Comparative therapeutic evaluation of different topicals and narrow band ultraviolet B therapy combined with systemic methotrexate in the treatment of palmoplantar psoriasis.

BACKGROUND: The incidence of uncomplicated psoriasis is 1-3% in the general population. The involvement of palm and sole is seen in 7-14.5% of cases. There are different topicals and systemic therapies available for treating the case of psoriasis but none is satisfactory for longer duration. AIM: The study involved the comparative therapeutic evaluation of the different topical regimens and narrow band ultraviolet B (NB-UVB) therapy in combination with systemic methotrexate. MATERIALS AND METHODS: The study was held in out-patient department of Skin, VD and Leprosy of B.R.D. Medical College, Gorakhpur, from July 2007 to December 2008. The group included 98 new cases of palmoplantar psoriasis. These cases were divided into eight groups according to the eight regimens involved in the study. The severity of psoriasis was assessed by the ESIF (erythema, scaling, induration and fissuring) score. RESULTS: The study showed that all the regimens had significant response rates. The combination of NB-UVB with systemic methotrexate had maximum response rate (64.85±4.52%) that was statistically significant (paired "t" at 16d.f. = 33.329, P<0.001) with minimum number of recurrences after stopping the treatment. The combination of halobetasol ointment with systemic methotrexate also had significant response rate (paired "t" at 19d.f. = 13.5183, P<0.001) but had maximum number of cases with recurrence (70%) after stopping the treatment. CONCLUSION: These results suggest that the combination of every regimen with systemic methotrexate resulted in an early and a good improvement in the quality of life of patients suffering from psoriasis. It also shows that NB-UVB in combination with systemic methotrexate is more efficacious and has minimum recurrence rate and side effects in the treatment of palmoplantar psoriasis.

Radiological and antroscopic study of maxillary antrum in multibacillary leprosy patients.

Sixty consecutive patients having multibacillary leprosy were examined for symptoms of nasal involvement and sinusitis. A complete ENT examination was carried out of all these patients and they were subjected to radiological examination of paranasal sinuses. Radiological abnormalities of maxillary antrum were found in 15 of 20 cases of lepromatous leprosy, 6 of 26 cases of borderline lepromatous and in 14 cases of mid-borderline leprosy. Localized or generalized mucosal thickening was the most common finding, followed by opacity of maxillary antrum. Radiological abnormalities were confirmed by antroscopy, which is the most appropriate technique for making an accurate diagnosis of maxillary antral diseases. Initially, antral involvement may begin with a localized area of mucol erythema, progressing to a typical granuloma formation and ulceration. The antero-inferior part of the antrum was found to be the most commonly affected region.

Helicobacter pylori and associated histopathological changes in gastric biopsies of patients with leprosy.

Two antral biopsies each from 104 patients of leprosy and 100 controls were studied to find out the prevalence of H. pylori and associated histopathological changes. Sections were stained with hematoxylene and eosin, AB/PAS (Ph 2.5) and Loeffler's methylene blue stains. Infection by H. pylori, inflammation and atrophy were found to be significantly more in leprosy patients as compared to controls (p < 0.01, < 0.005 and < 0.02 respectively). On comparing the histopathological changes in various subgroups of leprosy, H. pylori, inflammation and activity showed a statistically decreasing trend from tuberculoid to lepromatous subgroups (p < 0.05, < 0.001, < 0.01 respectively). Atrophy showed a significant increasing trend from tuberculoid to lepromatous group (< 0.001), it is concluded that despite a low prevalence of H. pylori and associated gastritis in patients with lepromatous leprosy, gastric epithelial damage is more marked due to altered immune response.

Leprosy with HIV infection in Manipur.

A 27 -year -old unmarried male presented with typical clinical features of lepromatous leprosy which was confirmed by slit-skin smear and histopathological examinations. He also had history of intra-venous use of heroin and tested positive for HIV-I antibody by ELISA and Western blot. This is the first case report of co-infection of leprosy and HIV from Manipur.

Autologous miniature skin punch grafting in vitiligo.

Forty-five sites of stable vitiligo in 32 patients refractory to medical treatment were subjected to autologous miniature skin punch grafting. Main instruments used were skin biopsy punches 1-3 mm in diameter. Donor sites selected were either gluteal region or extensor aspect of the thigh which were not affected by the disease in the past. Most of the grafts changed from brown to black and upper scales desquamated within 10-15 days. Uniform perigraft pigmentation was observed by 1-1½ months and 90% area was covered within 3-4 months. The cases were followed up for six months. Fair to excellent results were observed in 87.5% of the cases.

Detection of Mycobacterium leprae antigens in the sera of leprosy patients by sandwich immunoradiometric assay using monoclonal antibodies.

