Publications by authors named "Farhad Handjani"

39 Publications

The Evaluation of Serum Lipids Profile in Patients with Pemphigus Vulgaris: A Case-Control Study.

Malays J Med Sci 2020 Mar 30;27(2):57-63. Epub 2020 Apr 30.

Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Pemphigus vulgaris (PV) is a chronic autoimmune disease. Dyslipidemia, increased risk of atherosclerosis and higher cardiovascular morbidity, and mortality have been reported in several autoimmune conditions. It has been hypothesised that there might be an association between dyslipidemia and PV. Therefore, the objective of this study was to compare the serum lipid profile of patients with PV with healthy controls.

Methods: This case-control study was carried out on 113 patients with PV and 100 healthy controls. Total cholesterol, high-density lipoprotein (HDL) and triglycerides (TG) levels were measured and low-density lipoprotein (LDL), non-HDL cholesterol (non-HDL-C) and atherogenic index of plasma (AIP) were calculated. Chi-squared test and independent Student -test (or their alternatives) were used for group comparison.

Results: The mean age and BMI of patients and controls were 47.7 ± 14.5 and 28 ± 6.2 and, 44.5 ± 18.5 and 25.5 ± 5.1, respectively. Total cholesterol, LDL, HDL, non-HDL-C and TG were statistically different between the two groups ( values < 0.001; < 0.001; < 0.001; < 0.001 and 0.021, respectively). However, AIP was not significantly different (value = 0.752).

Conclusion: The serum lipid profile was significantly higher in PV patients compared to healthy controls. Therefore, PV patients may be more prone to develop atherosclerosis and this finding can be important in the overall management of these patients.
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http://dx.doi.org/10.21315/mjms2020.27.2.7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409567PMC
March 2020

Psychodermatology in Iran: A survey on knowledge, awareness, and practice patterns in Iranian dermatologists.

Dermatol Ther 2020 11 9;33(6):e14009. Epub 2020 Aug 9.

Psychodermatology, Psychiatry and Behavioral Sciences Department, College of Medicine, Central Michigan University, Saginaw, Michigan, USA.

Psychodermatology is an interdisciplinary field in dermatology which involves the interaction between mind and skin. Studies from various parts of the world demonstrate generalized lack of knowledge regarding psychocutaneous disorders among dermatologists. We provide this survey to evaluate the knowledge, awareness, and practice patterns of Iranian dermatologists about psychodermatology. A survey questionnaire on the topic of this study was randomly distributed among Iranian dermatologists in a national dermatology conference and also by mail. All collected data were entered into SPSS software version 20.0 and were analyzed using descriptive statistics. The questionnaires were filled out by 65 dermatologists aged 30 to 60 years. From this group, 60% (39) were male and 40% (26) were female. About 86% of the dermatologists saw more than 30 psychodermatology patients weekly and about 43% mentioned they felt somewhat comfortable managing psychodermatology patients. Alopecia, vitiligo, and acne were the most common primary dermatology diseases with secondary psychiatric problems. More than half of our responders mentioned that they did not take any psychodermatology courses during their training program. However, about 66% of the dermatologists expressed interest in participating in psychodermatology continuing medical education programs. Further collaboration between dermatologists and psychiatrists can shape a brilliant future in psychodermatology and improve the quality of life of patients. We highly recommend educational courses in psychodermatology for both dermatologists and psychiatrists.
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http://dx.doi.org/10.1111/dth.14009DOI Listing
November 2020

Overview of herbal and traditional remedies in the treatment of cutaneous leishmaniasis based on Traditional Persian Medicine.

Dermatol Ther 2020 07 10;33(4):e13566. Epub 2020 Jun 10.

Department of Phytopharmaceuticals (Traditional Pharmacy), School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.

This study aims to describe the herbal and traditional remedies in the treatment of cutaneous leishmaniasis (CL) with an overview on related available evidence in modern medicine. This study is a review that focuses on the most important Traditional Persian Medicine (TPM) sources including Avicenna's Canon of Medicine, Jorjani's Zakhīra-yi Khārazmshāhī, and Aazam-Khan's Eksir-e-Aazam, as well as pertinent information from Embase, PubMed, Scopus, Scientific Information Database, and Google Scholar by using the keywords salak, rīsh-e-balkhi, cutaneous leishmaniasis, and leishmaniasis for selected remedies. Several oral and topical herbal remedies, such as Vitis vinifera L. (Unripe grapes), Berberis vulgaris L., Rheum ribes L., Santalum album L., Cinnamomum camphora (L.) J.Presl (Camphor), Brassica nigra (L.) K. Koch, Crocus sativus L., Juniperus excelsa M. Bieb, honey, and Alum root, were mentioned in TPM resources for the treatment of CL. Furthermore, cauterization, cupping, and leech therapy were considered for this purpose. In this review, some evidence-based studies will also be presented that have demonstrated the therapeutic properties of some of these products. In conclusion, the sages of TPM have recommended several systemic or topical medications, in addition to physical procedures, for treatment of CL, all of which could be a base for conducting further research on its efficacy.
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http://dx.doi.org/10.1111/dth.13566DOI Listing
July 2020

CO laser treatment for plantar warts in children: A case series.

Dermatol Ther 2020 05 27;33(3):e13414. Epub 2020 Apr 27.

Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Several types of human papillomaviruses induce warts. Warts are one of the most common infections in childhood with a reported prevalence of up to 20%. Warts are divided clinically into genital and nongenital forms. Plantar warts are common nongenital warts. In this series, five pediatric cases treated with CO laser for their plantar warts are presented. One patient was a known case of Hodgkin's lymphoma. Three of our patients had history of unsuccessful treatments with other modalities, while the other had received no previous treatment. CO laser with continuous mode (focused and defocused) was used. In our cases, only one session was enough for clearance of the warts. All the patients were visited 1 week and 3 months after treatment to assess the efficacy and any possible recurrences. Follow-up showed that all the patients remained in remission up to 3 months posttreatment with no adverse events.
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http://dx.doi.org/10.1111/dth.13414DOI Listing
May 2020

Patients' preferences of cutaneous leishmaniasis treatment outcomes: Findings from an international qualitative study.

PLoS Negl Trop Dis 2020 02 24;14(2):e0007996. Epub 2020 Feb 24.

Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.

Background: Cutaneous leishmaniasis (CL) is a disease that often affects exposed skin areas and may heal leaving lifelong scars. Patients' expectations from treatment are rarely considered in drug development for CL. An initiative aiming to address shortcomings in clinical trial design and conduct for CL treatments involving the researchers' community is on-going. This manuscript presents patient-preferred outcomes for CL and an assessment on how to consider these in the conduct of future trials.

Methodology/principal Findings: We report preferred treatment outcomes by 74 patients with confirmed CL in endemic regions of Brazil, Burkina Faso, Colombia, Iran, Morocco, Peru and Tunisia during individual in-depth interviews. Beyond outcomes customarily considered in trials (such as lesion appearance and adverse events), patients talked about a large number of outcomes related to quality of life, such as pain, scar formation, and others affecting their work and daily activities. They also reported fears around getting rid of the parasite, disease recurrence, and possible sequelae.

Conclusions/significance: The study results provide a rich insight into important outcomes for CL treatments, as well as related topics, from the perspective of a diverse patient population. Among the outcomes identified, we argue that those related to quality of life as well as recurrence should be included to a greater extent for assessment in clinical trials, and discuss the suitability of measurement instruments such as the Dermatology Quality of Life Index (DLQI). Interviews also point out the potential need to address concerns related to parasitological cure or scar formation, such as social stigmatization and disability. In addition, patients should be given information in order to clarify reported misconceptions. This study therefore suggests a methodology for consulting CL patients on outcomes as elements of clinical trial design, and how to incorporate these outcomes in trials. It also discusses how reported outcomes could be addressed in clinical care.
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http://dx.doi.org/10.1371/journal.pntd.0007996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7058360PMC
February 2020

Evaluating prevalence of depression, anxiety and hopelessness in patients with Vitiligo on an Iranian population.

Health Qual Life Outcomes 2020 Feb 3;18(1):20. Epub 2020 Feb 3.

Molecular Dermatology Research Center, Shiraz University of Medical Sciences, P.O. Box: 7134844119, Zand Avenue, Shiraz, Iran.

Introduction: Vitiligo is caused by partial or complete destruction of melanocytes in the affected skin area and influences the patient's quality of life. Besides physical involvement, vitiligo patients experience a high level of stress. Depression and Anxiety are common psychiatric disorders in vitiligo patients.

Aim: This study, as the first study, evaluates hopelessness, anxiety, depression and general health of vitiligo patients in comparison with normal controls in an Iranian population.

Method: Hundred patients with vitiligo and hundred healthy controls were examined. General health, depression, hopelessness and anxiety were evaluated based on general health questionnaire. Anxiety, depression and hopelessness levels were analyzed using Chi-Square, and the mean value of general health was evaluated through t-test.

Results: The results showed that anxiety and hopelessness levels were significantly higher in vitiligo patients than those who are in healthy controls. This significant difference refers to high levels of anxiety and hopelessness among women with vitiligo. It was also found that the single patients were more anxious, hopeless and depressive, while the married patients were only more anxious and hopeless than those who are in the control group, respectively. General health of patients was significantly worse than in healthy controls. The low level of general health in patients was related to poorer level of general health among women with vitiligo.

Conclusion: It seems that women with vitiligo are more mentally stressed than men with vitiligo. Both singles and married vitiligo patients suffer from anxiety and hopelessness.
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http://dx.doi.org/10.1186/s12955-020-1278-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6998062PMC
February 2020

Family dermatology life quality index in patients with pemphigus vulgaris: A cross-sectional study.

Indian J Dermatol Venereol Leprol 2019 Aug 28. Epub 2019 Aug 28.

Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Background And Aims: Pemphigus vulgaris is a rare autoimmune intraepidermal vesiculobullous disease involving the skin and mucosa. It impacts the quality of life of both patients and their families.

Methods: A total of 70 patients with pemphigus vulgaris (either outpatient or hospitalized) were enrolled using the simple sampling method between 2016 and 2017 from the dermatology clinic at Faghihi Hospital, Shiraz, Iran. A validated Persian version of the Family Dermatology Life Quality Index (FLDQI) questionnaire was filled by a family caregiver. The questionnaire contained 10 items assessing the quality of life of the family. Demographic variables were recorded in a separate form.

