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Background: Pellagra is due to deficiency of niacin or its precursor tryptophan and is characterized by four Ds: The Dermatitis, Dementia, Diarrhea, and eventually Death if it is untreated. Not long ago, the disease was endemic in several parts of the world; including India. Over the past two decades, only a few pellagra cases have been reported. By the year 2011, Pellagra had almost disappeared due to public distribution system but, the clinical features still prevail in the Indian subcontinent to some extent. Objective: The study was carried out to report our experience with pellagra in a tertiary care hospital. Materials and Methods: We undertook a retrospective study of 335 clinically diagnosed pellagra cases attending the Nutrition Unit of tertiary care hospital from 1992 to 2012. Results: In a total of 335 patients of pellagra studied, there were 316 males and 17 females. Majority of patients were in 30–40 years with mean age 42.76 ± 11.6 years. Chronic energy deficiency was seen in 63.8% of patients. Chronic alcoholism and tuberculosis were noted in 3.88% and 1.19% of patients, respectively. Conclusion: Pellagra is a complex and multisystem disease that occurs due to varied etiological factors. Of these, inadequate diet is the best-recognized cause in the developing countries like India. This study clearly recommends that general ration should be regularly distributed, especially in areas where maize and sorghum are cultivated and consumed.

Systemic lupus erythematosus is an autoimmune connective tissue disorder that has well established cutaneous features and typically affects women. However, isolated bilateral periorbital involvement is a rare clinical presentation of systemic lupus erythematosus, which may often delay the diagnosis and treatment. We report such a case in a 20-year-old male.

Erythema nodosum leprosum (ENL), or type 2 lepra reaction, is a multi-system immune-mediated complication in patients with multibacillary leprosy, frequently associated with chronicity and recurrences. Management of ENL requires high doses of oral corticosteroids, which may not be universally effective and pose serious adverse effects. Thalidomide has proven to be a steroid-sparing agent and is useful in controlling the reactions. However, many centres do not employ it in outpatient settings due to adverse effects and teratogenicity risk. Hence, we studied the feasibility of treating ENLs and reported the therapeutic outcome.This is a five-year record-based analysis of ENL leprosy patients treated with thalidomide, includingdescriptive statistics of demographic variables. Clinical characteristics were stratified by treatment compliance status (yes/no). Incidence rates and rate ratios for recovery stratified by bacillary index, type of ENL presentation and MDT treatment status were calculated.Out of 102 ENL patients treated with thalidomide, 68 (66.7%) were compliant and improved. Among them, ENL recurrence was noted in 11(16.2%) patients. The commonest thalidomide side effect was pedal oedema (73.5%). Patients with bacillary index (BI) less than or equal to 4.0 had a 37% increase in the incidence of recovery. Patients with acute ENL were almost twice as likely to recover as those with chronic ENL. Also, the improvement was two and a half times greater among those who completed MDT as compared to those on MDT. The study showed that thalidomide treatment for patients with ENL is possible in outpatientclinics. We also successfully prevented pregnancies to a larger extent through counselling for contraception.We observed that early institution of thalidomide induces faster remission and prevents ENL recurrence., Competing Interests: The authors have declared that no competing interests exist.

Competing Interests: There are no conflicts of interest.

Background: Non-healing plantar ulcers are one of the significant causes of disability in leprosy patients. Plantar ulcers often take months or years to heal, affecting the patient's quality of life. Presence of comorbid conditions in these patients can delay wound healing. The study aimed to evaluate the role of associated comorbid conditions as risk factors in ulcer healing., Methodology/principal Findings: A total of 66 leprosy patients with plantar ulcers registered at LEPRA Society-Blue Peter Public Health and Research Center (BPHRC), Hyderabad, India from June 2018 to June 2019 were studied. Comprehensive clinical assessment was done, including screening for comorbid conditions and treated as per the recommended guidelines. About two-thirds of the participants were aged 50 and above, of which more than half were illiterates, and 93.5% were living below the poverty line. Majority of ulcers were seen on the forefoot; with the head of meta-tarsal bone 27 (41.6%) as the commonest site, followed by calcaneum 23 (38.3%) and great toe 10 (16.6%). Mean ulcer depth was 0.61 (0.57) cm, the area was 5.24 (6.73) cm2 and ulcer volume was 4.72 (14.33) cm3. Ulcer dimensions were significantly associated with low body mass index, hypertension and smoking., Conclusions/significance: Identifying the risk factors delaying wound healing and detailed assessment of ulcers are of profound importance to predict the outcome of plantar ulcers in leprosy patients. The study findings indicate the need for better policies by the leprosy control program for the comprehensive management of plantar ulcers., Competing Interests: The authors have declared that no competing interests exist.