Iranian Journal of Dermatology
Year:2007 | Volume:10 | Issue:2 (40)|Papers Count:15

Background and aim: Treatment of resistant warts is a common clinical problem. Immunotherapy with diphenyl cyclopropenone (DCP) as a contact sensitizer has been reported. The objective of this study was to evaluate the efficacy of DCP in refractory warts.Materials and methods: Nineteen patients with refractory warts referred to Razi Hospital in 2004 who had not responded to at least 2 treatment modalities, were sensitized with 2% DCP in acetone. Then treatment was started with application of] % DCP on plantar warts and 0.2% on other locations.Results: Two patients were not sensitized even after 3 attempts. Three other patients discontinued treatment due to side effects (severe eczema and pruritus). Six male and 8 female patients completed the trial, among them, 10 (71.5%) showed complete clearance of warts. Side effects reported were: local pruritus (21%), distant eczema (10.5%), local blister (26.3%). The patients received a mean of 5 treatment sessions.Conclusion: Topical immunotherapy with DCP is an effective treatment for refractory warts. Due to high efficacy, no scarring, and being a painless procedure it can be considered as a first line treatment of refractory warts.

Background and aim: Psoriasis is one of the most common inflammatory skin disorders with a genetic background. Several treatment modalities have been used, including systemic and bath PUVA. The aim of this study was to evaluate the efficacy of systemic and bath PUVA in the treatment of psoriasis in Razi Hospital.Materials and methods: This retrospective database study was done in Razi Hospital and the records of 390 psoriatic patients referred to phototherapy unit in 1999-2003 were studied. One hundred and forty nine patients were treated with systemic and 238 patients with bath PUVA.Results: The most common form of psoriasis was the plaque type and the majority of patients were male. Complete remission of disease was achieved in 20.1% of systemic PUVA and 17.2% of bath PUVA patients, usually after 20-29 sessions of phototherapy. The mean cumulative UVA dose for complete remission was 233.46 and 108.79 J/cm2 in systemic and bath PUVA groups, respectively. Relapse occurred in 33.3% and 17.07% of patients achieving complete remission in systemic and bath PUVA groups, respectively. Erythema was the most common side effect in both groups.Conclusion: Both systemic and bath PUVA are efficacious in the treatment of psoriasis. The total UVA dose needed for complete clearance was higher in systemic PUVA and relapse occurred more frequently in this group.

Background and aim: Psoriasis is a chronic inflammatory dermatosis that affects 0.6% to 4.8% of the population. Phototherapy is commonly used in the treatment of this disease. According to the results of previous studies that showed difference in minimal erythema dose between different body sites, it seems that the responses of psoriatic lesions are also different in various body sites. Our objective was to compare the response of psoriatic lesions to phototherapy in various body sites.Materials and methods: Forty patients with generalized chronic plaque-type psoriasis were enrolled in this study. All patients were examined prior and during phototherapy course every 10 sessions. In each patient time of clearance of psoriatic lesions at trunk, upper and lower extremities were recorded separately.Results: At the end of phototherapy course the lesions of the trunk were cleared completely in 32 patients, and remained partially in 8 patients. The lesions of the upper limbs were cleared completely in 37 patients, and remained partially in 3 patients. The lesions of the lower limbs were cleared completely in 22 patients, and remained partially in 16 patients. Incomplete responses were significantly higher on the lower limbs than the trunk and upper limbs.Conclusion: Therapeutic response of psoriatic lesions to phototherapy is lower on the lower limbs than the trunk and upper limbs.

Background and aim: Pemphigus vulgaris is an autoimmune vesiculobullous disorder. Prior to the advent of glucocorticoid therapy, it was often fatal. Now its mortality and morbidity is due to high dose glucocorticoid complications rather than the disease itself. This study was aimed to determine the effect of dapsone as a second adjuvant in the treatment of pemphigus vulgaris.Materials and methods: In this quasi-experimental open prospective study, 22 patients with moderate to severe pemphigus vulgaris were treated with prednisolone, azathioprine and dapsone. They were observed for 12-18 months.Results: Patients consisted of 10 females and 12 males with mean age of 41.71 years. The mean duration to reach to the maintenance dose of prednisolone (7.5 mg daily) was 13 months. No major relapse was observed but minor relapses were seen in 6 patients with mean prednisolone dose of 13.8 mg daily. Hemolysis was detected in only one patientand 4 patients had a little drop in hemoglobin level. We observed no other severe dapsone induced adverse reaction.Conclusion: These findings suggest that dapsone can be used as a second adjuvant for more rapid tapering of steroid dosage without significant flare of the disease.

