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The article presents information on the Classification of Leprosy. The real breakthrough in the classification of leprosy was enacted at the Madrid International Leprosy Congress, where, while adopting the Pan American Classification, the term uncharacteristic was replaced by the term indeterminate, as recommended by Hawana Congress and the Third Pan American Congress. The tuberculoid patient or Leprosy patient had a tendency, because of strong immunity, to have few skin lesions, which were most commonly simple well-defined macules or plaques that were hairless, anhidrotic, anesthetic, negative for acid-fast bacilli (AFB), and often had a thickened peripheral nerve in the region of the skin lesion.

This article reports that phase I in the prevention of hanseniasis and phase II have failed. The endemic and the stigma are rising in most developing countries, social rejection of patients and contacts continue, ignorance and counter-education prevail everywhere. Phase III is inaugurated in Brazil with the frank admission that "lepra is not a disease like any other," but rather an exceptional "psycho-social-somatic phenomenon" to be handled in an exceptional way. In 1976, a completely new program for the prophylaxis of hanseniasis was inaugurated by the Brazilian Ministry of Health, which was to be in accordance with the recommendations of the National Conference to Assess the Policies of Hanseniasis Control.

This article discusses the use and the mode of action of dapsone. It remains the standard treatment either alone or in combination, for the vast majority of patients suffering from leprosy despite recent reports of dapsone resistance from several different countries. Dapsone (DDS; di-amino di-phenyl sulphone) was discovered in 1908 and first given to leprosy patients in Carville Leprosarium in the United States over 30 years later in the form of glucosulphone (Promin), intravenously. A great deal of experimental work has been carried out on dapsone as a chemotherapeutic agent against streptococci and various mycobacteria. Further study of its effect on the membranes and contents of lysosomes seems to warrant consideration as one which may be useful not only for leprosy, but also for the other conditions in which this drug is often remarkably yet inexplicably, effective.

β2 glycoprotein I (β2GPI) is a phospholipid binding protein that plays an important role in endothelial stability, blood coagulation, clearance of apoptotic debris and other physiologic processes. Anti-β2GPI antibodies occur in normal individuals and transiently during the course of infections, but are also associated with thrombotic events in autoimmune disease: the antiphospholipid syndrome (APS). A total of 31 out of 37 treated leprosy patients previously found to present high titers of IgM anti-β2GPI and/or anticardiolipin antibodies (aCL) remained positive for IgM antiphospholipid antibodies (aPL), and exhibited high titers of anti-β2GPI. The 37 patients were part of the 77 aPL-positive patients from a previous study that evaluated 158 leprosy patients. The median time elapsed between the first and second sample was 66 months. None of the 37 patients had any thrombotic event and 24 had a reactional state and were still requiring the use of prednisone, thalidomide or both. None of them fulfilled World Health Organization criteria for leprosy recurrence. [ABSTRACT FROM PUBLISHER]

An essay regarding histopathology's limitations in the diagnosis and management of leprosy patients is presented. It presents clinical situations that involve non-specific findings and indeterminate histology wherein histopathology may be confusing or inadequate, while clinico-pathologic considerations is necessary. Meanwhile, a definition of indeterminate histology is also presented.

A letter to the editor is presented in response to the article "Is phenolic glycolipid-I really a specific antigen for leprosy?" by R. Sinha and colleagues that was published in a 2010 issue of the journal.

Hypnotherapy is a useful adjunctive psychotherapeutic procedure used in various conditions such as pain disorders, atopic dermatitis, and alopecia areata. However, it is less utilized in the field of dermatology. Only limited data exist on its role in the management of various skin diseases. There is dearth of literature on the role of hypnotherapy in Hansen's disease (HD). We report two cases of HD, one with very resistant neuralgia and the other with recurrent erythema nodosum leprosum (ENL). Both the patients were assessed using hospital anxiety and depression scale, dermatology life quality index and the neuralgia was assessed using the visual analog scale. Three sessions of hypnotherapy were given to both the patients. There was dramatic improvement in the incidence of ENL and neuralgia and we could rapidly reduce the dose of drugs used for both conditions. [ABSTRACT FROM AUTHOR]

