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1.
Dermatol Ther ; : e15216, 2021 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-34811862

RESUMO

BACKGROUND: SARS-COV2 vaccines were approved without long-term monitoring due to emergent situations. This has raised some issues about timing and protocol of receiving vaccines in specific situations such as patients receiving immunomodulatory agents including rituximab which is widely used for various disorders such as multiple sclerosis, pemphigus and many rheumatologic disorders. CASE PRESENTATION: We described two cases of pemphigus vulgaris (a new case and one with flare-up) following vaccination with Astrazeneca in Iran and reviewed the existing data in this regard through searching on PubMed, Google Scholar and Scopus. All of the relevant papers published until June 28, 2021, which we could access their full-texts were included. RESULTS: We found some recommendations made by rheumatologists, neurologists and dermatologists in regard to vaccination timing in this group of patients and tried to summarize them to provide a practical guide for clinicians. CONCLUSION: Clinicians should perform a careful, individualized risk-benefit assessment for their patients and consider a delay in RTX administration after completion of COVID vaccination if there is not any considerable risk of disease relapse or organ failure. Moreover, choosing vaccines with potential of providing protection after single dose, especially in countries with limited access to vaccines may be a reasonable approach. This article is protected by copyright. All rights reserved.

2.
J Lasers Med Sci ; 12: e21, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34733744

RESUMO

Introduction: Laser-assisted hair removal is widely used by a large number of patients complaining of unwanted hair. However, little is known about the effect of varying the pulse duration on clinical results and side effects. This study aimed to investigate the effectiveness of hair removal using an alexandrite laser with different pulse durations. Methods: Fifty female patients with facial hirsutism were subjected to a hair removal procedure with an alexandrite laser, using 3 and 10 milliseconds pulse durations on each side of the face every 5 weeks for three sessions. Photographs were taken and hair counts were checked before the treatment and one month postoperatively. Results: one month after the laser treatment, the clearance rate was 56% with both 3 and 10 milliseconds pulse durations. There was not any significant difference in clinical efficacy or the side effect profile. Conclusion: Using a 755 nm alexandrite laser for hair removal is an effective and safe method for delaying hair regrowth and this delay is not markedly different by increasing the pulse duration from 3 to 10 milliseconds.

3.
J Cosmet Dermatol ; 20(11): 3364-3368, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34619013

RESUMO

INTRODUCTION: The various cutaneous manifestations have lately appeared in the setting of COVID-19. Psoriasis flare-ups have been reported during a COVID-19 infection. CASE PRESENTATION: We present a case of a 32-year-old woman with COVID-19 who presented with generalized pustular psoriasis. She received oral prednisolone, hydroxyzine, and topical clobetasol. The patient received follow-up two weeks later and found that her lesions were favorably desquamating. METHODS: The PubMed, SCOPUS, and ISI Web of Science databases were thoroughly searched for English studies reporting psoriasis flare-ups following SARS-CoV-2 infection. Ten case reports/series were included after screening. CONCLUSIONS: Our case report brings awareness to clinicians for the possible cutaneous manifestation of COVID-19, which should be considered part of the differential diagnoses.


Assuntos
COVID-19 , Psoríase , Adulto , Feminino , Humanos , Psoríase/tratamento farmacológico , SARS-CoV-2
4.
Photobiomodul Photomed Laser Surg ; 39(9): 607-611, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34546111

RESUMO

Background: Artificial ultraviolet (UV) radiation is a mainstay in the treatment of a variety of inflammatory skin disorders. Despite existence from a wealth of studies on the impact of narrow-band UVB (NBUVB) on serum levels of nutrients, clinical data on its effect on serum homocysteine (HC) level, which is thought to be a risk factor for cardiovascular disorders, dementia, and depression, are scarce. Objective: To assess serum HC status before and after treatment with at least 30 sessions of NBUVB exposure in patients with various cutaneous disorders. Methods: A prospective cohort study was conducted on 39 patients with psoriasis, vitiligo, atopic dermatitis, and mycosis fungoides who underwent at least 30 sessions of NBUVB phototherapy. Serum HC was measured and compared before and after phototherapy. This study was approved by relevant ethics committee. Results: Levels of HC decreased by 24.8% after 30 sessions of NBUVB phototherapy (10.53 ± 3.64 µmol/L vs. 7.92 ± 3.26 µmol/L, p-value <0.0001) and this decrease was more prominent in male participants and patients older than 40 years. Conclusions: Based to our findings, NBUVB phototherapy might be a modality of choice especially for older male patients not only as an effective treatment for cutaneous conditions, but also as a modality with potential protective effects against cardio-cerebro-vascular accidents.


