Dermoscopic patterns in relation to the Clinicopathologic manifestations of Leprosy

Objectives@#Leprosy is a chronic granulomatous infection caused by the obligate intracellular organism Mycobacterium leprae. Current diagnostic tests for confirmation and treatment monitoring such as slit skin smear and biopsy are invasive and require time for processing, reading, and interpretation. Dermoscopy is a technique that allows the visualization of structures not readily seen by the naked eye. It can be performed at the point of care, providing a non-invasive link between clinical and histopathologic examination. This study aimed to determine the dermoscopic findings and associated clinicopathologic findings of the different forms of leprosy. @*Methods@#A cross-sectional study was conducted. All new and follow-up patients aged 19 years old and above clinically diagnosed with leprosy were invited to participate in the study during the three-month investigation period. Clinical and dermoscopic photographs of representative skin lesions were taken, and a review of slit skin smear and histopathology results was done. Data analysis was performed using Stata SE version 13. The association between dermoscopic findings and the following parameters: anatomic location, Ridley-Jopling classification, WHO classification, treatment duration, and average bacteriologic index were analyzed using Fisher’s exact test. The level of significance was set at 5%. @*Results@#A total of 57 lesions were included. Linear vessels (p=0.031), structureless areas (p=0.008), and globules (p=0.002) were found to be significantly associated with the anatomic location. Decreased hair was found to be significantly associated with treatment duration (p=0.038). No significant associations were found between dermoscopic findings and Ridley-Jopling classification, WHO classification, and ABI. Eight biopsies taken at the time of dermoscopy were reviewed, with all sites showing structureless or globular areas corresponding to the presence of granulomas on histopathology (100%). No other notable associations were observed. @*Conclusion@#Dermoscopy is a potentially useful tool to aid in the diagnosis and treatment monitoring of leprosy. Limitations of this study include the small sample size, the preponderance of subjects in the lepromatous pole, and assessments by a single trained dermoscopist. A longer study duration including a larger number of newly diagnosed leprosy patients is recommended.

Serum cytokines in erythema nodosum leprosum versus non-reactional leprosy: A systematic review and meta-analysis

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Erythema nodosum leprosum is an immune-mediated complication of leprosy whose underlying mechanism has not yet been fully elucidated, making management difficult.</p><p style="text-align: justify;"><strong>OBJECTIVES:</strong> To determine the serum cytokine profile of ENL compared to non-reactional leprosy states.</p><p style="text-align: justify;"><strong>METHODS:</strong> An open literature search was performed using MEDLINE, Cochrane Library, TRIP and HERDIN electronic databases using the keywords ("cytokines" or "inflammatory mediators") and ("erythema nodosum leprosum" or "ENL") and ("leprosy" or "lepra"). Studies were selected by two independent review authors. Risk of bias was assessed using the Newcastle-Ottawa Scale and statistical analysis was performed using RevMan 5.3 software.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Eight cross-sectional studies with 197 participants were included. Meta-analysis showed that both serum IL-17 and serum IFN-? were significantly decreased (Z 2.39, p = 0.02 and Z 2.74, p = 0.01, respectively) in ENL compared to non-reactional states. However, for IL-1?, IL-6, IL-10, IL-22, TNF-? and TGF-?, no significant differences were found between the two groups.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> ENL appears to be an exacerbation of the Th2 cytokine response seen in the lepromatous pole of leprosy. However, despite pooling of data, sample sizes remain small resulting in significant heterogeneity. Future studies involving large sample sizes and investigating a wider range of cytokines are encouraged.</p>

Androgenetic alopecia and its association with metabolic syndrome: A systematic review and meta-analysis

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> The study aimed to confirm the association between androgenetic alopecia (AGA) and Metabolic Syndrome (MetS). It also aimed to determine if early-onset AGA among males and AGA among females increases the risk of developing MetS, and if severity of AGA increases the odds of developing MetS.</p><p style="text-align: justify;"><strong>METHODS:</strong> Observational studies from electronic databases were selected by the consensus of three independent review authors. The Newcastle-Ottawa Scale for assessing the quality of non-randomized studies in meta-analysis was used. Statistical analyses were accomplished using Review Manager software.</p><p style="text-align: justify;"><strong>RESULTS:</strong> A total of 11 case-control studies, one prospective cohort study, and five cross-sectional studies were selected. In the meta-analysis of ten case-control studies and three cross-sectional studies (3840 participants), AGA was significantly correlated with MetS (OR 2.59, 95% CI 1.51 to 4.44; p<0.0005). Early-onset AGA among males (</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Although the pathophysiology still remains under investigation, the present study points to an association between AGA and MetS. It can be used as a marker to identify patients who should be screened for MetS and managed accordingly.</p>

Recurrent ulcerations and neuropathy in a Filipino child with previously undiagnosed leprosy: A case of Lucio phenomenon in the Philippines

@#<p style="text-align: justify;">Lucio phenomenon is a distinct necrotizing lepra reaction arising from diffuse lepromatous leprosy that may easily be mistaken for other systemic conditions. We report a 17-year old female admitted for a 4-year history of recurrent, extensive ulcerations with crusting and purulent discharge, involving the arms, legs, face, and back. Clinical presentation, slit skin smear and skin biopsy confirmed the diagnosis of Lucio phenomenon and treatment with multidrug therapy resulted in resolution of the ulcerations.</p>