Effect of expressive writing on psychological distress in patients with Vitiligo: a randomized clinical trial

Background: In this clinical trial, we examined whether or not expressive writing as a psychological intervention reduces psychological distress in vitiligo patients receiving phototherapy

Methods: A total of 139 adult vitiligo patients were asked to complete the GHQ-28 in order to identify their psychiatric disturbances. The GHQ-28 scores showed that 78 patients [56.5%] had psychiatric distress. They were later enrolled in this randomized controlled clinical trial conducted during June 2009 until Dec. 2009 at Razi Hospital in Tehran. Patients were randomly divided into 2 groups. Group A underwent the routine treatment protocol. Group B did the same, but they were also instructed to practice 'expressive writing'. The intervention continued 4 weeks. After 4 weeks, patients in both groups were re-evaluated using the GHQ-28

Results: The overall GHQ-28 scores and sub-scores were significantly reduced in both groups A [47.9 +/- 11.71, P=0.000] and B [48.94 +/- 10.69, P=0.000] after 4 weeks of intervention. However, no statistically significance difference was found between the two groups in terms of their overall scores [P=0.7] and their sub-scores

Conclusion: The effect of expressive writing on reducing psychological distress in patients with vitiligo remains equivocal. Nonetheless, further studies with larger sample sizes and of longer duration especially in non-western cultural contexts are recommended

Cutaneous leishmaniasis in suspected patients referred to the center for research and training in skin diseases and Leprosy, Tehran, Iran from 2008 to 2011

Cutaneous leishmaniasis [CL] is a major health problem in many parts of Iran, although diagnosis of CL especially in the endemic area is easy, but treatment and management of the disease is a global dilemma. Diagnosis of CL in non-endemic area is not as simple as in endemic foci. In this study, the status and the proportions of CL induced by Leishmania major and L. tropica among CL suspected patients referred to the Center for Research and Training in Skin Diseases and Leprosy, [CRTSDL] during 2008 to 2011 are described. CL patients with suspected lesions were clinically examined. History of trip to zoonotic CL and/or anthroponotic CL endemic areas and the characteristics of their lesion[s] were recorded. Diagnosis of the lesion was done using direct smear microscopy, culture and conventional polymerase chain reaction [PCR]. A total of 404 [M=256, F=148] patients with 776 lesions were recruited and parasitologically examined. The results showed that 255 of the patients with 613 lesions; patients with lesion[s] induced by L. major=147 [M=63, 43%, F=84, 57%] and lesion[s] induced by L. tropica=108 [M=35, 32%, F=73, 68%]. History of travel to endemic area was not always correlated with isolated Leishmania species. Although travel history to endemic area is an important factor to be considered for diagnosis, but parasitological confirmation is necessary initiation of treatment

[Identification of Malassezia species associated with seborrheic dermatitis using PCR-RFLP]

Malassezia is a lipophilic and dimorphic fungus which has different species. Some of them can be found as natural flora on the skin and in some conditions may cause seborrheic dermatitis. The aim of this study was to identify Malassezia species associated with seborrheic dermatitis in Iranian patients, using PCR-RFLP. In this study out of 79 patients with seborrheic dermatitis, isolates of 70 patients were positive for Malassezia species using PCR-RFLP. The Internal Transcribed Spacer 2 [ITS2] region was amplified by PCR employing the ITS3 and ITS4 primers and the restriction endonucleases AluI, BanI and MspAI were selected for producing distinct RFLP patterns. M. globosa [48.6%], M. furfur [40.0%], M. slooffiae [8.6%] and M. sympodialis [2.8%], were the microorganisms responsible for the infection among participants. M. pachydermatis, M. japonica, M. dermatis, M. restricta, M. obtuse, M. nana and M. yamatoensis were not isolated from any samples. Our findings suggest that the most common Malassezia species associated with seborrheic dermatitis was M. globosa, followed by M. furfur

Safety and efficacy of tacrolimus 0.03% ointment in the treatment of atopic dermatitis: a randomized, double-blind, placebo controlled clinical trial

