Zahra Hallaji

Razi Hospital, Tunis-Ville, Tūnis, Tunisia

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Publications (27)36.63 Total impact

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    ABSTRACT: Genital wart is the most common sexually transmitted disease worldwide. Sexual risk factors and sexual behavior pattern may be different in various countries. In this study, we tried to evaluate demographic information and some sexual behaviors and risk factors in Iranian patients with genital warts. In this cross-sectional study, 250 patients with anogenital warts were evaluated. They had been referred to the Sexually Transmitted Diseases Clinic of Razi Hospital. Demographic information and sexual risk factors and pattern of sexual behaviors were recorded in the questionnaires. One hundred twenty-five men and 125 women with genital warts were evaluated. The most common age group was 20- 30 years old; 24.8% were single; 29.6% had academic education; 35 (14%) of the patients had started sexual activity before 15 years of age; 92% reported unsafe sex; seven (2.8%) of them were HIV infected; two cases (0.8%) were homosexual; and seven cases (2.8%) were bisexual. Genital herpes simplex type 2 was the most common coincident sexually transmitted disease (6.4%). Genital wart in men may be as common as women, married and singles, and mostly involves younger people. Sexual high-risk behaviors and unsafe sex make them at risk for HIV infection. Sexual health education should be considered in high-risk groups.
    Archives of Iranian medicine. 09/2013; 16(9):518-20.
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    ABSTRACT: BACKGROUND: Primary immunodeficiency diseases (PIDs) are a group of heterogeneous inherited disorders, characterised by recurrent infections, autoimmunity and malignancy. Some PIDs such as hyper IgE syndrome (HIES) and Wiskott-Aldrich syndrome (WAS) may be initially presented as atopic dermatitis (AD), especially in its severe form, resulting in diagnostic delay and poor prognosis of patients. OBJECTIVE: The aim of this study was to evaluate the frequency of PIDs among patients with severe AD and to determine factors that can help to raise suspicion towards these disorders. METHODS: Seventy-five patients with a well-established diagnosis of severe AD were enrolled in this study. Initial immunological evaluations, including humoral and cellular investigation, were performed in all individuals. Patients underwent further investigations in a case of suspicion of a probable PID. RESULTS: Among all patients with severe AD, five (6.6%) were diagnosed with HIES and one (1.3%) with WAS. Family history of PIDs, family history of death in early infancy, positive history of recurrent infections such as skin and respiratory infections, otitis media and sinusitis were observed significantly higher in patients with a diagnosis of PID. CONCLUSIONS: The presence of an underlying PID could explain the poor prognosis and refraction to the treatment of some patients with severe AD. Several clinical and laboratory findings can help the physicians to focus towards PIDs which are more serious. Delay in diagnosis of PID cases with skin manifestation of AD without proper management may result in lower quality of life and higher morbidity and mortality rates.
    Allergologia et Immunopathologia 06/2013; · 1.23 Impact Factor
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    ABSTRACT: Background  The classic treatment for pemphigus vulgaris is prednisolone. Immunosuppressive drugs can be used in association. Objective  To compare the efficacy of Azathioprine in reducing the Disease Activity Index (DAI). Patients and methods  A double blind randomized controlled study was conducted on 56 new patients, assigned to two therapeutic groups: (i) prednisolone plus placebo; (ii) prednisolone plus Azathioprine. Patients were checked regularly for 1 year. 'Complete remission' was defined as healing of all lesions after 12 months, and prednisolone <7.5 mg daily, (DAI ≤ 1). Analysis was done by 'Intention To Treat' (ITT) and 'Treatment Completed Analysis' (TCA). Results  Both groups were similar in age, gender, disease duration, and DAI. Primary endpoint: By ITT and TCA, the mean DAI improved in both groups with no significant difference between them. The difference became significant for the last trimester (3 months; ITT: P = 0.033, TCA: P = 0.045). Secondary endpoint: The total steroid dose decreased significantly in both groups, with no significant difference between them, except for the last trimester (ITT: P = 0.011, TCA: P = 0.035). The mean daily steroid dose decreased gradually in both groups becoming statistically significant in favour of azathioprine, in the last trimester, especially at 12th months (ITT: P = 0.002, TCA: P = 0.005). Complete remission was significant at 12 months only for TCA (AZA/Control: 53.6%/39.9%, P = 0.043). Limitations  Sample size was rather small to demonstrate all differences. Other limitations include the choice of primary and secondary endpoints and the unavailability to measure thiopurine methyltransferase activity. Conclusion  Azathioprine helps to reduce prednisolone dose in long-run.
