Histopathological Diagnosis of Leprosy Type 1 Reaction with Emphasis on Interobserver Variation.

Upgrading typel lepra reaction or reversal reaction (RR) is an acute inflammatory complication of leprosy and a disparity exists between clinicians and pathologists for diagnosing a RR. Inter-observer variations among pathologists also compound this problem as no universally agreed diagnostic criteria exist. 120 biopsies and H&E stained slides were assessed by 3 pathologists. The pathologists were blinded to the clinical diagnosis and to each other's observations. Each pathologist assigned a likelihood of reaction by their histopathological observations as definitely reaction, probable reaction and no reaction. Clinicopathological correlation and interobserver agreement was analyzed statistically. Discordance between clinical and histopathological diagnosis was seen in 30.8% by pathologist 1 (P1), 23.7% by pathologist 2 (P2) and 34.5% bythe pathologist 3 (P3). Dermal edema, intragranuloma edema and epidermal erosion were consistent findings by all observers. Definite reaction was seen in 54.2% of cases by P1, 53.3% by P2 and 34.5% by P3. Kappa statistics for strength of agreement showed good agreement between 3 pathologists with P1 (κ = 0.83), P2 (κ = 0.61), P3 (κ = 0.62). RR are underdiagnosed on histopathological examination but this study shows that dermal edema, edema within the granuloma and partial obliteration of grenz zone by granuloma are reliable clues to diagnose a RR on histopathology.

Multiple keratoacanthomas of hands simulating discoid lupus erythematosus.

A 38-year-old woman presented with multiple, well-defined, erythematous, scaly, slightly pain-ful nodules progressing to plaques on the palms, dorsa of fingers of both hands since 6 years. Healed lesions had well-defined hyperpigmented margins with slight central atrophy. Clinical diagnosis of dis-coid lupus erythematosus was made, but histopatholgoy confirmed the diagnosis of keratoacanthomas.

Nail changes after carbamazepine.

Antiepileptics are known to produce different types of side effects including nail changes. A 20-year-old epileptic man had yellowish discolouration followed by dystrophy and onycholysis of his 15 nails after taking carbamazepine for 3 months which cleared within six months after discontinuation of the drug. This type of change has not been reported earlier with carbamazepine.

Hyperkeratotic oral lichen planus role of vitamin A.

Chronic tobacco chewing and smoking have been implicated as precipitating factors for the development of oral lichen planus (OLP). We here report a case of chronic cigarette smoker who developed OLP plaque, without any other clinical pattern of OLP and skin involvement, which did not respond to conventional corticosteroid treatment and dapsone, but responded when vitamin A was added.

Leprosy among circus workers.

Seven (2.31%) circus workers of two circus companies visiting Amritsar were detected to be suffering from leprosy. Whether or not they acquired the disease during their stay in circus is not so important, but it is necessary to detect and treat these itinerant persons. Our experience clearly underlines the necessity for undertaking surveys of various workers living in crowded conditions (like circus), because of their occupation.

Myco. leprae infection in normal, thymectomised irradiated and thymus transplanted mice.

Normal mice and thymectomised, X-irradiated and thymic transplanted groups of mice were challenged with 10(3) Myco. leprae in the foot pad. Course of infection was studied for a period of seven months by sacrificing animals every month and counting the bacilli from the pooled tissues. In the thymectomised irradiated group the counts showed a plateau from 5th month onwards, whereas in control and thymus implant group the counts rose in 6th and 7th months.

BCG induced immunity to Mycobacterium leprae in mice.

One to three BCG vaccinations were given to various groups of mice--25 to 2 days preceding challenge with Myco. leprae. Harvesting of Myco. leprae was done every month upto a period of 7 months. Lymph node enlargement was taken as an indicator of successful vaccination. An increasing degree of protection was noted in BCG immunised mice as observed by a reduced number of bacilli harvested. Protection afforded was proportional to the number of doses of BCG given.

Photochemotherapy For Psoria-sis.

Results of treatment of 50 psoriatic patients with psoralen and ultraviolet radiation are reported. A detailed analysis of the data is also given. None of the patients was resistant to treatment. Complete clearing of all lesions occurred in 22% of the patients in 16 days, in 96% of the patients in 40 days and in 100% of the patients in 45 days. It is concluded that photo chemotherapy with psoralen and ultraviolet radiation from conventional uv radiation therapy lamps is a safe and effective treatment for patients with psoriasis in this country.