Iranian Journal of Dermatology
Year:2005 | Volume:8 | Issue: 5 (33)|Papers Count:20

Background and Objective: Pentavalent antimony compounds are the first line treatment of cutaneous leishmaniasis. However, because of their potential toxic effects attempts to find more effective and safer drugs still is in function. The objective of this study was to compare the  efficacy of oral omeprazole and low dose systemic meglumine antimoniate (MA) and full dose systemic MA in the treatment of cutaneous leishmaniasis. Materials and Methods: A double blind clinical trial was performed on 150 patients with cutaneous leishmaniasis. The patients were randomly divided to three groups: 1) intramuscular injections of MA (60 mg/kg/day) and oral placebo for three weeks; 2) intramuscular injections of MA (30 mg/kg/day) and oral omeprazole (40 mg/day) for three weeks; 3) intramuscular injections of MA (30 mg/kg/day) and oral placebo for three weeks. All patients were visited every two weeks from the beginning of the trial up to 6 weeks and then at 8 and 12 weeks. The effectiveness of the treatment was classified in three levels as complete response, partial response and failure. Data were analyzed by SPSS software version 10 by using X2, Mann-Whitney, Kaplan-Mayer and ANOVA t tests. Results: Three months after the treatment, complete response and partial response in group one (43 patients) were 93% and 0%, respectively, which were significantly higher than other two groups (P<0.05). Complete response and partial response were 88.9% and 2.8% in group two (36 patients), and 80% and 2.2% in group three (45 patients), respectively. Efficacy of the treatment in group two was significantly higher than group three (P<0.05). Conclusion: Although oral omeprazole and low dose of systemic MA showed less efficacy in comparison to standard dose of systemic MA in treatment of cutaneous leishmaniasis, it can be considered as an alternative therapy in high risk patients (such as patients with heart, kidney and/or liver disease) under close supervision of specialized physician.      

Background and Objective: Studies concerning the relation between mycosis fungoides (MF) and its leukemic form Sezary syndrome (SS) and infection with human T lymphotropic virus 1 (HTLV 1) Have yielded different findings. The objective of this study is to determine the frequency of HTLV 1 infection in MF patients. Materials and Methods: In a case-control study, 150 clinically and histopathologically confirmed MF patients and 150 normal individuals were evaluated and compared for the HTLV 1 infection. Sera of the participants were taken and evaluated by ELISA method. Positive results were confirmed by Western blot. Results: HTLV 1 infection was detected in 3 of 150 MF patients and 2 of normal participants. Conclusion: This study shows no association between HTLV 1 infection and MF in Iranian patients.      

Background and Objective: Fixed drug eruption (FDE) is one kind of drug rashes that is characterized by re-appearance of the lesions on the same sites after re-exposure to the causative drug. This study was performed to evaluate the epidemiologic characteristics of FDE. Materials and Methods: This descriptive study was done on a series of 100FDE cases, whom were admitted at the outpatient dermatology clinic of Hazrat-e-Rasoul Hospital over a six-year period. The primary diagnosis of FDE was suggested according to clinical findings including a remaining hyperpigmentation at the site of healed skin lesion(s). Oral challenge test with a single low dose administration of the suspected drug was used to confinn the diagnosis. Recurrence of the lesion(s) at the same body area(s) was considered as positive result. Results: Most commonly causative agents were co-trimoxazole and codein, which were found in 88% and 3% FDE cases; respectively. The most common site of involvement was penile glans in 57.7% of male patients and trunk in 48.3% of females. In one patient, reaction to multiple drugs including co-trimoxazole, codein and tetracycline was observed and after re-challenge with each drug, re-appearance of the skin lesion at the same site was evident. Several patients reported concomitant acetaminophen intake, but there was no reaction to that drug. Conclusion: Co-trimoxazole is the most common cause of FDE.      

Background and Objective: Unwanted hair has been one of the problems that many researches have done about it. There are several ways for removal of unwanted hairs including laser. Laser hair removal is a new method in this field and the main objective of this study was to assess its effectiveness in Iranian patients. Materials and Methods: This study was done on 58 patients attending Isfahan's Shahid Beheshti Laser Center for laser hair removal. In the first session, diode laser (42-61 J/cm2, 810 nm wave length, 200 msec pulse duration, 5 mm spot size) was used and if there was not any severe skin reaction, it was repeated up to four times at 1-1.5 month intervals. The main outcome measure was the number of hairs per cm2counted from digital photographs taken before the treatment and one month after the last treatment. All patients were followed up to 4 months after their last laser session. Results: Fifty-eight patients with mean age of 30 years, Fitzpatrick skin types of II, III and IV and predominant black unwanted hairs were treated with an 810 nm diode laser. The mean hair reduction was 64% and the most reduction was seen in patients with skin type IV (70.4%). The most common side effect was transient post laser erythema (34.5%). There was a weak and negative but significant relation between the clearance rate and energy fluence (F-0.29, P<0.05).  owever, the relation between the age of the patients and clearance rate was positive (r=0.42, P<0.05). Conclusion: 810 nm diode laser is an effective and safe hair removal method in Iranian patients. The effect of energy fluence and age of the patients on the final hair reduction in the patients merits further attention in future studies.      