    Journal of the European Academy of Dermatology and Venereology 10/2012; · 2.69 Impact Factor
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    ABSTRACT: Narrowband ultraviolet B (NB-UVB) has been accepted as an effective therapy for generalized vitiligo. On the other hand, different factors seem to contribute to a good response. The purpose of this study is to evaluate the influence of disease duration on its clinical response to NB-UVB phototherapy. In this open and uncontrolled study, vitiligo was considered 'recent' when the duration of disease was less than or equal to 4 years and 'long standing' when it was greater than 4 years. The patients received NB-UVB thrice weekly with an initial dose of 200 mJ/cm(2) and 10% increments at each subsequent treatment. After categorizing the clinical response to four groups (mild, moderate, good, and excellent), duration of disease and clinical response to NB-UVB were correlated statistically using the t-test. There were 63 patients: 34 women and 29 men, aged 6-60 years. The mean of disease duration was 10.13 ± 9.1 years. Vitiligo was 'recent' in 26 and 'long standing' in 37 patients. The mean of overall response was 51.94 ± 18.48%. Higher grades of response were more prevalent in patients with recent vitiligo than those with long-standing disease, and there was also statistically significant difference in overall response between these two groups of disease duration (P = 0.023). The early treatment of generalized vitiligo may enhance the chance of successful repigmentation.
    Photodermatology Photoimmunology and Photomedicine 06/2012; 28(3):115-9. · 1.52 Impact Factor
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    ABSTRACT: Bullous pemphigoid is an immunobullous disease with high mortality and morbidity. Different aspects and characteristics in the patients vary in different areas in the world. Our objective was to study clinical and demographic characteristics of bullous pemphigoid in Iranian patients. In a retrospective descriptive study, we reviewed 122 patients with bullous pemphigoid within 1987-2007. Demographic characteristics, clinical manifestations, treatment, relapses and outcome were evaluated. The mean age of 122 patients was 65 ± 18.11 years including 35.2% male and 64.8% female. The most common manifestations were cutaneous bullae (97.5%). 27% had oral lesions. 30.3% had eosinophillia. 90 patients(73.8%) received oral prednisolone, 29 patients (23.8%) topical steroid, 2 patients tetracycline and 1 patient dapsone. 89 patients were followed after admission. Out of them 44 patients experienced first relapse and 22 patients second relapse. 41 cases (46%) were completely controlled. 11 cases (12%) were not controlled. Clinical and general characteristics of bullous pemphigoid patients differ in various regions in the world.
    Acta medica Iranica 05/2012; 50(5):335-8.
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    ABSTRACT: Sweet's syndrome and erythema nodosum are rarely seen together. Herein, we report a case of concurrent Sweet's syndrome and erythema nodosum and review previous cases.
    Iranian Journal of Dermatology. 01/2012;
  • Journal of the American Academy of Dermatology 01/2012; 66(1):e12-3. · 4.91 Impact Factor
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    ABSTRACT: Background  The place of cell-mediated immunity and cytokines in the immunopathogenesis of pemphigus vulgaris (PV) has not been fully established. Objective  To assess the serum levels of pro-inflammatory cytokines, Interleukine-6 (IL-6) and Interleukine-8 (IL-8), in PV patients before and after therapy, to evaluate the influence of therapy on the serum cytokine levels. Methods  Sixty-six newly diagnosed PV patients enrolled into the study. The serum levels of IL-8 and IL-6 were measured in 66 and 64 patients, respectively. According to the extent of skin and mucosal involvement, the patients were divided into two groups namely mild and severe. The serum levels of cytokines were measured using enzyme-linked immunosorbent assay (ELISA) method before and after 4 weeks of prednisolone plus azathioprine therapy. Results  In 64 patients studied for the serum level of IL-6, the median IL-6 level was significantly decreased from 1.6 to 0.9 pg/mL by therapy (P-value = 0.001). Segregating the patients according to the severity of the disease, the serum level of IL-6 did not differ significantly by therapy in patients with a mild disease. However, in patients with a severe disease the median serum level of IL-6 decreased significantly from 1.8 to 0.9 pg/mL after therapy (P-value = 0.001). No significant changes were found in the IL-8 level by treatment. Conclusion  The significant decrease in the IL-6 level after therapy suggests that blocking of IL-6 could have therapeutic benefits for the treatment of PV, particularly in severe forms.
