Unusual presentation of secondary syphilis mimicking erythema multiforme in HIV positive patient: a case report

Secondary syphilis is known as "The Great Imitator". It can mimic numerous diseases clinically and histologically, including erythema multiforme (EM). Coinfection with HIV often makes its manifestations more atypical leading to delays in diagnosis and therapy. A 34-year-old male-sex-male patient who had received coronavirus disease 2019 (COVID-19) vaccine 1 week earlier presented with complaints of slightly pruritic scaly erythematous targetoid plaques and erythematous macules on the trunk and extremities for 6 weeks. Histopathology examination showed basal cell vacuolar degeneration of the epidermis and lymphocytic infiltrates along the dermal-epidermal junction and superficial dermis, consistent with EM. Upon further investigation, syphilis and HIV serology were reactive (VDRL 1: 128, TPHA 1: 40960, CD4+ 461 cells/µl). Lesions improved significantly after a single dose of 2,4-million units of benzathine penicillin intramuscular injection. Secondary syphilis presenting as erythema multiforme (EM)-like eruptions is very rare. Physicians should be aware of this unusual presentation to prevent complications.

Comparison of tea tree oil 5%, tea tree oil 10%, and nystatin inhibition zones against vaginal Candida isolates in pregnancy

INTRODUCTION

Vulvovaginal candidiasis (VVC) in pregnancy frequently develops into recurrent infections. Clinical study suggests that conventional topical treatments for VVC are not always enough to eradicate Candida spp. from the vaginal microenvironment. This study aimed to evaluate the antifungal activity of tea tree oil (TTO) 5% and TTO 10% against Candida species causing VVC in pregnancy.

METHODOLOGY

In vitro experimental study was conducted in the Mycology Laboratory at Dermatovenereology Outpatient Clinic Dr. Soetomo General Hospital Surabaya. Eighteen isolates of Candida species were isolated from the vaginal thrush of 15 pregnant women diagnosed with VVC from March to May 2021. Antifungal susceptibility of TTO 5% and TTO 10% was evaluated by the disc diffusion method, with the inhibitory zone diameter as the main outcome.

RESULTS

The mean inhibitory zone diameter of TTO 5%, TTO 10%, and nystatin against all Candida spp. was 7.26 mm, 8.64 mm, and 25.57 mm, respectively (p < 0.001). The mean inhibitory zone diameter of TTO 5%, TTO 10%, and nystatin tend to be larger in C. albicans compared to the non-albicans, but the difference is not significant. Nystatin displayed the largest mean inhibitory zone diameters compared to TTO 5% and TTO 10% (p < 0.001) in all Candida species. Increased concentration from TTO 5% to TTO 10% resulted in a slight increment in the mean inhibitory zone diameters in all-Candida species (p = 0.001).

CONCLUSIONS

Tea Tree Oil displayed antifungal activity against Candida species causing VVC in pregnancy. Further studies are required to investigate optimal TTO concentrations as a VVC treatment in pregnancy.

The Efficacy of Moisturisers Containing Ceramide Compared with Other Moisturisers in the Management of Atopic Dermatitis: A Systematic Literature Review and Meta-Analysis

Atopic dermatitis (AD), also known as atopic eczema, is a chronic inflammatory skin condition that recurs frequently and has diverse clinical features. The main mechanism of AD is the dysfunction of the skin-epidermal barrier. One of the causes of stratum corneum (SC) structural integrity disruption is the decreased production of ceramide, an important lipid component in SC. The latest generation of moisturisers contain ceramide to help replace this lipid deficit. This study aimed to compare the efficacy of moisturisers containing ceramide with other moisturisers for AD management. Searches were conducted systematically on PubMed, the Cochrane Library, ScienceDirect, Clinicaltrials.gov, and Google Scholar for studies published from January 2012 to July 2022. Interventions and outcomes were compared in this study. Statistical analysis was performed with ReviewManager 5.4 software. Five articles met the eligibility and inclusion criteria. Three articles were meta-analyses on trans-epidermal water loss (TEWL) outcomes and two articles were meta-analyses on SCORing Atopic Dermatitis (SCORAD) outcomes. A meta-analysis of TEWL results found that TEWL values were not significantly different in subjects treated with ceramide-containing moisturisers (mean difference: -3.56, 95% CI [-8.63, 1.52], P = 0.17) with high heterogeneity (I2 = 92%) compared to other treatments. The change in SCORAD was significantly higher in moisturisers containing ceramide (mean difference: -0.98, 95% CI [-1.63, -0.33], P = 0.003) with low heterogeneity (I2 = 0%). Moisturisers containing ceramide improve SCORAD and TEWL; however only the changes in SCORAD in moisturisers containing ceramide is superior to other moisturisers.

