our population are limited. The objective of this study was to estimate the frequency and features of hirsutism in yound women in Iran.Materials and Methods: This descriptive-cross sectional study was performed on 800 female (18-25 years) medical students of Tehran medical universities in 1999. Evaluation included a history and a modified Ferriman-Gallwey hirsutism score in four different androgen-sensitive skin areas. The volunteers recorded their weight and height, the presence of menstural dysfuncion, acne, positive family history for hirsutism, as well as ingestion of oral contraceptive pills, corticosteroids or anabolic steroids using a questionnaire. Data were analyzed using chi-square test and P<0.05 was considered significant.Results: The frequency of hirsutism in our population was 22.8% (183 of 800). 17.3%, 5.1% and 0.3% of the population studied had mild, moderate and severe hirsutism, respectively. The prevalence of obesity (body mass index> 25), acne, positive family history for hirsutism, menstrual dysfunction, and consumption of corticosteroid and OCP was significantly higher in hirsutes.Conclusion: Hirsutism is a very common abnormality in this group of woman in Iran. Higher hirsutism frequency in this survey comparing to previous records in other population shows that the hirsutism definition and scoring system should be modified due to racial/ethnic variations in terminal hair quantity and distributions and different concept of this abnormality in each population.

Background and aim: Malassezia yeasts are normal flora of humans and warm-blooded animals. These lipophilic yeasts are associated with skin diseases in neonates such as pityriasis versicolor, neonatal postulitis and seborrhea or atopic dermatitis. Moreover in the recent years, these yeasts are increasingly isolated form fatal catheter-related fungemia in premature neonates. Concerning the role of Malassezia species in neonatal diseases and variation in their pathogenesis and sensitivity to antifungal drugs, we investigated the distribution of Malassezia species and related predisposing factors in neonates.Materials and Methods: 261 skin samples from scalp, chest and ear were collected from neonates in both Children Medical Center and Vali-Asr Hospitals using cellotape method and sterile wet swab. All samples were also inoculated in plates containing Leeming-Notman medium and Malassezia colonies were then sub-cultured on modified-Dixon and SCC media. Malassezia species were identified accoding to their macroscopic and microscopic morphological features and their physiological properties including tween assimilation test, catalase reaction and splitting of sculine.Results: In this study 36% of samples were collected from Vali-Asr Hospital and the rest from Children Medical Center. The average age of the examined individuals was 11.7 days. 58.7% of neonates were boys and 41.3% were girls. Based on culture results, 68.9% of examined neonates had Malassezia flora. Besides, significant differences in frequency of isolated Malassezia were not seen between either two examined hospitals nor NICU and neonatal wards. M. furfur was the most common isolated species followed in frequency by M. globes. In addition, M. obtusa and M. slooffia were recovered only once from trunk and head samples, respectively. Conclusion: In contrast to Malassezia flora in adults which is M.globosa, we isolated M. furfur as the dominant flora in neonates. This high prevalence of colonizationmay put hospitalized neonates in great danger of nosocomial Malassezia infections. Considering high mortality of Malassezia fungemia in neonates, skin should be cleaned effectively from Malassezia flora prior to administration of intra venous lipid or catheters.

Background and aim: Improvement of wound healing in normal subjects and in chronic ulcers has been always desired. The availability and acceptability of herbal medicine led us to study the effect of topical 10%mucilage of quince seed in human skin.Materials and Methods: This double-blind clinical trial has been conducted on 34 patients referring to Imam Hospital, clinic of dermatology for elective surgery or excisional biopsy of benign lesions. The patients were divided into 3 groups and their lesions were treated with either 10% quince mucilage or eucerin or left untreated. The wound surface was measured on the days 0, 3, 5, 7, 14 and 20. The data were analyzed by ANOVA.Results: The mean duration of complete healing was 10.72 days in quince mucilage, 15.62 days in eucerin, and 16.7 days in untreated group (P<0.05).Conclusion: 10% quince mucilage ointment improved wound healing. Further and larger studies are needed to evaluate the quince mucilage effect and its possible application for patients suffering form chronic ulcers.

