Matching between ctlinical examination and dermoscopy in patients with nail psoriasis: Should dermoscopy be used instead of clinical examination?

Background: Dermoscopy has emerged as a useful diagnostic tool to evaluate skin lesions, including psoriasis. We aimed to compare the clinical examination and digital dermoscopy findings of nail involvement in patients with psoriatic nails. Methods: This study included 60 patients with clinically diagnosed psoriasis. The nail findings and NAPSI were evaluated clinically and via dermoscopy, and then the severity of the disease was calculated using PASI criteria. Results: About 32 patients were males, with a median PASI score of 4.4, and pitting and subungual hyperkeratosis were the most common findings. The clinical and dermoscopic examination had a moderate diagnostic resemblance regarding onycholysis, subungual hyperkeratosis, and leukonychia. The resemblance between the two methods for the diagnosis of leukonychia in patients with a duration of disease <2 years (Kappa = 0.59) and 2-6 years was moderate (Kappa = 0.48), and for 6 years< was perfect (Kappa = 0.62). The resemblance for the diagnosis of subungual hyperkeratosis and onycholysis in subjects with a duration of disease <2 years was slight, and for 2-6 years and 6 years< were moderate. The resemblance between the NAPSI score by the two methods was also moderate (95%CI -0.89-0.81, P < 0.001). Conclusion: Dermoscopy is an efficient, supportive, and non-invasive method providing a better diagnosis of nail psoriasis.

Testosterone or dihydrotestosterone: what should be evaluated in hirsutism?

PURPOSE: Dihydrotestosterone is a more potent androgen derived from testosterone and androstenediones, but its measurement has not been routinely recommended in women with hirsutism, and there is limited information in this regard with equivocal findings. This study aimed to evaluate serum dihydrotestosterone level in patients with hirsutism compared to women without hirsutism. METHODS: In this case-control study (during 2021-2022), serum levels of total testosterone, free testosterone, and dihydrotestosterone were evaluated in 101 women with hirsutism and 101 healthy women. Hormonal levels were measured with chemiluminescent immunoassay method. Age and hormonal levels in each group, body mass index, menstrual status, complaint of decreased scalp hair density, and ovarian ultrasound findings in hirsutism group were collected and analyzed. RESULTS: There was significant difference in free testosterone and dihydrotestosterone levels (P < 0.001) and no significant difference in total testosterone level between two groups (P = 0.628). Dihydrotestosterone level was significantly higher in women with hirsutism with menses irregularity, complaint of decreased scalp hair density, and presence of polycystic ovary on ultrasound (P < 0.05). CONCLUSIONS: Measuring dihydrotestosterone level is not considered in routine evaluation of hirsutism, but we think that this significant difference shows that elevated level of dihydrotestosterone hormone in women with hirsutism is an important factor.

Dermatologic problems associated with personal protective equipment in health-care workers managing COVID-19 patients.

Background: The safety of health-care workers (HCWs) during the COVID-19 pandemic is a major concern worldwide. Dermatological problems due to personal protective equipment are annoying issues. We aimed to evaluate dermatological adverse events following the use of these protections in HCWs managing COVID-19 patients. Materials and Methods: One hundred and fifty-six workers managing COVID-19 patients were enrolled in this cross-sectional study. We conducted face-to-face interviews to collect the data and focused mainly on protection type and mucocutaneous symptoms with new onset or exaggeration after this equipment. Results: Dermatological problems following protective equipment usage occurred mainly during the 1st week (65.4%). The most common site of skin involvement was the nose (82.7%) and the most frequent visible complaints were the pressure effect and erythema on the nose in 80.8% and 57.7% of cases, respectively. There was a significant association between mask type and facial skin problems (P < 0.001). The main symptoms were itching (21.8% scalp, 39.1% face and body) and burning sensation (14.1% scalp, 23.7% face and body). Skin desquamation (37.2%) and dorsal hand dermatitis (41.66%) were significantly more frequent in atopic participants (P = 0.02 and P = 0.01, respectively). Hand involvement was significantly associated with frequency of hand washing (odds ratio = 1.97, 95% confidence interval = 1.04-3.74, P = 0.03). Conclusion: We found that skin problems related to protective equipment were common and frequently located on the face mainly due to facial masks. These complications should be prevented by proper use of this equipment.

