Large-scale epidemiological analysis of common skin diseases to identify shared and unique comorbidities and demographic factors.

Introduction: The utilization of large-scale claims databases has greatly improved the management, accessibility, and integration of extensive medical data. However, its potential for systematically identifying comorbidities in the context of skin diseases remains unexplored. Methods: This study aims to assess the capability of a comprehensive claims database in identifying comorbidities linked to 14 specific skin and skin-related conditions and examining temporal changes in their association patterns. This study employed a retrospective case-control cohort design utilizing 13 million skin/skin-related patients and 2 million randomly sampled controls from Optum's de-identified Clinformatics® Data Mart Database spanning the period from 2001 to 2018. A broad spectrum of comorbidities encompassing cancer, diabetes, respiratory, mental, immunity, gastrointestinal, and cardiovascular conditions were examined for each of the 14 skin and skin-related disorders in the study. Results: Using the established type-2 diabetes (T2D) and psoriasis comorbidity as example, we demonstrated the association is significant (P-values<1x10-15) and stable across years (OR=1.15-1.31). Analysis of the 2014-2018 data reveals that celiac disease, Crohn's disease, and ulcerative colitis exhibit the strongest associations with the 14 skin/skin-related conditions. Systemic lupus erythematosus (SLE), leprosy, and hidradenitis suppurativa show the strongest associations with 30 different comorbidities. Particularly notable associations include Crohn's disease with leprosy (odds ratio [OR]=6.60, 95% confidence interval [CI]: 3.09-14.08), primary biliary cirrhosis with SLE (OR=6.07, 95% CI: 4.93-7.46), and celiac disease with SLE (OR=6.06, 95% CI: 5.49-6.69). In addition, changes in associations were observed over time. For instance, the association between atopic dermatitis and lung cancer demonstrates a marked decrease over the past decade, with the odds ratio decreasing from 1.75 (95% CI: 1.47-2.07) to 1.02 (95% CI: 0.97-1.07). The identification of skin-associated comorbidities contributes to individualized healthcare and improved clinical management, while also enhancing our understanding of shared pathophysiology. Moreover, tracking these associations over time aids in evaluating the progression of clinical diagnosis and treatment. Discussion: The findings highlight the potential of utilizing comprehensive claims databases in advancing research and improving patient care in dermatology.

COVID-19 and the Unfinished Agenda of VISION 2020.

PURPOSE: To critically evaluate the potential impact of the coronavirus disease (COVID-19) pandemic on global ophthalmology and VISION 2020. DESIGN: Perspective supplemented with epidemiologic insights from available online databases. METHODS: We extracted data from the Global Vision Database (2017) and Global Burden of Disease Study (2017) to highlight temporal trends in global blindness since 1990, and provide a narrative overview of how COVID-19 may derail progress toward the goals of VISION 2020. RESULTS: Over 2 decades of VISION 2020 advocacy and program implementation have culminated in a universal reduction of combined age-standardized prevalence of moderate-to-severe vision impairment (MSVI) across all world regions since 1990. Between 1990 and 2017, low-income countries observed large reductions in the age-standardized prevalence per 100,000 persons of vitamin A deficiency (25,155 to 19,187), undercorrected refractive disorders (2,286 to 2,040), cataract (1,846 to 1,690), onchocerciasis (5,577 to 2,871), trachoma (506 to 159), and leprosy (36 to 26). Despite these reductions, crude projections suggest that more than 700 million persons will experience MSVI or blindness by 2050, principally owing to our growing and ageing global population. CONCLUSIONS: Despite the many resounding successes of VISION 2020, the burden of global blindness and vision impairment is set to reach historic levels in the coming years. The impact of COVID-19, while yet to be fully determined, now threatens the hard-fought gains of global ophthalmology. The postpandemic years will require renewed effort and focus on vision advocacy and expanding eye care services worldwide.

Comorbidities associated with non- healing of plantar ulcers in leprosy patients.

