Leprosy: a review of laboratory and therapeutic aspects - Part 2

Leprosy is a chronic infectious condition caused by Mycobacterium leprae(M. leprae). It is endemic in many regions of the world and a public health problem in Brazil. Additionally, it presents a wide spectrum of clinical manifestations, which are dependent on the interaction between M. leprae and host, and are related to the degree of immunity to the bacillus. The diagnosis of this disease is a clinical one. However, in some situations laboratory exams are necessary to confirm the diagnosis of leprosy or classify its clinical form. This article aims to update dermatologists on leprosy, through a review of complementary laboratory techniques that can be employed for the diagnosis of leprosy, including Mitsuda intradermal reaction, skin smear microscopy, histopathology, serology, immunohistochemistry, polymerase chain reaction, imaging tests, electromyography, and blood tests. It also aims to explain standard multidrug therapy regimens, the treatment of reactions and resistant cases, immunotherapy with bacillus Calmette-Guérin (BCG) vaccine and chemoprophylaxis.     

Leprosy in Brazil in the 21st century: analysis of epidemiological and operational indicators using inflection point regression

The objective of this study was to analyze the trend of epidemiological and operational indicators of leprosy in Brazil, from 2001 to 2017. This was a time series study involving nine indicators. The inflection point regression model was used. Decreasing trends were observed for the following: general detection (−4.8%), children under 15 (−3.7%), prevalence (−7.0%), and grade 2/million inhabitants (−3.5%). The proportion of individuals with grade 2 disability showed an upward trend (2.0%) from 2001 as well as contacts examined from 2003 (5.0%). The proportions of cure and of individuals with a degree of disability assessed at the time of the diagnosis and the cure showed a stationary behavior. Although advances are noted, there are still challenges to be overcome.     

Cutaneous tuberculosis: epidemiologic,etiopathogenic and clinical aspects - Part I

Cutaneous tuberculosis (CTB) is the result of a chronic infection by Mycobacteriumtuberculosis, M. ovis and occasionally by the Calmette-Guerin bacillus. The clinicalmanifestations are variable and depend on the interaction of several factorsincluding the site of infection and the host''s immunity. This article revises thecurrent knowledge about this disease''s physiopathology and immunology as well asdetailing the possible clinical presentations.     

Clear cell acanthoma of the areola and nipple: clinical, histopathological,and immunohistochemical features of two Brazilian cases

Clear cell acanthoma or Degos'' acanthoma is a distinct disease concerning itsclinical, histopathological, and immunohistochemical features. Its pathologic nature- whether neoplastic or reactive - is still under dispute among researchers. Thedisease shows a chronic course and often presents with a single papulonodular lesionon the lower limbs of adults. However, cases with multiple lesions, sometimesoccurring in an eruptive fashion, and with clear variation in the size and shape ofthe cutaneous lesions have been reported. So far, five cases in which the lesionswere exclusively located in the nipple area have been reported, all in Korean women.Four of these cases mimicked eczema and one, a polypoid nodule. The aim of thisarticle is to present clinical, histopathological, and immunohistochemical featuresof two additional cases in Brazilian women with similar nipple topography.