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Background: Cutaneous leishmaniasis is endemic to many parts of the world and has re-emerged in a number of endemic countries in recent years. Environmental changes, immune status of the host and treatment failure are the three most important risk factors associated with the re-emerging and spread of Leishmaniasis. Cutaneous leishmaniasis (CL) ranges from localized, self-healing type to the disfiguring mucocutaneous and diffuse cutaneous type., Objective: To access the trend of CL patient flow in ALERT Hospital, Addis Ababa, Ethiopia., Methods: Patients' clinical and laboratory records were collected retrospectively for 1651 leishmaniasis suspected individuals from ALERT Hospital, from January 1, 2007 to December 30, 2010., Results: From the suspected individuals, 234 cases were positive for Leishmania species with Giemsa stain and/or histopathology and confirmed for CL, of whom 30 (12.8%) were diagnosed in 2007, 29 (12.4%) in 2008, 75 (32.1%) in 2009, and 100 (42.7%) were in 2010., Conclusions and Recommendations: The overall proportion of cases with leishmaniasis among the suspected cases was 234/1651 (14.2%). The distribution of CL reports was higher for patients coming from Addis Ababa surrounding areas and Oromia region, 96/234 (41.03%) and 71/234 (30.34%), respectively. In general, the trend of leishmaniasis in and around Addis Ababa seems to be increasing, which calls for further detailed epidemiological studies, including vector and reservoir host studies, to help in the prevention and control of the disease.

Pain can be a significant problem for treated leprosy patients. It can be nociceptive due to tissue inflammation occurring during episodes of immune mediated reactions, or neuropathic due to leprosy affecting the somatosensory system. There are sparse epidemiological data on the prevalence and impact of neuropathic pain in treated leprosy patients. Tools for assessing neuropathic pain have not been validated in leprosy. We have examined nature of pain in a cross-sectional study to determine the prevalence of neuropathic pain (NP) in 80 recently treated leprosy patients in Ethiopia. Pain and depression were evaluated using the General Health Questionnaire (GHQ-12) and the Brief Pain Inventory (BPI) questionnaire. The Douleur Neuropathique en 4 Questions (DN4) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were used as screening tools for NP. Pain of any type was experienced by 60% of the patients. Pure nociceptive pain was experienced by 43%, pure NP by 11%, and mixed pain by 6%. Of the 14 patients who had NP either alone or in combination with nociceptive pain, 12 had high GHQ-12 scores, indicating possible depression. The DN4 had sensitivity and specificity of 100% and 45%, whereas the LANSS had 85% and 42%, respectively. This is the first study to differentiate nociceptive from NP in leprosy patients. The prevalence of NP is high in recently treated Ethiopian leprosy patients. We have validated the use of DN4 in leprosy and it is easier to use than LANSS. Depression is a common co-morbidity in patients with NP. The high prevalence and morbidity of NP in treated leprosy patients warrant clinical trials to assess the efficacy of pain therapies for leprosy-associated NP., (Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.)

We report a case of Angiolymphoid hyperplasia with eosinophilia in a 29 years old female Ethiopian patient. This case was diagnosed by establishing a clinicopathologic correlation. This is the first case of its kind ever reported in Ethiopia. The clinical features, dermatohistopathological findings, and treatment options are discussed with review of literature.

Objectives: To identify patients with typical symptoms of neuropathic pain in a well-defined cohort of multibacillary patients being followed up as part of a relapse study in Ethiopia; to identify risk factors for the development of neuropathic pain., Design: 96 patients who had completed MDT more than 10 years previously participated in the study, through a questionnaire., Results: 28 (29%) had symptoms of neuropathic pain and it was reported as severe in 12. Because the past history of these subjects is well documented, a risk factor analysis was carried out. The presence of leprosy-related impairment was the only significant risk factor for neuropathic pain that was identified., Conclusions: Neuropathic pain is an important problem in a proportion of people previously treated for leprosy. Further research into the management of the condition is required.

Syringomas are benign neoplasms of the skin commonly appearing around the eye lids. Though common in middle-aged women, it affects all age groups. The lesions are asymptomatic, firm, discrete, translucent or skin colored flat-topped papules. Once papules of syringoma come into being, which usually is after puberty, they remain as they are for a lifetime. Disseminated lesions appearing on the abdomen, scalp and genital area has been described earlier. We report the disseminated form (eruptive) syringoma involving the trunk, the neck, and the upper extremities while sparing the face. Our case created a diagnostic difficulty because of the unusual distribution of lesions. The case is presented and discussed with review of literature.

