Translate this page into:
Transepidermal elimination: Role in leprosy transmission
Naveen Kumar Kansal
Department of Dermatology and Venereology, All India Institute of Medical Sciences, Rishikesh - 249 203, Uttarakhand
|How to cite this article:
Kansal NK. Transepidermal elimination: Role in leprosy transmission. Indian J Dermatol Venereol Leprol 2019;85:313-314
I read with interest the Residents' Page article by Shah et al. on transepidermal elimination. Though transepidermal elimination in leprosy was mentioned only once, I would like to make a few comments about the significance of this phenomenon in histoid (and lepromatous) leprosy.
Nasal discharge from the untreated leprosy patient is considered the usual source of infection in the community and the cutaneous route is said to be unimportant. In tuberculoid leprosy, Mycobacterium leprae resides largely within the skin and the nerve and these patients are never considered infectious.
However, a number of workers have reported the presence of acid-fast bacilli in the epidermis.,,, Namisato et al. proposed transepidermal elimination as a mechanism for a “mass transport” of live leprosy bacilli in an untreated 35-year-old male lepromatous patient. The umbilicated/molluscoid lesion is one of the rarest morphological types of histoid leprosy. The fact that type 2 (pseudoisomorphic) Köebner's phenomenon has been reported in this form of histoid leprosy further substantiates the fact that viable bacilli must be eliminated transepidermally for this to occur clinically. Therefore, the skin may definitely be a portal for leprosy transmission, at least in the multibacillary cases. Studies are required to explore the contribution of cutaneous carriage and role of epidermal elimination of the bacilli in leprosy transmission. The need is acute as the multibacillary histoid and lepromatous cases are definitely a dreaded challenge to the elimination of this chronic mutilating disease.,
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
Shah H, Tiwary AK, Kumar P. Transepidermal elimination: Historical evolution, pathogenesis and nosology. Indian J Dermatol Venereol Leprol 2018;84:753-7.[Google Scholar]
Okada S, Komura J, Nishiura M. Mycobacterium leprae found in epidermal cells by electron microscopy. Int J Lepr Other Mycobact Dis 1978;46:30-4.[Google Scholar]
Ghorpade AK. Transepidermal elimination of Mycobacterium leprae in histoid leprosy: A case report suggesting possible participation of skin in leprosy transmission. Indian J Dermatol Venereol Leprol 2011;77:59-61.[Google Scholar]
Chander R, Jabeen M, Malik M. Molluscum contagiosum-like lesions in histoid leprosy in a 10-year-old Indian boy. Pediatr Dermatol 2013;30:e261-2.[Google Scholar]
Job CK, Jayakumar J, Kearney M, Gillis TP. Transmission of leprosy: A study of skin and nasal secretions of household contacts of leprosy patients using PCR. Am J Trop Med Hyg 2008;78:518-21.[Google Scholar]
Namisato M, Kakuta M, Kawatsu K, Obara A, Izumi S, Ogawa H. Transepidermal elimination of lepromatous granuloma: A mechanism for mass transport of viable bacilli. Lepr Rev 1997;68:167-72.[Google Scholar]
Ghorpade A. Molluscoid skin lesions in histoid leprosy with pseudo-isomorphic Koebner phenomenon. Int J Dermatol 2008;47:1278-80.[Google Scholar]
Sales AM, Ponce de Leon A, Düppre NC, Hacker MA, Nery JA, Sarno EN, et al. Leprosy among patient contacts: A multilevel study of risk factors. PLoS Negl Trop Dis 2011;5:e1013.[Google Scholar]
Palit A, Inamadar AC. Histoid leprosy as reservoir of the disease; a challenge to leprosy elimination. Lepr Rev 2007;78:47-9.[Google Scholar]