Results: The mean age of the patients was 51 ± 11.3 years and that of the family caregivers was 32 ± 8.8 years. The FLDQI score was higher (poorer quality of life) if the patient was male, older, had shorter disease duration or had fewer disease recurrences (P = 0.046, 0.01, 0.001 and >0.001, respectively). Higher scores were also obtained in the less-educated caregivers (P = 0.026) but there was no association with either gender or age (P = 0.399, 0.1).

Conclusion: Pemphigus vulgaris significantly affects the Family Dermatology Life Quality Index. Education and counseling of family caregivers by various support groups such as Pemphigus Family Associations could be effective in improving the quality of life of the caregivers.

Limitations: This study did not assess the effect of comprising domain analysis, severity of disease, patients' Dermatology Life Quality Index (DLQI), mucosal involvement, response to treatment, outpatient or admitted status, socioeconomic status, or the quality of life among the various family members.
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http://dx.doi.org/10.4103/ijdvl.IJDVL_276_18DOI Listing
August 2019

Leishmania cytochrome b gene sequence polymorphisms in southern Iran: relationships with different cutaneous clinical manifestations.

BMC Infect Dis 2019 Jan 29;19(1):98. Epub 2019 Jan 29.

Basic Sciences in Infectious Diseases Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Cutaneous leishmaniasis (CL) caused by Leishmania species, is a geographically extensive disease that infects humans and animals. CL is endemic in half of the 31 provinces of Iran, with 29,201 incidence cases reported in Fars province from 2010 to 2015. CL is polymorphic and may result in lesions characterized by different clinical features. Parasite genetic diversity is proposed to be one of the factors affecting the clinical outcome and lesion characteristics in CL patients. However, there is still very limited data regarding the genetic variation of Leishmania spp. based on the sequencing of Cytochrome b (Cyt b) gene.

Methods: All patients originated from endemic regions in Fars province. The amplification of the Cyt b gene from isolates of 100 patients with disparate clinical forms of CL was accomplished using Nested-PCR. Sequence analysis of the amplified Cyt b was used to scrutinize the genetic variations among Leishmania isolates and connect the results with clinical pictures. The clinical demonstrations were basically of two types, typical and atypical lesions. Molecular phylogenetic tree was constructed using the Neighbor-Joining method, with species/strains from this study compared to species/strains from other geographical regions.

Results: Leishmania major was identified as the predominant infecting Leishmania spp. (86% of cases), with the remainder of cases being infected by Leishmania tropica. Clinical examination of patients revealed 12 different clinical CL forms. Among Leishmania samples analyzed, five distinct haplotypes were recognized: three in L. major and two in L. tropica. We found a correlation between clinical outcomes and Cyt b sequence variation of Leishmania spp. involved. Moreover, we observed a higher presence of polymorphisms in L. major compared with L. tropica. This difference may be due to the different eco-epidemiologies of both species, with L. tropica being an anthroponosis compared to L. major, which is a zoonosis.

Conclusions: The sequence analysis of Cyt b gene from 25 L. major and L. tropica strains demonstrated genetic variability of L. major and L. tropica causing CL in southern Iran, and a feasible connection amid the genetic heterogeneity of the parasite, geographical source and clinical appearance of the disease in human was detected.
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http://dx.doi.org/10.1186/s12879-018-3667-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352432PMC
January 2019

Real life management of chronic urticaria: Multicenter and cross sectional study on patients and dermatologists in Iran.

Dermatol Ther 2019 03 13;32(2):e12796. Epub 2018 Dec 13.

Farabi Building, Shamsabad Street, Isfahan, Iran.

Recently, advances in understanding the etiology of urticaria and updates of diagnostic and therapeutic management guidelines have drawn attention to chronic urticaria (CU) morbidity. The present study aimed to evaluate Iranian dermatologists' practice and real life management of CU patients. A total of 35 dermatologists and 443 patients were included in the study. Number of female patients was 321 (72.5%). Mean (standard deviation) age of the study patients was 38 (13) years and the median (inter quartile range) of disease duration was 12 (6-48) months. Severity of patients' symptoms was mild for 32.1%, moderate for 38.7%, severe for 18.8%, and 10.4% of them had no evident signs or symptoms. The most common diagnostic methods were physical examination (96.6%), differential blood count (83.5%), erythrocyte sedimentation rate (77.4%), and C-reactive protein (62.8%). The number of dermatologists prescribed nonsedating antihistamines (nsAH) in regular dose and high dose mono therapy were 26 (74%) and 6 (17%), respectively. About 66% of dermatologists were familiar with British Association of Dermatologists (BAD) guideline. The most common first-line treatment for CU by Iranian dermatologists was nonsedating antihistamines in regular or high doses. The real-life management of patients with CU in Iran was in accordance with the available practice guidelines.
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http://dx.doi.org/10.1111/dth.12796DOI Listing
March 2019

Cryotherapy versus CO laser in the treatment of plantar warts: a randomized controlled trial.

Dermatol Pract Concept 2018 Jul 31;8(3):168-173. Epub 2018 Jul 31.

Department of Dermatology, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Warts are one of the most common infections in humans. Plantar warts are a subtype of non-genital warts, and several procedures and topical treatments have been used in its treatment. Cryotherapy is one of the most popular modalities, but it is time-consuming and remission rates vary in different studies. CO laser was the first laser used for treating warts. To date, no clinical trial has been done to compare CO laser with cryotherapy in the treatment of plantar warts.