    Journal of the European Academy of Dermatology and Venereology 11/2011; · 2.69 Impact Factor
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    ABSTRACT: Basal cell carcinoma (BCC) is the most common malignant skin tumor. Although mortality attributable to BCC is not high, the disease is responsible for considerable morbidity. There is evidence that the number of patients who develop more than one BCC is increasing. The aim of this study was to elucidate possible risk factors for developing Multiple BCC. Patients with histologically proven BCC (n = 218) were divided into two groups (single BCC and Multiple BCC) according to the number of their tumors and their profile were reviewed. Probable risk factors were compared between these two groups. Among 33 evaluated risk factors, mountainous area of birth, past history of BCC, history of radiotherapy (in childhood due to tinea capitis), abnormal underlying skin at the site of tumor, and pigmented pathologic type showed significant differences between the two groups. The high rate of additional occurrences of skin cancers among patients with previously diagnosed BCC emphasizes the need of continued follow-up of these individuals. Those with higher risk require closest screening.
    Indian Journal of Dermatology 07/2011; 56(4):398-402.
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    ABSTRACT: Studies on the interaction of pemphigus and pregnancy are limited to case reports and small case series. Pregnancy is not rare in Iranian pemphigus patients due to lower age at onset of the disease. We sought to investigate the outcome of pregnancy and the course of pemphigus in pemphigus patients in a retrospective study. The files of 779 pemphigus women younger than 50 presenting to our center from 1984 till 2006 were examined for any mention of pregnancy. Data related to outcome of pregnancy and the course of the disease were collected. Sixty-six patients with a history of pregnancy were identified. Forty-eight known pemphigus patients experienced one or more pregnancies during their disease (total pregnancy number: 52). The course of pemphigus was as follows in this group: 28 cases (54%) of exacerbation, 15 cases (31%) with no alteration, and 9 cases (17%) showing improvement. The rate of abortion was 9.6% (5 cases). In 18 cases, the disease had started during pregnancy, 2 of them (11%) ended in an abortion. Overall, postpartum flare was seen in 33 cases (47.1%). Pemphigus may be exacerbated during or after pregnancy, but often to a mild degree. Although the rate of stillbirth was not as high as previously reported, the rate of abortion was considerable. Pregnancy may have an uneventful course, especially in patients in clinical remission; nevertheless, careful monitoring of the high risk mother and fetus is mandatory.
    Indian journal of dermatology, venereology and leprology 01/2011; 77(4):534. · 0.98 Impact Factor
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    ABSTRACT: Background: Alopecia areata, a non-cicatricial form of hair loss, is believed to be an immunologic response that targets hair follicles. Genetic background is important in the pathogenesis of this disorder, although some evidence point to the role of melanocytic antigens. There are some reports on the relationship between alopecia areata and celiac disease. The aim of the present study was to identify antigliadin antibodies in patients with alopecia areata. Methods: Fifty patients, aged 2.5-50 years, with alopecia areata presenting to the dermatology clinic of Razi Educational Hospital in Tehran, Iran, and fifty healthy individuals, aged 5-48 were matched and enrolled in the study. After signing an informed consent form, blood samples (10 ml clotted blood) were obtained from the participants and sent to referral laboratory for the presence of antigliadin IgA and IgG antibodies. Concentrations of antibodies were measured by ELISA through a full automatic ELISA reader. The data were analyzed statistically. Results: The study included 29(58%) male and 21(42%) female patients with a mean age of 24.6 years. The control group included 29(58%) male and 21(42%) female individuals with a mean age of 24 years. In the case group, 9(18%) patients were positive for antigliadin antibody, while only one (2%) individual was positive for the antibody in the control group (p<0.001). No other differences were of statistical significance. Conclusions: Regarding the higher prevalence of antigliadin antibodies in patients with alopecia areata, it would be wise to screen the patients for celiac disease.
