“… on whether the case is histoid or not …”

Leprosy Mailing List – October 16^th, 2011 

Ref.:    “… on whether the case is histoid or not …”

From: T Ryan, Oxford, UK

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Dear Salvatore,

The letter from P. Narasimha Rao shattered the pleasure I have had enjoying reading "discussions we used to have among teachers and students of Dermatology".  This discussion, he states "is purely academic and has no therapeutic value".  This is at a time when this disease is staging a come back and the untrained troops are diminished in knowledge and quantity.  Dermatology has the capacity to make a contribution and will not be able to do so unless it gets more recognition and a better welcome than this.

Histoid leprosy is far removed from the anaesthetic hypopigmented patch that is perhaps the most easy to recognise and most likely to be diagnosed presentation of leprosy.  The pictures we have been looking at and the subtleties discussed are necessary.  The fact that we still do not have a full understanding of the enemy remains an advantage for the M leprae allowing it to present with these multibacillary forms.  Histoid leprosy by being small nests of clinically difficult to recognise lesions, which clearly is an environment that the M leprae enjoy, is calling out for a more academic approach.  I believe it was a Cypriot patient of mine that Colin MacDougal diagnosed as histoid, and with Dick Rees demonstrated dapsone resistance.

We had many academic discussions, and those discussions need to continue because they may contain clues to pathogenesis and ultimately be of enormous therapeutic value.  We may need new approaches to conquer this resurging disease and, the refined academic approach illustrated by the last few letters from Dermatologists are not an irrelevance.

Best regards,

Terence Ryan