Survey on Etiology of Stevens-Johnson syndrome and Toxic Epidermal Necrolysis in Pediatric Patients: A Six-Year Study from Iran

Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are among the most severe dermatologic reactions to the drugs. Data about SJS and TEN among pediatric population especially in Iran is limited. This study aimed to investigate the clinical and para-clinical characteristics of pediatric patients with SJS/TEN. Materials and Methods From 2010 to 2016, all SJS and TEN children from three teaching hospitals in Mashhad-Iran with age less than 15 years were included in the study. Patients’ catechistic, history, physical examinations, progress notes, laboratory findings, medical consults, treatments taken and the final outcome were extracted from medical records by researcher. Data were further analyzed by SPSS (version 17.0). Results Among 165 records, 48 children (58.3% male; mean age of 9.1 years) were among the SJS and TEN spectrum. Anticonvulsants (50%; including lamotrigine, phenobarbital, phenytoin, carbamazepine, valproate and clobazam) were the most common drugs followed by antibiotics (38.1%; including cefixime, penicillin, azithromycin, co-amoxiclav, cephalexin, co-trimoxazole and ceftriaxone), and analgesics (9.5%; including acetaminophen, ibuprofen and naproxen). Infectious agents were the possible cause of SJS/TEN in two patients. WBC counts, liver function tests, renal and electrolyte tests were significantly different in SJS and TEN groups. Conclusion The main suspected medications found in this study were anticonvulsants and antibiotics and the mortality rate was 12.5%. The main suspected medications found in this study were anticonvulsants and antibiotics and the mortality rate was 12.5%

Therapeutic Updates on Lichen planopilaris and Frontal Fibrosing Alopecia: A Systematic Review

Introduction: Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are skin diseases that affect the quality of life. Although a systematic review on LPP and FFA treatment was published in 2013, further updates are needed. The aim of this study is to review systematically the studies published after the last systematic review.Methods: We searched Scopus, PubMed, Embase, and ISI Web of Science. All the studies published during March 2012-June 2017 were included in this review. Two reviewers separately selected the studies and extracted the data. The results of studies were categorized as unimproved, stabilized, and improved based on the articles reports.Result: Among the 38 studies, 20, 17, and one studies assessed LPP, FFA, and both treatments, respectively. The papers were case reports, case series, cohorts, and randomized controlled trials. Antimalarial agents and pioglitazone resulted in enhancement in 73 and 71% of the LPP patients, respectively. Improvement and stabilization were observed in almost one third of the topical steroid users and 6/12 of Tacrolimus/Pimecrolimus users in LPP. Improvement and stabilization in FFA was found in 68% of the individuals using antimalarial agents, 83% of intralesional steroid users, all cases of finasteride users, and 95% of the people utilizing dutasteride.Conclusion: Contrary to the previous systematic review, we found antimalarial agents more effective than steroids in LPP. Finasteride/dutasteride may have favorable impacts on FFA. Intralesional steroids showed to be more effective than antimalarial agents in FFA. Still further studies are needed in order to define a treatment protocol. Low quality and heterogeneity of the articles were among the limitations for making a conclusion

Omental-Mesenteric Myxoid Hamartoma Mimicking Malignancy in a 14-month-old child (A Case Report)

Background: The omental-mesenteric myxoid hamartoma (OMMH) is a very rare lesion, mainly seen in children and characterized by multiple omental and mesenteric nodules, which may be confused with malignant neoplasm. Microscopically, these lesions consist of a richly vascularized myxoid stroma with plump mesenchymal cells. This lesion has a benign clinical course without recurrence during follow up. Case Presentation: We present a 14-month-old boy that was referred with history of abdominal distension, fever and vomiting for 3 months. Enhanced computed tomography (CT) revealed a huge well-demarcated hypodense and spherical mass which displaced bowel loops without obvious penetration to the intestinal walls.Histological and immunohistochemical examinations confirmed the diagnosis of OMMH.No evidence of recurrence was noted during 3 years follow up. Conclusion: OMMH is a very rare lesion and because of its aggressive appearance, differential diagnosis with malignancy is warranted. The clinical picture of our case also led to high suspicion of malignancy. However by consideration of histological and immunohistochemical findings we could achieve the correct diagnosis

Evaluating the effect of oral clarithromycin on acute cutaneous leishmaniasis lesions compared with systemic glucantime

Background and aim It is widely accepted that the high prevalence of leishmaniasis, demands the search for a tolerable effective treatment with the least side effects. This study aimed to evaluate the effect of treatment with clarithromycin on regression of lesions. Materials and methods This study was performed on 20 patients with leishmaniasis referred to dermatology clinic in 2017–2018. They were divided into two groups of intervention (500 mg oral clarithromycin twice a day) and control (20 mg/kg/day systematic glucantime). Induration size of lesions was recorded. Results We had 20 patients with acute cutaneous leishmaniasis (CL) with 45 lesions in the control group and 49 lesions in the intervention group. In the control group, the mean number of lesions was 3 ± 2.8 and 5 ± 4.3 in each person in the control and intervention group (p=.63). The mean size of the largest diameter of lesions’ induration at the beginning of the treatment was 19.81 ± 13 and 15.47 ± 15.6 mm in control and intervention group (p=.3) which changed to 1.59 and 0 respectively in three months after the treatment (p=.001). Conclusions We concluded oral clarithromycin had therapeutic effects on acute CL similar to systematic glucantime and could be considered as a safe and effective treatment option

Bacterial contamination in cutaneous leishmaniasis: Its effect on the lesions′ healing course

Background: The colonization of aerobic and anaerobic microbial agents on cutaneous leishmaniasis (CL) lesions, especially acute erosive ulcerative ones, has been mentioned in previous studies showing controversial results on the healing course of lesions with the use of antibiotics. Aims: The purpose of this study was to evaluate the prevalence of secondary bacterial infections in CL lesions and the effect of its elimination on the lesions′ improvement rate. Materials and Methods: This cross-sectional clinical trial was performed on 84 acute CL patients. The required skin samples were taken. Cultivation for bacteria was conducted. Patients with positive culture results were divided into two groups. Both groups received standard anti-leishmania treatment, whereas only one group was treated with cephalexin 40-50 mg/kg/day for 10 days. The improvement rate was evaluated in the following visits based on changes in the lesions′ induration size. Results: Among the 84 studied patients, 22.6% had a negative culture result whereas the result was positive in 77.4%. The most common pathogenic germs were Staphylococcus aureus (52.3%) and Staphylococcus epidermidis (9.5%); 34/5% of the positive lesions received antibiotic treatment. Finally, among the lesions with a 75-100% improvement rate, no significant difference was observed between the antibiotic-treated and -untreated groups (36.1% vs. 63.9%, respectively, P = 0.403). Conclusions: The most common pathogen was S. aureus and, as a primary outcome, the simultaneous treatment for microbial agents did not have any considerable effect on the improvement rate of CL lesions