    Tehran Uni Med J (TUMJ). 01/2011; 68(12):738-742.
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    ABSTRACT: Pemphigus is an autoimmune disorder, which results from interaction of exogenous and endogenous factors. One of these environmental factors is viral infections particularly, herpesviruses. We aimed to detect the presence of HSV 1 and 2 (herpes simplex virus) and HHV8 (human herpesvirus 8) in our patients who were suffering from pemphigus vulgaris. In this cross-sectional study, 38 patients (19 male and 19 female patients) with pemphigus vulgaris were entered, 32 skins and six peripheral blood cells samples were obtained from the study population. Thereafter, the presence of HHV8 and HSV DNA were evaluated by using polymerase chain reaction (PCR). The mean age of patients was 45.05 ± 17.24 years (range: 16-81 years). Twelve patients mentioned history of herpes labial in the past (31.57%). Results of PCR test for detection of HSV and HHV8 DNA in all 32 skin samples and five peripheral blood samples and one case with skin and blood samples were reported negative. Inability to detect HHV8 and HSV DNA in this study suggests that herpesviruses may be only occasional factors for development or exacerbation of pemphigus vulgaris.
    International journal of dermatology 11/2010; 49(11):1261-5. · 1.18 Impact Factor
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    ABSTRACT: Narrowband ultraviolet B (NB-UVB) phototherapy is an effective treatment for psoriasis. To compare the effects of three and five times weekly NB-UVB phototherapy in the treatment of chronic plaque psoriasis. Methods: Sixty-five patients with chronic plaque psoriasis were allocated to receive three or five times weekly NB-UVB, starting at low dose. Among the patients who completed the study, clearance was achieved in 18 out of 23 patients (78%) in the three times weekly group and in 15 out of 22 patients (68%) in the five times weekly group. The difference was not statistically significant (P=0.44). No statistically significant differences were found between the two groups in the number of treatments (P=0.95), cumulative UVB dose (P=0.51), and rate of side-effects. Length of the treatment period was significantly shorter in the five times weekly group (P<0.001). At the end of treatment, the mean psoriasis area and severity index score was lower in the three times weekly group (P=0.02). We recommend three times weekly NB-UVB for chronic plaque psoriasis; however, the more rapid clearance of psoriasis with five times weekly phototherapy may justify using this method in some patients.
    Photodermatology Photoimmunology and Photomedicine 02/2010; 26(1):10-5. · 1.52 Impact Factor
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    ABSTRACT: Milia en plaque, a rare inflammatory plaque type of milia is generally located in the periauricular area. Bilateral retroauricular milia en plaque is very rarely reported. Here, we report another case of bilateral retroauricular milia en plaque and review the previous cases.
    Dermatology online journal 01/2010; 16(1):12.
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    ABSTRACT: A 49-year-old man was first seen in our department for the evaluation of scleroderma-like skin changes and a nonhealing ulcer on his leg from years before referral. His medical history was of long duration. His growth was stunted at the age of 12. At 21 years of age, the patient noted graying of the scalp hair, most prominent on his temples, and the process was progressively completed by the age of 23. At the same age, atrophy and thinning of the skin and loss of subcutaneous fat resulted in a tense, shining, and adherent appearance of his skin, most obvious on his face and extremities. Soon after, he developed a high-pitched, hoarse voice. He had undergone bilateral cataract surgery at the age of 30. Around the age of 46, he developed a unilateral nonhealing chronic leg ulcer (Figure 1). He had separated from his wife because of infertility. He was the first offspring of his second-degree healthy relative parents. The other 3 siblings had similar signs and symptoms. Our patient gave the history of premature graying of the hair of his younger brother at the age of 18 and his 2 younger sisters at the age of 12 and 16. His brother had recently received diagnoses of bilateral cataract and diabetes mellitus. All of the siblings had ceased growth from early adolescence. On physical examination, our patient's weight was 48 kg and his height was 150 cm. He had normal intelligence. He was speaking with a high-pitched and childish voice. He had a bird-like appearance with a beak-shaped nose. Mottled and diffuse pigmentation and poikiloderma appearance was conspicuous on his neck (Figure 2). The entire skin was smooth, shiny, and scleroderma-like, and a marked decrease in the subcutaneous fat was noted over the extremities. A deep cutaneous ulcer was evident on his slimmed leg. Digital ulcers were not found, and radial and dorsalis pedis pulses were palpable. Clinodactyly of the toes were conspicuous. His nails were dystrophic and he had used dentures from the age of 20. On examination of the external genitalia, his testes were smaller than normal. In the biopsy taken from the leg ulcer, there were no signs of malignancy. There were no signs ofosteomyelitis on x-ray. Biopsy of the normal skin revealed atrophic epidermis and thick dermis with hyalinization of the collagen fibers and absence of pilosebaceous structures (Figure 3). The patient's scalp hair was thin and sparse and there were few axillary and pubic hairs. His fasting plasma glucose level was normal.
