clinicodemographic study of lepra reaction in patients attending dermatology department of a tertiary care hospital in Eastern India

Objective To find the relative prevalence of lepra reactions among leprosy patients attending Dermatology out-patient department, the pattern of reactions in different types of leprosy and histopathological features of reaction.

Methods The study was an institution-based, longitudinal study. A total 316 leprosy cases attended the Dermatology out-patient department [OPD] of a tertiary care hospital in Eastern India.

Results Out of 316 leprosy patients, 58 [18.4%] were diagnosed to have lepra reactions and relative prevalence of type 1 and type 2 reaction was 10.4% and 7.9%, respectively. Among 58 patients, 50 fulfilled the inclusion criteria and were considered for final evaluation. Lepra reactions were common in patients over 30 years of age. There was a high male preponderance and the male to female ratio was 4.5:1. More than 60% of the patients belonged to the below poverty line. Farmers and laborers were more affected. Almost 62% of the patients were literates but most of them had primary education only. Type 1 reaction was more common in BT patients [50%], whereas type 2 reaction were more commonly seen in LL patients [32%]. Erythema and swelling of the skin lesions, neuritis and edema of hands and feet were common features of type 1 reaction. Fresh crops of tender evanescent nodules, joint pain, neuritis and fever were common in type 2 reaction. Classical histopathological features were present in all the 50 slides examined. In type 1 reaction patients, lymphocytic infiltration [96%], dermal edema [93%], epithelioid cells [78%] and Langhans type giant cells [15%] were the common histological findings. Edema and foamy macrophages were seen in all cases of type 2 reaction patients. However, polymorphonuclear leucocytes and vasculitis were seen in 21 [95%] and 16 [73%] patients, respectively.

Conclusion Lepra reactions, both type 1 and 2, occur in about 20% of leprosy patients. Early detection is warranted to avoid complications.

Perifollicular hemorrhagic lesions and broken twisted hairs on legs

A 17-year-old girl presented with multiple perifollicular hemorrhagic lesions on legs for 2 weeks. There was history of intermittent gum bleeding for last 2 months. Clinical examination revealed follicular keratosis and broken twisted hair [corkscrew hair], in addition to hemorrhagic lesions. Perifollicular hemorrhagic lesions and corkscrew hair are virtually pathognomonic for scurvy. When specifically asked, mother revealed that the girl was on self-imposed diet with almost no citrus fruits. Based on history and clinical findings, diagnosis of scurvy was made. The response to vitamin C supplementation was very good and all the lesions disappeared within one month. Scurvy has been reported in increasing numbers in recent literature; hence, recognition of scurvy is essential to avoid many serious complications including internal bleeding and even, death

Cutaneous metastasis as presenting feature of internal malignancy - report of two cases

Cutaneous metastasis [CM] from internal malignancy is usually seen in advanced stage and hence is associated with bad prognosis. Sometimes, CM alone is a presenting feature without any obvious feature of internal malignancy. High index of suspicion and histopathology can establish the diagnosis of CM. Identification of underlying malignancy is based on clinical futures, histopathology, immunohistochemistry and other investigations. CM was the presenting feature in our cases and identification of CM led to search for underlying malignancy and then initiation of therapy