Clinico-Laboratory Findings of Malassezia Folliculitis in Indonesia: a Multicenter Study

BACKGROUND

Malassezia folliculitis (MF) is a humid-favored fungal skin disease caused by Malassezia species. Inaccurate treatments, changes in skin flora, and disease exacerbation are often occurred due to oversights in the diagnosis. Several diagnostic methods are established for MF.

OBJECTIVE

To identify clinico-laboratory findings of Malassezia folliculitis in Indonesia.

METHODS

The study was conducted from January 2014 to December 2018 in seven referral teaching hospitals. Medical records of MF-diagnosed patients were obtained and analyzed using the binomial test, chi-square test, and Cohen's Kappa coefficient in SPSS 26.0.

RESULTS

A total of 353 cases of MF were identified in seven referral teaching hospitals in Indonesia, 66.3% of which were males and 33.7% were females, dominated by the 17-25 years old group (44.5%). Itchy sensation (83.9%) was a major subjective complaint. Lesions were majorly found on the trunk-chest, back, and shoulder (68.3%), while the clinical manifestation are mostly follicular papule-pustular lesions (62.1%). Patients were 87.4% positive by KOH examination (modified Jacinto Jamora's criteria) and 69.1% positive by Wood's lamp. Generally, sex, age, subjective complaint, lesion location, clinical manifestation, and both examinations were statistically significant (p<0.001). A significant relationship between all the clinical criteria of the patients in the KOH; especially the clinical manifestation was significantly related to the Wood's lamp. The Cohen's Kappa assessment suggested that there was an agreement between KOH and Wood's lamp (κ = -0,272, p<0.001).

CONCLUSION

The clinical symptoms of Malassezia folliculitis are dominated by pruritus, papulopustular follicular lesions on the trunk, and the presence of spore load.

Dealing with tests and treatments for HIV, syphilis, and hepatitis B infection to prevent mother-to-child transmission (MTCT) from a tertiary hospital in Indonesia

Background: Mother-to-child transmission (MTCT) of Human Immunodeficiency Virus (HIV), syphilis, and Hepatitis B can cause a health burden and lead to morbidity and mortality in children. An attempt to eliminate the transmission has been made worldwide. This study aimed to evaluate the triple elimination of MTCT for HIV, syphilis, and hepatitis B in a tertiary hospital in Indonesia. Methods: We evaluated 690 medical records of new pregnant women seeking antenatal care (ANC) in a tertiary hospital in the east part of Indonesia from January to December 2018. Results: HIV, syphilis, and hepatitis B testing were performed on 97 patients (14.1%). HIV and hepatitis B, HIV and syphilis, and syphilis and hepatitis B testing were performed on 149 (21.6%), 6 (0.9%), and 6 (0.9%) patients, respectively. The prevalence of HIV, syphilis and hepatitis B was 4.2%, 0.4%, and 3.8%, respectively. HIV treatment by administering antiretroviral therapy (ART) was done in 86.2% of patients. Injection of benzathine penicillin G as the treatment of syphilis was done in 66.7% of syphilis patients. HBV DNA examination followed by tenofovir administration was done in 3.8% of hepatitis B patients. Conclusion: The testing rate of HIV, syphilis, and hepatitis B in pregnant women in a tertiary hospital in the east part of Indonesia in 2018 (14.1%) was below the target set by World Health Organization (≥ 95%). Increasing access to antenatal screening as early detection is the key to preventing mother-to-child transmission (MTCT).

