P. V. S. Prasad

A clinical study of psoriatic arthropathy

BACKGROUND The incidence of uncomplicated psoriasis is 1-3% in the general population. Arthritis is found in increased frequency in psoriatic patients and its incidence is estimated to be 5-7%. AIM To assess the prevalence of arthritis in psoriatic patients. METHODS Four hundred and seventy-two psoriatic patients were enrolled in the study out of which 40 patients had (psoriatic) arthropathy (PsA). Severity of psoriasis was assessed by the psoriasis area and severity index (PASI). Routine blood investigations were carried out along with radiological investigations. RESULTS Forty percent of the 40 PsA patients were in the age group of 51-60 years. Seven patients out of the 40 (17.5%) psoriatic arthropathic (PsA) patients had a family history of psoriasis. Nail involvement was observed in 37 cases (92.5%). Rheumatoid factor was present in five out of the 40 (12.5%) PsA patients. Serum uric acid levels were above normal in eighteen out of the 40 (45%) PsA patients. Asymmetric oligoarthropathy was the most commonly observed feature in 42.5% of the 40 PsA patients. Narrowing of joint spaces and erosions were observed in 62.5% and 45% of the 40 PsA patients. CONCLUSION There is an association between the duration of skin lesions and duration of arthropathy. Similarly the PASI score is also directly related with arthropathy.

Serum zinc level in vitiligo: A case control study

206 2. Day C, McCollum EV. Effect of acute dietary zinc deficiency in rat. Proc Exp Biol Med 1940;45:282-7. 3. Saxena N, Sharma RP, Singh VS. A study of serum zinc and copper levels in psoriasis. Indian J Dermatol Venereol Leprol 1990;56:216-8. 4. McMillan C, Rowe D. Plasma zinc in psoriasis: Relationship to surface area involvement. Br J Dermatol 1983;108:301-5. 5. Portnoy K, Molokhia M. Zinc and copper in psoriasis. Br J Dermatol 1972;86:205-9.

Leprosy therapy, past and present: can we hope to eliminate it?

Leprosy remains an important problem globally. Timely detection of new cases and prompt treatment with MDT continue to be the main intervention strategies. We review the various issues related to classification, treatment, drug resistance and the possible steps to eliminate the disease in the near future. The need for newer anti leprosy agents has been felt and various agents like fluroquinolones, macrolides and minocycline have all been tried in various combinations and duration. Uniform MDT in all leprosy patients might be a logical one too. Drug resistance can be identified by PCR based DNA sequence analysis which saves much time. Drugs like thalidomide analogues, pentoxifylline, selective cytokine inhibitory drugs have proved effective in controlling type-2 reaction in leprosy patients. New drugs for leprosy reactions are still needed. Far from being eliminated as a public health problem, leprosy still causes a considerable long term morbidity in both developing and developed world. New treatment and the optimal length of MDT requires further research. We need genome based technology to address the unresolved issues of transmission of M. leprae.

Fine needle aspiration cytology in leprosy

BACKGROUND Laboratory diagnosis of leprosy by slit skin smear and skin biopsy is simple but both techniques have their own limitations. Slit skin smear is negative in paucibacillary cases whereas skin biopsy is an invasive technique. Fine needle aspiration cytology (FNAC) from skin lesions in leprosy with subsequent staining with May-Grunwald-Giemsa (MGG) stain has been found useful. AIM To evaluate the possible role of cytology in classifying leprosy patients. METHODS Seventy-five untreated cases of leprosy attending the outpatient department were evaluated. Smears were taken from their skin lesions and stained using the MGG technique. Skin biopsy was also done from the lesions, which was compared with cytology smears. RESULTS A correlation of clinical features with FNAC was noticed in 87.5% of TT, 92.1% of BT, 81% of BL, and 66% of LL cases. Correlation of clinical with histopathological diagnoses revealed 12.5% specificity in TT leprosy, 55.3% in BT, 52.4% in BL and 50% in LL, and 100% in neuritic and histoid leprosy cases. Both correlations were found to be statistically significant by paired t test analysis. Thus, it was possible to distinguish the tuberculoid types by the presence of epithelioid cells and the lepromatous types by the presence of lymphocytes and foamy macrophages. CONCLUSION FNAC may be used to categorize the patients into paucibacillary and multibacillary types, but is not a very sensitive tool to classify the patients across the Ridley-Jopling spectrum.

Milker's nodule

Milkers nodule virus is a parapox virus that is endemic in cattle. The virus can be grown in tissue culture of both bovine and human cell lines. We report a 53-year-old male, milker who presented with multiple painful nodules on both hands for one month. The nodules were tender and showed central umblication and surrounding rim of erythema. Both epitrochlear and axillary lymph nodes were enlarged on both sides and were non-tender. The skin biopsy revealed marked edema in the epidermis with monouclear inflammatory cell infilitration in the upper dermis. The diagnosis was made on clinical basis. As there was no specific treatment the patient was managed only with antibiotics for secondary infection. The lesions partially resolved after two weeks. This case in reported for its occupational importance.