Assuntos
Terapia Ultravioleta , Vitiligo , Homocisteína , Humanos , Masculino , Fototerapia , Estudos Prospectivos
5.
Immunopharmacol Immunotoxicol ; 43(5): 507-518, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34287098

RESUMO

BACKGROUND: Rituximab is a FDA-approved monoclonal antibody for adults with moderate to severe potentially life-threatening pemphigus vulgaris. Recent studies have focused on assessments of efficacy and safety of low-dose rituximab (<2 gram in each cycle). METHOD: Databases were searched from 2010 to 2020 (last update: 1 June 2020). RESULT: Nine studies were entered; including180 cases (92: women, 88: men, age range: 9-83 years). The dosages of each Rituximab cycle varied between ultra-low-dose (≤500 mg for a cycle, either multiple infusions or a single infusion), low-dose (2 × 375 mg/m2 or 2 × 500 mg) and modified-dose (3 × 375 mg/m2 or 3 × 500 mg). The efficacy and safety of Rituximab in the studies are known by the recovery time, relapse time, and side events. According to the studies, 2 × 500 can lead to complete remission in a broad range, from 35 to 82%. These differences might be explained by different end-points and variable cumulative corticosteroid dosage after RTX administration. Although the studies showed that low dose RTX is efficient, there are some controversies regarding the choosing low-dose for severe patients. CONCLUSION: Considering the effectiveness of low-dose, intermediate dose, and ultra-low-dose protocols of Rituximab in inducing remission in pemphigus disease and considering factors such as cost of therapy, and the need to induce a minimum of immunosuppression for a minimum duration in the COVID-19 pandemic, suggested to use low-dose Rituximab protocol (2 infusions of 500 mg Rituximab: interval of 2 weeks) to induce the remission in mild-to-moderate pemphigus patients.


Assuntos
COVID-19/imunologia , Hospedeiro Imunocomprometido , Fatores Imunológicos/administração & dosagem , Pênfigo/tratamento farmacológico , Rituximab/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , COVID-19/virologia , Criança , Feminino , Humanos , Fatores Imunológicos/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pênfigo/diagnóstico , Pênfigo/imunologia , Indução de Remissão , Fatores de Risco , Rituximab/efeitos adversos , SARS-CoV-2/imunologia , Resultado do Tratamento , Adulto Jovem
6.
Int Immunopharmacol ; 99: 107971, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34298402

RESUMO

BACKGROUND: Alopecia areata (AA) is a chronic autoimmune disorder. Finding the best treatment regimen for it remains a challenge. Currently, one of the best documented treatment modalities for AA is topical immunotherapy. AIM: To evaluate the safety and efficacy of combined DPCP and anthralin versus standard protocol (DPCP alone). METHODS: A prospective randomized clinical trial was conducted on 50 patients with Alopecia areata who received DPCP alone (group D) or in combination with anthralin (group D/A). Percentage of hair regrowth after 6 months of treatment and the incidence of drug-related adverse effects were evaluated and compared between the two groups. RESULTS: Complete hair regrowth was observed among three patients in each group (18.75% in Group D and 15.79% in Group D/A) after 6 months. Moreover, 25% and 31% of patients in group D and 21% and 47% of patients in group D/A had > 75% and > 50% hair regrowth respectively at the end of the study (P-value: 0.696). In addition, earlier age of onset, chronicity of lesions, nail involvement, facial hair loss and extensive lesions at baseline were associated with poor clinical outcome. CONCLUSION: DPCP and anthralin was as effective as DPCP alone and anthralin did not add to the effect of DPCP in treating AA.