Atopic dermatitis [AD] is a chronic, relapsing, pruritic skin disease more common in infancy and childhood. Emollients, topical corticosteroids, and avoidance of irritating factors are the mainstay of its treatment, but fear of side effects has limited the use of topical corticosteroids. The objective of this study was to evaluate the safety and efficacy of topical tacrolimus 0.03% ointment in the treatment of AD. In this randomized, double-blind, clinical trial, 76 patients with AD older than 2 years were randomly allocated in two groups and treated with either tacrolimus 0.03% ointment [Abu-Rayhan Co., Iran] or placebo, twice a day for 6 weeks. Responses to treatment were compared every 2 weeks using SCORAD. Twenty-nine patients in tacrolimus group and 26 in placebo group completed the trial. The reduction in SCORAD after 2 and 4 weeks in tacrolimus group was significantly higher than placebo group [P<0.05]. The frequency of treatment-induced pruritus and burning sensation was similar in both groups but erythema was more observed in the placebo group [P<0.05]. Tacrolimus 0.03% ointment is more effective than placebo in the treatment of AD

[Evaluation of skin pH in normal population and its relationship with age, sex and anatomic location]

Everal studies have been conducted to evaluate skin pH in various diseases, but there are few reports in normal population. The aim of this study was to evaluate skin pH in healthy individuals. Fifty healthy volunteers were enrolled in this study. The subjects were divided by age into 5 groups, i.e., 10-20, 21-30, 31-40, 41-50 and 51-60 years old. In each group, 5 females and 5 males were examined. A pH meter [Courage and Khazaka electronic GmbH, Germany] was used to measure pH in 8 different locations of the body [forehead, cheek, nasolabial fold, neck, forearm, dorsal side of hand, palm and leg]. The mean values for pH in these locations were 5.25, 5.15, 5.06, 4.90, 4.75, 4.80, 4.69, and 4.83 respectively. pH was significantly higher in women [P<0.001]. There was a significant difference between skin pH in different age groups [P=0.002]. The highest and lowest amounts of pH belonged to the forehead [5.26 +/- 0.68] and leg [4.69 +/- 0.40], respectively. Age and sex and location have remarkable effects on skin pH

[Detection and analysis of BTNL2 gene mutations in patients diagnosed with skin sarcoidosis]

Sarcoidosis is a non-caseous granulomatous disease that can involve several organs such as lung, kidney, liver, heart and skin. In systemic sarcoidosis, skin lesions occur in 20-35% of patients. Cutaneous sarcoidosis with no systemic involvement was found in about 25% of patients. Mutation within Butyrophilin-like 2 [BTNL2] gene, rs2076530 was reported in systemic sarcoidosis. However, there is no report of evaluation of mutation in BTNL2 gene with the diagnosis of skin sarcoidosis. In this study ten patients with skin sarcoidosis were evaluated for the mutation of rs2076530 allele in exon 5 of BTNL2 gene. This assessment was performed by the single strand conformation polymerase chain reaction [SSCP-PCR] in which the existing mutations with positive shift were deteced using directl sequence analysis. Data from sequence analysis were evaluated and blusted by means of Choroms computer software. Our results showed the BTNL2 G->A transition of rs2076530 in seven patients and three patients were normal. This pilot study concludes the presence of a mutation at rs2076530 in exon 5 of BTNL2 gene in patients with skin sarcoidosis. Larger studies are needed to evaluate the role of this finding

[Comparison of the efficacy of weekly vs. twice a week intralesional injections of meglumine antimoniate in the treatment of anthroponotic cutaneous leishmaniasis: a randomized clinical trial]

