Green Formulation of Spironolactone Loaded Chitosan-Coated Nano Lipid Carrier for Treatment of Acne Vulgaris: A Randomized Double-Blind Clinical Trial.

Purpose: Spironolactone (SPN), which is classified as an anti-androgen, has demonstrated efficacy in treating acne. This study aimed to utilize ultrasonication to create a chitosan-coated nano lipid carrier (NLC) for enhancing the delivery of SPN to the skin and treating acne. Methods: Various hydrophilic-lipophilic balance (HLB) values were investigated to optimize the SPN-NLCs. Photon correlation spectroscopy, attenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR), transmission electron microscopy (TEM), and differential scanning calorimetry (DSC) were employed to characterize the solid state of SPN in nanoparticle form. Additionally, the optimized formulation was used in a double-blind, randomized clinical trial. Results: Reducing the HLB of the surfactant mixtures resulted in a reduction in the size of SPNNLCs. The formula with the smallest particle diameter (238.4±0.74 nm) and the lowest HLB value (9.65) exhibited the highest encapsulation efficiency (EE) of 79.88±1.807%. Coating the optimized SPN-NLC with chitosan increased the diameter, polydispersity index (PDI), zeta potential (ZP), and EE. In vitro skin absorption studies demonstrated sustained release profiles for chitosan-coated SPN-NLC. In the double-blind trial, a gel containing chitosan-coated SPN-NLC effectively treated mild to moderate acne vulgaris, leading to improved healing and reduced lesion count after 8 weeks of therapy compared to the placebo. It successfully addressed both non-inflammatory and inflammatory lesions without adverse effects on the skin. Conclusion: The findings indicate that chitosan-coated SPN-NLCs have the potential as nanoparticles for targeted SPN delivery to the skin, offering novel options for the treatment of acne vulgaris.

Predominance of Trichophyton tonsurans causing tinea capitis: A 12-year retrospective study in the north of Iran.

Background and Purpose: Among different clinical entities of dermatophytosis, tinea capitis (TC) is considered a major public health challenge in the world, especially in regions with poor health and low income. Therefore, this study aimed to provide a retrospective analysis of the patients suspected of TC who were referred to the medical mycology laboratory of Mazandaran, a northern province of Iran. Materials and Methods: A retrospective analysis was performed on the patients suspected of TC who were referred to the medical mycology laboratory from July 2009 to April 2022. Hair roots and skin scrapings were collected from the participants. The laboratory diagnosis was confirmed by direct microscopic examination and culture. Finally, 921 out of 11095 (8.3%) patients were suspected of TC. Results: Based on the findings, TC was confirmed in 209 out of 921 patients (22.7%). In terms of gender, 209 TC patients (75.1%) were male. Moreover, the male to female ratio of TC patients was 1:3.0. Trichophyton tonsurans (146/174, 83.91%) was the most etiological agent, followed by T. mentagrophytes (13/174, 7.47%), T. violaceum (9/174, 5.17%), Microsporum canis (3/174, 1.71%), T. verrucosum (2/174, 1.15%) and T. rubrum (1/174, 0.57%). Besides, endothrix (77.0%) was the most prevalent type of hair invasion. Conclusion: The results revealed the predominance of T. tonsurans, as a causative agent of TC. Despite the prevalence of TC, the absence of appropriate consideration highlights that it is a neglected complication among children.

Antifungal activity of miltefosine against both azole-susceptible and -resistant Aspergillus strains.

Miltefosine, an alkylphosphocholine, has been approved recently for the treatment of visceral leishmaniasis. Miltefosine has shown promise as a treatment for paracoccidioidomycosis, and has mixed activity against other fungi and yeast. There are limited data on the in-vitro activity of miltefosine against azole-resistant and -susceptible Aspergillus spp. As such, the aim of this study was to determine the in-vitro activity of miltefosine against Aspergillus strains. Miltefosine was tested against 108 azole-susceptible and -resistant Aspergillus strains isolated from Iran and other countries using the broth microdilution method. Miltefosine was found to be effective against azole-resistant Aspergillus isolates, with minimum inhibitory concentrations (MICs) ranging from 1.562 to 6.25 µg/mL. MIC50 and MIC90 were 1.562 and 3.125 µg/mL, respectively. Miltefosine had a higher geometric mean MIC (2.459 µg/mL) for wild-type Aspergillus isolates than itraconazole (0.220 µg/mL) and voriconazole (0.298 µg/mL). No significant difference was found between miltefosine MICs for azole-resistant Aspergillus isolates and azole-susceptible Aspergillus isolates (P>0.05). Miltefosine appears to have good in-vitro activity against azole-resistant Aspergillus strains, according to these findings. Furthermore, the findings suggest that miltefosine could be used to treat infections caused by azole-resistant Aspergillus spp.