Combination Therapy of Metadichol Nanogel and Lipocalin-2 Engineered Mesenchymal Stem Cells Improve Wound Healing in Rat Model of Excision Injury.

Purpose: Currently, several disorders including burns, trauma, excisional and diabetic wounds, and bedsores threaten the human health. Application of mesenchymal stem cells (MSCs) is recommended for treatment of skin disorders. However, because of oxidative stress and inflammation after skin injury, survival of transplanted MSCs is low which in turn negatively affects the efficiency of the MSCs-based therapy. In an attempt to address the aforementioned challenge and introducing a novel potential therapeutic strategy, we employed combination therapy by lipocalin 2 (Lcn2)-engineered MSCs and a Metadichol (an inverse agonist of vitamin D receptor (VDR)) nanogel in a rat model of excisional wound. Methods: First, human umbilical cord MSCs (hUC-MSCs) was transfected by a recombinant plasmid encoding Lcn2 gene. Next, a combination of Metadichol nanogel and the engineered MSCs was co-applied on wound in rat model of excision injury. Finally the improvement of wound healing in experimental groups was evaluated by photography and histological assessments (hematoxylin and eosin staining). Results: Our findings revealed that the repair rate was higher in the group received combination therapy comparing to control groups. Notably, Metadichol+Lcn2-MSCs showed significantly higher wound contraction rate compared to control group at all time points (P value < 0.001). Furthermore, wound repair rate was 95% 14 days after surgery, and 100% after 21 days in the treatment groups. Our results also revealed that the combination therapy improved and accelerated the wound healing process. Conclusion: Our findings suggest a novel potential therapeutic strategy i.e. Lcn2-engineered MSCs and Metadichol for wound healing. However, further preclinical and clinical studies are required.

Migratory routes, domesticated birds and cercarial dermatitis: the distribution of Trichobilharzia franki in Northern Iran.

BACKGROUND: One of the major migration routes for birds going between Europe and Asia is the Black Sea-Mediterranean route that converges on the Volga Delta, continuing into the area of the Caspian Sea. Cercarial dermatitis is a disorder in humans caused by schistosome trematodes that use aquatic birds and snails as hosts and is prevalent in areas of aquaculture in Northern Iran. Before the disorder can be addressed, it is necessary to determine the etiological agents and their host species. This study aimed to document whether domestic mallards are reservoir hosts and if so, to characterize the species of schistosomes. Previous work has shown that domestic mallards are reservoir hosts for a nasal schistosome. RESULTS: In 32 of 45 domestic mallards (Anas platyrhynchos domesticus) (71.1%), the schistosome Trichobilharzia franki, previously reported only from Europe, was found in visceral veins. Morphological and molecular phylogenetic analysis confirmed the species designation. These findings extend the range of T. franki from Europe to Eurasia. CONCLUSION: The occurrence of cercarial dermatitis in Iran is high in areas of aquaculture. Previous studies in the area have shown that domestic mallards are reservoir hosts of T. regenti, a nasal schistosome and T. franki, as shown in this study. The genetic results support the conclusion that populations of T. franki from Iran are not differentiated from populations in Europe. Therefore, the schistosomes are distributed with their migratory duck hosts, maintaining the gene flow across populations with compatible snail hosts in Iran.

