Iranian Journal of Dermatology
Year:2007 | Volume:10 | Issue:1 (39)|Papers Count:16

Background and aim: The clinical management of verrucae vulgaris is often challenging and no treatment is always effective. Early studies have suggested that pulsed-dye laser (PDL) may be highly effective in the treatment of verrucae through obliteration of dilated vessels in papillary dermis. The objective of this study was to compare safety and efficacy of585 nm with 595 nm PDL in the treatment of warts.Materials and methods: The randomized controlled trial was done on forty patients with warts referred to Razi Hospital in Tehran. Almost symmetrically distributed warts were randomized to receive PDL 585 nm or 595 nm on their left or right side and a similar lesion with respect to size, thickness and location was not treated as control. Each patient was treated in three sessions at three- week intervals. Warts were individually examined at the time of each treatment session and their size and adverse effects of treatment recorded. Complete response was defined as complete disappearance of lesions.Results: Thirty-six patients completed the trial. The mean size of the lesions before the treatment were 19.7±13.2 mm2 in PDL 585 nm group and 21.7±15.4 mm2 in PDL 595 nm group. After the last treatment the mean reduction in size of warts were 18.1±12.3 mm2 and 18.1±11.2 mm2 and the lesions cleared in 27 (75%) and 25 (69%) patients in PDL 585 nm and PDL595 nm groups, respectively (P value =0.83). Variable degrees of purpura and pain were observed in all patients which was classified as severe in l5 and 16 cases in PDL 585 nm group and 19 and 18 cases in PDL 595 nm group, respectively (P=0.8).Conclusion: The PDL is an effective treatment for verrucae vulgaris and there are no statistically significant differences between 585 nm and 595 nm with respect of their efficacy and adverse effects.

Background and aim: Antimonial compounds are regarded as the treatment of choice for cutaneous leishmaniasis (CL). Systemic administration of these drugs has some side effects such as cardiotoxicity. The objective of this study was to evaluate the electrocardiographic (ECG) changes in patients with CL treated with systemic Glucantime.Materials and methods: This study with simple sampling method was done on patients with CL who had indication for treatment with systemic Glucantime. Before and during the treatment (weekly) and 1 month after stopping the treatment ECGs were taken from patients. The patients with baseline abnormal ECG was not included in the study.Results: 131 patients were enrolled in this study. The most common change was prolonged QT interval that was seen in 19% of patients. ST depression occurred in 6.1% and minimal ST elevation occurred in 3%, inverted T was observed in 7.4% of patients. Single PAC and single PVC occurred in 0.7% and 2.29%, respectively. Also we observed bradycardia in 10.6% and left bundle branch block in 0.7% of the patients. All of these changes reversed 1 month after treatment except for left bundle branch block.Conclusion: Important ECG changes are minimal in CL patients with normal baseline ECG treated with Glucantime and its administration seems to be safe.

Background and aim: Skin cancer is the most common human cancer. Ultraviolet radiation is now recognized as the most important risk factor for skin cancer development. Light skin colored individuals that spend more time outdoors in day are more susceptible to disease. In this study skin cancer situation in Yazd (located in a hot, dry and desert area) was reviewed.Materials and methods: In this existing data study all recorded cancers in pathology laboratory of University of Medical Sciences of Yazd between 1988-1996 were reviewed and skin cancers were studied.Results: 2360 patients with cancer were recorded. Skin cancer was the most common with 646 cases (27.3%). Bladder, stomach, breast and esophagus cancers were the other most common cancers. Among skin cancers basal cell carcinoma was the most common (77%). Other skin cancers included squamous cell carcinoma (17.8%), malignant melanoma (2.8%) and miscellaneous tumors (2.4%). Skin cancers were 1.5 times more common in males, and the majority of patients were in seventh and eighth decades of life. 91.5% of skin cancers were on face, head and neck.Conclusion: Skin cancer was the most common human cancer in Yazd. Considering skin type and intensity of sun in this area, more intensive preventive programs must be implemented.

