Leprosy

Dermoscopy of borderline tuberculoid leprosy

“…Leprosy is a chronic granulomatous condition caused by Mycobacterium leprae and characterized by anesthetic hypopigmented patches and thickened, tender peripheral nerves. Borderline tuberculoid (BT) leprosy is the most common type of leprosy which presents with large, well‐ to ill‐defined hypopigmented patches . Clinically, BT is characterized by symmetrically distributed hypopigmented patches varying in size from 2 to 20 cm.…”

“…Differential diagnosis of BT leprosy includes lupus vulgaris (LV), sarcoidosis, granuloma faciale, lymphocytoma cutis, and mycosis fungoides. This mandates slit skin smears and skin biopsy to confirm the diagnosis . Dermoscopy has been a very useful tool and plays a significant supportive role in the diagnosis of granulomatous conditions …”

Treatment of leprosy/Hansen's disease in the early 21st century

“…The M. leprae genome has lost genes for catabolic and respiratory enzymes and other systems, explaining its limited ability to survive extracellularly (12). Several polymerase chain reaction (PCR) and reverse transcription PCR techniques can detect M. leprae DNA in tissue from patients, but despite being 100% specific for recognition of M. leprae DNA, such probes are no more sensitive than microscopic confirmation of M. leprae for diagnosing patients (13,14). The molecular basis for rifampin‐, dapsone‐, and ofloxacin‐resistance has also been identified, and resistant mutant M. leprae isolates can be identified by PCR DNA amplification of specific DNA fragments from skin biopsy specimens followed by molecular analyses (13–15).…”

“…The modes of leprosy transmission are not known, but could possibly occur by: (i) exposure to nasal and oral secretions of patients harboring bacilli, (ii) skin to skin contact, (iii) congenital transmission (18), (iv) dermal inoculation via tattoo needles (19), (v) from infected soil or sphagnum moss, and (vi) exposure to insect or arthropod vectors (12). Nasal inhalation of M. leprae with bacilli lodging on the inferior turbinates, followed by a brief bacteremia, followed by bacilli binding to Schwann cells and macrophages, is a widely accepted leprosy transmission hypothesis (14,20).…”

Leprosy: A disease not to be forgotten in the era of globalization

“…Skin lesions together with nerve involvement represent the most common clinical manifestations of leprosy, which is characterized by the existence of various clinical forms. A deep examination of the skin – distribution, configuration, primary lesions, depth of lesion – often permits a first but accurate classification of the type of leprosy 1,2 . Lepromatous leprosy and tuberculoid leprosy are the two major clinical presentations, even though a variety of intermediate forms may appear between these two extremes.…”