مجله دانشکده پزشکی اصفهان
پیاپی 269 (1392)

Due to the limited number of studies, failure to adequately investigating the impact of miltefosine in the treatment of cutaneous leishmaniasis, and the fact that faster recovery of injuries causes less scarring for the patient, the present study aimed to investigate the effect of topical miltefosine on the treatment of cutaneous leishmaniasis. In this clinical trial study, 64 patients with cutaneous leishmaniasis were equally treated in two groups with miltefosine and Glucantime. The first group of patients was treated with localized Glucantime 2 times a week (up to 28 days) and the second group was treated with localized miltefosine (ointment 6%), once daily (for 28 days), in a way that the lesion was completely smeared with the ointment. Patients were examined every week during treatment and the lesion size was recorded. All the patients’ lesions regarding their appearance, wound size, induration, erythema, and lesion size during weekly visits, at end of the treatment, and one month after the treatment were assessed. Mean age of the patients was 23.12 ± 13.30 years. The cure rate was 34.4% in patients treated with topical Glucantime, and 53.1% in the patients treated with topical miltefosine (P = 0.010). 1 month after the treatment, the cure rate was 50% in patients treated with topical Glucantime, and 81.3% in patients treated with miltefosine (P = 0.300). Mean size of the remaining scar caused by cutaneous leishmaniasis was 1.9 cm in the group treated with Glucantime, and 0.9 cm in the group treated with miltefosine (P = 0.001). According to the results of this study and other studies in this area, it can be concluded that topical miltefosine can treat the lesions faster than intralesional Glucantime injection. In addition, patients treated with topical miltefosine had smaller scars.

Skin cancer is the most common cancer in Iran and Isfahan. Behaviors taken to prevent skin cancer, especially in childhood and adolescence, have an effective role in prevention of skin cancer in the future. This study aimed to assess the knowledge, attitude and function of high school students in Isfahan Province. This was a cross-sectional study in 2012 over 1139 high school students in Isfahan Province. Data collected using a valid and reliable researcher-made questionnaires. Cluster random sampling method was used and data were analyzed using descriptive statistics. Overall, subjects had good knowledge (52.9%), poor attitude (28.3%) and poor function (27.5%) about skin cancer and protection against the sun rays. Conducting an intervention based on protection motivation theory to improve student's attitudes and behaviors is recommended to prevent skin cancer.

Hirsutism is the condition of excessive terminal hair growth in women with a typical male pattern distribution. Hirsutism is a common disorder that affects about 5-10% of women of reproductive age. Adipose tissue contributes up to 50% of the circulating testosterone in premenopausal women because of excessive androgen production in fat tissue. Therefore, it seems that hirsutism must be more common in people with simple obesity but controversy exists regarding this subject. The aim of this study was to evaluate the relation between body mass index (BMI) and hirsutism in a representative sample of Iranian woman. This cross-sectional case-control clinical trial study involved 800 individuals, 400 hirsute and 400 healthy women. The mean age of the participants was 28.0 ± 6.2 years. Hirsutism was determined by the Ferriman-Gallwey scoring system. Height and weight were measured by a Seca scale, body mass index was calculated as weight/height² (kg/m²), and collected data were analyzed using t and chi-square statistical tests. There were no significant differences between the two groups regarding age and height. However, body mass index and weight were significantly higher in the case group (P < 0.001). In the current study, hirsutism was more common in patients with a higher body mass index. The increased frequency of hirsutism in overweight women could be explained by increased insulin resistance and more androgen production by adipose tissue.

This study aimed to compare the efficacy of CO2 and Fraxel lasers on healing of the wound and the size of cutaneous leishmaniasis scars. In this randomized clinical trial study, 120 patients were randomly devided in two equal groups underwent CO2 and Fraxel lasers in treatment of leishmaniasis scars, respectively. In all cases, size and other aspects of scar were evaluated using a checklist before and 1, 3, and 6 months after the treatment. The patient's mean age was 27.21 ± 11.20 years. At the third and sixth months after the treatment, the healing rate of scars was statistically better in Fraxel laser group (49.2 and 76.8 percent, respectively) than CO2 laser group (36.7 and 44.7 percent, respectively) (P < 0.05 for both). Fraxel laser seems to be better than CO2 laser in variant aspects of treatment of leishmaniasis scars.