TITLE: Routes migratoires, oiseaux domestiques et dermatite cercarienne : répartition de Trichobilharzia franki dans le nord de l'Iran. ABSTRACT: Contexte : L'une des principales voies de migration des oiseaux à destination et en provenance de l'Europe et de l'Asie est la route mer Noire-Méditerranée qui converge vers le delta de la Volga et se poursuit dans la région de la mer Caspienne. La dermatite cercarienne est une affection causée chez l'homme par des trématodes Schistosomatidae utilisant des oiseaux aquatiques et des mollusques comme hôtes, qui est répandue dans les zones d'aquaculture du nord de l'Iran. Avant de pouvoir lutter contre cette parasitose, il est nécessaire de connaître les agents étiologiques et leurs espèces hôtes. Ce travail vise à documenter si les canards domestiques sont des hôtes réservoirs et si oui, à caractériser les espèces de schistosomes. Des travaux antérieurs ont montré que les canards domestiques sont des hôtes réservoirs pour un schistosome nasal. Résultats : Chez 32 de 45 canards domestiques (Anas platyrhynchos domesticus) (71,1 %), le schistosome Trichobilharzia franki, précédemment signalé uniquement en Europe, a été trouvé dans les veines viscérales. L'identification de l'espèce a été vérifiée par une analyse morphologique et phylogénétique moléculaire. Cela étend l'aire de répartition de l'Europe à l'Eurasie. Conclusion : La dermatite cercarienne est répandue dans les zones d'aquaculture en Iran. Des travaux antérieurs dans la région ont montré que les canards domestiques sont des hôtes réservoirs de T. regenti, un schistosome nasal et de T. franki, comme le montre cette étude. Les résultats génétiques soutiennent que les populations de T. franki d'Iran ne sont pas différenciées des populations d'Europe. Par conséquent, les schistosomes se dispersent avec leur hôte canard lors de la migration, maintenant un flux génétique entre les populations avec des mollusques hôtes compatibles en Iran.

Lifetime prevalence of recurrent aphthous stomatitis and its related factors in Northern Iranian population: The PERSIAN Guilan Cohort Study.

OBJECTIVES: Recurrent aphthous stomatitis (RAS) is one of the most prevalent oral inflammatory ulcerative lesions. The aim of this large population base study was estimated lifetime prevalence of RAS and its related factors among the Northern Iranian population. MATERIALS AND METHODS: This study was conducted on 10,520 participants aged 35-70 years based on the PERSIAN Guilan Cohort Study (PGCS). Prevalence proportions and multivariate logistic regression models were constructed for lifetime RAS prevalence using the SPSS software. Data on potential correlates of RAS including demographic profiles, lifestyle habits, and self-reported past medical histories were obtained. RESULTS: The lifetime prevalence of RAS was 8.3%. Multivariate logistic models showed that urbanization (adjusted odds ratio (AOR) = 1.2) and having a history of systemic disease, including rheumatic disease (AOR = 2.1), genital aphthous disease (AOR = 11.7), depression (AOR = 1.3), chronic headaches (AOR = 1.8), diabetes mellitus (AOR = 1.6), and epilepsy (AOR = 2), were independent predictors of RAS. In addition, smokers (AOR = 0.5) and individuals older than 50 years of age (AOR = 0.8) were less likely to have a history of RAS. The lifetime prevalence of RAS among the Northern Iranian population was relatively low. CONCLUSIONS: It seems that predisposing factors, such as younger age, urbanization, and systemic disease, including rheumatic disease, genital aphthous disease, depression, chronic headaches, diabetes mellitus, epilepsy, and not smoking, could contribute to RAS prevalence.

Skin Diseases among the Old Age Residents in a Nursing Home: A Neglected Problem.

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 the nursing home of Iran. AIMS: In this study, we set out to determine the frequency as well as the age and gender distribution of dermatological diseases in nursing home old age residents. METHODS: In a cross-sectional study, all patients over 60 years who were living in a charity nursing home complex of Rasht in 2017 participated in this study. Baseline information on sociodemographic variables, past medical history, and medication were gathered by medical staff during a face-to-face interview. Full-body skin examination was done by dermatologists. Biopsy, and pathological and laboratory methods were used to confirm the diagnosis of suspected lesions or disease. RESULTS: In this study, 259 people underwent the study. 52.9% were male, and their mean age was 73.5 years (SD = 9.1 years). Hypertension (20.9%); diabetes mellitus (9.7%), and hypothyroidism (2.3%) were the most common underlying diseases. Most of them (85.7%) had age-related skin changes. The benign neoplasm was the most common skin disease among patients (68.3%), followed by infectious diseases (46.3%) and erythemo-squamous (31.6%). None of them had precancerous lesions or skin cancers. There were not any differences between skin disorders and gender or age groups in this study. CONCLUSION: Our study suggests that skin manifestations and diseases are common among nursing home old age residents in this area. Therefore, this should constitute one of the top priorities of aged care physicians and nurses.

