Cutaneous ulceration as a presenting feature of type 1 lepra reaction: A case report.

Reactions in leprosy represent sudden shift in the immunological response and are seen in 11-25% of affected patients. It can be seen before, during or after the completion of multidrug therapy (MDT).1 Two types of reactions are recognized; Type 1 reaction (T1R), seen in borderline leprosy, affecting mainly skin and nerves; type 2 reaction (T2R) or erythema nodosum leprosum (ENL), seen in lepromatous leprosy, characterized by systemic features in addition to cutaneous lesions. Trophic ulcers and ulcerating ENL are well known entities while cutaneous ulceration in T1R is extremely rare; we describe an immune-competent woman with cutaneous ulceration as a presenting feature to highlight the need to recognize this entity at the earliest opportunity.

Effectiveness and safety of autologous platelet-rich plasma therapy with total contact casting versus total contact casting alone in treatment of trophic ulcer in leprosy: An observer-blind, randomized controlled trial.

BACKGROUND: Trophic ulcers secondary to leprosy pose a great stigma to patients and remain a challenge to the treating dermatologists. Platelet-rich plasma (PRP) introduces growth factors directly into the wound and aids in rapid healing. The role of PRP in the treatment of trophic ulcers in leprosy patients has not yet been established by randomized controlled trials. AIMS: To study the effectiveness and safety of autologous PRP therapy with total contact casting versus total contact casting alone in the treatment of trophic ulcers in leprosy. METHODS: In an observer-blind, randomized (1:1) controlled study, 118 patients were enrolled. PRP was prepared by the manual double-spin method (1600 rpm for 10 min followed by 4000 rpm for 10 min). After wound bed preparation, activated PRP was injected intra- and perilesionally, and platelet-poor plasma gel was applied over the ulcer bed. Occlusive dressings and total contact casting were then applied in Group A, and only total contact casting was applied in Group B. The same procedure was repeated every 2 weeks for 8 weeks. RESULTS: In all, 56 patients were analyzable in Group A and 52 in Group B. The surface area of the ulcer decreased significantly from first follow-up onward in both the groups (P < 0.001 in both the groups). Intergroup comparison showed that the reduction in the surface area of the ulcer was significantly more in Group A than in Group B from the first follow-up onward (P = 0.038) and the difference was maintained till the fifth follow-up (P < 0.001). At the end of the study, 91.10 ± 9.65% ulcer surface area reduction had occurred in Group A, whereas it was 79.77 ± 17.91% in Group B (P < 0.001). Trophic ulcers healed completely more often in paucibacillary leprosy patients (P < 0.001) and in those with a lower initial surface area of the ulcer (P < 0.001). LIMITATION: Short duration of treatment (8 weeks). CONCLUSION: PRP combined with total contact casting accelerates the healing of trophic ulcers of leprosy and is more effective than total contact casting alone. Complete remission is more likely to occur when the duration and surface area of ulcer are less and in the paucibacillary spectrum.

Ulcers in leprosy patients, an unrecognized clinical manifestation: a report of 8 cases.

BACKGROUND: Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae. It is a polymorphic disease with a wide range of cutaneous and neural manifestations. Ulcer is not a common feature in leprosy patients, except during reactional states, Lucio's phenomenon (LP), or secondary to neuropathies. CASES PRESENTATION: We report eight patients with multibacillary leprosy who presented specific skin ulcers as part of their main leprosy manifestation. Ulcers were mostly present on lower limbs (eight patients), followed by the upper limbs (three patients), and the abdomen (one patient). Mean time from onset of skin ulcers to diagnosis of leprosy was 17.4 months: all patients were either misdiagnosed or had delayed diagnosis, with seven of them presenting grade 2 disability by the time of the diagnosis. Reactional states, LP or neuropathy as potential causes of ulcers were ruled out. Biopsy of the ulcer was available in seven patients: histopathology showed mild to moderate lympho-histiocytic infiltrate with vacuolized histiocytes and intact isolated and grouped acid-fast bacilli. Eosinophils, vasculitis, vasculopathy or signs of chronic venous insufficiency were not observed. Skin lesions improved rapidly after multidrug therapy, without any concomitant specific treatment for ulcers. CONCLUSIONS: This series of cases highlights the importance of recognizing ulcers as a specific cutaneous manifestation of leprosy, allowing diagnosis and treatment of the disease, and therefore avoiding development of disabilities and persistence of the transmission chain of M. leprae.

Fenómeno de Lucio: a propósito de un caso / Lucio's phenomenon: a case report

Se presenta caso de paciente masculino de 67 años de edad, fototipo III, con antecedentes patológicos personales de lepra lepromatosa en tratamiento, que acude a consulta especializada de Dermatología en el Hospital Guillermo Fernández Baquero (La Habana, Cuba) por lesiones ulcerosas diseminadas. Se realizan complementarios y se concluye caso como fenómeno de Lucio. Resaltando la infrecuencia de este eritema necrosante y la severidad de los estados reactivos de la lepra pues son procesos distintos pero destructores de los tejidos, supuestamente dirigidos por el sistema inmunológico que aumentan en gran medida la morbimortalidad de esta enfermedad

A case of a 67 year old male patient, phototype III, with a personal pathological history of lepromatous leprosy in treatment is presented at a specialized dermatology clinic at Guillermo Fernández Vaquero hospital for disseminated ulcerative lesions. Complementary are performed and case is concluded as a phenomenon of Lucio. Highlighting the infrequency of this necrotizingerythema and the severity of the reactive states of leprosy are different but destructive processes of the tissues, supposedlydirected by the immune system that greatly increase the morbidity and mortality of this disease.

Leprosy presenting as a non-healing ulcer and associated unusual myth.

A case of a 70 year old lady with borderline tuberculoid leprosy who presented with a chronic ulcer and associated myth has been illustrated. The need for awareness programmes focusing on these types. of myths has been stressed.

Diagnóstico tardío de lepra lepromatosa. A propósito de un caso / No disponible

La lepra es una enfermedad infecciosa crónica, que afecta piel y nervios periféricos, la mucosa de las vías respiratorias superiores y también los ojos, además de algunas otras estructuras, ocurre en personas de cualquier edad y de ambos sexos causadas por el Mycobacterium leprae. El diagnóstico precoz reviste gran importancia ya que cura al enfermo, interrumpe la cadena de transmisión y evita las discapacidades. Presentamos un paciente masculino de 46 años de edad, trabajador agrícola sin antecedentes epidemiológicos conocidos y sin percepción del riesgo de la enfermedad que ingresa en el hospital municipal de Florida con fiebre, dolores articulares y lesiones en piel, diagnosticándose una lepra lepromatosa, discapacidad grado 2 según clasificación de la OMS dado por la deformidad de manos y pies, la pérdida de la estructura y la rigidez, constituyendo un diagnóstico tardío

Leprosy is an infectious disease with a chronic evolution that affects skin, peripheral nerves, upper respiratory tract and other structures. It appears in individuals of any age or sex and its etiological agent is Mycobacterium leprae. An early diagnosis is essential for preventing incapacities and interrupting the chain of transmission. We present a case of a 46 year old male, field worker, with a previous clinical history and no reception of the risk of illness. He entered the general hospital in Florida with fever, joint pains and skin lesions and was diagnosed of lepromatous leprosy, with grade 2 disabilities according to the WHO classification of the hand, feet and eye deformities, all the cause of a late diagnosis