Syphilis is a systemic and chronic infectious disease, caused by the spirochete Treponema pallidum. It is mainly transmitted through sexual contact or vertical transmission. It affects both sexes equally. It has active and latent periods. Syphilis manifestations range from classically known lesions to nonspecific clinical diagnosis, mimicking other clinical diseases and so hindering its diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Leprosy maybe “unmasked” in the context of immune reconstitution inflammatory syndrome and treating dermatologists, particularly in highly endemic areas for Hansen’s disease, need to be cognizant to this possibility. It may also reflect emergence of a previously clinically silent infection in the course of immunologic restoration. [ABSTRACT FROM PUBLISHER]

The article presents information about various literary publications related to dermatology. Some of the literary publications are: "Myoblastoma of the Tongue," by X. Vilanova and C. Cardenal; "Commentary on the Treatment of Psoriasis," by Enrique Alvarez Sainz de Aja; "Giant Prickle Celled Epithelioma," by G. Jaqueti del Pozo and R. Garcia Montelongo; "Advances in the Treatment of Skin Diseases," by P. Borrie; "Advances in the Treatment of Leprosy," by R.G. Cochrane; "Multiple Eczematous Sensitivities," by R.L. Baer.

The article presents a case study of a 32-year-old Indian man presented with a striking oedematous skin eruption, painful ankles and pyrexia. It states that the patient presented with type 1 or reversal reaction (TIR) before the initiation of therapy. It is essential to treat leprosy reactions with multidrug therapy (MDT) and oral corticosteroids to reduce acute inflammation and reverse nerve damage.

Introduction: Leprosy is a chronic infectious disease affecting mainly cutaneous and peripheral nervous system. Histopathology is an important tool to diagnosis leprosy in situation where it mimics other clinical condition. This study was conducted to know the correlation between clinical and histopathological diagnosis of Leprosy. Material and Methods: This was a retrospective study and patients were enrolled in whom leprosy was clinically diagnosed or suspected and histo-pathological examinations were carried upon. Results: A total of 71 patients were studied. Of them 48 patients (67.6%) were males and rest 23 (32.39%) patients were females. Mean age of patients at presentation was 37.85 +/- 2.021 years. Clinically in 42 patients (59.1%) type of leprosy could not be specified. Borderline tuberculoid was diagnosed in 7 patients (9.8%), Tuberculoid in 6(8.5%), Relapse in 3(4.2%), lepromatous in 6(8.5%) and Borderline, borderline lepromatous 1(1.4), Indeterminate 1 patient (1.4%). In 7% cases, Hansens disease was considered as differential diagnosis along with other clinical conditions. In 47% cases, data was not available. On histopathological evaluation on skin biopsies, epidermal changes seen were 29.5%. Of the total 71 patient, dermal changes seen were granuloma (42%), dermal infiltrate (11%), adnexal infiltrate (7%), nerve infiltrate (11%), adnexal with nerve infiltrate (6%), perivascular with adnexal infiltrate (20%) and nonspecific (3%). Dermal infiltrates in 46.4% cases constituted of lympho-histiocytes. In 48 patients (69%) leprosy was histopathologically confirmed and in rest 31% cases diagnoses was non-specific in 20 patients (28.1%), vasculitis, Dariers and Fungal infection 1 patient each (1.4%). Borderline Tuberculoid (BT) and TT was the most common diagnosis among leprosy patients around 29.2% each, followed by Indeterminate 25%, LL 8.3%, BL and and Pure neural 4.1% each. When clinical diagnosis and histopathological diagnosis was correlated it was found that the parity was seen in TT as 66.6%, BT 42.9%, LL 16.7%. Where Hansen's disease was kept as differential diagnosis two patients had leprosy. Conclusion: The study being retrospective the uniformity in clinical diagnosis and histopathological evaluation couldnot be assessed. With the limitations this study still give information about the importance of histopathology to diagnose Leprosy and for proper treatment category and decrease the burden of the disease in the society. [ABSTRACT FROM AUTHOR]

The authors discuss the improvement of case detection in eliminating leprosy through the National Leprosy Eradication Program (NLEP) in Odisha. They observe that NLEP was fast-tracked to attain the elimination target on early leprosy diagnosis and treatment. They note the use of sensitive indicators for leprosy surveillance quality monitoring in eliminating the disease.

