Cryotherapy: A Successful Monotherapy for Earlobe Keloids.

A keloid represents an excessive overgrowth of skin beyond the boundaries of an injury. Earlobe keloids usually follow ear piercing and can become large, sometimes producing remarkable disfigurement. Surgical excision, pressure dressing, intralesional corticosteroid injection, cryosurgery, radiation, and lasers have all been used to treat earlobe keloids. However, none has produced uniformly satisfactory results. Combinations of more than one modality have also been employed to yield successful outcomes. We describe cryotherapy as a single modality to treat seven-year-old, multiple earlobe keloids. Three cryotherapy sessions with two freezing-thawing cycles of 30-40 seconds' freezing time and two minutes' thawing time, undertaken one month apart, resulted in complete flatness of the keloids and no recurrence after 5 years. We also evaluate keloid-related and operational factors that determine the success of cryotherapy as a monotherapy for earlobe keloids.

Impact of polystyrene beads as a mosquito control measure to supplement lymphatic filariasis elimination activities in Socotra Island, Yemen.

Lymphatic filariasis (LF) is targeted for worldwide elimination. In Yemen, all mainland implementation units met the WHO criteria for stopping mass drug administration (MDA) after 5 rounds. However, in Socotra Island these criteria were not met. Our study evaluated the efficacy of applying expanded polystyrene beads (EPBs) on the Culex population and the effect on LF transmission. Human and mosquito surveys were conducted in 40 randomly selected households in Hadibo (capital of Socotra) before and after application of EPBs. The EPBs intervention resulted in a reduction in mosquito density of 80% and a 64.3% reduction in microfilaria prevalence. The majority of interviewed households (98%) thought EPBs considerably reduced the mosquito population. After the intervention all collected pools tested negative. Application of EPBs is an effective supplement to MDA for achieving the goal of LF elimination.

Impact of polystyrene beads as a mosquito control measure to supplement lymphatic filariasis elimination activities in Socotra Island, Yemen

Lymphatic filariasis [LF] is targeted for worldwide elimination. In Yemen, all mainland implementation units met the WHO criteria for stopping mass drug administration [MDA] after 5 rounds. However, in Socotra Island these criteria were not met. Our study evaluated the efficacy of applying expanded polystyrene beads [EPBs] on the Culex population and the effect on LF transmission. Human and mosquito surveys were conducted in 40 randomly selected households in Hadibo [capital of Socotra] before and after application of EPBs. The EPBs intervention resulted in a reduction in mosquito density of 80% and a 64.3% reduction in microfilaria prevalence. The majority of interviewed households [98%] thought EPBs considerably reduced the mosquito population. After the intervention all collected pools tested negative. Application of EPBs is an effective supplement to MDA for achieving the goal of LF elimination

[Human onchocerciasis and "sowda" in the Republic of Yemen]. / Onchocercoses humaines et "sowda" en République du Yémen.

The geophysics of the north Yemen, associating a north-south directed mountainous fish bone (rising in more of 2,000 meters), to numerous rivers or "wadis" is convenient to the development of simulium shelters, main vectors for cutaneous filariasis to Onchocerca sp. Following several missions of bio-clinical and epidemiological evaluations in neighbouring villages of wadis, it has been possible to study different clinical aspects: one reminding the classical african onchocerciasis with generalized and diffused dermatitis, and, on an other hand, a hyperreactive dermatitis on one side of the body and associated with a collateral lymphatic ganglion. This disease is well known for local populations as "aswad" meaning "black" or "sowda". Clinically whatever the studied focus, coexists the two types of onchodermatitis (uni or bilateral). Yhe sowda patients are proportionally less numerous than those touched by the generalized type. Frequent eye lesions of the West African onchocerciasis are not found in sowda cases. In classical optical microscopy, microfilaria is morphologically indifferenciable between sowda and onchocerciasis clinical aspects. Skin snips were carried out on patients of both groups. Identification of microfilaria by molecular biology through the study of the DNA genome was done out of 5 skin snips. Microfilaria was kept dry between laminas and the DNA extracted from rehydrated microfilaria. DNA was intensified with specific primers of Onchocerca type (O150PCR). This phase was followed by hybridisation of amplification products by PCR to specific stains: OVS-2 for Onchocerca volvulus species, OCH for Onchocerca ochengi, PFS1 and PSS1-BT respectively for the forest strain and the savannah strain of Onchocerca volvulus as described previously. We can distinguish 2 kinds of answers based on the clinical origin of the snip-tests: the first one concern 3 patients with numerous dermal microfilariae but without any clinical sowda and corresponding to microfilaria O. volvulus type but different from the forest or savannah strains found in sub-Saharan Africa. The second one corresponds to 2 patients with less than 5 microfilaria in their snip-test. They show the typical clinical picture of sowda. They are identified as microfilaria type Onchocerca but they do not belong to species volvulus, or to species ochengi. It seems quite probable that the clinical picture of sowda be the result of developing onchocerciasis of animal origin and not identified as to day. The ivermectin, therapeutic of choice for African onchocerciasis in annual unique cure seems less effective in the coverage of sowda. In that case rehearsal of cures every 3 months would be necessary for mass campaigns to limit the transmission of this filariasis.

Multidrug therapy--the pathway for global leprosy elimination.