Hypersensitivity reactions called reversal reaction (RR) and erythema nodosum leprosum (ENL) occur in leprosy. They are characterized by an increase in tumor necrosis factor-alpha (TNF-alpha). Thalidomide is an effective treatment for ENL but not RR. Its effectiveness in ENL is attributed to inhibition of TNF-alpha, and this does not explain its failure to treat RR. We assessed thalidomide's effect on TNF-alpha in RR. Mononuclear cells from RR and non-RR patients and healthy individuals were treated with thalidomide and M.leprae (AFB), a cytosol fraction of M. leprae or Dharmendra lepromin. Thalidomide suppressed TNF-alpha, but when some RR patients' cells were stimulated with AFB, it enhanced TNF-alpha.

Background: Skin diseases are common public health problems throughout the world. Studies on skin problems are rare in Ethiopia. Easy and cheap methods of identifying skin conditions in the community are poorly developed in the country., Objectives: (1) To assess whether the newly developed Dermatological Screening Questionnaire (DSQ) can be used to effectively screen for common skin diseases and (2) to estimate the prevalence of skin diseases in a rural community., Methods: A cross-sectional survey was conducted in the rural community residing on the islands of Lake Zeway. A locally prepared nine-item questionnaire (the DSQ) was used by lay-interviewers to screen for common skin diseases. Any respondent giving one or more positive responses, and a further 104 people who had replied negatively, underwent confirmatory diagnosis by specialist dermatologists., Results: A total of 4697 people were included in the survey. Of these, 992 (20.0%) respondents screened positive on the DSQ. Out of 62.5% (N = 620) examined by dermatologists, 98.6% (n = 611) were found to have one or more skin conditions. Amongst screen negatives, 10.6% had skin diseases. Sensitivity and specificity of the DSQ was found to be 98% and 91%, respectively. The weighted prevalence of clinically-confirmed skin disease was 22.5%. Scabies was the most common of all skin conditions, followed by fungal infections., Conclusion: Our survey revealed that easily preventable and treatable skin diseases are common in this rural community. Nearly all those who gave a positive response to the DSQ had one or more skin disease confirmed on clinical examination. This finding indicates that the DSQ is a useful instrument for identification of common skin diseases in the community.

Leprosy is a chronic disease that leads to physical disability as a result of nerve damage. Stigma and associated psychosocial problems are common and may increase the risk of mental disorders. This study was conducted to estimate the prevalence of mental distress amongst people attending a Specialized Leprosy and Dermatology Hospital, ALERT, Addis Ababa. Alternate patients from the daily register of outpatients were interviewed for symptoms of mental distress using the Self Reporting Questionnaire (SRQ). This questionnaire was administered by two specially trained nurses. The study population consisted of 786 people. Of these, 60% had leprosy and the remainder had other skin diseases. The sex distribution of the study population was approximately equal. The overall prevalence of mental distress was found to be 34.6%. Among people with leprosy the prevalence was 52.4%, compared with 7.9% in those with other skin conditions. This represented a 7-fold increased risk of mental distress in people with leprosy, adjusted OR = 7.14 (95% CI; 4.15, 12.35). Physical disability was also strongly associated with mental distress. This study showed that the 1-month prevalence of mental distress was significantly higher in patients with leprosy compared to patients with other dermatological conditions. Such a study allows identification of non-specific mental distress. Thus, future work should be directed at further characterizing the nature and severity of mental disorder in this group. However, our study has indicated a need for the integration of psychosocial care into our current medical treatment of patients with leprosy.

Evidence is accumulating that nitric oxide (NO) produced by macrophages has a role in the pathogenesis of reactions in leprosy. We followed the urinary levels of the metabolites of NO [nitrite (NO2-) and nitrate (NO3-)] and the clinical response to prednisolone treatment in leprosy patients (n = 9) admitted to ALERT leprosy hospital Addis Ababa, Ethiopia, because of reversal reaction (RR) or erythema nodosum leprosum (ENL). In untreated reactional leprosy patients, the levels of urinary NO metabolites (1645 +/- 454 microM, n = 9, ENL = 4, RR = 5) decreased significantly 2 weeks after high dose prednisolone treatment (1075 +/- 414 microM, P < 0.05), and remained stable 4 (895 +/- 385 microM, P < 0.02) and 6 weeks following treatment initiation (1048 +/- 452 microM, P < 0.02). This decrease was also present when the reactional patients were subdivided according to the type of reaction (ENL, RR) and coincided with a clinical improvement. In patients showing a poor clinical response to steroids, no or minor effects on the urinary NO metabolite levels were observed. We conclude that there is a correlation between the decrease in urinary NO metabolites and a favourable clinical response after high dose prednisolone treatment of reactional leprosy patients.