The author reflects on the improvement in the awareness and attitude towards leprosy which results from Mycobacterium leprae infection. He emphasizes the aspects that made the global application of multidrug therapy as a leprosy programme successful. He says that the improvement in treatment compliance and reduction of stigma towards people affected are due to increase participation of the patients. He also stresses the major problem for the programme is sustaining leprosy control activities.

LRRK2 (leucine-rich repeat kinase 2) is a gene of unknown function that has been linked to a number a human diseases, including PD (Parkinson’s disease), IBD (inflammatory bowel disease), leprosy and cancer. The papers from the LRRK2: Function and Dysfunction meeting in this issue of Biochemical Society Transactions explore our growing knowledge of LRRK2’s normal function, the role that it plays in disease and emerging strategies to exploit LRRK2 as a therapeutic target. [ABSTRACT FROM AUTHOR]

The article discusses a study that aims to evaluate the proportion and pattern of deformities among registered leprosy affected individuals (LAIs) in Chamrajanagar district, India. The study also aims to evaluate the care needs for disability limitation and rehabilitation among leprosy patients with deformity. It notes that the proportion of deformities in the district is rising and there is a need to monitor LAIs for deformity during treatment and maybe even after the completion of the treatment.

The article discusses various reports on neuropathies and the initial symptoms that clinicians need to be aware of during treatment. It states that dapsone is intended for infectious diseases treatment and was later shown to have anti-inflammatory properties. It mentions the constellation of hematological adverse reactions with oral dapsone therapy. It notes several dermatological conditions that are treated with dapsone which include leprosy, acne conglobata, dermatitis herpetiformis and Behcet's disease. It cites that guidelines to monitor the hematologic adverse effects of oral dapsone are in place but lack neurological side effects such as neuropathy.

The World Health Organization estimates that about 80% of the population of most developing countries relies on herbal medicines for their primary health care needs. Presently there are many medicinal herbs under investigation for their potential health protection. Among the products under investigation are commonly consumed products like vegetables, fruits and condiments expected to protect health and possess disease inhibiting properties like leprosy which caused by Mycobacterium leprae. This review therefore attempts to bridge the existing literature and modern research and offers immense scope for researchers engaged in validation of the traditional claims and development of safe, effective and globally accepted herbal drugs for treatment of leprosy. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article about efficacy of multidrug therapy (MDT) to treat leprosy cases in India which appeared in previous issue.

Wade's histoid leprosy is a rare form of multibacillary leprosy with distinctive characteristics which were first described in patients treated with a short course of sulfones. Wade's histoid leprosy may occur as a relapse, in the setting of sulfone resistance, or may present de novo. We report the clinical, histologic, immunologic, and bacteriologic features of three adult male patients with this rare variant of lepromatous leprosy as the initial presentation of the disease, observed in the Dermatology Department of Hospital Córdoba, Córdoba, Argentina between 1999 and 2003. Two of the three patients were from an endemic leprosy area. All patients presented with a number of erythematous to brownish gray, firm but elastic nodules involving mainly the extremities, which responded to treatment for multibacillary leprosy without reactional episodes. [ABSTRACT FROM AUTHOR]

The leprosy pathogen Mycobacterium leprae attacks Schwann cells in the peripheral nervous system, causing them to demyelinate. Recent work by Tapinos et al. shows that a direct mechanism of demyelination induced by M. leprae depends on the binding of the bacterium to the receptor tyrosine kinase ErbB2 on Schwann cells and the resulting activation of the Ras–Raf–MEK–ERK pathway. These findings have relevance for the potential treatment of leprosy and they highlight parallels between the dedifferentiation signal in leprosy and that in nerve injury and cancer. [Copyright &y& Elsevier]

