Nonsegmental vitiligo follows Blaschko's lines and embryonic pigmentary segments.

BACKGROUND: Pathogenic mechanism that determines the localization of vitiligo patches and thus a patterned distribution in patients with nonsegmental vitiligo has remained poorly elucidated. A distributional similarity of the vitiligo patches with Blaschko's lines has been documented in patients with segmental vitiligo, both isolated segmental vitiligo and mixed vitiligo but never in cases of nonsegmental vitiligo. METHODS: Distribution of nonsegmental vitiligo patches on face and neck regions was assessed and compared with Blaschko's lines and also with embryonic pigmentary segments on the face. RESULTS: This study has documented distributional similarity of the nonsegmental vitiligo patches on face and neck with Blaschko's lines and the "embryonic pigmentary segments" among 154 (58.6%) cases. Patches around the palpebral and other fissures like periorbital, perinasal, perioral, and periaural were more common. In addition to the vitiligo patches, the spared areas were also found to respect the embryonic segmental outlines and follow the Blaschko's lines. CONCLUSION: Distributional pattern of the individual nonsegmental vitiligo patches along the Blaschko's lines and embryonic pigmentary segments suggests that mosaicism might control the susceptibility to the disease process in a patterned manner. LIMITATION: No genetic testing could be performed to confirm the hypothesis. Evaluation of nonsegmental vitiligo was done only on the face and neck areas.

Lepra Ocular, conceptos actuales / An update in ocular Leproxy

Se cree que la lepra es la enfermedad sistemática con mayor incidencia de repercusión ocular, La afectación ocular se produce sobre todo en las formas lepromatosas. Las manifestaciones oculares son proteiformes y se relacionan con la invasión por el bacilo de las estructuras del segmento anterior y/o anejos, reacción inflamatoria y/o afectación neural de las estructuras oculares. La manifestación extraocular más frecuente es la madarosis de las cejas. La córnea es la parte más afectada del globo presentando una forma de queratitis patognomónica de localización temporal superior. En el iris aparecen también lesiones características como atrofia peripupilar aspecto atigrado y miosis insalvable por denervación. Es además característica la uveítis aguada y crónica. Las lesiones esclerales, son infrecuentes, aunque muy espectaculares. En el fondo de ojo solo se han descrito lesiones de forma esporádica

Leprosy the systemic disease with higher incidence of ocular findings. Eye disease is shown especially in lepromatous disease. Ocular complications are assorted and related to anterior segment and/or extraocular structures invasion by Mcobacterium leprae, inflammatory reaction, and nervous damage of the ocular structures. Superciliary madarosis is the most common extraocular finding. Cornea is the main affected structure of eye. There is a characteristic keratitis located in the superior temporal quadrant. The iris shows typical lesions like peripupilary atrophy, the pupil can be miotic and not responsive to mydriatics because of denervation. The scleral lesions are rare but amazing. Posterior segment lesions have been sporadically described

Pathology of a lepromatous eye.

Histopathological examination of an enucleated eye from a lepromatous leprosy patient showed the cornea, ciliary body, and part of the choroid to be infiltrated by macrophages filled with Mycobacterium leprae. The walls of blood vessels in the sclera, ciliary body and the anterior choroid demonstrated the presence of M. leprae, giving credence to the blood-borne entry of M. leprae into the eye. Unlike the eyes of experimental animals infected with M. leprae, histopathological study of this eye from a lepromatous leprosy patient demonstrated that M. leprae, although demonstrable in the anterior choroid, could not be found in the posterior parts of the eye, substantiating the claim that leprosy does not affect the posterior parts of the eye directly.

Study of ocular changes in leprosy patients.

In this study, 997 leprosy patients were examined, 528 of them with lepromatous leprosy (53%), 199 with borderline leprosy (20%), 167 with tuberculoid leprosy (16%) and 103 (10.3%) with indeterminate leprosy. Changes in the ocular bulb were noted in 314 patients (31.5%) specially in those with lepromatous leprosy. These alterations were greater with increasing age of the patient and length of disease. Severe ocular lesions were rare, probably due to previous systemic treatment. The "pearls" in the fundus of the eye resulting from leprosy were also studied.

