Iranian Journal of Dermatology

Abstract Background: Chronic graft versus host disease (ch.GVHD) is the most frequent late complication after allogenic stem-cell transplantation. Systemic immunosuppressive agents are usually required to control the disease. Psoralen plus UVA (PUVA) has been used for the treatment of ch.GVHD with variable beneficial effects. The objective of this study was to assess the efficacy and safety of a relatively lower dose of oral psoralen compared with previous reports, for the treatment of ch.GVHD patients with PUVA.
Methods: Eleven patients who received allogenic bone marrow transplantation and had severe progressive ch.GVHD that was unresponsive to conventional immunosuppressive treatments were treated with oral 8-methoxypsoralen (0.2 mg/kg, up to 10 mg) two hours before exposure to UVA.
Results: The patients received a median of 43 treatments (range: 18 to 72). Mean cumulative dose of UVA was 200.5 J/cm2 (range, 116.5-306.5 J/cm2). In four of the 11 patients, there was a complete resolution of cutaneous ch.GVHD and the remaining seven patients achieved partial response with PUVA treatment. Complete and partial remission was observed in four and six patients with lichenoid lesions, respectively, but all of the four patients with sclerodermoid GVHD showed partial response to PUVA treatment. We observed no side effects like phototoxicity, nausea and vomiting, and exacerbation of GVHD. Liver enzymes raised in five patients, causing no significant morbidity for them.
Conclusion: Low-dose psoralen plus UVA can be a safe and effective therapy for chronic cutaneous GVHD. Although the number of treatments and total cumulative exposure to UVA was rather high in our study, we observed no phototoxic reaction or severe irreversible liver damage due to phototherapy, which may be because of a relatively lower dose of methoxsalen used in our patients. Psoralen plus UVA is effective particularly in lichenoid GVHD lesions but sclerodermoid lesions may also benefit from this therapy.

Abstract Background: Pityriasis rosea is an inflammatory skin disorder with a known response to erythromycin. Considering similarities between erythromycin and azithromycin and lesser adverse effects of the latter, in a pilot study, we gave azithromycin to seven patients with pityriasis rosea and observed a noticeable improvement. The aim of this study was to evaluate the efficacy of azithromycin in patients with pityriasis rosea.
Methods: A double-blind, placebo-controlled clinical trial was performed in our clinic. Sixty patients over a period of 20 months were alternatively assigned to the treatment group or the placebo group. Patients in the treatment group received azithromycin, 250 mg/day, for 14 days. The response was categorized as complete response, partial response, or no response. All patients were followed up for 2 months.
Results: Age at presentation, sex, and average duration of the disease were comparable in both groups. Complete response was observed in 19 patients (63.3 %) in the treatment group and two in the placebo group (p<0.0001).
Conclusion: Oral azithromycin is effective in treating patients with pityriasis rosea.

Abstract Background: Scabies is a common skin disease and a public health problem. The topical antiscabietics have a poor compliance. The aim of this study was to compare the efficacy of oral Ivermectin with topical Lindane solution in the treatment of scabies. Methods: This was a prospective comparative open study. Fifty seven patients were randomized in two groups. One group (32 patients) received 200µg/kg body weight of Ivermectin in two oral doses with a one-week interval, and the second group, (25 patients) received 2 consecutive weekly topical applications of Lindane. All patients were followed up for 2 weeks. Results: A single oral dose of Ivermectin cured 72% of patients and 91% of the patients were cured after the second dose. Two applications of Lindane with a one-week interval cured 92% of cases. Conclusion: Compared to topical Lindane in the treatment of scabies, Ivermectin was at least as effective as Lindane.

