BACKGROUND: Redundant and wrinkled face is a common finding in patients with long-standing leprosy, which is responsible for the appearance of premature aging. Chemical peeling plays a role in dermal regeneration in the treatment of wrinkles. However, the effect of chemical peeling has rarely been studied in patients with leprosy. OBJECTIVE: To investigate the effect of chemical peeling on dermal connective tissue components and clinical improvement of facial wrinkles in patients with leprosy. METHODS: Five patients with clinically and bacteriologically inactive lepromatous leprosy were treated with 70% glycolic acid plus 35% trichloroacetic acid (GA-TCA). Histologic and clinical changes were evaluated at 0 and 90 days postpeel. RESULTS: Histologically, collagen fibers and ground substance increased significantly but elastic fibers did not change at 90 days postepeel. Clinically, fine wrinkles improved considerably, whereas most deep wrinkles remained unchanged at day 90. CONCLUSION: This study demonstrates that chemical peeling with GA-TCA, or medium-depth peeling, causes an increase in collagen and ground substance but not in elastic fibers. These changes result in limited clinical improvement in the facial wrinkles of leprosy patients. Therefore, medium-depth chemical peeling may be insufficient to improve the premature aging appearance in patients with leprosy.
Aging, Premature ; Collagen ; Connective Tissue* ; Elastic Tissue ; Humans ; Leprosy* ; Leprosy, Lepromatous ; Regeneration ; Trichloroacetic Acid

BACKGROUND: Eyelash ptosis(ELP) is a common finding in patients with long-standing leprosy. However, it has rarely been reported in the literature previously, because it has been diagnosed as trichiasis or entropion. OBJECTIVE: To determine the prevalence of ELP in Hansen's disease. METHODS: We took both frontal and lateral photographs of eyes in 20 patients and evaluated the degree of ptosis using a 4-point rating scale, in which 0 indicates no ptosis; 1, minimal; 2, moderate; and 3, severe. The evaluation was also performed in 20 normal persons as control group. RESULTS: All patients demonstrated ELP. In general, severity of ptosis in patient group is greater than that in control group. While the mean eyelash ptosis rating was 2.0+/-0.6 in the latter, it was 0.6+/-0.4 in the former, which is statistically significant (p<0.01). CONCLUSIONS: ELP is common in the patients with Hansen's disease and moderate to severe forms occurred more commonly in disease group compared with control group. ELP must be considered as a characteristic ocular finding in long-standing leprosy.
Eye ; Humans ; Leprosy ; Prevalence ; Trichiasis

Recently, there has been a strong decrease in the number of temporalis muscle transfer(TMT) operations in cases of lagophthalmos. The primary cause of this decline is patient dissatisfaction with drawbacks of eye clinching in concert with mouth closure, ectropion and ptosis. This is mostly true of patients who are now more commonly exposed to urban social environments. In 1997, I discontinued the use of TMT as part of my combination treatment method reported in this journal. Since 1998, I have removed the fascia in 20 TMT cases due to complications in the upper and lower eyelid areas. I then corrected these complications using my combination method. I still use TMT in cases of lower lip drooping. Lagophthalmos patients are treated using my combination method of gold lid loading in the upper eyelid and Alloderm insertion in the lower eyelid through fixation of both ends to the medial and lateral canthal ligaments respectively. Previously, I recommended the use of conchal cartilage but noted the complication of cartilage warping which caused creating new partial ectropion several months later. Alloderm has shown no complications and the results of its use remain most satisfactory.
Cartilage ; Ectropion* ; Eyelids ; Fascia ; Humans ; Leprosy* ; Ligaments ; Lip ; Mouth ; Social Environment

