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

Co-existence of cutaneous leishmaniasis with pleural effusion: a case report from Iran

Herein, a 12-year-old Afghan boy with chronic cutaneous leishmaniasis on the face and verrucous lesions on the body and pleural effusion suspected of having co-existent tuberculosis has been presented. The cutaneous lesions were appeared for five years before his admission. Leishman-Donovan bodies were seen in H and E [Hematoxylin and eosin] slide of skin lesion specimens. The pathogenic species was proved to be Leishmania tropica using Polymerase Chain Reaction [PCR] method. Purified Protein Derivative [PPD] and Leishmanin Skin Test [LST] were strongly positive. The patient was treated with systemic and intralesional meglumine antimoniate [Glucantime] for cutaneous leishmaniasis and then with anti-tuberculosis drugs for pleural effusion. Afterwards, pleural effusion was disappeared and cutaneous leishmaniasis cured

Association between HLA-DQB1[asterisk]03:01 and Bullous pemphigoid in Iranian patients

A common Human Leukocyte Antigen [HLA] class II allele, DQ beta 1[asterisk]03:01, seems to be associated with Bullous pemphigoid [BP] in Caucasians whereas previous studies in other ethnic groups showed other HLA class II alleles as genetic predisposing factors for BP. To investigate the association of HLA class II alleles and haplotypes with BP in Iranian population. Methods: Fifty patients with Bullous pemphigoid and 180 geographically matched, healthy individuals as control group enrolled into this study. HLA typing of class II [DR and DQ alleles] was carried out using polymerase chain reaction based on sequence-specific primers method. Class II DQA1 and DQB1 typing showed a significantly higher frequency of HLA-DQA1[asterisk]05:01 [45% vs. 33%, p=0.03], HLA-DQB1[asterisk]03:01 [36% vs. 23.6%, p=0.02] and HLA-DQB1[asterisk]04:01 [4% vs. 1.6%, p=0.04] in the BP patients compared with controls. For DRB1 allele frequencies, there were no significant disease associations. The frequency of DRB1[asterisk]08:01/DQA1[asterisk]05:01/DQB1[asterisk]03:01 [3% vs. 0%, p=0.02] haplotype showed an increase among patients compared with controls. Our data suggest that Iranian patients with BP present the same genetic predisposition linked to HLA-DQB1[asterisk]03:01 previously reported in Caucasians

Desmoglein ELISA in the diagnosis of pemphigus and its correlation with the severity of pemphigus vulgaris

Anti-desmoglein 3 and 1 autoantibodies are involved in the pathogenesis of pemphigus diseases. Our objective was to assess the value of ELISA in the diagnosis of pemphigus and its correlation with the severity of pemphigus vulgaris. Based on clinical presentation and histopathologic confirmation for the diagnosis of the pemphigus, 38 patients took part in the study. Sera of the patients were tested by desmoglein 1 and desmoglein 3 ELISA. Also, direct immunofluorescence was performed for all patients which revealed positive results in 36 patients [94.7%]. ELISA was positive in 37 of 38 pemphigus patients [Sensitivity: 97.3%]. The relationship between desmoglein 1 index values and skin severity was statistically significant [p<0.05]. Desmoglein 3 index values increased with oral severity although this was not statistically significant. Iranian patients similar to Indian patients had higher positive anti-desmoglein 1 autoantibodies. Desmoglein-ELISA test is appropriate in the diagnosis of pemphigus. Desmoglein 1 index value is statistically correlated with the severity of pemphigus vulgaris

[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

Skin lesions in 800 Iranian victims of mustard gas, 14-20 years after exposure

Mustard gas is a disabling chemical weapon and was widely used in First World War and Iraq-Iran war. Its toxic effects could be acute or chronic and they could particularly affect lungs, eyes and skin.To study the frequency of chronic complications of sulfur mustard gas in Iranian victims 14 to 20 years after exposure. This descriptive cross-sectional study was performed on 800 patients that were randomly selected from different provinces of Iran, who had been exposed to sulfur mustard gas during 1983 to 1988. These patients were clinically re-evaluated in 2002-2003 and laboratory tests were performed if necessary. The mean age of the patients at the time of study was 39.3 [ +/- 9.8] years. Three types of skin lesions were observed. Non-specific lesions including 39.6% xerosis, 19% pigmentary disorders, 17.4% cherry angioma, 12.7% seborrheic dermatitis, 12.2% eczema [dermatitis], 11.6% acneiform lesions, 7% tinea versicolor, 5.1% urticaria,, 3.6% vitiligo, 2.5% alopecia areata, 2% psoriasis, and 1.3% aphthous stomatitis. Specific skin lesion called mustard scar was defined according to morphology, location, history and observed in 44 [5.5%] patients. Malignant neoplasms including basal cell carcinoma, Bowen's disease, squamous cell carcinoma, mycosis fungoides and dermatofibrosarcoma protuberans occurred in 9 victims [1.1%]. Mustard gas can cause acute and late-onset skin lesions. Specific lesion of mustard gas called mustard scar is the most important finding of this study

[Identification of mycobacteria species in cutaneous lesions of sarcoidosis by PCR-restriction ragment length polymorphism [PCR-RFLP] method]

Sarcoidosis is a granulomatous multisystem disease of unknown etiology. It has recently been tired to detect Mycobacteria genome in biopsy specimens of patients with sarcoidosis by Polymorphism chain reaction method. To detect and identify Mycobacteria species in cutaneous lesions of the patients with sarcoidosis by PCR-RFLP. 20 patients with clinical diagnosis of sarcoidosis were enrolled in this study. Clinical manifestations, appearance of naked granuloma under light microscope and exclusion of other diagnoses confirmed the diagnosis of sarcoidosis in the patients. By PCR-RFLP, genome of Mycobacteria species was searched in paraffin embedded specimen of skin biopsies of the patients. Four PCR positive skin biopsy specimens of patients with cutaneous tuberculosis were used as positive control. 10 skin biopsy specimens with other than tuberculosis were used as negative control. Mycobacteria genome was not detected in any specimens of the patients. Our findings do not support the role of Mycobacteria species in the pathogenesis of sarcoidosis

[Coexistence of sezary syndrome with kaposi's sarcoma: report of a case with concurrent generalized dermatophyte infection]

Immunosuppression is known to be associated with increased rate of malignancies and widespread dermatophytosis in the patients with sezary syndrome and this may account for the occurrence of Kaposi's sarcoma and generalized dermatophytosis in patients in this report. Herein, we report a 58-year-old farmer man, who admitted with two months history of severely pruritic skin lesions, which progressed to erythroderma. Concurrently some vascular lesions were observed on glans penis off the patient suggestive of Kaposi's sarcoma. Leukocytosis with eosinophilia [20%] and atypical lymphocytosis [More than 10%] were present. Microscopic examination of biopsy of erythrodermic skin lesions on trunk revealed pautrier micro abscess with dermal lymphocytic infiltration and cellular atypia, and the peripheral blood sample showing sezary cells and high ratio of CD4/CD8 [45] lymphocyte were in favor of diagnosis of sezary syndrome. The pathologic evaluation of the vascular lesion of glans penis proved the diagnosis of Kaposi's sarcoma. During the progression of disease, the patient was invaded by generalized dermatophyte infection. KOH smear of annular skin lesion showed mycelia of dermatophyte and culture proved trichophytonrubrum to be the pathogenic agent