Background and aim: Vitiligo is an acquired idiopathic hypomelanotic disease. The purpose of this study was to review clinical characteristics of vitiligo and their significance in the progression of vitiligo.Materials and methods: Eight hundreds and sixteen cases of vitiligo were studied from February 2005 to October 2006. All of the patients were referred to dermatology clinics in Kerman city. Questionnaires were completed regarding progression, sex, family history, clinical type, age at onset, site of lesions, duration of disease, Koebner phenomenon, leukotrichia, and mucosal involvement.Results: Six hundreds and seven patients (74.39%) showed progression of disease and 209 patients (25.61%) did not show progression. There was no significant difference between the two groups in regard to sex, age at onset, leukotrichia, positive family history or longer duration; however, in patients with non-segmental clinical type, Koebner phenomenon and mucous membrane involvement indicated more progressive course of vitiligo (p<0.05).Conclusion: The progression or prognosis of vitiligo may be related to clinical characteristics such as clinical type, Koebner phenomenon, and mucous membrance involvement.

Background and aim: Appearance concerns are increasingly common. Indeed, clinical surveys in the private settings show that more and more people are dissatisfied with some aspects of their physical appearance. Concurrently, there is increasing demand for cosmetic specialists to perform procedures to enhance physical appearance. It is hypothetized that body image and acceptance of cosmetic surgery in the individual's environment motivate patients to have cosmetic procedure. Current study aimed to determine the demographics and body image concerns in persons seeking botulinum toxin type A injection as a cosmetic enhancement in private dermatologic clinics.Materials and methods: A questionnaire survey was done on 116 applicants attending 13 private dermatologic practices in Tehran.Results: The level of academic education and employment of women seeking this procedure was significantly higher than the average Iranian women. Forty-four percent of applicants reported previous cosmetic surgery which was significantly related to the experience of surgery among their first degree relatives. The number of applicants 20-35 years old was twice the number observed in USA, in the same age group.Conclusion: The high number of applicants in lower age groups is significant in this study. The best predictors of motivation for this cosmetic procedure were the level of education and individual's environmental acceptance, not their income.

Background and aim: Psoriasis is a common chronic inflammatory and proliferate disease that genetic and environmental factors have a role in its pathogenesis and duration. The objective of this study was to compare the levels of vitamin A and E in the serum of psoriasis patients and control group.Materials and methods: We evaluated 30 psoriasis patients and 30 healthy persons. Vitamin A and E levels were detected with the use of HPLC method. P value less than 0.05 (P<0.05) was considered as significant.Results: Demographic features were matched between groups. Vitamin A level was 1.09±0.27 in control group and 1.08±0.36 in patient group which did not have a meaningful statistical difference (p=0.91). Vitamin E level was 15.52±8.36 in control group and 9.02±5.41 in patient group and the difference was statistically significant (p=0.001). Comparing vitamin A and E levels according to disease severity showed no statistically significant difference.Conclusion: Our results show that vitamin E level in psoriasis patients is lower than healthy group that were matched by age and gender; although vitamin A level was not different between patient and control groups.

Background and aim: The stroma of basal cell carcinoma (BCC) is rich in mast cells. Morpheaform BCC has been reported to contain much more mast cells than the other types of BCC, but their significance remains unknown. In this study we investigated the significance of mast cells related to BCC and possible relationship between increased number of mast cells and clinical and histological parameters including the patient's age, sex, subtype of BCC and severity of peritumoral inflammation.Materials and methods: In this retrospective study, a total of 50 BCC specimens either biopsied or excised were examined histologically. H & E stained slides were examined under light microscopy and the severity of inflammation was assessed subjectively and graded as mild, moderate or severe. Then biopsy specimens were stained with Giesma to identify mast cells. Clinical data including sex and age were obtained form patients records. Finally the data were analysed by t test, Mann-Whitney and ANOVA by SPSS software and p<0.05 was considered as significant.Results: Superficial forms of BCC had more mast cells than did the deep subtypes (p=0.02). Although it was not statistically significant, but nodulocystic variant of BCC had less mast cells than other types. No significant relationship was found between the number of mast cells and the degree of peritumoral inflammation, age and gender. Conclusion: Our results support previous reports indicating that mast cells may have a contributory role in defining the subtype of BCC and degree of its aggressiveness. It seems that mast cells have a preventive role against aggression of BCC, as we found more mast cells in superficial BCC than deep ones.

Erythromycin was the first macolide discovered in 1952. In 1990s new macrolides including clarithromycin, azithromycin, and dirithromycin were introduced to the market. We provide a review of their structure, pharmacokinetics. mechanisms of action, and indications in dermatology.

Brooke-Spiegler syndrome is a rare autosomal recessive disease characterized by adnexal neoplasms, particularly trichoepithelioma, cylindroma, and occasionally spiradenoma, which usually develop in second to third decades of life.We report this syndrome in a 16-year-old woman with tumors on face and scalp.