Expression analysis of PD-1 and Tim-3 immune checkpoint receptors in patients with vitiligo; positive association with disease activity.

The contribution of immune checkpoint receptors in the immunopathogenesis of various autoimmune diseases has been addressed in previous reports. In this study,  the expression profile of T-cell immunoglobulin and mucin-domain containing-3 (Tim-3) and programmed cell death-1 (PD-1) checkpoint molecules was investigated in CD8+ T cells of Vitiligo patients. The association of Tim-3 and PD-1 expression with disease activity was also explored. The frequency of Tim-3+ /PD-1+ /CD8+ T cells in 30 patients with vitiligo and 30 sex- and age-matched controls was determined by flow cytometry. CD8+ T cells were then positively isolated by magnetic beads, and the mRNA expression of PD-1 and Tim-3 was determined by TaqMan-based real-time PCR. To measure the cytokines production, PBMCs were stimulated with PMA/ionomycin and concentrations of IL-4, IFN-γ and TNF-α were measured in culture supernatants by ELISA. Disease activity of patients with vitiligo was determined using the Vitiligo Area Severity Index. Patients with vitiligo have significantly shown more expression of Tim-3 and PD-1 on their CD8+ T cells compared with controls. Expression analysis of Tim-3 mRNA, but not PD-1, confirmed the results obtained from flow cytometry. While the production levels of TNF-α and IFN-γ were found higher by patients with vitiligo, IL-4 production was lower in patients compared with controls. A direct association was observed between the Tim-3 and PD-1 expression and also the production of pro-inflammatory cytokines with disease activity of patients with vitiligo. Our results indicate that Tim-3 and PD-1 are involved in immune dysregulation mechanisms of CD8+ T cells in vitiligo and may introduce as potential biomarkers for disease progression and targeted immunotherapy.

Prevalence of pediculosis and its related factors among primary school girls in the north of Iran.

INTRODUCTION: Head lice infestation is one of the main public health problems worldwide and a sanitary, cultural and economic indicator for communities' health. This study aims to estimate the prevalence of head lice infestation among female primary school children in selected districts of Mazandaran Province, Iran. METHODS: In this cross-sectional study, 3033 female school children were recruited using the consensus method. Head lice infestation was defined as visible adult lice, nymph or egg with the naked eye. Data were described by percent frequency and analyzed using the chi-squared test and multivariate logistic regression models. A p-value less than 0.05 was considered significant. RESULTS: Prevalence of head lice infestation among female school children was estimated at 7.9%. The adjusted odds ratios (OR) [95% confidence intervals (CI)] for rural residents, low level educated mothers, family size more than five and not combing their hair were 1.96 (1.41-2.78), 2.46 (1.35-4.49), 2.04 (1.12-3.70) and 3.94 (1.73-8.96), respectively. In addition, considering first grade students as a reference group, the ORs (95% CI) for second and third grades were 1.89 (1.18-3.05) and 1.69 (1.05-2.74), respectively. CONCLUSION: Our study showed that studying in urban schools, low educational level of mothers, grade, family size and no history of regular combing were predictors of head lice infestation.

Curcumin and Melanoma: From Chemistry to Medicine.

Melanoma is the most deadly form of skin cancer, with about 48,000 deaths each year worldwide. Growing evidence suggests that individual nutrients or dietary patterns might have important roles in the prevention of melanoma. Considering that melanoma is a potentially life-threatening cancer, novel protective and adjuvant treatments are needed to improve its prognosis. Curcumin is a bioactive substance extracted from rhizome of Curcuma longa L. Its global market is expected to grow in the next few years, especially in the pharmaceutical industry, due to its numerous physiological and pharmacological properties. For this review, we collected the available data on the protective and therapeutic role of curcumin against melanoma. We also discuss the chemistry, dietary sources, bioavailability, and metabolism of curcumin, and the mechanisms of action of its potential anticancer effects at the molecular level. Current challenges and future directions for research are also critically discussed.

