Pemphigus vulgaris activity score and assessment of convergent validity

Pemphigus is a rare autoimmune blistering disease with different phenotypes. The evaluation of therapeutic interventions requires a reliable, valid and feasible to use measurement. However, there is no gold standard to measure the disease activity in clinical trials. In this study we aimed to introduce the pemphigus vulgaris activity score [PVAS] measurement and to assess the convergent validity with the experts' opinion of disease activity. In PVAS scoring, the distribution of pemphigus vulgaris antigen expression in different anatomical regions is taking in to account with special consideration of the healing process. PVAS is a 0-18 scale, based on the extent of mucocutaneous involvement, type of lesion and the presence of Nikolsky's sign. The sum of the scores of total number of lesions, number of different anatomic regions involvement and Nikolsky's sign is weighted by the type of lesion. In the present study, PVAS was assessed in 50 patients diagnosed with pemphigus vulgaris by one dermatologist. Independently, five blinded experts scored all the patients through physician's global assessment [PGA]. The convergent validity with experts' opinion was assessed. The Spearman coefficient of correlation showed the acceptable value of 0.751 [95%CI: 0.534- 0.876]. PVAS is a valid, objective and simple-to-use scoring measurement. It showed a good correlation with PGA of pemphigus disease activity in Iranian patients with pemphigus vulgaris

Comparing pulsed-dye laser with cryotherapy in the treatment of common warts

No modality has been identified as the treatment of chice for treating common warts. Cryothearpy and pulsed-dye laser [PDL] are among common modalities for treating these lesions. The aim of this study was to compare pulsed dye laser with cryotherapy in terms of efficacy and complications. Of a total of 46 patients enrolled in this study, 7 patients withdrew the study, 20 patients underwent cryotherapy and 19 patients underwent PDL. Patients underwent a maximum of 4 therapeutic sessions at 3-week intervals in both groups. They were assessed for the remission rate [complete and partial], side effects and recurrence rate in each session and 1 month after termination of the treatments. At the end of the study complete remission was achieved in 37.8% of patients in cryotherapy group and in 52.3% of patients in PDL group. This difference wasn't statistically significant [P=0.229], though after first and second sessions of treatment complete and excellent partial remission occurred more in PDL group with significant difference [P=0.007 and P=0.021]. Pain and bulla formation occurred statistically higher in cryotherapy group [P=0.002 and P=0.001]. Other complications were rare in both groups. In terms of efficacy, we couldn't demonstrate the superiority of pulseddye laser therapy to cryotherapy in treating common warts. Both methods were safe for long-term complications but PDL was much safer for short-term complications

comparison between systemic PUVA therapy alone and combined with topical calciporiol in the treatment of generalized vitiligo

Vitiligo is a relatively common acquired depigmentary disorder affecting approximately 1% of general population. PUVA therapy is the most effective modality and commonly used as the primary treatment of generalized vitiligo. To evaluate the synergistic effect of topical calcipotriol and oral methoxalene plus PUVA in treatment of generalized vitiligo. In this clinical trial, 47 patients with generalized vitiligo [<40% involvement of skin surface area] were randomly assigned to two treatment groups. Both groups were treated with systemic PUVA three times weekly. One group was also treated with topical calcipotriol [0.005%]. Patients were evaluated for treatment response and possible side effects. The mean response rate at the end of the study was 63.9% +/- 24.1 in the calcipotriol and PUVA group and 60.6% +/- 23 in the PUVA group [P>0.05]. The number of PUVA sessions and the mean cumulative UVA dose for maximum response were 96. 6 +/- 22.7 and 584.1 +/- 118.1 J/cm [2] in the calcipotriol and PUVA group and 116.3 +/- 26.1 and 685.1 +/- 168.0 J/cm [2] in the PUVA group [P<0.05]. In patients with generalized vitiligo, combination of PUVA with calcipotriol is an effective and safe treatment. This method decreases number of PUVA sessions and UVA dosage compared to PUVA treatment alone and accelerates repigmentation