Background: Leprosy, or Hansen's disease, is a chronic infectious disease caused by Mycobacterium leprae. The purpose of this study was to describe the epidemiological characteristics of leprosy in Benin from 2006 to 2018.Methods: This descriptive retrospective study included data from January 2006 to December 2018. The data of all patients treated in the leprosy treatment centres (LTCs) of the Republic of Benin were obtained from the LTC registers and analysed using Stata/SE 11.0 software. Quantum GIS (Geographic Information System) version 2.18.23 software was used for mapping. The main indicators of leprosy were calculated according to the World Health Organization (WHO) recommendations.Results: During the study period, a total of 2785 (annual average of 214) new cases of leprosy were diagnosed. The median age of the patients was 38 years, with extremes ranging from 6 to 88 years. The sex ratio (males/females) was 1.18 (1509/1276). The departments of Plateau, Atacora, and Zou were the most endemic; their leprosy detection rate per 100,000 population during these thirteen years were 6.46 (479/7414297), 5.38 (534/9932880) and 5.19 (526/10134877), respectively. The leprosy detection rate declined from 3.8 to 1.32 per 100,000 inhabitants. The proportion of paediatric cases varied from 8.56 to 2.67% as the proportion of multibacillary forms increased from 72.95 to 90%. From 2006 to 2018, 622 leprosy patients detected had grade 2 disability (G2D) at screening, indicating an average rate of 5.06 (622/122877474) cases with G2D per million population. The proportion of grade 2 disabilities increased from 21.23 to 32% during the study period. The majority of new leprosy cases among foreign-born persons were Nigerian (85.71%). The completion of multidrug therapy (MDT) for paucibacillary (PB) and multibacillary (MB) leprosy cases ranged from 96.36 to 95.65% and from 90.53 to 94.12%, respectively.Conclusion: In Benin, leprosy remains a major health challenge; it is important to revitalize the epidemiological surveillance system to achieve its elimination by 2030. [ABSTRACT FROM AUTHOR]

Discusses the effectiveness of sulfanilamide in treating certain types of invasive bacterial diseases such as leprosy. Results of the preliminary laboratory procedures conducted among lepromatous patients; Toxic complications of sulfanilamide therapy in leprosy; Significance of the development of eosinophilia during the course of sulfanimide treatment.

The introduction of multidrug therapy has efficiently controlled leprosy in developing countries. However, Mycobacterium laprae may survive and cause relapse despite adequate treatment with antileprosy drugs. Relapse may be characterized by a combination of new signs or symptoms and presence of acid-fast bacilli on skin or nerve biopsy samples. We report a case of a child in whom ulnar abscess developed 12 months after successful completion of multidrug therapy with clinical and histopathological evidence of relapse. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

After the introduction of highly active antiretroviral therapy (HAART) in 1995 it took 3 years to recognize the new syndrome of lipodystrophy as a long-term complication of HAART [1]. It was found to be a direct toxic consequence of the various drugs used in combination regimens. Another 2 years later, an additional syndrome was described in patients who recently initiated HAART-the immune reconstitution inflammatory syndrome (IRIS) [2-4]. Although already recognized in the pre-HIV era in patients with treatment for tuberculosis [5, 6) and leprosy [7), it became substantially more frequent in HIV-infected patients on HAART. The term IRIS describes a collection of different inflammatory disorders which are associated with paradoxical deterioration of various preexisting infectious processes following commencement of HAART in HIV-infected patients. These preexisting infections in individuals with IRIS may have been previously diagnosed and treated or may have been symptomless and later revealed by the patient’s improved capacity to mount an inflammatory response. [ABSTRACT FROM AUTHOR]

Investigates the presence of whole-molecule disorder in 4,4'-Sulfonylbis[N-(4-nitrophenyl-methylene)benzenamine]. Crystal structure of the compound; Efficacy of Dapsone in treating leprosy; Molecular structure.

