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Granuloma inguinale: self-assessment
324
Correspondence
rale Erhaltungstherapie rnit Fumars~iurederivaten bei Psoriasis. Dermatol Helv 1992;185:225. 5..Roodnat JI, Chdstiaans M I l L Nugteren-Huying WM, et al. Akute Niereninsuffizienz bei der Behandlung der Psoriasis mit Fumars~ureestem. Schweiz IVied Wochenschr 1989; 119:826-30.
Granuloma
inguinale: Serf-Assessment
To the Editor: I read with great interest the answers to the case presented by Dr. Theodore Rosen in the SelfAssessment examination (Identification No. 895-201) in the January 1995 issue o f the JOURNAL(1995;32:153-4). Because the examination is designed to meet the continning education needs o f the members of the A A D and the international dermatologic community, I would like to make some corrections to this important discussion. Granuloma inguinale is endemic not only in Southeast Asia, India, New Guinea, and the Caribbean, but also in the northeastern part of Brazil 1"3 where Professor Lobo Jardim has studied more than 800 patients during the past 25 years. Dr. Jardim's;clinical classification of donovanosis 1,4 divides the clinical picture as follows: 9 Genital and perigenital lesions: ulceration with hypertrophic or fiat border, ulcerovegetafing, vegetating, elephantiasis 9 Extragenital 9 Systemic
Journal of the American Academy of Dermatology February, Part 1, !996
lowed by 500 m g twice daily for 2 to 3 weeks. The cure rate was 100%, and the patients did not report any adverse effects. Other benefits were the low cost o f treatment and the simplicity o f the drug administration. The cures were demonstrated in all cases with either direct smears or biopsy specimens. The follow-up smears became negative between the second and third week, at which time the treatment was stopped and before reepithelialization was completed. The patients were checked weekly until their ulcers were completely healed. After 6 months o f followup, no relapses were detected.
Sarita Martins, M D Department o f Dermatology Federal University of Pernambuco Recife, Brazil 51020-000 REFERENCES 1. Canizares O, Olansky S, Olansky A, et al. Sexually transrnitted diseases in tropics I. In: Canizares O, Harman R, eds. Clinical tropical dermatology. Boston: Blackwell Scientific Publications, 1992:485-524. 2. Richens J. The diagnosis and treatment of Donovanosis (granuloma ingninale). Genitottrin Med 1991;67:441-52. 3. O'Farrel N. Global eradication of donovanosis: an opportunity for limiting the spread of HIV-infection. Genitourin Med 1995;71:27-31. 4. Jardirn ML. Donovanose: proposta de classificagao clinica. An Bras Dermatol 1987;62:169-72. 5. Jardim ML, Melo Z. Tratamento da donovanose com o tianfenicol. An Bras Dermatol 1990;65:93-4.
There is no inguinal adenopathy in any clinical variant. Dr. Jardim 1-3,5 also described 40 patients treated on an outpatient basis; these patients (from Recife, Brazil) were given oral thiamphenicol at an initial dose o f 2.5 g m fol-
BOUND VOLUMES AVAILABLE TO SUBSCRIBERS Bound volumes of the JOURNALOFTHEAMERICANACADEMYOFDERMATOLOGYare available to subscribers(only) for the 1996 issues from the Publisher at a cost of $92.50 for domestic, $118.24 for Canadian, and $110.50 for intematiunal for volume 34 (January-June)and volume 35 (July-December).Shipping charges are included. Each bound volume contains a subject and author index and all advertisingis removed. Copies are shipped within 60 days after publication of the last issue in the volume. The binding is durable buckram with the journal name, volume number, and year stamped in gold on the spine. Paymentmust accompany all orders. Contact Mosby-Year Book, Inc., Subscription 'Services, 11830 Westline Industrial Dr., St. Louis, MO 63146-3318. USA: phone (800) 453-4351; (314) 453-4351. Subscriptions must be in force to qualify. Bound volumes are not available in place of a regularjournal subscription.
