Histochemical study of Erythema nodosum leprosum (ENL) lesions.

A histochemical study of ENL lesions was performed on skin biopsies from 14 leproma-tous patients. There was: 1) the presence of moderate amounts of PAS positive diastase resistant materials, acid mucopolysaccharide, neutral fat, phospholipid, aryl sulfatase and acid phosphatase in areas around and away from reactional sites; 2) the presence of slight amounts or complete absence of these materials within areas of acute inflammation. These changes were interpreted as the result of solubilization and leakage of hydrolytic enzymes into the surrounding tissue. A possible role of lysosomal enzymes in the pathogenesis of ENL lesions is discussed.

Therapy of leprosy.

The latest developments and ideas in the therapy of leprosy are discussed, the need for long-term studies being stressed. The therapeutic efficacy and effective dosages of some sulfones (especially diaphenylsulfone), thiambutosine and long-acting sulfonamides such as sulfamethoxine and sulfalene, are considered. The possibilities for two newer drugs, 4,4'-diacetyldiaminodiphenylsulfone and clofazimine (B-663), both still in the early stages of evaluation, are also described and the potential value of thalidomide in treatment of the lepra reaction is discussed. The authors make a number of recommendations for controlled trials and lines of investigation and, in particular, favour a biochemical approach to the correction of defective host defences. Diaphenylsulfone is still considered the drug of choice for use in the therapy of leprosy.

The course of open cases of tuberculoid leprosy at the Cebu leprosarium

The clinical features and histological findings in eight tuberculoid neural-type cases in the Philippines, that were hospitalized because bacteriologically positive and observed from two to more than six years, are recorded. In seven cases the principal lesions were of major grade, moderate or very marked; but one case, though otherwise essentially similar, was never more than of minor grade. In three, if not four, other cases, after partial subsidence of the condition, some of the lesions progressed as of the minor tuberculoid variety, giving further evidence of lack of fundamental type differentiation of the ordinarily recognized(major) tuberculoid condition from the lesser forms of neuromacular leprosy. In two cases there was unilateral involvement of a nerve trunk of an extremity on which the first lesion appeared further indicating that in this form of the disease such affection may occur by extension through the cutaneous nerves, and not necessarily by metastasis. Onset of the disease was commonplace, in three instances with anesthesia preceding the appearance of macules, which in the group as a whole were usually of the simple form at first. Development of tthe condition that led to hospitalization usually, though apparently not invariably, resulted from reaction, whether mild or severe. Several cases experienced one or more relapses by reaction after they came under observation. A striking feature of the condition, hitherto not emphasized, is a secondary eruption, primarily papular or mixed papular and macular, often abundant, that can be ascribed only to metastatic dissemination of the infecting agent by may of the blood stream...