زهرا حلاجی

Alopecia Areata is a chronic inflammatory disease which involves hair follicles. The aim of this study was to assess the efficacy of oral sulfasalazine in the treatment of recalcitrant alopecia areata.

Patients with refractory alopecia areata who were eligible for the study, after providing informed consent were treated with oral sulfasalazine for 6 months. After completion of treatment, regrowth of vellus and terminal hairs were determined based on clinical examination and comparing the new photographs with the baseline ones.

Sixteen patients were enrolled in the present study but only 5 patients completed it. No response was seen in 3 patients. After 4 months, 55-60% response to treatment was observed in 1 patient, but the disease relapsed at the end of fourth month. In 1 patient, 15% hair regrowth was observed but treatment was discontinued after the second month due to side effects. Side effects were observed in 2 patients.

Since only refractory alopecia areata patients had been enrolled to the study, the results could not be generalized to all patients with alopecia areata. Therapeutic response in the patients with alopecia areata is disappointing and any poor treatment response or failure of treatment in refractory cases of the disease cannot rule out the efficacy of the drug in the milder forms of the alopecia areata.

Psoriasis is a chronic papulosquamous disorder, which affects about 2% of the population. Psoriasis is relatively common in childhood: more than 10% of cases start before the age of 10. Tha aim of this study was to compare the clinical characteristics between pediatric-onset and adult-onset psoriasis in Iranian patients.

In 2006 and 2007, clinical data were collected from all patients with psoriasis diagnosis referred to Razi Hospital. They were categorized into two groups: pediatric-onset psoriasis patients and adult-onset psoriasis patients. Clinical variables such as number of patients, gender, age of onset, family history, and stress as a precipitating factor, the first site of involvement, clinical type and involved sites were compared between the two group.

From total of 162 patients, 50 patients (33.2%) were considered as pediatric-onset group. The percentage of males in the pediatric-onset group was 48% compared with 58.9% in the adult-onset group. In the pediatric-onset group positive family history was 20% and in the adult-onset group was 12.5%. Stress as a precipitating factor was nearly the same in both groups. Plaque type psoriasis was the most common clinical presentation and the head and neck was the most common site of involvement in both groups.

Our findings, similar to previous studies showed that the involvement of female gender, family history and the onset of psoriasis on the scalp in children were more than adults.

Palmoplantar pustulosis is a chronic dermatosis of palms and soles, which is associated with a high recurrence rate and resistance to treatment. Various treatments with different success rates have been used.The purpose of this study was to evaluate the efficacy of local bath PUVA in the treatment of palmoplantar pustulosis.

In this retrospective study, patients with palmoplantar pustulosis who were treated with local bath PUVA in Phototherapy clinic of Razi Hospital between 2005 and 2009 were evaluated for the therapeutic efficacy of local bath PUVA. Data were analyzed using t and chi-square tests.

Ninety-five patients with a mean age of 44.17 years included in this study. 49.5% of patients were males and 50.5% were females. Mean treatment cessions of patients were 42.5 sessions and mean cumulative dose was 251.8 J/cm2. In 16.8% of cases have very good response was observed. Good, moderate and poor responses were observed in 35.8%, 29.5% and 9.5% of cases, respectively. Treatment failure was observed in 8.4% of patients. Mean cumulative dose in patients with very good response was significantly higher than other response groups, (P=0.016). Mean number of treatment sessions was also significantly higher in that group with comparison with other groups, (P<0.05). Twenty percent of patients withdrawed from the study because of complications. However all complications recovered completely and no long term complications was observed.

This study demonstrated that local bath PUVA is an effective safe treatment for the treatment of palmoplantar pustulosis.

