Muco-cutaneous manifestations in 178 renal transplant recipients.

INTRODUCTION: Mucosal membrane and skin can be affected by immunosuppressive drug(s) and immunosuppression itself. The spectrum of muco-cutaneous lesions can range from malignancy at one end to infection, iatrogenic lesions, and esthetic effects on the other end. METHOD: In Razi Hospital of Guilan University of Medical Sciences, a cross-sectional study for the detection of muco-cutaneous lesions in 178 renal transplant recipients (RTRs) was conducted from the years 2001 to 2006. Biopsy and skin scraping according to the type of skin lesions were performed. RESULTS: A total of 31 RTRs (25%) had normal skin. Iatrogenic lesions were the most common (70%) followed by infectious lesions (57%), and miscellaneous skin lesions were exhibited by 26% of the patients. Among the iatrogenic skin lesions, gingival hyperplasia was the most common lesion (48%), followed by hypertrichosis and acne. Malignant lesions (biopsy proven) were recorded in seven patients (5%). Four patients were found to have Kaposi's sarcoma, and three patients were identified with basal cell carcinoma. CONCLUSION: Our results showed that muco-cutaneous lesions are crucial problems with RTRs. Attending physicians must pay close attention to skin care regularly and consider reduction of immunosuppression to a safe level, and patient must have self-checkups.

Partial-thickness burn wounds healing by topical treatment: A randomized controlled comparison between silver sulfadiazine and centiderm.

BACKGROUND: Burns are common event and associated with a high incidence of death, disability, and high costs. Centella asiatica (L.) is a medicinal herb, commonly growing in humid areas in several tropical countries that improve wound healing. On the basis of previous studies, we compared the efficacy of Centiderm versus silver sulfadiazine (SSD) in partial thickness burning patients. METHODS: Study population comprised burn victims referred to Velayat Burning Hospital at Rasht, Iran. The intervention group received Centiderm and control group SSD cream. Burn wounds were treated once daily at home. All of the wounds were evaluated till complete healing occurred and at the admission, days 3, 7, 14 objective signs; visual acuity score (VAS) and subjective signs were recorded. Re-epithelialization time and complete healing days were recorded. We used random fixed block for randomization. The randomization sequence was created using the computer. Patients and burning specialist physician were blinded. RESULTS: Seventy-five patients randomized into 2 groups; (40 patients: Centiderm group; 35 patients: SSD group). The mean age of them was 30.67 ±â€Š9.91 years and 19 of them were male (31.7%). Thirty patients in Centiderm and 30 patients in SSD group were analyzed. All of objective and subjective signs and mean of re-epithelialization and complete healing were significantly better in Centiderm group rather than SSD group (P < 0.05). There was no infection in Centiderm group. CONCLUSIONS: We showed that use of Centiderm ointment not only improved the objective and subjective signs in less than 3 days, but also the re-epithelialization and complete healing rather than SSD without any infection in the subjects.

Comparison of the efficacy of topical 1% lindane vs 5% permethrin in scabies: a randomized, double-blind study.

BACKGROUND: Permethrin, a pyrethroid insecticide, is not yet available in Iran and may be a useful substitute for the control of scabies in Iran. AIM: To compare the efficacy of topical lindane with topical permethrin in the treatment of scabies in a population in Iran. METHODS: In a double-blind, randomized study, all consecutive patients with scabies were randomized into two groups. One group and their family contacts received 1% lindane cream, and the other group and their family contacts were treated with topical 5% permethrin cream. Subsequently, patients were followed up at 2- and 4-week post-treatment. RESULTS: Of the 99 patients enrolled in the study, 47 patients received 1% lindane cream, and 52 patients were treated topically with 5% permethrin cream. Permethrin provided an improvement rate of 84.6% after two weeks, whereas lindane was effective only in 48.9% of patients. CONCLUSION: Permethrin (5%) cream was found to be significantly more effective in the treatment of scabies in comparison with lindane in this study, and it seems that it could be an alternative treatment.

Report of a new case with four skin diseases.

A 70 year old man is presented with four distinct skin diseases that were diagnosed concomitantly. Lichen planus, vitiligo, lichen sclerosis, and disseminated actinic porokeratosis were all diagnosed clinically and histologically in this man, who was otherwise healthy.

Quality of life in psoriatic patients: a study using the short form-36.

