Iranian Journal Of Dermatology
Volume:13 Issue: 1, Spring 2010

Although cryotherapy is still the first-line therapy for solar lentigines, due to side effects such as post-inflammatory hyperpigmentation (PIH), especially in patients with darker skin types, pigment specific lasers should be considered as initial treatment. The aim of this study was to evaluate the efficacy and safety of cryotherapy in comparison with 595-nm pulsed dye laser (PDL) with cutaneous compression in the treatment of solar lentigines. Twenty two patients (skin type II- IV) with facial or hand lentigines completed this study. Lesions of one side of the face or each hand were randomly assigned and treated with either cryotherapy or PDL. Treatments were performed with radiant exposures of 10 J/cm2, 7mm spot size and 1.5ms pulse duration with no epidermal cooling. Photographs were taken before treatment and one month later. The response rate and side effects were compared. PDL was more likely to produce substantial lightening of solar lentigines than cryotherapy, especially in skin types III and IV (n=8, n=9; P<0.05) but might be of no difference in type II (n=5; P>0.05). PIH was only seen in the cryotherapy group. PDL group only showed minimal erythema. No purpura was observed. PDL with compression is superior to cryotherapy in the treatment of solar lentigines in darker skin types.

Tinea capitis is predominantly a disease of preadolescent children. Although worldwide in distribution, an increase in its prevalence in Kuwait has recently been reported, particularly in children. Tinea capitis frequently spreads among family members and classmates. The aim of this study was to determine the prevalence of tinea capitis among elementary school children of Al-Ahmadi province in Southern Kuwait. This study was conducted between September 2006 and June 2007. All suspected cases of tinea capitis from 15 visited elementary schools were referred to the dermatology department at Al-Adan Hospital where a full history and examination was performed and the affected areas were scrapped. All obtained specimens were divided into two halves. The 1st half was mounted in a 20% potassium hydroxide solution and examined under light microscope. The 2nd half was cultured in Sabouraud''s Dextrose Agar (SDA) 4% and incubated at 25-27°C for 4 weeks. A total of 903 children from 15 elementary schools were included in this study out of which 191 children proved to have tinea capitis. Microsporum canis had the highest percentage (61.7%), while Trichophyton rubrum had the lowest (3.1%). Tinea capitis is a common fungal infection of the scalp in children. The grey patch type is the most common clinical type. A multi center study is needed to confirm the predominance of the isolated dermatophyte and to determine the modifiable and preventable risk factors.

Psoriasis is an inflammatory skin disease in which abnormal individual immune reactivity plays an important role. Eselectin and P-selectin are adhesion molecules expressed on vascular endothelial cells in several inflammatory skin diseases, including psoriasis. The aim of the present study was to describe selected immunological changes, concerning adhesion molecules status (sEselectin, sP-selectin), in psoriasis and also their correlation with disease activity. Serum levels of soluble E-selectin and soluble P-selectin were measured by enzyme-linked immunosorbent assay in 58 patients with psoriasis and 24 healthy control subjects. The relationships between these adhesion molecules and the Psoriasis Areaand Severity Index score were investigated. There was a significant correlation between the serum soluble E-selectin levels and Psoriasis Area and Severity Index score. Soluble E-selectin serum levels correlate with the extent of psoriatic lesions and could be used as marker of the disease activity in psoriatic patients but this finding needs further modification.

Pruritus is one of the most disabling problems in patients with chronic renal failure. It is a distressing symptom with a negative impact on quality of life and is also very frustrating for both patients and their physicians. The pathophysiological mechanisms of pruritus are mainly unknown. The aim of this study was to identify factors associated with pruritus in these patients. This cross sectional study was done on 100 patients who were under hemodialysis because of end stage renal disease. In patients who were suffering from uremic pruritus, the severity of pruritus was assessed and the relationship between the presence and severity of pruritus with serum levels of hemoglobin, creatinine, urea, phosphate, calcium, albumin, parathormone hormone (PTH) and alkaline phosphatase was evaluated. One hundred patients (48 women and 52 men) entered this study. Pruritus was found in 45% of the patients. We found a significant relationship between severity of pruritus with age and serum level of phosphate. No significant correlation was found between the severity of pruritus and sex, duration of dialysis, underlying renal disease and serum levels of hemoglobolin, urea, albumin, PTH, alkaline phosphatase, calcium, and creatinine. Pruritus is still a common problem in hemodialysis – dependent patients. Higher serum levels of phosphate seems to be an important factor associated with uremic pruritus.

