CLINICAL PATTERN OF VITILIGO AMONGST INDIANS

Vitiligo incidence in the series was 14 per thousand. The affliction of the younger subjects was frequent, the mean value of age at onset being 24.25 years. Both the sexes were affected and there was no significant difference between the two. The duration of the disease had wide variations, majority reporting in the course of one year. The emotional undertones and the ocurrence of the disease amongst family links were observed as provocating factors in some cases. Ivory white macules associated sometimes with erythematous tinge, leucotrichiae and islets of pigmentation were classic. The lower extremities were frequently involved, followed by face and other parts of the body. The disease was largely progressive, though in a few it was stationary. Vitiligo vulgaris was its commonest variant, followed by areata, zosteriformis, mucosae and acrofacialis. The associations namely diabetes mellitus, liver diseases and others were recorded. The occurrence of myasthenia gravis and trigeminal neuralgia in vitiligo was interesting. Its association on the basis of autoimmunity is brought out. The importance of the clinical parameters in anticipating the prognosis after psoralen therapy are discussed.

Topical lincomycin gel in acne vulgaris: a multicentric placebo controlled study

INTRODUCTION

Acne vulgaris is commonly treated with topical antibacterials. We evaluated lincomycin gel, a new topical formulation for mild to moderate acne.

MATERIAL AND METHODS

A multicentric, randomized, double blind, placebo controlled, clinical trial was conducted with lincomycin hydrochloride in 2% gel form in 200 patients with grade II and grade III acne. The severity of acne lesions was noted at baseline and after 4 weeks.

RESULTS

About 70% cases in the study group showed a good to excellent response, which was significantly more as compared to 23% in the placebo group. The frequency and severity of adverse reactions in the two groups were similar.

CONCLUSION

Lincomycin hydrochloride gel is an effective and safe treatment option for mild to moderate acne vulgaris.

Significance of histopathological classification in leprosy

A retrospective blind study was carried out on 2640 patients of leprosy to correlate the histopathological and clinical classification of leprosy using the criteria laid down by Ridley and Jopling. There was complete agreement between histopathological and clinical classification in 81.8% of the cases, with one step deviation in 5.1% of the cases. Histopathological diagnosis of indeterminate leprosy in high percentage (15.9%) as against 3.3% of indeterminate leprosy clinically in our series was an interesting feature. Type-wise correlation between histopathological with clinical classification was very high, it being the highest in LL (98%) followed by TT (97%), BT, BB and BL (95%, 89% and 87% respectively).

Treament of bechcet's disease

A case of Behcet's disease treated initially wiht corticosteroids to which dapsone was added subsequently and being kept in remission with dapsone alone is presented. High maintenance dose of corticosteroids necessitated the substitution with dapsone.

Treatment of reiter's disease

Two classical cases of Reiter's disease, one successfully treated with methotrexate and the other with sulphasalazine are reported.

Treatment of Reiter's disease

Two classical cases of Reiter's disease, one successfully treated with methotrexate and the other with sulphasalazine are reported.

Phenytoin therapy in recessive dystrophic epidermolysis bullosa

A case of recessive dystrophic epidermolysis bullosa in a 17-year-old boy is described. The diagnosis was based on clinical and histophathological findings. The patient is being treated with 200-300 mg of phenytoin sodium per day maintaining a blood level of 13-15 mg/litre and is under remission for 1 year.

Dapsone syndrome in Goa

Daspone syndrome was noted within six weeks of starting treatment in 1.3% of about 700 leprosy patients on MDT reporting to the skin department of Goa Medical College. Skin rash, photosensitivity, fever, lymphadenopathy, sore throat, hepatosplenomegaly, abnormal liver function tests and raised reticulocyte count were consistent features in all the patients. Other drugs, infectious mononucleosis and viral exanthemata were considered in differential diagnosis. Withdrawal of dapsone and administration of prednisolone controlled the condition within three to four weeks in majority of the patients. One patient died of ischemic heart disease unrelated to dapsone syndrome.

Osteomyelitis presenting as genital sore: a case report

A female attending the skin outpatient department presented with a genital sore which was treated as chancroid. On further investigation it proved to be the opening of a sinus secondary to chronic osteomyelitis of the pubic symphysis.

Dapsone haemolysis in leprosy. A preliminary report

Fifty one patients with leprosy from the Urban Leprosy Centre, attached to the Department of Dermatology and Venereology, Goa Medical College on treatment with Dapsone were studied from the point of view of development of haemolysis related to the drug. The findings are described and discussed. Anaemia developed in 60.7 percent of the patients during the course of treatment. It was mild and well compensated. The haemolytic effect of dapsone was related to the dose and duration of the treatment, being more manifested in doses above 50 mg daily.

Treatment of psoriasis: trioxalen and sunlight

Eighteen psoriasis patients were treated alternately with 40 mg of trioxalen and sunlight on the right side and sunlight only on the left side. Improvement was apparent faster on the psoralen-exposed side.

Fixed drug eruptions caused by medications: a report from India

Fifty-five patients with fixed drug eruption were investigated to determine the drug(s) causing the reaction. History, classic clinical features of well circumscribed erythema, edema and violaceous pigmentation, and the recurrence of the eruptions on the same sites on readministering drug were used as diagnostic criteria. This was confirmed by a provocative test. Sulfonamides and analgesics either alone or in combination were the most common causes of reaction.