Patients And Methods: This randomized controlled trial was performed in order to compare the efficacy and number of sessions needed to treat plantar warts in 60 patients who had received no previous treatment in the previous 3 months. They were randomly allocated to the cryotherapy or CO laser group. The number of sessions needed for response and the recurrence rate after a 3-month follow-up was compared in the 2 groups.

Results: Sixty patients with plantar warts were randomly allocated to either the CO laser or cryotherapy groups. Median age was 25 (range=18-53) and 27 (range= 18-75) years in the cryotherapy group and CO laser groups, respectively. Both groups were matched for age and sex (56% male and 44% female in the cryotherapy group and 34% male and 66% female in the CO laser group). The median number of sessions needed for complete resolution of the warts in the CO laser and cryotherapy groups were 1 (range=1-2) and 3 (range=1-12), respectively. The difference in the number of sessions was statistically significant between the 2 groups (P-value≤0.001). Recurrence rates after a 3-month follow-up was not statistically significant (P-value= 0.069).

Conclusion: The number of sessions needed to treat plantar warts was less using CO laser than cryotherapy; therefore, this modality can be a good addition to the already existing anti-wart armamentarium.
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http://dx.doi.org/10.5826/dpc.0803a03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092077PMC
July 2018

An international qualitative study exploring patients' experiences of cutaneous leishmaniasis: study set-up and protocol.

BMJ Open 2018 06 15;8(6):e021372. Epub 2018 Jun 15.

Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.

Introduction: Lack of investments in drug development, lack of standardisation of clinical trials and the complexity of disease presentations contribute to the current lack of effective, safe and adapted treatments for cutaneous leishmaniasis (CL). One aspect concerns outcomes affecting patients' quality of life (QoL): these are hardly assessed in trials, despite potential functional and/or aesthetic impairment caused by CL, which typically affects disadvantaged and vulnerable people living in rural areas. Here, we describe the approach used to bring perspectives of patients with CL into designing and assessing treatments.

Methods And Analysis: This international qualitative study uses interviews with patients to explore their experiences with CL to (1) elicit outcomes and eligibility criteria for clinical trials important to them and (2) to better understand their needs and views about the disease and their requirements and expectations from treatment. Here, we describe the set-up of this collaborative study and the protocol. Data collection is ongoing.The protocol includes study design, preparation, conduct and analysis of individual interviews with approximately 80 patients in seven countries (Burkina Faso, Brazil, two sites in Colombia, Iran, Morocco, Peru and Tunisia) where CL is prevalent. Principal investigators and sites were selected through an open call, and two workshops were organised for protocol development and training in conduct and analysis of qualitative health research. Patient recruitment aims at covering a maximum variation of experiences. Transcripts will be analysed to identify outcomes and eligibility criteria as well as further topics that are expected to emerge from the interviews, such as direct and indirect costs related to CL, its psychological impact, preferred modes of drug administration and traditional treatments.

Ethics And Dissemination: The study received ethical approval by the responsible committees of each of the participating institutions. Findings will be disseminated through publication in peer-reviewed journals, scientific meetings and to participants and their communities.
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http://dx.doi.org/10.1136/bmjopen-2017-021372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6009565PMC
June 2018

The myrtus communis L. solution versus ketoconazole shampoo in treatment of dandruff: A double blinded randomized clinical trial.

J Pak Med Assoc 2018 May;68(5):715-720

Research Center for Traditional Medicine and History of Medicine.

Objective: To evaluate the efficacy and safety of myrtus communis L. solution in the treatment of dandruff and to compare it with ketoconazole.

Methods: This double-blind randomised clinical trial was conducted at Shiraz University of Medical Sciences, Shiraz, Iran, from December 2015 to August 2016, and comprised patients with dandruff aged 18-60 years visiting the dermatology out-patient clinic. The subjects were randomised into two equal groups. The treatment group received myrtus communis L. solution and a placebo shampoo, while the control group received ketoconazole shampoo and a placebo solution. The total duration of the study for each subject was one month and subjects in both groups used their respective interventions 8 times during that period. The parameters studied were pruritus, erythema, severity of scaling, and the extent of scalp involvement. All subjects underwent scalp scaling tests at the beginning, after 10 days and at the end of the 30th day. SPSS 21 was used for data analysis.

Results: Of the 90 individuals, there were 45(50%) in each of the two groups. However, 74(82%) subjects completed the third visit and, of them, there were 37(50%) in each group. Both groups showed significant improvement in all outcome measures (p<0.001). There were no significant differences between the groups in terms of efficacy, satisfaction rate and side effects (p>0.05 for each outcome).

Conclusions: Myrtus solution was found to be effective in the treatment of dandruff.
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May 2018

Harmonized clinical trial methodologies for localized cutaneous leishmaniasis and potential for extensive network with capacities for clinical evaluation.

PLoS Negl Trop Dis 2018 01 12;12(1):e0006141. Epub 2018 Jan 12.

Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland.

Introduction: Progress with the treatment of cutaneous leishmaniasis (CL) has been hampered by inconsistent methodologies used to assess treatment effects. A sizable number of trials conducted over the years has generated only weak evidence backing current treatment recommendations, as shown by systematic reviews on old-world and new-world CL (OWCL and NWCL).

Materials And Methods: Using a previously published guidance paper on CL treatment trial methodology as the reference, consensus was sought on key parameters including core eligibility and outcome measures, among OWCL (7 countries, 10 trial sites) and NWCL (7 countries, 11 trial sites) during two separate meetings.

