Dermatology in the tropics

NTDs

• preventative chemoTx and transmission control (PCT) ones
  • mass drug administration
    • onchocerciasis
    • lympahatic filariasis
    • schistosomiasis
    • soil-transmitted helminths
• innovative and intensified disease management (IDM) ones
  • individual care findings and case management
    • leishmaniasis
    • buruli ulcer
    • mycetoma
    • yaws
      • azithromycin is turning yaws to PCT
    • scabies
      • ivermectin is turning scabies to PCT
    • ...

skin NTDs

• new movement to integrate disease controls between NTDs that manifest with skin symptoms
  • led by WHO and community dermatologists

exanthematology

• morphology of each rash
• distribution

leprosy

• Mycobacterium leprae
• 20,000-25,000 new cases/year
  • mostly in India
• respiratory transmission? difficult to determine because of long incubation period
• skin + peripheral nerve manifestation
  • M. leprae has affinity to Schwann cells and destroy them
• clinical manifestation differs in wide range depending on amount of bacilli and host immune response
• WHO classification
  • MB - multibacillary > 5 lesions
    • multi-drug Tx for 1 year
  • PB - paucibacillary 2-5 lesions
    • multi-drug Tx for 6 months
  • single lesion
    • single dose
• Rideley & Jpling classification
  • TT
  • BT
  • BB
  • BL
  • LL
• delay of Dx and Tx leads to long term disability and deformity resulted in stigma and discrimination

Buruli ulcer

• Mycobacterium ulcerans
• 75% of worldwide patients are in Ivory Coast, Ghana and Benin
  • rarely found in Japan and Australia (esp. in Victoria)
• transmission route unknown
  • patients are often in proximity of stagnant water body
• undermined wound edges, thick necrotic tissue, pain is liminited
• 3 months course

1. subcutaneous nodules
2. plaque
3. edema - develops pain
4. ulcer

• lipid toxin produced and secreted by M. ulcerans is pathogenetic
  • highly hydrophobic
  • M. ulcerans itself is not pathogenetic