Prevalence of Oral Mucosal Lesions and Their Association with Severity of Psoriasis among Psoriatic Patients Referred To Dermatology Clinic: A Cross-Sectional Study in Kashan/Iran.

BACKGROUND: Psoriasis is a common inflammatory papulosquamous disease of the skin with unknown aetiology that may be associated with the abnormal T-cell function. AIM: This study was aimed to determine the prevalence of oral mucosal lesions and their associations with severity of psoriasis in psoriatic patients attending the dermatologic clinic of Shahid Beheshti Teaching Hospital at Kashan, Iran. METHODS: In this cross-sectional descriptive analytic study, all consecutive patients with psoriasis who referred to the dermatologic clinic at the Shahid Beheshti Hospital of Kashan University of Medical Sciences in Kashan City/ Iran were enrolled. All patients were examined for the presence of oral lesions, and the clinical and epidemiological features of the disease were recorded in a questionnaire for each patient. A biopsy was taken from atypical suspected patients with oral lesions by an expert dermatologist. Data were analysed using the Statistical Package for Social Science (Version 18). Descriptive statistics tests; Cross tabulation and Chi-square with Fisher's exact test were used. RESULTS: Of total 177 psoriatic patients, 62 cases (35%) of patients were male, and 115 cases (65%) were female. Mean age of patients was 31.71 years. The oral lesion was seen in 83 cases (46.9%). Fissure tongue (28.2%) and geographic tongue (4.5%) were the most common oral lesions. The prevalence of oral lesions in patients with psoriasis significantly was associated with age, history of oral lesions, and with the onset of the oral lesions (P < 0.05). The most common form of psoriasis was chronic plaque form (Psoriasis Vulgaris) observed in 147 cases (83.1). The majority of patients (67.2%) were suffering from a mild form of the disease. Psoriasis Area and Severity Index (PASI) score of most patients was mild. CONCLUSIONS: The prevalence of oral lesions such as Fissure tongue and geographic tongue is higher in psoriatic patients suggests further studies for approving the clinical importance of these apparently nonspecific lesions as possible predictors or markers of the severity of the cases suspected to Psoriasis disease.

Wound Healing Effects of Curcumin: A Short Review.

Wound healing is a complex process that consists of several phases that range from coagulation, inflammation, accumulation of radical substances, to proliferation, formation of fibrous tissues and collagen, contraction of wound with formation of granulation tissue and scar. Since antiquity, vegetable substances have been used as phytotherapeutic agents for wound healing, and more recently natural substances of vegetable origin have been studied with the attempt to show their beneficial effect on wound treatment. Curcumin, the most active component of rhizome of Curcuma longa L. (common name: turmeric), has been studied for many years due to its bio-functional properties, especially antioxidant, radical scavenger, antimicrobial and anti-inflammatory activities, which play a crucial role in the wound healing process. Moreover, curcumin stimulated the production of the growth factors involved in the wound healing process, and so curcumin also accelerated the management of wound restoration. The aim of the present review is collecting and evaluating the literature data regarding curcumin properties potentially relevant for wound healing. Moreover, the investigations on the wound healing effects of curcumin are reported. In order to produce a more complete picture, the chemistry and sources of curcumin are also discussed.

Wound Healing Effect of Curcumin: A Review.

Wound healing is a complex process that consists of several phases that range from coagulation, inflammation, accumulation of radical substances, to proliferation, formation of fibrous tissues and collagen, contraction of wound with formation of granulation tissue and scar. Since antiquity, vegetable substances have been used as phytotherapeutic agents for wound healing, and more recently natural substances of vegetable origin have been studied with the attempt to show their beneficial effect on wound treatment. Curcumin, the most active component of rhizome of Curcuma longa L. (common name: turmeric), has been studied for many years due to its bio-functional properties, especially antioxidant, radical scavenger, antimicrobial and anti-inflammatory activities, which play a crucial role in the wound healing process. Moreover, curcumin stimulated the production of the growth factors involved in the wound healing process, and so curcumin also accelerated the management of wound restoration. The aim of the present review is collecting and evaluating the literature data regarding curcumin properties potentially relevant for wound healing. Moreover, the investigations on the wound healing effects of curcumin are reported. In order to produce a more complete picture, the chemistry and sources of curcumin are also discussed.

Spironolactone loaded nanostructured lipid carrier gel for effective treatment of mild and moderate acne vulgaris: A randomized, double-blind, prospective trial.