7.
J Med Virol ; 93(10): 5756-5767, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34241899

RESUMO

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has become a significant health problem globally. The virus has spread widely and become a global pandemic. The pathophysiology for SARS-CoV-2 has not been explained clearly. It has been associated with several multiorgan symptoms, among which its dermatological manifestations are of great interest. Primarily, there has been no report of skin features among COVID-19 patients. Nevertheless, recently there have been several reports regarding COVID-19 patients who presented with cutaneous manifestations. In the current review, we focus on the various cutaneous manifestations of COVID-19 infection.


Assuntos
COVID-19/complicações , Dermatopatias/etiologia , COVID-19/tratamento farmacológico , Dermatite Ocupacional/diagnóstico , Dermatite Ocupacional/etiologia , Dermatite Ocupacional/patologia , Dermatite Ocupacional/terapia , Diagnóstico Diferencial , Erupção por Droga/diagnóstico , Erupção por Droga/etiologia , Erupção por Droga/patologia , Erupção por Droga/terapia , Humanos , Equipamento de Proteção Individual/efeitos adversos , SARS-CoV-2 , Dermatopatias/diagnóstico , Dermatopatias/patologia , Dermatopatias/terapia
8.
Int Immunopharmacol ; 96: 107755, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34162136

RESUMO

BACKGROUND: Pemphigus is an autoimmune disease that is challenging to treat and has few available therapeutic options. Recently, several studies have demonstrated that rituximab may be an efficacious first-line treatment in newest guidelines. AIM: To compare the side effect profiles of rituximab administered after a course of immunosuppressant agents versus as a first-line therapy and evaluate the impact of patient characteristics and disease severity indices on occurrence of adverse effects. METHODS: A retrospective cross-sectional study was conducted on 999 patients with pemphigus vulgaris who received rituximab either as a first-line treatment or after conventional adjuvant therapies. The occurrence of partial or complete remission as well as the incidence of drug-related adverse effects were evaluated and compared between the two groups. RESULTS: Smoking, pulmonary comorbidity, and mucocutaneous phenotype were associated with an increased risk of developing infectious complications by 12.49, 5.79, and 2.37 fold, respectively. These associations were more prominent among those who received rituximab after immunosuppressant agents. CONCLUSIONS: Early use of rituximab benefits pemphigus patients, especially those with a mucocutaneous phenotype, pulmonary comorbidity, or history of smoking, and reduces their risk of infectious adverse events.

9.
Caspian J Intern Med ; 12(2): 162-166, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34012533

RESUMO

Background: Psoriasis is a chronic inflammatory disease affecting many organs. Recent studies have demonstrated that psoriasis is associated with cardiovascular disorders. We investigated the echocardiographic and conduction system changes in psoriasis patients. Methods: In this case-control study, 36 psoriatic patients and 36 healthy controls were enrolled. Demographic and clinical data, echocardiographic and P wave dispersion (PWD) in 12-lead electrocardiogram were evaluated in both groups. We recruited patients with confirmed diagnosis via biopsy and have not been under recent systemic treatment. Patients with underlying cardiovascular disease were excluded from the study. Results: Mean age was 41.56±16.20 and 39.67±13.85 year in case and control groups, respectively. There was no significant difference in the baseline characteristics of the two groups. PWD was significantly higher in the case group (p<0.05). High pulmonary artery pressure was observed in 14 psoriatic patients and 1 individual in the control group (p<0.001). Left ventricular diastolic dysfunction was significantly higher among individuals who were above 60 years of age (p<0.01) but not significantly different between the two groups. Conclusion: Psoriatic patients are more susceptible to future development of atrial fibrillation because of higher PWD. There is no significant difference between the diastolic function in these patients.