Rapid stretching of the skin over the weak connective tissue leads to development of striae distensae. Recently, researchers have shown special interest towards use of fractional photothermolysis in treatment of striae and several studies have shown its usefulness. We aimed to assess the efficacy of Fractional CO2 laser in treatment of striae alba. A randomized clinical trial was carried out in 6 women with striae alba. Ninety two striae were randomly divided into two groups. Five sessions of laser resurfacing were performed in group 1, every 2-4 weeks. Group 2 was treated with 10% glycolic acid and 0.05% tretinoin cream nightly. Photographs were taken from the striae before and two weeks after the end of the treatment. Mean surface area of striae compared between two groups. Patients’ views regarding the degree of improvement were assessed via visual analogue scale (VAS). Mean difference of striae surface area was significantly more after treatment in group 1 (-37.1 ± 15.6 cm2) in comparison with group 2 (-7.9 ± 9.0 cm2) (P < 0.001). Mean VAS was significantly higher in group 1 (3.05 ± 0.74) compared to group 2 (0.63 ± 0.66) (P < 0.001). Fractional photothermolysis via Fractional CO2 laser seems to be an effective method for treatment of striae alba.

Melasma is a common acquired hypermelanosis in areas exposed to sunlight, which exacerbates with sunlight, pregnancy, and endocrine diseases. Melasma is problematic regarding cosmetic especially in women. Many drugs have been used for its treatment, but regarding side effects, they have limited relative usage. Therefore, testing a new drug with higher effectiveness and fewer side effects is necessary. This study attempted to evaluate the effectiveness of kojic acid on melasma. In this study double-blind clinical trial study, 40 patients with melasma were enroled. One group of 20 people received kojic acid cream 2%, and the other used glycolic acid 10% and hydroquinone cream 2%. In the first group, 43 pigmented macules and in the second group, 21 pigmented macules existed. The changes of pigments in terms of recovery time, color tone and size of the pigments over a three-month treatment period was evaluated with clinical assessment, completing monthly questionnaire, and in a few cases with the aid of Wood's lamp. After the three-month treatment period, the collected data using the Friedman test, t-test were analyzed. In total, 79% of the patients were cured after 3 months. According to Friedman test, regarding healing time of the pigment, there was a significant difference between the groups (P = 0.008). Regarding the color tone changes of the pigment at the end of the second and third months, there was a significant difference between the two groups.Conclousion: Kojic acid 2% cream has a good efficacy in the treatment of melasma with no serious complications.

Mycosis fungoides (MF) is the most common and indolent form of cutaneous T-cell lymphomas (CTCL), that usually occurs in old adults. We aimed to determine epidemiologic features and patient's characteristics of Mycosis fungoides in Isfahan, Iran. We performed a retrospective study in Mycosis fungoides clinic of Alzahra hospital, that is the main center for treatment of patients with Mycosis fungoides in Isfahan, and evaluated clinicopathologic features of the disease. In 3 years, from 25 referred patients, 18 were diagnosed as Mycosis fungoides. Seven (38.9%) patients were men and 11 (61.1%) were women with male to female ratio of 1:1.57. The mean age of patients was 41.06 years. 88.9% of patients were in stages ΙA and ΙB. Most of our patients presented in early stages that were similar to other studies; while male to female ratio was different from other studies.

Pseudocatalase/superoxide dismutase (PSD) is a topical gel considered having therapeutic effects in vitiligo. This study was designed to evaluate the efficacy of this combination in vitiligo. This was a pilot randomized, double‑blind, placebo‑controlled trial on 46 symmetrical vitiligo lesions of limbs in 23 patients referring to dermatology clinics in Isfahan, Iran, in 2010. Patients were received this formula or placebo gels for the right and left lesions. Lesion area and degree of pigmentation were assessed at baseline and 2, 4, and 6 months later. There were no significant changes in lesion area and perifollicular pigmentation in each group (P =0.05). The results indicated no significant therapeutic effect for pseudocatalase/superoxide dismutase in vitiligo.