Combination effect of methotrexate with Narrowband Ultraviolet B (NB-UVB) phototherapy in psoriasis vulgaris patients in dermatology and venereology outpatient clinic Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

Background: Psoriasis is a chronic, recurrent, inflammatory skin disease that alters the quality of life. Systemic therapy and biologic agents are prescribed for severe and widespread psoriasis, but these drugs may have systemic side effects and immune suppression. Narrowband Ultraviolet B (NB-UVB) phototherapy remains one of the most effective and safe treatments for psoriasis.Methods: This study was an observational retrospective cohort with one group pretest and post-test design. A retrospective analysis was done on 16 medical records of patients who met the inclusion criteria. The efficacy of the therapy was identified and analyzed using the SPSS version 17 for Windows.Results: This study found that 16 psoriasis patients received NB-UVB phototherapy, 11 (68.75%) in men and 5 (31.25%) in women. The mean age was 47.31 years. There was a statistically significant difference in the reduction in PASI score before and after receiving combination methotrexate with 24 sessions of NB-UVB phototherapy (p=0.000); the delta PASI score was 45,02%. A statistical analysis based on the number of phototherapy sessions per week showed enhanced results when patients attended 3 phototherapy sessions per week (p = 0.001).Conclusion: There was a statistically significant reduction in PASI score in psoriasis vulgaris patients before and after receiving combination methotrexate with 24 sessions of NB-UVB phototherapy.

Risk Factors of Type 1 Leprosy Reaction in Leprosy Patients attending Leprosy Division of Dermatology and Venereology Outpatient Clinic of Dr Soetomo General Hospital in 2017–2019: A Retrospective Study

BACKGROUND: Type 1 leprosy reaction is a delayed hypersensitivity reaction caused by increased response of cellular-mediated immunity to Mycobacterium leprae. Manifestations include skin and nerve lesions, edema, and permanent disabilities. There are several risk factors that should be recognized to prevent disabilities. AIM: The aim of this study was to analyze the relationship of risk factors to the occurrence of type 1 leprosy reaction in leprosy patients treated at the Outpatient Clinic of Dr. Soetomo General Hospital. METHODS: This study was an analytical study with retrospective observational study design. Data were secondary from the medical records of leprosy patients at the Outpatient Clinic of Dr. Soetomo General Hospital from January 2017 to December 2019. RESULTS: Out of 364 patients in the Outpatient Clinic, 190 (52.2%) had leprosy without a reaction and 65 (17.9%) had type 1 reaction. Analysis showed that age, leprosy type, and treatment regimen were significantly associated with the incidence of type 1 reaction (p = 0.023; 0.003 and 0.004, respectively), with the leprosy type as the most dominant risk factor. Age 15–34 years old; leprosy types BB, BL, and BT; and the MB MDTL therapeutic regimen are risk factors for the occurrence of type I leprosy reaction. CONCLUSION: There is a statistically significant correlation between the risk factor and the occurrence of type 1 leprosy reaction in leprosy patient. The risk factor that has significant correlation is age 15–34 years; leprosy types BB, BL, and BT; and the MB MDTL therapeutic regimen. The most significant risk factor for the occurrence of type 1 leprosy reaction from our study is the type of leprosy (BB, BL, and BT).

Determinant factors of recurrence atopic dermatitis symptoms in children: A cross-sectional study

Background

Atopic dermatitis (AD) is a common health problem found in children. Understanding of the determinants of AD-related factors includes gender, family history, childbirth history, and exclusive breastfeeding.

Objective

Analyzing gender, family history, childbirth history, and exclusive breastfeeding on recurrence of AD symptoms in children.

Methods

This study employed a cross-sectional design with a purposive sampling method. The procedure for collecting data in this study included data on participant recurrence, gender, family history of atopy disease, childbirth history, and exclusive breastfeeding. The analysis used Chi-square and eta correlation test with p < 0.05.

Results

The results showed that 56.0% of male participants experienced recurrent atopic dermatitis symptoms and 56.7% of female participants did not experience recurrence (OR = 1.664; p = 0.349). It was reported that 61.3% of participants did not experience recurrent atopic symptoms with a family history of 1 atopic person and 71.4% of participants experienced recurrence with 2 atopic families (F = 2114; p = 0.349). Most participants who were delivered through cesarean delivery did not experience recurrent atopic dermatitis symptoms as much as 56.0%, while participants who had a history of spontaneous delivery mostly experienced recurrent atopic dermatitis symptoms as much as 52.9% (OR = 1.500; p = 0.467). There was a significant association between participants who received exclusive breastfeeding and recurrent atopic dermatitis symptoms (OR = 4.444; p = 0.032).

Conclusion

Recurrent of AD is influenced by exclusive breastfeeding and not influenced by gender, family history of atopy disease, and history of childbirth.