Spironolactone (SP) known as an anti-androgen drug, has been proven to be effective in treatment of acne. The quest to minimize the unnecessary systemic side effects associated with the oral drug administration of spironolactone, has led to a growing interest of loading SP on lipid nanoparticles to deliver the drug in a topical formulation. The aim of the current investigation was to prepare and compare the performance of SP loaded nanostructured lipid carrier (SP-NLC) and SP alcoholic gels (SP-ALC) on two groups of respective patient populations, group A and group B in the treatment of mild to moderate acne vulgaris. The results showed that SP-NLCs were spherical in shape with an average diameter of ∼240nm. The polydispersity index (PI) and zeta potential of these nanoparticles were 0.286 and -21.4 respectively. The gels showed non-Newtonian independent pseudoplastic and shear thinning behavior. The SP-NLCs was not toxic to fibroblast cell strains at the 24 and 48h periods. Results showed that the mean number of total lesions (37.66±9.27) and non-inflammatory lesions (29.26±7.99) in group A significantly decreased to 20.31±6.58 (p<0.05) and to 13.95±5.22 (p<0.05) respectively. A similar pattern was observed for group B where the mean number of total lesions and non-inflammatory lesions reduced from 33.73±9.40 to 19.13±5.53 (p<0.05) and from 25.65±8.12 to 13.45±4.48 (p<0.05) respectively. The total lesion count (TLC) was significantly decreased from 37.16±9.28 to 19.63±6.36 (for group A; p<0.071) and 32.60±9.32 to 18.33±5.55 (for group B; p<0.05) respectively. After treatment with SP-NLC for 8 weeks, the water content of the skin significantly (p<0.05) increased from 37.44±8.85 to 45.69±19.34 instrumental units. Therefore, the SP-NLC gel may help in controlling acne vulgaris with skin care benefits.

Resveratrol and the mitochondria: From triggering the intrinsic apoptotic pathway to inducing mitochondrial biogenesis, a mechanistic view.

BACKGROUND: Mitochondria, the power plants of the cell, are known as a cross-road of different cellular signaling pathways. These cytoplasmic double-membraned organelles play a pivotal role in energy metabolism and regulate calcium flux in the cells. It is well known that mitochondrial dysfunction is associated with different diseases such as neurodegeneration and cancer. A growing body of literature has shown that polyphenolic compounds exert direct effects on mitochondrial ultra-structure and function. Resveratrol is known as one of the most common bioactive constituents of red wine, which improves mitochondrial functions under in vitro and in vivo conditions. SCOPE OF REVIEW: This paper aims to review the molecular pathways underlying the beneficial effects of resveratrol on mitochondrial structure and functions. In addition, we discuss the chemistry and main sources of resveratrol. MAJOR CONCLUSIONS: Resveratrol represents the promising effects on mitochondria in different experimental models. However, there are several reports on the detrimental effects elicited by resveratrol on mitochondria. GENERAL SIGNIFICANCE: An understanding of the chemistry and source of resveratrol, its bioavailability and the promising effects on mitochondria brings a new hope to therapy of mitochondrial dysfunction-related diseases.

Evaluation of Candida Colonization and Specific Humoral Responses against Candida albicans in Patients with Atopic Dermatitis.

The aim of this study was to assess the candidal colonization and specific humoral responses against Candida albicans in patients with atopic dermatitis. One hundred patients with atopic dermatitis and 50 healthy individuals were enrolled in the study. Skin and oral specimens from all participants were cultured on CHROMagar Candida medium. Isolated yeasts were identified by using the sequence of the D1/D2 domain of the 26S rRNA gene. ELISA was used for detection of IgM, IgA, and IgG antibodies against C. albicans in sera of participants. Candida species were isolated from the skin and oral cavity of 31% of the patients and 12% of the controls. There was no significant difference between Candida colonization in patients and controls (P > 0.05). Candida albicans was isolated from the skin and oral cavity of 23% of the patients and 6% of the controls (P < 0.05). There were no significant differences between serum levels of IgM and IgA in patients and controls (P > 0.05). Serum level of IgG was significantly lower in patients than in controls (P < 0.05). Type of Candida colonization can change in patients with atopic dermatitis. In addition, these patients have abnormalities in the production of antibodies against Candida albicans that may have a role in the pathogenesis of atopic dermatitis.

Evaluation of candidal colonization and specific humoral responses against Candida albicans in patients with psoriasis.

