رضا محمودرباطی

Herpes zoster (Shingles; Zona) is an acute infectious skin disease that is caused by the reactivation of varicella zoster virus (VZV). After the initial infection (chickenpox) or vaccination, the virus remains inactive or latent in the dorsal root ganglia (DRG); when decreasing cell mediated immunity (CMI) occurs, the virus is reactivated from a latent phase to a lytic phase and frequently replicated in the dorsal ganglion cells then move to the sensory nerves into the skin and causes herpes zoster, which is typically characterized by painful neuralgia and unilateral dermatomal vesicular rash that normally lasts 3 to 5 weeks. The most common complication of herpes zoster is chronic pain owing to postherpetic neuralgia (PHN), which is estimated to occur in approximately 20% of the people aged 50 and over. Although herpes zoster is rarely fatal, the pain related to the acute phase of herpes zoster and subsequent PHN can cause psychological distress, physical disability, impaired sleep and consequently negatively affect the quality of life that can be significantly reduced by all of these occurrences. Due to increasing trend in the incidence of herpes zoster and increasing older people population, it will be expected that herpes zoster and subsequent PHN cause a significant economic burden to the healthcare system, the government, and families along with reducing the quality of life. The average lifetime risk of herpes zoster is estimated to be approximately 30% in developing countries. Although the risk of herpes zoster significantly increases with increasing age and diminished immune system function, any factor impacting on VZV-specific humoral and cellular immune responses may affect the risk of herpes zoster. This paper is provided an overview of the incidence and potential risk factors of herpes zoster with emphasis on the role of micronutrients and their deficiencies in the impaired immune system function. Also, the common method for prevention by zoster vaccine and the role of micronutrients in the efficacy of vaccination are shown.

The aggravating role of Staphylococcus aureus superantigens is well known in atopic dermatitis but has not yet been proven in psoriasis. The role of Staphylococcus aureus is emphasized in the initiation, maintenance and complications of psoriasis. We investigated the frequency of nasal, axillary, and perineal carriage of Staphylococcus aureus (S. aureus) in patients with psoriasis and its possible influence on the severity of the disease. One hundred patients with the clinical diagnosis of psoriasis participated in the study. Cultures of the bacterial flora were obtained from the right and left axilla and nasal nares and perineum, inoculated on standard bacterial medium (blood agar), and incubated at 37°C degrees for 48 h. one hundred patients with the clinical diagnosis of psoriasis (42% female and 58% male) comprised the study group. Mean age of the patients was 41.1±17.1 years. 42% of the patients carried S. aureus; of these, 32% were from the nose, 13% from axilla, and 11% from the perineum. Three patients were carrier in 3 sites. There was no significant difference in the severity of the disease between the carriers and non-carriers measured by the psoriasis area and severity index (PASI) Score. It seems that the severity of psoriasis is not influenced by staphylococcal carrier state.

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.

Lipoid proteinosis, a rare autosomal recessive disorder, presents in early childhood with hoarseness, skin infiltration and thickening, beaded papules on eyelid margins, and facial acneiform or pock- like scars. 

Pulsed dye laser (PDL) is an effective treatment for port- wine stain and can cause some short- term and long- term side- effects. Pyogenic granoluma is one of its late- onset adverse effects. Herein, we present two cases of pyogenic granoluma following treatment of port- wine stain with PDL.

Patients with keratotic lesions distributed in a unilateral, linear, zosteriform or localized pattern and revealing histopathologic features of dyskeratotic acantholysis have been reported previously. There is some controversy in the appropriate nosologic classification of this entity. Some authors consider it as a localized form of Darier’s disease while others place it as a variant of epidermal nevus. We report a 19-year-old girl who presented with 14 years history of an asymptomatic, hyperkeratotic area of skin-colored papules in a dermatomal distribution on the dorsum of her left hand and forearm. Pathological evaluation showed acantholysis and dyskeratosis. The controversy regarding the correct classification of such a patient is discussed.