Evaluating the effect of insulin sensitizers metformin and pioglitazone alone and in combination on women with polycystic ovary syndrome: an RCT

Background: Insulin resistance and hyperinsulinemia may play a role in pathogenesis of PCOS. One of the common therapeutic methods is using insulinsensitizing drugs such as metformin and thiazolidinediones

Objective: The purpose was to determine the effect of metformin and pioglitazone on clinical, hormonal and metabolic parameters in women with PCOS

Materials and Methods: Eighty four women randomly received one of the following for 3 months: metformin [n=28] [500 mg three times a day], pioglitazone [30 mg daily] [n=28] and combination of both metformin and pioglitazone [n=28] [30 mg/day pioglitazone plus 500 mg metformin three times a day]. Hormonal profile, fasting serum insulin, body weight, body mass index, menstrual status and waist to hip ratio were evaluated before and after treatment

Results: Metformin and pioglitazone and combination therapy induced favorable changes in fasting serum insulin, HOMA-IR index, QUICKI, fasting glucose to insulin ratio in women with PCOS. Body weight, BMI, and waist to hip ratio increased significantly after treatment with pioglitazone but the data were similar after administration of metformin or combination therapy. Total testosterone level decreased significantly only after treatment with metformin. After 3 months in patients who received pioglitazone or combination therapy, menstrual cycles became regular in 71.4% and 73.9% respectively. While menstrual improvement happened only in 36.4% of the patients treated with metformin

Conclusion: These findings suggest that insulin-sensitizing drugs induce beneficial effect in insulin resistance and menstrual cyclicity but only metformin ameliorated hyperandrogenemia in women with PCOS. Treatment with combination of metformin and pioglitazone did not show more benefit than monotherapy with each drug alone

Prevalence of metabolic syndrome in psoriasis patients

Objectives: To evaluate the prevalence of metabolic syndrome in patients with psoriasis in Yazd, Iran

Design: A cross sectional study conducted among Iranian patients with psoriasis and age and sex - matched controls

Setting: Department of Dermatology, Burn and Accident Hospital, Yazd, Iran

Subjects: A total of 110 patients with psoriasis and 110 nonpsoriasis patients were enrolled in this study

Intervention: Data on age, sex, weight, height, waist circumference and blood pressure of all participants were obtained. Severity of psoriasis was assessed using Body Surface Area [BSA] as mild [< 2% BSA], moderate [3-10% BSA] and severe [>10% BSA]. Fasting venous blood samples were collected and the fasting glucose and lipid levels were measured

Main Outcome Measure: We assessed fasting glucose, lipid profile, blood pressure and metabolic syndrome

Results: The mean ages of the cases and controls were 14.80 +/- 39 years and 14.25 +/- 39 years, respectively. The results showed that hypertension is significantly more common in psoriatic patients compared with controls. There was no significant difference in BMI, diabetes mellitus and hyperlipidemia between two groups. Metabolic syndrome was detected in 27.3% of patients with psoriasis and 20.9% of the patients in control group but this difference was not statistically significant [P value = 0.270]

Conclusion: The results of our study revealed that there is no close association between psoriasis and metabolic syndrome in Yazd

Acne keloidalis nuchae in a Caucasian woman

Acne keloidalis is a chronic inflammatory process involving the hair follicles of the nape of the neck and leading to hypertrophic scarring papules and plaques. Review of the literature shows that this process occurs only in males after puberty, especially in negroes. We, here, report a 31-year-old Caucasian woman who had hypertrophic papules in the nape of her neck since 10 years and histopathological examination confirmed it is as acne keloidalis. This is a rare case hitherto unreported in Caucasian females

Acute hemorrhagic edema of infancy: a case report

Acute hemorrhagic edema of infancy [AHEI] is a rare skin disorder introduced for the first time by Snow [1913]. The disorder which usually presents exclusively with skin manifestations occurs mostly in less than 2-year-old-age children. Most of the patients have suffered from a background of upper respiratory tract infection and have experienced vaccination or antibiotic treatment before beginning of the symptoms. Clinical sign of the disease is including petechiae, ecchymosis, and edema in head, face, and extremities. We present a typical case of AHEI in a 6- month-old infant

Evaluation of onychomycosis among diabetic patients of Yazd diabetic center

The population suffering from diabetes is increasing all over the world. In Iran, the prevalence of diabetes is reported from 5 to 8 percent and the highest figure is for Yazd and Booshehr Province. In diabetic patients infections of nail and skin pose a great danger. To determine the prevalence of onychomycosis in diabetic patients and its relation with age, gender, period of diabetes and its control. This descriptive study involved 262 diabetic type 2 patients which were referred to the Yazd diabetic clinic during years of 2008 to 2009. All the patients were examined by a dermatologist and the patients with clinical doubt were sent for the laboratory tests i.e. smear and culture. Confirmed cases of onychomycosis were treated with terbinafine 250mg/day for four months. The patients were followed up clinically every month and data were recorded. In the end of treatment protocol, direct smear and culture from nails was taken. 262 diabetic patients [123 men and 139 women] were examined. The mean age of patients and diabetic duration were 59.12 +/- 10.96 years and 7.24 +/- 12.8 years, respectively .Onychomycosis was diagnosed clinically in 18 patients [6.9%] and proved by culture only in 10 patients [3.8%]. 70% of onychomycosis cases were men and 60% were over 60 years old. No significant relation was found between the frequency of onychomycosis and the diabetic duration but in the patients having a weaker control of diabetes onychomycosis was more frequent. The frequency of onychomycosis in diabetic patients type 2 is 3.8% and it had a significant relation with the weak control of diabetes

Multidermatomal zosteriform lupoid cutaneous ieishmaniasis: a case report

Leishmaniasis is the result of infection with intracellular protozoan parasites belonging to the genus Leishmania. Cutaneous Leishmaniasis [CL] may present with unusual clinical variants such as acute paronychial, annular, palmoplantar, zosteriform, erysipeloid, lupoid and sporotrichoid. Infection is transmitted by the bite of the sandfly. We report a multidermatomal zosteriform lupoid cutaneous Leishmaniasis

Acne keloidalis nuchae in a white woman

Acne keloidalis is a chronic inflammatory process that involves hair follicles of the nape of the neck and leads to hypertrophic scarring. In all references, it is noticed that this process occurs only in males after puberty and is especially seen in the black race. In this case, we report a 31-year-old white woman who had hypertrophic papules in the nape of her neck since 10 years ago and in pathological examination, the diagnosis of acne keloidalis was confirmed