BACKGROUND: Non-healing plantar ulcers are one of the significant causes of disability in leprosy patients. Plantar ulcers often take months or years to heal, affecting the patient's quality of life. Presence of comorbid conditions in these patients can delay wound healing. The study aimed to evaluate the role of associated comorbid conditions as risk factors in ulcer healing. METHODOLOGY/PRINCIPAL FINDINGS: A total of 66 leprosy patients with plantar ulcers registered at LEPRA Society-Blue Peter Public Health and Research Center (BPHRC), Hyderabad, India from June 2018 to June 2019 were studied. Comprehensive clinical assessment was done, including screening for comorbid conditions and treated as per the recommended guidelines. About two-thirds of the participants were aged 50 and above, of which more than half were illiterates, and 93.5% were living below the poverty line. Majority of ulcers were seen on the forefoot; with the head of meta-tarsal bone 27 (41.6%) as the commonest site, followed by calcaneum 23 (38.3%) and great toe 10 (16.6%). Mean ulcer depth was 0.61 (0.57) cm, the area was 5.24 (6.73) cm2 and ulcer volume was 4.72 (14.33) cm3. Ulcer dimensions were significantly associated with low body mass index, hypertension and smoking. CONCLUSIONS/SIGNIFICANCE: Identifying the risk factors delaying wound healing and detailed assessment of ulcers are of profound importance to predict the outcome of plantar ulcers in leprosy patients. The study findings indicate the need for better policies by the leprosy control program for the comprehensive management of plantar ulcers.

Orientações para pessoas atingidas pela hanseníase durante a pandemia Covid-19 / Guidelines for persons affected by Hansen's disease (leprosy) during the Covid-19 pandemic / Pautas para las personas afectadas con la lepra durante la pandemia de Covid-19

Documento desenvolvido pela Sociedade Brasileira de Hansenologia com orientações às pessoas atingidas pela hanseníase sobre a prevenção e tratamento do Covid-19. O trabalho foi feito por um grupo de hansenologistas da Sociedade Brasileira de Hansenologia (SBH) em versões em português, espanhol e inglês e mostra como os médicos acreditam que a doença de Hansen e a COVID-19 podem interagir

Document developed by the Brazilian Society of Hansenology with guidance to people affected by leprosy on the prevention and treatment of Covid-19. The work was done by a group of Hansenologists from the Brazilian Society of Hansenology (SBH) in Portuguese, Spanish and English versions and shows how doctors believe that Hansen's disease and COVID-19 can interact

Documento desarrollado por la Sociedad Brasileña de Hansenología con orientación a las personas afectadas por la lepra sobre la prevención y el tratamiento de Covid-19. El trabajo fue realizado por un grupo de hansenólogos de la Sociedad Brasileña de Hansenología (SBH) en versiones en portugués, español e inglés y muestra cómo los médicos creen que la enfermedad de Hansen y COVID-19 pueden interactuar

Advice on leprosy and COVID-19 / Adivice on leprosy and COVID-19 / Conseils sur la lèpre et le COVID-19

The ILEP Technical Commission and the Global Leprosy Programme have issued the following advice on leprosy and COVID-19(AU)

La Commission Technique de l'ILEP et le Programme mondial de lutte contre la lèpre ont publié les conseils suivants sur la lèpre et COVID-19(AU)

Serological evidence of Toxoplasma gondii infection as potential risk for the development of lepromatous leprosy in an endemic area for both neglected tropical diseases in Brazil.