Treatment of cutaneous leishmaniasis, especially when caused by L. tropica, is challenging. Meglumine antimoniate [Glucantime[R]] is used as the standard treatment, but multiple injectiond are necessary. The objective of this study was to compare the efficacy of weekly intralesional injections with twice weekly injections of Glucantime for the treatment of anthroponotic cutaneous leishmaniasis [ACL]. This randomized open clinical trial was conducted, in Bam, Kerman province, Iran. 96 eligible patients according to inclusion and exclusion criteria who were willing to participate were included. The included patients were randomly assigned into two groups, one group treated with weekly intralesional injections of Glucantime[R] and the other group treated with intralesional Glucantime[R] twice a week. Type and size of each lesion [induration, ulcer and scar] were recorded weekly. Complete healing was defined as complete re-epithelialization and absence of induration in all lesions and was considered as the primary outcome measure. A total of 48 patients completed the study; complete cure was seen in 24 of 27 [89%] patients who received weekly intralesional MA with a mean duration of healing equals to 70 +/- 10 days. Complete cure was seen in 24 of 31 [77%] patients who received intralesional MA twice a week, the mean duration of healing in the latter group was 58 +/- 5 days. There was no significant difference between the two groups [P=0.23]. It seems that the efficacy of intralesional injections of Glucantime[R] once a week is similar to efficacy of twice a week Glucantime[R] injections

Comparison of skin erythema and melanin level in sulfur mustard induced chronic skin lesions and normal skin

Sulfur mustard gas is a chemical agent that has been used in many wars, especially in Iran-Iraq war. This chemical agent affects many organs including lungs, eyes and skin, causing numerous acute and chronic lesions including erythema and hyperpigmentation, respectively. This study was conducted to evaluate erythema and melanin in subjects with a history of exposure to sulfur mustard. This case-control study was done on 309 subjects. They were divided into four groups: sulfur mustard-exposed patients with skin lesions [n=87], sulfur mustard-exposed cases without current skin lesions [n=71], non sulfur mustard-exposed patients with dermatitis [n=78] and normal controls [n=74]. Erythema and melanin were measured in 4 areas [forehead, suprasternal, palm and back of hands] by Mexameter MX18 [Courage-Khazaka, Germany]. Erythema was significantly lower in suprasternal and palmar aspect of hands in sulfur mustard-exposed patients with dermatitis [P<0.05] while there was no significant difference in other areas. In terms of melanin, there was a significant difference in the dorsal aspect of hands in all four groups [P<0.05], where patients with dermatitis [both sulfur mustard exposed and normal population] had higher levels of melanin, probably due to pruritus in such areas. Forehead melanin of the normal population was also significantly lower than other three groups [P<0.05] while there was no significant difference between the melanin level of sulfur mustard exposed subjects [with or without dermatitis] and patients with dermatitis. Sulfur mustard contact can affect erythema and melanin content of the skin

[Evaluation of different diagnostic methods in onychomycosis]

Background: At present time, the diagnosis of onychomycosis is based on clinical signs, direct exam and fungal culture, whereas Pathologic methods have shown to be more sensitive than other methods

Objective: Evaluation of pathologic methods in the diagnosis of onychomycosis in comparison to direct smear and culture

Patients and Methods: A nail sample was cut form 96 suspected onychomycosis patients by nail clipper. Then it was divided to four pats, and one part was stored. One part was fixed in 4% formalin and examined pathologically [PATH-PAS method]. Another part was cultured in mycosil agar and Sabour and Dextrose Agar media and kept in room temperature for 4 weeks. Another part was directly examined by 10% KOH. The results of each method were recorded separately without knowing the results of others. Clinical signs with at least one positive result were considered as onychomycosis and the sensitivity of these methods were compared

Results: The most sensitive method was the combination of PATH-PAS and direct smear [98%]. There was no significant difference between the sensitivity of smear and pathological method, where as PATH-PAS and culture differed significantly

Conclusion: PATH-PAS is a simple and very sensitive method in the diagnosis of onychomycosis

[ review on evidence-based medicine]

Physicians' daily need for valid information about diseases, their limited time for finding this information, the inadequacy of traditional sources [E.g. textbooks] to address this matter, the disparity between physicians diagnostic skills and clinical judgment [Which increase with experience] and their up to date knowledge and clinical performance [Which decline by time], as well as dramatic development in the field of information technology that provides easy access to an uncountable number of data resources, all have resulted in the consideration of evidence-based medicine [EBM] as an appropriate approach to solve these problems. EBM is defined as: [The conscientious, explicit, and judicious use of current best evidence in making clinical decisions about the care of individual patients]. The full-blown practice of EBM comprises five steps: Step 1] Asking a well-built clinical question; step 2] Tracking down the best evidence which answer that question; step 3] Critically appraising that evidence for its validity, importance, and applicability; step 4] Integrating the critical appraisal with the clinical expertise and with the patients unique values and circumstances; and step 5] Evaluating our effectiveness and efficiency in executing steps 1-4 and seeking ways to improve them for next time

effects of different intervals of microdermabrasion sessions on skin biophysical parameters: a randomized, assessor-blind, within-patient trial