Dermatologic adverse effects of breast cancer chemotherapy: a longitudinal prospective observational study with a review of literature.

BACKGROUND: Breast cancer patients may experience an increased chance of survival with adjuvant chemotherapy. However dermatologic adverse effects can cause major discomfort due to physical or cosmetic problems. This study aims to describe dermatologic complications in breast cancer patients during chemotherapy. METHODS: This longitudinal prospective observational study included data on women with non-metastatic breast cancer whom were treated with AC-T protocol (anthracycline, cyclophosphamide, and taxane) adjuvant chemotherapy and consecutively enrolled during two years. The study was performed in an educational and tertiary referral center. The patients' information including age, body mass index (BMI), past medical history, and different dermatologic complications were collected for all participants. RESULTS: Of 190 enrolled women, all patients experienced alopecia, which occurred in 131 patients (68.9%) after the first cycle. Skin, mucosal, and nail involvement were respectively seen in 46 (24.2%), 51 (26.8%), and 86 (45.2%) cases. Cutaneous complications were observed mainly between the third and sixth chemotherapy cycles. Palmoplantar erythema and palmoplantar dysesthesia were the most common cutaneous complications. Dermatologic adverse effects were significantly more frequent in the patients with an underlying disease. CONCLUSION: These findings suggest that dermatologic adverse effects of adjuvant chemotherapy are common and could be induced by all components of AC-T regimen. These complications should be skillfully managed to increase patients' comfort.

Dermoscopic features of lichen planopilaris in Northern Iran: a prospective observational study.

BACKGROUND: Dermoscopy can be helpful in assessing nonpigmented lesions and inflammatory processes like lichen planopilaris (LPP). MATERIAL & METHODS: In this observational prospective study, 81 patients with a cicatricial alopecic patch on their scalp were included and underwent dermatologic examination. A biopsy was taken from the active part of the lesion based on dermoscopy evaluation. RESULTS: Analysis of 44 patients with definite diagnosis of LPP revealed that the mean age at the time of presentation was 44.05 ± 12.62 years. More than 77% of patients had at least one form of the follicular opening disorder. About 75% of patients had shaft disorders. The most common pattern of pigmentation was milky-red (97.73%). The irregular and ectatic vascular network were seen in 59.09% of patients. Patients with coiled and twisted hairs, small yellow dots, large yellow dots, and peripilar sign were more likely to have shorter disease duration (P < 0.05). Those with overall shaft disorders were younger (P = 0.02). Small yellow dots (P = 0.025) and peripilar sign (P = 0.039) were more common in female patients. CONCLUSION: Dermoscopy can be a helpful diagnostic tool in differentiating LPP among patients with primary cicatricial alopecia (PCA). Larger cohort studies are recommended to find the role of demographic factors in predicting the dermoscopic patterns among LPP patients.

Evaluation of serum folate level before and after bath PUVA therapy in patients referred to Razi Hospital, Rasht, Iran.

Ultraviolet (UV) radiation could disintegrate folate molecule, so phototherapy may reduce folate levels in the patients. The effect of phototherapy on serum folate in human body is questionable. We investigated the effect of bath PUVA therapy on serum folate level. This study was designed as a before-after study. Thirty-two patients completed study during 2 years. Our variables were demographic data, folate levels before and 8 weeks after treatment and cumulative dosage of UVA during 8 weeks of treatment. Serum folate was evaluated with chemiluminescence immunoassay technique. All data were analyzed using SPSS 18 software. Folate level changes were statistically significant before and after bath PUVA therapy. There was no significant difference in folate levels in psoriasis patients compared with nonpsoriasis patients. In psoriasis patients, folate levels had no significant correlation with psoriasis activity index before treatment. Decrease in folate levels was more significant in fair-skinned patients. There was no association between folate status and cumulative dosage of UVA. Bath PUVA therapy reduced serum folate level in our patients although none of them were folate deficient. Folate deficiency should be evaluated and corrected especially in fair-skinned cases, as it may be aggravated by phototherapy.