BACKGROUND: Mycobacterium leprae and Toxoplasma gondii infections are both neglected tropical diseases highly prevalent in Brazil. Infection with certain parasite species can significantly alter susceptibility to other important pathogens, and/or influence the development of pathology. Here we investigated the possible influence of M. leprae/T. gondii co-parasitism on the manifestation of leprosy and its clinical forms. METHODS: Participants (n = 291) were recruited in Campos dos Goytacazes city, Rio de Janeiro state, southeast Brazil, from August 2015 to December 2019 and clinically diagnosed for leprosy. Participants were selected based on the presence (patients) or absence (healthy controls) of the leprosy disease. Contacts of patients were also recruited for this study. Serum samples from patients (n = 199) with leprosy, contacts (n = 40) and healthy controls (n = 52) were investigated for levels of IgM and IgG anti-phenolic glycolipid-1 (PGL-1) by ELISA. Additionally, IgG antibody against soluble Toxoplasma antigen (STAg) was measured in sera samples from leprosy patients, contacts and healthy controls for Toxoplasma gondii serology by ELISA. Anti-PGL-1 IgG and IgM levels were compared using one-way ANOVA Kruskal-Wallis or Mann-Whitney, while Spearman test was used to correlate levels of IgG anti-STAg and IgM/IgG anti-PGL-1 from seropositive and seronegative individuals for T. gondii infection. The risk of T. gondii infection for leprosy disease was assessed using Fisher's test. RESULTS: Levels of IgM anti-PGL-1 antibodies were significantly higher in multibacillary (MB) patients compared to paucibacillary (PB) patients (P = 0.0068). Higher IgM and IgG levels anti-PGL-1 were detected in patients with the lepromatous forms. The serologic prevalence for T. gondii infection was 74.9%. We detected increased anti-STAg antibody levels in leprosy patients (79.4%), reaching 88.8% within those with lepromatous form of this disease. The leprosy risk increase in T. gondii seropositive individuals was two-fold (odds ratio [OR] = 2.055; 95% confidence intervals [95% CI]: 1.18-3.51) higher than those seronegative, and considering the lepromatous leprosy risk this increase was even dramatic (OR = 4.33; 95% CI: 1.76-9.69) in T. gondii seropositive individuals. Moreover the leprosy risk in T. gondii seropositive individuals was weakly correlated to the levels of IgG anti-STAg and IgM/IgG anti-PGL-1. CONCLUSIONS: Altogether, our results suggest that T. gondii infection may exert immunomodulatory properties that influence to the susceptibility of leprosy, mainly on its more severe clinical form. A better understanding of parasite immunomodulation can ultimately contribute to the development of medical applications.

Psoriasis increases the risk of concurrent inflammatory bowel disease: A population-based nationwide study in Korea.

BACKGROUND: The epidemiology of the association between psoriasis and inflammatory bowel disease is poorly defined and remains controversial. AIM: To evaluate the prevalence of inflammatory bowel disease in patients with psoriasis compared with the general population. METHODS: We searched the nationwide health claims database between 2011 and 2015 and evaluated the prevalence of inflammatory bowel disease, including Crohn's disease and ulcerative colitis. RESULTS: Prevalence of inflammatory bowel disease, Crohn's disease and ulcerative colitis in patients with psoriasis vs the general population in 2011 were 0.16, 0.05 and 0.12% vs 0.08, 0.03 and 0.06%, respectively, which increased significantly with time between 2011 and 2015. Patients with psoriasis consistently revealed higher standardized prevalence (age and sex adjusted) of inflammatory bowel disease, Crohn's disease and ulcerative colitis compared with the general population. Subgroup analysis revealed the highest risk of prevalent inflammatory bowel disease in patients younger than 19 years (crude odds ratio 5.33, 95% confidence interval 3.74-7.59). Severe psoriasis demonstrated higher odds of inflammatory bowel disease (odds ratio 2.96, 95% confidence interval 2.54-3.45) than mild psoriasis (odds ratio 1.68, 95% confidence interval 1.51-1.88). LIMITATIONS: Limited data for doing adjustment and cross-sectional study design. CONCLUSIONS: Psoriasis patients revealed higher risk of inflammatory bowel disease. In particular, young patients and those with severe psoriasis may require closer monitoring and comprehensive management.

Linking of psoriasis with osteopenia and osteoporosis: A cross-sectional study.

