What is New in the Pathogenesis and Management of Erythema Nodosum Leprosum.

Erythema nodosum leprosum (ENL) is a manifestation of type II lepra reaction, seen in lepromatous or borderline lepromatous leprosy. Although it is a common reaction encountered in clinical practice, there are an increasingly large number of newer updates in the pathophysiology and management of this condition. The treatment options have expanded far beyond just thalidomide and steroids and now extends to TNF-α inhibitors, thalidomide analogs, tenidap, cyclosporine A, plasma exchange, and even IVIG amongst others. These updates and the current knowledge of ENL are summarized in this review.

Diffuse cutaneous leishmaniasis in coexistence with leprosy.

Cutaneous leishmaniasis and leprosy are diseases both caused by intracellular pathogens that represent a major health predicament even today. Both these diseases have some characteristics in common, such as the involvement of mucocutaneous tissue, a course with a chronic granulomatous response, a broad clinical spectrum in relation to the host's immunity, and they often affect the poor population in tropical countries. Co-infection of the two diseases, although known to occur, is rarely encountered and reported. Even though new cases of leprosy are diagnosed in the region of coastal Karnataka of India, cutaneous leishmaniasis is rarely reported. We hereby describe a patient who presented with concurrent leprosy and diffuse cutaneous leishmaniasis.

Granulomatous cheilitis with granulomatous vulvitis: a rare association.

Granulomatous cheilitis and granulomatous vulvitis are rare disorders characterized by painless swelling of lips and vulva, respectively. Histopathology of both conditions show non-caseating epithelioid cell granulomas in the dermis. Both disorders have been associated with Crohn's disease rarely. Occurrence of the two conditions in the same patient is extremely infrequent. We hereby report, the association of granulomatous cheilitis with granulomatous vulvitis in a 30-year-old female.

A Comparative Study of the Efficacy of 4% Hydroquinone vs 0.75% Kojic Acid Cream in the Treatment of Facial Melasma.

BACKGROUND: Melasma is a common acquired cause of facial hyperpigmentation seen predominantly among females with significant psychological and social impact. It is often recalcitrant to treatment. Several topical hypopigmenting agents have been used to combat melasma. Hydroquinone and Kojic Acid are well established monotherapeutic agents for treating melasma. OBJECTIVES: This study focuses mainly on the efficacy of once daily application of 4% Hydroquinone and 0.75% Kojic Acid cream (containing 0.75% Kojic acid and 2.5% vitamin C) so as to determine an effective modality of treatment for facial melasma. MATERIALS AND METHODS: A total number of 60 patients with facial melasma attending the Out-patient department of Dermatology, Venerology and Leprosy, Fr. Muller Medical College Hospital, Mangalore from Oct 2008-April 2010 were studied. Patients were allocated alternately to group A and group B. Group A patients received 4% Hydroquinone cream and group B patient received a Kojic Acid cream (which contained 0.75% Kojic acid and 2.5% vitamin C) and were advised to apply topically once daily at night. Patients were followed up on 4(th), 8(th) and 12(th) week. At each visit side effects were noted and clinical response to treatment was calculated using the MASI score. STATISTICAL METHODS: Chi square test, student 't' test. RESULTS: At the 4(th) week post treatment evaluation, facial hyperpigmentation responded early to 4% Hydroquinone cream than to 0.75% Kojic Acid cream. At the end of 12 week treatment period, 4% Hydroquinone cream had an overall superiority to 0.75% Kojic Acid cream as a topical hypopigmenting agent. CONCLUSION: The results of the study show that 4% Hydroquinone cream is a better topical hypopigmenting agent with rapid rate of clinical improvement when compared to 0.75% Kojic Acid cream.

Management of pyoderma gangrenosum--an update.

Pyoderma gangrenosum is a neutrophilic dermatosis with distinctive clinical manifestations. It is frequently associated with systemic diseases like inflammatory bowel disease, rheumatoid arthritis and myeloproliferative diseases. The etiopathogenesis of pyoderma gangrenosum is still not well understood. Clinically it is classified into ulcerative, pustular, bullous and vegetative types. The diagnosis mainly depends on the recognition of evolving clinical features as there are no specific investigations for the diagnosis. It is essential to exclude other infectious diseases before therapy is initiated as corticosteroids and immunosuppressant therapy are the mainstays in the treatment of this disease. Recently, drugs like tacrolimus, mycophenolate mofetil and infliximab have shown promising results in this condition. Recent concepts regarding the various types of pyoderma gangrenosum and its management are reviewed.

A case report of fatal dapsone-induced agranulocytosis in an Indian mid-borderline leprosy patient.

Fatal agranulocytosis in an Indian male receiving 100mg of dapsone daily, hospitalized for mid-borderline leprosy in type I reaction with triple nerve paralysis is reported. Various case reports concerning dapsone-induced agranulocytosis are reviewed.

Leprosy in type I reaction and diabetes mellitus in a patient with HIV infection

A 24-year-old man was referred to our department with history of a pale red raised lesion over the right side of the face with impaired sensation of 3 months' duration. He also had generalized weakness and increased thirst for the past 1 month. He had been treated with multidrug therapy for leprosy for 3 months and oral prednisolone for 1 month by his general practitioner. He also presented with a history of multiple sexual exposures with commercial sex workers and an ulcer ovver the penis 2 years ago, which healed spontaneously.