Leprosy Mailing List – July 26th, 2012
Ref.: African Dermatopathology is desperately in need of addresses where large numbers of biopsies could be processed.
From: T Ryan, Oxford, UK
Dear Salvatore,
I refer to D Lockwood's paper (*) circulated by B Naafs in LML June 29th, 2012. I am in full agreement with the paper by Lockwood et al. and in a previous paper by Lockwood on how dermatologists uncertain about a clinical appearance usually reach a correct diagnosis because they habitually biopsy the skin.
In, Moshi, Tanzania the Regional Dermatology Training Centre (RDTC) has been a rich advocate of this Lockwood et al mission. 220 allied health professionals in 14 African countries have the Diploma of Dermatology and have been taught to biopsy the skin. BUT there is a paucity of centres in Africa able to process biopsy material. Even the RDTC fails to maintain the service at the Kilimanjaro Christian Medical Centre (KCMC). And a short period of reliability at ALERT, Addis-Ababa, Ethiopia, is followed by long periods of unreliability.
African Dermatopathology is desperately in need of addresses where large numbers of biopsies could be processed. Would it be possible to collate addresses of histopathologists willing to receive leprosy biopsies with sufficient experience to give a reliable report including the differential diagnoses that much of such material would require?
These 220 African dermatologists cannot currently rely on the RDTC/KCMC and cannot afford to pay for a service of this kind from centres having to cover the costs. A young European
dermatopathlogist Helmut Beltraminelli, teaches at the RDTC annually but, cannot secure the technology required to prepare an adequate service for leprosy at all times.
The RDTC is a WHO Collaborating Centre for Dermatology, Sexually transmitted Infections and Leprosy and has much benefited from teaching from Ben Naafs every year as well as from an experienced senior faculty, but once our graduates are in there home countries it becomes almost impossible to get biopsies from suspected leprosy processed adequately and at no cost when at times their alma mater is also short of reliable laboratory technology.
Having once headed the Department in Oxford with Colin MacDougal as a colleague I greatly miss the special skills of someone with experience in the histopathology of leprosy who was responsible for reading thousands of biopsies from the multi-drug therapy trials. But I also miss even more the skills of the histopathology technician. It is difficult enough to diagnose leprosy when the slides are of good quality but when they are of poor quality it can be far more difficult.
I keep Colin's Teaching slides in Oxford in 13 Norham Gardens where the Global Project on the History of Leprosy keeps its archives in support of the Website.
Best regards,
Terence Ryan
E-mail: userry282@aol.com
*
Lockwood DNJ, Nicholls P, Smith WCS, D a s L, Barkataki P, van Brakel W and, Suneetha S (2012 )
"Comparing the Clinical and Histological Diagnosis of Leprosy and Leprosy Reactions in the INFIR Cohort of Indian Patients with Multibacillary Leprosy."
PLoS Negl Trop D is 6(6): e170 2 . doi:10.1 3 71/journal.p ntd.0001702
LML - S Deepak, B Naafs, S Noto, P A M Schreuder
LML Archives: http://www.aifo.it/english/resources/online/lml-archives/index.htm
Dr Salvatore Noto
Padiglione Dermatologia Sociale
Ospedale San Martino
Largo R. Benzi, 10
16132 Genoa, Italy
Tel: (+39) 010 555 27 83 - Fax: (+39) 010 555 66 41 - E-mail: salvatore.noto@hsanmartino.it
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