Thalidomide and steroid in the management of erythema nodosum leprosum.

OBJECTIVE: The objective of the study was to assess the efficacy and safety profiles of combined treatment of prednisolone with thalidomide (Gr-A) and prednisolone with clofazimine (Gr. B) in patients with erythema nodosum leprosum (ENL) or type 2 lepra reactions. MATERIALS AND METHODS: Efficacy of both regimens was assessed on the basis of clinical recovery of recurrent ENL measured by reaction severity score (RSS), Visual Analog Scale (VAS), and recurrence of type 2 lepra reaction. The causality assessment of adverse drug reactions was done using the WHO UMC causality assessment scale. RESULTS: The average age of patients with recurrent ENL was 42.8 years (male) and 51.8yrs (female) and had mean duration of leprosy and recurrent ENL 2.4 years and 2.09 years, respectively. 80% of nonrecurrence was observed in Gr-A versus 66% in Gr-B. Significant (P < 0.05) lower RSS and VAS was found in both the treatment groups as compared to pretreatment value. The reduction in RSS and VAS was statistically significant (P < 0.05) in Gr-A compared to Gr-B treatment. CONCLUSION: Thalidomide combination with steroid was found to be more efficacious than clofazimine combination with steroid in the treatment of ENL both the treatment regimens showed few tolerable side effects. Improved strategies for the treatment and management of these reactions need to be developed.

Clinicoepidemiological profile of 590 cases of beetle dermatitis in western Orissa.

BACKGROUND: Beetle dermatitis is a very common condition in western Orissa. It is often misdiagnosed and causes significant morbidity among the rural population. AIM: This study was conducted to determine the epidemiological and clinical profile of beetle dermatitis in western Orissa. METHODS: All clinically diagnosed cases of beetle dermatitis were included in the study. Detailed history was taken and thorough clinical examination was conducted in all the cases. One urban and three rural localities were visited regularly to detect the epidemiological trends of the disorder. RESULTS: A total of 590 cases were studied: 486 males and 104 females. The age of the patients ranged from 2 to 65 years. Forty-four percent of the patients belonged to the pediatric age group. Majority of the cases (85%) presented during the months of March to July, indicating a distinct seasonal trend. The disorder was prevalent in the localities nearer to paddy and sugarcane fields and grasslands with stagnant water. The clinical lesions included papules, erosions, crusted lesions, urticarial plaques and vesiculobullous lesions. Distribution was mainly linear, but kissing lesions were also observed. Head, neck and upper extremities were the most commonly involved sites. Lymphadenopathy and systemic features such as fever and malaise were observed in 24% and 15% of the cases, respectively. CONCLUSION: Beetle dermatitis should be included in the differential diagnosis of the acute onset of vesiculobullous lesions in the endemic areas.

Fnac study of histoid nodule: an early tool for diagnosis.

Histoid lesion, a variety of lepromatous leprosy, is due to alteration in the growth pattern of Mycobacterium leprae, possibly due to loss of immunity in localized areas. The distinction is based on cellular morphology by demonstrating pallisading arrangement of multi-layered spindle-shaped histocytes. Cytodiagnosis by fine needle aspiration cytology is therefore an early tool to recognize the histoid variety, differentiating it from a conventional LL module, as it is a simple and less traumatic procedure.

Prevalence of leprosy among household contacts of leprosy cases in western Orissa.

The prevalence rate of leprosy among household contacts is an important epidemiological indicator in the character and trend of the disease. During the period January 2001 to December 2002, families of 400 primary cases were studied to detect contact (secondary) cases. Seventy-two cases were detected from 54 families; of these 72 cases, 45 (62.5%) were in the paediatric age-group (0-14 years) and of these 45.8% belonged to 6-14 years group. Out of the 72 cases, there were more (58) of paucibacillary (PNL+I+TT+BT) cases. Secondary cases were significantly high when there was lepromatous type of leprosy in the family. The attack rate among those exposed to paucibacillary type (TT, BT) of leprosy, though much less, was still observed. The influence of duration of contact revealed that a maximum number of cases (N=43, 59.7%) acquired the disease during 0-6 years of contact. A majority of the patients belonged to low-income groups, were illiterate and lived in extended families. The father was the source case for most of the secondary cases (N=41, 57%). Conjugal leprosy was very rare. The results of the study points to the fact that PB leprosy is still a potential source of infection and cannot be ignored. It is important to evolve a hospital-based surveillance programme for contacts of leprosy patients since early detection and treatment of contacts are important measures for reducing the reservoir of infection in the community.

Silent neuropathy in leprosy.