BACKGROUND: Psoriasis is an inflammatory skin disease that can considerably affect a patient's quality of life. Environmental and genetic factors, as well as superantigens and toxins from Candida species, may play various roles in the exacerbation and persistence of psoriasis. In the present study, we evaluated candidal colonization and specific humoral responses against Candida albicans in patients with psoriasis. METHODS: A total of 100 patients with psoriasis vulgaris and 50 healthy control individuals were enrolled in the study. Skin and oral specimens from all participants were cultured on CHROMagar Candida medium. Isolated yeast-like fungi were identified using the sequence of the D1/D2 domain of the 26S rRNA gene. Enzyme-linked immunosorbent assays (ELISAs) were used to detect immunoglobulin M (IgM), IgA, and IgG antibodies against C. albicans in sera of patients and healthy individuals. RESULTS: Candida species were isolated from the skin of 15% of patients and 4% of controls and from oral specimens of 60% of patients and 20% of controls. There was a significant difference in candidal colonization between patients and controls (P < 0.05). Serum IgM, IgA, and IgG levels against C. albicans were significantly lower in patients with psoriasis than in controls (P < 0.05). There was no significant association between serum levels of specific antibodies against C. albicans or the frequency of candidal colonization with the clinical severity of the disease (P > 0.05). CONCLUSIONS: The results of the present study show a higher rate of candidal colonization in patients with psoriasis in comparison with controls and a reduction in humoral immune responses in patients.

Serum lipids and lipoproteins in patients with psoriasis.

BACKGROUND: Psoriasis is a common chronic and recurrent inflammatory skin disorder characterized by hyperproliferation of keratinocytes and infiltration of T cells, monocytes/macrophages and neutrophils into dermal and epidermal layers of the skin. The prevalence of cardiovascular disorders in these patients is remarkably higher compared to normal individuals, which seems to be associated with the hyperlipidemia. This study was designed and conducted to investigate the serum lipid profile in psoriatic patients and its association with the severity of disease. MATHERIALS AND METHODS: This case-control study was performed on 50 plaque-type psoriasis patients and 50 healthy individuals as control, matched for age and sex. Blood samples were collected after 14 h fasting. Serum triglyceride, cholesterol and lipoproteins were assayed using the standard kit (made by Pars Azmon Co. Iran). RESULTS: Certain parameters, including serum triglyceride, cholesterol, low density lipoprotein (LDL), and very low density lipoprotein (VLDL), were significantly higher in the case group compared to the controls (P < 0.001), while high density lipoprotein (HDL) was significantly lower in the former (P < 0.001). In addition, there was a significant relationship between severity of psoriasis and serum lipid profile. CONCLUSION: The results have revealed the higher plasma level of lipids in psoriatic patients. This may elevate the risk of atherosclerosis, particularly cardiovascular disorders. Therefore, from the epidemiological point of view, screening psoriatic patients, particularly those with severe psoriasis, is recommended.

Effect of Aloe vera topical gel combined with tretinoin in treatment of mild and moderate acne vulgaris: a randomized, double-blind, prospective trial.

BACKGROUND: Topical retinoids are considered first-line therapy in the treatment of acne vulgaris, yet can be associated with cutaneous irritations. Combination therapy with natural preparations could be effective in treatment and decreasing adverse events. OBJECTIVE: The aim of this study was to compare the efficacy and safety of the combination of tretinoin (TR) cream (0.05%) and Aloe vera topical gel (50%) with TR and vehicle. MATERIAL AND METHODS: The randomized, double-blind, prospective 8-week trial evaluated inflammatory and non-inflammatory lesion scores and tolerability in 60 subjects with mild to moderate acne vulgaris (global acne grading system scale). RESULTS: Several formulations of A. vera leaf gel were prepared and the most stable one was selected for clinical study based on physicochemical evaluations. The combination therapy showed superior efficacy to TR and placebo. TR/Aloe vera gel (AVG) was significantly more effective in reducing non-inflammatory (p = 0.001), inflammatory (p = 0.011) and total (p = 0.003) lesion scores than control group. The highest percentage of adverse cutaneous effect was reported for scaling. At the end of study, erythema in the TR/AVG-treated group was significantly less severe (p = 0.046). CONCLUSION: The combination TR/AVG was well tolerated and significantly more effective than TR and vehicle for the treatment of mild to moderate acne vulgaris.

Comparison of topical triamcinolone and oral atorvastatin in treatment of paederus dermatitis Northern Iran.