BACKGROUND/PURPOSE: Psoriasis is a multisystem disease which has been related to vitamin-D deficiency through chronic inflammation. This psoriasis-related inflammatory state and vitamin-D deficiency may induce bone mineral density loss. The purpose of this study is to assess the relationship of psoriasis with bone mineral density, by comparing psoriatic patients with healthy controls and patients with osteopenia/osteoporosis. METHODS: A total of 185 subjects were studied; 58 psoriatic patients who had not been under systemic or biological treatment were included. Age, gender, body mass index, phosphocalcic metabolic parameters and hip and lumbar (L4) bone mineral density data were collected. These variables were compared with those collected in 61 healthy controls and 67 patients with osteopenia/osteoporosis. RESULTS: Psoriatic patients showed worse hip and lumbar spine bone mineral density levels than healthy controls (P = 0.001) and better levels than osteoporotic patients (P < 0.001). Multivariate analysis demonstrated a negative association of age and a positive association of body mass index in hip bone mineral density in psoriatic patients. LIMITATIONS: The main limitations are those of cross-sectional studies, such as a lack of follow up period, and a male predominance in the psoriatic group, which is corrected employing a multivariate analysis with an adjusted model for confounding factors. CONCLUSIONS: Bone mineral density levels in psoriatic patients are situated halfway between healthy controls and patients with osteopenia/osteoporosis. In addition, the higher body mass index in patients with psoriasis appears to confer a protective effect against further development of lower bone mineral density.

Management of severe strongyloidiasis attended at reference centers in Spain.

INTRODUCTION: Strongyloides stercoralis is a globally distributed nematode that causes diverse clinical symptoms in humans. Spain, once considered an endemic country, has experienced a recent increase in imported cases. The introduction of serology helps diagnosis and is currently replacing microbiological techniques in some settings, but its sensitivity is variable and can be low in immunocompromised patients. Diagnosis can only be confirmed by identification of larvae. Often, this "gold standard" can only be achieved in severe cases, such as disseminated S.stercoralis infection, or S.stercoralis hyperinfection syndrome, where parasite load is high. In addition, these clinical presentations are not well-defined. Our aim is to describe severe cases of S.stercoralis, their epidemiological profile, and their clinical details. METHODS: An observational retrospective study of disseminated S.stercoralis infection, or hyperinfection syndrome. Inclusion criteria: aged over 18, with a diagnosis of disseminated S.stercoralis infection, or hyperinfection syndrome, confirmed by visualization of larvae. Patients were identified through revision of clinical records for the period 2000-2015, in collaboration with eight reference centers throughout Spain. RESULTS: From the period 2000-2015, eighteen cases were identified, 66.7% of which were male, with a median age of 40 (range 21-70). Most of them were foreigners (94.4%), mainly from Latin America (82.3%) or Western Africa (17.6%). Only one autochthonous case was identified, from 2006. Immunosuppressive conditions were present in fourteen (77%) patients, mainly due steroids use and to retroviral coinfections (four HIV, two HTLV). Transplant preceded the clinical presentation in four of them. Other comorbidities were coinfection with HBV, Trypanosoma cruzi, Mycobacterium leprae or Aspergillus spp. All presented with digestive disorders, with 55.6% also presenting malaise. 44.4% of cases had fever, 27.8% skin complaints, and 16.7% respiratory or neurological disorders. One patient presented anemia, and one other nephrotic syndrome. Diagnosis was confirmed by identification of larvae in fresh stool samples (n = 16; 88.9%), concentration techniques (n = 6; 33.3%), larval culture (n = 5; 29.4%), or digestive biopsies (n = 8; 44%). S.stercoralis forms were identified during necropsy in one case. In addition, ten (55%) had a positive serology. All the cases were treated with ivermectin, six (33%) also received albendazole and one case received thiabendazole followed by ivermectin. All needed inpatient management, involving a mean hospitalization stay of 25 days (range 1-164). Two cases received intensive care and eventually died. CONCLUSIONS: Only eighteen cases of disseminated S.stercoralis infection/hyperinfection syndrome were identified from the 15-year period, most of which were considered to have been imported cases. Among those, immunosuppression was frequent, and mortality due to S.stercoralis was lower than previously described.

