Background:Peripheral nerve involvement results in deformities in leprosy. High doses (40-60 mg) of steroids along with anti-leprosy drugs is the preferred treatment, even though 70-75% cases still develop deformity. Early surgical decompression of nerves gives better chances of preventing deformity. We have analyzed the role of early surgical decompression in such cases.Materials and Methods:Five hundred nerves (386 ulnar, 60 median and 54 posterior tibial) not responding to the medical treatment in 12 weeks, were undertaken for external and internal nerve trunk decompression. These cases were followed up for five to 20 years at various intervals.Results:The pain in nerve (neuralgia) recovered in all cases of ulnar, median and posterior tibial nerves. Full sensory recovery to pinprick and feather or cotton wool touch was seen in 50% cases of all the three nerves. Twenty percent cases maintained the preoperative levels of sensory status. Plantar ulcers healed within six months after decompression of posterior tibial nerve but six cases showed recurrence. Overall motor recovery in ulnar nerve was 89% and 70% in median nerve.Conclusions:The sensory recovery restores protective sensation which prevents secondary injuries. The improvement of motor power gives better function and improves the appearance, which in the absence of surgical intervention was not possible.

BackgroundWhile prednisolone is commonly used to treat recent nerve function impairment (NFI) in leprosy patients, the optimal treatment duration has not yet been established. In this “Treatment of Early Neuropathy in Leprosy” (TENLEP) trial, we evaluated whether a 32-week prednisolone course is more effective than a 20-week course in restoring and improving nerve function.MethodsIn this multi-centre, triple-blind, randomized controlled trial, leprosy patients who had recently developed clinical NFI (<6 months) were allocated to a prednisolone treatment regimen of either 20 weeks or 32 weeks. Prednisolone was started at either 45 or 60 mg/day, depending on the patient’s body weight, and was then tapered. Throughout follow up, NFI was assessed by voluntary muscle testing and monofilament testing. The primary outcome was the proportion of patients with improved or restored nerve function at week 78. As secondary outcomes, we analysed improvements between baseline and week 78 on the Reaction Severity Scale, the SALSA Scale and the Participation Scale. Serious Adverse Events and the need for additional prednisolone treatment were monitored and reported.ResultsWe included 868 patients in the study, 429 in the 20-week arm and 439 in the 32-week arm. At 78 weeks, the proportion of patients with improved or restored nerve function did not differ significantly between the groups: 78.1% in the 20-week arm and 77.5% in the 32-week arm (p = 0.821). Nor were there any differences in secondary outcomes, except for a significant higher proportion of Serious Adverse Events in the longer treatment arm.ConclusionIn our study, a 20-week course of prednisolone was as effective as a 32-week course in improving and restoring recent clinical NFI in leprosy patients. Twenty weeks is therefore the preferred initial treatment duration for leprosy neuropathy, after which likely only a minority of patients require further individualized treatment.

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Further studies are needed to identify parameters likely to be helpful in the diagnosis of early nerve damage.

Siunmary 102 children with dermatitis predominantly affecting the weight-bearing areas of the feet, are described. Despite a clinical appearance suggestive of an allergic contact dermatitis, only thirteen children had positive patch tests to any substance in the European battery, or to constituents of their own footwear. The relationship of this condition to two similar dermatoses in the literature is discussed,

Infestation of the nose with larvae of certain files can occur in leprosy patients. This results in severe distress and agony and can cause extensive tissue damage. The predisposing fa ctors, clinical presentation and treatment is de scribed.

Objectives. To assess the burden of new leprosy cases in India and the efficiency of case detection work by ASHA in general health system. Methods. A sample survey of 804,536 persons was undertaken in 8 districts during 2009-2010: 4 each in Haryana (low endemic for leprosy) and Uttar Pradesh (high endemic for leprosy). About 20% population was covered from urban areas. Results. The survey suggested that burden of new case detection rate of leprosy in India per 10,000 population could be 4.41 in comparison to 1.09 as per government records. When present observation is adjusted to team performance in rural area, the NCDR increased to 10.64 per 10,000. This leads to suggest that NCDR in India could further increase to 9.76 times when adjusted to team performance. This data suggest that large numbers of early leprosy cases do not reach the health facilities where leprosy treatment is provided, although some chronically ill patients reach late, and thus multibacillary disease is found more in passive reporting. This could also be an indicator of a large number of established cases not being sufficiently self-motivated or lacking knowledge to utilize the free diagnosis and treatment services. Thus, the programme needs to be designed to meet these objectives effectively to better utilize the available services to reduce the leprosy burden. Conclusion. Active survey detected many folds higher leprosy cases in community, and this suggests that the information, education, and communication based approaches have a very minimal effect. If the programme continues to be based on IEC activities, the information should be designed in such a way that most persons suspected to have leprosy can know about free treatment, place of availability, and its effectiveness. However, leprosy elimination campaign surveys may be used as a tool to filter large pool of cases from community.

Background:Majority of the cosmetics are synthetic in nature and capable of causing dermatitis among frequent users. Some cosmetics (bindi, sindoor, etc.) that cause serious skin inflammation are specific to Indian culture.Aim:To study the prevalence of contact dermatitis due to various cosmetics indigenous among Indian users.Materials and Methods:A cross-sectional study of 2,150 patients who attended dermatitis clinic at a regional hospital in north India. A total of 400 of these were suspected of cosmetic dermatitis based on clinical grounds and were subjected to patch test using Indian Standard Series and Cosmetic series kit.Results:Among the 400 patients identified for cosmetic dermatitis, 352 (88%) were female and 326 (81.5%) between 20 and 49 years of age. Bindi/kumkum (30%), hair dye (18%), and deodorant/perfume (14%) were primary cosmetics causing contact dermatitis. Patch test with the suspected cosmetics was positive in 52.75% cases. Patients who visited their doctor in the early stages of appearance of symptoms (<3 months) were more likely to have positive patch test.Conclusion:Higher incidence of cosmetic dermatitis is observed in adult females aggravated by use of inferior quality cosmetics. Early detection of the disease can be helpful.