Estudo epidemiológico das alterações oculares em hansenianos no Amazonas / ?

O aparelho visual apresenta-se fregüentemente comprometido na hanseníase. O autor estudou 1056 pacientes ambulatoriais (14,00 por cento do registro ativo do Estado do Amazonas), representativos das várias formas clínicas da doença e em diferentes estágios do tratamento. O exame oftalmológico incluiu a medida da acuidade visual; o exame biomicroscópico do globo ocular e anexos; tonometria de aplanação; medida da sensibilidade da córnea com estesiômetro de Cochet & Bonnet; gonioscopia e oftalmoscopia. Foi registrado um índice de 32,01 por cento de comprometimento ocular. A acuidade visual estava comprometida em 257 olhos (12,30 por cento) e 101 pacientes (9,68 por cento) tinham acuidade visual menor que 0.1 em ambos os olhos. A causa mais freqüente de cegueira nesta série de pacientes foi alterações na córnea seguida de alterações da íris. O autor identificou vários fatores de risco para glaucoma nos pacientes estudados. Foram encontradas alterações fundoscópicas em 3,5 por cento dos pacientes. A maior freqüencia de lesões oculares leprosas foi encontrada nas formas multibacilares da doença, e os estados reacionais que constitui um agravo adicional ao olho estavam relacionadados com a gravidade e a freqüencia dessas alterações. O tempo de evolução estava também relacionado com a freqüencia e a gravidade das alterações oculares.

[Ocular histopathological studies in leprosy in the silent stage--II. Immunohistochemical studies].

The distribution of leprosy antigen in 21 eyes from 12 autopsy cases of lepromatous leprosy patients (5 eyes from 3 cases in the silent stage, 16 cases from 9 cases in the active stage) were examined with acid-fast staining and immunohistochemistry. Anti-BCG antibody, anti-phenolic glycolipid-I (PGL-I) antibody, and anti-lipoarabinomannan-B (LAM-B) antibody were used as primary antigens. In the active stage, anti-BCG antibody and anti-LAM-B antibody showed almost the same staining pattern. Some cases, which showed negative reaction to acid-fast staining, occasionally showed positive staining pattern with anti-BCG antibody and anti-LAM-B antibody, which had high sensitivity and the advantage of detection of leprosy antigen. Some anti-PGL-I antibody showed a different staining pattern from acid-fast staining, anti-BCG antibody and anti-LAM-B antibody. These findings seemed to be caused by the difference in structure of the epitope. In the silent stage, clinically nonpigmented epithelium of 6 cases from 4 eyes showed positive staining pattern with anti-PGL-I antibody. These findings suggested that leprosy antigen still remained in this stage.

A histological study of the eye lesions in 12 leprosy patients with tuberculoid lesion in 4 eyes.

The histological reactions in 12 eyes of 12 leprosy patients were studied (5 BT, 1 BB, 1 BL and 5 LL). Granuloma lesions composed of epithelioid cells, Langerhans giant cells, macrophages and lymphocytes were found in various intraocular tissues, e.g. cornea, sclera, iris, ciliary body or retina in 4 patients (1 BT and 3 LL). Of the 3 LL patients, according to the records, 2 were cured and in the other patient the outcome of the treatment was not mentioned. In view of the finding of the granulomatous lesions in the clinically cured patients and tuberculoid granuloma in the intraocular tissues in the LL patients, could there be some peculiarities in the intraocular sites? Or perhaps the tuberculoid reaction is just a manifestation of an upgrading reaction? More examinations on human leprosy eye specimens will be needed to answer these questions.

Eye in multi drug therapy.

Eyes of 237 multibacillary leprosy patients on Multi Drug Therapy were studied for a minimum period of 2 years and maximum period of 4 years. Ocular status remained unaltered in 75%, improved in 16% and there was worsening in 9% during the study period. The changes in those worsened were of microscopic nature and seen mostly among those with long duration of disease and among reactors.

Histopathological changes in the eyes of mangabey monkeys with lepromatous leprosy.

