Dermatology and Cosmetic

Causative agents of tinea unguium in Razi Hospital, Tehran, Iran in 2010 and 2011

Mehraban Falahati

Background and Aim: Tinea unguium is a common disease with worldwide distribution most commonly seen in adult patients. Trichophyton rubrum and T. interdigital are the most common causes. The aim of this study was to investigate the frequency of tinea unguium causative agents in a referral dermatology hospital in Tehran, Iran. Methods: This cross sectional study was conducted in 2010 and 2011 on clinically suspicious patients for tinea unguium referred to the Mycology Laboratory, Razi Hospital, Tehran, Iran. Samples from 700 patients were examined using direct smear microscopy and culture. Direct microscopic examination of the specimens was carried out using 20% potassium hydroxide solution. The specimens were cultured on Sabourad dextrose agar culture media containing chloramphenicol and cyclohexamid (Scc). For identifying the species of dermatophytes, complementary tests were used. Frequencies and relative frequencies were demonstrated in tables and chi-square and Fisher's exact tests were used to investigate any association between the categorical variables. Results: Of 700 dystrophic nail samples, 53 samples (7.6%) were positive according to both direct examination and culture. Thirty-eight patients were males. The most common clinical type was distal subungual onychomycosis which was observed in 79.2% of cases. The most frequent detected dermatophyte species. was T. interdigital (39.6%) followed by T. rubrum (37.7%). Forty-seven patients had tinea unguium on their toe nails, 4 patients on their finger nails, and 2 patients had it on both finger and toe nails. Nineteen patients had underlying diseases, and the most common underlying disease was cardiovascular disease (26.3%). Conclusion: Tinea unguium is a disease with worldwide distribution and identifying the causative agents and predisposing factors are necessary for better management of the patients.

Epidemiology and trend of skin cancer incidence in southern Iran

Hamid Salehiniya

Background and Aim: Skin cancer is the most common cancer in the Iran. The first step in planning for the prevention and treatment of cancers is collecting information about their incidence and trends. The present study aimed to investigate the epidemiology of skin cancer and its trend in southern Iran. Methods: This retrospective cross-sectional study was conducted by analyzing the existing data obtained from the National Cancer Registry System in Iran. The data included all records of skin cancer cases in southern Iran. Then, the incidence rates were standardized using direct method. The data were demonstrated in frequency tables and Cochrane-Armitage test for linear trend was used for evaluation of the incidence trend. Results: Skin cancer had a high incidence in the southern provinces of Iran. A total of 6230 cases of skin cancer during 6 years (2003-2008) were recorded in those provinces and the incidence rate of skin cancer was increasing (P=0.001). In all years of the study, skin cancer incidence was higher in males than women. In terms of frequency, Fars, Khuzestan, Bushehr and Hormozgan provinces had the highest age-standardized incidence. Conclusion: Considering the high incidence of skin cancer and its relationship to sun exposure, educating people on the correct sun protection, educating and empowering physicians and the people about early detection of skin cancers seems to be important in preventing its increasing trend.

Serum levels of copper and zinc in patients with pemphigus vulgaris admitted to Razi Hospital, Tehran, Iran in 2012 and 2013

Abbas Karimi

Background and Aim: Pemphigus vulgaris is a rare autoimmune intraepidermal blistering disease affecting the skin and mucous membranes. Copper and zinc are two necessary trace elements in the human body that have antioxidant activity in the wound healing process. The aim of this study was to determine the serumic level of zinc and copper in newly diagnosed patients with pemphigus vulgaris. Methods: In this study, 50 newly diagnosed patients with pemphigus vulgaris admitted to Razi Hospital in Tehran were studied with regards to their serum levels of copper and zinc alongside age, sex, body mass index (BMI), smoking and drug abuse status. Results: Eighteen percent (9 cases) and 50% (25 cases) of the patients showed copper and zinc deficiency, respectively. There was no significant association between copper and zinc levels and smoking, age, BMI or suffering from a chronic disease (P>0.05). Mean copper levels in women and men were not significantly with their respective different normal levels (P>0.05). Serum zinc level in men was lower than its normal range (P<0.05), but in women was not significantly different from its normal level. Conclusion: Serum concentration of copper and zinc did not show any association with pemphigus disease. Since decreased levels of copper and zinc may result in an increase of oxidative activity in autoimmune diseases enhancing disease severity, therefore conducting a robust case-control study for evaluating the their roles in disease severity may pave the way to treatment of those diseases.

