یحیی دولتی

Cutaneous leishmaniasis (CL) is a protozoan disease of the skin caused by a wide range of italic species. The disease is endemic in many countries. It has been recognized as a major public health problem in Iran. Many treatments have been suggested for it but none of them was fully effective.

The objective of this study was to compare the efficacy of a 5% garlic cream with placebo in CL.

A double blind, placebo controlled study was performed in Isfahan and Jahrom in 1997 and 1998. 197 patients were randomly selected. Exclusion criteria were: pregnancy, lactation, age less than 5 years and duration of disease more than 100 days. Each patient received garlic cream 5% or placebo for 3 weeks and was followed for another period of 40 days.

The study was completed as planned in 171 patients. 96 were treated with garlic 5% cream and 75 with placebo. Complete healing occurred in 18 (18.75%) of garlic group in comparison with 15 (20%) of placebo group. The difference was not significant (P=0.9865).

5% garlic cream was not effective in treatment of cutaneous leishmaniasis. Further studies with higher concentrations or different vehicle are needed.

Since there is no study in our country about determination the effects of psychogenic factors on psoriasis and because it seems necessary to evaluate the triggering factors of disease in order to lengthen the remission period and decrease the costs and complications, this study was performed to identify the relationship of stress with psoriasis expression and the severity of skin lesions.

This is a prospective case-control study with simple random sampling which has been performed on 95 subjects above 18 year old in Razi Hospital. The case group was selected from psoriatic patients and the control group from non-psoriatic patients in whom stress does not have any effect on their disease. Two groups were matched for age and sex. Stress was assessed by Holmes and Rahe protocol with some modifications approved by a psychiatrist. Severity of skin lesions in psoriatic patients was also assessed by PASI score. Data Analysis was performed by T test, multiple logistic regression and correlation of Spearman using SPSS (6) software.

The mean of severity of stress in psoriatic group was higher than control group (P=0.021). On the other hand, there was a relationship between stress and psoriasis expression; but there was no statistically significant correlation between severity of stress and severity of skin lesions in psoriatic patients (P=0.268).

Paying attention to the effect of stress on the expression of psoriasis, it is suggested to use psychological methods in addition to routine treatment: So we can reduce emotional stress and shorten the course of this disease.

A 58-year-old man had 3 years history of asymptomatic, extensive, yellowish patches on his face, neck, trunk and arms. Histopathological examination confirmed the diagnosis of diffuse plane xanthomatosis. This is a rare non-lipemic disease in which xanthomatous lesions develop in the skin in association with paraproteinemia. Serum lipids are usually normal. The histological features include both xanthomatous and inflammatory elements. The treatment of this condition is that of the underlying myeloproliferative disease or paraproteinemia.

A 47-year-old man with 3 years history of a pruritic plaque, 1×3 cm on his left leg attended a dermatology clinic. An incisional biopsy was done with the differential diagnoses of: 1) Hypertrophic lichen planus, 2) Lichen simplex chronicus, 3) Psoriasis, 4) Bowen's disease. A diagnosis of “Fibroepithelioma” was suggested by histopathologist who was not compatible with clinical diagnosis. Careful review of slide showed that the specimen had been cut horizontally in the laboratory, which had misled the pathologist. By vertical sectioning the block and doing another biopsy, the diagnosis of hypertrophic lichen planus was confirmed. The patient was treated with intralesional triamcinolone injection and 4 weeks later the lesion was completely healed with residual hyperpigmentation.