Results: Findings and level of consensus within and between OWCL and NWCL sites are presented and discussed. In addition, CL trial site characteristics and capacities are summarized.

Conclusions: The consensus reached allows standardization of future clinical research across OWCL and NWCL sites. We encourage CL researchers to adopt and adapt as required the proposed parameters and outcomes in their future trials and provide feedback on their experience. The expertise afforded between the two sets of clinical sites provides the basis for a powerful consortium with potential for extensive, standardized assessment of interventions for CL and faster approval of candidate treatments.
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http://dx.doi.org/10.1371/journal.pntd.0006141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5785032PMC
January 2018

Composition of minerals and trace elements at Mamasani thermal source: A possible preventive treatment for some skin diseases.

J Educ Health Promot 2017 4;6:110. Epub 2017 Dec 4.

Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Introduction: Some skin diseases are incurable and modern medicine can only control them. In addition, alternative treatment remedies including balneotherapy can be effective in improving skin conditions. However, there are only a limited number of studies on particular mineral or trace elements of mineral sources that have been identified in Iran. In this respect, the amount of minerals and trace elements in Mamasani thermal source, Fars Province, Iran, was measured using electrochemical, titration, and spectrophotometric methods and evaluated.

Materials And Methods: The amount of minerals and trace elements in Mamasani thermal source, Fars Province, Iran, was measured using electrochemical, titration, and spectrophotometric methods.

Results: The concentrations of natural gases such as HS and NO in Mamasani thermal source were measured to be 22.10 mg/L and 42.79 mg/L, respectively. The source also contained major ions such as chloride, sulfate, sodium, calcium, magnesium, potassium, and carbonate. Due to the high concentration of chloride, sulfate, and sodium ions in comparison with other major ions, the water source is also classified as sulfide water. The existing trace elements in this thermal water source are iron, zinc, copper, selenium, cobalt, chromium, boron, silisium, aluminum, magnesium, and molybdenum.

Conclusion: We concluded that bathing in this source could be beneficial. As nitrate concentration is close to the highest standard concentration for drinking water, it can be used in chronic dermatitis, psoriasis, burns, and allergy. Furthermore, the antibacterial and antifungal effects of sulfur-containing water in this source can be helpful in the treatment of leg ulcers, tinea versicolor, tinea corporis, and tinea capitis.
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http://dx.doi.org/10.4103/jehp.jehp_100_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747216PMC
December 2017

Health literacy in patients with epidermolysis bullosa in Iran.

J Educ Health Promot 2017 4;6:105. Epub 2017 Dec 4.

Department of Medical-Surgical Nursing, Fatemeh (PBUH) School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.

Introduction: Health literacy is a set of different skills, including reading, listening, analyzing, deciding, and applying these skills related to health status. Epidermolysis bullosa (EB) is a rare hereditary genetic disease which affects several aspects of the life of patients and their families. The aim of this study was to assess the health literacy of patients with EB in Iran.

Materials And Methods: Thirty-three patients from Iran with EB, aged above 15 years-old, were enrolled in the study. Iranian Health Literacy Questionnaire, which measures health literacy in five domains including reading, access, perception, assessment, and decision-making skills, was used for collecting the data. SPSS analytical software, version 22, was used for statistical analysis.

Results: In total, 19 (57.6%) patients were male and 14 (42.4%) female with an age range of 15-41 years. Nineteen (57.6%) patients had inadequate health literacy in reading skills. One-third of patients had enough health literacy in the realm of access, and two-thirds were excellent in perception. Overall, there was no significant correlation between the level of health literacy with age ( = 0.92), sex ( = 0.55), race ( = 0.58), and educational level ( = 0.51) of the patients.

Conclusion: The majority of the patients had inadequate health literacy in reading skills while these patients had acceptable health literacy in perception, assessment, and decision-making skills. Improvement of health literacy of these patients should be a priority for health policy makers with the aim of increasing their quality of life and decreasing their personal and social problems.
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http://dx.doi.org/10.4103/jehp.jehp_64_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747211PMC
December 2017

Interleukin-10 and Interferon-γ Levels in Patients with Cutaneous Leishmaniasis Treated with Cryotherapy.

Iran J Med Sci 2017 Sep;42(5):488-492

Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Pentavalent antimonials, as the 1st choice for the treatment of cutaneous leishmaniasis (CL), have various side effects. Also, there are some reports of drug resistance. Due to its safety, cryotherapy can be a good alternative or complementary treatment in CL. The aim of this study was to explore the possible systemic immunological mechanisms of cryotherapy besides its local effects in the treatment of CL. Twenty patients with CL were selected. The disease was confirmed via a direct smear. A venous blood sample was collected to determine IL-10 and IFN-γ levels before starting cryotherapy. Then, 1 week after 8 sessions of cryotherapy were completed (i.e., 63 d), a 2nd venous sample was taken in order to compare the results with the pretreatment levels of these cytokines using the ELISA method. Cryotherapy resulted in no change in the levels of IL-10 and significantly increased the IFN-γ levels in our patients with CL. Given these or even results, a larger sample size is needed in order to better assess the systemic immunological effects of cryotherapy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5722967PMC
September 2017

Efficacy of cryotherapy plus topical Juniperus excelsa M. Bieb cream versus cryotherapy plus placebo in the treatment of Old World cutaneous leishmaniasis: A triple-blind randomized controlled clinical trial.