Microdermabrasion has recently become a popular procedure among physicians and patients, whereas few studies have assessed the efficacy of different microdermabrasion protocols nowadays applied. The objective of this study was to assess the effects of microdermabrasion, as well as to compare the effects of weekly and biweekly intervals of microdermabrasion sessions on skin biophysical parameters. Ten patients entered this randomized, investigator-blind, split face study and underwent a series of six microdermabrasion treatments. One side of the face was treated every week and the other side was treated every 2 weeks, randomly. Stratum corneum hydration, sebum secretion and skin pH measurements were taken before and after the procedure on all sessions and also 1 and 4 weeks after the last treatment. After 6 sessions of microdermabrasion and following comparison to baseline, a significant decrease in sebum content and a significant increase in skin pH were observed only on the side treated with the intervals of 2 weeks. Changes in skin hydration were not significant on either side. Microdermabrasion may have noticeable effects on skin barrier functions. It is recommended to have 2 week interval between sessions

Comparison of topical azithromycin and clindamycin in the treatment of mild to moderate acne vulgaris

Acne vulgaris is the most common cause for dermatology visits and is one of the most common diseases that people experience during their lives. Although this disease is not life-threatening, it may affect the life quality of the patients because of developing irreparable complications on the skin. Dermatologists are in agreement about topical treatment in the mild to moderate acne vulgaris, but extensive using of tropical antibiotics and drug resistance have decreased their therapeutic benefits. In this study, we tried to compare the therapeutic effects of tropical azithromycin and clindamycin. This study was designed and performed as a double blind, randomized clinical trial. Thirty two patients with mild to moderate acne were treated with azithromycin and 30 patients, who were matched with the former group based on age, sex and severity of the disease, were treated with clindamycin for 12 weeks and results of their treatment were compared with each other. results of this study showed that ratio of response to treatment and decreasing the grade of the disease and number of nodules, papules and pustules were not significantly different in the first month of the treatment in both groups while just the number of nodules in the group on azithromycin showed more decrease in the last months of treatment in comparison with clindamycin [0.88 +/- 0.75 vs. 0.25 +/- 0.75, p=0.015]. Also, clindamycin had more side effects, but the rate of satisfaction with both drugs were high and showed no difference. In this study, no significant association was found between sex and response to treatment and evaluation of association between age and response to treatment showed a significant reverse association between age and decreasing the number of pustules [p=0.002, r= - 0.492]. Sum of findings in this study show that topical azithromycin is an effective antibiotic with acceptable side effects and high degree of satisfaction in patients and it can be used for the treatment of mild forms of acne

Evaluation of clinical trials

In a number of important clinical issues such as evaluation of the efficacy or effectiveness of therapeutic or preventive interventions as well as for comparing the harms of interventions, randomized controlled trials [RCTs] provide the highest levels of evidence, either directly or indirectly. It is obvious that critical appraisal of these studies to assess their validity and precision is of paramount importance. The aim of this review is to provide the readership an outline about different types of RCTs, the importance of proper appraisal of RCTs, an overview of the most important factors that have an influence on the validity of an RCT and a strategy for systematic evaluation of those factors, and to introduce some useful methods for improving design, implementation and reporting of RCTs as well as some tools that are used for the evaluation of these studies. It is expected that after reading this review, the reader obtains some knowledge about different phases and types of RCTs, as well as being enabled to evaluate the four major factors: randomization sequence generation, randomization concealment, blinding and intention to treat analysis that affect the validity of an RCT

Laser-assisted hair removal: comparison of long-pulsed alexandrite and long-pulsed Nd: YAG lasers, individually and in combination

