Assessment of Clinical, Histopathological, and Bacteriological Findings in Treated Leprosy Patients with Persistent Skin Lesions: A Retrospective Cohort Study

Meenakshi Patial Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;

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Vinod Hanumanthu Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;

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Seema Chhabra Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;

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Itu Singh The Leprosy Mission, Stanley Browne Research Laboratory, New Delhi, India;

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Debajyoti Chatterjee Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

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Tarun Narang Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;

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Sunil Dogra Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;

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ABSTRACT.

Since the introduction of multidrug therapy (MDT), various disabilities/morbidities due to leprosy have been prevented. However, there is a subset of patients in whom the skin lesions do not resolve completely or remain unchanged despite a full course of MDT, which is a great source of anxiety to the patient and their family members. Hence, we tried to ascertain the putative causes and risk factors of persistent skin lesions (PSLs) by analyzing the clinical, histopathological, bacteriological, and drug resistance patterns. This is a retrospective, cohort study wherein 35 patients who had PSLs after completion of MDT were included. The majority of the patients were 18 to 30 years of age, with males predominating. Borderline tuberculoid leprosy was the most common clinical spectrum observed (71.4%). The majority had PSLs distributed predominantly over photo-exposed sites (upper limbs > trunk > face). Eight patients (22.8%) had a history of contact with leprosy patients in their family, and six patients (17.1%) had associated comorbidities. Improvement in histopathological parameters such as a decrease in granuloma fraction was observed in 22 patients (62.8%) with PSLs after release from treatment in comparison with baseline. Four patients (11.4%) were noted to have drug resistance (three to rifampicin and one to dapsone). Thus, our study emphasizes that leprosy patients with PSLs after completion of MDT should undergo histopathological evaluation and drug resistance studies.

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Author Notes

Authors’ addresses: Meenakshi Patial, Vinod Hanumanthu, Tarun Narang, and Sunil Dogra, Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, E-mails: meenakshi.patial7@gmail.com, drvinodh15@gmail.com, narangtarun@yahoo.co.in, and sundogra@hotmail.com. Seema Chhabra, Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, E-mail: drseemachhabra@gmail.com. Itu Singh, The Leprosy Mission, Stanley Browne Research Laboratory, New Delhi, India, E-mail: itusingh@gmail.com. Debajyoti Chatterjee, Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, E-mail: devchat1984@gmail.com.

Address correspondence to Tarun Narang, Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. E-mail: narangtarun@yahoo.co.in
  • 1.

    Eichelmann K , Gonzalez Gonzalez SE , Salas-Alanis JC , Ocampo-Candiani J , 2013. Leprosy. An update: definition, pathogenesis, classification, diagnosis, and treatment. Actas Dermosifiliogr 104: 554563.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Maymone MBC , Laughter M , Venkatesh S , Dacso MM , Rao PN , Stryjewska BM , Hugh J , Dellavalle RP , Dunnick CA , 2020. Leprosy: clinical aspects and diagnostic techniques. J Am Acad Dermatol 83: 114.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Mi Z , Liu H , Zhang F , 2020. Advances in the immunology and genetics of leprosy. Front Immunol 11: 567.

  • 4.

    World Health Organization , 2018. Guidelines for the Diagnosis, Treatment and Prevention of Leprosy. Available at: http://iris.who.int/handle/10665/274127. Accessed October 4, 2023.

    • PubMed
    • Export Citation
  • 5.

    Jain S , Ramesh V , Singh A , Yadav A , Ramam M , Khandpur S , 2016. Clinical and histopathological features of paucibacillary leprosy before and after multidrug therapy: a prospective study. Trans R Soc Trop Med Hyg 110: 350358.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Lockwood DN , Butlin CR , Penna GO , 2021. Current leprosy multi-drug treatment duration for MB patients (12 months) produces good clinical outcomes over many years. Lepr Rev 92: 97101.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Rao PN , Suneetha S , Rathod SP , Narang T , Dogra S , Singal A , Gupta S , Vora R , 2022. Dermlep Study part 3: post-RFT events in leprosy patients presenting to dermatologists. Indian Dermatol Online J 13: 340345.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Podder I , Saha A , Bandyopadhyay D , 2018. Clinical and histopathological response to multidrug therapy in paucibacillary leprosy at the end of 6 months: a prospective observational study from eastern India. Indian J Dermatol 63: 4752.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Rao PN , Rathod S , Suneetha S , Dogra S , Gupta SK , Vora R , Kamoji S , Tambe S , 2020. The DermLep Study I: results of prospective nation-wide survey of the number & profile of leprosy patients seen by dermatologists in India. Indian Dermatol Online J 11: 701711.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Malathi M , Thappa DM , 2013. Fixed-duration therapy in leprosy: limitations and opportunities. Indian J Dermatol 58: 93100.

  • 11.

    Naafs B , Kolk AH , Chin A , Lien RA , Faber WR , Van Dijk G , Kuijper S , Stolz E , Van Joost T , 1990. Anti-Mycobacterium leprae monoclonal antibodies cross-react with human skin: an alternative explanation for the immune responses in leprosy. J Invest Dermatol 94: 685688.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Singh I , Yadav AR , Mohanty KK , Katoch K , Bisht D , Sharma P , Sharma B , Gupta UD , Sengupta U , 2012. Molecular mimicry between HSP 65 of Mycobacterium leprae and cytokeratin 10 of the host keratin; role in pathogenesis of leprosy. Cell Immunol 278: 6375.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Narang T , Bishnoi A , Thakur V , Chatterjee D , Razmi TM , Kamat D , Dogra S , 2020. Persistent plaques after release from treatment in slit-skin smear negative leprosy patients: wait and watch or adopt a proactive approach? Dermatol Ther 33: e14226.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Shereef PH , Thomas M , 1992. Hypopigmented macules in leprosy – a histopathological and histochemical study of melanocytes. Indian J Lepr 64: 189191.

  • 15.

    Kumaran SM , Bhat IP , Madhukara J , Rout P , Elizabeth J , 2015. Comparison of bacillary index on slit skin smear with bacillary index of granuloma in leprosy and its relevance to present therapeutic regimens. Indian J Dermatol 60: 5154.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Narang T , Kamat D , Thakur V , Lavania M , Singh I , Ahuja M , Dogra S , 2022. Equal rates of drug resistance in leprosy cases with relapse and recurrent/chronic Type 2 reaction: time to revise the guidelines for drug-resistance testing in leprosy? Clin Exp Dermatol 47: 297302.

    • PubMed
    • Search Google Scholar
    • Export Citation
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