Alopecia areata, a non-cicatricial form of hair loss, is believed to be an immunologic response that targets hair follicles. Genetic background is important in the pathogenesis of this disorder, although some evidence point to the role of melanocytic antigens. There are some reports on the relationship between alopecia areata and celiac disease. The aim of the present study was to identify antigliadin antibodies in patients with alopecia areata. Fifty patients, aged 2.5-50 years, with alopecia areata presenting to the dermatology clinic of Razi Educational Hospital in Tehran, Iran, and fifty

Since the systemic steroids are introduced in Pemphigus Vulgaris treatment, the prognosis of disease improved significantly. This study was designed to evaluate determining factors in the prognosis of pemphigus vulgaris in Iranian patients. In this study, 119 patients with documented pemphigus vulgaris who had presented to Razi Hospital from 2001 until 2003 were included. These patients had presented for the first time and treated with prednisolone and Azathioprine. Morality rate, minor and major relapses and duration of first remission had been defined as prognostic criteria and correlation between them and other demographic variables and disease characteristics were investigated.

Psoriasis is one of the most common inflammatory skin disorders with a genetic background. Several treatment modalities have been used, including systemic and bath PUVA. The aim of this study was to evaluate the efficacy of systemic and bath PUVA in the treatment of psoriasis in Razi Hospital.

This retrospective database study was done in Razi Hospital and the records of 390 psoriatic patients referred to phototherapy unit in 1999-2003 were studied. One hundred and forty nine patients were treated with systemic and 238 patients with bath PUVA.

The most common form of psoriasis was the plaque type and the majority of patients were male. Complete remission of disease was achieved in 20.1% of systemic PUVA and 17.2% of bath PUVA patients, usually after 20-29 sessions of phototherapy. The mean cumulative UVA dose for complete remission was 233.46 and 108.79 J/cm2 in systemic and bath PUVA groups, respectively. Relapse occurred in 33.3% and 17.07% of patients achieving complete remission in systemic and bath PUVA groups, respectively. Erythema was the most common side effect in both groups.

Both systemic and bath PUVA are efficacious in the treatment of psoriasis. The total UVA dose needed for complete clearance was higher in systemic PUVA and relapse occurred more frequently in this group.

Azathioprine is the most widely used immunosuppressive agent as an adjunct to corticosteroids in the treatment of pemphigus vulgaris (PV). Thiopurine methyl transferase (TPMT) is a key enzyme in azathioprine metabolism and a genetic polymorphism controls its activity in human tissue. TPMT activity can provide a rational basis to determine suitable dose of azathioprine, theoretically. The aim of this study was to evaluate the clinical relevancy of this hypothesis in PV patients.

In this cross sectional study in Razi Hospital, the activity of TPMT in the red blood cells of 52 PV patients who received azathioprine for at least 12 months and 29 PV patients who did not receive this drug was measured and correlated to the clinical response and side effects observed.

The mean of TPMT activity was not significantly different in patients with unfavourable response, comparing to patients with favorable response to azathioprine (P=0.087). No relationship was observed between total dose of corticosteroid and TPMT activity (r=0.089, P=0.583). There was no difference between the mean of TPMT activity in patients receiving azathioprine and those not receiving this drug (P=0.36).

A direct relationship was not observed between TPMT activity and clinical efficacy and side effects in PV patients under treatment with azathioprine. Larger prospective studies in more homogenous patients are needed to evaluate the clinical relevance of TPMT polymorphism and to determine accurate azathioprine dosing guidelines based on TPMT activity.

This is a report of a 40- year- old woman presented to our outpatient dermatology clinic. She had a 40- day history of sudden development of skin lesions on the exposed. Dermatologic examination revealed relatively limited brown – reddish plaques on the hands, feet, face, one elbow and groin regions. She has been taking carbamazepine (200 mg/ day) for 13 years. Otherwise, no serious problems were found. A clinical diagnosis of drug- induced pellagra was made based on the morphology. After discontinuing carbamazepine, treatment with nicotinamide (500 mg/day) was initiated and the eruption faded away and resolved within 3 weeks. Pellagra is a disease caused by a deficiency of the niacin and may occur with certain drugs.