Background and aim: Uremic pruritus is a relatively common and distressing problem for patients with chronic renal failure. Serotonin and histamine have been reported as possible mediators of uremic pruritus. Granisetron, a potent and selective inhibitor of 5-HT3 receptors was developed for relief of chemotherapy induced nausea. There are some studies about effect of Ondansetron in uremic pruritus and recently one case report described relief of renal itch with Granisetron. The aim of our study was to evaluate the effect of Granisetron on uremic pruritus in patients with chronic renal failure under dialysis.Materials and methods: 14 uremic patients under hemodialysis with moderate and severe pruritus were enrolled in this open trial. Patients received Granisetron tablet (1 mg twice a day) for 1 month. Patients were asked to complete a questionnaire assessing the severity of pruritus on twice a day.Results: 77% of the patients responded to the treatment and on the 1st, 2nd and 4th weeks of treatment, the mean values of pruritus score were 23 (range 11-40), 16(range 8-35), 8(range 0-35) points, respectively, while at baseline (before treatment) it was 31 (range 20-35) points (p=0.03). Pruritus disappeared in 7 patients at the end of 4th week, and was mild in 3 others. This effect was maintained during the study. Weekly clinical and laboratory examinations showed no side effects.Conclusion: Granisetron may be an effective, safe and well tolerated drug for the treatment of uremic pruritus in hemodialysis patients.

Background and aim: Contact dermatitis is an inflammatory skin response due to contact with environmental materials manifested as acute or chronic eczema. Patch test is the standard test to recognize responsible allergen. The objective of this study was to evaluate the frequency of false positive patch test responses in patients with Exited Skin Syndrome (ESS).Materials and methods: Fourteen patients older than 12 years with allergic contact dermatitis who had more than one positive reaction in first patch test were re-tested with the same allergens at the time of remission of their eczema. The patches were removed after 48 hours and responses read according to ICDRG guidelines.Results: The patients included 5 men and 9 women with a mean age of 34.92 years. The most common allergens in first patch test were: nickel sulfate (10), cobalt chloride (5), colophony (4), potassium dichromate, PTBF, fragrance mix and MCI/MI (3 each). In the repeated test, the most common positive responses were: nickel (10), cobalt and colophony (4 each), potassium dichromate and fragrance mix (3 each). In 6 of 14 patients the results of second test was different from first one. Three of these patients had active eczema at the time of first test, which in 2 of them one positive response and in one of them, 2 positive responses became negative in second test.Conclusion: It is recommended that patch test be repeated after a while in patients with multiple positive reactions in first test, particularly after remission of active eczema.

Background and aim: Diabetes mellitus is a metabolic disease with multiple complications. Skin tag is a pedunculated papule, which is more common in women and has been suggested as a cutaneous marker of diabetes mellitus. The aim of this study was to determine the frequency of diabetes mellitus in patients with skin tags.Materials and methods: This descriptive study was done on 100 patients with skin tags. The investigation included fasting blood sugar (FBS) and glucose tolerance test (OTT).Results: 66 patients had normal FBS, 27 had diabetes mellitus, 5 had impaired OTT and 2 had impaired fasting glucose. Over all, 34 had abnormal glucose metabolism, 7 were unaware of their metabolic abnormality. Among 40 hospitalized patients 50% had abnormal glucose metabolism meanwhile 23.3% of 60 outpatients had this abnormality (p<0.01). No association was seen between BMI, obesity, gender, location and number of skin tags with abnormal metabolism of glucose.Conclusion: It is recommended to consider skin tags as a cetaceous marker for abnormality of glucose metabolism.

