In 1995, I graduated from high school and got accepted as a student at faculty of Medicine University of Indonesia, Jakarta. After graduated as a doctor, I worked as a general practitioner in several hospital and clinics, such as Dr.Cipto Mangunkusumo Hospital, Jalan Baja Primary Health Care Facility, Kebayoran Lama Primary Health Care Facility, and Bulungan Clinic. In 2011, I continue my study in Dermatology and Venereology at faculty of Medicine University of Indonesia, Jakarta. In 2015, I graduated as dermatovenereologist and started to work in Pasar Minggu Regional Hospital, Jakarta until now.
Introduction Leprosy is a chronic granulomatous infection caused by Mycobacterium Leprae. There are two types of Lepra reaction, Reversal Reaction (type 1 lepra reaction) and Erythema nodosum leprosum (type 2 lepra reaction). Skin lesions in type 2 lepra reaction manifest as numerous erythematous and tender nodules and plaques in different parts of the body. Bullous lesions are rarely found in type 2 lepra reaction. Case Report A 31 years old male, with multiple painful reddish swelling and fluid filled lesions in his face, trunk and extremities. He has been diagnosed as lepromatous leprosy on WHO multidrug therapy (MDT) for the past 13 months. There were several history of type 2 lepra reaction, which manifest as multiple painful reddish swelling without any fluid filled lesions before. They were usually managed by high doses of corticosteroids result in improvement. For the first time, on this occasion he had also developed multiple fluid filled lesions. Dermatological examinations revealed multiple erythematous tender nodules and plaques on face, trunk and extremities. He also had multiple bullous lesions on upper and lower extremities. Nikolsky sign was negative. Bilateral ulnar nerves were thickened and tender. Laboratory results revealed anemia, polymorphonuclear leukocytosis and increased ESR. Slit skin smear examination showed solid and fragmented acid fast bacilli with bacteriological index (BI) of 2 2/3 + and morphological index (MI) of 8%. Skin biopsy of bullous lesion show subcorneal bullae with diffuse polymorphonuclear cell infiltrate in the dermis, a few foamy histiocytes, vasculitis, and neutrophilic panniculitis. He was treated with a high dose systemic corticosteroid, intravenous injection of methylprednisolone starting at 62,5mg/day and tappered off over one month period. Anti leprosy drugs were continued. Topical treatments consist of normal saline wound dressing and application of topical antibiotic. He showed good response to the treatment. Discussion Lepra reactions caused by an alteration of immunological balance in a leprosy patient. Erythema nodosum leprosum is an immune complex reaction and seen mostly in lepromatous type. Antibodies reacts to M.leprae antigen to form the immune complex which circulated and deposited in various tissues. This process will lead to activation of complement and causing damage of the tissues. Bullous lesions in type 2 reactions are very rare. There were only a few reports of bullous erythema nodosum leprosum. They have been associated with very high bacillary load in lepromatous leprosy patients.
Al-Moatasem Al-Mamari graduated from the medical college at Sultan Qaboos University (SQU), in Oman, in 2014. Then joined the psychiatry residency program in Oman Medical Specialties Board (OMSB) in Oman. Currently, he is the deputy chief resident, in his third residency year.
Background – Various studies have suggested that depression is more prevalent among patients with skin disorders than in the general population. Most of the studies addressing this subject involve Euro-American populations. Objectives –The present study aimed to estimate the prevalence of depressive symptoms among patients with dermatological disorders and, then, to decipher the clinical–demographic factors associated with depressive symptoms. Methods – A cross-sectional analytical study was conducted among a random sample of patients attending a dermatology clinic in Muscat. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for depressive symptoms. A logistic regression model was used to find the adjusted and unadjusted odds ratios (ORs). Results – A total of 260 patients participated in this study, with a response rate of 81%. The prevalence of depression symptoms was 24%. According to regression analysis, family history of depression, comorbid medical disorders, and treatment with topicals or isotretinoin were significant predictors of depression (OR = 9.41, 95% confidence interval [CI]: 2.27–39.05, P = 0.002; OR = 2.0, 95% CI: 1.2–3.21, P = 0.05; OR = 2.28, 95% CI: 1.09–4.76, P = 0.028; and OR = 2.78; 95% CI: 1.08–7.19, P = 0.035, respectively). Conclusion – This study indicates that depressive symptoms are common among patients with dermatological disorders in Oman, particularly in those with a family history of depression and medical comorbidities, and those who use a specific dermatological medication. Screening for depression in patients attending dermatology clinics is essential in order to detect and promptly treat patients suffering from depression.