Bikash Ranjan Kar

Methotrexate in resistant ENL.

This is a report of a case of steroid resistant severe Type 2 reaction that was managed with methotrexate and prednisolone. Synergistic action of both the drugs in severe Type 2 reaction make them one of the preferred combinations in the absence of other agents such as thalidomide.

Presence of Mycobacterium leprae in epidermal cells of lepromatous skin and its significance.

A 49-year-old man with lepromatous leprosy treated with dapsone monotherapy for 12 years (1967 to 1979) reported in the hospital in 2003, with relapsed disease. A slit skin smear showed a bacteriological index of 4+. Biopsies from skin lesions before and after anti-leprosy therapy showed features of lepromatous leprosy. Both biopsies showed unusual features of bacillary clumps in epidermal cells demonstrating clearly that dissemination of M. leprae can take place even through unbroken skin. The presence of lepra bacilli in clumps in the epidermis is an indicator that the skin is a potential route of transmission of the disease.

Single lesion borderline lepromatous leprosy.

A patient is reported who presented with a single lesion on the face which, on histopathological examination, was found to be borderline lepromatous leprosy. The importance of doing skin smears as a routine in all patients to differentiate Multibacillary from Paucibacillary disease is emphasized.

Penile tuberculoid leprosy in a five year old boy

A 5-year-old contact of a lepromatous leprosy patient with a tuberculoid lesion on the anterior aspect of the shaft of the penis is reported. The child was clinically suspected to have borderline tuberculoid leprosy during a survey of contacts of leprosy patients, which on histopathology revealed features of subpolar tuberculoid leprosy. The father of the child was recently detected as a case of lepromatous leprosy and was started on multibacillary regime of WHO multidrug therapy. The reason for the localization of the lesion to the shaft of the penis is also suggested. Skin as a route of transmission of tuberculoid leprosy is also emphasized.

Comparison of clinical efficacy of topical tazarotene 0.1% cream with topical clobetasol propionate 0.05% cream in chronic plaque psoriasis: a double-blind, randomized, right-left comparison study.

BACKGROUND No controlled data is available till date comparing topical tazarotene and clobetasol in Indian psoriatic patients. OBJECTIVE The aim was to compare the clinical efficacy of 12 weeks of once-daily tazarotene 0.1% cream with that of once-daily clobetasol propionate 0.05% cream in the treatment of patients with chronic plaque psoriasis. METHODS About 36 patients with bilaterally symmetrical lesions were enrolled in this double-blind randomized controlled study. A left-right randomized study was conducted. RESULTS Clobetasol cream was better than tazarotene cream in reducing the erythema throughout the treatment period with statistically significant differences favoring clobetasol at weeks 2, 4, 6 and 8 ( P <0.05). Tazarotene was better in reducing the induration at weeks 2 ( P <0.05), 4, 10 and 12. Clobetasol cream was better in reducing the scaling throughout the treatment period with statistically significant differences favoring clobetasol over the entire treatment period. Treatment success rate was 100% with clobetasol and 88% with tazarotene at the end of week 12 with clobetasol achieving 100% success rate at the end of week 6. Treatment with tazarotene resulted in uniform reduction of plaque elevation and was not associated with the development of hot spots. CONCLUSION Topical tazarotene 0.1% cream is less effective than topical clobetasol propionate 0.05% cream in the treatment of plaque psoriasis. It has more effect on induration than on erythema and scaling of psoriatic lesions.

Co-existence of Lichen Sclerosus et Atrophicus and Morphoea Along Lines of Blaschko.

Lichen sclerosus (LS) is an inflammatory dermatitis of unknown etiology that mostly affects the genital region in both the sexes. In active cases the histopathologic changes differentiate between LS and morphoea though in chronic cases it is very difficult to diagnose with certainty. Coexistence of both the conditions in a single patient indicates that these lesions represent a spectrum of similar pathologic process. Coexistence of both the conditions along Blaschkos lines is so far not described in literature. We report an Indian patient with both LS and morphoea occurring along Blaschkos lines.

Subcutaneous cystic swelling in a leprosy patient.

Received: November, 2004. Accepted: January, 2005. Source of Support: Nil. A 45-year-old male attended the hospital with complaints of a subcutaneous swelling over the dorsum of the right hand since 6 months. He had been diagnosed as a case of lepromatous leprosy 4 years earlier and treated with the WHO multibacillary multidrug regimen for 24 months. After 6 months of starting MDT, the patient started getting recurrent erythema nodosum leprosum for which he received systemic prednisolone off and on. He developed the subcutaneous swelling while on oral corticosteroid treatment (Total cumulative dose of 12600 mg in last 2 years with maximum dose of 40 mg per day) for control of type II lepra reaction. There was no history of trauma preceding the onset of the lesion.

Nevus depigmentosus treated with suction blister grafting: Follow-up after 10 years

Nevus depigmentosus is a congenital hypomelanotic condition for which no effective treatments are available. The hypopigmentation is permanent and enlarges in proportion with growth in the person. Here, I report a patient of nevus depigmentosus on whom we performed suction blister grafting and the resultant pigmentation was satisfactory even at a follow-up after 10 years.