Bullous Pemphigoid in Iranian patients: a descriptive study on 122 cases

Bullous pemphigoid is an immunobullous disease with high mortality and morbidity. Different aspects and characteristics in the patients vary in different areas in the world. Our objective was to study clinical and demographic characteristics of bullous pemphigoid in Iranian patients. In a retrospective descriptive study, we reviewed 122 patients with bullous pemphigoid within 1987-2007. Demographic characteristics, clinical manifestations, treatment, relapses and outcome were evaluated. The mean age of 122 patients was 65 +/- 18.11 years including 35.2% male and 64.8% female. The most common manifestations were cutaneous bullae [97.5%]. 27% had oral lesions. 30.3% had eosinophillia. 90 patients [73.8%] received oral prednisolone, 29 patients [23.8%] topical steroid, 2 patients tetracycline and 1 patient dapsone. 89 patients were followed after admission. Out of them 44 patients experienced first relapse and 22 patients second relapse. 41 cases [46%] were completely controlled. 11 cases [12%] were not controlled. Clinical and general characteristics of bullous pemphigoid patients differ in various regions in the world

[Assessment of the relationship between psoriatic arthritis and nail involvement score [NAPSI] in psoriatic patients visiting Razi hospital dermatology clinic from 1386-87]

Psoriasis is a chronic skin disorder involving many parts of the body including skin, nails and joints with severe negative effects on patient's quality of life. Nail involvement is one of the most difficult involvements of this disease to treat. Psoriatic arthritis categorized in sero-negative spondilo-arthropaties with some deforming characteristics. The aim of the present study was to evaluate the relationship between psoriatic arthritis and nail involvement based on standard psoriatic nail involvement score [NAPSI]. Psoriatic patients visiting dermatology clinic of Razi hospital were selected. Patients with arthritis enrolled as the case group while patients that had no joint involvement participated in control group. After matching, demographic data of both groups as well as NAPSI score and nail involvement characteristics collected through special questionnaires and analyzed with SPSS version 14. A total of 30 patients with psoriatic arthritis and 75 patients without arthritis were enrolled the study. Analysis of collected data demonstrated that nail involvement among patients with psoriatic arthritis [mean NAPSI score=46] was more common and severe than patients without joint involvement [mean NAPSI score=9.23] [P<0.05]. It seems that there is a significant difference between psoriatic patients presenting with or without arthritis and presence of arthritis probably can determine occurrence and extension of nail involvement

randomized comparative study between three times and five times weekly phototherapy with nbuvb for treating chronic plaque type psoriasis

Psoriasis is a chronic inflammatory skin disease that is estimated to affect 0.6% to 4.8% of the general population. The optimum number of NB-UVB phototherapy sessions is yet to be determined. The aim of this study was to compare therapeutic effects of NB-UVB in treating chronic plaque type psoriasis three times weekly vs. five times weekly. This study was designed as a single-blinded randomized controlled trial. Patients with chronic plaque type psoriasis who were candidates for phototherapy were randomized in two groups, one group received NB-UVB three times a week [group A] while the other group received the same treatment five times a week [group B]. Patients' PASI score was determined before commencing the study and after 12 weeks of treatment. At the end of the study, response rate, PASI score of patients and total dose of UVB per patient were determined. A total of 47 patients were enrolled. Thirty two patients [19 in group A, 13 in group B] completed the study. Total response rate was 71.9% after 12 weeks of treatment [23 out of 32 patients] while nine patients [28.1%] had no response. Response rate was 78.9% [15 out of 19] in group A Vs. 61.5% [8 out of 13 patients] in group B [p>0.05]. Total UVB dose received, treatment sessions, erythema and final PASI score was lower in group A [p>0.05]. With similar therapeutic effects, it seems that three times a week regimen may be superior to five times a week for its lower total UVB dose received and higher safety profile

epidemiologic study on basal cell carcinoma and its related risk factors in patients referred to Razi hospital tumor clinic in autumn 2005-2006

Basal cell carcinoma [BCC] is the most common cutaneous malignancy UV light is an important risk factor for BCC, as well as X-ray and other ionizing radiations. The aim of this study was evaluation and risk factor assessment of BCC cases referred to Razi hospital tumor clinic. Patients referred from general clinics with skin biopsies consistent with Basal Cell Carcinoma were enrolled. A questionnaire including epidemiologic data, risk factor exposure and specification of skin lesions was completed for each patient. From October 2005 to October 2006, a total of 476 patients with cutaneous malignancy referred to Tumor clinic of Razi hospital. Of them, 367 patients had BCC. 215 were male [58%] and 152 were female [42%]. Mean age of patients was 62 [ +/- 12.7] and 62 [ +/- 13.4] years for men and women, respectively. The most common risk factors for BCC were radiotherapy and chronic sun exposure. The most common tumor sites were scalp, nose and ears. Of different clinico-pathologic types, nodulo-ulcerative type was the most common. It seems that radiotherapy is an important risk factor in Iranian BCC patients and it is useful to have a screening program for case finding and treating patients in early stages

[ relation between thiopurine methyl transferase activity and efficacy and side effects of azathioprine in patients with pemphigus vulgaris]

Azathioprine is the most widely used immunosuppressive agent as an adjunct to corticosteroids in the treatment of pemphigus vulgaris [PV]. Thiopurine methyl transferase [TPMT] is 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. 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. The mean of TPMT activity was not significantly different in patients with unfavourable 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]. 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

comparison between systemic PUVA therapy alone and combined with topical calciporiol in the treatment of generalized vitiligo

Vitiligo is a relatively common acquired depigmentary disorder affecting approximately 1% of general population. PUVA therapy is the most effective modality and commonly used as the primary treatment of generalized vitiligo. To evaluate the synergistic effect of topical calcipotriol and oral methoxalene plus PUVA in treatment of generalized vitiligo. In this clinical trial, 47 patients with generalized vitiligo [<40% involvement of skin surface area] were randomly assigned to two treatment groups. Both groups were treated with systemic PUVA three times weekly. One group was also treated with topical calcipotriol [0.005%]. Patients were evaluated for treatment response and possible side effects. The mean response rate at the end of the study was 63.9% +/- 24.1 in the calcipotriol and PUVA group and 60.6% +/- 23 in the PUVA group [P>0.05]. The number of PUVA sessions and the mean cumulative UVA dose for maximum response were 96. 6 +/- 22.7 and 584.1 +/- 118.1 J/cm [2] in the calcipotriol and PUVA group and 116.3 +/- 26.1 and 685.1 +/- 168.0 J/cm [2] in the PUVA group [P<0.05]. In patients with generalized vitiligo, combination of PUVA with calcipotriol is an effective and safe treatment. This method decreases number of PUVA sessions and UVA dosage compared to PUVA treatment alone and accelerates repigmentation