PLoS Negl Trop Dis 2017 Oct 5;11(10):e0005957. Epub 2017 Oct 5.

Medicinal Plants Processing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Cutaneous leishmaniasis is one of the highly prevalent endemic diseases in the Middle East and North Africa. Many treatment modalities have been recommended for this condition but success rates remain limited. Herbal remedies have also been used for treatment but evidence-based clinical trials with these products are sparse. In-vitro and in-vivo studies have shown the anti-leishmanial and curative effects of extract of fruits and leaves of Juniperus excelsa (J. excelsa). The aim of this study was to determine the efficacy of topical J. excelsa M. Bieb extract as an adjuvant to cryotherapy for the treatment of human CL.

Materials And Methods: This study was designed as a two-arm triple-blind randomized placebo-controlled clinical trial using a parallel design. Seventy-two patients with clinical diagnosis of CL confirmed by leishmania smears were allocated to receive either a topical formulation of leaf of J. excelsa extract (group A) or placebo (group B) for 3 months. Both groups received cryotherapy as baseline standard treatment. Patients were evaluated before and weekly after the intervention was initiated until complete cure.

Results: Overall, 82% of patients in group A, experienced complete cure and 9% of them had partial cure. On the other hand, 34% in group B reported complete cure, while 14% of them had partial cure at the end of treatment protocol with a significant difference between the two groups (P< 0.001). The mean duration to healing of the lesions in patients who received J. excelsa extract was statistically significantly shorter than the placebo group (p = 0.04). No significant side effect was seen in the J. excelsa extract group except for mild to moderate local irritation after a few weeks in a few numbers of patients.

Conclusion: The results of this study showed that topical J. excelsa extract can be used as an adjuvant treatment modality in addition to cryotherapy for accelerating the time to cure in addition to increasing the complete cure rate in CL.

Trial Registration: ClinicalTrials.gov IRCT2015082523753N1.
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http://dx.doi.org/10.1371/journal.pntd.0005957DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655399PMC
October 2017

Multiple keratoacanthoma centrifugum marginatum associated with juvenile idiopathic arthritis and persistent corneal epithelial defect: an unusual case.

G Ital Dermatol Venereol 2017 Oct;152(5):524-526

Molecular Dermatology Research Center and Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

We report here a case of a child with multiple keratoacanthoma centrifugum marginatum in association with corneal epithelial defect and juvenile arthritis. Keratoacanthoma is a skin tumor and the patient presented with an uncommon type of it.
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http://dx.doi.org/10.23736/S0392-0488.16.04800-8DOI Listing
October 2017

Frequency of Neurological Disorders in Bullous Pemphigoid Patients: A Cross-Sectional Study.

Int Sch Res Notices 2017 24;2017:6053267. Epub 2017 May 24.

Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Bullous pemphigoid (BP) is an autoimmune subepidermal blistering skin disorder which occurs mostly in the elderly. Several studies have reported an association between BP and neurological disorders (ND).

Objective: The purpose of this study was to evaluate the association between BP and neurological disorders in Iranian patients.

Methods: In this cross-sectional study, 87 patients with BP were enrolled. They were compared to 184 controls. Statistical analysis was done by SPSS statistical software version 19.

Results: Out of 87 patients with BP, 17 (19.5%) had at least one neurological disease. Cerebrovascular accident (CVA) was the most common neurological disease that was seen in 7 patients (8.0%) in the case group and 4 (2.1%) in the control group. The incidence of CVA was significantly different between BP patients and the control group ( = 0.022). Dementia was observed in 6 patients in the case group (16.8%) and 2 (1.0%) in the control group. The incidence of dementia was significantly different between BP patients and the control group ( = 0.008). In this study, the incidences of Parkinson's disease ( = 0.830), epilepsy ( = 0.067), and multiple sclerosis ( = 0.326) were not statistically significant between the two groups.

Conclusion: The incidence of CVA and dementia in patients with BP compared to the control group was significantly higher.
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http://dx.doi.org/10.1155/2017/6053267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5463116PMC
May 2017

Topical mycophenolate mofetil in the treatment of vitiligo: a pilot study.

Dermatol Pract Concept 2017 Apr 30;7(2):31-33. Epub 2017 Apr 30.

Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Vitiligo is a multifactorial disease that is characterized by circumscribed depigmented macules and patches. Autoimmune reactions may play an important role in the pathogenesis of the disease. Mycophenolate mofetil is a drug that inhibits DNA synthesis in lymphocytes and has been used in autoimmune diseases such as immunobullous skin diseases, lupus erythematosus, and autoimmune hepatitis.

Objectives: The objective of this study was to show the efficacy of topical mycophenolate mofetil in the treatment of vitiligo.

Methods: Thirty patients with limited vitiligo were enrolled in this study. The patients applied a topical preparation of mycophenolate mofetil 15% twice daily for three months and at the end of every month, repigmentation was assessed using the Vitiligo Area Scoring Index (VASI).

Results: At the end of the third month, 36.6 % (n=11) of the patients showed about 25% repigmentation of the lesions. No side effects were observed throughout the study.

Conclusion: This study showed that topical mycophenolate mofetil can be somewhat effective in the treatment of vitiligo; however, it seems to be inferior to potent topical steroids in inducing repigmentation.
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http://dx.doi.org/10.5826/dpc.0702a06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424659PMC
April 2017

Lip leishmaniasis: a case series with molecular identification and literature review.