•

No significant association of gender, family history, and childbirth on recurrence of atopic dermatitis symptoms.

•

There is a significant association between exclusive breastfeeding and recurrent atopic dermatitis.

•

Participants who experience atopic dermatitis as much as 57.1% consume exclusive breastfeeding.

A comparison study of the 0.1% tretinoin cream versus fractional microneedle radiofrequency combination with fractional CO2 laser for the treatment of striae alba in Indonesian patients

Striae distensae (SD) are linear scar tissue in the dermis that arises from stretching the skin. There are two types of SD, striae rubrae and striae albae (SA) which is marked with a line hypopigmentation that cause a psychological problem, especially in the high skin type. The standard therapy is a 0.1% tretinoin cream, but it takes a long time to reach the collagen so it needs invasive measures to reach these targets. This study was comparing 0.1% tretinoin cream with combination therapy of fractional microneedle radiofrequency (FMR) and fractional CO₂ laser for SA. The number of subjects in this study was 11 patients each group with Fitzpatrick skin types IV or V. Biopsy was taken before and after therapy. The clinical changes in SA lesions in this study were represented by measurements of the length and width. The percentage of collagen area is the amount of collagen fibers with Masson's trichrome staining. The clinical changes of lesion in the combination therapy decreased. The percentage change in collagen area in the combination therapy group had a higher increase. The side effect experienced by all combination group subjects was postinflammatory hyperpigmentation, two subjects in 0.1% tretinoin cream group experienced irritation.

Efficacy of topical epigallocatechin gallate (EGCG) 1% on the healing of chronic plantar ulcers in leprosy

BACKGROUND

Chronic plantar ulcers in leprosy (CPUL) occur in areas that have a sensory and an autonomic nerve impairment where the wound healing takes longer. Framycetin gauze dressing (FGD) is best used in the wound healing process during the inflammatory phase because it contains antibiotics. Epigallocatechin gallate (EGCG) is the highest component in the extract of green tea that can accelerate blood vessel formation, has an anti-inflammatory effect, and reepithelialization.

OBJECTIVE

To investigate the effect of topical EGCG 1% on the healing of CPUL.

MATERIALS AND METHODS

An analytical experimental approach comparing the topical EGCG 1% and FGD applied every 3 days up to 8 weeks on the healing of CPUL. Size of the ulcers, side effects and possible complications from both approaches were monitored weekly.

RESULTS

Ulcer healing in the EGCG group was significantly better than the FGD group with significant clinical and statistical differences (p < .032). There were no side effects in both the study groups. Complications, such as an increase in the size of the ulcer, were noted in one subject in the control group. This may have been caused by FGD and claw foot condition.

CONCLUSIONS

EGCG 1% is more effective than FGD in accelerating the healing process of CPUL.

Dermoscopic evaluation of tinea capitis: A case report

Tinea capitis is the most common fungal infection in children. Recently, the dermoscopic examination of the hair and scalp or trichoscopy has surfaced on and proven to be a very effective, proficient, and efficient useful tool in diagnosing and screening of some hair disorders. Case: A 12-year-old boy presented with circular lesions with sharp margins on the scalp, with breaking hairs forming patches of partial alopecia. Scrapings of the scalp, containing broken hairs, were collected and submitted for direct examination by using KOH preparation revealed chains of arthroconidia covering the hair shaft. Dermoscopic examination was performed and revealed the presence of fine scale, broken hairs and comma hair. Discussion: Our patient reavealed a good clinical improvement evaluated by microscopic examination and dermoscopic evaluation. After effective antifungal therapy for 8 weeks duration, the hair fully regrows. Conclusion: Scalp dermoscopy or “trichoscopy” represents a valuable, noninvasive technique for the evaluation of patients with hair loss due to tenia capitis.

Subcutaneous phaeohyphomycosis: A rare case

Phaeohyphomycosis is a rare fungal infection caused by melanized fungi which usually involve the skin and subcutaneous tissue. It is an infrequent cause of infection in human beings. Common clinical manifestations are subcutaneous cystic swellings, which is localized, characterized by subcutaneous asymptomatic nodular lesions that develop after traumatic implantation of fungus from contaminated soil, thorns or wood splinters, especially on extremities. We report a case of subcutaneous phaeohyphomycosis presenting as multiple cystic swellings over the left lower leg with unknown predisposing factors. At first, the patient was misdiagnosed as soft tissue tumor and subcutaneous tuberculosis, then got surgical and anti-tuberculosis therapy respectively, but there was no improvement. Further investigation revealed granulomatous inflammation on histopathology examination and black-coloured colonies identifed as Exophiala dermatitidis on fungal culture. This case of phaeohyphomycosis was successfully treated by itraconazole monotherapy without surgical excision and still under follow-up.