Dermatitis caused by stimulation of beetle paederus, is a common health problem in Northern and some southern parts of Iran. Since by now, traditional medicine and some corticosteroid agents have been used for treatment of dermatitis caused by beetle paederus. Because, there are few researches about classical treatment of the disease at academic level, this study planned to compare the effectiveness of triamcinolone ointment and atorvastatin tablet with placebo in treatment ofpaederus dermatitis in Northern Iran. A randomized double-blind clinical trial was carried out on 30 patients referred to the hospital and clinics at Sari and Neka countries in Northern Iran during 6 months. Patients were randomly divided into two therapeutic equal groups. The first group was triamcinolone ointment twice a day and a placebo atorvastatin tablet daily. The second group was oral atorvastatin one tablet (20 mg) daily and a placebo triamcinolone ointment twice a day. In Seventh day of visits, therapeutic response of the patients in triamcinolone and atorvastatin group were 93.33 and 80%, respectively. No significant differences were found in therapeutic outcome between the two groups (p > 0.05). The results showed both oftriamcinolone ointment and oral atorvastatin had similar effect on paederus dermatitis. Because the paederus dermatitis is a self-limited disease use of topical therapy for treatment of the disease is recommend.

Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia.

BACKGROUND: Finasteride, a type II-selective 5alpha-reductase inhibitor, as a causative agent of decreasing dihydroxy testosterone (DHT) level, is effective in the treatment of male androgenic alopecia. AIM: We compared the local and oral finasteride in the treatment of androgenic alopecia. METHOD: This is a double blind, randomized clinical trial study of 45 male patients, who were referred with alopecia to the private clinics and departments in Boo-Ali Sina Hospital, in Sari. Patients with male androgenic alopecia were selected according to the history and physical examinations. The patients were randomly divided into two: topical finasteride (A) and oral finasteride (B) groups. Topical finasteride group (A) received a topical gel of 1% finasteride and placebo tablets, while the oral finasteride group (B) received finasteride tablets (1 mg) and gel base (without drug) as placebo for 6 months. The patients were followed by clinical observation and recording of side effects prior to the treatment and at the end of first week, and then by a monthly follow-up. The size of bald area, total hair count, and terminal hair were studied. Data were analyzed by descriptive and Chi-square statistical test. RESULTS: The mean duration of hair loss was 18.8+/-23.10 months. Each month the terminal hair, size of bald area and hair count between the two groups were compared. There were no significant differences between the two groups as a viewpoint of hair thickness, hair counts and the size of bald area. Serial measurements indicated a significant increase in hair counts and terminal hair counts between the two groups. CONCLUSIONS: The results of this study showed that the therapeutic effects of both finasteride gel and finasteride tablet were relatively similar to each other.

Cutaneous and mucosal manifestations in patients on maintenance hemodialysis: a study of 101 patients in Sari, Iran.

INTRODUCTION: Cutaneous and mucosal disorders are of the common problems in patients on long-term hemodialysis. The aim of this study was to evaluate the frequency of dermatologic problems among patients with end-stage renal disease (ESRD) who receive maintenance hemodialysis. MATERIALS AND METHODS: One hundred and one patients with ESRD on hemodialysis were studied. All of patients were fully examined for cutaneous, nail, hair, and mucosal changes by a single dermatologist. Complementary diagnostic measures such as biopsy of the lesions were carried out, where necessary. RESULTS: The patients were 43 (42.6%) women and 58 (57.4%) men with a mean age of 50.0 +/- 12.3 years. The duration of hemodialysis was 36.0 +/- 11.0 months. Dermatologic examination revealed that 95 patients (94.1%) suffered from cutaneous problems. Skin discoloration (66.3%) was the most common skin lesion. Pruritus was seen in 38.6% of the patients. Hair, mucous membrane, and nail problems were present in 37.6%, 23.8%, and 43.6% of the patients, respectively. There was a significant association of the number of cutaneous manifestations with the age of the patients (P = .001), but not with hemodialysis duration. The most common hair disorder was hair loss in 9.9% of the patients and the most common oral mucosal problem was furred tongue (7.9%). Of the nail disorders, nail bed paleness (16.8%) was the most common. CONCLUSIONS: Cutaneous and mucosal lesions in patients with ESRD can vary from each patient population to another. Factors such as diagnostic accuracy, climate, and early treatment influence some disorders such as pruritus, xerosis, and infections.