Concluded Case

Non-diabetic adult presented with asymptomatic swelling of left little toe since 4-5 years (Figures 1). X-ray shows osteomyelitis (Figure 2) There were few patches seen (Figures 3-4). Skin biopsy was done (Figure 5). Figures 6-9 presents histopathology report. Suggests diagnosis. Thank you.

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Concluded answer

Clinical diagnosis: Hansen’s disease with osteomyelitis Leprosy remains a major global health problem, especially in the developing world. The number of new cases of leprosy identified worldwide has not changed over the last two decades. A hypopigmented patch of Indeterminate leprosy is the most frequently noticed sign of early leprosy. There is a high level of agreement among clinicians and histopathologists regarding diagnosis of determined leprosy but there is greater differences regarding diagnosis of Indeterminate leprosy among clinicians and histopathologists all over the world. The profile of leprosy patients presenting in an outpatient clinic has radically changed and more and more early Indeterminate lesions are encountered. The term Progressive Indeterminate leprosy is coined for Indeterminate leprosy progressing to cause various deformities and disabilities without becoming determinate. Source: New Concept of Progressive Indeterminate Leprosy - Infolep https://www.leprosy-information.org/.../new-concept-progressive-indeterminate-lepros...

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Clinical diagnosis: Hansen’s disease with osteomyelitis Leprosy remains a major global health problem, especially in the developing world. The number of new cases of leprosy identified worldwide has not changed over the last two decades. A hypopigmented patch of Indeterminate leprosy is the most frequently noticed sign of early leprosy. There is a high level of agreement among clinicians and histopathologists regarding diagnosis of determined leprosy but there is greater differences regarding diagnosis of Indeterminate leprosy among clinicians and histopathologists all over the world. The profile of leprosy patients presenting in an outpatient clinic has radically changed and more and more early Indeterminate lesions are encountered. The term Progressive Indeterminate leprosy is coined for Indeterminate leprosy progressing to cause various deformities and disabilities without becoming determinate. Source: New Concept of Progressive Indeterminate Leprosy - Infolep https://www.leprosy-information.org/.../new-concept-progressive-indeterminate-lepros...

aconthosis nigricans

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Leprosy mdt mb 6month drssing

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There is congenital malformation in little toe Lt foot . There is no evidence of Osteomyeliti of terminal phalanges. Whatever swelling in little toe for last 5 years is due to skin infection (Fungal Infectio)Tell me why blackening of normal skin between two toes.

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The evolution of the present scenario It is a bifid distal phalanx of little toe It is bulky It is pressing against 4th toe On long term skin develop chronic inflammatory changes The moisture trapped between the skin of toes causes excoriation and chronic subdued infection Treat the cause Otherwise it will recur Presently skin care between the toes Keep it dry Absolute alcohol swabs can help Also give a course of oral antibiotics Long term solution is debulking the little toe Get a plastic surgeon evaluate If the biopsy suggest some thing more,it could be secondary Very rarely malignant change can occur in chronic inflammatory conditions

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Leprosy

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