BACKGROUND: Quality of life (QOL) is increasingly recognized as an important outcome measure in dermatology. Psoriasis has a great impact on QOL of patients, and has a strong effect on social relations, psychological status, and daily activities. This study describe and compare the impact of different grades of severity of psoriasis on QOL of patients in north of Iran. METHODS: This cross-sectional study was performed on 55 patients diagnosed with psoriasis and 55 healthy controls. The patients were selected by consecutive sampling from April to December 2006. The controls were recruited by simple random sampling among patient escorts. After obtaining written informed consent, all the members were included into the study. The Psoriasis Area and Severity Index (PASI) standard questionnaire was used to determine the severity of the disease. In addition, the short-form-36 questionnaire, which is validated for use in Iran, was employed. The gathered data were analyzed using the Stata (V 8.0, SE) (Copyright 1984-2003, Stata Corporation, 4905 Lakeway Drive Special Edition, College Station, Texas 77845 USA) and analyses of covariance (ANCOVA) test. RESULTS: Overall, The mean PASI scores was 5.4 ± 6.7, total QOL scores had a significant difference between patients and controls (61.1 ± 17.0 vs. 71.9 ± 22.4) (P < 0.05), especially in three domains: Role-physical (58.5 ± 23.3 vs. 70.8 ± 26.2), general health (43.8 ± 21.6 vs. 61.5 ± 27.3), and social functioning (62.7 ± 26.7 vs. 79.5 ± 27.5) (P < 0.01). Physical activities were affected in >50% of the cases. This figure significantly increased with the increasing severity of psoriasis. In addition, social relationships were disrupted in more than half of the patients, but with no significant difference between different grades of severity (P > 0.05). There is no significant difference between adjusted score of multiple domains of QOL in psoriatic patients according to PASI levels (ANCOVA, P > 0.05). CONCLUSIONS: The physicians' awareness of the importance of patients' QOL in both physical and emotional aspects could improve and enhance the psychological evaluation of the psoriatic patient, which will promote his/her positive outcome. And, PASI score can't to predict the QOL really.

Skin Disorders among Elder Patients in a Referral Center in Northern Iran (2011).

Background. Geriatric health care has become a worldwide concern, but a few statistical studies were carried out about skin diseases in this age group. In this study, we set out to determine the frequency as well as the age and gender distribution of dermatological diseases in geriatric patients. Materials and Methods. In a cross-sectional study, all patients over 60 years who were accepted to department of dermatology in north of Iran participated in this study. Baseline information and clinical examination were done by a group of dermatologists. Biopsy, Pathological and laboratory methods were used in order to confirm the diagnosis. Results. 440 patients were accepted to the department that 232 patients were male (52.7%). Benign neoplasm was as the common skin disease among patients (65%), followed by erythemo-squamous (35.3%) and precancerous lesions (26.1%). The most common precancerous lesion was actinic keratosis (24.3%). BCC by 8.8% was the most prevalent skin carcinoma. Pruritus was the common problem in other dermatological disease (22%). Conclusion. Skin disorders especially precancerous lesion are among those important health problems in elderly patients in this geographic area. Increasing general awareness about risk factors of these diseases and doing more researches in other regions are highly recommended.

Comparison of anxiety and depression in patients with acne vulgaris and healthy individuals.

BACKGROUND: Acne vulgaris is a chronic inflammatory disease of the pilosebaceous units, which chiefly involves face and upper part of the trunk. Its prevalence is highest in adolescence, where the individual counters several psychosocial changes. Depression, suicidal thoughts, and low self esteem are reported in the patients with this disease. AIM: The goal of this study is to compare prevalence of anxiety and depression in the patients with acne vulgaris and normal population. MATERIALS AND METHODS: In this cross-sectional study, 82 patients with acne vulgaris and 82 persons without acne who referred to a dermatology clinic and a specialized office for skin diseases in Rasht were studied. Anxiety and depression were evaluated by Hospital Anxiety and Depression Scale (HADS) questionnaire and severity of acne was evaluated by Global Acne Grading System (GAGS). Data were analyzed by SPSS ver. 14.0 software, independent T-test, multi variate analysis of covariance (MANCOVA) and chi-square test for comparison the quantitative and ordinal data, respectively; with α=0.05. RESULTS: Prevalence of anxiety and mean of anxiety scores were 68.3% and 9.17 ± 3.52, respectively, in patients group and 39.1% and 7.10 ± 3.07, respectively, in control group in which there was a significant difference (P = 0.001). Prevalence of depression and mean of depression scores were 25.6% and 5.34 ± 3.29, respectively, in patients group and 28.1% and 5.01 ± 3.32, respectively, in control group in which there was no significant difference. CONCLUSION: According to high prevalence of anxiety in patients with acne vulgaris, assessment of the screening mental status of the patients by simple questionnaire such as HADS is suggested.

Lepromatous leprosy with extensive unusual ulcerations and cachexia. Is it the first case of Lucio's phenomenon from Iran?

We report a 33-year-old Iranian woman with widespread ulcerative lesions in the setting of lepromatous leprosy. We think that the sudden appearance of the characteristic necrotic lesions in the absence of fever and other systemic manifestation, and in accordance with epidermal necrosis and the presence of large numbers of AFB in the endothelium are all in favor of the diagnosis of Lucio's phenomenon for this patient. To our knowledge this is the first patient who may have had this phenomenon reported from the Middle East.