    SKINmed 01/2010; 8(3):184-6.
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    ABSTRACT: To the best of our knowledge there is only one report about salivary desmoglein (Dsg) 1 and 3 enzyme-linked immunosorbent assay (ELISA) in pemphigus vulgaris (PV), whereas several studies have been performed on serum. To find the sensitivity of serum and salivary anti-Dsg1 and 3 antibodies in the diagnosis of PV, and to determine the relationship between disease severity and phenotype with antibody levels. Fifty new patients with PV were included in this study. The diagnosis of PV was confirmed by histopathology and direct immunofluorescence. Demographical data, disease severity and phenotypes were recorded on questionnaire sheets. Dsg1 and Dsg3 ELISA were performed on serum and salivary samples of patients and controls. Thirty-seven patients had mucocutaneous phenotype; whereas mucosal dominant and cutaneous dominant phenotypes were seen in 11 and 2 patients respectively. The sensitivities of serum anti-Dsg3 and anti-Dsg1 were 94% and 72% respectively. The sensitivities of salivary anti-Dsg3 and anti-Dsg1 antibodies were accordingly 94% and 70%. Compared with mucosal phenotype, serum and salivary anti-Dsg1 antibodies were significantly higher in the patients with mucocutaneous phenotype. Serum Dsg1 antibodies were related with cutaneous and serum Dsg3 antibodies with mucosal severity scores. Salivary Dsg1 antibodies were significantly correlated with mucosal severity (P=0.00); however there was no correlation between this antibody and cutaneous severity (P=0.07). Salivary Dsg3 antibodies were not correlated with mucosal severity (P=0.16). Saliva Dsg ELISA could be used for diagnosis of PV. Salivary Dsg1 antibodies had a significant correlation with mucosal severity.
    Journal of the European Academy of Dermatology and Venereology 09/2009; 24(3):275-80. · 2.69 Impact Factor
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    ABSTRACT: To evaluate the relationship between thiopurine methyltransferase (TPMT) activity and the safety and efficacy of azathioprine sodium in the treatment of pemphigus vulgaris. Cross-sectional study. Referral university hospital for autoimmune blistering diseases. One hundred thirty-nine patients with pemphigus vulgaris treated with azathioprine. Intervention The TPMT activity in red blood cells was measured using high-performance liquid chromatography. Main Outcome Measure Severe adverse effects were defined as those judged serious enough that azathioprine therapy be discontinued in 139 patients treated with azathioprine. To evaluate the relationship of clinical response and TPMT concentration in 52 patients who had been treated with a combination of prednisolone and azathioprine only for at least 1 year were included in the study, and the clinical response was considered favorable if there was no recurrence of pemphigus vulgaris in the first year of treatment. The median activity of TPMT was 44.7 ng/mL/h (interquartile range, 28.7 ng/mL/h). Eleven patients (7.9%) had low TPMT activity (TPMT-HL), 127 patients (91.4%) had normal TPMT activity (TPMT-HH), and 1 patient (0.7%) had supranormal enzyme activity; TPMT activity was noted in all patients. Serious adverse effects occurred in 14 patients (10.1%). There was no relationship between development of adverse effects and TPMT activity (P = .29). Eleven patients with low TMPT activity had been treated with azathioprine for a mean (SD) of 10.2 (4.1) months. Only 1 patient exhibited serious adverse effects. The TPMT enzyme activity was not different in 28 patients with unfavorable clinical response compared with 24 patients with favorable clinical response (P = .09). Conclusion Larger prospective studies are needed to determine the clinical relevance of TPMT activity and to determine accurate azathioprine dosing guidelines based on TPMT activity.
