The Medical Treatment of Vitiligo: An Historical Review.

Discolorations of the skin, such as vitiligo, were recognized thousands of years ago. White spots caused by vitiligo and other disorders have caused significant social opprobrium to those disfigured by these pigmentary disorders, throughout history and still in the present day. Treatments have been desperately sought with only partial success. Recent advances suggest that vitiligo and other pigmentary disorders might soon be curable.

Trabajos científicos y colaboraciones. Actualización en tratamiento de la lepra (y II) / No disponible

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Levamisole in dermatology : a review.

Levamisole, an anthelmintic agent with a wide range of immunomodulatory actions, has been used successfully as monotherapy and an adjunct to treatment in a variety of diseases. Since 1990, combination therapy of levamisole and fluorouracil has played an important role in the treatment of resected Dukes stage C adenocarcinoma of the colon. Because of its immunomodulating effects levamisole has been used in a wide range of diseases with and without success. In dermatologic disease levamisole has been successfully used in the treatment of parasitic, viral and bacterial infections including leprosy, collagen vascular diseases, inflammatory skin diseases and children with impaired immune a variety of reasons. It has also been used in combination with other drugs for treating a number of dermatologic disorders, e.g. in combination with cimetidine for treating recalcitrant warts, with prednisolone for treating lichen planus, erythema multiforme and aphthous ulcers of the mouth. Adverse affects of levamisole are mild and infrequent and include rash, nausea, abdominal cramps, taste alteration, alopecia, arthralgia, and a flu-like syndrome. It can rarely cause agranulocytosis. More studies need to be undertaken to study the full potential of levamisole in dermatologic diseases.

Avaliaçäo da reaçäo de Mitsuda em pacientes virchovianos inativos antes e após imunoterapia / Assessment of the Mitsuda reaction in lepromatous patients inactive before and after immunotherapy

Neste estudo investigou-se o potencial imunomodulador do levamisole e da mistura BCG/Mycobacterium leprae em pacientes virchovianos inativos, utilizando como parâmetro a reaçao de Mitsuda. Vinte pacientes, classificados como Mitsuda histologicamente negativos há 10 anos, foram divididos em três grupos: cinco pacientes que foram somente reavaliados frente a mitsudina: oito pacientes que receberam levamisole e, sete que receberam a mistura de BCG vivo mais M. leprae morto. Os resultados mostraram que: 1) o levamisole nao alterou a reatividade à mitsudina em nenhum dos casos estudados; 2) as modificaçoes da reatividade verificadas com o uso da mistura (tres casos) ou aquelas que ocorreram espontaneamente (tres casos) foram sempre de pequena amplitude e refletiram variaçoes próprias de pacientes com algum grau de resistência ao Mycobacterium leprae.

[Assessment of the Mitsuda reaction in lepromatous patients inactive before and after immunotherapy]. / Avaliação da reação de Mitsuda em pacientes virchovianos inativos antes eapós imunoterapia.

In this study the immunopotentiator levamisole as well as a mixture of BCG/Mycobacterium leprae were investigated in inactive lepromatous leprosy patients by using the Mitsuda reaction as a parameter. Twenty lepromatous patients ten years ago classified as histologically negative for Mitsuda's test were divided into three groups: five patients that were only retested with Mitsuda antigen; eight patients that received oral levamisol and seven patients that received a mixture of alive BCG plus autoclaved M. leprae. The results indicated that: 1) the levamisole did not alter the reactivity to lepromin in any of the patients studied; 2) neither the changes in the reactivity to lepromin by using the mixture (3 cases) nor those that occurred spontaneously (3 cases) were clear. They properly reflected the natural variation of patients with some degree of resistance to Mycobacterium leprae.