Factors associated with the functional capacity of older adults with leprosy.

OBJECTIVE:: to investigate the association between socio-demographic and clinical factors and the functional capacity of older adults with leprosy. METHOD:: cross-sectional analytical study conducted in Fortaleza, Ceará, Brazil, with 77 older adult patients with leprosy in a referral service, through interview, medical records and application of the Katz Index and the Lawton and Brody Scale. RESULTS:: the mean age was 68.23 years, with prevalence of men, in stable union/married, with mean monthly family income of 2.04 minimum wages, positive bacillary index, clinical dimorphic form and grade zero disability. In the Lawton and Brody scale, independence (58.5%) was predominant and associated to the variables "living arrangement" and "educational attainment". Total independence (87.0%) was predominant in the Katz Index and statistically associated to the variable monthly family income. CONCLUSION:: most of the participants were classified as independent in the instruments used. Furthermore, the instruments pointed to a greater number of associations with socio-demographic and clinical factors not related to leprosy. OBJETIVO:: investigar a associação de fatores sociodemográficos e clínicos à capacidade funcional de idosos com hanseníase. MÉTODO:: estudo transversal, analítico realizado em Fortaleza, Ceará, com 77 idosos com hanseníase acompanhados em serviço de referência, através de entrevista, consulta ao prontuário e aplicação do Índice de Katz e Escala de Lawton e Brody. RESULTADOS:: a média de idade foi de 68,23 anos, com prevalência de sexo masculino, união estável/casado, renda familiar mensal média de 2,04 salários mínimos, índice baciloscópico positivo, forma clínica dimorfa e Grau de Incapacidade Física zero. Na escala de Lawton e Brody prevaleceu a independência (58,5%) com associação às variáveis "com quem reside" e "escolaridade". Destacou-se a independência total (87,0%) no índice de Katz, associando-se estatisticamente a variável renda familiar mensal. CONCLUSÃO:: a maioria dos participantes mostrou-se independente nos instrumentos utilizados. Ademais, os instrumentos apontaram mais associações a fatores sociodemográficos e clínicos não relacionados com a hanseníase.

Factors associated with the functional capacity of older adults with leprosy / Factores asociados a la capacidad funcional de las personas mayores con lepra / Fatores associados à capacidade funcional de idosos com hanseníase

ABSTRACT Objective: to investigate the association between socio-demographic and clinical factors and the functional capacity of older adults with leprosy. Method: cross-sectional analytical study conducted in Fortaleza, Ceará, Brazil, with 77 older adult patients with leprosy in a referral service, through interview, medical records and application of the Katz Index and the Lawton and Brody Scale. Results: the mean age was 68.23 years, with prevalence of men, in stable union/married, with mean monthly family income of 2.04 minimum wages, positive bacillary index, clinical dimorphic form and grade zero disability. In the Lawton and Brody scale, independence (58.5%) was predominant and associated to the variables "living arrangement" and "educational attainment". Total independence (87.0%) was predominant in the Katz Index and statistically associated to the variable monthly family income. Conclusion: most of the participants were classified as independent in the instruments used. Furthermore, the instruments pointed to a greater number of associations with socio-demographic and clinical factors not related to leprosy.