Correspondence
rale Erhaltungstherapie rnit Fumars~iurederivaten bei Psoriasis. Dermatol Helv 1992;185:225. 5..Roodnat JI, Chdstiaans M I l L Nugteren-Huying WM, et al. Akute Niereninsuffizienz bei der Behandlung der Psoriasis mit Fumars~ureestem. Schweiz IVied Wochenschr 1989; 119:826-30.
Granuloma
inguinale: Serf-Assessment
To the Editor: I read with great interest the answers to the case presented by Dr. Theodore Rosen in the SelfAssessment examination (Identification No. 895-201) in the January 1995 issue o f the JOURNAL(1995;32:153-4). Because the examination is designed to meet the continning education needs o f the members of the A A D and the international dermatologic community, I would like to make some corrections to this important discussion. Granuloma inguinale is endemic not only in Southeast Asia, India, New Guinea, and the Caribbean, but also in the northeastern part of Brazil 1"3 where Professor Lobo Jardim has studied more than 800 patients during the past 25 years. Dr. Jardim's;clinical classification of donovanosis 1,4 divides the clinical picture as follows: 9 Genital and perigenital lesions: ulceration with hypertrophic or fiat border, ulcerovegetafing, vegetating, elephantiasis 9 Extragenital 9 Systemic
Journal of the American Academy of Dermatology February, Part 1, !996
lowed by 500 m g twice daily for 2 to 3 weeks. The cure rate was 100%, and the patients did not report any adverse effects. Other benefits were the low cost o f treatment and the simplicity o f the drug administration. The cures were demonstrated in all cases with either direct smears or biopsy specimens. The follow-up smears became negative between the second and third week, at which time the treatment was stopped and before reepithelialization was completed. The patients were checked weekly until their ulcers were completely healed. After 6 months o f followup, no relapses were detected.
Sarita Martins, M D Department o f Dermatology Federal University of Pernambuco Recife, Brazil 51020-000 REFERENCES 1. Canizares O, Olansky S, Olansky A, et al. Sexually transrnitted diseases in tropics I. In: Canizares O, Harman R, eds. Clinical tropical dermatology. Boston: Blackwell Scientific Publications, 1992:485-524. 2. Richens J. The diagnosis and treatment of Donovanosis (granuloma ingninale). Genitottrin Med 1991;67:441-52. 3. O'Farrel N. Global eradication of donovanosis: an opportunity for limiting the spread of HIV-infection. Genitourin Med 1995;71:27-31. 4. Jardirn ML. Donovanose: proposta de classificagao clinica. An Bras Dermatol 1987;62:169-72. 5. Jardim ML, Melo Z. Tratamento da donovanose com o tianfenicol. An Bras Dermatol 1990;65:93-4.
There is no inguinal adenopathy in any clinical variant. Dr. Jardim 1-3,5 also described 40 patients treated on an outpatient basis; these patients (from Recife, Brazil) were given oral thiamphenicol at an initial dose o f 2.5 g m fol-
BOUND VOLUMES AVAILABLE TO SUBSCRIBERS Bound volumes of the JOURNALOFTHEAMERICANACADEMYOFDERMATOLOGYare available to subscribers(only) for the 1996 issues from the Publisher at a cost of $92.50 for domestic, $118.24 for Canadian, and $110.50 for intematiunal for volume 34 (January-June)and volume 35 (July-December).Shipping charges are included. Each bound volume contains a subject and author index and all advertisingis removed. Copies are shipped within 60 days after publication of the last issue in the volume. The binding is durable buckram with the journal name, volume number, and year stamped in gold on the spine. Paymentmust accompany all orders. Contact Mosby-Year Book, Inc., Subscription 'Services, 11830 Westline Industrial Dr., St. Louis, MO 63146-3318. USA: phone (800) 453-4351; (314) 453-4351. Subscriptions must be in force to qualify. Bound volumes are not available in place of a regularjournal subscription.