Thinking outside the skin: Look at the thyroid for true diagnosis

Keratoderma is a group of disorders characterized by abnormal thickening of skin. Acquired palmar keratoderma has many underlying causes. The association of thyroid disease and palmar keratoderma rarely reported. Hypothyroidism, although very rare association, must be suspected in patients with acquired PPK, particularly when it occurs in setting of systemic symptoms or predisposing conditions. We report first case of acquired plantar keratoderma associated with undiagnosed hypothyroidism in Down syndrome

Vitiligo and autoantibodies of celiac disease

Vitiligo is an acquired, idiopathic disorder characterized by circumscribed depigmented macules and patches. The exact etiology and pathogenesis of vitiligo is not clear. Many theories have been presented regarding this subject among them aautoimmune theory is the most important one. The association of vitiligo with other autoimmune disorders has been reported, but the relationship between vitiligo and celiac disease is controversial. The aim of this study was to study the frequency of celiac autoantibodies in a group of vitiligo patients compared with control. This was a cross sectional case control study that involved 128 individuals, 64 vitiligo patients and 64 individuals as control group. The means age of participants was 30.3 +/- 14.4 years. IgA anti Endomysial antibody and IgA anti-glutaminase antibody were measured by ELISA method in the serum of all participants. Data were analyzed by SPSS software version 15. The serum of two vitiligo patients [3.1%] was positive for antibodies. All control groups were seronegative for these antibodies [P < 0.05]. There was nosignificant effect of sex and job on seropositivity. There may be a relationship between celiac disease and vitiligo. This may indicate a common basic autoimmune mechanism that is an explanation for few case reports that gluten free diets were effective in the treatment of vitiligo patients. Both T test and exact fisher test showed no effect of age, sex and job anseropositivity of these patients [p=0.56 and p=0.74, respectively]

[Prevalence of androgenetic alopecia among women between 20-70 years old in Isfahan province in 2008-2009]

Androgenetic alopecia is an extremely common disorder affecting both men and women. The incidence is generally considered to be greater in males than females, although some evidence suggests that the apparent differences in incidence may be a reflection of different expression in males and females. This genetically determined disorder is progressive through the gradual conversion of terminal hairs into indeterminate hairs and finally to vellus hairs. Patients have a reduction in the terminal-to-vellus hair ratio, normally at least 2:1. Following miniaturization of the follicles, fibrous tracts remain. Patients with this disorder usually have a typical distribution of hair loss. This is a cross sectional study that conducted in Isfahan health center in 2007-2008. Using simple random sampling, we selected 1800 women in urban health center areas for hair loss. We evaluated the type of hair loss by Ludwig classification. The data was collected through administration of a specifically designed questionnaire and was analyzed using SPSS software. The chi-square and student tests were used for data analysis. According to results of this study the of 1800 women, 712 [39.6%] had hair loss. Mean age of females who had hair loss was 50.4 +/- 13 years. Thyroid disorders, ferritin serum level and androgenic hormones may play role in hair loss and their existance should be assessed

Imaging techniques in dermatology

Since the discovery of X-rays, the use of imaging technology has continued to play an important role in medicine. Technological advancements have led to the development of various imaging modalities, most of which have been used to image organs deep within the human body. More recently, attention has focused on the application of imaging technology for evaluation of the skin. A variety of techniques are currently being used to examine the skin and these include specialized photography, surface microscopy, ultrasound, laser Doppler perfusion imaging, confocal microscopy, magnetic resonance imaging and optical coherence tomography. These modalities can provide information that can assist in the management of skin problems. Although many of these techniques are still undergoing research, they are showing promise as useful clinical tools in dermatology. In this review article we discuss about each of these technologies in brief

[Evaluation of therapeutic response of Keloid and Hypertrophic scars to bleomycin tatto and to cryotherapy followed by intralesional triamcinolone injection]

Keloid and hypertrophic scars are abnormal healing responses to injury due to overgrowth of dense fibrous tissue developing after healing of skin injury. Several treatments for keloids and hypertrophic have been suggested, from which cryotherapy followed by intralesional corticosteroid injection is the most common. The aim of this study was to compare the therapeutic responses of bleomycin tattoo and cryotherapy followed by intralesional triamcinolone injection methods for treatment of keloids and hypertrophic scars. The study was performed on 45 patients divided into two groups. Group A [23 patients] treated with bleomycin tatto and group B [22 patients] treated with cryotherapy and intralesional injection of triamcinolone. Each group received one treatment per month for a period of four months, and was followed up for three months after the treatment. Therapeutic response was defined as the percentage of scar height reduction. Patients treated with bleomycin showed 88.3%+/-14 and the next group showed 67.3%+/-22.5 reduction of scar height, that were significantly different. Also 69% of group A and 49% of group B became symptom free. It is concluded that bleomycin tattoo showed a better therapeutic response for Keloid and hypertrophic scars