Health status and perceived stress in patients with psoriasis and normal individuals in Shahrekord: A case-control study

Zeinab Ghafari

Background and Aim: The aim of this study was to compare the health status and perceived stress in patients with psoriasis and healthy individuals in Shahrekord, Iran. Methods: In this case-control study, 45 patients with psoriasis and 45 healthy individuals were recruited through convenient sampling. Healthy individuals and patients were matched according to their sex, age and education levels. The instruments of research were SF-36 and perceived stress questionnaires. Results: This study showed that the mean perceived stress in psoriasis patients (27.0±4.6) was higher than healthy individuals (20.5±12.2) (P=0.001). Mean score of health status in patients was 44.9±7.9 less than its average in normal healthy subjects (62.1±7.5) (P0.001). Conclusion: Psychological stress may play a role in the exacerbation of psoriasis because of visibility of psoriatic lesions. It is associated with deep effects on the health status of the patients.

Cutaneous leishmaniasis in Iran: Demographic description and therapeutic outcomes

Abdollah Mohammadian-Hafshejani

Background and Aim: The aim of this study was to investigate various aspects of the treatment in patients with cutaneous leishmaniasis in Iran in the first half of 2014. Methods: This cross sectional study was conducted on the existing data of 3684 patients with cutaneous leishmaniasis, whom were registered at the Disease Management Center of the Iranian Ministry of Health in the first half of 2014. Version 11 of Stata was used for statistical analysis and the level of significance was considered equals to 0.05. Results: Of 3684 patients entered into the study (%55.1) were male and the mean age of the patients was 27±18 years. More than 34% of patients were treated with intralesional injections of meglumine antimoniate (MA) and 25% of patients recieved systemic MA injections. There were statistically significant correlations between the size and number of the lesions and the chosen treatment regimen (P<0.001). Thirty-five percent of patients treated with systemic MA between 7 to 10 days and 43.3% of patients recieved intralesional MA injections for 5 to 8 weeks. Conclusion: More than %99 of patients fully recovered without complication or treatment failure. It seems that Iranian patients suffered milder CL in comparison with some other coutries.

Topical corticosteroids

Saman Ahmad Nasrollahi

Topical corticosteroids (TCs) are very useful in the treatment of some skin disorders such as eczema and psoriasis. TCs exhibit potent anti-inflammatory and anti-proliferative effects responsible for their efficacy in the treatment of skin disorders. TCs can be classified into different groups according to their potency that depends on the intrinsic activity of the corticosteroid molecule, the characteristics of the vehicle (cream, ointment, lotion) that directly influence patient’s compliance and may modify penetration through the skin. British National Formulary classified them into four potency groups with Class I grouping the most potent molecules (e.g. clobetasol propionate) and Class IV the least potent (e.g. hydrocortisone). In contrast, the American classification considers seven potency groups, with super potent, potent, upper mid-strength, mid-strength, lower mid-strength, mild and least potent.

Leprosy updates

Alireza Khatami

Leprosy is a chronic infectious disease which mainly affects the skin and peripheral nervous system. It has been associated with significant fear and stigma because of causing disabilities and deformities. According to the latest reports by World Health Organization (WHO), there were more than 180000 registered leprosy cases in the first quarter of 2014 and over 214000 new cases were detected in 2013. In this brief review, updates on a new causative agent for leprosy, Mycobactrium leprosmatosis, armadillos and the possibility of existence of a zoonotic form of leprosy, new strains of M. leprae and their importance, and the latest available leprosy statistics in Iran will be presented.