Ph value of infant’s skin is higher on diaper area compared to nondiaper area

Prolonged use of diaper may alter skin barrier function due to exposure to irritants from feces and urine, concurrent mechanical friction and occlusion, thus render the skin prone to inflammation and infection. Measurement of skin pH value may be used to document skin barrier function, especially in tropical countries such as Indonesia, and to expose the difference between diapered and non-diapered skin. The purpose of this study is to compare the pH value between baby’s diapered and non-diapered skin. In this cross-sectional study, the skin pH of 43 healthy babies aged 6 to 12 months were measured using pH-meter on diaper and non-diaper area of the skin. pH values were documented and compared. The mean pH value of diaper area was 6,11 ± 0,72 g/m2/h (95% CI, 4,88 – 8,02) and non-diaper area was 5,91 ± 0,69 g/m2/h (95% CI, 4,53 – 7,69), with significant difference (p=0,005). pH values increased significantly on diaper area compared to nondiaper area, revealing impaired barrier function on diapered skin, despite no pathological skin changes.

Comparison amount of microphthalmia-associated transcription factor in vitiligo before and after narrowband-ultraviolet B therapy

Vitiligo is the most commonly seen depigmentation disease with clinical manifestations of milk colored white macules, complex pathogenesis that is not well understood so that evolution of the disease is unpredictable and therapeutic outcomes are often unsatisfactory. Until now narrowband-ultraviolet B (NB-UVB) is considered the most effective and safe treatment for vitiligo. Therapy evaluation by looking at melanocytes function that can be seen with microphthalmia-associated transcription factor (MITF) immunohisto - chemistry will become more objective and accurate. This is a comparative analytic experimental study using pre-post test method comparing MITF in vitiligo patients before and after receiving NB-UVB conducted at Dr. Soetomo general hospital Surabaya, 12 vitiligo samples treated only with NB-UVB twice a week until 8 times therapies. The first exposure dose was 200 mJ and gradually increased 20% every therapy. Biopsy was performed before and after therapies and then MITF was compared. There was a significant difference between the amount of MITF in vitiligo before NB-UVB and after NB-UVB therapy stastistically, p=<0.001 (p=0.05). MITF is useful for indicators of treatment success.

The Correlation of Ig M Anti PGL-1 antibody between blood veins and dryed capillary blood on filter papers in household contact of leprosy patient

Delays of leprosy detection and treatment can lead to disability and potential transmission. Serologic examination has the advantage in detecting Subclinical Leprosy. The procedure of serologic test, which is one of its main limitation, could be simplified by the use filter paper. This study aims to assess the effectiveness of the use of capillary blood dropped on filter paper as a substitute for venous blood in household contact of leprosy patients. Seventeen samples of capillary blood dried on filter paper and venous blood samples from the same individual were examined by ELISA method to determine the levels of IgM anti-Phenolic glycolipid-1 (PGL-1). The mean of anti- PGL-1 IgM levels of filter paper samples 163.31±126.16; whereas the mean of levels from venous samples was 473.16±411.26. There was significant difference and correlation between these two groups. Samples on filter paper in household contact can be used to determine the level of anti-PGL-1 IgM in serum by converting on the regression basis. Further study is required to evaluate the potency of filter paper methods to conduct large-scale serological screening.

ACANTHAMOEBA SP.S-11 PHAGOCYTOTIC ACTIVITY ON MYCOBACTERIUM LEPRAE IN DIFFERENT NUTRIENT CONDITIONS

Background:

Mycobacterium leprae (M. leprae) is a pathogenic bacterium that causes leprosy. The presence of M. leprae in the environment is supported by microorganisms that act as the new host for M. leprae. Acanthamoeba’s potential to be a host of M. leprae in the environment. Acanthamoeba sp. is Free Living Amoeba (FLA) that classified as holozoic, saprophytic, and saprozoic. The existence of nutrients in the environment influence Acanthamoeba ability to phagocytosis or pinocytosis. This study is aimed to determine Acanthamoeba sp.S-11 phagocytic activity to Mycobacterium leprae (M. leprae) which cultured in non-nutrient media and riched-nutrient media.

