Efficacy of combination therapy of pimecrolimus 1% cream and mometasone cream with either agent alone in the treatment of childhood vitiligo

Objective: to evaluate the efficacy of the combination therapy of mometasone and pimecrolimus in the treatment of vitiligo in children

Methods: in this double-blind randomized controlled trial, 50 patients were enrolled. Based on the planned treatment protocol, three lesions with approximately identical size at similar anatomic sites were selected in each patient. Lesions were divided to three groups: pimecrolimus cream 1 % [twice a day], mometasone furoate ointment 0.1 % [every night], and combined therapy group [pimecrolimus twice a day on weekdays and mometasone every night on weekends], all being applied for three months. They were followed up for three months

Results: forty patients [with 46% of cases being male] with a mean age of 10.6 years completed the study. There was no significant difference in response rate between three groups at the end of the treatment

Conclusion: our study results did not demonstrate significant difference in the response rate and adverse effects between combined treatment group and either alone

Pattern of cutaneous disorders in the South Eastern Iran, Kerman

To identify the pattern of common cutaneous disorders in the region of South Eastern Iran, Kerman Province. In this study, 1000 patients who had been referred to the Afzalipour hospital clinic during a three months period in the autumn of 2013 were included. Excluding those who had repeat visits, 900 new cases were detected including multiple diagnoses in some patients. Dermatology residents analyzed the medical records of the patients [history, physical examination and laboratory investigations]. The diagnoses were classified according to WHO International Classification of Diseases, revision [ICD 10]. Descriptive statistics were used to analyze the data. There were 500 male [55.5%] and 400 female [44.5%] patients and the mean age of the patients was 30.7 +/- 6 years. Among the non-infective diseases, dermatitis and urticaria [31%] were the most common cutaneous disorders for attendance, followed by infectious diseases [19%], pigmentary diseases [15%], acne vulgaris [14%], papulosquamous diseases [10%], out of which psoriasis contributed to 45 [5%] cases. Hair diseases [3%], skin tumors [2.2%], nail diseases [2%], adverse drug reactions [2%], vesiculobullous diseases [1%] and cutaneous manifestations of systemic diseases [0.8%] contributed to the rest of cases. The management of the vast majority of cases [85%] consisted of advice with a prescription, while only [5%] of patients required admission. Dermatitis and skin infections were the most common cutaneous disorders in our study population. On the basis of the present data, improving the socio-economic status, environmental and personal hygiene, as well as, specific instructions to the risk group can be beneficial

Epidemiology and Clinical Features of Atopic Dermatitis in Kerman, a Desert Area of Iran

BACKGROUND: Epidemiologic studies of atopic dermatitis (AD) in desert areas are still lacking. OBJECTIVE: The aim of this study was to investigate the epidemiology of AD in children in Kerman city, a desert area in Iran. METHODS: We evaluated preschool children (age, 2 to 7 years) and primary school students (age, greater than 7 up to 12 years) in Kerman. We selected 865 students to estimate the prevalence and assess other features of AD such as distribution of lesions, personal history, family history of atopy, aggravating factors, associated symptoms, and morphological variants. RESULTS: The prevalence of AD was 9.1% in our study population. The prevalence of AD was 9.17% and 9.09% in males and females, respectively. The prevalence of AD in the age range of 2 to 7 years was 13.53% and 8.33% among children aged greater than 7 up to 12 years. In total, 82.27% of the patients were in chronic stage of the disease, and 31.6% had a personal history of other atopic diseases. At least one first-degree family member with atopy was seen in 46.83% of the patients. The most common sites of involvement were the head and neck. The most involved areas in the limbs were extensor surfaces. The most frequent morphological variant of AD was the common type. CONCLUSION: The prevalence of AD in Kerman was higher than in other Iranian cities but lower than that in developed countries. Diversity in the clinical features of AD has been observed among different studies, and the diagnostic criteria of AD should be adapted in proportion to the studied area.

Clinical and demographic profile of childhood alopecia areata in Iran

To evaluate the clinical profile of alopecia areata [AA] in Iranian children. One hundred Iranian children aged less than 16 years participated in this cross-sectional study. Data were obtained by administering a parental-recall questionnaire; and clinical and demographic parameters and associated diseases were evaluated. The mean age of AA onset was 8.9 +/- 2.1 years. The scalp was the most common site of involvement. Thirty-five percent of the patients had a precipitating factor, with psychological stress being the most common factor. Associated diseases were recorded in 60% of the patients, with the most common associated disease being eczema. Twenty-one percent of the patients were positive for a family history of AA. Severity and extent of the disease and the age of onset showed significant relationships with parents' educational and economic status [p<0.05]. Nail changes were also strongly associated with severity and extent of the disease [P=0.006]. Our results suggest that the severity and extent of the disease both increase with anearly age of onset, low parent educational levels, low socioeconomic status, and nail changes

survey on Helicobacter pyloriseropositivity status in Iranian children with atopic dermatitis