Laser is one of the most recent techniques which has widespread use in the treatment of many skin diseases. This technique has been successfully used to remove unwanted hairs in hirsutism. The aim of this study was to evaluate and compare the efficacy and safety of long-pulsed 755 nm alex and rite and long-pulsed 1064 nm Nd: YAG lasers individually and in combination for permanent hair removal. This single-blind r and omized clinical trial was conducted on 25 patients. They were treated by alex and rite or Nd: YAG or combination of them in 4 sessions with 8 weeks intervals. The treatment was applied on their medial and lateral sides of both legs. All the parameters of the systems were set on the company defaults. Subjects were evaluated 1 and 8 months after completion of the treatment. Hair count was measured by Visiomed device and digital camera photographs every session. To calculate mean hair reduction, the difference between hair count before and after treatment was divided by hair count before treatment. Pain severity, measured by Visual Analogue Scale [VAS], and side effects [bullae, scar and pigmentation changes] were recorded every session. The data were analyzed with ANOVA, post hoc Tukey and chi square tests. Fifteen patients completed the study and 10 patients were excluded due to appearance of bullae in 2 patients and refuse to continue in 8 patients. The mean hair reduction measured by Visiomed 8 months after last treatment was: 61.96 21.09, 60.03 23.40 and 68.05 21.23 percent for alex and rite, Nd: YAG and combination therapy, respectively. When digital camera photos were used for measurement of hair reduction these values were 85.99 11.62, 73.60 16.57 and 79.61 18.08 percent, respectively. The differences between the systems were not significant [ANOVA, P>0.05]. In paired comparison of the systems, no significant differences were observed either [Tukey test]. The incidence of adverse effects [hyperpigmentation] and pain severity were significantly greater in area received combination therapy [P<0.001]. Both alex and rite and Nd: YAG laser systems were effective in hair removal. In contrast, combination therapy did not have more efficacy and also caused more side effects

Opinions of experts from Asia on the diagnosis and treatment of pemphigus vulgaris

Pemphigus vulgaris [PV] is the most common blistering disease in Iran and many other Asian countries with a relatively high incidence and involvement of both skin and mucous membranes in majority of patients. The aim of this study was to assess the opinions of Asian experts on the diagnosis and management of PV. A questionaire-based mailed/emailed survey was conducted. The questionnaire was sent to 29 dermatologists from different countries of Asia [23 from Iran and 6 from India, Kuwait, Turkey and Bangladesh] who are in charge of the treatment of autoimmune blistering disorders with at least 5 years experience in this field who visit at least five new PV patients annually. Questions induced duration of experience, number of patients treated and diagnostic and treatment approaches for PV. Descriptive data were reported using SPSS 11.5 and some data are reported as mean SD. All 29 physicians participated in the survey. Among them, 79.3% visit their patients within 6 months after the onset of symptoms. Diagnosis of PV is confirmed by histologic and direct immunofluorescence examinations by 65.5% of physicians. All of them initiate the treatment with corticosteroids [48.3% with a dose of at least 2 mg/kg/day prednisolone] and 89.7% add adjuvant immunosuppressors at the same time. Of the adjuvant agents used, azathioprine is used by 82.8% of physicians. Different trends in diagnostic techniques and treatment options for PV among the experienced authorities emphasize the urgent need for large-scale controlled trials to reach consensus st and ards in this field. In addition, regional and worldwide consensus meetings to consider all regional and genetic similarities and differences are highly recommended

Prevalence of cutaneous manifestations in end stage renal disease patients under hemodialysis in Imam Khomeini hospital, Tehran in 2003

