RESUMO
Background Erythema nodosum leprosum (ENL) is an immune complex-mediated reaction that clinically presents as tender erythematous evanescent nodules, mostly associated with systemic symptoms. Oral prednisolone is the drug of choice, with doses ranging from 0.5 to 1 mg/kg. Some cases may develop new lesions and systemic symptoms despite 1 mg/kg prednisolone, and in ideal practice, physicians escalate the prednisolone dose for immediate arrest of inflammation to prevent complications. However, a high dose of prednisolone has more side effects in the long term and causes more immunosuppression. Methods In cases of ENL, those not responding to a conventional once-daily regimen were given a split dose of oral prednisolone instead of increasing the dose. They were followed up for response, and serum cortisol was measured to see for hypothalamic-pituitary-adrenal (HPA) axis suppression. Results Eight cases of ENL (three nodular, three necrotic, one pustular, and one nodulcerative) had a dramatic response to split-dose therapy without any relapse and HPA axis suppression. Conclusion A split-dosing regimen can be a good treatment option in ENL with better control, less steroid dependency, and a lower relapse rate.
RESUMO
Background: Frontal fibrosing alopecia (FFA) is an important cause of scarring alopecia seen mostly in post-menopausal women but sometimes in pre-menopausal women and men. Although considered a variant of lichen planopilaris due to its histopathological characteristics, it has distinct clinical features and associations, which make it a unique entity. We hereby report a series of patients with FFA from North-East India. Aims and Objective: This study aimed to analyse the clinical and histopathological characteristics of FFA. Materials and Methods: We retrospectively analysed clinical records and histopathological features of FFA cases diagnosed in the Dermatology Outpatient Department from April 2013 to February 2023. Results: A total of 21 patients, who were diagnosed with FFA from April 2013 to February 2023, were analysed. Of these, 19 patients were female, with a male-to-female ratio of 9.5:1. The mean age of study population was 48.33 years. The majority of the patients were from the post-menopausal age group (15/19 females, 78.94%). Lichen planus pigmentosus (6, 28.57%) was the most commonly associated disease, followed by androgenetic alopecia and lichen planopilaris (2 each, 9.52%). The main histological features noted were perifollicular lymphocytic infiltrate in 18 (85.71%), followed by hydropic degeneration of basal follicular keratinocytes in 15 (71.42%) and melanin incontinence in 14 (66.66%) patients. Conclusion: Our study is the first study from North-East India focusing on the clinical presentation and histopathological characteristics of FFA. Furthermore, with respect to the recent development in FFA, our study attempted to determine the clinical significance of the proposed criteria for the diagnosis of FFA patients by Tolkachjov et al. (2018), viz. International FFA Cooperative Group Criteria (2021).
