The Histopathological Changes and Immunohistochemical Findings of Acute, Chronic Nonlupoid and Chronic Lupoid Types of Cutaneous Leishmaniasis

Abstract: Background & Aims: Dry type localized cutaneous Leishmaniasis due to Leishmania tropica is one of the most prevalent cutaneous parasitic infections in Kerman province. It seems that cellular immune response and the nature of immune inflammatory cells comprising the inflammatory background play a determinant role in this infection. Methods: Skin biopsies of 53 patients with acute(<2 years duration), nonlupoid chronic(≥2 years duration) and lupoid chronic (new lesions around old scar) types of cutaneous leishmaniasis due to Leishmania tropica were studied by hematoxylin-eosin staining for evaluation of inflammatory cells and epidermal and dermal changes. Immunohistochemical staining was used to determine immunophenotypic patterns (CD1a, CD68, CD3, CD8, CD4, CD20) and to evaluate host immune response at tissue level, the correlation between the presence and concentration of certain cell types, and the clinical presentation and duration of disease. Results: Mean percentages of epidermal and dermal Langerhans cells CD1a+ were higher in lupoid than in acute lesions. Also, the predominant T lymphocyte in acute, chronic and lupoid leishmaniasis was T CD8+. Conclusion: It seems that Langerhans cells CD1a+ are responsible for the suppression of the inflammatory response against L.tropica infection and by providing Leishmania antigens in a steady state induce tolerance to the Leishmania antigens and consequently cause cutaneous chronic lupoid leishmaniasis. This study also suggests that T CD8+ play an effective role in parasite elimination and in the process of healing of cutaneous leishmaniasis due to Leishmania tropica. Keywords: Leishmania tropica, Immunohistochemistry, CD1 antigens, CD8-positive T-Lymphocyte

Efficacy of microneedling plus topical 4 tranexamic acid solution vs 4 hydroquinone in the treatment of melasma: A single-blind randomized clinical trial

Background: There are various treatment modalities for melasma, but none of them are effective on dermal component of melasma. Aims: In this study, we decided to evaluate the efficacy of microneedling plus tranexamic acid in comparison with 4 hydroquinone in the treatment of melasma. Methods: This is a single-blind randomized clinical trial on 70 participants with 14 dropout, and therefore, 60 patients with melasma completed the study. Patients were randomized based on simple randomization in 2 groups of A (microneedling plus topical 4 tranexamic acid, monthly) and B (topical 4 hydroquinone, nightly). Evaluation of mean MASI score, patient and physician assessments was performed at 4th, 8th and12th weeks of the treatment. Statistical analysis was performed by paired t test, chi-square test and Fisher's exact test, respectively. Results: Sixty women (30 patients in each group) were completed the study. Mean MASI score in group A was significantly lower at the end of the treatment (6.84 ± 4.31) than at the baseline (12.89 ± 5.16) (P <.01). Mean MASI score in group B was significantly lower at the end of the treatment (7.16 ± 4.38) than at the baseline (13.56 ± 4.88) (P <.01). There was no statistical difference between 2 groups regarding MASI score, physician and patient assessments during the treatment. Percentage of patient satisfaction was significantly higher than physician satisfaction in both treatment groups (P <.01). Conclusion: In our study, the combination of microneedling with tranexamic acid did not differ from 4 hydroquinone in the treatment of melasma. © 2020 Wiley Periodicals, Inc

Frequency of Diabetes Mellitus in Skin Tag Patients in Comparison with Control Group

Abstract: Background & Aims: Diabetes mellitus is one of the most common types of chronic disease leading to serious complications such as blindness, end stage renal disease (ESRD), neuropathy and cardiac disorders. Skin tag is a common benign skin tumor that its association with impaired carbohydrate metabolism has been reported in some studies. The aim of this study was to compare the frequency of diabetes and other carbohydrate metabolism disorders in patients with and without skin tag. Methods: In a case- control study on 200 individuals over 30 years old referring to Dermatology Clinic of Afzalipour Hospital, 100 individuals with at least 3 skin tags as case group and 100 individuals without skin tag as control group underwent FBS and standard GTT tests. Results: There was no significant difference between case and control groups in the frequency of diabetes (19% vs. 10%), IGTT (11%vs.13%) and IFG (19% vs. 15%).Mean FBS and GTT were significantly higher in the case group compared to the control group. There was a positive correlation between the total number of skin tags and mean FBS (r= 0.33, P= 0.001) and GTT (r= 0.37, P= 0.000). The frequency of diabetes in patients with at least 20 skin tags was 45.8%. Positive predictive value, negative predictive value, sensitivity and specificity of skin tag for the diagnosis of diabetes were 19%, 90%, 52% and 65% respectively. Conclusion: This study revealed that patients with skin tags are at a higher risk of carbohydrate metabolism disorders. Therefore, screening of patients with skin tag for carbohydrate metabolism disorders is recommended. Keywords: Diabetes mellitus, Skin ta

Immunopathology of anthroponotic cutaneous leishmaniasis and incidental diagnostic tool of metastatic granuloma: A case-control study