Twelve patients of silent neuropathy attending the OPD of Skin and VD, VSS Medical College Hospital during 1996-1998 were taken for study. On clinical analysis 5 cases were present as silent neuropathy, 4 cases during MDT and 3 cases after completion of MDT Seventy percent of cases showed good response to systemic steroid.

Lupus vulgaris on keloid.

A 28-year-old man presented with multicentric lupus vulgaris on keloids over chest, axilla, neck and back for last 6 months. He had pulmonary tuberculosis. All the laboratory investigations were in favour of clinical diagnosis. The patient responded to antituberculosis therapy.

Itraconazole pulse therapy in onychomycosis.

A prospective study of 30 clinically and mycologically diagnosed cases of onychomycosis was carried out for a period of twelve months from May 1996 to April 1997. Itraconazole pulse therapy was given for the 1st week followed by 3 week drug-free period, for 1st 3 months for the finger nail cases and 4 monthes for finger nail + toe nail and toe nail cases. Patients were evaluated at baseline, week 4, week 12, week 16, week 24, up to 12 months and assessed as cleared or markedly improved with clinical and mycological success. The result of our study is very much encouraging. It suggests that the use of itraconazole pulse therapy will maintain the continuous treatment efficacy and is cost effective than continuous therapy.

Clinico-mycological profile of superficial mycoses.

Clinico-mycological study of 2743 clinically diagnosed cases of superficial mycoses attending skin and VD OPD of VSS Medical College during the year 1995 - 96 was conducted. Male predominance was observed. Highest incidence of tinea versicolor was found. T. rubrum was the commonest fungus isolated.

Pentoxifylline in reactions in leprosy.

A study was conducted to assess the response of reactions in leprosy to pentoxifylline therapy. Ten cases were studied; 8 cases had type 2 reaction and 2 cases had type 1 reaction. Pentoxifylline was given orally 400 mg three times daily. In patients with type 2 reaction, good response was observed within one week. There was near complete regression of ENL lesions within one month. Cases with type 1 reaction did not respond to pentoxifylline.

Vulval lichen planus leading to urethral stenosis.

An 8-year-old female child presented with difficulty in micturition preceded by some vulval lesions. She had itching around vulva associated with burning sensation and gradually developed a whitish patch. Histology was compatible with lichen planus.

Metronidazole in management of trophic ulcers in leprosy.

Efficacy of metronidazole was assessed in 20 leprosy cases with trophic ulcers with poor response to oral and topical antibiotic. Oral metronidazole 400 mg three times daily for one week and topical metronidazole gel 1% for three weeks were found to be very effective.

Hereditary onycho-osteo dysplasia syndrome.

We report a two and a half year old male child with dystrophy of all the nails, absent patellae and iliac horns. In addition he had dysmorphic facial features, sparing of lunula and bilateral hallux valgus deformity, hitherto not reported earlier.

Male gonads in leprosy--a clinico-pathological study.

Sixty male leprosy patients (mean age 27.2 +/- 5.04 years) selected at random, were studied for gonadal involvement with the mean duration of illness 4.17 +/- 3.27 years. Only lerpomatous and borderline leprosy cases developed testicular and epididymal changes. Testicular pain and/or swelling (lepromatous 62.5%, borderline 30%) was the main presenting feature. Altered sexual function was observed in 34(56.6%) cases, and 11 patients revealed altered sexual hair pattern. Gynecomastia was seen in 9 cases. Reduced testicular size along with its soft feeling was present in 25% of cases while no testicular sensation was felt in 8 (13.3%) cases, and impaired testicular sensation in 9 (15%) of them. Spermogram revealed azoospermia in 19 (35%) and oligospermia in 16 (26.6%) cases. Histo-pathology revealed evidences of leprous pathology irrespective of testicular size, semen picture and clinical manifestations. There was marked variation in histopathological findings in testes and hence it was difficult to categorise them into vascular, interstitial and obliterative phase.

Discoid Lupus Erythematosus Resembling Lupus Vulgaris.

A case of discoid lupus erythematosus (DLE) in a 20 year old female patient is presented. The, case clinically resembled lupus causing bilateral ectropion and exposure keratitis in both eyes.

Studies on the Antifungal Activity of Pterocarpus Marsupium: a Clinical Evaluation.

Pmarsupium (Hindi Bijasar) is a powerful astringent and is used chiefly in diarrhoeas. It is also an useful remedy for diabetes mellitus and various skin diseases as mentioned in literature. In a blind clinical trial, the usefulness of this drug as a topical agent against T.cruris and T. corporis was elevated. The drug yielded good response within 3 days of the first application.