Alopecia areata is an idiopathic disease in which there is patchy hair loss. Many treatments for hair loss coin (less than 50% hair loss) has been proposed Including corticosteroid injections, topical 5% minoxidil, and anthralin cream or ointment on the skin without hair. Since recent studies on the role of autoantibodies and autoimmune disease in alopecia areata have raised and the drugs used in its treatment are immunomodulators, this study aimed to compare the efficiency of tacrolimus and minoxidil with minoxidil alone in the treatment of alopecia areata. This randomized, double-blind clinical trial study was done in Alzahra Hospital and Sedigheh Tahira Center of Dermatology and Leishmaniasis, affiliated to Isfahan University of Medical Sciences, from September 2012 to September 2013. In this study, 96 lesions in 54 patients with alopecia areata with various size and number of lesions were studied in two treatment groups. One group recived minoxidil 5% solution and tacrolimus 0.1% cream, and the other received minoxidil 5% solution and placebo cream. The mean lesion area at the onset of treatment, one and two months after starting the treatment, and one and three months after ending the therapy were measured compared between the groups in both sexes and various ages. After the treatment, the lesions in group minoxidil and tacrolimus increased and in the group treated with placebo cream and minoxidil solution decreased. In our study, minoxidil 5% solution alone was more effective in treatment of alopecia areata compared to combination of minoxidil 5% solution and tacrolimus 0.1% cream.

Cutaneous leishmaniasis (CL) is a public health problem in several endemic countries. Recent studies on mouse model and a few clinical experiments showed that the type of immune response generated at the site of infection and especially balance between regulatory and effector T-cells determines the outcome of the disease toward self-limiting or long-lasting lesions. The aim of this study was to evaluate the role of natural regulatory T-cells (nTregs) in early and late cutaneous lesions of human Leishmania major (L. major) infection. Skin biopsies were collected from parasitologically proven lesions of 28 patients with cutaneous leishmaniasis, divided into two groups of early and late lesions. The causative agents were identified to be L. major. Quantitative real-time reverse transcription polymerase chain reaction (PCR) and immunofluorescent staining of biopsies were used to assess the Foxp3 mRNA expression and frequency of nTregs in two groups. Mann-Whitney U test was used to determine the significance of deferences between the two groups. Mean relative expressions of Foxp3 mRNA were 0.53 ± 0.23 and 1.26 ± 0.99 in early and late lesions, respectively, which was significantly upper in chronic lesions (P = 0.007). Parallel results were obtained in tissue staining method. Increased in gene expression and protein staining of nTreg markers in chronic biopsy samples indicates a role for these cells in chronic L. major induced leishmaniasis and supports the effectiveness of regulatory T cell-based immunotherapy for treatment of chronic cutaneous leishmaniasis.

Lasers and light-based treatments are currently the standard and useful methods for treating various stages of aging. Several studies have shown that the most successful results in treating wrinkles are achieved via combination of different treatment protocols. In this study, we compared the efficacy and patient satisfaction in treatment of facial static wrinkles using CO2 fraxel laser alone or with radiofrequency. In this clinical trial study, 50 patients with the inclusion criteria were randomly selected from Novin Laser Clinic, Isfahan, Iran, and divided into two groups. Group I were treated with CO2 fraxel laser and group II were treated with CO2 fraxel laser and radiofrequency. 3 and 6 months after the treatment, clinical improvement and patient satisfaction were evaluated and compared between the groups. 3 and 6 months after the treatment, patient satisfaction and clinical improvement were not significantly different between the two studied groups treated with CO2 fraxel laser alone or with radiofrequency. According to our findings, adding radiofrequency to the treatment of facial static wrinkles with CO2 fraxel laser does not any effect on patient satisfaction and clinical improvement. More studies on patients with different skin types could be useful.

Diphencyprone (DCP) is a contact sensitizer used to treat dermatological disorders with an immunological origin, such as extensive alopecia areata. Vitiligo is a rare but known side effect of diphencyprone therapy formed in the treatment site or remote areas.Case Report: In this paper, we report a 37-year-old man developed alopecia totalis with loss of eyebrows and eyelashes presented some vitiligo patches on his scalp and arm distant from the location of diphencyprone application. In addition, 42-year-old woman with 25 years history of hair loss and 3 months diphencyprone application revealed some vitiligo patches on the scalp with distant to the site of application at the 6th week is reported. Considering the absence of personal and family history of vitiligo in our two cases, the hypothesis of latent vitiligo was not proved. The positive patch test in left arm of one of the patients also suggested the direct role of diphencyprone as the cause of vitiligo occurrence. As the development of vitiligo by diphencyprone is unpredictable and the depigmentation may persist indefinitely, it is important to inform all patients about this potential adverse effect before starting the treatment.