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

BCL-2 and bax expression in skin flaps treated with finasteride or azelaic acid

Despite all modern surgical techniques, skin flap that is considered as the main method in most reconstructive surgeries puts the skin tissue at danger of necrosis and apoptosis derived from ischemia. Therefore, finding a treatment for decreasing the apoptosis derived from flap ischemia will be useful in clinic. In present study, we evaluated the effect of azelaic acid 20% and finasteride on expression of BCL-2 and bax proteins after the skin flap surgery. For this purpose, 21 rats were entered in three groups including control, azelaic acid 20% and finasteride, all experienced skin flap surgery and then flap tissue was assessed for determining the expression of proteins in 5 slices prepared from each rat that were graded between - to +++ scales. Both azelaic acid and finasteride increased the expression of BCL-2 protein [p < 0.05] and decrease the expression of bax protein [p < 0.05]. These results suggested an antiapoptotic role for finasteride and azelaic acid in preserving the flap after the ischemia reperfusion insult

[Langerhans cell histiocytosis: a case report]

Langerhans cell histiocytosis [LCH] is a proliferative disorder of langerhans cells and lymphocytes having different subtypes and a wide range of clinical manifestations and severity ranging from a unifocal self-limited disorder to multi-system involvement and even death. Along with clinical manifestations, diagnosis is made through existence of specific immunohistochemistry markers. Where treatment is necessary, different treatment modalities have been proposed; though none have found to be optimal. This paper introduces a 23-year old girl with an extensive yellowish to red-brown maculopapular rash over her face accompanied with polyuria, polydipsia, and fatigue

[ unusual presentation of deep morphea [morphea profunda]: peripheral sensory motor nerve involvement, insulin dependent diabetes mellitus and hypothyroidism]

This case report introduces a 28-year-old male patient with morphea profunda, peripheral sensory motor nerve involvement, insulin dependent diabetes mellitus and hypothyroidism as an unusual presentation of deep morphea who dramatically responded to prednisolone and metothrexate after 4 months of treatment

[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

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

[Frequency of contact sensitivity in patients with contact or atopic dermatitis with patch test]

Eczema is a common inflammatory skin disease. Although history and physical examination are important in diagnosis of allergen, because of extent of environmental allergens, those are not simply recognized. The objective of this study was to determine allergens in patients with contact or atopic dermatitis referred to Razi hospital. This descriptive, cross sectional study was performed on patients with contact or atopic dermatitis in 2003-2004 with European Standard Series patch test containing 24 allergens. In this study 223 patients were tested with a mean age of 31 years [SD= 12]. The most common involved location was hand [59%]. The most common allergens were nickel sulphate [23/2%], cobalt [11/4%] and thiuram [8/3%]. Nickel sulphate was the most common contact allergen in this study

[ comparison between the efficacy of intralesional injection of 2% Zinc Sulfate solution with Glucantime in the treatment of acute old world cutaneous Leishmaniasis: a randomized, double-blind, controlled clinical trial]

Several treatment modalities have been used for cutaneous leishmaniasis[CL] with various results. In vitro and in vivo studies have shown inhibitory effects of zinc sulfate [ZnSO4] on Leishmania parasites. To compare the efficacy of intralesional injections of 2% ZnSO4 solution with meglumineantimonate[Glucantime] in the treatment of acute Old World CL. Seventy-two patients with CL with a duration of less than 8 weeks were recruited in a randomized, double-blind, clinical trial in Isfahan province - an area endemic for Leishmania major - after giving written informed consent. They were treated with 6 weekly intralesional injections of either 2% sterile ZnSO4 solution or Glucantime prepared in identical vials. The primary outcome measure was complete re-epithelialization of CL lesions. Among 36 patients with 53 lesions treated with ZnSO4 and 36 patients with 53 lesions treated with Glucantime, 13 patients with 19 lesions and 22 patients with 31 lesions completed the trial, respectively. Inadequacy of treatment was the main reason for drop-out in 12 [33.3%] and 2 [5.5%] patients in ZnSO4 and Glucantime groups, respectively [P < 0.05]. Complete re-epithelialization was observed in 2 [10.5%] and 19 [61.3%] lesions 1 week after the end of treatment in the ZnSO4 and Glucantime groups, respectively [P < 0.05]. A six-week course of weekly intralesional injections of 2% ZnSO4 solution was less effective than Glucantime in the treatment of acute Old World CL