Intravenous Immunoglobulin: Revisited - My Experience.

BACKGROUND: Many a times while treating dermatoses conventional therapies are either contraindicated or not effective. Intravenous immunoglobulin (IVIG) is a good alternative available to tide over crises. METHOD: Over the last 15 years of my practice I have used IVIg in various severe or recalcitrant diseases (including TEN, autoimmune blistering disease,connective tissue disorders , chronic urticaria etc) which were either unresponsive to conventional modality of therapy or primary therapy could not be given because of co-morbidities. RESULT: IVIg a sterile, highly purified preparation containing more than 95% unmodified IgG,was first approved by FDA in 1981 for 6 diseases. As mentioned above in many circumstances we reached a situation when either conventional primary therapy was contraindicated or patients were not responding. IVIg came to our rescue in large number of conditions to tide over the crisis and also created the environment leading to conventional therapy becoming effective. Very few minor side effects like low grade fever and myalgia were observed in very few cases. No serious or severe side effects were seen, however , one has to be prepared for anaphylactic reaction which is a theoretical possibility. CONCLUSION: It can be said that IVIg though not a magic drug, is a very effective tool available in the armamentarium of Dermatologists to treat plethora of chronic and intractable dermatoses.

Nerve conduction studies in early tuberculoid leprosy.

CONTEXT: Hansen's disease is a chronic illness; besides involving skin and peripheral nerves, it affects multiple organs. Nerve involvement is always present in leprosy, and it may be present much before the patient manifests clinically. AIMS: To assess nerve conduction parameters in thickened and contralateral non-thickened nerves in early tuberculoid leprosy. MATERIALS AND METHODS: Fifty new untreated male patients with tuberculoid and borderline tuberculoid leprosy in the age group of 15-50 years with thickened peripheral nerves on one side were included in the study. Nerve conduction studies consisting of sensory and motor velocity (NCV), distal latencies, and amplitude were carried out on thickened ulnar, common peroneal, and posterior tibial nerves and contralateral normal nerves. STATISTICAL ANALYSIS USED: Mean values along with coefficient of variation were obtained for various parameters. These were compared with normal values of the control population. P value was used to verify statistical significance. RESULTS: Nerve conduction parameters were deranged in most of the thickened nerves. Sensory parameters were affected early in the disease process. CONCLUSION: Additional parameters are required to assess nerve damage in early cases, where it is more in slow conducting fibers (average velocity fibers). Change in conduction velocity may not be marked; this calls for the measurement of fast fibers separately because potentials recorded are mainly from myelinated fibers.