Chronic generalized pruritus without primary skin lesions: a longitudinal prospective observational study.

Pruritus is among the most common complaints in the field of dermatology. It is also a disturbing symptom of many systemic disorders. Chronic pruritus (CP) refers to the cases of the symptom which last longer than 6 weeks. We conducted a prospective analysis of patients with generalized pruritus without primary skin lesions. All patients underwent primary evaluations and then were followed from 12 to 18 months for further evaluations. Of the 5,127 patients referred to our dermatology clinic, 49 patients with generalized pruritus without primary skin lesions were evaluated. Most of the patients (44%) were in the age group of 40-60 years and female (58%). The duration of pruritus was 37.04 ± 30.4 weeks. Fifty percent of the patients with generalized pruritus had a systemic cause of pruritus. The most common underlying diseases were thyroid disorders (16.67%), diabetes mellitus (12.5%), and malignancy (8.33%). There were no significant statistical differences among the patients in terms of their age, gender, and disease duration with the underlying diseases (P = 0.47, P = 0.99, P = 0.816, respectively). However, the average age of the onset of pruritus was 12 years earlier in the women regardless of the underlying diseases (P = 0.011). Based on the findings of the study, we recommend considering endocrine disorders and malignancies as the most common underlying diseases leading to chronic pruritus without primary skin lesions.

Association between Immunofluorescence Pattern and Mucosal Involvement in Patients with Bullous Pemphigoid.

Bullous pemphigoid is an acquired autoimmune subepidermal blistering disease which is associated with mucocutaneous lesions. The type and amount of autoantibody deposition may have a role in mucosal lesions. We studied the association between mucosal involvement and direct immunofluorescence pattern in cutaneous lesions of patients with bullous pemphigoid. In this retrospective analytical cross-sectional study, we studied the demographic data, clinical presentations, and immunopathological findings of 69 patients with bullous pemphigoid admitted to our hospital 2008-2016. Patients were allocated into two groups on the basis of the mucosal involvement, and direct immunofluorescence patterns were evaluated. The data were analyzed using SPSS version18. The mean age of patients was 70.9±14.97 (mean ± Standard Deviation) years old. In our study, 56.5% of patients were women. All patients showed deposition of IgG and C3 in the dermoepidermal junction, with different severity. Patients with mucosal involvement (40.6% of cases) had a more prominent deposition of IgG, IgA, and C3 at the dermoepidermal junction compared with patients without mucosal involvement, which represented a statistically significant difference (P<0.05). Logistic regression analysis showed that lower age, IgA, and C3 deposition (P<0.05) were associated with mucosal involvement. Deposition of IgA and C3 (in addition to IgG) at the dermoepidermal junction seems to be a marker of mucosal involvement in patients with bullous pemphigoid. Attention to direct immunofluorescence pattern in patients with bullous pemphigoid may be helpful in prediction of mucosal involvement in these patients.

A 36-Year-Old Renal Transplant Recipient Female with Leg Ulcer: A Case Report and Brief Review.

BACKGROUND: Opportunistic infections are common in organ transplant recipients. After 6 months of transplantation, patients have the highest risk of opportunistic infections such as cryptococcosis. CASE PRESENTATION: The report presents the case of a 36-year-old female renal transplant recipient, with complaints of few subcutaneous painful and warm nodules and large, warm, erythematous, nontender plaques on the mildly edematous right leg and ankle. Incisional biopsy of the subcutaneous nodule over the leg showed panniculitis with small- to medium-sized vasculitis associated with round yeast forms, and culture of the fragments revealed C. neoformans var. grubii. CONCLUSIONS: This article also reviews in brief the treatment of this rare complication. Reviewing the literature showed that since the cryptococcal cutaneous lesions are often nonspecific, the clinical picture solely is not enough to construct a definite diagnosis and there must be a high clinical suspicion.

