[Evaluation of therapeutic effect of capsaicin pomade [Caspian 0.03%] in hemodialysis related pruritus]

Pruritus is one of the common problems in hemodialysis patients with end stage renal disease. Approximately, 60% of these patients suffer from this condition. There are several causes for pruritus, thus, various treatments are applied in order to control it. The aim of this study was to evaluate the therapeutic effect of capsaicin on pruritus, compared with placebo, in hemodialysis patients. This randomized double blind cross over clinical trial study, was performed on 34 hemodialysis patients with uremic pruritus in 1386. All patients were divided in two groups. One group received Caspian 0.03%, while the other, placebo for four weeks. Treatment was stopped for two weeks and continued as cross over technique. Pruritus scores were analyzed with Paired t-test and Repeated measurement ANOVA. In this study, the difference between Mean of pruritus score before capsian treatment and in weeks following 1 to 4 was statistically significant [P=0.0001]. In placebo group, the difference between pruritus score before treatment and in weeks 1 to 4 was statistically significant [P=0.0001]. There was no significant difference before treatment in two groups, however, after each week, the difference was significant [P=0.0001]. Repeated measurement test showed that reduction in pruritus severity in capsian group was more than placebo group, during treatment period [P=0.0001]. Although our study indicated the appropriate effects of Capsian in pruritus, the placebo also has a good effect in controlling hemodialysis related pruritus. Our placebo had emollient property; therefore, we can apply it to control the pruritus in these patients

[ study of 101 cases of onychomycosis and associate factors in patients referred to Boali Sina Hospital and Toba dermatology outpatient clinics in Sari]

Onychomycosis is a nail fungal infection caused by various species of dermatophytes, yeasts and non-dermatophytic molds and represents about 30% of cutaneous mycotic infections. The goal of this study was to investigate the frequency of onychomycosis and its associated factors in patients referred to Boali Sina Hospital and Toba dermatology outpatient clinics, Sari. In this cross-sectional study, nail specimens were collected from 101 patients suspected of onychomycosis during a 14 month period. Nail specimens were examined by direct microscopy, using potassium hydroxide [KOH] 20%, KOH + CFW, KONCPA [KOH treated nail clipping+PAS] and also culturing on sabouraud's dextrose agar, containing chloramphenicol [SC], and sabouraud's dextrose agar containing cyclohexamide and chloramphenicol [SCC] mediums. In this study, 79 [78%] of patients were female and 22 [22%] were male. Yeasts were isolated in 30% cases of onychomycosis, mainly from fingernails. Candida albicans, and C.krusei was the most prevalent species. Non-dermatophytic filamentous fungi were yielded at 24%, especially from toenails, with Aspergillus terreus being the most prevalent species. Dermatophytes were found in 7% of the samples, especially from toenails. Trichophyton mentagrophytes was the predominant species. Unknown filamentous fungi were identified in 19% of samples, while mixed infections were identified in 20% of samples. The highest prevalence rate of onychomycosis was identified in the patients within the 30 to 49 years of age group. Distal and lateral subfungual onychomycosis [DLSO] was the most prevalent clinical types with [88%], followed by WSO [5%], PSO [5%], TDO [1%] and DLSO + PSO [1%]. The results of our study showed that onychomycosis is one of the most prevalent infections in patients who are suffering from nail disorders. Yeast and yeast like organisms cause these infections more than other fungus in this region. Women are more infected, as they are in daily contact with detergents and moisture

[Identification of malassezia species isolated from patients with pityriasis versicolor and seborrhoeic dermatitis by PCR-RFLP]

Lipophilic yeast of the genus Malassezia are members of normal human cutaneous micro flora which are also associated with several skin diseases. It is strongly suspected that Malassezia species are responsible for pityriasis versicolor [PV], and seborrhoeic dermatitis [SD]. Considering various sensitivities among Malassezia species to antifungal, accurate species identification will facilitate the treatment of relevant diseases. Malassezia species can be identified through their morphological features and bio-chemical characteristics. However, these phenotypic methods are usually time consuming, and lack sufficient discriminatory power. Development of DNA- based methods for detection and identification of Malassezia species provide helpful alternatives for solving problems. The aim of this study was to examine the distribution of Malassezia species in patients with pityriasis versicolor and seborrhoeic dermatitis, using molecular methods. A total of 63 clinical isolates of Malassezia spp, 30 strains isolated from patients with PV and 33 strains isolated from patients with SD, were studied. To investigate the strains at molecular level, genomic DNA of Malassezia isolates were extracted and amplified within the ITS1 region [located between 18S and 5.8S rDNA] by polymerase chain reaction [PCR] assay. DNA sequencing of ITS1 of rDNA in Malassezia spp was performed to type the species. Restriction fragment length polymorphism [RFLP] analysis of ITS1 PCR product with two restrictive enzymes CFOI and BSTF5I, was used in subsequent species identification. In this study, 37 patients with PV [20 females, 17 males; 2 to 64 years old], 81.1% [30 case] yielded growth of Malassezia in culture, while the frequency of isolation of M. globosa was 53.3% [16 case], M .furfur 40% [12 case] and M. sympodialis 6.7% [2 case]. Of the 41 patients with SD [22 females, 19 males; 1 to 52 years old], 80.5% [33 case] yielded growth of Malassezia in culture, while the frequency of M. furfur was 42.4% [14 case], M.globosa 39. 4% [13 case], M. restrict 15.2% [5 case] and M. sympodialis 3% [1 case]. This PCR-RFLP Profile allows us to clearly identify important Malassezia species. The results of the PCR-RFLP analyses of clinical isolates were in complete agreement with those from DNA sequencing, morphological features and bio-chemical characterization. In patients with PV, the most frequently isolated species were M. globosa, followed by M .furfur. However, in patients with SD, the most frequently isolated species were M. furfur, followed by M. globosa. The PCR-RFLP system applied for the ITS1 fragment of the rDNA is a reliable, simple and rapid method for identification of the most important Malassezia species, but further work will be necessary in applying these techniques to additional patients

[ effect of ketoconazole 2% solution in comparison with ketoconazole 2% shampoo on clinical signs and malassezia yeasts in seborrhoeic dermatitis patients]

Seborrhoeic dermatitis [SD] is a common skin disorder. Malassezia yeasts have an important role in the etiology of SD. Since anti-fungal agents, especially in azoles are effective for treating SD, in this study, the effect of ketoconazole 2% solution on clinical signs and Malassezia in SD patients were assayed. 100 patients with SD were enrolled in this study. Patients were scored in regard to the severity of lesions at the initial evaluation and every 2 weeks for a 1 month period. Microscopic examination and culture of patients scale in days 0 and 28 were used for isolation and identification of Malassezia species. Patients were divided into two groups [ketoconazole 2% solution and shampoo] and followed after 14 and 28 days, and then clinical response was graded. 58% of patients showed lesions on their heads. In day 0, 51% of patients showed > 7 yeasts in each microscopic field. 77% of scale samples were positive to Malassezia spp. Growth and M. globosa [57.1%] had the most frequency. In day 28, 89.6% and 82.6% of treated patients with solution and shampoo showed 1-3 yeast in within entire smear, respectively. 94.8% and 82.6% of scale samples were negative to Malassezia spp growth, respectively. In day 0, patients with moderate SI had the most prevalence, whereas in day 28, patients with mild SI were predominant. Statistical test showed the correlation is significance only between SI and treatment with solution. The results of our study showed that according to decrease of yeast load and increase of improvement of SD signs after treatment with ketoconazole 2% solution, compared with ketoconazole 2% shampoo, 2% ketoconazole solution can be considered as an appropriate agent in treatment of Sd