Hypopigmented skin lesions with doubtful/minimal sensory impairment: A histopathology-based analysis

Abstract

Background: Cardinal criteria proposed by the World Health Organisation (WHO) lack sensitivity to diagnose indeterminate leprosy. Aims: To estimate the frequency of hypopigmented skin lesions with doubtful/minimal sensory impairment showing histopathology features of indeterminate leprosy. To compare between the histopathology findings noted in specimens showing features suggestive of indeterminate leprosy and those showing a non-specific dermatitis pattern. Materials and Methods: Data on patients who attended our department with hypopigmented patches with doubtful/minimal sensory impairment from January 2018 to December 2019 and who underwent a skin biopsy were collected. A pathologist blinded to the clinical findings reviewed the histopathology specimens using a pre-set questionnaire. Results: We studied sixteen biopsy specimens from 14 patients. Eight specimens (50%) showed histopathology suggestive of indeterminate leprosy and the remaining eight showed a non-specific dermatitis pattern. A higher percentage of patients with indeterminate pattern showed mast cells (87.5% vs 25%) and fibrosis around nerve twig or sweat duct (75% vs 12.5%) when compared to those who showed a non-specific dermatitis pattern. Limitations: Small sample size and retrospective study design were the limitations. Conclusions: We found histopathology features of indeterminate leprosy in 50% of the skin biopsy specimens from hypopigmented lesions with doubtful/minimal sensory impairment. The present study highlights the need to improve the diagnostic definition of indeterminate leprosy.

Skin lesions with minimal or doubtful sensory impairment—Better to defer biopsy?

“…I read with interest the article “Hypopigmented skin lesions with doubtful/minimal sensory impairment: a histopathology-based analysis” by Sasidharanpillai et al . [ 1 ] The authors deserve appreciation for bringing out a real-life situation in the diagnosis of indeterminate leprosy. Here, I wish to advance the discussion on how cases of hypopigmented skin lesions with doubtful or minimal sensory impairment may be managed.…”

Letter in response to previous publication: Author's replyskin lesions with minimal or doubtful sensory impairment: The need for a better diagnostic definition

“…We thank the authors for their interest in our article entitled “Hypopigmented skin lesions with minimal or doubtful sensory impairment: A histopathology-based analysis” and putting forth an interesting suggestion. [ 1 ]…”

“…Authors recommend that a biopsy should be performed only when the lesion manifests definite sensory impairment so as to reduce the frequency of inconclusive results (50% in our study). [ 1 ] We agree that it is advisable “never to diagnose leprosy, when in doubt’’ as the diagnosis is often accompanied by psychological trauma to the affected patient; moreover, exposing individuals to drugs like rifampicin and dapsone (which have hepatotoxic potential) for several months on the basis of suspicion may not be the ideal practice. For exactly the same reason, we did not offer treatment to 6 out of the 12 cases with minimal and to one of the two patients with doubtful sensory impairment and who showed inconclusive histology findings.…”

“…For exactly the same reason, we did not offer treatment to 6 out of the 12 cases with minimal and to one of the two patients with doubtful sensory impairment and who showed inconclusive histology findings. [ 1 ] However, the question is whether we should withhold a diagnostic facility which can help in early diagnosis in half the cases so as to avoid inconclusive results in the other half.…”

“…Two out of the three lesions (66.7%) with doubtful sensory impairment in our study showed histopathology suggestive of indeterminate leprosy, and we could offer treatment. [ 1 ]…”