BMC Infect Dis 2017 01 25;17(1):96. Epub 2017 Jan 25.

Department of Medical Parasitology & Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Mucocutaneous leishmaniasis (MCL), a protozoan infectious disease, is very rare in Iran despite the endemicity of both cutaneous and visceral forms. It is transmitted by the Phlebotomus sand fly. The lip is considered one of the extraordinary sites. Lesions usually initiate with erythematous papules, slowly enlarges and then it ulcerates. The diagnosis of MCL encompasses epidemiological, clinical and laboratory aspects. Usually, the combination of some of these elements is necessary for the final diagnosis. So, lip leishmaniasis lesions can be challenging to diagnose.

Case Presentation: We presented seven rare cases of lip leishmaniasis. Tissue impression smear, culture, PCR and phylogenetic analysis were carried out for explicit diagnosis. Skin scraping investigation showed several Leishmania spp. amastigotes in the cytoplasm of macrophages. Culture examination was positive for Leishmania spp. PCR was positive for L. major, L. tropica, and L. infantum. Differential diagnosis includes orofacial granulomatosis, basal cell carcinoma, squamous cell carcinoma, and mesenchymal tumors. The cases were treated with systemic meglumine antimoniate (Glucantime). No relapses were observed during 1 year of follow-up. Early detection of the infection are necessary in order to start effective treatment and prevent more serious complications.

Conclusions: In this paper, we reported seven rare cases of lip leishmaniasis in Iran, emphasized the importance of clinical and diagnostic features of lesions, characterized the phylogenetic kinship of isolated parasites, and reviewed the literature on lip leishmaniasis.
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http://dx.doi.org/10.1186/s12879-016-2178-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5264488PMC
January 2017

Cutaneous Leishmaniasis of the Eyelids: A Case Series with Molecular Identification and Literature Review.

Korean J Parasitol 2016 Dec 31;54(6):787-792. Epub 2016 Dec 31.

Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Cutaneous leishmaniasis (CL) is a protozoan disease which is endemic in Iran. It is transmitted by the sand fly. The eyelid is rarely involved possibly because the movement of the lids impedes the sand fly from biting the skin in this region. Here, we report 6 rare cases of eyelid CL. The patients were diagnosed by skin scraping, culture, and PCR from the lesions. Skin scraping examination showed spp. amastigotes in the cytoplasm of macrophages. Culture examination was positive for spp. PCR was positive for and . The lesions were disguised as basal cell carcinoma, chalazion, hordeolum, and impetigo. The patients were treated with intramuscular meglumine antimoniate (20 mg/kg/day) for at least 3 weeks. They showed a dramatic response, and the lesions almost completely disappeared. We emphasized the importance of clinical and diagnostic features of lesions, characterized the phylogenetic relationship of isolated parasites, and reviewed the literature on ocular leishmaniasis.
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http://dx.doi.org/10.3347/kjp.2016.54.6.787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266367PMC
December 2016

Historical Evidence of Treating Vitiligo in Persia.

Pharm Hist (Lond) 2016 Jun;46(2):30-2

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June 2016

Angiotensin converting enzyme activity in alopecia areata.

Enzyme Res 2014 1;2014:694148. Epub 2014 Oct 1.

Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz 71348 44119, Iran ; Department of Dermatology, Shiraz University of Medical Sciences, Shiraz 71348 44119, Iran.

Background. Alopecia areata (AA) is a chronic inflammatory disease of the hair follicle. The exact pathogenesis of AA remains unknown, although recent studies support a T-cell mediated autoimmune process. On the other hand, some studies have proposed that the renin-angiotensin-aldosterone system (RAAS) may play a role in autoimmunity. Therefore, we assessed serum activity of angiotensin converting enzyme (ACE), a component of this system, in AA. Methods. ACE activity was measured in the sera of 19 patients with AA and 16 healthy control subjects. In addition, the relationship between severity and duration of the disease and ACE activity was evaluated. Results. Serum ACE activity was higher in the patient group (55.81 U/L) compared to the control group (46.41 U/L), but the difference was not statistically significant (P = 0.085). Also, there was no correlation between ACE activity and severity (P = 0.13) and duration of disease (P = 0.25) in the patient group. Conclusion. The increased serum ACE activity found in this study may demonstrate local involvement of the RAAS in the pathogenesis of AA. Assessment of ACE in a study with a larger sample size as well as in tissue samples is recommended in order to further evaluate the possible role of RAAS in AA.
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http://dx.doi.org/10.1155/2014/694148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4198813PMC
October 2014

Serum prolactin levels in psoriasis vulgaris.

ISRN Dermatol 2014 23;2014:586049. Epub 2014 Feb 23.

Student Research Committee, Shiraz University of Medical Sciences, Shiraz 7134844119, Iran.