Paralytic lagophthalmos and ectropion in the treatment of leprosy patients are serious complications of facial paralysis, which may lead to exposure keratitis and corneal ulceration, which can further lead to blindness. In 1995, 1997, 1999 and 2001, we reported in this journal on the surgical treatment of paralytic lagophthalmos and ectropion. In the 1st report, made in 1995, for lid closing, I (Ahn) performed various methods of traditional surgery such as temporal muscle transfer, medial and lateral canthoplasty, as well as gold implantation. In the 2nd report, made in 1997, we (Ahn and Park) presented a combination treatment of gold plate with minor changes of design and weight in the upper lid and medial canthoplasty with horizontal shortening in the lower lid. In the 3rd report, made in 1999, we described an additional graft of conchal cartilage in the lower lid. However, the lateral end of the cartilage would warp and create new partial ectropion several months later. Therefore, we shifted from cartilage to Alloderm(R), acellular dermal graft. In the 4th report, made in 2001, we reported that Alloderm(R) is a good substitute for the cartilage and is also an effective volume filler to the atrophic lower lid. The medial portion of the lower lid often presented with a recurrence of the ectropion, despite having tightened the bilateral plication of the medial and lateral canthal ligaments with an Alloderm(R) graft in the inferior border of the tarsus. In order to treat the recurring ectropion, a modified permanent tarsorrhaphy was performed. We have noted that a modified permanent tarsorrhaphy on the medial canthal area in Z-plasty successfully corrected the partial ectropion and resulted in decreased epiphora and increased esthetic satisfaction.
Ankle ; Blindness ; Cartilage ; Corneal Ulcer ; Ectropion* ; Facial Paralysis ; Humans ; Keratitis ; Lacrimal Apparatus Diseases ; Leprosy ; Ligaments ; Recurrence ; Temporal Muscle ; Transplants

Changes in the eye resulting from leprosy include lagophthalmos, ectropion and the eyelid retraction. In lagophthalmos, an interpalpebral gap(lid gap) of 2mm or less, which is most preferred after correction, does not have any adverse effect on the vision. However, a gap of 3mm or greater can cause or make the eye susceptible to the dryness of the cornea or other vision problems. Bell's phenomenon will adequately prevent eye damages, especially corneal damage when the lid gap is less than 3mm. Although static methods such as autogenous canthal sling, lateral tarsal strip, medial tarsorrhaphy and gold implant had a positive cosmetic effect when used in combination, the lid gap could hardly reduce to less than 3mm. Frequent recurrence of lagophthalmos and ectropion after static methods required further definite surgical treatment. We applied a dynamic method of modified Gillies to correct lagophthalmos and it was successful in reducing the lid gap to less than 2mm in most cases.
Cornea ; Cosmetics ; Ectropion ; Eye ; Eyelids ; Leprosy ; Recurrence ; Vision, Ocular

A case of generalized pustular psoriasis in a 12 year-old girl is described. She had generalized pustular eruptions on erythematous base, presenting lake of pus, yellowish brown crusts and denudation associated with high fever and chills. With the administration of oral etretinate at a dose of 0.8mg/kg/day for 1 week, rapid and dramatic remission was achieved. About 3 months after her discharge, there developed another wave of new pustules with fever. She was again placed on etretinate therapy. However, there was no expected response as before with developing new pustules continuously. At that time, we tried combination therapy with etretinate and methotrexate. the pustules and erythema began to remit, with eventual clearing of the skin in 6 weeks.
Acitretin* ; Child ; Chills ; Erythema ; Etretinate* ; Female ; Fever ; Humans ; Lakes ; Methotrexate* ; Psoriasis ; Skin ; Suppuration

The measurements of skull in roentgenogram were made in 234 cases of korean adults, 128 male and 106 female. Results were obtained as follows. The Cephalic index was 84.7 in male, 84 in female, and 84.09 in both gender. The result was greater than other reported results. The Anterior-Posterior(AP) diameter of pituitary fossa was 1.19+/-0.14cm in male, 1.21+/-0.16cm in female and 1.20+/-0.15cm in both gender. The result was greater than other results. The depth of pituitary fossa was 1.00+/-0.13cm in male 0.99+/-0.12cm in female and 1.20+/-0.99cm in both gender. The mean value of AP diameter and depth of pituitary fossa was greater than the other reported results. The Basal Angle was 127.20+/-5.23 in male, 127.86+/-5.07 in female and 127.50+/-5.21 in both gender, which were smaller than other results. The sphenoid type was classified into 3 types as sella, presella, and concha. The percentage of each type was : sella type with 78%, presella type with 20%, and concha type in 2%. The pineal gland calcification rate in korean adults was lower than that of Westerners. The occurance of Metopic suture and Mendosal suture in simple skull X-ray was rare. We believe the above measurement will provide helpful information in planning a surgical approach as well as in understanding the data discrepancies between skulls of the Asian and European populations.
Adult* ; Asian Continental Ancestry Group ; Female ; Humans ; Male ; Pineal Gland ; Skull* ; Sutures