10.
J Altern Complement Med ; 27(4): 323-330, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33571040

RESUMO

Objectives: Corticosteroids as the main treatment of hand eczema can cause major side effects. This study compared the effect of topical preparation of Sambucus ebulus L. leaves and hydrocortisone on the severity of hand eczema. Design: Ninety-four patients with hand eczema aging 18-60 years were recruited in two groups (S. ebulus vs. hydrocortisone). Interventions: The patients used topical medications twice a day and were followed for 4 weeks. The observations were made at the first visit, and also second and fourth weeks of the study. Outcome measures: The primary outcomes were changes in the severity of hand eczema (hand eczema severity index [HECSI]) and life quality (dermatology life quality index [DLQI]). Secondary outcomes were the rate of healing and the severity of itching. Results: Thirty-eight patients in hydrocortisone and 43 in S. ebulus fulfilled all phases of the follow-up. In both groups, the HECSI, itching scores decreased over time without any significant difference between the groups (p = 0.49, 0.57, respectively). The DLQI scores were significantly better in the S. ebulus group (p = 0.02) after 4 weeks of medication. There was no significant difference between the healing rates of the two groups (p = 0.33). Conclusions: Topical use of S. ebulus can be as effective as that of hydrocortisone when it comes to reducing the severity of hand eczema.


Assuntos
Eczema/tratamento farmacológico , Preparações de Plantas , Sambucus , Administração Tópica , Adolescente , Adulto , Método Duplo-Cego , Feminino , Humanos , Irã (Geográfico) , Masculino , Medicina Tradicional , Pessoa de Meia-Idade , Preparações de Plantas/administração & dosagem , Preparações de Plantas/farmacologia , Preparações de Plantas/uso terapêutico , Pele/efeitos dos fármacos , Pele/patologia , Resultado do Tratamento , Adulto Jovem
11.
Int Immunopharmacol ; 92: 107299, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33418246

RESUMO

Pemphigus encompasses a rare heterogeneous group of autoimmune blistering diseases characterized by cutaneous and/or mucosal blistering. Multiple factors, such as some specific types of drugs, have been found to be involved in the induction of pemphigus. Here, we have designed a systematic review by searching PubMed/Medline and Embase databases to find the drugs, involved in pemphigus induction and exacerbation (updated on 19 August 2019). From 1856 initially found articles, 134 studies (198 patients; 170 patients in the drug-induced patients and 28 in exacerbation group) have been included. Regarding drug-induced cases, the mean age was 57.19 ± 16.9-year-old (ranged 8-105), and patients had developed pemphigus within a mean of 154.27 days. Pemphigus vulgaris (38.9%), pemphigus foliaceus (33.5%), and paraneoplastic pemphigus (3.6%) were the most common subtypes. Furthermore, penicillamine (33.1%), captopril (7.7%), and bucillamine (6.5%) were the most reported drugs related to pemphigus induction; penicillamine was associated with the most persistent disease. Regardless of disease subtype, cutaneous, mucocutaneous, and mucosal involvements were reported in 68.6%, 30.1%, and 1.3% of patients, respectively. In total, the IgG deposition in the pathological studies, being positive for autoreactive antibodies in the serum against desmoglein 3 (Dsg3), and desmoglein 1 (Dsg1), were reported in 93%, 34.9%, and 72.7% of reported patients, respectively. Regarding the management of such patients, in 75% of healed cases, treatment (mainly transient systemic and topical corticosteroids and/or azathioprine) was needed besides stopping the probable pemphigus-inducing culprit drug, while drug cessation was enough to control the disease in 25%. As the outcomes, the lesions in 129 of 147 (87.8%) patients had been healed, while in 18 (12.2%), no healing was reported; fifteen out of 18 had died. In conclusion, some specific groups of treatments can induce pemphigus, including penicillamine, captopril, and bucillamine; despite the similar clinical and pathological manifestations to classical pemphigus, most of the cases are less severe and have a better prognosis.


Assuntos
Captopril/efeitos adversos , Cisteína/análogos & derivados , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Pênfigo/patologia , Penicilamina/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Antirreumáticos/efeitos adversos , Cisteína/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Humanos , Pênfigo/induzido quimicamente , Pênfigo/imunologia
12.
Exp Dermatol ; 28(6): 674-681, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31046170

RESUMO

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.