Background: Cutaneous leishmaniasis (CL) is a neglected disease with important public health concerns in many parts of the world including Iran. Objectives: We aimed to explore the histological changes and immunohistochemical quantification of inflammatory cells and their role in the immunopathology of acute, chronic non-lupoid, and chronic lupoid skin lesions in anthroponotic CL (ACL). Methods: In this study, skin biopsies of 53 patients with ACL were taken. Samples were studied by light microscopy and immunohistochemistry to quantify the immune and inflammatory cells. Results: Of the 53 skin lesions, 38 were acute, nine chronic non-lupoid and six chronic lupoid. CD68+ macrophages were the most common cells. CD3+ T-lymphocytes were present as diffuse and focal dermal infiltrates and CD8+ cytotoxic T-lymphocytes were the dominant lymphocyte type, constituting more than 50 of the lymphocyte population. CD4+ T-lymphocytes in chronic non-lupoid (10.57 ± 2.37) and chronic lupoid (14.40 ± 1.28) lesions were more than those observed in the acute form (8.61 ± 1.31), but the differences were not statistically significant. CD20+ B-lymphocytes constituted a small percentage of inflammatory cell infiltrates. CD1a + Langerhans cells showed progressively higher percentages from acute to chronic non-lupoid to chronic lupoid lesions. The differences were statistically significant (P &lt; 0.05) between acute and chronic lupoid lesions. CD68+ macrophages were the most common cells and CD8+ T lymphocytes remained the predominant T-lymphocytes in acute, chronic non-lupoid, and chronic lupoid lesions, suggesting their central role in the pathogenesis and possible healing of CL. Conclusion: Focusing on the deep dermis, periadnexal and/or peripheral margins or even papillary tip of inflammatory sites of sandfly bites, we sometimes find granuloma inside lymphatic vessels (lymphangiectatic metastatic granuloma) or even infected macrophages with engulfed Leishman bodies faraway. Knowledge of the histopathological and immunohistochemical findings for various forms of ACL is essential in improving clinical and medical strategies and crucial for proper prophylactic and therapeutic plans. © 2020 Elsevier Lt

Preliminary reliability and validity of Persian version of the Family Dermatology Life Quality Index (FDLQI)

Purpose: Family Dermatology Life Quality Index (FDLQI) is an instrument for assessing the quality of life of family members of dermatologic patients. The aim of this study was to describe the cultural adaptation of this questionnaire and to assess psychometric properties of the Persian version. Methods: At first, the questionnaire was translated into Persian, and then back-translation was performed. The whole cycle was repeated until a consensus was reached about the optimal translation. In the next step, cognitive debriefing was performed, and after approval of the Persian version by FDLQI developers, it was distributed among 100 family members of dermatological patients in order to evaluate its validity and reliability. Results: Mean age of participants was 37.1 years (±12.3). Mean score of FDLQI was 15.4 (±5.5) with maximum and minimum scores of 30 and 6, respectively. The quality of life of studied participants showed no significant difference based on age-group, sex, educational level and the family relationship. Cronbach’s alpha was calculated as 0.87. Exploratory factor analysis revealed a one-factor solution that accounted for 40.7 % of the variance. The unidimensional model was supported by confirmatory factor analysis. Conclusions: The results of the present study showed that the Persian version of FDLQI has acceptable factorial validity and internal consistency reliability

Prenatal pregabalin is associated with sex-dependent alterations in some behavioral parameters in valproic acid-induced autism in rat offspring

This study was performed to evaluate the effects of prenatal exposure to pregabalin (PGB) on behavioral changes of rat offspring in an animal model of valproic acid (VPA)-induced autism-like symptoms. Pregnant rats received VPA (600 mg/kg/i.p.) once at 12.5 gestational days for autism-like symptom induction in offspring. After the delivery single male and single female offspring from each mother were randomly selected for behavioral test (anxiety, pain response, pleasure, and motor function) at 60th day adulthood (n = 7). Offspring received prenatal PGB (15 & 30 mg/kg/i.p.) during gestational days 9.5 to 15.5 either alone or in combination with VPA (PGB15, PGB30, PGB15 + VPA, and PGB30 + VPA). Control offspring received normal saline during the same period. The result showed that prenatal VPA exposure was associated with autism-like behaviors in rat offspring. PGB treatment during the gestational period revealed significant reduction in sucrose preference test and anxiety in elevated plus maze and open field test in offspring. Also, PGB treatments exhibited a dose-dependent increase in pain threshold in prenatally VPA exposed rats in tail-flick and hot plate test. Also, there was a sex-related significant impairment in motor function in beam balance and open field test, and male rats were affected more than females. However, no significant sex differences in sucrose preference and pain sensitivity were observed in prenatal PGB-treated rat offspring. In conclusion, prenatal exposure to VPA increased the risk of autism-like behaviors in the offspring rats, and PGB treatment during the gestational period was associated with some beneficial effects, including anxiety reduction and motor impairment in autism-like symptoms in rat offspring. © 2020 International Society for Developmental Neuroscienc