An immunological technique for demonstration of Mycobacterium leprae antigen in sera was developed by using specific as well as cross-reactive monoclonal antibodies. The sandwich immunoradiometric assay which we developed is a simple, robust assay that is sensitive to the nanogram level. Sera from 72 leprosy patients were screened for the presence of antigen by this assay. A total of 69% of untreated tuberculoid leprosy patients showed 35-kDa antigen positivity, and 45% of these patients showed anti-35-kDa antibody positivity. Consistently higher antigen positivity rates for the 35-, 12-, and 30- to 40-kDa components of M. leprae were observed in lepromatous leprosy patients than in tuberculoid leprosy patients. During the course of therapy the antigen positivity rate gradually declined, and the antigen could not be detected in any of the 15 patients with subsided cases of leprosy. As antigen is presumably in excess before the antibody response is evoked, our experimental approach for antigen detection is likely to be useful by itself or along with antibody detection for diagnosis of early leprosy.

Sarcoidosis masquerading as leprosy, pulmonary tuberculosis and urolithiasis.

A middle aged man presented as a recalcitrant case of borderline leprosy with concomitant pulmonary tuberculosis and urolithiasis which continued to progress relentlessly despite adequate multiduring antileprosy and antitubercular treatment. After detailed and relevant workup, the diagnosis of sarcoidosis was made. Rapid clinical improvement occurred with steroid therapy.

Detection of antibodies to 35 kD determinant of M. leprae in urine and serum of leprosy patients.

Urine and serum samples from 67 subjects comprising 55 active cases of different types of leprosy and 12 normal controls were subjected to monoclonal antibody based urine antibody competition test (UACT) and serum antibody competition test (SACT) respectively. It was possible to demonstrate M. leprae specific antibodies in the urine of 50% of the seropositive subjects. Urine antibody positivity was observed to the extent of 52% in BL/LL subjects, 50% in BB and 43% in TT/BT types of leprosy.

Pseudo-ainhum Associated with Spina-bifida Occulta and Hemivertebra.

A 7 year old girl had pseudo-ainhum, spina-bifida occulta, A hemivertebra and focal, neurogical deficit. The disease process was progressive for the last three years leading to amputation of the third digit and formation of constricting bands around -the fourth and the fifth digits of the left foot.

Flare up of Nickel Contact Dermatits Following Oral Challenge.

A patient having contact dermatitis due to nickel on the wrist, sides of neck, thighs and legs, confirmed by patch tests with nickel sulphate, showed aggravation of the dermatitis following oral provocation with 25 mg nickel sulphate.

Occupational Dermatoses Among the Cashew Nut Workers in Karnataka.

Seventy five female workers employed in the cashew nut industry in Karnataka to slice off the outer hard shells from the nuts and thus exposed to the chashew nut shell oil had a characteristic cauterization type of reaction manifesting as brownish-black, thickened sheets of dead skin covering the dorsal as well as the palmar aspects of hands including the fingers and feet. Smaller but similer lesions were also seen on these parts of the forearms, abdomen, neck and face which were not covered with clothes. The fingers were thinned and tapering and several nails of the hands and feet were thickened, discolored and eaten away. The other changes included loss of the dermatoglyphic patterns, maceration of the hands, small pits on the finger tips and pitted keratolysis seen in some cases only. Similar changes were also seen on the feet of both the male workers exposed to the same oil, in the section which extracts the oil from the sliced shells. In contrast 29, feamle wokers engaged to peel off the thin reddish covering on the cashew nut had normal hands and feet, except for the two callosities on the flexural aspect of the proximal phalanx of the right middle finger and proximal interphalangeal joint of the right index finger respectively, caused by the friction of the peeling knife. An open patch test with the cashew nut shell oil used as such in 17 workers produced a cauterization type of reaction in 32 workers irrespective of the nature of their duties, while the standard occluded patch test with 10% cashew nut shell oil in polyethylene glycol showed a mild cauterization type of reaction in only 6 workers. Patch tests with 1% and 0.1% concentrations of the shell oil were negative in all the workers. Two barrier creams tested to protect the workers from the cashew nut shell oil produced reasonably effective results within a week.

Histiocytic lymphoma simulating lepromatous leprosy--a case report.

Histiocytic lymphomas are known to begin with skin lesions and remain localised to the skin for months or years before visceral involvement becomes evident. We report a case of nodular histiocytic lymphoma with clinical features simulating lepromatous leprosy.

Metals Causing Contact Dermatitis in Varanasi.

Contact dermatitis due to jewellery was studied in 22 cases. All the patients showed positive patch tests with at least one antigen. Nickel was the most common sensitizer followed in the order of frequency by copper, chromium, cobalt and silver. male Female to ratio was 1: 3.66. Wrist was affected in the majority.

Familial Biphasic Cutaneous Amyloidosis.

A Bengali family had familial biphasic cutaneous amyloidosis in 6 of the 11 members in 3 generations. The propositti developed intense itching, thickening and pigmentation of the skin associated with discrete, brownish black papules bilaterally on the legs, ankles, popliteal fossae and extensor aspects of the thighs. Face, neck, scalp and oral mucosa were spared. There was hyperkeratosis of the palms and soles. None of them had lymphadenopathy, macroglossia, hepatosplenomegaly, neuropathy or gingival hypertrophy.