Evaluation of Lipid Profile in Patients with Cherry Angioma: A Case-Control Study in Guilan, Iran.

BACKGROUND: Cherry angioma is the most common type of acquired cutaneous vascular proliferation which would increase with aging due to some angiogenic factors but the exact pathogenesis is unknown. Usually angiogenic factors are synthesized in human body to compensate occlusive effects of atherogenic agents such as serum lipids. Our hypothesis was that increased levels of these angiogenic factors could be a trigger for development of cherry angioma. This study has been designed to compare frequency of dyslipidemia in subjects with and without cutaneous cherry angioma. METHODS: In this case-control study, 122 cases with cherry angioma and 122 control subjects without cherry angioma were enrolled. Demographic characteristics, number of the cherry angioma lesions, and serum lipid profile were collected for all subjects. The data was analyzed using SPSS 18 software. RESULTS: Mean levels of the total cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein were higher in patients with cherry angioma compared to control subjects in which differences were significant for total cholesterol, low-density lipoprotein, and triglyceride (P < 0.05) but not for high-density lipoprotein level. CONCLUSION: Serum lipids may have a role in producing angiogenic factors and development of cherry angioma and it seems logical to evaluate lipid profile in these cases.

Inflammatory myopathies in a patient with Darier disease, a possible association.

BACKGROUND: Darier disease (DD) is an autosomal dominant genetic disorder which develops from a mutation in the ATP2A2 gene. Inflammatory myopathies (IM) are the largest group of potentially treatable myopathies. In this case, we report development of IM in a patient with DD for the second time in the literature. CASE PRESENTATION: The patient is a 59-year-old female, a known case of DD, who developed proximal muscle weakness 2 weeks prior to admission. Elevated muscle-enzymes, as well as typical electromyographic and radiologic confirmed the diagnosis of IM. CONCLUSIONS: Abnormalities in intracellular calcium homeostasis may explain the association between DM and DD, therefore it is noteworthy to keep this association in mind and conduct more research regarding this issue.

Nail Involvements as an Indicator of Skin Lesion Severity in Psoriatic Patients.

Psoriasis is a recurrent chronic inflammatory skin disease with various mild to severe clinical manifestations. The relationship between severity of the skin lesions and nail involvement has always been underestimated. Aim of the study was to evaluate the severity of skin involvement in psoriatic patients with and without nail manifestations. In this analytic cross-sectional study, patients with psoriasis referred to Razi University Hospital of Rasht from November 2015 to March 2016 were enrolled. Demographical features (i.e. age, gender) were obtained. Psoriasis severity and nail involvement criteria were assessed by Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI), respectively. All the gathered data were analyzed by SPSS software. In this study, 71 psoriatic patients with a mean age of 39.23±17.9 years (mean ± Standard Deviation; range: 4 to 77 years old) were studied. 22 patients (31%) had nail involvements. PASI scores were 11.7±5.7 and 5.7±4.5 in the two groups with and without nail involvements, respectively (P<0.001). There were no significant differences between age, age of onset, and duration of the disease between the two groups (P>0.05).The correlation coefficient between PASI and NAPSI was 0.367, which was statistically significant (P<0.001). Based on the findings of our study, nail involvement is an important criterion in determining the severity of skin manifestations in psoriatic patients. Additionally, a high percentage of such patients probably manifest both skin and nail manifestations. Therefore it is highly recommended to consider nail involvement when evaluating psoriasis.

Discoid Lupus Erythematosus Presenting as Upper Eyelid Edema and Erythema.