Introduction of dapsone therapy paved the way for better and more humanitarian way of dealing with the leprosy victims who, prior to 1943, were simply rejected and segregated from society. Emergence of dapsone-resistant M. leprae and mycobacterial persistence provoked our quest for another solution. More drugs were discovered for treatment of leprosy. But the real breakthrough was the recommendation of regimens of multidrug therapy (MDT) for the treatment of leprosy by the WHO Study Group on Chemotherapy of Leprosy in October 1981. Subsequent world wide development of leprosy control activities was phenomenal. The impact of MDT has led to the cure of over eight million leprosy sufferers and the saving of one million patients from becoming crippled. Leprosy prevalence has decreased by 80% in ten years. By the end of May 1999 the leprosy burden remained concentrated in only 12 countries of the world. These achievements are mainly attributed to the development and worldwide adoption of the MDT programme.

Review of leprosy control activities in Yemen.

Leprosy control activities in Yemen are reviewed historically and up to the present time. Since 1983 the World Health Organization's multidrug therapy has been used in the National Leprosy Control Programme. Current activities are carried out in 63 leprosy clinics distributed all over the country and staffed by trained primary health care workers and medical assistants. In Yemen leprosy prevalence has declined from 1400 per 10,000 population in 1990 to 647 in 1997. Over the same period, new case detection rates per 10,000 population increased from 185 to 517. A backlog of leprosy cases continues to transmit the disease in Yemen.

[Onchodermatitis (sowda) in patients in Yémen. Clinical and histologic course after treatment with ivermectin]. / Onchodermatite (Sowda) chez des patients du Yémen. Evolution clinique et histologique après traitement par ivermectine.

Sowda skin lesions are of medical and social importance in Yemen. Ivermectin (Mectizan) chose as a control strategy plan in onchocerciasis is active during 3 months for the less on clinical and histological data. After a short increase of itching and oedematous skin aspects clinical signs decrease. Some patients notice an itching rebound after 90 days. Histologically, localized ingratiates, presence of mononuclear cells and melenin loaded histiocytes and eosinophils decreased. The rythm cure has to be studied on a longer period but 3 to 6 months repetition between oral treatment with 200 micrograms/kg dose during two years could be effective.

Dermatologists combat leprosy in Yemen.

BACKGROUND: Leprosy has been prevalent in Yemen for many years. The ostracization and stigmatization of leprosy patients are well documented in the yemeni literature. No control activities were carried out until 1980. AIM: To document the development of leprosy control activities in the Republic of Yemen during the period from 1982 to 1996. MATERIALS AND METHODS: The dermatologists in Yemen used various methods, including the media, to fight the stigma of leprosy and thus to mobilize the community for the reintegration of leprosy patients. They sought support from international non-governmental organizations (NGOs) to start mobile teams all over the country. RESULTS: The support of the German Leprosy Relief Association (GLRA) and the World Health Organization (WHO) enabled the National Leprosy Control Program (NLCP) to reach people in remote areas. The prevalence of leprosy has declined from 1.9 per 10,000 population in 1989 to 0.5 per 10,000 population in 1996. CONCLUSIONS: The stigma associated with leprosy also extends to other skin diseases. To combat this stigma, various methods, such as health education, training of medical personnel, and mass treatment for skin diseases, have been used.

PIP: In the Republic of Yemen, leprosy patients face social stigmatization and considerable suffering. Diagnosis and treatment are delayed by the poor health infrastructure, difficult terrain, and political instability, resulting in unnecessary complications and deformities. The National Leprosy Control Program, established in 1982 with the support of the German Leprosy Relief Association and the World Health Organization, has sought to reach people in remote rural areas. 63 leprosy clinics have been established in 14 regions; 60 of these clinics are integrated into the primary health care system. In addition, dermatologists, with support from international nongovernmental organizations, have campaigned through the media and mobile teams for an end to the ostracism of leprosy patients and urged their reintegration into the community. Other interventions have included the production of posters for health education, construction of an orthopedic workshop, reconstructive surgeries performed by an international corps of volunteer physicians, training courses for medical personnel, and a rehabilitation program to teach sewing to women with leprosy. As a result of early passive detection and other leprosy control efforts, Yemen's leprosy caseload has declined from a peak of 2314 registered for treatment in 1989 to 765 in 1996. The prevalence of leprosy has declined from 1.9/10,000 population in 1989 to 0.5/10,000 in 1996. A combined leprosy-tuberculosis pilot project is under development. By the year 2000, leprosy should be eliminated as a public health problem in Yemen.

Retrospective analysis of 194 leprosy cases in the Republic of Yemen.

A review of the case files of 194 leprosy patients registered at a representative skin and venereal diseases out-patient clinic was done to assess the epidemiological and clinical patterns of the disease in Yemen. Almost all patients came from the poorer social groups and there was clustering of patients around some families. About 55% of the patients were aged 20 to 39 years and about 35% were aged over 40 years at the time of detection. Males were affected about three times as females; in males MB cases occurred about twice as often as PB cases and 12% of the cases presented as pure neuritic leprosy. Reactions were noticed in 39 cases (20%), six having type 1 and 27 having type 2 reaction. Bacterial index (BI) among 123 positive cases ranged from 0.1 to 6, about 70% of these cases showing mean BI of more than 2.0. Patients' response to treatment (MDT) was very good and BI decreased by about 1.55 (+/-0.05) logs per year. About 50% of the patients had some disability (14% grade 1), and the disability rate among PB cases was about 70%. Our findings indicate the need for earlier diagnosis and better disability preventive measures.