Background and Objective: Leishmaniases represent a group of diseases caused by protozoan parasite of the genus Leishmania. Control strategies are not always effective; it seems that the sole control measure is to search for an effective vaccine. The objective of this study was evaluation of the rate of protection and immune response induction in Balb/c mice immunized with alum precipitated autoclaved Leishmania major (Alum-ALM) vaccine mixed with M. vaccae. Materials and Methods: Eleven groups of female 8-10 week old Balb/c mice were immunized subcutaneously (SC) three times, 21 days apart, with different doses of Alum-ALM mixed with different doses of either M. vaccae or BCG. The immunized animals and control group were challenged with 1 ×106 L. major. Development and progression of leishmania infection were assessed by footpad swelling measurement at the site of challenge and parasite burden in lymph nodes. The immune responses of vaccinated animals were evaluated in vivo by leishmanin skin test (LST) and in vitro by measurement of cytokine (IFN-y and IL-4) levels in mononuclear cell culture supematants and titration of serum anti-leishmania antibodies (IgG and its sub-classes). Results: Footpad thickness measurement after challenge with live L. major showed no significant difference between immunized groups and control group. However, there were some prominent exceptional cases in the parasite burden titration in groups 1,4,6, and 8. Immunization with low dose of Alum-ALM mixed with M. vaccae or BCG induced IFN-yproduction, and diminished IL-4 level (in vitro), and caused a stronger LST response in a group that received BCG as and  adjuvant. Mice that were immunized with high doses of Alum-ALM mixed with high doses of M. vaccae showed an increase in footpad thickness at the site of challenge and higher levels of IL-4 and IgG1. Conclusion: It seems that immunization of mice with a low dose of Alum-ALM mixed with M. vaccae as an adjuvant might induce a Th1 type response. M.vaccae mixed with low dose of Alum- ALM has an inhibitory influence on the parasite burden in the infected tissues of mice. Also, BCG mixed with different doses of Alum-ALM induces a Thl immune response in Balb/c mice. Apparently, there is n? significant difference in adjuvancity of BCG and M. vaccae. High dose of Alum-ALM mixed with high dose of M. vaccae induces a Th 2 response.      

Background and Objective: Several investigations have shown positive effects of microcurrent electrical current on fracture healing. In this study, the effects of microcurrent (microampere) on the full thickness incisional would healing of rabbits were evaluated by histological and tensiometerical methods. Materials and Methods: Thirty male adult rabbits were randomly divided into control and experimental groups. Each group divided into 3 subgroups, based on duration of study (4,7,15 days). Under general anesthesia and sterile conditions, one full thickness incision on skin of each rabbit was made. From the day of surgery, the experimental group received electrotherapy daily for 2 hours (current intensity: 200 µA/cm2, current density: 66 µA/cm2, frequency 0.5 Hz). Polarity was negative at first 3 days and was positive thereafter. At the end, rabbits were killed by choloroform and 2 samples were obtained from the wound tissue and the adjacent normal skin for histologic and tensiometeric studies. Number of neurtophils and fibroblasts and cross sections of vessels were counted. Data were analysed using student t test. Results: The number of fibroblasts on seventh day (862.6±70.1) was significantly higher (P<0.05) than control group (468±2+59). Tensile strength of experimental group at fifteenth day (2138.2±212) was significantly higher than relevant control group (1443.1±218.8). Conclusion: Daily application of microcurrent electrical current significantly accelerated wound healing process of incisional wound of skin of rabbits.      

