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Leprosy (Hansen’s disease) is mainly affecting skin & nerve. Lepra reaction is common amongst leprosy patient. We report 64 year female patient who completed MB-MDT treatment and was on steroid therapy for treatment of ENL reaction. We observed unusual presentation of palatal perforation which rarely seen in ENL case. On examination it found that perforation was present on hard palate midline at the level of first molar tooth. Such type of presentation rarely seen in ENL cases till date few such reports have published in the journals. Keyword: Multi-bacillary leprosy case, Chronic ENL reaction, palatal perforation.

Hansen Disease (leprosy) is a chronic inflammatory infectious disease that primarily targets skin, nerves and other internal organs (testis, liver etc.) caused by the acid fast intracellular bacilli, Mycobacterium leprae. Clinical presentation occurs with a wide spectrum including hypo pigmented anaesthetic patches, raised erythematous plaques and nodules and thickened peripheral nerves showing tenderness. The most important complication is the disability and deformity. The diagnosis of leprosy is frequently delayed because of its similarity with other more common skin conditions prevailing in some non endemic areas. We present a rare case report of tinea barbae in an old treated case of leprosy. This case is one of the rarest fungal infection in leprosy patient searched in PUBMED as there were other more tinea infection involving various sites in body which sometimes misdiagnosed as leprosy.

Objective: The aim of this meta-analysis was to evaluate the efficacy of topical phenytoin in the treatment of ulcers of different origin compared with other standard topical treatment. Methods: Randomized controlled trials were identified by searching PubMed, Embase, Medline, and Web of Science. Outcomes were complete wound healing rate and reduction in wound volume or surface area. Results: Thirteen studies with 980 patients were included. Topical phenytoin were associated with a statistically significant improvement of complete wound healing rate compared with other line of management in 11 randomized control trial of 815 patients (odds ratio = 3.03, 95% confidence interval 2.23-4.10, Z = 7.14, P < 0.00001). No publication bias exists in this meta-analysis. Three studies from India also confirmed that the topical phenytoin was associated with a statistically significant percent reduction in wound volume compared with the other dressing (mean difference 23.56, 95% confidence interval 19.48-27.64, Z = 11.32, P < 0.00001). Conclusion: The existent evidence shows that topical phenytoin is more effective for ulcer treatment.

We report an unusual case of hyperpigmentation in a 40-year-old female who was on treatment for leprosy with rifampicin 450 mg daily for 2 months. After scrutinizing the treating physician's previous prescriptions and history, it was found that the patient has never taken clofazimine and minocycline, which were considered to cause hyperpigmentation in antileprosy regimen.

We report a female case who developed hypothyroid in the course of multibacillary multidrug therapy regimen for leprosy. The evaluation was made to rule out the possible cause of rifampicin induced hypothyroidism in Hashimoto′s thyroiditis.