Background. Psoriasis is a chronic inflammatory skin disease affecting approximately 1-3% of Caucasians. Prolactin has proliferative effects on human keratinocytes, a dominant feature of psoriasis, and it is thought that this hormone may play a role in the pathogenesis of the disease. This study was conducted to confirm or refute these findings in order to better understand the disease pathogenesis. Methods. The subjects were 90 individuals aged between 15 and 47 years. They were divided into three groups of 30 individuals each: psoriatic patients, atopic dermatitis patients, and control group. A questionnaire was filled regarding their demographic and medical history. All of the study subjects underwent venous blood sampling (5 mL), and serum TSH and prolactin levels were checked. Subjects with abnormal TSH were omitted. Results. None of the patients in the study had raised prolactin, and there was no significant difference in the serum prolactin level between patients with psoriasis and atopic dermatitis and the control group. There was no relationship between the severity of psoriasis and serum levels of prolactin. Conclusion. Prolactin does not seem to play a role in the pathogenesis of psoriasis as its serum levels are comparable with atopic dermatitis patients and that of the normal population.
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http://dx.doi.org/10.1155/2014/586049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953392PMC
April 2014

Comparison of 10% potassium hydroxide solution versus cryotherapy in the treatment of molluscum contagiosum: an open randomized clinical trial.

J Dermatolog Treat 2014 Jun 27;25(3):249-50. Epub 2013 Aug 27.

Department of Dermatology, Molecular Dermatology Research Center, Faghihi Hospital, Shiraz University of Medical Sciences , Shiraz , Iran .

Introduction: Molluscum contagiosum (MC) is a common cutaneous viral infection. Potassium hydroxide (KOH), as a strong alkali, and cryotherapy have been used for its treatment. The objective of this study was to compare these two treatment modalities.

Methods: 30 patients, aged between 1 and 24 years of age, were randomly divided into 2 groups: 15 were treated with KOH 10% solution and 15 were treated with cryotherapy. KOH 10 % was applied by the patient or their parent(s) two times a day until the lesions disappeared completely. Cryotherapy was performed with liquid nitrogen spray, repeated weekly for 4 weeks. The assessment of response and side effects were performed weekly for 4 weeks.

Results: In the KOH group, 86.6% had complete response, 6.7% had partial response and 6.7% had no response after 4 weeks. In the cryotherapy group, 93.3% had complete response and 6.7% had partial response. There was no statistically significant difference between the two groups (p > 0.05). Postinflammatory hyperpigmentation, as a side effect, was mostly noted with cryotherapy.

Conclusion: Both treatment modalities were equally effective. Since KOH is inexpensive and confers better cosmetic results compared to cryotherapy, it can be used as a suitable treatment modality for MC.
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http://dx.doi.org/10.3109/09546634.2013.832135DOI Listing
June 2014

Predictive value of the cow's milk skin prick test in infantile colic.

Ann Saudi Med 2010 Nov-Dec;30(6):468-70

Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran.

Background And Objectives: Infantile colic is a common problem among young infants. Cow's milk allergy has been suggested as one of the causes. We aimed to investigate the value of the cow's milk skin test for the diagnosis of cow's milk allergy in exclusively breast-fed infants with infantile colic.

Methods: Exclusively breast-fed infants with infantile colic were enrolled in this study. On the first visit, the average hours of crying of the infant in a 24-h period were recorded and the cow's milk skin test was performed. If the infant had a positive skin test, elimination of cow's milk from the mothers' diet was advised. Infants with negative skin tests were divided into case and control groups. Cow's milk was eliminated from the diet of mothers in the case group. After 2 weeks, the number of hours of crying were recorded again. The reduction in the crying hours was compared between the two groups using the chi-square test.

Results: Skin tests were positive in 3 of 114 cases (2.6%) of infantile colic. All three cases recovered completely following elimination of cow's milk from the mother's diet. Among the 111 patients with negative skin tests, 77 patients completed the study: 35 in the case group and 42 in the control group. The reduction in crying hours in infants in the case group was not significantly different from that in the control group.

Conclusion: Elimination of cow's milk from the mothers' diet is not beneficial for infants with a negative skin test. Infants with a positive skin test may benefit from this management.
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http://dx.doi.org/10.4103/0256-4947.72269DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2994164PMC
March 2011

Porokeratosis of Mibelli with mutilation: a case report.

Cutis 2010 Aug;86(2):77-80

Department of Dermatology, Shiraz University of Medical Sciences, Iran.

Porokeratosis is a rare keratinization disorder of the skin characterized by annular plaques with an atrophic center surrounded by a raised keratotic wall that spreads centrifugally. We report a case of porokeratosis of Mibelli with mutilation. A 30-year-old woman presented with atrophic plaques on the index fingers of both hands with a keratotic ridge in some margins of the plaques. There was loss of the distal phalanx of the left index finger. In the right hand, shortening of the right distal phalanx and flexion contracture of the distal interphalangeal joint were noted in the index finger.
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August 2010

Enhancing the Quality of Research Publication: AuthorAID in the Eastern Mediterranean.

J Tehran Heart Cent 2010 30;5(4):169-71. Epub 2010 Sep 30.

Translator and Editorial Consultant, Granada, Spain.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3466853PMC
October 2012

A giant polypoid basal cell carcinoma of the lower extremity.

Arch Iran Med 2010 Mar;13(2):153-5

Department of Dermatology, Shiraz University of Medical Sciences, Shiraz, Iran.

Less than 1% of basal cell carcinomas are giant basal cell carcinomas. Giant basal cell carcinomas are rare. They preferentially involve the trunk and are commonly associated with neglect. Giant basal cell carcinomas of 10 cm or greater are associated with a high rate of metastasis. We report a case of giant basal cell carcinoma of the leg which is not associated with neglect and no signs of metastasis, despite being more than 10 cm in diameter. The present paper includes a brief review of the literature.
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March 2010