Elephantiasis, elastin, and chronic wound healing: 19th century and contemporary viewpoints relevant to hypotheses concerning lymphedema, leprosy, erysipelas, and psoriasis--review and reflections.

Both wound healing and lymphedema have fibrosis of the skin in common. They also share destruction of elastin by elastases from neutrophils as a significant feature. These are not new observations, and the writings of Unna and Kaposi are recalled. The contemporary observations on elastin by Gerli and his team are discussed in the light of these much earlier opinions.

A public health approach for leprosy detection based on a very short term-training of primary health care workers in basic dermatology.

INTRODUCTION: In countries where leprosy control is integrated to general heath services, health workers, at primary health care level, often manage a large number of patients with skin diseases including leprosy. The distinction of leprosy from others skin diseases requires more skill and attention. Basic dermatological knowledge will help these staff to provide a better quality of care. A few years ago, a short term training programme focussed on leprosy and some common skin diseases was set up in Mali through a pilot project. This study will evaluate the impact of this training on the detection of leprosy at primary health care level. METHODS: health care workers from two health districts were invited to participate in the training. Trainee was submitted to an anonymous written test before training, immediately after and 12-18 months post-training using a standardized scoring system. The suspected or referred leprosy cases before and after training were compared. Data were recorded and analysed with the software Epi info version 6.04. RESULTS: Overall, 495 HCW attended the three anonymous written tests (before training, just after and 12-18 months later). The proportion of participants who gave correct answers before training, just after were respectively: 33 and 57% for correct diagnosis, 5 and 39% for test of sensation and 28 and 47% for referral. Eight patients suspected of leprosy were referred for further examination; in these, five cases of leprosy were detected. DISCUSSION: The training showed a huge improvement in the skill of the participants in managing leprosy patients. This study addresses how leprosy control can be improved by involving primary health care staff and by the implementation of only a single day's training on basic dermatology. CONCLUSION: The role of the dermatologist in this post-elimination era of leprosy needs to be reconsidered and adapted to the increasing need to take multiple programmes, inclusive of dermatology and leprosy, into primary health care services and those interested in leprosy control should fund these programmes.

Lymphatics in leprosy: relationship to elastic fibres and observations following intra-lesional injections of colloidal carbon.

An investigation of skin lymphatics in leprosy has been undertaken. Examination of 62 skin biopsies from 31 patients with various classifications of leprosy has revealed dilated initial lymphatics within granulomas of lepromatous leprosy, but no significant abnormalities in non-lepromatous disease or in non-granulomatous skin. Colloidal carbon injected intra-lesionally failed to appear within granulomas, but could be seen in lymphatics in non-granulomatous dermis. Elastic fibres were also absent within granulomas. AFB were clearly identified within endothelial cells of initial lymphatics. We suggest lymphatic malfunction may be compartmental, existing only within the granulomas and not in the surrounding normal appearing dermis.

United Nations and nongovernmental organizations. Healthy skin for all.

The International League of Dermatologic Societies, the International Foundation for Dermatology, and the International Society of Dermatology: Tropical, Ecological, and Geographic, are the leading nongovernmental dermatology organizations that communicate with United Nations agencies such as the World Health Organization and UNESCO. The common goal of health for all must include healthy skin for all, and it therefore must include concepts such as primary health care, disability, wound healing, and advancement of women as well as the control and elimination of specific diseases such as leprosy.

Post-kala-azar dermal leishmaniasis.

Ten patients with post-kala-azar dermal leishmaniasis (2 females, 8 males-aged 17-47 years) are described. Two of them had macular lesions in which very few Leishman-Donovan bodies were seen and who responded well to treatment with stibophen. Five patients had both macular and nodular lesions, Leishman-Donovan bodies being present in nodules but not in macules. Treatment with stibophen caused partial regression of nodules. Nodular lesions were found in three patients, who did not have macules. They contained numerous Leishman-Donovan bodies and treatment produced only temporary improvement. The variable response to treatment with stibophen may have been due to differences in parasitic load. The difficulty in distinguishing this disease from leprosy is discussed.