42 THE NOSE AND PARANAS AL SINUSES ^tvt SCLEROMA <£ s ^.^ V^'j~*u,; Scleroma is found in certain parts of Eastern Europe, Indonesia and Central and Southern America, and is due to KJebsiella rhinoscleromatDsis. It consists of a hard rubbery nodular infiltration of the mucous membrane, reddish- brown in colour at first, but becoming pale pink later when fibrosis occurs. There is nasal obstruction, crusted discharge and a slowly progressive, but painless, stenosis of the nasal cavity. Prolonged antibiotic treatment by ampicillin, streptomycin or tetracycline may be helpful. Local excision of the lesions tends to destroy healthy tissue, and stenosis may be treated by dilatation of the nasal cavities and the insertion of polythene tubes which are retained for up to 2 months. LEISHMANIASIS This condition is rare in Britain, but is met with in Eastern Mediterranean countries and South America, It begins with an induration of the skin of the upper lip spreading to the cheek and the nasal vestibule. Later there is an ulcerated granulating area in the anterior part of the lateral wall and floor of the nasal cavity to give rise to considerable narrowing of the nose. Similar granulations may appear on the gums. Histological examination of a piece of excised tissue will show the Leishman-Donovan bodies. Treatment is by injections, either intramuscular or intravenous, of organic pentavalent antimony compounds, or, in resistant cases, of pentamidine. LEPROSY Leprosy is due to M. leprae which may invade the nasal mucosa and result in the destruction of the cartilaginous and bony frameworks of the nose with consequent collapse. Lepromatous granuloma and ulceration of the mucosa may be found. The condition is diagnosed from syphilis, tuberculosis and lupus by histological examination which shows macrophages containing the acid-fast bacilli. Treatment is by sulphone in increasing doses until a mainten- ance dose of 100 mg daily is attained, and this must be continued for many years.