RESUMEN Objetivo: investigar la asociación de factores sociodemográficos y clínicos a la capacidad funcional de los ancianos con lepra. Método: estudio transversal, analítico, realizado en Fortaleza, Ceará, realizado entre 77 ancianos con lepra mediante entrevista, acompañados en servicio de referencia, consulta al prontuario y aplicación del Índice de Katz y de la Escala de Lawton y Brody. Resultados: la edad promedio era de 68,23 años, con prevalencia del sexo masculino, unión estable/casado, renda familiar mensual promedio de 2,04 salarios mínimos, índice bacteriológico positivo, forma clínica dimorfa y grado de incapacidad física cero. En la escala de Lawton y Brody prevaleció la independencia (58,5%) asociada a las variables "con quien reside" y "escolaridad". Se destacó la independencia total (87,0%) en el índice de Katz, asociándolo estadísticamente a la variable "ingreso mensual del hogar". Conclusión: la mayoría de los participantes demostró independencia de acuerdo con los instrumentos utilizados. Además, las escalas señalaron un número mayor de asociaciones a factores sociodemográficos y clínicos no relacionados con la lepra.

RESUMO Objetivo: investigar a associação de fatores sociodemográficos e clínicos à capacidade funcional de idosos com hanseníase. Método: estudo transversal, analítico realizado em Fortaleza, Ceará, com 77 idosos com hanseníase acompanhados em serviço de referência, através de entrevista, consulta ao prontuário e aplicação do Índice de Katz e Escala de Lawton e Brody. Resultados: a média de idade foi de 68,23 anos, com prevalência de sexo masculino, união estável/casado, renda familiar mensal média de 2,04 salários mínimos, índice baciloscópico positivo, forma clínica dimorfa e Grau de Incapacidade Física zero. Na escala de Lawton e Brody prevaleceu a independência (58,5%) com associação às variáveis "com quem reside" e "escolaridade". Destacou-se a independência total (87,0%) no índice de Katz, associando-se estatisticamente a variável renda familiar mensal. Conclusão: a maioria dos participantes mostrou-se independente nos instrumentos utilizados. Ademais, os instrumentos apontaram mais associações a fatores sociodemográficos e clínicos não relacionados com a hanseníase.

Erectile Dysfunction in Male Adults With Atopic Dermatitis and Psoriasis.

INTRODUCTION: Patients with psoriasis have increased risk of cardiovascular disease, but data on atopic dermatitis (AD) are less clear-cut. However, it is well-established that erectile dysfunction (ED) can serve as a risk marker for coronary disease. AIM: To investigate the incidence, prevalence, and risk of ED in men with psoriasis and AD. METHODS: The sample included all Danish men at least 30 years old. In patients with AD and psoriasis, we determined disease severity based on use of systemic therapy. We performed a cross-sectional study (January 1, 2008) using logistic regression to estimate the prevalence and odds ratio of ED. Moreover, in a cohort study design, patients were followed from January 1, 2008 through December 31, 2012, and Cox regression models were used to estimate adjusted hazard ratios of new-onset ED. Models were adjusted for potential confounding factors, including age, socioeconomic status, health care consumption, smoking, alcohol abuse, diabetes, and cholesterol-lowering drug use. MAIN OUTCOME MEASURES: The outcome was initiation of pharmacotherapy used for treatment of ED. RESULTS: The sample consisted of 1,756,679 Danish men (age range = 30-100 years), of which 2,373 and 26,536 had adult AD (mild = 1,072; severe = 1,301) and psoriasis (mild = 21,775; severe = 4,761), respectively. Mean ages (SDs) were 53.0 (14.6), 46.7 (12.0), and 56.3 (13.8) years for the general population, patients with AD, and patients with psoriasis, respectively. Prevalences of ED were 8.7%, 6.7%, and 12.8% for the general population, patients with AD, and patients with psoriasis, respectively. Adjusted odds ratios (logistic regression) of ED were decreased in patients with AD (0.68; 0.57-0.80) but increased in those with psoriasis (1.15; 1.11-1.20). Adjusted odds ratios for mild and severe AD were 0.63 (0.48-0.82) and 0.72 (0.58-0.88), respectively, and those for psoriasis these were 1.16 (1.11-1.21) and 1.13 (1.03-1.23). Adjusted hazard ratios (Cox regression) were 0.92 (0.76-1.11) for AD and 1.14 (1.08-1.20) for psoriasis. The ED risk was not increased in men with mild AD (0.85; 0.63-1.14) or severe AD (0.97; 0.76-1.24) but was significantly increased in men with mild psoriasis (1.13; 1.09-1.20) and severe psoriasis (1.17; 1.04-1.32). CONCLUSION: We found an increased prevalence and risk of ED in men with psoriasis, whereas the risk was comparable to (and even slightly lower than) the general population for men with AD. Egeberg A, Hansen PR, Gislason GH, et al. Erectile Dysfunction in Male Adults With Atopic Dermatitis and Psoriasis. J Sex Med 2017;14:380-386.

