Generic selectors
Exact matches only
Search in title
Search in content
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter To Editor
2008:74:2;174-176
doi: 10.4103/0378-6323.39723
PMID: 18388394

Clinicohistopathological correlation of leprosy

Amrish N Pandya, Hemali J Tailor
 Department of Pathology, Government Medical College, Surat, India

Correspondence Address:
Amrish N Pandya
702/B, Amrutdhara Apartments, Opposite St. Xavier's School, Ghod Dod Road, Surat - 395 001
India
How to cite this article:
Pandya AN, Tailor HJ. Clinicohistopathological correlation of leprosy. Indian J Dermatol Venereol Leprol 2008;74:174-176
Copyright: (C)2008 Indian Journal of Dermatology, Venereology, and Leprology
Table 1: Clinical and histopathological correlation
Table 1: Clinical and histopathological correlation

Sir,

Leprosy is one of the major public health problems of the developing countries. The principle of reducing the load of infection in society, to break the chain of infection, is the cornerstone of leprosy control work today. Clinical judgment and skin smear examination is required for early diagnosis and adequate treatment to make the patient noninfectious. But in some early and borderline cases of leprosy, it is difficult to label only on clinical basis. So, histopathological examination is a must for confirmation of diagnosis in doubtful cases of leprosy. Moreover, correct labeling of paucibacillary and multibacilllary cases is a prerequisite. No multibacilllary case should be treated as paucibacillary case. So, clinicohistopathological correlation of leprosy cases assumes a pivotal role for early diagnosis and for proper labeling of a case.

Fifty skin biopsies, of clinically suspected leprosy cases, were stained by Haematoxylin and Eosin and Ziehl Neelsen stain methods. The Ridley and Jopling classification was followed in both clinical and histopathological diagnoses. We also included indeterminate and histoid types of leprosy for analysis. The data pertaining to age, sex, clinical and histopathological classification of the type of leprosy were collected and analyzed. In analyzing the histopathology of a lesion, special attention was given to the following features, viz., invasion of the epidermis with or without erosion, involvement of the sub-epidermal zone, character and extent of granuloma, density of lymphocytic infiltrate, epithelioid cells and other cellular elements, nerve involvement and the presence of M. leprae .

Results of our study are mentioned in [Table - 1].

When M. leprae enters a person with sufficient cell-mediated immunity (CMI) against it, the bacilli will be destroyed. If the CMI is slightly impaired, some bacilli will multiply and a lesion will develop. Depending upon the degree of the immunity, more apparent clinical and histopathological features of the various types of leprosy may gradually develop. On histopathological study, the type of the granuloma cell serves to provide the spectrum of leprosy in two, with epithelioid cells extending from TT to BB and macrophages occurring in BL and LL.

Lymphocytes are the most numerous of all in BL, a few in BB and most scanty in LL. Erosion of epidermis by granuloma is often a valuable sign for the identification of TT. Infiltration of the subepidermal zone is almost invariable in TT, but inconstant in BT. This zone is almost clear, unless compressed by an expanding granuloma, in BB, BL and LL. In the present study, a complete parity between clinical type and histological type was noted in 58% cases [Table - 1].

Ridley and Jopling in their study of 82 cases found complete agreement between clinical and histological types in 56 patients (68.3%). [2] Kar et al. in their study observed total parity in 70%. They also observed highest parity in stable poles, i.e. TT (87.5%) and LL (71.4%), followed by IL (81.2%), BT (60.9%), BB (54.5%) and BL (53.8%). [3] Kalla et al. in a study of 736 patients observed highest parity in LL and TT group (76.7% and 75.6%), respectively, followed by BT (44.2%), BL (43.7%) and BB (37.0%). [4] Jerath and Desai in a study of 130 cases found complete agreement in 89 cases (68.5%). The figures for individual groups were TT (74.5%), BT (64.7%), BB (53.8%) and BL (28.5%), LL (61.5%) and indeterminate leprosy (88.8%). [5] Considering the data of present study and other comparative studies, we can say that maximum disparity is seen in borderline cases. Parity in the polar group is maximum, because they are stable and showed a fixed histopathology, while borderline and indeterminate groups may have different histopathology in different site and lesion.

The clinicopathological picture is determined by the equilibrium between the agent and the host resistance. Skin has different pathophysiological subunits wherein there is some local modulation of the central host response as a result of which there are different grades of resistance and hence different clinicopathological responses in different areas. We conclude from our study that histopathological examination should be carried out in all cases of leprosy to arrive at a definite diagnosis of leprosy and to classify the type of the disease.

References
1.
Sehgal VN. Leprosy. Dermatol Clin 1994;12:629-41.
[Google Scholar]
2.
Ridley DS, Jopling. WHO classification of leprosy according to immunity: A five group system. Int J Lepr 1966;34:255-73.
[Google Scholar]
3.
Kar PK, Arora PN. Clinicopathological study of macular lesions in leprosy. Indian J Lepr 1994;66:435-41.
[Google Scholar]
4.
Kalla G, Salodkar A, Kachhawa D. Clinical and histopathological correlation in leprosy. Int J Lepr 2000;68:184-5.
[Google Scholar]
5.
Jerath VP, Desai SR. Diversities in clinical and histopathological classification of Leprosy. Lepr India 1982;54:30.
[Google Scholar]

Fulltext Views
252

PDF downloads
126
Show Sections