New modalities in the treatment of end-stage renal disease [ESRD] patients have increased their life expectancy and quality of life. A wide range of cutaneous manifestations are seen in ESRD patients. This study was conducted to determine the prevalence of cutaneous manifestations in ESRD patients on maintenance hemodialysis in the dialysis department of Imam Khomeini hospital. One hundred and four hemodialysis patients on maintenance hemodialysis in April, May, and June 2003 were interviewed and examined for skin problems. Almost all patients had at least one cutaneous lesion. The most common cutaneous findings were changes in skin color and nail disorders [79.8%]. The other common cutaneous manifestations were xerosis [74%] and pruritus [51%]. Xerosis was more common in those patients with serum calcium level greater than 9.3 gr/dl [P<0.05]. Hyperpigmentation was more frequent in patients with urine volume <500 ml [P<0.05] and in those who were more than 24 months on continuous hemodialysis [P<0.05]. Pruritus was more common in those patients with a history of drinking alcohol [P<0.05]. Nail involvement was seen in all 14 patients who were positive for HCV Ab, but was absent in those 5 patients who were positive for HBs Ag. Cutaneous manifestations are very common in ESRD patients on maintenance hemodialysis

Patch test results in patients with clinical diagnoses of contact and/or atopic dermatitis in Isfahan

Patch testing is an important diagnostic tool to confirm allergic contact dermatitis. Determination of the validity and usefulness of a standard patch test allergen series with consideration of age, sex and race difference can reduce diagnostic errors in patients with allergic contact dermatitis. This study was done to determine the frequency of contact sensitization to 28 common allergens in patients with clinical diagnoses of contact and/or atopic dermatitis. Materials and In a cross sectional study during 6 months, 250 patients with contact and/or atopic dermatitis were patch tested with DKG standard patch test series and evaluated after 24, 48 and 72 hours after application of patch test. Data were analyzed using SPSS. 11 software by X[2], Fisher's exact and t tests. Positive patch test results were seen in 32% of all evaluated patients. 45.8% of patients with age above 40 years and 28.0% of patient with age below 40 years had a positive patch test. Potassium dichromate and nikel sulfate were the most common allergens in our study. In this study only 13 of 18 [46.4%] tested allergens showed positive reaction. Low positive rate of standard DKG series in this study shows that allergen series of standard patch test should be revised based on reginal conditions, allergens and social habits

[ 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

[Behavioral characteristics in 3-12 month old infants with atopic dermatitis: a case control study]

Atopic dermatitis [AD] is a chronic disorder that is most common in early childhood. Both immunological and psychological factors are important in AD pathogenesis and should therefore be taken into account. The aim of this study was to compare behavioral characteristics of 30 infants [3-12 month-old] with AD with 40 controls. The infants with the definite diagnosis of atopic dermatitis referring to Children Medical Center and Center for Research and Training in Skin Diseases and Leprosy were included in the study. The severity of atopic dermatitis was determined by SCORAD criteria. For assessing behavioral characteristics Infant Behavior Questionnarie [IBQ] for measuring 11 scales of behavioral characteristics was used. Questionnaires were filled by the researchers with the cooperation of the parents or the child care givers. The AD group showed significantly higher scores in perceptual sensitivity, soothability and high pleasure, but not other characteristics. Infants with AD tend to have higher perceptual sensitivity to the environment around them and show more pleasure and excitement when subjected to an intense, rapid, novel or incogruit stimuli compared with non atopic infants

frequency of skin allergens in patients with contact dermatitis

Eczema is one of the most widely spread inflammatory skin disorders. Contact dermatitis is an eczematous dermatitis that is produced as a result of contact with a substance in the environment. The substance can act as an irritant or allergen. Every country has allergens particular to itself. Determining the frequency of skin allergens in patients with contact dermatitis in Tehran. In this cross-sectional descriptive study, all the data about the patients with chronic contact dermatitis who were visited in a dermatology clinic in Tehran from the year 1993 to 2003 and patch tested with 23 allergens of European Standard Series [ESS] were analyzed. In this study 222 patients were surveryed. The mean age of the patients was 33.5 Years [SD=13.8]. 66.5% of the patients were females. The most common site of involvement [49%] was their hands. The mean duration of the disease was 54 months [SD=62]. Clinical diagnosis included: 59% allergic contact dermatitis, 24% irritant dermatitis, 10% atopic dermatitis, and 7% other types of dermatitis. One-hundred and forty five [65.3%] of them had at least one positive reaction. The most common allergens were: nickle sulfate 22.6%, cobalt chloride 14.5%, and fragrance mix 13.6%. Nickel was the most common contact allergen among the patients surveyed