How accurately do clinical diagnosis correlate with biopsy findings in leprosy?

Objective To document the clinical profile of leprosy patients and to determine concordance between clinical and histopathological diagnosis using Ridley and Jopling classification

Methods 58 clinically and histological confirmed cases of leprosy ranging in age from 7-70 years who attended dermatology outpatient department [OPD] in Saraswathi Institute of Medical Sciences were included in the study. Slit-skin smear examination was performed in all cases. Histopathological investigations were carried out in all cases to confirm the diagnosis and to classify the cases

Results A total of 58 clinically diagnosed cases of leprosy comprised the study material. Out of them, 42 [72.4%] were males and 16 [27.6%] females with male to female ratio of 2.6:1. The highest number of cases was in age group 20-29 years with 22 [37.9%] cases. 10 [17.2%] cases were multibacillary and 48 [82.8%] cases were paucibacillary. The most common site of biopsy was from lower extremities in 24 [41.4%] cases

Clinically, maximum number of patients was borderline tuberculoid [BT] type with 22 [37.9%] cases, followed by tuberculoid leprosy [TT] in 14[24.1%] cases. Lepromatous leprosy [LL] was confirmed in 3 [5.2%] cases. Most common clinical presentation was altered sensation in 57 [98.3%] cases, skin plaques in 46 [79.3%] cases and nerve involvement was noted in 36 [62.1%] cases. Maximum clinicopathological correlation was noted in both poles i.e. LL with 3 [100%] cases and TT with 12 [85.7%] cases and maximum disparity was noted in borderline lepromatous leprosy [BL] in 3 [60%] cases. Overall concordance between clinical and histopathological diagnosis observed in our study was 46 [79.3%] cases

Conclusion Leprosy continues to remain a public health problem. Clinical-histopathological discordance leading to inadequate treatment could be contributory. Our study revealed a 20.7% rate of discordance. Early assessment and adequate management is essential for reducing the discordance rate

Skin in aviation and space environment.

The aerospace environment is a dynamic interaction between man, machine and the environment. Skin diseases are not particularly significant aeromedically, yet they could permanently affect an aviator's status for continued flying duty. A number of dermatological conditions lend themselves to flying restrictions for the aviator. Aircrew and ground crew are exposed to a myriad of elements that could also adversely impact their flying status. Inflight stresses during flights as well as space travel could impact certain behaviors from a dermatological standpoint. With the advent of space tourism, dermatological issues would form an integral part of medical clearances. With limited literature available on this subject, the review article aims to sensitize the readers to the diverse interactions of dermatology with the aerospace environment.

Osler-Weber-Rendu syndrome: a case report with familial clustering.

Osler-Weber-Rendu syndrome, also known as hereditary hemorrhagic telangiectasia, is a rare autosomal dominant disorder manifested by telangiectases of the skin and mucous membranes and arteriovenous malformations of various organ systems. We present a case of Osler-Weber-Rendu syndrome with 11 affected members in her family.

Clinico epidemiological study of pityriasis alba.

Even though pityriasis alba is commonly encountered in dermatological practice, there is paucity of Indian studies on the subject. A clinico epidermiological study was carried out in 200 patients attending the skin department of Command Hospital, Air Force, Bangalore. Atopic background was detected in 85.5% of cases. Bacterial and fungal culture studies failed to reveal any infective aetiology. Helmenthiasis and iron deficiency anaemia were detected in 15.5% and 16.5% of patients respectively. However no other nutritional deficiency was observed in the present study. Majority (84.5%) of patients had lesions of less than 6 months duration at the time of presentation. Face was involved in 91% of patients and generalized pityriasis alba was observed in 3 patients, all of them being infants. Pigmenting pityriasis alba was observed in 7 patients. Hyperkeratosis, parokeratosis, acanthosis, spongiosis and perivascular infiltration were the consistent histological features of pityriasis alba.