Tropical dermatology

B Leppard

The purpose of this chapter is to provide an overview of tropical diseases that most commonly
affect the skin. This will be useful for health workers who may not be familiar with tropical
diseases and also as a guide to help those who are already working in the tropics and who see
them all the time.

Skin disease is extemely common in the tropics, affecting up to 50% of the population. Most are
infections or infestations such as impetigo, ringworm, and scabies. These can easily be treated
but continue to be common because of overcrowding, poverty, and the lack of resources given to
health care (training of health personnel and lack of basic medicines). To a large extent such
diseases can be controlled with very simple measure suitable for use by those with minimal
training. Atopic eczema is just as common in urban areas in the tropics as in the west. Skin
cancers are uncommon in those with a black skin because of the protective effect of
melanin, but are common in albinos. The spectrum of tropical dermatology All the common
inflammatory dermatoses occur in the tropics but may have a different appearance in pigmented
skin. Erythema, readily visible in Caucasians, will not be so apparent in black skin. Infections
and infestations occurring in the tropics produce distinctive skin changes These may be due to
the presence of the organism, ova, or larvae in the skin. In other diseases a reaction to the
organism produces a rash.

Bacterial infections

Impetigo is particularly prone to occur in the tropics and may complicate any area of minor
trauma to the skin. It is characterised by erythema, and exudative lesions forming crusts.

Bullae may develop. If possible swabs should be taken for bacteriology and the appropriate
antibiotics given.

Erysipelas is a localised streptococcal infection with erythema and tenderness accompanied by

fever and malaise. Treatment is with penicillin.

Leprosy
Leprosy is a chronic infection of the skin and nerves by Mycobacterium leprae. It is spread by
droplet infection and has a long incubation period (anything from two months to 40 years). There
is a spectrum of clinical disease depending on the patients cell mediated immunity to the
organism.
Diagnosis
Typical clinical findings:

(a) In tuberculoid leprosy (TT) there is a single anaesthetic patch or plaque with a raised border.

ABC of Dermatology 110

(b) In lepromatous leprosy (LL) there are widespread symmetrical shiny papules, nodules, and
plaques which are not anaesthetic.

(c) In borderline leprosy (BT, BB, BL) there are varying numbers of lesions, few in BT and
numerous in BL. They may be widespread but are asymmetrical.
(d) Palpably enlarged cutaneous nerves (great auricular nerve in the neck, the superficial branch
of the radial nerve at the wrist, the ulnar nerve at the elbow, the lateral popliteal nerve at the
knee, and the sural nerve on the lower leg).

(e) Glove and stocking sensory loss causing blisters, ulcers or both on anaesthetic fingers or toes.
(f) Deformity due to invasion of the peripheral nerves with leprosy bacilli, a leprosy reaction or
recurrent trauma to anaesthetic limbs.

Slit skin smears measure the numbers of bacilli in the skin (Bacterial Index (BI)) and the % of
these that are living (Morphological Index (MI)).

Treatment
Paucibacillary leprosy (BI of 0 or 1):

Rifampicin 600 mg once a month (supervised) for

Dapsone 100 mg daily six months

Multibacillary leprosy (BI of 2 or more):

Rifampicin 600 mg once a month (supervised)

Clofazamine 300 mg once a month (supervised) for two years

Clofazamine 50 mg/day

Dapsone 100 mg/day