Verrucous lepromatous leprosy: a rare form of presentation - Report on two cases

Abstract

Leprosy skin lesions are described as hypochromic or erythematous macules, pale erythematous or reddish-brown plaques, papules, nodules, and diffuse cutaneous infiltration, depending on the clinical form of the disease. They may be accompanied by hypo or anesthesia, alopecia, and hypo or anhidrosis. Verrucous lesions are now quite uncommon in leprosy. The literature is sparse, with only 25 reported cases of this association, especially in the lepromatous pole of the disease. This work is a report on two cases of lepromatous leprosy of long evolution, coursing with vegetant verrucous lesions.

A rare form of Hansen's disease presenting as filiform verrucous papules on the feet

“…1 , 4 Despite this large number of patients, only 25 cases of verrucous lepromatous lesions have been reported to date. 5 …”

“…Verrucous lepromatous lesions were first described in 1897 at the First International Conference on Leprosy. 5 Since then, Patki 6 described 18 cases of verrucous lesions in leprosy and subdivided these into 3 distinct morphologic types: (1) lesions having fingerlike projections and resembling filiform warts, (2) thick hornlike projections, and (3) hyperkeratosis and deep transverse fissures corresponding to the skin creases of the anterior aspects of the ankles. 6 …”

“… 5 , 6 Less commonly, the face, wrists, elbows, and heels have also presented with lepromatous verrucous lesions. 5 , 7 Palmoplantar involvement is rare in all cutaneous presentations of Hansen's disease. This rarity is thought to be a result of the thicker epidermis and fibrofatty tissue in acral skin.…”

“…They typically occur in advanced cases of lepromatous leprosy on acral sites but do not constitute a distinct morphologic subtype of disease. 5 It is important to consider leprosy in the differential diagnosis of acral verrucous lesions in the right clinical context. Correct diagnosis is essential, as verrucous lesions are highly treatable with standard multidrug therapy.…”

Ulcers in leprosy patients, an unrecognized clinical manifestation: a report of 8 cases

“…Cutaneous lesions of leprosy usually present as hypoesthetic hypochromic macules, papules, plaques, and diffuse infiltration of the skin with alopecia and xerosis [2]. Less frequent manifestations include blisters, hyperpigmented patches, verrucous lesions, macrocheilia, and pure neural leprosy [2–6]. Extra-cutaneous involvement in multibacillary leprosy includes eyes, nasal mucosa, joints, lymph nodes, testicles, liver, and spleen [2].…”