Discoid Lupus Erythematosus (DLE) is an autoimmune disorder that usually occurs on sun exposed areas of head and neck. Infrequently it could be presented by palpebral involvement and rarely unilateral upper eye lid edema and erythema have been reported as the sole manifestation of DLE. We describe a 38-year-old woman with chronic left upper eye lid edema and erythema from one year ago which was induced by steroid injection for left eyebrow alopecia. Histopathologic and direct immunofluorescent studies were made on palpebral skin tissue and confirmed DLE diagnosis. Antinuclear antibody (ANA) titer was 1/160 with speckled pattern. She was treated by oral hydroxychloroquine (400 mg daily) with moderate improvement after three months. We should think about DLE in cases with chronic upper eye lid edema and erythema. The aim of this case report is to emphasize that ophthalmologist and dermatologists should be aware of different presentations of DLE in the periorbital area to prevent misdiagnosis.

Assessment of the Prevalence and Risk Factors Associated With Glucocorticoid-Induced Diabetes Mellitus in Pemphigus Vulgaris Patients.

Pemphigus vulgaris is a chronic autoimmune disease and glucocorticoids are one of the main treatments. Our study investigates the prevalence and associated factors of glucocorticoid-induced diabetes mellitus in these patients under different glucocorticoid regimens. 36 patients with first diagnosed Pemphigus vulgaris based on pathological and direct immunofluorescence findings who had received different glucocorticoid regimens (1-2 mg/kg oral or 1-2 mg/kg oral with 1g methylprednisolone pulse daily for 3 consecutive days with or without azathioprine) were evaluated during 2014-2016. Our study found that 22.2% of patients had impaired fasting glucose and incidence of corticosteroid-induced diabetes mellitus was 22.2% with no difference between oral and pulse therapy of corticosteroid. The first day after pulse therapy 19 patients of 21 had post bolus hyperglycemia that 36% of them became diabetic after 8 weeks. None of the variables, including age, BMI, HbA1c, LDL, HDL, TG, cholesterol, family history and blood pressure were associated with diabetes. Pretreatment FBS was the factor that would increase the likelihood of glucocorticoid-induced diabetes mellitus, 42.2% of patients with pretreatment FBS 100-126 developed diabetes in comparison with 17.2% in normal pretreatment FBS. Although the group who received azathioprine was associated with increased incidence of diabetes, the overall corticosteroid dose in this group was significantly higher than the other group (P=0.012), and controversy with other studies could be because of difference in corticosteroid dosage and small number of patients. The incidence of diabetes was not different between the group with glucocorticoid pulses and oral prednisolone without pulse therapy. Higher pretreatment FBS can be related to increased incidence of diabetes, but results from this study due to small number of patients are preliminary and multicenter studies are needed.

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.

Comparison the efficacy of fluconazole and terbinafine in patients with moderate to severe seborrheic dermatitis.

Background. Topical agents can be unpleasant due to long-term therapies in patients with moderate to severe seborrheic dermatitis. Systemic antifungal therapy is another alternative in treatment. Aim. This study was conducted to compare the efficacy of oral fluconazole and terbinafine in the treatment of moderate to severe seborrheic dermatitis. Methods. 64 patients with moderate to severe seborrheic dermatitis (SD) were enrolled in a randomized, parallel-group study. One study group took terbinafine 250 mg daily (n = 32) and the other one fluconazole 300 mg (n = 32) weekly for four weeks. Seborrheic dermatitis area severity index (SDASI) and the intensity of itching were calculated before, at the end of treatment, and two weeks after treatment. Results. Both drugs significantly reduced the severity of seborrheic dermatitis (P < 0.001). Multivariate linear regression revealed that efficacy of terbinafine is more than fluconazole (P < 0.01, 95% CI (0.63-4.7)). Moreover, each index of SD severity reduced 0.9 times after treatment. (P < 0.002, 95% CI (0.8-1.02)). The itching rate significantly diminished (P < 0.001); however, there was no difference between these two drugs statistically. Conclusions. Both systemic antifungal therapies may reduce the severity index of SD. However, terbinafine showed more reduction in the intensity of the disease. In other words, the more the primary intensity of the disease is, the more its reduction will be. This trial is resgistered with 201102205871N1.