Efficacy of Topical Insulin Therapy for Chronic Trophic Ulcers in Patients with Leprosy: A Randomized Interventional Pilot Study.

BACKGROUND: Chronic trophic ulcers (CTUs), especially those located over the plantar region, are a leading cause of deformity and disability in patients with leprosy. Despite the various treatment modalities available, CTUs can be chronic and refractory to treatment. The successful use of topical insulin in various types of wounds led researchers to evaluate its safety and efficacy in the treatment of plantar CTUs. METHODS: Forty-two patients who had completed a multidrug treatment for leprosy were recruited and randomized into two groups. In the test group, 23 patients received 10 units (0.1 mL) of topical insulin (Actrapid) in 1 mL of normal saline twice daily over treated areas. The placebo group (n = 19) received topical normal saline only. The primary end point was the proportion of patients with complete wound closure by 12 weeks. Secondary end points included time to healing, wound area reduction, Physician Global Assessment of Efficacy scores, and Dermatology Life Quality Index scores at the end of 12 weeks. RESULTS: The majority of CTUs (80%) were situated over the forefoot; the metatarsal head of the hallux was the most common site (86%). Wound healing was faster (0.61 ± 0.31 vs 0.14 ± 0.42 cm per week, P < .0001), and the number of days to complete healing was significantly shorter in the test group compared with the placebo group (31.5 ± 17.6 vs 44.3 ± 16.2 days, P = .02). The only observed adverse effect in the test group was white granular deposits over the CTU (n = 10). CONCLUSIONS: Topical insulin therapy may be a safe, efficacious, cheap, and easily available treatment option in CTUs among patients with leprosy.

Mirror therapy for improving motor functions in patients with leprosy with grade 2 disabilities.

BACKGROUND: Mirror therapy has been used to treat phantom limb pain and to improve motor function after stroke. We evaluated the efficacy of mirror therapy in patients with leprosy with paresis. METHODS: Twenty-four patients with leprosy who presented with unilateral grade 2 disabilities were recruited from July 2016 to November 2016 and randomly assigned. Group A, the mirror group, participated in the mirror therapy, and group B, the control group, were treated with a sham therapy. After the interventions, the paretic muscle/limb function, hand coordination abilities, walking, and abilities to perform activities of daily living were reevaluated with the voluntary muscle testing (VMT) at weeks 3, 6, and 12. RESULTS: In group A, there was an increase in the VMT score from baseline with a median of 2 (interquartile range 0-6) to 3 (2-5) at 3 weeks after initiation of VMT with a further increase to 5 (4-7) at 6 weeks and to 5 (4-8) at 12 weeks, which remained elevated at a median of 6 (5-8) even after 4 weeks after intervention. By contrast, the control group showed the following trend in response to the sham therapy: 2 (1-3) at baseline, 2 (2-4) at 3 weeks after intervention, 3 (3-6) at 6 weeks, 4.25 (3-5) at 12 weeks, and 4 (4-7) at 16 weeks. In group A, VMT scores increased from baseline by 26.9% (p < 0.001), 18.02% (p < 0.001), and 15.46% (p < 0.001) at 3, 6, and 12 weeks, respectively, compared with group B in which VMT scores increased from baseline by 17.13% (p < 0.001), 11.02% (p < 0.001), and 3.93% (p > 0.05) at 3, 6, and 12 weeks, respectively. The muscle strength in mirror group participants improved markedly compared with the control group (post hoc Bonferroni p = 0.027). CONCLUSION: Mirror therapy is a safe and cost-effective approach in the treatment of paretic limbs of patients with leprosy. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that mirror therapy improves muscle strength in patients with leprosy associated with paresis.

Sparfloxacin-induced photo-onycholysis and photosensitivity characteristically sparing lepromatous skin lesions: an interesting observation.

Sparfloxacin is an antibiotic in the quinolone group of antibacterial agents, which often induce photosensitive skin reactions, more often phototoxic reactions than photoallergic ones, and sometimes associated photo-onycholysis. We present a case of phototoxic dermatitis with photo-onycholysis in a 38-year-old man probably induced by sparfloxacin, which was prescribed to him along with rifampicin and clofazimine because he was suffering from borderline lepromatous leprosy. He developed exaggerated sunburn-like eruptions mainly on sun-exposed sites along with painful onycholysis of the fingernails. Interestingly, the hypopigmented patches of leprosy were spared, which is a very rare phenomenon. Withdrawal of sparfloxacin along with administration of systemic steroids and other supportive measures helped heal the skin eruptions with hyperpigmentation, but the photo-onycholysis was slow to resolve.

Tuberculoid leprosy masquerading as systemic lupus erythematosus: an interesting observation.

Leprosy is a chronic granulomatous infectious multisystem disease that may present with protean manifestations. It mimics many systemic and dermatological disorders. Here we report a case in which an elderly female presented with malar rash, intermittent fever, and arthralgia. Her diagnosis was significantly delayed due to a close clinical resemblance to systemic lupus erythematosus. It is important to be aware of such manifestations of leprosy and improve awareness of it in clinicians to avoid misdiagnosis and delay in treatment.