A 19-Year Retrospective Study of Adverse Drug Reactions to Multidrug Therapy in Leprosy Requiring a Change in Regime.

BACKGROUND AND AIMS: Multidrug therapy (MDT) in leprosy has brought the prevalence of leprosy to elimination levels. However, these drugs are not without toxicity. The primary aim of this study was to find the prevalence of adverse drug reactions (ADR) to MDT and the secondary aim to study the clinical features of these drug reactions. MATERIALS AND METHODS: This is a19-year retrospective descriptive study of all new leprosy cases with ADR to MDT, requiring a change in regime. RESULTS: There were 901 new leprosy cases in the study period. There were 28 cases of documented ADR to MDT necessitating a change in regime, thus accounting for a prevalence of 3.11%. There were 24 males (85.71%) and 4 females (14.29%) with a male/female ratio 6:1. Mean age was 39.58 years. Borderline tuberculoid was the commonest type of leprosy in which ADR were seen (46.43%). Dapsone was the commonest drug to cause ADR seen in 17 cases (60.71%). Hepatic involvement in the form of drug-induced hepatitis was the commonest presentation of ADR in this study accounting for 13 cases (46.43%), followed by skin rash, 9 cases (32.14%). There were no ADR reported to clofazimine. No ADR was reported to the alternative regimes given. CONCLUSIONS: The prevalence of ADRs was low in this study, with dapsone being the commonest drug. There were no adverse reactions to clofazimine. No adverse reactions were reported with the alternative regimes of ofloxacin and minocycline.

Leprosy in Families: Clinicoepidemiological Profile from a Tertiary Care Centre.

OBJECTIVES: The primary objective of this retrospective study was to determine the prevalence of leprosy in families, and the secondary objective was to study the clinicoepidemiological features of leprosy in families. RESULTS: There were a total of 901 cases of leprosy who attended our leprosy centre during this 18 year period. There were 49 cases of leprosy in this group whose family members also had documented leprosy (n = 49). A total of 61 family members of the index cases were affected by leprosy, thus making a total of 110 cases. There were 30 males (61.22%) and 19 females (38.78%) in the index cases. The age group of 21-40 years comprised the maximum number of cases in the index group, accounting for 24.49%. Borderline tuberculoid (BT) was the commonest type of leprosy in both the index cases and family members accounting for 48.98% and 55.74%, respectively. Conjugal leprosy was present in 16 couples. In 68.75% of leprosy in couples, one member was of the lepromatous type. Children (10-15 years age group) accounted for 10 cases in this study (9.09%). In children, 90% of the cases had one member with lepromatous leprosy. CONCLUSIONS: The prevalence of leprosy in families in this study was 5.44%. BT was the most common type of leprosy in both the index cases and family members. The prevalence of conjugal leprosy was 1.78%, with majority of the partners having the lepromatous type. Of the affected children, 90% had family members with lepromatous type of leprosy.

Disseminate and recurrent infundibulo-folliculitis in an Indian patient: A case report with review of literature.

A 17-year-old male patient presented with multiple discrete and confluent monomorphic skin-colored pinhead-sized follicular papules, with occasional pustules distributed on the neck, upper chest, upper posterior trunk, and proximal extremities of 4 months duration. The lesions were asymptomatic, and there was no prior history of topical application or history of atopic dermatitis. Routine investigations were normal. Histopathology of the papules showed a mononuclear infiltrate at the infundibulum of the hair follicle. We made a final diagnosis of disseminate and recurrent infundibulo-folliculitis. The patient was started on NB-UVB and topical tacrolimus. We are reporting an interesting case in an Indian patient.

Chronic Eosinophilic Leukemia Presenting Predominantly with Cutaneous Manifestations.

A 37-year-old male presented with severe oral and genital mucosal ulcers, lichenoid eruption and twenty-nail dystrophy. Systemic examination was normal, except for anemia. On investigations, he was found to have persistently elevated peripheral eosinophilia, absolute eosinophil count >5000/mm(3), bone marrow showing increased eosinophilic precursors, and infiltration by atypical cells. The serum vitamin B12 levels were grossly elevated, and Philadelphia chromosome study was negative. Thus, a diagnosis of chronic eosinophilic leukemia was made. The patient showed excellent response to imatinib mesylate. We are reporting a rare type of leukemia presenting with predominantly cutaneous manifestations.

A clinical and histopathological study of histoid leprosy.

BACKGROUND: Histoid leprosy (HL) is a rare variant of lepromatous leprosy presenting with well-defined smooth shiny papules and nodules. This can mimic many other dermatoses and can be missed clinically. METHODS: This is a retrospective 10-year study. Data were obtained and analyzed from case records of the urban leprosy clinic at the Government Medical College, Trivandrum, Kerala (India). RESULTS: There were 17 cases of HL in this study. The male/female ratio was 16 : 1 and the 41-50-year-old age group accounted for the maximum number of cases (six, 35.29%); 11 cases (64.70%) were de novo cases of HL. Papules were the commonest skin lesions encountered (17, 100%), while the upper and lower limbs and trunk were the most common sites involved (11, 64.70%). Earlobe infiltration was seen in 10 cases (58.82%). Lepra reactions were seen in four (23.52%) cases. Deformity/disability occurred only in two cases (11.76%). The mean morphological index was 30.58%, while the mean bacteriological index was 5.17. Epidermal atrophy and a well-circumscribed dermal area packed with spindle-shaped histiocytes and positive for acid-fast bacilli were the main histopathological features seen. CONCLUSIONS: The majority of cases in this study were de novo. HL can occur even when there is no history of inadequate or irregular treatment. Papules rather than nodules were the most common skin lesions seen. Earlobe infiltration was seen in the majority of cases unlike that reported in the literature. Lepra reactions are very rare in HL.