Inoculation leprosy after tattooing

RR Mittal, Anju Singla, Rajan Gupta

 Dept. of Skin and VD, Rajindra Hospital, Patiala-147 001, India

Correspondence Address:
R R Mittal
Dept. of Skin and VD, Rajindra Hospital, Patiala-147 001
India

To the Editor,

Inoculation leprosy after tattooing was reported even in early 30′s thus establishing that skin contact was responsible for leprosy. Later observations showed that people contracted leprosy after short visits to endemic areas without any chance of close skin to skin contact thus showing that there were other portals of entry, also. Later experimental studies in nude mice confirmed that spread by nasal route occurred and was more important.

Inoculation leprosy usually has been observed as cases of paucibacillary leprosy.[1] Inoculation leprosy after vaccination,[2] metallic wire injury,[3] dog bite[4] has also been reported.

A 15-year-old Bihari male labourer who migrated to Punjab has his left leg tattooed at a Hihari village fair 3 years back and developed progressive hypopigmented anaesthetic patch at the site of tattoo 1 year after it. Tattoo was 4x4 cm in size, circular, at the outer aspect of left lower leg, 8 cm below the knee joint. One 6x5 cm, hypopigmented, dry, finely scaly plaque with well developed margin which was sloping outwards, covered tattoo and extended beyond it. Temperature, superficial touch and deep pain sensations were impaired. Nerves were not thickened. SSS was negative. Histopathologically, epidermis was normal. Grenz zone was absent and dermis

revealed multiple well formed but loose tuberculoid granulomas around hair follicle and thickened nerves, thus confirming the diagnosis of Borderline Tuberculoid leprosy.

Though custom of tattooing has become rare in urban areas but it is still prevalent in States like U.P, Bihar especially in remote villages. The incubation period in our patient was one year as he developed borderline tuberculoid leprosy after one year of tattooing.

Inoculation leprosy is rare but cases still occur even now in the era when it is thought that leprosy is on the verge of eradication.

1.	Singh G, Tutakne MA, Tiwari, et al. Inoculation leprosy developing after tattooing-a case report. Ind J Lepr 1985;54:887-888. [Google Scholar]
2.	Sehgal VN, et al. Inoculation leprosy subsequent to small pox vaccination. Dermatologica 1970;141:393. [Google Scholar]
3.	Kapoor TR, Bhale Rao SM. Post traumatic tuberculoid leprosy. Lepr India 1979;51:11. [Google Scholar]
4.	Gupta CM, Tutakne MA, Tiwari VD, et al. Inoculation leprosy subsequent to dog bite. Ind J Lepr 1984;56:919-920. [Google Scholar]