Lepra bacilli invade the nasal mucosa from early stage. The infiltrated mucous membrane breaks down and ulcerates easily. Irritating crusts and ulcers occur, creating in perforation of the septum. When most of the septum and inner mucosal lining of the nose is destroyed, the nose is deprived of its support and it collapses. The nasal bones are typically intact, and the collapsed nose adheres to the facial skeleton, giving the characteristic 'sunken and short nose' deformities. We have operated on 25 patients with deformities such as short nose, sunken nose, collumela deformity and ala collapse since 1992. In short nose we operated with a paramedian forehead flap and rib cartilage graft in a cantilever pattern. In ala collapse we used a conchal cartilage graft. Lastly, in collumela deformity we used the local flap and a composite graft.
Cartilage ; Congenital Abnormalities* ; Forehead ; Humans ; Leprosy* ; Mucous Membrane ; Nasal Bone ; Nasal Mucosa ; Nose ; Ribs ; Skeleton ; Transplants ; Ulcer

BACKGROUND: Damage of the facial nerve, especially buccal and marginal mandibular branches, causes facial palsy and paralytic deformity of the lips such as lower lip ectropion, lip drooping, deviation of the mouth, inability of closing mouth, and the loss of the nasolabial folds. OBJECTIVE: To find out the best surgical method to correct paralytic deformity of the lips. METHODS: We reviewed retrospectively the various surgical treatment modalities of the paralytic deformity of the lips performed in The Institute for Leprosy Research for 13 years. RESULTS: One hundred and twenty five surgical procedures were performed in 80 patients with Hansen's disease. Of these, the static method, dermal suspension flap, was done in 15 cases, the dynamic methods were done in 64 cases, and others were done in 46 cases. All patients showed postoperatively clinical improvement above the average. Two patients received reoperation or additional procedures due to relapse of the condition. CONCLUSIONS: The dynamic method using tensor fascia lata was superior to other treatment modalities.
Congenital Abnormalities ; Ectropion ; Facial Nerve ; Facial Paralysis ; Fascia Lata ; Humans ; Leprosy ; Lip ; Mouth ; Recurrence ; Reoperation ; Retrospective Studies

BACKGROUND: Ulnar nerve palsy in patients with Hansen disease causes hand wasting and atrophy. To masquerade these deformities, patients injected paraffin or silicone into the lesions, which results in paraffinomas. Several years later, painful inflammation, ulceration or abscesses may develop in the paraffinomas. OBJECTIVE: To investigate the clinical characteristics of paraffinomas in patients with Hansen disease, and to evaluate and compare the effects of various surgical treatment methods of paraffinomas. METHODS: Fifty-seven patients with paraffinomas were randomized to receive debridement(curettage) with primary closure, skin graft, skin flap, or second intention at the hospital of Korean Hansen Welfare Association from 1998 to 2012. We analyzed retrospectively the final cosmetic results of three methods, primary closure, skin graft, and skin flap, in 33 patients with more than 6 months follow-up. The final results were classified into 4 grades, excellent, good, fair, and poor. RESULTS: Of 57 patients, the ratio of male and female was 42:15 and the average age was 73 and 71 years repectively. The location of the lesions was the hand and wrist in 54 patients and the face in 3. The total number of procedures was 72 and that of 3 methods was 55. In 33 patients, 19 showed above fair grades and the recurrence rate was 42%(14/33). There were no serious postoperative complications. CONCLUSION: Wide and thorough curettage as debridement was very important to reduce recurrence and the primary closure was most efficient in consideration of an old age of patient, simplicity of procedure and cosmeosis.
Abscess ; Atrophy ; Congenital Abnormalities ; Curettage ; Debridement ; Female ; Follow-Up Studies ; Hand ; Humans ; Inflammation ; Intention ; Leprosy* ; Male ; Paraffin ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Silicones ; Skin ; Transplants ; Ulcer ; Ulnar Neuropathies ; Wrist