RESUMO
The significant inter-patient variability in progression, and response to therapy makes it a great challenge for the physician to predict the outcome of vitiligo at the very outset. Subjective factors like stress, pregnancy, sunburn and illness have been identified as aggravating factors for vitiligo. However, a few studies have evaluated the statistical significance of objective clinical parameters in predicting the outcome of vitiligo. Our retrospective analysis of 199 consecutive patients with vitiligo who presented to our OPD was aimed at evaluation of these objective clinical parameters utilizing a standard proforma. Patients already on treatment, and those with duration of disease less than 6 months were excluded from the study. Progression was defined as an increase in size or number of lesions in the 3 months prior to presentation. In all 76.9% patients had progression of vitiligo. The clinical parameters significantly associated with progression were a positive family history (p=0.027), mucosal involvement (p=0.032), Koebner's phenomenon (p=0.036) and nonsegmental vitiligo (p=0.033). Thrichrome sign, leucotrichia, longer duration and higher age at onset did not correlate significantly with progression. The one significant observation that we found to have the poor prognostic implication in vitiligo is the presence of mucosal vitiligo. The clinical prediction of disease progression at the outset enables the physician to set realistic treatment goals and optimize the therapeutic regimen for the individual patient.
RESUMO
La lepra es, sobre todo, una enfermedad de los nervios periféricos y se requiere una técnica más sencilla que a biopsia neural para evaluar el compromiso neural, especialmente en lepra neurítica pura (PN). Este trabajo fue diseñado para evaluar el papel de la FNAC en el diagnóstico y clasificación de la lepra. Se efectuó un estudio prospectivo en 25 pacientes con lepra clínicamente activa y al menos un nervio periférico sensitivo engrosado. Los aspirados neurales se evalúan por May-Grunwald-Giemsa y tinción Fite. Se realizan tests de la lepromina, frotis cutáneos (SSS), y biopsias cutáneas (excepto en casos PN) y biopsias neurales y con FNAC. El FNAC neural en 23 casos (92%) proporciona aspirados y se comparan con valor diagnóstico. Basados en estos resultados, se desarrolló un criterio citológico para la interpretación de aspirados neurales y los casos se clasifican como paucibacilares (18), BB(2), LL(1) y no-diagnósticos (2). Todos los casos PN en lepra son comparables con la patología neural y el criterio citológico propuesto puede ser útil en la clasificación de los aspirados neurales.