Materials and Methods:

This research conducted by culturing Acanthamoeba sp.S-11 and M. leprae on different nutrient media conditions. M. leprae intracellular DNA were isolated and amplified by M. leprae specific primers through Real Time PCR (Q-PCR).

Result:

The results showed that Acanthamoeba co-cultured on non-nutrient media were more active to phagocyte M. leprae than on rich-nutrient media.

Conclusion:

The use of non-nutrient media is recommended to optimize Acanthamoeba sp. phagocytic activity to M. leprae.

Lactobacillus plantarum IS-10506 supplementation reduced SCORAD in children with atopic dermatitis

Lactobacillus plantarum IS-10506 is a novel probiotic isolated from dadih, an Indonesian traditional fermented buffalo milk. It's in vitro and in vivo probiotic properties have been assessed. Probiotic function has been shown in vivo by the suppression of allergic reactions in BALB/c mice through the action of T-regulatory cells cytokines by balancing Th1 and Th2 immune response. Atopic dermatitis (AD) is a chronic recurrent inflammatory skin disease characterised by the imbalance of Th1 and Th2. The aim of the study was to assess the probiotic function of L. plantarum IS-10506 in children with mild and moderate AD. A randomised double-blind placebo-controlled trial comparing microencapsulated L. plantarum IS-10506 (10¹⁰ cfu/day) and placebo (skim milk-Avicel) twice daily for 12 weeks was conducted in an outpatient clinic on children with mild and moderate AD. The trial included 22 AD children divided into intervention and control groups of n=12 and n=10 patients, respectively. Scoring Atopic Dermatitis Index (SCORAD) and serum immunoglobulin E (IgE), interleukin (IL)-4, interferon gamma (IFN-γ), forkhead box P3 (Foxp3+)/IL-10, and IL-17 levels were assessed. Demographic and baseline characteristics were not significantly different between the two groups. SCORAD and levels of IL-4, IFN-γ, and IL-17 were significantly lower in the probiotic group than those in the placebo group, while the IgE levels were not significantly changed. The ratio of Foxp3+ to IL-10 was significantly higher in the probiotic group than that in placebo group. Supplementation with the probiotic L. plantarum IS-10506 offered a potential treatment for children with AD. Further long-term studies with a larger sample size are required to confirm the therapeutic efficacy of L. plantarum IS-10506 in AD.

Effectiveness of 32 versus 20 weeks of prednisolone in leprosy patients with recent nerve function impairment: A randomized controlled trial

BACKGROUND

While prednisolone is commonly used to treat recent nerve function impairment (NFI) in leprosy patients, the optimal treatment duration has not yet been established. In this "Treatment of Early Neuropathy in Leprosy" (TENLEP) trial, we evaluated whether a 32-week prednisolone course is more effective than a 20-week course in restoring and improving nerve function.

METHODS

In this multi-centre, triple-blind, randomized controlled trial, leprosy patients who had recently developed clinical NFI (<6 months) were allocated to a prednisolone treatment regimen of either 20 weeks or 32 weeks. Prednisolone was started at either 45 or 60 mg/day, depending on the patient's body weight, and was then tapered. Throughout follow up, NFI was assessed by voluntary muscle testing and monofilament testing. The primary outcome was the proportion of patients with improved or restored nerve function at week 78. As secondary outcomes, we analysed improvements between baseline and week 78 on the Reaction Severity Scale, the SALSA Scale and the Participation Scale. Serious Adverse Events and the need for additional prednisolone treatment were monitored and reported.

RESULTS

We included 868 patients in the study, 429 in the 20-week arm and 439 in the 32-week arm. At 78 weeks, the proportion of patients with improved or restored nerve function did not differ significantly between the groups: 78.1% in the 20-week arm and 77.5% in the 32-week arm (p = 0.821). Nor were there any differences in secondary outcomes, except for a significant higher proportion of Serious Adverse Events in the longer treatment arm.

CONCLUSION

In our study, a 20-week course of prednisolone was as effective as a 32-week course in improving and restoring recent clinical NFI in leprosy patients. Twenty weeks is therefore the preferred initial treatment duration for leprosy neuropathy, after which likely only a minority of patients require further individualized treatment.