Psoriasis is a common inflammatory skin disorder. There has been considerable interest in herbal medicine as a treatment for psoriasis. In a previous study HESA-A, a marine-herbal drug, was found to be beneficial in the treatment of psoriasis vulgaris. The aim of this study was to assess the efficacy and tolerability of HESA-A in patients with psoriasis. Nineteen patients with a mean PASI score of 13.04±6.14 (min=3.90, max=27.70) were recruited to receive daily dosage of 30 mg/kg of HESA-A tablets for at least 4 weeks. The patients were followed every two weeks for determining PASI score changes and drug side effects until the end of the study. At the end of the study, the mean PASI score of the patients reduced to 9.60±5.30 (min=0.90, max=19.1). PASI score reduced in 14 patients (73.7%) and increased in 5 patients (26.3%) during the study. Two patients achieved 75 to 100% improvement in PASI score and two achieved 50 to 75%. In 10 patients (52.6%), 1 to 50% improvement in the PASI score was detected. There was a statically significant correlation between the duration of treatment and PASI improvement. (P-value = 0.024) Although this drug was very safe and tolerable, our study did not find rapid and acceptable efficacy in the treatment of chronic plaque psoriasis as shown in a previous study. According to our findings, HESA-A was more effective when used for a prolonged time and in respect of the safety profile of HESA-A, we can use this drug as a maintenance or adjuvant therapy for chronic plaque psoriasis in longer terms.

Epidermolysis Bullosa Puriginosa is a genetic mechanobullous diseasecharacterized by pruritus, lichenified or nodular prurigo-like lesions,occasional trauma-induced blistering, excoriations, milia, nail dystrophyand albopapuloid lesions that appear at birth or later. Scarring andprurigo are most prominent on the shins. Herein, we report a case witha history of blisters since childhood followed by intensely pruritic lesionspredominantly on the shins and dystrophy of the toenails, milia,excoriations and diffuse post-lesional hyper and hypopigmentation.

Pityriasis rosea (PR) is an acute, self-limiting papulosquamous exanthem. A number of atypical variants of PR, regarding morphology and distribution of the lesions or severity of the symptoms, may be observed. Herein, we present the first case of atypical PR with hypopigmented lesions and a target-shape herald patch.

Rothmund–Thomson syndrome is a rare autosomal recessive genodermatosis characterized by early onset of poikiloderma and several other cutaneous and organ involvements. We are going to report a 14-year-old girl who has been diagnosed with Rothmund– Thomson syndrome since she was 3 years old and has been suffering from pain and swelling of the right elbow and forearm for about 6 months. There are few previous reports on Rothmund–Thomson syndrome associated with malignant fibrous histiocytoma. We decided to report this case as another supporting document for this association.

A 12-year-old girl was visited at our clinic with multiple soft tissue and bony painless swellings over her right hand since she was 2 years old (Figure 1). Soft tissue masses increased in size and number. She was born to non-consanguineous parents. Her early development was normal and she had no other medical problems. There was no family history of similar problem. Examination revealed multiple compressible soft tissue masses and hard nodules of varying size over fingers and manus of the right hand with superficial hyperkeratosis. There was no limb asymmetry. Her height and weight were within normal range. Examination of parents was normal. X-ray of the right hand is shown in figure 2. A biopsy specimen was taken from a skin nodule. What is your diagnosis? Move on to next page for the answer and discussion