Adelantos terapéuticos en lepra / Progress in leprosy therapeutic

Se comentan los recientes aportes terapéuticos, dividiéndose el trabajo en los siguientes capítulos: I)Resistencia bacteriana a los diversos fármacos, en especial a la D.D.S. en su forma secundaria, así como la primaria. Dosis a emplear con la monoterapia. Causas de aparición de la resistencia (tratamiento irregular y/o bajas dosis). II) Asociación medicamentosa: sus ventajas y los principales esquemas en enfermos vírgenes y en casos de resistencia a las sulfonas. III) Tratamiento de la reacción leprosa. IV) Inmunoterapia en lepra: sus objetivos, los medios más comúnmente empleados, sus riesgos y efectos colaterales

Adelantos terapéuticos en lepra / Progress in leprosy therapeutic

Se comentan los recientes aportes terapéuticos, dividiéndose el trabajo en los siguientes capítulos: I)Resistencia bacteriana a los diversos fármacos, en especial a la D.D.S. en su forma secundaria, así como la primaria. Dosis a emplear con la monoterapia. Causas de aparición de la resistencia (tratamiento irregular y/o bajas dosis). II) Asociación medicamentosa: sus ventajas y los principales esquemas en enfermos vírgenes y en casos de resistencia a las sulfonas. III) Tratamiento de la reacción leprosa. IV) Inmunoterapia en lepra: sus objetivos, los medios más comúnmente empleados, sus riesgos y efectos colaterales

[Immunomodulator treatment of multibacillary leprosy using extracts of microbial ribosomes]. / Traitement immunomodulant de la lèpre multibacillaire par extraits de ribosomes microbiens.

Ribomunyl can in practice be profitably included in the range of immunostimulants, but it requires weekly injections and hence surveillance that will also enable any adverse reactions to be monitored. Its action and tolerance after polychemotherapy have still to be studied. On the basis of our experience, we feel that only isoprinosine, whose effectiveness and good tolerance we have demonstrated, can be used for self-treatment in a mass campaign.

Evaluation of levamisole, an immunopotentiator, in the treatment of lepromatous leprosy.

Twenty subpolar lepromatous leprosy patients under multidrug therapy for a period of 1 to 3 years, who continued to be bacteriologically positive (BI 2 to 1 in Dharmendra's grade) were taken in the study. Ten cases (trial group) were given levamisole as an immuno-stimulator for 1 year along with chemotherapy. Another 10 cases (control group) continued to take chemotherapy alone. There was no conversion of Mitsuda reactivity in any of the cases from both the groups. There was no improvement of leucocyte migration inhibition in either group. In both trial and control groups, statistically significant clinical and bacteriological improvements and increase of E. rosette counts are found at the end of one year. However, only the bacteriological improvement in the trial showed statistical significance, when the improvements were compared with those of the control group. No adverse effect due to levamisole therapy was encountered.

Effect of levamisole on bacterial index in BL and LL leprosy.

A 150 mg levamisole tablet once in every fortnight along with specific antileprosy drugs were administered to ten patients each in BL and LL groups of leprosy. A similar number of patients in each group receiving only specific antileprosy treatment served as controls. After 11/2 years of study a more significant improvement was noted in the bacteriological status in the levamisole-treated group. Thus, levamisole can be used as an effective adjunct for quicker recovery in lepromatous patients.

Levamisole in cases of E.N.L.

Levamisole, the anthelmintic drug was tried in ENL (Erythema Nodosum Leprosum) cases using double blind control trial in dosage of 150 mg/day on three consecutive days for three months. It was found that levamisole was not effective in ENL cases and no severe side effect was seen in these cases.

A comparative evaluation of levamisole in leprosy.

Ninety adult leprosy patients attending the skin outpatient department of Institute Hospital of Varanasi, India, were selected for the study. A group of thirty patients including 10 cases of lepromatous, 10 of borderline and 10 cases in reaction of which 5 were of type 1 and 5 of type II reaction were treated with levamisole and DDS. Levamisole was given in the doses of 150 mg. daily for three consecutive days which was repeated after every 12 days. The effects were compared with two similar groups receiving clofazimine plus DDS and DDS alone respectively for six months. It was observed that levamisole was useful in bringing down both the types of reactions in a period shorter than required by clofazimine. Clinical improvement in non-reaction cases was found to be similar in all the three groups. Minor side effects were also seen with levamisole and clofazimine in some cases.