A 65-year-old Brazilian man presented with an erythematous nodular lesion on the left forearm (Fig. 1). The patient had been treated with multidrug therapy for 8 months for lepromatous leprosy. During therapy, he developed recurrent episodes of reactions which were treated with high doses of prednisone and thalidomide. The histopathology of the cutaneous nodular lesion showed a granulomatous inflammatory infiltrate; some histiocytes contained vacuolations and others demonstrated oval-like or coma-like structures (Fig. 2). The specimen was cultivated in Sabouraud agar at room temperature. The colonies were transferred to Petri dishes containing Niger Seed Agar (NSA) (Fig. 3). The confirmed diagnosis was Cryptococcus neoformans var. neoformans based on microscopy and physiology, including the canavanine–glycine–bromothymol blue (CGB) medium (Lazéra MS, Pires FDA, Camillo-Coura L et al. Natural habitat of Cryptococcus neoformans var. neoformans in decaying wood forming hollows in living trees. J Med Vet Mycol 1996; 34: 127–131). The liquor culture was negative. Hemoculture and urine culture were also negative. Latex agglutination test was blood positive and liquor negative. The patient's hemogram revealed normocytic anemia and normal total and differential white blood count. The CD4 count was 189/m3 and the CD8 count was 141/m3. Serology for anti-human immunodeficiency virus-I (anti-HIV-I) antibodies was negative. The X-ray of the lungs showed an areolar image in the superior lobe of the right lung. Therapy with prednisone was suspended and fluconazole (300 mg/day) was prescribed. The nodular cutaneous lesion regressed completely after 90 days. The patient was submitted to a second skin biopsy for treatment control. The culture of the specimen taken was still positive and the histopathology showed the same picture as before treatment. After 5 months of continued therapy with fluconazole, another biopsy was performed... [ABSTRACT FROM AUTHOR]

Editorial. Comments on the World Health Organization's global strategy to eliminate leprosy as a public health problem by 2000. Administration of Multiple Drug Treatment therapies in curing leprosy patients; Activities that have rendered leprosy surveillance data uninterpretable.

The article discusses the resurgence of leprosy in India despite India declaring the elimination of leprosy as a public health emergency in 2005. Topics include the treatment of Leprosy, a chronic infectious disease caused by Mycobacterium leprae with a multidrug therapy of dapsone and rifampicin, the stigma faced by leprosy patients in India and objectives of India's National Health Policy 2017.

Skin biopsies from US leprosy patients were tested for mutations associated with drug resistance. Dapsone resistance was found in 4 of 6 biopsies from American Samoa patients. No resistance was observed in patients from other origins. The high rate of dapsone resistance in patients from American Samoa warrants further investigation. [ABSTRACT FROM AUTHOR]

An editorial is presented which addresses the author's views about the treatment of leprosy (Hansen's disease) in relation to changes involving American medicine during the 20th century, and it mentions another article which appears in the same issue of the journal and deals with science, cultural attitudes, and the understanding of diseases. Treatments for cancer and heart disease are examined, along with medical cures and various forms of survivorship care.

AbstractBackground An increase in tumor necrosis factor (TNF) has been implicated in type II leprosy reaction. Thalidomide, which inhibits TNF, is an effective drug, but has severe side-effects in pregnant women. Other therapeutic drugs are required. Methods Clofazimine and pentoxifylline were evaluated for their efficacy against severe type II leprosy reaction in four patients (three men and one woman). Results All four patients showed a similar fast response to treatment. Conclusions The results obtained in this study are promising; however, clofazimine and pentoxifylline must be evaluated in a larger group of patients in order to determine their value in controlling type II leprosy reaction. [ABSTRACT FROM AUTHOR]

Reports on the use of thalidomide as treatement of erythema nodosum leprosum (ENL) which is a complication of lepromatous leprosy. The drug having been studied for this use since 1965; The number of people in the United States affected by that complication of leprosy; The US Food and Drug Administration approving thalidomide for this use; What thalidomide does; Other possible uses for thalidomide. INSET: The drug that changed US Pharmaceutical History, by C.M..

States that advances in Hansen's disease research and treatment are also being applied to the prevention of ulcers and amputations in diabetics and others without protective sensation in their feet; Use of Hansen's disease research in the identification, treatment and prevention of tuberculosis; The Lower Extremity Amputation Prevention Program developed at the Gillis W. Long Hansen's Disease Center in Carville, Louisiana.

Focuses on the possibility of vaccine therapy. Research on the capability of vaccines to reduce the recurrence and severity of herpes lesions; Study on vaccine therapy for leprosy; Past attempts at developing vaccines aimed at treating tuberculosis; Vaccine therapy approach to a disease called leishmaniasis; Skepticism of some scientists about vaccine therapy.