The body mechanical: Building a caring community, crafting a functioning body.

When Hansen's disease became treatable in Taiwan in the mid-20th century, a group of Hansen's disease patients lost their sick role despite still having lingering symptoms that continued to evolve. While sociologists have explored in-depth situations in which the social role of the sick is ambiguous, few studies have investigated body experiences under liminality that requires sick people to find a new sick role. Living with lingering symptoms in a post-Hansen's disease world, the Hansen's disease patients I have studied face the conundrum of having to find an alternative sick role. Ethnographic fieldwork demonstrates how patients develop a specific set of body techniques that shape and are shaped by their membership in a patient community. Exploring the reinforcing projects of re-embodiment and sociality around Hansen's disease, I argue that patients are able both to legitimate each other's feelings of sickness and to use those feelings to manage their illness and, as such, to collectively acquire an alternative sick role. Adding to existing discussions of active patients, this article identifies the body mechanical as a way of practicing active patienthood organized around fixing, trials, mending and functionality.

Vitiligo on black skin: epidemiological and clinical aspects in dermatology, Cotonou (Benin).

BACKGROUND: Vitiligo is unsightly on darkly pigmented skin and leads important stigmatization because of the mix-up with leprosy. PATIENTS AND METHODS: We analyzed retrospectively the epidemiological and clinical patterns of vitiligo on darkly pigmented skin between 1988 and 2008 in the Department of Dermatology in Cotonou (Benin). The diagnosis was made based on the clinical characteristics of vitiligo. RESULTS: Two hundred and forty-six patients were seen, representing 0.9% of new consultations. The gender ratio was 1 : 1, and the mean age of patients was 25.9 years. The mean duration of the lesions was 30.9 months. Among the 246 patients, an associated pathology was found in 26% of cases. These included atopy (23.2%), diabetes (1.6%), thyroid disease (0.8%), and alopecia (0.4%). A family history of vitiligo was present in 1.2% of cases. The sites of the lesions were in descending order of frequency: head (60.6%), lower limbs (40.2%), upper limbs (33.3%), trunk (22.4%), genitals (13.0%), and neck (8.9%). On the head, the most common sites affected were the lips (65.1%), cheek (20.8%), and ears (16.8%). According to the different clinical forms, vitiligo was achromic (76%), speckled (12.6%), and trichromic (11.4%). Vitiligo vulgaris was the commonest form of the disease (52.4%), followed by localized vitiligo (36.2%), segmental vitiligo (9.8%), and vitiligo universalis (1.6%). Triggering factors were identified in 4.5% of patients. CONCLUSION: Our survey shows that the patterns of vitiligo are similar to that reported from other African countries with a few distinguishing particularities.

Towards a toolkit for cross-neglected tropical disease morbidity and disability assessment.

BACKGROUND: Neglected tropical diseases (NTDs) are a group of often chronic and disabling infectious conditions, closely related to poverty and inequities. While it is estimated that millions of people are affected, accurate and internationally comparable data about NTD-related morbidity and disability are lacking. Therefore we aimed to develop and pilot a toolkit to assess and monitor morbidity and disability across NTDs. METHODS: A cross-sectional, non-random survey design with a mixed methods approach was used. We conducted a literature review on existing tools to assess and monitor disability, followed by a Delphi study with NTD experts to compile a prototype toolkit. A first-phase validation study was conducted in Northeast Brazil among people with Chagas disease, leishmaniasis, leprosy and schistosomiasis. RESULTS: Instruments included were the clinical profile, WHODAS, P-scale, SRQ, WHOQOL-BREF and WHOQOL-DIS. Most questions in the various instruments were readily understood with the exception of the WHOQOL-BREF, where additional explanations and examples were often needed. The respondents were very appreciative of the instruments and found it valuable to have the opportunity to talk about these aspects of their condition. CONCLUSIONS: Our findings support the acceptability and relevance of five of the six instruments tested and the concept of a cross-NTD toolkit.

