<p class="abstract">Necrotizing fasciitis (NF) is a life-threatening soft tissue infection with a high misdiagnosis rate. Here, we present the case of NF with hypoesthesia due to prior leprosy in a limited resource area. Laboratory risk indicator for NF (LRINEC) score was used to determine the diagnosis of NF. Resuscitation and broad-spectrum antibiotic were initiated, followed by surgical debridement due to lack of wound improvement and skin graft to cover the wound was done. This case report highlights the usage of LRINEC score to reduce misdiagnosis, ensure early diagnosis, and improve patient management in NF with masking effect.</p>

Background: Leprosy is one of the chronic skin infection which shares long term impact. It might cause permanent disability, and treatment might take longer before the patient completely recovered. These possibilities highly affect the quality of life (QoL). Methods: A retrospective cohort study was conducted in the outpatient department of leprosy, in Sitanala Hospital, Tangerang, Indonesia. A total of 102 patients' QoL were assessed by Indonesian version of WHOQOL-BREF and sociodemographic and clinical course data were collected from medical records. P-value smaller than 0.05 is appraised as statistically significant. Results: Low income was related to worse leprosy form (lepromatous leprosy type) and immune reaction (erythema nodosum leprosum). QoL scores could be predicted by form of leprosy, immune reaction, impairment grade, and duration of illness. Conclusions: QoL scores in patients with leprosy could be predicted by illness characteristics and duration of illness, whereas forms of leprosy predicted all domains of QoL.

<p>The human skin possesses a microenvironment conducive to the growth of the skin microbiome, which plays in many physiological functions in cutaneous immunity homeostasis and maturation. The microbiome composition depends on many variables, such as endogenous (host condition) or exogenous (environmental) factors and topographic location. Host-skin microbes’ interaction can be mutualism or pathogenicity. Dysbiosis or alteration in skin microbiota is associated with various dermatological diseases, including leprosy. Dysbiosis is driven by the alteration of the microbial communities themselves or due to the intrinsic features of the host. Leprosy is a chronic granulomatous disease caused by <em>Mycobacterium leprae</em> targeting the nerves and skin, leading to loss of sensation on the skin, with or without dermatologic lesions, and correlated with long term consequences, such as deformities or disability. Microvascular dysfunction and significant alterations in capillary structure due to invasion of <em>M. leprae</em> lead to altered hydration levels of the skin caused by disruption of blood flow; which changes the resident microbial community structure. The skin microbiome composition differences in leprosy patient’s skin lesions were observed; skin microbial diversity in the leprosy patients was lower than in healthy individuals. The diversity reduction was observed in freshly diagnosis leprosy patients, those at various stages of MDT, and post-MDT; indicated that both the interaction between skin microbial community and<strong> </strong><em>M. leprae</em> or the ongoing therapeutic regimen impacted the skin microbiome variation. </p><p> </p>