    Archives of dermatology 10/2008; 144(9):1143-7. · 4.76 Impact Factor
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    ABSTRACT: Psoriasis is a non-contagious disorder that affects the skin as red scaly patches. Although the role of Malassezia species in the pathogenesis of psoriasis is still not fully understood, it is thought that these lipophilic yeasts might be a trigger factor in the exacerbation of psoriatic lesions. Using culture in a specific medium followed by the polymerase chain reaction-restriction fragment length polymorphism method, the presence of Malassezia species in the skin of 110 patients with psoriasis was compared with that in a control group of 123 healthy patients. The recovery rate of Malassezia species from the skin of patients with psoriasis was significantly lower than that in the controls. In both psoriatic and healthy skin, Malassezia globosa was isolated as the predominant species. In psoriatic patients, the rate of colonization of Malassezia furfur and Malassezia restricta was almost twice that in the controls, whereas M. globosa was isolated more frequently from healthy individuals than from patients. Considering the higher lipase activity secretion by M. furfur in comparison with other Malassezia species, the enzymatic release of arachidonic acid and its metabolites by M. furfur may exacerbate the inflammatory and hyperproliferative changes observed in psoriasis.
    Journal of Cutaneous Pathology 07/2008; 35(11):1027-31. · 1.77 Impact Factor
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    ABSTRACT: A positive history of smoking is less common in patients with pemphigus than in healthy subjects. The aim of this case-control study was to compare the remission rate and clinical locations involved in smokers and nonsmokers with pemphigus vulgaris. Seventy patients with pemphigus vulgaris, treated with a uniform protocol, were enrolled. The sites of involvement, average time needed for disease control, and number of relapses were compared in smokers and nonsmokers. At the end of the first and second years of treatment, the rate of remission was compared in the two groups. Ten of the patients were current cigarette smokers, but the other 60 (85.7%) had no history of smoking. There was no difference in the rate of cutaneous or mucosal involvement between smokers and nonsmokers. The predominant subtype was the mucocutaneous type in both groups. Smokers with pemphigus vulgaris achieved partial remission more frequently than nonsmokers at the end of the first year of treatment. The number of patients in remission at the end of the second year of therapy was significantly higher for smokers with pemphigus than for nonsmokers. The main reason for disease activity in both groups was recurrence. Cigarette smoking may not affect the rate of cutaneous or mucosal involvement in pemphigus; however, the data indicate that remission may be achieved sooner in pemphigus patients who smoke.
    International journal of dermatology 07/2008; 47(6):567-70. · 1.18 Impact Factor
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    ABSTRACT: Pemphigus vulgaris (PV) is a rare autoimmune blistering disease of the skin and mucous membranes. It varies in its clinical profile and epidemiologic characteristics in different parts of the world. To determine the clinical features of PV in Iran in a prospective manner. The study included 140 patients with newly registered PV attending our dermatology clinic between January 2003 and June 2004. RESULTS The mean age at the onset of the disease was 41.5 +/- 15.7 years, with a female to male ratio of 1.59 : 1. At presentation to our clinic, both skin and mucosal involvement was observed in 95 patients (67.9%). Cutaneous lesions without the involvement of the mucous membranes were seen in nine patients (6.4%), and exclusive mucosal involvement was present in 36 patients (25.7%). The most common initial localization of the disease was the oral cavity, which was involved in 93 patients (77.5%). The most frequent cutaneous and mucosal sites involved were the thorax and oral cavity, respectively. Although minor differences were noted, the results of this study are in relatively good agreement with the literature with regard to the age, gender, and initial presentation of PV in Iran. Some skin sites, such as the scalp, thorax, and axilla, may be more commonly affected in men. Patients with initial mucosal lesions were significantly younger than those with initial cutaneous involvement. Mucosal lesions other than the oral mucosa may be more common than previously thought.
    International Journal of Dermatology 12/2007; 46(11):1166-70. · 1.34 Impact Factor