(LML) d.d. pure neuritic leprosy and diabetic neuropathy

 

Leprosy Mailing List – March 11,  2021 

  

Ref.:  (LML) d.d. pure neuritic leprosy and diabetic neuropathy 

From:  P Narasimha Rao, Hyderabad, India  

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Dear Pieter, 

This mail is in response to the LML mail of Suryanarayana Rao dated 13 February 21.   

 

The responses already received  provided valuable information and insight on how to differentiate PNL from diabetic neuropathy. Nonetheless, I would like to contribute  following information which is mostly clinical.  

 

1. The patients of PNL are mostly young individuals, which is the Indian experience.   
2. Usually one limb is affected in PNL,  (mono neuritis) compared in Diabetic neuropathy which is usually bilateral and symmetrical.  
3. There is always associated prominently  thickened peripheral nerve  in PNL.  
4. The anaesthesia/ hypoesthesia is localised to that effected limb. Very striking. Xerosis of the effected part / area  is usually prominent. So are the disabilities.  
5. Ultrasonography to confirm thickening of suspected nerve trunk is  the objective test. The faculties to perform  and the expertise is  available at many centres  in India. 
6.  Always perform a skin smear and skin biopsy from the suspected site /cases of PNL. In few patients they can yield surprisingly positive results. In which case classification/ grouping of the case  in the leprosy spectrum has to be re evaluated.  
7. While the Management principles of diabetic neuropathy are useful in management of PNL, the care of the limb, exercises and self care principles applicable to leprosy are very important.  

 

With best regards  

 

P Narasimha Rao  

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LML - S Deepak, B Naafs, S Noto and P Schreuder 

LML blog link: http://leprosymailinglist.blogspot.it/ 

Contact: Dr Pieter Schreuder