Background and Objective: Skin diseases are one of the common medical problems in population. According to dermatological journals only scant studies has estimated the prevalence of skin diseases in the general population. This study was performed to assess the prevalence of skin diseases in Hamedan rural areas in western Iran in 2002. Materials and Methods: A random cluster sampling carried out and 9450 residents in rural areas of Hamedan enrolled into the study. All participants were examined by specialist teams and skin biopsies were done when required. All examination results were recorded in relevant forms and were analysed. Results: The most commonly observed skin diseases in study area were pityriasis alba (21%), melasma (18.5%), dermatitides (16.5%), nail disorders (13%), and acne (11.7%). The most commonly involved anatomic areas were head and neck (66.0%),58.3% of patients were male and the age range of all examined people was from 1 to 75 years. Conclusion: We found that prevalence and distribution of skin disorders in Hamedan are different from other parts of the world. Community-level education may reduce the severity and duration of these diseases resulted in a reduction of their burden of disease and public health improvement.      

Background and Objective: Shingles, also known as herpes zoster, results from the reactivation of the varicella-zoster virus (VZV) within the peripheral nerves and their relevant dermatomes, usually decades after recovery from chickenpox, the primary infection with VZV. Materials and Methods: In this cross-sectional study all patients with herpes zoster disease referred to the infectious and tropical diseases clinic of Yazd in a 6-year-periodbetween 1999and 2004 were reviewed. Results: One hundred nine patients were reviewed. The disease was most prevalent in patients from 61 to 70 years of age (28.4%), and 52.23% of them were male. The most commonly involved regions were thoracic (49%), followed by cervical (25.0%), lumbosacral (21%) and trigeminal (12%) dermatomes. Herpes zoster was most frequently observed in summer and the lowest frequency was in spring. Bilateral involvement was observed in 3% of cases. Conclusion: The results of current study are similar to other Iranian and foreign studies. The disease was more frequently observed in the elderly people. It affects both genders and both sides of the body with similar frequency. The most commonly involved dermatome was thoracic.      

Background and Objective: Mycobacterium leprae is an intracellular micro-organism that is the causative agent of leprosy. This micro-organism has a long division time and does not grow in vitro. For there reasons it is difficult to evaluate the effects of drugs on it. Amongst techniques used for detection of micro-organisms polymerase chain reaction (PCR) is promising. This study was conducted to diagnose lyprosy using two antigens by PCR. Materials and Methods: In this study by selecting specific M. leprae 36 kDa and 18kDa antigens, a set of primers were designed for each gene and biopsies from 15patients were screened for presence of M. leprae by PCR. Results: Specific segments of M. leprae antigens were replicated in 5 patients with these primers. Conclusion: PCR is a relevant and promising method for M.leprae detection in biopsies of leprosy patients and it can be considered as a method of choice for early leprosy detection, especially in high risk groups.      

Diabetes mellitus is the most prevalent endocrine disease that is recognized by hyperglycemia due to a defect in insulin synthesis (type I), insulin function or both (type II).To review the common skin manifestations of diabetes we have performed an extensive search in the literature, with an emphasis on the recent articles. Skin manifestations of diabetes are presented in four main categories as follows: 1-manifestations due to diabetes such as necrobiosis lipoidica and diabetic dermopathy, 2-skin infections, 3-manifestations due to diabetes complications such as diabetic ulcer, and 4-skin reactions to diabetes treatment. Cutaneous manifestations occur in about two thirds of diabetic patients and may take place as a result of microvascular complications, wound healing defect and/or other unknown mechanisms. Generally, cutaneous manifestations in diabetes happen after the background diabetic process has present but sometimes they occur long time before the diagnosis of diabetes.      

Basal cell carcinoma is the, most common skin cancer that has nodular, superficial, micronodular, Morpheaform, pigmented, metatypical and fibroepithelioma of Pinkus subtypes. In this report, we evaluated the efficacy of cryosurgery with liquid nitrogen for basal cell carcinoma in three patients. The response was good and patients were followed regularly. There were no recurrences after 25 months follow-up. This method is fast and appropriate for certain types of basal cell carcinomas.      

There are no reports of association of specific cutaneous conditions in patients with local recurrent palmar peeling. Herein, we report a case with characteristic clinical presentation of local recurrent palmar peeling associated with a port-wine stain lesion. To the best of our knowledge, that association has not been reported before. Interesting points in the presented case are unilateral occurrence of the peeling disorder and its limitation to the region of port-wine stain.      

Cutaneous nocardiosis is an acute or chronic infectious disease caused by a gram positive, aerobic bacterium. This disease may be limited to the skin or my manifest as a systemic disease. In cutaneous disease, skin lesions usually occur on the sites of trauma and present as cellulitis, pustules, abscess and pyoderma. The most common cause of cutaneous nocardiosis is Nocardia brasiliensis. Herein, we report a young male patient who has lost his right hanet) after an accident. Cutaneous nocardiosis developed near the amputation stamp. The patient completely cured after treatment with cotrimoxazole.