Background and aim: Eczema is a common inflammatory skin disease. Although history and physical examination are important in diagnosis of allergen, because of extent of environmental allergens, those are not simply recognized. The objective of this study was to determine allergens in patients with contact or atopic dermatitis referred to Razi hospital.Materials and Methods: This descriptive, cross sectional study was performed on patients with contact or atopic dermatitis in 2003-2004 with European Standard Series patch test containing 24 allergens.Results: In this study 223 patients were tested with a mean age of 31 years (SD=12). The most common involved location was hand (59%). The most common allergens were nickel sulphate (23/2%), cobalt (11/4%) and thiuram (8/3%).Conclusion: Nickel sulphate was the most common contact allergen in this study.

Delivery of drugs into systemic circulation via skin has generated lots of interest during the last decade. Transdermal drug delivery systems offer many advantages over the conventional forms or sustained release delivery systems. When technically feasible, topical delivery of drug products for both local and systemic indications offer many advantages over oral or parenteral routes, such as the need for fewer administration, constant blood level, elimination of the potential for both under and overdosing, and avoidance of first-pass metabolism. Skin structure shows that it is relatively impermeable to exogenous substances and drugs. Understanding this structure will help us to improve drug delivery using prodrugs, chemical enhancers, iontophoresis, electroporation and ultrasound waves. This review will overview the structure and function of skin, the skin routes, the interactions between skin and drug delivery systems and advantageous and disadvantageous of skin as a route for drug delivery. Thus the properties and interactions of three entities-the skin, the drug and the drug delivery excipients-are going to be considered.

Pemphigus vulgaris is a blistering autoimmune disease with suprabasal cleft formation, which is the most common autoimmune blistering disease in eastern countries, such as Middle East. Predisposition to pemphigus is linked to genetic factors. Tuberous sclerosis is also a genetic disorder of hamartoma formation in many organs, particularly the skin, brain, eye, kidney and heart.We report a 17-year-old boy with pemphigus vulgaris associated with tuberous sclerosis, which to our knowledge the first report of this association.  

Acquired port-wine stain is a rare vascular lesion that mimics a congenital port-wine stain clinically and histologically, but is acquired after birth. A survey on more than 60 reported cases in the literature reveals that most of these cases are idiopathic, but some of the cases developed after physical or mechanical trauma, hormonal changes, chronic sun exposure, and medications (OCP, isotretinoin, etc). The pathogenesis of acquired port-wine stain like its congenital counterpart is obscure, but is thought to be related to a functional deficit of perivascular sympathetic neural control after mechanical trauma or other possible factors. Laser is the first choice of treatment in both congenital and acquired port-wine stains.We, herein report two rare cases of acquired port-wine stains. Both of the cases presented at the age of 15 years. One of them was idiopathic and the other one developed after a mild electrical burn on her hand. The histopathological findings of their biopsy specimens were compatible with the diagnosis of port-wine stain.  

Granuloma annulare (GA) is an inflammatory benign cutaneous disease of unknown etiology that may manifest different clinical features. The most common presentation or classic form of the disease is manifested as flesh colored, annular grouped papules, commonly involving the hands and feet. Various skin injuries and infections have been reported to trigger GA, including insect bites, warts, herpes zoster, acquired immunodeficiency syndrome and Epstein-Barr virus infections. Several clinical manifestations have been reported for this disease such as localized, generalized, subcutaneous, linear, and perforating and patch GA, have been reported. Linear form is a rare variant of localized GA, and other skin diseases occurring in a linear configuration such as rheumatoid nodule, wart, morphea, and epidermal nevus must be differentiated from linear GA. This report describes a case of a 3 cm linear, flesh-colored, lesion with beaded border on dorsum of right index finger in a 8-year-old girl with histological findings of GA.