Leprosy [part 2]: treatment and disease control

Although, leprosy is a very variable disease, affecting different people in different ways according to their immune response, it is no longer an incurable disease. In areas, where leprosy is less common, the ability to suspect leprosy and refer the patient to the specialist is the most important skill required for junior doctors working in dermatology, general practitioner and other specialities. The Multi-drug therapy "MDT" has been a continuing process and neither relapse nor drug resistance are significant problems. In the present we will review the treatment of leprosy and disease control and recent WHO recommendations

Daivobet once daily versus twice daily for the treatment of Psoriasis vulgaris

Combination therapy is being used with increasing frequency in the treatment of psoriasis in order to improve the efficacy and reduce side effects. Daivobet is the best example combining the effect of calcipotriol and betamethasone dipropionate. Eighty three patients diagnosed as mild to moderate psoriasis vulgaris were enrolled in the study. They were divided into two groups. The first group of 47 patients were instructed to apply daivobet once daily, the other group of 36 patients applied daivobet twice daily. Psoriasis area and severity index [PASI], was used for evaluation of the response to treatment, after 2, 3, and 4 weeks. The reduction in PASI score at the end of the study was statistically significant for both groups [p-value <0.0001 for both groups]. There was no significant statistical difference regarding efficacy between once daily or twice daily application. We recommend once daily application of topical combination therapy of calcipotriol and betamethazone dipropionate for the treatment of mild to moderate psoriasis which is efficacious with less side effects

Candidosis endocrinopathy syndrome

Candidosis Endocrinopathy Syndrome [CES] is the combination of candidiasis, juvenile idiopathic hypoparathyroidism and Addison's disease. Other components such as keratoconjunctivitis, hypothyroidism or pernicious anemia may be present. W report a 40 years old Libyan woman who presented with repeated attacks of muscle twitching, cramps, tetany and rigidity. Also there was a history of a epileptiform seizures and mental retardation. On examination there was bilateral cataract. Oral examination revealed multiple white plaques over buccal mucosa and tongue with fissured lips and widely separated and hypoplastic teeth. There was no thyroid swelling. All 20 nails were thin, ridged, brittle and discolored. Chvostek's sign and Trousseau's sign were positive. Laboratory investigations showed low serum calcium [3.0 mg/dl] with normal serum phosphate and high alkaline phosphates [284 U/L]; serum sodium and postassium were within normal. Microscopic examination of 20 percent potassium hydroxide [KOH] preparation from oral mucosa and nails was positive for candida species. No evidence of intracranial clacification on X-ray of the skull but CT-Scan of the brain showed bilateral clacification of the basal ganglia. In conclusion, our case showed evidence of mucocutaneous candidiasis [MC], eye involvement, hypoparathyroidism, but no evidence of Addison's disease or hypothyroidism. All patients diagnosed with CES need life-long follow-up, because even though this patient didn't have all the components of the syndrome, they may appear later in life