The prevalence and pattern of leprosy in a school survey

The prevalence of leprosy in a school survey conducted in Panaji, India was found to be 5.3 per 1,000 with males predominating. The majority of patients had a single lesion on exposed parts of the body showing the clinical characteristics of tuberculoid leprosy. However, clinical features of indeterminate leprosy were seen in two patients and borderline tuberculoid in a single case. On the other hand, histopathologically, the majority of the patients were classified as having borderline tuberculoid or indeterminate leprosy. A disparity between the clinical and histopathologic diagnosis was evident. This observation emphasizes the importance of studying both the clinical and histopathologic features in deciding the precise status of a patient in the leprosy spectrum.

Correlation between clinical and histopathologic classification in leprosy

A detailed histopathologic study, utilizing hematoxylin and eosin stain, was done in 95 fresh uncomplicated cases of leprosy. The microscopic features were classified according to Ridley's (1974) definition, while the clinical grouping was done using the criteria of Ridley and Jopling (1962). The disparity between them on comparison was explicit. In one third of the cases the two were in consonance with each other. In many there was a shift of one step either towards the tuberculoid or lepromatous end of the spectrum. The remaining were classified as indeterminate because of early histopathologic changes. This disparity was expected because the parameters used for the histopathologic classification were precise and also took into account the immunologic aspect. The histologic definitions seem practical and may prove useful in assessment of the status of the disease with or without treatment.

Dystrophic epidermolysis bullosa. Interesting gastro-intestinal manifestations

Involvement of the large intestine in a long standing case of dystrophic epidermolysis bullosa was characterized by recurrent episodes of diarrhoea synchronizing with exacerbation of the skin lesions. The radiological investigations revealed two narrow segments, one each in the descending and transverse colon, with ulcer craters in the lower part of the former. The haustra from the distal half of the transverse colon to the sigmoid colon were lost.

Pattern of reactions in leprosy: a clinical appraisal

The term 'reactions' is applied in the present text, to describe the acute episodes, recognized with the different types of leprosy. The incidence of reactions was found to be 9.7% of 1053 cases examined. They were seen in all types of leprosy, but their frequency and severity was marked in lepromatous and borderline cases, and in majority of them, the age ranged from 20-40 years. The precipitating factor(s) could not be established in many; in some dapsone was incriminated, followed by bacterial infection and malnutrition. The exacerbations of the existing lesion(s) either alone or in combination with new lesions (E.N.L.) and E.N.L. lesions alone, were the presenting clinical features. The constitutional symptoms were observed largely in the types other than the tuberculoid. Foot drop and contractures of the fingers were the common sequels of the reactions. An attempt has been made to explain their mechanisms in the light of the recent literature.

The age of onset of leprosy

The age of onset was determined in 1,053 consecutive patients having different types of leprosy. There were 675 males and 378 females. The majority had onset of the disease between ages 20 and 39, although all age groups were affected. The age of onset was significantly related to the type of leprosy; the mean was lowest in tuberculoid, highest in neuritic, while in borderline and lepromatous it was in between. The comparison of reports of the age of onset from India and elsewhere suggest that this varies in different regions with the country, and from country to country.

Epidemiological and clinical pattern of leprosy in Goa

A review of 1,053 patients of leprosy revealed its prevalence in the hospital population as 2.4 per thousand. The commonly affected age group was 20-39 in both sexes; males predominating females in 1.8 : 1. The sequence of frequency of clinical types of leprosy was tuberculoid, borderline, neuritic and lepromatous. Mostly the patients report in the course of 2 years of awareness of the disease. The clinical features were classical and type specific.

Epidemiological and clinical patterns of genital lesions

A 5-year study of 668 patients with genital lesions revealed that teenagers and those in the age group of 20 to 40 are most vunerable. The poor, the uneducated and unmarried persons are at high risk. Chancroid and syphilis are the majority of cases. Inguinal bubo, herpes pregenitalis, condylomata acuminata, erosive balanitis and traumatic ulcers were seen less frequently. Most of the genital lesions had the classic clinical features. The findings of this study suggest that the pattern of genital lesions is showing borderline changes.

Malignant syphilis and hepatitis. Case report

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Chronic plasma cell balanitis of Zoon. Report of two cases

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Dystrophic epidermolysis bullosa in a family. Response to vitamin E (tocopherol)

Three cases of the dystrophic type of epidermolysis bullosa in three generations comprising 18 individuals are described. Two of the three cases were females and the other male. The index case was of the vegetans type, while the other two cases were the usual dystrophic type. The unusual clinical and histological features in the latter cases are highlighted. The autosomal recessive transmission of the disease is brought out. The therapeutic role of vitamin E in dosage of 300 mg per day in the management of these cases is emphasized.

Some unusual manifestations of syphilis. Condylomata lata of the face. A retrospective diagnosis

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Inoculation leprosy subsequent to small-pox vaccination

A case of high resistant tuberculoid leprosy in a 25-year-old female, developing after small-pox vaccination is described. This case supports the hypothesis of inoculation leprosy.