Background and aim: Efficacy of vaccines is mainly depending on the type of adjuvant used. Efficacy trials of first generation vaccine against leishmaniasis showed a limited efficacy due to lack of an appropriate adjuvant. The objective of this study was to investigate whether positively charged liposomes containing ALM could induce Th 1 type immune response in susceptible Balb/c mice.Materials and methods: Liposomes containing ALM were prepared by dehydration-rehydration method. Female mice, 6-8 weeks old were immunized subcutaneously with prepared liposomes or as control with empty liposomes, ALM alone or PBS, 3 times, 3 weeks apart. Different groups of mice were challenged with virulent L. major. Immune responses of animals were evaluated in vivo by delayed type hypersensivity (DTH) and in vitro by titration of anti-Leishmania antibody isotypes using ELISA technique.Results: The results showed that footpad swelling in the group of mice immunized with DRV-PCICHOLALM- DDAB was significantly smaller than the control groups (p<0.05). IgG2a titer was significantly higher in immunized mice with DRV-PCICHOL-ALM-DDAB compared the control groups (p<0.01) and DRVPCICHOL- ALM (p<0.05). DTH response of groups received ALM incorporated into liposomes were significantly stronger than the control groups (p<0.001).Conclusion: Smaller lesion size, stronger DTH response and a high IgG2a titer are indicative of a Th1 response. It seems that positively charged liposomes might be used as an immunoadjuvant to induce a Th1 type of response.

Background and aim: It seems that melanocytic nevi, freckle and lentigo are more common in women with melasma, and a common genetic background may exist. In this study the prevalence and number of lentigo, freckle and melanocytic nevus were compared in women with and without melasma.Materials and methods: In a case-control study, 120 women with melasma (case group) and 120 women without melasma (control group), matched for age, were examined by a dermatologist. The singnosis of lesions were done only by clinical observation. Data were analysed by SPSS software using chi-square (or Fisher) test and p<0.05 was considered as significant.Results: The mean age was 29.97±6.6 years in case group and 29.7±6.7 in control group (non significant). Prevalence of freckles was higher in control group (24.3% versus 4.16%, p<0.001). 77 patients (64.1%) in case group and 20 (16.6%) of control group had lentigo (p<0.001). The mean number of lentigo in case group was 25.2 and in control group was 8 (p=0.01). The prevalence of melanocytic nevus in control group was lower than case group (96.6% versus 98.3%), but this difference was not significant. The mean number of melanocytic nevi was 2.8 in control group and 13.2 in case group (p<0.001). Campbell de Morgan angiomas were seen in 26 (21.8%) of case group and in 6 (5%) of control group (p<0.001).The mean number of these angiomas was 1 in control group and 5.2 in case group (p=0.02).Conclusion: The prevalence and number of melanocytic nevi were higher in women who had melasma. Common factors or genes may have a role in appearing of melasma and moles.

Cutaneous manifestations of thyroid diseases can be divided into three groups:1-Specific lesions such as the thyroglossal duct cyst and cutaneous metastases form thyroid malignancy. 2-Nonspecific signs secondary to thyroid hormone imbalance.3-Cutaneous signs of associated systemic and dermatologic disorders.This review constitutes a summary and update of the cutaneous manifestations of thyroid diseases.

Localized morphea is a disorder of unknown cause in which there is localized sclerosis of the skin. Disabling pansclerotic morphea of childhood is a rare severe mutilating form of morphea involving the dermis, fat, fascia, muscle and even bone, usually starting before the age of 14 years. Here, an eight-year-old boy with progressive sclerosis of palmar surface of wrist and hand and digits without involvement of finger tips is presented whose major signs were flexion contracture of wrist and claw hand deformity of third and fourth fingers. Due to progressive nature of the disease he was treated with prednisolone and hydroxychloroquine and the progression of the disease was controlled.

Perforating granuloma annulare (PGA) is a rare subtype of GA. It is characterized by crops of erythematous umblicated or scaly papules. Plaques, pustule-like lesions and scars may also be seen. It can be localized or generalized.Transepithelial elimination of mucinous, degenerating collagen fibers and surrounding palisading lymphohistiocytic granulomas, are important histologic features.The patient reported here was a 23-year-old man with recurrent crops (every few weeks) of umbilicated papular lesions predominantly affecting trunk and extremities for 8 years, which resolved with varioliform scars.