Dermatology Hospital

Today our main focus of the day was on common skin infections found in tropical climate areas and Asia. This mainly included leprosy and fungal infections. For most of the morning we listened to a lecture about the disease states and their treatments, and then were able to see patients in the afternoon.  I was very excited for today's learning experience, as I feel like a lot of the reason I came to Thailand was to learn about disease states that we don't see often in the united states, and may become more prevalent as people continue to be world travelers.

Leprosy fun facts:
While the incidence of the disease is definitely decreasing, there are still new cases being reported every year. In the US, the disease is most commonly seen in Texas and Louisiana. You would think that with the decreasing number of cases it would be very easy to treat, but it actually seems that since its a more rare disease, physicians diagnose it late, giving time for the disease to progress. Lots of the diseases  that we learned today stressed the importance of early diagnosing and treatment in preventing morbidity and mortality, so a late diagnoses leaves a lot of patients with a permanent disability.

These first two pictures show the dose packs provided from the World Health Organization (WHO)  that are free for patient.  When treating leprosy, patients must take a combination of drugs, and not all of them are daily, so compliance can be an issue. The dose packs help patients take the right tablets at the right times and come in packs of 4 weeks, so its pretty east for patients.

The most severe form of leprosy is Lepromatous Leprosy, abbreviated "LL" in these pictures. As I mentioned earlier, even though the overall incidence of leprosy is lower in the world, the cases that do pop up are more serious. Most of the patients that we saw today also had a complication called Erythema Nodosum Leprosy (ENL), which is essentially when your immune response catches up with your disease state and decides to be hypersensitive to the bacteria that has been causing leprosy all along. This presents as even more bumps. Unfortunately once it happens, its a chronic relapsing condition, and must be treated with corticosteroids for quite some time.

Lastly,  you will notice an overall darker colored skin on patients with leprosy, which is a side effect from one of the medications they take in combination with other drugs.  Luckily it's a reversible side effect, so patients don't have to worry about permanent cosmetic changes.

Fungal infection fun facts
 The 2 diseases we saw today were mycetomas and chromoblastomycoses. They generally happen on extremities and occur when someone cuts them self on something infected with the fungus. It's asymptomatic for the most part, so patients don't worry about it, however like the other disease state its important to catch it early in order to prevent long term nerve damage and physical deformities. Make sure you all go to your doctor regularly, folks!