110^ International Journal of Leprosy^ 1988

len followed after 2 hr by exposure to sun-light for 15 min. She was unable to toleratethe treatment, and the treatment waschanged to topical PUVASOL after 1 week.The 8-methoxypsoralen solution (0.75%)was applied topically, and she was advisedto expose the lesion to sunlight for 2 min 1hr after the topical application. The lesionwas subsequently cleaned with soap andwater.

The lesion showed mild repigmentationat the end of 1 month and significant repig-nictitation at the end of 3 months. Topicaltherapy was discontinued and pigmentationwas seen to persist 3 months later. Unlikevitiligo where repigmentation is usually fol-licular, pigmentation was diffuse.

PUVA is an accepted mode of therapy invitiligo and acts possibly by a) increasingthe number of melanocytes, b) hypertrophyof melanocytcs, c) increasing the arboriza-tion of dendrites, d) increasing the size ofmelanosomes, e) stimulating tyrosinase ac-tivity and promoting new tyrosinase for-mation, and f) enhanced migration of ac-tivated melanocytes from skin appendage('). The last modality probably does not play

an important role in repigmentation of tu-berculoid leprosy since the lesions show al-opecia and are anhydrotic. This is also pos-sibly the reason for the pigmentation beingdiffuse instead of follicular, as seen in viti-ligo.

—C. R. Srinivas, M.D.Assistant Prgfessm-Depthiment of Dermatology and STDKastilrba Medical College

and HospitalManipalKarnataka 576119, India

REFERENCES1. HONIGSMANN, H., WoLff, K., FITZPATRICK, T. 11.,

PATIIAK, NI. A. and PARRisil, J. A. Oral photo-chemotherapy with psoralens and UVA(l'UVA):principles and practice. In: Dermatology in GeneralMedicine. 3rd ed. Fitzpatrick, T.13., Eisen, A., Wollf,K., Freedberg, I. NI. and Austen, K. F., eds. NewDelhi: McGraw Hill Book Company, 1987, pp.1533-1558.SRINIVAS, C. R., NAIK, R. P. C., KRUPASHANKAR,D. S. and NIENON, S. K. Photoactivated 8-me-thoxypsoralen in repigmentation of tuberculoid lep-rosy. Int. J. Lepr. 55 (1987) 159-160.

A Family with Histoid Leprosy

To THE EDITOR:We recently saw a family in which eight

members were suffering from histoid lep-rosy and two had borderline tuberculoid(BT) leprosy. The occurrence of leprosy inseveral members of a family is not uncom-mon, but involvement of many memberswith the same type of leprosy is not usual.Moreover in this family three generationsof the same family were involved. This in-cited us to bring this family to the attentionof our colleagues working in the field of lep-rosy who might encounter similar cases.

The index case, a 75-year-old male, wasa known case of histoid leprosy registeredwith our clinic at Benghazi, Libya. He had7 sons and 5 daughters; 1 son (37 years old)and I daughter (age 35) had histoid leprosy.They both came voluntarily to the clinicbecause of their skin lesions. The son's wifewas also found to have histoid leprosy, hav-

ing been discovered on active clinical ex-amination of the family contacts. A positivehistory of consanguinity was found betweenthem, she being his first cousin's sister. Thecouple had 8 sons and 2 daughters; 2 sonsaged 14 years and 9 years, respectively, werefound to have histoid leprosy. On exami-nation of the wife's other family contacts,one of her uncles (40 years old) was foundto have histoid leprosy.

The daughter of the index case had 5 sonsand 3 daughters; 1 son (age 14) had histoidleprosy, 2 daughters (18 and 10 years old,respectively) were found to have BT lep-rosy. The clinical findings were confirmedby histopathology.

The description of this family supportsthe view that heredity plays an importantrole in the transmission of leprosy. Occur-rence of the same type of leprosy in manymembers of the same family leads one to

56, 1^ Correspondence^ 111

speculate that genetics is playing a signifi-cant role in the determination of the de-velopment of a particular type of leprosy ina person.

—Malkit Singh, M.D.— Fatma H. Shahat, D.D.

—M. S. Belhaj, D.D.—E. A. Manghoush, M.B.

Departnient of MedicineUnit of DermatologyFacility of AledicineAl-.-Irab Medical UniversityBenghazi, Libya

Reprint requests to Malkit Singh, M.D.,P.O. Box 6674, Benghazi, Libya.

Lupus and Lepros

To THE EDITOR:

For many centuries skin tuberculosis hasbeen termed lupus vulgaris. The great Ger-man pathologist Rudolf Virchow (6) was in-trigued by this name and established that ithad appeared in the writings of the mastersof the Salerno school of medicine, foundedin the 10th century, and particularly in thoseof Roger of Salerno (ca. 1180). Neverthelessthe origin of the term remained obscure.

It is generally assumed that the word lu-pus (Latin: a wolf) alludes to the tissue de-struction characteristic of tuberculosis. In1736, for example, Turner remarked that". . . it is termed lupus, for that is, say some,of a ravenous nature, and like that fiercecreature, not satisfy'd but with flesh" (5).

Paradoxically, though, lupus vulgaris is anextremely chronic affliction: the very slowprogression of the destructive process is instrong contrast to the feeding habits of eventhe most indolent of wolves.

Could lupus, therefore, be a corruption ofsome other word used to describe a chronicand disfiguring skin disease? An intriguingpossibility is that it originated from the sameGreek word, lepros, from which leprosy wasderived. This word originally denominatedvarious skin diseases characterized by peel-ing and was used to translate the Hebrewword Tsara'ath. (Leprosy, as we now defineit, was known by the Greeks as Elephan-tiasis Graecorum.) This, in turn, raises thepossibility that the lesions termed Tsara'athin the old Testament and Gospels includedskin tuberculosis. At a time when tuber-culosis was prevalent in cattle in Great Brit-ain, many cases of lupus vulgaris were seenand over half were due to bovine tuberclebacilli (4). There is ample evidence that cat-

tle farming was well established in ancientIsrael, and it has been suggested that the"wen" of cattle (Leviticus 22:22) referred totuberculosis (3). (Pulmonary tuberculosisalso afflicted the Israelites and was termedShachepheth.) Thus, there is a strong like-lihood that lupus vulgaris occurred in Israelbefore and during the time of Christ andthat it was included in the conditions termedTsara'ath and, subsequently, /epros. Hencethe names for skin lesions due to Mycobac-terium leprae and to Al. tuberculosis couldhave a common etymological origin.

As Tsara'ath was amenable to healing bythe laying on of hands (Luke 5:12-15), ithas been suggested that the disease had apsycogenic rather than an organic cause (2).

On the other hand, it is noteworthy thatscrofula, lupus vulgaris, and other nonpul-monary manifestations of tuberculosis were,for many centuries, considered curable bythe touch of a reigning monarch, hence thecollective epithet "King's Evil" (4 7). Thebelief that this gift was bestowed by DivineGrace, and Christ's particular directions toHis followers that they should heal the vic-tims of Tsara'ath (Matthew 10:8), estab-lished a further speculative link betweenBiblical "leprosy" and tuberculosis.

—John M. Grange, M.Sc., M.D.Cardiothoracic InstituteF11117(1,11 RoadLondon SI73 6I1P, U.K.

REFERENCES1. CRAWFURD, R. Tin' King's Evil. Oxford: Clarendon

Press, 1911.2. LLOYD DAVIES, M. and LLOYD DAVIES, T. A. Bibli-

cal ills and remedies. J. R. Soc. Med. 80 (1987) 534—535.