To evaluate the presence of Sinti-Helicobacter pylori antibody in the sera of children with and without atopic dermatitis [AD] in Kerman province, Iran. In the current study the cases consisted of 128 patients with AD, aged from 6 month to 16 years. One hundred and twenty eight healthy children matched for sex and age were chosen as control subjects. The enrolled patients were selected consequentially from the cases referred to the dermatology and pediatric clinics of Afzalipour hospital, an academic medical referral center in the capital of Kerman province. The diagnosis of AD was made based on the UK working party's diagnostic criteria for atopic dermatitis. The control subjects were chosen randomly among children who were referred to the center for periodic vaccination program and before receiving the vaccines. The subjects in control group who had a personal or family history of allergies [including asthma, atopic dermatitis or allergic rhinitis] were excluded as well. A sample consisting of 3 milliliters of blood was obtained from each subject in the study [including the cases and the controls] for H. pylori serology. In children under 1 year of age, the amount of collected blood samples we reduced to the minimum in the acceptable range. The status of infection with Helicobacter pylori was determined in all subjects quantitatively by measurement of specific IgG antibody via enzyme-linked immunosorbent assay [ELISA] method [Trinity Biotech Monbind Captia[tm], USA]. The mean age of the cases with AD and the controls were 5.74 +/- 4.05 and 6.05 +/- 3.36 years, respectively. Of all the children in both cases and controls 45.5% and 55.8% were females, respectively and the remaining were males. Anti-H. pylori IgG antibody was positive in the cases with AD and the control group 25.2% and 24%, respectively that was not statistically significant. The results of this study showed no association between H. pylori infection and AD

Koebnerization in a woman with extragenital lichen sclerosus

Lichen sclerosus [LS] is a chronic benign inflammatory disorder of skin and mucosa which affects patients of all age groups, sex and race, particularly caucasian prepubertal girls and postmenopausal women. The etiology of LS is unknown, but it has been suggested that genetic predisposition to inflammatory disorders, immunological constitutions, hormonal influences and local factors might play a role. Extragenital LS are most common on the neck, shoulders and upper portion of the trunk. It is generally asymptomatic, but occasionally pruritic. The Koebner sign is a well-known diagnostic marker in LS. Typical lesions have been noted to occur following surgical operations, infections, rubbing of skin, in old thermal burn scar, sexual abuse and under tight clothing. We describe a 25-year-old Iranian woman presented with a 2-month history of extragenital LS. The multiple classical lesions of disease were presented over her neck, shoulders, upper part of trunk, the medial area of her thighs and feet at the dorsal site. The diagnosis of LS was confirmed by histological findings. Beside LS classical lesions on her back, linear lesions including Koebner phenomenon were observed at the sites of rubbing and itching of skin

[Linear granuloma annulare of the finger]

Granuloma annulare [GA] is an inflammatory benign cutaneous disease of unknown etiology that may manifest different clinical features. The most common presentation or classic form of the disease is manifested as flesh colored, annular grouped papules, commonly involving the hands and feet. Various skin injuries and infections have been reported to trigger GA, including insect bites, warts, herpes zoster, acquired immunodeficiency syndrome and Epstein-Barr virus infections. Several clinical manifestations have been reported for this disease such as localized, generalized, subcutaneous, linear, perforating and patch GA, have been reported. Linear form is a rare variant of localized GA, and other skin diseases occuring in a linear configuration such as rheumatoid nodule, wart, morphea, and epidermal nevus must be differentiated from linear GA. This report describes a case of a 3 cm linear, flesh-colored, lesion with beaded border on dorsum of right index finger in a 8-year-old girl with histological findings of GA

Evaluation of In Vitro production of IFN-gamma, IL-10, IL-12 and IL-13 by blood cells in patients with cutaneous leishmaniasis lesions

This study investigated the in vitro production of interferon-gamma, interleukin [IL]-10, IL-12, and IL-13, after antigenic stimulation of the cells [with Leishmania antigen and lipopolysaccharide] using whole blood from patients with cutaneous leishmaniasis lesions caused by Leishmania tropica and in normal volunteers with history of cutaneous leishmaniasis. ELISA results showed that the mean production of interferon-gamma by cells of whole blood in patients with lesions in response to Leishmania antigen was significantly lower than corresponding values in volunteers with history of cutaneous leishmaniasis [P< 0.05] and significantly higher levels of IL-10 production in patients with lesions were observed compared with cured volunteers of the disease [P<0.01]. A similar level of IL-12, including p40 subunit of IL-12, was detected in both groups tested in this study in response to stimulation of parasite antigen. The levels of the IL-13 after stimulation with Leishmania antigen were significantly more in patients compared with volunteers with history of cutaneous leishmaniasis [P< 0.01]. There was no significant difference in the mean production of IFN-gamma, IL-10, IL-12 and IL-13 by PHA or LPS stimulated cells from patients with lesions and volunteers with history of the disease, indicating that there was no qualitative defect in cytokine production in these patients. In this study, we have detected the decreased production of interferon- gamma by cells of patients with lesions of cutaneous leishmaniasis in response to parasite antigen and unbalanced production of regulatory cytokines such as IL-10 and IL-13 using the whole-blood stimulation assay technique. The required small volume of blood and the rapid set up time are the advantages in this assay technique. Using this assay for further immunodetection of cytokines may confirm its value for clinical investigation