Assuntos
Doenças Autoimunes/imunologia , Receptor Celular 2 do Vírus da Hepatite A/metabolismo , Receptor de Morte Celular Programada 1/metabolismo , Vitiligo/imunologia , Adulto , Biomarcadores/metabolismo , Linfócitos T CD8-Positivos/imunologia , Separação Celular , Progressão da Doença , Feminino , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Humanos , Imunoterapia , Interferon gama/imunologia , Interleucina-4/imunologia , Masculino , RNA Mensageiro/metabolismo , Fator de Necrose Tumoral alfa/imunologia
13.
Acta Med Iran ; 52(5): 381-4, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24902019

RESUMO

Kaposi's sarcoma is a low-grade vascular tumor that its prevalence is increasing all around the world due to the increasing prevalence of HIV and organ transplantations. In this study, we assessed risk factors of Kaposi's sarcoma among Iranian patients were referred to Dermatopathology Department of Razi Hospital of Tehran University of Medical Sciences between the years of 2006 to 2011. Also, disease stages have been assessed on pathologic specimens. Thirty four patients diagnosed with Kaposi's sarcoma entered the study. Of the 34 patients, 29% were female, and 71% were male, mean age was 66 years and average disease duration was 6 months. The most common patient's pathologic stages were reported: patch 32%, patch to plaque 24%, plaque 12%. The most prevalent location of involvement was lower extremity (88%), and upper extremity was involved in 24%. At presentation time, the mean number of lesions was 3 to 4. 15% of patients had a history of smoking and 15% had a history of immunosuppressive drugs. HIV infection did not observe in the patients. Based on the present study, Kaposi's sarcoma is a disease of elderly and is higher in older men. The most common site of Kaposi's sarcoma involvement is lower extremity, and the most common pathologic stage was the patch to plaque.


Assuntos
Dermatologia , Hospitais Especializados , Vigilância da População , Sarcoma de Kaposi/epidemiologia , Neoplasias Cutâneas/epidemiologia , Pele/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Sarcoma de Kaposi/patologia , Neoplasias Cutâneas/patologia
14.
Iran J Immunol ; 10(1): 1-9, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23502333

RESUMO

BACKGROUND: A common Human Leukocyte Antigen (HLA) class II allele, DQß1*03:01, seems to be associated with Bullous pemphigoid (BP) in Caucasians whereas previous studies in other ethnic groups showed other HLA class II alleles as genetic predisposing factors for BP. OBJECTIVE: To investigate the association of HLA class II alleles and haplotypes with BP in Iranian population. METHODS: Fifty patients with Bullous pemphigoid and 180 geographically matched, healthy individuals as control group enrolled into this study. HLA typing of class II (DR and DQ alleles) was carried out using polymerase chain reaction based on sequence-specific primers method. RESULTS: Class II DQA1 and DQB1 typing showed a significantly higher frequency of HLA-DQA1*05:01 (45% vs. 33%, p=0.03), HLA-DQB1*03:01 (36% vs. 23.6%, p=0.02) and HLA-DQB1*04:01 (4% vs. 1.6%, p=0.04) in the BP patients compared with controls. For DRB1 allele frequencies, there were no significant disease associations. The frequency of DRB1*08:01/DQA1*05:01/DQB1*03:01 (3% vs. 0%, p=0.02) haplotype showed an increase among patients compared with controls. CONCLUSION: Our data suggest that Iranian patients with BP present the same genetic predisposition linked to HLA-DQB1*03:01 previously reported in Caucasians.


Assuntos
Predisposição Genética para Doença , Cadeias beta de HLA-DQ/genética , Penfigoide Bolhoso/genética , Grupos Étnicos , Feminino , Frequência do Gene , Estudos de Associação Genética , Haplótipos , Teste de Histocompatibilidade , Humanos , Irã (Geográfico) , Masculino , Mutação , Polimorfismo Genético
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