Leprosy is the third leading cause of preventable blindness; however, little is known about the spread of infection to the eye. We have studied the eyes of three sooty managabey monkeys. Two were experimentally infected with Mycobacterium leprae; the third was not infected. In one of the infected animals there was histopathological evidence of lepromatous leprosy as evidenced by a chronic inflammatory infiltrate at the limbus, and detection of acid-fast bacilli in the corneal stroma, blood vessel walls, and corneal nerves. The latter were damaged as a result of the bacillary invasion. Electron microscopy revealed involvement and distortion of keratocytes with M. leprae and invasion of the corneal stroma by macrophages containing bacilli. Both infected animals showed focal collections of lymphocytes in the superficial stroma of the conjunctiva and in the ciliary body. This is the first report of the ocular manifestations of leprosy in any primate, including man, in which the duration of infection is known.

[Physical disabilities in Hansen's disease at the time of diagnosis. I. Disability evaluation]. / Incapacidades físicas em hanseníase no momento do diagnóstico. I--Avaliação das incapacidades.

The evaluation of the physical disabilities at the moment of the hanseniasis diagnosis was carried out through the clinical and epidemiological forms of the 8,915 cases recorded in the State of São Paulo, Brazil, from 1981 to 1983. The records of the physical disabilities were studied by three different methods: the disabilities at their highest grade, the disabilities' grade index achieved from the arithmetic mean of the added values of the different disability grades, and the absolute disabilities frequency. The study suggested that the maximum grade was the best evaluation method of the physical disabilities at the moment of the diagnosis, being an important indicator for the evaluation of prevention efforts and of the hanseniasis control.

Incapacidades físicas em hanseníase no momento do diagnóstico: I. Avaliaçäo das incapacidades / Physical disabilities in Hansen's disease at the moment of the diagnosis: I. Disability evaluation

A avaliaçäo das incapacidades físicas no momento do diagnóstico da hanseníase foi realizada através das fichas clínico-epidemiológicas dos 8.915 casos registrados no Estado de Säo Paulo entre 1981 e 1983. Os registros de incapacidades físicas foram analisados por três métodos: grau máximo de incapacidade, índice de incapacidades obtidos pela média aritmética da somatória dos graus de incapacidades e freqüência absoluta das incapacidades. O trabalho sugeriu que o grau máximo foi o melhor método de avaliaçäo das incapacidades físicas no momento do diagnóstico sendo, um importante indicador para avaliaçäo das medidas de prevençäo e controle da hanseníase

Unusual histological lesions in the eye of a leprosy patient.

A pathological study of an eye from a leprosy patient is reported. In addition to the granulomatous lesions in the anterior aspect of the eye, microgranulomas are demonstrated in the retina of this patient, a very uncommon finding in leprosy.

Ocular leprosy: a case report and discussion of the pathology.

Although leprosy is considered rare in Australia outside the Northern Aboriginal population, its presence within Indian and Southeast Asian migrant groups must be considered. A case of ocular leprosy is presented in which the definitive diagnosis was delayed because lid changes had been diagnosed as senile ectropion. The pathology of ocular leprosy is discussed, together with relevant therapeutic considerations.

Untreated Hansen's disease of the eye: a clinicopathological report.

A Maltese immigrant presented with intermittent bilateral anterior uveitis for which no cause could be found. The inflammation did not respond to topical treatment and ultimately the left eye developed a hypopyon and was enucleated. Histological examination revealed granulomatous inflammation and large numbers of Mycobacterium leprae throughout the anterior segment. Occasional foci of inflammation containing Mycobacterium leprae were found in the vitreous extending to the retina at the posterior pole. These findings in the posterior segment have rarely been reported. Eye infection in Hansen's disease is frequent and delays in diagnosis are common.

Prevalence of leprosy among slum dwellers.

Distribution of leprosy among slum dwellers in two areas of Bangalore City were studied. Out of a random sample of 483 it was found that 150 were suffering from leprosy while 74 tuberculoid and 25 lepromatous cases were detected, the remaining showed up as borderline and polyneuritic types. The important socio economic features and the consequences of this chronic disease have been discussed.