Abstract Background: Sulfur mustard gas is a chemical agent that has been used in many wars, especially in Iran-Iraq war. This chemical agent affects many organs including lungs, eyes and skin, causing numerous acute and chronic lesions including erythema and hyperpigmentation, respectively. This study was conducted to evaluate erythema and melanin in subjects with a history of exposure to sulfur mustard.
Methods: This case-control study was done on 309 subjects. They were divided into four groups: sulfur mustard-exposed patients with skin lesions (n=87), sulfur mustard-exposed cases without current skin lesions (n=71), non sulfur mustard-exposed patients with dermatitis (n=78) and normal controls (n=74). Erythema and melanin were measured in 4 areas (forehead, suprasternal, palm and back of hands) by Mexameter MX18 (Courage-Khazaka, Germany).
Results: Erythema was significantly lower in suprasternal and palmar aspect of hands in sulfur mustard-exposed patients with dermatitis (P<0.05) while there was no significant difference in other areas. In terms of melanin, there was a significant difference in the dorsal aspect of hands in all four groups (P<0.05), where patients with dermatitis (both sulfur mustard exposed and normal population) had higher levels of melanin, probably due to pruritus in such areas. Forehead melanin of the normal population was also significantly lower than other three groups (P<0.05) while there was no significant difference between the melanin level of sulfur mustard exposed subjects (with or without dermatitis) and patients with dermatitis.
Conclusion: Sulfur mustard contact can affect erythema and melanin content of the skin.

Abstract Background: Inpatient therapy in dermatology offers a number of advantages in several ways i.e. careful monitoring of patients’ conditions, improvement of their skin lesions under the supervision of trained staff, absence of domestic pressure and increasing the quality of patients’ life index. The objective of this study was to describe the patterns of admission for patients with dermatological diseases in Iran Methods: In this retrospective study, data were collected by completing a questionnaire for 481 patients admitted to Razi skin hospital in Tehran during 18 months. Results: The mean age of admitted patients was 44.03 years ± 19.15. Bullous diseases (39.92%), psoriasis (20.79%), dermatitis (9.56%) and neoplasms (6.65%) were found as the most common reasons for admission. The mean duration of hospitalization was 22.79 days and neoplasms had the highest mean hospitalization period. Conclusions: Patient's admission patterns differ from country to country and there should be prioritizing plans to reach better results.

Abstract Psoriasis is a chronic, genetically determined skin disease. A variety of biochemical and molecular biological alterations have been identified, but the pathogenesis of psoriasis is still not clear. For patients with mild to moderate psoriasis, topical therapies are generally used. However, approximately one-third of the patients have a moderate to severe psoriasis and need a systemic therapy. Beside well known therapeutical approach

Abstract Granuloma annulare is a benign, relatively common dermatosis of childhood and young adults. Lesions typically occur on the extremities. Localized facial and periocular involvement is rare. We describe a 25- year-old woman with asymptomatic skin-color, firm, and papular lesions on both periocular areas since 6 months ago. Histological examination revealed palisading necrobiotic granuloma, characterized by an acellular central area containing mucin surrounded by palisading histiocytes, suggestive of granuloma annulare. Granuloma annulare should be considered for any acquired papular lesions of the periocular area at any age to avoid multiple surgical excisions at a later stage of life.

Abstract Kaposi's sarcoma is one of malignancies that is most seen in HIV positive or immunocompromised patients. Kaposi's sarcoma typically involves the skin. We present a HIV negative, 31-year-old Iranian woman from Tehran with Kaposi's sarcoma associated with corticosteroid use.

Abstract Pseudoxanthoma Elasticum is an inherited disorder characterized by generalized fragmentation and progressive calcification of the elastic tissues in the dermis, blood vessels and Bruch’s membrane of the eye. Herein, we report 3 patients in a family with pseudoxanthoma elasticum: a father and his two sons.

Abstract A 7 – year - old Caucasian girl presented with a 3-month history of nodules on her thighs and buttocks. During a one-month period, the lesions gradually increased in size and number. They became indurate and tender. Similar nodules appeared on forearms after 4 months. The lesions gradually healed with a depressed scar. On physical examination, we found many indurate areas 10-40 mm in diameter .The surface of some of them was erythematous and scaly. The lesions were not ulcerated and did not have a discharge (figure 1). On examination, she was afebrile and healthy, organs such as heart, lungs, abdomen , joints and muscles were normal. Laboratory evaluation findings including complete blood cell count, liver and renal function test values, ESR, CRP,VDRL, BUN, Creatinin, complement were all normal .The titers for FANA, Anti ds DNA, Anti Sm, Anti Scl-70, Anti –RNP, Anti-Ro, Anti-La, Anti –Jo1, Anti Phospholipid Ab, Anti cardiolipin Ab, c- ANCA , p- ANCA were negative. A skin biopsy was taken (figures 2).