Leprosy and lymphatic filariasis comorbidity: the case for an integrated functional limitation grading system.

Worldwide, both lymphatic filariasis (LF) and leprosy are major causes of morbidity and functional limitation. Despite an abundance of data on the impairment caused by these infections in isolation, there is little data on disability in patients unfortunate enough to be affected by both infections. We present two cases of patients with LF and leprosy comorbidity. Both cases suffer from Grade 2 disability and chronic lymphedema in the same limb (left and right leg, respectively). These morbidities cause significant functional limitation in the patients' activities of daily living. Both LF and leprosy are endemic in India and their comorbid conditions contribute to functional limitation. However, there is still currently no integrated scale for assessment of interventions for functional limitation in these patients. Investigating and managing impairment and functional limitations individually is the least cost effective and sustainable strategy. Considering the similarities of caring for functional limitations in both diseases and assuming its efficacy, augmentation of LF care services with leprosy referral centres may be beneficial. Integrated approaches have been pilot tested at district level in states in India under the title 'Integrated Prevention of Deformity project' (IPoD). Further work is required to identify a reliable, holistic, functional impairment scoring system, which allows for comparison between diseases. This may help promote greater understanding of impairments and functional limitations these cause and allow effective monitoring and evaluation of all aspects, activities and stages of similar programmes.

Mental disorders in leprosy: an underdiagnosed and untreated population.

OBJECTIVE: To describe the frequency of psychiatric comorbidities in leprosy patients and check if they had been previously diagnosed and were in psychiatric care. METHOD: The study was conducted with a sample of 120 leprosy patients being treated at two reference hospitals for leprosy in Salvador, Bahia, Brazil. Survey participants were more than 18 years of age, had a confirmed diagnosis of leprosy and was undergoing antimicrobial treatment. Patients were evaluated face-to-face with a socio-demographic questionnaire and the Mini-International Neuropsychiatric Interview (MINI-Plus) in Portuguese. The period of data collection was between October 2009 and June 2012. RESULTS: The assessment using the MINI-Plus showed that 34 (28.3%) patients did not receive any psychiatric diagnosis and 86 (71.7%) met the criteria for at least one. Of these 86 patients, 25 (20.8%) had one diagnosis, 26 (21.7%) had two diagnoses and the rest, 35 (29.2%), had three or more psychiatric diagnoses. All patients with a moderate or high risk of suicide had one or more psychiatric comorbidities. CONCLUSION: Leprosy patients have a high prevalence of psychiatric comorbidities. Furthermore, most of them had no previous psychiatric diagnosis and the majority was not undergoing treatment.

Comorbidities in psoriasis.

Moderate to severe psoriasis is associated with concomitant diseases that may have a significant impact on patients. It is necessary for the treating physician to recognize these concomitant diseases, known as comorbidities, early as they influence the management options. Important comorbidities are psoriatic arthritis, metabolic syndrome, Crohn's disease, depression, and cancer. Patients with severe psoriasis may be at an increased risk for myocardial infarction and this subgroup of patients tends to have a reduced life expectancy. The presence of co-morbid diseases is associated with an increase in concomitant medication, some of which may worsen psoriasis; conversely, systemic treatment of psoriasis with certain drugs may impact the co-morbid conditions. As dermatologists are the primary health-care providers for psoriasis, adequate knowledge of comorbidities helps in choosing the appropriate therapy as well as timely intervention.